Reliability of the evaluation for left ventricular ejection fraction by ECG-gated multi-detector CT (MDCT): comparison with biplane cine left ventriculography.

OBJECTIVE: To evaluate the reliability of measurement for left ventricular ejection fraction (LVEF) by ECG-gated multi-detector CT (MDCT) comparing with biplane cine left ventriculography that is current gold standard. MATERIAL AND METHOD: The authors reviewed the data from 15 patients who were referred for coronary CT angiography for clinical indications and underwent cardiac catheterization within 14 days. Coronary CTA studies were performed on MDCT Somatom Sensation 16, Siemens, Germany, Slice thickness 1 mm, Slice collimation 0. 75 mm, and Pitch 0. 3. L VEF were measured with MDCTby Simpson s method and compared with values measured by biplane area length method from cardiac catheterization. The L VEF from both techniques were compared using intraclass correlation power analysis (SPSS analysis software). RESULTS: The study population consisted with six men and nine women with a mean age of 54+/-10 years. The LVEF measured from MDCT and cine ventriculography were 54.7 +/-10% and 56. 3+/-10%, respectively. LVEF measured with MDCT by interpreter I and interpreter 2 was significantly correlated with L VEF measured with biplane cine ventriculography (ICC= 0.99 and 0.98, respectively). The interobserver reliability was excellent with ICC = 0.9. CONCLUSION: LVEF measurement with MDCT during coronary CT angiography can be performed easily, very accurately, and compare well with measures taken from biplane cine left ventriculography.

Furlow Palatoplasty in Submucous Cleft Palate-Timing of Operation

PURPOSE: In order to determine the differences in speech outcome based on timing of operation in submucous cleft palate, we have reviewed our experiences in the Furlow palatoplasty over the last 11 years. METHODS: From March 1996 to March 2006, 38 submucous cleft palate patients received Furlow palatoplasty. 10 developmentally delayed patients were excluded and 5 patients were lost to follow up. The rest 23 patients were reviewed. Speech was evaluated preoperatively and postoperatively, and speech therapy was performed accordingly. Perceptual speech assessment included hypernasality, nasal emission and articulation disorder. Cinefluorography was performed to aid perceptual assessment. Based on timing of operation, the patients were divided into 3 groups as following: Group A under 24 months(8 patients), Group B from 25 to 48 months(6 patients), and Group C over 49 months (9 patients). Except 1 patient under speech therapy yet, resultant speech was compared. RESULTS: The rate of abnormal speech was higher in Group C(3/9, 33.3%) than in Group A(0%) or B(0%). All 3 patients who had been discontinued of speech therapy from the parent's judgment had abnormal speech. The reason for the discontinuation was that the regular speech therapy was a burden at school age. Any patients who had continued speech therapy had normal speech. CONCLUSION: The results of our study shows that operative timing is associated with speech development. Maintenance of speech therapy was an important factor for normal speech development. It will be helpful to perform a palatoplasty before 48 months of age to complete speech therapy before the school age.

Micro-focus X-ray for cochlear implantation research on small animals / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To develop an imaging system suitable for cochlear implant research on small laboratory animals.</p><p><b>METHODS</b>A novel micro-focus X-ray imaging system was developed. The key features of the system were the use of a micro-focus X-ray source (less than 10 micrometers) and an appropriate choice of source-object and object-image distance. The new X-ray modality was evaluated on heads of cats, guinea pigs and rats.</p><p><b>RESULTS</b>It proved to be an useful tool to provide excellent image of small animal cochlea, allowing a clear electrode position to be established, and also helped greatly in detecting the breakage of electrode array.</p><p><b>CONCLUSIONS</b>Experimental studies performed in cats, guinea pigs and rats confirmed that micro-focus radiography was an important tool for cochlear implant research in laboratory</p>

Terapia fibrinolítica para trombose de próteses valvares cardíacas: resultados imediatos e tardios / Fibrinolytic therapy for thrombosis in cardiac valvular prosthesis short and long term results

OBJECTIVE: To assess the short- and long-term results of the use of streptokinase (SK) for the treatment of thromboses in cardiac valvular prostheses. METHODS: Seventeen patients with cardiac prosthetic thrombosis diagnosed by clinical, echocardiographic, and radioscopic findings underwent fibrinolytic treatment with a streptokinase bolus of 250,000 U followed by 100.000 U/hour. Short- and long-term results were assessed by radioscopy and echocardiography. RESULTS: Of the 17 patients, 12 had mechanical double-disk prostheses (4 aortic, 6 mitral, 2 tricuspid), 4 had single-disk prostheses (2 aortic, 1 mitral, and 1 tricuspid), and 1 had a tricuspid bioprosthesis. The success rate was 64.8 percent, the partial success rate was 17.6 percent, and the nonsuccess rate was 17.6 percent. All patients with a double-disk prosthesis responded, completely or partially, to the treatment. None of the patients with a single-disk prosthesis had complete resolution of the thrombosis. The time of streptokinase infusion ranged from 6 to 80 hours (mean of 56 h). The mortality rate due to the use of streptokinase was 5.8 percent and was secondary to cerebral bleeding. During streptokinase infusion, 3 (17.6 percent) embolic episodes occurred as follows: 1 cerebral, 1 peripheral, and 1 coronary. The rethrombosis index was 33 percent in a mean follow-up of 42 months. CONCLUSION: The use of fibrinolytic agents was effective and relatively safe in patients with primary thrombosis of a double-disk prosthesis. A fatal hemorrhagic complication occurred in 1 (5.8 percent) patient, and embolic complications occurred in 3 (17.6 percent) patients. In a mean 42-month follow-up, 67 percent of the patients were free from rethrombosis

Enfermedad coronaria diagnosticada por cinecoronariografía y su relación con la enfermedad periodontal: estudio preliminar / Coronary disease diagnosed by cinecoronariography and its relation to periodontal disease: a preliminary study

En los últimos años, importantes estudios han demostrado la relación existente entre infeción como enfermedad periodontal (EP) y condiciones inflamatorias crónicas como la enfermedad coronaria (EC). Con el objeto de evaluar la relación entre EP y EC, se realizó este estudio prospectivo, observacional, doble ciego. Se estudiaron 181 pacientes de ambos sexos (75 por ciento hombres y 25 por ciento mujeres) con edades comprendidas entre los 35 y 65 años. La muestra incluyó pacientes que ingresaron al servicio de hemodinamia del ICYCC para ser sometidos a cinecoronariografía diagnóstica. A dichos pacientes se los citó al servicio de odontología para diagnosticar la severidad de la EP. Para ello se registraron en "los dientes de Ramfjord" los siguientes parámetros: profundidad de sondaje, pérdida de inserción, movilidad, lesión de furcación y pérdida ósea radiográfica. Los pacientes se dividieron en dos grupos, A y B, de acuerdo a la presencia o ausencia de enfermedad coronaria significativa (ECS) respectivamente. Se consideró ECS a la presencia de por lo menos una obstrucción en la arteria coronaria epicárdica principal o una de sus ramas que comprometieran la luz en un 70 por ciento. Los grupos antes mencionados A (n=107) y B (n=74) fueron subclasificados de acuerdo a la presencia o ausencia de EP, quedando así la población inicial dividida en 4 subgrupos: A1=ECS+EP; A2=ECS+ sin EP; B1= sin ECS+EP; B2= sin ECS+ sin EP. Al correlacionar los diferentes factores de riesgo coronario (FRC) en análisis univariado utilizando el método de Fisher, la hipercolesterolemia (OR=5,6), el tabaquismo (OR=2,4), la hipertensión arterial (OR=2,6), la diabetes (OR=4,4), el sexo masculino (OR=2,5), dieron resultados estadísticamente significativos (ES) al relacionarlos con la EC. Se evaluó la asociación de EP con EC obteniendo un OR=3,4 siendo ES. Al realizar un análisis multivariado se observó que la hipercolesterolemia (p=0,0002) y la enfermedad periodontal (p=0,0147) demostraron ser FRC independientes

Diseño y análisis de un sistema para medir los movimientos mandibulares / Design and analysis of a system to record mandibular movements

Este estudio tuvo como objetivo diseñar un sistema que permitiera analizar y cuantificar el movimiento mandibular en nuestro medio, con las mínimas interferencias posibles. Para ello se utilizó un soporte intraoral en acrílico, un sistema de emisión de luz conformado por cuatro LEDs (diodos emisores de luz), dos superiores y dos inferiores, dos cámaras de video y se creó un software para el análisis. Se evaluó la masticación con zanahoria y chicle y los movimientos bordeantes, todo en el plano frontal y sagital. Los resultados más cercanos a la realidad se obtuvieron con LEDs izquierdos. Los ciclos mostrados durante la masticación de chicle tienen un componente vertical mayor que el anteroposterior o el horizontal, cuando se comparó con la zanahoria. El período de duración de un ciclo fue de 0.68 para la zanahoria y de 0.88 segundos para el chicle. Se encontraron pausas durante el movimiento de 0.06 a 0.33 segundos y una velocidad durante el ciclo de 225 milímetros por segundo. A pesar de que el sistema aún tiene dificultades, demostró ser útil para registrar y cuantificar el movimiento mandibular

Bronchogenic cyst presenting as dysphagia.

We report an adult patient who masqueraded as a case of gastroesophageal reflux disease for over 6 years. On close questioning he was found to have severe constricting pain in the retrosternal region and non progressive dysphagia for 6 years. Cineradiography of the oesophagus and CT scan chest revealed a large bronchogenic cyst compressing the oesophagus and the trachea. Excision of the cyst relieved the symptoms.

Comparative evaluation of cine-esophagogram with esophageal manometry in assessing esophageal motility in progressive systemic sclerosis.

BACKGROUND: Esophageal manometry is considered the gold standard in the diagnosis of esophageal motility disorders. Cine-esophagogram using barium is also a good investigation to screen patients for motor disorders of the esophagus. Comparison between these two investigations has not often been reported in patients with progressive systemic sclerosis (PSS). AIM: To determine relative merits of cine-esophagogram and esophageal manometry in detecting esophageal motor dysfunction in PSS patients. METHODS: Thirty-five patients with PSS irrespective of esophageal symptoms underwent esophageal manometry and cine-esophagogram, results and their were compared. RESULTS: Sensitivity and specificity of cine-esophagogram as compared to manometry were 96.1% (95% CI 88.7%-100%) and 55.5% (95% CI 23%-87.9%) respectively. Its positive predictive value was 86%. CONCLUSION: While esophageal manometry can identify esophageal motor disorder in PSS, cine-esophagogram can be resorted to in doubtful situations, for confirmation of diagnosis.

Tetralogy of Fallot in adults--107 cases.

Clinical and haemodynamic profile of 107 adult patients above the age of 15 years with TOF was analysed. Cardiac catherization and selective cine-angiography were performed in all cases. Infundibular pulmonary stenosis, mal-alignment type of ventricular septal defect, mitral-aortic fibrous continuity and equal systolic pressures in both the ventricles and aorta were considered mandatory for the diagnosis of Tetralogy of Fallot. Aortic regurgitation was seen in 26 cases (24%), tricuspid regurgitation in 22 cases (21%), absent pulmonary valve in 3 cases (3%), branch pulmonary artery stenosis in 9 case (8.4%), major aortopulmonary collaterals in 15 cases (14%), right atrial pressure was more than 10 mmHg in 10 cases (11%) and right ventricular end diastolic pressure more than 9 mmHg in 73 cases (68%). The left ventricular end diastolic pressure was above 13 mmHg in 58 cases (54%).

Dextrocardia em situs inversus totalis com doença obstrutiva coronária: tratamento pela angioplastia coronária por via braquial / Dextrocardia with coronary disease in situs inversus totalis. treatment with coronary angioplasty by brachial approach

A dextrocardia em "situs inversus totalis" com lesão obstrutiva coronária é uma situação rara, existindo na literatura referência a apenas alguns casos tratados pela angioplastia coronária por via femoral. No presente trabalho descreve-se o caso de um paciente de 61 anos submetido com sucesso à dilatação de duas artérias por via braquial. Discutem-se aspectos técnicos relacionados com o procedimento, o qual pode ser facilmente executado, desde que se disponha de material adequado

Dextrocardia in "situs inversus totalis" with obstructive coronary disease is a rare clinical situation, with few cases treated by coronary angioplasty using the femoral approach being reported. In this report we describe the case of a 61-year-old male patient who underwent successful! dilatation of two arteries by the brachial approach. We discuss technical aspects related to the procedure, which may be easily performed when proper equipment is available

Videofluoroscopia da deglutiçäo e do esfíncter velo-faríngico: padronizaçäo do exame / Videofluoroscopy of deglutition and of the velopharyngeal sphincter: standardization of the examination

A videofluoroscopia é um exame que vem sendo amplamente usado no diagnóstico, acompanhamento e condutas adotadas nas alteraçöes de deglutiçäo e patologias que acometem o esfíncter velo-faríngico. Aqui no Brasil, entretanto, o emprego deste exame era limitado devido ao desconhecimento deste por parte dos fonoaudiólogos. A videofluoroscopia fornece a estes profissionais dados importantes, dando-lhes bases seguras e objetivas na decisäo de condutas, sobretudo com pacientes portadores de fissuras lábio-palatais. Neste artigo, descreveu-se o exame videofluoroscópico, apresentando-se um protocolo de exame e os principais dados a serem observados em cada item. Nove indivíduos foram avaliados como sujeitos controle para servir como base para os exames de indivíduos portadores de alguma patologia. Em todos os nove indivíduos a delgutiçäo apresentou os padröes de normalidade esperados. No que concerne ao fechamento do esfíncter velo-faríngico durante a fonaçäo, 3 sujeitos apresentaram padräo de fechamento coronal; 4 do tipo ciruclar e 2 do tipo circular com prega de Passavant. A videofluoroscopia é hoje, sem dúvida, um instrumento fundamental de auxílio ao fonoaudiólogo nos casos de insuficiência ou incompetência velo-faríngica e de alteraçöes de deglutiçäo

Exame otorrinolaringológico, cinefluoroscopia e análise perceptual auditiva em crianças com indicaçäo de adenoidectomia / Otolaryngologic examination, cineradiography and hearing perceptual analysis in children with adenoidectomy indication

No presente trabalho foram avaliadas as relaçöes entre os exames otorrinolaringológico, cinefluoroscopia e análise perceptual auditiva, efetuados em 20 criançass com indicaçäo cirúrgica de remoçäo de adenóide. Entre os parâmetros observados concluímos que foi de grande importância a movimentaçäo das paredes laterais da faringe e o grau de obstruçäo da coluna área na relaçäo entre o tamanho da adenóide e o tamanho da rinofaringe. Por sua vez, os dados da análise perceptual auditiva foram correspondentes aos achados cinefluoroscópicos

Estudo cinerradiocardiográfico na doença pulmonar obstrutiva crônica / Cineradiocardiographic study in chronic obstructive pulmonary disease

Foram estudados 20 pacientes portadores de doença pulmonar obstrutiva crônica. Caracterizou-se a reduçäo da capacidade vital com sinais de hiperinsuflaçäo pulmonar, verificando-se a existência de obstruçäo ao fluxo aéreo tanto em regiöes proximais quanto distais. A resistência pulmonar total e a complacência estática estavam aumentadas na maioria dos casos. Gasometricamente observou-se hipoxemia, sem retençäo de gás carbônico. O exame radioisotópico revelou vários graus de dilataçäo da artéria pulmonar, possibilitando cogitar da presença de hipertensäo, que se confirma pelo aumento do tempo médio de trânsito pulmonar. Verificaram-se alteraçöes na motilidade miocárdica regional do ventrículo direito em 90% dos pacientes, sendo em 15% de grau acentuado. O volume telessistólico em 95% dos casos estava elevado e o telediastólico em 55% dos pacientes. Estas observaçöes representam distúrbio funcional incipiente, näo permitindo concluir pela reduçäo do débito ou da fraçäo de ejeçäo. A motilidade ventricular esquerda estava normal em 85% dos casos. Em 15% se observou reduçäo, sendo acentuada em apenas um caso. Quatro pacientes, ou seja, 20%, apresentaram aumento discreto ou moderado dos volumes. A fraçäo de ejeçäo em apenas um paciente, isto é, 5% dos casos, observou-se reduzida. Em três estava aumentada, näo refletindo porém uma situaçäo anormal, podendo traduzir o aumento do volume ejetado na vigência de um miocárdio normal. A aorta em 75% dos casos estava alongada. Face à faixa etária dos pacientes estudados, pode-se concluir pela presença de aortoesclerose com modificaçöes estruturais do seu calibre

O valor diagnostico da radioscopia na avaliação da prótese de Omni Science / Diagnostic value of radioscopy in the evaluation of the Omni Science prosthesis

Foi realizada cineradioscopia com intensificador de imagem em 19 pacientes portadores de protese de Omni Science, valvula dotada de disco radiopaco que permite facil visibilizacao na radioscopia. Para determinar a sensibilidade e a especificidade do metodo foram estudados 16 pacientes assintomaticos e 3 com suspeita clinica de trombose de protese. Nos assintomaticos, visibilizou-se o disco em todos.Nos outros nao foi visto o disco em 2 casos e, no terceiro, a excursao estava bastante prejudicada. Conclui-se que a radioscopia e um importante auxiliar nao invasivo na avaliacao deste tipo de protese metalica

Corrected transposition of the great arteries

The corrected transposition of the great arteries is an usual congenital cardiac malformation, which consisitsof transposition of great arteries and ventricular inversion, and which is caused by abnormal developement ofconotruncus and ventricular looping. High frequency of associated cardiac malformations makes it difficult to getaccurate morphologic diagnosis. A total of 18 cases of corrected transposition of the great arteries is presented,in which cardiac catheterization and angiocardiography were done at the Department of Radiology, Seoul NationalUniversity Hospital between Sep. 1976 and June 1981. The clinical, radiogrpahic ,and operative findings with theemphasis on the angiocardiographic findings were analized. The resuls are as follows; 1. Among 18 cases, 13 caseshave normal cardiac position, 2 cases have dextrocardia with situs solitus, 2 cases have dextrocardia with situsinversus and 1 case has levocardia with situs inversus. 2. Segmental sets are {S.L.L.} in 15 cases, and {I.D.D} in3 cases and there is no exception to loop rule. 3. Side by side interrelationships of both ventricles and bothsemilunar valves are noticed in 10 and 12 cases respectively. 4. Subaortic type conus is noted in all 18 cases. 5.Associated cardiac malformations are VSD in 14 cases, PS in 11, PDA in 3, PFO in 3, ASD in 2, right aortic arch in2, tricuspid insufficiency, mitral prolapse, persistent left SVC and persistent right SVC in 1 case respectively.6. For accurate diagnosis of corrected TGA, selective biventriculography using biplane cineradiography is anessential procedure.