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Pleuropulmonalni sinovijalni sarkomi rijetki su zloćudni tumori mekog tkiva.1-3 No, metastaza pleuropulmonalnog sinovijalnog sarkoma s valvularnim lezijama, što je bio slučaj s našom bolesnicom, još je rjeđa. Predstavljamo slučaj 42-godišnje bolesnice s metastatskim pleuropulmonarnim sinovijalnim sarkomom koji se proširio u šupljinu lijeve klijetke i prouzročio opstrukciju mitralnog zaliska.

Introduction: Cervicocerebral arterial dissections (CAD) account for nearly 20% of strokes in patients under the age of 45, therefore they are an important cause of stroke in young adults. Most CADs are considered ‘spontaneous’, although pre-existing disorders of the arterial wall and trauma are the main predisposing factors. It is important to recognise and treat this syndrome because of a relatively benign course and potentially excellent outcome in most patients. We describe a case where a definite temporal correlation was present between neck movement, trivial trauma and acute arterial dissection. Case report: We present the case of a 48-year old professional male ballet dancer with a spontaneous right internal carotid artery dissection presented as transient leftsided weakness, right-sided tinnitus and blurry vision in his right eye, following intense jerky head movements during dancing. The initial neurological examination revealed right side Horner syndrome. The initial head CT was negative. He was subsequently admitted to the Stroke unit and referred for a color Doppler flow imaging revealing a subintimal hematoma in the proximal part of the right internal carotid artery and reverse flow in the right ophthalmic artery. Transcranial doppler showed markedly reduced hemodynamic in the right middle cerebral artery. Head MRI revealed multiple acute ischemic lesions (emboli) in right frontal regions, basal ganglia, external capsule and knee of the internal capsule. MR angiography of the head and neck revealed narrowing and stenosis of the right carotid artery, with pathological morfological changes from the bifurcation to the intracranial part of the artery beneath the pyramid, suggestive of dissection. Laboratory findings revealed hyperlipidemia and elevated liver enzymes. The patient was treated with antiplatelet, antihypertensive and hypolipidemic agents, as well as physical therapy. After hospital discharge, a carotid ultrasound follow-up 14 days after through the outpatient clinic revealed the persistence of the subintimal hematoma, but the blood flow through all studied arteries was now physiological. At five-month follow-up, neurological examination was unremarkable except for slight right eyelid ptosis. Carotid color Doppler imaging showed complete resorption of the subintimal hematoma with physiological hemodynamics in all studied arteries. Conclusion: There seems to be an important association between neck movements, minor non-penetrating neck trauma and trivial neck torsion precipitating carotid dissection. Whether `spontaneous' dissections are truly spontaneous or effect of forgotten indirect neck trauma is questionable. A review of the literature shows that in many 'spontaneous' dissections, a history of abnormal neck movement, minor trauma or exercise was present. A history of such subtle precipitating events should be taken while diagnosing young patients with stroke. Sometimes the causal potential trauma antecedates immediately the initial symptoms of dissection and there is a definitive temporal correlation, but sometimes the onset of dissection may precede the clinical symptoms by hours or days and it might loosen the association between the two. Hyperextension of the neck has been considered as an important precipitating factor, particularly in the presence of inherent vessel wall abnormalities. By an early identification and treatment, particularly in high-risk patients, it is possible to reduce the incidence of stroke secondary to carotid dissection. Carotid Doppler ultrasound is a noninvasive, accessible and prompt imaging method and has a central role in the assessment of midcervical carotid artery dissections.

Objective: The aim of this study was to evaluate the relationship between common carotid artery intima-media thickness and risk factors in patients who underwent coronary artery bypass grafting surgery (CABG) based on extent of coronary artery disease. Material and Methods: This study included all patients with coronary artery disease hospitalized in the Department of Cardiology during the period from 2007 to 2014, who underwent CABG. Two groups were formed: patients who underwent CABG of three and more vessels (CABG 3+) and patients who underwent CABG of two or less vessels (CABG 2-). Carotid intima-media thickness (C-IMT) was assessed by carotid ultrasound according to the Mannheim Carotid Intima-Media Thickness Consensus. Results: The study included 66 patients. There were 35 patients in the CABG3+ group and 31 patients in the CABG2- group. We found no statistically significant difference in the mean intima-media thickness of the common carotid artery between these two groups (p= 0.5637), neither between C-IMT and the extent of the coronary artery disease (p=0.82612). The CABG 3+ group had higher incidence of arterial hypertension (p=0.0298) and hyperlipidemia (p=0.0388). No statistically significant difference was found between age, gender, previous ischemic stroke, and smoking between groups. Discussion: Our study did not show statistically significant relationship between common carotid artery (CCA) IMT and the extent of CABG surgery and coronary artery disease. Arterial hypertension and hyperlipidemia are more important risk factors, more commonly present in patients with greater extent of CABG surgery.

Moždani udar je u razvijenim zemljama prvi uzrok invalidnosti i drugi uzrok smrti. Najnovije europske statistike o kardiovaskularnim bolestima navode da od kardiovaskularnih bolesti umire godišnje 4,3 milijuna ljudi u Europi. Nešto manje od polovine smrti uzrokovano je ishemičnom bolesti srca, a oko trećine CVB-om.31 Uzroci moždanog udara su u oko 30% slučajeva emboli koji potječu iz srca, u 25% slučajeva ateroskleroza velikih cerebralnih arterija (85% su zbog karotidne aterosklerotičke bolesti), u oko 20% slučajeva okluzije malih moždanih arterija (lakunarni infarkti), u 20% slučajeva uzroci su višestruki ili neodređeni, a u oko 5% slučajeva radi o neaterosklerotičkim vaskulopatijama, hiperkoagulabilnim stanjima i hematološkim bolestima. Moždani udar je, dakle, vrlo značajan uzrok smrtnosti, a aterosklerotička stenotičko-obliterativna bolest karotidnih arterija je uzrok moždanog infarkta u oko 20-25% bolesnika. Brojne su dijagnostičke metode razvijene za kvalitetno verificiranje karotidne patologije zbog njene velike važnosti u etiologiji moždanog infarkta.32 Doplerski pregled karotidnih arterija je dominantna neinvazivna slikovna metoda u dijagnostici karotidne patologije i u praksi se vrlo često indicira. Ultrazvuk je izvrsna metoda za rano otkrivanje, kvantifikaciju i karakterizaciju aterosklerotičnih promjena. Iako se dopler u početku smatralo metodom samo dijagnostičkog probira (screening) koja treba smanjiti broj nepotrebnih angiografija, danas je to i metoda postoperativnog praćenja uspješnosti samog kirurškog zahvata.4 No, danas na raspolaganju stoje i brojne druge dijagnostičke metode poput CT-angiografije i MR-angiografije kao i digitalne suptrakcijske angiografije, koja se dugo smatrala metodom zlatnog standarda u dijagnostici i stupnjevanju stenoza ACI i drugih promjena. Između ostalog, medikamentno liječenje te kirurški postupci poput karotidne endarterektomije (CEA) i endovaskularnog liječenja (CAS, CBA) su uvelike pridonijeli uspješnosti rješavanja stenotičko obliterativnih promjena karotidnih arterija., In developed countries, stroke is the primary cause of invalidity and the second cause of mortality. The newest European statistics of cardiovascular disease presumes that in one year 4,3 million people will die of cardiovascular disease. Little less of 50% of deaths is caused by ischemic heart disease, and one third of deaths is caused by CVD. Stroke is in 30% of cases caused by emboli emerging from the heart, in 25% of cases by atherosclerosis of large cerebral arteries (85% are due to carotid atherosclerotic disease), in about 20% of cases by occlusions of small cerebral arteries (lacunar infarct), in 20% of cases by multiple or unspecified causes, and in about 5% of cases by vasculopathies, hypercoagulable conditions and hematological diseases. Stroke is, therefore, a very significant cause of mortality, and stenotic-obliterative disease of carotid arteries is the cause of stroke in about 20-25% of patients. Numerous diagnostic methods were developed for efficient verification of carotid pathology due to its great importance in the etiology of stroke. Doppler examination of carotid arteries is a dominant non-invasive imaging method in the diagnosis of carotid pathology and is often indicated in practice. Ultrasound is an excellent method for early discovery, quantification and classification of atherosclerotic changes. Although Doppler was initially considered merely a method of diagnostic screening which was supposed to reduce the number of unnecessary angiographies, today it is a method of post-operative monitoring of success of the very surgical procedure. However, there are also other diagnostic procedures available today, such as CT-angiography, MR-angiography and digital subtraction angiography, which has long been considered a gold standard method for diagnosing and grading ACI stenosis and other changes. In addition to that, pharmacological treatment and surgical procedures like carotid endarterectomy (CEA) and endovascular treatment (CAS-carotid artery stenting, CBA-carotid balloon angioplasty) have substantially contributed to the success rate of treating stenotic-obliterative changes in carotid arteries.