Postirradiation changes in the rectum and perirectal tissue were assessed by computed tomography (CT) in 55 patients (total of 60 examinations) and correlated with radiation dose and time elapsed. Thickening of the perirectal fascia, increased density of the perirectal fat, and swelling of the rectal wall occurred in 48, 60, and 8% of patients, respectively, regardless of radiation dose within 30 Gy. However, widening of the presacral space was seen in 8% of patients receiving a rectal dose of less than 45 Gy, a percentage that increased to 16% for patients receiving 45 Gy or more. Thickening of the perirectal fascia, increased density of the perirectal fat, widening of the presacral space, and muscular changes were seen regardless of the time from the start of therapy. CT does not appear to be reliable enough in detecting residual or recurrent tumor in the rectum. However, knowledge of the CT features of postirradiation changes is helpful for diagnosis in patients with pelvic malignancies.

Adult↗

PubMedDate not supplied

The natural course of atraumatic shoulder instability.

Over the years, we have observed a shifting among loose shoulder, voluntary dislocation, habitual dislocation, and sustained subluxation, leading us to the conclusion that they are all varieties of the same condition: atraumatic shoulder instability. For this study, we followed the natural course of atraumatic shoulder instability in 341 patients (573 shoulders) for 3 years or more. There were 467 cases of loose shoulder, 49 cases of voluntary dislocation, 56 cases of habitual dislocation, and 1 case of sustained subluxation. The average follow-up period was 4 years and 6 months. Spontaneous recovery occurred in 50 cases. The average age of patients at the onset of atraumatic shoulder instability who exhibited a change in instability was 14.6 years. The average age of patients at the onset of atraumatic shoulder instability who exhibited no change in shoulder instability was 19.4 years. There was a significant difference of P < .01 in the age of onset between these two groups. The incidence of spontaneous recovery in the group that discontinued overhead sports was 8.7 times greater than in the group that continued to play overhead sports. The incidence of spontaneous recovery in the group that discontinued non-overhead sports was only 1.4 times greater than in the group that continued to play non-overhead sports. However, no instance of spontaneous recovery was observed among patients who changed from playing non-overhead sports to playing overhead sports. The spontaneous recovery of atraumatic shoulder instability encountered in this study shows that it is best to place priority on observing the course of atraumatic shoulder instability for several years and to avoid performing unnecessary surgery.

Activities of Daily Living↗

PubMedDate not supplied

In vitro studies of immobilized heparin and sulfonated polyurethane using epifluorescent video microscopy.

In situ surface modification techniques to improve the blood compatibility of blood contacting surfaces of medical devices have been developed by the authors. The techniques include heparin immobilization and sulfonated polymer grafting onto a polyurethane (PU) surface by using either ozone oxidation or photo reaction. These modified PUs were evaluated using an epifluorescent video microscope combined with a parallel plate flow cell. The epifluorescent video microscope system measured the amount of platelet coverage on the PU surfaces using whole human blood containing mepacrine labeled platelets perfused at a wall shear rate of 100 sec-1 for 20 min. Platelet activation and complement activation were also measured. Both immobilized heparin and sulfonated PUs showed significantly lower levels of platelet adhesion than the control PU. The platelet activation levels of these modified PUs also correspond to the results of the platelet adhesion. As for complement activation, heparin the immobilized surface showed the least complement activation, while sulfonated PU and the control PU showed higher levels of complement activation. In situ surface modification techniques, which use either ozone oxidation or photo reaction, are useful in a variety of medical devices even of a complex design, such as membrane oxygenators or artificial hearts.

Allylamine↗

PubMedDate not supplied

Amelioration of frozen gait by tandospirone, a serotonin 1A agonist, in a patient with pure akinesia developing resistance to L-threo-3,4-dihydroxyphenylserine.

A 71-year-old woman presented with severe akinesia, frozen gait, and compromised postural reflexes, without rigidity, tremor, or vertical gaze disturbance. With a working diagnosis of pure akinesia, we administered amantadine (150 mg/d) and L-threo-3,4-dihydroxyphenylserine (DOPS) (600 mg/d), which alleviated her symptoms. When frozen gait recurred 2 months later, we increased the dose of L-threo-DOPS to 900 mg/d and added levodopa (300 mg/d) combined with carbidopa, but this failed to improve the patient's symptoms. We then combined administration of tandospirone, a serotonin (5-HT) 1A agonist with L-threo-DOPS (600 mg/d), resulting in marked clinical improvement. Tandospirone is reported to activate noradrenergic neurons via the 5-HT 1A receptor, which could account for such striking improvement in a patient previously responsive to the noradrenergic precursor L-threo-DOPS given alone.

Aged↗

PubMedDate not supplied

Corticosteroid-induced psychotic and mood disorders: diagnosis defined by DSM-IV and clinical pictures.

The authors investigated long-term outcome and treatment strategy of corticosteroid-induced psychotic and mood disorders as defined by DSM-IV. Review of medical records of 2,069 referral patients revealed 18 applicable patients. Their clinical characteristics, longitudinal courses, and treatments were studied. The authors identified 15 patients with mood disorder and 3 patients with psychotic disorder. Increasing doses or resumption of corticosteroids had the strongest influence on the psychiatric course. These two corticosteroid-induced psychiatric disorders may have different pathophysiological substrates closely related to patient vulnerability. Effective psychopharmacological treatment options were indicated with consideration being given to the underlying diseases.

Adult↗

PubMedDate not supplied

CT and MR findings of splenic angiosarcoma.

A surgically confirmed primary splenic angiosarcoma is described. Although angiography showed most of the characteristic findings of the present patient, MR imaging provided a useful information as a supplemental tool. The tumor demonstrated low-signal intensity on both T1- and T2-weighted images, which might differ from hemangioma findings. Subacute hemorrhage within the tumor was revealed by MR imaging, suggesting the way in which the tumor grew during a short period of time. This finding was different from reported angiosarcoma MR findings of siderotic nodules within the tumor. After the administration of Gd-DTPA, MR images clearly demonstrated heterogeneous enhancement within the tumor, which corresponded to the pathologic findings of solid parenchyma with necrotic tissues.

Contrast Media↗