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Purpose: To assess the technical and clinical success rates of superior rectal artery embolization in the treatment of symptomatic Grades 2 and 3 hemorrhoidal disease.Materials and Methods: Since March 2019, 43 patients (24 men and 19 women; mean age, 52 years [18-77 years]) with symptomatic hemorrhoidal disease have been treated and completed the 6-month follow-up with anamnestic questionnaire and disease scores, including French bleeding, Goligher prolapse, visual analog scale for pain, and quality of life. Clinical success was assessed at 7 days, 1 month, and 6 months of follow-up by updating the clinical scores. Statistical analysis was performed using SPSS 25.0.Results: In all, 25 patients had Grade 2 prolapse and 18 patients had Grade 3 prolapse, with 96% and 77%, respectively, having bleeding as a symptom. All patients were discharged within 24 hours. The reduction in the French bleeding score (global and single entity) in Grade 3 prolapse was statistically significant (P ¼ .001). Improvement in the quality of life was significant in both groups (P < .05). No serious complications were registered.Conclusions: Hemorrhoidal embolization was a safe and effective technique in the treatment of symptomatic hemorrhoidal disease with minimal hospitalization, pain, and disruption of daily activities. It can be offered to patients unwilling to undergo a surgical procedure but can also be indicated in the emergency setting for patients on anticoagulant therapy or those unfit for surgery. ABBREVIATIONSCI ¼ confidence intervals, FBS ¼ French bleeding score, QoL ¼ quality of life, SRA ¼ superior rectal artery, VAS ¼ visual analog scale
VEBs in young people and athletes are generally benign; however, in some cases, they can be a sign of underlying heart disease and predispose to the risk of SCD during sports. Clinical Case A 14–year–old boy arrives for renewal of competitive sports eligibility. He practices competitive football; always eligible according to previous checks; not familiar with heart disease or SCD; asymptomatic; with normal cardiac objectivity. Basic ECG: RS conduction and repolarisation within normal limits. ECG during exercise: 2 monomorphic VEBs, RBB type with superior axis (Fig. 3). For this reason, he performs TT Echocardiogram and ECG sec. Holter. Holter ECG: 1 SVEB 0 VEB. MB Color Doppler Echocardiogram: LV of normal size and wall thickness with a normal pump function; no alterations of the regional dynamics, undamaged valve systems, RV in the standard; suspected image due to anomaly of coronary origin (right coronary artery from the left sinus of Valsalva). Fig. 1 shows a modified PSAX. In particular, the image highlights the origin of the right coronary and left coronary from the left sinus of Valsalva. The course of the right coronary is parallel to the anterior aortic wall. The cardiac CT confirmed the anomalous origin of the right coronary from the left coronary sinus with a course between the aorta and pulmonary artery. In the proximal section, the right coronary would seem to run for about 12 mm within the adventitia of the aortic wall (Fig. 2) Hence, myocardial scintigraphy was performed on stress testing, given a possible corrective strategy. Discussion Anomalies involving the origin of the coronary arteries and among these, the right coronary artery originating from the left represent one of the leading causes of SCD in athletes under 35 years of age. It is a pathology challenging to diagnose. Indeed, the affected subjects, in most cases, are healthy at the sports doctor visit. Early identification is a priority in the diagnostic classification of a young athlete. In this case, the evidence of extra systolic beats on the exercise stress test and the subsequent ultrasound demonstration of the anatomical anomaly proved significant. The importance of echocardiography in recognizing coronary anomalies in young athletes, as highlighted in our report, should also suggest introducing this method as a screening test for their early identification and, consequently, the prevention of MCI.
Left ventricular isolated hypoplasia is a seldom-described cardiac abnormality. Right ventricular hypoplasia is usually associated with congenital anomalies of the pulmonary or the tricuspid valve, whereas biventricular isolated apical hypoplasia has never been described. We report the case of a 48-year-old man with no history of known cardiac disease who was found to have a complex cardiac abnormality characterized by: 1) Deficiency of the myocardium within the biventricular apex with adipose tissue infiltration; 2) Truncated right ventricle because of an absent trabecular portion of the inflow tract; 3) Truncated and spherical left ventricular apex; 4) Origin of the mitral papillary muscle in the flattened anterior left ventricular apex. Multimodality imaging was performed to delineate the morphological and functional characteristics of this cardiomyopathy fully. To the best of our knowledge, this is the first description of a new cardiac abnormality characterized by the hypoplasia of the apical region of both ventricles in the absence of valvular or coronary artery disease.
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