Coronary artery-cardiac chamber shunt: cineangiographic analysis.

Coronary artery-cardiac chamber shunts (CA-CC shunts) were observed in 101 out of 2267 consecutive patients (4.5%) receiving selective coronary angiography. In these patients, contrast medium injected into the coronary artery escaped directly into the cardiac chamber. CA-CC shunts were angiographically classified into the following two types. Type I: The endocardial layer was diffusely opacified, and contrast medium escaped into the cardiac chamber on systole (n = 83). Type II: Contrast medium escaped directly into the cardiac chamber via an undilated branch (n = 11). Type I and type II shunts were observed simultaneously in 7 patients. It is speculated that type I is a shunt via a persistent arterio-sinusoidal vessel, while type II is a shunt via a persistent arterio-luminal vessel. Both types were observed frequently (24.9%) in hypertrophic cardiomyopathy. The degree of CA-CC shunts in hypertrophic cardiomyopathy was not influenced by the presence or absence of myocardial squeezing. CA-CC shunts are considered to be due to an abnormality in the coronary microcirculation of the myocardium. We describe the angiographic features of the two types of CA-CC shunt and discuss their pathophysiological significance.

[Radiosensitivity of soft tissue sarcomas].

The correlation between the effectiveness of radiation therapy and the histology of soft tissue sarcomas was investigated. Of 31 cases with a soft tissue sarcoma of an extremity treated by conservative surgery and postoperative radiation of 3,000-6,000 cGy, local recurrence occurred in 12; 5 out of 7 synovial sarcomas, 4 of 9 MFH, one of 8 liposarcomas, none of 4 rhabdomyosarcomas and 2 of 3 others. As for the histological subtyping, the 31 soft tissue sarcomas were divided into spindle cell, pleomorphic cell, myxoid and round cell type, and recurrence rates were 75%, 33.3%, 16.7% and 0%, respectively. From the remarkable difference in recurrence rate, it was suggested that round cell and myxoid type of soft tissue sarcomas showed a high radiosensitivity compared to the spindle cell type with low sensitivity. Clarifying the degree of radiosensitivity is helpful in deciding on the management of limb salvage in soft tissue sarcomas of an extremity.

Ultrasound and CT diagnosis of intramural duodenal hematoma.

An 8-year-old boy with traumatic duodenal hematoma is reported. Diagnosis is easy if one is familiar with its typical findings in modern imaging modalities.

[Effective radiation therapy of two cases of primary Ewing's sarcoma of the rib].

Two cases of primary Ewing's sarcoma of the rib are reported, in which radiation therapy was quite effective. Case 1 was an 18-year-old female who had had an operation and radiation therapy for Ewing's sarcoma of the left 7th rib. She was referred to our hospital after a recurrent tumor was found. Radiation therapy (tumor dose 46.2 Gy) and chemotherapy were given. The tumor disappeared and there has been no relapse for 1 year and 3 months after the treatment. Case 2 was a 2-year-old-infant. Radiation therapy (tumor dose 74 Gy) was given for primary Ewing's sarcoma of the left 6th rib. The tumor became small and was successfully removed at operation. There has been no relapse or distant metastasis for 8 months following the operation. We emphasize the importance of multidisciplinary treatment in case 1 and the usefulness of preoperative radiotherapy in case 2.

[Digital subtraction angiography of the coronary artery: evaluation of morphological aspects].

The usefulness of digital subtraction angiography (DSA) in coronary angiography was evaluated in terms of its ability to delineate the coronary artery and aortocoronary (A-C) bypass grafts. First, 59 intra-arterial injections of contrast media were made for 23 patients with ischemic heart disease. With aortic root injection, the proximal coronary artery was moderately well visualized, but visualization of the peripheral arteries was inadequate. By selective coronary injection, good images of the coronary arteries were obtained using small quantity of contrast media; however, detailed evaluations of the degrees of stenosis and collateral circulation were difficult, because of limitations in spatial resolution and misregistration artifacts due to cardiac pulsations. In addition, the patencies of 12 A-C bypass grafts were evaluated using intravenous (IV-) DSA for three cases and intraaortic (IA-) DSA for five cases. Ten grafts were shown to be patent. With IV-DSA, the graft was imaged as superimposed on the ascending aorta. In IA-DSA, a small (4F) catheter was introduced via the right brachial artery and advanced to the ascending aorta where an aortic root injection was performed. With aortic root injection, not only the anastomotic portion but also the distal native coronary artery were visualized. Lateral and severe left anterior oblique projections were best to visualize the grafts. IA-DSA using 4F catheter could be performed for outpatients without complications. The patency of a graft can be evaluated with the time density curve between two points in the graft, and the coronary blood flow can be calculated using the time density curve measurements and the diameter of the artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Initial pulmonary artery involvement in Takayasu arteritis.

Although the pulmonary artery is involved in many cases of Takayasu arteritis, few cases have been reported in which the pulmonary artery was initially involved. Two such cases are reported here. Both of these cases had been initially diagnosed as chronic pulmonary embolism. The importance of considering Takayasu arteritis in cases of chronic pulmonary arterial obstruction of unknown cause is emphasized. Bronchial-pulmonary artery communication and coronary-bronchial artery communication in Takayasu arteritis are also discussed.

[Postoperative radiotherapy with the electron beam in breast cancer].

The usefulness of postoperative radiotherapy for breast cancer was investigated in 152 patients. A dose of 50 Gy was given to the axillar, supraclavicular and internal mammary lymphnode areas using a 12 MeV electron and to the chest wall using a 6 MeV electron. The five and 10-year survival rates were 79.1% and 50.8%, respectively. The five-year survival rates according to the TNM staging were 100% for stage I, 78.4% for stage II, 58.8% for stage III and 0% for stage IV. The local recurrence rate was 8.8%, the metastasis rate was 33.1% and the recurrence rate in the ipsilateral supraclavicular regions previously treated by prophylactic irradiation was 2.6%, while it was 8.9% in the ipsilateral chest wall.