[Congestive heart failure caused by the thyroid stimulating hormone(TSH) secreting pituitary adenoma: report of two cases].

A 42-year-old man and a 31-year-old man with congestive heart failure caused by the thyroid stimulating hormone(TSH) secreting pituitary adenoma were reported. Heart failure was improved after transsphenoidal resection of the pituitary adenoma in each patient. The syndrome of inappropriate secretion of TSH causes hyperthyroidism. Thyroid hormone acts directly on cardiac muscle to increase the stroke volume. Hyperthyroidism itself reduces the peripheral vascular resistance and an elevated basal metabolism which is the basic physiologic change in hyperthyroidism dilates small vessels and reduces vascular resistance. The reduced vascular resistance contributes to increase stroke volume. Thyroid hormone also acts directly on the cardiac pacemakers to be apt to cause tachycardiac atrial fibrillation. These mechanical changes in hyperthyroidism increase not only the cardiac output but also the venous return. The increased blood volume and the shortened ventricular filling time due to tachycardia result in congestive heart failure. TSH secreting pituitary adenoma is a rare tumor, however heart failure is common disease. TSH secreting pituitary adenoma should be taken into consideration in patients with heart failure. The presented cases were very enlightening to understand the relation between brain tumor and heart disease.

[MR imaging of posterior cruciate ligament injuries].

Posterior cruciate ligament(PCL) injuries are less frequent than anterior cruciate ligament(ACL) injuries, but are presumably more common than once thought. Thirty-nine patients with PCL injuries identified on MR images were studied. The criteria for PCL injury were complete tear, partial tear, and avulsion fracture. The approximate site of a partial tear was categorized as proximal, midsubstance, distal, or combination. Fourteen patients(35.9%) had complete tears of the PCL, 21 patients(53.8%) had partial tears, and four patients(10.3%) had avulsion fractures. A total of 12 patients (30.7%) had isolated PCL injuries, while the remaining 27 patients demonstrated evidence of other coexistent knee injuries, such as meniscal tears and ligamentous injuries. Of coexistent knee injuries, meniscal tears(18 patients, 46.2%) were most often seen.

Prostatic abscess in young males: a rare complication of Crohn's disease.

We report a rare case of prostatic abscess with Crohn's disease in a 21-year-old male. Computed tomography showed a typical prostatic abscess. Moreover, filling of the abscess cavities with contrast medium was demonstrated after micturition, which represented the rupturing of the abscess into the urethra. Crohn's disease should be included in the differential diagnosis of prostatic abscesses even in young males.

Biopsy of lung nodules with use of I-I device under intermittent CT fluoroscopic guidance: preliminary clinical study.

PURPOSE: To investigate the efficacy of computed tomography (CT) fluoroscopy and a new needle holder (the I-I device) in lung nodule biopsy. MATERIALS AND METHODS: The I-I device is made of acrylate resin and was used to keep the entire needle in the tomographic plane. This study consisted of biopsies of 79 lung nodules in 77 patients. The final diagnoses were malignant in 54 patients, benign in 23, and unconfirmed in two. The biopsy procedure time from the beginning of the CT fluoroscopy procedure to the removal of the needle was measured for 24 needle passes. The radiation dose on the physician's hand was measured in five cases with use of a thermoluminescence ring. RESULTS: Fifty-one malignant and 20 benign lesions were correctly diagnosed with histologic specimens (90%). In 58 of 77 patients (75%), the biopsy procedures were completed within a single breath-hold. Pneumothorax occurred in 20 of 77 patients (26%) and chest tube insertion was required in five. The incidence of pneumothorax was significantly lower in patients who held their breath during biopsy procedures compared with those who did not (P < .0001; chi2 test). The biopsy procedure time ranged from 15 to 39 seconds (mean: 28.2 sec). The mean radiation dose on the physician's hand was 2 mSv/case. CONCLUSION: The diagnostic accuracy of biopsy with use of the I-I device under CT fluoroscopic guidance is comparable with that of the conventional method; however, a combination of CT fluoroscopy and the I-I device enables rapid biopsy procedures.

Current and future therapies for ischemic cerebrovascular disease.

Stroke is the third leading cause of death in the adult population. It makes great demands on patients, who must not only survive the complications of the acute stages but also must cope with the great physical and economic costs of long-term disabilities. Therefore, there is an urgent need to establish generally useful treatments for ischemic stroke. Currently, there are three treatment approaches based on pathophysiologic concepts derived from basic research: (i) pharmacologic strategies for arterial recanalization, (ii) neuronal protection and (iii) the inhibition of undesirable damaging host responses. The key to current treatment is the emergent administration of tissue plasminogen activator (t-PA). Thrombolytic treatment improves outcome when given to carefully selected patients within 3 h of stroke onset. Numerous neuroprotective agents have been developed in the last decade, and a new wave of therapies is now on the horizon that could potentially minimize ischemic brain damage. This article highlights recent advances in pharmacological interventions for ischemic stroke.

Bronchoarterial inversion: radiographic-CT correlation in combined right middle and lower lobe collapse.

Pulmonary arteries of the right middle (RML) and right lower (RLL) lobes lie toward the lung periphery relative to their corresponding bronchi, i.e., along their lateral or posterior aspects. In contrast, those of the right upper lobe (RUL) tend to be located along the medial or anterior aspect of the bronchi. We postulate that a reversal of the normal bronchoarterial relationship at the lung base may indicate combined RML and RLL collapse. We evaluated bronchoarterial relation by computed tomography (CT) and posteroanterior (PA) chest radiographs n patients with combined RML and RLL collapse. On PA chest radiographs, an inverse bronchoarterial relationship could be recognized in the lower perihilar region in seven of 10 patients. In the 10 patients with complete collapse of both the RML and RLL, CT disclosed that the normal bronchoarterial relationship of the RUL was preserved, despite caudal extension of the RUL. In no case were arteries visible along the lateral aspect of bronchi. Thus, on frontal radiographs, when the bronchoarterial relationship in the right lower lung is inverse to that of normal subjects, combined collapse is strongly suggested.

Early squamous cell carcinoma of the lung: CT and pathologic correlation.

PURPOSE: To study the factors that influence computed tomographic (CT) visibility of early squamous cell carcinoma, which was defined as a lesion confined to the bronchial wall without lymph node metastasis. MATERIALS AND METHODS: CT was performed in 18 patients with 18 early squamous cell carcinoma lesions. The 5.0-mm or thinner sections were reviewed independently by three observers who were aware of the bronchoscopic findings, and the visibility of the lesions was correlated with histopathologic findings. RESULTS: Tumors consisted of 13 flat and five polypoid lesions. Three of the lesions were epithelial, eight were subepithelial, and seven were cartilaginous or extracartilaginous. Eleven lesions were visualized at CT as an endobronchial mass or focal bronchial wall thickening. Lesions with polypoid growth and/or cartilaginous or extracartilaginous invasion were all visualized, even on 5-mm-thick sections. Subepithelial lesions could be demonstrated when located at bronchi with craniocaudal orientation. CONCLUSION: CT is a valuable tool for diagnosis of early squamous cell carcinomas, particularly when lesions show polypoid growth and/or invade the cartilaginous layer.

[Treatment of metastatic brain tumors: effect of surgery of multiple metastatic brain tumors and systemic metastasis with special reference to quality of life].

To assess the efficacy of surgical resection of brain metastases from patients with multiple brain metastases or/and with other systemic metastases, the authors analysed treatment results of 90 cases of metastatic brain tumors. The patients were divided into three groups. Group A (nine cases): Patients with single brain tumor and their primary cancers were well controlled. Their brain tumors were removed surgically and followed by radiation. Their mean survival time was 17.0 months, and 14.6 months were independent (Karnofsky score greater than or equal to 70) in cases of lung cancer. Five patients (55.6%) improved by treatment. Group B (21 cases): Patients with multiple brain metastases or/and with systemic metastases. Their brain tumor(s) which gave rise to neurological symptoms were surgically removed in order to improve their quality of life. In cases of lung cancer, mean survival time was 9.5 months and 7.1 months were independent. 11 patients (52.3%) improved by treatment. Group C (60 cases): Patients treated conservatively. Their mean survival time was 4.9 months and 2.7 months were independent in cases of lung cancer. Only 13 patients (21.7%) improved by treatment. However 23 (38.3%) deteriorated in their quality of life during treatment. Two patients of this group had single brain tumor and their primary cancers were controlled well. They refused surgery. Their mean survival time was 13.0 months, and 7.0 months were independent. These times were statistically shorter than group A. Seven patients had similar systemic and neurological states as those in group B. Their mean survival time was 5.0 months and 3.0 months were independent. These times were also statistically shorter than those in group B.(ABSTRACT TRUNCATED AT 250 WORDS)