Persistent Trigeminal Artery Variant: MR Angiographic Demonstration. A Report of Two Cases.

A variant (PTAV) is the persistence after birth of the fetal carotid-basilar anastomosis between the internal carotid artery and a cerebellar artery. We describe two cases of a PTAV demonstrated on MR angiography. A comparison with a persistant trigeminal artery is made and an explanation of the extended Saltzman classification is given. These variants have only little clinical significance, but their recognition is crucial before surgical or interventional procedures or to understand paradoxical cerebellar lesions. MRA appears inferior to selective angiography in diagnosing these variants.

Wavelet analysis of voluntary cough sound in patients with respiratory diseases.

Changes in the characteristics of the cough sound may refer to some specific pathological processes and their evolution. In this pilot study we analyzed voluntary cough sound properties in subjects with asthma bronchiale (AB) and chronic obstructive pulmonary disease (COPD) and discriminated them from the control cough sound in healthy subjects. The wavelet transform was used due to a nonstationarity of cough sound recordings. The duration of cough sound was longer during pathological conditions. The longest duration and the highest power of the cough sound were found in COPD. In AB patients, higher frequencies were detected compared with chronic bronchitis and the power of cough sound was shifted to a higher frequency range compared with control coughs. Cough sounds were classified using discriminant analysis with a correct classification rate of about 85-90 %. The method of cough analysis enables an objective quantification of voluntary cough sound with a useful diagnostic and prognostic value.

Comparison between degree of carotid stenosis observed at angiography and in histological examination.

BACKGROUND: The generally accepted indications for carotid endarterectomy are the clinical picture and degree of per cent stenosis of the carotid artery. Despite the fact that stenosis measurement is defined, the methods vary considerably. The correlation of particular methods, especially angiography and duplex sonography, has been repeatedly demonstrated. However, the correlation between any technique and true anatomical stenosis, as evaluated on the surgical specimen, has been only anecdotally reported. METHOD: During carotid endarterectomy, the atherosclerotic plaque was removed in one piece and subsequently stored and histologically processed. The histological slides were evaluated under an optical microscope, scanned and the slide with maximum stenosis was determined using a planimetric program. Both the minimal lumen area and the area of the whole plaque were measured. The stenosis was calculated using the planimetric method. On the maximum stenosis slice, the minimal diameter and the diameter of the whole plaque were also measured. Angiographic images were scanned and the per cent stenoses were remeasured, according to the NASCET and ECST criteria. In total, of 147 cases, all above-mentioned parameters were obtained. Student's t tests for paired samples were used to evaluate the results. FINDINGS: The t-tests indicated significant differences between the per cent stenosis as measured on the anatomical specimen and on the angiogram (p<0.05). The results indicate that the angiographic measurement underestimates the degree of in-situ anatomical stenosis. The underestimation was more marked the less the degree of stenosis. CONCLUSIONS: Our study finds that per cent stenosis measurement obtained by angiography with NASCET or ECST methods does not reliably reflect the anatomical degree of per cent stenosis, which makes questionable the rigorous following of percentage stenosis using angiography as the sole indicator for carotid endarterectomy in all cases.

Analysis of the cough sound frequency in adults and children with bronchial asthma.

It is well known that the frequency distribution of cough sound varies in different pathological conditions. Its identification could have diagnostic value. In this study the cough sound frequency in adults (n=20, 51.7 +/- 11 yrs), children (n=21, 11.8 +/- 0.4 yrs) asthmatics and healthy volunteers (n=25, 21 yrs) was explored. All patients were suffering from bronchial asthma. They were on a stable therapeutic regime and in a quiet status. Voluntary cough sound was recorded by a microphone and a tape recorder an ddigitally processed. Overlapping technique and Fast Fourier Transform were used to estimate the sound spectra. The records were smoothed by the method of Pascal triangle. They demonstrate the mean values of cough sound spectra. The registered pseudo three-dimensional plots of cough sound frequency (1 K spectra as function in time) of adults showed that the intensity of frequencies increased from 100 to 900 Hz in 3-4 waves. These frequencies afterwards decreased and between 1 to 2 kHz a smaller elevation was present. The spectra of children resembled to the spectrum of adults but had a smoother course. The spectra of asthmatics had some specificity and differed from the spectrum of healthy volunteers.

The effect of the pulsatile electromagnetic field in patients suffering from chronic obstructive pulmonary disease and bronchial asthma.

Pulsatile electromagnetotherapy (PETh) stimulates biological tissues and processes; it modulates ion exchange across cell membranes and thus regulates the tone of smooth muscles. On the basis of these effects we hypothetized that PETh might treat COPD and bronchial asthma. We examined 117 (61 females, 56 males) adult patients who were decided in 4 groups. The 1st consisted of 16 patients with COPD who were treated by PETh and pharmacologically. The 2nd group (control) consisted of 24 patients with COPD who were treated only with medicaments. The 3rd group consisted of 37 asthmatics, treated by PETh and medicaments. The 4th group (control) consisted of 40 asthmatics treated only with medicaments. The effectiveness of PETh was assessed by lung function tests, which were performed using a Spirometer 100 Handi (Germany). We measured FVCex, FEV1, percentage of FEV1/FVCex, MEF25, 50, 75, PEF and registered the flow-volume loops. PETh was applied by apparatus MTU 500H (Therapy System, Czech Republic). It was administered 10 doses; once daily for 20 min, with a frequency of 4.5 Hz and a magnetic induction 3 T. The initial 3 doses were about 25% lower then the later doses. PETh was very effective in patients with COPD. The measured indexes improved about 200-660 ml or ml x s(-1), except FVC. PETh was less effective in asthmatics. Most indices improved without statistical significance, about 50-620 ml or ml x s(-1). The indices of FEV1/FVC and MEF25 deteriorated. The changes in controls without PETh were very small. (Tab. 2, Fig. 1, Ref. 19.)

The sensitivity of tussiphonography for assessing the effectiveness of treatment.

Our previous studies have demonstrated that tussiphonogram is suitable not only for the detection of pathological condition in the respiratory tract but also for treatment effectiveness assessment. The purpose of this study was to evaluate the possibilities of tussiphonography in detection of already little pathological changes in the airways and lungs. Therefore the changes of voluntary cough sound indexes were compared with pulmonary function tests in selected group of asthmatics before and after a pulsatile electromagnetic therapy in which the effect of therapy on pulmonary function tests was minimal. After magnetotherapy in 18 patients with increased expiratory forced lung capacity by 7.3% and increased peak inspiratory flow by 31.7% in average the voluntary cough sound intensity decreased by 37.8%, the sound duration shortened by 11% and the sound pattern showed the tendency to normalization. The improvement of mentioned cough indexes was absent in 17 patients who were treated by magnetotherapy too, but at the same time suffered from respiratory viral infection and in 22 patients treated only with climatotherapy and antiasthmatics. Changes of flow-volume loops in patients were not in the close relation to other followed indices. The correlation analysis showed a functional connection in relative differences of cough sound indices and some pulmonary function tests. The results confirmed the suitability of tussiphonography to indicate even mild pathological changes in respiratory tract. (Fig. 4, Ref. 21.)

[Use of recording methods and sound analysis of cough in the study of sound phenomena associated with respiration]. / Pouzitie metódy registrácie a analýzy zvuku kasl'a pre stúdium zvukových fenoménov spojených s dýchaním.

The objective registration of the human body functions is one of the main tasks of the modern and prospective medicine. The registration of the heart, brain, muscles etc. activity have a long tradition. The registration of sound processes, for instance coughing was not solved completely despite their diagnostic importance. The authors worked out a new non invasive and precise method for cough sound registration and analysis which allows evaluation of the sound pattern, intensity and time duration. Application of this method for registration and analysis of the cry of new-borns gave rise to doubts about its suitability for an assessment of other sounds related to respiratory organs, except that of a cough. We registered and analysed the sound samples from Hirschberg's and Szende's (1982) sound archive for the purpose of the evaluation of the acceptability of the described method. The sound phenomena (109 samples of coughing, crying, barking and breathing) we transcribed from a record on a tape. The recorded signal was converted by A/D converter and analysed by computer by means of our own application programme. The sound and its pattern was transformed into a graphical record. This examination was completed by a sound frequency analysis based on the fast Fourier transformation with help of a computer likewise with our own application programme. It was found out that the used method reflected well the quantitative an qualitative differences of the evaluated sound samples. The graphical records reliably expressed the acoustic sound timbre as it shows the records of dog's and seelion's barking, cough, cry and cackling stridor of new-borns. The histographic curves which expressed the sound pattern showed a principally similar course. The intensity of sound examples was different. The sound samples duration were very often longer as the measurable time extent of software (0-819.2 ms) and therefore its evaluation was omitted. The repeated evaluation of the same sound phenomenon gave equal values. The spectrographic analysis confirmed the differences in sound samples. The values of the evaluated cough and cry sounds do not differ principally from the values registered in the previous author's observations. The results proved that the described method of cough sound registration and analysis was suitable for evaluation of different sound phenomena related to respiratory organs. (Fig. 3, Ref. 14.)

Analysis of the cough sound: an overview.

Coughing is presented by a sudden air expulsion from the airways which is characterized by a typical sound. This sound is so characteristic that it allows identification of the cough and its distinction from other vocal manifestations. The cough sound is a very important symptom of well over 100 diseases and other conditions of medical significance. Changes in its character may have a considerable value in identifying the mechanisms of airway pathology present in respiratory diseases. The cough sound gives information about the pathophysiological mechanisms of coughing by indicating the structural nature of the tissue during therapy that leads to certain patterns of cough. Similarly the character of the cough sound gives information about the behaviour of the glottis and whether the glottis behaves differently in different pathological conditions. Analysis of the cough sound record has significant value in prognosis because its changes may indicate the effectiveness of therapy or the progress of disease. Despite recent progress in cough sound research the attention paid to this interesting physiological and clinical problem is still not sufficient to solve completely various open questions, including our correct knowledge of the mechanism of creation of cough sounds.

A new scleral suction trephine for retrieval of corneoscleral donor tissue.

BACKGROUND: Removal of donor corneo-scleral shell from a cadaver, leaving the remainder of the eye in place, has become a popular technique. Manual removal can result in excessive trauma to the corneal endothelium or an uneven scleral rim. METHODS: We describe a new technique for corneal retrieval using a sceral suction trephine. RESULTS: The scleral suction trephine was cut evenly in our eyebank study. There was no additional trauma to the endothelium and the scleral rim was regular. CONCLUSION: Suction trephination of the sclera in retrieval of corneal donor tissue appears to be safe and effective.

Human excimer laser keratectomy. Immunohistochemical analysis of healing.

OBJECTIVE: To analyze human corneal responses to excimer laser by immunohistochemistry. METHODS: Corneas cultured for 3 weeks after laser ablation or taken from patients 5 to 16 months after laser treatment were exposed to antibodies to beta, integrin; types VII, IV, and III collagen; fibronectin; type I procollagen; and prolyl 4-hydroxylase. Antibody distributions were compared with those of normal corneas and unablated regions of treated corneas. RESULTS: After 3 weeks, distribution of beta, integrin, and types VII and IV collagen was patchy; heavy deposits of fibronectin appeared subepithelially. Keratocytes stained for prolyl-4-hydroxylase and type I procollagen. With increasing postoperative time, fibronectin diminished, and beta 4 integrin and type VII collagen became linear, stromal staining of types III and IV collagen increased and their diminished. CONCLUSIONS: Components of basement membrane, attachment complexes, and stromal matrix are synthesized shortly after laser treatment. Changes in these elements persist for 16 months in the human cornea.

Human excimer laser keratectomy. Clinical and histopathologic correlations.

PURPOSE: To understand the healing capabilities of the diseased human cornea after excimer laser photoablation by morphologic analysis of laser-treated corneas. METHODS: Twelve corneal specimens were obtained 5 to 16 months after lamellar or full-thickness keratoplasty following phototherapeutic keratectomy for undercorrected myopic epikeratoplasty (2 eyes), corneal leukomas (2 eyes), herpes zoster corneal scarring (1 eye), band keratopathy (2 eyes), adenoviral subepithelial opacity (1 eye), keratoconus (1 eye), herpes simplex corneal scarring (2 eyes), granular corneal dystrophy (1 eye), and recurrent lattice dystrophy (1 eye). The morphology of the corneas was examined by light and electron microscopy. RESULTS: Epithelial hyperplasia, abnormal epithelial attachment, and disorganized stromal matrices were observed. Evidence of residual disease frequently observed in these specimens indicated that the pathology either was not excised at the time of laser keratectomy or was recurrent. CONCLUSIONS: The response of the diseased cornea to excimer laser treatment has similar characteristics to the responses previously observed in animal studies. Incomplete ablation of diseased tissue and/or recurrence of the initial disease was the major reason for failure of the treatment. Possible causes for the inability to remove diseased tissues and superficial scars with the excimer laser include (1) insufficiently achieved ablation depth and/or diameter and (2) decreased laser ablation rates of scarred cornea.

Lamellar keratoplasty performed with a corneal scleral button.

Tissue for lamellar corneal surgical procedures is usually harvested from whole eyes. We describe a surgical technique for the rehabilitation of corneoscleral defects with lamellar keratoplasty in which the donor tissue is obtained from a preserved corneoscleral button instead of a whole globe. This technique is illustrated with a case involving the treatment of a limbal dermoid in a 26-month-old boy.

A surgical technique for the treatment of central corneal perforations.

BACKGROUND: Generally, corneal perforations of 2 mm in diameter or greater are treated using graft material for tectonic support. A surgical technique for the primary repair of such perforations without the use of any additional tissue is presented. METHODS: This procedure is demonstrated by a case report. The technique involves creation of an elliptical defect out of a circular one, thus allowing for primary closure, with the addition of glue. A definitive penetrating keratoplasty was subsequently performed with several important modifications described herein. RESULTS: A water-tight closure was obtained with this technique for 1 month while the inflammation subsided. Preoperative visual acuity was light perception. One year postoperatively, it was count fingers at 8 feet with mild irregular astigmatism. CONCLUSION: This technique is useful for perforations which are central, larger than 2 mm in diameter, and when corneal or scleral material is not readily available for patch grafting.

Electron microscopic findings in a cornea with recurrence of herpes simplex keratitis after excimer laser phototherapeutic keratectomy.

Excimer laser phototherapeutic keratectomy is emerging as an alternative therapy to corneal transplantation for the treatment of multiple corneal diseases. We report three cases of recurrence of herpes simplex keratitis after treatment of herpetic corneal scars with the excimer laser. In two cases, the patients underwent subsequent corneal transplantation. One corneal button examined with transmission electron microscopy (TEM) demonstrated a well-differentiated epithelium over the area of ablation, a linear, continuous basal lamina, and no viral particles. Anterior stromal scarring may have resulted from the laser treatment itself or may represent incomplete ablation of previous scars. Whether reactivation of the virus was stimulated by the laser or occurred as part of the natural history of the disease is uncertain. We recommend that patients who undergo excimer laser treatment for herpes simplex scarring receive careful follow-up including antiviral coverage.

A prospective, randomized comparison of thermal cautery and argon laser for permanent punctal occlusion.

Permanent punctal occlusion was performed by two techniques on 27 patients (73 puncta). Patients were randomly assigned to be treated with either thermal cautery or argon laser for keratitis sicca. Follow-up assessment disclosed that the puncta to which thermal cautery was applied remained closed significantly longer than those to which laser treatment was applied (P < .05, log-rank test). Using time to recanalization of a punctum as the end point, we found a long-term advantage of thermal cautery over argon laser treatment.

Arcuate keratotomy for the correction of spherical hyperopia in human cadaver eyes.

BACKGROUND: A new experimental surgical technique to correct spherical hyperopia by steepening of the central corneal curvature was performed on human cadaver eyes. METHODS: Ten eyes were used in the study. All were pretreated with glycerin to ensure a uniform corneal thickness between .55 and .65 mm on ultrasonic pachometry. A constant intraocular pressure of approximately 30 to 40 mm Hg was maintained in each eye by the injection of saline into the vitreous cavity. This was verified by pneumotonometry. A vertical blade diamond knife was set at 100% of the thinnest of four paracentral readings. Each eye underwent preoperative computed topography. One set of five eyes had 12 incisions made following a 5.75-millimeter diameter Mendez hexagonal marker that included unconnected T incisions at each junction (ie, "Hex T" pattern). The other set of five eyes had four arcuate incisions made following a 6-millimeter diameter zone marker; each incision was 60 degrees in arc. Immediately after surgery, computed topography was repeated. RESULTS: The hexagonal keratotomy set of eyes had an average steepening of the cornea of 0.80 D with a range of -1.05 to + 4.38 D. The arcuate keratotomy set had an average steepening of +2.12 D with a range of +1.27 to +3.27 D. CONCLUSIONS: This study suggests arcuate keratotomy may be a more effective procedure in the correction of spherical hyperopia when compared with hexagonal keratotomy. The amount of corneal steepening achieved in a cadaver eye model may not be the same as when performed in vivo.

Subconjunctival fibrosis after conjunctival autograft.

While largely successful, the use of a conjunctival autograft in the exposed scleral bed following a pterygium excision can result in postoperative complications. We report two cases of a previously undescribed complication: subconjunctival fibrosis at the harvest site of the graft. In one case, the fibrosis caused an asymptomatic, purely cosmetic defect; however, in the other case, the scar tissue constricted the extraocular movement with resultant diplopia. We call attention to this complication as it can affect visual function; we discuss its management and prevention.