Lumbosacral nerve root avulsions: MR imaging demonstration of acute abnormalities.

Most of the previously reported lumbosacral nerve root avulsions presented with pseudomeningoceles at the time of delayed initial imaging. We report a case of traumatic lumbosacral nerve root injury associated with an isolated femur fracture and demonstrate the evolution of pseudomeningoceles following nerve root avulsions and edema in the perineural fat identified on the initial MR imaging.

The clinical features of takotsubo cardiomyopathy.

BACKGROUND: Cardiologists have recently recognized a reversible form of heart failure of unknown origin characterized by a takotsubo-shaped hypokinesis of the left ventricle on left ventriculography. AIM: To clarify the clinical features of this cardiomyopathy. DESIGN: Observational study. METHODS: Seven patients with reversible ventricular dysfunction were followed for 4.5 years. Clinical course, routine examinations, and cardiac catheterizations in each patient were documented. RESULTS: The cardiomyopathy developed in six elderly female and one male patients (mean age 75.3 years), all of whom had been exposed to stress. Cardiac enzymes did not significantly increase, but serum norepinephrine increased remarkably (1.19 ng/ml). Coronary angiography revealed normal coronary arteries. However, left ventriculography showed akinesis in the apical segments, together with hyperkinesis in the basal segments (a takotsubo shape). The abnormal kinesis normalized within 17.4 hospital days without any treatment in five patients, and with haemodynamic support for 3 days in the other two. Endocardial biopsies did not suggest any specific pathology. The cardiac events did not recur over a 1-4 year follow-up. DISCUSSION: Coronary vasospasm, myocarditis and other substantial diseases previously described were ruled out as the cause of takotsubo cardiomyopathy in our subjects. Prognosis was good without any form of treatment, provided that the patients survived the severe heart failure state. Catecholaminergic or adrenoceptor-hyperactive cardiomyopathy may be the cause of this cardiomyopathy.

[Minocycline for the treatment of bronchiolitis obliterans associated with rheumatoid arthritis].

We discribe a rare case of rheumatoid arthritis (RA) complicated with bronchiolitis obliterans that was successfully treated with minocycline. Sixty four-year old woman with a four-years history of RA was admitted to the hospital because of dyspnea on exertion and polyarthritis. Pulmonary function test revealed marked decrease in V25 (0.10 l/s: 6.9%) and MMFR (12.6%). High resolution CT of the lung showed scattered centri-lobular micronodules in both lung fields, mucoid impaction, and hyperinflation. These findings indicated the presence of bronchiolitis obliterans. After 3 months of the treatment with minocycline, the patient showed a significant improvement of both arthritis and pulmonary function. Chest CT findings also improved after 1 year. The present case suggests that minocycline is effective for the treatment of bronchiolitis obliterans seen in patients with RA.

[Plain film and CT findings of pulmonary involvement in rheumatoid arthritis].

OBJECTIVES: To analyze the plain film and CT findings of rheumatoid arthritis (RA)-associated lung diseases and to correlate them with clinical manifestations. METHODS/MATERIALS: We retrospectively reviewed the plain chest and CT findings of 51 RA patients with lung diseases. Sixteen CT findings were separately corded as present or absent, and drew up our classification of lung diseases as follows; 1. interstitial pneumonia/pulmonary fibrosis (IP/PF), 2. airway disease (AD), 3. parenchymal disease (PD), and 4. mixed. Four plain film findings were also recorded, and classified in IP/PF or AD group. This classification was analyzed with reference to clinical parameters and courses. RESULTS: Fifty-one patients were classified as follows; 1. IP/PF (n = 32, 62.6%), 2. AD (n = 15, 29.4%), 3. PD (n = 3, 5.9%), 4. mixed (n = 1, 2.0%). CT findings of PD were compatible with bronchiolitis obliterans organizing pneumonia with rapid improvement. IP/PF diagnosed with CT was depicted by the plain chest in 25 patients (78.1%). There is no false positive of the plain chest diagnosis in terms of IP/PF. As compared with IP/PF, AD consisted of significantly higher prevalence in female patients and patients with severe articular involvement and sinusitis. In spite of variable outcome in patients with AD, those with IP/PF showed the progression of honeycombing, and 4 of them were died from respiratory failure. CONCLUSIONS: CT based classification of rheumatoid lung diseases correlates with clinical manifestations and prognosis and is useful for clinical management in patients of RA. CT diagnosis is useful especially when plain chest does not demonstrate typical IP/PF pattern.

Paraventricular nucleus connections to spinal cord and pituitary.

In rats anesthetized with pentobarbital or a mixture of urethane and chloralose, horseradish peroxidase (HRP) was injected into the intermediolateral column of the spinal cord (Th7 and Th9) or the posterior pituitary lobe. HRP positive cells were found mainly in the dorsomedial part of the paraventricular nuclease (PVN) of the spinal injected animals. These cells are large in size and are bipolar or multipolar. On the other hand, those in the pituitary injected animals were predominantly localized in the dorsolateral cap of the PVN. These latter cells are more rounded, have fewer projections, and are the same size as those in the dorsomedial part of the PVN.