Images in cardiovascular medicine. Takayusu's arteritis involving the abdominal aorta and renal arteries.
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Biomedical subjects
Publications and source records attributed to S C Reddy.
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Aneurysm of the membranous ventricular septum causing subpulmonic obstruction in patients with corrected transposition is rare but well documented. Higher left-sided (morphologic right) ventricular pressure causes protrusion of the aneurysm into the pulmonary outflow tract of the right-sided morphologic left ventricle, causing obstruction related to lack of conus and proximity of the aneurysm to subpulmonary region. Echo Doppler studies and angiography are useful in making a correct diagnosis. Surgical resection of the aneurysm along with closure of the ventricular septal defect is the treatment of choice. The prognosis is likely to be excellent.
In a prospective study of 325 patients with adult rheumatoid arthritis, ocular complications were seen in 73 patients (22.4%). Keratoconjunctivitis sicca was the most common ocular lesion. Other lesions were episcleritis, scleritis, marginal thinning of the cornea with keratolysis, stromal corneal opacities with peripheral vascularisation, and iridocyclitis. The mean duration of the arthritis and the mean duration of seropositivity were found to be significantly higher in patients with ocular complications. Physicians should include ophthalmic examination as a routine in their protocol for patients with rheumatoid arthritis to facilitate early diagnosis and treatment of ocular complications.
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Osteosarcoma is the most common primary malignant tumour of bone and it usually metastasises to the lung. In the nasal cavity metastatic disease is extremely rare. We describe a case of osteosarcoma presenting with recurrent epistaxis, and proptosis due to secondaries in the nasal cavity. To our knowledge such a case has not been reported previously in the available English literature.
The associations between retinal findings and haematological parameters in acute leukaemia are controversial. Sixty-three newly-diagnosed acute leukaemia patients, aged 12-77 years, were studied prospectively for the presence of intra-retinal haemorrhages (IRH), white-centred haemorrhages (WCH), cotton wool spots (CWS) and macular haemorrhages (MH), Thirty-three patients (52.4%) showed at least one retinal abnormality. The prevalence of individual findings was: IRH (30 cases), WCH (20 cases), CWS (5 cases), MH (11 cases). In contrast to previous studies, there was no association between any of these retinal findings and the haemoglobin level or the platelet count. There was a higher median WBC in patients with IRH (68 x 10(9)/l) than in those without IRH (15.4 x 10(9)/l), P = 0.037. When the acute myeloblastic leukaemia cases were considered separately, an association was also found between higher WBC and the presence of WCH and CWS. There was no association between retinal findings and FAB type in the AML cases. We conclude that a high WBC may be at least as important as anaemia and thrombocytopenia in the pathogenesis of the retinopathy of acute leukaemia.
The periaqueductal gray (PAG) plays a central role in the integration of defense responses to threatening or stressful stimuli. Little is known about the neurochemical development of the human PAG around the time of birth, when the fetus makes the transition to extrauterine life and independent defense responses are needed. We analyzed receptor binding to selected neurotransmitters implicated in PAG function in 7 fetuses (19 to 26 gestational weeks), 9 infants (38 to 74 postconceptional weeks), 1 child (4 years), and 3 adults (20 to 68 years). Tissue autoradiography was used with radioligands for opioid, nicotinic, muscarinic, kainate, and serotoninergic receptors. By midgestation, binding to nicotinic, muscarinic, serotoninergic, opioid, and kainate receptors is already localized to the human PAG. The subsequent developmental profiles are unique for each radioligand. Binding to nicotinic and serotoninergic receptors decreases significantly from the fetal to mature periods, but at different tempos. In contrast, there is no significant change from midgestation to infancy for muscarinic, kainate, and opioid binding: between infancy and the mature period there is a downward trend in binding for muscarinic and kainate receptors and an upward trend for opioid receptors. This study provides baseline information about the neurochemical development of the human PAG in early life. This information is of value in considering the neurochemical substrate of the maturation of defense responses in human infancy, and in evaluating potential neurochemical disorders of the developing human PAG.
Transcatheter occlusion of ostium secundum atrial septal defects (ASD) with the buttoned device has been shown to be feasible, effective, and safe. The final decision to implant the device is largely based on the balloon sizing of the ASD during cardiac catheterization. Only subjective criteria of ASD size and the septal rims on echocardiography have been used before catheterization, balloon sizing, and transcatheter occlusion. The purpose of this study was to determine whether objective echo criteria could be developed to predict successful occlusion of the ASD. During a 46-month period ending August 1992, 29 children with secundum ASD were evaluated for transcatheter occlusion. The device was successfully implanted in 15 (group A); in the remaining 14 children, this procedure could not be performed (group B). Preocclusion echos were analyzed by independent investigators who had no knowledge of outcome of the procedure. Echo parameters studied included size of ASD, length of atrial septum (LAS), and size of the superior and inferior rims in precordial and subcostal views and maximum jet width by color flow mapping. From these measurements several ratios were derived, and the data were compared. A smaller (p < 0.05) ASD was present in the group of patients with successful implantation of the device; LAS was similar (p > 0.1) in both groups. A lower (p < 0.05) ratio of ASD to LAS and a higher (p < 0.05) ratio of the superior and inferior septal rims to ASD were associated with the group of patients with successful implantation of the device.(ABSTRACT TRUNCATED AT 250 WORDS)
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The upper eyelid crease height pretarsal skin and eyebrow height were studied in 305 Malay subjects (146 males and 159 females) varying in age from 2-80 years, who were randomly selected from the residents of Kota Bharu, Kelantan. In females, from the age of 11 years the mean pretarsal skin height increased progressively with age. In males, however, it decreased with age up to 60 years. In both sexes, subjects more than 60 years old showed highest values for pretarsal skin height. The mean eyelid crease height increased progressively with age from 11 years onwards in males but not in females. The mean eyebrow height increased with age in females but not in males. Eyebrow and eyelid measurements seem to show a definite racial variation. Besides establishing normal values for eyelid and eyebrow measurements in Malays, our findings indicate that age and sex should be taken into consideration to achieve satisfactory results in cosmetic eyelid surgery in Malays.
Recent echocardiographic ABD algorithms can estimate LV volume on-line from a single long-axis plane. The objective of this study was to assess the capability and limitations of transesophageal ABD to estimate stroke volume and cardiac output in patients before and after coronary artery bypass surgery by correlating these data with simultaneous thermodilution measurements. ABD data were acquired on-line from the transverse-plane four-chamber view and the longitudinal-plane two-chamber view and calculated by automated area-length and Simpson's rule formulas for volume. Thirty-three studies were attempted in 18 patients. Technically adequate ABD data were available in all patients from at least one view. Twenty-two (67%) of 33 studies from the four-chamber view and 27 (82%) of 33 studies from the two-chamber view were technically adequate. Cardiac output by all ABD methods was significantly correlated with thermodilution values (r range 0.72 to 0.89; SEE range 0.48 to 0.55 L/min). The two-chamber view underestimated cardiac output slightly, by an average of 0.4 L/min, whereas the four-chamber view consistently underestimated cardiac output by an average of 1.9 L/min. The area-length and Simpson's rule algorithms produced similar results. Biplane transesophageal ABD is an alternative method for estimating cardiac output; the two-chamber view in particular has potential for on-line volume determination.
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The case report of a young patient with recurrence of intraventricular thrombus represents an unusual presentation with no apparent clinical explanation despite echocardiographic, surgical, and pathologic confirmation. The other unusual feature of this case is the absence of predisposing factors for intraventricular thrombus. The patient developed the second left ventricular thrombus after he stopped taking anticoagulants. The authors' recommendation for such a patient is that he continue to receive anticoagulants for life.
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Ovarian vein thrombophlebitis is often misdiagnosed because of vague symptoms leading to unnecessary surgery, morbidity, and mortality. CT findings in such a case are very useful in making a definite diagnosis of ovarian vein thrombophlebitis. We consider CT the preferred method for evaluating pain in the right lower quadrant associated with a mass in the postpartum patient.
Abdominal complications of ventriculoperitoneal shunts include fluid collections and migration of the peritoneal end of the shunt tube, producing a wide spectrum of symptoms and signs. Cross-sectional imaging methods have proved to be very useful in the early diagnosis of these complications. I have described the diagnosis and management of an unusual case of intrahepatic abscess from migration of a ventriculoperitoneal shunt.
Combined procedure was performed in 25 eyes and triple procedure in 32 eyes of Fuchs' dystrophy. Pre-operative visual acuity was 20/100 or less in 63.2% of eyes. The graft was clear in 76% of combined procedure and in 97% of triple procedure eyes. Post-operative visual acuity of 20/40 or better was obtained in 57.9% of eyes. The common cause of graft failure was allograft reaction. The other causes attributable to visual failure were opacification of posterior capsule, secondary glaucoma, macular degeneration and pre-existing glaucomatous cupping. Intraocular lens insertion at the time of surgery helps in rapid visual rehabilitation.