Multilevel evoked potentials were examined in 17 patients who became comatose after cardiac arrest and resuscitation. In 4 patients, the P1 through N3 components of the somatosensory evoked cerebral potential (SECP) were present altogether within 100 ms after the ischemic insults. They all subsequently regained consciousness, though three of them developed intelligence and motor disturbances to some extent. In 11 patients who regained consciousness, or remained in a vegetative state, the evoked potentials which reflect brainstem functions, such as the auditory evoked brainstem potential, the R1 wave of the orbicularis oculi reflex and the slow positive wave of the somatosensory evoked brainstem potential, were recognized. The somatosensory evoked spinal potential and spinal monosynaptic reflex showed normal appearances in the state of vegetation and even after the determination of brain death. The measures of SECP could be useful in predicting restoration of consciousness.

Adult↗

PubMedDate not supplied

Adult-onset foveomacular vitelliform dystrophy with retinal folds.

BACKGROUND: Adult-onset foveomacular vitelliform dystrophy is characterized by a solitary, oval, slightly elevated, yellowish subretinal lesion of the fovea. We examined a patient with adult-onset foveomacular vitelliform dystrophy with stellate retinal folds by optical coherence tomography and scanning laser ophthalomoscopy. CASE: A 58-year-old Japanese woman with a complaint of decreased vision in her right eye was diagnosed as having adult-onset foveomacular vitelliform dystrophy. OBSERVATIONS: Ophthalmoscopic examination revealed a yellowish lesion of one-third disc diameter in size at the fovea in the right eye. Fluorescein angiography demonstrated an irregular block of choroidal fluorescence corresponding to the yellowish lesion, which was surrounded by stellate retinal folds. Optical coherence tomography images showed a steep elevation of the retinal pigment epithelium (RPE) as a focally protruded reflective band over an optically clear space. Scanning laser ophthalmoscopy provided morphologic enhancement in the specifically affected layers of the macula. Using an argon green laser, band-shaped bright reflexes were seen in the right fovea. The helium-neon laser revealed a bright patch corresponding to the yellowish lesion over the fovea, which was surrounded by stellate retinal folds. The diode laser revealed a bright patch corresponding to the yellowish lesion. CONCLUSION: The stellate retinal folds of this patient were considered to be caused by the steep elevation of the RPE with an extracellular accumulation of the vitelliform deposits.

Electroretinography↗

PubMedDate not supplied

Comparison of imaging methods for diagnosing enlarged parathyroid glands in chronic renal failure.

Three noninvasive imaging methods, CT, scintigraphy with 201TlCl and 99mTcO4-, and ultrasonography, were performed on 36 patients with chronic renal failure and secondary hyperparathyroidism. The patients subsequently underwent total parathyroidectomy and parathyroid autograft. The detection rates of the three methods for the 143 excised parathyroid glands were compared according to gland weight and location. Computed tomography detected 53.8% of all glands and 77.6% of 76 glands weighing more than 500 mg. Scintigraphy detected 51.0% of all glands and 77.6% of glands heavier than 500 mg. Ultrasonography detected 42.7% of all glands and 65.8% of glands heavier than 500 mg. The detection rate of upper glands was best with CT (53.5 and 87.9%): that of lower glands was best with scintigraphy (62.0 and 78.6%). Although the combination of the three methods diagnosed 66.4% of all glands and 89.5% of glands heavier than 500 mg, CT and scintigraphy, the best two combinations, visualized 64.3 and 88.2%.

Adult↗