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Sample records for carotid body glomus

  1. CaV3.2 T-type Ca2+ channels mediate the augmented calcium influx in carotid body glomus cells by chronic intermittent hypoxia.

    PubMed

    Makarenko, Vladislav V; Ahmmed, Gias U; Peng, Ying-Jie; Khan, Shakil A; Nanduri, Jayasri; Kumar, Ganesh K; Fox, Aaron P; Prabhakar, Nanduri R

    2016-01-01

    Chronic intermittent hypoxia (CIH) is a hallmark manifestation of sleep apnea. A heightened carotid body activity and the resulting chemosensory reflex mediate increased sympathetic nerve activity by CIH. However, the mechanisms underlying heightened carotid body activity by CIH are not known. An elevation of intracellular calcium ion concentration ([Ca(2+)]i) in glomus cells, the primary oxygen-sensing cells, is an essential step for carotid body activation by hypoxia. In the present study, we examined the effects of CIH on the glomus cell [Ca(2+)]i response to hypoxia and assessed the underlying mechanisms. Glomus cells were harvested from adult rats or wild-type mice treated with 10 days of either room air (control) or CIH (alternating cycles of 15 s of hypoxia and 5 min of room air; 9 episodes/h; 8 h/day). CIH-treated glomus cells exhibited an enhanced [Ca(2+)]i response to hypoxia, and this effect was absent in the presence of 2-(4-cyclopropylphenyl)-N-((1R)-1-[5-[(2,2,2-trifluoroethyl)oxo]-pyridin-2-yl]ethyl)acetamide (TTA-A2), a specific inhibitor of T-type Ca(2+) channels, and in voltage-gated calcium channel, type 3.2 (CaV3.2), null glomus cells. CaV3.2 knockout mice exhibited an absence of CIH-induced hypersensitivity of the carotid body. CIH increased reactive oxygen species (ROS) levels in glomus cells. A ROS scavenger prevented the exaggerated TTA-A2-sensitive [Ca(2+)]i response to hypoxia. CIH had no effect on CaV3.2 mRNA levels. CIH augmented Ca(2+) currents and increased CaV3.2 protein in plasma membrane fractions of human embryonic kidney-293 cells stably expressing CaV3.2, and either a ROS scavenger or brefeldin-A, an inhibitor of protein trafficking, prevented these effects. These findings suggest that CIH leads to an augmented Ca(2+) influx via ROS-dependent facilitation of CaV3.2 protein trafficking to the plasma membrane. PMID:26561606

  2. Heteromeric TASK-1/TASK-3 is the major oxygen-sensitive background K+ channel in rat carotid body glomus cells.

    PubMed

    Kim, Donghee; Cavanaugh, Eric J; Kim, Insook; Carroll, John L

    2009-06-15

    Carotid body (CB) glomus cells from rat express a TASK-like background K+ channel that is believed to play a critical role in the regulation of excitability and hypoxia-induced increase in respiration. Here we studied the kinetic behaviour of single channel openings from rat CB cells to determine the molecular identity of the 'TASK-like' K+ channels. In outside-out patches, the TASK-like background K+ channel in CB cells was inhibited >90% by a reduction of pH(o) from 7.3 to 5.8. In cell-attached patches with 140 mM KCl and 1 mM Mg2+ in the bath and pipette solutions, two main open levels with conductance levels of approximately 14 pS and approximately 32 pS were recorded at a membrane potential of -60 mV. The K+ channels showed kinetic properties similar to TASK-1 (approximately 14 pS), TASK-3 (approximately 32 pS) and TASK-1/3 heteromer (approximately 32 pS). The presence of three TASK isoforms was tested by reducing [Mg2+](o) to approximately 0 mM, which had no effect on the conductance of TASK-1, but increased those of TASK-1/3 and TASK-3 to 42 pS and 74 pS, respectively. In CB cells, the reduction of [Mg2+](o) to approximately 0 mM also caused the appearance of approximately 42 pS (TASK-1/3-like) and approximately 74 pS (TASK-3-like) channels, in addition to the approximately 14 pS (TASK-1-like) channel. The 42 pS channel was the most abundant, contributing approximately 75% of the current produced by TASK-like channels. Ruthenium red (5 microM) had no effect on TASK-1 and TASK-1/3, but inhibited TASK-3 by 87%. In CB cells, ruthenium red caused approximately 12% inhibition of TASK-like activity. Methanandamide reduced the activity of all three TASKs by 80-90%, and that of TASK-like channels in CB cell also by approximately 80%. In CB cells, hypoxia caused inhibition of TASK-like channels, including TASK-1/3-like channels. These results show that TASK-1, TASK-1/3 and TASK-3 are all functionally expressed in isolated CB cells, and that the TASK-1/3 heteromer

  3. Microsurgical anatomy of the human carotid body (glomus caroticum): Features of its detailed topography, syntopy and morphology.

    PubMed

    Schulz, Sissy-Amelie; Wöhler, Aliona; Beutner, Dirk; Angelov, Doychin N

    2016-03-01

    The human glomus caroticum (GC) is not readily accessible during ordinary anatomical teaching courses because of insufficient time and difficulties encountered in the preparation. Accordingly, most anatomical descriptions of its location, relationship to neighboring structures, size and shape are supported only by drawings, but not by photographs. The aim of this study is to present the GC with all associated roots and branches. Following microscope-assisted dissection and precise photo-documentation, a detailed analysis of location, syntopy and morphology was performed. We carried out this study on 46 bifurcations of the common carotid artery (CCA) into the external (ECA) and internal (ICA) carotid arteries and identified the GC in 40 (91%) of them. We found significant variations regarding the location of the GC and its syntopy: GC was associated with CCA (42%), ECA (28%) and ICA (30%) lying on the medial or lateral surface (82% or 13%, respectively) or exactly in the middle (5%) of the bifurcation. The short and long diameter of its oval form varied from 1.0×2.0 to 5.0×5.0mm. Connections with the sympathetic trunk (100%), glossopharyngeal (93%), vagus (79%) and hypoglossal nerve (90%) could be established in 29 cadavers. We conclude that precise knowledge of this enormous variety might be very helpful not only to students in medicine and dentistry during anatomical dissection courses, but also to surgeons working in this field. PMID:26704358

  4. Angiotensin AT1 receptor-mediated excitation of rat carotid body chemoreceptor afferent activity.

    PubMed

    Allen, A M

    1998-08-01

    1. A high density of angiotensin II receptors was observed in the rat carotid body by in vitro autoradiography employing 125I-[Sar1, Ile8]-angiotensin II as radioligand. Displacement studies demonstrated that the receptors were of the AT1 subtype. 2. The binding pattern indicated that the AT1 receptors occurred over clumps of glomus cells, the principal chemoreceptor cell of the carotid body. Selective lesions of the sympathetic or afferent innervation of the carotid body had little effect on the density of receptor binding, demonstrating that the majority of AT1 receptors were intrinsic to the glomus cells. 3. To determine the direct effect of angiotensin II on chemoreceptor function, without the confounding effects of the vasoconstrictor action of angiotensin II, carotid sinus nerve activity was recorded from the isolated carotid body in vitro. The carotid body was superfused with Tyrode solution saturated with carbogen (95 % O2, 5 % CO2), maintained at 36 C, and multi-unit nerve activity recorded with a suction electrode. 4. Angiotensin II elicited a dose-dependent excitation of carotid sinus nerve activity (maximum increase of 36 +/- 11 % with 10 nM angiotensin II) with a threshold concentration of 1 nM. The response was blocked by the addition of an AT1 receptor antagonist, losartan (1 microM), but not by the addition of an AT2 receptor antagonist, PD123319 (1 microM). 5. In approximately 50 % of experiments the excitation was preceded by an inhibition of activity (maximum decrease of 24 +/- 8 % with 10 nM angiotensin II). This inhibitory response was markedly attenuated by losartan but not affected by PD123319. 6. These observations demonstrate that angiotensin II, acting through AT1 receptors located on glomus cells in the carotid body, can directly alter carotid chemoreceptor afferent activity. This provides a means whereby humoral information about fluid and electrolyte homeostasis might influence control of cardiorespiratory function. PMID:9660892

  5. Angiotensin AT1 receptor-mediated excitation of rat carotid body chemoreceptor afferent activity

    PubMed Central

    Allen, A M

    1998-01-01

    A high density of angiotensin II receptors was observed in the rat carotid body by in vitro autoradiography employing 125I-[Sar1,Ile8]-angiotensin II as radioligand. Displacement studies demonstrated that the receptors were of the AT1 subtype.The binding pattern indicated that the AT1 receptors occurred over clumps of glomus cells, the principal chemoreceptor cell of the carotid body. Selective lesions of the sympathetic or afferent innervation of the carotid body had little effect on the density of receptor binding, demonstrating that the majority of AT1 receptors were intrinsic to the glomus cells.To determine the direct effect of angiotensin II on chemoreceptor function, without the confounding effects of the vasoconstrictor action of angiotensin II, carotid sinus nerve activity was recorded from the isolated carotid body in vitro. The carotid body was superfused with Tyrode solution saturated with carbogen (95% O2, 5% CO2), maintained at 36 °C, and multi-unit nerve activity recorded with a suction electrode.Angiotensin II elicited a dose-dependent excitation of carotid sinus nerve activity (maximum increase of 36 ± 11% with 10 nm angiotensin II) with a threshold concentration of 1 nm. The response was blocked by the addition of an AT1 receptor antagonist, losartan (1 μm), but not by the addition of an AT2 receptor antagonist, PD123319 (1 μm).In approximately 50% of experiments the excitation was preceded by an inhibition of activity (maximum decrease of 24 ± 8% with 10 nm angiotensin II). This inhibitory response was markedly attenuated by losartan but not affected by PD123319.These observations demonstrate that angiotensin II, acting through AT1 receptors located on glomus cells in the carotid body, can directly alter carotid chemoreceptor afferent activity. This provides a means whereby humoral information about fluid and electrolyte homeostasis might influence control of cardiorespiratory function. PMID:9660892

  6. Revelations about carotid body function through its pathological role in resistant hypertension.

    PubMed

    Paton, Julian F R; Ratcliffe, Laura; Hering, Dagmara; Wolf, Jacek; Sobotka, Paul A; Narkiewicz, Krzysztof

    2013-08-01

    Much recent attention has been given to the carotid body because of its potential role in cardiovascular disease states. One disease, neurogenic hypertension, characterised by excessive sympathetic activity, appears dependent on carotid body activity that may or may not be accompanied by sleep-disordered breathing. Herein, we review recent literature suggesting that the carotid body acquires tonicity in hypertension. We predict that carotid glomectomy will be a powerful way to temper excessive sympathetic discharge in diseases such as hypertension. We propose a model to explain that signalling from the 'hypertensive' carotid body is tonic, and hypothesise that there will be a sub-population of glomus cells that channel separately into reflex pathways controlling sympathetic motor outflows. PMID:23828147

  7. Immunohistochemical localization of dopamine D2 receptor in the rat carotid body.

    PubMed

    Wakai, Jun; Takayama, Anna; Yokoyama, Takuya; Nakamuta, Nobuaki; Kusakabe, Tatsumi; Yamamoto, Yoshio

    2015-10-01

    Dopamine modulates the chemosensitivity of arterial chemoreceptors, and dopamine D2 receptor (D2R) is expected to localize in the glomus cells and/or sensory nerve endings of the carotid body. In the present study, the localization of D2R in the rat carotid body was examined using double immunofluorescence for D2R with various cell markers. D2R immunoreactivity was mainly localized in glomus cells immunoreactive to tyrosine hydroxylase or dopamine β-hydroxylase (DBH), but not in S100B-immunoreactive sustentacular cells. Furthermore, D2R immunoreactivity was observed in petrosal ganglion cells and nerve bundles in the carotid body, but not in the nerve endings with P2X2 immunoreactivity. In the carotid ganglion, a few punctate D2R-immunoreactive products were detected in DBH-immunoreactive nerve cell bodies. These results showed that D2R was mainly distributed in glomus cells, and suggested that D2R plays a role in the inhibitory modulation of chemosensory activity in a paracrine and/or autocrine manner. PMID:26272445

  8. CaV3.2 T-type Ca²⁺ channels in H₂S-mediated hypoxic response of the carotid body.

    PubMed

    Makarenko, Vladislav V; Peng, Ying-Jie; Yuan, Guoxiang; Fox, Aaron P; Kumar, Ganesh K; Nanduri, Jayasri; Prabhakar, Nanduri R

    2015-01-15

    Arterial blood O2 levels are detected by specialized sensory organs called carotid bodies. Voltage-gated Ca(2+) channels (VGCCs) are important for carotid body O2 sensing. Given that T-type VGCCs contribute to nociceptive sensation, we hypothesized that they participate in carotid body O2 sensing. The rat carotid body expresses high levels of mRNA encoding the α1H-subunit, and α1H protein is localized to glomus cells, the primary O2-sensing cells in the chemoreceptor tissue, suggesting that CaV3.2 is the major T-type VGCC isoform expressed in the carotid body. Mibefradil and TTA-A2, selective blockers of the T-type VGCC, markedly attenuated elevation of hypoxia-evoked intracellular Ca(2+) concentration, secretion of catecholamines from glomus cells, and sensory excitation of the rat carotid body. Similar results were obtained in the carotid body and glomus cells from CaV3.2 knockout (Cacna1h(-/-)) mice. Since cystathionine-γ-lyase (CSE)-derived H2S is a critical mediator of the carotid body response to hypoxia, the role of T-type VGCCs in H2S-mediated O2 sensing was examined. Like hypoxia, NaHS, a H2S donor, increased intracellular Ca(2+) concentration and augmented carotid body sensory nerve activity in wild-type mice, and these effects were markedly attenuated in Cacna1h(-/-) mice. In wild-type mice, TTA-A2 markedly attenuated glomus cell and carotid body sensory nerve responses to hypoxia, and these effects were absent in CSE knockout mice. These results demonstrate that CaV3.2 T-type VGCCs contribute to the H2S-mediated carotid body response to hypoxia. PMID:25377087

  9. Carotid body remodelling in l-NAME-induced hypertension in the rat.

    PubMed

    Felix, A S; Rocha, V N; Nascimento, A L R; de Carvalho, J J

    2012-05-01

    The carotid body (CB) is a chemoreceptor organ located at the bifurcation of the common carotid artery. It is made up of the carotid glomus, a structure containing type 1 cells surrounded by type 2 cells. The aim of this study was to evaluate the morphological changes of the CB and carotid glomus in the rat model of l-NAME-induced hypertension. Male Wistar rats were divided in two groups: control untreated rats (C) and rats receiving l-NAME 40 mg/kg/day (LN) for 6 weeks. At the end of the experiment, the systolic blood pressure was 63% higher in the LN group compared with the C group. Morphometric analysis showed that the area of the CB was 29% greater in the LN group compared with the C group. The density of nuclei in the CB was similar between groups, but it was 31% less in the carotid glomus of the LN group. Cells in the CB of the LN group displayed cytoplasmic vacuolation and expressed several biogenic amines. There were more elastic fibres, proteoglycans and collagen fibres in the LN group compared with the C group. Immunohistochemistry showed increased expression of nuclear factor kB, substance P, vascular endothelial growth factor and neuronal nitric oxide synthase in the LN group, while expression of the protein gene product 9.5 was decreased. l-NAME alters cell morphology and the expression of extracellular matrix molecules in the CB and carotid glomus in rats with l-NAME-induced hypertension. PMID:21899859

  10. Carotid body tumor: a 25-year experience.

    PubMed

    Metheetrairut, Choakchai; Chotikavanich, Chanticha; Keskool, Phawin; Suphaphongs, Nit

    2016-08-01

    Carotid body tumor is an uncommon hypervascular benign tumor in the head and neck region. It usually presents as a slow growing mass at the carotid bifurcation. Because of the high rate of neurovascular complications, resection of this tumor is considered challenging for otolaryngologists. Between 1988 and 2013, 40 carotid body tumors from 38 patients were diagnosed and underwent resection at Siriraj Hospital (25 female and 13 male patients). Their age ranged from 15 to 59 years. Seven patients had bilateral tumors simultaneously whereas six cases had familial history of carotid body tumor. Carotid angiography was performed in 29 cases; other additional diagnostic studies included CT scan, MRI, and MRA to detect the widening of carotid bifurcation, its extension, and multifocal tumors. All diagnosed tumors were successfully removed. However, internal carotid artery and carotid bifurcation were injured in 11 cases (27.5 %). Shamblin class III and previous biopsy history were considered risk factors for vascular injury. Postoperative cranial nerves deficit was found in 20 % of the cases and CNS complication occurred in two patients (5 %). There was no surgical mortality. Additionally, upon the mean follow-up period of 36 months, no recurrence or malignant transformation was detected in this study. Multidisciplinary approach, early tumor detection, meticulous preoperative evaluation, and modern vascular surgical technique are the key success factors for tumor removal. PMID:26233244

  11. Symptomatic carotid stenosis in the setting of bilateral disease and coexisting carotid body tumor: management with a carotid stent and staged excision.

    PubMed

    Smeds, Matthew; Jacobs, Donald

    2013-12-01

    The aim of the paper is to describe the management of a patient with bilateral carotid artery stenosis, symptomatic on the left, with coexisting left carotid body tumor with left carotid stenting followed by right carotid endarterectomy and excision of carotid body tumor. A 60-year-old man with significant bilateral carotid stenosis was referred to us with symptomatic left carotid disease and concomitant left carotid body tumor. A Precise nitinol carotid stent (Cordis Endovascular, Miami Lakes, FL, USA) was placed in his left carotid artery followed by interval carotid endarterectomy on the right. Excision of the carotid body tumor was then performed. Carotid stenting is a treatment option in patients with carotid stenosis and coexisting carotid body tumor. To our knowledge, this is the first reported carotid stent for symptomatic carotid stenosis in a patient with a concomitant carotid body tumor. PMID:23493283

  12. Peptide receptor radionuclide therapy with (177)Lu DOTATATE in a case of recurrent carotid body paraganglioma with spinal metastases.

    PubMed

    Gupta, Santosh Kumar; Singla, Suhas; Karunanithi, Sellam; Damle, Nishikant; Bal, Chandrasekhar

    2014-05-01

    Paragangliomas are rare benign neuroendocrine tumors, and 80% of all paragangliomas are either carotid body tumors or glomus jugulare tumors. We present a case of recurrent unresectable carotid body paraganglioma with nodal and T7 vertebral metastases in a 30-year-old man 6 years postsurgery detected with Ga DOTANOC PET/CT and was administered with peptide receptor radionuclide therapy using Lu DOTATATE. After 5 cycles of Lu DOTATATE (total cumulative activity of 750 mCi [27 GBq]), significant response at the primary site on Ga DOTANOC PET/CT and complete disappearance of nodal and T7 vertebral metastases were noted. PMID:24217545

  13. The neurogenic niche in the carotid body and its applicability to antiparkinsonian cell therapy.

    PubMed

    López-Barneo, José; Pardal, Ricardo; Ortega-Sáenz, Patricia; Durán, Rocío; Villadiego, Javier; Toledo-Aral, Juan José

    2009-08-01

    The carotid body (CB) is a neural crest-derived organ whose major function is to sense changes in arterial O(2) tension to elicit hyperventilation during hypoxia. The CB is composed of clusters of neuron-like glomus, or type I, cells that are highly dopaminergic and contain large amounts of the glial cell line-derived neurotrophic factor (GDNF). Glomus cells are enveloped by glia-like sustentacular, or type II, cells. In chronic hypoxia the CB grows with increase in glomus cell number. This adaptive response depends on a collection of neural progenitors that can be isolated and induced to form clonal neurospheres in vitro. CB neurospheres contain numerous newly differentiated glomus cells, which maintain their functional properties and the ability to synthesize dopamine and GDNF. Intrastriatal CB transplants have been assayed in animal models of Parkinson's disease (PD) to test whether they increase the striatal dopamine levels and/or exert a neuroprotective action on the nigrostriatal pathway. Two pilot safety studies performed on PD patients subjected to CB autotransplantation have suggested that a major limitation of this technique is the small size of the organ. This could, however, be overcome by the in vitro formation of new CB tissue derived from adult CB stem cells. PMID:19263191

  14. Histochemical demonstration of tripeptidyl aminopeptidase I in the rat carotid body.

    PubMed

    Atanasova, Dimitrinka; Lazarov, Nikolai

    2015-03-01

    Tripeptidyl aminopeptidase I (TPP I) is a lysosomal exopeptidase that is widely distributed throughout the central nervous system (CNS) and internal organs in many mammalian species. The enzyme is involved in the breakdown of collagen and different peptides. The carotid body (CB) is the main peripheral arterial chemoreceptor playing an important role in the control of breathing and the autonomic control of cardiovascular function. In response to hypoxia its neuron-like glomus cells release a variety of peptide transmitters that trigger an action potential through the afferent fibers, thus conveying the chemosensory information to the CNS. In the present study we investigated the histochemical localization of TPP I in the CB of rats. Enzyme histochemistry showed high activity of TPP I in CB glomeruli. In particular, the glomus cells contained many TPP I-positive granules, while the glial-like sustentacular cells displayed a slightly fainter reaction. The interglomerular connective tissue was also weakly stained. The results show that both the parenchymal cells of the rat CB express, albeit with different intensity, TPP I. Taken together with our previous enzyme histochemical investigations on the rat CB, it seems likely that the glomus cells possess enzymatic equipment necessary for the neuropeptide intracellular and collagen extracellular initial degradation. These findings also suggest that TPP I is involved in the general turnover of chemotransmitters between glomus cells and sensory nerve endings which emphasizes its importance for chemoreception under hypoxic conditions. PMID:25636608

  15. Carotid Body Chemoreflex Mediates Intermittent Hypoxia-Induced Oxidative Stress in the Adrenal Medulla

    PubMed Central

    Kumar, Ganesh K.; Peng, Ying-Jie; Nanduri, Jayasri; Prabhakar, Nanduri R.

    2016-01-01

    Intermittent hypoxia (IH) increases reactive oxygen species generation resulting in oxidative stress in the adrenal medulla (AM), a major end-organ of the sympathetic nervous system which facilitates catecholamine secretion by hypoxia. Here, we show that carotid body chemoreflex contributes to IH-induced oxidative stress in the AM. Carotid bodies were ablated by cryocoagulation of glomus cells, the putative O2 sensing cells. Carotid body ablated (CBA) and control rats were exposed to IH and the redox state of the AM was assessed biochemically. We found that IH raised reactive oxygen species levels along with an increase in NADPH oxidase (Nox), a pro-oxidant enzyme and a decrease in superoxide dismutase-2 (SOD2), an anti-oxidant enzyme. Further, IH increased hypoxia-inducible factor (HIF)-1α, whereas decreased HIF-2α, the transcriptional regulator of Nox and SOD-2, respectively. These IH-induced changes in the AM were absent in CBA rats. Moreover, IH increased splanchnic nerve activity and facilitated hypoxia-evoked catecholamine efflux from the AM and CBA prevented these effects. These findings suggest that IH-induced oxidative stress and catecholamine efflux in the AM occurs via carotid body chemoreflex involving HIF α isoform mediated imbalance in pro-, and anti-oxidant enzymes. PMID:26303481

  16. Towards the Sensory Nature of the Carotid Body: Hering, De Castro and Heymans†

    PubMed Central

    de Castro, Fernando

    2009-01-01

    The carotid body or glomus caroticum is a chemosensory organ bilaterally located between the external and internal carotid arteries. Although known by anatomists since the report included by Von Haller and Taube in the mid XVIII century, its detailed study started the first quarter of the XX. The Austro-German physiologist Heinrich E. Hering studied the cardio-respiratory reflexes searched for the anatomical basis of this reflex in the carotid sinus, while the Ghent School leaded by the physio-pharmacologists Jean-François Heymans and his son Corneille focussed in the cardio-aortic reflexogenic region. In 1925, Fernando De Castro, one of the youngest and more brilliant disciples of Santiago Ramón y Cajal at the Laboratorio de Investigaciones Biológicas (Madrid, Spain), profited from some original novelties in histological procedures to study the fine structure and innervation of the carotid body. De Castro unravelled them in a series of scientific papers published between 1926 and 1929, which became the basis to consider the carotid body as a sensory receptor (or chemoreceptor) to detect the chemical changes in the composition of the blood. Indeed, this was the first description of arterial chemoreceptors. Impressed by the novelty and implications of the work of De Castro, Corneille Heymans invited the Spanish neurologist to visit Ghent on two occasions (1929 and 1932), where both performed experiences together. Shortly after, Heymans visited De Castro at the Instituto Cajal (Madrid). From 1932 to 1933, Corneille Heymans focused all his attention on the carotid body his physiological demonstration of De Castro's hypothesis regarding chemoreceptors was awarded with the Nobel Prize in Physiology or Medicine in 1938, just when Spain was immersed in its catastrophic Civil War. PMID:20057927

  17. Multiple Glomus Tumors of the Omentum

    PubMed Central

    Jung, Won Beom; Park, In Ja; Song, Joon Seon; Cho, Kyung-Ja

    2015-01-01

    A glomus tumor is a very rare neoplasm consisting of cells that resemble the modified smooth muscle cells of normal glomus bodies. Here, we report a case of a 39-year-old male with multiple omental glomus tumors. The patient underwent a complete resection of the glomus tumors. This is a rare case of omental glomus tumors, and to our knowledge, this patient is the first with multiple omental glomus tumors to be described. PMID:26361617

  18. A preliminary anatomical study on carotid body of Makouei sheep.

    PubMed

    Najafi, Gholamreza; Soltanalinejad, Farhad; Hasanzadeh, Hamed

    2013-01-01

    The carotid is a small mass of chemoreceptor's and sustentacular cells that detects changes in the composition of the arterial blood. The aim of the present study was to identify the size, color, location, blood and nerve supply of the carotid body in Makouei sheep. Fourteen heads of sheep from both sexes were collected from Urmia public slaughter-house. The exact situation and nerve supply of the carotid body was determined. Before dissection, blue latex was injected into right and left common carotid arteries. All the branches of the common carotid artery and the branch supplying carotid body were investigated. This study showed that, carotid body in sheep has been situated around the muscular branch of the occipital artery. The mean weight, width and length, thickness of carotid body were 0.01 g, 0.83 mm, 1.07 mm, and 1.06 mm respectively. Blood to the carotid body was supplied by glomic artery which was a branch of occipital artery. It was innervated by herring nerve which was a branch of glossopharyngeal nerve. PMID:25653785

  19. A preliminary anatomical study on carotid body of Makouei sheep

    PubMed Central

    Najafi, Gholamreza; Soltanalinejad, Farhad; Hasanzadeh, Hamed

    2013-01-01

    The carotid is a small mass of chemoreceptor's and sustentacular cells that detects changes in the composition of the arterial blood. The aim of the present study was to identify the size, color, location, blood and nerve supply of the carotid body in Makouei sheep. Fourteen heads of sheep from both sexes were collected from Urmia public slaughter-house. The exact situation and nerve supply of the carotid body was determined. Before dissection, blue latex was injected into right and left common carotid arteries. All the branches of the common carotid artery and the branch supplying carotid body were investigated. This study showed that, carotid body in sheep has been situated around the muscular branch of the occipital artery. The mean weight, width and length, thickness of carotid body were 0.01 g, 0.83 mm, 1.07 mm, and 1.06 mm respectively. Blood to the carotid body was supplied by glomic artery which was a branch of occipital artery. It was innervated by herring nerve which was a branch of glossopharyngeal nerve. PMID:25653785

  20. Oxygen sensing by the carotid body: mechanisms and role in adaptation to hypoxia.

    PubMed

    López-Barneo, José; González-Rodríguez, Patricia; Gao, Lin; Fernández-Agüera, M Carmen; Pardal, Ricardo; Ortega-Sáenz, Patricia

    2016-04-15

    Oxygen (O2) is fundamental for cell and whole-body homeostasis. Our understanding of the adaptive processes that take place in response to a lack of O2(hypoxia) has progressed significantly in recent years. The carotid body (CB) is the main arterial chemoreceptor that mediates the acute cardiorespiratory reflexes (hyperventilation and sympathetic activation) triggered by hypoxia. The CB is composed of clusters of cells (glomeruli) in close contact with blood vessels and nerve fibers. Glomus cells, the O2-sensitive elements in the CB, are neuron-like cells that contain O2-sensitive K(+)channels, which are inhibited by hypoxia. This leads to cell depolarization, Ca(2+)entry, and the release of transmitters to activate sensory fibers terminating at the respiratory center. The mechanism whereby O2modulates K(+)channels has remained elusive, although several appealing hypotheses have been postulated. Recent data suggest that mitochondria complex I signaling to membrane K(+)channels plays a fundamental role in acute O2sensing. CB activation during exposure to low Po2is also necessary for acclimatization to chronic hypoxia. CB growth during sustained hypoxia depends on the activation of a resident population of stem cells, which are also activated by transmitters released from the O2-sensitive glomus cells. These advances should foster further studies on the role of CB dysfunction in the pathogenesis of highly prevalent human diseases. PMID:26764048

  1. Radiation therapy of carotid body tumors

    SciTech Connect

    Valdagni, R.; Amichetti, M. )

    1990-02-01

    Chemodectomas of carotid artery bifurcation are generally managed with surgery, irradiation being reserved for inoperable, bulky, and recurrent tumors. Probably due to this pretreatment selection of patients, chemodectomas are anedoctally considered radioresistant tumors, although this concept is not supported by the recent literature. From 1968 to 1987, 13 carotid body tumors in seven patients were treated with irradiation as sole treatment (10 lesions) or as postoperative modality (three lesions). Familial occurrence and bilateral presentation were observed in 3 of 7 and in 6 of 7 patients, respectively. Total dose of irradiation was of 46-60 Gy (median 50 Gy, mean 52.25 Gy) with dose per fraction of 1.8-2.5 Gy. Local control (subjective or objective) was obtained in all the patients. Clinical results following World Health Organization (WHO) criteria were: 3 of 13 complete response, 7 of 13 partial response and 3 of 13 no change. Follow-up range is 1-19 years. Acute side effects were minimal and mid- or long-term toxicity was absent.32 references.

  2. Peripheral Chemoreceptors: Function and Plasticity of the Carotid Body

    PubMed Central

    Kumar, Prem; Prabhakar, Nanduri R.

    2014-01-01

    The discovery of the sensory nature of the carotid body dates back to the beginning of the 20th century. Following these seminal discoveries, research into carotid body mechanisms moved forward progressively through the 20th century, with many descriptions of the ultrastructure of the organ and stimulus-response measurements at the level of the whole organ. The later part of 20th century witnessed the first descriptions of the cellular responses and electrophysiology of isolated and cultured type I and type II cells, and there now exist a number of testable hypotheses of chemotransduction. The goal of this article is to provide a comprehensive review of current concepts on sensory transduction and transmission of the hypoxic stimulus at the carotid body with an emphasis on integrating cellular mechanisms with the whole organ responses and highlighting the gaps or discrepancies in our knowledge. It is increasingly evident that in addition to hypoxia, the carotid body responds to a wide variety of blood-borne stimuli, including reduced glucose and immune-related cytokines and we therefore also consider the evidence for a polymodal function of the carotid body and its implications. It is clear that the sensory function of the carotid body exhibits considerable plasticity in response to the chronic perturbations in environmental O2 that is associated with many physiological and pathological conditions. The mechanisms and consequences of carotid body plasticity in health and disease are discussed in the final sections of this article. PMID:23728973

  3. Extradigital Glomus Tumor Revisited: Painful Subcutaneous Nodules Located in Various Parts of the Body

    PubMed Central

    Temiz, Gökhan; Şirinoğlu, Hakan; Demirel, Hakan; Yeşiloğlu, Nebil; Sarıcı, Murat; Filinte, Gaye Taylan

    2016-01-01

    Background: Glomus tumor is a common lesion of the subungual area of the hand fingers. However, glomus tumors located outside the hand region are rare and the diagnosis is often difficult due to their low incidence and lack of distinct clinical features in the physical examination. The presented article contains five cases of extradigital glomus tumors with a short review of the literature. Patients and Methods: Five cases of extradigital glomus tumor were included in the study. All lesions were purple colored subcutaneous nodules with sharp pain by digital palpation. All lesions were examined with ultrasound imaging were operated under local anesthesia using loupe magnification. Results: Among five patients, only one patient was female with a mean age of 35. Two lesions were located at the arm region, two at the crural region and one at the sternal area. The smallest nodule was 0.5 cm and the biggest lesion was 2 cm in diameter. In all the cases, the early postoperative period was uneventful without any surgical complication or acute recurrence. The postoperative 1st year examination of all patients revealed complete resolution of the pain and no recurrence was encountered. Conclusions: Glomus tumor should be kept in mind in the differential diagnosis of all painful subcutaneous lesions especially for those with purple reflection on the skin surface. In this manner, patients with extradigital glomus tumors may be diagnosed earlier and unnecessary and wrong treatments may be prevented. PMID:26955123

  4. Possible Role of TRP Channels in Rat Glomus Cells.

    PubMed

    Kim, Insook; Fite, Lasha; Donnelly, David F; Kim, Jung H; Carroll, John L

    2015-01-01

    Carotid body (CB) glomus cells depolarize in response to hypoxia, causing a [Ca(2+)](i) increase, at least in part, through activation of voltage-dependent channels. Recently, Turner et al. (2013) showed that mouse glomus cells with knockout of TASK1/3(-/-) channels have near-normal [Ca(2+)](i) response to hypoxia. Thus, we postulated that TRP channels may provide an alternate calcium influx pathway which may be blocked by the TRP channel antagonist, 2-APB (2-aminoethoxydiphenylborane). We confirmed that 2-APB inhibited the afferent nerve response to hypoxia, as previously reported (Lahiri S, Patel G, Baby S, Roy A (2009) 2-APB mediated effects on hypoxic calcium influx in rat carotid body glomus cells. FASEB 2009, Abstract, LB157; Kumar P, Pearson S, Gu Y (2006) A role for TRP channels in carotid body chemotransduction? FASEB J 20:A12-29). To examine the mechanism for this inhibition, we examined dissociated rat CB glomus cells for [Ca(2+)](i) responses to hypoxia, anoxia (with sodium dithionite), 20 mM K(+), NaSH, NaCN, and FCCP in absence/presence of 2-APB (100 μM). Also the effect of 2-APB on hypoxia and/or anoxia were investigated on NADH and mitochondria (MT) membrane potential. Our findings are as follows: (1) 2-APB significantly blocked the [Ca(2+)](i) increase in response to hypoxia and anoxia, but not the responses to 20 mM K(+). (2) The [Ca(2+)](i) responses NaSH, NaCN, and FCCP were significantly blocked by 2-APB. (3) Hypoxia-induced increases in NADH/NAD(+) and MT membrane depolarization were not effected by 2-APB. Thus TRP channels may provide an important pathway for calcium influx in glomus cells in response to hypoxia. PMID:26303485

  5. Carotid body tumor imitator: An interesting case of Castleman's disease

    PubMed Central

    Shakir, Hakeem J.; Diletti, Sara M.; Hart, Alexandra M.; Meyers, Joshua E.; Dumont, Travis M.; Siddiqui, Adnan H.

    2015-01-01

    Background: There are very few reports in the literature of Castleman's disease affecting the carotid artery and a single previous report of a case of Castleman's disease of the neck originally mistaken as a carotid body tumor. Case Description: We describe a rare case of Castleman's disease, manifesting with classic radiographic hallmarks of a carotid body tumor. The postoperative pathologic examination identified the resected mass as Castleman's lymphadenopathy. The management of this particular case is discussed, and the findings are highlighted. Conclusions: We present a unique case of a tumor initially and incorrectly diagnosed as a carotid body tumor. However, after comprehensive treatment with endovascular and surgical modalities and subsequent pathologic examination, the diagnosis of this rare entity was made. PMID:26677415

  6. Reflex carotid body chemoreceptor control of phrenic sympathetic neurons.

    PubMed

    Bałkowiec, A; Revenko, S; Szulczyk, P

    1993-04-01

    The reflex reaction of phrenic sympathetic neurons to stimulation of carotid body chemoreceptors was tested in chloralose-anesthetized and paralyzed cats with both vago-aortic nerves cut. During systemic hypoxia (animals ventilated with 10% O2 in N2) the sympathetic phrenic nerve activity increased from 100% in the control to 269%. This increase was markedly attenuated after cutting both sinus nerves. Reflex excitatory response in phrenic sympathetic neurons with the latency of 150 msec was evoked by electrical stimulation of the right carotid sinus nerve (3 pulses of 0.2 msec, 333 Hz). The central transmission time of the reflex was about 90 msec. Injecting 0.1 ml of 1 M NaHCO3 saturated with CO2 (in order to activate carotid body chemoreceptors) into the right or left carotid sinus, evoked excitatory responses in sympathetic neurons regardless of the side. The stimulation of carotid body chemoreceptors also increased somatic phrenic nerve activity. The three methods applied to the stimulation of carotid body chemoreceptors produced increase of phrenic nerve sympathetic activity. PMID:8390088

  7. Pharmacology of pH effects on carotid body chemoreceptors in vitro.

    PubMed

    Eyzaguirre, C; Zapata, P

    1968-04-01

    1. The carotid body and the carotid nerve were removed from anaesthetized cats and placed in a small Perspex channel through which Locke solution (at various pH values and usually equilibrated with 50% O(2) in N(2)) was allowed to flow. The glomus was immersed in the flowing solution while the nerve was lifted into oil covering the saline. Sensory discharges were recorded from the nerve and their frequency was used as an index of receptor activity. At times, a small segment of carotid artery, containing pressoreceptor endings, was removed together with the glomus. In this case, pressoreceptor discharges were recorded from the nerve.2. The amplitude of either chemo- or pressoreceptor discharges was not changed by strong acid solutions. Acid decreased the frequency of the baroreceptor discharges only when pH fell to less than 4.0. Solutions at low pH increased the chemosensory discharge, but acid depressed the increased chemoreceptor discharge elicited by KCl. These experiments indicated that H(+) ions probably acted as membrane ;stabilizers' without depolarizing either the nerve fibres or endings.3. Acid solutions increased the action of acetylcholine chloride (AChCl) (100-200 mug) on chemoreceptors. This effect probably was due either to inactivation of tissue cholinesterase or to enhanced sensitivity of the sensory endings to ACh.4. Choline chloride (10(-3)M), which favours ACh synthesis, protected the preparation against decay during prolonged experimentation. Hemicholinium-3 (HC-3), which blocks ACh synthesis in low concentrations (10(-5)M), depressed the chemosensory response to acid and to hypoxia when such stimuli were applied repeatedly. This concentration of HC-3 did not change effects of applied ACh.5. Substances which affect ACh release markedly changed the chemoreceptor discharge increase induced by acidity and other forms of stimulation. In the absence of Ca(2+), acid, anoxia, and interruption of flow provoked receptor depression while receptor

  8. Surgical Excision of Carotid Body Tumor Through Modified Approach-A Case Report.

    PubMed

    Prabakaran, Sureshkannan; Subburayulu, Anand Shankar; Ravikumar, P T

    2016-06-01

    Paragangliomas arising from the carotid body in the carotid bifurcation are termed as carotid body tumors. They are usually slow growing and asymptomatic. Considering the anatomical location, invasion or pressure on the adjacent vascular and neural tissues, the importance of early diagnosis and management is critical. In this article a case of carotid body tumor excised through transverse neck skin crease incision is presented along with literature review on the diagnosis, grading and different surgical approaches. PMID:27298550

  9. Carotid body denervation prevents fasting hyperglycemia during chronic intermittent hypoxia

    PubMed Central

    Shin, Mi-Kyung; Yao, Qiaoling; Jun, Jonathan C.; Bevans-Fonti, Shannon; Yoo, Doo-Young; Han, Woobum; Mesarwi, Omar; Richardson, Ria; Fu, Ya-Yuan; Pasricha, Pankaj J.; Schwartz, Alan R.; Shirahata, Machiko

    2014-01-01

    Obstructive sleep apnea causes chronic intermittent hypoxia (IH) and is associated with impaired glucose metabolism, but mechanisms are unknown. Carotid bodies orchestrate physiological responses to hypoxemia by activating the sympathetic nervous system. Therefore, we hypothesized that carotid body denervation would abolish glucose intolerance and insulin resistance induced by chronic IH. Male C57BL/6J mice underwent carotid sinus nerve dissection (CSND) or sham surgery and then were exposed to IH or intermittent air (IA) for 4 or 6 wk. Hypoxia was administered by decreasing a fraction of inspired oxygen from 20.9% to 6.5% once per minute, during the 12-h light phase (9 a.m.–9 p.m.). As expected, denervated mice exhibited blunted hypoxic ventilatory responses. In sham-operated mice, IH increased fasting blood glucose, baseline hepatic glucose output (HGO), and expression of a rate-liming hepatic enzyme of gluconeogenesis phosphoenolpyruvate carboxykinase (PEPCK), whereas the whole body glucose flux during hyperinsulinemic euglycemic clamp was not changed. IH did not affect glucose tolerance after adjustment for fasting hyperglycemia in the intraperitoneal glucose tolerance test. CSND prevented IH-induced fasting hyperglycemia and increases in baseline HGO and liver PEPCK expression. CSND trended to augment the insulin-stimulated glucose flux and enhanced liver Akt phosphorylation at both hypoxic and normoxic conditions. IH increased serum epinephrine levels and liver sympathetic innervation, and both increases were abolished by CSND. We conclude that chronic IH induces fasting hyperglycemia increasing baseline HGO via the CSN sympathetic output from carotid body chemoreceptors, but does not significantly impair whole body insulin sensitivity. PMID:25103977

  10. Carotid body denervation prevents fasting hyperglycemia during chronic intermittent hypoxia.

    PubMed

    Shin, Mi-Kyung; Yao, Qiaoling; Jun, Jonathan C; Bevans-Fonti, Shannon; Yoo, Doo-Young; Han, Woobum; Mesarwi, Omar; Richardson, Ria; Fu, Ya-Yuan; Pasricha, Pankaj J; Schwartz, Alan R; Shirahata, Machiko; Polotsky, Vsevolod Y

    2014-10-01

    Obstructive sleep apnea causes chronic intermittent hypoxia (IH) and is associated with impaired glucose metabolism, but mechanisms are unknown. Carotid bodies orchestrate physiological responses to hypoxemia by activating the sympathetic nervous system. Therefore, we hypothesized that carotid body denervation would abolish glucose intolerance and insulin resistance induced by chronic IH. Male C57BL/6J mice underwent carotid sinus nerve dissection (CSND) or sham surgery and then were exposed to IH or intermittent air (IA) for 4 or 6 wk. Hypoxia was administered by decreasing a fraction of inspired oxygen from 20.9% to 6.5% once per minute, during the 12-h light phase (9 a.m.-9 p.m.). As expected, denervated mice exhibited blunted hypoxic ventilatory responses. In sham-operated mice, IH increased fasting blood glucose, baseline hepatic glucose output (HGO), and expression of a rate-liming hepatic enzyme of gluconeogenesis phosphoenolpyruvate carboxykinase (PEPCK), whereas the whole body glucose flux during hyperinsulinemic euglycemic clamp was not changed. IH did not affect glucose tolerance after adjustment for fasting hyperglycemia in the intraperitoneal glucose tolerance test. CSND prevented IH-induced fasting hyperglycemia and increases in baseline HGO and liver PEPCK expression. CSND trended to augment the insulin-stimulated glucose flux and enhanced liver Akt phosphorylation at both hypoxic and normoxic conditions. IH increased serum epinephrine levels and liver sympathetic innervation, and both increases were abolished by CSND. We conclude that chronic IH induces fasting hyperglycemia increasing baseline HGO via the CSN sympathetic output from carotid body chemoreceptors, but does not significantly impair whole body insulin sensitivity. PMID:25103977

  11. Surgical complications of carotid body tumors surgery: a review.

    PubMed

    Amato, B; Serra, R; Fappiano, F; Rossi, R; Danzi, M; Milone, M; Quarto, G; Benassai, G; Bianco, T; Amato, M; Furino, E; Compagna, R

    2015-12-01

    Carotid body tumor (CBT) is a rare neoplasm, although it represents about 65% of head and neck paragangliomas. Surgical excision is considered the appropriate therapy for CBTs. The aim of this study was to evaluate surgical outcomes on a large scale. We reviewed 19 studies between 2004 to 2014 with a total of 625 procedures. We observed a higher number of cases in women (62%). Only 3 (0,48%) deaths were reported as surgical complication. Total cranial nerve injuries were 302 (48,32%) of which 194 (31,04%) were transient and 108 (17,28%) were permanent. We found a total of 174 (27,84%) arterial injuries, most of which are external carotid artery (ECA) injuries. Cerebrovascular accident due to surgery were 15 (2,4%). We concluded that surgical resection remains the treatment of choice for these disease despite the related morbidity. PMID:26498887

  12. Tetrodotoxin as a tool to elucidate sensory transduction mechanisms: the case for the arterial chemoreceptors of the carotid body.

    PubMed

    Rocher, Asuncion; Caceres, Ana Isabel; Obeso, Ana; Gonzalez, Constancio

    2011-12-01

    Carotid bodies (CBs) are secondary sensory receptors in which the sensing elements, chemoreceptor cells, are activated by decreases in arterial PO(2) (hypoxic hypoxia). Upon activation, chemoreceptor cells (also known as Type I and glomus cells) increase their rate of release of neurotransmitters that drive the sensory activity in the carotid sinus nerve (CSN) which ends in the brain stem where reflex responses are coordinated. When challenged with hypoxic hypoxia, the physiopathologically most relevant stimulus to the CBs, they are activated and initiate ventilatory and cardiocirculatory reflexes. Reflex increase in minute volume ventilation promotes CO(2) removal from alveoli and a decrease in alveolar PCO(2) ensues. Reduced alveolar PCO(2) makes possible alveolar and arterial PO(2) to increase minimizing the intensity of hypoxia. The ventilatory effect, in conjunction the cardiocirculatory components of the CB chemoreflex, tend to maintain an adequate supply of oxygen to the tissues. The CB has been the focus of attention since the discovery of its nature as a sensory organ by de Castro (1928) and the discovery of its function as the origin of ventilatory reflexes by Heymans' group (1930). A great deal of effort has been focused on the study of the mechanisms involved in O(2) detection. This review is devoted to this topic, mechanisms of oxygen sensing. Starting from a summary of the main theories evolving through the years, we will emphasize the nature and significance of the findings obtained with veratridine and tetrodotoxin (TTX) in the genesis of current models of O(2)-sensing. PMID:22363245

  13. Tetrodotoxin as a Tool to Elucidate Sensory Transduction Mechanisms: The Case for the Arterial Chemoreceptors of the Carotid Body

    PubMed Central

    Rocher, Asuncion; Caceres, Ana Isabel; Obeso, Ana; Gonzalez, Constancio

    2011-01-01

    Carotid bodies (CBs) are secondary sensory receptors in which the sensing elements, chemoreceptor cells, are activated by decreases in arterial PO2 (hypoxic hypoxia). Upon activation, chemoreceptor cells (also known as Type I and glomus cells) increase their rate of release of neurotransmitters that drive the sensory activity in the carotid sinus nerve (CSN) which ends in the brain stem where reflex responses are coordinated. When challenged with hypoxic hypoxia, the physiopathologically most relevant stimulus to the CBs, they are activated and initiate ventilatory and cardiocirculatory reflexes. Reflex increase in minute volume ventilation promotes CO2 removal from alveoli and a decrease in alveolar PCO2 ensues. Reduced alveolar PCO2 makes possible alveolar and arterial PO2 to increase minimizing the intensity of hypoxia. The ventilatory effect, in conjunction the cardiocirculatory components of the CB chemoreflex, tend to maintain an adequate supply of oxygen to the tissues. The CB has been the focus of attention since the discovery of its nature as a sensory organ by de Castro (1928) and the discovery of its function as the origin of ventilatory reflexes by Heymans group (1930). A great deal of effort has been focused on the study of the mechanisms involved in O2 detection. This review is devoted to this topic, mechanisms of oxygen sensing. Starting from a summary of the main theories evolving through the years, we will emphasize the nature and significance of the findings obtained with veratridine and tetrodotoxin (TTX) in the genesis of current models of O2-sensing. PMID:22363245

  14. Increase in cytosolic Ca2+ produced by hypoxia and other depolarizing stimuli activates a non-selective cation channel in chemoreceptor cells of rat carotid body

    PubMed Central

    Kang, Dawon; Wang, Jiaju; Hogan, James O; Vennekens, Rudi; Freichel, Marc; White, Carl; Kim, Donghee

    2014-01-01

    The current model of O2 sensing by carotid body chemoreceptor (glomus) cells is that hypoxia inhibits the outward K+ current and causes cell depolarization, Ca2+ influx via voltage-dependent Ca2+ channels and a rise in intracellular [Ca2+] ([Ca2+]i). Here we show that hypoxia (<5% O2), in addition to inhibiting the two-pore domain K+ channels TASK-1/3 (TASK), indirectly activates an ∼20 pS channel in isolated glomus cells. The 20 pS channel was permeable to K+, Na+ and Cs+ but not to Cl− or Ca2+. The 20 pS channel was not sensitive to voltage. Inhibition of TASK by external acid, depolarization of glomus cells with high external KCl (20 mm) or opening of the Ca2+ channel with FPL64176 activated the 20 pS channel when 1 mm Ca2+ was present in the external solution. Ca2+ (10 μm) applied to the cytosolic side of inside-out patches activated the 20 pS channel. The threshold [Ca2+]i for activation of the 20 pS channel in cell-attached patches was ∼200 nm. The reversal potential of the 20 pS channel was estimated to be −28 mV. Our results reveal a sequential mechanism in which hypoxia (<5% O2) first inhibits the K+ conductance and then activates a Na+-permeable, non-selective cation channel via depolarization-induced rise in [Ca2+]i. Our results suggest that inhibition of K+ efflux and stimulation of Na+ influx both contribute to the depolarization of glomus cells during moderate to severe hypoxia. PMID:24591572

  15. Glomus-like bodies within a neurofibroma: a novel neoplasm arising in neurofibromatosis type 1 or a coincidence?

    PubMed

    Thareja, Sumeet; Honigbaum, Alexis; Jukic, Drazen

    2015-04-01

    Neurofibromatosis type 1 is a relatively common genetic disorder with variable phenotypes. Tumors with features of both glomus tumors and neurofibromas are exceedingly rare in literature. Herein, we report a not yet described neoplasm with features of both a glomangioma/glomus tumor and a neurofibroma arising in a patient with segmental neurofibromatosis. Our case report supports the theory of a common lineage/ancestor cell between neurofibromas and glomus tumors and adds it to the spectrum of neoplasms that may arise in the setting of Von Recklinghausen's disease. PMID:25384450

  16. Carotid body chemoreceptors, sympathetic neural activation, and cardiometabolic disease.

    PubMed

    Iturriaga, Rodrigo; Del Rio, Rodrigo; Idiaquez, Juan; Somers, Virend K

    2016-01-01

    The carotid body (CB) is the main peripheral chemoreceptor that senses the arterial PO2, PCO2 and pH. In response to hypoxemia, hypercapnia and acidosis, carotid chemosensory discharge elicits reflex respiratory, autonomic and cardiovascular adjustments. The classical construct considers the CB as the main peripheral oxygen sensor, triggering reflex physiological responses to acute hypoxemia and facilitating the ventilatory acclimation to chronic hypoxemia at high altitude. However, a growing body of experimental evidence supports the novel concept that an abnormally enhanced CB chemosensory input to the brainstem contributes to overactivation of the sympathetic nervous system, and consequent pathology. Indeed, the CB has been implicated in several diseases associated with increases in central sympathetic outflow. These include hypertension, heart failure, sleep apnea, chronic obstructive pulmonary disease and metabolic syndrome. Indeed, ablation of the CB has been proposed for the treatment of severe and resistant hypertension in humans. In this review, we will analyze and discuss new evidence supporting an important role for the CB chemoreceptor in the progression of autonomic and cardiorespiratory alterations induced by heart failure, obstructive sleep apnea, chronic obstructive pulmonary disease and metabolic syndrome. PMID:26920146

  17. Regulation of carotid body oxygen sensing by hypoxia-inducible factors.

    PubMed

    Prabhakar, Nanduri R; Semenza, Gregg L

    2016-01-01

    Oxygen (O2) sensing by the carotid body and its chemosensory reflex is critical for homeostatic regulation of breathing and blood pressure. Carotid body responses to hypoxia are not uniform but instead exhibit remarkable inter-individual variations. The molecular mechanisms underlying variations in carotid body O2 sensing are not known. Hypoxia-inducible factor-1 (HIF-1) and HIF-2 mediate transcriptional responses to hypoxia. This article reviews the emerging evidence that proper expression of the HIF-α isoforms is a key molecular determinant for carotid body O2 sensing. HIF-1α deficiency leads to a blunted carotid body hypoxic response, which is due to increased abundance of HIF-2α, elevated anti-oxidant enzyme activity, and a reduced intracellular redox state. Conversely, HIF-2α deficiency results in augmented carotid body sensitivity to hypoxia, which is due to increased abundance of HIF-1α, elevated pro-oxidant enzyme activity, and an oxidized intracellular redox state. Double heterozygous mice with equally reduced HIF-1α and HIF-2α showed no abnormality in redox state or carotid body O2 sensing. Thus, mutual antagonism between HIF-α isoforms determines the redox state and thereby establishes the set point for hypoxic sensing by the carotid body. PMID:26265380

  18. Dual effects of nitric oxide on cat carotid body chemoreception.

    PubMed

    Iturriaga, R; Villanueva, S; Mosqueira, M

    2000-09-01

    We studied the effects of nitric oxide (NO) released by NO donors on cat carotid body (CB) chemosensory activity during normoxia and hypoxia. CBs excised from pentobarbital sodium-anaesthetized cats were perfused with Tyrode at 38 degrees C and pH 7.40. The frequency of chemosensory discharges (f(x)) was recorded from the carotid sinus nerve, and changes of NO concentration were measured by a chronoamperometric technique, with NO-selective carbon-fiber microelectrodes inserted in the CB. During steady chemosensory excitation induced by hypoxia, bolus injections of NO (DeltaNO = 0. 5-12 microM), released by S-nitroso-N-acetylpenicillamine (SNAP) and 6-(2-hydroxy-1-methyl-nitrosohydrazino)-N-methyl-1-hexanamine++ + (NOC-9), transiently reduced f(x) in a dose-dependent manner. However, during normoxia, the same concentration of NO (DeltaNO = 0. 5-13 microM) released by the NO donors increased f(x) in a dose-dependent manner. The present results show a dual effect of NO on CB chemoreception that is dependent on the PO(2) levels. During hypoxia, NO is predominantly an inhibitor of chemoreception, whereas, in normoxia, NO increased f(x). The mechanisms by which NO produces chemosensory excitation during normoxia remain to be determined. PMID:10956344

  19. Cerebral foreign body reaction after carotid aneurysm stenting.

    PubMed

    Lorentzen, Anastasia Orlova; Nome, Terje; Bakke, Søren Jacob; Scheie, David; Stenset, Vidar; Aamodt, Anne Hege

    2016-02-01

    Flow diverter stents are new important tools in the treatment of large, giant, or wide-necked aneurysms. Their delivery and positioning may be difficult due to vessel tortuosity. Common adverse events include intracranial hemorrhage and ischemic stroke, which usually occurs within the same day, or the next few days after the procedure. We present a case where we encountered an unusual intracerebral complication several months after endovascular treatment of a large left internal carotid artery aneurysm, and where brain biopsy revealed foreign body reaction to hydrophilic polymer fragments distally to the stent site. Although previously described, embolization of polymer material from intravascular equipment is rare. We could not identify any other biopsy verified case in the literature, with this particular presentation of intracerebral polymer embolization--a multifocal inflammation spread out through the white matter of one hemisphere without hemorrhage or ischemic changes. PMID:26510943

  20. Glomus Tumor of the Hand

    PubMed Central

    Lee, Won; Kwon, Soon Beom; Eo, Su Rak; Kwon, Chan

    2015-01-01

    Background Glomus tumors were first described by Wood in 1812 as painful subcutaneous tubercles. It is an uncommon benign neoplasm involving the glomus body, an apparatus that involves in thermoregulation of cutaneous microvasculature. Glomus tumor constitutes 1%-5% of all hand tumors. It usually occurs at the subungual region and more commonly in aged women. Its classical clinical triad consists of pain, tenderness and temperature intolerance, especially cold sensitivity. This study reviews 15 cases of glomus tumor which were analyzed according to its anatomic location, surgical approach and histologic findings. Methods Fifteen patients with subungual glomus tumors of the hand operated on between January 2006 and March 2013, were retrospectively reviewed. Patients were evaluated preoperatively with standard physical examination including ice cube test and Love's test. Diagnostic imaging consisted of ultrasonography, computed tomography, and magnetic resonance imaging. All procedures were performed with tourniquet control under local anesthesia. Eleven patients underwent excision using the transungual approach, 3 patients using the volar approach and 1 patient using the lateral subperiosteal approach. Results Total of 15 cases were reviewed. 11 tumors were located in the nail bed, 3 in the volar pulp and 1 in the radial aspect of the finger tip. After complete excision, patients remained asymptomatic in the immediate postoperative period. In the long term follow up, patients exhibited excellent cosmetic results with no recurrence. Conclusions Accurate diagnosis should be made by physical, radiologic and pathologic examinations. Preoperative localization and complete extirpation is essential in preventing recurrence and subsequent nail deformity. PMID:26015884

  1. Carotid body, insulin, and metabolic diseases: unraveling the links.

    PubMed

    Conde, Sílvia V; Sacramento, Joana F; Guarino, Maria P; Gonzalez, Constancio; Obeso, Ana; Diogo, Lucilia N; Monteiro, Emilia C; Ribeiro, Maria J

    2014-01-01

    The carotid bodies (CB) are peripheral chemoreceptors that sense changes in arterial blood O2, CO2, and pH levels. Hypoxia, hypercapnia, and acidosis activate the CB, which respond by increasing the action potential frequency in their sensory nerve, the carotid sinus nerve (CSN). CSN activity is integrated in the brain stem to induce a panoply of cardiorespiratory reflexes aimed, primarily, to normalize the altered blood gases, via hyperventilation, and to regulate blood pressure and cardiac performance, via sympathetic nervous system (SNS) activation. Besides its role in the cardiorespiratory control the CB has been proposed as a metabolic sensor implicated in the control of energy homeostasis and, more recently, in the regulation of whole body insulin sensitivity. Hypercaloric diets cause CB overactivation in rats, which seems to be at the origin of the development of insulin resistance and hypertension, core features of metabolic syndrome and type 2 diabetes. Consistent with this notion, CB sensory denervation prevents metabolic and hemodynamic alterations in hypercaloric feed animal. Obstructive sleep apnea (OSA) is another chronic disorder characterized by increased CB activity and intimately related with several metabolic and cardiovascular abnormalities. In this manuscript we review in a concise manner the putative pathways linking CB chemoreceptors deregulation with the pathogenesis of insulin resistance and arterial hypertension. Also, the link between chronic intermittent hypoxia (CIH) and insulin resistance is discussed. Then, a final section is devoted to debate strategies to reduce CB activity and its use for prevention and therapeutics of metabolic diseases with an emphasis on new exciting research in the modulation of bioelectronic signals, likely to be central in the future. PMID:25400585

  2. Carotid body, insulin, and metabolic diseases: unraveling the links

    PubMed Central

    Conde, Sílvia V.; Sacramento, Joana F.; Guarino, Maria P.; Gonzalez, Constancio; Obeso, Ana; Diogo, Lucilia N.; Monteiro, Emilia C.; Ribeiro, Maria J.

    2014-01-01

    The carotid bodies (CB) are peripheral chemoreceptors that sense changes in arterial blood O2, CO2, and pH levels. Hypoxia, hypercapnia, and acidosis activate the CB, which respond by increasing the action potential frequency in their sensory nerve, the carotid sinus nerve (CSN). CSN activity is integrated in the brain stem to induce a panoply of cardiorespiratory reflexes aimed, primarily, to normalize the altered blood gases, via hyperventilation, and to regulate blood pressure and cardiac performance, via sympathetic nervous system (SNS) activation. Besides its role in the cardiorespiratory control the CB has been proposed as a metabolic sensor implicated in the control of energy homeostasis and, more recently, in the regulation of whole body insulin sensitivity. Hypercaloric diets cause CB overactivation in rats, which seems to be at the origin of the development of insulin resistance and hypertension, core features of metabolic syndrome and type 2 diabetes. Consistent with this notion, CB sensory denervation prevents metabolic and hemodynamic alterations in hypercaloric feed animal. Obstructive sleep apnea (OSA) is another chronic disorder characterized by increased CB activity and intimately related with several metabolic and cardiovascular abnormalities. In this manuscript we review in a concise manner the putative pathways linking CB chemoreceptors deregulation with the pathogenesis of insulin resistance and arterial hypertension. Also, the link between chronic intermittent hypoxia (CIH) and insulin resistance is discussed. Then, a final section is devoted to debate strategies to reduce CB activity and its use for prevention and therapeutics of metabolic diseases with an emphasis on new exciting research in the modulation of bioelectronic signals, likely to be central in the future. PMID:25400585

  3. Glomus tumour of the stomach.

    PubMed

    Troller, Rebekka; Soll, Christopher; Breitenstein, Stefan

    2016-01-01

    Glomus tumours are benign tumours typically arising from the glomus bodies and primarily found under the fingernails or toenails. These rare neoplasms account for <2% of all soft tissue tumours and are generally not found in the gastrointestinal tract. We report a case of a 40-year-old man presenting with recurrent epigastric pain and pyrosis. Endoscopy revealed a solitary tumour in the antrum of the stomach. Fine-needle aspiration biopsy was suspicious for a gastrointestinal stroma tumour. After CT indicated the resectability of the tumour, showing neither lymphatic nor distant metastases, a laparoscopic-assisted gastric wedge resection was performed. Surprisingly, histology revealed a glomus tumour of the stomach. PMID:27343282

  4. Distribution of transient receptor potential channels in the rat carotid chemosensory pathway.

    PubMed

    Buniel, Maria C F; Schilling, William P; Kunze, Diana L

    2003-09-22

    Glomus cells in the carotid body respond to decreases in oxygen tension of the blood and transmit this sensory information in the carotid sinus nerve to the brain via neurons in the petrosal ganglion. G-protein-coupled membrane receptors linked to phospholipase C may play an important role in this response through the activation of the cation channels formed by the transient receptor potential (TRP) proteins. In the present study, expression of TRPC proteins in the rat carotid body and petrosal ganglion was examined using immunohistochemical techniques. TRPC3, TRPC4, TRPC5, TRPC6, and TRPC7 were present in neurons throughout the ganglion. TRPC1 was expressed in only 28% of petrosal neurons, and of this population, 45% were tyrosine hydroxylase (TH)-positive, accounting for essentially all the TH-expressing neurons in the ganglion. Because TH-positive neurons project to the carotid body, this result suggests that TRPC1 is selectively associated with the chemosensory pathway. Confocal images through the carotid body showed that TRPC1/3/4/5/6 proteins localize to the carotid sinus nerve fibers, some of which were immunoreactive to an anti-neurofilament (NF) antibody cocktail. TRPC1 and TRPC3 were present in both NF-positive and NF-negative fibers, whereas TPRC4, TRPC5, and TRPC6 expression was primarily localized to NF-negative fibers. Only TRPC1 and TRPC4 were localized in the afferent nerve terminals that encircle individual glomus cells. TRPC7 was not expressed in sensory fibers. All the TRPC proteins studied were present in type I glomus cells. Although their role as receptor-activated cation channels in the chemosensory pathway is yet to be established, the presence of TRPC channels in glomus cells and sensory nerves of the carotid body suggests a role in facilitating and/or sustaining the hypoxic response. PMID:12900933

  5. Regulation of tyrosine hydroxylase gene expression in the rat carotid body by hypoxia.

    PubMed

    Czyzyk-Krzeska, M F; Bayliss, D A; Lawson, E E; Millhorn, D E

    1992-04-01

    The activity (Vmax) of tyrosine hydroxylase (TH; EC 1.14.16.2), the rate limiting enzyme in the synthesis of catecholamines, is increased in carotid body, superior cervical ganglion, and the adrenal medulla during hypoxia (i.e., reduced PaO2). The present study was undertaken to determine if the increase in TH activity in these tissues during hypoxia is regulated at the level of TH mRNA. Adult rats were exposed to hypoxia (10% O2) or room air for periods lasting from 1 to 48 h. The carotid bodies, superior cervical ganglia, and adrenals were removed and processed for in situ hybridization using 35S-labeled oligonucleotide probes. The concentration of TH mRNA was increased by hypoxia at all time points in carotid body type I cells, but not in cells of either superior cervical ganglion or adrenal medulla. The increase in TH mRNA in carotid body during hypoxia did not require innervation of the carotid body or intact adrenal glands. In addition, hypercapnia, another physiological stimulus of carotid body activity, failed to induce an increase in TH mRNA in type I cells. Our findings suggest that hypoxia stimulates TH gene expression in the carotid body by a mechanism that is intrinsic to type I cells. PMID:1347783

  6. Autoradiographic localization of alpha-bungarotoxin-binding sites in the carotid body of the rat.

    PubMed

    Chen, I; Mascorro, J A; Yates, R D

    1981-01-01

    Radioiodinated alpha-bungarotoxin (alpha-Bgt) was used to localize alpha-Bgt-acetylcholine receptors in the carotid body of the rat. The gamma spectrometer analyses indicated a high uptake of [125I] alpha-Bgt in carotid bodies incubated in vitro (1.51 fmole per organ). Incorporation of the isotope was effectively blocked by pretreatment of carotid bodies with d-tubocurarine and unlabeled alpha-Bgt, but not by atropine. Light microscopic autoradiography showed a heavy labeling of some parenchymal cells. Electron-microscopic autoradiography revealed that labeling was localized along the interface between parenchymal cells, especially where their cytoplasmic processes engage in complex interdigitations. The silver grain counts on electron-microscopic autoradiographs suggest that labelings are preferentially associated with the plasma membrane of certain Type I cells. It is suggested that these Type I cells in the rat's carotid body probably are provided with nicotinic acetylcholine receptors on their plasma membranes. PMID:7273116

  7. Magnetic resonance and computed tomography imaging of a carotid body tumor in a dog

    PubMed Central

    2012-01-01

    A 5-year-old castrated male Labrador Retriever was presented to a referring veterinarian for a swelling in the neck region. Based on the results of histopathology, a carotid body tumor, was diagnosed. The dog was referred to a medical imaging unit for further staging and follow up. This report describes the magnetic resonance (MR) and computed tomographic (CT) appearance of a carotid body tumor. PMID:22507757

  8. The Carotid Body and Arousal in the Fetus and Neonate

    PubMed Central

    2012-01-01

    Arousal from sleep is a major defense mechanism in infants against hypoxia and/or hypercapnia. Arousal failure may be an important contributor to SIDS. Areas of the brainstem that have been found to be abnormal in a majority of SIDS infants are involved in the arousal process. Arousal is sleep state dependent, being depressed during AS in most mammals, but depressed during QS in human infants. Repeated exposure to hypoxia causes a progressive blunting of arousal that may involve medullary raphe GABAergic mechanisms. Whereas CB chemoreceptors contribute heavily to arousal in response to hypoxia, serotonergic central chemoreceptors have been implicated in the arousal response to CO2. Pulmonary or chest wall mechanoreceptors also contribute to arousal in proportion to the ventilatory response and decreases in their input may contribute to depressed arousal during AS. Little is known about specific arousal pathways beyond the NTS. Whether CB chemoreceptor stimulation directly stimulates arousal centers or whether this is done indirectly through respiratory networks remains unknown. This review will focus on arousal in response to hypoxia and CO2 in the fetus and newborn and will outline what we know (and don’t know) about the involvement of the carotid body in this process. PMID:22684039

  9. Effects of specific carotid body and brain hypoxia on respiratory muscle control in the awake goat.

    PubMed Central

    Smith, C A; Engwall, M J; Dempsey, J A; Bisgard, G E

    1993-01-01

    1. We assessed the effects of specific brain hypoxia on the control of inspiratory and expiratory muscle electromyographic (EMG) activities in response to specific carotid body hypoxia in seven awake goats. We used an isolated carotid body perfusion technique that permitted specific, physiological, steady-state stimulation of the carotid bodies or maintenance of normoxia and normocapnia at the carotid bodies while varying the level of systemic, and therefore, brain oxygenation. 2. Isolated brain normocapnic hypoxia of up to 1.5 h duration increased inspired minute ventilation (VI) by means of increases in both tidal volume (VT) and respiratory frequency (fR). Electromyographic activities of both inspiratory and expiratory muscles were augmented as well. These responses were similar to those produced by low levels of whole-body normoxic hypercapnia. We conclude that moderate levels of brain hypoxia (Pa,O2 approximately 40 mmHg) in awake goats caused a net stimulation of ventilatory motor output. 3. Hypoxic stimulation of the carotid bodies alone caused comparable increases in VT and fR, and EMG augmentation of both inspiratory and expiratory muscles whether the brain was hypoxic or normoxic. These responses were quite similar to those obtained over a wide range of whole-body normoxic hypercapnia. We conclude that the integration of carotid body afferent information is not affected by moderate brain hypoxia in awake goats. 4. We found no evidence for an asymmetrical recruitment pattern of inspiratory vs. expiratory muscles in response to carotid body hypoxia or in response to brain hypoxia alone. 5. Our data support the concept that moderate brain hypoxia results in a net stimulation of respiratory motor output. These findings question the significance of 'central hypoxic depression' to the regulation of breathing under physiological levels of hypoxaemia in the awake animal. PMID:8487210

  10. Carotid body potentiation during chronic intermittent hypoxia: implication for hypertension.

    PubMed

    Del Rio, Rodrigo; Moya, Esteban A; Iturriaga, Rodrigo

    2014-01-01

    Autonomic dysfunction is involved in the development of hypertension in humans with obstructive sleep apnea, and animals exposed to chronic intermittent hypoxia (CIH). It has been proposed that a crucial step in the development of the hypertension is the potentiation of the carotid body (CB) chemosensory responses to hypoxia, but the temporal progression of the CB chemosensory, autonomic and hypertensive changes induced by CIH are not known. We tested the hypothesis that CB potentiation precedes the autonomic imbalance and the hypertension in rats exposed to CIH. Thus, we studied the changes in CB chemosensory and ventilatory responsiveness to hypoxia, the spontaneous baroreflex sensitivity (BRS), heart rate variability (HRV) and arterial blood pressure in pentobarbital anesthetized rats exposed to CIH for 7, 14, and 21 days. After 7 days of CIH, CB chemosensory and ventilatory responses to hypoxia were enhanced, while BRS was significantly reduced by 2-fold in CIH-rats compared to sham-rats. These alterations persisted until 21 days of CIH. After 14 days, CIH shifted the HRV power spectra suggesting a predominance of sympathetic over parasympathetic tone. In contrast, hypertension was found after 21 days of CIH. Concomitant changes between the gain of spectral HRV, BRS, and ventilatory hypoxic chemoreflex showed that the CIH-induced BRS attenuation preceded the HRV changes. CIH induced a simultaneous decrease of the BRS gain along with an increase of the hypoxic ventilatory gain. Present results show that CIH-induced persistent hypertension was preceded by early changes in CB chemosensory control of cardiorespiratory and autonomic function. PMID:25429271

  11. Role of the carotid bodies in chemosensory ventilatory responses in the anesthetized mouse.

    PubMed

    Izumizaki, Masahiko; Pokorski, Mieczyslaw; Homma, Ikuo

    2004-10-01

    We examined the effects of carotid body denervation on ventilatory responses to normoxia (21% O2 in N2 for 240 s), hypoxic hypoxia (10 and 15% O2 in N2 for 90 and 120 s, respectively), and hyperoxic hypercapnia (5% CO2 in O2 for 240 s) in the spontaneously breathing urethane-anesthetized mouse. Respiratory measurements were made with a whole body, single-chamber plethysmograph before and after cutting both carotid sinus nerves. Baseline measurements in air showed that carotid body denervation was accompanied by lower minute ventilation with a reduction in respiratory frequency. On the basis of measurements with an open-circuit system, no significant differences in O2 consumption or CO2 production before and after chemodenervation were found. During both levels of hypoxia, animals with intact sinus nerves had increased respiratory frequency, tidal volume, and minute ventilation; however, after chemodenervation, animals experienced a drop in respiratory frequency and ventilatory depression. Tidal volume responses during 15% hypoxia were similar before and after carotid body denervation; during 10% hypoxia in chemodenervated animals, there was a sudden increase in tidal volume with an increase in the rate of inspiration, suggesting that gasping occurred. During hyperoxic hypercapnia, ventilatory responses were lower with a smaller tidal volume after chemodenervation than before. We conclude that the carotid bodies are essential for maintaining ventilation during eupnea, hypoxia, and hypercapnia in the anesthetized mouse. PMID:15194670

  12. Carotid body chemoreflex: a driver of autonomic abnormalities in sleep apnoea.

    PubMed

    Prabhakar, Nanduri R

    2016-08-01

    What is the topic of this review? This article presents emerging evidence for heightened carotid body chemoreflex activity as a major driver of sympathetic activation and hypertension in sleep apnoea patients. What advances does it heighlight? This article discusses the recent advances on cellular, molecular and epigenetic mechanisms underlying the exaggerated chemoreflex in experimental models of sleep apnoea. The carotid bodies are the principal peripheral chemoreceptors for detecting changes in arterial blood oxygen concentration, and the resulting chemoreflex is a potent regulator of the sympathetic tone, blood pressure and breathing. Sleep apnoea is a disease of the respiratory system that affects several million adult humans. Apnoeas occur during sleep, often as a result of obstruction of the upper airway (obstructive sleep apnoea) or because of defective respiratory rhythm generation by the CNS (central sleep apnoea). Patients with sleep apnoea exhibit several co-morbidities, with the most notable among them being heightened sympathetic nerve activity and hypertension. Emerging evidence suggests that intermittent hypoxia resulting from periodic apnoea stimulates the carotid body, and the ensuing chemoreflex mediates the increased sympathetic tone and hypertension in sleep apnoea patients. Rodent models of intermittent hypoxia that simulate the O2 saturation profiles encountered during sleep apnoea have provided important insights into the cellular and molecular mechanisms underlying the heightened carotid body chemoreflex. This article describes how intermittent hypoxia affects the carotid body function and discusses the cellular, molecular and epigenetic mechanisms underlying the exaggerated chemoreflex. PMID:27474260

  13. Evidence for a carotid body homolog in the lizard Tupinambis merianae.

    PubMed

    Reichert, Michelle N; Brink, Deidre L; Milsom, William K

    2015-01-15

    The homolog to the mammalian carotid body has not yet been identified in lizards. Observational studies and evolutionary history provide indirect evidence for the existence of a chemoreceptor population at the first major bifurcation of the common carotid artery in lizards, but a chemoreceptive role for this area has not yet been definitively demonstrated. We explored this possibility by measuring changes in cardiorespiratory variables in response to focal arterial injections of the hypoxia mimic sodium cyanide (NaCN) into the carotid artery of 12 unanesthetized specimens of Tupinambis merianae. These injections elicited increases in heart rate (f(H); 101±35% increase) and respiratory rate (f(R); 620±119% increase), but not mean arterial blood pressure (MAP). These responses were eliminated by vagal denervation. Similar responses were elicited by injections of the neurotransmitters acetylcholine (ACh) and serotonin (5-HT) but not norepinephrine. Heart rate and respiratory rate increases in response to NaCN could be blocked or reduced by antagonists to ACh (atropine) and/or 5-HT (methysergide). Finally, using immunohistochemistry, we demonstrate the presence of putative chemoreceptive cells immunopositive for the cholinergic cell marker vesicular ACh transporter (VAChT) and 5-HT on internal lattice-like structures at the carotid bifurcation. These results provide evidence in lizards for the existence of dispersed chemoreceptor cells at the first carotid bifurcation in the central cardiovascular area that have similar properties to known carotid body homologs, adding to the picture of chemoreceptor evolution in vertebrates. PMID:25524981

  14. Carotid baroreceptor influence on forearm vascular resistance during low level lower body negative pressure

    NASA Technical Reports Server (NTRS)

    Thompson, Cynthia A.; Ludwig, David A.; Convertino, Victor A.

    1991-01-01

    The degree of forearm vasoconstriction induced by low levels of lower body negative pressure (LBNP) provides a measure of the responsiveness of the cardiopulmonary baroreflex. The validity of this measurement is based on the assumption that this vasoconstriction response is not influenced by unloading of carotid baroreceptors. To test the hypothesis that arterial baroreceptor unloading does not alter the degree of forearm vascular resistance during low levels of LBNP, 12 subjects were exposed to -15 and -20 mm Hg LBNP with and without additional artificial (+ 10 mm Hg neck pressure) unloading of the carotid baroreceptors. There was no measurable influence of carotid unloading on forearm vascular resistance at either level of LBNP. It is concluded that forearm vascular resistance measured during cardiopulmonary baroreceptor unloading is unaffected by carotid baroreceptor unloading within the magnitude encountered during low levels of LBNP.

  15. Carotid body overactivity induces respiratory neurone channelopathy contributing to neurogenic hypertension.

    PubMed

    Moraes, Davi J A; Machado, Benedito H; Paton, Julian F R

    2015-07-15

    Why sympathetic activity rises in neurogenic hypertension remains unknown. It has been postulated that changes in the electrical excitability of medullary pre-sympathetic neurones are the main causal mechanism for the development of sympathetic overactivity in experimental hypertension. Here we review recent data suggesting that enhanced sympathetic activity in neurogenic hypertension is, at least in part, dependent on alterations in the electrical excitability of medullary respiratory neurones and their central modulation of sympatho-excitatory networks. We also present results showing a critical role for carotid body tonicity in the aetiology of enhanced central respiratory modulation of sympathetic activity in neurogenic hypertension. We propose a novel hypothesis of respiratory neurone channelopathy induced by carotid body overactivity in neurogenic hypertension that may contribute to sympathetic excess. Moreover, our data support the notion of targeting the carotid body as a potential novel therapeutic approach for reducing sympathetic vasomotor tone in neurogenic hypertension. PMID:25900825

  16. Spexin is expressed in the carotid body and is upregulated by postnatal hyperoxia exposure.

    PubMed

    Porzionato, Andrea; Rucinski, Marcin; Macchi, Veronica; Stecco, Carla; Sarasin, Gloria; Sfriso, Maria M; Di Giulio, Camillo; Malendowicz, Ludwik K; De Caro, Raffaele

    2012-01-01

    Spexin is a recently identified peptide which is expressed in many different endocrine and nervous tissues. Due to the absence of data regarding spexin expression in the carotid body, the first aim of the present study was to investigate, through immunohistochemistry and Real-Time PCR, the expression and distribution of spexin in the rat and human carotid body. Moreover, the carotid body is known to undergo various structural and functional modifications in response to hyperoxic stimuli during the first postnatal period. Thus, we also evaluated if hyperoxia during the first postnatal weeks may produce changes in the spexin expression. Materials consisted of carotid bodies obtained at autopsy from five human adult subjects and sampled from 10 six-weeks old Sprague-Dawley rats. Five rats were maintained in normoxia for the first six postnatal weeks; five rats were exposed to 60% hyperoxia for 2 weeks and then maintained in normoxia for other 4 weeks. Diffuse anti-spexin immunoreactivity was found in type I cells of both humans and rats. No spexin immunoreactivity was visible in the type II cells. Hyperoxia exposure during the first 2 weeks of postnatal life caused a reduction of volume in the carotid body still apparent after 4 weeks of normoxia. Using real-time PCR, spexin expression was 6-7 times higher in hyperoxia-exposed rats than in normoxia-exposed ones. The expression of spexin in type I cells suggests a possible modulator role in peripheral chemoreception. Moreover, the ascertained role of spexin in the regulation of cell proliferation in other tissues (e.g., adrenal gland cortex) suggests a possible role of spexin also in the hyperoxia-induced plasticity of the carotid body. PMID:23080164

  17. Thermal effects on ventilation in cats: participation of carotid body chemoreceptors.

    PubMed

    Fadic, R; Larrain, C; Zapata, P

    1991-10-01

    In pentobarbitone anesthetized cats, raising body temperature from 37 to 40 degrees C by external heat increased respiratory frequency, tidal volume, frequency of spontaneous gasps and mean inspiratory flow. It reduced end-tidal CO2 pressure, together with inspiratory and expiratory durations. After bilateral section of the carotid nerves, raising body temperature still induced hyperventilation, but the increase in gasp frequency was less pronounced and no significant change in tidal volume was observed. In comparison to steady ventilatory values in the intact condition, significant reductions in tidal volume at 38 degrees C and in gasp frequency at 37, 39 and 40 degrees C were observed after bilateral carotid neurotomy. Brief hyperoxic tests induced transient decreases in tidal volume and increases in end-tidal CO2 pressure which were significantly larger at 40 degrees C than at 37 degrees C. These changes disappeared after bilateral carotid neurotomy. Anesthetic block of both carotid nerves produced transient reductions in tidal volume at any given temperature. We conclude that carotid body afferents contribute to the hyperventilation evoked by hyperthermia. After their interruption, such contribution is replaceable from other thermal afferents. PMID:1759053

  18. Inherent variations in CO-H2S-mediated carotid body O2 sensing mediate hypertension and pulmonary edema.

    PubMed

    Peng, Ying-Jie; Makarenko, Vladislav V; Nanduri, Jayasri; Vasavda, Chirag; Raghuraman, Gayatri; Yuan, Guoxiang; Gadalla, Moataz M; Kumar, Ganesh K; Snyder, Solomon H; Prabhakar, Nanduri R

    2014-01-21

    Oxygen (O2) sensing by the carotid body and its chemosensory reflex is critical for homeostatic regulation of breathing and blood pressure. Humans and animals exhibit substantial interindividual variation in this chemosensory reflex response, with profound effects on cardiorespiratory functions. However, the underlying mechanisms are not known. Here, we report that inherent variations in carotid body O2 sensing by carbon monoxide (CO)-sensitive hydrogen sulfide (H2S) signaling contribute to reflex variation in three genetically distinct rat strains. Compared with Sprague-Dawley (SD) rats, Brown-Norway (BN) rats exhibit impaired carotid body O2 sensing and develop pulmonary edema as a consequence of poor ventilatory adaptation to hypobaric hypoxia. Spontaneous Hypertensive (SH) rat carotid bodies display inherent hypersensitivity to hypoxia and develop hypertension. BN rat carotid bodies have naturally higher CO and lower H2S levels than SD rat, whereas SH carotid bodies have reduced CO and greater H2S generation. Higher CO levels in BN rats were associated with higher substrate affinity of the enzyme heme oxygenase 2, whereas SH rats present lower substrate affinity and, thus, reduced CO generation. Reducing CO levels in BN rat carotid bodies increased H2S generation, restoring O2 sensing and preventing hypoxia-induced pulmonary edema. Increasing CO levels in SH carotid bodies reduced H2S generation, preventing hypersensitivity to hypoxia and controlling hypertension in SH rats. PMID:24395806

  19. Role of. alpha. sub 2 -adrenergic receptors in the carotid body response to hypoxia

    SciTech Connect

    Kou, Y.R.; Ernsberger, P.; Cherniack, N.S.; Prabhakar, N.R. )

    1990-02-26

    Clonidine, which acts in part as an {alpha}{sub 2}-adrenergic receptor agonist, depresses ventilation. The authors examined the role of {alpha}{sub 2}-receptors in carotid chemoreceptor activity. The density of {alpha}{sub 2}-receptors was determined in membrane fractions of 18 cat carotid bodies using {sup 125}I-iodoclonidine with 0.1 mM epinephrine or 10 {mu}M SKF-86466 defining nonspecific binding. {alpha}{sub 2}-Adrenergic receptor density averaged 0.6{plus minus}0.1 fmol/carotid body (mean {plus minus} SEM) and was comparable to other sympathetic target tissues. The authors then studied the effects of an agonist (guanabenz) and an antagonist (SKF-86466; 6-Cl-N-methyl-2,3,4,5-tetrahydro-1-H3-benzazepine) specific for {alpha}{sub 2}-receptors on baseline and hypoxia-stimulated carotid body discharge, in 10 anesthetized, paralyzed and artificially ventilated cats. Intracarotid infusion of guanabenz for 5 minutes caused a dose-dependent depression of the baseline activity and reduced the chemoreceptor response to hypoxia by 88.0{plus minus}5.8% of the vehicle-injected controls. Intravenous administration of SKF-86466 reversed the effects of guanabenz on the carotid body activity. in contrast, chemoreceptor depression caused by dopamine was unaffected by SKF-86466. SKF-86466 alone increased baseline discharge and potentiated the chemoreceptor response to hypoxia by 34.0 {plus minus} 9.6% of the controls. These results demonstrate that {alpha}{sub 2}-adrenergic receptors are present in the cat carotid body and they exert an inhibitory influence on the chemoreceptor response to hypoxia.

  20. A case of congenital agenesis of the common carotid artery associated with an ectopic parathyroid adenoma mimicking a carotid body tumor.

    PubMed

    Malm, Ian-James; Olcott, Clara M; Chan, Jason Y K; Loyo, Myriam; Kim, Young J

    2013-01-01

    Ectopic parathyroid adenomas can be encountered during four gland explorations, but nearly 80% of adenomas are localized with ultrasound and sestamibi imaging. Ectopic adenomas are thought to arise from abnormal migration during development. As a cervical congenital anomaly, common carotid artery agenesis is an extremely rare anomaly characterized by separate origins of the internal and external carotid arteries directly from the aortic arch. Here we present a case of a 75 year old man with primary hyperparathyroidism who was found to have congenital agenesis of the common carotid artery associated with an ectopic parathyroid adenoma within the parapharyngeal space, which mimicked a carotid body tumor based on location and imaging. The successful identification and resection of the ectopic parathyroid adenoma presented here demonstrate the importance of preoperative imaging studies to allow appropriate operative planning as well as the utility of intraoperative parathyroid hormone assay in predicting cure during surgery. PMID:23993711

  1. Gene Expression Profiling Supports the Neural Crest Origin of Adult Rodent Carotid Body Stem Cells and Identifies CD10 as a Marker for Mesectoderm-Committed Progenitors.

    PubMed

    Navarro-Guerrero, Elena; Platero-Luengo, Aida; Linares-Clemente, Pedro; Cases, Ildefonso; López-Barneo, José; Pardal, Ricardo

    2016-06-01

    Neural stem cells (NSCs) are promising tools for understanding nervous system plasticity and repair, but their use is hampered by the lack of markers suitable for their prospective isolation and characterization. The carotid body (CB) contains a population of peripheral NSCs, which support organ growth during acclimatization to hypoxia. We have set up CB neurosphere (NS) cultures enriched in differentiated neuronal (glomus) cells versus undifferentiated progenitors to investigate molecular hallmarks of cell classes within the CB stem cell (CBSC) niche. Microarray gene expression analysis in NS is compatible with CBSCs being neural crest derived-multipotent progenitor cells able to sustain CB growth upon exposure to hypoxia. Moreover, we have identified CD10 as a marker suitable for isolation of a population of CB mesectoderm-committed progenitor cells. CD10 + cells are resting in normoxia, and during hypoxia they are activated to proliferate and to eventually complete maturation into mesectodermal cells, thus participating in the angiogenesis necessary for CB growth. Our results shed light into the molecular and cellular mechanisms involved in CBSC fate choice, favoring a potential use of these cells for cell therapy. Stem Cells 2016;34:1637-1650. PMID:26866353

  2. Percutaneous Injection of Lidocaine Within the Carotid Body Area in Carotid Artery Stenting: An 'Old-New' Technique

    SciTech Connect

    Mourikis, Dimitrios; Chatoupis, Konstantinos; Katsenis, Konstantinos; Vlahos, Lampros; Chatziioannou, Achilles

    2008-07-15

    Severe bradycardia is a common untoward effect during balloon angioplasty when performing carotid artery stenting. Therefore atropine injection even before dilatation and the presence of an anesthesiologist are advocated in all patients. In the surgical literature, injection of a local anesthetic agent into the carotid sinus before carotid endarterectomy was performed in an attempt to ameliorate perioperative hemodynamic instability. This study was undertaken to test the hypothesis that percutaneous infiltration of the carotid sinus with local anesthetic immediately before balloon dilatation reduces bradycardia and ameliorates the need for atropine injection or the presence of an anesthesiologist. Infiltration of the carotid sinus with 5 ml of 1% lidocaine, 3 min before dilatation, was performed in 30 consecutive patients. No one exhibited any significant rhythm change that required atropine injection. The anesthesiologist did not face any hemodynamic instability during the carotid artery stenting procedure.

  3. Case report of malignant pulmonary parenchymal glomus tumor: imaging features and review of the literature.

    PubMed

    Cunningham, Jane D; Plodkowski, Andrew J; Giri, Dilip D; Hwang, Sinchun

    2016-01-01

    Glomus tumor is rare tumor which arises from glomus body and is most frequently found in the soft tissue of the extremities. The lung is a rare ectopic site, and a malignant glomus tumor arising from pulmonary parenchyma is particularly uncommon. To deepen our understanding on their imaging features, we report a case of malignant glomus tumor of pulmonary parenchyma confirmed with surgical histopathology and immunochemistry and review the medical literature on pulmonary parenchymal glomus tumors with emphasis on their imaging features. PMID:26498485

  4. Do the carotid body chemoreceptors mediate cardiovascular and sympathetic adjustments induced by sodium overload in rats?

    PubMed

    Pedrino, Gustavo R; Mourão, Aline A; Moreira, Marina C S; da Silva, Elaine F; Lopes, Paulo R; Fajemiroye, James O; Schoorlemmer, Guss H M; Sato, Mônica A; Reis, Ângela A S; Rebelo, Ana C S; Cravo, Sergio L

    2016-05-15

    Acute plasma hypernatremia induces several cardiovascular and sympathetic responses. It is conceivable that these responses contribute to rapid sodium excretion and restoration of normal conditions. Afferent pathways mediating these responses are not entirely understood. The present study analyses the effects of acute carotid chemoreceptor inactivation on cardiovascular and sympathetic responses induced by infusion of hypertonic saline (HS). All experiments were performed on anesthetized male Wistar rats instrumented for recording of arterial blood pressure (ABP), renal blood flow (RBF) and renal sympathetic nerve activity (RSNA). Animals were subjected to sham surgery or carotid chemoreceptor inactivation by bilateral ligation of the carotid body artery (CBA). In sham rats (n=8), intravenous infusion of HS (3 M NaCl, 1.8 ml/kg b.wt.) elicited a transient increase (9±2mmHg) in ABP, and long lasting (30 min) increases in RBF (138±5%) and renal vascular conductance (RVC) (128±5%) with concurrent decrease in RSNA (-19±4%). In rats submitted to CBA ligation (n=8), the pressor response to HS was higher (24±2mmHg; p<0.05). However, RBF and RVC responses to HS infusion were significantly reduced (113±5% and 93±4%, respectively) while RSNA was increased (13±2%). When HS (3M NaCl, 200μl) was administrated into internal carotid artery (ICA), distinct sympathetic and cardiovascular responses were observed. In sham-group, HS infusion (3M NaCl, 200μl) into ICA promoted an increase in ABP (26±8mmHg) and RSNA (29±13%). In CBA rats, ABP (-3±5.6mmHg) remained unaltered despite sympathoinhibition (-37.6±5.4%). These results demonstrate that carotid body chemoreceptors play a role in the development of hemodynamic and sympathetic responses to acute HS infusion. PMID:27060222

  5. CT AND MRI FEATURES OF CAROTID BODY PARAGANGLIOMAS IN 16 DOGS.

    PubMed

    Mai, Wilfried; Seiler, Gabriela S; Lindl-Bylicki, Britany J; Zwingenberger, Allison L

    2015-01-01

    Carotid body tumors (paragangliomas) arise from chemoreceptors located at the carotid bifurcation. In imaging studies, this neoplasm may be confused with other neck neoplasms such as thyroid carcinoma. The purpose of this retrospective, cross-sectional study was to describe computed tomographic (CT) and magnetic resonance imaging (MRI) characteristics of confirmed carotid body tumors in a multi-institutional sample of dogs. A total of 16 dogs met inclusion criteria (14 examined using CT and two with MRI). The most common reason for imaging was a palpable cervical mass or respiratory signs (i.e., dyspnea or increased respiratory noises). The most commonly affected breed was Boston terrier (n = 5). Dogs were predominantly male castrated (n = 10) and the median age was 9 years [range 3-14.5]. Most tumors appeared as a large mass centered at the carotid bifurcation, with poor margination in six dogs and discrete margins in ten dogs. Masses were iso- to hypoattenuating to adjacent muscles in CT images and hyperintense to muscles in T1- and T2-weighted MRI. For both CT and MRI, masses typically showed strong and heterogeneous contrast enhancement. There was invasion into the adjacent structures in 9/16 dogs. In six of these nine dogs, the basilar portion of the skull was affected. The external carotid artery was entrapped in seven dogs. There was invasion into the internal jugular vein in three dogs, and into the external jugular, maxillary, and linguo-facial veins in one dog. Imaging characteristics helped explain some clinical presentations such as breathing difficulties, Horner's syndrome, head tilt, or facial nerve paralysis. PMID:25846946

  6. The Role of Hypoxia-Inducible Factors in Oxygen Sensing by the Carotid Body

    PubMed Central

    Prabhakar, Nanduri R.

    2013-01-01

    Chronic intermittent hypoxia (IH) associated with sleep-disordered breathing is an important cause of hypertension, which results from carotid body-mediated activation of the sympathetic nervous system. IH triggers increased levels of reactive oxygen species (ROS) in the carotid body, which induce increased synthesis and stability of hypoxia-inducible factor 1α (HIF-1α) and calpain-dependent degradation of HIF-2α. HIF-1 activates transcription of the Nox2 gene, encoding NADPH oxidase 2, which generates superoxide. Loss of HIF-2 activity leads to decreased transcription of the Sod2 gene, encoding manganese superoxide dismutase, which converts superoxide to hydrogen peroxide. Thus, IH disrupts the balance between HIF-1-dependent pro-oxidant and HIF-2-dependent anti-oxidant activities, and this loss of redox homeostasis underlies the pathogenesis of autonomic morbidities associated with IH. PMID:23080136

  7. Expression of leptin and leptin receptor isoforms in the rat and human carotid body.

    PubMed

    Porzionato, Andrea; Rucinski, Marcin; Macchi, Veronica; Stecco, Carla; Castagliuolo, Ignazio; Malendowicz, Ludwik K; De Caro, Raffaele

    2011-04-18

    Leptin is known to play a role in the modulation of metabolism and control of breathing acting mainly on central nervous structures, although additional actions on peripheral arterial chemoreceptors have also been suggested in the literature. We therefore examined by means of immunohistochemistry the expression of leptin and leptin receptors in the carotid bodies of rats and humans. Leptin expression and relative expression of leptin receptor isoforms were also studied in rats by real-time PCR. No leptin or leptin receptor immunoreactivities were visible in the type II cells of either series. In rat carotid bodies, diffuse positive stainings for leptin and leptin receptors (both with antibody recognizing all receptor isoforms and antibody specific for Ob-Rb) were observed in type I cells. In human carotid bodies, the mean percentage (±standard error) of leptin immunoreactive type I cells was 39.4%±5.1% and the percentages of leptin receptor immunoreactive type I cells were 57.3%±3.9% with antibody recognizing all receptor isoforms and 33.3%±4.2% with antibody specific for isoform Ob-Rb. Double immunofluorescences with anti-tyrosine hydroxylase (type I cell marker) and anti-glial fibrillary acidic protein (type II cell markers) confirmed the selective location of leptin and Ob-Rb in type I cells. Real-time PCR showed the expression of leptin and Ob-Ra, Ob-Rb, Ob-Rc and Ob-Rf isoform mRNA in the rat carotid body, levels of expression being Ob-Rf>Ob-Rc>Ob-Ra>Ob-Rb. Ob-Re mRNA was not detected. The above findings suggest a role of circulating or locally produced leptin in the regulation of chemoreceptor discharge and/or metabolic sensing function, by means of direct action on type I cells. PMID:21334312

  8. Presynaptic action of adenosine on a 4-aminopyridine-sensitive current in the rat carotid body

    PubMed Central

    Vandier, C; Conway, A F; Landauer, R C; Kumar, P

    1999-01-01

    Plasma adenosine concentration increases during hypoxia to a level that excites carotid body chemoreceptors by an undetermined mechanism. We have examined this further by determining the electrophysiological responses to exogenous adenosine of sinus nerve chemoafferents in vitro and of whole-cell currents in isolated type I cells.Steady-state, single-fibre chemoafferent discharge was increased approximately 5-fold above basal levels by 100 μM adenosine. This adenosine-stimulated discharge was reversibly and increasingly reduced by methoxyverapamil (D600, 100 μM), by application of nickel chloride (Ni2+, 2 mM) and by removal of extracellular Ca2+. These effects strongly suggest a presynaptic, excitatory action of adenosine on type I cells of the carotid body.Adenosine decreased whole-cell outward currents at membrane potentials above -40 mV in isolated type I cells recorded during superfusion with bicarbonate-buffered saline solution at 34–36 °C. This effect was reversible and concentration dependent with a maximal effect at 10 μM.The degree of current inhibition induced by 10 μM adenosine was voltage independent (45.39 ± 2.55% (mean ± s.e.m.) between −40 and +30 mV) and largely (∼75%), but not entirely, Ca2+ independent. 4-Aminopyridine (4-AP, 5 mM) decreased the amplitude of the control outward current by 80.60 ± 3.67% and abolished the effect of adenosine.Adenosine was without effect upon currents near the resting membrane potential of approximately −55 mV and did not induce depolarization in current-clamp experiments.We conclude that adenosine acts to inhibit a 4-AP-sensitive current in isolated type I cells of the rat carotid body and suggest that this mechanism contributes to the chemoexcitatory effect of adenosine in the whole carotid body. PMID:10050009

  9. Surgical Therapy of Glomus Vagale Tumors

    PubMed Central

    Browne, J. Dale; Fisch, Ugo; Valavanis, Anton

    1993-01-01

    Lying between the carotid bifurcation and the jugular foramen, glomus vagale tumors share characteristics with paragangliomas of those two structures, such as invasion of the carotid artery, destruction of the skull base, and cranial neuropathies. This capability for local invasion provides a therapeutic challenge with regard to the proper assessment of tumor extent and the selection of appropriate treatment. In order to clarify an approach to the management of glomus vagale tumors, we reviewed a 10-year experience with 15 patients treated for this tumor at the University of Zürich Department of Otolaryngology, using a new system of classification. This system highlights the relative position of a vagal paraganglioma to the jugular foramen and is helpful in designing the proper therapy. Pitfalis in surgical technique, recommended preoperative evaluation, and the roles of balloon occlusion and irradiation in the treatment of these tumors, are discussed. ImagesFigure 2Figure 3Figure 4Figure 4p188-bFigure 5 PMID:17170910

  10. Gene expression and function of adenosine A(2A) receptor in the rat carotid body.

    PubMed

    Kobayashi, S; Conforti, L; Millhorn, D E

    2000-08-01

    The present study was undertaken to determine whether rat carotid bodies express adenosine (Ado) A(2A) receptors and whether this receptor is involved in the cellular response to hypoxia. Our results demonstrate that rat carotid bodies express the A(2A) and A(2B) Ado receptor mRNAs but not the A(1) or A(3) receptor mRNAs as determined by reverse transcriptase-polymerase chain reaction. In situ hybridization confirmed the expression of the A(2A) receptor mRNA. Immunohistochemical studies further showed that the A(2A) receptor is expressed in the carotid body and that it is colocalized with tyrosine hydroxylase in type I cells. Whole cell voltage-clamp studies using isolated type I cells showed that Ado inhibited the voltage-dependent Ca(2+) currents and that this inhibition was abolished by the selective A(2A) receptor antagonist ZM-241385. Ca(2+) imaging studies using fura 2 revealed that exposure to severe hypoxia induced elevation of intracellular Ca(2+) concentration ([Ca(2+)](i)) in type I cells and that extracellularly applied Ado significantly attenuated the hypoxia-induced elevation of [Ca(2+)](i). Taken together, our findings indicate that A(2A) receptors are present in type I cells and that activation of A(2A) receptors modulates Ca(2+) accumulation during hypoxia. This mechanism may play a role in regulating intracellular Ca(2+) homeostasis and cellular excitability during hypoxia. PMID:10926550

  11. Opioid peptides in the rabbit carotid body: identification and evidence for co-utilization and interactions with dopamine.

    PubMed

    González-Guerrero, P R; Rigual, R; González, C

    1993-05-01

    The rabbit carotid body is a catecholaminergic organ that contains dopamine and norepinephrine in a proportion of nearly 5:1. Chronic (15 days) carotid sinus nerve denervation or superior cervical ganglionectomy did not modify the carotid body dopamine content (5-6 nmol/mg of protein, equivalent to 250 pmol per carotid body), but sympathectomy reduced by approximately 50% the norepinephrine content. The carotid body has also a very high content of opioid activity (250 equivalent pmol of Leu-enkephalin/mg of protein) as measured by a radioreceptor assay that detects preferentially delta-opioid activity. In the carotid body the degree of opioid posttranslational processing to low-molecular-weight peptides (mostly Leu- and Met-enkephalin) is nearly 80%. HPLC identification of opioid peptides revealed that the sequences of Met- and Leu-enkephalin were in a proportion of nearly 6:1, indicating that the main opioid precursor in the carotid body is proenkephalin A. Chronic denervations of the carotid body did not modify the levels or the degree of opioid precursor processing. Acute hypoxic exposure of the animals (8% O2 in N2; 3 h) resulted in a parallel decrease of dopamine and opioid activity, without any change in the degree of opioid processing. Norepinephrine levels were not affected by hypoxia. These findings suggest corelease of dopamine and opioids during natural hypoxic stimulation. In agreement with the analytical data, [D-Ala2, D-Leu5]enkephalin, but not [D-Ala2,N-Me-Phe4,Gly5-ol]-enkephalin, reduced the in vitro release of dopamine induced by low PO2, a high external K+ concentration, and dinitrophenol. Naloxone augmented the release response elicited by low PO2 stimulation.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8473894

  12. Effects of nitric oxide gas on cat carotid body chemosensory response to hypoxia.

    PubMed

    Iturriaga, R; Mosqueira, M; Villanueva, S

    2000-02-14

    It has been proposed that nitric oxide (NO) is an inhibitory modulator of carotid body (CB) chemoreception to hypoxia. However, the effects of NO gas on carotid chemoreception have not been tested yet. The role played by NO has been revealed by the use of pharmacological tools (i.e., NO donors and NO synthase inhibitors). Here, we studied the effects of NO gas (25 ppm in N(2)) on the chemosensory response to hypoxia (PO(2) approximately 30 Torr) in the cat CB perfused in vitro. During steady hypoxic chemoreceptor excitation, bolus injections or perfusion of Tyrode equilibrated with NO reduced the increased frequency of carotid chemosensory discharges (f(x)). Perfusion for 2 min of Tyrode equilibrated with NO also reduced the rate of the rise of the chemosensory response, as well as the maximal amplitude, as compared with the normal chemosensory response to hypoxia. Present results provide direct evidence that NO gas is an inhibitory modulator of CB hypoxic chemoreception. PMID:10677601

  13. Fractal analysis of the structural complexity of the connective tissue in human carotid bodies

    PubMed Central

    Guidolin, Diego; Porzionato, Andrea; Tortorella, Cinzia; Macchi, Veronica; De Caro, Raffaele

    2014-01-01

    The carotid body (CB) may undergo different structural changes during perinatal development, aging, or in response to environmental stimuli. In the previous literature, morphometric approaches to evaluate these changes have considered quantitative first order parameters, such as volumes or densities, while changes in spatial disposition and/or complexity of structural components have not yet been considered. In the present study, different strategies for addressing morphological complexity of CB, apart from the overall amount of each tissue component, were evaluated and compared. In particular, we considered the spatial distribution of connective tissue in the carotid bodies of young control subjects, young opiate-related deaths and aged subjects, through analysis of dispersion (Morisita's index), gray level co-occurrence matrix (entropy, angular second moment, variance, correlation), and fractal analysis (fractal dimension, lacunarity). Opiate-related deaths and aged subjects showed a comparable increase in connective tissue with respect to young controls. However, the Morisita's index (p < 0.05), angular second moment (p < 0.05), fractal dimension (p < 0.01), and lacunarity (p < 0.01) permitted to identify significant differences in the disposition of the connective tissue between these two series. A receiver operating characteristic (ROC) curve was also calculated to evaluate the efficiency of each parameter. The fractal dimension and lacunarity, with areas under the ROC curve of 0.9651 (excellent accuracy) and 0.8835 (good accuracy), respectively, showed the highest discriminatory power. They evidenced higher level of structural complexity in the carotid bodies of opiate-related deaths than old controls, due to more complex branching of intralobular connective tissue. Further analyses will have to consider the suitability of these approaches to address other morphological features of the CB, such as different cell populations, vascularization, and innervation

  14. Measurements of intracellular Ca2+ in dissociated type I cells of the rabbit carotid body.

    PubMed Central

    Biscoe, T J; Duchen, M R; Eisner, D A; O'Neill, S C; Valdeolmillos, M

    1989-01-01

    1. The carotid body chemoreceptors are stimulated in situ by cyanide (CN-), which mimics the effect of hypoxia. We have shown that CN- increases a calcium-dependent potassium conductance (gK(Ca)) in single type I cells dissociated from the carotid body of the rabbit. We have now used the Ca2(+)-sensitive fluorophore, Fura-2, to measure intracellular Ca2+ directly in single type I cells. 2. CN- reversibly increased [Ca2+]i from approximately 90 nM to a mean of approximately 200 nM. Some of this Ca2+ originated from an intracellular store, which was depleted by exposure to Ca2(+)-free solutions. Prolonged application of CN- caused a sustained increase in [Ca2+]i, suggesting that CN- impairs the removal or sequestration of Ca2+. 3. pHi measured with the dye BCECF (2,7-bis(2-carboxyethyl)-5(and-6)-carboxyfluorescein) did not change consistently in response to CN-, although pHi changed predictably in response to both ammonium chloride and to acidification of the superfusate with CO2. 4. Potassium-induced depolarization (35 mM-K+) caused a large, cadmium-sensitive rise in [Ca2+]i. The K(+)-induced Ca2+ load was used to study the regulation of [Ca2+]i. 5. The clearance of a Ca2+ load was slowed either by removal of [Na+]o or by application of CN-. This shows that both a Na+-Ca2+ exchange and an energy-dependent process or processes contribute to the regulation of [Ca2+]i. 6. Carbachol (CCh, 10-100 microM), which also hyperpolarizes type I cells, caused a small transient rise in [Ca2+]i, indicating release from an exhaustible intracellular pool. The response to CN- was unaffected by prior or continued exposure to CCh, suggesting that the two stimuli operate by distinct mechanisms. 7. The increased gK(Ca) seen in type I cells in response to CN- thus reflects a change in cellular Ca2+ homeostasis. The rise in [Ca2+]i presumably underlies the documented increase in transmitter release from the carotid body in response to CN-. If chemotransduction is a consequence of the

  15. Biophysical studies of the cellular elements of the rabbit carotid body.

    PubMed

    Duchen, M R; Caddy, K W; Kirby, G C; Patterson, D L; Ponte, J; Biscoe, T J

    1988-07-01

    The carotid body is a major sensor of oxygen partial pressure in the arterial blood, and plays a role in the control of respiration. Despite extensive investigation of the structure, the cellular basis of the transduction mechanism remains poorly understood. We have developed a preparation of freshly dissociated cells from the rabbit carotid body, in which two cell types may be identified using morphological criteria. The preparation allows application of the patch clamp technique to characterize the properties of the cells which have otherwise proved difficult to study in situ. Carotid bodies of rabbits were dissociated using a combination of enzymatic and mechanical procedures. The dissociated preparation obtained consisted of clusters of spherical or ovoid cells of 12-15 microns in diameter and a distinct population of spherical cells of 8-10 microns diameter. Electron microscopic techniques were used to identify the cells present in the preparation. Again two populations of cells could be distinguished. A population of cells 10-12 microns in diameter, often found in clusters, possessed the dense-cored vesicles characteristic of Type I cells, while a population of smaller cells (diameter 5-7 microns) had peripherally condensed nuclear chromatin and fine cytoplasmic surface extensions characteristic of Type II cells. Patch clamp study of the cells showed that they represent two electrophysiologically distinct populations. The larger cells, corresponding to Type I cells, were found to be excitable, generating fast, sodium-dependent action potentials that were recorded both in the cell attached and whole cell recording configurations. The smaller Type II cells did not generate action potentials. Voltage clamp study of Type I cells allowed definition of a range of voltage-gated currents. These included an inactivating, tetrodotoxin-sensitive inward sodium current, a high threshold sustained inward calcium current, and outward potassium currents. A component of the

  16. The human carotid body transcriptome with focus on oxygen sensing and inflammation – a comparative analysis

    PubMed Central

    Mkrtchian, Souren; Kåhlin, Jessica; Ebberyd, Anette; Gonzalez, Constancio; Sanchez, Diego; Balbir, Alexander; Kostuk, Eric W; Shirahata, Machiko; Fagerlund, Malin Jonsson; Eriksson, Lars I

    2012-01-01

    The carotid body (CB) is the key oxygen sensing organ. While the expression of CB specific genes is relatively well studied in animals, corresponding data for the human CB are missing. In this study we used five surgically removed human CBs to characterize the CB transcriptome with microarray and PCR analyses, and compared the results with mice data. In silico approaches demonstrated a unique gene expression profile of the human and mouse CB transcriptomes and an unexpected upregulation of both human and mouse CB genes involved in the inflammatory response compared to brain and adrenal gland data. Human CBs express most of the genes previously proposed to be involved in oxygen sensing and signalling based on animal studies, including NOX2, AMPK, CSE and oxygen sensitive K+ channels. In the TASK subfamily of K+ channels, TASK-1 is expressed in human CBs, while TASK-3 and TASK-5 are absent, although we demonstrated both TASK-1 and TASK-3 in one of the mouse reference strains. Maxi-K was expressed exclusively as the spliced variant ZERO in the human CB. In summary, the human CB transcriptome shares important features with the mouse CB, but also differs significantly in the expression of a number of CB chemosensory genes. This study provides key information for future functional investigations on the human carotid body. PMID:22615433

  17. Sclerosing paraganglioma of the carotid body: a potential pitfall of malignancy.

    PubMed

    Santi, Raffaella; Franchi, Alessandro; Saladino, Valeria; Trovati, Massimo; Cenacchi, Giovanna; Squadrelli-Saraceno, Massimo; Nesi, Gabriella

    2015-06-01

    Paragangliomas (PGs) of the head and neck region are typically benign, slow-growing neuroendocrine tumours. At times, they may exhibit unusual histological features, such as prominent stromal sclerosis (sclerosing PG), which may raise concerns of malignancy. We describe a case of sclerosing PG of the carotid body, emphasizing the value of immunohistochemical stains for differential diagnosis. A 43-year-old woman presented with a painless lump on the neck. A magnetic resonance imaging scan demonstrated a hypervascular lesion of the carotid body, which was surgically excised. Grossly, the lesion measured 1.8 cm at maximum diameter. On microscopic examination, irregular nests and tiny bundles of neoplastic cells were found between thick bands of fibrous tissue. Focal nuclear cytomegaly and marked pleomorphism were noted. Neoplastic cells proved to be immunoreactive for chromogranin, synaptophysin and neuron specific enolase, but negative for cytokeratins, smooth muscle actin and CD34. Ultrastructurally, numerous mitochondria, rough endoplasmic reticulum structures and endocrine granules were seen in the cytoplasm of the tumour cells. On consideration of the above-mentioned clinico-pathological and ultrastructural findings a diagnosis of sclerosing PG was established. Sclerosing PG is a rare entity which may mimic a malignant neoplasm. The recognition of this unusual morphological variant of PG, together with appropriate immunostains, leads to the correct diagnosis. PMID:25194351

  18. Extradigital glomus tumor: a rare etiology for wrist soft tissue mass.

    PubMed

    Friske, Justin E; Sharma, Vipul; Kolpin, Stephanie A; Webber, Nicholas P

    2016-09-01

    Glomus tumors are rare benign hamartomas arising from the neuromyoarterial glomus body, a highly specialized arteriovenous anastomosis responsible for thermoregulation. Although classically associated with a subungual location, less common extradigital glomus tumors can present a diagnostic challenge because of their rarity and nonspecific presentation. This case report adds to the literature of proven extradigital glomus tumors with documented pathologic and magnetic resonance imaging characteristics and describes their place in the differential for soft tissue mass of the wrist. Occasionally, a combination of imaging findings and clinical history as described may help suggest the diagnosis prospectively. PMID:27594949

  19. A new case of lower extremity glomus tumor Up-to date review and case report

    PubMed Central

    Frumuseanu, B; Balanescu, R; Ulici, A; Golumbeanu, M; Barbu, M; Orita, V; Topor, L

    2012-01-01

    Glomus tumor (glomus cell tumor) is a rare, hamartomatous, usually benign neoplasm, whose cells resemble the modified smooth muscle cells of the normal glomus body. The diagnosis of a lower extremity is often delayed, due to the lack of awareness and low level of suspicion, by the treating physician. The glomus tumor (GT) often involves the nail beds. The unusual location of the lower extremity often leads to missed or delayed diagnosis and management. There is a paucy of information about GT in general, especially among orthopedic surgeons. The aim of this article is to make the surgical community more aware of this disease PMID:22802895

  20. The relationship between distribution of body fat mass and carotid artery intima-media thickness in Korean older adults.

    PubMed

    Park, Jin-Kee; Park, Hyuntae; Kim, Kwi-Baek

    2015-10-01

    [Purpose] The aim of this study was to examine the relationships between the amount and distribution of body fat and the carotid intima-media thickness to explore whether coronary artery disease risk may be mediated through effects on the amount of fat mass in older adults. [Subjects and Methods] A total of 200 elderly females was participated. The percentage of body fat mass was measured by the bioelectrical impedance analysis method, and the carotid intima-media thickness was measured by B-mode ultrasound. Analysis of covariance was performed to assess independent associations between the four categories of percentage of body fat mass and the carotid intima-media thickness after multivariate adjustment. Logistic regression analyses were utilized to calculate odds ratios and 95% confidence intervals for examining independent associations between percentage of body fat mass and the estimated risk of coronary artery disease. [Results] Analysis of covariance showed that the carotid intima-media thickness was significantly thick in both obesity and overweight groups. When multivariate-adjusted OR for the estimated risk of coronary artery disease, the odds ratios for the obesity and overweight groups were 3.0 (95% confidence interval, 1.1 to 8.7) and 2.5 (95% confidence interval, 1.0 to 6.1), respectively. [Conclusion] This study demonstrates that elderly females with a high body fat mass are more likely to have the estimated risk of CAD than who fit body fat mass in elderly female. PMID:26633917

  1. The relationship between distribution of body fat mass and carotid artery intima-media thickness in Korean older adults

    PubMed Central

    Park, Jin-Kee; Park, Hyuntae; Kim, Kwi-Baek

    2015-01-01

    [Purpose] The aim of this study was to examine the relationships between the amount and distribution of body fat and the carotid intima-media thickness to explore whether coronary artery disease risk may be mediated through effects on the amount of fat mass in older adults. [Subjects and Methods] A total of 200 elderly females was participated. The percentage of body fat mass was measured by the bioelectrical impedance analysis method, and the carotid intima-media thickness was measured by B-mode ultrasound. Analysis of covariance was performed to assess independent associations between the four categories of percentage of body fat mass and the carotid intima-media thickness after multivariate adjustment. Logistic regression analyses were utilized to calculate odds ratios and 95% confidence intervals for examining independent associations between percentage of body fat mass and the estimated risk of coronary artery disease. [Results] Analysis of covariance showed that the carotid intima-media thickness was significantly thick in both obesity and overweight groups. When multivariate-adjusted OR for the estimated risk of coronary artery disease, the odds ratios for the obesity and overweight groups were 3.0 (95% confidence interval, 1.1 to 8.7) and 2.5 (95% confidence interval, 1.0 to 6.1), respectively. [Conclusion] This study demonstrates that elderly females with a high body fat mass are more likely to have the estimated risk of CAD than who fit body fat mass in elderly female. PMID:26633917

  2. H2S production by reactive oxygen species in the carotid body triggers hypertension in a rodent model of sleep apnea.

    PubMed

    Yuan, Guoxiang; Peng, Ying-Jie; Khan, Shakil A; Nanduri, Jayasri; Singh, Amritha; Vasavda, Chirag; Semenza, Gregg L; Kumar, Ganesh K; Snyder, Solomon H; Prabhakar, Nanduri R

    2016-01-01

    Sleep apnea is a prevalent respiratory disease in which episodic cessation of breathing causes intermittent hypoxia. Patients with sleep apnea and rodents exposed to intermittent hypoxia exhibit hypertension. The carotid body senses changes in blood O2 concentrations, and an enhanced carotid body chemosensory reflex contributes to hypertension in sleep apnea patients. A rodent model of intermittent hypoxia that mimics blood O2 saturation profiles of patients with sleep apnea has shown that increased generation of reactive oxygen species (ROS) in the carotid body enhances the chemosensory reflex and triggers hypertension. CO generated by heme oxygenase-2 (HO-2) induces a signaling pathway that inhibits hydrogen sulfide (H2S) production by cystathionine γ-lyase (CSE), leading to suppression of carotid body activity. We found that ROS inhibited CO generation by HO-2 in the carotid body and liver through a mechanism that required Cys(265) in the heme regulatory motif of heterologously expressed HO-2. We showed that ROS induced by intermittent hypoxia inhibited CO production and increased H2S concentrations in the carotid body, which stimulated its neural activity. In rodents, blockade of H2S synthesis by CSE, by either pharmacologic or genetic approaches, inhibited carotid body activation and hypertension induced by intermittent hypoxia. Thus, our results indicate that oxidant-induced inactivation of HO-2, which leads to increased CSE-dependent H2S production in the carotid body, is a critical trigger of hypertension in rodents exposed to intermittent hypoxia. PMID:27531649

  3. Effects of cyanide and uncouplers on chemoreceptor activity and ATP content of the cat carotid body.

    PubMed

    Obeso, A; Almaraz, L; Gonzalez, C

    1989-03-01

    In cat carotid bodies (c.b.'s) incubated in vitro with [3H]tyrosine to label the stores of catecholamines, it was found that CN promotes dose- and Ca2+-dependent release of [3H]dopamine (DA) from c.b. tissues in parallel to the increased electrical activity recorded from the carotid sinus nerve (c.s.n.). Two different uncouplers, dinitrophenol (DNP) and carbonyl-cyanide-m-chlorophenyl-hydrazone (CCCP), both activate also in a dose-dependent fashion, release of DA and electrical activity in the c.s.n. However, while cyanide (CN) (10(-4) M) applied during 5 min reduced the adenosine triphosphate (ATP) content of the c.b. by 45%, DNP (2.5 x 10(-4) M) and CCCP (10(-6) M) applied for the same period of time did not modify the ATP levels of the organ. At the above concentrations, the 3 agents increased about 8-fold the electrical activity recorded from the c.s.n. Thus, contrary to the postulates of the metabolic hypotheses, our findings indicate that the decrease in the ATP content in the c.b. is not a prerequisite for the activation of the chemoreceptors. We propose alternative mechanisms to explain the chemostimulant action of the metabolic poisons. PMID:2720379

  4. Inhibitory effects of NO on carotid body: contribution of neural and endothelial nitric oxide synthase isoforms.

    PubMed

    Valdés, Viviana; Mosqueira, Matías; Rey, Sergio; Del Rio, Rodrigo; Iturriaga, Rodrigo

    2003-01-01

    We tested the hypothesis that nitric oxide (NO) produced within the carotid body is a tonic inhibitor of chemoreception and determined the contribution of neuronal and endothelial nitric oxide synthase (eNOS) isoforms to the inhibitory NO effect. Accordingly, we studied the effect of NO generated from S-nitroso-N-acetylpenicillamide (SNAP) and compared the effects of the nonselective inhibitor N(omega)-nitro-l-arginine methyl ester (l-NAME) and the selective nNOS inhibitor 1-(2-trifluoromethylphenyl)-imidazole (TRIM) on chemosensory dose-response curves induced by nicotine and NaCN and responses to hypoxia (Po(2) approximately 30 Torr). CBs excised from pentobarbitone-anesthetized cats were perfused in vitro with Tyrode at 38 degrees C and pH 7.40, and chemosensory discharges were recorded from the carotid sinus nerve. SNAP (100 microM) reduced the responses to nicotine and NaCN. l-NAME (1 mM) enhanced the responses to nicotine and NaCN by increasing their duration, but TRIM (100 microM) only enhanced the responses to high doses of NaCN. The amplitude of the response to hypoxia was enhanced by l-NAME but not by TRIM. Our results suggest that both isoforms contribute to the NO action, but eNOS being the main source for NO in the cat CB and exerting a tonic effect upon chemoreceptor activity. PMID:12388352

  5. Carotid body chemosensory excitation induced by nitric oxide: involvement of oxidative metabolism.

    PubMed

    Mosqueira, Matias; Iturriaga, Rodrigo

    2002-08-01

    Nitric oxide (NO) produces a dual effect on carotid body (CB) oxygen chemoreception. At low concentration, NO inhibits chemosensory response to hypoxia, while in normoxia, medium and high [NO] increases the frequency of carotid chemosensory discharges (f(x)). Since NO and peroxynitrite inhibit mitochondrial respiration, it is plausible that the NO-induced excitation may depend on the mitochondrial oxidative metabolism. To test this hypothesis, we studied the effects of oligomycin, FCCP and antimycin A that produce selective blockade of hypoxic and NaCN-induced chemosensory responses, leaving nicotinic response less affected. CBs excised from pentobarbitone-anaesthetised cats were perfused in vitro with Tyrode (P(O(2)) approximately 125 Torr, pH 7.40 at 38 degrees C). Hypoxia (P(O(2)) approximately equal 30 Torr), NaCN and nicotine (1-100 microg) and S-nitroso-N-acetylpenicillamide (SNAP, 300-600 microg) increased f(x). Oligomycin (12.5-25 microg), antimycin A (10 microg) and FCCP (5 microM) transiently increased f(x). Subsequently, chemosensory responses to hypoxia, NaCN and SNAP were reduced or abolished, while the response to nicotine was less affected. The electron donor system tetramethyl-p-phenylene diamide and ascorbate that bypasses the electron chain blockade produced by antimycin A, restores the excitatory responses to NaCN and SNAP. Present results suggest that the chemoexcitatory effect of NO depends on the integrity of mitochondrial metabolism. PMID:12126919

  6. Hypoxic pulmonary vasoconstriction, carotid body function and erythropoietin production in adult rats perinatally exposed to hyperoxia

    PubMed Central

    Prieto-Lloret, Jesus; Ramirez, Maria; Olea, Elena; Moral-Sanz, Javier; Cogolludo, Angel; Castañeda, Javier; Yubero, Sara; Agapito, Teresa; Gomez-Niño, Angela; Rocher, Asuncion; Rigual, Ricardo; Obeso, Ana; Perez-Vizcaino, Francisco; González, Constancio

    2015-01-01

    Adult mammalians possess three cell systems that are activated by acute bodily hypoxia: pulmonary artery smooth muscle cells (PASMC), carotid body chemoreceptor cells (CBCC) and erythropoietin (EPO)-producing cells. In rats, chronic perinatal hyperoxia causes permanent carotid body (CB) atrophy and functional alterations of surviving CBCC. There are no studies on PASMC or EPO-producing cells. Our aim is to define possible long-lasting functional changes in PASMC or EPO-producing cells (measured as EPO plasma levels) and, further, to analyse CBCC functional alterations. We used 3- to 4-month-old rats born and reared in a normal atmosphere or exposed to perinatal hyperoxia (55–60% O2 for the last 5–6 days of pregnancy and 4 weeks after birth). Perinatal hyperoxia causes an almost complete loss of hypoxic pulmonary vasoconstriction (HPV), which was correlated with lung oxidative status in early postnatal life and prevented by antioxidant supplementation in the diet. O2-sensitivity of K+ currents in the PASMC of hyperoxic animals is normal, indicating that their inhibition is not sufficient to trigger HPV. Perinatal hyperoxia also abrogated responses elicited by hypoxia on catecholamine and cAMP metabolism in the CB. An increase in EPO plasma levels elicited by hypoxia was identical in hyperoxic and control animals, implying a normal functioning of EPO-producing cells. The loss of HPV observed in adult rats and caused by perinatal hyperoxia, comparable to oxygen therapy in premature infants, might represent a previously unrecognized complication of such a medical intervention capable of aggravating medical conditions such as regional pneumonias, atelectases or general anaesthesia in adult life. Key points Adult animals that have been perinatally exposed to oxygen-rich atmospheres (hyperoxia), recalling those used for oxygen therapy in infants, exhibit a loss of hypoxic pulmonary vasoconstriction, whereas vasoconstriction elicited by depolarizing agents is

  7. Acrolein inhalation alters arterial blood gases and triggers carotid body-mediated cardiovascular responses in hypertensive rats

    PubMed Central

    Perez, Christina M.; Hazari, Mehdi S.; Ledbetter, Allen D.; Haykal-Coates, Najwa; Carll, Alex P.; Cascio, Wayne E.; Winsett, Darrell W.; Costa, Daniel L.; Farraj, Aimen K.

    2016-01-01

    Context Air pollution exposure affects autonomic function, heart rate, blood pressure and left ventricular function. While the mechanism for these effects is uncertain, several studies have reported that air pollution exposure modifies activity of the carotid body, the major organ that senses changes in arterial oxygen and carbon dioxide levels, and elicits downstream changes in autonomic control and cardiac function. Objective We hypothesized that exposure to acrolein, an unsaturated aldehyde and mucosal irritant found in cigarette smoke and diesel exhaust, would activate the carotid body chemoreceptor response and lead to secondary cardiovascular responses in rats. Materials and methods Spontaneously hypertensive (SH) rats were exposed once for 3 h to 3 ppm acrolein gas or filtered air in whole body plethysmograph chambers. To determine if the carotid body mediated acrolein-induced cardiovascular responses, rats were pretreated with an inhibitor of cystathionine γ-lyase (CSE), an enzyme essential for carotid body signal transduction. Results Acrolein exposure induced several cardiovascular effects. Systolic, diastolic and mean arterial blood pressure increased during exposure, while cardiac contractility decreased 1 day after exposure. The cardiovascular effects were associated with decreases in pO2, breathing frequency and expiratory time, and increases in sympathetic tone during exposure followed by parasympathetic dominance after exposure. The CSE inhibitor prevented the cardiovascular effects of acrolein exposure. Discussion and conclusion Pretreatment with the CSE inhibitor prevented the cardiovascular effects of acrolein, suggesting that the cardiovascular responses with acrolein may be mediated by carotid body-triggered changes in autonomic tone. (This abstract does not reflect EPA policy.) PMID:25600140

  8. Volatile Anaesthetic Depression of the Carotid Body Chemoreflex-Mediated Ventilatory Response to Hypoxia: Directions for Future Research

    PubMed Central

    Pandit, J. J.

    2014-01-01

    In assessing whether volatile anaesthetics directly depress the carotid body response to hypoxia it is necessary to combine in meta-analysis studies of when it is “functionally isolated” (e.g., recordings are made from its afferent nerve). Key articles were retrieved (full papers in English) and subjected to quantitative analysis to yield an aggregate estimate of effect. Results from articles that did not use such methodology were assessed separately from this quantitative approach, to see what could be learned also from a nonquantitative overview. Just 7 articles met the inclusion criteria for hypoxia and just 6 articles for hypercapnia. Within these articles, the anaesthetic (mean dose 0.75, standard deviation (SD) 0.40 minimum alveolar concentration, MAC) statistically significantly depressed carotid body hypoxic response by 24% (P = 0.041), but a similar dose (mean 0.81 (0.42) MAC) did not affect the hypercapnic response. The articles not included in the quantitative analysis (31 articles), assessed qualitatively, also indicated that anaesthetics depress carotid body function. This conclusion helps direct future research on the anaesthetic effects on putative cellular/molecular processes that underlie the transduction of hypoxia in the carotid body. PMID:24808974

  9. Relevance of the Carotid Body Chemoreflex in the Progression of Heart Failure

    PubMed Central

    Andrade, David C.; Lucero, Claudia; Toledo, Camilo; Madrid, Carlos; Marcus, Noah J.; Schultz, Harold D.; Del Rio, Rodrigo

    2015-01-01

    Chronic heart failure (CHF) is a global health problem affecting millions of people. Autonomic dysfunction and disordered breathing patterns are commonly observed in patients with CHF, and both are strongly related to poor prognosis and high mortality risk. Tonic activation of carotid body (CB) chemoreceptors contributes to sympathoexcitation and disordered breathing patterns in experimental models of CHF. Recent studies show that ablation of the CB chemoreceptors improves autonomic function and breathing control in CHF and improves survival. These exciting findings indicate that alterations in CB function are critical to the progression of CHF. Therefore, better understanding of the physiology of the CB chemoreflex in CHF could lead to improvements in current treatments and clinical management of patients with CHF characterized by high chemosensitivity. Accordingly, the main focus of this brief review is to summarize current knowledge of CB chemoreflex function in different experimental models of CHF and to comment on their potential translation to treatment of human CHF. PMID:26779536

  10. KISS1 and KISS1R expression in the human and rat carotid body and superior cervical ganglion.

    PubMed

    Porzionato, A; Fenu, G; Rucinski, M; Macchi, V; Montella, A; Malendowicz, L K; De Caro, R

    2011-01-01

    KISS1 and its receptor, KISS1R, have both been found to be expressed in central nervous system, but few data are present in the literature about their distribution in peripheral nervous structures. Thus, the aim of the present study was to investigate, through immunohistochemistry, the expression and distribution of KISS1 and KISS1R in the rat and human carotid bodies and superior cervical ganglia, also with particular reference to the different cellular populations. Materials consisted of carotid bodies and superior cervical ganglia were obtained at autopsy from 10 adult subjects and sampled from 10 adult Sprague-Dawley rats. Immunohistochemistry revealed diffuse expression of KISS1 and KISS1R in type I cells of both human and rat carotid bodies, whereas type II cells were negative. In both human and rat superior cervical ganglia positive anti-KISS1 and -KISS1R immunostainings were also selectively found in ganglion cells, satellite cells being negative. Endothelial cells also showed moderate immunostaining for both KISS1 and KISS1R. The expression of both kisspeptins and kisspeptin receptors in glomic type I cells and sympathetic ganglion cells supports a modulatory role of KISS1 on peripheral chemoreception and sympathetic function. Moreover, local changes in blood flow have been considered to be involved in carotid body chemoreceptor discharge and kisspeptins and kisspeptin receptors have also been found in the endothelial cells. As a consequence, a possible role of kisspeptins in the regulation of carotid body blood flow and, indirectly, in chemoreceptor discharge may also be hypothesized. PMID:22193294

  11. KISS1 and KISS1R expression in the human and rat carotid body and superior cervical ganglion

    PubMed Central

    Porzionato, A.; Fenu, G.; Rucinski, M.; Macchi, V.; Montella, A.; Malendowicz, L.K.; De Caro, R.

    2011-01-01

    KISS1 and its receptor, KISS1R, have both been found to be expressed in central nervous system, but few data are present in the literature about their distribution in peripheral nervous structures. Thus, the aim of the present study was to investigate, through immunohistochemistry, the expression and distribution of KISS1 and KISS1R in the rat and human carotid bodies and superior cervical ganglia, also with particular reference to the different cellular populations. Materials consisted of carotid bodies and superior cervical ganglia were obtained at autopsy from 10 adult subjects and sampled from 10 adult Sprague-Dawley rats. Immunohistochemistry revealed diffuse expression of KISS1 and KISS1R in type I cells of both human and rat carotid bodies, whereas type II cells were negative. In both human and rat superior cervical ganglia positive anti-KISS1 and -KISS1R immunostainings were also selectively found in ganglion cells, satellite cells being negative. Endothelial cells also showed moderate immunostaining for both KISS1 and KISS1R. The expression of both kisspeptins and kisspeptin receptors in glomic type I cells and sympathetic ganglion cells supports a modulatory role of KISS1 on peripheral chemoreception and sympathetic function. Moreover, local changes in blood flow have been considered to be involved in carotid body chemoreceptor discharge and kisspeptins and kisspeptin receptors have also been found in the endothelial cells. As a consequence, a possible role of kisspeptins in the regulation of carotid body blood flow and, indirectly, in chemoreceptor discharge may also be hypothesized. PMID:22193294

  12. Brainstem PCO2 modulates phrenic responses to specific carotid body hypoxia in an in situ dual perfused rat preparation

    PubMed Central

    Day, Trevor A; Wilson, Richard J A

    2007-01-01

    Inputs from central (brainstem) and peripheral (carotid body) respiratory chemoreceptors are coordinated to protect blood gases against potentially deleterious fluctuations. However, the mathematics of the steady-state interaction between chemoreceptors has been difficult to ascertain. Further, how this interaction affects time-dependent phenomena (in which chemoresponses depend upon previous experience) is largely unknown. To determine how central PCO2 modulates the response to peripheral chemostimulation in the rat, we utilized an in situ arterially perfused, vagotomized, decerebrate preparation, in which central and peripheral chemoreceptors were perfused separately (i.e. dual perfused preparation (DPP)). We carried out two sets of experiments: in Experiment 1, we alternated steady-state brainstem PCO2 between 25 and 50 Torr in each preparation, and applied specific carotid body hypoxia (60 Torr PO2 and 40 Torr PCO2) under both conditions; in Experiment 2, we applied four 5 min bouts (separated by 5 min) of specific carotid body hypoxia (60 Torr PO2 and 40 Torr PCO2) while holding the brainstem at either 30 Torr or 50 Torr PCO2. We demonstrate that the level of brainstem PCO2 modulates (a) the magnitude of the phrenic responses to a single step of specific carotid body hypoxia and (b) the magnitude of time-dependent phenomena. We report that the interaction between chemoreceptors is negative (i.e. hypo-additive), whereby a lower brainstem PCO2 augments phrenic responses resulting from specific carotid body hypoxia. A negative interaction may underlie the pathophysiology of central sleep apnoea in populations that are chronically hypocapnic. PMID:17082232

  13. EPAC signalling pathways are involved in low PO2 chemoreception in carotid body chemoreceptor cells

    PubMed Central

    Rocher, Asuncion; Caceres, Ana I; Almaraz, Laura; Gonzalez, Constancio

    2009-01-01

    Chemoreceptor cells of the carotid bodies (CB) are activated by hypoxia and acidosis, responding with an increase in their rate of neurotransmitter release, which in turn increases the electrical activity in the carotid sinus nerve and evokes a homeostatic hyperventilation. Studies in isolated chemoreceptor cells have shown that moderate hypoxias (≈ 46 mmHg) produces smaller depolarisations and comparable Ca2+ transients but a much higher catecholamine (CA) release response in intact CBs than intense acidic/hypercapnic stimuli (20% CO2, pH 6.6). Similarly, intense hypoxia (≈ 20 mmHg) produces smaller depolarizations and Ca2+ transients in isolated chemoreceptor cells but a higher CA release response in intact CBs than a pure depolarizing stimulus (30–35 mm external K+). Studying the mechanisms responsible for these differences we have found the following. (1) Acidic hypercapnia inhibited ICa (∼60%; whole cell) and CA release (∼45%; intact CB) elicited by ionomycin and high K+. (2) Adenylate cyclase inhibition (SQ-22536; 80 μm) inhibited the hypoxic release response (>50%) and did not affect acidic/hypercapnic release, evidencing that the high gain of hypoxia to elicit neurotransmitter release is cAMP dependent. (3) The last effect was independent of PKA activation, as three kinase inhibitors (H-89, KT 5720 and Rp-cAMP; ≥ 10 × IC50) did not alter the hypoxic release response. (4) The Epac (exchange protein activated by cAMP) activator (8-pCPT-2′-O-Me-cAMP, 100 μm) reversed the effects of the cyclase inhibitor. (5) The Epac inhibitor brefeldin A (100 μm) inhibited (54%) hypoxic induced release. Our findings show for the first time that an Epac-mediated pathway mediates O2 sensing/transduction in chemoreceptor cells. PMID:19581380

  14. Carotid body denervation improves autonomic and cardiac function and attenuates disordered breathing in congestive heart failure

    PubMed Central

    Marcus, Noah J; Rio, Rodrigo; Schultz, Evan P; Xia, Xiao-Hong; Schultz, Harold D

    2014-01-01

    In congestive heart failure (CHF), carotid body (CB) chemoreceptor activity is enhanced and is associated with oscillatory (Cheyne–Stokes) breathing patterns, increased sympathetic nerve activity (SNA) and increased arrhythmia incidence. We hypothesized that denervation of the CB (CBD) chemoreceptors would reduce SNA, reduce apnoea and arrhythmia incidence and improve ventricular function in pacing-induced CHF rabbits. Resting breathing, renal SNA (RSNA) and arrhythmia incidence were measured in three groups of animals: (1) sham CHF/sham–CBD (sham–sham); (2) CHF/sham–CBD (CHF–sham); and (3) CHF/CBD (CHF–CBD). Chemoreflex sensitivity was measured as the RSNA and minute ventilatory () responses to hypoxia and hypercapnia. Respiratory pattern was measured by plethysmography and quantified by an apnoea–hypopnoea index, respiratory rate variability index and the coefficient of variation of tidal volume. Sympatho-respiratory coupling (SRC) was assessed using power spectral analysis and the magnitude of the peak coherence function between tidal volume and RSNA frequency spectra. Arrhythmia incidence and low frequency/high frequency ratio of heart rate variability were assessed using ECG and blood pressure waveforms, respectively. RSNA and responses to hypoxia were augmented in CHF–sham and abolished in CHF–CBD animals. Resting RSNA was greater in CHF–sham compared to sham–sham animals (43 ± 5% max vs. 23 ± 2% max, P < 0.05), and this increase was not found in CHF–CBD animals (25 ± 1% max, P < 0.05 vs. CHF–sham). Low frequency/high frequency heart rate variability ratio was similarly increased in CHF and reduced by CBD (P < 0.05). Respiratory rate variability index, coefficient of variation of tidal volume and apnoea–hypopnoea index were increased in CHF–sham animals and reduced in CHF–CBD animals (P < 0.05). SRC (peak coherence) was increased in CHF–sham animals (sham–sham 0.49 ± 0.05; CHF–sham 0.79

  15. Glomus Tumor: Twenty-Year Experience and Literature Review.

    PubMed

    Chou, Tingmao; Pan, Shin Chen; Shieh, Shyh Jou; Lee, Jin Wei; Chiu, Haw Yen; Ho, Chien Liang

    2016-03-01

    Glomus tumors are rare, usually benign, vascular hamartomas consisting cells resembling the smooth muscle cells of the normal glomus body. They can be solitary or multiple, whereas solitary tumors are majorly located on the digits. Digital glomus tumors most commonly appear in subungual region and show a strong female predominance. There are several classical symptoms, clinical tests, and imaging tools, such as X-ray, magnetic resonance imaging, and ultrasonography, which can provide good accuracy for clinical diagnosis. However, misdiagnosis and delayed diagnosis are still commonly observed because primary physicians are unfamiliar with classical symptoms and clinical tests. Complete surgical excision often can result in complete relief of symptoms. Recurrence is largely caused by incomplete excision, but repeated image study is recommended to rule out new or malignant lesions. This series is a retrospective review of 50 cases with glomus tumors managed at our institute. We aim to review the key aspects of glomus tumor and provide a simple guideline for earlier diagnosis and treatment. PMID:26808758

  16. Subungual glomus tumors of the hand: Treated by transungual excision

    PubMed Central

    Jawalkar, Harshad; Maryada, Venkateshwar Reddy; Brahmajoshyula, Venkatramana; Kotha, Guruvardhan Kumar V

    2015-01-01

    Background: Glomus tumors are benign hamartomas arising from the glomus body, mostly occurring in the subungual region of the digits. A triad of excruciating pain, localized tenderness and cold sensitivity is the key to diagnosing these tumors. Two surgical approaches are described in the literature for excision of subungual glomus tumors-transungual and periungual. We reviewed retrospectively the results of subungual glomus tumors of the hand treated by transungual excision. Materials and Methods: Twelve patients (9 females and 3 males) with histopathologically confirmed subungual glomus tumors of the hand were treated by transungual excision at our institute. The mean age of the patients was 40.5 years (range 28–63 years). All patients presented with pain in the nail bed and cold sensitivity. A bluish-brown discoloration was present in 6 patients. Love's pin test was positive in all and Hildreth's test was positive in 8 patients. The mean duration of followup was 38 months (range 8–72 months). Results: All patients had complete pain relief. There was no new nail deformity and no recurrence till last followup. One patient had deformity of the nail preoperatively due to previous surgery, which persisted after excision of the tumor. All of them returned to their preoperative occupation and regained full function of the hand. Conclusions: The transungual approach provides good access to the entire lesion and facilitates complete excision. Contrary to reported literature, we did not find the development of any new nail deformity with this approach. PMID:26229160

  17. Asymptomatic Glomus Tumor of the Mediastinum

    PubMed Central

    Kanakis, Meletios; Rapti, Nikoletta; Chorti, Maria; Lioulias, Achilleas

    2015-01-01

    Glomus tumors are rare benign neoplasms that predominate in limbs. Infrequently, they can occur in a wide anatomic distribution, to include sites not known to contain glomus cells. Although glomus tumors are usually small, pain and tenderness are common clinical symptoms. We report the case of a 69-year-old man with an asymptomatic large mediastinal glomus tumor, who underwent surgical resection. PMID:26442165

  18. Carotid artery intima-media thickness and distensibility in children and adolescents: reference values and role of body dimensions.

    PubMed

    Doyon, Anke; Kracht, Daniela; Bayazit, Aysun K; Deveci, Murat; Duzova, Ali; Krmar, Rafael T; Litwin, Mieczyslaw; Niemirska, Anna; Oguz, Berna; Schmidt, Bernhard M W; Sözeri, Betul; Querfeld, Uwe; Melk, Anette; Schaefer, Franz; Wühl, Elke

    2013-09-01

    Carotid intima-media thickness (cIMT) and carotid artery distensibility are reliable screening methods for vascular alterations and the assessment of cardiovascular risk in adult and pediatric cohorts. We sought to establish an international reference data set for the childhood and adolescence period and explore the impact of developmental changes in body dimensions and blood pressure (BP) on carotid wall thickness and elasticity. cIMT, the distensibility coefficient, the incremental modulus of elasticity, and the stiffness index β were assessed in 1155 children aged 6 to 18 years and sex-specific reference charts normalized to age or height were constructed from 1051 nonobese and nonhypertensive children. The role of body dimensions, BP, and family history, as well as the association between cIMT and distensibility, was investigated. cIMT increased and distensibility decreased with age, height, body mass index, and BP. A significant sex difference was apparent from the age of 15 years. Age- and height-normalized cIMT and distensibility values differed in children who are short or tall for their age. By stepwise multivariate analysis, standardized systolic BP and body mass index were independently positively associated with cIMT SD scores (SDS). Systolic BP SDS independently predicted all distensibility measures. Distensibility coefficient SDS was negatively and β SDS positively associated with cIMT SDS, whereas incremental modulus of elasticity was independent of cIMT. Morphological and functional aspects of the common carotid artery are particularly influenced by age, body dimensions, and BP. The reference charts established in this study allow to accurately compare vascular phenotypes of children with chronic conditions with those of healthy children. PMID:23817494

  19. Extracellular potassium and chemosensitivity in the rat carotid body, in vitro.

    PubMed Central

    Pepper, D R; Landauer, R C; Kumar, P

    1996-01-01

    1. The effects of raising extracellular potassium concentration ([K+]o) from 3.0 to 5.3, 9.5 or 16.8 mM on chemoreceptor responses to hypoxia, hypercapnia and asphyxia were examined in a superfused in vitro rat carotid body preparation. 2. Single-exponential functions with offset were fitted to the chemoreceptor discharge responses to ramp decreases in Po2. Increasing [K+]o was without effect upon the rate constants of the fitted exponential functions (P > 0.20). Increasing [K+]o, significantly increased the horizontal asymptote (chemoreceptor discharge in hyperoxia) in a non-linear fashion when all levels of [K+]o were included in the analysis (P < 0.001) but not when a comparison was made only between 3.0 and 5.3 mM Ko+ (P > 0.40). The rightward position of the response curves, as quantified by the Po2 at 50% maximum discharge, was linearly related to [K+]o but only when all levels of [K+]o were included in the analysis (P < 0.03). Chemoreceptor sensitivity to [K+]o increased non-linearly as [K+]o was increased but this effect was not dependent upon the Po2 (P > 0.90). 4. Increasing PCO2 in hyperoxia increased chemoreceptor discharge linearly at all levels of [K+]o. Whilst discharge at any level of PCO2 was elevated by increased levels of [K+]o, raising [K+]o did not increase CO2 sensitivity (P > 0.20). Similarly, increasing PCO2 did not increase chemosensitivity to [K+]o. The lack of effect of [K+]o upon CO2 chemosensitivity was also observed as Po2 was decreased to hypoxic levels (P > 0.10). 5. Our data demonstrate that an elevation of [K+]o can increase chemoreceptor discharge in the in vitro carotid body in a PO2- and PCO2-independent manner, suggesting that the PO2-dependent effects of [K+]o, previously reported in vivo may be due to other indirect effects of [K+]o or hypoxia. PMID:8799903

  20. Almitrine has no effect on gas exchange after bilateral carotid body resection in severe chronic airflow obstruction.

    PubMed

    De Backer, W; Vermeire, P; Bogaert, E; Janssens, E; Van Maele, R

    1985-01-01

    Using a double-blind cross-over design, a single dose of 100 mg almitrine bismesylate and placebo were administered orally to eight patients with chronic airflow obstruction having undergone bilateral carotid body resection (BCBR) up to two years earlier to alleviate their extreme dyspnoea. In an open study, two other patients have been given almitrine before and three weeks after BCBR. In all patients, arterial blood gases, ventilation and breathing patterns, neuromuscular drive and hypoxic responsiveness have been studied before and three hours after drug administration. Almitrine failed to improve gas exchange in the patients with BCBR, nor did it affect ventilation, ventilatory or hypoxic drive. In the patients studied before and after BCBR, almitrine only improved gas exchange significantly before BCBR. It is concluded that in man almitrine acts solely as a peripheral chemoreceptor agonist and that the well-documented improvement in V/Q relationship is mediated through carotid body stimulation. PMID:3904873

  1. Neuroprotective and reparative effects of carotid body grafts in a chronic MPTP model of Parkinson's disease.

    PubMed

    Muñoz-Manchado, Ana B; Villadiego, Javier; Suárez-Luna, Nela; Bermejo-Navas, Alfonso; Garrido-Gil, Pablo; Labandeira-García, José L; Echevarría, Miriam; López-Barneo, José; Toledo-Aral, Juan J

    2013-03-01

    Intrastriatal transplantation of dopaminergic carotid body (CB) cells ameliorates parkinsonism in animal models and, with less efficacy, in Parkinson's disease patients. CB-based cell therapy was initially proposed because of its high dopamine content. However, later studies suggested that its beneficial effect might be due to a trophic action exerted on nigrostriatal neurons. Compatible with this concept are the high levels of neurotrophic factors encountered in CB cells. To test experimentally this idea, unilateral striatal transplants were performed with a sham graft in the contralateral striatum, as a robust internal control. Thereafter, the dopaminergic neurotoxin 1-methyl-4-phenyl-1,2,3,6, -tetrahydropyridine was injected during 3 months. CB grafts protected from degeneration ipsilateral nigral dopaminergic neurons projecting to the transplant in a dose-dependent manner regarding size and glial cell line-derived neurotrophic factor expression. Grafts performed at different times after the onset of the neurotoxic treatment demonstrated with histological and behavioral methods protection and repair of the nigrostriatal pathway by CB transplants. This study provides a mechanistic explanation for the action of CB transplants on parkinsonian models. It should also help to improve cell therapy approaches to Parkinson's disease. PMID:22743091

  2. Central role of carotid body chemoreceptors in disordered breathing and cardiorenal dysfunction in chronic heart failure

    PubMed Central

    Marcus, Noah J.; Del Rio, Rodrigo; Schultz, Harold D.

    2014-01-01

    Oscillatory breathing (OB) patterns are observed in pre-term infants, patients with cardio-renal impairment, and in otherwise healthy humans exposed to high altitude. Enhanced carotid body (CB) chemoreflex sensitivity is common to all of these populations and is thought to contribute to these abnormal patterns by destabilizing the respiratory control system. OB patterns in chronic heart failure (CHF) patients are associated with greater levels of tonic and chemoreflex-evoked sympathetic nerve activity (SNA), which is associated with greater morbidity and poor prognosis. Enhanced chemoreflex drive may contribute to tonic elevations in SNA by strengthening the relationship between respiratory and sympathetic neural outflow. Elimination of CB afferents in experimental models of CHF has been shown to reduce OB, respiratory-sympathetic coupling, and renal SNA, and to improve autonomic balance in the heart. The CB chemoreceptors may play an important role in progression of CHF by contributing to respiratory instability and OB, which in turn further exacerbates tonic and chemoreflex-evoked increases in SNA to the heart and kidney. PMID:25505417

  3. Multidisciplinary Management of Carotid Body Tumors in a Tertiary Urban Institution

    PubMed Central

    Galyfos, George; Stamatatos, Ioannis; Kerasidis, Stavros; Stefanidis, Ioannis; Giannakakis, Sotirios; Kastrisios, Georgios; Geropapas, Georgios; Papacharalampous, Gerasimos; Maltezos, Chrisostomos

    2015-01-01

    Objective. Aim of this study is to present the experience of our institution in carotid body tumors (CBTs) treatment. Methods. All cases treated in a Vascular Surgery Department within 2.5 years (03/2013–09/2015) were retrospectively evaluated. Demographics, diagnostic, and treatment strategy were recorded. All patients with known CBT underwent ultrasound and magnetic resonance imaging preoperatively. All cases were classified according to the Shamblin type and evaluated by a radiologist, otolaryngologist, and anesthesiologist before and after surgery. Major outcomes included mortality, stroke, cranial nerve injury, and recurrence. Results. Overall, nine patients (mean age: 59.5 ± 16.3 years) with a total of ten CBTs were treated. There was no gender prevalence and most of the cases (55%) were asymptomatic. There were no functional or familial cases. There was only one bilateral case treated in a staged manner. No preoperative embolization of CBTs was performed. Mortality and stroke rates were null. No severe complication was observed in the early and late setting. No malignancy was recorded. Mean follow-up was 15.6 ± 7.8 months. Conclusions. Multidisciplinary management of patients with CBTs is imperative for optimal results, especially in type III tumors, bilateral or functional cases. After careful treatment planning and intraoperative manipulations, complications could be avoided even without preoperative embolization. PMID:26783464

  4. Research Report: Intermittent hypobaric hypoxia and hyperbaric oxygen on GAP-43 in the rat carotid body.

    PubMed

    Peng, Zhengwu; Fan, Juan; Liu, Ling; Kuang, Fang; Xue, Fen; Wang, Bairen

    2015-01-01

    Adaptive changes in the carotid body (CB) including the expression of the growth-associated protein-43 (GAP-43) have been studied in response to low, but not high, oxygen exposure. Expression of GAP-43 in the CB of rats under different atmospheric pressures and oxygen partial pressure (PO2) conditions was investigated. Mature male Sprague-Dawley rats were exposed to intermittent hypobaric hypoxia (IHH, 0, 1, 2 and 3 weeks), intermittent hyperbaric oxygen (IHBO2, 0, 1, 5 and 10 days, sacrificed six hours or 24 hours after the last HBO2 exposure), and intermittent hyperbaric normoxia (IHN, same treatment pattern as IHBO2). GAP-43 was highly expressed (mainly in type I cells) in the CB of normal rats. IHH u-regulated GAP-43 expression in the CB with significant differences (immunohistochemical staining [IHC]: F(3,15)=40.64, P < 0.01; western blot [WB]: F(3,16) = 53.52, P < 0.01) across the subgroups. GAP-43 expression in the CB was inhibited by IHBO2 (controls vs. IHBO2 groups, IHC: F(6,30) = 15.85, P < 0.01; WB: F(6,29) = 15.95, P < 0.01). No detectable changes in GAP-43 expression were found for IHN. These findings indicated that different PO2 conditions, but not air pressures, played an important role in the plasticity of the CB, and that GAP-43 might be a viable factor for the plasticity of the CB. PMID:26742253

  5. Carotid intima media thickness is associated with body fat abnormalities in HIV-infected patients

    PubMed Central

    2014-01-01

    Background HIV-infected patients may be at increased risk of cardiovascular (CV) events, and lipodystrophy is generally associated with proatherogenic metabolic disturbances. Carotid intima-media thickness (cIMT) has been used as a surrogate marker for atherosclerosis and it has been shown to be an independent risk factor for CV disease. Our objective was to evaluate cIMT in HIV-infected patients on combined anti-retroviral therapy (cART) with and without lipodystrophy defined by fat mass ratio (L-FMR), and to determine the association of lipodystrophy and visceral obesity [(visceral (VAT), subcutaneous adipose tissue (SAT) volume and VAT/SAT ratio, objectively evaluated by CT scan] with cIMT. Methods Cross-sectional study of 199 HIV-infected patients. Body composition by DXA and abdominal CT, lipids, blood pressure, inflammatory markers, and cIMT by ultrasonography were performed. L-FMR was defined as the ratio of the percentage of trunk fat mass to the percentage of lower limb fat mass by DXA. Categorical variables were compared using the chi-square or Fisher’s exact test. Spearman correlation coefficients were estimated to study the association between cIMT and clinical and metabolic characteristics. Means of cIMT, adjusted for age, were calculated, using generalized linear models. Results L-FMR was present in 41.2% of patients and cIMT was higher in these patients [0.81 (0.24) vs. 0.76 (0.25); p = 0.037)]. Lipodystrophic patients had higher VAT and VAT/SAT ratio and lower SAT. cIMT was associated with lipodystrophy evaluated by FMR, trunk fat, total abdominal fat, VAT and VAT/SAT ratio. No association was observed between cIMT and leg fat mass. Using generalized linear models, cIMT means were adjusted for age and no significant differences remained after this adjustment. The adjusted mean of cIMT was 0.787 (95% CI: 0.751-0.823) in patients without lipodystrophy, and 0.775 (95% CI: 0.732-0.817) in those with lipodystrophy (p = 0.671). Conclusions

  6. Acute hypoxia modifies cAMP levels induced by inhibitors of phosphodiesterase-4 in rat carotid bodies, carotid arteries and superior cervical ganglia

    PubMed Central

    Nunes, Ana R; Batuca, Joana R; Monteiro, Emília C

    2010-01-01

    Background and purpose: Phosphodiesterase (PDE) inhibitors are useful to treat hypoxia-related diseases and are used in experiments studying the effects of oxygen on 3′-5′-cyclic adenosine monophosphate (cAMP) production. We studied the effects of acute hypoxia on cAMP accumulation induced by PDE inhibitors in oxygen-specific chemosensors, the carotid bodies (CBs) and in non-chemosensitive CB-related structures: carotid arteries (CAs) and superior cervical ganglia (SCG). Experimental approach: Concentration–response curves for the effects of a non-specific PDE inhibitor [isobutylmethylxanthine (IBMX) ], PDE4 selective inhibitors (rolipram, Ro 20-1724) and a PDE2 selective inhibitor (erythro-9-(2-hydroxy-3-nonyl)adenine) on cAMP levels were obtained in normoxic (20% O2/5% CO2) or hypoxic (5% O2/5% CO2) conditions. Key results: Responses to the PDE inhibitors were compatible with the presence of PDE4 in rat CBs, CAs and SCG but in the absence of PDE2 in CAs and CBs. Acute hypoxia enhanced the effects of IBMX and PDE4 inhibitors on cAMP accumulation in CAs and CBs. In SCG, acute hypoxia reduced cAMP accumulation induced by all the four PDE inhibitors tested. Differences between the effects of Ro 20-1724 and rolipram on cAMP were found in CAs and CBs during hypoxia. Conclusions and implications: The effects of PDE4 inhibitors could be potentiated or inhibited by acute hypoxia depending on the PDE isoforms of the tissue. The similarities between the characterization of PDE4 inhibitors at the CBs and CAs, under normoxia and hypoxia, did not support a specific role for cAMP in the oxygen-sensing machinery at the CB and suggested that no direct CB-mediated, hyperventilatory, adverse effects would be expected with administration of PDE4 inhibitors. PMID:20082613

  7. Intermittent Hypoxia-Induced Carotid Body Chemosensory Potentiation and Hypertension Are Critically Dependent on Peroxynitrite Formation

    PubMed Central

    Moya, Esteban A.; Arias, Paulina; Varela, Carlos; Oyarce, María P.; Del Rio, Rodrigo; Iturriaga, Rodrigo

    2016-01-01

    Oxidative stress is involved in the development of carotid body (CB) chemosensory potentiation and systemic hypertension induced by chronic intermittent hypoxia (CIH), the main feature of obstructive sleep apnea. We tested whether peroxynitrite (ONOO−), a highly reactive nitrogen species, is involved in the enhanced CB oxygen chemosensitivity and the hypertension during CIH. Accordingly, we studied effects of Ebselen, an ONOO− scavenger, on 3-nitrotyrosine immunoreactivity (3-NT-ir) in the CB, the CB chemosensory discharge, and arterial blood pressure (BP) in rats exposed to CIH. Male Sprague-Dawley rats were exposed to CIH (5% O2, 12 times/h, 8 h/day) for 7 days. Ebselen (10 mg/kg/day) was administrated using osmotic minipumps and BP measured with radiotelemetry. Compared to the sham animals, CIH-treated rats showed increased 3-NT-ir within the CB, enhanced CB chemosensory responses to hypoxia, increased BP response to acute hypoxia, and hypertension. Rats treated with Ebselen and exposed to CIH displayed a significant reduction in 3-NT-ir levels (60.8 ± 14.9 versus 22.9 ± 4.2 a.u.), reduced CB chemosensory response to 5% O2 (266.5 ± 13.4 versus 168.6 ± 16.8 Hz), and decreased mean BP (116.9 ± 13.2 versus 82.1 ± 5.1 mmHg). Our results suggest that CIH-induced CB chemosensory potentiation and hypertension are critically dependent on ONOO− formation. PMID:26798430

  8. An evaluation on management of carotid body tumour (CBT). A twelve years experience*

    PubMed Central

    BOSCARINO, G.; PARENTE, E.; MINELLI, F.; FERRANTE, A.; SNIDER, F.

    2014-01-01

    Summary Objectives Carotid Body Tumor (CBT) is a rare lesion of the neuroendocrine system but it is the most common form of head and neck paraganglioma (PGL). Our objective is to discuss the optimal management of these lesions to provide the best outcome of patients treated by surgical resection. Patients and Methods A retrospective evaluation was obtained by review of the records of 20 patients with 26 CBT treated at our institution between 2000 and 2012. Primary tumor characteristics, diagnostic protocols, surgical treatment, short and long-term outcomes were collected and analyzed. Results A total of 26 CBTs resections were performed on 20 patients; the age range was 21–89 years. There was a female prevalence (14 women-80% and 6 men-20%). Familial cases occurred in 6 patients (30%); of these, 3 patients had bilateral lesions and 1 patient multiple paragangliomas. In all cases no lymph node metastasis was found. All lesions were grouped into three groups according to the latero-lateral diameter: Group I < 3 cm; Group II 3<>5cm; Group III >5cm. All patients were managed by surgical resection of the CBT. There were no operative deaths. Overall we found transitory neurological impairment in 15,3% and permanent neurological deficit in 7,6% of cases. No complications occurred in all resections of Group I tumors. In Group II only 1 resection was followed by dysphonia by recurrent nerve palsy (after vagal nerve en-bloc resection). In Group III only 1 resection was followed by permanent vagus nerve palsy. Conclusions Surgical removal of the tumor is the only treatment that can ensure a complete eradication of the disease. Family screening is of great importance in patients with hereditary forms. Careful preoperative planning of surgical procedure by integrated diagnostic imaging and a full mastery of the surgical technique can minimize the risk of the most common postoperative complications. Lifelong follow-up is mandatory to make early diagnosis of recurrent disease

  9. Comparative gene expression profile of mouse carotid body and adrenal medulla under physiological hypoxia

    PubMed Central

    Ganfornina, MD; Pérez-García, MT; Gutiérrez, G; Miguel-Velado, E; López-López, JR; Marín, A; Sánchez, D; González, C

    2005-01-01

    The carotid body (CB) is an arterial chemoreceptor, bearing specialized type I cells that respond to hypoxia by closing specific K+ channels and releasing neurotransmitters to activate sensory axons. Despite having detailed information on the electrical and neurochemical changes triggered by hypoxia in CB, the knowledge of the molecular components involved in the signalling cascade of the hypoxic response is fragmentary. This study analyses the mouse CB transcriptional changes in response to low PO2 by hybridization to oligonucleotide microarrays. The transcripts were obtained from whole CBs after mice were exposed to either normoxia (21% O2), or physiological hypoxia (10% O2) for 24 h. The CB transcriptional profiles obtained under these environmental conditions were subtracted from the profile of control non-chemoreceptor adrenal medulla extracted from the same animals. Given the common developmental origin of these two organs, they share many properties but differ specifically in their response to O2. Our analysis revealed 751 probe sets regulated specifically in CB under hypoxia (388 up-regulated and 363 down-regulated). These results were corroborated by assessing the transcriptional changes of selected genes under physiological hypoxia with quantitative RT-PCR. Our microarray experiments revealed a number of CB-expressed genes (e.g. TH, ferritin and triosephosphate isomerase) that were known to change their expression under hypoxia. However, we also found novel genes that consistently changed their expression under physiological hypoxia. Among them, a group of ion channels show specific regulation in CB: the potassium channels Kir6.1 and Kcnn4 are up-regulated, while the modulatory subunit Kcnab1 is down-regulated by low PO2 levels. PMID:15890701

  10. Carotid Body Ablation Abrogates Hypertension and Autonomic Alterations Induced by Intermittent Hypoxia in Rats.

    PubMed

    Del Rio, Rodrigo; Andrade, David C; Lucero, Claudia; Arias, Paulina; Iturriaga, Rodrigo

    2016-08-01

    Chronic intermittent hypoxia (CIH), the main feature of obstructive sleep apnea, enhances carotid body (CB) chemosensory responses to hypoxia and produces autonomic dysfunction, cardiac arrhythmias, and hypertension. We tested whether autonomic alterations, arrhythmogenesis, and the progression of hypertension induced by CIH depend on the enhanced CB chemosensory drive, by ablation of the CB chemoreceptors. Male Sprague-Dawley rats were exposed to control (Sham) conditions for 7 days and then to CIH (5% O2, 12/h 8 h/d) for a total of 28 days. At 21 days of CIH exposure, rats underwent bilateral CB ablation and then exposed to CIH for 7 additional days. Arterial blood pressure and ventilatory chemoreflex response to hypoxia were measured in conscious rats. In addition, cardiac autonomic imbalance, cardiac baroreflex gain, and arrhythmia score were assessed during the length of the experiments. In separate experimental series, we measured extracellular matrix remodeling content in cardiac atrial tissue and systemic oxidative stress. CIH induced hypertension, enhanced ventilatory response to hypoxia, induced autonomic imbalance toward sympathetic preponderance, reduced baroreflex gain, and increased arrhythmias and atrial fibrosis. CB ablation normalized blood pressure, reduced ventilatory response to hypoxia, and restored cardiac autonomic and baroreflex function. In addition, CB ablation reduced the number of arrhythmias, but not extracellular matrix remodeling or systemic oxidative stress, suggesting that reductions in arrhythmia incidence during CIH were related to normalization of cardiac autonomic balance. Present results show that autonomic alterations induced by CIH are critically dependent on the CB and support a main role for the CB in the CIH-induced hypertension. PMID:27381902

  11. Study of the effects of age and body mass index on the carotid wall vibration: extraction methodology and analysis.

    PubMed

    Yousefi Rizi, Fereshteh; Setarehdan, Seyed Kamaledin; Behnam, Hamid; Alizadeh Sani, Zahra

    2014-07-01

    This study aims to non-invasively extract the vibrations of the carotid wall and evaluate the changes in the carotid artery wall caused by age and obesity. Such evaluation can increase the possibility of detecting wall stiffness and atherosclerosis in its early stage. In this study, a novel method that uses a phase-tracking method based on the continuous wavelet transform calculates the carotid wall motion from the ultrasound radio frequency signals. To extract the high-frequency components of the wall motion, wall vibration, the empirical mode decomposition was then used. The posterior wall (intima-media) motion and vibration were extracted for 54 healthy volunteers (mean age: 33.87 ± 14.73 years), including 13 overweight subjects (body mass index > 25) and 14 female participants using their radio frequency signals. The results showed that the dominant frequency of the wall vibration correlates with age (r = -0.5887, p < 0.001) and body mass index (r = -0.4838, p < 0.001). The quantitative analysis further demonstrated that the dominant frequency of the vibration in the radial direction of the carotid wall decreases by age and is lower in overweight subjects. Besides, the peak-to-peak amplitude of the wall vibration showed significant correlations with age (r = -0.5456, p < 0.001) and body mass index (r = -0.5821, p < 0.001). The peak-to-peak amplitude also decreases by age and is lower in overweight subjects. However, there were no significant correlations between these features of the wall vibrations and systolic/diastolic blood pressure and sex. Our proposed measures were certified using the calculated arterial stiffness indices. The average power spectrum of the elderly subjects'wall motion in the frequency range of the wall vibration (>100 Hz) is decreased more in comparison with the young subjects. Our results revealed that the proposed method may be useful for detecting the stiffness and distortion in the carotid wall that occur prior to wall thickening

  12. Peripheral chemoreceptors determine the respiratory sensitivity of central chemoreceptors to CO2 : role of carotid body CO2.

    PubMed

    Smith, Curtis A; Blain, Grégory M; Henderson, Kathleen S; Dempsey, Jerome A

    2015-09-15

    We asked if the type of carotid body (CB) chemoreceptor stimulus influenced the ventilatory gain of the central chemoreceptors to CO2 . The effect of CB normoxic hypocapnia, normocapnia and hypercapnia (carotid body PCO2 ≈ 22, 41 and 68 mmHg, respectively) on the ventilatory CO2 sensitivity of central chemoreceptors was studied in seven awake dogs with vascularly-isolated and extracorporeally-perfused CBs. Chemosensitivity with one CB was similar to that in intact dogs. In four CB-denervated dogs, absence of hyper-/hypoventilatory responses to CB perfusion with PCO2 of 19-75 mmHg confirmed separation of the perfused CB circulation from the brain. The group mean central CO2 response slopes were increased 303% for minute ventilation (V̇I)(P ≤ 0.01) and 251% for mean inspiratory flow rate (VT /TI ) (P ≤ 0.05) when the CB was hypercapnic vs. hypocapnic; central CO2 response slopes for tidal volume (VT ), breathing frequency (fb ) and rate of rise of the diaphragm EMG increased in 6 of 7 animals but the group mean changes did not reach statistical significance. Group mean central CO2 response slopes were also increased 237% for V̇I(P ≤ 0.01) and 249% for VT /TI (P ≤ 0.05) when the CB was normocapnic vs. hypocapnic, but no significant differences in any of the central ventilatory response indices were found between CB normocapnia and hypercapnia. These hyperadditive effects of CB hyper-/hypocapnia agree with previous findings using CB hyper-/hypoxia.We propose that hyperaddition is the dominant form of chemoreceptor interaction in quiet wakefulness when the chemosensory control system is intact, response gains physiological, and carotid body chemoreceptors are driven by a wide range of O2 and/or CO2 . PMID:26171601

  13. Properties of a transient K+ current in chemoreceptor cells of rabbit carotid body.

    PubMed Central

    López-López, J R; De Luis, D A; Gonzalez, C

    1993-01-01

    1. Adult rabbit carotid body chemoreceptor cells, enzymatically dispersed and short-term cultured, exhibit an inactivating outward K+ current that is reversibly inhibited by low PO2. In the present work we have characterized the biophysical and pharmacological properties of this current using the whole-cell voltage clamp recording technique. 2. Inactivating current was recorded after blockage of Ca2+ currents with extracellular Co2+, Cd2+, or after complete washing out of Ca2+ channels. 3. The threshold of activation of this inactivating current was about -40 mV. Current activated very quickly (mean rise time 4.8 +/- 0.42 ms at +60 mV) but inactivated more slowly. Inactivation was well fitted by two exponentials with time constants of 79.7 +/- 6.6 and 824 +/- 42.8 ms (at +40 mV). The inactivation process showed a little voltage dependence. 4. The steady-state inactivation was well fitted by a Boltzman function. Inactivation was fully removed at potentials negative to -80 mV and was complete at voltages near -10 mV; 50% inactivation occurred at -41 mV. 5. Recovery from inactivation had several components and was voltage dependent. Initial recovery was fast, but full recovery, even at -100 mV, required more than 30 s. 6. Inactivating current was selectively blocked by 4-aminopyridine (4-AP), in a dose-dependent manner (IC50, 0.2 mM). The duration of chemoreceptor cells action potentials was augmented by 1 mM 4-AP from 2.3 +/- 0.36 to 7.0 +/- 0.25 ms at 0 mV. Tetraethylamonium (TEA), at concentrations above 5 mM, blocked inactivating and non-inactivating components of the whole K+ current. 7. Inactivating current was modulated by cyclic AMP (cAMP). Bath application of 2 mM dibutyryl cAMP reduced peak amplitude by 18.7 +/- 2.9% (at +30 mV) and slowed down the rise time of the current. The effect was not voltage dependent. Forskolin (10-20 microM) also affected inactivating current, by accelerating the inactivation process. In the same preparations neither dibutyryl c

  14. Properties of ionic currents from isolated adult rat carotid body chemoreceptor cells: effect of hypoxia.

    PubMed Central

    López-López, J R; González, C; Pérez-García, M T

    1997-01-01

    1. The electrical properties of chemoreceptor cells from neonatal rat and adult rabbit carotid bodies (CBs) are strikingly different. These differences have been suggested to be developmental and/or species related. To distinguish between the two possibilities, the whole-cell configuration of the patch-clamp technique was used to characterize the ionic currents present in isolated chemoreceptor cells from adult rat CBs. Since hypoxia-induced inhibition of O2-sensitive K+ currents is considered a crucial step in O2 chemoreception, the effect of hypoxia on the adult rat chemoreceptor cell currents was also studied. 2. Outward currents were carried mainly by K+, and two different components could be distinguished: a Ca(2+)-dependent K+ current (IK(Ca)) sensitive to Cd2+ and charybdotoxin (CTX), and a Ca(2+)-insensitive, voltage-dependent K+ current (IK(V)). IK(V) showed a slow voltage-dependent activation (time constant (tau) of 87.4 ms at -20 mV and 8.8 ms at +60 mV) and a very slow inactivation, described by the sum of two exponentials (tau 1 = 684 +/- 150 ms and tau 2 = 4.96 +/- 0.76 s at + 30 mV), that was almost voltage insensitive. The kinetic and pharmacological properties of IK(V) are typical of a delayed rectifier K+ channel. 3. Voltage-dependent Ca2+ currents (ICa) were present in nineteen of twenty-seven cells. TTX-sensitive Na+ currents were also observed in about 10% of the cells. 4. Low PO2 (< 10 mmHg) reduced the whole outward current amplitude by 22.17 +/- 1.96% (n = 27) at +20 mV. This effect was absent in the presence of Cd2+. Since low PO2 did not affect ICa, we conclude that hypoxia selectively blocks IK(Ca). 5. The properties of the currents recorded in adult rat chemoreceptor cells, including the specific inhibition of IK(Ca) by hypoxia, are similar to those reported in neonatal rat CB cells, implying that the differences between rat and rabbit chemoreceptor cells are species related. PMID:9080372

  15. Extradigital Glomus Tumor-a Rare Cause for Undiagnosed Chronic Pain in Unusal Sites.

    PubMed

    Venugopal, P R

    2015-12-01

    Glomus tumor is a benign vascular tumor derived from the modified smooth muscle cells of the glomus body. The single most common site is the subungual region of the finger, but other common sites include the palm, wrist, forearm, and foot. In this article, we present a rare situation of glomus tumor occurring on the back of the chest over the scapular area in an elderly male patient. The tumor cells exhibited positive expression for CD34 and smooth muscle actin. This paper highlights the fact that a glomus tumor is a benign neoplasm that may occur in multiple locations. Therefore, the significance of a histological and immunohistochemical approach for a correct characterization of this lesion is required. PMID:27011481

  16. Glomus tumor of the shoulder: A case report and review of the literature

    PubMed Central

    PROIETTI, AGNESE; ALÌ, GRETA; QUILICI, FRANCESCA; BERTOGLIO, PIETRO; MUSSI, ALFREDO; FONTANINI, GABRIELLA

    2013-01-01

    Glomus tumors are benign neoplasms that arise from neuromyoarterial glomus bodies, with clinical manifestations that include acute pain, cold intolerance and tenderness. Glomus tumors may occur anywhere in the skin, soft tissue or gastrointestinal tract, but are most frequently encountered in the nail bed of the hands. The present study reports the case of a 30-year-old female with a history of shoulder pain caused by a cystic neoformation. Following surgery, a microscopic examination revealed nests of small cells of a rounded and regular shape. The tumor cells exhibited positive expression for CD34 and smooth muscle actin. This study supports and confirms the fact that a glomus tumor is a benign neoplasm that may occur in multiple locations. Therefore, the significance of a histological and immunohistochemical approach for a correct characterization of this lesion is required. PMID:24137457

  17. Effects of mitochondrial uncouplers on intracellular calcium, pH and membrane potential in rat carotid body type I cells

    PubMed Central

    Buckler, K J; Vaughan-Jones, R D

    1998-01-01

    Mitochondrial uncouplers are potent stimulants of the carotid body. We have therefore investigated their effects upon isolated type I cells. Both 2,4-dinitrophenol (DNP) and carbonyl cyanide p-trifluoromethoxyphenyl hydrazone (FCCP) caused an increase in [Ca2+]i which was largely inhibited by removal of extracellular Ca2+ or Na+, or by the addition of 2 mm Ni2+. Methoxyverapamil (D600) also partially inhibited the [Ca2+]i response. In perforated-patch recordings, the rise in [Ca2+]i coincided with membrane depolarization and was greatly reduced by voltage clamping the cell to −70 mV. Uncouplers also inhibited a background K+ current and induced a small inward current. Uncouplers reduced pHi by 0.1 unit. Alkaline media diminished this acidification but had no effect on the [Ca2+]i response. FCCP and DNP also depolarized type I cell mitochondria. The onset of mitochondrial depolarization preceded changes in cell membrane conductance by 3–4 s. We conclude that uncouplers excite the carotid body by inhibiting a background K+ conductance and inducing a small inward current, both of which lead to membrane depolarization and voltage-gated Ca2+ entry. These effects are unlikely to be caused by cell acidification. The inhibition of background K+ current may be related to the uncoupling of oxidative phosphorylation. PMID:9824720

  18. Effects of mitochondrial uncouplers on intracellular calcium, pH and membrane potential in rat carotid body type I cells.

    PubMed

    Buckler, K J; Vaughan-Jones, R D

    1998-12-15

    1. Mitochondrial uncouplers are potent stimulants of the carotid body. We have therefore investigated their effects upon isolated type I cells. Both 2,4-dinitrophenol (DNP) and carbonyl cyanide p-trifluoromethoxyphenyl hydrazone (FCCP) caused an increase in [Ca2+]i which was largely inhibited by removal of extracellular Ca2+ or Na+, or by the addition of 2 mM Ni2+. Methoxyverapamil (D600) also partially inhibited the [Ca2+]i response. 2. In perforated-patch recordings, the rise in [Ca2+]i coincided with membrane depolarization and was greatly reduced by voltage clamping the cell to -70 mV. Uncouplers also inhibited a background K+ current and induced a small inward current. 3. Uncouplers reduced pHi by 0.1 unit. Alkaline media diminished this acidification but had no effect on the [Ca2+]i response. 4. FCCP and DNP also depolarized type I cell mitochondria. The onset of mitochondrial depolarization preceded changes in cell membrane conductance by 3-4 s. 5. We conclude that uncouplers excite the carotid body by inhibiting a background K+ conductance and inducing a small inward current, both of which lead to membrane depolarization and voltage-gated Ca2+ entry. These effects are unlikely to be caused by cell acidification. The inhibition of background K+ current may be related to the uncoupling of oxidative phosphorylation. PMID:9824720

  19. Long-term influence of neonatal hypoxia on catecholamine activity in carotid bodies and brainstem cell groups of the rat.

    PubMed Central

    Soulier, V; Dalmaz, Y; Cottet-Emard, J M; Lagercrantz, H; Pequignot, J M

    1997-01-01

    1. In order to determine the long-term influence of neonatal hypoxia on catecholaminergic activity in peripheral arterial chemoreceptors and brainstem noradrenergic cell groups (A1, A2, A5 and A6), 1-day-old male rat pups were subjected to hypoxia (10% oxygen) for 6 days and then supplied with normal air. Control animals were kept at normoxia from birth. Rats were killed at either 3 or 8 weeks of age. 2. The content of dopamine and noradrenaline in carotid bodies of neonatally hypoxic rats was increased at both 3 and 8 weeks of age. 3. Noradrenaline turnover was selectively decreased in the caudal portion of A2 (located in the area of chemosensory afferent projection) at 8 weeks of age (-76 +/- 2%), while this turnover was unaffected in rostral A2 cells. Noradrenergic activity in A1, A5 and A6 was altered by neonatal hypoxia in an age-dependent fashion. 4. The data suggest that neonatal hypoxia induces long-term changes in the basal activity of the carotid body and brainstem noradrenergic cell groups. Such changes might contribute to neuronal regulation of the delayed respiratory, arousal and neural sequelae associated with neonatal hypoxia. These changes could also be involved in the early programming of respiratory and blood pressure control. PMID:9032699

  20. Lower body positive pressure application with an antigravity suit in acute carotid occlusion.

    PubMed

    Berthet, Karine; Lukaszewicz, Anne Claire; Bousser, Marie-Germaine; Payen, Didier

    2010-01-01

    The challenge in acute stroke is still to reperfuse as early as possible the ischemic territory. Since fibrinolytic therapies have a limited window with potential risk of bleeding, having a nonpharmacologic mean to recruit vessels in area surrounding necrosis might be useful. We propose here to use antigravity suit inflated at "venous" pressure levels to shift blood towards thoracic and brain territories. We report two cases of spectacular clinical recovery after acute carotid occlusion. PMID:20798842

  1. An unusual presentation of foreign body in the common carotid artery.

    PubMed

    Lahiri, Somdatta; Ghosh, Shibajyoti; Sengupta, Goutam; Bakshi, Udayan

    2011-12-01

    Penetrating trauma to neck resulting in arteriovenous (AV) fistula and aneurysms involving the carotid system are uncommon injuries with life-threatening consequences. We report here a case of a young factory worker who developed a traumatic AV fistula with false aneurysm, with however, no other complications. He was successfully operated when he presented to us two months after the injury and is doing well in follow-up. PMID:23204711

  2. Effects of hypercapnia on membrane potential and intracellular calcium in rat carotid body type I cells.

    PubMed Central

    Buckler, K J; Vaughan-Jones, R D

    1994-01-01

    1. An acid-induced rise in the intracellular calcium concentration ([Ca2+]i) of type I cells is thought to play a vital role in pH/PCO2 chemoreception by the carotid body. In this present study we have investigated the cause of this rise in [Ca2+]i in enzymatically isolated, neonatal rat type I cells. 2. The rise in [Ca2+]i induced by a hypercapnic acidosis was inhibited in Ca(2+)-free media, and by 2 mM Ni2+. Acidosis also increased Mn2+ permeability. The rise in [Ca2+]i is dependent, therefore, upon a Ca2+ influx from the external medium. 3. The acid-induced rise in [Ca2+]i was attenuated by both nicardipine and methoxyverapamil (D600), suggesting a role for L-type Ca2+ channels. 4. Acidosis depolarized type I cells and often (approximately 50% of cells) induced action potentials. These effects coincided with a rise in [Ca2+]i. When membrane depolarization was prevented by a voltage clamp, acidosis failed to evoke a rise in [Ca2+]i. The acid-induced rise in [Ca2+]i is a consequence, therefore, of membrane depolarization. 5. Acidosis decreased the resting membrane conductance of type I cells. The reversal potential of the acid-sensitive current was about -75 mV. 6. A depolarization (30 mM [K+]o)-induced rise in [Ca2+]i was blocked by either the removal of extracellular Ca2+ or the presence of 2 mM Ni2+, and was also substantially inhibited by nicardipine. Under voltage-clamp conditions, [Ca2+]i displayed a bell-shaped dependence on membrane potential. Depolarization raises [Ca2+]i, therefore, through voltage-operated Ca2+ channels. 7. Caffeine (10 mM) induced only a small rise in [Ca2+]i (< 10% of that induced by 30 mM extracellular K+). Ca(2+)-induced Ca2+ release is unlikely, therefore, to contribute greatly to the rise in [Ca2+]i induced by depolarization. 8. Although the replacement of extracellular Na+ with N-methyl-D-glucamine (NMG), but not Li+, inhibited the acid-induced rise in [Ca2+]i, this was due to membrane hyperpolarization and not to the inhibition

  3. Incidental gastric glomus tumor after laparoscopic sleeve gastrectomy

    PubMed Central

    Oruç, Mehmet Tahir; Aslaner, Arif; Çekiç, Sema; Sakar, Alkan; Yardimci, Erdem Can

    2016-01-01

    Gastric glomus tumors (GGTs) are unusual benign, subepithelial, mesenchymal neoplasms of modified smooth muscle cells representing a neoplastic counterpart of glomus bodies. A 38-year-old woman was admitted to our clinic presenting morbid obesity. Routine preoperative evaluations, such as laboratory analysis, abdominal ultrasonography, and upper gastrointestinal endoscopy, were performed. She underwent a classical laparoscopic sleeve gastrectomy (LSG). The postoperative course was uneventful and she was discharged for outpatient control. Her histopathology report revealed a GGT 0.8 cm in diameter. No further treatment was done and she had lost 28 kg at the postoperative sixth month. Here, we present the case of GGT, which was diagnosed incidentally after LSG. PMID:27284541

  4. Carotid Endarterectomy

    MedlinePlus

    ... the carotid arteries. This limits or blocks the flow of oxygen-rich blood to your brain, which can lead to a stroke. Carotid Arteries Figure A shows ... normal carotid artery that has normal blood flow. Figure C show the inside of a carotid ...

  5. Glomus Tumor of the Thenar Eminence in Neurofibromatosis Type 1: Case Report and Literature Review

    PubMed Central

    Scaravilli, Gabriele; Rossi, Roberto; Artiaco, Stefano; Merolla, Giovanni

    2015-01-01

    Neurofibromatosis type 1 (NF1) is a disease characterized by increased tumorigenesis susceptibility, caused by mutations of the oncosuppressor gene NF1. The glomus tumor (GT) is a rare, very painful mesenchymal neoplasm, arising from the glomus body. In recent years, it has been highlighted the association between NF1 and GT. We report a case of a man aged 65 years, suffering from NF1, with intense pain at the thenar eminence of the right hand, successfully treated with the excision of the mass. PMID:25674553

  6. Carotid artery surgery

    MedlinePlus

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  7. Hyperbaric Oxygen Therapy Improves Glucose Homeostasis in Type 2 Diabetes Patients: A Likely Involvement of the Carotid Bodies.

    PubMed

    Vera-Cruz, P; Guerreiro, F; Ribeiro, M J; Guarino, M P; Conde, S V

    2015-01-01

    The carotid bodies (CBs) are peripheral chemoreceptors that respond to hypoxia increasing minute ventilation and activating the sympathetic nervous system. Besides its role in ventilation we recently described that CB regulate peripheral insulin sensitivity. Knowing that the CB is functionally blocked by hyperoxia and that hyperbaric oxygen therapy (HBOT) improves fasting blood glucose in diabetes patients, we have investigated the effect of HBOT on glucose tolerance in type 2 diabetes patients. Volunteers with indication for HBOT were recruited at the Subaquatic and Hyperbaric Medicine Center of Portuguese Navy and divided into two groups: type 2 diabetes patients and controls. Groups were submitted to 20 sessions of HBOT. OGTT were done before the first and after the last HBOT session. Sixteen diabetic patients and 16 control individual were included. Fasting glycemia was143.5 ± 12.62 mg/dl in diabetic patients and 92.06 ± 2.99 mg/dl in controls. In diabetic patients glycemia post-OGTT was 280.25 ± 22.29 mg/dl before the first HBOT session. After 20 sessions, fasting and 2 h post-OGTT glycemia decreased significantly. In control group HBOT did not modify fasting glycemia and post-OGTT glycemia. Our results showed that HBOT ameliorates glucose tolerance in diabetic patients and suggest that HBOT could be used as a therapeutic intervention for type 2 diabetes. PMID:26303484

  8. Interleukin-1β promotes the neurogenesis of carotid bodies by stimulating the activation of ERK1/2.

    PubMed

    Xue, Fen; Liu, Ling; Fan, Juan; He, ShanShan; Li, Rui; Peng, Zheng-Wu; Wang, Bai-Ren

    2015-12-01

    The carotid body (CB) is a complex sensory organ that functions to sense homeostatic O2 in the blood. Previous studies have shown that CBs express interleukin (IL)-1 receptor type I and that the chemosensitivity of CBs is increased following stimulation with pro-inflammatory cytokines. However, the effects of pro-inflammatory cytokines, such as IL-1β, on the neurogenesis of CB are unclear. Thus, in this study, we aimed to assess the effects of IL-1β and intermittent hypobaric hypoxia (IHH) plus IL-1β on the phosphorylation of extracellular signal-regulated kinase (ERK) 1/2, tyrosine hydroxylase (TH) and the expression of nestin, a well-established stem cell marker in the nervous system. The results showed that TH, nestin expression and ERK1/2 phosphorylation were increased in the rat CB following intraperitoneal injection of IL-1β. Moreover, IL-1β had additive effects on IHH. These results suggested that the plasticity of CB was increased following treatment with IL-1β and that ERK1/2 may be involved in neurogenic signaling in CBs. PMID:26327233

  9. Gastric glomus tumor: A case report

    PubMed Central

    2010-01-01

    Gastric glomus tumors are rare mesenchymal tumors of the gastrointestinal tract. We describe a 72-year-old patient who presented with episodes of melena and was subsequently investigated for a tumor of the antrum of the stomach. Surgical resection revealed a 2 × 2 × 1.7 cm well circumscribed submucosal tumor, extending into the muscularis propria. The histopathologic examination of the specimen demonstrated a glomus tumor of the stomach. We discuss the preoperative investigation, the diagnostic problems and the surgical treatment of the patient with this rare submucosal lesion. PMID:20307271

  10. Percutaneous radiofrequency ablation of primary intraosseous spinal glomus tumor.

    PubMed

    Becce, Fabio; Richarme, Delphine; Letovanec, Igor; Gilgien, Willy; Theumann, Nicolas

    2012-04-01

    The glomus tumor is a rare, benign, but painful vascular neoplasm arising from the neuromyoarterial glomus. Primary intraosseous glomus tumor is even rarer, with only about 20 cases reported in the literature so far, 5 of which involved the spine. Surgical resection is currently considered the treatment of choice. We herewith present an uncommon case of primary intraosseous spinal glomus tumor involving the right pedicle of the eleventh thoracic vertebra (T11). To our knowledge, this is the first case of primary intraosseous spinal glomus tumor successfully treated by percutaneous CT-guided radiofrequency ablation (RFA). PMID:22072240

  11. Glomus perpusillum, a new arbuscular mycorrhizal fungus.

    PubMed

    Błaszkowski, Janusz; Kovács, Gábor M; Balázs, Tímea

    2009-01-01

    A new arbuscular mycorrhizal fungal species of genus Glomus, G. perpusillum (Glomeromycota), forming small, hyaline spores is described and illustrated. Spores of G. perpusillum were formed in hypogeous aggregates and occasionally inside roots. They are globose to subglobose, (10-)24(-30) microm diam, rarely egg-shaped, oblong to irregular, 18-25 x 25-63 microm. The single spore wall of G. perpusillum consists of two permanent layers: a finely laminate, semiflexible to rigid outer layer and a flexible to semiflexible inner layer. The inner layer becomes plastic and frequently contracts in spores crushed in PVLG-based mountants and stains reddish white to grayish red in Melzer's reagent. Glomus perpusillum was associated with roots of Ammophila arenaria colonizing sand dunes of the Mediterranean Sea adjacent to Calambrone, Italy, and this is the only site of its occurrence known to date. In single-species cultures with Plantago lanceolata as host plant, G. perpusillum formed vesicular-arbuscular mycorrhiza. Phylogenetic analyses of partial SSU sequences of nrDNA placed the species in Glomus group A with no affinity to its subgroups. The sequences of G. perpusillum unambiguously separated from the sequences of described Glomus species and formed a distinct clade together with in planta arbuscular mycorrhizal fungal sequences found in alpine plants. PMID:19397199

  12. Regulation of hypoxia-inducible factor-α isoforms and redox state by carotid body neural activity in rats

    PubMed Central

    Peng, Ying-Jie; Yuan, Guoxiang; Khan, Shakil; Nanduri, Jayasri; Makarenko, Vladislav V; Reddy, Vaddi Damodara; Vasavda, Chirag; Kumar, Ganesh K; Semenza, Gregg L; Prabhakar, Nanduri R

    2014-01-01

    Previous studies reported that chronic intermittent hypoxia (CIH) results in an imbalanced expression of hypoxia-inducible factor-α (HIF-α) isoforms and oxidative stress in rodents, which may be due either to the direct effect of CIH or indirectly via hitherto uncharacterized mechanism(s). As neural activity is a potent regulator of gene transcription, we hypothesized that carotid body (CB) neural activity contributes to CIH-induced HIF-α isoform expression and oxidative stress in the chemoreflex pathway. Experiments were performed on adult rats exposed to CIH for 10 days. Rats exposed to CIH exhibited: increased HIF-1α and decreased HIF-2α expression; increased NADPH oxidase 2 and decreased superoxide dismutase 2 expression; and oxidative stress in the nucleus tractus solitarius and rostral ventrolateral medulla as well as in the adrenal medulla (AM), a major end organ of the sympathetic nervous system. Selective ablation of the CB abolished these effects. In the AM, sympathetic activation by the CB chemoreflex mediates CIH-induced HIF-α isoform imbalance via muscarinic acetylcholine receptor-mediated Ca2+ influx, and the resultant activation of mammalian target of rapamycin pathway and calpain proteases. Rats exposed to CIH presented with hypertension, elevated sympathetic activity and increased circulating catecholamines. Selective ablation of either the CB (afferent pathway) or sympathetic innervation to the AM (efferent pathway) abolished these effects. These observations uncover CB neural activity-dependent regulation of HIF-α isoforms and the redox state by CIH in the central and peripheral nervous systems associated with the chemoreflex. PMID:24973414

  13. Type I cell ROS kinetics under hypoxia in the intact mouse carotid body ex vivo: a FRET-based study.

    PubMed

    Bernardini, A; Brockmeier, U; Metzen, E; Berchner-Pfannschmidt, U; Harde, E; Acker-Palmer, A; Papkovsky, D; Acker, H; Fandrey, J

    2015-01-01

    Reactive oxygen species (ROS) mainly originating from NADPH oxidases have been shown to be involved in the carotid body (CB) oxygen-sensing cascade. For measuring ROS kinetics, type I cells of the mouse CB in an ex vivo preparation were transfected with the ROS sensor construct FRET-HSP33. After 2 days of tissue culture, type I cells expressed FRET-HSP33 as shown by immunohistochemistry. In one population of CBs, 5 min of hypoxia induced a significant and reversible decrease of type I cell ROS levels (n = 9 CBs; P < 0.015), which could be inhibited by 4-(2-aminoethyl)benzensulfonylfluorid (AEBSF), a highly specific inhibitor of the NADPH oxidase subunits p47(phox) and p67(phox). In another population of CBs, however, 5 min of hypoxia induced a significant and reversible increase of ROS levels in type I cells (n = 8 CBs; P < 0.05), which was slightly enhanced by administration of 3 mM AEBSF. These different ROS kinetics seemed to coincide with different mice breeding conditions. Type I cells of both populations showed a typical hypoxia-induced membrane potential (MP) depolarization, which could be inhibited by 3 mM AEBSF. ROS and MP closely followed the hypoxic decrease in CB tissue oxygen as measured with an O2-sensitive dye. We conclude that attenuated p47(phox) subunit activity of the NADPH oxidase under hypoxia is the physiological trigger for type I cell MP depolarization probably due to ROS decrease, whereas the observed ROS increase has no influence on type I cell MP kinetics under hypoxia. PMID:25318107

  14. Dissociation between blood pressure and heart rate response to hypoxia after bilateral carotid body removal in men with systolic heart failure.

    PubMed

    Niewinski, Piotr; Janczak, Dariusz; Rucinski, Artur; Tubek, Stanislaw; Engelman, Zoar J; Jazwiec, Przemyslaw; Banasiak, Waldemar; Sobotka, Paul A; Hart, Emma C J; Paton, Julian F R; Ponikowski, Piotr

    2014-03-01

    While the ventilatory response to hypoxia is known to be mediated by the carotid bodies, the origin of the haemodynamic alterations evoked by hypoxia is less certain. Bilateral carotid body removal (CBR) performed to treat congestive heart failure may serve as a model to improve our understanding of haemodynamic responses to hypoxia in humans. We studied six congestive heart failure patients before and 1 month after CBR [median (interquartile range): age, 58.5 (56-61) years old; and ejection fraction, 32 (25-34)%]. Peripheral chemosensitivity (hypoxic ventilatory response) was equated to the slope relating lowest oxygen saturation to highest minute ventilation following exposures to hypoxia. Likewise, systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) slopes were calculated as slopes relating the lowest oxygen saturations to the highest SBP, DBP and HR responses. We found that CBR reduces the hypoxic ventilatory response (91%, P < 0.05), SBP (71%, P < 0.05) and DBP slopes (59%, P = 0.07). In contrast, the HR slope remained unchanged. The dissociation between the blood pressure and HR responses after CBR shows involvement of a different chemoreceptive site(s) maintaining the response to acute hypoxia. We conclude that carotid bodies are responsible for ventilatory and blood pressure responses, while the HR response might be mediated by the aortic bodies. The significant reduction of the blood pressure response to hypoxia after CBR suggests a decrease in sympathetic tone, which is of particular clinical relevance in congestive heart failure. PMID:24243836

  15. Bilateral carotid artery injury response in side impact using a vessel model integrated with a human body model.

    PubMed

    Danelson, Kerry A; Gayzik, F Scott; Yu, Mao M; Martin, R Shayn; Duma, Stefan M; Stitzel, Joel D

    2009-10-01

    In a far-side crash configuration, the occupant can experience severe excursion from the seat space. Given this challenge, there are research efforts focused on alternate restraints, such as four-point belts. A potential implication of this geometry would be interaction of the belt with the occupant's neck. This study examines the response of the carotid arteries using a Finite Element Model (FEM) in a far-side crash configuration with a reversed three-point restraint. A FEM of the carotid artery and neck fascia was developed and integrated with the Total Human Model for Safety (THUMS) version 1.44. This model was subjected to four test conditions simulating far-side crashes. Load conditions included a low velocity impact of approximately 4 m/s and a higher velocity impact of approximately 10 m/s. For each velocity, the model was restrained with a belt placed low on the neck and a belt placed higher on the neck. Strain data in each element of the carotid arteries was analyzed. The overall response of the vessel was examined to determine locations of high strain values. Low belt placement resulted in more head excursion, stretching the carotid on the non-struck side. High belt placement resulted in compression of the artery on the struck side due to direct loading of the vessel from the belt. Strain values in the carotid artery elements increased with increasing speed of impact. The lower and higher speed tests with a low belt configuration resulted in a maximum principal strains, at maximal belt engagement, of 0.223 and 0.459, respectively. Corresponding values for the high belt configuration were 0.222 and 0.563. In both belt configurations, the non-struck side vessel stretched more than the struck side vessel; however, the non-struck side vessel experienced higher compressive forces. Strain values measured during the simulations can be compared to a value of 0.31 to intimal failure in previous experimental tests. These results quantitatively illustrate the two

  16. Bilateral Carotid Artery Injury Response in Side Impact Using a Vessel Model Integrated with a Human Body Model

    PubMed Central

    Danelson, Kerry A.; Gayzik, F. Scott; Yu, Mao M.; Martin, R. Shayn; Duma, Stefan M.; Stitzel, Joel D.

    2009-01-01

    In a far-side crash configuration, the occupant can experience severe excursion from the seat space. Given this challenge, there are research efforts focused on alternate restraints, such as four-point belts. A potential implication of this geometry would be interaction of the belt with the occupant’s neck. This study examines the response of the carotid arteries using a Finite Element Model (FEM) in a far-side crash configuration with a reversed three-point restraint. A FEM of the carotid artery and neck fascia was developed and integrated with the Total Human Model for Safety (THUMS) version 1.44. This model was subjected to four test conditions simulating far-side crashes. Load conditions included a low velocity impact of approximately 4 m/s and a higher velocity impact of approximately 10 m/s. For each velocity, the model was restrained with a belt placed low on the neck and a belt placed higher on the neck. Strain data in each element of the carotid arteries was analyzed. The overall response of the vessel was examined to determine locations of high strain values. Low belt placement resulted in more head excursion, stretching the carotid on the non-struck side. High belt placement resulted in compression of the artery on the struck side due to direct loading of the vessel from the belt. Strain values in the carotid artery elements increased with increasing speed of impact. The lower and higher speed tests with a low belt configuration resulted in a maximum principal strains, at maximal belt engagement, of 0.223 and 0.459, respectively. Corresponding values for the high belt configuration were 0.222 and 0.563. In both belt configurations, the non-struck side vessel stretched more than the struck side vessel; however, the non-struck side vessel experienced higher compressive forces. Strain values measured during the simulations can be compared to a value of 0.31 to intimal failure in previous experimental tests. These results quantitatively illustrate the two

  17. Carotid Ultrasound

    MedlinePlus

    ... plaque narrows the carotid arteries and reduces the flow of oxygen-rich blood to the brain. If the plaque ruptures, a blood clot can form on its surface. A clot can mostly or completely block blood flow through a carotid artery, which can cause a ...

  18. Role of voltage-dependent calcium channels in stimulus–secretion coupling in rabbit carotid body chemoreceptor cells

    PubMed Central

    Rocher, Asunción; Geijo-Barrientos, Emilio; Cáceres, Ana Isabel; Rigual, Ricardo; González, Constancio; Almaraz, Laura

    2005-01-01

    We have defined Ca2+ channel subtypes expressed in rabbit carotid body (CB) chemoreceptor cells and their participation in the stimulus-evoked catecholamine (CA) release. Ca2+ currents (ICa) activated at –30 mV, peaked at +10 mV and were fully blocked by 200 μm Cd2+. L-type channels (sensitive to 2 μm nisoldipine) activated at –30 mV and carried 21 ± 2% of total ICa. Non-L-type channels activated at potentials positive to –10 mV and carried: N channels (sensitive to 1 μm ω-conotoxin-GVIA) 16 ± 1% of total ICa, P/Q channels (sensitive to 3 μm ω-conotoxin-MVIIC after nisoldipine plus GVIA) 23 ± 3% of total ICa and R channels (resistant to all blockers combined) 40 ± 3% of total ICa. CA release induced by hypoxia, hypercapnic acidosis, dinitrophenol (DNP) and high K+o in the intact CB was inhibited by 79–98% by 200 μm Cd2+. Hypoxia, hypercapnic acidosis and DNP, depolarized chemoreceptor cells and eventually generated repetitive action potential discharge. Nisoldipine plus MVIIC nearly abolished the release of CAs induced by hypoxia and hypercapnic acidosis and reduced by 74% that induced by DNP. All these secretory responses were insensitive to GVIA. 30 and 100 mm K+o brought resting membrane potential (Em) of chemoreceptor cells (–48.1 ± 1.2 mV) to –22.5 and +7.2 mV, respectively. Thirty millimolar K+o-evoked release was abolished by nisoldipine but that induced by 100 mm K+o was mediated by activation of L, N, and P/Q channels. Data show that tested stimuli depolarize rabbit CB chemoreceptor cells and elicit CA release through Ca2+ entry via voltage-activated channels. Only L and P/Q channels are tightly coupled to the secretion of CA. PMID:15528240

  19. Association between adjunctive metformin therapy in young type 1 diabetes patients with excess body fat and reduction of carotid intima-media thickness.

    PubMed

    Burchardt, Paweł; Zawada, Agnieszka; Kaczmarek, Jolanta; Marcinkaniec, Justyna; Wysocki, Henryk; Wierusz-Wysocka, Bogna; Grzymisławski, Marian; Rzeźniczak, Janusz; Zozulińska-Ziółkiewicz, Dorota; Naskręt, Dariusz

    2016-08-25

    INTRODUCTION    Lipoprotein-associated phospholipase A2 (Lp-PLA2) and cholesteryl ester lipase (CEL) may oxidize low-density lipoproteins (oxLDL). OBJECTIVES    The aim of the study was to determine the influence of metformin on the metabolism of atherogenic lipid fractions in relation to Lp-PLA2 and CEL levels, as well as assess consequent improvement in the intima-media thickness (IMT) of the common carotid artery in young type 1 diabetes patients with excess body fat. PATIENTS AND METHODS    It was an open-label randomized clinical trial that lasted 6 months. It included a total of 84 people with metabolic decompensation (glycated hemoglobin >7.5%, >58.5 mmol/mol) of diabetes. Adjunctive metformin therapy (in addition to insulin) was administered in 42 patients, and the remaining 42 patients received insulin alone. Glycated low-density lipoproteins (LDLs), oxLDL, Lp-PLA2, and CEL were assessed by commercially available enzyme-linked immunosorbent assay kits. Cartoid IMT was measured using the Carotid Analyser for Research tool. Biochemical analyses were performed using routine laboratory techniques. RESULTS    The reduction of mean carotid IMT was observed in young type 1 diabetic adults treated additionally with metformin (0.6 ±0.1 cm vs 0.53 ±0.1 cm; P = 0.002). This effect was probably due to weight reduction (90 ±16 kg vs 87 ±15 kg, P = 0.054) and the decrease in atherogenic glycated LDL levels (1.5 ±0.5 mg/dl vs 1.6 ±1.046 mg/dl, P = 0.006). No such correlations were observed in patients treated with insulin alone. Additionally, in patients receiving metformin, glycated LDL levels were inversely correlated with Lp-PLA2 levels (r = -0.31, P <0.05). CONCLUSIONS    Additional use of metformin in young type 1 diabetic patients with excess body fat leads to a significant reduction of mean IMT in the common carotid artery. Concentrations of CEL and Lp-PLA2 were significantly increased in both study arms despite improved glucose metabolism

  20. Tasting arterial blood: what do the carotid chemoreceptors sense?

    PubMed Central

    Prabhakhar, Nanduri R.; Joyner, Michael J.

    2015-01-01

    The carotid bodies are sensory organs that detect the chemical composition of the arterial blood. The carotid body sensory activity increases in response to arterial hypoxemia and the ensuing chemoreflex regulates vital homeostatic functions. Recent studies suggest that the carotid bodies might also sense arterial blood glucose and circulating insulin levels. This review focuses on how the carotid bodies sense O2, glucose, and insulin and some potential implications of these sensory functions on physiological regulation and in pathophysiological conditions. Emerging evidence suggests that carbon monoxide (CO)-regulated hydrogen sulfide (H2S), stemming from hypoxia, depolarizes type I cells by inhibiting certain K+ channels, facilitates voltage-gated Ca2+ influx leading to sensory excitation of the carotid body. Elevated CO and decreased H2S renders the carotid bodies insensitive to hypoxia resulting in attenuated ventilatory adaptations to high altitude hypoxia, whereas reduced CO and high H2S result in hypersensitivity of the carotid bodies to hypoxia and hypertension. Acute hypoglycemia augments the carotid body responses to hypoxia but that a prolonged lack of glucose in the carotid bodies can lead to a failure to sense hypoxia. Emerging evidence also indicates that carotid bodies might sense insulin directly independent of its effect on glucose, linking the carotid bodies to the pathophysiological consequences of the metabolic syndrome. How glucose and insulin interact with the CO-H2S signaling is an area of ongoing study. PMID:25642193

  1. Epistaxis as a rare presenting feature of glomus tympanicum.

    PubMed

    Tatla, T; Savy, L E; Wareing, M J

    2003-07-01

    Glomus tumours are the most common primary neoplasms of the middle ear, typically benign and slowly progressive. Pulsatile tinnitus and ipsilateral hearing loss are the most common symptoms at presentation by far; otalgia, aural fullness and otorrhoea being less frequent. A case of primary glomus tympanicum presenting with recurrent epistaxis, previously unreported in the literature, is described and associated imaging presented. PMID:12901820

  2. [Glomus tumor of the finger pulp: an unusual pediatric case].

    PubMed

    Abbassi, A; Amrani, A; Dendane, M A; El Alami, Z; El Madhi, T; Gourinda, H

    2012-07-01

    Glomus tumor is a rare benign tumor. Diagnosis is often delayed because of the absence of specific symptoms and confirmation can only be made by histological study. Treatment is always surgical. We report a clinical case of glomus tumor of the thumb pulp in a 6-year-old girl, and we discuss clinical, radiological and histological aspects of this tumor. PMID:22727476

  3. Extracutaneous glomus tumour of the trachea

    PubMed Central

    Łochowski, Mariusz Piotr; Jesionek-Kupnicka, Dorota; Kozak, Józef

    2015-01-01

    A 38-year-old man presenting expiratory stridor and high-grade dyspnoea was admitted to hospital in Lodz in February 2013. Chest radiographs and computed tomography scans showed a solid lesion in the upper part of the trachea occluding 85% of the airway lumen. A segmental resection of the trachea with a subsequent end-to-end anastomosis was performed. Histopathology showed an extracutaneous glomus tumour. There were no postoperative complications. Tracheal resection is the primary curative method in cases of this rare tumour. PMID:26702289

  4. Intravascular extra-digital glomus tumor of the forearm

    PubMed Central

    Muneer, Mohammed; Alkhafaji, Ali; El-Menyar, Ayman; Al-Hetmi, Talal; Al-Basti, Habib; Al-Thani, Hassan

    2016-01-01

    Intravascular glomus tumor in the forearm is very rare and usually presents with persistent pain and focal tenderness. The diagnosis of this condition can be easily missed or delayed. There is no successful treatment so far other than surgical excision in most of cases. We presented a 45-year-old female presented with intravascular glomus tumor in her left forearm. The swelling was excised and the post-operative course was uneventful. Intravascular glomus tumor of the forearm is extremely rare and the persistent pain and tenderness are very suspicious. Diagnostic imaging may not be indicated in every case. PMID:27421300

  5. Anaesthetic management of left main bronchial glomus tumour

    PubMed Central

    Krishnakumar, Mathangi; Sharma, Rammurti; Pawar, Harshwardhan Singh; Hasnain, Shahbaz

    2016-01-01

    Glomus tumours involving bronchus are rare. Surgical resection is the treatment of choice for this tumour, with excellent prognosis. The nature and location of tumour pose a significant challenge for perioperative anaesthetic management. However, there is a paucity of case reports on anaesthetic risks involved in case of a bronchial glomus tumour. We present a case of glomus tumour involving left main stem bronchus, subjected to bronchial sleeve resection. The various anaesthetic implications of this tumour type and airway management with right double lumen tube are discussed. PMID:27141112

  6. Glomus Tumor Causing Anterior Thigh Pain: A Case Report

    PubMed Central

    So, Sang Young; Kim, Byng Mook; Lee, Sun Yeul; Shin, Yong Sup; Lee, Won Hyung

    2014-01-01

    Glomus tumors are a rare, benign neoplasm and 75% exist in the subungual region. Extradigital glomus tumors are much more difficult to diagnose because of their atypical location and symptoms. Furthermore, if their symptoms are similar to neuropathic pain, the patient can suffer from misdirected treatment due to misdiagnosis. It is essential to perform careful evaluation of the lesion itself in order to reduce misdiagnosis. Ultrasonography is a useful, non-invasive method that can be easily performed in the pain clinic for local evaluation and diagnosis. We report a case of misdiagnosed glomus tumor in the thigh which was properly diagnosed after ultrasonography. PMID:24748947

  7. Multiple glomus tumors and segmental neurofibromatosis: there are no coincidences.

    PubMed

    Cabral, Rita; Santiago, F; Tellechea, O

    2011-01-01

    Segmental neurofibromatosis is a rare subtype of neurofibromatosis type 1 (NF1). Glomus tumors are uncommon benign tumors. The authors report the association between these two rare conditions, not yet reported. PMID:21426870

  8. Carotid Artery Disease

    MedlinePlus

    ... from the NHLBI on Twitter. What Is Carotid Artery Disease? Carotid artery disease is a disease in ... blood to your face, scalp, and neck. Carotid Arteries Figure A shows the location of the right ...

  9. Radiosurgery of Glomus Jugulare Tumors: A Meta-Analysis

    SciTech Connect

    Guss, Zachary D.; Batra, Sachin; Limb, Charles J.; Li, Gordon; Sughrue, Michael E.; Redmond, Kristin; Rigamonti, Daniele; Parsa, Andrew T.; Chang, Steven; Kleinberg, Lawrence; Lim, Michael

    2011-11-15

    Purpose: During the past two decades, radiosurgery has arisen as a promising approach to the management of glomus jugulare. In the present study, we report on a systematic review and meta-analysis of the available published data on the radiosurgical management of glomus jugulare tumors. Methods and Materials: To identify eligible studies, systematic searches of all glomus jugulare tumors treated with radiosurgery were conducted in major scientific publication databases. The data search yielded 19 studies, which were included in the meta-analysis. The data from 335 glomus jugulare patients were extracted. The fixed effects pooled proportions were calculated from the data when Cochrane's statistic was statistically insignificant and the inconsistency among studies was <25%. Bias was assessed using the Egger funnel plot test. Results: Across all studies, 97% of patients achieved tumor control, and 95% of patients achieved clinical control. Eight studies reported a mean or median follow-up time of >36 months. In these studies, 95% of patients achieved clinical control and 96% achieved tumor control. The gamma knife, linear accelerator, and CyberKnife technologies all exhibited high rates of tumor and clinical control. Conclusions: The present study reports the results of a meta-analysis for the radiosurgical management of glomus jugulare. Because of its high effectiveness, we suggest considering radiosurgery for the primary management of glomus jugulare tumors.

  10. Anomalous course of the external carotid artery.

    PubMed

    Kawai, Katsushi

    2016-09-01

    The course and the branching patterns of the external carotid artery were investigated macroscopically in a total of 550 bodies or 1100 head sides of Japanese subjects, donated for student dissection at Kumamoto University from 1994 to 2014. With the exception of 14 head sides, the external carotid arteries running between the posterior belly of the digastric and stylohyoid muscles were found in 42 (3.87 %) out of 1086 head sides. Strictly speaking, they passed between the stylohyoid muscle and the stylohyoid branch of the facial nerve in 23 out of these 42 head sides. In the remaining 19 instances, the stylohyoid branch of the facial nerve was cut and its relationship to the external carotid artery was not clear. The external carotid artery running lateral to the intact stylohyoid branch of the facial nerve, medial to the digastric muscle was not found. The external carotid arteries running lateral to the digastric muscle were found in 4 (0.37 %) out of 1086 head sides. As a result, it is proposed that plural, potential courses of the external carotid artery originally exist and that some parts of such potential courses remain as branches of the external carotid artery in the usual instance, while the anomalous courses of the external carotid artery are induced mainly by anastomosis between the muscular branches supplying the wall of the head and neck in contrast to the usual external carotid artery induced mainly by the branches originally supplying the pharynx. PMID:26439732

  11. Carotid artery anatomy (image)

    MedlinePlus

    There are four carotid arteries, two on each side of the neck: right and left internal carotid arteries, and right and left external carotid arteries. The carotid arteries deliver oxygen-rich blood from the heart to the head and brain.

  12. A Glomus Tumour of the Elbow: A Case Report and Review of the Literature

    PubMed Central

    Anley, Cameron; Vrettos, Basil; Roche, Stephen; Solomons, Michael

    2013-01-01

    Extradigital glomus tumours are relatively uncommon. We present a case report of a glomus tumour of the elbow and review of the literature with regards to the clinical features, work-up and management of these tumours, to highlight the importance of considering a glomus tumour as part of the differential diagnosis in patient with atypical pain around the elbow.

  13. [Glomus tumor of volar elbow capsule. Case report].

    PubMed

    Burnier, M; Erhard, L

    2014-02-01

    Glomus tumors are rare tumors, benign but painful and responsible for a major functional impairment. Although their preferential localization is digital, 35% of glomus tumors are extradigital. Ignorance of this disease characterized by atypical clinical signs and the absence of specific imaging are responsible for a significant diagnostic delay, 7 to 10 years in extradigital forms. Treatment by surgical excision simply ensures immediate disappearance of pain without recurrence in 90% of cases. It is therefore necessary to emphasize the existence of this sometimes debilitating condition benefiting from effective therapeutic solution. We report the case of a glomus tumor of the anterior capsule of the left elbow in a 24-year-old woman with a diagnostic delayed by 12 years. PMID:24394237

  14. Carotid baroreflex responsiveness in heat-stressed humans

    NASA Technical Reports Server (NTRS)

    Crandall, C. G.

    2000-01-01

    The effects of whole body heating on human baroreflex function are relatively unknown. The purpose of this project was to identify whether whole body heating reduces the maximal slope of the carotid baroreflex. In 12 subjects, carotid-vasomotor and carotid-cardiac baroreflex responsiveness were assessed in normothermia and during whole body heating. Whole body heating increased sublingual temperature (from 36.4 +/- 0.1 to 37.4 +/- 0.1 degrees C, P < 0.01) and increased heart rate (from 59 +/- 3 to 83 +/- 3 beats/min, P < 0. 01), whereas mean arterial blood pressure (MAP) was slightly decreased (from 88 +/- 2 to 83 +/- 2 mmHg, P < 0.01). Carotid-vasomotor and carotid-cardiac responsiveness were assessed by identifying the maximal gain of MAP and heart rate to R wave-triggered changes in carotid sinus transmural pressure. Whole body heating significantly decreased the responsiveness of the carotid-vasomotor baroreflex (from -0.20 +/- 0.02 to -0.13 +/- 0.02 mmHg/mmHg, P < 0.01) without altering the responsiveness of the carotid-cardiac baroreflex (from -0.40 +/- 0.05 to -0.36 +/- 0.02 beats x min(-1) x mmHg(-1), P = 0.21). Carotid-vasomotor and carotid-cardiac baroreflex curves were shifted downward and upward, respectively, to accommodate the decrease in blood pressure and increase in heart rate that accompanied the heat stress. Moreover, the operating point of the carotid-cardiac baroreflex was shifted closer to threshold (P = 0.02) by the heat stress. Reduced carotid-vasomotor baroreflex responsiveness, coupled with a reduction in the functional reserve for the carotid baroreflex to increase heart rate during a hypotensive challenge, may contribute to increased susceptibility to orthostatic intolerance during a heat stress.

  15. Inhibition of [3H]catecholamine release and Ca2+ currents by prostaglandin E2 in rabbit carotid body chemoreceptor cells.

    PubMed Central

    Gómez-Niño, A; López-López, J R; Almaraz, L; González, C

    1994-01-01

    Basal release of [3H]catecholamine ([3H]CA) from rabbit carotid bodies (CBs), previously incubated in the presence of [3H]tyrosine, was not significantly modified by prostaglandin E2 (PGE2). On the contrary, PGE2 (3-300 nM) produced a dose-dependent inhibition of the low PO2-evoked release of [3H]CA. The inhibition was greatest (55%) at a low intensity of hypoxic stimulation (incubating solution PO2 approximately 66 mmHg) and decreased with increasing intensities of hypoxia. Chronic denervation of the CB did not modify the response to PGE2. The release of [3H]CA induced by incubating the CBs in a hypercapnic-acidic solution (PCO2 approximately 132 mmHg; pH = 6.60) and by dinitrophenol (100 microM) was not significantly modified by 300 nM PGE2. PGE2 (300 nM) inhibited the release of [3H]CA elicited by incubating the CBs in a high K+ (35 mM)-containing solution. The release response elicited by high K+ (25 mM) was strongly augmented by a dihydropyridine agonist of Ca2+ channels, Bay K 8644, at a concentration of 1 microM. The Bay K 8644 effect was partly inhibited by PGE2 (300 nM). Using whole-cell recordings in freshly dispersed or short-term cultured chemoreceptor cells from adult rabbits it was found that Ca2+ currents (ICa) were reversibly inhibited by bath application of PGE2. A good parallelism exits between the dose-response curves for PGE2 inhibition of ICa in isolated chemoreceptor cells and high extracellular [K+]- or hypoxia-evoked release of [3H]CA from the whole CB.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7519263

  16. Carotid Artery Disease

    MedlinePlus

    ... brain with blood. If you have carotid artery disease, the arteries become narrow, usually because of atherosclerosis. ... one of the causes of stroke. Carotid artery disease often does not cause symptoms, but there are ...

  17. Carotid artery disease

    MedlinePlus

    ... you have had a stroke or TIA, a nervous system (neurological) exam will show other problems. You may also have the following tests: Blood cholesterol and triglycerides test Blood sugar (glucose) test Ultrasound of the carotid arteries ( carotid ...

  18. Carotid artery surgery - discharge

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000238.htm Carotid artery surgery - discharge To use the sharing features on this page, please enable JavaScript. You had carotid artery surgery to restore proper blood flow to your ...

  19. Carotid artery surgery - slideshow

    MedlinePlus

    ... page: //medlineplus.gov/ency/presentations/100124.htm Carotid artery surgery - series To use the sharing features on ... 4 Normal anatomy Overview There are four carotid arteries, with a pair located on each side of ...

  20. Carotid sinus syndrome.

    PubMed

    Mallet, Mark

    2003-02-01

    This article reviews the recent literature about carotid sinus syndrome. It looks principally at the various ways in which it may present, the limited knowledge of its pathophysiology, and the role of carotid sinus massage in the investigation of carotid sinus syndrome. PMID:12619336

  1. Carotid endarterectomy or stenting?

    PubMed Central

    Ng, P Y

    2009-01-01

    The relative role of surgical or endovascular treatment in carotid stenosis remains controversial. Results of recent studies add even more confusion to the debate. Major clinical trials so far have shown a wide range of complication rates for carotid endarterectomy and carotid stenting. Only surgeons or interventionists who can maintain a complication rate of 3% or below should consider treating patients with asymptomatic disease.

  2. Molecular identification of Kvα subunits that contribute to the oxygen-sensitive K+ current of chemoreceptor cells of the rabbit carotid body

    PubMed Central

    Sanchez, Diego; López-López, Jose R; Pérez-García, M Teresa; Sanz-Alfayate, Gloria; Obeso, Ana; Ganfornina, Maria D; Gonzalez, Constancio

    2002-01-01

    Rabbit carotid body (CB) chemoreceptor cells possess a fast-inactivating K+ current that is specifically inhibited by hypoxia. We have studied the expression of Kvα subunits, which might be responsible for this current. RT-PCR experiments identified the expression of Kv1.4, Kv3.4, Kv4.1 and Kv4.3 mRNAs in the rabbit CB. There was no expression of Kv3.3 or Kv4.2 transcripts. Immunocytochemistry with antibodies to tyrosine hydroxylase (anti-TH) and to specific Kv subunits revealed the expression of Kv3.4 and Kv4.3 in chemoreceptor cells, while Kv1.4 was only found in nerve fibres. Kv4.1 mRNA was also found in chemoreceptor cells following in situ hybridization combined with anti-TH antibody labelling. Kv4.1 and Kv4.3 appeared to be present in all chemoreceptor cells, but Kv3.4 was only expressed in a population of them. Electrophysiological experiments applying specific toxins or antibodies demonstrated that both Kv3.4 and Kv4.3 participate in the oxygen-sensitive K+ current of chemoreceptor cells. However, toxin application experiments confirmed a larger contribution of members of the Kv4 subfamily. [Ca2+]i measurements under hypoxic conditions and immunocytochemistry experiments in dispersed CB cells demonstrated the expression of Kv3.4 and Kv4.3 in oxygen-sensitive cells; the presence of Kv3.4 in the chemoreceptor cell membrane was not required for the response to low PO2. In summary, three Kv subunits (Kv3.4, Kv4.1 and Kv4.3) may be involved in the fast-inactivating outward K+ current of rabbit CB chemoreceptor cells. The homogeneous distribution of the Kv4 subunits in chemoreceptor cells, along with their electrophysiological properties, suggest that Kv4.1, Kv4.3, or their heteromultimers, are the molecular correlate of the oxygen-sensitive K+ channel. PMID:12122138

  3. Growth Rate Analysis of an Untreated Glomus Vagale on MRI

    PubMed Central

    Wang, Jeffrey Tzu-Yu; Wang, Allen Yu-Yu; Cheng, Sheila; Gomes, Lavier; Da Cruz, Melville

    2016-01-01

    Paragangliomas are slow growing, hypervascular neuroendocrine tumors that develop in the extra-adrenal paraganglion tissues. Paraganglioma involving the vagus nerve ganglia is termed glomus vagale. The slow growth of head and neck paragangliomas especially in the absence of symptom may obviate the necessity for any active intervention, in which case, a “wait and scan” policy is implemented involving long-term clinical and radiologic follow-ups. We present a case of a 71-year-old female with an untreated left glomus vagale who underwent a conservative “wait and rescan” plan of management and the tumor was observed with 8 serial MRI scans over a period of 7.4 years. A growth rate analysis was conducted which demonstrated a slow growth. A literature review of radiologic studies examining the natural history of head and neck paragangliomas was also performed. PMID:27073708

  4. A metastatic glomus jugulare tumor. A temporal bone report

    SciTech Connect

    El Fiky, F.M.; Paparella, M.M.

    1984-01-01

    The clinicopathologic findings in the temporal bone of a patient with a highly malignant metastasizing glomus jugulare tumor are reported. The patient exhibited all the symptoms of primary malignant tumors of the ear, including facial paralysis, otorrhea, pain, hearing loss, tinnitus, dizziness, and vertigo. He was treated with cobalt irradiation followed by radium implant in the ear canal for a residual tumor; then a left-sided radical mastoidectomy was performed.

  5. In vitro activation of cyclo-oxygenase in the rabbit carotid body: effect of its blockade on [3H]catecholamine release.

    PubMed Central

    Gómez-Niño, A; Almaraz, L; González, C

    1994-01-01

    The release of prostaglandin E2 (PGE2) from rabbit carotid bodies (CBs) incubated in basal conditions (PO2 approximately 132 mmHg; PCO2 approximately 33 mmHg; pH = 7.42) amounts to 94.4 +/- 10.1 pg (mg protein)-1 (10 min)-1 (mean +/- S.E.M.). Incubation of the CB in a hypoxic solution (PO2 approximately 46 mmHg) produced a significant 40% increase (P < 0.05) in the release of PGE2. Indomethacin (2 microM) prevented the hypoxia-induced release of PGE2. Sensory plus sympathetic denervation of the CB 4 days prior to the experiments did not modify either basal or low PO2-induced PGE2 release, indicating that intraglomic nerve endings are not significant sources for the PGE2 released. Incubation of the CB in an acidic-hypercapnic solution (PO2 approximately 132 mmHg; PCO2 approximately 132 mmHg; pH = 6.60) or in a high K(+)-containing solution (35 mM) was also effective in promoting an increase in the outflow of PGE2 from the organs. The release of [3H]catecholamines ([3H]CA) from the CB elicited by incubating the organs in low PO2 solutions (PO2 ranged between 66 and 13 mmHg) was potentiated by two inhibitors of cyclo-oxygenase, acetylsalicylic acid (ASA, 100 microM) and indomethacin (2 microM). The effect persisted after chronic denervation of the organ. The secretory response elicited by acidic stimuli was also augmented by cyclo-oxygenase inhibitors. Thus, [3H]CA release elicited by incubating the CBs in the acidic-hypercapnic solution increased by 300% in the presence of indomethacin (2 microM), and ASA (100 microM) more than doubled the release induced by dinitrophenol (100 microM), a protonophore that mimics an acidic stimulus. Indomethacin, but not ASA, moderately increased the high K(+)-evoked [3H]CA release. The effect of indomethacin on the release of [3H]CA elicited by acidic and hypoxic stimuli was reversed by PGE2 in a dose-dependent manner (0.3-300 nM). These results show that low PO2 and high PCO2-low pH, the natural stimuli to the CB, as well as high

  6. Living with Carotid Artery Disease

    MedlinePlus

    ... from the NHLBI on Twitter. Living With Carotid Artery Disease If you have carotid artery disease, you can take steps to manage the ... treatment plan, and getting ongoing care. Having carotid artery disease raises your risk of having a stroke . ...

  7. [Carotid atherosclerosis and dementia].

    PubMed

    Harlé, Louise-Marine; Plichart, Matthieu

    2015-09-01

    Over the past decade a growing interest has been devoted to exploring the role of atherosclerosis in the development of dementia. Despite a well-known association between atherosclerosis risk factors in middle-life with later cognitive decline, the pathophysiological pathways underlying this association remain unclear. The current hypothesis is that neurodegenerative and vascular lesions coexist and have a synergistic role in the development of cognitive impairment and dementia. Carotid atherosclerosis (e.g. carotid plaques and intima-media thickness as measured by carotid ultrasonography) has been associated with cognitive decline and dementia and may help to better understand the complex interaction between the vascular and neurodegenerative processes. Furthermore, carotid atherosclerosis has been used in the recent field for dementia risk prediction. In this review, we discuss the physiopathological implications from the current available data on the relationship between carotid atherosclerosis and dementia as well as the interest of carotid biomarkers for individual dementia risk prediction. PMID:26395304

  8. Carotid Artery Disease

    MedlinePlus

    ... small balloon on its tip. They inflate the balloon at the blockage site in the carotid artery to flatten or compress the plaque against the artery wall. Carotid angioplasty is often combined with the placement of a small, metal, mesh-like device called a stent. When a stent is placed inside of a ...

  9. Glomus tumor of the anterior urethra: A rare case report and review of the literature

    PubMed Central

    HE, TAO; HU, JIA; JIN, LU; LI, YIFAN; LIU, JIAJU; DING, YU; LI, JIAN; TAO, LINGZHI; CHEN, ZEBO; NI, LIANGCHAO; YANG, SHANGQI; MAO, XIANGMING; LAI, YONGQING

    2016-01-01

    Glomus tumors are rare and benign neoplasms, which normally originate from peripheral soft tissue. To date, reported cases of glomus tumor occurring in genitourinary tract, particularly in the urethra, are exceedingly rare. The present study presented a rare case of glomus tumor of the anterior urethra in a 42 year-old male, his main complaints were a history of anterior urethra pain for 3 years, and a palpable and tender mass in the urethra for 2 weeks. Urethrocystoscopy examination and the resection of the urethral mass were performed. Pathological and immunohistochemical examination revealed that the mass was a benign glomus tumor. The patient remained in good condition by 6 month follow-up, and revealed no problems or recurrence following surgery. This is the first case, to the best of our knowledge, to present a glomus tumor occurring in a male's urethra and the present report provided a supplementary review for the previous cases and the literature. PMID:27284444

  10. Carotid stenting and endarterectomy.

    PubMed

    Yip, Hon-Kan; Sung, Pei-Hsun; Wu, Chiung-Jen; Yu, Cheuk-Man

    2016-07-01

    Stroke, either ischemic or hemorrhagic, remains the second commonest cause of death worldwide in the last decade. Etiologies for ischemic stroke (IS) vary widely. Atherothrombotic occlusion is an essential cause to which carotid artery stenosis (CAS) is a major contributor. Administration of anti-platelet agent to patients with CAS has been shown to reduce incidence of long-term IS. In additional, in patients with symptomatic CAS, clinical trials have demonstrated that carotid endarterectomy (CEA) is superior to medical therapy for prevention of future CAS-related IS. However, CEA is not suitable for CAS post-radiotherapy or those located at higher level of the internal carotid artery; and major complications of this procedure including cranial nerve injuries have stimulated the interest of using percutaneous transfemoral carotid stenting as an alternative approach. Although transfemoral arterial approach of carotid stenting is not inferior to CEA in improving clinical outcomes, it has been reported to be associated with vascular complication and has its limitations in patients with athero-occlusive disease of abdominal aorta or bilateral iliac arteries, level II or III aortic arch, or bovine type carotid arterial anatomy. Therefore, transradial/transbrachial arterial approach has emerged as a novel method for carotid stenting. This article provides a critical review on interventional approaches for the treatment of CAS. PMID:27061654

  11. Photoacoustic imaging of carotid artery atherosclerosis

    NASA Astrophysics Data System (ADS)

    Kruizinga, Pieter; van der Steen, Antonius F. W.; de Jong, Nico; Springeling, Geert; Robertus, Jan Lukas; van der Lugt, Aad; van Soest, Gijs

    2014-11-01

    We introduce a method for photoacoustic imaging of the carotid artery, tailored toward detection of lipid-rich atherosclerotic lesions. A common human carotid artery was obtained at autopsy, embedded in a neck mimicking phantom and imaged with a multimodality imaging system using interstitial illumination. Light was delivered through a 1.25-mm-diameter optical probe that can be placed in the pharynx, allowing the carotid artery to be illuminated from within the body. Ultrasound imaging and photoacoustic signal detection is achieved by an external 8-MHz linear array coupled to an ultrasound imaging system. Spectroscopic analysis of photoacoustic images obtained in the wavelength range from 1130 to 1250 nm revealed plaque-specific lipid accumulation in the collagen structure of the artery wall. These spectroscopic findings were confirmed by histology.

  12. Carotid artery surgery

    MedlinePlus

    ... Aspirin and heart disease Butter, margarine, and cooking oils Carotid artery surgery - discharge Cholesterol and ... by: Daniel Kantor, MD, Kantor Neurology, Coconut Creek, FL and Immediate Past President of the ...

  13. Angioplasty and stent placement - carotid artery

    MedlinePlus

    Carotid angioplasty and stenting; CAS; Angioplasty - carotid artery; Carotid artery stenosis - angioplasty; ... Carotid angioplasty and stenting (CAS) is done using a small surgical cut. Your surgeon will make a surgical cut in your groin after using some ...

  14. [Evaluation of carotid stenosis by using carotid ultrasonography].

    PubMed

    Seike, Nahoko; Ito, Michiko; Yasaka, Masahiro

    2010-12-01

    Carotid stenosis is observed in several diseases such as atherosclerosis, moyamoya disease, and aortitis. Carotid stenosis can be assessed using computed tomography (CT), magnetic resonance angiography (MRA), ultrasonography, or cerebral angiography. Carotid ultrasonography is superior to other modalities because it is a noninvasive, repeatable, and easy method that does not involve much cost. The intima-media complex thickness (IMT) can be easily measured using carotid ultrasonography. The incidence of cerebral and cardiovascular events increases with increase in the thickness of the IMT. The percentage of stenosis was expressed using the NASCET, ECST, or area methods. The NASCET criterion of 70% stenosis for performing carotid endarterectomy for symptomatic carotid stenosis corresponded to 85% ECST stenosis, 90% area stenosis, and 200 cm/sec of peak systolic velocity. Carotid ultrasonography provides information on not only carotid stenosis but also unstable plaques such as ulcer, hypoechoic plaque, thin fibrous cap, and mobile plaque. In patients with moyamoya disease, carotid ultrasonography often reveals that the diameter of the internal carotid artery (ICA) is greatly reduced at the proximal portion above the bulbus (resembling a champagne bottle neck) and is less than 50% that of the common carotid artery (champagne bottle neck sign); the diameter of the ICA is smaller than that of the external carotid artery (diameter reversal sign). In patients with aortitis, IMT thickness is frequently observed at the common carotid artery (Macaroni sign) but not at the ICA. PMID:21139180

  15. Screening for Carotid Artery Stenosis

    MedlinePlus

    ... Task Force learned about the potential benefits and harms of screening for carotid artery stenosis: Health professionals ... blood flow through the arteries. Potential Benefits and Harms of Carotid Artery Stenosis Screening and Treatment The ...

  16. Malignant glomus tumor with oncocytic features: an unusual presentation of dysphagia.

    PubMed

    Ugras, Nesrin; Yercİ, Ömer; Yalçınkaya, Ulviye; Gülcü, Barış; Öztürk, Ersin; Yıldırım, Çınar; Çavuşoğlu, İlkin

    2015-07-01

    Glomus tumors in the gastrointestinal tract are unusual, as the previous series in the literature have been mainly limited to the stomach. Less than 10 cases of esophageal glomus tumors have been described in the literature. Oncocytic glomus tumors are a recently identified, rare variant of the glomus tumor. We report a 47-year-old female who presented with an approximately 3-month history of dysphagia and weight loss. Upper gastrointestinal endoscopy showed a black-purple, hypervascular, protruding lesion measuring approximately 65 mm at the 37th cm of the esophagus. The patient underwent an Ivor Lewis operation via open thoracotomy. The resected specimen had a protuberant, ulcerated mass measuring 80 × 35 mm in the posterior wall of the esophagus. Based on the histopathological, immunohistochemical and electron microscope findings, the final diagnosis was a malignant glomus tumor with oncocytic features. To our knowledge, this is the first report of a malignant glomus tumor with oncocytic features in an esophageal location. PMID:25908295

  17. Common Carotid Intima Media Thickness and Ankle-Brachial Pressure Index Correlate with Local but Not Global Atheroma Burden: A Cross Sectional Study Using Whole Body Magnetic Resonance Angiography

    PubMed Central

    Weir-McCall, Jonathan R.; Khan, Faisel; Lambert, Matthew A.; Adamson, Carly L.; Gardner, Michael; Gandy, Stephen J.; Ramkumar, Prasad Guntur; Belch, Jill J. F.; Struthers, Allan D.; Rauchhaus, Petra; Morris, Andrew D.; Houston, J. Graeme

    2014-01-01

    Background Common carotid intima media thickness (CIMT) and ankle brachial pressure index (ABPI) are used as surrogate marker of atherosclerosis, and have been shown to correlate with arterial stiffness, however their correlation with global atherosclerotic burden has not been previously assessed. We compare CIMT and ABPI with atheroma burden as measured by whole body magnetic resonance angiography (WB-MRA). Methods 50 patients with symptomatic peripheral arterial disease were recruited. CIMT was measured using ultrasound while rest and exercise ABPI were performed. WB-MRA was performed in a 1.5T MRI scanner using 4 volume acquisitions with a divided dose of intravenous gadolinium gadoterate meglumine (Dotarem, Guerbet, FR). The WB-MRA data was divided into 31 anatomical arterial segments with each scored according to degree of luminal narrowing: 0 = normal, 1 = <50%, 2 = 50–70%, 3 = 70–99%, 4 = vessel occlusion. The segment scores were summed and from this a standardized atheroma score was calculated. Results The atherosclerotic burden was high with a standardised atheroma score of 39.5±11. Common CIMT showed a positive correlation with the whole body atheroma score (β 0.32, p = 0.045), however this was due to its strong correlation with the neck and thoracic segments (β 0.42 p = 0.01) with no correlation with the rest of the body. ABPI correlated with the whole body atheroma score (β −0.39, p = 0.012), which was due to a strong correlation with the ilio-femoral vessels with no correlation with the thoracic or neck vessels. On multiple linear regression, no correlation between CIMT and global atheroma burden was present (β 0.13 p = 0.45), while the correlation between ABPI and atheroma burden persisted (β −0.45 p = 0.005). Conclusion ABPI but not CIMT correlates with global atheroma burden as measured by whole body contrast enhanced magnetic resonance angiography in a population with symptomatic peripheral

  18. Urgent Intracranial Carotid Artery Decompression after Penetrating Head Injury

    PubMed Central

    Kim, Seong Joon

    2013-01-01

    We describe a case of intracranial carotid artery occlusion due to penetrating craniofacial injury by high velocity foreign body that was relieved by decompressive surgery. A 46-year-old man presented with a penetrating wound to his face. A piece of an electric angular grinder disc became lodged in the anterior skull base. Computed tomography revealed that the disc had penetrated the unilateral paraclinoid and suprasellar areas without flow of the intracranial carotid artery on the lesion side. The cavernous sinus was also compromised. Removal of the anterior clinoid process reopened the carotid blood flow, and the injection of glue into the cavernous sinus restored complete hemostasis during extraction of the fragment from the face. Digital subtraction angiography revealed complete recanalization of the carotid artery without any evidence of dissection. Accurate diagnosis regarding the extent of the compromised structures and urgent decompressive surgery with adequate hemostasis minimized the severity of penetrating damage in our patient. PMID:23634269

  19. Carotid Artery Disease

    MedlinePlus

    ... and efficacy continues to be studied in several medical centers. This procedure involves the placement of a small flexible tube (catheter) into an artery from the groin. The catheter is then directed to the neck to reach the carotid artery blockage. A balloon pushes open the artery wall and a stent ( ...

  20. Carotid Artery Screening

    MedlinePlus

    ... or radiologist then places the transducer on the skin in various locations, sweeping over the area of interest or angling the sound beam from a different location to better see an area of concern. Doppler sonography and Carotid IMT US are performed using the ...

  1. A phosphate transporter from the mycorrhizal fungus Glomus versiforme.

    PubMed

    Harrison, M J; van Buuren, M L

    1995-12-01

    Vesicular-arbuscular (VA) mycorrhizal fungi form symbiotic associations with the roots of most terrestrial plants, including many agriculturally important crop species. The fungi colonize the cortex of the root to obtain carbon from their plant host, while assisting the plant with the uptake of phosphate and other mineral nutrients from the soil. This association is beneficial to the plant, because phosphate is essential for plant growth and development, especially during growth under nutrient-limiting conditions. Molecular genetic studies of these fungi and their interaction with plants have been limited owing to the obligate symbiotic nature of the VA fungi, so the molecular mechanisms underlying fungal-mediated uptake and translocation of phosphate from the soil to the plant remain unknown. Here we begin to investigate this process by identifying a complementary DNA that encodes a transmembrane phosphate transporter (GvPT) from Glomus versiforme, a VA mycorrhizal fungus. The function of the protein encoded by GvPT was confirmed by complementation of a yeast phosphate transport mutant. Expression of GvPT was localized to the external hyphae of G. versiforme during mycorrhizal associations, these being the initial site of phosphate uptake from the soil. PMID:8524398

  2. Carotid-cardiac baroreflex influence on forearm vascular resistance during low level LBNP

    NASA Technical Reports Server (NTRS)

    Ludwig, David

    1990-01-01

    Twelve healthy males were tested at low levels of lower body negative pressure (LBNP) with and without artificial stimulation of the carotid-cardiac baroreceptors. The carotid-cardiac baroreceptors were stimulated by applying a pressure of 10 mmHg to the carotid artery via a pressurized neck chamber. During the procedure, forearm blood flow (FBF) and forearm vascular resistance (FVR) were measured using a Whitney mercury silastic strain gauge technique. FBF decreased while FVR increased with increased intensity of LBNP. Both FBF and FVR were unaffected by carotid-cardiac baroreceptor stimulation.

  3. Effects of Arbuscular-Mycorrhizal Glomus Species on Drought Tolerance: Physiological and Nutritional Plant Responses

    PubMed Central

    Ruiz-Lozano, J. M.; Azcon, R.; Gomez, M.

    1995-01-01

    The tolerance of lettuce plants (Lactuca sativa L. cv. Romana) to drought stress differed with the arbuscular-mycorrhizal fungal isolate with which the plants were associated. Seven fungal species belonging to the genus Glomus were studied for their ability to enhance the drought tolerance of lettuce plants. These fungi had different traits that affected the drought resistance of host plants. The ranking of arbuscular-mycorrhizal fungal effects on drought tolerance, based on the relative decreases in shoot dry weight, was as follows: Glomus deserticola > Glomus fasciculatum > Glomus mosseae > Glomus etunicatum > Glomus intraradices > Glomus caledonium > Glomus occultum. In this comparative study specific mycorrhizal fungi had consistent effects on plant growth, mineral uptake, the CO(inf2) exchange rate, water use efficiency, transpiration, stomatal conductance, photosynthetic phosphorus use efficiency, and proline accumulation under either well-watered or drought-stressed conditions. The ability of the isolates to maintain plant growth effectively under water stress conditions was related to higher transpiration rates, levels of leaf conductance, and proline, N, and P contents. Differences in proline accumulation in leaves among the fungal symbioses suggested that the fungi were able to induce different degrees of osmotic adjustment. The detrimental effects of drought were not related to decreases in photosynthesis or water use efficiency. Neither of these parameters was related to P nutrition. The differences in P and K acquisition, transpiration, and stomatal conductance were related to the mycorrhizal efficiencies of the different fungi. Our observations revealed the propensities of different Glomus species to assert their protective effects during plant water stress. The greater effectiveness of G. deserticola in improving water deficit tolerance was associated with the lowest level of growth reduction (9%) under stress conditions. The growth of plants

  4. An extremely rare case of a glomus tumor in the popliteal fossa.

    PubMed

    Kawanami, Katsuhisa; Matsuo, Toshihiro; Deie, Masataka; Izuta, Yasunori; Wakao, Norimitsu; Kamiya, Mitsuhiro; Hirasawa, Atsuhiko

    2016-12-01

    Glomus tumors are the benign perivascular tumors that typically present with hypersensitivity to cold, paroxysmal severe pain, and pinpoint tenderness. This tumor is usually subungual lesions and accounts for 1.6% of all soft-tissue tumors. However, extradigital glomus tumors are extremely rare and can be difficult to diagnose, as they typically have a diameter of less than about 1 cm. We report a glomus tumor in the popliteal fossa of a 17-year-old male patient who experienced severe posterior knee pain while playing sports. A physical examination did not reveal a mass, although a glomus tumor was identified in the popliteal fossa using magnetic resonance imaging. We successfully performed open excision to remove the tumor, and the patient achieved a restored postoperative gait and could perform sports activities with no pain. These tumors are extremely rare in the knee area, and typically have a diameter of less than about 1 cm, which can complicate their diagnosis and treatment, despite the presence of severe pain. Therefore, we recommend that clinicians be aware of extradigital glomus tumors, as careful imaging can facilitate an early diagnosis and treatment. PMID:27408511

  5. How Can Carotid Artery Disease Be Prevented?

    MedlinePlus

    ... from the NHLBI on Twitter. How Can Carotid Artery Disease Be Prevented? Taking action to control your risk factors can help prevent or delay carotid artery disease and stroke . Your risk for carotid artery ...

  6. Management of Carotid Artery Trauma

    PubMed Central

    Lee, Thomas S.; Ducic, Yadranko; Gordin, Eli; Stroman, David

    2014-01-01

    With increased awareness and liberal screening of trauma patients with identified risk factors, recent case series demonstrate improved early diagnosis of carotid artery trauma before they become problematio. There remains a need for unified screening criteria for both intracranial and extracranial carotid trauma. In the absence of contraindications, antithrombotic agents should be considered in blunt carotid artery injuries, as there is a significant risk of progression of vessel injury with observation alone. Despite CTA being used as a common screening modality, it appears to lack sufficient sensitivity. DSA remains to be the gold standard in screening. Endovascular techniques are becoming more widely accepted as the primary surgical modality in the treatment of blunt extracranial carotid injuries and penetrating/blunt intracranial carotid lessions. Nonetheless, open surgical approaches are still needed for the treatment of penetrating extracranial carotid injuries and in patients with unfavorable lesions for endovascular intervention. PMID:25136406

  7. Obesity and carotid artery remodeling

    PubMed Central

    Kozakova, M; Palombo, C; Morizzo, C; Højlund, K; Hatunic, M; Balkau, B; Nilsson, P M; Ferrannini, E

    2015-01-01

    Background/Objective: The present study tested the hypothesis that obesity-related changes in carotid intima-media thickness (IMT) might represent not only preclinical atherosclerosis but an adaptive remodeling meant to preserve circumferential wall stress (CWS) in altered hemodynamic conditions characterized by body size-dependent increase in stroke volume (SV) and blood pressure (BP). Subjects/Methods: Common carotid artery (CCA) luminal diameter (LD), IMT and CWS were measured in three different populations in order to study: (A) cross-sectional associations between SV, BP, anthropometric parameters and CCA LD (266 healthy subjects with wide range of body weight (24–159 kg)); (B) longitudinal associations between CCA LD and 3-year IMT progression rate (ΔIMT; 571 healthy non-obese subjects without increased cardiovascular (CV) risk); (C) the impact of obesity on CCA geometry and CWS (88 obese subjects without CV complications and 88 non-obese subjects matched for gender and age). Results: CCA LD was independently associated with SV that was determined by body size. In the longitudinal study, baseline LD was an independent determinant of ΔIMT, and ΔIMT of subjects in the highest LD quartile was significantly higher (28±3 μm) as compared with those in the lower quartiles (8±3, 16±4 and 16±3 μm, P=0.001, P<0.05 and P=0.01, respectively). In addition, CCA CWS decreased during the observational period in the highest LD quartile (from 54.2±8.6 to 51.6±7.4 kPa, P<0.0001). As compared with gender- and age-matched lean individuals, obese subjects had highly increased CCA LD and BP (P<0.0001 for both), but only slightly higher CWS (P=0.05) due to a significant increase in IMT (P=0.005 after adjustment for confounders). Conclusions: Our findings suggest that in obese subjects, the CCA wall thickens to compensate the luminal enlargement caused by body size-induced increase in SV, and therefore, to normalize the wall stress. CCA diameter in obesity could

  8. Unusual presentation of glomus tympanicum tumour: New bone formation in the middle ear.

    PubMed

    Kumar, Gaurav; Andreou, Zenon; Virk, Jagdeep Singh; Owa, Anthony

    2014-09-16

    The objective of this study is to increase awareness of the rare presentation, diagnostic difficulties and management of glomus tympanicum of the middle ear. A 49 years old male, with a background of hypertension and epilepsy, presented with a two month history of left sided conductive hearing loss, pulsatile tinnitus and headache. Clinically and radiologically a diagnosis of glomus tympanicum was made. Intraoperatively, extensive osteogenesis of the middle ear resulting in ossicular fixation and erosion was found. This patient required a two stage operation for full clearance of disease. A stapedectomy drill was used to drill off the bony overgrowth surrounding the ossicles resulting in improved hearing thresholds and full clearance of the disease at two year follow up. Glomus tympanicum can result in new bone formation in the middle ear with resultant ossicular fixation and conductive hearing loss. This can be effectively treated surgically with restoration of hearing. PMID:25232551

  9. Unusual presentation of glomus tympanicum tumour: New bone formation in the middle ear

    PubMed Central

    Kumar, Gaurav; Andreou, Zenon; Virk, Jagdeep Singh; Owa, Anthony

    2014-01-01

    The objective of this study is to increase awareness of the rare presentation, diagnostic difficulties and management of glomus tympanicum of the middle ear. A 49 years old male, with a background of hypertension and epilepsy, presented with a two month history of left sided conductive hearing loss, pulsatile tinnitus and headache. Clinically and radiologically a diagnosis of glomus tympanicum was made. Intraoperatively, extensive osteogenesis of the middle ear resulting in ossicular fixation and erosion was found. This patient required a two stage operation for full clearance of disease. A stapedectomy drill was used to drill off the bony overgrowth surrounding the ossicles resulting in improved hearing thresholds and full clearance of the disease at two year follow up. Glomus tympanicum can result in new bone formation in the middle ear with resultant ossicular fixation and conductive hearing loss. This can be effectively treated surgically with restoration of hearing. PMID:25232551

  10. Management of carotid artery stenosis

    PubMed Central

    Louridas, George; Junaid, Asad

    2005-01-01

    OBJECTIVE To clarify the definition of carotid artery diseases, the appropriateness of screening for disease, investigation and management of patients presenting with transient ischemic attacks, and management of asymptomatic carotid bruits. SOURCES OF INFORMATION MEDLINE was searched using the terms carotid endarterectomy, carotid disease, and carotid stenosis. Most studies offer level II or III evidence. Consensus statements and guidelines from various neurovascular societies were also consulted. MAIN MESSAGE Patients with symptoms of hemispheric transient ischemic attacks associated with >70% stenosis of the internal carotid artery are at highest risk of major stroke or death. Risk is greatest within 48 hours of symptom onset; patients should have urgent evaluation by a vascular surgeon for consideration of carotid endarterectomy (CEA). Patients with 50% to 69% stenosis might benefit from urgent surgical intervention depending on clinical features and associated comorbidity. Patients with <50% stenosis do not benefit from surgery. Asymptomatic patients with >60% stenosis should be considered for elective CEA. CONCLUSION Symptomatic carotid artery syndromes need urgent carotid duplex evaluation to determine the need for urgent surgery. Those with the greatest degree of stenosis derive the greatest benefit from timely CEA. PMID:16060177

  11. Clinical and Histopathological Diagnosis of Glomus Tumor: An Institutional Experience of 138 Cases

    PubMed Central

    Mravic, Marco; LaChaud, Gregory; Nguyen, Alan; Scott, Michelle A.; Dry, Sarah M.; James, Aaron W.

    2015-01-01

    Background Glomus tumors are relatively uncommon subcentimeteric benign perivascular neoplasms usually located on the fingers. With their blue-red color and common subungual location, they are commonly confused for vascular or melanocytic lesions. To date there is no comprehensive review of an institutional experience with glomus tumors. Methods A 14-year retrospective review of all cases within University of California, Los Angeles, with either a clinical or pathological diagnosis of glomus tumor was performed. Data obtained included demographic information, tumor description, pathological diagnoses, immunohistochemical studies, radiographic and treatment information, and clinical course. Rates of concordance between clinical and pathological diagnoses and an evaluation of overlap with other entities were assessed. Results Clinical diagnosis of glomus tumor showed concordance with a histopathological diagnosis (45.4% of cases). The most common alternate clinical diagnoses included lipoma, cyst, or angioma. A pathological diagnosis of glomus tumor was most common in the fourth to seventh decades of life. The most common presentation was a subcentimeter lesion on the digit. Deep-seated tumors had a strikingly increased risk for malignancy (33%). Radiological studies were not relied on frequently (18.2% of cases). Immunohistochemical analysis showed diffuse αSMA and MSA expression in nearly all cases (99% and 95%, respectively), with focal to diffuse CD34 immunostaining in 32% of cases. Discussion Our study illustrates trends in the clinical versus pathologic diagnoses of glomus tumor, common competing diagnoses, a difference in demographics than is commonly reported (older age groups most commonly affected), and important differences in the use adjunctive diagnostic tools including radiology and immunohistochemistry. PMID:25614464

  12. Giant Glomus Tumor and Neuroma in the Fifth Ray A Case Report.

    PubMed

    Valero, José; Gallart, José; González, David; Deus, Javier; Lahoz, Manuel

    2016-03-01

    We present the case of a patient with a glomus tumor that was atypical because of its large size and histologic characteristics. It was located in the dorsal-distal zone of the fifth ray of the left foot and was associated with a neuroma under the fifth metatarsal head. Although the pain (of a neurologic type) was attributed to the neuroma, the unknown nature and evolution of the dorsal lesion (glomus tumor) made surgical treatment necessary. Surgery, together with compensating treatment of the functional alterations of the patient's feet (pronation of the subastragalar joint, supination of the forefoot, and fifth metatarsal overload syndrome), resolved the case. PMID:27031555

  13. Malignant Glomus Tumour (Glomangiosarcoma) with Additional Neuroendocrine Differentiation in a Horse.

    PubMed

    Peters, M; Grafen, J; Kuhnen, C; Wohlsein, P

    2016-05-01

    A 13-year-old Icelandic crossbred horse was presented with headshaking and progressive impairment of chewing. A slowly growing mass was identified in the anterior maxilla. This was associated with lysis of the alveolar bone and the roots of the incisors and there were nodular proliferations affecting the nasal septum and conchae. There was no response to chemotherapy and so the horse was humanely destroyed. Based on morphological, immunohistochemical and ultrastructural findings the mass was classified as a malignant glomus tumour with multifocal vascular spaces and additional neuroendocrine differentiation. An oronasal glomus tumour with neuroendocrine differentiation has not been described previously in an animal. PMID:27102445

  14. Carotid Artery Stenting versus Endarterectomy

    PubMed Central

    Gahremanpour, Amir; Perin, Emerson C.; Silva, Guilherme

    2012-01-01

    For about 2 decades, investigators have been comparing carotid endarterectomy with carotid artery stenting in regard to their effectiveness and safety in treating carotid artery stenosis. We conducted a systematic review to summarize and appraise the available evidence provided by randomized trials, meta-analyses, and registries comparing the clinical outcomes of the 2 procedures. We searched the MEDLINE, SciVerse Scopus, and Cochrane databases and the bibliographies of pertinent textbooks and articles to identify these studies. The results of clinical trials and, consequently, the meta-analyses of those trials produced conflicting results regarding the comparative effectiveness and safety of carotid endarterectomy and carotid stenting. These conflicting results arose because of differences in patient population, trial design, outcome measures, and variability among centers in the endovascular devices used and in operator skills. Careful appraisal of the trials and meta-analyses, particularly the most recent and largest National Institutes of Healthsponsored trial (the Carotid Revascularization Endarterectomy vs Stenting Trial [CREST]), showed that carotid stenting and endarterectomy were associated with similar rates of death and disabling stroke. Within the 30-day periprocedural period, carotid stenting was associated with higher risks of stroke, especially for patients aged >70 years, whereas carotid endarterectomy was associated with a higher risk of myocardial infarction. The slightly higher cost of stenting compared with endarterectomy was within an acceptable range by cost-effectiveness standards. We conclude that carotid artery stenting is an equivalent alternative to carotid endarterectomy when patient age and anatomy, surgical risk, and operator experience are considered in the choice of treatment approach. PMID:22949763

  15. Cervical carotid pseudoaneurysm: A carotid artery stenting complication

    PubMed Central

    Raso, Jair; Darwich, Rogerio; Ornellas, Carlos; Cariri, Gustavo

    2011-01-01

    Background: As carotid artery stenting becomes increasingly used, more complications are likely to occur. We present a case of Staphylococcus septicemia and pseudoaneurysm arising in the neck portion of the carotid artery after stenting. Case Description: A 51-year-old man was admitted with mild left hemiparesis. CT and MRI showed right hemisphere ischemia. Duplex Scan and MRA showed bilateral severe stenosis of the carotid arteries in the neck. A percutaneous angioplasty with stenting of the left carotid artery was performed. Two weeks after the procedure, he developed fever and swelling in the right leg and shoulder. An abscess, near where the groin had been punctured for the angioplasty was surgically drained. Blood samples were positive for S. aureus. After treatment the patient complained of a painful bulky pulsatile left cervical mass. Duplex scan and MRA showed a pseudoaneurysm of the left carotid artery. We excised the pseudoaneurysm and rebuilt the carotid artery with a saphenous vein graft. The postoperative period was uneventful, and the MRA revealed a patent saphenous graft. Conclusion: Mycotic pseudoaneurysm of the carotid artery is a rare complication of percutaneous angioplasty and stenting. Surgical treatment with saphenous vein graft is the treatment of choice. PMID:21748038

  16. A case of a glomus tumor of the stomach resected by laparoscopy endoscopy cooperative surgery.

    PubMed

    Nakajo, Keiichiro; Chonan, Akimichi; Tsuboi, Rumiko; Nihei, Kousuke; Iwaki, Tomoyuki; Yamaoka, Hajime; Sato, Shun; Matsuda, Tomomi; Nakahori, Masato; Endo, Mareyuki

    2016-09-01

    A 56-year-old woman who was found to have a submucosal tumor (SMT) of the stomach in a medical check-up was admitted to our hospital for a detailed investigation of the SMT. Upper gastrointestinal endoscopy revealed an SMT of 20mm at the anterior wall of the antrum of the stomach. Endoscopic ultrasonography showed a hyperechoic tumor in the fourth layer of the stomach wall. CT examination showed a strongly enhancing tumor on arterial phase images and persistent enhancement on portal venous phase images. Laparoscopy endoscopy cooperative surgery was performed with a diagnosis of SMT of the stomach highly suspicious of a glomus tumor. Immunohistochemistry revealed expression of α-SMA but no expression of desmin, c-kit, CD34, or S-100. The tumor was finally diagnosed as a glomus tumor of the stomach. PMID:27593365

  17. Epithelioid Glomus Tumor of the Uterine Cervix: A Case Report and Review.

    PubMed

    Aynardi, Jason T; Kim, Sarah H; Barroeta, Julieta E

    2016-05-01

    Herein, we report a case of epithelioid glomus tumor involving the uterine cervix. A 67-yr-old woman with a long-standing history of cervical dysplasia underwent cervical conization. In addition to the patient's high-grade squamous intraepithelial lesion, histologic examination demonstrated an incidental, 0.2-cm glomus tumor in the cervical submucosa. The tumor was composed of bland epithelioid cells in scattered nests closely associated with small-caliber blood vessels. Immunohistochemically, the tumor cells were diffusely positive for smooth muscle actin and caldesmon and only focally positive for desmin and CD34. To our knowledge, only 2 similar case reports exist in the literature. The present case is the first cervical case seen with epithelioid features and in association with cervical dysplasia. PMID:26630229

  18. An intermediate term benefits and complications of gamma knife surgery in management of glomus jugulare tumor.

    PubMed

    Hafez, Raef F A; Morgan, Magad S; Fahmy, Osama M

    2016-01-01

    Glomus tumors are rare skull base slow-growing, hypervascular neoplasms that frequently involve critical neurovascular structures, and delay in diagnosis is frequent. Surgical removal is rarely radical and is usually associated with morbidity or mortality. Gamma knife surgery (GKS) has gained an increasing dependable role in the management of glomus jugulare tumors, with high rate of tumor growth control, preserving or improving clinical status and with limited complications. This study aims to evaluate intermediate term benefits and complications of gamma knife surgery in management of twenty-two patients bearing growing glomus jugulare tumors at the International Medical Center (IMC), Cairo, Egypt, between 2005 and 2011. The mean follow-up period was 56 months (range 36-108 months); there were 3 males, 19 females; mean age was 43.6 years; 15 patients had GKS as the primary treatment; 2 patients had surgical residuals; 2 had previous radiation therapy; and 3 previously underwent endovascular embolization. The average tumor volume was 7.26 cm3, and the mean marginal dose was 14.7 Gy. Post gamma knife surgery through the follow-up period neurological status was improved in 12 patients, 7 showed stable clinical condition and 3 patients developed new moderate deficits. Tumor volume post GKS was unchanged in 13 patients, decreased in 8, and showed tumor regrowth in 1 patient. Tumor progression-free survival in our studied patients was 95.5% at 5 and 7 years of the follow-up period post GKS. Gamma knife surgery could be used safely and effectively with limited complications as a primary management tool in the treatment of glomus jugulare tumors controlling tumor growth with preserving or improving clinical status especially those who do not have significant cranial or cervical extension, elderly, and surgically unfit patients; moreover, it is safe and highly effective as adjuvant therapy as well. PMID:26879488

  19. Lessons learnt from carotid artery trials.

    PubMed

    Van Damme, H; Limet, R

    2006-01-01

    The objective of the authors is to assess the natural history of carotid artery disease and the role of carotid intervention in preventing ipsilateral stroke. The development of endovascular techniques for correction of carotid artery stenoses made this less invasive technique very popular, with an inherent risk of unregulated overuse by a variety of medical specialists, who are not always well informed on the natural history of carotid artery disease. It re-opened the discussion on the value of carotid endarterectomy for stroke prophylaxis. This ongoing debate offers the opportunity to distil evidence-based guidelines for the management of extracranial carotid artery stenoses. In recent papers, some authors expressed doubts on the validity and general applicability of the results of the pivotal randomised trials of carotid endarterectomy. The excellent results in terms of operative outcome and long term stroke prevention would, according to certain comments, not be attainable in routine practice. Another criticism of carotid endarterectomy is its higher operative morbidity in terms of cranial nerve lesions and myocardial infarctions, compared to endovascular procedures. This consideration is, for some authors, the main reason to espouse carotid artery stenting as a better alternative to carotid endarterectomy. Any evidence supporting this point of view is missing. The supposed equivalence or non-inferiority of carotid artery stenting is purely speculative. The aim of this review paper is to summarize the crude data of carotid surgery trials. The authors aim to answer four questions. For which lesions is carotid endarterectomy most beneficial ? Are the results of randomised carotid surgery trials biased by the selection of patients ? Is operative morbidity, other than stroke, under-estimated ? Is carotid artery stenting safe and efficacious ? An in-depth review with a critical analysis is made of recently published and on-going trials, comparing carotid surgery

  20. Chronic Interactions Between Carotid Baroreceptors and Chemoreceptors in Obesity Hypertension.

    PubMed

    Lohmeier, Thomas E; Iliescu, Radu; Tudorancea, Ionut; Cazan, Radu; Cates, Adam W; Georgakopoulos, Dimitrios; Irwin, Eric D

    2016-07-01

    Carotid bodies play a critical role in protecting against hypoxemia, and their activation increases sympathetic activity, arterial pressure, and ventilation, responses opposed by acute stimulation of the baroreflex. Although chemoreceptor hypersensitivity is associated with sympathetically mediated hypertension, the mechanisms involved and their significance in the pathogenesis of hypertension remain unclear. We investigated the chronic interactions of these reflexes in dogs with sympathetically mediated, obesity-induced hypertension based on the hypothesis that hypoxemia and tonic activation of carotid chemoreceptors may be associated with obesity. After 5 weeks on a high-fat diet, the animals experienced a 35% to 40% weight gain and increases in arterial pressure from 106±3 to 123±3 mm Hg and respiratory rate from 8±1 to 12±1 breaths/min along with hypoxemia (arterial partial pressure of oxygen=81±3 mm Hg) but eucapnia. During 7 days of carotid baroreflex activation by electric stimulation of the carotid sinus, tachypnea was attenuated, and hypertension was abolished before these variables returned to prestimulation values during a recovery period. After subsequent denervation of the carotid sinus region, respiratory rate decreased transiently in association with further sustained reductions in arterial partial pressure of oxygen (to 65±2 mm Hg) and substantial hypercapnia. Moreover, the severity of hypertension was attenuated from 125±2 to 116±3 mm Hg (45%-50% reduction). These findings suggest that hypoxemia may account for sustained stimulation of peripheral chemoreceptors in obesity and that this activation leads to compensatory increases in ventilation and central sympathetic outflow that contributes to neurogenically mediated hypertension. Furthermore, the excitatory effects of chemoreceptor hyperactivity are abolished by chronic activation of the carotid baroreflex. PMID:27160198

  1. Sympathoinhibition and hypotension in carotid sinus hypersensitivity.

    PubMed

    Smith, M L; Ellenbogen, K A; Eckberg, D L

    1992-12-01

    Carotid sinus reflex hypersensitivity is a known cause of syncope in humans. The condition is characterized by cardioinhibition and vasodepression, each to varying degrees. The extent and importance of sympathoinhibition has not been determined in patients with carotid sinus hypersensitivity. This study reports on the extent of sympathoinhibition measured directly directly during carotid massage with and without atrioventricular sequential pacing, in a patient with symptomatic carotid sinus reflex hypersensitivity. Carotid massage elicited asystole, hypotension and complete inhibition of muscle sympathetic nerve activity. Carotid massage during atrioventricular pacing produced similar sympathoinhibition, but with minimal hypotension. Therefore, sympathoinhibition did not contribute importantly to the hypotension during carotid massage in the supine position in this patient. Further investigations are required to elucidate the relation of sympathoinhibition to hypotension in patients with carotid sinus hypersensitivity in the upright position. PMID:1290922

  2. How Is Carotid Artery Disease Treated?

    MedlinePlus

    ... Links Related Topics Atherosclerosis Carotid Endarterectomy Carotid Ultrasound Stents Stroke Send a link to NHLBI to someone ... outward against the wall of the artery. A stent (a small mesh tube) is then put in ...

  3. Sympathoinhibition and hypotension in carotid sinus hypersensitivity

    NASA Technical Reports Server (NTRS)

    Smith, M. L.; Ellenbogen, K. A.; Eckberg, D. L.

    1992-01-01

    Carotid sinus reflex hypersensitivity is a known cause of syncope in humans. The condition is characterized by cardioinhibition and vasodepression, each to varying degrees. The extent and importance of sympathoinhibition has not been determined in patients with carotid sinus hypersensitivity. This study reports on the extent of sympathoinhibition measured directly directly during carotid massage with and without atrioventricular sequential pacing, in a patient with symptomatic carotid sinus reflex hypersensitivity. Carotid massage elicited asystole, hypotension and complete inhibition of muscle sympathetic nerve activity. Carotid massage during atrioventricular pacing produced similar sympathoinhibition, but with minimal hypotension. Therefore, sympathoinhibition did not contribute importantly to the hypotension during carotid massage in the supine position in this patient. Further investigations are required to elucidate the relation of sympathoinhibition to hypotension in patients with carotid sinus hypersensitivity in the upright position.

  4. Multimodality Imaging of Carotid Stenosis

    PubMed Central

    Adla, Theodor; Adlova, Radka

    2015-01-01

    Four diagnostic modalities are used to image the following internal carotid artery: digital subtraction angiography (DSA), duplex ultrasound (DUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA). The aim of this article is to describe the potentials of these techniques and to discuss their advantages and disadvantages. Invasive DSA is still considered the gold standard and is an indivisible part of the carotid stenting procedure. DUS is an inexpensive but operator-dependent tool with limited visibility of the carotid artery course. Conversely, CTA and MRA allow assessment of the carotid artery from the aortic arch to intracranial parts. The disadvantages of CTA are radiation and iodine contrast medium administration. MRA is without radiation but contrast-enhanced MRA is more accurate than noncontrast MRA. The choice of methods depends on the clinical indications and the availability of methods in individual centers. However, the general approach to patient with suspected carotid artery stenosis is to first perform DUS and then other noninvasive methods such as CTA, MRA, or transcranial Doppler US. PMID:26417185

  5. Carotid bruits as predictor for carotid stenoses detected by ultrasonography: an observational study

    PubMed Central

    Johansson, Elias P; Wester, Per

    2008-01-01

    Background Carotid surgery in asymptomatic subjects with carotid stenosis is effective to prevent ischemic stroke. There is, however, uncertainty how to find such persons at risk, because mass screening with carotid artery ultrasonography (US) is not cost-effective. Signs of carotid bruits corresponding to the carotid arteries may serve as a tool to select subjects for further investigation. This study is thus aimed at determining the usefulness of carotid bruits in the screening of carotid stenoses. Methods 1555 consecutive carotid ultrasonography investigations from 1486 cases done between January 2004 and March 2006 at Norrlands University Hospital, Sweden, were examined. 356 subjects, medium age 69 (27–88) years, had a significant (≥ 50%) US-verified carotid stenosis uni- or bilaterally, 291 had been examined for signs of carotid bruits. The likelihood ratios for carotid bruits to predict US-verified carotid stenoses were calculated and expressed as likelihood percentages. Results Thirty-one out of 100 persons (31%) with carotid bruit as an indication to perform carotid US had a significant (≥ 50%) carotid stenosis. 281 of the 356 (79%) cases with significant carotid stenoses were found among patients with cerebrovascular disease (CVD). 145 of 226 (64%) CVD patients with a significant carotid stenosis had a carotid bruit. In patients with 50–99% carotid stenoses carotid bruits had an accuracy of 75% (436/582), a sensitivity of 71% (236/334), a specificity of 81% (200/248), a positive likelihood ratio at 3.65 and a negative likelihood at 0.36. Patients with 70–99% stenoses had the highest sensitivity at 77% (183/238). In patients with 100% carotid stenoses, carotid bruits had a sensitivity of 26% (15/57) and a specificity of 49% (256/525). Conclusion Although carotid bruits are not accurate to confirm or to exclude significant carotid stenoses, these signs are appropriate for directed screening for further investigation with carotid US if the patient

  6. Carotid chemoreceptor “resetting” revisited

    PubMed Central

    Carroll, John L.; Kim, Insook

    2012-01-01

    Carotid body (CB) chemoreceptors transduce low arterial O2 tension into increased action potential activity on the carotid sinus nerves, which contributes to resting ventilatory drive, increased ventilatory drive in response to hypoxia, arousal responses to hypoxia during sleep, upper airway muscle activity, blood pressure control and sympathetic tone. Their sensitivity to O2 is low in the newborn and increases during the days or weeks after birth to reach adult levels. This postnatal functional maturation of the CB O2 response has been termed “resetting” and it occurs in every mammalian species studied to date. The O2 environment appears to play a key role; the fetus develops in a low O2 environment throughout gestation and initiation of CB “resetting” after birth is modulated by the large increase in arterial oxygen tension occurring at birth. Although numerous studies have reported age-related changes in various components of the O2 transduction cascade, how the O2 environment shapes normal CB prenatal development and postnatal “resetting” remains unknown. Viewing CB “resetting” as environment-driven (developmental) phenotypic plasticity raises important mechanistic questions that have received little attention. This review examines what is known (and not known) about mechanisms of CB functional maturation, with a focus on the role of the O2 environment. PMID:22982216

  7. Carotid Plaques Correlates in Patients With Familial Hypercholesterolemia.

    PubMed

    Waluś-Miarka, Małgorzata; Czarnecka, D; Wojciechowska, W; Kloch-Badełek, M; Kapusta, M; Sanak, M; Wójcik, M; Małecki, M T; Starzyk, J; Idzior-Waluś, B

    2016-05-01

    Patients with familial hypercholesterolemia (FH) are at increased risk of premature cardiovascular disease. We compared factors associated with the presence of carotid plaques and carotid intima-media thickness (cIMT), markers of subclinical atherosclerosis, in 241 patients with FH (98, 40.7% men; mean age 41 ± 18.4 years). Patients with FH having carotid plaques (36.5%) had mean age, apolipoprotein (apo) B, glucose, apoA1, systolic blood pressure (SBP) and diastolic BP, waist/hip ratio (WHR), and body mass index higher than patients without plaques. Logistic regression revealed that apoB (odds ratio [OR] per 1 unit change 1.03,P= .005), high-density lipoprotein cholesterol (HDL-C; OR per 1 standard deviation [SD] change 0.59,P= .015), and non-HDL-C (OR per 1SD change 1.53,P= .04) were significantly associated with the presence of plaques. The cIMT correlated with obesity parameters, BP, apoB, glucose, high-sensitivity C-reactive protein, creatinine, γ-glutamyl transpeptidase, and alanine transaminase (P< .001). Regression analysis revealed that cIMT was significantly associated with apoB, SBP, and WHR. These results confirm the role of apoB-containing lipoproteins and low HDL-C with the presence of carotid plaques and apoB, BP, and WHR with cIMT. PMID:26198473

  8. Minimal nocturnal oxygen saturation predicts future subclinical carotid atherosclerosis: the Wisconsin sleep cohort.

    PubMed

    Gunnarsson, Sverrir I; Peppard, Paul E; Korcarz, Claudia E; Barnet, Jodi H; Hagen, Erika W; Hla, K Mae; Palta, Mari; Young, Terry; Stein, James H

    2015-12-01

    Previous data on the associations between nocturnal oxygen saturation parameters and carotid atherosclerosis are conflicting. We examined the prospective associations of nocturnal oxygen saturation (SaO2 ) and cardiovascular disease (CVD) risk factors with carotid intima-media thickness (IMT) and plaques. We used data on 689 Wisconsin sleep cohort participants who had baseline overnight polysomnography followed by carotid ultrasonography a mean (SD) of 7.8 (2.5) years later. Far wall common carotid IMT was measured using B-mode ultrasound. Bilateral common, bifurcation and internal carotid artery segments were evaluated for plaque score. Participants (8) were aged 56 years (55% male); 32% had hypertension and mean body mass index (BMI) was 31 (7) kg m(2). Mean and minimum nocturnal SaO2 were 95% (2) and 86% (7), respectively. Mean percentage sleep time with SaO2 < 90% was 2% (8). Both mean (odds ratio [OR]: 0.60 lower plaque count per 5% higher mean SaO2, 95% confidence interval [CI]: 0.38-0.96, P = 0.033) and minimum SaO2 (OR: 0.88 lower plaque count per 5% higher minimum SaO2, 95% CI: 0.80-0.97, P = 0.013) predicted carotid plaque score after adjusting for age, sex and BMI. Minimum SaO2 predicted future plaque score after adding adjustment for traditional CVD risk factors (OR: 0.90 lower plaque count per 5% higher minimum SaO2, 95% CI: 0.81-0.99, P = 0.038). Mean SaO2 was not associated with carotid IMT after CVD risk factor adjustment. We conclude that minimum nocturnal SaO2 is an independent predictor of future carotid plaque burden. Other nocturnal SaO2 parameters are not associated with future carotid IMT or plaques after adjusting for traditional CVD risk factors. PMID:26096939

  9. Taking your carotid pulse (image)

    MedlinePlus

    ... take oxygenated blood from the heart to the brain. The pulse from the carotids may be felt on either side of the front of the neck just below the angle of the jaw. This rhythmic "beat" is caused by varying volumes of blood being pushed out of the heart ...

  10. The prevalence of carotid plaque with different stability and its association with metabolic syndrome in China: The Asymptomatic Polyvascular Abnormalities Community study.

    PubMed

    Wang, Anxin; Wu, Lingyun; Liu, Xiaoxue; Su, Zhaoping; Luo, Yanxia; Chen, Shuohua; Li, Haibin; Liu, Xiangtong; Tao, Lixin; Guo, Jin; Zhang, Feng; Cao, Yibin; Zhao, Xingquan; Wu, Shouling; Guo, Xiuhua

    2016-08-01

    Few studies have investigated the prevalence of carotid plaque with different stability in Chinese. As is well known, carotid atherosclerosis is tightly associated with metabolic syndrome (MetS); however, the data about the association between the presence of carotid plaque with different stability and MetS was limited. The aim of our study was to investigate the prevalence of carotid plaque with different stability and its potential association with MetS in general Chinese population.The Asymptomatic Polyvascular Abnormalities Community study is a community-based study to investigate the epidemiology of asymptomatic polyvascular abnormalities in Chinese adults. A total of 5393 participants were finally eligible and included in this study. The carotid plaque and its stability were assessed using ultrasonography. The MetS was defined using the criteria from US National Cholesterol Education Program-Adult Treatment Panel III. Data were analyzed with multivariate logistic regression models.Of the 5393 subjects, 1397 (25.9%) participants had stable carotid plaque, 1518 (28.1%) had unstable carotid plaque in participants, and 1456 (27.0%) had a MetS. MetS was, respectively, significantly associated with the prevalence of carotid plaque (odds ratio [OR]: 1.25; 95% confidence interval [CI]: 1.07, 1.47), stable carotid plaque (OR: 1.23; 95% CI: 1.02,1.48), and unstable carotid plaque (OR: 1.27; 95% CI: 1.03,1.56) after adjusting for age, gender, level of education, income, smoking, drinking, physical activity, body mass index, low-density lipoprotein, and high-sensitivity C-reactive protein. With the number of MetS components, the prevalence of carotid plaque, stable carotid plaque, and unstable carotid plaque significantly increased (P for trend <0.0001), respectively.In summary, the prevalence of carotid plaque was 54.1%, stable carotid plaque was 25.9%, and unstable carotid plaque was 28.1%. Our study revealed that the prevalence of carotid plaque, stable carotid plaque

  11. Glomus africanum and G. iranicum, two new species of arbuscular mycorrhizal fungi (Glomeromycota).

    PubMed

    Błaszkowski, Janusz; Kovács, Gábor M; Balázs, Tímea K; Orlowska, Elzbieta; Sadravi, Mehdi; Wubet, Tesfaye; Buscot, François

    2010-01-01

    Two new arbuscular mycorrhizal fungal species (Glomeromycota) of genus Glomus, G. africanum and G. iranicum, are described and illustrated. Both species formed spores in loose clusters and singly in soil and G. iranicum sometimes inside roots. G. africanum spores are pale yellow to brownish yellow, globose to subglobose, (60-)87(-125) μm diam, sometimes ovoid to irregular, 80-110 x 90-140 μm. The spore wall consists of a semipermanent, hyaline, outer layer and a laminate, smooth, pale yellow to brownish yellow, inner layer, which always is markedly thinner than the outer layer. G. iranicum spores are hyaline to pastel yellow, globose to subglobose, (13-)40(-56) μm diam, rarely egg-shaped, prolate to irregular, 39-54 x 48-65 μm. The spore wall consists of three smooth layers: one mucilaginous, short-lived, hyaline, outermost; one permanent, semirigid, hyaline, middle; and one laminate, hyaline to pastel yellow, innermost. Only the outermost spore wall layer of G. iranicum stains red in Melzer's reagent. In the field G. africanum was associated with roots of five plant species and an unrecognized shrub colonizing maritime sand dunes of two countries in Europe and two in Africa, and G. iranicum was associated with Triticum aestivum cultivated in southwestern Iran. In one-species cultures with Plantago lanceolata as the host plant G. africanum and G. iranicum formed arbuscular mycorrhizae. Phylogenetic analyses of partial SSU sequences of nrDNA placed the two new species in Glomus group A. Both species were distinctly separated from sequences of described Glomus species. PMID:20943558

  12. Mitochondrial Genome Rearrangements in Glomus Species Triggered by Homologous Recombination between Distinct mtDNA Haplotypes

    PubMed Central

    Beaudet, Denis; Terrat, Yves; Halary, Sébastien; de la Providencia, Ivan Enrique; Hijri, Mohamed

    2013-01-01

    Comparative mitochondrial genomics of arbuscular mycorrhizal fungi (AMF) provide new avenues to overcome long-lasting obstacles that have hampered studies aimed at understanding the community structure, diversity, and evolution of these multinucleated and genetically polymorphic organisms. AMF mitochondrial (mt) genomes are homogeneous within isolates, and their intergenic regions harbor numerous mobile elements that have rapidly diverged, including homing endonuclease genes, small inverted repeats, and plasmid-related DNA polymerase genes (dpo), making them suitable targets for the development of reliable strain-specific markers. However, these elements may also lead to genome rearrangements through homologous recombination, although this has never previously been reported in this group of obligate symbiotic fungi. To investigate whether such rearrangements are present and caused by mobile elements in AMF, the mitochondrial genomes from two Glomeraceae members (i.e., Glomus cerebriforme and Glomus sp.) with substantial mtDNA synteny divergence, were sequenced and compared with available glomeromycotan mitochondrial genomes. We used an extensive nucleotide/protein similarity network-based approach to investigate dpo diversity in AMF as well as in other organisms for which sequences are publicly available. We provide strong evidence of dpo-induced inter-haplotype recombination, leading to a reshuffled mitochondrial genome in Glomus sp. These findings raise questions as to whether AMF single spore cultivations artificially underestimate mtDNA genetic diversity. We assessed potential dpo dispersal mechanisms in AMF and inferred a robust phylogenetic relationship with plant mitochondrial plasmids. Along with other indirect evidence, our analyses indicate that members of the Glomeromycota phylum are potential donors of mitochondrial plasmids to plants. PMID:23925788

  13. Glomus tumor of the ovary masquerading as granulosa cell tumor: case report.

    PubMed

    Slone, Stephen P; Moore, Grace D; Parker, Lynn P; Rickard, Kyle A; Nixdorf-Miller, Allison S

    2010-01-01

    A solid right adnexal mass in a 73-year-old woman bled profusely with mobilization mimicking a granulosa cell tumor. There was almost complete replacement of the ovary by a circumscribed, 4.0 cm tumor with a hemorrhagic, solid cut surface. Morphologic and phenotypic correlation supported a diagnosis of glomus tumor. Large gaping vessels and small sinusoidal-type vessels formed an anastomotic vascular network with an inner endothelial lining (CD31+/CD34+) and an outer layer of glomocytes (actin+/desmin-/inhibin-). The hemangiopericytoma-like vasculature accounted for bleeding during surgery. PMID:19952942

  14. Increased Vessel Depiction of the Carotid Bifurcation with a Specialized 16-Channel Phased Array Coil at 3T

    PubMed Central

    Tate, Quinn; Kim, Seong-Eun; Treiman, Gerald; Parker, Dennis L.; Hadley, J. Rock

    2012-01-01

    The purpose of this work was to design and construct a multi-channel receive-only RF coil for 3 Tesla magnetic resonance imaging of the human carotid artery and bifurcation with optimized signal to noise ratio in the carotid vessels along the full extent of the neck. A neck phantom designed to match the anatomy of a subject with a neck representing the body habitus often seen in subjects with carotid arterial disease, was constructed. Sixteen circular coil elements were arranged on a semi-rigid fiberglass former that closely fit the shape of the phantom, resulting in a 16-channel bilateral phased array coil. Comparisons were made between this coil and a typical 4-channel carotid coil in a study of 10 carotid vessels in 5 healthy volunteers. The 16-channel carotid coil showed a 73% average improvement in signal to noise ratio (SNR) at the carotid bifurcation. This coil also maintained an SNR greater than the peak SNR of the 4-channel coil over a vessel length of 10 cm. The resulting increase in SNR improved vessel depiction of the carotid arteries over an extended field of view, and demonstrated better image quality for higher parallel imaging reduction factors compared to the 4-channel coil. PMID:22777692

  15. Carotid blood flow measured by an ultrasonic volume flowmeter in carotid stenosis and patients with dementia.

    PubMed Central

    Uematsu, S; Folstein, M F

    1985-01-01

    The volume flowmeter is a simple, noninvasive Doppler ultrasound technique that provides accurate measurement of carotid artery diameter and flow. The device provides a useful laboratory test that can aid significantly in diagnosis of carotid stenosis and dementia. PMID:2935592

  16. What Are the Signs and Symptoms of Carotid Artery Disease?

    MedlinePlus

    ... What Are the Signs and Symptoms of Carotid Artery Disease? Carotid artery disease may not cause signs or symptoms until it severely narrows or blocks a carotid artery. Signs and symptoms may include a bruit, a ...

  17. Expression of phenazine biosynthetic genes during the arbuscular mycorrhizal symbiosis of Glomus intraradices

    PubMed Central

    León-Martínez, Dionicia Gloria; Vielle-Calzada, Jean-Philippe; Olalde-Portugal, Víctor

    2012-01-01

    To explore the molecular mechanisms that prevail during the establishment of the arbuscular mycorrhiza symbiosis involving the genus Glomus, we transcriptionally analysed spores of Glomus intraradices BE3 during early hyphal growth. Among 458 transcripts initially identified as being expressed at presymbiotic stages, 20% of sequences had homology to previously characterized eukaryotic genes, 30% were homologous to fungal coding sequences, and 9% showed homology to previously characterized bacterial genes. Among them, GintPbr1a encodes a homolog to Phenazine Biosynthesis Regulator (Pbr) of Burkholderia cenocepacia, an pleiotropic regulatory protein that activates phenazine production through transcriptional activation of the protein D isochorismatase biosynthetic enzyme phzD (Ramos et al., 2010). Whereas GintPbr1a is expressed during the presymbiotic phase, the G. intraradices BE3 homolog of phzD (BGintphzD) is transcriptionally active at the time of the establishment of the arbuscular mycorrhizal symbiosis. DNA from isolated bacterial cultures found in spores of G. intraradices BE3 confirmed that both BGintPbr1a and BGintphzD are present in the genome of its potential endosymbionts. Taken together, our results indicate that spores of G. intraradices BE3 express bacterial phenazine biosynthetic genes at the onset of the fungal-plant symbiotic interaction. PMID:24031884

  18. Glomus drummondii and G. walkeri, two new species of arbuscular mycorrhizal fungi (Glomeromycota).

    PubMed

    Błaszkowski, Janusz; Renker, Carsten; Buscot, François

    2006-05-01

    Two new ectocarpic arbuscular mycorrhizal fungal species, Glomus drummondii and G. walkeri (Glomeromycota), found in maritime sand dunes of northern Poland and those adjacent to the Mediterranean Sea are described and illustrated. Mature spores of G. drummondii are pastel yellow to maize yellow, globose to subglobose, (58-)71(-85) micromdiam, or ovoid, 50-80x63-98 microm. Their wall consists of three layers: an evanescent, hyaline, short-lived outermost layer, a laminate, smooth, pastel yellow to maize yellow middle layer, and a flexible, smooth, hyaline innermost layer. Spores of G. walkeri are white to pale yellow, globose to subglobose, (55-)81(-95) micromdiam, or ovoid, 60-90x75-115 microm, and have a spore wall composed of three layers: a semi-permanent, hyaline outermost layer, a laminate, smooth, white to pale yellow middle layer, and a flexible, smooth, hyaline innermost layer. In Melzer's reagent, only the inner- and outermost layers stain reddish white to greyish rose in G. drummondii and G. walkeri, respectively. Both species form vesicular-arbuscular mycorrhizae in one-species cultures with Plantago lanceolata as the host plant. Phylogenetic analyses of the ITS and parts of the LSU of the nrDNA of spores placed both species in Glomus Group B sensu Schüssler et al. [Schüssler A, Schwarzott D, Walker C, 2001. A new fungal phylum, the Glomeromycota: phylogeny and evolution. Mycolological Research 105: 1413-1421.]. PMID:16769509

  19. [A case of catecholamine-secreting glomus jugulare tumor: treatment strategy and perioperative management].

    PubMed

    Motegi, Hiroaki; Terasaka, Shunsuke; Yamaguchi, Shigeru; Kobayashi, Hiroyuki; Asaoka, Katsuyuki; Iwasaki, Yoshinobu

    2008-11-01

    Advances of neuroimaging, skull base technique and embolization improved outcome in patients who present with tumor of the glomus jugulare. Catecholamine secreting subgroup, however, is considered to be extremely high risk because of potentially serious complication of an intra- and perioperative hypertension crisis. The authors present detailed description of treatment strategies and perioperative management with a catecholamine secreting glomus jugulare. A 57-year-old woman, in whom the noradrenaline level in plasma was twenty times higher than normal, presented with uncontrolled labile hypertension and carcinoid syndrome. Magnetic resonance imaging (MRI) and 123I-meta-iodobenzylguanidine (MIBG) scan depicted the tumor as originating from the jugular foramen extending to the infratemporal fossa. Alpha catecholamine blocker and magnesium sulfate treatment was commenced prior to embolization and surgery. Under cranial nerve and hemodynamic monitoring, tumor resection via the infratemporal fossa type A was performed. The patient remained hemodynamically stable and the lower cranial nerve injury was able to be avoided. The plasma noradrenaline level decreased and hypertension became normalized. We emphasize treatment strategy, intra- and perioperative management of this rare entity. PMID:19048923

  20. Expression of phenazine biosynthetic genes during the arbuscular mycorrhizal symbiosis of Glomus intraradices.

    PubMed

    León-Martínez, Dionicia Gloria; Vielle-Calzada, Jean-Philippe; Olalde-Portugal, Víctor

    2012-04-01

    To explore the molecular mechanisms that prevail during the establishment of the arbuscular mycorrhiza symbiosis involving the genus Glomus, we transcriptionally analysed spores of Glomus intraradices BE3 during early hyphal growth. Among 458 transcripts initially identified as being expressed at presymbiotic stages, 20% of sequences had homology to previously characterized eukaryotic genes, 30% were homologous to fungal coding sequences, and 9% showed homology to previously characterized bacterial genes. Among them, GintPbr1a encodes a homolog to Phenazine Biosynthesis Regulator (Pbr) of Burkholderia cenocepacia, an pleiotropic regulatory protein that activates phenazine production through transcriptional activation of the protein D isochorismatase biosynthetic enzyme phzD (Ramos et al., 2010). Whereas GintPbr1a is expressed during the presymbiotic phase, the G. intraradices BE3 homolog of phzD (BGintphzD) is transcriptionally active at the time of the establishment of the arbuscular mycorrhizal symbiosis. DNA from isolated bacterial cultures found in spores of G. intraradices BE3 confirmed that both BGintPbr1a and BGintphzD are present in the genome of its potential endosymbionts. Taken together, our results indicate that spores of G. intraradices BE3 express bacterial phenazine biosynthetic genes at the onset of the fungal-plant symbiotic interaction. PMID:24031884

  1. Hyphal Elongation of Glomus fasciculatus in Response to Root Exudates †

    PubMed Central

    Elias, Karol S.; Safir, Gene R.

    1987-01-01

    The spore germination rates on water agar of the vesicular-arbuscular mycorrhizal fungus Glomus fasciculatus were highest at water potentials of −4 to −6 bars. Root exudates from plants grown in a sterile nutrient solution, with or without phosphorus, did not affect germination. Root exudates collected from 2-, 4-, and 6-week-old Trifolium repens cv. `Ladino' seedlings that were deprived of P enabled hyphal growth from germinated Glomus fasciculatus spores of 21.4, 14.7, and 7.6 mm, respectively. Hyphal elongation in the presence of exudates from plants grown with P, or in the absence of exudates, was negligible (<1 mm). Root P at 2 weeks was not significantly different between plants grown with and without P. There were no significant differences between the quantities of exudates from plants grown with or without P at 2, 4, and 6 weeks. The data suggest that it is the quality of exudates from plants experiencing P deprivation that is important in stimulating vesicular-arbuscular mycorrhizal hyphal elongation. PMID:16347418

  2. Left carotid steal. A new observation.

    PubMed

    Shumacker, H B; Isch, J H

    1975-04-01

    A patient had an occlusion of the left subclavian artery just proximal to the takeoff of a previously placed subclavian-carotid graft. This caused reversal of flow in the graft and a symptomatic steal of blood via to the intracranial arteries. An axilloaxillary graft restored forward flow. In a second patient, a steal occurred from the right carotid and vertebral systems into the distal carotid system of the left side that has been isolated by a proximal carotide artery occlusion from arteriosclerosis. A saphenous vein, used as a bypass from the subclavian to the carotid artery, restored normal flow. Thus, the carotide system may be the low-pressure area responsible for the steal, although this is rarer than the subclavian. PMID:1147756

  3. Atherosclerotic carotid stenosis and cognitive function.

    PubMed

    Wang, Tao; Mei, Bin; Zhang, Junjian

    2016-07-01

    Atherosclerosis carotid stenosis is associated with stroke and cognitive impairment. Progressive cognitive decline may be an even greater problem than stroke, but it has not been widely recognized and therefore must be adequately addressed. Although both Carotid Endarterectomy (CEA) and Carotid Artery Stenting (CAS) have been proven can prevent future stroke in patients with atherosclerotic carotid stenosis, the influence of CEA and CAS on cognitive function is not clear. In the first part of this review, we evaluated the literature concerning carotid stenosis and the risk of cognitive impairment. Studies have suggested that both symptomatic and asymptomatic carotid stenosis are associated with cognitive impairment. In the second part, we reviewed the impact of CEA and CAS on cognitive function, some studies have shown benefits, but others have not. PMID:27152468

  4. Aseptic polyurethane carotid patch rejection: complication, allergy or miraculous healing?

    PubMed

    Tshomba, Y; De Dominicis, D; Marone, E M; Mascia, D; Sanvito, F; Chiesa, R

    2011-12-01

    Carotid endarterectomy plays an important role in the prevention of ischemic stroke; patching could reduce the risk of intra- and postoperative complications and late restenosis among primary closure. Materials actually available for the patch tailoring are synthetic or biological: which is the best is still debated. We present the case of a polyurethane (PU) carotid patch rejection three years after its implant, with no evident arterial discontinuity and no sign of infection. Histopathological analysis on hematoxylin-eosin stained sections of the regenerated arterial wall tissue removed revealed plasma cell infiltration and clusters of foreign body giant cells. PU patch rejection has been seldom described in literature. This is an unusual late complication that should be considered at long-term follow-up evaluation of these patients. PMID:21750481

  5. [Carotid endarterectomy and carotid stenting: a vascular surgeon's point of view].

    PubMed

    Beloyartsev, D F

    2016-01-01

    Presented in the article is a review of the literature related to comparing the outcomes of carotid endarterectomy and carotid stenting in treatment of atherosclerotic stenosis of the internal carotid artery. Special attention is paid to carefully considering the clinical situations wherein preference should be given to either method of intervention. PMID:27159933

  6. Carotid Stump Syndrome: Pathophysiology and Endovascular Treatment Options

    SciTech Connect

    Lakshminarayan, Raghuram; Scott, Paul M.; Robinson, Graham J.; Ettles, Duncan F.

    2011-02-15

    Carotid stump syndrome is one of the recognised causes of recurrent ipsilateral cerebrovascular events after occlusion of the internal carotid artery. It is believed that microemboli arising from the stump of the occluded internal carotid artery or the ipsilateral external carotid artery can pass into the middle cerebral artery circulation as a result of patent external carotid-internal carotid anastomotic channels. Different pathophysiologic causes of this syndrome and endovascular options for treatment are discussed.

  7. Carotid artery stenting: current and emerging options

    PubMed Central

    Morr, Simon; Lin, Ning; Siddiqui, Adnan H

    2014-01-01

    Carotid artery stenting technologies are rapidly evolving. Options for endovascular surgeons and interventionists who treat occlusive carotid disease continue to expand. We here present an update and overview of carotid stenting devices. Evidence supporting carotid stenting includes randomized controlled trials that compare endovascular stenting to open surgical endarterectomy. Carotid technologies addressed include the carotid stents themselves as well as adjunct neuroprotective devices. Aspects of stent technology include bare-metal versus covered stents, stent tapering, and free-cell area. Drug-eluting and cutting balloon indications are described. Embolization protection options and new direct carotid access strategies are reviewed. Adjunct technologies, such as intravascular ultrasound imaging and risk stratification algorithms, are discussed. Bare-metal and covered stents provide unique advantages and disadvantages. Stent tapering may allow for a more fitted contour to the caliber decrement between the common carotid and internal carotid arteries but also introduces new technical challenges. Studies regarding free-cell area are conflicting with respect to benefits and associated risk; clinical relevance of associated adverse effects associated with either type is unclear. Embolization protection strategies include distal filter protection and flow reversal. Though flow reversal was initially met with some skepticism, it has gained wider acceptance and may provide the advantage of not crossing the carotid lesion before protection is established. New direct carotid access techniques address difficult anatomy and incorporate sophisticated flow-reversal embolization protection techniques. Carotid stenting is a new and exciting field with rapidly advancing technologies. Embolization protection, low-risk deployment, and lesion assessment and stratification are active areas of research. Ample room remains for further innovations and developments. PMID:25349483

  8. Quantification of carotid vessel atherosclerosis

    NASA Astrophysics Data System (ADS)

    Chiu, Bernard; Egger, Micaela; Spence, J. D.; Parraga, Grace; Fenster, Aaron

    2006-03-01

    Atherosclerosis is characterized by the development of plaques in the arterial wall, which ultimately leads to heart attacks and stroke. 3D ultrasound (US) has been used to screen patients' carotid arteries. Plaque measurements obtained from these images may aid in the management and monitoring of patients, and in evaluating the effect of new treatment options. Different types of measures for ultrasound phenotypes of atherosclerosis have been proposed. Here, we report on the development and application of a method used to analyze changes in carotid plaque morphology from 3D US images obtained at two different time points. We evaluated our technique using manual segmentations of the wall and lumen of the carotid artery from images acquired in two US scanning sessions. To incorporate the effect of intraobserver variability in our evaluation, manual segmentation was performed five times each for the arterial wall and lumen. From this set of five segmentations, the mean wall and lumen surfaces were reconstructed, with the standard deviation at each point mapped onto the surfaces. A correspondence map between the mean wall and lumen surfaces was then established, and the thickness of the atherosclerotic plaque at each point in the vessel was estimated to be the distance between each correspondence pairs. The two-sample Student's t-test was used to judge whether the difference between the thickness values at each pair corresponding points of the arteries in the two 3D US images was statistically significant.

  9. Use of Absorbable Sutures in Canine Carotid Arteries

    PubMed Central

    Rey, Alejandro R.; Carrillo-Farga, Joaquin; Velasco, Carlos O.; Valencia, Martin O.V.

    1990-01-01

    To study the functional and microstructural characteristics of polydioxanone sutures in vascular surgery, we created 48 vascular anastomoses in the right and left common carotid arteries of 24 mongrel dogs. In each animal, polydioxanone sutures were used in 1 carotid artery, and polypropylene sutures were used in the contralateral carotid artery. Twelve groups of 2 animals each were then formed. The 1st group was observed for 1 month, the 2nd for 2 months, the 3rd for 3 months, and so on until the 12th group, which was observed for 12 months. At the end of each observation period, reoperation was undertaken to evaluate the vascular anastomoses by means of angiography and microscopy. The polypropylene anastomoses showed a marked deformity, with tissue retraction and a foreign body reaction. In contrast, the polydioxanone anastomoses exhibited satisfactory healing, without deformity, and were well tolerated histologically. We believe that polydioxanone may be a useful, alternative vascular suture material. (Texas Heart Institute Journal 1990;17:99-102) Images PMID:15227391

  10. What to Expect After Carotid Endarterectomy

    MedlinePlus

    ... getting larger. As part of your long-term treatment, you can take steps to keep your carotid arteries healthy. One important step is to not smoke. Smoking increases the risk of carotid artery disease and stroke. If you smoke, ask your doctor about programs and products that can help you ...

  11. Stereotactic radiosurgery of glomus jugulare tumors: current concepts, recent advances and future perspectives.

    PubMed

    Sager, Omer; Dincoglan, Ferrat; Beyzadeoglu, Murat

    2015-01-01

    Stereotactic radiosurgery (SRS), a very highly focused form of therapeutic irradiation, has been widely recognized as a viable treatment option in the management of intracranial pathologies including benign tumors, malign tumors, vascular malformations and functional disorders. The applications of SRS are continuously expanding thanks to the ever-increasing advances and corresponding improvements in neuroimaging, radiation treatment techniques, equipment, treatment planning and delivery systems. In the context of glomus jugulare tumors (GJT), SRS is being more increasingly used both as the upfront management modality or as a complementary or salvage treatment option. As its safety and efficacy is being evident with compiling data from studies with longer follow-up durations, SRS appears to take the lead in the management of most patients with GJT. Herein, we address current concepts, recent advances and future perspectives in SRS of GJT in light of the literature. PMID:25768334

  12. The arbuscular mycorrhizal fungus Glomus geosporum in European saline, sodic and gypsum soils.

    PubMed

    Landwehr, Melanie; Hildebrandt, Ulrich; Wilde, Petra; Nawrath, Kerstin; Tóth, Tibor; Biró, Borbála; Bothe, Hermann

    2002-08-01

    Plants of saline and sodic soils of the Hungarian steppe and of gypsum rock in the German Harz mountains, thus soils of high ionic strength and electric conductivity, were examined for their colonization by arbuscular mycorrhizal fungi (AMF). Roots of several plants of the saline and sodic soils such as Artemisia maritima, Aster tripolium or Plantago maritima are strongly colonized and show typical AMF structures (arbuscules, vesicles) whereas others like the members of the Chenopodiaceae, Salicornia europaea, Suaeda maritima or Camphorosma annua, are not. The vegetation of the gypsum rock is totally different, but several plants are also strongly colonized there. The number of spores in samples from the saline and sodic soils examined is rather variable, but high on average, although with an apparent low species diversity. Spore numbers in the soil adjacent to the roots of plants often, but not always, correlate with the degree of AMF colonization of the plants. As in German salt marshes [Hildebrandt et al. (2001)], the dominant AMF in the Hungarian saline and sodic soils is Glomus geosporum. All these isolates provided nearly identical restriction fragment length polymorphism (RFLP) patterns of the internal transcribed spacer (ITS) region of spore DNA amplified by polymerase chain reaction (PCR). Cloning and sequencing of several PCR products of the ITS regions indicated that ecotypes of the G. geosporum/ Glomus caledonium clade might exist at the different habitats. A phylogenetic dendrogram constructed from the ITS or 5.8S rDNA sequences was nearly identical to the one published for 18S rDNA data (Schwarzott et al. 2001). It is tempting to speculate that specific ecotypes may be particularly adapted to the peculiar saline or sodic conditions in such soils. They could have an enormous potential in conferring salt resistance to plants. PMID:12189475

  13. Future Management of Carotid Stenosis: Role of Urgent Carotid Interventions in the Acutely Symptomatic Carotid Patient and Best Medical Therapy for Asymptomatic Carotid Disease

    PubMed Central

    Bazan, Hernan A.; Smith, Taylor A.; Donovan, Melissa J.; Sternbergh, W. Charles

    2014-01-01

    Background Stroke is the fourth leading cause of death in the United States, leading to devastating disability. Most strokes are ischemic, and nearly one-third of these are caused by carotid disease. The primary mechanism of carotid-related stroke is an atheroembolic event from an unstable atherosclerotic plaque rupture. In the 1990s, randomized trials demonstrated the benefit of carotid endarterectomy (CEA) in reducing the risk of stroke in both symptomatic and asymptomatic carotid disease. Methods We review best medical therapy (BMT) for asymptomatic carotid disease and recent randomized trials comparing CEA and carotid angioplasty stenting (CAS), and we discuss the role of urgent carotid interventions in patients with acute neurologic symptoms. Results In 2010, 2 large trials demonstrated the efficacy of CAS in select patients, although CAS was associated with an increased procedural stroke risk compared to CEA. An age effect was observed; patients >75 years do worse with CAS compared to CEA. As BMT has evolved in the past decade, a future trial (CREST-2) will address whether BMT is equal to intervention (CEA or CAS) in asymptomatic carotid disease. In a subgroup of patients with asymptomatic carotid disease, CEA plus BMT will likely remain the mainstay therapy for carotid disease compared to BMT alone. CEA and CAS will continue to play complementary roles in the future, as CAS will be done in select patients in whom CEA cannot be undertaken because of high-risk anatomical or medical conditions. Finally, a role for urgent carotid interventions in a select group of patients who present with acute neurologic symptoms is developing as a way to prevent recurrent stroke after an initial carotid plaque rupture event. Conclusion CAS has an increasingly higher risk of stroke with advancing age. Patients treated with CAS have a 1.76-fold increased risk of stroke (95% CI, 1.35-2.31) with each 10-year increase in age. No such age effect is seen in patients treated with CEA

  14. Carotid Baroreflex Function During Prolonged Exercise

    NASA Technical Reports Server (NTRS)

    Raven, P. B.

    1999-01-01

    Astronauts are often required to work (exercise) at moderate to high intensities for extended periods while performing extra-vehicular activities (EVA). Although the physiologic responses associated with prolonged exercise have been documented, the mechanisms involved in blood pressure regulation under these conditions have not yet been fully elucidated. An understanding of this issue is pertinent to the ability of humans to perform work in microgravity and complies with the emphasis of NASA's Space Physiology and Countermeasures Program. Prolonged exercise at a constant workload is know to result in a progressive decrease in mean arterial pressure (MAP) concomitant with a decrease in stroke volume and a compensatory increase in heart rate. The continuous decrease in MAP during the exercise, which is related to the thermoregulatory redistribution of circulating blood volume to the cutaneous circulation, raises the question as to whether there is a loss of baroreflex regulation of arterial blood pressure. We propose that with prolongation of the exercise to 60 minutes, progressive increases on central command reflect a progressive upward resetting of the carotid baroreflex (CBR) such that the operating point of the CBR is shifted to a pressure below the threshold of the reflex rendering it ineffectual in correcting the downward drift in MAP. In order to test this hypothesis, experiments have been designed to uncouple the global hemodynamic response to prolonged exercise from the central command mediated response via: (1) continuous maintenance of cardiac filling volume by intravenous infusion of a dextran solution; and (2) whole body surface cooling to counteract thermoregulatory cutaneous vasodialation. As the type of work (exercise) performed by astronauts is inherently arm and upper body dependent, we will also examine the physiologic responses to prolonged leg cycling and arm ergometry exercise in the supine positions with and without level lower body negative

  15. [Pharmacological preconditioning in carotid endarterectomy].

    PubMed

    Kuznetsov, M R; Karalkin, A V; Fedin, A I; Virganskii, A O; Kunitsyn, N V; Kholopova, E A; Yumin, S M

    2015-01-01

    The study was aimed at examining efficacy of preoperative preparation (pharmacological preconditioning) for carotid endarterectomy in patients with chronic cerebrovascular insufficiency. For this purpose, we analysed the outcomes of surgical treatment in a total of 80 patients presenting with haemodynamically significant unilateral and bilateral lesions of carotid arteries. Of these, 40 patients were operated on immediately and a further 40 patients underwent surgery after pharmacological preconditioning with Actovegin taken at a daily dose of 1,200 mg for 1.5 months. It was demonstrated that preoperative preparation prior to surgery increases cerebral perfusion which is determined by means of single-photon emission computed tomography, thus substantially improving the outcomes of surgical treatment. Statistically significant differences in cognitive function of these groups of patients were revealed 7 days and 6 months after the operation. Improvement of cognitive functions was associated with fewer symptom-free postoperative cerebral ischaemic foci in various regions of the brain. A conclusion was made on a positive role of pharmacological preconditioning with Actovegin in surgical management of cerebrovascular insufficiency, first of all in relation to more complete restoration of cognitive functions. PMID:26355920

  16. Carotid Sheath Abscess Caused by a Tooth Decay Infection on the Opposite Side

    PubMed Central

    Tuncturk, F. Ruya; Uzun, Lokman; Kalcioglu, M. Tayyar; Egilmez, Oguz Kadir; Timurlenk, Emine; Erguven, Muferet

    2015-01-01

    Deep neck infections are mortal diseases that need emergency treatment. It can occur at any age but usually in pediatric ages. In this report, a left cervical carotid space abscess of a pediatric patient was discussed. It was interesting that the only origin of the left carotid sheath abscess was right inferior first molar tooth decay. Right neck spaces were all clean. Patient had no immunosupression and also there were no congenital masses such as branchial cleft cysts, foreign bodies, or masses suspicious for malignancies in cervical ultrasound and MRI. We discussed this rare condition under the light of the literature. PMID:25878916

  17. [A Case of Carotid Free-Floating Thrombus Treated by Carotid Ultrasonography-Guided Endovascular Approach].

    PubMed

    Otawa, Masato; Kinkori, Takeshi; Watanabe, Kenichi; Ando, Ryo; Tambara, Masao; Arima, Toru

    2016-06-01

    We experienced a case of carotid free-floating thrombus treated by carotid ultrasonography-guided endovascular approach. A 63-year-old man was brought to our hospital with the chief complaint of sudden onset left hemiplegia. MRI revealed acute infarction of the right MCA territory due to the right M1 occlusion. Carotid ultrasonography showed a pedunculated, polypoid mobile plaque floating with the cardiac beat. We attempted ultrasonography-guided endovascular treatment. Under proximal balloon protection, the floating plaque was successfully aspirated into the Penumbra aspiration catheter. Carotid stent was also placed to stabilize the residual pedicle of the plaque. Aspirated plaque was identified as fresh thrombus by pathological examination. Carotid ultrasonography-guided endovascular approach was effective for getting the picture of real-time dynamics of the carotid FFT. PMID:27270147

  18. Carotid stent infection: a rare but potentially fatal complication of carotid artery stenting.

    PubMed

    Son, Seungnam; Choi, Nack-Cheon; Choi, Dae Seob; Cho, Oh Hyun

    2015-04-01

    Infections involving endovascular devices are rare and, to our knowledge, only three cases of infection with an inserted carotid stent have ever been reported. A 68-year-old man underwent carotid artery stenting (CAS) of the left proximal internal carotid artery. Two days after CAS the patient developed a high fever and investigation showed that the inserted carotid stent was infected. The infection could not be controlled despite adequate antibiotic therapy. Eventually a rupture of the carotid artery occurred and the patient underwent emergency resection of the left carotid bifurcation in addition to stent removal and reconstruction with a saphenous vein interposition graft. The patient recovered fully without any neurological sequelae. PMID:24688061

  19. Skin Temperature Over the Carotid Artery, an Accurate Non-invasive Estimation of Near Core Temperature

    PubMed Central

    Imani, Farsad; Karimi Rouzbahani, Hamid Reza; Goudarzi, Mehrdad; Tarrahi, Mohammad Javad; Ebrahim Soltani, Alireza

    2016-01-01

    Background: During anesthesia, continuous body temperature monitoring is essential, especially in children. Anesthesia can increase the risk of loss of body temperature by three to four times. Hypothermia in children results in increased morbidity and mortality. Since the measurement points of the core body temperature are not easily accessible, near core sites, like rectum, are used. Objectives: The purpose of this study was to measure skin temperature over the carotid artery and compare it with the rectum temperature, in order to propose a model for accurate estimation of near core body temperature. Patients and Methods: Totally, 124 patients within the age range of 2 - 6 years, undergoing elective surgery, were selected. Temperature of rectum and skin over the carotid artery was measured. Then, the patients were randomly divided into two groups (each including 62 subjects), namely modeling (MG) and validation groups (VG). First, in the modeling group, the average temperature of the rectum and skin over the carotid artery were measured separately. The appropriate model was determined, according to the significance of the model’s coefficients. The obtained model was used to predict the rectum temperature in the second group (VG group). Correlation of the predicted values with the real values (the measured rectum temperature) in the second group was investigated. Also, the difference in the average values of these two groups was examined in terms of significance. Results: In the modeling group, the average rectum and carotid temperatures were 36.47 ± 0.54°C and 35.45 ± 0.62°C, respectively. The final model was obtained, as follows: Carotid temperature × 0.561 + 16.583 = Rectum temperature. The predicted value was calculated based on the regression model and then compared with the measured rectum value, which showed no significant difference (P = 0.361). Conclusions: The present study was the first research, in which rectum temperature was compared with that

  20. Progression of carotid-artery disease in type 2 diabetic patients: a cohort prospective study.

    PubMed

    Bosevski, Marijan; Stojanovska, Lily

    2015-01-01

    In order to assess the progression of carotid-artery disease in type 2 diabetic cohort (n=207 patients), the dynamic change in carotid intima-media thickness (CIMT) and the occurrence of plaques were followed for a period of 31.35±10.59 months. The mean CIMT at the beginning of the study was 0.9178±0.1447 mm, with a maximal value of 1.1210±0.2366 mm. The maximal value of CIMT changed by 0.07 mm/year. Progression of CIMT was noted in 86.8% and its regression in 7.8% of patients. The occurrence of carotid plaques was detected in 41.8% of patients. Multiple regression analysis revealed the maximal value of CIMT to be associated with diastolic blood pressure, despite mean CIMT being predicted by body mass index. The presence of peripheral arterial disease and hypo-high-density lipoproteinemia were found to be predictors for the occurrence of carotid plaques. Our data have clinical implications in predicting risk factors for the progression of carotid-artery disease in type 2 diabetic patients for their appropriate management. PMID:26527880

  1. Associations between bicycling and carotid arterial stiffness in adolescents: The European Youth Hearts Study.

    PubMed

    Ried-Larsen, M; Grøntved, A; Østergaard, L; Cooper, A R; Froberg, K; Andersen, L B; Møller, N C

    2015-10-01

    The aim of the study was to investigate the associations between bicycling and carotid arterial stiffness, independent of objectively measured moderate-and-vigorous physical activity. This cross-sectional study included 375 adolescents (age 15.7 ± 0.4 years) from the Danish site of the European Youth Heart Study. Total frequency of bicycle usage was assessed by self-report, and carotid arterial stiffness was assessed using B-mode ultrasound. After adjusting for pubertal status, body height, and objectively measured physical activity and other personal lifestyle and demographic factors, boys using their bicycle every day of the week displayed a higher carotid arterial compliance {standard beta 0.47 [95% confidence interval (CI) 0.07-0.87]} and distension [standard beta 0.38 (95% CI -0.04 to 0.81)]. Boys using their bicycle every day of the week furthermore displayed a lower Young's elastic modulus [standard beta -0.48 (95% CI -0.91 to -0.06)]. Similar trends were observed when investigating the association between commuter bicycling and carotid arterial stiffness. These associations were not observed in girls. Our observations suggest that increasing bicycling in adolescence may be beneficial to carotid arterial health among boys. PMID:25156494

  2. Progression of carotid-artery disease in type 2 diabetic patients: a cohort prospective study

    PubMed Central

    Bosevski, Marijan; Stojanovska, Lily

    2015-01-01

    In order to assess the progression of carotid-artery disease in type 2 diabetic cohort (n=207 patients), the dynamic change in carotid intima-media thickness (CIMT) and the occurrence of plaques were followed for a period of 31.35±10.59 months. The mean CIMT at the beginning of the study was 0.9178±0.1447 mm, with a maximal value of 1.1210±0.2366 mm. The maximal value of CIMT changed by 0.07 mm/year. Progression of CIMT was noted in 86.8% and its regression in 7.8% of patients. The occurrence of carotid plaques was detected in 41.8% of patients. Multiple regression analysis revealed the maximal value of CIMT to be associated with diastolic blood pressure, despite mean CIMT being predicted by body mass index. The presence of peripheral arterial disease and hypo-high-density lipoproteinemia were found to be predictors for the occurrence of carotid plaques. Our data have clinical implications in predicting risk factors for the progression of carotid-artery disease in type 2 diabetic patients for their appropriate management. PMID:26527880

  3. Influence of chronic exercise on carotid atherosclerosis in marathon runners

    PubMed Central

    Taylor, Beth A; Zaleski, Amanda L; Capizzi, Jeffrey A; Ballard, Kevin D; Troyanos, Christopher; Baggish, Aaron L; D'Hemecourt, Pierre A; Dada, Marcin R; Thompson, Paul D

    2014-01-01

    Objectives The effect of habitual, high-intensity exercise training on the progression of atherosclerosis is unclear. We assessed indices of vascular health (central systolic blood pressure (SBP) and arterial stiffness as well as carotid intima-medial thickness (cIMT)) in addition to cardiovascular risk factors of trained runners versus their untrained spouses or partners to evaluate the impact of exercise on the development of carotid atherosclerosis. Setting field study at Boston Marathon. Participants 42 qualifiers (mean age±SD: 46±13 years, 21 women) for the 2012 Boston Marathon and their sedentary domestic controls (46±12 years, n=21 women). Outcomes We measured medical and running history, vital signs, anthropometrics, blood lipids, C reactive protein (CRP), 10 years Framingham risk, central arterial stiffness and SBP and cIMT. Results Multiple cardiovascular risk factors, including CRP, non-high-density lipoprotein cholesterol, triglycerides, heart rate, body weight and body mass index (all p<0.05), were reduced in the runners. The left and right cIMT, as well as central SBP, were not different between the two groups (all p>0.31) and were associated with age (all r≥0.41; p<0.01) and Framingham risk score (all r≥0.44; p<0.01) independent of exercise group (all p>0.08 for interactions). The amplification of the central pressure waveform (augmentation pressure at heart rate 75 bpm) was also not different between the two groups (p=0.07) but was related to age (p<0.01) and group (p=0.02) in a multiple linear regression model. Conclusions Habitual endurance exercise improves the cardiovascular risk profile, but does not reduce the magnitude of carotid atherosclerosis associated with age and cardiovascular risk factors. PMID:24531453

  4. Evaluation of Carotid Plaque Using Ultrasound Imaging

    PubMed Central

    2016-01-01

    Traditional risk factors for predicting of cardiovascular disease are not always effective predictors for development of cardiovascular events. This review summarizes several newly developed noninvasive imaging techniques for evaluating carotid plaques and their role in cardiovascular disease risk. PMID:27358696

  5. Retained subintimal pellet in a carotid artery.

    PubMed

    Manousi, Maria; Sarantitis, Ioannis; Papadoulas, Spyros; Diamantopoulos, Athanasios; Kakkos, Stavros K; Lampropoulos, George; Tsolakis, Ioannis A

    2011-06-01

    A shotgun pellet is depicted in the present image in a carotid artery under the intima, which remained intact without local complications for up to six months. There is lack of data regarding the natural history of such a carotid pellet, but the experience from the myocardium is that, in the absence of infection, completely embedded missiles are usually asymptomatic, tolerated well and may be left in place. PMID:21860728

  6. Carotid artery stenting in recently symptomatic patients.

    PubMed

    Setacci, C; de Donato, G; Setacci, F; Sirignano, P; Galzerano, G; Borrelli, M P; Cappelli, A

    2013-02-01

    Treatment of acute stroke is time-dependent, with the best outcomes resulting from the earliest interventions. However, for patients with acute ischemic stroke due to a high-grade stenosis of the internal carotid artery, despite maximal medical treatment, an effective intervention to improve their neurologic symptoms and clinical outcome has not yet been established. There are two major concerns: first, cerebral revascularization in the acute stage remains challenging because of the possibility that hemorrhagic infarction or hyperperfusion syndrome will occur after revascularization; second, alarms about carotid artery stenting in patients with acute symptoms are related to the fact that, while with carotid endarterectomy the plaque is completely removed, after stenting it is only remodelled and its stabilization is essential to avoid embolic events during the procedure and in the post-operative period. Although level 1 evidence seems clearly in favor of carotid endarterectomy in symptomatic patients, carotid stenting has been proposed as a possible alternative in selected cases if the procedure is performed in high-volume center with documented low perioperative stroke and death rates. This review summarizes indications and results for carotid artery stenting in recently symptomatic patients. PMID:23296417

  7. Triple inoculation with Bradyrhizobium, Glomus and Paenibacillus on cowpea (Vigna unguiculata [L.] walp.) development

    PubMed Central

    de Lima, André Suêldo Tavares; Xavier, Terezinha Ferreirab; de Lima, Cláudia Elizabete Pereira; de Paula Oliveira, José; Mergulhão, Adália Cavalcanti do Espírito Santo; Figueiredo, Figueiredo, Márcia do Vale Barreto

    2011-01-01

    The use of microorganisms to improve the availability of nutrients to plants is of great importance to agriculture. This study aimed to evaluate the effect of triple inoculation of cowpea with arbuscular mycorrhizal fungi (AMF), plant growth-promoting bacteria (PGPB) and rhizobia to maximize biological nitrogen fixation (BNF) and promote plant growth. The experiment was conducted in a greenhouse using cowpea plants (Vigna unguiculata L. Walp cv. IPA 206). The treatments included inoculation with strains of Bradyrhizobium sp. (BR 3267 and EI – 6) individually and as a mixture, an absolute control (AC) and mineral nitrogen control (NC), all combined with the presence or absence of native AMF (Glomus etunicatum) and PGPB (Paenibacillus brasilensis - 24) in a 5x2x2 factorial design. All treatments were replicated three times. Contrasts were performed to study the treatment of variables. Inoculation with Bradyrhizobium sp. (BR 3267 and EI – 6) and G. etunicatum favored nitrogen acquisition and phosphorus availability for the cowpea plants. Inoculation with P. brasilensis – 24 increased colonization by Bradyrhizobium sp. and G. etunicatum and promoted cowpea growth, while the nitrogen from symbiosis was sufficient to supply the plants nutritional needs. PMID:24031707

  8. Comparative uptake kinetics and transport of cadmium and phosphate in Phleum pratense-Glomus deserticolum associations

    SciTech Connect

    Arnold, P.T.; Kapustka, L.A. )

    1993-01-01

    Mycorrhizal plants (timothy grass, Phleum pretense with Glomus deserticolum) were compared to nonmycorrhizal timothy grass to determine the effect of the mycorrhizal condition on the uptake and transport of cadmium. Companion experiments were conducted to ascertain phosphate uptake kinetics of mycorrhizal and nonmycorrhizal plants. Divalent cation competition experiments also were employed in this study. Comparisons of the high-affinity uptake mechanisms between mycorrhizal and nonmycorrhizal plants identified higher levels of phosphate uptake were due to an increase in the number of uptake sites rather than to differences in affinity. The respective values for K[sub m] for high-affinity phosphate uptake were 2.5 [plus minus] 1.3 [mu]MP (mycorrhizal) and 3.4 [plus minus] 1.3 [mu]MP (nonmycorrhizal), but these values were not statistically different at the [alpha] = 0.05 level. High-affinity Cd[sup 2+] uptake differed significantly between mycorrhizal (4.5 [plus minus] 2.8 [mu]M) and nonmycorrhizal (2.8 [plus minus] 1.1 [mu]M) plants. Presence of Ca[sup 2+] at 1.0mM concentration conferred considerable competitive protection in both the mycorrhizal and the nonmycorrhizal conditions. The effect of Ca[sup 2+] was an approximate fourfold increase in the respective K[sub m] values.

  9. Surgical Management of Giant Transdural Glomus Jugulare Tumors with Cerebellar and Brainstem Compression

    PubMed Central

    Carlson, Matthew L.; Driscoll, Colin L. W.; Garcia, Joaquin J.; Janus, Jeffrey R.; Link, Michael J.

    2012-01-01

    Objective The objective of this study is to discuss the management of advanced glomus jugulare tumors (GJTs) presenting with intradural disease and concurrent brainstem compression. Study Design This is a retrospective case series. Results Over the last decade, four patients presented to our institution with large (Fisch D2; Glasscock-Jackson 4) primary or recurrent GJTs resulting in brainstem compression of varying severities. All patients underwent surgical resection through a transtemporal, transcervical approach resulting in adequate brainstem decompression; the average operative time was 12.75 hours and the estimated blood loss was 2.7 L. All four patients received postoperative adjuvant radiotherapy in the form of intensity-modulated radiation therapy or stereotactic radiosurgery. Combined modality treatment permitted tumor control in all patients (range of follow-up 5 to 9 years). Conclusion A small subset of GJTs may present with intracranial transdural extension with aggressive brainstem compression mandating surgical intervention. Surgical resection is extremely challenging; the surgical team must be prepared for extensive operating time and the patient for prolonged aggressive rehabilitation. Newly diagnosed and recurrent large GJTs involving the brainstem may be controlled with a combination of aggressive surgical resection and postoperative radiation. PMID:23730549

  10. Symbiotic role of Glomus mosseae in phytoextraction of lead in vetiver grass [Chrysopogon zizanioides (L.)].

    PubMed

    Punamiya, Pravin; Datta, Rupali; Sarkar, Dibyendu; Barber, Summer; Patel, Mandakini; Das, Padmini

    2010-05-15

    Lead (Pb) has limited solubility in the soil environment owing to complexation with various soil components. Although total soil Pb concentrations may be high at a given site, the fraction of soluble Pb that plants can extract is very small, which is the major limiting factor for Pb phytoremediation. The symbiotic effect of arbuscular mycorrhizal (AM) fungus, Glomus mosseae was examined on growth and phytoextraction of lead (Pb) by vetiver grass [Chrysopogon zizanioides (L.)]. A hydroponic study, Phase I (0, 1, 2, and 4mM Pb) was conducted followed by an incubation pot study, Phase II (0, 400, 800, and 1200 mg kg(-1) Pb) where vetiver plants were colonized with G. mosseae. The results obtained indicate that plants colonized by the AM fungi not only exhibit better growth (increase in plant biomass), but also significantly increase Pb uptake in root and higher translocation to the shoot at all given treatments. Moreover, plants colonized with AM fungi had higher chlorophyll content and reduced levels of low molecular weight thiols, indicating the ability to better tolerate metal-induced stress. Results from this study indicate that vetiver plants in association with AM fungi can be used for improved phytoextraction of Pb from contaminated soil. PMID:20061082

  11. Phyto-Extraction of Nickel by Linum usitatissimum in Association with Glomus intraradices.

    PubMed

    Amna; Masood, Sajid; Syed, Jabir Hussain; Munis, Muhammad Farooq Hussain; Chaudhary, Hassan Javed

    2015-01-01

    Plants show enhanced phytoremediation of heavy metal contaminated soils particularly in response to fungal inoculation. Present study was conducted to find out the influence of Nickel (Ni) toxicity on plant biomass, growth, chlorophyll content, proline production and metal accumulation by L. usitatissimum (flax) in the presence of Glomus intraradices. Flax seedlings of both inoculated with G. intraradices and non-inoculated were exposed to different concentrations i.e., 250, 350 and 500 ppm of Ni at different time intervals. Analysis of physiological parameters revealed that Ni depressed the growth and photosynthetic activity of plants. However, the inoculation of plants with arbuscular mycorrhizae (G. intraradices) partially helped in the alleviation of Ni toxicity as indicated by improved plant growth under Ni stress. Ni uptake of non- mycorrhizal flax plants was increased by 98% as compared to control conditions whereas inoculated plants showed 19% more uptake when compared with the non-inoculated plants. Mycorrhizal plants exhibited increasing capacity to remediate contaminated soils along with improved growth. Thus, AM assisted phytoremediation helps in the accumulation of Ni in plants to reclaim Ni toxic soils. Based on our findings, it can be concluded that the role of flax plants and mycorrhizal fungi is extremely important in phytoremediation. PMID:25763643

  12. Transcriptome analysis of Glomus mosseae/Medicago sativa mycorrhiza on atrazine stress

    PubMed Central

    Song, Fuqiang; Li, Jize; Fan, Xiaoxu; Zhang, Quan; Chang, Wei; Yang, Fengshan; Geng, Gui

    2016-01-01

    Arbuscular mycorrhizal fungi (AMF) protect host plants against diverse biotic and abiotic stresses, and promote biodegradation of various contaminants. In this study effect of Glomus mosseae/Medicago sativa mycorrhiza on atrazine degradation was investigated. It was observed that the atrazine degradation rates with any addition level in mycorrhizal treatments were all significantly higher than those in non- mycorrhizal treatments. When atrazine was applied at 20 mg kg−1, the removal efficiency was up to 74.65%. Therefore, G. mosseae can be considered as ideal inhabitants of technical installations to facilitate phytoremediation. Furthermore, a total of 10.4 Gb was used for de novo transcriptome assembly, resulting in a comprehensive data set for the identification of genes corresponding to atrazine stress in the AM association. After comparative analysis with edgeR, a total of 2,060 differential expressed genes were identified, including 570 up-regulated genes and 1490 down-regulated genes. After excluding ‘function unknown’ and ‘general function predictions only’ genes, 172 up-regulated genes were obtained. The differentially expressed genes in AM association with and without atrazine stress were associated with molecular processes/other proteins, zinc finger protein, intracellular/extracellular enzymes, structural proteins, anti-stress/anti-disease protein, electron transport-related protein, and plant growth associated protein. Our results not only prove AMF has important ecological significance on atrazine degradation but also provide evidence for the molecular mechanisms of atrazine degradation by AMF. PMID:26833403

  13. 9p21 locus rs10757278 is associated with advanced carotid atherosclerosis in a gender-specific manner.

    PubMed

    Zivotić, Ivan; Djurić, Tamara; Stanković, Aleksandra; Djordjević, Ana; Končar, Igor; Davidović, Lazar; Alavantić, Dragan; Zivković, Maja

    2016-06-01

    Single nucleotide polymorphisms from the chromosome locus 9p21 are reported to carry a risk for various cardiovascular diseases. One of the lead single nucleotide polymorphisms, rs10757278, was mostly investigated in association with coronary artery disease but rarely with carotid atherosclerosis. In this study, we aimed to analyze the association of rs10757278 A/G polymorphism with carotid plaque presence in advanced carotid atherosclerosis. The study included 803 participants, 486 patients with high-grade stenosis (>70%) who were undergoing carotid endarterectomy and 317 controls from Serbian population. Genotypes were determined using the real-time polymerase chain reaction. According to the recessive model of inheritance, GG genotype was significantly and independently associated with carotid plaque in females only (odds ratio 2.42, CI = 1.20-4.90, P = 0.013). Odds ratio was adjusted for age, body mass index, hypertension, TC, LDLC, HDLC and TG, and P value was corrected for multiple comparisons. Our preliminary findings suggest a gender-specific association of rs10757278 polymorphism with carotid plaque. Further studies on larger sample and in genetically and environmentally similar populations are needed. PMID:26941057

  14. Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis

    SciTech Connect

    Mayberg, M.R.; Eskridge, J.; Winn, H.R.; Eskridge, J. ); Wilson, S.E. ); Yatsu, F. ); Weiss, D.G. ); Messina, L. ); Hershey, L.A. ); Colling, C. ); Deykin, D. )

    1991-12-18

    The objective of this study was to determine whether carotid endarterectomy provides protection against subsequent cerebral ischemia in men with ischemic symptoms in the distribution of significant ipsilateral internal carotid artery stenosis. The study group was comprised of men who presented within 120 days of onset of symptoms that were consistent with transient ischemic attacks, transient monocular blindness, or recent small completed strokes between July 1988 and February 1991. Among 5,000 patients screened, 189 individuals were randomized with angiographic internal carotid artery stenosis greater than 50% ipsilateral to the presenting symptoms. Forty-eight eligible patients who refused entry were followed up outside of the trial. For a selected cohort of men with symptoms of cerebral or retinal ischemia in the distribution of a high-grade internal carotid artery stenosis, carotid endarterectomy can effectively reduce the risk of subsequent ipsilateral cerebral ischemia. The risk of cerebral ischemia in this subgroup of patients is considerably higher than previously estimated.

  15. Internal carotid artery rupture caused by carotid shunt insertion

    PubMed Central

    Illuminati, Giulio; Caliò, Francesco G.; Pizzardi, Giulia; Vietri, Francesco

    2015-01-01

    Introduction Shunting is a well-accepted method of maintaining cerebral perfusion during carotid endarterectomy (CEA). Nonetheless, shunt insertion may lead to complications including arterial dissection, embolization, and thrombosis. We present a complication of shunt insertion consisting of arterial wall rupture, not reported previously. Presentation of case A 78-year-old woman underwent CEA combined with coronary artery bypass grafting (CABG). At the time of shunt insertion an arterial rupture at the distal tip of the shunt was detected and was repaired via a small saphenous vein patch. Eversion CEA and subsequent CABG completed the procedure whose postoperative course was uneventful. Discussion Shunting during combined CEA-CABG may be advisable to assure cerebral protection from possible hypoperfusion due to potential hemodynamic instability of patients with severe coronary artery disease. Awareness and prompt management of possible shunt-related complications, including the newly reported one, may contribute to limiting their harmful effect. Conclusion Arterial wall rupture is a possible, previously not reported, shunt-related complication to be aware of when performing CEA. PMID:26255001

  16. Pulsatility index in carotid arteries is increased in levothyroxine-treated Hashimoto disease.

    PubMed

    Owecki, M; Sawicka-Gutaj, N; Owecki, M K; Ambrosius, W; Dorszewska, J; Oczkowska, A; Michalak, M; Fischbach, J; Kozubski, W; Ruchała, M

    2015-07-01

    The aim of this case-control study was to evaluate carotid hemodynamic variables and traditional cardiovascular risk factors in women with Hashimoto thyroiditis (HT). The study group consisted of 31 females with HT on levothyroxine (L-T4) and 26 euthyroid women with HT without L-T4 matched for age and body mass index (BMI) as controls. Carotid intima-media thickness (CIMT), carotid extra-media thickness (CEMT), and pulsatility indexes in common carotid artery (PI CCA) and in internal carotid artery (PI ICA) were measured. BMI, waist circumference, lipid profile, fasting glucose and insulin levels, and parameters of thyroid function [TSH, free thyroxine (FT4) and antithyroperoxidase antibodies (TPOAbs)] were assessed. The study and the control groups did not differ in age, BMI, waist circumference, lipid profile, fasting glucose, and insulin levels. Results are expressed as median (IQR). Treated HT group had higher FT4 levels than nontreated [17.13 (5.11) pmol/l vs. 14.7 (2.27) pmol/l; p=0.0011] and similar TSH [1.64 (2.08) IU/ml vs. 2.07 (3.14) IU/ml; p=0.5915]. PI CCA and PI ICA were higher in the study group than in controls (p=0.0224 and p=0.0477, respectively). The difference remained statistically significant for PI ICA and PI CCA after adjustment for other variables (coefficient=0.09487; standard error=0.04438; p=0.037 and coefficient=0.1786; standard error=0.0870; p=0.0449, respectively). CIMT and CEMT were similar in both groups (p=0.8746 and p=0.0712, respectively). Women with HT on L-T4 replacement therapy have increased PI in common and internal carotid arteries than nontreated euthyroid HT patients. Therefore, it seems that hypothyroidism, but not autoimmune thyroiditis per se, influences arterial stiffness. PMID:25671800

  17. Interaction of central venous pressure, intramuscular pressure, and carotid baroreflex function

    NASA Technical Reports Server (NTRS)

    Shi, X.; Foresman, B. H.; Raven, P. B.; Blomqvist, C. G. (Principal Investigator)

    1997-01-01

    Seven healthy volunteer men participated in an experiment involving lower body positive pressure (LBPP) of 30 Torr and acute volume expansions of 5-6% (VE-I) and 9-10% (VE-II) of their total blood volume (TBV) to differentiate the effect of increased intramuscular pressure and central venous pressure (CVP) on the maximal gain (Gmax) of the carotid baroreflex. During each experimental condition, the heart rate (HR), mean arterial pressure (MAP; intraradial artery or Finapres), and CVP (at the 3rd-4th intercostal space) were monitored continuously. Gmax was derived from the logistic modeling of the HR and MAP responses to ramped changes in carotid sinus transmural pressure using a protocol of pulsatile changes in neck chamber pressure from +40 to -65 Torr. The increase in CVP during +30-Torr LBPP was 1.5 mmHg (P < 0.05) and was similar to that observed during VE-I (1.7 mmHg, P > 0.05). The Gmax of the carotid baroreflex of HR and MAP was significantly decreased during LBPP by -0.145 +/- 0.039 beats x min(-1) x mmHg(-1) (38%) and -0.071 +/- 0.013 mmHg/mmHg (25%), respectively; however, VE-I did not affect Gmax. During VE-II, CVP was significantly greater than that elicited by LBPP, and the Gmax of the carotid baroreflex of the HR and MAP responses was significantly reduced. We conclude that carotid baroreflex responsiveness was selectively inhibited by increasing intramuscular pressure, possibly resulting in an activation of the intramuscular mechanoreceptors during LBPP. Furthermore, it would appear that the inhibition of the carotid baroreflex, via cardiopulmonary baroreceptor loading (increased CVP), occurred when a threshold pressure (CVP) was achieved.

  18. Periodontal Microbiota and Carotid Intima-Media Thickness

    PubMed Central

    Desvarieux, Moïse; Demmer, Ryan T.; Rundek, Tatjana; Boden-Albala, Bernadette; Jacobs, David R.; Sacco, Ralph L.; Papapanou, Panos N.

    2009-01-01

    Background Chronic infections, including periodontal infections, may predispose to cardiovascular disease. We investigated the relationship between periodontal microbiota and subclinical atherosclerosis. Methods and Results Of 1056 persons (age 69±9 years) with no history of stroke or myocardial infarction enrolled in the Oral Infections and Vascular Disease Epidemiology Study (INVEST), we analyzed 657 dentate subjects. Among these subjects, 4561 subgingival plaque samples were collected (average of 7 samples/subject) and quantitatively assessed for 11 known periodontal bacteria by DNA-DNA checkerboard hybridization. Extensive in-person cardiovascular risk factor measurements, a carotid scan with high-resolution B-mode ultrasound, white blood cell count, and C-reactive protein values were obtained. In 3 separate analyses, mean carotid artery intima-media thickness (IMT) was regressed on tertiles of (1) burden of all bacteria assessed, (2) burden of bacteria causative of periodontal disease (etiologic bacterial burden), and (3) the relative predominance of causative/over other bacteria in the subgingival plaque. All analyses were adjusted for age, race/ethnicity, gender, education, body mass index, smoking, diabetes, systolic blood pressure, and LDL and HDL cholesterol. Overall periodontal bacterial burden was related to carotid IMT. This relationship was specific to causative bacterial burden and the dominance of etiologic bacteria in the observed microbiological niche. Adjusted mean IMT values across tertiles of etiologic bacterial dominance were 0.84, 0.85, and 0.88 (P=0.002). Similarly, white blood cell values increased across tertiles of etiologic bacterial burden from 5.57 to 6.09 and 6.03 cells × 109/L (P=0.01). C-reactive protein values were unrelated to periodontal microbial status (P=0.82). Conclusions Our data provide evidence of a direct relationship between periodontal microbiology and subclinical atherosclerosis. This relationship exists independent

  19. Who Is at Risk for Carotid Artery Disease?

    MedlinePlus

    ... Prevention Living With Clinical Trials Links Related Topics Atherosclerosis Carotid Endarterectomy Carotid Ultrasound Stents Stroke Send a ... who don’t have diabetes. Family history of atherosclerosis . People who have a family history of atherosclerosis ...

  20. Stroke from an External Carotid: Lesion Pattern and Mechanisms.

    PubMed

    Nicolas, Kagan; Hubert, Lathelyse; Leclère, Franck Marie; Etienne, Marchand; Robert, Martinez

    2016-04-01

    Traditionally, patients with symptomatic external carotid stenosis present with neck or face pain, retinal ischemic symptoms or jaw claudication and rarely as ipsilateral cerebrovascular events. In this present case, our patient suffered a stroke from a paradoxical embolism from the external carotid, without involvement of the internal carotid artery. A plaque ulceration of the external carotid's origin was the cause of this cerebral emboli. Duplex ultrasound showed a pathologic left external carotid, with a floating thrombus in the internal carotid. The diagnostic was confirmed by a computerized tomography scan. An external carotid thromboendarterectomy was performed 6 days after symptom onset, and intraoperative findings confirmed the plaque rupture with an extensive clot in the carotid bifurcation. PMID:26802301

  1. Carotid artery disease following external cervical irradiation

    SciTech Connect

    Elerding, S.C.; Fernandez, R.N.; Grotta, J.C.; Lindberg, R.D.; Causay, L.C.; McMurtrey, M.J.

    1981-01-01

    A retrospective study of 910 patients surviving at least five years after cervical irradiation for Hodgkin's disease, non-Hodgkin's lymphoma, or primary head an neck neoplasms showed the incidence of stroke following cervical irradiation was 63 of 910 patients (6.3%) during a mean period of observation of nine years. This represents a trend toward an increased risk for this population observed over the same period of time (p . 0.39). A prospective study of 118 similar patients currently living five years after cervical radiotherapy was performed to determine the incidence of carotid artery disease occurring as a consequence of neck irradiation. Abnormal carotid phonangiograms (CPA) were found in 25% of the patients and abnormal oculoplethysmographs (OPG) were found in 17%. These studies represent significant carotid lesions that are not expected in such a population. It is concluded that the carotid stenoses demonstrated are most likely a consequence of prior irradiation. Patients that are five-year survivors of cervical irradiation should have noninvasive vascular laboratory studies performed as part of their routine follow-up examinations in order to detect these carotid lesions while they are occult.

  2. Carotid intraplaque neovascularization quantification software (CINQS).

    PubMed

    Akkus, Zeynettin; van Burken, Gerard; van den Oord, Stijn C H; Schinkel, Arend F L; de Jong, Nico; van der Steen, Antonius F W; Bosch, Johan G

    2015-01-01

    Intraplaque neovascularization (IPN) is an important biomarker of atherosclerotic plaque vulnerability. As IPN can be detected by contrast enhanced ultrasound (CEUS), imaging-biomarkers derived from CEUS may allow early prediction of plaque vulnerability. To select the best quantitative imaging-biomarkers for prediction of plaque vulnerability, a systematic analysis of IPN with existing and new analysis algorithms is necessary. Currently available commercial contrast quantification tools are not applicable for quantitative analysis of carotid IPN due to substantial motion of the carotid artery, artifacts, and intermittent perfusion of plaques. We therefore developed a specialized software package called Carotid intraplaque neovascularization quantification software (CINQS). It was designed for effective and systematic comparison of sets of quantitative imaging biomarkers. CINQS includes several analysis algorithms for carotid IPN quantification and overcomes the limitations of current contrast quantification tools and existing carotid IPN quantification approaches. CINQS has a modular design which allows integrating new analysis tools. Wizard-like analysis tools and its graphical-user-interface facilitate its usage. In this paper, we describe the concept, analysis tools, and performance of CINQS and present analysis results of 45 plaques of 23 patients. The results in 45 plaques showed excellent agreement with visual IPN scores for two quantitative imaging-biomarkers (The area under the receiver operating characteristic curve was 0.92 and 0.93). PMID:25561454

  3. 21 CFR 870.3850 - Carotid sinus nerve stimulator.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Carotid sinus nerve stimulator. 870.3850 Section... nerve stimulator. (a) Identification. A carotid sinus nerve stimulator is an implantable device used to decrease arterial pressure by stimulating Hering's nerve at the carotid sinus. (b) Classification....

  4. 21 CFR 870.3850 - Carotid sinus nerve stimulator.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Carotid sinus nerve stimulator. 870.3850 Section... nerve stimulator. (a) Identification. A carotid sinus nerve stimulator is an implantable device used to decrease arterial pressure by stimulating Hering's nerve at the carotid sinus. (b) Classification....

  5. 21 CFR 870.3850 - Carotid sinus nerve stimulator.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Carotid sinus nerve stimulator. 870.3850 Section... nerve stimulator. (a) Identification. A carotid sinus nerve stimulator is an implantable device used to decrease arterial pressure by stimulating Hering's nerve at the carotid sinus. (b) Classification....

  6. Effect of Inoculation with Glomus versiforme on Cadmium Accumulation, Antioxidant Activities and Phytochelatins of Solanum photeinocarpum

    PubMed Central

    Tan, Shi-Yun; Jiang, Qiu-Yun; Zhuo, Feng; Liu, Hui; Wang, Yu-Tao; Li, Shao-Shan; Ye, Zhi-Hong; Jing, Yuan-Xiao

    2015-01-01

    The plant growth, phosphate acquisition, Cd translocation, phytochelatins (PCs) production and antioxidant parameters [superoxide dismutase (SOD), catalase (CAT), guaiacol peroxidase (POD), ascorbate peroxidase (APX), glutathione reductase (GR), glutathione (GSH), ascorbate (ASA) and malonaldehyde (MDA)] were investigated in Cd-hyperaccumulator Solanum photeinocarpum inoculated with Glomus versiforme BGC GD01C (Gv) in Cd-added soils (0, 5, 10, 20, 40 mg Cd kg-1 soil). Mycorrhizal colonization rates were generally high (from 77% to 94%), and hardly affected by Cd. Gv colonization significantly enhanced P acquisition, growth and total Cd uptakes in both shoots and roots of S. photeinocarpum at all Cd levels. Meanwhile, Gv symbiosis significantly increased Cd concentration in the roots, and decreased Cd concentration in the shoots at all Cd levels, which indicates that Gv could promote phytostabilization by enhancing Cd accumulation in the roots to inhibit its translocation to shoots and the “dilution effects” linked to an increase in plant dry matter yield and a reduced Cd partitioning to shoots. Moreover, the improvement of CAT, POD and APX activities in the leaves of mycorrhizal plants infers that Gv symbiosis helped S. photeinocarpum to relieve oxidative damage to biomolecules in Cd-contaminated soil. The evident decline of MDA content in the leaves of mycorrhizal plants indicates that Gv symbiosis evidently improved antioxidant activities, and the enhancement of PCs production in the leaves of mycorrhizal plants suggests that Gv-inoculated plant may be more efficient to relieve Cd phytotoxicity. Therefore, the possible mechanisms of Cd phytotoxicity alleviation by Gv can be concluded as the decline of Cd concentration in the shoots and the improvement of P acquisition, PCs production and activities of CAT, POD, APX in mycorrhizal plants. PMID:26176959

  7. Effect of Inoculation with Glomus versiforme on Cadmium Accumulation, Antioxidant Activities and Phytochelatins of Solanum photeinocarpum.

    PubMed

    Tan, Shi-Yun; Jiang, Qiu-Yun; Zhuo, Feng; Liu, Hui; Wang, Yu-Tao; Li, Shao-Shan; Ye, Zhi-Hong; Jing, Yuan-Xiao

    2015-01-01

    The plant growth, phosphate acquisition, Cd translocation, phytochelatins (PCs) production and antioxidant parameters [superoxide dismutase (SOD), catalase (CAT), guaiacol peroxidase (POD), ascorbate peroxidase (APX), glutathione reductase (GR), glutathione (GSH), ascorbate (ASA) and malonaldehyde (MDA)] were investigated in Cd-hyperaccumulator Solanum photeinocarpum inoculated with Glomus versiforme BGC GD01C (Gv) in Cd-added soils (0, 5, 10, 20, 40 mg Cd kg-1 soil). Mycorrhizal colonization rates were generally high (from 77% to 94%), and hardly affected by Cd. Gv colonization significantly enhanced P acquisition, growth and total Cd uptakes in both shoots and roots of S. photeinocarpum at all Cd levels. Meanwhile, Gv symbiosis significantly increased Cd concentration in the roots, and decreased Cd concentration in the shoots at all Cd levels, which indicates that Gv could promote phytostabilization by enhancing Cd accumulation in the roots to inhibit its translocation to shoots and the "dilution effects" linked to an increase in plant dry matter yield and a reduced Cd partitioning to shoots. Moreover, the improvement of CAT, POD and APX activities in the leaves of mycorrhizal plants infers that Gv symbiosis helped S. photeinocarpum to relieve oxidative damage to biomolecules in Cd-contaminated soil. The evident decline of MDA content in the leaves of mycorrhizal plants indicates that Gv symbiosis evidently improved antioxidant activities, and the enhancement of PCs production in the leaves of mycorrhizal plants suggests that Gv-inoculated plant may be more efficient to relieve Cd phytotoxicity. Therefore, the possible mechanisms of Cd phytotoxicity alleviation by Gv can be concluded as the decline of Cd concentration in the shoots and the improvement of P acquisition, PCs production and activities of CAT, POD, APX in mycorrhizal plants. PMID:26176959

  8. Sex-specific responses of Populus deltoides to Glomus intraradices colonization and Cd pollution.

    PubMed

    Chen, Lianghua; Zhang, Danju; Yang, Wanqin; Liu, Yang; Zhang, Li; Gao, Shun

    2016-07-01

    The positive effects of arbuscular mycorrhizal fungi (AM) on the survival, growth and physiology of plants under various stress conditions have been widely recognized. However, whether sex-dependent susceptibility to AM colonization exists, which can induce a differential tolerance between the sexes to stress conditions, is still unclear. In this study, we investigated the effects of Glomus intraradices on Cd-stressed males and females of Populus deltoides (spiked with 10 mg Cd per kg dry substrate) in terms of morphology, physiology, biochemistry, ultrastructure, and toxin storage and translocation. Exposure to Cd promoted the colonization by G. intraradices in males, but not in females. Generally, females suffered more impairments than males in response to Cd stress, reflected by leaf symptoms, the extent of lipid peroxidation, and integrity of the cellular ultrastructure, whether they were inoculated or not. Inoculation with G. intraradices alleviated the phytotoxic effects of Cd in females by stimulating antioxidant enzymes, decreasing levels of reactive oxygen species (ROS) and restricting Cd transfer to the shoots. In contrast, these beneficial effects induced by AM were not detected in mycorrhizal males compared to non-mycorrhizal males, based on thiobarbituric acid-reactive substances (TBARS) and cellular ultrastructure. Inoculation with AM promoted Cd accumulation in males but not in females, and caused the sequestration of more toxic Cd in the root systems in both sexes. Therefore, our results suggest that inoculated males of P. deltoides are suitable candidates for phytostabilization in Cd-polluted soils, due to their higher accumulation ability and greater tolerance relative to inoculated females. PMID:27115844

  9. Management of Striga hermonthica on sorghum (Sorghum bicolor) using arbuscular mycorrhizal fungi (Glomus mosae) and NPK fertilizer levels.

    PubMed

    Isah, K M; Kumar, Niranjan; Lagoke, S T O; Atayese, M O

    2013-11-15

    Trials were conducted in the screen house of Niger State College of Agriculture, Mokwa (09 degrees 18'N; 05 degrees 04'E) in the Southern Guinea Savannah agro-ecological zone of Nigeria during October-December, 2008 and January-March, 2009. The objective was to evaluate the effect of management of Striga hermonthica on sorghum (Sorghum bicolor) using Arbuscular mycorrhizal fungi and NPK fertilizer levels. The trials were laid out in split-split plot arrangement in a randomized complete block design. The main-plot treatments consisted of three sorghum varieties; SAMSORG 3, ICSVIII and SAMSORG 14 while the sub-plot treatments consisted of inoculations; Striga mixed with Glomus, Striga only and Glomus only as well as no inoculation control. The sub-sub-plot treatments were made up of NPK fertilizer levels; (100 kg N, 50 kg P2O5, 50 kg K2O ha(-1)), (50 kg N, 50 kg P2O5, 50 kg K2O ha(-1)) and (0 kg N, 0 kg P2O5, 0 kg K2O ha(-1)). The result obtained showed that sorghum variety SAMSORG 3 were taller, having more vigour and lower reaction to Striga parasitism which resulted in the crop producing higher dry matter compared to the other two varieties. The plots inoculated with Striga only supported shorter plants of sorghum varieties, higher vigour and lower reaction score to Striga compared to Striga mixed with Glomus. It is obvious in this study that the crop performance increases with increase in the rates of NPK fertilizer applied. PMID:24511701

  10. Evaluation oF Epicardial Fat and Carotid Intima-Media Thickness in Obese Children

    PubMed Central

    Elshorbagy, Hatem Hamed; Fouda, ElSaeed R.; Kamal, Naglaa M.; Bassiouny, Mohammed M.; Fathi, Waleed M.

    2016-01-01

    Background: Epicardial fat has a role in cardiovascular diseases. Objectives: To assess epicardial fat and its relation with carotid intima-media thickness (IMT) in obese adolescents with metabolic syndrome (MetS). Patients and Methods: The study included 60 obese adolescents and 25 control subjects. According to the presence or absence of MetS, obese subjects were divided into two subgroups. We measured weight, height, calculated Body Mass Index, waist circumference, hip circumference, systolic blood pressure, diastolic blood pressure and biochemical parameters (fasting glucose, total cholesterol, triglycerides, high density lipoprotein cholesterol, and low density lipoprotein cholesterol, High sensitivity C-reactive protein, fasting insulin, a homeostasis model assessment index of insulin resistance. plus an echocardiographic examination with measurement of epicardial adipose tissue thickness (EATT). Results: Left ventricular mass index measurements were significantly higher in MetS group than both non-MS and control groups. The MetS and non-MetS obese patients had significantly higher carotid IMT in comparison to the control group. Carotid IMT measurements were significantly higher in MetS group had than both non-MetS and control groups. Also, EATT was significantly increased in patients with MetS compared to control group. Among MetS obese group, EATT was positively correlated with body mass index-standard deviation score, waist circumference, fasting glucose, fasting insulin, insulin resistance, triglyceride levels, left ventricular thickness, left ventricular mass index and myocardial performance index. EATT was found to be the only predictor of carotid IMT. Conclusions: EATT is closely related to carotid IMT and early cardiac dysfunction in obese adolescents with MetS. PMID:26848373

  11. Current status of carotid ultrasound in atherosclerosis

    PubMed Central

    2016-01-01

    Cardiovascular disease (CVD) primarily caused by atherosclerosis is a major cause of death and disability in developed countries. Sonographic carotid intima-media thickness (CIMT) is widely studied as a surrogate marker for detecting subclinical atherosclerosis for risk prediction and disease progress to guide medical intervention. However, there is no standardized CIMT measurement methodology in clinical studies resulting in inconsistent findings, thereby undermining the clinical value of CIMT. Increasing evidences show that CIMT alone has weak predictive value for CVD while CIMT including plaque presence consistently improves the predictive power. Quantification of plaque burden further enhances the predictive power beyond plaque presence. Sonographic carotid plaque characteristics have been found to be predictive of cerebral ischaemic events. With advances in ultrasound technology, enhanced assessment of carotid plaques is feasible to detect high-risk/vulnerable plaques, and provide risk assessment for ischemic stroke beyond measurement of luminal stenosis. PMID:27429912

  12. Reinterventions in vascular and endovascular carotid surgery.

    PubMed

    Setacci, F; Borrelli, M P; De Donato, G; Galzerano, G; Setacci, C

    2014-12-01

    In recent years the number of carotid revascularization has increased steadily. This increased has inevitably resulted in an increase (relative) in complications, both after carotid endarterectomy (CEA) and carotid stenting (CAS), despite the technical evolutions of new available materials and the expertise of the operators. So, complications which may potentially require operative intervention, although not very frequent, are possible. However, after diagnosis, immediate management should be undertaken in order to avoid sequelae which are often irreversible and potentially fatal. To minimize this risk, it's important that these procedures are performed by skilled operators in high-volume Centers of activity. The aim of this review is to assess local complications which can lead to re-interventions after CEA and CAS. PMID:25069448

  13. Place of drug therapy in the treatment of carotid stenosis.

    PubMed

    Andaluz, Norberto; Zuccarello, Mario

    2005-01-01

    Carotid stenosis is an important cause of transient ischaemic attacks and stroke. The cause of carotid stenosis is most often atherosclerosis; contributing to the pathogenesis of the lesion are endothelial injury, inflammation, lipid deposition, plaque formation, fibrin, platelets and thrombin. Carotid stenosis accounts for 10-20% of cases of brain infarction, depending on the population studied. Despite successful treatment of selected patients who have had an acute ischaemic stroke with tissue plasminogen activator and the promise of other experimental therapies, prevention remains the best approach to reducing the impact of ischaemic stroke. High-risk or stroke-prone patients can be identified and targeted for specific interventions. At this juncture, treatment of carotid stenosis is a well established therapeutic target and a pillar of stroke prevention. There are two main strategies for the treatment of carotid stenosis. The first approach is to stabilise or halt the progression of the carotid plaque through risk factor modification and medication. Hypertension, diabetes mellitus, smoking, obesity and high cholesterol levels are closely associated with carotid stenosis and stroke; control of these factors may decrease the risk of plaque formation and progression. The second approach is to eliminate or reduce carotid stenosis through carotid endarterectomy or carotid angioplasty and stenting. Carotid endarterectomy, which is the mainstay of therapy for severe carotid stenosis, is beyond the scope of this review. Anticoagulants seem to play little role (if any) in the medical (i.e. non-surgical) treatment of carotid stenosis. Adoption of a healthy lifestyle combined with the reduction of risk factors has been shown to lead to a reduction in the extent of carotid stenosis. The medical treatment of carotid stenosis should be based on the triad of the reduction of risk factors, patient education, and use of antiplatelet agents. PMID:15984896

  14. One very rare and one new tracheal tumour found by electron microscopy: glomus tumour and acinic cell tumour resembling carcinoid tumours by light microscopy.

    PubMed Central

    Heard, B E; Dewar, A; Firmin, R K; Lennox, S C

    1982-01-01

    Tracheal tumours were removed surgically from two patients and diagnosed as carcinoid tumours by routine light microscopy. At a later date, electron microscopy was performed on stored tumour tissue and no neurosecretory granules were found in either case. One showed features of a glomus tumour and the other of an acinic cell tumour. Only two glomus tumours appear to have been reported previously in the trachea, and no acinic cell tumours. Electron microscopy is thus sometimes of great assistance in diagnosing accurately unusual tumours of the lower respiratory tract. Images PMID:6281934

  15. Post Tracheostomy Carotid-Tracheal Fistula.

    PubMed

    Shylendran, Sudhin; Baliyan, Vinit; Yadav, Ajay K; Kumar, Atin; Gamanagatti, Shivanand

    2016-03-01

    Tracheostomy is the life saving procedure in patients presenting with upper airway obstruction. The procedure is also performed in patients on chronic ventilatory support. It is generally considered a safe procedure with a low complication rate. Vascular injuries are the most serious and life threatening complications. Injury to a high lying innominate artery is the most frequent vascular injury in such cases. Injury to other vessels e.g. carotid arteries is less frequent. We are presenting one such rare type of vascular injury with a fistulous communication between trachea and carotid artery leading to massive hemoptysis. PMID:27066421

  16. Bilateral carotid aneurysms unmasked by severe hypopituitarism.

    PubMed Central

    Michils, A.; Balériaux, D.; Mockel, J.

    1991-01-01

    We describe a patient who initially presented with severe hyponatraemia and grand mal seizures, without any focal neurological symptoms. The final diagnosis was that of giant bilateral carotid aneurysms extending into the sella turcica with anterior hypopituitarism. To the best of our knowledge, this is the first case report of symmetrical carotid aneurysms manifested exclusively by an acute endocrine emergency with none of the concomitant usual focal signs such as headache, failing vision, oculomotor palsy or subarachnoid hemorrhage. Images p286-a Figure 1 PMID:2062778

  17. Acute carotid artery dissection treated with stenting and hematoma aspiration guided by ultrasonography.

    PubMed

    Geng, Liming; Zha, Changsong; Liu, Hao; Xu, Jianjun; Xiang, Yuexia; Zou, Zhongmin

    2013-10-01

    We report the successful treatment of dissection with stenosis of the carotid artery by stenting and aspiration of hematoma. A male patient, presenting with acute blurred vision and weakness and numbness of the right side of his body, was diagnosed with common carotid artery (CCA) dissection and severe stenosis of the internal carotid artery and CCA by digital subtraction arteriography and color Doppler ultrasonography (CDU). Two stents were separately implanted into the left internal carotid artery and CCA to restore blood flow and seal the opening of the dissection. The hematoma inside the CCA dissection was transcutaneously aspirated under CDU guidance after thrombolysis with tissue plasminogen activator. Three days after the operation, the dissection was still sealed. The patient was discharged 1 week later without any signs or symptoms. Follow-up examination at 70 days confirmed complete healing of the CCA dissection. Transcutaneous intradissection hematoma aspiration with CDU guidance may be applicable in treating arterial dissection, especially when conservative treatments cannot be expected to improve severe flow disturbances. PMID:22941665

  18. An Integrated Backscatter Ultrasound Technique for the Detection of Coronary and Carotid Atherosclerotic Lesions

    PubMed Central

    Kawasaki, Masanori

    2015-01-01

    The instability of carotid and coronary plaques has been reported to be associated with acute coronary syndrome, strokes and other cerebrovascular events. Therefore, recognition of the tissue characteristics of carotid and coronary plaques is important to understand and prevent coronary and cerebral artery disease. Recently, an ultrasound integrated backscatter (IB) technique has been developed. The ultrasound IB power ratio is a function of the difference in acoustic characteristic impedance between the medium and target tissue, and the acoustic characteristic impedance is determined by the density of tissue multiplied by the speed of sound. This concept allows for tissue characterization of carotid and coronary plaques for risk stratification of patients with coronary and cerebral artery disease. Two- and three-dimensional IB color-coded maps for the evaluation of tissue components consist of four major components: fibrous, dense fibrosis, lipid pool and calcification. Although several ultrasound techniques using special mathematical algorithms have been reported, a growing body of literature has shown the reliability and usefulness of the IB technique for the tissue characterization of carotid and coronary plaques. This review summarizes concepts, experimental procedures, image reliability and the application of the IB technique. Furthermore, the IB technique is compared with other techniques. PMID:25574937

  19. Effects of partial neuromuscular blockade on carotid baroreflex function during exercise in humans.

    PubMed

    Gallagher, K M; Fadel, P J; Strømstad, M; Ide, K; Smith, S A; Querry, R G; Raven, P B; Secher, N H

    2001-06-15

    1. This investigation was designed to determine the contribution of central command to the resetting of the carotid baroreflex during static and dynamic exercise in humans. 2. Thirteen subjects performed 3.5 min of static one-legged exercise (20 % maximal voluntary contraction) and 7 min dynamic cycling (20 % maximal oxygen uptake) under two conditions: control (no intervention) and with partial neuromuscular blockade (to increase central command influence) using Norcuron (curare). Carotid baroreflex function was determined at rest and during steady-state exercise using a rapid neck pressure/neck suction technique. Whole-body Norcuron was repeatedly administered to effectively reduce hand-grip strength by approximately 50 % of control. 3. Partial neuromuscular blockade increased heart rate, mean arterial pressure, perceived exertion, lactate concentration and plasma noradrenaline concentration during both static and dynamic exercise when compared to control (P < 0.05). No effect was seen at rest. Carotid baroreflex resetting was augmented from control static and dynamic exercise by partial neuromuscular blockade without alterations in gain (P < 0.05). In addition, the operating point of the reflex was relocated away from the centring point (i.e. closer to threshold) during exercise by partial neuromuscular blockade (P < 0.05). 4. These findings suggest that central command actively resets the carotid baroreflex during dynamic and static exercise. PMID:11410641

  20. An integrated backscatter ultrasound technique for the detection of coronary and carotid atherosclerotic lesions.

    PubMed

    Kawasaki, Masanori

    2015-01-01

    The instability of carotid and coronary plaques has been reported to be associated with acute coronary syndrome, strokes and other cerebrovascular events. Therefore, recognition of the tissue characteristics of carotid and coronary plaques is important to understand and prevent coronary and cerebral artery disease. Recently, an ultrasound integrated backscatter (IB) technique has been developed. The ultrasound IB power ratio is a function of the difference in acoustic characteristic impedance between the medium and target tissue, and the acoustic characteristic impedance is determined by the density of tissue multiplied by the speed of sound. This concept allows for tissue characterization of carotid and coronary plaques for risk stratification of patients with coronary and cerebral artery disease. Two- and three-dimensional IB color-coded maps for the evaluation of tissue components consist of four major components: fibrous, dense fibrosis, lipid pool and calcification. Although several ultrasound techniques using special mathematical algorithms have been reported, a growing body of literature has shown the reliability and usefulness of the IB technique for the tissue characterization of carotid and coronary plaques. This review summarizes concepts, experimental procedures, image reliability and the application of the IB technique. Furthermore, the IB technique is compared with other techniques. PMID:25574937

  1. Unilateral Direct Carotid Cavernous Fistula Causing Bilateral Ocular Manifestation

    PubMed Central

    Demartini Jr., Zeferino; Liebert, Fernando; Gatto, Luana Antunes Maranha; Jung, Thiago Simiano; Rocha Jr., Carlos; Santos, Alex Marques Borges; Koppe, Gelson Luis

    2015-01-01

    Unilateral carotid cavernous fistula presents with ipsilateral ocular findings. Bilateral presentation is only seen in bilateral fistulas, usually associated with indirect (dural) carotid cavernous fistulas. Direct carotid cavernous fistulas are an abnormal communication between the internal carotid artery and the cavernous sinus. They typically begin with a traumatic disruption in the artery wall into the cavernous sinus, presenting with a classic triad of unilateral pulsatile exophthalmos, cranial bruit and episcleral venous engorgement. We report the case of a 38-year-old male with traumatic right carotid cavernous sinus fistula and bilateral ocular presentation successfully treated by interventional neuroradiology. PMID:26955353

  2. Improving imaging to optimize screening strategies for carotid artery stenosis.

    PubMed

    Pandya, Ankur; Gupta, Ajay

    2016-01-01

    Carotid stenosis is a major risk factor for ischemic stroke. Recently, the United States Preventive Services Task Force issued a recommendation against screening for carotid stenosis in the general population. There is the potential for efficient risk-stratifying or staged screening approaches that identify individuals at highest risk for carotid stenosis and stroke, but these tools have yet to be proven effective in external validation studies. In this paper, we review how medical imaging can be used to detect carotid stenosis and highlight several areas that could be improved to identify potentially efficient screening strategies for carotid stenosis. PMID:26275846

  3. Concurrence of the tortuosity of bilateral common and left internal carotid arteries in a case with common origin of the innominate trunk and left common carotid artery.

    PubMed

    Yildiz, Sema; Cece, Hasan; Karayol, Sibel; Ziylan, Zeki

    2010-10-01

    Anatomical variations of carotid arterial system, which are not infrequently encountered, have great impact on the surgical approaches of the neck. Although few reports on common carotid artery tortuosity have been published, no case of symptomatic concurrent common carotid and internal carotid artery tortuosity has been reported. Herein, we report the first case with concurrent common origin of the innominate trunk and left common carotid artery and common and internal carotid artery tortuosity presenting with an oropharyngeal mass. PMID:20407773

  4. A surgical case of paraclinoid carotid aneurysm associated with ipsilateral cervical internal carotid artery dissection.

    PubMed

    Takeuchi, Satoru; Wada, Kojiro; Sakakibara, Fumihiro; Mori, Kentaro

    2012-01-01

    This report presents a 60-year-old with a large paraclinoid carotid aneurysm associated with cervical interal carotid artery (ICA) dissection (CICAD). She had a fall while riding a bicycle and hit her head on the ground. Computed tomography scan done at another facility showed a round mass lesion near the sella. Her medical history revealed gradual decrease in left eye vision since two years. Left carotid artery digital subtraction angiography demonstrated a CICAD with an intimal flap and a large paraclinoid aneurysm (15.5 mm in size). She underwent a high-flow bypass with a so-called double-insurance bypass and proximal ligation of the cervical ICA and the postoperative course was uneventful. She was discharged without any new neurological deficits. We suggest that the possible nature of carotid artery dissection (CAD)-related hemodynamic changes should be taken into consideration in cases of intracranial aneurysm associated with CAD. PMID:23135031

  5. Mixing in the human carotid artery during carotid drug infusion studied with PET.

    PubMed

    Junck, L; Koeppe, R A; Greenberg, H S

    1989-10-01

    The safety and efficacy of drug infusion into the carotid artery require adequate mixing of the infused solution with carotid blood. Using positron emission tomography (PET), we studied the mixing of solutions infused into the human carotid artery in seven patients by analyzing the distribution of [15O]H2O infused into the carotid artery and by vein. At four infusion rates ranging from 0.5 to 10 ml/min, the variability in distribution averaged 16.5-17.8% among the pixels in a large volume of interest, without dependence on the infusion rate. The overall correlation between [15O]H2O influx with arterial infusion and [15O]H2O influx with venous injection was 0.78-0.82 at the four infusion rates, with no trend toward higher correlations at the faster infusion rates. The distribution into the anterior, middle, and posterior cerebral artery territories differed from distribution throughout the entire carotid territory by an average of 6.2-9.6% at the four infusion rates, with no trend toward smaller differences at the faster infusion rates. Infusions performed into a vinyl tube simulating the carotid artery indicated that at 0.5 ml/min, the velocity of fluid exiting the catheter makes no apparent contribution to mixing. We conclude that with infusions at the carotid bifurcation, mixing in the human carotid artery is complete or nearly complete over a wide range of infusion rates. The mixing appears to result from the patterns of blood flow within the artery, and not from jet effects at the catheter tip. PMID:2789230

  6. The role of the solitary and paramedian reticular nuclei in mediating cardiovascular reflex responses from carotid baro- and chemoreceptors

    PubMed Central

    Miura, Mitsuhiko; Reis, Donald J.

    1972-01-01

    1. With dye-filled micro-electrodes single neurones in the medulla of anaesthetized paralysed cats were identified which: (a) fired rhythmically in synchrony with or were modulated by the cardiac cycle, and which ceased firing with occlusion of the ipsilateral common carotid artery (carotid sinus baroreceptor neurones); (b) were excited by stimulation of carotid body chemoreceptors by close intra-arterial injection of lobeline into the thyroid artery (carotid body chemoreceptor neurones). 2. Twelve carotid baroreceptor neurones were identified, in thirty-three cats, nine of which were localized in the intermediate area of the nucleus of the solitary tract (NTS) within 1 mm ahead of or behind the obex; three units were located either in the parahypoglossal area or the dorsal portion of the paramedian reticular nucleus (PRN). 3. Of the twenty-one carotid chemoreceptor neurones which were identified, thirteen were localized in the NTS, three in the parahypoglossal area and four in the dorsal PRN. 4. Bilateral lesions of the paramedian reticular area of medulla destroying the PRN, abolished or reversed the depressor response to electrical stimulation of myelinated fibres of the carotid sinus nerve (CSN), attenuated the depressor response to carotid sinus stretch and augmented the pressor response to chemoreceptor stimulation by lobeline. Such lesions did not significantly alter the reflex heart rate responses. 5. Small lesions of the NTS within an area 1 mm rostral to the obex abolished all reflex blood pressure and heart rate responses to electrical stimulation of the CSN or natural stimulation of carotid baro- or chemoreceptors. 6. Baroreceptors and chemoreceptors of the CSN project both to the intermediate zone of the NTS and to more medial areas of the medulla, particularly the dorsal PRN and parahypoglossal area. 7. The PRN serves to mediate the reflex depressor, but not cardio-vagal, response from myelinated baroreceptors and buffers the pressor responses from

  7. Emergency carotid thromboendarterectomy: safe and effective.

    PubMed

    Schneider, C; Johansen, K; Königstein, R; Metzner, C; Oettinger, W

    1999-11-01

    Whether to perform emergency carotid thromboendarterectomy (CTEA) in the presence of crescendo transient ischemic attacks or stroke-in-evolution is controversial, with the operative mortality in some reports exceeding 20% and improvement in neurologic deficit of less than 40% in others. Our anecdotal experience with emergency CTEA for acute, persistent, or crescendo neurologic deficit had been strikingly better than published reports. Accordingly, we carried out a restrospective comparison of 43 such patients undergoing emergency CTEA with 237 patients concurrently undergoing elective CTEA for conventional indications. A standard protocol followed in emergency CTEA patients included carotid Doppler ultrasonography, computed cerebral tomography (CT), four-vessel cerebral arteriography, and intravenous heparin. Exclusions from emergency CTEA included coma or cerebral CT scan evidence for either hemorrhagic or ischemic infarction with edema. Operative techniques included standard carotid endarterectomy with Dacron patch or direct suture, eversion endarterectomy, or shortening resection. No mortality or central neurologic complications resulted among the 43 emergency CTEA patients, in comparison to no deaths and one temporary hemiparesis (0.4% central neurologic morbidity) in the 237 elective CTEA patients. Our results suggest that in the absence of coma or cerebral CT scan evidence for an unstable blood-brain barrier, emergency carotid reconstruction can be performed safely and with excellent outcome notwithstanding the magnitude and severity of the acute preoperative neurologic deficit. PMID:10501879

  8. Pseudo-Orbital Apex Syndrome in the Acute Trauma Setting Due to Ipsilateral Dissection of Internal Carotid Artery.

    PubMed

    Anders, Ursula M; Taylor, Elise J; Martel, Joseph R; Martel, James B

    2016-01-01

    Traumatic causes of orbital apex and superior orbital fissure syndrome are uncommon. The authors present the first case of a traumatic superior orbital fissure syndrome simulating orbital apex syndrome, with loss of vision from posterior ischemic optic neuropathy. A 35-year-old man was initially felt to have a right orbital apex syndrome with left craniofacial and orbital trauma. CT revealed left orbital fractures, a right superior orbital fissure fracture, a retained metallic foreign body in the right sphenoid sinus, and a right frontoparietal subdural hematoma. CT angiography showed a secondary dissection and occlusion of the right internal carotid artery from osseous erosion of the posterolateral wall of the sphenoid sinus. Internal carotid artery dissection is a possible, though rare, cause of ischemic optic neuropathy. The right pseudo-orbital apex syndrome resulted from a mechanical superior orbital fissure syndrome and posterior ischemic optic neuropathy from an internal carotid artery dissection. PMID:25216200

  9. Automated carotid artery intima layer regional segmentation

    NASA Astrophysics Data System (ADS)

    Meiburger, Kristen M.; Molinari, Filippo; Rajendra Acharya, U.; Saba, Luca; Rodrigues, Paulo; Liboni, William; Nicolaides, Andrew; Suri, Jasjit S.

    2011-07-01

    Evaluation of the carotid artery wall is essential for the assessment of a patient's cardiovascular risk or for the diagnosis of cardiovascular pathologies. This paper presents a new, completely user-independent algorithm called carotid artery intima layer regional segmentation (CAILRS, a class of AtheroEdge™ systems), which automatically segments the intima layer of the far wall of the carotid ultrasound artery based on mean shift classification applied to the far wall. Further, the system extracts the lumen-intima and media-adventitia borders in the far wall of the carotid artery. Our new system is characterized and validated by comparing CAILRS borders with the manual tracings carried out by experts. The new technique is also benchmarked with a semi-automatic technique based on a first-order absolute moment edge operator (FOAM) and compared to our previous edge-based automated methods such as CALEX (Molinari et al 2010 J. Ultrasound Med. 29 399-418, 2010 IEEE Trans. Ultrason. Ferroelectr. Freq. Control 57 1112-24), CULEX (Delsanto et al 2007 IEEE Trans. Instrum. Meas. 56 1265-74, Molinari et al 2010 IEEE Trans. Ultrason. Ferroelectr. Freq. Control 57 1112-24), CALSFOAM (Molinari et al Int. Angiol. (at press)), and CAUDLES-EF (Molinari et al J. Digit. Imaging (at press)). Our multi-institutional database consisted of 300 longitudinal B-mode carotid images. In comparison to semi-automated FOAM, CAILRS showed the IMT bias of -0.035 ± 0.186 mm while FOAM showed -0.016 ± 0.258 mm. Our IMT was slightly underestimated with respect to the ground truth IMT, but showed uniform behavior over the entire database. CAILRS outperformed all the four previous automated methods. The system's figure of merit was 95.6%, which was lower than that of the semi-automated method (98%), but higher than that of the other automated techniques.

  10. Intracranial Carotid Calcification on Cranial Computed Tomography

    PubMed Central

    Subedi, Deepak; Zishan, Umme Sara; Chappell, Francesca; Gregoriades, Maria-Lena; Sudlow, Cathie; Sellar, Robin

    2015-01-01

    Background and Purpose— Intracranial internal carotid artery calcification is associated with cerebrovascular risk factors and stroke, but few quantification methods are available. We tested the reliability of visual scoring, semiautomated Agatston score, and calcium volume measurement in patients with recent stroke. Methods— We used scans from a prospective hospital stroke registry and included patients with anterior circulation ischemic stroke or transient ischemic stroke whose noncontrast cranial computed tomographic scans were available electronically. Two raters measured semiautomatic quantitative Agatston score, and calcium volume, and performed qualitative visual scoring using the original 4-point Woodcock score and a modified Woodcock score, where each image on which the internal carotid arteries appeared was scored and the slice scores summed. Results— Intra- and interobserver coefficient of variations were 8.8% and 16.5% for Agatston, 8.8% and 15.5% for calcium volume, and 5.7% and 5.4% for the modified Woodcock visual score, respectively. The modified Woodcock visual score correlated strongly with both Agatston and calcium volume quantitative measures (both R2=0.84; P<0.0001); calcium volume increased by 0.47-mm/point increase in modified Woodcock visual score. Intracranial internal carotid artery calcification increased with age by all measures (eg, visual score, Spearman ρ=0.4; P=0.005). Conclusions— Visual scores correlate highly with quantitative intracranial internal carotid artery calcification measures, with excellent observer agreements. Visual intracranial internal carotid artery scores could be a rapid and practical method for epidemiological studies. PMID:26251250

  11. Management of carotid stenosis. History and today

    PubMed Central

    Jargiełło, Tomasz; Drelich-Zbroja, Anna

    2013-01-01

    Internal carotid stenosis constitutes a significant clinical challenge, since it is the cause of 20–25% of ischemic brain strokes. The management of the internal carotid stenosis for many years has been raising controversies amongst neurologists, vascular surgeons and interventional radiologists mainly due to the introduction of endovascular stenting as an alternative to surgical treatment. Its application, however, requires knowledge of specific selection criteria for this kind of treatment as well as of the methods of monitoring patients after stent implantation into the internal carotid artery. Duplex Doppler ultrasound examination is currently a basis for the diagnosis of the arterial stenosis of precranial segments of the carotid arteries. It allows a reliable assessment of not only the course and morphology of the walls, but also of the hemodynamics of blood flow. Interventional treatment is applicable in patients with internal carotid stenosis of ≥70%, which is accompanied by an increase of the systolic flow velocity above 200 cm/s and the end-diastolic velocity above 50–60 cm/s in the stenotic lumen. In most cases, such a diagnosis in duplex Doppler ultrasound examination does not require any confirmation by additional diagnostic methods and if neurological symptoms are also present, it constitutes a single indication for interventional treatment. When deciding about choice of surgical or endovascular method of treatment, the following factors are of crucial importance: morphology of atherosclerotic plaque, its size, echogenicity, homogeneity of its structure, its surface and outlines. By means of ultrasound examinations, patients can be monitored after endovascular stent implantation. They enable evaluation of the degree of stent patency and allow for an early detection of symptoms indicating stenosis recurrence or presence of in-stent thrombosis. When interpreting the findings of the US checkup, it is essential to refer to the initial examination

  12. [Pulse pressure and common carotid arterial wall thickness assessed by ultrasonography].

    PubMed

    Kawamoto, R; Doi, T

    2000-06-01

    This study was conducted on a total of 358 normotensive (mean blood pressure < 107 mmHg) inpatients (182 men and 176 women, mean age: 67.8 years) who had no cardiorenal or nutrition disorders that would affect blood pressure, lipid and glucose metabolism and who had not been given depressors or antilipidemic agents during the four years from September 1995 to August 1999. In addition to the known risk factors for atherosclerosis, the effects of pulse pressure and mean blood pressure on sclerotic changes of the carotid arteries were examined. These sclerotic changes were assessed by measuring the thickness of the combined intima-media of the common carotid artery (carotid arterial wall thickness) by ultrasonography (Hitachi EUB-565) and linear probe (7.5 MHz). When the patients were divided into three groups based on pulse pressure (PP1, lower than 51 mmHg: PP2, 51-65 mmHg; PP3, higher than 65 mmHg), the age of the group with higher pulse pressure was significantly higher (p = 0.0011), women more (p = 0.0315). However there were no differences in background factors such as body mass index, Brinkman index, lipid metabolism, uric acid, and glucose metabolism. There was observed a positive correlation between the mean blood pressure and the pulse pressure for both men and women (r = 0.31, p < 0.001, respectively). As for the relation between the pulse pressures and the blood pressure parameters, the systolic blood pressure, pulse pressure and the mean blood pressure were significantly higher in the group with higher pulse pressure (p < 0.001, respectively), but the diastolic blood pressure was significantly lower (p = 0.0275). As for the relation between the pulse pressure and the carotid wall thickness, the groups of both men and women with higher pulse pressures had significantly greater carotid arterial wall thickness (p < 0.001, p = 0.0042, respectively). Logistic regression analysis of the carotid arterial wall thickness (defined as hypertrophic if greater than 1

  13. Anatomical Considerations on Surgical Anatomy of the Carotid Bifurcation

    PubMed Central

    Michalinos, Adamantios; Chatzimarkos, Markos; Arkadopoulos, Nikolaos; Safioleas, Michail

    2016-01-01

    Surgical anatomy of carotid bifurcation is of unique importance for numerous medical specialties. Despite extensive research, many aspects such as precise height of carotid bifurcation, micrometric values of carotid arteries and their branches as their diameter, length, and degree of tortuosity, and variations of proximal external carotid artery branches are undetermined. Furthermore carotid bifurcation is involved in many pathologic processes, atheromatous disease being the commonest. Carotid atheromatous disease is a major predisposing factor for disabling and possibly fatal strokes with geometry of carotid bifurcation playing an important role in its natural history. Consequently detailed knowledge of various anatomic parameters is of paramount importance not only for understanding of the disease but also for design of surgical treatment, especially selection between carotid endarterectomy and carotid stenting. Carotid bifurcation paragangliomas constitute unique tumors with diagnostic accuracy, treatment design, and success of operative intervention dependent on precise knowledge of anatomy. Considering those, it becomes clear that selection and application of proper surgical therapy should consider anatomical details. Further research might ameliorate available treatment options or even lead to innovative ones. PMID:27047690

  14. Usefulness of contrast-enhanced ultrasound for detection of carotid plaque ulceration in patients with symptomatic carotid atherosclerosis.

    PubMed

    ten Kate, Gerrit L; van Dijk, Anouk C; van den Oord, Stijn C H; Hussain, Burhan; Verhagen, Hence J M; Sijbrands, Eric J G; van der Steen, Antonius F W; van der Lugt, Aad; Schinkel, Arend F L

    2013-07-15

    Previous data have indicated that carotid plaque ulceration is a strong predictor of cerebrovascular events. Standard ultrasound and color Doppler ultrasound (CDUS) scans have poor diagnostic accuracy for the detection of carotid plaque ulceration. The aim of the present prospective study was to assess the value of contrast-enhanced ultrasound (CEUS) scans for the detection of carotid plaque ulceration. The Institutional Ethics Committee approved the study protocol, and all patients provided informed consent. The patients had symptomatic stenosis of the internal carotid artery and underwent carotid computed tomographic angiography as part of their clinical evaluation. All patients underwent a CDUS examination in conjunction with CEUS. Carotid plaque ulceration was defined as the presence of ≥1 disruptions in the plaque-lumen border ≥1 × 1 mm. Carotid computed tomographic angiography was used as reference technique. The study population consisted of 20 patients (mean age 64 ± 9 years, 80% men), and 39 carotid arteries were included in the present analysis. Computed tomographic angiography demonstrated that the plaque surface was smooth in 15 (38%), irregular in 7 (18%) and ulcerated in 17 (44%) carotid arteries. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CDUS for the detection of ulceration was 29%, 73%, 54%, 46%, and 57%, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CEUS for the detection of ulceration was 88%, 59%, 72%, 63%, and 87%, respectively. CEUS had superior sensitivity and diagnostic accuracy for the assessment of carotid plaque ulceration compared with CDUS. CEUS improved the intrareader and inter-reader variability for the assessment of carotid plaque ulceration compared with CDUS. In conclusion, CEUS could be an additional method for the detection of carotid plaque ulceration. The role of CDUS for the assessment of carotid

  15. Carotid Stiffness: A Novel Cerebrovascular Disease Risk Factor

    PubMed Central

    van Sloten, Thomas T.; Stehouwer, Coen D.A.

    2016-01-01

    Carotid stiffening is considered an important element in the pathogenesis of cerebrovascular diseases. These include stroke as well as vascular dementia and depression. However, results of individual studies evaluating the association between carotid stiffening and incident stroke have been inconsistent. Therefore, we have conducted a systematic review and meta-analysis, showing that carotid stiffening is associated with incident stroke independently of cardiovascular risk factors and aortic stiffness. In addition, carotid stiffening improved stroke risk prediction beyond the Framingham stroke risk factors and aortic stiffness. Other studies have shown that carotid stiffening is associated with a higher incidence of vascular dementia and depressive symptoms. This suggests that carotid stiffness is a potential separate target for prevention strategies of cerebrovascular disease. PMID:27493900

  16. Definition of Best Medical Treatment in Asymptomatic and Symptomatic Carotid Artery Stenosis.

    PubMed

    Paraskevas, Kosmas I; Mikhailidis, Dimitri P; Veith, Frank J; Spence, J David

    2016-05-01

    Implementation of best medical treatment (BMT) is the cornerstone of the management of patients with either asymptomatic or symptomatic carotid artery stenosis. We review the literature to define the components of BMT. Smoking cessation, maintaining a healthy body weight, moderate exercise, and a Mediterranean diet are essential lifestyle measures. Moderate alcohol consumption may also be beneficial but recommending it to patients may be hazardous if they consume too much. The importance of lifestyle measures is largely underestimated by both physicians and patients. Blood pressure and diabetes control, antiplatelet agents, and lipid-lowering treatment with statins/ezetimibe comprise the pharmacological components of BMT. Initiation of an intensive regimen of BMT is a sine qua non for patients with carotid artery stenosis whether or not they are offered or undergo an invasive revascularization procedure. PMID:26721504

  17. Endovascular Treatment of Extracranial Internal Carotid Aneurysms Using Endografts

    SciTech Connect

    Baldi, Sebastian Rostagno, Roman D.; Zander, Tobias; Llorens, Rafael; Schonholz, Claudio; Maynar, Manuel

    2008-03-15

    Aneurysms of the extracranial internal carotid artery (EICA) are infrequent. They are difficult to treat with conventional surgery because of their distal extension into the skull base. We report three cases of EICA aneurysms in two symptomatic patients successfully treated with polytetrafluoroethylene self-expanding endografts using an endovascular approach. The aneurysms were located distal to the carotid bifurcation and extended to the subpetrous portion of the internal carotid artery.

  18. Successful Reconstruction of Asymptomatic Bilateral External Carotid Artery Aneurysms.

    PubMed

    Loja, Melissa N; Pevec, William C

    2016-04-01

    True aneurysms of the external carotid artery (ECA) are extremely rare with an unknown incidence and natural history. We present the successful operative management of an asymptomatic 65-year-old man found to have bilateral internal carotid artery stenosis and bilateral ECA aneurysms. His bilateral carotid arteries were reconstructed with bifurcated interposition grafts in a staged fashion. The patient recovered without sequelae and continues to be asymptomatic 1 year after reconstruction. We present the operative management of this rare case. PMID:26802292

  19. Internal Carotid Artery Aneurysm Mimicking Peritonsillar Abscess

    PubMed Central

    Brzost, Jacek; Waniewska, Martyna; Szczepanski, Miroslaw J.

    2015-01-01

    The extracranial internal carotid artery aneurysm (EICAA) is an uncommon arterial lesion. Patients typically present with neurologic symptoms resulting from impaired cerebral perfusion and compression symptoms of cranial nerves. Often EICAA presents as a pulsatile neck mass, which is otherwise asymptomatic. We present a case of an 84-year-old female, who was initially referred to the Emergency Department for Otolaryngology with suspected peritonsillar abscess. The patient had a history of recent upper airway infection and cardiovascular comorbidities, including hypertension and ischaemic stroke complicated by extensive neurologic deficits. Physical examination revealed a compact, nonpulsatile mass in the lateral parapharyngeal space and local erythema of the mucosa. Duplex Doppler Ultrasonography and Computed Tomography revealed an atherosclerotic aneurysm of the right internal carotid artery, measuring 63 × 55 × 88 mm, stretching from the skull base to the angle of the mandible. PMID:26124973

  20. The Development of Carotid Stent Material

    PubMed Central

    He, Dongsheng; Liu, Wenhua; Zhang, Tao

    2015-01-01

    Endovascular angioplasty with stenting is a promising option for treating carotid artery stenosis. There exist a rapidly increasing number of different stent types with different materials. The bare-metal stent is the most commonly used stent with acceptable results, but it leaves us with the problems of thrombosis and restenosis. The drug-eluting stent is a breakthrough as it has the ability to reduce the restenosis rate, but the problem of late thrombosis still has to be addressed. The biodegradable stent disappears after having served its function. However, restenosis and degradation rates remain to be studied. In this article, we review every stent material with its characteristics, clinical results and complications and point out the standards of an ideal carotid stent. PMID:26019710

  1. [Carotid surgery, indications, results and perspectives].

    PubMed

    Kün, P; Battino, J; Cloarec, M; Witchitz, S; Vanet, R; Mergy, R

    1985-01-01

    A series of 215 patients who had undergone 250 carotid artery operations were followed up for a mean of 30 months. Perioperative mortality was 2%, neurologic morbidity was 7% but with permanent sequelae in 1.39% of cases. Recurrence of stenosis was detected in 0.8% of patients but there were no cases of postoperative thrombosis. Indications for surgery were based on the existence of hemispheric ischemic accidents corresponding to the territory supplied by the artery operated upon, and on anatomic and evolutive arguments drawn from results of non-invasive review examinations: ultrasonography and Doppler. Results obtained: 81.9% of patients were asymptomatic after 30 months, appear to be superior to those of the natural history of carotid artery lesions. PMID:4056617

  2. Carotid-cardiac baroreflex response and LBNP tolerance following resistance training

    NASA Technical Reports Server (NTRS)

    Tatro, D. L.; Dudley, G. A.; Convertino, V. A.

    1992-01-01

    The purpose of this study was to examine the effect of lower body resistance training on cardiovascular control mechanisms and blood pressure maintenance during an orthostatic challenge. Lower body negative pressure (LBNP) tolerance, carotid-cardiac baroreflex function (using neck chamber pressure), and calf compliance were measured in eight healthy males before and after 19 wk of knee extension and leg press training. Resistance training sessions consisted of four or five sets of 6-12 repetitions of each exercise, performed two times per week. Training increased strength 25 +/- 3 (SE) percent (P = 0.0003) and 31 +/- 6 percent (P = 0.0004), respectively, for the leg press and knee extension exercises. Average fiber size in biopsy samples of m. vastus lateralis increased 21 +/- 5 percent (P = 0.0014). Resistance training had no significant effect on LBNP tolerance. However, calf compliance decreased in five of the seven subjects measured, with the group average changing from 4.4 +/- 0.6 ml.mm Hg-1 to 3.9 +/- 0.3 ml.mm Hg-1 (P = 0.3826). The stimulus-response relationship of the carotid-cardiac baroreflex response shifted to the left on the carotid pressure axis as indicated by a reduction of 6 mm Hg in baseline systolic blood pressure (P = 0.0471). In addition, maximum slope increased from 5.4 +/- 1.3 ms.mm Hg-1 before training to 6.6 +/- 1.6 ms.mm Hg-1 after training (P = 0.0141). Our results suggest the possibility that high resistance, lower extremity exercise training can cause a chronic increase in sensitivity and resetting of the carotid-cardiac baroreflex.

  3. Interaction of semicircular canal stimulation with carotid baroreceptor reflex control of heart rate

    NASA Technical Reports Server (NTRS)

    Convertino, V. A.

    1998-01-01

    The carotid-cardiac baroreflex contributes to the prediction of orthostatic tolerance; experimental attenuation of the reflex response leads to orthostatic hypotension in humans and animals. Anecdotal observations indicate that rotational head movements about the vertical axis of the body can also induce orthostatic bradycardia and hypotension through increased parasympathetic activity. We therefore measured the chronotropic response to carotid baroreceptor stimulation in 12 men during varying conditions of vestibulo-oculomotor stimulation to test the hypothesis that stimulation of the semicircular canals associated with head movements in the yaw plane inhibits cardioacceleration through a vagally mediated baroreflex. Carotid-cardiac baroreflex response was assessed by plotting R-R intervals (ms) at each of 8 neck pressure steps with their respective carotid distending pressures (mmHg). Calculated baroreflex gain (maximal slope of the stimulus-response relationship) was measured under 4 experimental conditions: 1) sinusoidal whole-body yaw rotation of the subject in the dark without visual fixation (combined vestibular-oculomotor stimulation); 2) yaw oscillation of the subject while tracking a small head-fixed light moving with the subject (vestibular stimulation without eye movements); 3) subject stationary while fixating on a small light oscillating in yaw at the same frequency, peak acceleration, and velocity as the chair (eye movements without vestibular stimulation); and 4) subject stationary in the dark (no eye or head motion). Head motion alone and with eye movement reduced baseline baroreflex responsiveness to the same stimulus by 30%. Inhibition of cardioacceleration during rotational head movements may have significant impact on functional performance in aerospace environments, particularly in high-performance aircraft pilots during high angular acceleration in aerial combat maneuvers or in astronauts upon return from spaceflight who already have

  4. Carotid artery aneurysm: last among equals.

    PubMed

    Dhillon, Ajit Kaur; Rowlands, Timothy; McMahon, Greg

    2016-01-01

    A 66-year-old man presented initially with a swelling in the left side of the neck, which was confirmed to be a carotid artery aneurysm on ultrasonography. He was subsequently admitted reporting intermittent episodes of visual loss in the left eye and right arm weakness. Further imaging confirmed multiple, small acute infarcts in the left cerebral hemisphere. The patient underwent open repair of the aneurysm and made an uncomplicated recovery with no persisting neurological deficit. PMID:27190119

  5. Psychometric and EEG changes after carotid endarterectomy.

    PubMed

    Valenti, Pietro; Ortelli, Paola; Zanon, Antonio; Schiff, Sami; Montagnese, Sara; Avruscio, Giampietro; Del Piccolo, Franco; Mapelli, Daniela; Puato, Massimo; Rattazzi, Marcello; Amodio, Piero; Pauletto, Paolo

    2015-02-01

    The influence of carotid stenosis and its surgical treatment on brain function is still poorly defined. We therefore performed a study to assess psychometric and quantified EEG findings after carotid endarterectomy (CEA). Sixty-nine non-demented patients (aged 72 ± 7 years) with severe carotid stenosis (≥ 70%) eligible for CEA were studied. Forty patients (group A) had unilateral stenosis, and 29 patients (group B) had bilateral stenosis. Before and 5 months after CEA all the patients were evaluated by the Trail Making Test A, the Symbol Digit Test, and spectral EEG analysis. At baseline, compared to group A, group B patients performed slowly the Trail Making Test A (Z: 1.45 ± 1.4 vs. 0.76 ± 1.3; p <  0.05), but not the Symbol Digit Test (Z: 0.83 ± 1.38 vs. 0.64 ± 1.26; p = 0.59). Altogether, the patients with at least one abnormal psychometric test were 29% (group A: 26%; group B: 33%, p = 0.56). The EEG did not differ significantly between patients of group A compared to group B. After CEA, psychometric tests improved (mean Z score from 0.73 ± 1.12 to 0.45 ± 1.15, p <  0.05). The improvement was similar in group A and B. The EEG mean dominant frequency improved only in group B patients and it was related to the improvement in psychometric tests (r = 0.43, p = 0.05). Low psychometric performance was detectable in about 1/ 3 of non-demented patients with severe carotid stenosis. CEA improved mental performance and, in patients with severe bilateral stenosis, accelerated the EEG frequency. PMID:25034456

  6. Are Carotid Stent Fractures Clinically Significant?

    SciTech Connect

    Garcia-Toca, Manuel; Rodriguez, Heron E.; Naughton, Peter A.; Keeling, Aiofee; Phade, Sachin V.; Morasch, Mark D.; Kibbe, Melina R.; Eskandari, Mark K.

    2012-04-15

    Purpose: Late stent fatigue is a known complication after carotid artery stenting (CAS) for cervical carotid occlusive disease. The purpose of this study was to determine the prevalence and clinical significance of carotid stent fractures. Materials and Methods: A single-center retrospective review of 253 carotid bifurcation lesions treated with CAS and mechanical embolic protection from April 2001 to December 2009 was performed. Stent integrity was analyzed by two independent observers using multiplanar cervical plain radiographs with fractures classified into the following types: type I = single strut fracture; type II = multiple strut fractures; type III = transverse fracture; and type IV = transverse fracture with dislocation. Mean follow-up was 32 months. Results: Follow-up imaging was completed on 106 self-expanding nitinol stents (26 closed-cell and 80 open-cell stents). Eight fractures (7.5%) were detected (type I n = 1, type II n = 6, and type III n = 1). Seven fractures were found in open-cell stents (Precise n = 3, ViVEXX n = 2, and Acculink n = 2), and 1 fracture was found in a closed-cell stent (Xact n = 1) (p = 0.67). Only a previous history of external beam neck irradiation was associated with fractures (p = 0.048). No associated clinical sequelae were observed among the patients with fractures, and only 1 patient had an associated significant restenosis ({>=}80%) requiring reintervention. Conclusions: Late stent fatigue after CAS is an uncommon event and rarely clinically relevant. Although cell design does not appear to influence the occurrence of fractures, lesion characteristics may be associated risk factors.

  7. Aterofisiol® in carotid plaque evolution

    PubMed Central

    Amato, Bruno; Compagna, Rita; Amato, Maurizio; Gallelli, Luca; de Franciscis, Stefano; Serra, Raffaele

    2015-01-01

    Background In patients with carotid stenosis, the risk of plaque rupture is related to the composition of the atherosclerotic plaque rather than to its magnitude. In this regard, we evaluated the effects of a supplement, Aterofisiol,® containing omega-3 (EPA [eicosapen acid] DHA [docosahexaenoic acid]), vitamin K2, vitamin B6, vitamin B12, oligomeric proanthocyanidins (OPC) and resveratrol on the composition of atherosclerotic plaque and on neurological symptoms in patients with carotid stenosis undergoing carotid endarterectomy. Methods The study was randomized, prospective, and double-blinded. Eligible patients were of both sexes, with carotid stenosis >70% who underwent endarterectomy. Enrolled patients were randomly allocated to receive either one tablet of acetylsalicylic acid 100 mg (Cardioaspirin®) + one tablet of Aterofisiol every 24 hours or one tablet of Cardioaspirin + one tablet of placebo every 24 hours. Each treatment was started 30 days before the surgery and was stopped 5 days before the surgery. The plaques were removed “en bloc” using standard surgical technique. Results During the study period, 214 patients (135 men and 79 women) were enrolled for intent-to-treat and randomized in two groups: Group A: 107 patients (68 men and 39 women) were treated with Cardioaspirin + Aterofisiol. Group B: 107 patients (67 men and 40 women) were treated with Cardioaspirin + placebo. At the end of the study, 202 patients participated fully (103 patients in Group A and 99 patients in Group B), making up the protocol evaluation population (94.4%). The mean lipid content of removed plaques was significantly lower (P<0.05) in Group A. We recorded a significantly lower incidence of neurological symptoms in Group A in comparison with Group B (P<0.05). Conclusion In the study, Aterofisiol showed to be effective in reducing the amounts of cholesterol and lipids in the plaques and in reducing adverse neurological events in the study group with respect to controls

  8. The first derivative of the carotid displacement pulse.

    NASA Technical Reports Server (NTRS)

    Khan, A. H.; Spodick, D. H.

    1972-01-01

    The amplitude and time relationships of the carotid derivative in normal individuals and unselected cardiac patients is investigated together with the effects of different contraction strengths in patients with pulsus alternans and subjects challenged with isoproterenol and propranolol. Data regarding the relationship between the preejection period (PEP) and the ratio of peak to total amplitude of the carotid displacement pulse derivative are presented. It is found that cardiac abnormality tends to reduce the rate of rise of the carotid displacement pulse. The results obtained show that the PEP is a somewhat more sensitive index of the changes studied than the carotid displacement derivative.

  9. Carotid Stump Syndrome: Case Report and Endovascular Treatment.

    PubMed

    Dakhoul, Lara Toufic; Tawk, Rabih

    2014-01-01

    Objectives. To highlight the case of a patient with multiple transient ischemic attacks and visual disturbances diagnosed with carotid stump syndrome and managed with endovascular approach. Case Presentation. We present the case of a carotid stump syndrome in an elderly patient found to have moderate left internal carotid artery stenosis in response to an advertisement for carotid screening. After a medical therapeutic approach and a close follow-up, transient ischemic attacks recurred. Computed tomographic angiography showed an occlusion of the left internal carotid artery and the presence of moderate stenosis in the right internal carotid artery, which was treated by endovascular stenting and balloon insertion. One month later, the patient presented with visual disturbances due to the left carotid stump and severe stenosis of the left external carotid artery that was reapproached by endovascular stenting. Conclusion. Considerations should be given to the carotid stump syndrome as a source of emboli for ischemic strokes, and vascular assessment could be used to detect and treat this syndrome. PMID:26425620

  10. Complete carotid and coronary revascularization in brain malperfusion.

    PubMed

    Aramendi, Claudia; Cubero, Alain; Cortés, Andrés; Rivas, Daniel; Crespo, Alejandro; Aramendi, José I

    2016-09-01

    A 54-year-old man presented with unstable angina and stroke with right hemiplegia and aphasia due to left main coronary plus 3-vessel disease, severe stenosis of bilateral internal carotid, proximal left common carotid, and proximal left subclavian arteries. Simultaneous complete revascularization was undertaken with the use of conventional cardiopulmonary bypass and moderate hypothermia (25℃). The left internal mammary artery and two saphenous vein grafts were used for coronary artery bypass, and brain revascularization consisted of a left aorta-to-common carotid Dacron graft and bilateral carotid endarterectomy. Recovery was good. PMID:26980597

  11. [An integrated segmentation method for 3D ultrasound carotid artery].

    PubMed

    Yang, Xin; Wu, Huihui; Liu, Yang; Xu, Hongwei; Liang, Huageng; Cai, Wenjuan; Fang, Mengjie; Wang, Yujie

    2013-07-01

    An integrated segmentation method for 3D ultrasound carotid artery was proposed. 3D ultrasound image was sliced into transverse, coronal and sagittal 2D images on the carotid bifurcation point. Then, the three images were processed respectively, and the carotid artery contours and thickness were obtained finally. This paper tries to overcome the disadvantages of current computer aided diagnosis method, such as high computational complexity, easily introduced subjective errors et al. The proposed method could get the carotid artery overall information rapidly, accurately and completely. It could be transplanted into clinical usage for atherosclerosis diagnosis and prevention. PMID:24195385

  12. Revealing Natural Relationships among Arbuscular Mycorrhizal Fungi: Culture Line BEG47 Represents Diversispora epigaea, Not Glomus versiforme

    PubMed Central

    Schüßler, Arthur; Krüger, Manuela; Walker, Christopher

    2011-01-01

    Background Understanding the mechanisms underlying biological phenomena, such as evolutionarily conservative trait inheritance, is predicated on knowledge of the natural relationships among organisms. However, despite their enormous ecological significance, many of the ubiquitous soil inhabiting and plant symbiotic arbuscular mycorrhizal fungi (AMF, phylum Glomeromycota) are incorrectly classified. Methodology/Principal Findings Here, we focused on a frequently used model AMF registered as culture BEG47. This fungus is a descendent of the ex-type culture-lineage of Glomus epigaeum, which in 1983 was synonymised with Glomus versiforme. It has since then been used as ‘G. versiforme BEG47’. We show by morphological comparisons, based on type material, collected 1860–61, of G. versiforme and on type material and living ex-type cultures of G. epigaeum, that these two AMF species cannot be conspecific, and by molecular phylogenetics that BEG47 is a member of the genus Diversispora. Conclusions This study highlights that experimental works published during the last >25 years on an AMF named ‘G. versiforme’ or ‘BEG47’ refer to D. epigaea, a species that is actually evolutionarily separated by hundreds of millions of years from all members of the genera in the Glomerales and thus from most other commonly used AMF ‘laboratory strains’. Detailed redescriptions substantiate the renaming of G. epigaeum (BEG47) as D. epigaea, positioning it systematically in the order Diversisporales, thus enabling an evolutionary understanding of genetical, physiological, and ecological traits, relative to those of other AMF. Diversispora epigaea is widely cultured as a laboratory strain of AMF, whereas G. versiforme appears not to have been cultured nor found in the field since its original description. PMID:21853113

  13. Carotid Stenting for Restenosis after Endarterectomy

    SciTech Connect

    Counsell, Andrew; Ghosh, Jonathan McCollum, Charles C. N.; Ashleigh, Raymond

    2011-06-15

    Introduction: Restenosis after carotid endarterectomy (CEA) has been described in 8-19% of patients, 14-23% of whom become symptomatic. This study analyzes our experience with carotid artery stenting (CAS) for post-CEA recurrent stenoses.MethodRetrospective database and case-note review. Results: Between January 2000 and September 2008, a total of 27 patients (15 symptomatic) with hemodynamically significant internal carotid artery post-CEA restenosis underwent CAS. Median stenosis of target vessels was 90% (range 75-95%). There was one periprocedural death (3.7%); no others occurred during the median 34-month follow-up (range 0.1-84 months). There was one late transient ischemic attack 12 months after CAS that was not associated with in-stent restenosis. One 90% restenosis and one occlusion were detected during follow-up at 38 and 57 months after CAS. The remaining patients had no evidence of further restenosis and remained free from cerebrovascular symptoms. Conclusion: CAS offers a feasible option for the management of carefully selected patients with symptomatic and asymptomatic restenosis after CEA.

  14. Early carotid endarterectomy in selected stroke patients.

    PubMed

    Kahn, M B; Patterson, H K; Seltzer, J; Fitzpatrick, M; Smullens, S; Bell, R; DiMuzio, P; Carabasi, R A

    1999-09-01

    Although there are several reports suggesting the safety of performing carotid endarterectomy (CE) within 4 weeks (early) of a nondisabling stroke, at many institutions it is not standard practice. Benefits of early surgery may include reduction in the number of strokes or carotid occlusions during the time between stroke and surgery, as well as a reduction in the cost of medical care due to the elimination of interval anticoagulation and close follow-up. This review examines the outcomes of early CE in selected patients after a nondisabling stroke. A total of 1065 CEs were performed between November 1991 and April 1998. Seventy-five patients were identified by computerized hospital record and office chart review as having CE after a nondisabling stroke. Criteria for early surgery included 1) nondisabling stroke ipsilateral to a carotid stenosis >50%, 2) neurological stability, and 3) no evidence of hemorrhagic stroke or significant cerebral edema by CT/MRI evaluation. This review suggests that early CE can be performed in selected patients with an acceptable perioperative morbidity and mortality. PMID:10466988

  15. Carotid artery rupture and cervicofacial actinomycosis.

    PubMed

    Kummer, Anne; Lhermitte, Benoît; Ödman, Micaela; Grabherr, Silke; Mangin, Patrice; Palmiere, Cristian

    2012-11-01

    Cervicofacial actinomycosis is an uncommon, progressive infection caused by bacilli of the Actinomyces genus. Actinomyces are common commensal saprophytes in the oral cavity which may have medical importance as facultative pathogens. Subsequent to local injuries to the oral mucosa, they may penetrate the deep tissues and be responsible for suppurative or granulomatous infections. We herein report a case of a 65-year-old man who underwent surgery followed by chemotherapy and radiotherapy for a tonsillar carcinoma. An ulcerous lesion in the base of the tongue developed and spread to the carotid artery wall. The man died of a massive hemorrhage due to left carotid artery rupture. Postmortem computed tomography angiography performed prior to autopsy allowed the precise localization of the source of bleeding to be detected. Postmortem biochemical investigations confirmed the presence of inflammation associated with local bacterial infection. Histological investigations revealed the rupture of the left carotid artery surrounded by numerous colonies of Actinomyces. Acute and chronic inflammation with tissue necrosis as well as post-actinic, fibrotic changes were also found in the tissues surrounding the ruptured artery wall. PMID:22819527

  16. Routine ultrasound surveillance after carotid endarterectomy.

    PubMed

    Pratesi, C; Pulli, R; Ferlaino, E; Michelagnoli, S; Bernacchi, R; Borgioloi, F; Nuzzaci, G

    1996-02-01

    Ultrasounds (US) are employed in preoperative carotid disease diagnosis and in carotid endarterectomy (CEA) follow-up. The authors present their experience about postoperative modifications in CEA site with US evaluation with particular interest in restenosis. Clinical and instrumental examinations were performed at intervals 1, 3, 6, 12, and 24 months following surgery. Follow-up data were available on 189 CEAs. In 58 cases a primary closure was performed, whereas in the other 131 cases, a patch was applied. 15 restenosis (7.9%) were seen during the follow-up control period with 2 cases of haemodynamic restenosis (1%). Good results were recorded with PTFE patch angioplasty (restenosis 4.4%), instead of vein (restenosis 14.2%) and a biosynthetic material called Omniflow (restenosis 9.5%). A vein patch dilatation was encountered in 13 applications (30.9%). In conclusion the routine application of US after carotid endarterectomy allowed us to monitor the evolution of the repair processes and of the stenotic lesions from the very beginning. PMID:8606212

  17. Carotid bypass using the Gore Hybrid Vascular Graft as a rescue technique for on-table failed carotid endarterectomy.

    PubMed

    Valenti, Domenico; Sayed, Saiqa; Mistry, Hiren; Rashid, Hisham; Gambhir, Raghvinder; Slim, Hani

    2016-07-01

    Carotid endarterectomy (CEA) remains the "gold standard" for atherosclerotic lesions involving the carotid bifurcation. Carotid bypass grafting using either polytetrafluoroethylene or long saphenous vein is a suitable alternative technique, especially in challenging endarterectomy and on-table failed CEA. We report our initial experience of using the Gore Hybrid Vascular Graft (W. L. Gore & Associates, Flagstaff, Ariz) in six patients as a rescue technique when standard CEA failed. PMID:26409841

  18. Temporary axillary-carotid shunting for unusual instances of carotid stenosis.

    PubMed

    Shumacker, H B; Isch, J H; Jolly, W W

    1976-07-01

    A method has been developed which entails the introduction of the larger end of a Javid shunt tube in the axillary artery and the other in the internal carotid with only momentary interruption of blood flow. The method of closing the incision after the thromboendarterectomy almost entirely eliminates a second period of carotid occlusion. This procedure may be useful in unusual instances in which it is believed advantageous to avoid even the relatively short occlusion periods usually necessary when using the standard intraluminal shunt technique. PMID:936041

  19. Surgical Exposure to Control the Distal Internal Carotid Artery at the Base of the Skull during Carotid Aneurysm Repair.

    PubMed

    Davis, Laura; Zeitouni, Anthony; Makhoul, Nicholas; Steinmetz, Oren K

    2016-07-01

    Extracranial carotid artery aneurysms are rare. Treatment options for these lesions include endovascular interventions, such as coiling and stenting, or surgical reconstruction, such as resection and primary reanastomosis, or interposition bypass grafting. In this report, we describe the surgical technique used to perform surgical repair of an internal carotid artery aneurysm extending up to the base of the skull. Anterior exposure of the infratemporal fossa and distal control of the carotid artery at the level of the carotid canal was achieved through a transcervical approach, performing double mandibular osteotomies with superior reflection of the middle mandibular section. PMID:26902936

  20. Carotid artery stenting versus endarterectomy: a systematic review.

    PubMed

    Gahremanpour, Amir; Perin, Emerson C; Silva, Guilherme

    2012-01-01

    For about 2 decades, investigators have been comparing carotid endarterectomy with carotid artery stenting in regard to their effectiveness and safety in treating carotid artery stenosis. We conducted a systematic review to summarize and appraise the available evidence provided by randomized trials, meta-analyses, and registries comparing the clinical outcomes of the 2 procedures. We searched the MEDLINE, SciVerse Scopus, and Cochrane databases and the bibliographies of pertinent textbooks and articles to identify these studies. The results of clinical trials and, consequently, the meta-analyses of those trials produced conflicting results regarding the comparative effectiveness and safety of carotid endarterectomy and carotid stenting. These conflicting results arose because of differences in patient population, trial design, outcome measures, and variability among centers in the endovascular devices used and in operator skills. Careful appraisal of the trials and meta-analyses, particularly the most recent and largest National Institutes of Health-sponsored trial (the Carotid Revascularization Endarterectomy vs Stenting Trial [CREST]), showed that carotid stenting and endarterectomy were associated with similar rates of death and disabling stroke. Within the 30-day periprocedural period, carotid stenting was associated with higher risks of stroke, especially for patients aged >70 years, whereas carotid endarterectomy was associated with a higher risk of myocardial infarction. The slightly higher cost of stenting compared with endarterectomy was within an acceptable range by cost-effectiveness standards. We conclude that carotid artery stenting is an equivalent alternative to carotid endarterectomy when patient age and anatomy, surgical risk, and operator experience are considered in the choice of treatment approach. PMID:22949763

  1. Static elastic studies of lathyritic rabbit carotid arteries and thoracic aorta.

    PubMed

    Terpin, T; Roach, M R

    1983-05-01

    Sixteen New Zealand White rabbits with an average initial weight of 1.6 kg were used to determine if lathyrism altered the static elastic properties of the aorta and carotid arteries. Eight were given 1% beta-aminopropionitrile in their drinking water for the same period. All were fed regular rabbit chow. Blood pressures and body weights were taken twice weekly. Blood pressure was not significantly different between the two groups but the lathyritic animals did lose weight while the controls gained. The rabbits were sacrificed at the end of 4 weeks with an overdose of sodium pentobarbital (Nembutal) and the carotid arteries and thoracic aorta were removed for pressure--volume experiments. From these experiments tension--strain curves, elasticities, and slack of the collagen were obtained. The longitudinal distensibility curves for the aortas and carotid arteries for both groups were almost identical. The longitudinal elasticities of elastin and collagen, and the slack were not significantly different between the two groups. The circumferential-distensibility curves for the same arteries showed few differences, however, the elasticities of elastin and collagen, and the slack decreased indicating an alteration in the elastin and a decrease in collagen fibres or a defect in the intramolecular cross-links of collagen. PMID:6883203

  2. Relation between visceral fat and carotid intimal media thickness in Mexican postmenopausal women: a preliminary report

    PubMed Central

    Azpilcueta, Yessica Mireya Moreno; Ortiz, Sergio Rosales

    2016-01-01

    Aim of the study To investigate the relationship between visceral fat and carotid IMT (intima media thickness) in Mexican postmenopausal women. Material and methods In 71 postmenopausal women divided in two groups: group 1, IMT > 1 mm and group 2, IMT ≤ 1 mm, blood pressure, body mass index (BMI), waist hip ratio (WHR), visceral and subcutaneous fats and carotid IMT were analyzed. Descriptive statistics were used and the comparison among those with abnormal and normal IMT was carried out using Mann-Whitney U test; also Spearman's correlation analysis was done. Results When comparing group 1 (n = 9, 12.7%) with group 2 (n = 62, 87.3%), it was found that the subcutaneous fat, visceral fat and systolic blood pressure were significantly greater in group 1 (p < 0.018, p < 0.001 and p < 0.006, respectively), and also in this group there was a correlation between BMI and subcutaneous fat (ρ = 0.686, p < 0.041) and between visceral fat and the systolic blood pressure (ρ = 0.712, p < 0.031). In group 2, there was a correlation between IMT and diastolic blood pressure (ρ = 0.251, p < 0.049). Conclusion Subcutaneous and visceral fat have an unfavorable effect in the carotid IMT and in blood pressure. PMID:27582681

  3. Choosing Wisely for Syncope: Low‐Value Carotid Ultrasound Use

    PubMed Central

    Scott, John W.; Schwartz, Aaron L.; Gates, Jonathan D.; Gerhard‐Herman, Marie; Havens, Joaquim M.

    2014-01-01

    Background The United States spends more than $750 billion annually on tests and procedures that do not benefit patients. Although there is no physiological indication for carotid ultrasound in “simple” syncope in the absence of focal neurological signs or symptoms suggestive of stroke, there is concern that this practice remains common for routine syncope workups. Methods and Results We used a 5% random‐sample Medicare claims database to evaluate large‐scale national trends in utilization of low‐value carotid ultrasound imaging for simple syncope. We found that 16.5% of all Medicare beneficiaries with simple syncope underwent carotid imaging and 6.5% of all carotid ultrasounds ordered in 2009 were for this low‐value indication. These findings were complemented by a manual chart review of 313 patients at a large academic medical center who underwent carotid ultrasound for simple syncope over a 5‐year period. For the 48 (15.4%) of 313 patients with stenosis ≥50%, carotid ultrasound did not yield a causal diagnosis. Only 2% of the 313 patients imaged experienced a change in medications after a positive study, and <1% of patients underwent a carotid revascularization procedure. Conclusions These data suggest that carotid ultrasound for patients with uncomplicated syncope are still commonly ordered and may be an easy target for institutions striving to curtail low‐value care. PMID:25122665

  4. Is carotid duplex scanning sufficient as the sole investigation prior to carotid endarterectomy?

    PubMed

    Collins, P; McKay, I; Rajagoplan, S; Bachoo, P; Robb, O; Brittenden, J

    2005-11-01

    Carotid endarterectomy (CEA) is the accepted treatment for certain patients who have had, or who are at risk of having, a stroke if they have a significant narrowing of the internal carotid artery. Rapid and accurate classification of the degree of stenosis is important as the benefit of surgery is highly dependent on this. The aim of this study was to assess whether the addition of angiography to duplex scanning resulted in a change in patient management in a unit where duplex scanning was used as the sole imaging investigation prior to CEA. The study population consisted of 64 patients with significant internal carotid artery stenosis on duplex scanning who were suitable for, and wished to be considered for, CEA. All patients underwent an angiogram. In this study 9 (14%) patients did not proceed to surgery on the basis of angiography and in a further 11 (17%) patients insufficient views of the distal vessel were obtained on duplex scanning. Three of these patients had extensive disease which excluded surgery. One patient experienced a transient ischaemic attack (TIA) at the time of angiography. In conclusion, this audit has highlighted the limitations in performing duplex scanning alone, and the costs that this can incur on the patient who may undergo an unnecessary operation. We cannot recommend duplex scanning as the sole investigation prior to CEA. There is need to evaluate the role of additional non-invasive carotid imaging such as magnetic resonance angiography or CT angiography in the assessment of these patients. PMID:16249605

  5. Numerical simulation of blood flow and plaque progression in carotid-carotid bypass patient specific case.

    PubMed

    Filipovic, Nenad; Saveljic, Igor; Nikolic, Dalibor; Milosevic, Zarko; Kovacevic, Pavle; Velicki, Lazar

    2015-01-01

    This study describes computer simulation of blood flow and plaque progression pattern in a patient who underwent surgical treatment for infected carotid prosthetic tube graft using carotid-carotid cross-over bypass. The 3D blood flow is governed by the Navier-Stokes equations, together with the continuity equation. Mass transfer within the blood lumen and through the arterial wall is coupled with the blood flow and is modelled by the convection-diffusion equation. Low-density lipoprotein (LDL) transport in lumen of the vessel is described by Kedem-Katchalsky equations. The inflammatory process is solved using three additional reaction-diffusion partial differential equations. Calculation based on a computer simulation showed that flow distribution in the left carotid artery (CA) was around 40-50% of the total flow in the right common CA. Also, the left CA had higher pressure gradient after surgical intervention. Plaque progression simulation predicted development of the atherosclerotic plaque in the position of the right common CA and the left internal CA. A novel way of atherosclerotic plaque progression modelling using computer simulation shows a potential clinical benefit with significant impact on the treatment strategy optimization. PMID:26291584

  6. Extramedullary plasmacytoma in the carotid space: Expanding the differential diagnosis

    PubMed Central

    Deshpande, Sneha Satish; Kane, Shubhada; Arya, Supreeta

    2014-01-01

    Plasma cell neoplasms have been classified into various types, with a range of clinical and radiological presentations. Extramedullary plasmacytoma (EMP) is a subset of plasma cell neoplasms which presents as an isolated non-osseous soft tissue mass. Though carotid space neoplasms are commonly encountered, EMP in the carotid space is rare and seldom considered in the initial differential diagnosis of a carotid space mass. These tumors can be treated by surgery or radiotherapy. On the other hand, the commonly encountered tumors in the carotid space are treated surgically. Also, it is mandatory to exclude multiple myeloma in the patients presenting with EMP. Hence, accurate and early diagnosis has therapeutic and prognostic implications. We report a rare case of EMP of the carotid space, describing the imaging features and the differential diagnoses with clues pointing to this rare entity. PMID:25489135

  7. Peripheral Neural Detection of Danger–Associated and Pathogen–Associated Molecular Patterns

    PubMed Central

    Kazymov, Vitaly; Marina, Nephtali; Singer, Mervyn; Gourine, Alexander V.

    2013-01-01

    Objective: Bidirectional links between the nervous and immune systems modulate inflammation. The cellular mechanisms underlying the detection of danger-associated molecular patterns and pathogen-associated molecular patterns by the nervous system are not well understood. We hypothesized that the carotid body, a tissue of neural crest origin, detect pathogen associated molecular patterns and danger associated molecular patterns via an inflammasome-dependent mechanism similar to that described in immune cells. Design: Randomized, controlled laboratory investigation. Setting: University laboratory. Subjects: C57Bl/6J mice; juvenile Sprague-Dawley rats, primary human neutrophils. Interventions: Rat carotid body chemosensitive cells, and human neutrophils, were treated with TLR agonists to activate inflammasome-dependent pathways. In mice, systemic inflammation was induced by the pathogen associated molecular pattern zymosan (intraperitoneal injection; 500 mg/kg). Isolated carotid body/carotid sinus nerve preparations were used to assess peripheral chemoafferent activity. Ventilation was measured by whole-body plethysmography. Measurements and Main Results: Chemosensitive carotid body glomus cells exhibited toll-like receptor (TLR-2 and TLR-4), NLRP1, and NLRP3 inflammasome immunoreactivities. Zymosan increased NLRP3 inflammasome and interleukin-1β expression in glomus cells (p < 0.01). Human neutrophils demonstrated similar LPS-induced changes in inflammasome expression. Carotid body glomus cells also expressed IL-1 receptor and responded to application of IL-1β with increases in intracellular [Ca2+]. Four hours after injection of zymosan carotid sinus nerve chemoafferent discharge assessed in vitro (i.e., in the absence of acidosis/circulating inflammatory mediators) was increased five-fold (p < 0.001). Accordingly, zymosan-induced systemic inflammation was accompanied by enhanced respiratory activity. Conclusions: In carotid body chemosensitive glomus cells

  8. Congenital Absence of the Internal Carotid Artery

    SciTech Connect

    Florio, Francesco; Balzano, Silverio; Nardella, Michele; Strizzi, Vincenzo; Cammisa, Mario; Bozzini, Vincenzo; Catapano, Giuseppe; D'Angelo, Vincenzo

    1999-01-15

    We report three cases of congenital absence of an internal carotid artery (ICA), diagnosed incidentally by digital subtraction angiography. The analysis of the cases is based on the classification of segmental ICA agenesis proposed by Lasjaunias and Berenstein. Usually the patients with this rare vascular anomaly are asymptomatic; some may have symptoms related to cerebrovascular insufficiency, compression by enlarged intracranial collateral vessels, or complications associated with cerebral aneurysms. Diagnosis of congenital absence of ICA is made by skull base computed tomography (CT) scan, CT and magnetic resonance angiography, and conventional or digital subtraction angiography.

  9. Concomitant Carotid and Coronary Artery Reconstruction

    PubMed Central

    Craver, Joseph M.; Murphy, Douglas A.; Jones, Ellis L.; Curling, Patrick E.; Bone, David K.; Smith, Robert B.; Perdue, Garland D.; Hatcher, Charles R.; Kandrach, Michael

    1982-01-01

    Data are presented on 68 patients who underwent concomitant carotid endarterectomy (CE) and coronary artery bypass surgery (CAB) at Emory University Hospital from January 1974 to February 1981. This group is then compared with a randomly selected, matched population without known carotid disease who underwent CAB alone. Asymptomatic bruit was the reason for investigation in 40 patients (59%); another 23 patients (34%) experienced transient cerebral ischemic attacks (TIAs); and five patients (7%) had TIA and prior stroke. Carotid stenoses (>75% luminal narrowing) were demonstrated as follows: isolated left, 24 patients; isolated right, 27 patients; and bilateral lesions, 16 patients. One patient had innominate artery stenosis. Associated total occlusion of one or both vertebral arteries was demonstrated in six patients. Ninety-seven per cent of patients had disabling angina pectoris prior to operation; the angina was unstable in 57%, 15% had congestive heart failure, and 54% had had at least one prior myocardial infarction (MI). Single-vessel coronary disease was present in 12.5% of patients, double in 37.5%, triple in 41.1%, and left main stenosis in 9%; 43% of patients had abnormal ventricular contractility. CE was performed on 67 patients (36 left and 31 right); aortocarotid bypass was performed on one. The CE procedures were performed immediately prior to the sternotomy for CAB under the same anesthesia. CAB consisted of single bypass in eight patients (11.8%); double in 16 patients (23.5%); triple in 22 patients (32.4%); and quadruple or more in 22 patients (32.4%) (mean = 2.9 grafts per patient). There was no hospital mortality. Perioperative MI occurred in 2.0% and stroke with residual deficit in 1.3%. Cumulative survival is 98.5% at two years. Sixty-three patients (92%) reported improvement or elimination of anginal symptoms after operation. Rehospitalization for stroke was necessary in 3.7% patients. Postoperative activity levels are; self-care only, 3

  10. Recommendations for Carotid Stenting in Korea

    PubMed Central

    Chang, Hyuk Won; Suh, Sang-il; Jeong, Hae Woong; Suh, Dae Chul

    2015-01-01

    Carotid artery angioplasty with stenting (CAS) is being performed in many hospitals in Korea. Most of the guidelines which are being used are similar, but the practical aspects such as techniques are different between hospitals. For example, usage of various protective devices, the oral antiplatelet regimen prior to procedure and placing of temporary pacemaker to prevent bradycardia are different between hospitals. In this article, we summarize and propose the guidelines for CAS which is currently being accepted in Korea. These guidelines may be helpful in providing protocol to neurointerventionalist who perform CAS and to standardize the process including reporting of CAS in the future comparative trials in Korea. PMID:25763292

  11. Management of Extracranial Carotid Artery Disease

    PubMed Central

    Ooi, Yinn Cher

    2015-01-01

    Stroke is the third leading cause of death in developed nations. Up to 88% of strokes are ischemic in nature. Extracranial carotid artery atherosclerotic disease is the third leading cause of ischemic stroke in the general population and the second most common non-traumatic cause among adults <45 years of age. The aim of this paper is to provide comprehensive, evidence-based recommendations for the management of extracranial atherosclerotic disease, including imaging for screening and diagnosis, medical management and interventional management. PMID:25439328

  12. Successful Endovascular Treatment of a Left Common Carotid Artery Aneurysm Following Failed Surgery of a Right Common Carotid Artery Aneurysm

    SciTech Connect

    Cil, Barbaros E. Ucar, Ibrahim; Ozsoy, Fatma; Arat, Anil; Yorgancioglu, Cem; Boeke, Erkmen

    2005-04-15

    Aneurysm of the common carotid artery is a rare and serious disease requiring prompt treatment in order to avoid neurologic complications. A 39-year-old man presented with voice impairment and a pulsatile mass at the right side of his neck and was found by color Doppler examination to have bilateral common carotid artery aneurysms of unknown origin. The right-sided large aneurysm was treated with placement of an 8 mm interposition Gore-Tex graft between the right common and internal carotid arteries. The surgical graft thrombosed 7 days after the surgery but the left-sided aneurysm was successfully treated by a Jostent peripheral stent-graft. Color Doppler examination showed a patent stent and no filling of the aneurysm on his first and sixth-month follow-up. Bilateral common carotid artery aneurysm is an exceptionally unusual condition and endovascular treatment of carotid artery aneurysms with covered stents may become an effective treatment alternative for these lesions.

  13. Access to the carotid artery bifurcation: Cadaveric study with application to nasotracheal intubation as a technique to improve access to a high carotid artery bifurcation.

    PubMed

    Foreman, Paul M; Harrigan, Mark R; Griessenauer, Christoph J; Loukas, Marios; Tubbs, R Shane

    2015-12-01

    Carotid endarterectomy (CEA) is a common and efficacious surgical procedure for the prevention of ischemic stroke due to atherosclerosis of the internal carotid artery (ICA). A high common carotid artery bifurcation can make CEA technically difficult due to limited carotid artery exposure. A cadaveric study was performed to evaluate the efficacy of nasotracheal intubation for improving access to a high carotid artery bifurcation. Based on this study, nasotracheal intubation does not improve access to a high carotid artery bifurcation as compared with orotracheal intubation. PMID:26312946

  14. Glaucoma Management in Carotid Cavernous Fistula.

    PubMed

    Calafiore, Silvia; Perdicchi, Andrea; Scuderi, Gianluca; Contestabile, Maria Teresa; Abdolrahimzadeh, Solmaz; Recupero, Santi Maria

    2016-01-01

    Carotid cavernous fistulas (CCF) are vascular communications between the carotid artery and the cavernous sinus. Ophthalmologists are called to diagnose and manage the condition in cases that present with ocular features. A 73-year-old female was referred to our glaucoma center clinic. Eight years before, she had started receiving medication for glaucoma and had undergone laser iridotomy, but a satisfactory management of intraocular pressure (IOP) had not been achieved. The patient was complaining of intermittent diplopia, bilateral proptosis, and conjunctival chemosis over the past 6 months. Best-corrected visual acuity in the right (OD) and left eye (OS) was 9/10 and 10/10, respectively. Visual field testing showed slight paracentral field defects mostly in OS. IOP was 20 mm Hg in OD and 34 mm Hg in OS. We referred the patient to neuroradiology, and MRI angiography revealed a CCF with angiographic classification of Cognard grade 2. Closure of the CCF by transarterial embolization was performed in the neuroradiology department. One week following the procedure, the clinical signs of diplopia, proptosis, and conjunctival chemosis had greatly improved, and IOP was reduced to 12 mm Hg OD and 19 mm Hg in OS. Glaucoma treatment was maintained with topical brimatoprost, brinzolamide, and timolol. Owing to the risk of vision loss associated with vascular stasis, retinal ischemia, and high IOP, ophthalmologists must be aware of the clinical features of CCF and should request appropriate imaging studies such as MRI angiography in order to confirm the diagnosis and plan multidisciplinary treatment. PMID:27462258

  15. Stenting of Extracranial Carotid Artery Stenosis

    PubMed Central

    Koshimae, N.; Morimoto, T.; Nagata, K.

    2003-01-01

    Summary The purpose of this study is to evaluate our cases of cervical internal carotid artery stenosis for safty stenting. We investigate the preoperative internal carotid artery stenosis using by integrated backscatter (IBS) method of ultra sonography, comparing with the thirty five surgical specimens as to their nature, histological structure, thickness of fibrous cap. We choose the protection method according to plaque structure, and placed Easy-Wall stent or Smart stent after prePTA. We added post PTA according to the extent of expansion and IVUS findings. Calibrated IBS = IBS value (ROI) /intinal IBS value of ‘bleeding’, ‘lipiď, ‘thrombus’, fiber, ‘hyalinization’ were -27.5, -22.5, -15.2, -11.1, +2.1. That of the thin fibrous cap were -10.9*, that of thic fibrous cap were -2.4 (*p < 0.001). There was a good coleration between the extent of expansion and expected histological findings. All conplications were two cases of small cerebral infarction and a case of bleeding from the complicated lung cancer. The protection at prePTA lead to no complications in case of acute cerebral infarctions. It is very important to check the histological specimen carefully for safty stenting. PMID:20591243

  16. Glaucoma Management in Carotid Cavernous Fistula

    PubMed Central

    Calafiore, Silvia; Perdicchi, Andrea; Scuderi, Gianluca; Contestabile, Maria Teresa; Abdolrahimzadeh, Solmaz; Recupero, Santi Maria

    2016-01-01

    Carotid cavernous fistulas (CCF) are vascular communications between the carotid artery and the cavernous sinus. Ophthalmologists are called to diagnose and manage the condition in cases that present with ocular features. A 73-year-old female was referred to our glaucoma center clinic. Eight years before, she had started receiving medication for glaucoma and had undergone laser iridotomy, but a satisfactory management of intraocular pressure (IOP) had not been achieved. The patient was complaining of intermittent diplopia, bilateral proptosis, and conjunctival chemosis over the past 6 months. Best-corrected visual acuity in the right (OD) and left eye (OS) was 9/10 and 10/10, respectively. Visual field testing showed slight paracentral field defects mostly in OS. IOP was 20 mm Hg in OD and 34 mm Hg in OS. We referred the patient to neuroradiology, and MRI angiography revealed a CCF with angiographic classification of Cognard grade 2. Closure of the CCF by transarterial embolization was performed in the neuroradiology department. One week following the procedure, the clinical signs of diplopia, proptosis, and conjunctival chemosis had greatly improved, and IOP was reduced to 12 mm Hg OD and 19 mm Hg in OS. Glaucoma treatment was maintained with topical brimatoprost, brinzolamide, and timolol. Owing to the risk of vision loss associated with vascular stasis, retinal ischemia, and high IOP, ophthalmologists must be aware of the clinical features of CCF and should request appropriate imaging studies such as MRI angiography in order to confirm the diagnosis and plan multidisciplinary treatment. PMID:27462258

  17. Hypothermia during Carotid Endarterectomy: A Safety Study

    PubMed Central

    Candela, Serena; Dito, Raffaele; Casolla, Barbara; Silvestri, Emanuele; Sette, Giuliano; Filippi, Federico; Taurino, Maurizio; Brancadoro, Domitilla; Orzi, Francesco

    2016-01-01

    Background CEA is associated with peri-operative risk of brain ischemia, due both to emboli production caused by manipulation of the plaque and to potentially noxious reduction of cerebral blood flow by carotid clamping. Mild hypothermia (34–35°C) is probably the most effective approach to protect brain from ischemic insult. It is therefore a substantial hypothesis that hypothermia lowers the risk of ischemic brain damage potentially associated with CEA. Purpose of the study is to test whether systemic endovascular cooling to a target of 34.5–35°C, initiated before and maintained during CEA, is feasible and safe. Methods The study was carried out in 7 consecutive patients referred to the Vascular Surgery Unit and judged eligible for CEA. Cooling was initiated 60–90 min before CEA, by endovascular approach (Zoll system). The target temperature was maintained during CEA, followed by passive, controlled rewarming (0.4°C/h). The whole procedure was carried out under anesthesia. Results All the patients enrolled had no adverse events. Two patients exhibited a transient bradycardia (heart rate 30 beats/min). There were no significant differences in the clinical status, laboratory and physiological data measured before and after CEA. Conclusions Systemic cooling to 34.5–35.0°C, initiated before and maintained during carotid clamping, is feasible and safe. Trial Registration ClinicalTrials.gov NCT02629653 PMID:27058874

  18. Treatment of Traumatic Carotid-Cavernous Fistula

    PubMed Central

    Wu, Z.; Zhang, Y.; Wang, C.; YANG, X.; Li, Y.

    2000-01-01

    Summary From 1986 to the end of 1998, 482 cases of traumatic carotid-cavernous fistula (TCCF) were treated by means of intravascular embolisation technique. The experience is overviewed in this article. Many kinds of detachable balloon catheters (including Chinese made detachable balloon catheters), coils and cyano aery late were used as embolic materials. Transcervical, transfemoral, anterior communicating artery, posterior communicating artery approach, or transvenous approach were selected according to conditions. A combination of different approaches or materials was used for complex TCCF. We found that the special sign, named “bileakage sign”, indicated multileakage of TCCF and was not mentioned before. All 482 cases of TCCF were embolised successfully, of which 405 cases maintained the patency of internal carotid artery (ICA). No death related to the treatment occurred in our group and the symptoms or signs in 462 cases were relieved after embolisation. Emergency embolisation was needed in some conditions such as serious epistaxis, delayed or repeatedly subdural haematoma and rapid visual impairment. Endovascular treatment of TCCF is a safe and efficient method. The time of operation, approach, and materials for embolisation must be carefully selected in order to obtain the best result. PMID:20667206

  19. Should patients with asymptomatic significant carotid stenosis undergo simultaneous carotid and cardiac surgery?

    PubMed Central

    Ogutu, Peter; Werner, Raphael; Oertel, Frank; Beyer, Michael

    2014-01-01

    A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was whether patients with severe asymptomatic carotid and coronary artery diseases should undergo simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG). A total of 624 papers were found using the reported search, of which 20 represent the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study results of these papers are tabulated. Previous cohort studies showed mixed results, while advocating for the necessity of a randomized controlled trial (RCT). A recent RCT showed that patients undergoing prophylactic or simultaneous CEA + CABG had lower rates of stroke (0%) compared with delayed CEA 1–3 months after CABG (7.7%), without significant perioperative mortality difference. This study included patients with unilateral severe (>70%) asymptomatic carotid stenosis requiring CABG. An earlier partly randomized trial also showed better outcomes for patients undergoing simultaneous procedures (P = 0.045). Interestingly, systematic reviews previously failed to show compelling evidence supporting prophylactic CEA. This could be partly due to the fact that these reviews collectively analyse different cohort qualities. Neurological studies have, however, shown reduced cognitive and phonetic quality and function in patients with unilateral and bilateral asymptomatic carotid artery stenosis. Twenty-one RCTs comparing lone carotid artery stenting (CAS) and CEA informed the American Heart Association guidelines, which declared CAS comparable with CEA for symptomatic and asymptomatic carotid stenosis (CS). However, the risk of death/stroke for CAS alone is double that for CEA alone in the acute phase following onset of symptoms, while CEA alone is associated with a doubled risk of myocardial infarction. There is

  20. Ultrasound screening for asymptomatic carotid stenosis in subjects with calcifications in the area of the carotid arteries on panoramic radiographs: a cross-sectional study

    PubMed Central

    2011-01-01

    Background Directed ultrasonic screening for carotid stenosis is cost-effective in populations with > 5% prevalence of the diagnosis. Occasionally, calcifications in the area of the carotid arteries are incidentally detected on odontological panoramic radiographs. We aimed to determine if directed screening for carotid stenosis with ultrasound is indicated in individuals with such calcifications. Methods This was a cross-sectional study. Carotid ultrasound examinations were performed on consecutive persons, with findings of calcifications in the area of the carotid arteries on panoramic radiography that were otherwise eligible for asymptomatic carotid endarterectomy. Results Calcification in the area of the carotid arteries was seen in 176 of 1182 persons undergoing panoramic radiography. Of these, 117 fulfilled the inclusion criterion and were examined with carotid ultrasound. Eight persons (6.8%; 95% CI 2.2-11.5%) had a carotid stenosis - not significant over the 5% pre-specified threshold (p = 0.232, Binomial test). However, there was a significant sex difference (p = 0.008), as all stenoses were found in men. Among men, 12.5% (95%CI 4.2-20.8%) had carotid stenosis - significantly over the 5% pre-specified threshold (p = 0.014, Binomial test). Conclusions The incidental finding of calcification in the area of the carotid arteries on panoramic radiographs should be followed up with carotid screening in men that are otherwise eligible for asymptomatic carotid endarterectomy. Trial Registration The study was registered at http://www.clinicaltrials.gov; NCT00514644 PMID:21752238

  1. [A Novel, Less Invasive Protection Method for Carotid Artery Stenting].

    PubMed

    Ohshima, Tomotaka; Goto, Shunsaku; Yamamoto, Taiki; Imai, Tasuku; Nishizawa, Toshihisa; Shimato, Shinji; Kato, Kyozo

    2016-07-01

    Purpose: We present a novel, less invasive protection method for carotid artery stenting. Case presentation: A 67-year-old man presented with symptomatic severe left carotid artery stenosis. A transfemoral approach was dangerous because of an abdominal aortic aneurysm. A 6Fr Axcelguide Simmonds catheter was inserted into the right brachial artery, and advanced into the left common carotid artery. Next, a 6Fr Optimo 100-cm catheter was coaxially navigated into the left common carotid artery. A PercuSurge GuardWire 300-cm was coaxially navigated into the left external carotid artery. Under flow reversal with the 2 balloons, another PercuSurge GuardWire 300-cm was navigated into the distal left internal carotid artery through the lesion. After both PercuSurge GuardWire balloons were inflated, the 6Fr Optimo was deflated and retrieved using a catheter exchange technique. Then, under distal double-balloon protection, routine stenting was performed. Conclusions: This technique is safer and less invasive than previous methods, especially in cases with difficult femoral access and vulnerable carotid plaque. PMID:27384116

  2. Experimental determination of circumferential properties of fresh carotid artery plaques.

    PubMed

    Lawlor, Michael G; O'Donnell, Michael R; O'Connell, Barry M; Walsh, Michael T

    2011-06-01

    Carotid endarterectomy (CEA) is currently accepted as the gold standard for interventional revascularisation of diseased arteries belonging to the carotid bifurcation. Despite the proven efficacy of CEA, great interest has been generated in carotid angioplasty and stenting (CAS) as an alternative to open surgical therapy. CAS is less invasive compared with CEA, and has the potential to successfully treat lesions close to the aortic arch or distal internal carotid artery (ICA). Following promising results from two recent trials (CREST; Carotid revascularisation endarterectomy versus stenting trial, and ICSS; International carotid stenting study) it is envisaged that there will be a greater uptake in carotid stenting, especially amongst the group who do not qualify for open surgical repair, thus creating pressure to develop computational models that describe a multitude of plaque models in the carotid arteries and their reaction to the deployment of such interventional devices. Pertinent analyses will require fresh human atherosclerotic plaque material characteristics for different disease types. This study analysed atherosclerotic plaque characteristics from 18 patients tested on site, post-surgical revascularisation through endarterectomy, with 4 tissue samples being excluded from tensile testing based on large width-length ratios. According to their mechanical behaviour, atherosclerotic plaques were separated into 3 grades of stiffness. Individual and group material coefficients were then generated analytically using the Yeoh strain energy function. The ultimate tensile strength (UTS) of each sample was also recorded, showing large variation across the 14 atherosclerotic samples tested. Experimental Green strains at rupture varied from 0.299 to 0.588 and the Cauchy stress observed in the experiments was between 0.131 and 0.779 MPa. It is expected that this data may be used in future design optimisation of next generation interventional medical devices for the

  3. Readmissions after Carotid Artery Revascularization in the Medicare Population

    PubMed Central

    Al-Damluji, Mohammed Salim; Dharmarajan, Kumar; Zhang, Weiwei; Geary, Lori; Stilp, Erik; Dardik, Alan; Mena-Hurtado, Carlos; Curtis, Jeptha P.

    2015-01-01

    Background In appropriately selected patients with severe carotid stenosis, carotid revascularization reduces ischemic stroke. Prior clinical research has focused on the efficacy and safety of carotid revascularization, but few investigators have considered readmission as a clinically important outcome. Objectives To examine frequency, timing, and diagnoses of 30-day readmission following carotid revascularization; to assess differences in 30-day readmission between patients undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS); to describe hospital variation in risk-standardized readmission rates (RSRR); and to examine whether hospital variation in procedural choice (CEA vs. CAS) was associated with differences in RSRRs. Methods We used Medicare fee-for-service administrative claims data to identify acute care hospitalizations for CEA and CAS from 2009–2011. We calculated crude 30-day all-cause hospital readmissions following carotid revascularization. To assess differences in readmission after CAS compared with CEA, we used Kaplan-Meier survival curves and fitted mixed-effect logistic regression. We estimated hospital RSRRs using hierarchical generalized logistic regression. We stratified hospitals into 5 groups by their proportional CAS use and compared hospital group median RSRRs. Results Of 180,059 revascularizations from 2,287 hospitals, CEA and CAS were performed in 81.5% and 18.5% of cases, respectively. The unadjusted 30-day readmission rate following carotid revascularization was 9.6%. Readmission risk after CAS was higher than after CEA. There was modest hospital-level variation in 30-day RSRRs (Median: 9.5%, Range: 7.5%–12.5%). Variation in proportional use of CAS was not associated with differences in hospital RSRR (range of median RSRR across hospital quartiles: 9.49%–9.55%, P 0.771). Conclusions Almost 10% of Medicare patients undergoing carotid revascularization were readmitted within 30-days of discharge. Compared with CEA

  4. High Agatston Calcium Score of Intracranial Carotid Artery

    PubMed Central

    Kao, Hung-Wen; Liou, Michelle; Chung, Hsiao-Wen; Liu, Hua-Shan; Tsai, Ping-Huei; Chiang, Shih-Wei; Chou, Ming-Chung; Peng, Giia-Sheun; Huang, Guo-Shu; Hsu, Hsian-He; Chen, Cheng-Yu

    2015-01-01

    Abstract The effect of intracranial internal carotid artery (ICA) calcification on cognitive impairment is uncertain. Our objective was to investigate whether intracranial ICA calcification is a significant cognitive predictor for cognitive impairment. Global cognition and degrees of intracranial ICA calcification of 579 subjects were assessed with Mini-Mental State Examination (MMSE) and Agatston calcium scoring method, respectively. Other risk factors for cognitive impairment, including age, education level, hypertension, diabetes mellitus, smoking, hyperlipidemia, and body mass index, were documented and analyzed for their associations with cognitive function. In univariate analyses, older age, lower education level, hypertension, diabetes mellitus, and higher intracranial ICA Agatston scores were significantly associated with cognitive impairment. In ordinal logistic regression, only age and total intracranial ICA Agatston score were significant risk factors for cognitive impairment. After adjustment for the other documented risk factors, subjects were 7% (95% CI: 5–10; P < 0.001) and 6% (95% CI: 0–13; P = 0.04) more likely to have lower cognitive category with every year increment of age and every 100-point increment of the total intracranial ICA Agatston score respectively. These results suggest an important role of the intracranial ICA calcification on cognitive impairment. PMID:26426620

  5. Intraoperative anesthetic management of patients undergoing glomus tumor resection using a low-dose isoflurane-fentanyl technique.

    PubMed

    Jellish, W S; Murdoch, J; Leonetti, J

    1994-01-01

    Glomus jugulare and vagale tumors present unique problems to both anesthesiologists and surgeons. The anesthetic plant must be tailored to each patient and provide hemodynamic stability, a consistent intraoperative environment, and rapid awakening after prolonged administration. In this report, we describe our anesthetic method used for paraganglioma resection, which utilizes a combination technique of low-dose isoflurane with a narcotic infusion initiated after bolus administration. Results from the last three patients anesthetized by this "balanced" technique were compared to a similar patient who received isoflurane anesthesia exclusively for a major portion of the surgical procedure. The patients receiving the balanced anesthesia required no hemodynamic support during the procedure and were awakened within 15 to 25 minutes of surgical completion. The patient receiving high-dose isoflurane, however, had a prolonged anesthetic wake-up time and did not follow verbal commands for approximately 12 hours after surgical completion. This patient also required hemodynamic support with a phenylephrine infusion during tumor resection. The balanced technique seems to be superior to a straight inhalational technique. Neurological assessment and intubation times after prolonged surgery were reduced with superb hemodynamic stability throughout. This anesthetic method produces a stable intraoperative environment and provides deep surgical anesthesia during periods when muscle relaxants cannot be utilized. PMID:17170932

  6. Intraoperative Anesthetic Management of Patients Undergoing Glomus Tumor Resection Using a Low-Dose Isoflurane-Fentanyl Technique

    PubMed Central

    Jellish, W.S.; Murdoch, J.; Leonetti, J.

    1994-01-01

    Glomus jugulare and vagale tumors present unique problems to both anesthesiologists and surgeons. The anesthetic plant must be tailored to each patient and provide hemodynamic stability, a consistent intraoperative environment, and rapid awakening after prolonged administration. In this report, we describe our anesthetic method used for paraganglioma resection, which utilizes a combination technique of low-dose isoflurane with a narcotic infusion initiated after bolus administration. Results from the last three patients anesthetized by this “balanced” technique were compared to a similar patient who received isoflurane anesthesia exclusively for a major portion of the surgical procedure. The patients receiving the balanced anesthesia required no hemodynamic support during the procedure and were awakened within 15 to 25 minutes of surgical completion. The patient receiving high-dose isoflurane, however, had a prolonged anesthetic wake-up time and did not follow verbal commands for approximately 12 hours after surgical completion. This patient also required hemodynamic support with a phenylephrine infusion during tumor resection. The balanced technique seems to be superior to a straight inhalational technique. Neurological assessment and intubation times after prolonged surgery were reduced with superb hemodynamic stability throughout. This anesthetic method produces a stable intraoperative environment and provides deep surgical anesthesia during periods when muscle relaxants cannot be utilized. PMID:17170932

  7. Biochar and Glomus caledonium Influence Cd Accumulation of Upland Kangkong (Ipomoea aquatica Forsk.) Intercropped with Alfred Stonecrop (Sedum alfredii Hance)

    PubMed Central

    Hu, Junli; Wu, Fuyong; Wu, Shengchun; Lam, Cheung Lung; Lin, Xiangui; Wong, Ming Hung

    2014-01-01

    Both biochar application and mycorrhizal inoculation have been proposed to improve plant growth and alter bioaccumulation of toxic metals. A greenhouse pot trial was conducted to investigate growth and Cd accumulation of upland kangkong (Ipomoea aquatica Forsk.) intercropped with Alfred stonecrop (Sedum alfredii Hance) in a Cd-contaminated soil inoculated with Glomus caledonium and/or applied with biochar. Compared with the monocultural control, intercropping with stonecrop (IS) decreased kangkong Cd acquisition via rhizosphere competition, and also decreased kangkong yield. Gc inoculation (+M) accelerated growth and Cd acquisition of stonecrop, and hence resulted in further decreases in kangkong Cd acquisition. Regardless of IS and +M, biochar addition (+B) increased kangkong yield via elevating soil available P, and decreased soil Cd phytoavailability and kangkong Cd concentration via increasing soil pH. Compared with the control, the treatment of IS + M + B had a substantially higher kangkong yield (+25.5%) with a lower Cd concentration (−62.7%). Gc generated additive effects on soil alkalinization and Cd stabilization to biochar, causing lower DTPA-extractable (phytoavailable) Cd concentrations and post-harvest transfer risks. PMID:24728157

  8. Biochar and Glomus caledonium influence Cd accumulation of upland kangkong (Ipomoea aquatica Forsk.) intercropped with Alfred stonecrop (Sedum alfredii Hance).

    PubMed

    Hu, Junli; Wu, Fuyong; Wu, Shengchun; Lam, Cheung Lung; Lin, Xiangui; Wong, Ming Hung

    2014-01-01

    Both biochar application and mycorrhizal inoculation have been proposed to improve plant growth and alter bioaccumulation of toxic metals. A greenhouse pot trial was conducted to investigate growth and Cd accumulation of upland kangkong (Ipomoea aquatica Forsk.) intercropped with Alfred stonecrop (Sedum alfredii Hance) in a Cd-contaminated soil inoculated with Glomus caledonium and/or applied with biochar. Compared with the monocultural control, intercropping with stonecrop (IS) decreased kangkong Cd acquisition via rhizosphere competition, and also decreased kangkong yield. Gc inoculation (+M) accelerated growth and Cd acquisition of stonecrop, and hence resulted in further decreases in kangkong Cd acquisition. Regardless of IS and +M, biochar addition (+B) increased kangkong yield via elevating soil available P, and decreased soil Cd phytoavailability and kangkong Cd concentration via increasing soil pH. Compared with the control, the treatment of IS + M + B had a substantially higher kangkong yield (+25.5%) with a lower Cd concentration (-62.7%). Gc generated additive effects on soil alkalinization and Cd stabilization to biochar, causing lower DTPA-extractable (phytoavailable) Cd concentrations and post-harvest transfer risks. PMID:24728157

  9. Multitrophic interactions among Western Corn Rootworm, Glomus intraradices and microbial communities in the rhizosphere and endorhiza of maize.

    PubMed

    Dematheis, Flavia; Kurtz, Benedikt; Vidal, Stefan; Smalla, Kornelia

    2013-01-01

    The complex interactions among the maize pest Western Corn Rootworm (WCR), Glomus intraradices (GI-recently renamed Rhizophagus intraradices) and the microbial communities in both rhizosphere and endorhiza of maize have been investigated in view of new pest control strategies. In a greenhouse experiment, different maize treatments were established: C (control plants), W (plants inoculated with WCR), G (plants inoculated with GI), GW (plants inoculated with GI and WCR). After 20 days of WCR root feeding, larval fitness was measured. Dominant arbuscular mycorrhizal fungi (AMF) in soil and maize endorhiza were analyzed by cloning of 18S rRNA gene fragments of AMF, restriction fragment length polymorphism and sequencing. Bacterial and fungal communities in the rhizosphere and endorhiza were investigated by denaturing gradient gel electrophoresis of 16S rRNA gene and ITS fragments, PCR amplified from total community DNA, respectively. GI reduced significantly WCR larval development and affected the naturally occurring endorhiza AMF and bacteria. WCR root feeding influenced the endorhiza bacteria as well. GI can be used in integrated pest management programs, rendering WCR larvae more susceptible to predation by natural enemies. The mechanisms behind the interaction between GI and WCR remain unknown. However, our data suggested that GI might act indirectly via plant-mediated mechanisms influencing the endorhiza microbial communities. PMID:24376437

  10. Multitrophic interactions among Western Corn Rootworm, Glomus intraradices and microbial communities in the rhizosphere and endorhiza of maize

    PubMed Central

    Dematheis, Flavia; Kurtz, Benedikt; Vidal, Stefan; Smalla, Kornelia

    2013-01-01

    The complex interactions among the maize pest Western Corn Rootworm (WCR), Glomus intraradices (GI—recently renamed Rhizophagus intraradices) and the microbial communities in both rhizosphere and endorhiza of maize have been investigated in view of new pest control strategies. In a greenhouse experiment, different maize treatments were established: C (control plants), W (plants inoculated with WCR), G (plants inoculated with GI), GW (plants inoculated with GI and WCR). After 20 days of WCR root feeding, larval fitness was measured. Dominant arbuscular mycorrhizal fungi (AMF) in soil and maize endorhiza were analyzed by cloning of 18S rRNA gene fragments of AMF, restriction fragment length polymorphism and sequencing. Bacterial and fungal communities in the rhizosphere and endorhiza were investigated by denaturing gradient gel electrophoresis of 16S rRNA gene and ITS fragments, PCR amplified from total community DNA, respectively. GI reduced significantly WCR larval development and affected the naturally occurring endorhiza AMF and bacteria. WCR root feeding influenced the endorhiza bacteria as well. GI can be used in integrated pest management programs, rendering WCR larvae more susceptible to predation by natural enemies. The mechanisms behind the interaction between GI and WCR remain unknown. However, our data suggested that GI might act indirectly via plant-mediated mechanisms influencing the endorhiza microbial communities. PMID:24376437

  11. Biochar and Glomus caledonium Influence Cd Accumulation of Upland Kangkong (Ipomoea aquatica Forsk.) Intercropped with Alfred Stonecrop (Sedum alfredii Hance)

    NASA Astrophysics Data System (ADS)

    Hu, Junli; Wu, Fuyong; Wu, Shengchun; Lam, Cheung Lung; Lin, Xiangui; Wong, Ming Hung

    2014-04-01

    Both biochar application and mycorrhizal inoculation have been proposed to improve plant growth and alter bioaccumulation of toxic metals. A greenhouse pot trial was conducted to investigate growth and Cd accumulation of upland kangkong (Ipomoea aquatica Forsk.) intercropped with Alfred stonecrop (Sedum alfredii Hance) in a Cd-contaminated soil inoculated with Glomus caledonium and/or applied with biochar. Compared with the monocultural control, intercropping with stonecrop (IS) decreased kangkong Cd acquisition via rhizosphere competition, and also decreased kangkong yield. Gc inoculation (+M) accelerated growth and Cd acquisition of stonecrop, and hence resulted in further decreases in kangkong Cd acquisition. Regardless of IS and +M, biochar addition (+B) increased kangkong yield via elevating soil available P, and decreased soil Cd phytoavailability and kangkong Cd concentration via increasing soil pH. Compared with the control, the treatment of IS + M + B had a substantially higher kangkong yield (+25.5%) with a lower Cd concentration (-62.7%). Gc generated additive effects on soil alkalinization and Cd stabilization to biochar, causing lower DTPA-extractable (phytoavailable) Cd concentrations and post-harvest transfer risks.

  12. Healthy response from chromium survived pteridophytic plant-Ampelopteris prolifera with the interaction of mycorrhizal fungus-Glomus deserticola.

    PubMed

    Singh, Joginder; Kumar, Manoj; Vyas, Anil

    2014-01-01

    Interaction between arbuscular mycorrhizal fungus Glomus deserticola and pteridophytic member Ampelopteris prolifera was found abundant on entire growth level based on elemental composition and gaseous exchange as a potential remediation system for phytoextraction of chromium. Inoculated A. prolifera (AM) and non-inoculated A. prolifera (Non-AM) were supplied with two Cr species: 12 mmol of trivalent cation (Cr(+3)) [Cr(III)] and 0.1 mmol of divalent dichromate anion (Cr2O7(-2)) [Cr(VI)]. Both Cr species were found to be depressed in overall growth and inefficient stomatal conductance (g(s)) and net photosynthesis (NP). Mycorrhizal association was found to be natural scavenger of Cr toxicity as indicated by greater growth in plants exposed to Cr species, and increased gas exchange of Cr(III) treated plants. Though, chromium reduction resulted lower level of nitrogen (N), phosphorus (P), and potassium (K) but interestingly elevated the level of aluminum (Al), iron (Fe), and zinc (Zn) uptake in many folds which is the significance of sustainable growth of plant. PMID:24912233

  13. Utility of Combining PET and MR Imaging of Carotid Plaque.

    PubMed

    Vesey, Alex T; Dweck, Marc R; Fayad, Zahi A

    2016-02-01

    By harnessing the versatility and soft tissue imaging capabilities of MR imaging alongside the unmatched sensitivity and biomolecular flexibility of PET, the potential to provide detailed multiparametric plaque characterization in the carotid arteries is clear. The ability to acquire simultaneous, and dynamic multimodal data is perhaps PET/MR's greatest strength that will be of major interest to researchers investigating carotid and coronary atherosclerosis alike. This review summarizes the current status of dedicated hybrid PET/MR imaging; to crystallize the rationale for and advantages of this technique with respect to carotid atherosclerosis; and to discuss current limitations, challenges, and future directions. PMID:26610660

  14. External Carotid-Internal Jugular Fistula as a Late Complication After Carotid Endarterectomy: A Rare Case

    SciTech Connect

    Bakar, Bulent; Cekirge, Saruhan; Tekkok, Ismail Hakki

    2011-02-15

    A 66-year-old man presented with mild amnesia, progressive fatigue, ataxia, visual hallucinations, and debility. His past medical history included right-sided carotid endarterectomy performed elsewhere 6 years previously. Cranial magnetic resonance imaging showed left parieto-occipital arteriovenous malformation-like tortous vessels, venous congestion, and ischemic areas. Cerebral angiography showed right-sided compound external carotid artery-internal jugular vein (IJV) fistula, and distal occlusion of the right IJV. Transvenous embolization via contralateral IJV was performed, and the fistula, together with fistulous portion of the distal IJV, was sealed using coils. Two years later, patient is well with normal neurologic examination findings. The presence of an arteriovenous communication after vascular surgery is a serious complication with potential long-term effects and therefore should be diagnosed and treated as promptly as possible.

  15. Pathophysiology and management of reperfusion injury and hyperperfusion syndrome after carotid endarterectomy and carotid artery stenting.

    PubMed

    Farooq, Muhammad U; Goshgarian, Christopher; Min, Jiangyong; Gorelick, Philip B

    2016-01-01

    Cerebral hyperperfusion is a relatively rare syndrome with significant and potentially preventable clinical consequences. The pathophysiology of cerebral hyperperfusion syndrome (CHS) may involve dysregulation of the cerebral vascular system and hypertension, in the setting of increase in cerebral blood flow. The early recognition of CHS is important to prevent complications such as intracerebral hemorrhage. This review will focus on CHS following carotid endarterectomy and carotid artery stenting. We will discuss the typical clinical features of CHS, risk factors, pathophysiology, diagnostic modalities for detection, identification of patients at risk, and prevention and treatment. Although currently there are no specific guidelines for the management of CHS, identification of patients at risk for CHS and aggressive treatment of hypertension are recommended. PMID:27602202

  16. SCAI/SVM expert consensus statement on carotid stenting: Training and credentialing for carotid stenting.

    PubMed

    Aronow, Herbert D; Collins, Tyrone J; Gray, William A; Jaff, Michael R; Kluck, Bryan W; Patel, Rajan A G; Rosenfield, Kenneth A; Safian, Robert D; Sobieszczyk, Piotr S; Wayangankar, Siddharth A; White, Christopher J

    2016-02-01

    Carotid artery stenting (CAS) has become an integral part of the therapeutic armamentarium offered by cardiovascular medicine programs for the prevention of stroke. The purpose of this expert consensus statement is to provide physician training and credentialing guidance to facilitate the safe and effective incorporation of CAS into clinical practice within these programs. Since publication of the 2005 Clinical Competence Statement on Carotid Stenting, there has been substantial device innovation, publication of numerous clinical trials and observational studies, accumulation of extensive real-world clinical experience and widespread participation in robust national quality improvement initiatives [5]. Collectively, these advances have led to substantial evolution in the selection of appropriate patients, as well as in the cognitive, technical and clinical skills required to perform safe and effective CAS. Herein, we summarize published guidelines, describe training pathways, outline elements of competency, offer strategies for tracking outcomes, specify facility, equipment and personnel requirements, and propose criteria for maintenance of CAS competency. PMID:26602705

  17. Effect of Menopausal Status on Carotid Intima-Media Thickness and Presence of Carotid Plaque in Chinese Women Generation Population

    PubMed Central

    Zhou, Yong; Wang, Dandan; Yang, Xin; Wang, Anxin; Gao, Xiang; Guo, Yuming; Wu, Shouling; Zhao, Xingquan

    2015-01-01

    Menopause is an important physiological stage in women's life. The potential association of menopause with carotid intima-media thickness as well as with occurrence and stability of carotid plaque in Chinese female population is unclear. We conducted a population-based, cross-sectional study by recruiting 2,131 participants aged above 40 years from northeast of China. Carotid intima-media thickness (CIMT), presence of carotid plaque and its stability were evaluated by carotid duplex sonography. Among the participants, 1,133 (53.2%) were identified to be postmenopausal. After adjusting for potential confounding factors, presence of CIMT at 50th- 75th and ≥75th percentiles, carotid plaque and its unstable status were found to be significantly associated with the postmenopausal status (P < 0.001). When matched the participants by age, post-menopausal status was still associated with a higher risk of having unstable plaque. Moreover, our data show that postmenopausal status is a risk factor for intracranial arterial stenosis when compared with premenopausal status in the univariate analysis (OR = 1.314, P = 0.043), and such relationship is lost when the confounding factors are adjusted (OR = 0.828, P = 0.225). In conclusion, the vascular risk factors increase as the menopausal status changes. Compared with premenopausal status, postmenopausal status is associated with higher morbidity of CIMT, carotid plaque and its unstable status. PMID:25627797

  18. Carotid false aneurysm after carotid stent fracture: report of a surgical solution.

    PubMed

    Sirignano, Pasqualino; Setacci, Francesco; Galzerano, Giuseppe; de Donato, Gianmarco; Setacci, Carlo

    2015-02-01

    Stent fracture has been well documented in the Literature and in the majority of cases arises from the exposition of the stent to unfavourable stresses and biomechanical forces. We report a case of carotid false aneurysm after stent placement for post-surgery restenosis. Stent fracture is a clinical reality that sometimes should be considered prior to stent deployment and may require monitoring or treatment after occurrence. PMID:24788063

  19. Evolution of Internal Carotid Artery Occlusion in Non-Traumatic Carotid Dissection

    PubMed Central

    RUSU, Octavia; VASILE, Mihai; BAJENARU, Ovidiu; ANTOCHI, Florina

    2014-01-01

    Cervical artery dissection is becoming a more frequently identified cause of ischemic stroke among the young and middleaged patients. The pathogenesis of non-traumatic dissection has not been yet entirely elucidated, but certain risk factors have been reported. We present the case of a young patient with ischemic stroke in the middle cerebral artery territory secondary to internal carotid artery dissection and occlusion, in whom we identified two rarely incriminated risk factors: migraine and recent infection (pneumonia). PMID:25705278

  20. The relationship between preoperative serum cortisol level and the stability of plaque in carotid artery stenosis patients undergoing carotid endarterectomy

    PubMed Central

    Qin, Feng; Sun, Yudong; Hu, Wenping; Wei, Xiaolong; Li, Zhenjiang

    2016-01-01

    Background Stability of plaque has been implicated as risk factor for stroke. Serum cortisol regulates lipoprotein metabolism and immune response, contributing to plaque stability in atherosclerosis. However, the relationship between serum cortisol and stability of carotid plaque has not been well characterized. We conducted a serology analysis to identify the relationship between serum cortisol and carotid plaque stability. Methods Between May 2013 to October 2015, 73 patients with carotid stenosis patients undergoing carotid endarterectomy (CEA) were enrolled in our study. Serum cortisol was analyzed at 8:00 AM in the morning before surgery via liquid chromatography tandem mass spectrometry. According to the classification made by the American Heart Association, hematoxylin-and-eosin staining was performed to divide these patients into either a stable or unstable group, according to the morphology of fibrous cap, lipid core and intima layer. A curve fitting method was used to identify the relationship between preoperative serum cortisol and stability of carotid plaque. Univariate and multivariate logistic regression analysis were used to identify carotid plaque stability-associated serum cortisol. Results Curve fitting’s result represents a U-shape characteristic. A total of 314.92 and 395.23 nmol/L were considered as the cut point for preoperative serum cortisol when trisected the patients. When adjusted for degree of stenosis, hyperlipemia, smoking and low-density lipoprotein (LDL), univariate and multivariate logistic regression analysis’ results demonstrated that preoperative serum cortisol can significantly affect carotid plaque stability. The odds ratio values in multivariate logistic regression analysis for C reactive protein (CRP), white blood cell (WBC), interleukin-6 (IL-6) and preoperative serum cortisol level were 7.67 and 20.86 respectively. Conclusions Preoperative serum cortisol was associated with stability of carotid plaque in patients

  1. Comparison of Neurocognitive Outcomes after Carotid Endarterectomy and Carotid Artery Stenting.

    PubMed

    Kim, Jerry J; Schwartz, Samuel; Wen, Johnny; deVirgilio, Christian; Lobue, Abeline; Walot, Irwin; Koopmann, Matthew; Donayre, Carlos; White, Rodney A

    2015-10-01

    Cognitive and emotional outcomes after carotid endarterectomy (CEA) and carotid artery stenting with embolic protection device (CAS + EPD) are not clear. Patients were entered prospectively into a United States Food and Drug Administration-approved single-center physician-sponsored investigational device exemption between 2004 and 2010 and received either CEA or CAS + EPD. Patients underwent cognitive testing preprocedure and at 6, 12, and 60 months postprocedure. Cognitive domains assessed included attention, memory, executive, motor function, visual spatial functioning, language, and processing speed. Beck Depression and anxiety scales were also compared. There were a total of 38 patients that met conventional indications for carotid surgery (symptomatic with ≥50% stenosis or asymptomatic with ≥70% stenosis)-12 patients underwent CEA, whereas 26 patients underwent CAS + EPD. Both CEA and CAS + EPD patients showed postprocedure improvement in memory and executive function. No differences were seen at follow-up in regards to emotional dysfunction (depression and anxiety), attention, visual spatial functioning, language, motor function, and processing speed. Only two patients underwent neuropsychiatric testing at 60 months-these CAS + EPD patients showed sustained improvement in memory, visual spatial, and executive functions. In conclusion, cognitive and emotional outcomes were similar between CEA and CAS + EPD patients. PMID:26463299

  2. Ischemic stroke: carotid and vertebral artery disease.

    PubMed

    Vilela, P; Goulão, A

    2005-03-01

    Ischemic strokes may have distinct aetiologies, including several different intrinsic arterial pathological disorders. The diagnosis and understanding of these arterial diseases is critical for the correct management of stroke as different treatment approaches are undertaken according to the aetiology. Atherosclerosis is by far the most common arterial disease among adults, and other pathological processes include arterial dissection, small vessel disease, inflammatory and non-inflammatory vasculopathy and vasomotor disorders. In children, there are several vasculopathies responsible for vaso-occlusive disease such as sickle-cell anemia, acute regressive angiopathy and Moya-Moya disease, neurofibromatosis, dissections, vasculitis associated with intracranial and systemic infections. An overview of the major carotid and vertebral pathological diseases responsible for ischemic stroke in adults and children, highlighting the accuracy of the different imaging modalities for its diagnosis and the imaging appearance of these diseases, is given. PMID:15657789

  3. Data on TREM-1 activation destabilizing carotid plaques.

    PubMed

    Rao, Velidi H; Rai, Vikrant; Stoupa, Samantha; Subramanian, Saravanan; Agrawal, Devendra K

    2016-09-01

    The data described herein are related to the article entitled "Tumor necrosis factor-α regulates triggering receptor expressed on myeloid cells-1-dependent matrix metalloproteinases in the carotid plaques of symptomatic patients with carotid stenosis" (Rao et al., 2016) [1]. Additional data are provided on the dose-response effect of TNF-α, TREM-1 antibody and recombinant rTREM-1/Fc fusion chimera (TREM-1/FC) on the expression of MMP-1 and MMP-9 in vascular smooth muscle cells (VSMCs) isolated from human carotid endarterectomy tissues. Data are also presented on the distribution of CD86+ M1- and CD206+ M2-macrophages and their co-localization with TREM-1 in symptomatic carotid plaques as visualized by dual immunofluorescence. The interpretation of this data and further extensive insights can be found in Rao et al. (2016) [1]. PMID:27331093

  4. Endovascular treatment of carotid cavernous sinus fistula: A systematic review

    PubMed Central

    Korkmazer, Bora; Kocak, Burak; Tureci, Ercan; Islak, Civan; Kocer, Naci; Kizilkilic, Osman

    2013-01-01

    Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial work-up of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions. PMID:23671750

  5. Assessment of Carotid Artery Stenosis and the Use of Statins

    PubMed Central

    Whayne, Thomas F.

    2015-01-01

    General thinking has previously centered on managing carotid artery stenosis (CAS) by carotid endarterectomy and subsequently, stenting for higher risk patients. However for CAS and other forms of vascular disease, especially when asymptomatic, there is new emphasis on defining underlying mechanisms. Knowledge of these mechanisms can lead to medical treatments that result in possible atherosclerotic plaque stabilization, and even plaque regression, including in the patient with CAS. For now, the key medication class for a medical approach are the statins. Their use is supported by good cardiovascular clinical trial evidence including some directed carotid artery studies, especially with a demonstrated decrease in carotid intima-media thickness. Procedural controversy still exists but the current era in medicine offers significant support for medical management of asymptomatic CAS while techniques to recognize the vulnerable plaque evolve. If CAS converts to a symptomatic status, early referral for endarterectomy or stenting is indicated. PMID:26417184

  6. Rat Carotid Artery Balloon Injury Model

    PubMed Central

    Tulis, David Anthony

    2010-01-01

    i. Summary Numerous and diverse experimental animal models have been used over the years to examine reactions to various forms of blood vessel disease and/or injury across species and in multiple vascular beds in a cumulative effort to relate these findings to the human condition. In this context, the rat carotid artery balloon injury model is highly characterized and commonly used for investigating gross morphological, cellular, biochemical, and molecular components of the response to experimentally-induced arterial injury. The mechanical damage caused by the balloon catheter completely removes the intimal endothelial lining and creates a distending mural injury in the operated vessel. This elicits a reproducible remodeling response characterized by vascular smooth muscle cell (SMC) mitogenesis and migration (via phenotypic switching), SMC apoptosis, partial vascular endothelial cell regeneration, enhanced matrix synthesis, and establishment of an invasive neointima in time-dependent fashion. This multi-factorial process allows for investigation of these many important pathophysiological processes and can serve as a valuable “proof-of-concept” tool to verify and substantiate in vitro results; however, inherent anatomical and adaptive constraints of this in vivo model ration comparison to the diseased human system (see Note 1). In this chapter, brief overview of the materials needed and the methodologies commonly employed for successful routine performance of this important experimental animal model will be provided. Individual sub-sections will cover animal care and handling, pre- and post-operative procedures, and the surgery proper. Protocols for histopathology and morphometry and procedures for data management and interpretation pertinent to the rat carotid artery balloon injury model will be discussed in Chapter __ of this series. Notes will conclude with important caveats, limitations, and considerations for practical use of this technique. PMID:18287662

  7. Carotid and Jugular Classification in ARTSENS.

    PubMed

    Sahani, Ashish Kumar; Shah, Malay Ilesh; Joseph, Jayaraj; Sivaprakasam, Mohanasankar

    2016-03-01

    Over past few years our group has been working on the development of a low-cost device, ARTSENS, for measurement of local arterial stiffness (AS) of the common carotid artery (CCA). This uses a single element ultrasound transducer to obtain A-mode frames from the CCA. It is designed to be fully automatic in its operation such that, a general medical practitioner can use the device without any prior knowledge of ultrasound modality. Placement of the probe over CCA and identification of echo positions corresponding to its two walls are critical steps in the process of measurement of AS. We had reported an algorithm to locate the CCA walls based on their characteristic motion. Unfortunately, in supine position, the internal jugular vein (IJV) expands in the carotid triangle and pulsates in a manner that confounds the existing algorithm and leads to wrong measurements of the AS. Jugular venous pulse (JVP), on its own right, is a very important physiological signal for diagnosis of morbidities of the right side of the heart and there is a lack of noninvasive methods for its accurate estimation. We integrated an ECG device to the existing hardware of ARTSENS and developed a method based on physiology of the vessels, which now enable us to segregate the CCA pulse (CCP) and the JVP. False identification rate is less than 4%. To retain the capabilities of ARTSENS to operate without ECG, we designed another method where the classification can be achieved without an ECG, albeit errors are a bit higher. These improvements enable ARTSENS to perform automatic measurement of AS even in the supine position and make it a unique and handy tool to perform JVP analysis. PMID:25700474

  8. Carotid and Aortic Stiffness in Patients with Heterozygous Familial Hypercholesterolemia

    PubMed Central

    Meshkov, Alexey N.; Rozhkova, Tatyana A.; Kalinina, Maria V.; Deev, Alexander D.; Rogoza, Anatoliy N.; Balakhonova, Tatyana V.; Boytsov, Sergey A.

    2016-01-01

    Background The role of plasma cholesterol in impairing arterial function and elasticity remains unclear. We evaluated arterial stiffness, measured locally in the common carotid artery by high-resolution echo-tracking, and aortic stiffness, using carotid-femoral pulse wave velocity (PWV) (the “gold-standard” measurement of arterial stiffness), in treatment-naive patients with heterozygous familial hypercholesterolemia (FH). Methods The study included 66 patients with FH (10–66 years old) and 57 first-degree relatives without FH (11–61 years old). Carotid-femoral PWV was determined by SphygmoCor (AtCor, Australia). The parameters of carotid stiffness β-index, Peterson elastic modulus and local PWV were assessed with regard to the common carotid artery at a distance of 1cm from the bifurcation (AlokaProsound Alpha7, Japan). Results FH patients showed significantly higher β-index (6.3(4.8–8.2) vs. 5.2(4.2–6.4), p = 0.005), Ep (78(53–111) kPa vs. 62(48–79) kPa, p = 0.006), local PWV (5.4(4.5–6.4) m/c vs. 4.7(4.2–5.4) m/c, p = 0.005), but comparable values of carotid-femoral PWV (6.76(7.0–7.92) m/c vs. 6.48(6.16–7.12) m/c, p = 0.138). Carotid arteries and the aorta stiffened with age in patients with FH, but after 30 years, carotid arteries stiffened more significantly than the aorta. Conclusions Our study demonstrated that treatment-naive patients with FH had stiffer carotid arteries than their relatives, but showed no difference in aortic stiffness. We also found out that the rate of reduction of elasticity of the aorta and carotid arteries in FH patients varies: it is observed earlier in carotid arteries than in the aorta. PMID:27434535

  9. Cavernous Carotid Artery Pseudoaneurysm Following a Radical Cavernous Sinus Resection

    PubMed Central

    Katzir, Miki; Gil, Ziv; Cohen, José Enrique; Sviri, Gill Efraim

    2016-01-01

    Iatrogenic cavernous carotid pseudoaneurysms are a special group among other intracranial aneurysms. They can occur during the dissection phase of the surgery if the tumor encases a vessel. Complications of their rupture as hemorrhage or stroke are life threatening. Early recognition and treatment is mandatory to avoid catastrophic sequelae. We present the successful diagnosis and endovascular treatment of a postoperative cavernous carotid pseudoaneurysm following radical cavernous sinus resection. PMID:27330923

  10. Mycotic pseudo-aneurysm of the extracranial carotid artery.

    PubMed

    Desimpelaere, J; Seynaeve, P; Kockx, M; Appel, B; Gyselinck, J; Mortelmans, L

    1997-08-01

    A rare case of mycotic pseudo-aneurysm of the common carotid artery as a complication in an immunosuppressed paediatric patient is presented. Treatment of pseudo-aneurysms of the common carotid artery is generally considered to be an emergency, necessitating quick and accurate diagnosis. In patients with septicemia, angiography has to be avoided. We were able to provide the surgeon with the exact diagnosis and accurate topographical information with helical CT with 3D reformation. PMID:9351308

  11. Is Acute Carotid Artery Stent Thrombosis an Avoidable Complication?

    PubMed

    Köklü, Erkan; Yüksel, İsa Öner; Bayar, Nermin; Arslan, Şakir

    2015-10-01

    The most serious complication of carotid artery stenting (CAS) is acute carotid artery stent thrombosis (ACAST). ACAST is a very rare complication, but it may lead to dramatic and catastrophic consequences. The most important cause is inadequate or ineffective antiaggregant therapy. It is very important to identify, before CAS, those patients who might be candidates for ACAST and to start antiplatelet therapy for them. Testing patients who are candidates for CAS for acetylsalicylic acid and clopidogrel resistance may prevent this complication. PMID:26303788

  12. A Lumped Parameter Method to Calculate the Effect of Internal Carotid Artery Occlusion on Anterior Cerebral Artery Pressure Waveform

    PubMed Central

    Abdi, M.; Navidbakhsh, M.; Razmkon, A.

    2016-01-01

    Background and Objective Numerical modeling of biological structures would be very helpful tool to analyze hundreds of human body phenomena and also diseases diagnosis. One physiologic phenomenon is blood circulatory system and heart hemodynamic performance that can be simulated by utilizing lumped method. In this study, we can predict hemodynamic behavior of one artery of circulatory system (anterior cerebral artery) when disease such as internal carotid artery occlusion is occurred. Method Pressure-flow simulation is one the leading common approaches for modeling of circulatory system behavior and forecasts of hemodynamic in numerous physiological conditions. In this paper, by using lumped model (electrical analogy), CV system is simulated in MATLAB software (SIMULINK environment). Results The performance of healthy blood circulation and heart is modeled and the obtained results used for further analyses. The stenosis of internal carotid artery at different rates was, then, induced in the circuit and the effects are studied. In stenosis cases, the effects of internal carotid artery occlusion on  left anterior cerebral artery pressure waveform are investigated. Conclusion The findings of this study may have implications not only for understanding the behavior of human biological system at healthy condition but also for diagnosis of diseases in circulatory and cardiovascular system of human body. PMID:27026953

  13. Imaging of the Fibrous Cap in Atherosclerotic Carotid Plaque

    SciTech Connect

    Saba, Luca; Potters, Fons; Lugt, Aad van der; Mallarini, Giorgio

    2010-08-15

    In the last two decades, a substantial number of articles have been published to provide diagnostic solutions for patients with carotid atherosclerotic disease. These articles have resulted in a shift of opinion regarding the identification of stroke risk in patients with carotid atherosclerotic disease. In the recent past, the degree of carotid artery stenosis was the sole determinant for performing carotid intervention (carotid endarterectomy or carotid stenting) in these patients. We now know that the degree of stenosis is only one marker for future cerebrovascular events. If one wants to determine the risk of these events more accurately, other parameters must be taken into account; among these parameters are plaque composition, presence and state of the fibrous cap (FC), intraplaque haemorrhage, plaque ulceration, and plaque location. In particular, the FC is an important structure for the stability of the plaque, and its rupture is highly associated with a recent history of transient ischaemic attack or stroke. The subject of this review is imaging of the FC.

  14. Carotid endarterectomy in awake patients: safety, tolerability and results

    PubMed Central

    Mendonça, Célio Teixeira; Fortunato Jr, Jerônimo A.; de Carvalho, Cláudio A.; Weingartner, Janaina; Filho, Otávio R. M.; Rezende, Felipe F.; Bertinato, Luciane P.

    2014-01-01

    Objective To analyze the results of 125 carotid endarterectomies under loco-regional anesthesia, with selective use of shunt and bovine pericardium patch. Methods One hundred and seventeen patients with stenosis ≥ 70% in the internal carotid artery on duplex-scan + arteriography or magnetic resonance angiography underwent 125 carotid endarterectomies. Intraoperative pharmacological cerebral protection included intravenous administration of alfentanil and dexametasone. Clopidogrel, aspirin and statins were used in all cases. Seventy-seven patients were males (65.8%). Mean age was 70.8 years, ranging from 48 to 88 years. Surgery was performed to treat symptomatic stenosis in 69 arteries (55.2%) and asymptomatic stenosis in 56 arteries (44.8%). Results A carotid shunt was used in 3 cases (2.4%) due to signs and symptoms of cerebral ischemia after carotid artery clamping during the operation, and all 3 patients had a good outcome. Bovine pericardium patch was used in 71 arteries ≤ 6 mm in diameter (56.8%). Perioperative mortality was 0.8%: one patient died from a myocardial infarction. Two patients (1.6%) had minor ipsilateral strokes with good recovery, and 2 patients (1.6%) had non-fatal myocardial infarctions with good recovery. The mean follow-up period was 32 months. In the late postoperative period, there was restenosis in only three arteries (2.4%). Conclusion Carotid artery endarterectomy can be safely performed in the awake patient, with low morbidity and mortality rates. PMID:25714212

  15. Recommendations for Management of Patients with Carotid Stenosis

    PubMed Central

    Lovrencic-Huzjan, Arijana; Rundek, Tatjana; Katsnelson, Michael

    2012-01-01

    Stroke is a one of the leading causes of morbidity and mortality in the world. Carotid atherosclerosis is recognized as an important factor in stroke pathophysiology and represents a key target in stroke prevention; multiple treatment modalities have been developed to battle this disease. Multiple randomized trials have shown the efficacy of carotid endarterectomy in secondary stroke prevention. Carotid stenting, a newer treatment option, presents a less invasive alternative to the surgical intervention on carotid arteries. Advances in medical therapy have also enabled further risk reduction in the overall incidence of stroke. Despite numerous trials and decades of clinical research, the optimal management of symptomatic and asymptomatic carotid disease remains controversial. We will attempt to highlight some of the pivotal trials already completed, discuss the current controversies and complexities in the treatment decision-making, and postulate on what likely lies ahead. This paper will highlight the complexities of decision-making optimal treatment recommendations for patients with symptomatic and asymptomatic carotid stenosis. PMID:22645702

  16. Traumatic carotid-rosenthal fistula treated with Jostent Graftmaster.

    PubMed

    Allam, Hesham; Callison, R Charles; Scodary, Daniel; Alawi, Aws; Hogan, Daniel W; Alshekhlee, Amer

    2014-12-28

    Traumatic injuries of the carotid artery may result in severe morbidity and mortality. The most common location of carotid artery injury is the cavernous segment, which may result in fistulous connection to the cavernous sinus and ophthalmic veins, which in turn lead to pressure symptoms in the ipsilateral orbit. Unlike the commonly reported direct traumatic carotid-cavernous fistula, we describe an unusual case of a 38-year-old man presented with a traumatic brain injury led to a fistula connection between the cavernous carotid artery and the ipsilateral basal vein of Rosenthal, with eventual drainage to the straight and transverse sinuses. The basal vein of Rosenthal is usually formed from confluence of anterior and middle cerebral veins deep in the Sylvian fissure and drain the insular cortex and the cerebral peduncles to the vein of Galen. Immediate endovascular deployment of a covered stent in the cavernous carotid artery allowed sealing the laceration site. Three months follow up showed a non-focal neurological examination and healed carotid laceration over the covered stent. PMID:25550998

  17. Antioxidant plasma concentration and supplementation in carotid intima media thickness.

    PubMed

    Riccioni, Graziano; Bazzano, Lydia A

    2008-06-01

    Cerebrovascular diseases represent a major problem in Western countries. Oxidative stress, an important condition of increased amounts of reactive oxygen species, is now recognized to be a prominent feature of many acute and chronic diseases, and even of the normal aging process. Carotid intima media thickness is an important marker of atherosclerosis that correlates with established coronary heart disease. Changes in carotid intima media thickness, measured by B-mode high-resolution carotid ultrasonography, represent an important and early step in carotid plaque formation and progression and are the most common currently used marker to evaluate the progression of atherosclerotic processes. Several therapeutic strategies have been adopted to slow the early atherosclerotic process in asymptomatic subjects in order to reduce the risk of cardiovascular events. An additional step to slow the atherosclerotic process may include interventions to decrease newly emerging coronary risk factors, such as oxidative stress and inflammation. Consuming a diet rich in fruits and vegetables will provide antioxidant vitamins, and carotenoids, which are believed to inhibit tissue damage derived from oxidative processes and may slow the progression of early atherosclerosis, modify the increase in carotid intima media thickness and, consequently, reduce cardiovascular events. This review synthesizes the published literature regarding antioxidant vitamins plasma concentration and supplementation and carotid intima media thickness. PMID:18510488

  18. Endovascular Treatment of Iatrogenic and Traumatic Carotid Artery Dissection

    SciTech Connect

    Schulte, Stefan; Donas, Konstantinos P. Pitoulias, Georgios A.; Horsch, Svante

    2008-09-15

    This paper reports on the early and midterm results of endovascular treatment of acute carotid artery dissections, its specific problems, and its limitations. We encountered seven patients with symptomatic extracranial carotid artery dissection, three cases of which occurred after carotid endarterectomy, two after carotid angioplasty and stenting, and two after trauma. Balloon-expandable and self-expanding stents were placed using a transfemoral approach. Success in restoring the carotid lumen was achieved in all patients. No procedure-related complications occurred. All patients experienced significant clinical improvement while in the hospital and achieved complete long-term recovery. At follow-up (mean, 22.4 months), good luminal patency of the stented segments was observed. In conclusion, in this small series, primary stent-supported angioplasty seems to be a safe and effective strategy in the treatment of selected patients having acute traumatic extracranial carotid artery dissection, with excellent early and midterm results. Larger series and longer-term follow-up are required before definitive recommendations can be made.

  19. Protective effects of Glomus iranicum var. tenuihypharum on soil and Viburnum tinus plants irrigated with treated wastewater under field conditions.

    PubMed

    Gómez-Bellot, María José; Ortuño, María Fernanda; Nortes, Pedro Antonio; Vicente-Sánchez, Javier; Martín, Félix Fernández; Bañón, Sebastián; Sánchez-Blanco, María Jesús

    2015-07-01

    Currently, irrigation using recycled water is increasing, especially in semiarid environments, but a potential problem of using reclaimed wastewater is its elevated salt levels. The application of arbuscular mycorrhizal fungi (AMF) could be a suitable option to mitigate the negative effects produced by the salinity. In this work, the combined effect of Glomus iranicum var. tenuihypharum and two types of water: Control, C, with EC <0.9 dS m(-1) and reclaimed water (wastewater previously treated in a sewage treatment plant) with EC 4 dS m(-1) during a first saline period (11 weeks) and with EC 6 dS m(-1) during a second saline period (25 weeks), was evaluated for laurustinus (Viburnum tinus) plants under field conditions. This plant is a popular shrub very used for gardening. Chemical properties of soil as well as physiological behavior, leaf nutrition, and esthetic value of plants were evaluated. Due to the high salinity from wastewater at 6 dS m(-1), laurustinus plants decreased their stem water potential values and, to a lesser extent, the stomatal conductance. Also, the visual quality of the plants was diminished. The inoculated AMF satisfactorily colonized the laurustinus roots and enhanced the structure of the soil by increasing the glomalin and carbon contents. Furthermore, G. iranicum var. tenuihypharum inoculation decreased Na and Cl content, stimulated flowering and improved the stem water potential of the plants irrigated with both types of reclaimed water. The AMF also had a positive effect as a consequence of stimulation of plant physiological parameters, such as the stem water potential and stomatal conductance. Effective AMF associations that avoid excessive salinity could provide wastewater reuse options, especially when the plants grow in soils. PMID:25492808

  20. Stereotactic LINAC-Radiosurgery for Glomus Jugulare Tumors: A Long-Term Follow-Up of 27 Patients

    PubMed Central

    El Majdoub, Faycal; Hunsche, Stefan; Igressa, Alhadi; Kocher, Martin; Sturm, Volker; Maarouf, Mohammad

    2015-01-01

    Background The optimal treatment of glomus jugulare tumors (GJTs) remains controversial. Due to the critical location, microsurgery still provides high treatment-related morbidity and a decreased quality of life. Thus, we performed stereotactical radiosurgery (SRS) for the treatment of GJTs and evaluated the long-term outcome. Methods Between 1991 and 2011, 32 patients with GJTs underwent SRS using a linear accelerator (LINAC) either as primary or salvage therapy. Twenty-seven patients (median age 59.9 years, range 28.7–79.9 years) with a follow-up greater than five years (median 11 years, range 5.3–22.1 years) were selected for retrospective analysis. The median therapeutic single dose applied to the tumor surface was 15 Gy (range 11–20 Gy) and the median tumor volume was 9.5 ml (range 2.8–51 ml). Results Following LINAC-SRS, 10 of 27 patients showed a significant improvement of their previous neurological complaints, whereas 12 patients remained unchanged. Five patients died during follow-up due to old age or other, not treatment-related reasons. MR-imaging showed a partial remission in 12 and a stable disease in 15 patients. No tumor progression was observed. The actuarial overall survival rates after five, ten and 20 years were 100%, 95.2% and 79.4%, respectively. Conclusions Stereotactic LINAC-Radiosurgery can achieve an excellent long-term tumor control beside a low rate of morbidity in the treatment of GJTs. It should be considered as an alternative therapy regime to surgical resection or fractionated external beam radiation either as primary, adjuvant or salvage therapy. PMID:26069957

  1. Assessment of Tumor Volumes in Skull Base Glomus Tumors Using Gluc-Lys[{sup 18}F]-TOCA Positron Emission Tomography

    SciTech Connect

    Astner, Sabrina T.; Bundschuh, Ralph A.; Beer, Ambros J.; Ziegler, Sibylle I.; Krause, Bernd J.; Schwaiger, Markus; Molls, Michael; Grosu, Anca L.; Essler, Markus

    2009-03-15

    Purpose: To assess a threshold for Gluc-Lys[{sup 18}F]-TOCA positron emission tomography (PET) in target volume delineation of glomus tumors in the skull base and to compare with MRI-based target volume delineation. Methods and Materials: The threshold for volume segmentation in the PET images was determined by a phantom study. Nine patients with a total of 11 glomus tumors underwent PET either with Gluc-Lys[{sup 18}F]-TOCA or with {sup 68}Ga-DOTATOC (in 1 case). All patients were additionally scanned by MRI. Positron emission tomography and MR images were transferred to a treatment-planning system; MR images were analyzed for lesion volume by two observers, and PET images were analyzed by a semiautomated thresholding algorithm. Results: Our phantom study revealed that 32% of the maximum standardized uptake value is an appropriate threshold for tumor segmentation in PET-based target volume delineation of gross tumors. Target volume delineation by MRI was characterized by high interobserver variability. In contrast, interobserver variability was minimal if fused PET/MRI images were used. The gross tumor volumes (GTVs) determined by PET (GTV-PET) showed a statistically significant correlation with the GTVs determined by MRI (GTV-MRI) in primary tumors; in recurrent tumors higher differences were found. The mean GTV-MRI was significantly higher than mean GTV-PET. The increase added by MRI to the common volume was due to scar tissue with strong signal enhancement on MRI. Conclusions: In patients with glomus tumors, Gluc-Lys[{sup 18}F]-TOCA PET helps to reduce interobserver variability if an appropriate threshold for tumor segmentation has been determined for institutional conditions. Especially in patients with recurrent tumors after surgery, Gluc-Lys[{sup 18}F]-TOCA PET improves the accuracy of GTV delineation.

  2. Automated calculation of bifurcation carotid angle for analyzing the risk of carotis plaques by using carotid CT angiographic images

    NASA Astrophysics Data System (ADS)

    Demir, N.; Demir, S.

    2015-05-01

    The aim of this study is calculation of bifurcation carotid angle by detection of vessel boundaries to assist the medical doctors if this angle is a risk factor about formation of carotid plaques.Carotid ct angiography images are clustered automatically by ISODATA unsupervised classification algorithm. Since the spectral digital numbers (DN) of vessel pixels are bigger than the other part of the images, the cluster which has the biggest median value of DN among all other classes gives the vessel class. The cluster image in raster format is converted into the vector format which allows working on the vessel geometry. The converted vector vessel cluster dataset has been simplified using Douglas-Peucker algorithm to eliminate the zigzag effects of pixel data which are remained on the vector form dataset. Then the cluster polygon is converted to lines and the vertices which will be used for the calculation of bifurcation carotid angle. For sorting the vertex points to calculate the angle on each vertex, alpha-shapes algorithm is applied along the boundary. Then all the angles on each vertex point along the boundary of vessels are calculated. It is also visually clear that the angle which has the minimum value among all the calculated angles, gives the bifurcation carotid angle for one projected plane. The final carotid angle has calculated and 18 sample datasets are used to test the method.

  3. Life-threatening common carotid artery blowout: rescue treatment with a newly designed self-expanding covered nitinol stent.

    PubMed

    Kim, H S; Lee, D H; Kim, H J; Kim, S J; Kim, W; Kim, S Y; Suh, D C

    2006-03-01

    Carotid blowout is a devastating complication in patients with head and neck malignancy. A covered stent offers an alternative to treatment of a carotid blowout patient thought to be at high risk for surgery or carotid occlusion. Stent placement in the common carotid artery or carotid bulb is a technical challenge because of large luminal diameter and luminal calibre discrepancy between internal carotid artery and common carotid artery. We present four patients with common carotid rupture and massive bleeding who were treated with self-expanding covered stents, among them, two cases were treated with newly designed self-expanding polytetrafluoroethylene (PTFE)-covered nitinol stents. PMID:16498035

  4. Increased Superoxide Anions Level may be Related with Impaired Endothelium-Dependent Relaxation of Cerebral and Carotid Arteries in Simulated Microgravity Rats

    NASA Astrophysics Data System (ADS)

    Ma, Jin; Zhang, Ran; Ren, Xin-Ling

    2008-06-01

    Our previous works showed that there is a significant increase in nitrite and nitrate content of cerebral and carotid arteries of hindlimb unweighting rats, and this result suggests that NOS activity or NO production may be increased by HU in the cerebral and carotid arteries ,and this may result in a enhanced endothelium-dependent dilatory responses in these artery of hindlimb unweighting rats. The aim of this work is to investigate the effects of hindlimb unweighting on endothelium mediated relaxation and find the possible mechanisms which may result in the alteration. Twenty male healthy SD rats, which body weight ranged from 250g to 280g, were divided into control and hindlimb unweighting simulated microgravity groups randomly. After three weeks, the basilar artery and carotid artery were isolated and arterial dilatory responsiveness were examined in vitro using isolated arterial rings from rats. And the Superoxide Anions Levels were detected by oxidation-sensitive dye dihydroethidium and laser scanning confocal microscope. The data showed: Dilatory responses of both basilar and carotid arterial rings to Acetylcholine(10-10~10-4 mol/L ) was decreased in simulated microgravity rats as compared with that of controls, but dilatory responses of isolated arterial rings to Sodium Nitroprussid (10-10~10-4 mol/L ) was similar in both simulated Microgravity rats and control rats, and stronger superoxide anions signals were detected in basilar and carotid arteries from HU rats, while compared with that of control rats. These results indicate that endothelium-dependent relaxation of both basilar artery and carotid artery have been diminished by 3-week hindlimb unweighting, and increased superoxide anions levels may contribute to this alteration.

  5. Impaired carotid baroreflex control of arterial blood pressure in multiple sclerosis.

    PubMed

    Huang, Mu; Allen, Dustin R; Keller, David M; Fadel, Paul J; Frohman, Elliot M; Davis, Scott L

    2016-07-01

    Multiple sclerosis (MS), a progressive neurological disease, can lead to impairments in the autonomic control of cardiovascular function. We tested the hypothesis that individuals with relapsing-remitting MS (n = 10; 7 females, 3 males; 13 ± 4 yr from diagnosis) exhibit impaired carotid baroreflex control of blood pressure and heart rate compared with sex, age, and body weight-matched healthy individuals (CON: n = 10; 7 females, 3 males). At rest, 5-s trials of neck pressure (NP; +40 Torr) and neck suction (NS; -60 Torr) were applied to simulate carotid hypotension and hypertension, respectively, while mean arterial pressure (MAP; finger photoplethysmography), heart rate (HR), cardiac output (CO; Modelflow), and total vascular conductance (TVC) were continuously measured. In response to NP, there was a blunted increase in peak MAP responses (MS: 5 ± 2 mmHg) in individuals with MS compared with healthy controls (CON: 9 ± 3 mmHg; P = 0.005), whereas peak HR responses were not different between groups. At the peak MAP response to NP, individuals with MS demonstrated an attenuated decrease in TVC (MS, -10 ± 4% baseline vs. CON, -15 ± 4% baseline, P = 0.012), whereas changes in CO were similar between groups. Following NS, all cardiovascular responses (i.e., nadir MAP and HR and percent changes in CO and TVC) were not different between MS and CON groups. These data suggest that individuals with MS have impaired carotid baroreflex control of blood pressure via a blunted vascular conductance response resulting in a diminished ability to increase MAP in response to a hypotensive challenge. PMID:27075533

  6. Proposed clinical internal carotid artery classification system

    PubMed Central

    Abdulrauf, Saleem I; Ashour, Ahmed M; Marvin, Eric; Coppens, Jeroen; Kang, Brian; Hsieh, Tze Yu Yeh; Nery, Breno; Penanes, Juan R; Alsahlawi, Aysha K; Moore, Shawn; Al-Shaar, Hussam Abou; Kemp, Joanna; Chawla, Kanika; Sujijantarat, Nanthiya; Najeeb, Alaa; Parkar, Nadeem; Shetty, Vilaas; Vafaie, Tina; Antisdel, Jastin; Mikulec, Tony A; Edgell, Randall; Lebovitz, Jonathan; Pierson, Matt; Pires de Aguiar, Paulo Henrique; Buchanan, Paula; Di Cosola, Angela; Stevens, George

    2016-01-01

    Introduction: Numerical classification systems for the internal carotid artery (ICA) are available, but modifications have added confusion to the numerical systems. Furthermore, previous classifications may not be applicable uniformly to microsurgical and endoscopic procedures. The purpose of this study was to develop a clinically useful classification system. Materials and Methods: We performed cadaver dissections of the ICA in 5 heads (10 sides) and evaluated 648 internal carotid arteries with computed tomography angiography. We identified specific anatomic landmarks to define the beginning and end of each ICA segment. Results: The ICA was classified into eight segments based on the cadaver and imaging findings: (1) Cervical segment; (2) cochlear segment (ascending segment of the ICA in the temporal bone) (relation of the start of this segment to the base of the styloid process: Above, 425 sides [80%]; below, 2 sides [0.4%]; at same level, 107 sides [20%]; P < 0.0001) (relation of cochlea to ICA: Posterior, 501 sides [85%]; posteromedial, 84 sides [14%]; P < 0.0001); (3) petrous segment (horizontal segment of ICA in the temporal bone) starting at the crossing of the eustachian tube superolateral to the ICA turn in all 10 samples; (4) Gasserian-Clival segment (ascending segment of ICA in the cavernous sinus) starting at the petrolingual ligament (PLL) (relation to vidian canal on imaging: At same level, 360 sides [63%]; below, 154 sides [27%]; above, 53 sides [9%]; P < 0.0001); in this segment, the ICA projected medially toward the clivus in 275 sides (52%) or parallel to the clivus with no deviation in 256 sides (48%; P < 0.0001); (5) sellar segment (medial loop of ICA in the cavernous sinus) starting at the takeoff of the meningeal hypophyseal trunk (ICA was medial into the sella in 271 cases [46%], lateral without touching the sella in 127 cases [23%], and abutting the sella in 182 cases [31%]; P < 0.0001); (6) sphenoid segment (lateral loop of ICA within the

  7. Carotid artery stenting and patient outcomes: The CABANA surveillance study

    PubMed Central

    Hopkins, L Nelson; White, Christopher J; Foster, Malcolm T; Powell, Richard J; Zemel, Gerald; Diaz-Cartelle, Juan

    2014-01-01

    Objectives The purpose of the prospective, multicenter, nonrandomized CABANA study was to evaluate periprocedural clinical outcomes in high surgical risk patients with carotid artery stenosis treated with the Carotid WALLSTENT plus FilterWire EZ Embolic Protection System by a diverse group of clinicians. Background There is a need for additional evidence evaluating carotid artery stenting (CAS) performed by operators with various experience and training levels. Methods The study enrolled symptomatic (≥50% carotid artery stenosis) and asymptomatic (≥80% carotid stenosis) patients at high risk for carotid endarterectomy. Study centers were grouped into three tiers based on previous CAS experience while individual operators were grouped by their CAS training. The primary endpoint was the 30-day composite of major adverse events [MAEs; including stroke, death, and myocardial infarction (MI)]. Individual event rates were evaluated across the overall study, and by center experience and physician training tier. Results Of 1,097 enrolled patients, 1,025 were evaluable for 30-day MAE rate. The stroke rate (3.3%) was a major contributing factor in the overall MAE rate (4.6%). Mortality was 1.3% and the MI rate was 0.5%. There was no statistically significant association between MAE rates among the center experience tiers (P = 0.61) nor among the operator training categories (P = 0.26). Conclusions CAS with the Carotid WALLSTENT and FilterWire EZ yielded a low 30-day MAE rate that did not differ significantly across operator experience and training levels. Clinicaltrials.gov identifier: NCT00741091. © 2014 Wiley Periodicals, Inc. PMID:24948033

  8. Carotid dosimetry for T1 glottic cancer radiotherapy

    PubMed Central

    Lim, C C; Whitehurst, P; Thomson, D; Ho, K F; Lowe, M; Sykes, A; Lee, LW; Yap, B; Slevin, N

    2014-01-01

    Objective: Radiotherapy for T1 glottic cancer is commonly delivered using a lateral parallel opposed pair of megavoltage photon fields. There is increasing reported evidence of cerebrovascular events due to radiation-induced carotid stenosis. An alternative field arrangement is to use an anterior oblique technique. This study compares the carotid dosimetry between the two techniques and reviews the evidence for the risk of radiation-induced vascular events. Methods: The radiotherapy plans of 10 patients with T1 glottic cancer treated with an anterior oblique technique were examined for carotid dose. Alternative plans were then created using a parallel opposed pair of fields and the dose to the carotids compared. All patients received 50 Gy in 16 fractions treating once daily, for 5 days in a week. Results: The average of the mean dose to the carotids with the anterior oblique technique was 21 Gy compared with 37 Gy using the lateral parallel opposed pair arrangement (p < 0.0001). Conclusion: An anterior oblique field arrangement for the treatment of T1 glottic cancer results in a significantly lower radiation dose to the carotid arteries, which may be clinically important in terms of reducing the risk of cerebrovascular events in long-term survivors. Advances in knowledge: Although the anterior oblique technique for treating early glottic cancers is well described, and it is predictable that the dose received by the carotid arteries should be lower with this technique, to our knowledge this is the first study to quantify that reduction in dose with a series of patients. PMID:24628251

  9. Endovascular repair for an extracranial internal carotid aneurysm with cervical access: A case report

    PubMed Central

    Rivera-Chavarría, Ignacio J.; Alvarado-Marín, Juan C.

    2015-01-01

    Background Carotid aneurysms are a rare pathology. This vascular disorder can be asymptomatic or it can cause local compression. The disorder poses a high risk of embolization and rupture. Presentation of case A 79 years old female, presents with a right internal carotid fusiform aneurysm, approximately 3.8 cm in diameter, localized 3.30 cm from the common carotid artery bifurcation with an extremely tortuous common carotid artery. Discussion Surgical management of the extracranial internal carotid artery remains varying and challenging, particularly with a distal internal carotid aneurysm and with anatomical difficulties. Conclusion Endovascular management of an internal carotid aneurysm with cervical access using an expanded polytetrafluoroethylene covered stent with Heparin Bioactive Surface in the carotid area, is safe and effective. PMID:26706595

  10. Protocol for electrophysiological monitoring of carotid endarterectomies

    PubMed Central

    Liu, Hong; Di Giorgio, Anthony M; Williams, Eric S; Evans, William; Russell, Michael J

    2010-01-01

    Near zero stroke rates can be achieved in carotid endarterectomy (CEA) surgery with selective shunting and electrophysiological neuromonitoring. though false negative rates as high as 40% have been reported. We sought to determine if improved training for interpretation of the monitoring signals can advance the efficacy of selective shunting with electrophysiological monitoring across multiple centers, and determine if other factors could contribute to the differences in reports. Processed and raw beta band (12.5-30 Hz) electroencephalogram (EEG) and median and tibial nerve somatosensory evoked potentials (SSEP) were monitored in 668 CEA cases at six surgical centers. A decrease in amplitude of 50% or more in any EEG or SSEP channel was the criteria for shunting or initiating a neuroprotective protocol. A reduction of 50% or greater in the beta band of the EEG or amplitude of the SSEP was observed in 150 cases. No patient showed signs of a cerebral infarct after surgery. Selective shunting based on EEG and SSEP monitoring can reduce CEA intraoperative stroke rate to a near zero level if trained personnel adopted standardized protocols. We also found that the rapid administration of a protective stroke protocol by attending anesthesiologists was an important aspect of this success rate. PMID:23554663

  11. Solitary fibrous tumor surrounding the carotid sheath.

    PubMed

    Gómez-Oliveira, Guillermo; Alvarez-Flores, Modesto; Arribas-García, Ignacio; Martínez-Gimeno, Carlos

    2010-03-01

    Solitary fibrous tumors (SFTs) are rare spindle cell neoplasms that are mostly found arising from the pleura. Although SFTs recently have been reported in other regions, they are rare in the head and neck and have often been misdiagnosed due to their rarity. SFTs are benign in most cases. Clinically, SFTs usually manifest as well-circumscribed, slow-growing, smooth and painless masses. Symptoms are often minimal, although they may include sore throat, difficulty in swallowing, change of voice or trismus. CT-Scan and MRI are the most sensitive imaging procedures used. The treatment of choice is complete surgical excision of the lesion. Because recurrences have been noted up to 30 years after surgery, long-term follow up is mandatory. In this article, we present a case of a Solitary Fibrous Tumor arising in the parapharyngeal space in a 20-year-old man, involving the carotid sheath, treated by surgical excision with no recurrence after 1 year. The clinical presentation, surgical management and pathological findings are described. PMID:19767703

  12. Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis

    PubMed Central

    Brott, Thomas G.; Hobson, Robert W.; Howard, George; Roubin, Gary S.; Clark, Wayne M.; Brooks, William; Mackey, Ariane; Hill, Michael D.; Leimgruber, Pierre P.; Sheffet, Alice J.; Howard, Virginia J.; Moore, Wesley S.; Voeks, Jenifer H.; Hopkins, L. Nelson; Cutlip, Donald E.; Cohen, David J.; Popma, Jeffrey J.; Ferguson, Robert D.; Cohen, Stanley N.; Blackshear, Joseph L.; Silver, Frank L.; Mohr, J.P.; Lal, Brajesh K.; Meschia, James F.

    2010-01-01

    BACKGROUND Carotid-artery stenting and carotid endarterectomy are both options for treating carotid-artery stenosis, an important cause of stroke. METHODS We randomly assigned patients with symptomatic or asymptomatic carotid stenosis to undergo carotid-artery stenting or carotid endarterectomy. The primary composite end point was stroke, myocardial infarction, or death from any cause during the periprocedural period or any ipsilateral stroke within 4 years after randomization. RESULTS For 2502 patients over a median follow-up period of 2.5 years, there was no significant difference in the estimated 4-year rates of the primary end point between the stenting group and the endarterectomy group (7.2% and 6.8%, respectively; hazard ratio with stenting, 1.11; 95% confidence interval, 0.81 to 1.51; P = 0.51). There was no differential treatment effect with regard to the primary end point according to symptomatic status (P = 0.84) or sex (P = 0.34). The 4-year rate of stroke or death was 6.4% with stenting and 4.7% with endarterectomy (hazard ratio, 1.50; P = 0.03); the rates among symptomatic patients were 8.0% and 6.4% (hazard ratio, 1.37; P = 0.14), and the rates among asymptomatic patients were 4.5% and 2.7% (hazard ratio, 1.86; P = 0.07), respectively. Periprocedural rates of individual components of the end points differed between the stenting group and the endarterectomy group: for death (0.7% vs. 0.3%, P = 0.18), for stroke (4.1% vs. 2.3%, P = 0.01), and for myocardial infarction (1.1% vs. 2.3%, P = 0.03). After this period, the incidences of ipsilateral stroke with stenting and with endarterectomy were similarly low (2.0% and 2.4%, respectively; P = 0.85). CONCLUSIONS Among patients with symptomatic or asymptomatic carotid stenosis, the risk of the composite primary outcome of stroke, myocardial infarction, or death did not differ significantly in the group undergoing carotid-artery stenting and the group undergoing carotid endarterectomy. During the

  13. Contemporary carotid imaging: from degree of stenosis to plaque vulnerability.

    PubMed

    Brinjikji, Waleed; Huston, John; Rabinstein, Alejandro A; Kim, Gyeong-Moon; Lerman, Amir; Lanzino, Giuseppe

    2016-01-01

    Carotid artery stenosis is a well-established risk factor of ischemic stroke, contributing to up to 10%-20% of strokes or transient ischemic attacks. Many clinical trials over the last 20 years have used measurements of carotid artery stenosis as a means to risk stratify patients. However, with improvements in vascular imaging techniques such as CT angiography and MR angiography, ultrasonography, and PET/CT, it is now possible to risk stratify patients, not just on the degree of carotid artery stenosis but also on how vulnerable the plaque is to rupture, resulting in ischemic stroke. These imaging techniques are ushering in an emerging paradigm shift that allows for risk stratifications based on the presence of imaging features such as intraplaque hemorrhage (IPH), plaque ulceration, plaque neovascularity, fibrous cap thickness, and presence of a lipid-rich necrotic core (LRNC). It is important for the neurosurgeon to be aware of these new imaging techniques that allow for improved patient risk stratification and outcomes. For example, a patient with a low-grade stenosis but an ulcerated plaque may benefit more from a revascularization procedure than a patient with a stable 70% asymptomatic stenosis with a thick fibrous cap. This review summarizes the current state-of-the-art advances in carotid plaque imaging. Currently, MRI is the gold standard in carotid plaque imaging, with its high resolution and high sensitivity for identifying IPH, ulceration, LRNC, and inflammation. However, MRI is limited due to time constraints. CT also allows for high-resolution imaging and can accurately detect ulceration and calcification, but cannot reliably differentiate LRNC from IPH. PET/CT is an effective technique to identify active inflammation within the plaque, but it does not allow for assessment of anatomy, ulceration, IPH, or LRNC. Ultrasonography, with the aid of contrast enhancement, is a cost-effective technique to assess plaque morphology and characteristics, but it is

  14. Blunt carotid artery injury after minor facial trauma

    PubMed Central

    Murabit, Amera; Tredget, Edward E

    2012-01-01

    A healthy young man presented three days after suffering a punch to the face resulting in minimally displaced mandibular fractures. History revealed an episode of anterograde amnesia and a delayed episode of dysphonia. Apart from the fractured mandible, the physical examination was otherwise noncontributory. Imaging revealed severe luminal narrowing of the left cervical internal carotid artery distal to the carotid bifurcation, consistent with carotid dissection; and two focal hypodensities in the left frontal and parietal cortices, highly suggestive of acute secondary embolic infarcts. The patient was treated with systemic anticoagulation for three months and experienced no further neurological symptoms. His mandibular fractures, treated conservatively, healed without any complications. Blunt carotid artery injuries are uncommon and diverse. Neurological symptoms may develop in a delayed fashion, thus, a high index of suspicion based on knowledge of the injury mechanisms and patterns of associated injuries may enable earlier diagnosis and treatment. Angiographic imaging is essential for the diagnosis and classification of injury characteristics (eg, type, location, etc). Treatment must be considered on an individual patient basis depending on the presentation, grade and morphology of the lesion. Although no level I clinical trials exist on the topic, anticoagulation seems to be the treatment of choice in most cases and surgical intervention is not commonly indicated. Carotid artery dissection without complete thrombosis may be effectively treated with systemic anticoagulation or antiplatelet therapy in the majority of cases. PMID:23997588

  15. Blunt carotid artery injury after minor facial trauma.

    PubMed

    Murabit, Amera; Tredget, Edward E

    2012-01-01

    A healthy young man presented three days after suffering a punch to the face resulting in minimally displaced mandibular fractures. History revealed an episode of anterograde amnesia and a delayed episode of dysphonia. Apart from the fractured mandible, the physical examination was otherwise noncontributory. Imaging revealed severe luminal narrowing of the left cervical internal carotid artery distal to the carotid bifurcation, consistent with carotid dissection; and two focal hypodensities in the left frontal and parietal cortices, highly suggestive of acute secondary embolic infarcts. The patient was treated with systemic anticoagulation for three months and experienced no further neurological symptoms. His mandibular fractures, treated conservatively, healed without any complications. Blunt carotid artery injuries are uncommon and diverse. Neurological symptoms may develop in a delayed fashion, thus, a high index of suspicion based on knowledge of the injury mechanisms and patterns of associated injuries may enable earlier diagnosis and treatment. Angiographic imaging is essential for the diagnosis and classification of injury characteristics (eg, type, location, etc). Treatment must be considered on an individual patient basis depending on the presentation, grade and morphology of the lesion. Although no level I clinical trials exist on the topic, anticoagulation seems to be the treatment of choice in most cases and surgical intervention is not commonly indicated. Carotid artery dissection without complete thrombosis may be effectively treated with systemic anticoagulation or antiplatelet therapy in the majority of cases. PMID:23997588

  16. Pulp Stone, Haemodialysis, End-stage Renal Disease, Carotid Atherosclerosis

    PubMed Central

    Patil, Santosh; Sinha, Nidhi

    2013-01-01

    Objectives: The aim of this study was to determine the relationship between the presence of pulp calcification and carotid artery calcification on the dental panoramic radiographs in End Stage Renal Disease (ESRD) patients who were on haemodialysis. Methods: A total of 112 End Stage Renal Disease (ESRD) patients on who were haemodialysis participated in this study. The periapical and the panoramic radiographs for all the patients were evaluated for the presence or absence of the narrowing of the dental pulps and for pulp stones in the pulp chambers and the pulp canals. The panoramic radiographs were also evaluated to determine the carotid calcification. Results: Carotid calcifications were detected in none of the patients. 84 (74.99%) patients had dental pulp narrowing, and 38 (33.92%) patients had pulp stones. There was no statistical correlation between pulp narrowing and Carotid Artery Calcification (CAC) in the haemodialysis patient group. There was also no statistical correlation between pulp stones and CAC in the haemodialysis patients. Conclusion: However, the incidental finding of CAC on a panoramic radiograph can provide life-saving information for the vascular disease patients, but in the present study, no significant relationship was found between the presence of the pulpal calcification and CAC in the ESRD patients who were on haemodialysis. Therefore, the presence of pulp calcification does not seem to serve as a diagnostic marker for carotid atherosclerosis. PMID:23905147

  17. Arterial function of carotid and brachial arteries in postmenopausal vegetarians

    PubMed Central

    Su, Ta-Chen; Torng, Pao-Ling; Jeng, Jiann-Shing; Chen, Ming-Fong; Liau, Chiau-Suong

    2011-01-01

    Background: Vegetarianism is associated with a lower risk of cardiovascular disease. However, studies of arterial function in vegetarians are limited. Methods: This study investigated arterial function in vegetarianism by comparing 49 healthy postmenopausal vegetarians with 41 age-matched omnivores. The arterial function of the common carotid artery was assessed by carotid duplex, while the pulse dynamics method was used to measure brachial artery distensibility (BAD), compliance (BAC), and resistance (BAR). Fasting blood levels of glucose, lipids, lipoprotein (a), high-sensitivity C-reactive protein, homocysteine, and vitamin B12 were also measured. Results: Vegetarians had significantly lower serum cholesterol, high-density and low-density lipoprotein, and glucose compared with omnivores. They also had lower vitamin B12 but higher homocysteine levels. Serum levels of lipoprotein (a) and high-sensitivity C-reactive protein were no different between the two groups. There were no significant differences in carotid beta stiffness index, BAC, and BAD between the two groups even after adjustment for associated covariates. However, BAR was significantly lower in vegetarians than in omnivores. Multiple linear regression analysis revealed that age and pulse pressure were two important determinants of carotid beta stiffness index and BAD. Vegetarianism is not associated with better arterial elasticity. Conclusion: Apparently healthy postmenopausal vegetarians are not significantly better in terms of carotid beta stiffness index, BAC, and BAD, but have significantly decreased BAR than omnivores. Prevention of vitamin B12 deficiency might be beneficial for cardiovascular health in vegetarians. PMID:21915169

  18. Outcome of Carotid Artery Stenting for Radiation-Induced Stenosis

    SciTech Connect

    Dorresteijn, Lucille; Vogels, Oscar; Leeuw, Frank-Erik de; Vos, Jan-Albert; Christiaans, Marleen H.; Ackerstaff, Rob; Kappelle, Arnoud C.

    2010-08-01

    Purpose: Patients who have been irradiated at the neck have an increased risk of symptomatic stenosis of the carotid artery during follow-up. Carotid angioplasty and stenting (CAS) can be a preferable alternative treatment to carotid endarterectomy, which is associated with increased operative risks in these patients. Methods and Materials: We performed a prospective cohort study of 24 previously irradiated patients who underwent CAS for symptomatic carotid stenosis. We assessed periprocedural and nonprocedural events including transient ischemic attack (TIA), nondisabling stroke, disabling stoke, and death. Patency rates were evaluated on duplex ultrasound scans. Restenosis was defined as a stenosis of >50% at the stent location. Results: Periprocedural TIA rate was 8%, and periprocedural stroke (nondisabling) occurred in 4% of patients. After a mean follow-up of 3.3 years (range, 0.3-11.0 years), only one ipsilateral incident event (TIA) had occurred (4%). In 12% of patients, a contralateral incident event was present: one TIA (4%) and two strokes (12%, two disabling strokes). Restenosis was apparent in 17%, 33%, and 42% at 3, 12, and 24 months, respectively, although none of the patients with restenosed vessels became symptomatic. The length of the irradiation to CAS interval proved the only significant risk factor for restenosis. Conclusions: The results of CAS for radiation-induced carotid stenosis are favorable in terms of recurrence of cerebrovascular events at the CAS site.

  19. Invasive and non-invasive modalities of imaging carotid stenosis.

    PubMed

    Tang, T Y; U-King-Im, J M; Walsh, S R; Young, V E; Sadat, U; Li, Z Y; Patterson, A J; Varty, K; Gillard, J H

    2009-12-01

    Despite recent therapeutic advances, acute ischemic complications of atherosclerosis remain the primary cause of morbidity and mortality in Western countries, with carotid atherosclerotic disease one of the major preventable causes of stroke. As the impact of this disease challenges our healthcare systems, we are becoming aware that factors influencing this disease are more complex than previously realized. In current clinical practice, risk stratification relies primarily on evaluation of the degree of luminal stenosis and patient symptomatology. Adequate investigation and optimal imaging are important factors that affect the quality of a carotid endarterectomy (CEA) service and are fundamental to patient selection. Digital subtraction angiography is still perceived as the most accurate imaging modality for carotid stenosis and historically has been the cornerstone of most of the major CEA trials but concerns regarding potential neurological complications have generated substantial interest in non-invasive modalities, such as contrast-enhanced magnetic resonance angiography. The purpose of this review is to give an overview to the vascular specialist of the current imaging modalities in clinical practice to identify patients with carotid stenosis. Advantages and disadvantages of each technique are outlined. Finally, limitations of assessing luminal stenosis in general are discussed. This article will not cover imaging of carotid atheroma morphology, function and other emerging imaging modalities of assessing plaque risk, which look beyond simple luminal measurements. PMID:19935602

  20. Carotid Artery Stenting Trials: Conduct, Results, Critique, and Current Recommendations

    SciTech Connect

    Macdonald, Sumaira

    2012-02-15

    The carotid stenting trialists have demonstrated persistence and determination in comparing an evolving technique, carotid artery stenting (CAS), against a mature and exacting standard for carotid revascularisation, carotid endarterectomy (CEA). This review focuses on their endeavours. A total of 12 1-on-1 randomised trials comparing CAS and CEA have been reported; 6 of these can be considered major, and 5 of these reflect (in part) current CAS standards of practice and form the basis of this review. At least 18 meta-analyses seeking to compare CAS and CEA exist. These are limited by the quality and heterogeneity of the data informing them (e.g., five trials were stopped prematurely such that they collectively failed to reach recruitment target by >4000 patients). The Carotid Stenting Trialists' Collaboration Publication represents a prespecified meta-analysis of European trials that were sufficiently similar to allow valid conclusions to be drawn; these trials and conclusions will be explored. When the rate of myocardial infarction (MI) is rigorously assessed, CAS and CEA are equivalent for the composite end point of stroke/death and MI, with more minor strokes for CAS and more MIs for CEA. These outcomes have a discrepant impact on quality of life and subsequent mortality. The all-stroke death outcomes for patients <70 years old are equivalent, with more minor strokes occurring in the elderly during CAS than CEA. There are significantly more severe haematomas and cranial nerve injuries after CEA. The influence of experience on outcome cannot be underestimated.

  1. Anatomical and functional characteristics of carotid sinus stimulation in humans

    NASA Technical Reports Server (NTRS)

    Querry, R. G.; Smith, S. A.; Stromstad, M.; Ide, K.; Secher, N. H.; Raven, P. B.

    2001-01-01

    Transmission characteristics of pneumatic pressure to the carotid sinus were evaluated in 19 subjects at rest and during exercise. Either a percutaneous fluid-filled (n = 12) or balloon-tipped catheter (n = 7) was placed at the carotid bifurcation to record internal transmission of external neck pressure/neck suction (NP/NS). Sustained, 5-s pulses, and rapid ramping pulse protocols (+40 to -80 Torr) were recorded. Transmission of pressure stimuli was less with the fluid-filled catheter compared with that of the balloon-tipped catheter (65% vs. 82% negative pressure, 83% vs. 89% positive pressure; P < 0.05). Anatomical location of the carotid sinus averaged 3.2 cm (left) and 3.6 cm (right) from the gonion of the mandible with a range of 0-7.5 cm. Transmission was not altered by exercise or Valsalva maneuver, but did vary depending on the position of the carotid sinus locus beneath the sealed chamber. These data indicate that transmission of external NP/NS was higher than previously recorded in humans, and anatomical variation of carotid sinus location and equipment design can affect transmission results.

  2. Increased LDL susceptibility to oxidation accelerates future carotid artery atherosclerosis

    PubMed Central

    2012-01-01

    Background We analyzed the causal relationship between LDL susceptibility to oxidation and the development of new carotid artery atherosclerosis over a period of 5 years. We previously described the determinants related to a risk of cardiovascular changes determined in a Japanese population participating in the Niigata Study, which is an ongoing epidemiological investigation of the prevention of cardiovascular diseases. Methods We selected 394 individuals (169 males and 225 females) who underwent a second carotid artery ultrasonographic examination in 2001 - 2002 for the present study. The susceptibility of LDL to oxidation was determined as the photometric absorbance and electrophoretic mobility of samples that had been collected in 1996 - 1997. The measurements were compared with ultrasonographic findings obtained in 2001 - 2002. Results The multivariate-adjusted model showed that age (odds ratio (OR), 1.034; 95% confidence interval (95%CI), 1.010 - 1.059), HbA1c (OR, 1.477; 95%CI, 0.980 - 2.225), and photometric O/N (OR, 2.012; 95%CI, 1.000 - 4.051) were significant variables that could independently predict the risk of new carotid artery atherosclerosis. Conclusion The susceptibility of LDL to oxidation was a significant parameter that could predict new carotid artery atherosclerosis over a 5-year period, and higher susceptibility was associated with a higher incidence of new carotid artery atherosclerosis. PMID:22230558

  3. Intracranial Pseudoaneurysms, Fusiform Aneurysms and Carotid-Cavernous Fistulas

    PubMed Central

    Lv, Xianli; Jiang, Chuhan; Li, Youxiang; Lv, Ming; Zhang, Jingbo; Wu, Zhongxue

    2008-01-01

    Summary The study assessed the effectiveness and safety of endovascular covered stents in the management of intracranial pseudoaneurysms, fusiform aneurysms and direct carotid-cavernous fistulas. Fourteen endovascular covered stents were used to repair three pseudoaneurysms, six fu-siform aneurysms and six direct carotid-cavernous fistulas. Aneurysms were in the carotid artery in seven cases, in the vertebral artery two cases. It was not possible to treat two additional cases transcutaneously for technical reasons
2/15. Percutaneous closure of the lesions with an endovascular covered stent was successful in 13 of 15 cases. Initial follow-up showed good stent patency. No complications were observed after stent implantation. During follow-up, stent thromboses were detected in two of nine patients with follow-up digital subtracted angiography. One carotid-cavernous fistula of Barrow Type A transformed into Barrow Type D at nine month follow-up study was cured with a procudure of Onyx-18 injection. Endovascular covered stents may be an option for percutaneous closure of intracranial pseudoaneurysms, fusiform aneurysms and direct carotid-cavernous fistulas. Endoluminal vascular repair with covered stents offers an alternative therapeutic approach to conventional modalities. PMID:20557743

  4. Delayed presentation of a carotid pseudoaneurysm following penetrating neck trauma

    PubMed Central

    Alfawaz, Abdullah; Li, Xiaoyi; Kénel-Pierre, Stefan; Yang, Jane; Rey, Jorge; Robinson, Handel

    2016-01-01

    Objective: Penetrating carotid trauma in a hemodynamically stable patient invariably presents with a pseudoaneurysm on initial imaging. Although extremely rare, delayed pseudoaneurysm formation has been reported. The purpose of this paper is to define this rare entity and propose a diagnostic and treatment plan. Methods: We present a case of delayed presentation of carotid pseudoaneurysm following penetrating neck trauma. A systematic review of the literature was performed. Results: A 21-year-old male presents to the trauma center after sustaining a gunshot wound to the left upper back resulting in a zone 2 hematoma and pneumothorax. Bullet fragment artifact interfered with computed tomography. Carotid angiogram was normal. The patient was discharged after 3 days. He returned to the Emergency Department 3 months later with a painful pulsatile hematoma. Computed tomography angiogram revealed a 6-cm pseudoaneurysm arising from the proximal left internal carotid artery (ICA). A left common carotid artery (CCA) to ICA bypass with reversed great saphenous vein was performed. The patient’s post-operative course was uneventful, neurologic deficits improved, and he was discharged. Conclusion: Delayed presentation of traumatic pseudoaneurysms has been reported, although usually these cases are iatrogenic access complications in extremities. While endovascular therapies are first line for zone 1 and 3 vascular injuries, management of zone 2 injuries is still controversial. This patient was treated with a bypass due to the need to evacuate the hematoma that was exerting a mass effect in the neck. PMID:27489718

  5. An Experimental and Computational Study of Blunt Carotid Artery Injury

    PubMed Central

    Gayzik, F. Scott; Bostrom, Ola; Örtenwall, Per; Duma, Stefan M.; Stitzel, Joel D.

    2006-01-01

    A carotid artery dissection begins as a tear or defect of the intimal lining of the artery, and can lead to luminal occlusion and ultimately cerebral ischemia. Our aim is to conduct an organ level validation of a finite element model of the carotid artery using an experiment designed to elicit internal layer failure within fluid-filled carotid artery samples. A 2.4-kg beveled guillotine is dropped from three heights (0.3, 0.5 and 0.7 m) onto fluid-filled porcine carotid arteries and resulting damage is recorded. These events are modeled using finite element analysis. Stress, strain and strain rate are correlated to experimental outcome. Internal layer damage is reported in half of the experiments, with damage occurring with 100% frequency at a drop height of 0.7 m. Simulations of this experiment result in maximum principal stress and strain values of 1.43 MPa and 46.2% respectively. The strain level predicted by the model for this impact scenario approaches the strain to intimal failure level for porcine arteries found in the literature. The results of this study represent an important step in validating this finite element carotid artery model at the organ level. PMID:16968627

  6. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial

    PubMed Central

    2010-01-01

    Summary Background Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. Methods The International Carotid Stenting Study (ICSS) is a multicentre, international, randomised controlled trial with blinded adjudication of outcomes. Patients with recently symptomatic carotid artery stenosis were randomly assigned in a 1:1 ratio to receive carotid artery stenting or carotid endarterectomy. Randomisation was by telephone call or fax to a central computerised service and was stratified by centre with minimisation for sex, age, contralateral occlusion, and side of the randomised artery. Patients and investigators were not masked to treatment assignment. Patients were followed up by independent clinicians not directly involved in delivering the randomised treatment. The primary outcome measure of the trial is the 3-year rate of fatal or disabling stroke in any territory, which has not been analysed yet. The main outcome measure for the interim safety analysis was the 120-day rate of stroke, death, or procedural myocardial infarction. Analysis was by intention to treat (ITT). This study is registered, number ISRCTN25337470. Findings The trial enrolled 1713 patients (stenting group, n=855; endarterectomy group, n=858). Two patients in the stenting group and one in the endarterectomy group withdrew immediately after randomisation, and were not included in the ITT analysis. Between randomisation and 120 days, there were 34 (Kaplan-Meier estimate 4·0%) events of disabling stroke or death in the stenting group compared with 27 (3·2%) events in the endarterectomy group (hazard ratio [HR] 1·28, 95% CI 0·77–2·11). The incidence of stroke, death, or procedural myocardial infarction was 8·5% in the stenting group compared with 5·2% in the endarterectomy group (72 vs 44 events

  7. Radioiodine Therapy Does Not Change the Atherosclerotic Burden of the Carotid Arteries

    PubMed Central

    Andersen, Ulrik Bjørn; Sørensen, Christian Hjort; Nygaard, Birte; Jensen, Lars Thorbjørn

    2016-01-01

    Background and aim: Atherosclerosis evolves or accelerates when arteries are exposed to ionizing radiation, both early and late after exposure. Radioiodine therapy of benign thyroid disease exposes the carotid arteries to 4–50 Gy, and may thereby increase the risk of atherosclerosis. Increased risk of cerebrovascular events has been reported after radioiodine therapy. This study aimed to examine whether atherosclerosis develops early or late after radioiodine therapy of benign thyroid disease. Method: Patients treated for benign thyroid disorders (nontoxic goiter, adenoma, and hyperthyroidism) were examined with ultrasound for the main outcome, carotid intima media thickness (CIMT), and for plaque presence (plaque presence only in late damage). Signs of early damage from radioiodine were studied in 39 radioiodine-treated patients, who were examined before treatment and at 1, 3, 6, and 12 months after treatment. Late changes were studied in a cross-sectional case-control design, with radioiodine-treated patients as cases (n = 193) and patients treated with surgery as controls (n = 95). Data were analyzed with repeated measurement for longitudinal data, and with multivariate regression for cross-sectional data. Results were adjusted for age, sex, cholesterol, smoking status, known atherosclerotic disease, and body mass index. Results: No changes in CIMT were found in the patients followed prospectively for one year after treatment with radioactive iodine for benign thyroid disease (p = 0.58). In the study on late effects, there was no difference in CIMT (p = 0.25) or presence of plaques (p = 0.70) between those treated with radioactive iodine and those treated with surgery (9.8 and 5.6 years since treatment, respectively). Furthermore, the level of thyrotropin (TSH) did not influence these atherosclerosis markers. Conclusion: No early changes in CIMT were detected in patients treated with radioactive iodine for benign thyroid disease. No signs

  8. Active changes of lignification-related enzymes in pepper response to Glomus intraradices and/or Phytophthora capsici *

    PubMed Central

    Zheng, Hu-zhe; Cui, Chun-lan; Zhang, Yu-ting; Wang, Dan; Jing, Yu; Kim, Kil Yong

    2005-01-01

    The activities of enzymes responsible for lignification in pepper, pre-inoculation with arbuscular mycorrhizal (AM) fungus of Glomus intraradices and/or infection with pathogenic strain of Phytophthora capsici, and the biological control effect of G. intraradices on Phytophthora blight in pepper were investigated. The experiment was carried out with four treatments: (1) plants pre-inoculated with G. intraradices (Gi), (2) plants pre-inoculated with G. intraradices and then infected with P. capsici (Gi+Pc), (3) plants infected with P. capsici (Pc), and (4) plants without any of the two microorganisms (C). Mycorrhizal colonization rate was reduced by about 10% in pathogen challenged plants. Root mortality caused by infection of P. capsici was completely eliminated by pre-inoculation with antagonistic G. intraradices. On the ninth day after pathogen infection, Peroxidase (POD) activity increased by 116.9% in Pc-treated roots but by only 21.2% in Gi+Pc-treated roots, compared with the control, respectively. Polyphenol oxidase (PPO) and Phenylalanine ammonia-lyase (PAL) activities gradually increased during the first 3 d and dramatically decreased in Pc-treated roots but slightly decreased in Gi+Pc-treated roots, respectively. On the ninth day after pathogen infection, PPO and PAL decreased by 62.8% and 73.9% in Pc-treated roots but by only 19.8% and 19.5% in Gi+Pc-treated roots, compared with the control, respectively. Three major POD isozymes (45 000, 53 000 and 114 000) were present in Pc-treated roots, while two major bands (53 000 and 114 000) and one minor band (45 000) were present in spectra of Gi+Pc-treated roots, the 45 000 POD isozyme was significantly suppressed by G. intraradices, suggesting that the 45 000 POD isozyme was induced by the pathogen infection but not induced by the antagonistic G. intraradices. A 60 000 PPO isozyme was induced in Pc-treated roots but not induced in Gi+Pc-treated roots. All these results showed the inoculation of antagonistic G

  9. Left or Right Carotid Endarterectomy in Patients with Atherosclerotic Disease: Ipsilateral Effects on Cognition?

    ERIC Educational Resources Information Center

    Brand, N.; Bossema, E. R.; van Ommen, M.; Moll, F. L.; Ackerstaff, R. G. A.

    2004-01-01

    We evaluated hemispheric functions ipsilateral to the side of carotid endarterectomy (CEA) in patients with a severe stenosis in the left or right carotid artery. Assessments took place 1 day before and 3 months after CEA. Only right-handed males were included. Nineteen patients underwent surgery of the left carotid artery and 17 of the right.…

  10. Hemodynamic effects of long-term morphological changes in the human carotid sinus.

    PubMed

    Seong, Jaehoon; Jeong, Woowon; Smith, Nataliya; Towner, Rheal A

    2015-04-13

    Previous investigations of morphology for human carotid artery bifurcation from infancy to young adulthood found substantial growth of the internal carotid artery with advancing age, and the development of the carotid sinus at the root of the internal carotid artery during teenage years. Although the reasons for the appearance of the carotid sinus are not clearly understood yet, it has been hypothesized that the dilation of the carotid sinus serves to support pressure sensing, and slows the blood flow to reduce pulsatility to protect the brain. In order to understand this interesting evolvement at the carotid bifurcation in the aspects of fluid mechanics, we performed in vitro phase-contrast MR flow experiments using compliant silicone replicas of age-dependent carotid artery bifurcations. The silicone models in childhood, adolescence, and adulthood were fabricated using a rapid prototyping technique, and incorporated with a bench-top flow mock circulation loop using a computer-controlled piston pump. The results of the in vitro flow study showed highly complex flow characteristics at the bifurcation in all age-dependent models. However, the highest magnitude of kinetic energy was found at the internal carotid artery in the child model. The high kinetic energy in the internal carotid artery during childhood might be one of the local hemodynamic forces that initiate morphological long-term development of the carotid sinus in the human carotid bifurcation. PMID:25702250

  11. Computed tomography of the carotid space and related cervical spaces. Part 1. Anatomy

    SciTech Connect

    Silver, A.J.; Mawad, M.E.; Hilal, S.K.; Sane, P.; Ganti, S.R.

    1984-03-01

    The carotid space, parapharyngeal space, and paraspinal space are described. The carotid space is shown on computed tomography (CT) to be posterior to the parapharyngeal space and separated from it by the styloid apparatus. The paraspinal space is posterior to the carotid space and separated from it by the longus and anterior scalene muscles.

  12. Hemodynamic Effects of Long-term Morphological Changes in the Human Carotid Sinus

    PubMed Central

    Seong, Jaehoon; Jeong, Woowon; Smith, Nataliya; Towner, Rheal A.

    2015-01-01

    Previous investigations of morphology for human carotid artery bifurcation from infancy to young adulthood found substantial growth of the internal carotid artery with advancing age, and the development of the carotid sinus at the root of the internal carotid artery during teen age years. Although the reasons for the appearance of the carotid sinus are not clearly understood yet, it has been hypothesized that the dilation of the carotid sinus serves to support pressure sensing, and slows the blood flow to reduce pulsatility to protect the brain. In order to understand this interesting evolvement at the carotid bifurcation in the aspects of fluid mechanics, we performed in vitro phase-contrast MR flow experiments using compliant silicone replicas of age-dependent carotid artery bifurcations. The silicone models in childhood, adolescence, and adulthood were fabricated using a rapid prototyping technique, and incorporated with a bench-top flow mock circulation loop using a computer-controlled piston pump. The results of the in vitro flow study showed highly complex flow characteristics at the bifurcation in all age-dependent models. However, the highest magnitude of kinetic energy was found at the internal carotid artery in the child model. The high kinetic energy in the internal carotid artery during childhood might be one of the local hemodynamic forces that initiate morphological long-term development of the carotid sinus in the human carotid bifurcation. PMID:25702250

  13. Performing Permanent Distal Middle Cerebral with Common Carotid Artery Occlusion in Aged Rats to Study Cortical Ischemia with Sustained Disability

    PubMed Central

    Roy, Lisa A.; Haenzi, Barbara; Tsai, Shi-Yen; Kartje, Gwendolyn; Beech, John S.; Cash, Diana; Moon, Lawrence

    2016-01-01

    Stroke typically occurs in elderly people with a range of comorbidities including carotid (or other arterial) atherosclerosis, high blood pressure, obesity and diabetes. Accordingly, when evaluating therapies for stroke in animals, it is important to select a model with excellent face validity. Ischemic stroke accounts for 80% of all strokes, and the majority of these occur in the territory of the middle cerebral artery (MCA), often inducing infarcts that affect the sensorimotor cortex, causing persistent plegia or paresis on the contralateral side of the body. We demonstrate in this video a method for producing ischemic stroke in elderly rats, which causes sustained sensorimotor disability and substantial cortical infarcts. Specifically, we induce permanent distal middle cerebral artery occlusion (MCAO) in elderly female rats by using diathermy forceps to occlude a short segment of this artery. The carotid artery on the ipsilateral side to the lesion was then permanently occluded and the contralateral carotid artery was transiently occluded for 60 min. We measure the infarct size using structural T2-weighted magnetic resonance imaging (MRI) at 24 hr and 8 weeks after stroke. In this study, the mean infarct volume was 4.5% ± 2.0% (standard deviation) of the ipsilateral hemisphere at 24 hr (corrected for brain swelling using Gerriet’s equation, n = 5). This model is feasible and clinically relevant as it permits the induction of sustained sensorimotor deficits, which is important for the elucidation of pathophysiological mechanisms and novel treatments. PMID:26967269

  14. Combined vector velocity and spectral Doppler imaging for improved imaging of complex blood flow in the carotid arteries.

    PubMed

    Ekroll, Ingvild Kinn; Dahl, Torbjørn; Torp, Hans; Løvstakken, Lasse

    2014-07-01

    Color flow imaging and pulsed wave (PW) Doppler are important diagnostic tools in the examination of patients with carotid artery disease. However, measurement of the true peak systolic velocity is dependent on sample volume placement and the operator's ability to provide an educated guess of the flow direction. Using plane wave transmissions and a duplex imaging scheme, we present an all-in-one modality that provides both vector velocity and spectral Doppler imaging from one acquisition, in addition to separate B-mode images of sufficient quality. The vector Doppler information was used to provide automatically calibrated (angle-corrected) PW Doppler spectra at every image point. It was demonstrated that the combined information can be used to generate spatial maps of the peak systolic velocity, highlighting regions of high velocity and the extent of the stenotic region, which could be used to automate work flow as well as improve the accuracy of measurement of true peak systolic velocity. The modality was tested in a small group (N = 12) of patients with carotid artery disease. PW Doppler, vector velocity and B-mode images could successfully be obtained from a single recording for all patients with a body mass index ranging from 21 to 31 and a carotid depth ranging from 16 to 28 mm. PMID:24785436

  15. Performing Permanent Distal Middle Cerebral with Common Carotid Artery Occlusion in Aged Rats to Study Cortical Ischemia with Sustained Disability.

    PubMed

    Wayman, Christina; Duricki, Denise A; Roy, Lisa A; Haenzi, Barbara; Tsai, Shi-Yen; Kartje, Gwendolyn; Beech, John S; Cash, Diana; Moon, Lawrence

    2016-01-01

    Stroke typically occurs in elderly people with a range of comorbidities including carotid (or other arterial) atherosclerosis, high blood pressure, obesity and diabetes. Accordingly, when evaluating therapies for stroke in animals, it is important to select a model with excellent face validity. Ischemic stroke accounts for 80% of all strokes, and the majority of these occur in the territory of the middle cerebral artery (MCA), often inducing infarcts that affect the sensorimotor cortex, causing persistent plegia or paresis on the contralateral side of the body. We demonstrate in this video a method for producing ischemic stroke in elderly rats, which causes sustained sensorimotor disability and substantial cortical infarcts. Specifically, we induce permanent distal middle cerebral artery occlusion (MCAO) in elderly female rats by using diathermy forceps to occlude a short segment of this artery. The carotid artery on the ipsilateral side to the lesion was then permanently occluded and the contralateral carotid artery was transiently occluded for 60 min. We measure the infarct size using structural T2-weighted magnetic resonance imaging (MRI) at 24 hr and 8 weeks after stroke. In this study, the mean infarct volume was 4.5% ± 2.0% (standard deviation) of the ipsilateral hemisphere at 24 hr (corrected for brain swelling using Gerriet's equation, n = 5). This model is feasible and clinically relevant as it permits the induction of sustained sensorimotor deficits, which is important for the elucidation of pathophysiological mechanisms and novel treatments. PMID:26967269

  16. Independent Association of Muscular Strength and Carotid Intima-Media Thickness in Children.

    PubMed

    Melo, X; Santa-Clara, H; Santos, D A; Pimenta, N M; Minderico, C S; Fernhall, B; Sardinha, L B

    2015-07-01

    The aim of this cross-sectional study was to examine the influence of muscular strength on carotid intima-media thickness (cIMT) in children, controlling for the effect of cardiorespiratory fitness (CRF) and central adiposity and to examine if differences among muscular strength tertiles translate to physiological differences. We assessed cIMT of the common carotid artery in 366 children between 11-12 years of age (191 girls). Measures included cIMT assessed with high-resolution ultrasonography, a maximal handgrip strength test, body fat mass and lean mass from DXA and CRF determined using a maximal cycle ergometer test. Association between muscular strength and cIMT adjusted for CRF and central adiposity, as measured by trunk fat, was tested with multiple linear regression analysis. Differences in risk factors among muscular strength groups were tested with ANOVA. The Muscular Strength Index (MSI) was inversely associated with cIMT independently of CRF and central adiposity (p<0.05). The low MSI group had the highest values of cIMT, waist circumference and systolic blood pressure and the lowest CRF (p<0.05). There was an inverse and independent association between muscular strength and cIMT. Low muscular strength was associated with higher levels of cardiovascular disease risk factors in children. PMID:25875317

  17. Carotid intima-media thickness as a marker of atherosclerosis in hemodialysis patients.

    PubMed

    Abbasi, M R; Abbaszadeh, S H; Rokni-Yazdi, H; Lessan-Pezeshki, M; Khatami, M R; Mahdavi-Mazdeh, M; Ahmadi, F; Seifi, S; Gatmiri, S M

    2016-01-01

    Atherosclerotic changes in carotid arteries of hemodialysis (HD) patients reflect global atherosclerotic changes in vasculature. Carotid intima-media thickness (CIMT) can be used for atherosclerosis prediction and assessment of cardiovascular risks in HD patients, and thus screening high-risk patients. In this cross-sectional study, CIMT was measured using ultrasonography (B-mode with 5-10-MHz multifrequency linear probe) in HD patients in our hospitals. Additionally, we assessed the relationship between their CIMT and some cardiovascular risk factors. A total of 62 HD patients (64.5% male) were included. Age, body mass index, low-density lipoprotein, fasting blood sugar, history of diabetes mellitus and cardiovascular disease, serum albumin, and duration and adequacy of HD in study patients had significant association with their CIMT. There were no significant relationships between CIMT and patient's gender, smoking, serum calcium, phosphate, calcium x phosphate product, hemoglobin, and uric acid level. More diagnostic modalities must be performed for detecting the impact of atherosclerosis on HD patients with high CIMT. PMID:27051132

  18. Carotid intima-media thickness as a marker of atherosclerosis in hemodialysis patients

    PubMed Central

    Abbasi, M. R.; Abbaszadeh, S. H.; Rokni-Yazdi, H.; Lessan-Pezeshki, M.; Khatami, M. R.; Mahdavi-Mazdeh, M.; Ahmadi, F.; Seifi, S.; Gatmiri, S. M.

    2016-01-01

    Atherosclerotic changes in carotid arteries of hemodialysis (HD) patients reflect global atherosclerotic changes in vasculature. Carotid intima-media thickness (CIMT) can be used for atherosclerosis prediction and assessment of cardiovascular risks in HD patients, and thus screening high-risk patients. In this cross-sectional study, CIMT was measured using ultrasonography (B-mode with 5-10-MHz multifrequency linear probe) in HD patients in our hospitals. Additionally, we assessed the relationship between their CIMT and some cardiovascular risk factors. A total of 62 HD patients (64.5% male) were included. Age, body mass index, low-density lipoprotein, fasting blood sugar, history of diabetes mellitus and cardiovascular disease, serum albumin, and duration and adequacy of HD in study patients had significant association with their CIMT. There were no significant relationships between CIMT and patient's gender, smoking, serum calcium, phosphate, calcium x phosphate product, hemoglobin, and uric acid level. More diagnostic modalities must be performed for detecting the impact of atherosclerosis on HD patients with high CIMT. PMID:27051132

  19. Carotid Endothelial VCAM-1 Is an Early Marker of Carotid Atherosclerosis and Predicts Coronary Artery Disease in Swine

    PubMed Central

    Masseau, I.; Bowles, D. K.

    2015-01-01

    Objective The aim was to determine if endothelial VCAM-1 (eVCAM-1) expression in the common carotid artery (CCA) would correlate with predictive markers of atherosclerotic disease, would precede reduction of markers of endothelial cell function and would predict coronary artery disease (CAD). Methods and results Carotid arterial segments (bifurcation, proximal and distal CCA) were harvested from 14 and 24 month-old male castrated familial hypercholesterolemic (FH) swine, a model of spontaneous atherosclerosis. Quantification of local expression of eVCAM-1, intimal macrophage accumulation, oxidative stress, intima-media (I/M) ratio, intima-media thickness (IMT), endothelial nitric oxide synthase (eNOS) and phosphorylated eNOS (p-eNOS) in selected regions of the carotids revealed a relationship between local inflammation and atheroscle-rotic plaque progression. Importantly, inflammation was not uniform throughout the CCA. Endo-thelial VCAM-1 expression was the greatest at the bifurcation and increased with age. Finally, eV-CAM-1 best estimated the severity of CAD compared to blood levels of glucose, hypercholestero-lemia, carotid IMT, and p-eNOS. Conclusion Our data suggested that eVCAM-1 was closely associated with atherosclerotic plaque progression and preceded impairment of EDD. Thus, this study supported the use of carotid VCAM-1 targeting agents to estimate the severity of CAD. PMID:26702331

  20. Treatment of recurrent head and neck carcinoma involving the carotid artery: carotid reconstruction with ePTFE graft.

    PubMed

    He, Xiang-bo; Li, Jing-jia; Chen, Yue-hong; Shu, Chang; Tang, Qing-lai; Yang, Xin-ming

    2011-12-01

    The aim of our study is to investigate the feasibility of reconstructing the carotid artery using expanded polytetraflouroethylene (ePTFE) in patients with recurrent head and neck carcinoma involving the carotid artery. Ten patients, who had recurrent head and neck carcinoma involving the carotid artery, received carotid artery resection and reconstruction with ePTFE, tissue defects were repaired by pectoralis major myocutaneous flap. Results show that eight patients did not present any vascular and neurologic complications. One patient presented slight hemiparesis, another patient developed wound infection and pharyngocutaneous fistula. The mean follow-up period was 33.1 ± 16.0 months. The 2-year survival rate was 50% (5/10), and there was one patient who survived for 60 months without locoreginal recurrence or distant metastasis. En bloc resection of tumor and involved carotid-associated ePTFE reconstruction provide effective improvement in the locoregional control of the recurrent head and neck carcinoma. The pedicle pectoralis major myocutaneous flap can provide not only wound bed with affluent blood supply for the vascular grafts, but also reparation of skin or the tissue defects of oropharynx and hypopharynx. PMID:21400255

  1. The vasa vasorum of the rabbit carotid artery.

    PubMed Central

    Barker, S G; Causton, B E; Baskerville, P A; Gent, S; Martin, J F

    1992-01-01

    The anatomy of the vasa vasorum of the carotid arteries was assessed by light and electron microscopy in a series of 25 New Zealand White male rabbits. The low viscosity acrylic resin, LR White, was used to cast the microvasculature. The carotid artery was found to have an endothelial monolayer placed directly upon a broad fenestrated internal elastic lamina. The media consisted of 12-18 laminae comprised of smooth muscle cells, elastin, collagen and ground substance. Vasa vasorum were confined to the adventitial layer, with no penetration into the media. They arose directly from the lumen of the carotid artery in addition to the arterial branching points. The potential role of the vasa vasorum in the aetiology of atherosclerotic plaques is discussed. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 PMID:1506278

  2. [Unusual location of a parathyroid adenoma: the carotid sheath].

    PubMed

    Smayra, T; Abi Khalil, S; Abboud, B; Halabi, G; Slaba, S

    2006-01-01

    We report the imaging features of an occult parathyroid adenoma with unusual location in the carotid sheath. Our patient presented with primary hyperparathyroidism. Following negative neck ultrasound and scintigraphy, exploratory neck dissection with partial thyroidectomy was performed twice over a 2 day period without biological response. Cervical and mediastinal CT and MRI were performed with no result. Digital angiography showed a tumoral blush supplied by the left inferior thyroid artery and located in close contact with the carotid artery. Venous sampling of the neck confirmed the left location of the adenoma and a third surgical intervention found the adenoma embedded in the left carotid sheath. This is an unusual case of parathyroid adenoma that necessitated the use of several imaging techniques. PMID:16415782

  3. Ultrasound common carotid artery segmentation based on active shape model.

    PubMed

    Yang, Xin; Jin, Jiaoying; Xu, Mengling; Wu, Huihui; He, Wanji; Yuchi, Ming; Ding, Mingyue

    2013-01-01

    Carotid atherosclerosis is a major reason of stroke, a leading cause of death and disability. In this paper, a segmentation method based on Active Shape Model (ASM) is developed and evaluated to outline common carotid artery (CCA) for carotid atherosclerosis computer-aided evaluation and diagnosis. The proposed method is used to segment both media-adventitia-boundary (MAB) and lumen-intima-boundary (LIB) on transverse views slices from three-dimensional ultrasound (3D US) images. The data set consists of sixty-eight, 17 × 2 × 2, 3D US volume data acquired from the left and right carotid arteries of seventeen patients (eight treated with 80 mg atorvastatin and nine with placebo), who had carotid stenosis of 60% or more, at baseline and after three months of treatment. Manually outlined boundaries by expert are adopted as the ground truth for evaluation. For the MAB and LIB segmentations, respectively, the algorithm yielded Dice Similarity Coefficient (DSC) of 94.4% ± 3.2% and 92.8% ± 3.3%, mean absolute distances (MAD) of 0.26 ± 0.18 mm and 0.33 ± 0.21 mm, and maximum absolute distances (MAXD) of 0.75 ± 0.46 mm and 0.84 ± 0.39 mm. It took 4.3 ± 0.5 mins to segment single 3D US images, while it took 11.7 ± 1.2 mins for manual segmentation. The method would promote the translation of carotid 3D US to clinical care for the monitoring of the atherosclerotic disease progression and regression. PMID:23533535

  4. Ultrasound Common Carotid Artery Segmentation Based on Active Shape Model

    PubMed Central

    Yang, Xin; Jin, Jiaoying; Xu, Mengling; Wu, Huihui; He, Wanji; Yuchi, Ming; Ding, Mingyue

    2013-01-01

    Carotid atherosclerosis is a major reason of stroke, a leading cause of death and disability. In this paper, a segmentation method based on Active Shape Model (ASM) is developed and evaluated to outline common carotid artery (CCA) for carotid atherosclerosis computer-aided evaluation and diagnosis. The proposed method is used to segment both media-adventitia-boundary (MAB) and lumen-intima-boundary (LIB) on transverse views slices from three-dimensional ultrasound (3D US) images. The data set consists of sixty-eight, 17 × 2 × 2, 3D US volume data acquired from the left and right carotid arteries of seventeen patients (eight treated with 80 mg atorvastatin and nine with placebo), who had carotid stenosis of 60% or more, at baseline and after three months of treatment. Manually outlined boundaries by expert are adopted as the ground truth for evaluation. For the MAB and LIB segmentations, respectively, the algorithm yielded Dice Similarity Coefficient (DSC) of 94.4% ± 3.2% and 92.8% ± 3.3%, mean absolute distances (MAD) of 0.26 ± 0.18 mm and 0.33 ± 0.21 mm, and maximum absolute distances (MAXD) of 0.75 ± 0.46 mm and 0.84 ± 0.39 mm. It took 4.3 ± 0.5 mins to segment single 3D US images, while it took 11.7 ± 1.2 mins for manual segmentation. The method would promote the translation of carotid 3D US to clinical care for the monitoring of the atherosclerotic disease progression and regression. PMID:23533535

  5. Effects of lifestyle modification on metabolic parameters and carotid intima-media thickness in patients with type 2 diabetes mellitus.

    PubMed

    Kim, So Hun; Lee, Suk Jeong; Kang, Eun Seok; Kang, Shinae; Hur, Kyu Yeon; Lee, Hyun Joo; Ahn, Chul Woo; Cha, Bong Soo; Yoo, Ji Soo; Lee, Hyun Chul

    2006-08-01

    The aim of this study was to examine the effects of a 6-month intensive lifestyle modification intervention on metabolic parameters and carotid intima-media thickness (IMT) in patients with type 2 diabetes mellitus. Fifty-eight subjects with type 2 diabetes mellitus were randomly assigned to the intervention group or the control group. The subjects in the intervention group participated in a 16-week intensive lifestyle modification program and subsequent monthly meetings during the 6-month study period. Control subjects received basic dietary education and usual care. Anthropometric data, metabolic parameters, and carotid IMT were examined before the intervention and after 6 months. Lifestyle modification intervention group patients showed a significant reduction in HbA1c (-1.0% +/- 1.3% vs +0.1% +/- 1.2%, P = .002), fasting blood glucose (-1.6 +/- 1.5 vs +0.3 +/- 2.5 mmol/L, P = .001), and 2-hour postprandial plasma glucose (-2.1 +/- 2.5 vs +0.8 +/- 4.4 mmol/L, P = .003) compared with control patients after 6 months. Body weight (-2.0 +/- 2.6 vs +0.2 +/- 1.7 kg, P = .001), body mass index (-0.8 +/- 1.0 vs 0.0 +/- 0.8 kg/m2, P = .003), and systolic blood pressure (-8.2 +/- 15.9 vs +0.4 +/- 14.1 mm Hg, P = .041) were significantly decreased in the intervention group. A significantly reduced carotid mean IMT progression was seen in the intervention group after 6 months (-0.040 +/- 0.136 vs +0.083 +/- 0.167 mm, P = .007). Changes in HbA1c (r = 0.34, P = .028), fasting plasma glucose (r = 0.31, P = .045), and 2-hour postprandial plasma glucose (r = 0.37, P = .015) correlated with the mean carotid IMT change after adjustment for age and sex. In conclusion, a 6-month intensive lifestyle modification intervention in patients with type 2 diabetes mellitus resulted in improved glycemic control and decreased progression of carotid IMT. PMID:16839841

  6. A cohort study of duplex Doppler examinations of the carotid artery in primary open angle glaucoma

    PubMed Central

    Marmion, Vincent J; Aldoori, Munther I; Woodcock, John P

    2014-01-01

    Objectives To explore the possibility of pathological change in the common carotid artery at the bifurcation and in the internal carotid artery beyond the bifurcation which could contribute to a reduced diastolic pressure as observed in primary open angle glaucoma. Design Duplex ultrasonic examinations of carotid bifurcations were conducted on 80 patients. Carotid artery defects were allocated into three types: no demonstrable flow defects, internal carotid artery abnormalities and disease in the carotid bulb. Setting Bristol Royal Infirmary Vascular Laboratory. Participants Eighty patients (mean age 69.6 years) providing a total of 160 sides to the analysis. Main outcome measures An estimated central retinal artery pressure, intraocular pressure and field loss were recorded for each side measured. Results Doppler investigations revealed significant levels of pathological change in the internal carotid distinct from changes at the carotid bulb. The disease revealed in the internal carotid artery was significantly associated with intraocular pressure (p = 0.032), with an effect small to medium in magnitude. The Q2 measure, derived from mean arterial pressure and intraocular pressure, was also substantively associated with disease in the internal carotid artery. Both intraocular pressure and the Q2 measure effectively discriminated between groups, with field loss providing rather less discriminating capability. There was a strong trend towards a higher intraocular pressures and a greater visual field loss with internal carotid artery disease. Conclusions Pathological changes in the extra cranial carotid artery in primary open angle glaucoma exceed those in the arteries classified as normal. The presence of disease specifically in the internal carotid artery emphasised the need for a mechanism for the evaluation of the internal carotid apart from the carotid bulb. A basis for clarifying the presence of an ischaemic zone is proposed. PMID:25289141

  7. Periodontitis and carotid atheroma: is there a causal relationship?

    PubMed

    Tzorbatzoglou, I D; Sfyroeras, G S; Giannoukas, A D

    2010-02-01

    Periodontal diseases are highly prevalent in the population. Several studies implicated that chronic periodontitis may affect the arterial wall inducing subclinical atherosclerosis by triggering a systemic inflammatory response. Three theories have been put forward to explain potential mechanisms involved: the theory of bacterial invasion, the cytokine theory and the autoimmunization theory. Periodontal inflammation could have a role in the initiation and progression of arterial diseases such as coronary artery disease and carotid atherosclerosis. Further clinical studies are required to investigate if there is a causal relationship of chronic periodontitis with echolucent unstable carotid plaques. PMID:20224528

  8. [Ways to improve immediate and remote results of carotid endarterectomy].

    PubMed

    Kuzhuget, R A; Karpenko, A A; Kamenskaya, O V; Ignatenko, P V; Starodubtsev, V B; Postnov, V G

    2016-01-01

    The authors analysed the results of carotid endarterectomy in a total of 469 patients with the use of simultaneous assessment of the oxygen status and collateral blood flow of the brain in order to determine feasibility of placing a temporary bypass, carried out at the Centre of Vascular and Hybrid Surgery of the Novosibirsk Scientific Research Institute of Circulatory Pathology named after Academician E.N. Meshalkin in 2008-2012. It was shown that it is more appropriate to use a temporary bypass based on simultaneous assessment of the oxygen status and collateral blood flow of the brain: in synchronous decrease of the degree of cerebral oxygenation during tentative occlusion by more than 20% of the baseline level, or in absolute values of cerebral oxygenation below 40% and simultaneous decrease of retrograde pressure below 40 mm Hg. It was determined that simultaneous assessment of tolerance of the brain to ischaemia significantly decreased the incidence of using a temporary bypass from 16 to 3% (χ2=22.51; p<0.00001), accompanied by a tendency towards a decrease in the incidence of perioperative stroke from 2.6 to 0.8% (odds ratio 0.30; 95% CI 0.06-1.55; p=0.15). Long-term results of carotid endarterectomy after 4 years showed that a decrease in the number of temporary shunts did not influence cumulative survival (log-rank test; p=0.73), the incidence of stroke (log-rank test; p=0.68) and patency of the reconstructed carotid arteries in the remote period (log-rank test; p=0.70). It was determined that in the remote period of carotid endarterectomy restenoses of reconstructed carotid arteries were encountered statistically significantly less often in the group of eversion carotid endarterectomy as compared with classic carotid endarterectomy (OR 0.23; 95% CI 0.07-070; p=0.009) and with prosthetic repair of the internal carotid artery (OR 0.13; 95% CI 0.02-0.83; p=0.03). PMID:27100546

  9. Wavelet-based neural network analysis of internal carotid arterial Doppler signals.

    PubMed

    Ubeyli, Elif Derya; Güler, Inan

    2006-06-01

    In this study, internal carotid arterial Doppler signals recorded from 130 subjects, where 45 of them suffered from internal carotid artery stenosis, 44 of them suffered from internal carotid artery occlusion and the rest of them were healthy subjects, were classified using wavelet-based neural network. Wavelet-based neural network model, employing the multilayer perceptron, was used for analysis of the internal carotid arterial Doppler signals. Multi-layer perceptron neural network (MLPNN) trained with the Levenberg-Marquardt algorithm was used to detect stenosis and occlusion in internal carotid arteries. In order to determine the MLPNN inputs, spectral analysis of the internal carotid arterial Doppler signals was performed using wavelet transform (WT). The MLPNN was trained, cross validated, and tested with training, cross validation, and testing sets, respectively. All these data sets were obtained from internal carotid arteries of healthy subjects, subjects suffering from internal carotid artery stenosis and occlusion. The correct classification rate was 96% for healthy subjects, 96.15% for subjects having internal carotid artery stenosis and 96.30% for subjects having internal carotid artery occlusion. The classification results showed that the MLPNN trained with the Levenberg-Marquardt algorithm was effective to detect internal carotid artery stenosis and occlusion. PMID:16848135

  10. Reflections by contrarians on the post-CREST evaluation of carotid stenting for stroke prevention.

    PubMed

    Barnett, Henry J M; Pelz, David M; Lownie, Stephen P

    2010-12-01

    Carotid angioplasty and stenting has become a popular alternative to carotid endarterectomy for the treatment of carotid stenosis in stroke. Evidence from early randomized controlled trials comparing these interventions revealed mixed results. The largest such trial, the Carotid Revascularization Endarterectomy vs. Stenting Trial recently showed equivalence of the procedures in a mixed cohort of both symptomatic and asymptomatic patients. These results have been heralded in North America as definitively demonstrating the safety and efficacy of carotid angioplasty and stenting, making it an attractive alternative to carotid endarterectomy. It is therefore probable that many more asymptomatic patients will be subjected to Carotid angioplasty and stenting, perceived by many to be less invasive than carotid endarterectomy. The authors argue that the design of Carotid Revascularization Endarterectomy vs. Stenting Trial was flawed by the mixture of two dissimilar patient groups, thus violating the principle of ceteris paribus, essential for the validity of a randomized controlled trials. The evidence for any invasive treatment of asymptomatic carotid disease is weak, with recent data favouring purely medical management. The authors believe that carotid angioplasty and stenting in asymptomatic patients should cease until better evidence is available. PMID:21050401

  11. Treatment of a ballistic wound of the common carotid artery revealed by a spontaneous carotid-jugular fistula.

    PubMed

    Mlynski, Amélie; Mocellin, Nicolas; Imperato, Marc; Molimard, Benoît; Bordier, Emmanuel; Menguy, Paul; Baranger, Bernard

    2011-02-01

    The case reported is of a 30-year-old patient with a left internal carotid-jugular fistula secondary to the explosion of an improvised explosive device during the Afghan war. Carotid resection with arterial bypass using a venous allograft and internal jugular ligation were performed by left cervicotomy associated with sternotomy at a specialized center. The management of cervical arteriovenous fistulas that occur as a result of penetrating trauma faced during the war must be considered and it should be noted that, on battlefields, treatment is not always performed in specialized units. PMID:21183314

  12. [Glomus tumor with diplopia].

    PubMed

    Zemba, M; Cucu, B; David, L; Stinghe, Alina; Furedi, Gabriel; Halmaci, Viorica; Enache, Veronica; Lacusteanu, Monica

    2009-01-01

    This paper highlights the case of a 46-year-old female patient who seeks ophthalmic medical advice for her complaint about double vision on right gaze. Patient's medical history reveals several symptoms like headaches, progressive hearing loss on right side and dysphonia for which all investigations proved irrelevant. Thourough clinical examination, lab exams and imaging techniques revealed the cause for this symptoms i.e. glomic tumour with middle ear extention. We find this case to be exceptional as ocular symptoms led to the diagnose of a non-ocular serious, possible life threatening condition, bearing in mind that previously occured non-ocular symptoms couldn't elucidate the cause. PMID:19899551

  13. How Is Carotid Artery Disease Diagnosed?

    MedlinePlus

    ... pictures of the body from many angles. A computer combines the pictures into two- and three-dimensional images. For this test, your doctor may give ... National Institutes of Health Department of Health and Human Services USA.gov

  14. Occupational death due to bilateral carotid artery occlusion - a medico-legal case report.

    PubMed

    Das, Siddhartha; Patra, Ambika Prasad; Shaha, Kusa Kumar; Sukumar, Sanjay; Chaudhari, Vinod Ashok; Rahman, Nisreen Abdul

    2015-05-01

    Occupational deaths are work-related deaths and usually occur in the work place of an individual. A case of occupational death in a female factory worker has been described, where the saree she was wearing accidentally got entangled in the moving belt and caused ligature strangulation. She was unconscious throughout indicating bilateral occlusion of the carotids and died a day after the incident. The authors have described the correlation between the distribution of the injuries on the body and the manner a saree is worn. Investigation of the workplace revealed that the place where she was standing was located between two machines, and the space was inadequate for normal movement. Some suggestions have been offered which may decrease the incidences of occupational ligature strangulation due to entanglement of dress materials in the moving machineries. PMID:25882146

  15. Acute Carotid Artery Stent Thrombosis Due to Dual Antiplatelet Resistance

    SciTech Connect

    Köklü, Erkan Arslan, Şakir; Yüksel, İsa Öner; Bayar, Nermin; Koç, Pınar

    2015-08-15

    Carotid artery stenting (CAS) is a revascularization modality that is an alternative to carotid endarterectomy. The efficacy of CAS in primary and secondary prevention from ischemic stroke has been demonstrated in various trials. Acute thrombosis of CAS is a rare complication that can lead to dramatic and catastrophic consequences. We discuss a case of acute CAS thrombosis in a patient who had previously undergone successful CAS. CAS was performed in a 73-year-old man who had had dysarthria lasting 2 weeks with 95 % stenosis in his left internal carotid artery. An acute cerebrovascular event resulting in right-sided hemiplegia developed 24 h after the procedure. Computed tomographic carotid angiography revealed complete occlusion of the stent with thrombus. The cause of stent thrombosis was thought to be antiaggregant resistance to both acetylsalicylic acid and clopidogrel. The most important cause of acute CAS thrombosis is inadequate or ineffective antiaggregant therapy. Evaluating patients who are candidates for CAS for acetylsalicylic acid and clopidogrel resistance may preclude this complication.

  16. Aortic Baroreceptors Display Higher Mechanosensitivity than Carotid Baroreceptors

    PubMed Central

    Lau, Eva On-Chai; Lo, Chun-Yin; Yao, Yifei; Mak, Arthur Fuk-Tat; Jiang, Liwen; Huang, Yu; Yao, Xiaoqiang

    2016-01-01

    Arterial baroreceptors are mechanical sensors that detect blood pressure changes. It has long been suggested that the two arterial baroreceptors, aortic and carotid baroreceptors, have different pressure sensitivities. However, there is no consensus as to which of the arterial baroreceptors are more sensitive to changes in blood pressure. In the present study, we employed independent methods to compare the pressure sensitivity of the two arterial baroreceptors. Firstly, pressure-activated action potential firing was measured by whole-cell current clamp with a high-speed pressure clamp system in primary cultured baroreceptor neurons. The results show that aortic depressor neurons possessed a higher percentage of mechano-sensitive neurons. Furthermore, aortic baroreceptor neurons show a lower pressure threshold than that of carotid baroreceptor neurons. Secondly, uniaxial stretching of baroreceptor neurons, that mimics the forces exerted on blood vessels, elicited a larger increase in intracellular Ca2+ rise in aortic baroreceptor neurons than in carotid baroreceptor neurons. Thirdly, the pressure-induced action potential firing in the aortic depressor nerve recorded in vivo was also higher. The present study therefore provides for a basic physiological understanding on the pressure sensitivity of the two baroreceptor neurons and suggests that aortic baroreceptors have a higher pressure sensitivity than carotid baroreceptors.

  17. Metabolic syndrome showed significant relationship with carotid atherosclerosis.

    PubMed

    Kawada, Tomoyuki; Andou, Takeshi; Fukumitsu, Masayuki

    2016-05-01

    Metabolic syndrome (MetS) is associated with an increased risk of cardiovascular disease. We assessed the associations between MetS and the indicators of carotid atherosclerosis as assessed by ultrasonography taking into consideration of confounders in the general population. A total of 1281 subjects (856 males, 425 females) were included in the present study. The total plaque score and maximum intima-media thickness (IMT) of the carotid arteries were measured as indicators of atherosclerosis. Cardiovascular risk factors were several metabolic components, serum uric acid, serum C-reactive protein (CRP), and lifestyle factors. MetS was defined according to the criteria of the National Cholesterol Education Program. The prevalences of an elevated total plaque score (≥5) and elevated IMT (>1 mm) of the carotid arteries were significantly higher in subjects with MetS as compared to subjects without MetS. Furthermore, a trend was observed towards higher prevalences of these indicators of atherosclerosis as the number of components of MetS increased. Logistic regression analysis revealed a significant association between elevated plaque score and MetS even after adjustments for age, serum uric acid, serum CRP and lifestyle factors in the males. Among the indicators of atherosclerosis assessed by carotid ultrasonography, a significant independent association was observed between the total plaque score and MetS in males in the general population. PMID:25810113

  18. Bilateral carotid and bilateral vertebral artery dissection following facial massage.

    PubMed

    Chakrapani, Andrea L; Zink, Walter; Zimmerman, Robert; Riina, Howard; Benitez, Ronald

    A 50-year-old woman underwent facial massage. After 13 days, she experienced left retro-orbital pain, ptosis, and miosis. Magnetic resonance imaging (MRI) showed stenotic dissection of bilateral cervical internal carotid and vertebral arteries. The intracranial vasculature was intact. She was treated conservatively with long-term oral anticoagulation and remains asymptomatic 18 months later. PMID:18388028

  19. [Revascularization of the carotid and vertebral arteries in the elderly].

    PubMed

    Illuminati, G; Bezzi, M; D'Urso, A; Giacobbi, D; Ceccanei, G; Vietri, F

    2004-01-01

    From January 1994 to July 2004, 323 patients underwent 348 revascularization of carotid bifurcation for atherosclerotic stenoses. Eighty eight patients (group A) were 75 year-old or older, whereas 235 (group B) were younger than 75 years. Postoperative mortality/neurologic morbidity rate was 1% in group A, and 1.4% in group B. At 5 years, patency and freedom from symptoms/stroke were, respectively, 91% and 92% in group A, and 89% and 91% in group B. None of these differences was statistically significant. In the same time period, 26 internal carotid arteries were revascularized in 24 patients, 75 or more aged, for a symptomatic kinking. Postoperative mortality/morbidity rate was absent, whereas, at 5 years, patency and freedom from symptoms/stroke were, respectively, 88% and 92%. Twelve vertebral arteries were revascularized in 12 patients, 75 or more aged, for invalidating symptoms of vertebrobasilar insufficiency. Postoperative mortality/neurologic morbidity rate was absent. In one case postoperative recurrence of symptoms occurred, despite a patent revascularization. Patency and freedom from symptoms/stroke were 84% and 75%, at 5 years. Revascularization of carotid and vertebral arteries in the elderly can be accomplished with good results, superposable to those of standard revascularization of carotid bifurcation in a younger patients' population. PMID:15803810

  20. Early carotid endarterectomy after a nondisabling stroke: a prospective study.

    PubMed

    Ricco, J B; Illuminati, G; Bouin-Pineau, M H; Demarque, C; Camiade, C; Blecha, L; Neau, J P

    2000-01-01

    On the recommendation of several studies, carotid endarterectomy (CEA) should be delayed for at least 6 weeks in patients suffering an acute nondisabling stroke. Our objective was to determine if these patients could be safely operated on earlier, thus decreasing the risk of a recurrent stroke prior to surgery. This prospective study, carried out from January 1990 to December 1997, included 72 consecutive patients having a nondisabling hemispheric stroke with severe ipsilateral carotid stenosis (NASCET 70-99%). All patients underwent CEA within 15 days of stroke onset. Patients were considered to have a nondisabling hemispheric stroke if (1) symptoms of hemispheric ischemia persisted longer than 24 hr and (2) the resulting deficit caused no major impairment in their everyday activities. All patients were examined by a neurologist prior to carotid angiography and contrast CT scan. Hemorrhage seen on the initial CT scan eliminated the patient from the study. If the CT scan with contrast injection was negative, patients underwent magnetic resonance imaging. CEA was performed under general anesthesia with intraluminal shunting. All patients had a postoperative duplex scan and yearly follow-up by a neurologist and a surgeon, with a duplex scan of the carotid arteries. Mean follow-up was 53 months. Our study shows that CEA can be performed relatively safely within 15 days following an acute nondisabling stroke. The arbitrary 6-week delay for CEA may unnecessarily expose patients with high-grade stenosis to a recurrent stroke, which could be prevented by earlier surgery. PMID:10629271

  1. Serum Osteoprotegerin Is Associated With Calcified Carotid Plaque

    PubMed Central

    Kwon, Ami; Choi, Yun-Seok; Choi, Yong-Won; Chung, Woo-Baek; Park, Chul-Soo; Chung, Wook-Sung; Lee, Man-Young; Youn, Ho-Joong

    2016-01-01

    Abstract Osteoprotegerin (OPG) is a kind of tumor necrosis factor, which is related to bone metabolism and vascular calcification. The increase of Osteoprotegerin concentration in serum is related to cardiovascular diseases in humans. The purpose of this study was to figure out the relevance between osteoprotegerin in serum and carotid calcification. Serum OPG concentrations were compared in 145 patients who underwent carotid sonography (average age: 68 ± 9 years old, male: female = 81:64). A calcified plaque (CP) (37 people [27%]), a noncalcified plaque (NCP) (54 people [37%]), and a nonplaque (NP) (54 people [37%]) were classified for this study. No significant differences among 3 groups were demonstrated in the distribution of age, diabetes, high blood pressure, and hyperlipidemia. Serum osteoprotegerin concentrations were significantly increased in CP group rather than NCP group or NP group; (median [interquartile range], 4016 [1410] vs 3210 [1802] pg/mL, P < 0.05 and 4016 [1410] vs 3204 [1754] pg/mL, P < 0.05). Serum osteoprotegerin concentrations did not indicate a significant difference between NCP Group or NP Group. This study had proved that patient group accompanied with carotid calcification in carotid artery disease had an increased serum OPG concentration, so it could consider that OPG plays an important function on calcification related to arteriosclerosis. PMID:27082605

  2. Factor analytic reduction of the carotid-cardiac baroreflex parameters

    NASA Technical Reports Server (NTRS)

    Ludwig, David A.

    1989-01-01

    An accepted method for measuring the responsiveness of the carotid-cardiac baroreflex to arterial pressure changes is to artificially stimulate the baroreceptors in the neck. This is accomplished by using a pressurized neck cuff which constricts and distends the carotid artery and subsequently stimulates the baroreceptors. Nine physiological responses to this type of stimulation are quantified and used as indicators of the baroreflex. Thirty male humans between the ages 27 and 46 underwent the carotid-cardiac baroreflex test. The data for the nine response parameters were analyzed by principle component factor analysis. The results of this analysis indicated that 93 percent of the total variance across all nine parameters could be explained in four dimensions. Examination of the factor loadings following an orthogonal rotation of the principle components indicated four well defined dimensions. The first two dimensions reflected location points for R-R interval and carotid distending pressure respectively. The third dimension was composed of measures reflecting the gain of the reflex. The fourth dimension was the ratio of the resting R-R interval to R-R interval during simulated hypertension. The data suggests that the analysis of all nine baroreflex parameters is redundant.

  3. Spontaneous carotid cavernous fistula in Ehlers Danlos syndrome.

    PubMed Central

    Fox, R; Pope, F M; Narcisi, P; Nicholls, A C; Kendall, B E; Hourihan, M D; Compston, D A

    1988-01-01

    A patient is described with Ehlers Danlos syndrome presenting with spontaneous carotid cavernous fistula, in whom there was biochemical evidence for defective type III collagen synthesis. Despite the risks associated with arterial manipulation, the fistula was successfully closed by interventional neuroradiology and the patient has since remained well. This outcome is in contrast with the results in previous reports. Images PMID:3204406

  4. Apathetic syndrome from carotid dissection: a dangerous condition

    PubMed Central

    Gerace, Carmela; Corsi, Fabio Massimo; Comanducci, Giovanna

    2013-01-01

    Isolated behavioural disturbances can mimic psychiatric diseases and delay diagnosis of acute brain disease. We reported the case of a patient with carotid dissection manifesting only with apathetic syndrome that was initially considered as a possible postpartum depression, causing a threatening diagnostic delay. PMID:24000207

  5. 21 CFR 882.5175 - Carotid artery clamp.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Carotid artery clamp. 882.5175 Section 882.5175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... (the principal artery in the neck that supplies blood to the brain) and has a removable...

  6. 21 CFR 882.5175 - Carotid artery clamp.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Carotid artery clamp. 882.5175 Section 882.5175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... (the principal artery in the neck that supplies blood to the brain) and has a removable...

  7. 21 CFR 882.5175 - Carotid artery clamp.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Carotid artery clamp. 882.5175 Section 882.5175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... (the principal artery in the neck that supplies blood to the brain) and has a removable...

  8. 21 CFR 882.5175 - Carotid artery clamp.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Carotid artery clamp. 882.5175 Section 882.5175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... (the principal artery in the neck that supplies blood to the brain) and has a removable...

  9. 21 CFR 882.5175 - Carotid artery clamp.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Carotid artery clamp. 882.5175 Section 882.5175 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... (the principal artery in the neck that supplies blood to the brain) and has a removable...

  10. Design of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST)

    PubMed Central

    Sheffet, Alice J.; Roubin, Gary; Howard, George; Howard, Virginia; Moore, Wesley; Meschia, James F.; Hobson, Robert W.; Brott, Thomas G.

    2009-01-01

    Rationale Carotid endarterectomy (CEA) and medical therapy were shown superior to medical therapy alone for symptomatic (≥50%) and asymptomatic (≥60%) stenosis. Carotid angioplasty stenting (CAS) offers a less invasive alternative. Establishing safety, efficacy, and durability of CAS requires rigorous comparison with CEA in symptomatic and asymptomatic patients. Aims The objective is to compare the efficacy of CAS versus CEA in patients with symptomatic (≥50%) or asymptomatic (≥60%) extracranial carotid stenosis. Design The Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) is a prospective, randomized, parallel, two-arm, multi-center trial with blinded endpoint adjudication. Primary endpoints are analyzed using standard time-to-event statistical modeling with adjustment for major baseline covariates. Primary analysis is on an intent-to-treat basis. Study Outcomes The primary outcome is the occurrence of any stroke, myocardial infarction, or death during a 30-day peri-procedural period, and ipsilateral stroke during follow-up of up to four years. Secondary outcomes include restenosis and health-related quality of life. PMID:20088993

  11. Children and Adolescent Obesity Associates with Pressure-Dependent and Age-Related Increase in Carotid and Femoral Arteries' Stiffness and Not in Brachial Artery, Indicative of Nonintrinsic Arterial Wall Alteration

    PubMed Central

    García-Espinosa, Victoria; Curcio, Santiago; Castro, Juan Manuel; Arana, Maite; Giachetto, Gustavo; Chiesa, Pedro; Zócalo, Yanina

    2016-01-01

    Aim. To analyze if childhood obesity associates with changes in elastic, transitional, and/or muscular arteries' stiffness. Methods. 221 subjects (4–15 years, 92 females) were assigned to normal weight (NW, n = 137) or obesity (OB, n = 84) groups, considering their body mass index z-score. Age groups were defined: 4–8; 8–12; 12–15 years old. Carotid, femoral, and brachial artery local stiffness was determined through systodiastolic pressure-diameter and stress-strain relationships. To this end, arterial diameter and peripheral and aortic blood pressure (BP) levels and waveforms were recorded. Carotid-femoral, femoropedal, and carotid-radial pulse wave velocities were determined to evaluate aortic, lower-limb, and upper-limb regional arterial stiffness, respectively. Correlation analysis between stiffness parameters and BP was done. Results. Compared to NW, OB subjects showed higher peripheral and central BP and carotid and femoral stiffness, reaching statistical significance in subjects aged 12 and older. Arterial stiffness differences disappeared when levels were normalized for BP. There were no differences in intrinsic arterial wall stiffness (elastic modulus), BP stiffness relationships, and regional stiffness parameters. Conclusion. OB associates with BP-dependent and age-related increase in carotid and femoral (but not brachial) stiffness. Stiffness changes would not be explained by intrinsic arterial wall alterations but could be associated with the higher BP levels observed in obese children. PMID:27066273

  12. Children and Adolescent Obesity Associates with Pressure-Dependent and Age-Related Increase in Carotid and Femoral Arteries' Stiffness and Not in Brachial Artery, Indicative of Nonintrinsic Arterial Wall Alteration.

    PubMed

    García-Espinosa, Victoria; Curcio, Santiago; Castro, Juan Manuel; Arana, Maite; Giachetto, Gustavo; Chiesa, Pedro; Zócalo, Yanina; Bia, Daniel

    2016-01-01

    Aim. To analyze if childhood obesity associates with changes in elastic, transitional, and/or muscular arteries' stiffness. Methods. 221 subjects (4-15 years, 92 females) were assigned to normal weight (NW, n = 137) or obesity (OB, n = 84) groups, considering their body mass index z-score. Age groups were defined: 4-8; 8-12; 12-15 years old. Carotid, femoral, and brachial artery local stiffness was determined through systodiastolic pressure-diameter and stress-strain relationships. To this end, arterial diameter and peripheral and aortic blood pressure (BP) levels and waveforms were recorded. Carotid-femoral, femoropedal, and carotid-radial pulse wave velocities were determined to evaluate aortic, lower-limb, and upper-limb regional arterial stiffness, respectively. Correlation analysis between stiffness parameters and BP was done. Results. Compared to NW, OB subjects showed higher peripheral and central BP and carotid and femoral stiffness, reaching statistical significance in subjects aged 12 and older. Arterial stiffness differences disappeared when levels were normalized for BP. There were no differences in intrinsic arterial wall stiffness (elastic modulus), BP stiffness relationships, and regional stiffness parameters. Conclusion. OB associates with BP-dependent and age-related increase in carotid and femoral (but not brachial) stiffness. Stiffness changes would not be explained by intrinsic arterial wall alterations but could be associated with the higher BP levels observed in obese children. PMID:27066273

  13. Cerebral hemodynamic changes and electroencephalography during carotid endarterectomy

    SciTech Connect

    Algotsson, L.; Messeter, K.; Rehncrona, S.; Skeidsvoll, H.; Ryding, E. )

    1990-05-01

    Some patients undergoing endarterectomy for occlusive carotid artery disease run a risk of brain ischemia during cross-clamping of the artery. The present study of 15 patients was undertaken to evaluate changes in cerebral blood flow (CBF), as measured with an intravenous (IV) tracer (133Xenon) technique, and to relate CBF changes to changes in the electroencephalogram (EEG). CBF was measured before and after induction of anesthesia, during cross-clamping of the carotid artery, after release of the clamps, and at 24 hours after the operation. All the patients were anesthetized with methohexitone, fentanyl, and nitrous oxide and oxygen. EEG was continuously recorded during the operation. Carotid artery shunts were not used. In 8 patients, cross-clamping of the carotid artery did not influence the EEG. In this group of patients, induction of anesthesia caused a 38% decrease in CBF, which presumably reflects the normal reaction to the anesthetic agent given. There were no further changes in CBF during cross-clamping. In 7 patients, the EEG showed signs of deterioration during the intraoperative vascular occlusion. In these patients, anesthesia did not cause any CBF change, whereas cross-clamping the artery induced a 33% decrease in CBF. In individual patients, the severity of EEG changes correlated with the decrease in CBF. The absence of a change in CBF by anesthesia and a decrease due to cross-clamping of the carotid artery may be explained by the presence of a more advanced cerebrovascular disease and an insufficiency to maintain CBF during cross-clamping.

  14. METABOLIC SYNDROME INCREASES CAROTID ARTERY STIFFNESS: THE NORTHERN MANHATTAN STUDY

    PubMed Central

    Della-Morte, David; Gardener, Hannah; Denaro, Federica; Boden-Albala, Bernadette; Elkind, Mitchell S.V.; Paik, Myunghee C.; Sacco, Ralph L.; Rundek, Tatjana

    2010-01-01

    Background Arterial Stiffness, an intermediate pre-clinical marker of atherosclerosis, has been associated with an increased risk of stroke and cardiovascular disease (CVD). The metabolic syndrome and its components are established CVD risk factors and may also increase arterial stiffness, but data on this potential relationship is limited. The goal of this study was to determine the association between the metabolic syndrome (MetSyn) and carotid artery stiffness (STIFF) in an elderly multi-ethnic cohort. Methods STIFF was assessed by carotid ultrasound as part of the Northern Manhattan Study (NOMAS), a prospective population-based cohort of stroke-free individuals. STIFF was calculated as [ln(systolicBP/diastolicBP)/Strain], where Strain was [(Systolic Diameter Diastolic Diameter)/Diastolic Diameter]. MetSyn was defined by the National Cholesterol Education Program: Adult Treatment Panel III (NCEP ATP III) criteria. LogSTIFF was analyzed as the dependent variable in linear regression models, adjusting for demographics, education, current smoking, presence of carotid plaque and intima-media thickness. Results STIFF was analyzed in 1133 NOMAS subjects (mean age 65±9 years; 61% women; 58% Hispanic, 22% Black, 20% White). The prevalence of MetSyn was 49%. The mean LogSTIFF was 2.01±0.61 among those with and 1.90±0.59 among those without MetSyn (p=0.003). MetSyn was significantly associated with increased logSTIFF in the final adjusted model (parameter estimate β=0.100, p=0.01). Among individual MetSyn components, waist circumference and elevated blood pressure were most significantly associated with a mean increase in logSTIFF (p<0.01). Conclusion MetSyn is significantly associated with increased carotid artery stiffness in a multiethnic population. Increased carotid artery stiffness may, in part, explain a high risk of stroke among individuals with the metabolic syndrome. PMID:20536608

  15. Genetic Polymorphisms Influence Cognition in Patients Undergoing Carotid Interventions.

    PubMed

    Hitchner, Elizabeth; Morrison, Doug; Liao, Phoebe; Rosen, Allyson; Zhou, Wei

    2016-09-01

    While carotid interventions help decrease the risk of stroke, nearly 40% of patients experience cognitive deterioration. Genetic polymorphism in apolipoprotein E (ApoE) and brain-derived neurotrophic factor (BDNF) have been implicated in cognitive impairment; however, it is unclear whether they may influence cognitive changes in patients undergoing carotid intervention. In this study, we seek to assess the role of genetic polymorphisms in carotid intervention-related cognitive change. Polymorphisms related to cognitive function were chosen for this preliminary analysis. Over 2 years, patients undergoing carotid interventions were prospectively recruited. Patients underwent neuropsychological testing 2 weeks prior to and at 1 month following their procedure. Saliva samples were collected for genetic analysis. Logistic regressions were used to identify associations between polymorphisms and cognitive measures. A total of 91 patients were included; all were male with an average age of 70 years. The majority of patients exhibited hypertension (95%) and a history of smoking (81%). Presence of ApoE 4 allele was associated with depression (p= 0.047). After correcting for age and genetic polymorphisms in BDNF and serotonin transporter (5-HTT), ApoE 4 allele was associated with depression (p= 0.044) and showed a trend with baseline cognitive impairment (p= 0.10). Age ≥ 70 years was associated with baseline cognitive impairment after adjusting for the three genetic polymorphisms (p= 0.03). Patients with ApoE 4 and BDNF A polymorphisms performed less well on the visual and verbal memory measures, respectively. Polymorphisms in ApoE and BDNF may provide insight on cognition in patients undergoing carotid interventions; however, the mechanism of this relationship remains unclear. PMID:27574384

  16. Vascular balloon injury and intraluminal administration in rat carotid artery.

    PubMed

    Zhang, Wei; Trebak, Mohamed

    2014-01-01

    The carotid artery balloon injury model in rats has been well established for over two decades. It remains an important method to study the molecular and cellular mechanisms involved in vascular smooth muscle dedifferentiation, neointima formation and vascular remodeling. Male Sprague-Dawley rats are the most frequently employed animals for this model. Female rats are not preferred as female hormones are protective against vascular diseases and thus introduce a variation into this procedure. The left carotid is typically injured with the right carotid serving as a negative control. Left carotid injury is caused by the inflated balloon that denudes the endothelium and distends the vessel wall. Following injury, potential therapeutic strategies such as the use of pharmacological compounds and either gene or shRNA transfer can be evaluated. Typically for gene or shRNA transfer, the injured section of the vessel lumen is locally transduced for 30 min with viral particles encoding either a protein or shRNA for delivery and expression in the injured vessel wall. Neointimal thickening representing proliferative vascular smooth muscle cells usually peaks at 2 weeks after injury. Vessels are mostly harvested at this time point for cellular and molecular analysis of cell signaling pathways as well as gene and protein expression. Vessels can also be harvested at earlier time points to determine the onset of expression and/or activation of a specific protein or pathway, depending on the experimental aims intended. Vessels can be characterized and evaluated using histological staining, immunohistochemistry, protein/mRNA assays, and activity assays. The intact right carotid artery from the same animal is an ideal internal control. Injury-induced changes in molecular and cellular parameters can be evaluated by comparing the injured artery to the internal right control artery. Likewise, therapeutic modalities can be evaluated by comparing the injured and treated artery to the

  17. Comparative analysis of the biaxial mechanical behavior of carotid wall tissue and biological and synthetic materials used for carotid patch angioplasty.

    PubMed

    Kamenskiy, Alexey V; Pipinos, Iraklis I; MacTaggart, Jason N; Kazmi, Syed A Jaffar; Dzenis, Yuris A

    2011-11-01

    Patch angioplasty is the most common technique used for the performance of carotid endarterectomy. A large number of patching materials are available for use while new materials are being continuously developed. Surprisingly little is known about the mechanical properties of these materials and how these properties compare with those of the carotid artery wall. Mismatch of the mechanical properties can produce mechanical and hemodynamic effects that may compromise the long-term patency of the endarterectomized arterial segment. The aim of this paper was to systematically evaluate and compare the biaxial mechanical behavior of the most commonly used patching materials. We compared PTFE (n  =  1), Dacron (n  =  2), bovine pericardium (n  =  10), autogenous greater saphenous vein (n  =  10), and autogenous external jugular vein (n  =  9) with the wall of the common carotid artery (n  =  18). All patching materials were found to be significantly stiffer than the carotid wall in both the longitudinal and circumferential directions. Synthetic patches demonstrated the most mismatch in stiffness values and vein patches the least mismatch in stiffness values compared to those of the native carotid artery. All biological materials, including the carotid artery, demonstrated substantial nonlinearity, anisotropy, and variability; however, the behavior of biological and biologically-derived patches was both qualitatively and quantitatively different from the behavior of the carotid wall. The majority of carotid arteries tested were stiffer in the circumferential direction, while the opposite anisotropy was observed for all types of vein patches and bovine pericardium. The rates of increase in the nonlinear stiffness over the physiological stress range were also different for the carotid and patching materials. Several carotid wall samples exhibited reverse anisotropy compared to the average behavior of the carotid tissue. A similar characteristic was

  18. Emergent surgical embolectomy for middle cerebral artery occlusion due to carotid plaque rupture followed by elective carotid endarterectomy.

    PubMed

    Kiyofuji, Satoshi; Inoue, Tomohiro; Hasegawa, Hirotaka; Tamura, Akira; Saito, Isamu

    2014-09-01

    Embolic intracranial large artery occlusion with severe neurological deficit is associated with an extremely poor prognosis. The safest and most effective treatment strategy has not yet been determined when such emboli are associated with unstable proximal carotid plaque. The authors performed emergent surgical embolectomy for left middle cerebral artery (MCA) occlusion, and the patient experienced marked neurological recovery without focal deficit and regained premorbid activity. Postoperative investigation revealed "vulnerable plaque" of the left internal carotid artery without apparent evidence of cardiac embolism, such as would be seen with atrial fibrillation. Specimens from subsequent elective carotid endarterectomy (CEA) showed ruptured vulnerable plaque that was histologically consistent as a source of the intracranial embolic specimen. Surgical embolectomy for MCA occlusion due to carotid plaque rupture followed by CEA could be a safer and more effective alternative to endovascular treatment from the standpoint of obviating the risk of secondary embolism that could otherwise occur as a result of the manipulation of devices through an extremely unstable portion of plaque. Further, this strategy is associated with a high probability of complete recanalization with direct removal of hard and large, though fragile, emboli. PMID:24905562

  19. Metallic foreign body in the sphenoid sinus after ballistic injury: a case report.

    PubMed

    Akhaddar, A; Abouchadi, A; Jidal, M; Gazzaz, M; Elmostarchid, B; Naama, O; Rzin, A; Boucetta, M

    2008-05-01

    Paranasal sinus injuries by foreign bodies have a lower incidence compared with facial injuries. Among them, penetrating maxillofacial injuries to the sphenoid sinus and skull base remain rare. We report the case of a 41-year-old man who presented with, after a missile-related maxillofacial injury, a metallic foreign body enclosed within the sphenoid sinus with carotid-canal fracture. Angiographic evaluation showed a mass in the right internal carotid artery. The foreign object was successfully extracted through a transmaxillary sublabial approach with a good outcome. We discuss the extensive preoperative evaluation and interdisciplinary management of this unusual injury. PMID:17628677

  20. Reductions in carotid chemoreceptor activity with low-dose dopamine improves baroreflex control of heart rate during hypoxia in humans.

    PubMed

    Mozer, Michael T; Holbein, Walter W; Joyner, Michael J; Curry, Timothy B; Limberg, Jacqueline K

    2016-07-01

    The purpose of the present investigation was to examine the contribution of the carotid body chemoreceptors to changes in baroreflex control of heart rate with exposure to hypoxia. We hypothesized spontaneous cardiac baroreflex sensitivity (scBRS) would be reduced with hypoxia and this effect would be blunted when carotid chemoreceptor activity was reduced with low-dose dopamine. Fifteen healthy adults (11 M/4 F) completed two visits randomized to intravenous dopamine or placebo (saline). On each visit, subjects were exposed to 5-min normoxia (~99% SpO2), followed by 5-min hypoxia (~84% SpO2). Blood pressure (intra-arterial catheter) and heart rate (ECG) were measured continuously and scBRS was assessed by spectrum and sequence methodologies. scBRS was reduced with hypoxia (P < 0.01). Using the spectrum analysis approach, the fall in scBRS with hypoxia was attenuated with infusion of low-dose dopamine (P < 0.01). The decrease in baroreflex sensitivity to rising pressures (scBRS "up-up") was also attenuated with low-dose dopamine (P < 0.05). However, dopamine did not attenuate the decrease in baroreflex sensitivity to falling pressures (scBRS "down-down"; P > 0.05). Present findings are consistent with a reduction in scBRS with systemic hypoxia. Furthermore, we show this effect is partially mediated by the carotid body chemoreceptors, given the fall in scBRS is attenuated when activity of the chemoreceptors is reduced with low-dose dopamine. However, the improvement in scBRS with dopamine appears to be specific to rising blood pressures. These results may have important implications for impairments in baroreflex function common in disease states of acute and/or chronic hypoxemia, as well as the experimental use of dopamine to assess such changes. PMID:27418545

  1. The association of central retinal artery occlusion and extracranial carotid artery disease.

    PubMed Central

    Douglas, D J; Schuler, J J; Buchbinder, D; Dillon, B C; Flanigan, D P

    1988-01-01

    To determine the incidence of associated carotid artery disease and the effect of carotid endarterectomy on subsequent neurologic sequelae, a retrospective study of 66 patients with central retinal artery occlusion (CRAO) was undertaken. Ipsilateral extracranial carotid artery disease was present in 23 of 33 patients (70%) who had carotid arteriography. Sixteen patients had carotid endarterectomy following their CRAO (Group I) and 50 did not (Group II). Seven of the 40 patients available for follow-up in Group II had a subsequent stroke (mean follow-up: 54 months). Of the seven Group II patients shown to have associated carotid disease (Group IIs), three (43%) had a subsequent stroke during follow-up (mean: 28.3 months) compared to zero in Group I (p = 0.033; mean follow-up: 18.7 months). Because of the strong association between CRAO and ipsilateral carotid artery disease and because of the significantly higher incidence of subsequent ipsilateral stroke in CRAO patients with carotid disease who did not undergo endarterectomy, thorough evaluation of the carotid arteries followed by carotid endarterectomy, if indicated, is warranted in CRAO patients who have no other obvious etiology for the occlusion. PMID:3389947

  2. Risk Factors For Stroke, Myocardial Infarction, or Death Following Carotid Endarterectomy: Results From the International Carotid Stenting Study

    PubMed Central

    Doig, D.; Turner, E.L.; Dobson, J.; Featherstone, R.L.; de Borst, G.J.; Stansby, G.; Beard, J.D.; Engelter, S.T.; Richards, T.; Brown, M.M.

    2015-01-01

    Objectives Carotid endarterectomy (CEA) is standard treatment for symptomatic carotid artery stenosis but carries a risk of stroke, myocardial infarction (MI), or death. This study investigated risk factors for these procedural complications occurring within 30 days of endarterectomy in the International Carotid Stenting Study (ICSS). Methods Patients with recently symptomatic carotid stenosis >50% were randomly allocated to endarterectomy or stenting. Analysis is reported of patients in ICSS assigned to endarterectomy and limited to those in whom CEA was initiated. The occurrence of stroke, MI, or death within 30 days of the procedure was reported by investigators and adjudicated. Demographic and technical risk factors for these complications were analysed sequentially in a binomial regression analysis and subsequently in a multivariable model. Results Eight-hundred and twenty-one patients were included in the analysis. The risk of stroke, MI, or death within 30 days of CEA was 4.0%. The risk was higher in female patients (risk ratio [RR] 1.98, 95% CI 1.02–3.87, p = .05) and with increasing baseline diastolic blood pressure (dBP) (RR 1.30 per +10 mmHg, 95% CI 1.02–1.66, p = .04). Mean baseline dBP, obtained at the time of randomization in the trial, was 78 mmHg (SD 13 mmHg). In a multivariable model, only dBP remained a significant predictor. The risk was not related to the type of surgical reconstruction, anaesthetic technique, or perioperative medication regimen. Patients undergoing CEA stayed a median of 4 days before discharge, and 21.2% of events occurred on or after the day of discharge. Conclusions Increasing diastolic blood pressure was the only independent risk factor for stroke, MI, or death following CEA. Cautious attention to blood pressure control following symptoms attributable to carotid stenosis could reduce the risks associated with subsequent CEA. PMID:26460291

  3. Body Hair

    MedlinePlus

    ... girlshealth.gov/ Home Body Puberty Body hair Body hair Even before you get your first period , you ... removing pubic hair Ways to get rid of hair top Removing body hair can cause skin irritation, ...

  4. Habitual fish intake and clinically silent carotid atherosclerosis

    PubMed Central

    2014-01-01

    Background Fish consumption is recommended as part of a healthy diet. However, there is a paucity of data concerning the relation between fish consumption and carotid atherosclerosis. We investigated the association between habitual fish consumption and asymptomatic carotid atherosclerosis, defined as the presence of plaques and/or increased intima-media thickness (≥ 0.90 mm), in non-diabetic participants. Methods Nine hundred-sixty-one (range of age: 18–89 yrs; 37.1% males) adult participants without clinically known atherosclerotic disease were randomly recruited among the customers of a shopping mall in Palermo, Italy, and cross-sectionally investigated. Each participant answered a food frequency questionnaire and underwent high-resolution ultrasonographic evaluation of both carotid arteries. Routine laboratory blood measurements were obtained in a subsample of 507 participants. Results Based on habitual fish consumption, participants were divided into three groups: non-consumers or consumers of less than 1 serving a week (24.0%), consumers of 1 serving a week (38.8%), and consumers of ≥ 2 servings a week (37.2%). Age-adjusted prevalence of carotid atherosclerosis (presence of plaques or intima media thickness ≥ 0.9 mm) was higher in the low fish consumption group (13.3%, 12.1% and 6.6%, respectively; P = 0.003). Multivariate analysis evidenced that carotid atherosclerosis was significantly associated with age (OR = 1.12; 95% CI = 1.09-1.14), hypertension on pharmacologic treatment (OR = 1.81; 95% CI = 1.16-2.82), and pulse pressure (OR = 1.03; 95% CI = 1.01-1.04), while consuming ≥2 servings of fish weekly was protective compared with the condition of consumption of <1 serving of fish weekly (OR = 0.46; 95% CI = 0.26-0.80). Conclusions High habitual fish consumption seems to be associated with less carotid atherosclerosis, though adequate interventional trials are necessary to confirm the role of fish

  5. Carotid Intima-media thickness in childhood and adolescent obesity relations to abdominal obesity, high triglyceride level and insulin resistance

    PubMed Central

    Fang, Jie; Zhang, Jian Ping; Luo, Cai Xia; Yu, Xiao Mei; Lv, Lan Qiu

    2010-01-01

    Aim: To investigate risk factors which impact on common carotid artery intima media thickness (IMT). Methods: A total of 86 obese children and adolescents and 22 healthy children and adolescents with normal weight were enrolled. Moreover, 23 of 86 obese children and adolescents were diagnosed with metabolic syndrome (MetS). The clinical, biochemical data and the IMT of the common carotid artery were measured in all subjects. Results: Obese and obese with MetS subjects demonstrated a significantly (p < 0.01) thicker intima media (0.69mm, 0.66mm) as compared to the control group (0.38mm), but there was no significant difference of IMT between obese and MetS group. IMT was correlated to body weight, body mass index, waist circumference, waist to hip ratio, systolic blood pressure, diastolic blood pressure, fasting insulin, homoeostasis model assessment-insulin resistance, triglyceride, high-density lipoprotein- cholesterol, low-density lipoprotein-cholesterol, alanine aminotransferase, aspartate aminotransferase and fatty liver. Waist circumference, waist to hip ratio, triglyceride and homoeostasis model assessment-insulin resistance were independent determinants of mean IMT level. Conclusion: Obesity especially abdominal obesity, high TG and insulin resistance may be the main risk predictors of increased IMT. PMID:20827427

  6. Cavernous carotid artery pseudo-aneurysm treated by stenting in acromegalic patient.

    PubMed

    de Souza, Jorge Marcondes; Domingues, Flavio S; Espinosa, Gaudencio; Gadelha, Monica

    2003-06-01

    We report on a case of endovascular management of pseudoaneurysm of the cavernous segment of the internal carotid artery with covered stent reconstruction. A 36 years-old woman with a history of previous transsphenoidal approach for pituitary macroadenoma and false aneurysma formation was studied in a protocol that included balloon test occlusion and cerebral blood flow evaluation. An endovascular covered stent deployment in the area of the carotid laceration was performed with isolation of the aneurysm from the circulation and maintenance of the carotid flow. Helical angio-CT and cerebral digital subtraction angiography showed the carotid preservation without stenosis in the stented area. In conclusion, endovascular stent reconstruction for post-transsphenoidal carotid artery laceration and false aneurysm is demonstrated as useful technical adjunct in the management strategy and with the potential for carotid sacrifice morbidity avoidance. PMID:12894285

  7. Interobserver agreement on the diagnosis of carotid artery calcifications on panoramic radiographs

    PubMed Central

    Yoon, Suk-Ja; Shim, Sung-Kyun; Kang, Byung-Cheol; Lim, Hoi-Jeong; Kim, Min-Seok; Kim, Sun-Hun

    2014-01-01

    Purpose This study was performed to investigate the interobserver agreement on the detection of carotid artery calcifications on panoramic radiographs. Materials and Methods This study consisted of panoramic radiographs acquired from 634 male patients of the age of 50 years or older. Having excluded carotids of no diagnostic quality, 1008 carotids from the panoramic radiographs of the patients were interpreted by two oral and maxillofacial radiologists independently for the presence of carotid artery calcifications. Statistical analysis was used to calculate the interobserver agreement. Results Interobserver agreement was obtained for 932 carotids (92.4%). Inconsistent interpretation of 76 carotids (7.5%) between the two observers was found. Cohen's kappa value was 0.688 (p<0.001). Conclusion The probability of a match between the two observers was substantially high. PMID:24944963

  8. GliSODin, a vegetal sod with gliadin, as preventative agent vs. atherosclerosis, as confirmed with carotid ultrasound-B imaging.

    PubMed

    Cloarec, M; Caillard, P; Provost, J C; Dever, J M; Elbeze, Y; Zamaria, N

    2007-02-01

    Prevention of cardiovascular disease should target high-risk subjects based on genetic/familial factors, blood chemistry, blood pressure, body mass index (BMI), and a history of/or current cigarette smoking. We selected active adults (n=76) aged 30-60 and investigated these risk factors, in order to recommend preventive measures. Another interesting variable is the preclinical status or atheroma of the arterial (carotid) wall or lumen. We also investigated the presence of oxidative stress in, and the anti-oxidant status of these subjects. We studied the anti-oxidative efficacy of superoxide dismutase (SOD) and variations of malondialdehyde (MDA). Supplementation with GliSODin, a vegetal SOD associated with gliadin, was effective in controlling the thickness of the carotid artery intima and media layers as measured by ultrasonography-B. We could demonstrate the preventive efficacy of GliSODin at a preclinical stage in subjects with risk factors of cardiovascular disease. PMID:17441415

  9. Spontaneous closure of posttraumatic high-flow carotid-cavernous fistula following cerebral angiography.

    PubMed

    Meena, Ugan Singh; Gupta, Pankaj; Shrivastava, Trilochan; Purohit, Devendra

    2016-01-01

    Traumatic carotid-cavernous fistula (TCCF) is a direct communication between cavernous portion of the internal carotid artery (ICA) and cavernous sinus due to tear in ICA. Most of the cases are treated by endovascular embolization. Spontaneous resolution of high-flow TCCFs is extremely rare. We report a case of posttraumatic, direct, high-flow carotid cavernous fistula (Barrow type A) that resolved spontaneously after cerebral angiography. PMID:27057229

  10. Endovascular exclusion of an external carotid artery pseudoaneurysm using a covered stent.

    PubMed

    Riesenman, Paul J; Mendes, Robert R; Mauro, Matthew A; Farber, Mark A

    2007-01-01

    Aneurysmal lesions of the external carotid artery are extremely rare. A case is presented of a 3.8 cm right external carotid artery pseudoaneurysm treated by transluminal exclusion using an endovascular stent-graft. Following stent-graft placement, complete occlusion of the aneurysmal sac and main vessel lumen patency was successfully demonstrated. This report demonstrates the technical feasibility of utilizing stent-grafts to treat aneurysmal lesions involving the external carotid artery. PMID:17497068

  11. Brainstem infarction in a patient with internal carotid dissection and persistent trigeminal artery: a case report

    PubMed Central

    2010-01-01

    Background The primitive trigeminal artery (PTA) is the most commonly described fetal anastomosis between the carotid and vertebrobasilar circulations. Case presentation We report a 42-year-old patient presenting with internal carotid dissection, and imaging features of brainstem infarction. Conclusion Based on the imaging studies we presume occlusive carotid dissection with extensive thrombosis within a persistent trigeminal artery as the cause of this brainstem ischemia. PMID:20598138

  12. Spontaneous closure of posttraumatic high-flow carotid-cavernous fistula following cerebral angiography

    PubMed Central

    Meena, Ugan Singh; Gupta, Pankaj; Shrivastava, Trilochan; Purohit, Devendra

    2016-01-01

    Traumatic carotid-cavernous fistula (TCCF) is a direct communication between cavernous portion of the internal carotid artery (ICA) and cavernous sinus due to tear in ICA. Most of the cases are treated by endovascular embolization. Spontaneous resolution of high-flow TCCFs is extremely rare. We report a case of posttraumatic, direct, high-flow carotid cavernous fistula (Barrow type A) that resolved spontaneously after cerebral angiography. PMID:27057229

  13. Carotid resection and reconstruction associated with treatment of head and neck cancer

    PubMed Central

    Kroeker, Teresa R.

    2011-01-01

    Patients with head and neck cancer may experience carotid artery involvement. We present a series of 10 patients, all with stage IVB disease, who required carotid resection and reconstruction to achieve a complete resection. Nine of the 10 patients had previous radiation treatment to the neck. Six died of distant disease, and three died of other causes with no local or regional recurrences. Carotid resection and reconstruction can be done safely, achieving local and regional control. PMID:22046061

  14. Missed Total Occlusion Due to the Occipital Artery Arising from the Internal Carotid Artery

    SciTech Connect

    Ustunsoz, Bahri Gumus, Burcak; Koksal, Ali; Koroglu, Mert; Akhan, Okan

    2007-02-15

    A 56-year-old man was referred for digital subtraction angiography (DSA) with an ultrasound diagnosis of right proximal internal carotid artery (ICA) stenosis for possible carotid artery stenting. DSA revealed total occlusion of the ICA and an occipital artery arising from the stump and simulating continuation of the ICA. An ascending pharyngeal artery also arose from the same occipital artery. This case is of interest because this is a rare variation besides being a cause of misdiagnosis at carotid ultrasound.

  15. Cataract surgery in a case of carotid cavernous fistula

    PubMed Central

    Nair, Akshay Gopinathan; Praveen, Smita Vittal; Noronha, Veena Olma

    2014-01-01

    A carotid-cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. The ocular manifestations include conjunctival chemosis, proptosis, globe displacement, raised intraocular pressure and optic neuropathy. Although management of CCF in these patients is necessary, the ophthalmologist may also have to treat other ocular morbidities such as cataract. Cataract surgery in patients with CCF may be associated with many possible complications, including suprachoroidal hemorrhage. We describe cataract extraction surgery in 60-year-old female with bilateral spontaneous low-flow CCF. She underwent phacoemulsification via a clear corneal route under topical anesthesia and had an uneventful postoperative phase and recovered successfully. Given the various possible ocular changes in CCF, one must proceed with an intraocular surgery with caution. In this communication, we wish to describe the surgical precautions and the possible pitfalls in cataract surgery in patients with CCF. PMID:25370401

  16. [Post-traumatic carotid cavernous fistula: report of two cases].

    PubMed

    Pons, Y; Ukkola-Pons, E; Hunkemöller, I; Raynal, M; Lepage, P; Blondet, E; Rigal-Sastourne, J C; Héran, F; Kossowski, M

    2010-01-01

    Carotid cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. The authors reported the clinical presentation and therapeutic procedure of two cases. The physician has to be aware of this diagnosis when a patient is referred for a posttraumatic exophthalmia. The medical behaviour is multidisciplinary (ENT, ophthalmologist, radiologist and neurosurgeon). The imaging of choice is the angiography but angio-MRI and angio-CT can help to confirm the diagnosis. The endovascular embolization is the treatment of choice. It presents an acceptable risk of complication and a low risk of failure. In this paper the authors report 2 posttraumatic CCF cases treated with success by endovascular embolization. PMID:21491776

  17. Treatment of Carotid Siphon Aneurysms with a Microcell Stent

    PubMed Central

    Leonardi, M.; Dall’Olio, M.; Princiotta, C.; Simonetti, L.

    2008-01-01

    Summary The treatment of giant, large, multiple or wide-necked carotid siphon aneurysms has always represented a challenge for neurosurgeons and neuroradiologists. Very recently the use of stents with tiny holes has been proposed by two companies: Balt Silk Stent in Europe and Pi-peline in America. We have used the Silk stent on a few patients and describe our first case who now has an eleven month follow-up. The carotid siphon presented three converging aneurysms sharing a very large common neck. The Silk stent (Balt Extrusion, Montmorency, France) was deployed through a 4F Balt introducer. The procedure was uneventful and very quick. As soon as the stent was positioned contrast medium stagnation was displayed within the aneur-ysm. The patient’s post-operative course was normal and she was discharged three days later in good health. PMID:20557742

  18. Internal carotid pseudo-occlusion: early and late results.

    PubMed

    Pulli, R; Frosini, P; Gatti, M; Narcetti, S; Bernacchi, R; Pratesi, C

    1997-02-01

    Internal carotid pseudo-occlusion (ICP) is a pathology of difficult diagnostic evaluation and treatment in the group of extracranial carotid diseases. The authors report the results of 24 ICP(S) surgically treated in the last five years. No perioperative death was reported. The neurological morbility rate was as low as 4% (1/24), which is quite a good results for this high-risk pathology. Clinical and instrumental follow-up was performed (at 1-3-6-12-24 months from surgery). Six early asymptomatic thromboses (25%) were observed, and the remaining patients showed patent vessels and no symptoms at all. In conclusion surgical treatment of ICP is often able to prevent cerebral ischaemia, and the high rate of early occlusion should not limit surgical indication. PMID:9128116

  19. CrossFit-related cervical internal carotid artery dissection.

    PubMed

    Lu, Albert; Shen, Peter; Lee, Paul; Dahlin, Brian; Waldau, Ben; Nidecker, Anna E; Nundkumar, Anoop; Bobinski, Matthew

    2015-08-01

    CrossFit is a high-intensity strength and conditioning program that has gained popularity over the past decade. Potential injuries associated with CrossFit training have been suggested in past reports. We report three cases of cervical carotid dissection that are associated with CrossFit workouts. Patient 1 suffered a distal cervical internal carotid artery (ICA) dissection near the skull base and a small infarct in Wernicke's area. He was placed on anticoagulation and on follow-up has near complete recovery. Patient 2 suffered a proximal cervical ICA dissection that led to arterial occlusion and recurrent middle cerebral artery territory infarcts and significant neurological sequelae. Patient 3 had a skull base ICA dissection that led to a partial Horner's syndrome but no cerebral infarct. While direct causality cannot be proven, intense CrossFit workouts may have led to the ICA dissections in these patients. PMID:25917634

  20. Traumatic Carotid Artery Dissection: A Different Entity without Specific Guidelines

    PubMed Central

    Galyfos, George; Filis, Konstantinos; Sigala, Fragiska; Sianou, Argiri

    2016-01-01

    According to literature data, there are no distinct guidelines regarding the proper diagnostic and therapeutic management of traumatic carotid artery dissection (TCAD). Although most of cases evaluated in research studies refer to spontaneous carotid artery dissection, traumatic cases demand special considerations as far as diagnosis and treatment are concerned. Although both types of dissection share some common characteristics, a patient with TCAD usually presents with several concomitant injuries as well as a higher bleeding risk, thus complicating decision making in such patients. Therefore, aim of this review is to present available data regarding epidemiology, clinical presentation, diagnostics and treatment strategy in cases with TCAD in order to produce useful conclusions for everyday clinical practice. PMID:27051653

  1. Vasoconstrictive Responses by the Carotid and Auricular Arteries in goats to Ergot Alkaloid Exposure

    NASA Astrophysics Data System (ADS)

    Aiken, Glen; Flythe, Michael

    2014-11-01

    A fungal endophyte (Neotyphodium coenophialum) infects most plants of ‘Kentucky 31’ tall fescue (Lolium arundinaceum) and produces ergot alkaloids that cause persistent constriction of the vascular system in grazing livestock. Consequently, animals undergoing this toxicosis cannot regulate core body temperature and are vulnerable to heat and cold stresses. An experiment was conducted to determine if the caudal and auricular arteries in goats (Capra aegagrus hircus) vasoconstrict in response to ergot alkaloids. Seven, rumen fistulated goats were fed ad libitum orchardgrass (Dactylis glomeratia) hay and ruminally infused with endophtye-free seed (E-) for a 7-day adjustment period. Two periods followed with E- and endophyte-infected (E+) seed being randomly assigned to the 2 goat groups in period 1 and then switching treatments between groups in period 2. Infused E+ and E- seed were in equal proportions to the hay such that concentrations of ergovaline and ergovalanine were 0.80 µg per g dry matter for the E+ treatment. Cross-sections of both arteries were imaged using Doppler ultrasonography on days 0, 2, 4, 6, 8, and 12 in period 1 and on days 0, 1, 2, 3, 6, 7, and 9 in period 2. Differences from average baseline areas were used to determine presence or absence of alkaloid-induced vasoconstriction. Carotid arteries initiated constriction on imaging day 2 in both periods, and auricular arteries initiated constriction on imaging day 2 in period 1 and on day 6 in period 2. Luminal areas of the carotid arteries in E+ goats were 46% less than baseline areas in both periods after vasoconstriction occurred, whereas auricular arteries in E+ goats were 52% less than baseline areas in period 1 and 38% in period 2. Both arteries in E+ goats in period 1 relaxed relative to baseline areas by imaging day 2 after they were switched to the E- treatment. Results indicated that goats can vasoconstrict when exposed to ergot alkaloids that could disrupt their thermoregulation.

  2. Vasoconstrictive responses by the carotid and auricular arteries in goats to ergot alkaloid exposure1

    PubMed Central

    Aiken, Glen E.; Flythe, Michael D.

    2014-01-01

    A fungal endophyte (Neotyphodium coenophialum) infects most plants of “Kentucky 31” tall fescue (Lolium arundinaceum) and produces ergot alkaloids that cause persistent constriction of the vascular system in grazing livestock. Consequently, animals undergoing this toxicosis cannot regulate core body temperature and are vulnerable to heat and cold stresses. An experiment was conducted to determine if the caudal and auricular arteries in goats (Capra aegagrus hircus) vasoconstrict in response to ergot alkaloids. Seven, rumen fistulated goats were fed ad libitum orchardgrass (Dactylis glomeratia) hay and ruminally infused with endophtye-free seed (E−) for a 7-day adjustment period. Two periods followed with E− and endophyte-infected (E+) seed being randomly assigned to the 2 goat groups in period 1 and then switching treatments between groups in period 2. Infused E+ and E− seed were in equal proportions to the hay such that concentrations of ergovaline and ergovalanine were 0.80 μg per g dry matter for the E+ treatment. Cross-sections of both arteries were imaged using Doppler ultrasonography on days 0, 2, 4, 6, 8, and 12 in period 1 and on days 0, 1, 2, 3, 6, 7, and 9 in period 2. Differences from average baseline areas were used to determine presence or absence of alkaloid-induced vasoconstriction. Carotid arteries initiated constriction on imaging day 2 in both periods, and auricular arteries initiated constriction on imaging day 2 in period 1 and on day 6 in period 2. Luminal areas of the carotid arteries in E+ goats were 46% less than baseline areas in both periods after vasoconstriction occurred, whereas auricular arteries in E+ goats were 52% less than baseline areas in period 1 and 38% in period 2. Both arteries in E+ goats in period 1 relaxed relative to baseline areas by imaging day 2 after they were switched to the E− treatment. Results indicated that goats can vasoconstrict when exposed to ergot alkaloids that could disrupt their

  3. Anesthetic Management During Emergency Surgical Ligation for Carotid Blowout Syndrome.

    PubMed

    Klein Nulent, Casper G A; de Graaff, Henri J D; Ketelaars, Rein; Sewnaik, Aniel; Maissan, Iscander M

    2016-08-15

    A 44-year-old man presented to our emergency department with a pharyngeal hemorrhage, 6 weeks after a total laryngectomy and extensive neck dissection. Immediate surgical intervention was necessary to stop massive arterial hemorrhage from the pharynx. The head and neck surgeon successfully ligated the common carotid artery during this procedure. We describe the anesthetic strategy and the thromboelastometry (ROTEM®)-guided massive transfusion protocol. PMID:27310900

  4. [Ectopic internal carotid artery of the oropharynx: two cases report].

    PubMed

    Xie, Sanlin; Chen, Shiyan; Chen, Xianming

    2016-02-01

    Ectopic internal carotid artery (ICA) is a very rare congenital variation. Unless the diagnosis is made before neck or tonsil surgery, massive hemorrhage and even death may result from injury to the vessel. Therefore, knowledge of the presence of ectopic ICAs may be important. We report two cases suffering from dysphagia associated with ectopic ICA manifesting itself as a pulsative protruding of the right lateral wall of the oropharynx. PMID:27373046

  5. Morphological variation of carotid artery bifurcation level in digital angiography.

    PubMed

    Kurkcuoglu, A; Aytekin, C; Oktem, H; Pelin, C

    2015-01-01

    Knowing of the level of carotid artery bifurcation (CB) is important for vascular surgery in the neck, radical neck dissections, carotid sinus baroreceptor stimulation, catheterisations, and aneurysms. The aim of this study was to determine the CB level in relation with the cervical vertebral levels, compare them on the right and the left sides, and investigate the relation of CB level with the length of neck. In this study, 100 conventional carotid angiographies were performed. The CB level was determined in relation with 10 different levels which were the levels of the cervical vertebrae and intervertebral disks, and the relation of CB level with the length of neck was investigated. The right and left CB levels of the patients were also determined, and compared. The highest level of CB was at the level of C2 vertebra, and the lowest level of CB was at the level of C6-C7 intervertebral disk in both male and female. When all patients were taken into consideration, CB level was most frequently seen at the level of C4-C5 (29%) on the right side, and at the level of C4 (26%) on the left side. The CB levels were not symmetrical in 10 female and 23 male. Knowing of the anatomical variations of CB level is important in surgical procedures. The anatomical differences must be taken into consideration since the neighbouring structures of CB change in case of variations. We believe that the results of this study will shed light to planning of all interventional methods concerning common carotid artery and its branches as well as surgery in the neck, and will help to minimise the complications. PMID:26050808

  6. Identification of Atherosclerotic Plaques in Carotid Artery by Fluorescence Spectroscopy

    NASA Astrophysics Data System (ADS)

    Rocha, Rick; Villaverde, Antonio Balbin; Silveira, Landulfo; Costa, Maricília Silva; Alves, Leandro Procópio; Pasqualucci, Carlos Augusto; Brugnera, Aldo

    2008-04-01

    The aim of this work was to identify the presence of atherosclerotic plaques in carotid artery using the Fluorescence Spectroscopy. The most important pathogeny in the cardiovascular disorders is the atherosclerosis, which may affect even younger individuals. With approximately 1.2 million heart attacks and 750,000 strokes afflicting an aging American population each year, cardiovascular disease remains the number one cause of death. Carotid artery samples were obtained from the Autopsy Service at the University of São Paulo (São Paulo, SP, Brazil) taken from cadavers. After a histopathological analysis the 60 carotid artery samples were divided into two groups: normal (26) and atherosclerotic plaques (34). Samples were irradiated with the wavelength of 488 nm from an Argon laser. A 600 μm core optical fiber, coupled to the Argon laser, was used for excitation of the sample, whereas another 600 optical fiber, coupled to the spectrograph entrance slit, was used for collecting the fluorescence from the sample. Measurements were taken at different points on each sample and then averaged. Fluorescence spectra showed a single broad line centered at 549 nm. The fluorescence intensity for each sample was calculated by subtracting the intensity at the peak (550 nm) and at the bottom (510 nm) and then data were statistically analyzed, looking for differences between both groups of samples. ANOVA statistical test showed a significant difference (p<0,05) between both types of tissues, with regard to the fluorescence peak intensities. Our results indicate that this technique could be used to detect the presence of the atherosclerotic in carotid tissue.

  7. Carotid Artery Stenting: Single-Center Experience Over 11 Years

    SciTech Connect

    Nolz, Richard Schernthaner, Ruediger Egbert; Cejna, Manfred; Schernthaner, Melanie Lammer, Johannes Schoder, Maria

    2010-04-15

    This article reports the results of carotid artery stenting during an 11-year period. Data from 168 carotid artery stenting procedures (symptomatic, n = 55; asymptomatic, n = 101; symptoms not accessible, n = 12) were retrospectively collected. Primary technical success rate, neurological events in-hospital, access-site complications, and contrast-induced nephropathy (n = 118) were evaluated. To evaluate the influence of experience in carotid artery stenting on intraprocedural neurologic complications, patients were divided into two groups. Group 1 included the first 80 treated patients, and group 2 the remainder of the patients (n = 88). In-stent restenoses at last-follow-up examinations (n = 89) were assessed. The overall primary technical success rate was 95.8%. The in-hospital stroke-death rate was 3.0% (n = 5; symptomatic, 5.4%; asymptomatic, 2.0%; p = 0.346). Neurologic complications were markedly higher in group 1 (4.2%; three major strokes; symptomatic, 2.8%, asymptomatic, 1.4%) compared to group 2 (2.4%; one major and one minor stroke-symptomatic, 1.2%, asymptomatic 1.2%), but this was not statistically significant. Further complications were access-site complications in 12 (7.1%), with surgical revision required in 1 (0.6%) and mild contrast-induced nephropathy in 1 (0.85%). Twenty-one (23.6%) patients had >50% in-stent restenosis during a mean follow-up of 28.2 months. In conclusion, advanced experience in carotid artery stenting leads to an acceptable periprocedural stroke-death rate. In-stent restenosis could be a critical factor during the follow-up course.

  8. [Neurology and carotid artery interventions. What has to be done first?].

    PubMed

    Reiff, T; Ringleb, P A

    2013-11-01

    Optimum therapy for patients with carotid stenosis requires the interdisciplinary cooperation of surgeons, neurologists and angiologists. Important diagnostic methods are ultrasound sonography, contrast-enhanced computed tomography, magnetic resonance tomography and digital subtraction angiography. Treatment of carotid artery stenosis depends on whether the stenosis is symptomatic or asymptomatic. The treatment of choice (medical therapy only vs. carotid artery stenting vs. carotid endarterectomy) depends on the characteristics of the stenosis, the presence of cerebral lesions and the general physical condition of the patient. After the intervention continuous monitoring and treatment of vascular risk factors are mandatory. PMID:24170021

  9. Pseudoaneurysm of the Common Carotid Artery in an Infant due to Swallowed Fish Bone

    PubMed Central

    Jean Roger, Moulion Tapouh; Marcus, Fokou; Emmanuel, Fongang; Boniface, Moifo; Alain Georges, Juimo

    2015-01-01

    Carotid artery pseudoaneurysm is a rare condition, particularly in the paediatric population. Only about 30 cases of carotid artery aneurysms in infants have been published until now. This paper reports the case of a giant pseudoaneurysm of the left common carotid artery due to swallowed fish bone by an 8-year-old boy. This pseudoaneurysm was 5.5 cm transverse-diameter and resulted in severe respiratory distress. It was treated by resection and end-to-end anastomosis with satisfactory outcome after one-year follow-up. To the best of our knowledge, this is the largest carotid artery pseudoaneurysm ever described in children. PMID:26783485

  10. Late intracranial haemorrhage and subsequent carotid-cavernous sinus fistula after fracture of the facial bones.

    PubMed

    Chang, Chien-Ming; Cheng, Chi-Sheng

    2013-12-01

    Carotid-cavernous sinus fistula is an arteriovenous fistula between the internal carotid artery and the cavernous sinus, and is usually caused by a traumatic tear or a ruptured aneurysm of the cavernous segment of the internal carotid artery. We describe a rare case of delayed intracranial haemorrhage and carotid-cavernous sinus fistula that presented 3 weeks after fracture of the facial bones. The patient developed orbital apex syndrome including ptosis of upper eyelid, pulsatile exophthalmos, chemosis, loss of ocular motility, monocular blindness on the right, and numbness of the right infraorbital region. After transcatheter intra-arterial embolisation, the ptosis and chemosis improved. PMID:23958350

  11. Pressure Drop in Tortuosity/Kinking of the Internal Carotid Artery: Simulation and Clinical Investigation

    PubMed Central

    Wang, Lijun; Zhao, Feng; Wang, Daming; Hu, Shen; Liu, Jiachun; Zhou, Zhilun; Lu, Jun; Qi, Peng; Song, Shiying

    2016-01-01

    Background. Whether carotid tortuosity/kinking of the internal carotid artery leads to cerebral ischemia remains unclear. There is very little research about the hemodynamic variation induced by carotid tortuosity/kinking in the literature. The objective of this study was to research the blood pressure changes induced by carotid tortuosity/kinking. Methods. We first created a geometric model of carotid tortuosity/kinking. Based on hemodynamic boundary conditions, the hemodynamics of carotid tortuosity and kinking were studied via a finite element simulation. Then, an in vitro system was built to validate the numerical simulation results. The mean arterial pressure changes before and after carotid kinking were measured using pressure sensors in 12 patients with carotid kinking. Results. Numerical simulation revealed that the pressure drops increased with increases in the kinking angles. Clinical tests and in vitro experiments confirmed the numerical simulation results. Conclusions. Carotid kinking leads to blood pressure reduction. In certain conditions, kinking may affect the cerebral blood supply and be associated with cerebral ischemia. PMID:27195283

  12. Treatment of a Traumatic Carotid-Cavernous Fistula with a Covered Stent: Some Considerations

    PubMed Central

    Meijer, F.J.A.; Van Der Vliet, A.M.

    2009-01-01

    Summary This article discusses some considerations concerning covered stent placement in a patient with a traumatic direct carotid-cavernous fistula. Our case supports recent reports in the literature that covered stent placement can be an acceptable alternative when detachable balloon occlusion or coil occlusion of a direct carotid-cavernous fistula fails or cannot be done. Positioning of a covered stent in the internal carotid artery can be technically challenging. No specific covered stents for neurovascular use have been designed or registered. Because of limited experience with covered stent placement in the carotid artery the optimal preventive and therapeutic strategies for thromboembolic complications are not known. PMID:20465898

  13. Carotid endarterectomy. A survey of UK anaesthetic practice.

    PubMed

    Knighton, J D; Stoneham, M D

    2000-05-01

    We conducted a postal questionnaire survey of the members of the Vascular Anasthesia Society of Great Britain and Ireland, asking questions about the provision of anasthesia for carotid endartectomy. Of 215 respondents, 187 were currently providing anasthesia for carotid endarterectomy. The majority of respondents (69%) always use general anasthesia for this operation but 99/215 (46%) had some experience of regional anasthesia for carotid endartectomy. Amongst those currently using regional anasthesia, combined deep and superficial cervical plexus block was the technique used by 71%. Other regional techniques used included local infiltration and superficial block alone. During regional anasthesia, most (66%) anasthetists used cerebral monitoring techniques such as stump pressure or transcranial Doppler as well as keeping the patient awake. However, in a significant proportion of cases (37%) under general anasthesia no cerebral monitoring was used. Reported surgical shunt insertion rates were lower in awake (mean 42%) patients than those receiving general anasthesia (61%). Respondents using regional anasthesia were more likely to feel that their technique was appropriate than those using general anasthesia. PMID:10792144

  14. Carotid Cavernous Fistula Associated with Persistent Trigeminal Artery

    PubMed Central

    Hurst, Robert W.; Howard, Robert S.; Zager, Eric

    1998-01-01

    Carotid-cavernous fistula (CCF) associated with persistent trigeminal artery (PTA) is a rare but important clinical entity. We present a case treated by microcoil embolization with preservation of internal carotid, PTA, and hasilar artery flow following embolization. A 62-year-old female developed pulsatile tinnitus followed by left eye proptosis and diplopia. Examination revealed a cranial nerve VI palsy and an objective bruit over the left orbit. Angiographic evaluation revealed a carotid cavernous fistula originating from a persistent trigeminal artery. Placement of a detachable balloon across the fistula site while preserving the PTA proved impossible, and the fistula was treated with microcoils following placement of a microcatheter across the fistula into the cavernous sinus. Complete closure of the fistula was followed by resolution of the patient's symptoms. Preservation of all major vessels including the PTA was accomplished through the use of coil embolization. Careful evaluation of the angiogram is necessary to identify PTA associated with a CCF. Previous reports have described treatment of CCF with PTA by surgical or balloon ocolusion, some involving sacrifice of the PTA. Examination of the relevant embryology and anatomy reveals, however, that occlusion of the PTA must be approached with caution due to potential supply to the posterior circulation. ImagesFigure 1 PMID:17171071

  15. Vessel Wall Imaging of the Intracranial and Cervical Carotid Arteries.

    PubMed

    Choi, Young Jun; Jung, Seung Chai; Lee, Deok Hee

    2015-09-01

    Vessel wall imaging can depict the morphologies of atherosclerotic plaques, arterial walls, and surrounding structures in the intracranial and cervical carotid arteries beyond the simple luminal changes that can be observed with traditional luminal evaluation. Differentiating vulnerable from stable plaques and characterizing atherosclerotic plaques are vital parts of the early diagnosis, prevention, and treatment of stroke and the neurological adverse effects of atherosclerosis. Various techniques for vessel wall imaging have been developed and introduced to differentiate and analyze atherosclerotic plaques in the cervical carotid artery. High-resolution magnetic resonance imaging (HR-MRI) is the most important and popular vessel wall imaging technique for directly evaluating the vascular wall and intracranial artery disease. Intracranial artery atherosclerosis, dissection, moyamoya disease, vasculitis, and reversible cerebral vasoconstriction syndrome can also be diagnosed and differentiated by using HR-MRI. Here, we review the radiologic features of intracranial artery disease and cervical carotid artery atherosclerosis on HR-MRI and various other vessel wall imaging techniques (e.g., ultrasound, computed tomography, magnetic resonance, and positron emission tomography-computed tomography). PMID:26437991

  16. Increased carotid intima-media thickness in scuba divers

    PubMed Central

    Rezaali, Saeed; Shams-Hosseini, Narges Sadat

    2014-01-01

    Background Scuba divers work in high pressure conditions which may cause some changes in physiological status to adapt to this situation. In this study, the carotid intima-media thickness (CIMT) was assessed in divers as a risk factor of cerebrovascular and cardiovascular disorders. Methods This historical cohort study was performed on 16 male professional scuba divers as case group and 30 healthy people as controls with age range of 26-66 years. CIMT of both carotids of supine participants was measured by a 10 MHz linear ultrasonic probe quantitatively. Relationship between experience of diving and carotid IMT was evaluated. Results All the participants were males (mean age 42.9 ± 10.58. and for the control group was (47.05 ± 12.31 years). The mean right CIMT in divers and control group was 524.31 ± 149.40 and 443.66 ± 59.62 micrometer, respectively. Furthermore, the mean left CIMT in divers and control group was 624.57 ± 116.15 and 458.44 ± 49.56 micrometer, respectively. Conclusion The findings demonstrated that long-term occupational diving leads to increased intima-media thickness in scuba divers. PMID:24800047

  17. Evaluation of Subfoveal Choroidal Thickness in Internal Carotid Artery Stenosis

    PubMed Central

    Akçay, Betül İlkay Sezgin; Kardeş, Esra; Maçin, Sultan; Ünlü, Cihan; Özgürhan, Engin Bilge; Maçin, Aydın; Bozkurt, Tahir Kansu; Ergin, Ahmet; Surmeli, Reyhan

    2016-01-01

    Purpose. To evaluate the relationship between internal carotid artery (ICA) stenosis and subfoveal choroidal thickness (SFCT) in the elderly population. Methods. A total of 42 eyes of 21 patients with more than 70% ICA stenosis (Group 1) on one side and less than 70% stenosis (Group 2) on the other side were recruited for this study. ICA stenosis was diagnosed using both the B-mode and Doppler ultrasound. The two groups were compared in terms of the percentage of stenosis, SFCT measurements, intraocular pressure, ocular perfusion pressure, refractive error, and peak systolic velocity. Eyes were examined with the RTVue-100 OCT device by the EDI-OCT technique. Results. The mean age of the patients was 71.9 ± 10.8 years. The mean percentage of ICA stenosis was 74 ± 4.9% in Group 1 and 47.5 ± 7.7% in Group 2. The mean SFCT was 231.9 ± 44.6 μm in Group 1 and 216.2 ± 46.8 μm in Group 2, which was significantly lower (P = 0.028). A statistically significant positive correlation was found between the percentage of internal carotid artery stenosis and SFCT (r = 0896, P = 0.001). Conclusions. Compensatory SFCT increase can be seen in ipsilateral internal carotid artery stenosis greater than 70%. PMID:26989500

  18. Symptomatic vs. asymptomatic plaque classification in carotid ultrasound.

    PubMed

    Acharya, Rajendra U; Faust, Oliver; Alvin, A P C; Sree, S Vinitha; Molinari, Filippo; Saba, Luca; Nicolaides, Andrew; Suri, Jasjit S

    2012-06-01

    Quantitative characterization of carotid atherosclerosis and classification into symptomatic or asymptomatic type is crucial in both diagnosis and treatment planning. This paper describes a computer-aided diagnosis (CAD) system which analyzes ultrasound images and classifies them into symptomatic and asymptomatic based on the textural features. The proposed CAD system consists of three modules. The first module is preprocessing, which conditions the images for the subsequent feature extraction. The feature extraction stage uses image texture analysis to calculate Standard deviation, Entropy, Symmetry, and Run Percentage. Finally, classification is performed using AdaBoost and Support Vector Machine for automated decision making. For Adaboost, we compared the performance of five distinct configurations (Least Squares, Maximum- Likelihood, Normal Density Discriminant Function, Pocket, and Stumps) of this algorithm. For Support Vector Machine, we compared the performance using five different configurations (linear kernel, polynomial kernel configurations of different orders and radial basis function kernels). SVM with radial basis function kernel for support vector machine presented the best classification result: classification accuracy of 82.4%, sensitivity of 82.9%, and specificity of 82.1%. We feel that texture features coupled with the Support Vector Machine classifier can be used to identify the plaque tissue type. An Integrated Index, called symptomatic asymptomatic carotid index (SACI), is proposed using texture features to discriminate symptomatic and asymptomatic carotid ultrasound images using just one index or number. We hope this SACI can be used as an adjunct tool by the vascular surgeons for daily screening. PMID:21243411

  19. Vessel Wall Imaging of the Intracranial and Cervical Carotid Arteries

    PubMed Central

    Choi, Young Jun; Jung, Seung Chai; Lee, Deok Hee

    2015-01-01

    Vessel wall imaging can depict the morphologies of atherosclerotic plaques, arterial walls, and surrounding structures in the intracranial and cervical carotid arteries beyond the simple luminal changes that can be observed with traditional luminal evaluation. Differentiating vulnerable from stable plaques and characterizing atherosclerotic plaques are vital parts of the early diagnosis, prevention, and treatment of stroke and the neurological adverse effects of atherosclerosis. Various techniques for vessel wall imaging have been developed and introduced to differentiate and analyze atherosclerotic plaques in the cervical carotid artery. High-resolution magnetic resonance imaging (HR-MRI) is the most important and popular vessel wall imaging technique for directly evaluating the vascular wall and intracranial artery disease. Intracranial artery atherosclerosis, dissection, moyamoya disease, vasculitis, and reversible cerebral vasoconstriction syndrome can also be diagnosed and differentiated by using HR-MRI. Here, we review the radiologic features of intracranial artery disease and cervical carotid artery atherosclerosis on HR-MRI and various other vessel wall imaging techniques (e.g., ultrasound, computed tomography, magnetic resonance, and positron emission tomography-computed tomography). PMID:26437991

  20. The role of completion imaging following carotid artery endarterectomy.

    PubMed

    Ricco, Jean-Baptiste; Schneider, Fabrice; Illuminati, Giulio; Samson, Russell H

    2013-05-01

    A variety of completion imaging methods can be used during carotid endarterectomy to recognize technical errors or intrinsic abnormalities such as mural thrombus or platelet aggregation, but none of these methods has achieved wide acceptance, and their ability to improve the outcome of the operation remains a matter of controversy. It is unclear if completion imaging is routinely necessary and which abnormalities require re-exploration. Proponents of routine completion imaging argue that identification of these abnormalities will allow their immediate correction and avoid a perioperative stroke. However, much of the evidence in favor of this argument is incidental, and many experienced vascular surgeons who perform carotid endarterectomy do not use any completion imaging technique and report equally good outcomes using a careful surgical protocol. Furthermore, certain postoperative strokes, including intracerebral hemorrhage and hyperperfusion syndrome, are unrelated to the surgical technique and cannot be prevented by completion imaging. This controversial subject is now open to discussion, and our debaters have been given the task to clarify the evidence to justify their preferred option for completion imaging during carotid endarterectomy. PMID:23601598