Left ventricular electromechanical mapping in stunned myocardium.
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Biomedical subjects
Publications and source records attributed to S Ehara.
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OBJECTIVE: Pasteurized autogenous bone graft sterilized at a low temperature (60 degrees C) is one option for reconstruction after resection of bone and soft tissue tumors. The purpose of this investigation was to assess the normal and abnormal radiographic and scintigraphic findings of pasteurized intercalary autogenous bone graft after resection of bone and soft tissue sarcomas. DESIGN: This was a retrospective evaluation of the radiography and bone scintigraphy findings in patients after treatment of bone and soft tissue sarcomas using an intercalary pasteurized autogenous bone graft. PATIENTS: Among 10 consecutive patients, eight had intercalary grafts, and they constitute the subjects of this study. All available radiography and bone scintigraphy findings were reviewed for the healing process and the possibility of complications. RESULTS AND CONCLUSIONS: Healing and incorporation of the graft were observed in five patients during the follow-up, but the other three did not heal satisfactorily. Rapid incorporation of pasteurized autogenous bone graft can be demonstrated by means of radiography and bone scintigraphy.
Magnetic resonance (MR) imaging findings of two patients with Stewart-Treves syndrome are presented. MR imaging showed edematous changes in the subcutaneous fat and skin masses that proved to be angiosarcomas. MR signal intensity of the tumor was low compared with fat on T1-weighted images and intermediate and heterogeneous on T2-weighted images. In one patient, administration of intravenous Gd-DTPA showed marked enhancement in the early phase, which persisted until the delayed phase. These finding on dynamic MR imaging may reflect the abundant vascular spaces seen in these tumors.
OBJECTIVE: To investigate the radiological features of the nutrient canal in the fibula. DESIGN AND PATIENTS: One hundred and seventy-nine dried fibulae were studied regarding the type, number, location, and direction of the nutrient canal. They were classified into a usual type (type I: a radiolucent line confined to the cortex) and an atypical type (type II: a radiolucent line extending beyond the cortex). RESULTS: Among the total of 230 nutrient canals seen on radiography, 197 (86%) were type I and 33 (14%) were type II. On CT scans, the ossified rim of the canal extended into the medullary cavity in type II canals. The most common site was the posteromedial aspect in both type I and type II canals. Type II canals were significantly more common in fibulae with two or three nutrient canals. The frequency of the upward direction was more common in type II canals. CONCLUSION: Nutrient canals with extension of the ossified rim into the medullary canal are the cause of linear lucency that may simulate a fracture. Their features are slightly different from those of usual canals.
We describe a case of intracranial chondrosarcoma in a 46-year-old woman. The preoperative diagnosis was meningioma as plain radiography and computed tomography of the head revealed a tumor with discrete calcifications predominantly in the right frontoparietal region and hyperostosis of the inner table of the skull overlying the tumor. However, the tumor was histologically composed of cartilaginous tissue without meningiomatous differentiation and the final diagnosis was a low-grade chondrosarcoma based on its histological appearance and size, together with the radiologic images. Intracranial chondrosarcoma occurring above the skull base is extremely rare and 19 cases were found in our literature review. Intracranial chondrosarcoma showing hyperostosis of the skull has not been reported in the cases. The discussion includes its differential diagnosis, origin, and clinical behavior.
Both right ventricular infarction and complete atrioventricular block were frequently seen in patients with acute inferior myocardial infarction before the introduction of reperfusion therapy (RT). However, the effect of reperfusion therapy on these 2 complications is not well known. To evaluate the effect of reperfusion therapy in them, we retrospectively studied the in-hospital outcome of 103 consecutive patients with acute inferior myocardial infarction within 72 hr after the onset, 23 with right ventricular infarction and 36 with complete atrioventricular block. Patients were divided into 2 groups: RT group (n = 63) in which Thrombolysis in Myocardial Infarction (TIMI) III flow was obtained by reperfusion therapy within 24 hr after the onset, and the non-RT group (n = 40) in which TIMI III flow was not obtained or did not receive reperfusion therapy. Patients with right ventricular infarction in the RT group had a larger proportion of proximal occlusion of the right coronary artery and the absence of preinfarction angina. There were no effects of perfusion on complete atrioventricular block. In 23 patients with right ventricular infarction and 36 patients with complete atrioventricular block, in-hospital stay, duration of using temporary pacing and Swan-Ganz catheter were shorter in the RT group than the non-RT group. Reperfusion therapy does not decrease the incidence of both complications. However, successful reperfusion therapy results in a rapid improvement in hemodynamic instability and atrioventricular conduction injury, and early hospital discharge. Preinfarction angina may be associated with a protective effect against the development of these 2 complications.
PURPOSE: DICOM clients could not access more than one archive simultaneously in the previous PACS systems. We developed a proxy server which makes it possible for clients to query and retrieve images from multivendor DICOM archives simultaneously. METHODS: We used a Web server that supports the DICOM query and retrieve(Q/R) service class as a proxy server. This system consisted of two DICOM servers and six DICOM clients of different vendors in the Radiology Department. Through Web browsers on the clients, requests for Q/R were transmitted to the proxy server by hypertext transfer protocol. The proxy server communicated with DICOM servers by DICOM Q/R Service Class(C-FIND, C-MOVE), and then DICOM servers directly transmitted images to DICOM clients by DICOM Storage Service Class(C-STORE). RESULTS: DICOM clients could transmit Q/R requests to two DICOM servers simultaneously via the proxy server and receive requested images promptly. Confirmation of conformance among the proxy server, DICOM archives, and DICOM clients became much easier than previously. CONCLUSION: A Web server working as a proxy server of the DICOM Q/R Service Class is an effective solution for allowing DICOM clients to communicate with multiple DICOM archives.
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OBJECTIVE: To determine whether there is a relationship between the peritumoral edema caused by osteoid osteoma seen on magnetic resonance (MR) imaging and the patient's age, duration of symptoms, or location of the lesion. DESIGN AND PATIENTS: All histologically proven osteoid osteomas seen in our institutions during a 5-year period in patients with known age, gender, duration of symptoms, and available radiological and MR imaging examinations were included in this study. The extent of the edema in the bone marrow and extraosseous soft tissue around the nidus of osteoid osteoma on T2-weighted MR imaging were graded from 1 (nonexistent) to 4 (extensive) by two masked observers. The relationships between the patient's age, duration of symptoms, and location of lesions were evaluated by Pearson's correlation coefficient and analysis of variance. RESULTS: Twenty-seven cases met the inclusion criteria. The observer agreement on grading was good. Patients of 15 years of age or younger had significantly higher grades than patients older than 15 years. There was a moderate negative linear correlation between the patient's age and peritumoral edema. No significant relationship was identified between edema and the duration of symptoms or the location of lesions. CONCLUSION: Osteoid osteomas in younger patients tend to be associated with more extensive peritumoral edema.
The purpose of this investigation is to assess the importance of clinical information for the detection of non-displaced wrist fractures in children. Twenty non-displaced fractures of the distal radius in children younger than 15 years of age and twenty age-matched controls were evaluated by five blinded observers before and after giving clinical data, and a receiver operating characteristic (ROC) analysis using a continuous rating scale with a line-marking method was performed. The detection of the fractures was significantly improved with clinical information, and the main reason for this was an increase in true positive fraction. Availability of adequate clinical data should be emphasized for interpreting radiography.
A case of an 18-year-old woman with fibrous dysplasia arising in the calcaneus, which is extremely rare, is reported, with the emphasis placed on differential diagnosis from low-grade central osteosarcoma. She had a severe pain in her left ankle after sprain. Plain radiographs showed a radiolucent lesion measuring 6.3 x 2.5 cm with a sclerotic margin in the left calcaneus. CT scans showed a well-defined lytic lesion with disruption of the lateral cortex and an ossification or calcification in its center. On MR imaging, the lesion had isointensities and high intensities on T1 and T2 weighted images, respectively, but its central portions showed lower intensities both on T1 and T2 weighted images. The lesion was enhanced with gadolinium except for the central portions. The specimen obtained by open biopsy consisted of fibrous tissue and foci of irregular woven bone. None of the nuclear atypia, mitoses, longitudinal stream of bone or invasive nature of growth was detected. The diagnosis of fibrous dysplasia was histologically made. The lesion was curetted and packed with autogenous bone chips. No evidence of recurrence was noted postoperatively.
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Chronic renal failure (CRF) is one of the risk factors of a worse outcome for patients with coronary artery disease. However, few studies have assessed the outcome in such patients. This study investigated the clinical characteristics, treatment modalities, and prognosis for patients with angina pectoris accompanied by CRF and evaluated the validity of current treatment strategy for these patients. A total of 593 patients (248 with stable angina and 345 with unstable angina) admitted to our institution were studied. Renal failure was defined as serum creatinine of > or = 2.0 mg/dl. Patients were divided into 2 groups, with renal failure (46 patients) and without renal failure (547 patients), and the former group was further divided into 2 groups with hemodialysis (26 patients) and without hemodialysis (20 patients). The mean follow-up period was 2.5 +/- 1.2 years and the follow-up rate was 99%. The prevalences of congestive heart failure (26% vs 3%, p < 0.001), hypertension (72% vs 45%, p < 0.005), and multivessel coronary artery disease (65% vs 33%, p < 0.001) were higher in patients with CRF. The left ventricular end-diastolic volume was greater in patients with CRF than in patients without CRF (114 +/- 36 vs 85 +/- 24 ml/m2, p < 0.001). The calcification score of both coronary arteries and abdominal aorta evaluated by electron-beam computed tomography was higher in patients with CRF (2,187 +/- 2,727 vs 631 +/- 841, p = 0.03; 4,091 +/- 3,068 vs 2,191 +/- 2,249, p = 0.02, respectively). In-hospital cardiac mortality was higher in patients with CRF than in patients without CRF (8.7% vs 0.7%, p < 0.001). The cumulative survival was 88% at 1 year and 65% at 3 years in patients with CRF and 99% and 97% in patients without CRF, respectively (p < 0.001). The incidence of re-hospitalization due to congestive heart failure was higher in patients with CRF (19% vs 1.3%, p < 0.0001). The cumulative survival in CRF was 93% at 1 year, 57% at 3 years in the medical treatment group and 87% and 75% in the invasive therapy group, respectively (p = 0.1). Patients with angina pectoris and CRF had a poor prognosis under the current treatment strategy. Newly developed therapeutic strategies, such as rotational atherectomy, minimally invasive direct coronary artery bypass surgery and combinations, will be necessary to improve the long-term prognosis for these patients.
Lipomas are common benign soft tissue tumors which tend to be indolent, and symptoms caused by nerve compression are unusual. However, a parosteal lipoma, occurring adjacent to the proximal radius may easily cause paralysis of the posterior interosseous nerve because of a specific anatomical relationship of these structures in that area. Two cases of parosteal lipoma of the proximal radius causing paralysis of the posterior interosseous nerve are reported. CT and MR imaging demonstrate the characteristic fatty mass around the radius and are specific in making the diagnosis. Surgical excision should be promptly performed to ensure optimal recovery from the nerve paralysis.
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