Functional MRI of Motor Speech Area Combined with Motor Stimulation during Resting Period

PURPOSE: To evaluate functional MR imaging of the motor speech area with and without motor stimulation duringthe rest period. MATERIALS AND METHODS: Nine healthy, right-handed volunteers(M:F=7:2, age:21-40years) wereincluded in this study. Brain activity was mapped using a multislice, gradient echo single shot EPI on a 1.5T MRscanner. The paradigm consisted on a series of alternating rest and activation tasks, performed six times. Each volunteer in the first study(group A) was given examples of motor stimulation during the rest period, while eachin the second study(group B) was not given examples of a rest period. Motor stimulation in group A was achieved bycontinuously flexing five fingers of the right hand. In both groups, maximum internal word generation was achievedduring the activation period. Using fMRI analysis software(Stimulate 5.0) and a cross-correlationmethod(background threshold, 200; correlation threshold, 0.3; ceiling, 1.0; floor, 0.3; minimal count, 3),functional images were analysed. After correlating the activated foci and a time-signal intensity curve, theactivated brain cortex and number of pixels were analysed and compared between the two tasks. The t-test was usedfor statistical analysis. RESULT: In all nine subjects in group A and B, activation was observed in and adjacentto the left Broca's area. The mean number of activated pixels was 31.6 in group A and 27.8 in group B, adifference which was not statistically significant(P>0.1). Activities in and adjacent to the right Broca 's areawere seen in seven of group A and four of group B. The mean number of activated pixels was 14.9 in group A and 18in group B. Eight of nine volunteers in group A showed activity in the left primary motor area with negativecorrelation to the time-signal intensity curve. The mean number of activated pixels for this group was 17.5. Inthree volonteers, activation in the right primary motor area was also observed, the mean number of activatedpixels in these cases was 10.0. CONCLUSION: During the rest period, functional MR imaging of the motor speechcenter combined with motor stimulation was more effective than that without stimulation, and simultaneouslyprovided mapping of the primary motor area.

Difficulty of balloon dilatation in corrosive esophageal strictures

To objectively assess the difficulty in the procedures of corrosive esophageal strictures, the success rates, the number of sessions and balloon dilatation and complications were evaluated in 66 patients with esophageal strictures who underwent balloon dilatation. These patients were grouped into three according to the causes as corrosive esophageal strictures (n=24), non-corrosive benign strictures (n=22) and malignant strictures (n=22). Success rates were 29% in corrosive esophageal strictures, 86% in noncorrosive benign strictures, and 85% in malignant strictures. Required average number of sessions and balloon dilations were 3.4 and 7.4 in corrosive strictures and 1.4 and 2 in noncorrosive benign and malignant strictures, respectively. Esophageal rupture occured in 33% of corrosive strictures, 4% of each noncorrosive benign and malignant strictures. Pain in corrosive esophageal strictures was severest. In conclusion, balloon dilatation in corrosive strictures has low success rate and high complication rate and requires more frequent dilation, which implies that it is more difficult than other strictures.

Fluoroscopic extraction of esophageal foreign body

The purpose of this study is to report our 5-year experience with fluoroscopic removal of blunt esophageal foreign body or impacted food in 15 consecutive patients who were referred by endoscopists because they couldn's remove it endoscopically. The foreign body or impacted food was a pieced of meat, a bean, a badug stone or a beef bone. Thirteen patients had underlying disease(11 of corrosive stricture, 2 of postoperative stricture) but 2 patients did not. We removed the object using one of the following 4 techniques: Basket extraction technique, Foley catheter technique, single balloon technique (dilatation of stenosis for passing the food into the stomach and for the treatment of the stricture as well), double balloon technique(removal of the foreign body by trapping it with two valvuloplasty balloons). Removal was successful in all patients. Esophageal perforation occurred in one patient using the single balloon technique, who treated nonoperatively by means of fasting, antibiotics and parenteral alimentation. No procedure related death occurred in these series. In conclusion, fluoroscopic removal of blunt esophageal foreign bodies of impacted food with various techniques is promising alternative to esophagoscopic removal.

Balloon dilatation for the treatment of stricture of gastrojejunostomy

Enteroenteric anastomotic strictures of UGI tract are common and require treatment if significant obstruction occurs. We performed fluoroscopic guided balloon dilatation in 6 patients who had symptomatic stricture of gastrojejunostomy. The stricture was successfully resolved in 4 patients with benign stricture. But 2 patients with malignant stricture had recurrence of obstructive symptom 2 weeks later, and they required a stent. Asymptomatic balloon rupture was seen in one patient, but other procedural complications did not occur. We found that fluoroscopic guided balloon dilatation is an effective and safe method in the treatment of anastomotic stricture of gastrojejunostomy. We also found transient effect in malignant gastrojejunal anastomotic strictures, which required an interventional procedure, such as placement of a stent.

Balloon dilatation for the treatment of stricture of gastrojejunostomy

Enteroenteric anastomotic strictures of UGI tract are common and require treatment if significant obstruction occurs. We performed fluoroscopic guided balloon dilatation in 6 patients who had symptomatic stricture of gastrojejunostomy. The stricture was successfully resolved in 4 patients with benign stricture. But 2 patients with malignant stricture had recurrence of obstructive symptom 2 weeks later, and they required a stent. Asymptomatic balloon rupture was seen in one patient, but other procedural complications did not occur. We found that fluoroscopic guided balloon dilatation is an effective and safe method in the treatment of anastomotic stricture of gastrojejunostomy. We also found transient effect in malignant gastrojejunal anastomotic strictures, which required an interventional procedure, such as placement of a stent.