Aims:There is still a wide debate regarding the management of patients with chronic coronary syndrome, the choice of optimal non-invasive stress test, and the decision for coronary revascularization. Evidence has accumulated demonstrating the utility of global longitudinal strain (GLS) as a predictor of significant coronary disease. To evaluate the application of speckle tracking during resting echocardiography and after isometric loading with the hand-grip test, and to compare GLS parameters with fractional flow reserve (FFR). Methods and results:Patients with known CCS who underwent angiography with evidence of coronary stenosis >40%<90% and were referred for functional assessment were enrolled in this study. Patients with previous MI, depressed LV systolic function, and poor acoustic window were excluded. Patients underwent a standard echocardiography with recordings suitable for LV speckle tracking. Subsequently, a dynamic hand-grip test was performed for 3 min, then the same images were captured. Global longitudinal strain was calculated at rest (rGLS), under stress conditions (sGLS), as well as the absolute difference between the two measurements - ΔGLS. Then, patients underwent invasive functional assessment with measurement of the FFR of the coronary lesion. Correlation analysis of myocardial strain parameters and FFR was performed. A total of 106 patients were included in the study. The mean rGLS was -18.5 ± 1.8, sGLS: -19.1 ± 2.0 and ΔGLS: 0.62 ± 1.4. In total, 44% of patients had a functionally significant coronary lesion when assessed with FFR. There was a statistically significant correlation between ΔGLS and FFR values, r = 0.660, P < 0.001. ΔGLS of 0.35 showed good diagnostic performance capacity (AUC 0.896, 95% CI: 0.83-0.96, specificity 85%, sensitivity 92%) for a functionally significant coronary lesion. Conclusion:Dynamic GLS during isometric hand-grip exercise is a feasible method for functional assessment in patients with chronic coronary syndrome.
INTRODUCTION: Oncocytic papillary cystadenoma is a rare benign epithelial neoplasm of the salivary glands, infrequently arising in the parotid gland. Its preoperative imaging characteristics are poorly described, and the diagnosis is often established only after surgical excision and histopathologic examination. CASE PRESENTATION: We report two female patients (62 and 77 years old) who presented with parotid masses. Multiparametric MRI demonstrated multiloculated cystic lesions with distinctive features: (1) markedly low signal intensity (“signal void”) on T2-weighted and diffusion-weighted images with corresponding low apparent diffusion coefficient (ADC) values; (2) hyperintense signal on fat-suppressed T1-weighted sequences; and (3) minimal or absent enhancement of cystic components on post-contrast T1-weighted images, with enhancement confined to papillary projections. Facial nerve displacement without invasion was observed. Both patients underwent subtotal conservative parotidectomy with nerve preservation. Histopathologic analysis confirmed oncocytic papillary cystadenoma, and postoperative recovery was uneventful. IMAGING FINDINGS: The combination of T2/DWI signal void, fat-suppressed T1 hyperintensity, and post-contrast “vanishing” appearance is uncommon among parotid tumors and may represent a potential and previously underrecognized imaging feature of oncocytic papillary cystadenoma. CONCLUSION: Multiparametric MRI may reveal a potentially reproducible imaging pattern in oncocytic papillary cystadenoma, which, when interpreted in the appropriate clinical context, may assist in preoperative assessment and support nerve-sparing surgical planning; however, these observations are based on a limited number of cases and require validation in larger series.
The management of ocular hypertension and the various forms of glaucoma during pregnancy and lactation represents a significant clinical challenge. The main concerns are related to the selection of an appropriate therapeutic strategy, with special attention paid to the risks associated with treatment for both the mother and the fetus or breastfed infant. There is no universally accepted management protocol for these patients. Owing to the understandable lack of randomized clinical trials in this population, there is currently no officially approved antiglaucoma medication for use during pregnancy or breastfeeding. Selective laser trabeculoplasty is an excellent option for reducing intraocular pressure during pregnancy and lactation, particularly in view of its favorable safety profile. Two clinical cases of patients with ocular hypertension and elevated intraocular pressure who underwent selective laser trabeculoplasty are presented. A sustained and significant reduction in intraocular pressure was achieved. In both cases, the need for antiglaucoma medication was eliminated throughout the follow-up period.
