Coronary venous aneurysm in patients without cardiac arrhythmia as detected by MDCT: an anatomic variant or a pathologic entity.

OBJECTIVES: The aim of this study was to determine the prevalence of coronary venous aneurysm in patients with no history of cardiac arrhythmia using 64-slice multidetector computed tomography. BACKGROUND: Coronary vein aneurysm frequently has been reported in association with cardiac arrhythmias such as ventricular pre-excitation. METHODS: Coronary computed tomography angiograms of 187 patients (108 men, 79 women; mean age +/- SD, 60 +/- 12 years) were analyzed retrospectively for the presence of a focal coronary venous aneurysm. Fusiform aneurysm was defined as a focal dilatation of twice the normal vein. However, any size of diverticular aneurysms was included. Cross-sectional diameters of normal and aneurysmal segments of the posterior interventricular vein, great cardiac vein, and coronary sinus (CS) were measured at mid-diastole, late systole, and atrial systole. The Student t test was used for continuous variables and contingency tables were used for categorical variables. RESULTS: A single aneurysm was found in 19 (10%) patients (fusiform, n =16; diverticular, n = 3). The most common anatomic location was the posterior interventricular vein near the confluence with the CS (n = 14), followed by the great cardiac vein near the junction with the CS (n = 3), and the CS (n = 2). The mean diameter of the aneurysms was 9.3 +/- 1.2 mm (range, 8.1 to 11.4 mm) at mid-diastole and 10.4 +/- 1.4 mm (range, 8.5 to 12.7 mm) at late systole. However, the difference was not statistically significant. All normal CSs and 1 aneurysm arising from the CS showed contraction during atrial systole, which may suggest atrial myocardial coverage of these structures. Patients with a venous aneurysm were significantly older than patients without an aneurysm (67.6 +/- 11 vs. 59 +/- 12 years, respectively; p = 0.006). CONCLUSIONS: Coronary vein aneurysms (especially the fusiform type) were seen in up to 10% of patients with no history of cardiac arrhythmia and can be well visualized on computed tomography angiograms.

Orthopaedic management of the upper extremity of stroke patients.

Cerebrovascular accidents often produce significant pathology, including upper extremity muscle contractures and deformities that may be painful and aesthetically unappealing and that interfere with activities of daily living and hygiene. Orthopaedic intervention may be required to manage these disabilities. Nonsurgical management includes brachial plexus and phenol nerve blocks, which provide temporary relief of painful contractures and allow for a period of spontaneous neurologic recovery of up to 6 months. Definitive surgical procedures should be avoided during this time. After this period, surgical management can be valuable in releasing muscle spasticity, managing painful contractures, and positioning the deformed extremity in a more functional and aesthetically appealing position. Current surgical management is directed at reducing or eliminating muscle spasticity and joint contractures, with the goal of correcting deformities in shoulder adduction, elbow flexion, forearm pronation, wrist and finger flexion, intrinsic muscle spasticity, thumb-in-palm deformity, wrist extension, and finger extension.