Myocardial bridging as one of the causes of atypical chest pain in young women.

INTRODUCTION: Myocardial bridging is congenital anomaly which usually has benign prognosis but there are also reports suggesting that it can be associated with ischemic clinical syndromes presenting with chest pain. Coronary computed tomography angiography is a well-established method for detecting myocardial bridging. However, clinical significance of this anomaly still remains unclear. METHODS: We studied 977 patients who presented with recurrent typical or atypical chest pain in outpatient clinic. All patients have undergone detailed clinical examination, ECG stress testing and coronary computed tomography angiography. RESULTS: Highest positive prediction for having myocardial bridging was for patients presenting with atypical chest pain with negative ECG stress test and who were younger women. CONCLUSION: Coronary computed tomography angiography may be preferable method for evaluation of chest pain in younger women presenting with atypical chest pain.

[Unusual IOL Calcification following Vitreoretinal Surgery with Silicone Oil Endotamponade]. / Ungewöhnliche Kalzifikation intraokularer Kunstlinsen nach vitreoretinalem Eingriff mit Silikonölendotamponade.

PURPOSE: Calcification of intraocular lenses (IOL), although nowadays less frequent than in the past, is a well-documented complication that can still necessitate their explantation. Although mostly noted in hydrophilic materials it has been rarely reported in hydrophobic intraocular lenses. We wish to report on two unusual cases of intraocular lense (one hydrophobic and one hydrophilic with hydrophobic surface) calcification following vitrectomy and silicon oil endotamponade. METHODS: In the course of treatment both patients underwent multiple ocular interventions due to re-detachment/persistent macular hole including local rt-PA or triamcinolone injection due to persistent postoperative anterior chamber inflammation/macular oedema. Finally and after thorough patient examination with characteristic visual complaints and difficulty in the retinal assessment the extraction of the calcified lenses was considered necessary. The configuration as well as the elemental analysis of the opacified surface of the IOLs was performed by means of high magnification microscopy, scanning electron microscopy and energy dispersive X-ray spectroscopy (EDX). Intraocular and systemic histories of both patients were summarised. RESULTS: The scanning electron microscopy and EDX analysis demonstrated massive calcium-based deposits on the surface of the hydrophilic and a diffuse vacuolation and calcification consisting of oxygen (O), silicon (Si), magnesium (Mg), aluminium (Al), sulphur (S) and phosphorus (P) on the surface of the hydrophobic IOL. CONCLUSION: The explantation of an IOL due to calcification represents an unusual event. The careful consideration of systemic and ocular factors that promote calcification processes can help reduce the incidence of calcification. Despite all efforts in material production and risk factor analysis, it is not always possible to define or even predict the exact cause of this phenomenon and in the presence of corresponding clinical symptoms IOL exchange remains as the sole option.

Digital orthopantomograms in osteoporosis detection: mandibular density and mandibular radiographic indices as skeletal BMD predictors.

OBJECTIVES: To determine the correlation of skeletal bone mineral density (BMD) with mandibular density and mandibular radiographic indices estimated on digital panoramic radiographs. METHODS: Study comprised 112 female subjects older than 45 years. Digital panoramic radiographs were taken, and patients were referred to densitometric measuring (dual energy X-ray absorptiometry) of BMD in the hip bones and lumbar spine regions (L1-L4). On the radiographs, mandibular bone density was estimated and the following indices were measured by the DIGORA(®) software (Soredex, Tuusula, Finland): mental index (MI), gonial index (GI), antegonial index (AI), panoramic mandibular index (PMI) and alveolar crest resorption degree (M/M). Mandibular cortical index (MCI) was visually estimated. RESULTS: Mandibular density and visual index MCI are significant predictors of hip and spine BMD. Mandibular density was marked by a significant square trend: it decreased until the age of 54 years and remained constant until the age of 64 years when it started to increase. Significant correlations were found between MI, AI and PMI values and BMD in the hip but not in the lumbar spine region. The GI and M/M values did not show statistically significant correlations with BMD of either region. CONCLUSIONS: Mandibular bone density and mandibular radiographic indices are useful in detecting patients with decreased BMD. The applicability of orthopantomograms in diagnosing osteoporosis/osteopenia should be recognized as the potential greatest benefit of this everyday diagnostic method in dental practice.

Metastases development following local tumour treatment.

Transplantable mouse methylcholanthrene- induced fibrosarcoma (CMC4 tumour growing in CBA/HZgr mice), characterized by lung metastases developing shortly after local tumour cell transplantation, was used as an experimental model to investigate the problem of tumour metastases after local tumour treatment. Surgery and/or irradiation were performed on locally growing tumour of particular size. Further, heavily irradiated, viable but not dividing tumour cells, imitating the situation in treated tumour-bearing organism, were injected intraperitoneally in a parallel group of treated tumour-bearing mice. The animals were killed 35 days after tumour transplantation and the number and volume of lung metastases were determined. Depending on the treatment performed, when the tumour mass was reduced or even eliminated, the number of lung metastases and their volume were significantly lower than in control mice, but the addition of tumour mass (injection of heavily irradiated tumour cells) resulted in a significant increase in lung metastases parameters, pointing to a possible role of the host's immune reaction against the tumour. Further, the release of a simple molecule, such as nitric oxide, from tumour mass seems to be detrimental for the survival of tumour cells and subsequently their metastases through the induction of angiogenesis and possible suppression of immune reaction. Thus, complex mechanisms could be involved when a locally growing tumour is exposed to a particular therapeutic approach.

[Malignant melanoma of the cornea after blunt trauma]. / Malignes Melanom der Kornea nach stumpfem Trauma.

We report the case of a 67-year-old woman who presented with a persisting corneal erosion after blunt injury. Six years later, a highly prominent corneal tumor had developed at the site of the initial erosion. Histological analysis revealed a malignant melanoma. This case provides evidence that malignant melanoma may be a long-term complication of corneal epithelial disorders.

Endonasal endoscopic dacryocystorhinostomy in a four-month-old infant.

The authors present a case of endonasal endoscopic dacryocystorhinostomy in a 4-month-old girl suffering from remarkable epiphora, persistent bulging and recurrent abscesses in the medial canthal region of the left eye. All conservative therapeutic attempts failed. Several external incisions were performed in order to solve the acute phases of the inflamed lacrimal sac. The procedure was performed by means of otologic microsurgical instruments under endoscopic control. No silicone stent was used. Ten months after surgery, the girl is doing very well.

Computed tomographic imaging to determine the frequency of anatomical variations in pneumatization of the ethmoid bone.

The present study was performed on axial and coronal CT scans of 212 patients. Scans were analyzed by an anatomist and a radiologist for the presence of Haller's cells, agger nasi cells, Onodi's cells and pneumatized crista galli. Results demonstrated the presence of Haller's cells in 21.2%, Onodi's cells in 10.4% and pneumatized crista galli in 2.4% of patients. A pneumatized anterior clinoid process was found in 0.5% of the patients. The data obtained in our study were compared with those reported in other anatomic and radiologic studies.

Topoanatomic relations of the ophthalmic artery viewed in four horizontal layers.

In the present paper we have studied the gross anatomy of the ophthalmic artery in 200 human cadaver dissections viewed in four horizontal layers. The ophthalmic artery can be divided into the origin, intracranial, intracanalicular and intraorbital parts. The most common origin of the artery was from the medial half of the anterior side of the internal carotid artery (ICA) in its upper curve (52%), followed by the medial half of the superior side (44%), and in only 4% from the medial side of the upper curve of the ICA. We have examined the topographic anatomy of the ophthalmic artery in detail, and found a rare anastomosis of the ophthalmic artery with the frontal branch of the middle meningeal artery.

[Pneumatization of the middle nasal turbinate: a CT study]. / Pneumatizacija srednje nosne skoljke: CT prikaz.

Anatomic variations of the middle turbinate may be an important factor in the pathogenesis of inflammatory processes of the paranasal sinuses. A detailed analysis of coronal and axial plane CT scans of the paranasal sinuses obtained from 120 patients was performed. Paradoxical curve of the middle concha was detected in 24.2% of patients. Pneumatized middle turbinate was found in 42.5% and "true" concha bullosa in 8.3% of patients. Bilateral concha bullosa was found in 1.7% of patients.

Gonadectomy abrogates sex differences in the effectiveness of chemical carcinogenesis in mice.

Sham-gonadectomized and gonadectomized male and female mice were given methylcholanthrene s.c. to assess the influence of sex hormones on carcinogenesis. Gonadectomy decreased the concentration of the respective sex hormone and increased the concentration of the opposite sex hormone. The results showed that androgens enhanced the effectiveness of carcinogenesis, while estrogens had the opposite effect. Gonadectomy effectively abrogated the sex differences in tumor induction.