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PubMed1986

Regional cerebral blood flow during interictal state: differences between temporal lobe epilepsy and primary generalized epilepsy.

Regional cerebral blood flow (rCBF) was investigated during interictal state by 133Xenon intravenous clearance technique in two groups of epileptic patients: group I (n = 28) having partial complex seizures (temporal lobe epilepsy); group II (n = 14) having generalized seizures (primary generalized epilepsy). Mean hemispheric CBF was decreased in group I and unchanged in group II compared to normal controls. Modifications in rCBF pattern were observed in group I but not in group II. A marked hypoperfusion of one temporal region was found in patients from group I showing a unilateral and fixed epileptic focus. Hypoperfusion of other cerebral areas at a distance from the epileptic focus was greater for patients with a left epileptic focus than for those with a right epileptic focus. Patients with the same severity of disease and bilateral and variable foci had no significant modification of mean hemispheric CBF and rCBF distribution. These observations indicate that interictal investigations of rCBF may be of interest for a differential classification of epilepsy.

Adolescent↗

PubMed2006

Differing myocardial response to a single session of hemodialysis in end-stage renal disease with and without type 2 diabetes mellitus and coronary artery disease.

BACKGROUND: Though hemodialysis (HD) acutely improves cardiac function, the impact of background diseases like coronary artery disease (CAD) and Type 2 diabetes (DM) in the setting of end-stage renal disease (ESRD) is not known. Tissue velocity echocardiography (TVE) offers a fast choice to follow changes in myocardial function after HD in ESRD with concomitant DM and /or CAD. METHODS: 46 subjects (17 with ESRD, Group 1; 15 with DM, Group 2; 14 with DM+CAD, Group 3) underwent standard and TVE prior to and shortly after HD. Besides standard Doppler variables, regional myocardial systolic and diastolic velocities, as well as systolic strain rate were post processed. RESULTS: Compared with pre-HD, post-HD body weight (kg) significantly decreased in all the three groups (51 +/- 9 vs. 48 +/- 8, 62 +/- 10 vs.59 +/- 10, and 61 +/- 9 vs. 58 +/- 9 respectively; all p < 0.01). Left ventricular end diastolic dimensions (mm) also decreased post- HD (46 +/- 5 vs. 42 +/- 7, 53 +/- 7 vs. 50 +/- 7, 51 +/- 7 vs. 47 +/- 8 respectively; all p < 0.01). Regional longitudinal peak systolic velocity in septum (cm/s) significantly increased post-HD in Group 1(5.7 +/- 1.6 vs. 7.2 +/- 2.3; p < 0.001) while remained unchanged in the other two groups. Similar trends were noted in other left ventricular walls. When the myocardial velocities (cm/s) were computed globally, the improvement was seen only in Group 1 (6.3 +/- 1.5 vs. 7.9 +/- 2.0; p < 0.001). Global early regional diastolic velocity (cm/s) improved in Group 1, remained unchanged in Group 2, while significantly decreased in Group 3(-5.9 +/- 1.3 vs. -4.1 +/- 1.8; p < 0.01). Global systolic strain rate (1/sec) increased in the first 2 Groups but remained unchanged (-0.87 +/- 0.4 vs. -0.94 +/- 0.3; p = ns) in Group 3. CONCLUSION: A single HD session improves LV function only in ESRD without coexistent DM and/or CAD. The present data suggest that not only dialysis-dependent changes in loading conditions but also co-existent background diseases determine the myocardial response to HD.

Adult↗

PubMed1993

Factors influencing 1-year patency of coronary artery saphenous vein grafts. Studio Indobufene nel Bypass Aortocoronarico (SINBA).

BACKGROUND: To evaluate the possible influence of a series of clinical angiographic and surgical variables on the 1-year patency of saphenous vein (SV) coronary graft, data collected prospectively in a multicenter randomized clinical trial were analyzed. METHODS AND RESULTS: The study group included 349 patients--847 SV distal anastomoses--who underwent angiography at a median time of 374 days after surgery. By logistic binomial regression analysis, age, sex, smoking habits, hypertension, high cholesterol, previous myocardial infarction, and angina were not found to be significant factors leading to graft occlusion. Among the angiographic and surgical variables, the following were retained as predictive of higher occlusion risk: (1) vessel diameter (< or = 1.5 mm versus > 1.5 mm, odds ratio (OR) = 2.46); (2) the location of the grafted vessel, namely, the right coronary artery versus the left anterior descending (OR = 2.15); and (3) the wall motion of the vessel-dependent myocardial region (altered versus normal: OR = 2.12). The presence of two or three risk factors multiplied the occlusion risk up to 11-fold. CONCLUSIONS: The study suggests that vessel diameter, wall motion of the vessel-dependent myocardial region, and location of the grafted vessel are the main determinants of SV coronary graft patency during the first postoperative year. Knowledge of these artery-specific factors may provide a basis for estimating the risk of graft occlusion, thereby modifying surgical strategy and postoperative surveillance.

Aspirin↗

PubMed2003

Investigating the generators of the scalp recorded visuo-verbal P300 using cortically constrained source localization.

Considerable ambiguity exists about the generators of the scalp recorded P300, despite a vast body of research employing a diverse range of methodologies. Previous investigations employing source localization techniques have been limited largely to equivalent current dipole models, with most studies identifying medial temporal and/or hippocampal sources, but providing little information about the contribution of other cortical regions to the generation of the scalp recorded P3. Event-related potentials (ERPs) were recorded from 5 subjects using a 124-channel sensor array during the performance of a visuo-verbal Oddball task. Cortically constrained, MRI-guided boundary element modeling was used to identify the cortical generators of this target P3 in individual subjects. Cortical generators of the P3 were localized principally to the intraparietal sulcus (IPS) and surrounding superior parietal lobes (SPL) bilaterally in all subjects, though with some variability across subjects. Two subjects also showed activity in the lingual/inferior occipital gyrus and mid-fusiform gyrus. A group cortical surface was calculated by non-linear warping of each subject's segmented cortex followed by averaging and creation of a group mesh. Source activity identified across the group reflected the individual subject activations in the IPS and SPL bilaterally and in the lingual/inferior occipital gyrus primarily on the left. Activation of IPS and SPL is interpreted to reflect the role of this region in working memory and related attention processes and visuo-motor integration. The activity in left lingual/inferior occipital gyrus is taken to reflect activation of regions associated with modality-specific analysis of visual word forms.

Adult↗

PubMed2002

Preoperative predictors of cancerous involvement of the neurovascular bundles in patients with localized prostate cancer.

BACKGROUND: The purpose of this study was to identify preoperative variables that would be useful in objectively selecting prostate cancer patients for nerve-sparing prostatectomy. METHODS: Twenty-six patients with clinical T1c-T2c cancers were evaluated for cancerous involvement in the region of the neurovascular bundles (NVB) from prostatectomy specimens. Preoperative prostate-specific antigen (PSA) and pathologic features in systematic biopsy specimens also were reviewed. RESULTS: A total of eight (31%) patients had cancerous involvement in the region of the NVB, including four on the right side, three on the left side and one on both sides. The percentage of each biopsy specimen occupied by the cancer was scored from zero to four and defined as the positive biopsy score. Preoperative PSA (P = 0.046), mean positive biopsy score (total sum of positive biopsy score divided by number of biopsy specimens; P = 0.001), number of cores containing cancer (P = 0.011), percentage of cores involved (P = 0.036) and maximum positive biopsy score (P < 0.001) were significant for predicting cancerous involvement in the NVB region using univariate analysis. However, only the mean positive biopsy score was independently significant according to multivariate analysis. To predict cancerous involvement in the region of each NVB, we found that ipsilateral mean positive biopsy score (total sum of corresponding positive biopsy score divided by number of ipsilateral biopsy specimens), number of cores involved on the ipsilateral side, percentage of cores involved on the ipsilateral side and maximum positive biopsy score on the ipsilateral side were significant predictive variables: the ipsilateral mean positive biopsy score being most appropriate for clinical practice. CONCLUSION: Ipsilateral mean positive biopsy score in systematic biopsy specimens can be an appropriate variable for selecting patients with localized prostate cancer for nerve-sparing prostatectomy.

Aged↗

PubMed2005

Measurement of cardiac time intervals by Doppler tissue M-mode imaging of the anterior mitral leaflet.

OBJECTIVE: We sought to evaluate a new method of measuring cardiac time intervals from Doppler tissue imaging (DTI) of the anterior leaflet of the mitral valve. BACKGROUND: For a reliable analysis of the regional cardiac performance by DTI, a reference of time intervals of global cardiac events in the same cardiac cycle and based on the same imaging modality is required to reduce measurement error. METHODS: We conducted a comparison of the measurements of isovolumic contraction and relaxation time and left ventricular (LV) ejection time by DTI M-mode analysis of the anterior mitral leaflet and the traditional approach based on spectral Doppler recordings. The measurements were done in 20 control subjects and 40 patients with cardiac diseases known to affect cardiac time intervals: heart failure, aortic stenosis, and essential hypertension with LV hypertrophy. RESULTS: Mean difference in milliseconds (95% limits of agreement) of measurements were not different overall (-0.20 [-10.58; 10.18], -1.95 [-16.66; 12.76], 1.48 [-8.34; 11.34], and 0 [-0.06; 0.07] for isovolumic contraction time, LV ejection time, isovolumic relaxation time, and calculated index of myocardial performance, respectively). Intraobserver variability was low. Analysis of patients with different categories of cardiac diseases confirmed the expected values for time intervals and index of myocardial performance. CONCLUSIONS: Measurement of isovolumic periods and LV ejection time was feasible and reliable by DTI M-mode analysis of the anterior mitral valve leaflet. The DTI method can, therefore, be used for obtaining information of global events in the cardiac cycle from the same heart beat as used for analysis of regional cardiac performance.

Aged↗

PubMed2005

Quantification of resting myocardial blood flow velocity in normal humans using real-time contrast echocardiography. A feasibility study.

BACKGROUND: Real-time myocardial contrast echocardiography (MCE) is a novel method for assessing myocardial perfusion. The aim of this study was to evaluate the feasibility of a very low-power real-time MCE for quantification of regional resting myocardial blood flow (MBF) velocity in normal human myocardium. METHODS: Twenty study subjects with normal left ventricular (LV) wall motion and normal coronary arteries, underwent low-power real-time MCE based on color-coded pulse inversion Doppler. Standard apical LV views were acquired during constant IV. infusion of SonoVue. Following transient microbubble destruction, the contrast replenishment rate (beta), reflecting MBF velocity, was derived by plotting signal intensity vs. time and fitting data to the exponential function; y (t) =A (1-e(-beta(t-t0))) + C. RESULTS: Quantification was feasible in 82%, 49% and 63% of four-chamber, two-chamber and apical long-axis view segments, respectively. The LAD (left anterior descending artery) and RCA (right coronary artery) territories could potentially be evaluated in most, but contrast detection in the LCx (left circumflex artery) bed was poor. Depending on localisation and which frames to be analysed, mean values of beta were 0.21-0.69 s(-1), with higher values in medial than lateral, and in basal compared to apical regions of scan plane (p = 0.03 and p < 0.01). Higher beta-values were obtained from end-diastole than end-systole (p < 0.001), values from all-frames analysis lying between. CONCLUSION: Low-power real-time MCE did have the potential to give contrast enhancement for quantification of resting regional MBF velocity. However, the technique is difficult and subjected to several limitations. Significant variability in beta suggests that this parameter is best suited for with-in patient changes, comparing values of stress studies to baseline.

Adult↗

PubMed1990

Brain protection of nicergoline against hypoxia: EEG brain mapping and psychometry.

In a double-blind, placebo-controlled trial human brain function and mental performance as well as the antihypoxidotic properties of nicergoline were studied utilizing blood gas analysis, EEG brain mapping and psychometry. Hypoxic hypoxidosis was experimentally induced by a fixed gas combination of 9.8% oxygen (O2) and 90.2% nitrogen (N2) equivalent to 6,000 m altitude, which was inhaled for 23 min under normobaric conditions by 16 healthy volunteers. They received randomized after an adaptation session placebo, 10 mg, 30 mg and 60 mg nicergoline (NIC). Evaluation of blood gases, brain mapping and psychometry was carried out at 0, 2, 4, 6, 8 hrs oral drug administration. Blood gas analysis demonstrated a drop in PO2 from 95 to 35 and 34 mm Hg in the 14 and 23 min of inhalation, respectively. PCO2 decreased too (38 to 34 and 34 mm Hg), while pH increased (7.39 to 7.44 and 7.44). Base excess increased (-0.6 to 0.6 and 0.4) while standard bicarbonate decreased (24.4 to 24.1 and 23.8 mmol/l). Thus, blood gases remained stable between the 14 and 23 min of hypoxia during which time the neurophysiological and behavioral evaluations were carried out. EEG brain mapping exhibited an increase in delta/theta activity mostly over the parietal, temporal and central regions (left more than right), while alpha activity decreased (mostly over the parietal, central, frontal, fronto-temporal and temporo-occipital regions). 30 and 60 mg NIC attenuated this deterioration of vigilance. At the behavioral level, hypoxic hypoxidosis induced a deterioration of the noo- and thymospsyche which was mitigated by NIC. Based on 13 psychometric variables, the hypoxia-induced performance decrement was on the overall (2nd-8th hr) 43% after placebo as compared with pretreatment normoxic values, while only 29, 24 and 31% after 10, 30 and 60 mg nicergoline, respectively. The difference between placebo and the optimal dosage of nicergoline 30 mg reached the level of statistical significance (p less than 0.01, multiple Wilcoxon).

Adult↗

PubMed1994

Prolonged wall motion abnormalities after chest pain at rest in patients with unstable angina: a possible manifestation of myocardial stunning.

Although myocardial "stunning" would be expected to occur in unstable angina, there is no published report in which the recovery of regional left ventricular function was serially monitored in this syndrome. To determine whether the time course of the regional wall motion abnormalities associated with unstable angina is consistent with myocardial stunning, 20 consecutive patients with unstable angina were studied prospectively. Regional left ventricular wall motion was assessed by two-dimensional echocardiography during or immediately after angina at rest and at serial times thereafter. Six of the 20 patients fulfilled the inclusion criteria. The recovery of segmental wall motion after chest pain was consistently found to be delayed in all six patients, but a considerable variability was observed. In at least two subjects, the improvement was rapid and the wall motion abnormalities disappeared almost completely within 2 hours after the chest pain. Both of these patients had the shortest duration of angina (approximately 10 minutes). In contrast, in three other patients with longer duration of chest pain, the improvement was slower and significant wall motion abnormalities were still present at 24 hours after the chest pain. In five control patients who had angiographically-documented coronary artery disease but no recent episode of angina, there was no significant change in segmental wall motion during a period of observation equivalent to that used in the unstable angina group. This study evaluated for the first time the time course of wall motion abnormalities in patients with unstable angina. The results demonstrate that angina at rest is followed by a prolonged depression of contractile function, which may persist for up to 24 hours or even longer. Because none of the patients had evidence of acute myocardial infarction or recurrent ischemia, our observations suggest myocardial stunning as the pathophysiologic substrate for the slow recovery of wall motion. The present results are consistent with the concept that myocardial stunning does occur in unstable angina and indeed may be a component of the natural history of this disorder; however, further investigations using simultaneous measurements of function and flow will be necessary to unequivocally distinguish myocardial stunning from hibernation and silent ischemia.

Angina, Unstable↗

PubMed2006

Multiple brain networks for visual self-recognition with different sensitivity for motion and body part.

Multiple brain networks may support visual self-recognition. It has been hypothesized that the left ventral occipito-temporal cortex processes one's own face as a symbol, and the right parieto-frontal network processes self-image in association with motion-action contingency. Using functional magnetic resonance imaging, we first tested these hypotheses based on the prediction that these networks preferentially respond to a static self-face and to moving one's whole body, respectively. Brain activation specifically related to self-image during familiarity judgment was compared across four stimulus conditions comprising a two factorial design: factor Motion contrasted picture (Picture) and movie (Movie), and factor Body part a face (Face) and whole body (Body). Second, we attempted to segregate self-specific networks using a principal component analysis (PCA), assuming an independent pattern of inter-subject variability in activation over the four stimulus conditions in each network. The bilateral ventral occipito-temporal and the right parietal and frontal cortices exhibited self-specific activation. The left ventral occipito-temporal cortex exhibited greater self-specific activation for Face than for Body, in Picture, consistent with the prediction for this region. The activation profiles of the right parietal and frontal cortices did not show preference for Movie Body predicted by the assumed roles of these regions. The PCA extracted two cortical networks, one with its peaks in the right posterior, and another in frontal cortices; their possible roles in visuo-spatial and conceptual self-representations, respectively, were suggested by previous findings. The results thus supported and provided evidence of multiple brain networks for visual self-recognition.

Adolescent↗

PubMed2003

EEG differences in ADHD-combined type during baseline and cognitive tasks.

This study examines the relation between neurologic, behavioral, and performance indicators of attention-deficit-hyperactivity disorder. Twenty-three males age nine to 11 years with attention-deficit-hyperactivity disorder, including symptoms of hyperactivity, and 23 matched controls served as participants. Differences between groups were investigated using referential 19-channel quantitative electroencephalogram, behavioral rating scale data, and continuous performance test data. Results from the behavioral data were consistent with previous research. Behavioral ratings for participants with attention-deficit-hyperactivity disorder were significantly more negative than controls. Control participants performed significantly better on the continuous performance test, with fewer errors, faster reaction times, and less variability in reaction time. Electroencephalogram results indicated differences between participants with attention-deficit-hyperactivity disorder and control participants primarily in the alpha bandpass, with evidence of increased alpha in posterior regions during baseline for the group with attention-deficit-hyperactivity disorder. Additionally, participants with attention-deficit-hyperactivity disorder manifested decreased alpha in left frontal regions when reading. The results are discussed in terms of possible differences in electroencephalographic data as a function of degree of hyperactivity, as well as the impact of task specificity on the electroencephalogram.

Attention Deficit Disorder with Hyperactivity↗

PubMedDate not supplied

[Biological markers of schizophrenic symptoms: functional neuroimaging].

Despite heterogeneous phenotype, lack of pathognomonic symptoms and great variability of symptoms during the course of the illness, functional neuroimaging studies have showed specific patterns of activation associated to particular schizophrenic symptoms or symptom dimensions. Negative symptoms have been associated to hypofrontality; auditory hallucinations seem to be related to abnormalities in brain regions involved in language and, reality distortion dimension has been associated to left temporal lobe impairments.

Biomarkers↗

PubMed2005

Quantitative assessment of regional myocardial function in mice by tissue Doppler imaging: comparison with hemodynamics and sonomicrometry.

BACKGROUND: Tissue Doppler imaging (TDI) is a novel echocardiographic method to quantify regional myocardial function. The objective of this study was to assess whether myocardial velocities and strain rate (SR) could be obtained by TDI in mice and whether these indices accurately quantified alterations in left ventricular (LV) systolic function. METHODS AND RESULTS: TDI was performed in 10 healthy mice to measure endocardial (v(endo)) and epicardial systolic velocities and SR. In further experiments, TDI indices were compared with dP/dt(max) and with sonomicrometer-derived regional velocities, at rest and after administration of dobutamine or esmolol. TDI indices were also studied serially in 8 mice before and 4 and 7 hours after endotoxin challenge. Myocardial velocities and SR were obtained in all mice with low measurement variability. TDI indices increased with administration of dobutamine (v(endo) from 2.2+/-0.3 to 3.8+/-0.2 cm/s [P<0.01]; SR from 12+/-2 to 20+/-2 s(-1) [P<0.05]) and decreased with administration of esmolol (v(endo) 1.4+/-0.2 cm/s [P<0.05]; SR 6+/-1 s(-1) [P<0.01]). Both indices correlated strongly with dP/dt(max) (r2=0.79 for SR and r2= 0.69 for v(endo); both P<0.0001). SR and shortening fraction were predictors of dP/dt(max) even after adjustment for the confounding effect of the other variables. V(endo) correlated closely with sonomicrometer-measured velocity (r2=0.71, P<0.0005). After endotoxin challenge, decreases in both v(endo) and SR were detected before decreases in shortening fraction became manifest. CONCLUSIONS: Myocardial velocities and SR can be measured noninvasively in mice with the use of TDI. Both indices are sensitive markers for quantifying LV global and regional function in mice.

Animals↗

PubMed2000

Influence of age and cardiovascular factors on regional pulsed wave Doppler myocardial imaging indices.

AIMS: To describe the influence of age and other cardiovascular factors on regional pulsed wave Doppler myocardial imaging (DMI), and to compare DMI with conventional transmitral echocardiography and the atrioventricular plane displacement (AVPD) method. METHODS AND RESULTS: Eighty-eight healthy subjects aged 20-81 years were examined by DMI, performed in the intraventricular septum just below the mitral annulus and in the corresponding lateral region, by transmitral pulsed wave Doppler echocardiography, and by AVPD. The DMI peak velocity during the left ventricular (LV) early filling phase (e), decreased with age from 12.3 +/- 2.3 cm/s in the youngest to 7.0 +/- 1.7 cm/s in the oldest tercentile (r=- 0.76, P<0.001). The DMI peak velocity during atrial contraction (a), increased from 7.5 +/- 2.2 cm/s in the youngest to 9.7 +/- 1.7 cm/s in the oldest tercentile (r=0.41, P<0.001). The DMI systolic peak velocity (s), decreased with age from 8.2 +/- 1.1 (youngest tercentile) to 6.9 +/- 1.1 (oldest tercentile), r=-0.39, P<0.001 cm/s, while the fraction shortening of the LV increased from 33.7 +/- 4.1 to 38.2 +/- 5.9% (r=0.36, P<0.01). The DMI e/a correlated with the transmitral early/atrial (E/A) (r=0.83, P<0.001) and with the AVPD measurement of diastolic function AV-LA/AV-mean (r=0.82, P<0.001). The DMI e velocity correlated with the transmitral E velocity (r=0.38, P<0.001). In the multiple regression analysis of DMI e, age was the strongest factor and LV mass index correlated inversely and independently with e. No DMI variables were influenced by gender, while transmitral E correlated with gender. The LV dimension variables explained 35% (R2 adjusted) of the DMI e velocity changes; only 7% of the transmitral E changes were explained by those variables. CONCLUSION: Regional DMI indices are highly age-dependent. In comparision with conventional echocardiography, regional DMI might be more influenced by LV geometry and by myocardial structural changes. These findings suggest a complementary role for regional DMI to conventional echocardiography for the assessment of myocardial function.

Adult↗

PubMed1995

Angiotensin-I converting enzyme genotypes and left ventricular hypertrophy in patients with hypertrophic cardiomyopathy.

BACKGROUND: The variability of the phenotypic expression of left ventricular hypertrophy (LVH) in patients with hypertrophic cardiomyopathy (HCM) indicates a potential role for additional modifying genes. Variants of angiotensin-I converting enzyme (ACE) gene have been implicated in cardiac hypertrophy. To assess whether ACE genotypes influence the phenotypic expression of hypertrophy, we determined the left ventricular mass index (LVMI) and extent of hypertrophy in 183 patients with HCM. METHODS AND RESULTS: LVMI was derived by the area-length method using two-dimensional echocardiograms. Extent of LVH was determined by a point score method (1 to 10 points). DNA was extracted from blood, and ACE genotyping was performed by polymerase chain reaction (PCR) with an established protocol. Amplification of DNA in the region of polymorphism by PCR of alleles I and D showed 490- and 190-bp products, respectively. ACE genotypes DD, ID, and II were present in 60, 90, and 33 patients with HCM, respectively. In genetically independent patients (n = 108), the mean LVMI (g/m2) was 148 +/- 35.3 in those with DD (n = 35) and 134.2 +/- 33.3 in those with ID and II (n = 73) genotypes (P = .046). LVH score was 6.69 +/- 1.71 in patients with DD and 5.55 +/- 2.19 in those with ID and II genotypes (P = .004). Regression analysis showed that ACE genotypes accounted for 3.7% and 6.5% of the variability of LVMI and LVH score (P = .046 and P = .008, respectively). In 26 patients from a single family, LVMI and LVH score were also greater in patients with DD than in those with ID and II genotypes. ACE genotypes accounted for 14.7% and 10.4% of the variability of the LVMI and extent of hypertrophy, respectively. CONCLUSIONS: ACE genotypes influence the phenotypic expression of hypertrophy in HCM.

Adult↗

PubMed1992

Neuro-ophthalmological function of patients with pineal region tumors approached transtentorially in the semisitting position.

To optimize orientation and operative exposure for aggressive resection, the authors approached pineal region tumors transtentorially with the patient in a semisitting position. In the current report, 12 consecutive patients were evaluated to document operative ocular morbidity referable to the brain stem as well as visual deficits secondary to occipital lobe retraction. Before craniotomy, ophthalmological findings related to dorsal midbrain dysfunction were evident in four of the 10 patients who had previously undergone ventricular shunting. The other patients developed a partial or complete Parinaud's syndrome in the early postoperative period and some suffered additional deficits such as cranial nerve palsies. These deficits improved to varying degrees in all patients. Although each had full visual fields preoperatively, an absolute or incomplete left homonymous hemianopsia developed in the immediate postoperative period. Such visual field deficits fully resolved over a variable period of time in 10 of the 12 patients. One patient has a permanent left homonymous hemianopsia, while another has a left homonymous paracentral scotoma. Eight patients were able to return to preoperative pursuits. While ocular abnormalities related to dorsal midbrain dysfunction are most probably independent of operative approach, visual field deficits attributable to occipital lobe retraction were common in patients after a occipital transtentorial approach performed in the semisitting position. Reading difficulties associated with ocular motor dysfunction due to dorsal midbrain involvement represent the principal long-term neuro-ophthalmological complaint of patients who have undergone pineal region surgery.

Adolescent↗

PubMed1997

Variability in frame by frame analysis of left ventricular wall motion from contrast angiograms.

BACKGROUND: Measurement of the timing of left ventricular (LV) wall motion, of asynchrony, and of diastolic function from contrast angiograms requires delineation of the endocardial border frame by frame through the cardiac cycle. This study was performed to determine the magnitude of intraobserver and interobserver variability in manual border tracing, and to measure the impact of this variability on the derived functional parameters. METHODS: The contrast ventriculograms of 25 patients with coronary artery disease (CAD) or with normal coronary arteries were analyzed frame by frame, by two observers or twice by the same observer. Motion was measured using the centerline method at each twelfth of systole and of diastole. Variability was calculated as the absolute difference between repeated measurements of: wall motion, asynchrony, and the time at which each region of the LV reached 10%, 50%, and 100% of peak contraction, and 50% of filling. RESULTS: Intraobserver and interobserver variability in wall motion were similar, and varied with time in the cycle, and with location on the LV contour. Variability was highest at end systole, when it averaged 8% of the normal mean for wall motion. Variability in timing was highest at peak contraction; however, the variability in measuring asynchrony averaged only 18 msec. CONCLUSION: Analysis of the magnitude and synchrony of regional LV wall motion through the cardiac cycle from contrast ventriculograms can be performed with reproducibility comparable to that at end systole.

Aged↗

PubMed1989

Anatomic findings in dicephalic conjoined twins: implications for morphogenesis.

The morphogenesis of conjoined twins is incompletely understood. We therefore conducted a postmortem study of dicephalus dibrachii dipus conjoined twins. The twins were born without pertinent history or prenatal diagnosis at 38 weeks and lived for several hours. External genitalia were female and partly duplicated; a caudal appendage was present in the thoracolumbar region. The heart and liver were shared and exhibited major abnormalities in configuration. Four lungs, three kidneys and adrenal glands, and two spleens were identified; biliary and upper gastrointestinal tracts appeared as mirror images. From these findings, we postulate three major sets of consequences arising from the anatomical disposition of the twin notochords ("paleoaxes"). 1) The degree of convergence/divergence of craniocaudal paleoaxes is variable. Convergences are maximal in the upper thoracic and sacral regions, where duplication of organs in minimal because of interaction aplasia. 2) In the horizontal plane, paleoaxes are sufficiently divergent to produce a degree of twin expression posteriorly, whereas anteriorly they converge to form a single, anterior, midline "neoaxis." Interposed between these zones of paleoaxial and neoaxial expression are areas of variable interaction aplasia. 3) The left twin was in situs solitus; the right twin was in situs inversus in a manner resembling polysplenia.

Abnormalities, Multiple↗