Retroclival epidural hematoma secondary to decompressive craniectomy in cerebellar infarction: MR demonstration

A simple and rapid methodology for the preparation of single-cell suspension from animal tissues is described. It uses a device called a "tissue press" to mince the tissue into small pieces of desired sizes which are then dissociated into single cells using a pipette. The device is inexpensive and the method economizes time and labor. An example of its use in DNA double-strand breaks study, using microgel electrophoresis, is described.     

Haemoptysis associated with pulmonary varices: demonstration using computed tomographic angiography

A 67 yr old female with mitral stenosis presented with an acute haemoptysis caused by the rupture of pulmonary varices. Chest radiography and bronchoscopy showed nonspecific abnormalities. The diagnosis of this rare but potentially lethal complication was made using computed tomographic angiography with three-dimensional volume rendering.     

Anomalous systemic arterial supply to the basal segment of the left lung: demonstration using MR angiography

Open reduction with internal stabilization is considered to be the standard therapy for the treatment of displaced acetabular fractures. The internal fixation is routinely achieved by the use of plates and screws. The use of cerclage wires and cables as a reduction aid and definitive implant for stabilization has only occasionally been reported in the literature. The indication was mostly limited to use in elderly patients with insufficient bone stock. A newly instrument developed on the basis of a standard bone elevator is presented. It allows a safe, semiclosed application of a cerclage wire around the greater ischiatic notch through use of the second window of the ilioinguinal approach. A wide dissection at the "outside" of the pelvis is not necessary.     

MR angiography in the preoperative evaluation of abdominal aortic aneurysms: a preliminary study

PURPOSE: The ability of magnetic resonance (MR) angiography to depict visceral and renal vessels was evaluated in patients with abdominal aortic aneurysms (AAAs). PATIENTS AND METHODS: MR sequences (sagittal T1-weighted, two-dimensional coronal, and three-dimensional axial time-of-flight) were compared in a prospective blinded fashion with conventional angiograms obtained preoperatively in 23 patients with AAAs. Results were correlated with surgical findings when available. RESULTS: Operative aortic clamp site was correctly predicted with conventional angiography in 95% of patients and with MR angiography in 86% (P > .1). Aneurysm neck measurements obtained with the two modalities were within 1 cm in 91% of cases. With conventional angiography as the standard of reference, 96% of all renal arteries were identified on MR angiograms but 36% of accessory arteries were missed. MR angiography enabled identification of patients who had at least one renal artery stenosis greater than 50% with a sensitivity of 100% and specificity of 89%. For identifying individual renal artery, celiac artery, and superior mesenteric artery stenoses of similar severity, the sensitivity and specificity were 67% and in excess of 96%, respectively. The celiac artery could not be evaluated in one case. CONCLUSION: The results of this small study suggest that the role of MR angiography in the preoperative evaluation of AAA warrants further investigation.     

Ampullary carcinoma: demonstration by current MR techniques

Rheumatoid arthritis (RA) is characterised by chronic inflammation of synovial tissue with aggressive proliferation of synovial cells causing destruction of cartilage and bone. Immunopathological mechanisms, infectious causes and genetic factors have been discussed, but the etiology of the disease has not been understood until now. Especially, the mechanisms driving tumourlike growth and invasive behaviour of fibroblastoid synovial cells have not been identified yet. Our aim is to find cellular factors which are mediators for such pathways. One possibility to approach this, is searching for disease-relevant genes. We applied the mRNA-differential display technique to compare mRNA expression patterns of normal and rheumatic synovial fibroblasts. We identified an upregulation of the human semaphorin E gene in rheumatoid synovial fibroblastoid cells. Interestingly semaphorin E is a member of a protein-family described to play an immunosuppressive role via inhibition cytokines. A relevance of this finding towards the pathogenesis of RA is discussed.     

Adult intussusception: demonstration by current MR techniques

We describe magnetic resonance findings in three patients with small bowel intussusception from different etiologies including idiopathic, adenomatous polyps, and hamartomatous polyps. Magnetic resonance findings showed a bowel-within-bowel appearance in two patients and a coiled-spring appearance in one patient. These findings were best shown on T2-weighted images, and clear definition was present on breathing independent T2-weighted images using half fourier acquisition snap shot turbo spin echo T2-weighted images.     

Magnetic resonance imaging and MR angiography of endoluminally treated abdominal aortic aneurysms

Molecular biology has provided various new insights into the mechanisms operative in the pathogenesis of rheumatoid arthritis. Reflecting the unique character of rheumatoid synovium, advances have been achieved addressing the molecular changes taking place at the area of interaction between the aggressively growing synovium and the articular cartilage and bone. Key issues in the review period addressing this interaction were hyperplasia of rheumatoid arthritis synovium, mechanisms of activation and cell cycle regulation of synovial fibroblasts, pathways of synovial attachment to cartilage and bone, and the regulation of matrix-degrading enzymes.     

MR angiography of aneurysms in Beh?et disease: a report of four cases

Two new pregnane-type steroidal alkaloids, saligcinnamide [(20S,2'E)-20-(N,N-dimethylamino)-3beta-(3'-phenyl-2'-propenyl-N-meth ylamido)pregnane](1) and N(a)-methyl epipachysamine-D [(20S)-20-(N,N-dimethylamino)-3beta-(N-methylbenzamido)pregnane](2 ), along with a known base, epipachysamine D [(20S)-20-(N,N-dimethylamino)-3beta-(benzamido)pregnane] (3), were isolated from the EtOH extracts of the roots and stems of Sarcococca saligna. The new bases exhibited antibacterial activity against several human pathogenic bacteria. Two derivatives of 1, dihydrosaligcinnarnide [(20S)-20-(N,N-dimethylamino)-3beta-(3'-phenylpropionoyl-N-meth ylamido)pregnane](4) and dihydrosaligcinnamine [(20S)-20-(N,N-dimethylamino)-3beta-N-(3'-phenylpropyl-N-methylamino)pre gnane](5), and a derivative of 2, N(a)-methyl epipachysamine [(20S)-20-(N,N-dimethylamino)-3beta-(N-benzyl,N-methylamino)pregnane](6) were prepared and their antibacterial activity determined.     

Bilateral pulmonary artery aneurysms in a patient with Behcet syndrome: evaluation with radionuclide angiography and V/Q lung scanning

The case of a 14-year-old girl with Behcet syndrome is described. Besides painful and recurrent oral ulcerations, the patient had a cough and intermittent hemoptysis. The initial chest roentgenogram revealed bilateral parahilar opacities. CT and MRI scans of the thorax showed bilateral thrombosing aneurysms of the pulmonary arteries. Pulmonary blood flow imaging was performed after technegas ventilation lung scanning and Tc-99m MAA injection using a first-pass radionuclide angiography procedure. Altered blood flow in the left pulmonary artery was shown. Bilateral and well-defined ventilation/perfusion mismatched areas suggested a high probability of pulmonary embolism. Little additional information was obtained on subsequent contrast pulmonary angiography. The high incidence of pulmonary artery hypertension and associated vascular injury risk makes pulmonary angiography an unsafe procedure in patients with pulmonary Behcet syndrome. The need for pulmonary angiography could be obviated in such cases with the use of high-precision MRI and ventilation/perfusion lung scanning, including radionuclide pulmonary angiography.     

Thoracic aortic dissection that wasn't: CT demonstration of probable paradoxical embolus secondary to unsuspected pulmonary embolus

A patient presented with chest pain, cyanosis and acute ischaemia of the left arm. Aortic dissection was considered to be the likely diagnosis. CT demonstrated multiple large pulmonary emboli and a serpiginous thrombus occluding the origin of the left subclavian artery. Venous thrombosis was proven. The sudden onset of cyanosis followed immediately by a systemic arterial embolus with morphology typical of a venous source was very likely the result of transforaminal shunting induced by massive pulmonary emboli. Post-mortem studies have demonstrated a high incidence of asymptomatic patent foramen ovale in normal individuals. Using contrast echocardiography techniques, any physiological or pathological rise in right heart pressure increases the likelihood of right to left transforaminal shunting of blood or embolic material.     

MR angiography with ultrashort echo time in cerebral aneurysms treated with Guglielmi detachable coils

We evaluated a time-of-flight three-dimensional MR angiographic sequence with an ultrashort echo time for its ability to characterize the perfusional state of cerebral aneurysms that had been treated with Guglielmi detachable coils and to depict adjacent cerebral arteries. The results were compared with findings at conventional MR angiography and digital subtraction angiography. Adjacent vessels were seen better in 36% of patients imaged with the new technique. Both MR angiographic methods detected residual cerebral aneurysmal perfusion with a tendency to overestimate the patent portion of the aneurysm.     

Progressive venous occlusion in a neonate with Sturge-Weber syndrome: demonstration with MR venography

Progressive cerebral sinovenous occlusion in a neonate with Sturge-Weber syndrome was documented by using two-dimensional time-of-flight MR venography. There was no evidence of intraluminal thrombus on routine spin-echo images obtained either before or after the onset of seizures, despite MR venographic evidence in both studies of venous abnormalities.     

Aortocaval fistula: diagnosis with MR angiography

A case of intramuscular hemangioma (large vessel type) occurring in an eighteen year old woman is described. Medical history reported a pulled muscle in the same region 5 years earlier. By needle biopsy was performed the diagnosis of hematoma evolved to sclerosis. Since pain persisted the neoplasia was removed. Intramuscular hemangioma is a benign neoplasia. Recurrences are always due to incomplete excision. Angiosarcomas and liposarcomas are the two tumors to be differentiated from hemangiomas of skeletal muscle. The relative paucity of cases combined with widespread histological pictures make the diagnosis very difficult.     

MR angiography: basic principles and theory

The most commonly used MR angiography techniques are categorized as time-of-flight, phase-contrast, or contrast-enhanced methods. When the basic principles of the various MR angiographic methods are understood, the techniques can be used to achieve high-quality angiograms. This article describes the physical principles and theory of some of the most widely used MR angiographic methods.     

Bronchial carcinoid tumor: demonstration by dynamic inversion recovery turbo-flash MR imaging

A 38-year-old woman was referred to our hospital following the discovery of a right hilar mass on chest radiograph. Retrospectively, a hilar mass could be seen on a chest X-ray which had been obtained 5 years earlier. A coronal dynamic inversion recovery turbo-FLASH gadolinium-enhanced sequence was performed, demonstrating the right lesion which enhanced during the systemic arterial phase indicating an arterial supply from the bronchial arterial circulation. The surgical and pathological findings were a bronchial carcinoid tumor, with foci of bone formation.     

Intracranial aneurysms: detection and characterization with MR angiography with use of an advanced postprocessing technique in a blinded-reader study

PURPOSE: To assess magnetic resonance (MR) angiography for the detection and characterization of angiographically proved intracranial aneurysms by using an advanced method of postprocessing, in a blinded-reader study. MATERIALS AND METHODS: One hundred fifty-eight vessels were examined with catheter angiography and three-dimensional time-of-flight MR angiography in 44 patients with 63 aneurysms and 15 patients with no aneurysm at catheter angiography. Postprocessing was performed off-line with an advanced multifeature-extraction, ray-tracing algorithm. MR angiograms were interpreted independently by three neuroradiologists blinded to the catheter angiographic results for presence, location, size, and morphology of the aneurysm. Proof of diagnosis was consensus reading of catheter angiograms. RESULTS: Mean sensitivity for detection of aneurysms was 75% (range, 70%-79%). As a screening tool (ie, detection of at least one aneurysm necessitating catheter angiography), mean sensitivity was 91% for all aneurysms and 95% for aneurysms larger than 3 mm. This method was not adequate for detection of lobulation or size of aneurysm. CONCLUSION: MR angiography with an advanced method of postprocessing can result in highly sensitive, specific studies for the diagnosis of intracranial aneurysms that are of sufficient size to be considered for surgical treatment, but it is inadequate for characterization of aneurysms.     

Three-dimensional respiratory-gated MR angiography of coronary arteries: comparison with conventional coronary angiography

OBJECTIVE: MR coronary angiography is most often performed using two-dimensional techniques. Although three-dimensional (3D) acquisitions do have important advantages, they take too long for a single breath-hold and are thus susceptible to respiratory motion artifacts. The purpose of this study was to investigate the accuracy of a unique respiratory-gated 3D MR angiographic technique in identifying the proximal coronary arteries in patients suspected of having coronary artery disease. In addition, we investigated the capability of this technique to detect proximal stenoses. SUBJECTS AND METHODS: We performed a prospective blinded study in 20 patients who were referred for conventional coronary angiography. A cardiac-gated 3D gradient-echo sequence with fat suppression was used. Retrospective respiratory gating was performed using navigator echoes of the diaphragm position. Using multiplanar reformatting, two independent readers blindly analyzed the data sets for visualization of major coronary arteries, lengths of imaged segments, and detection of significant stenoses (> 50% occlusion of the luminal diameter by conventional angiography). RESULTS: Seventy-seven of 80 (96%) coronary arteries were positively identified. In one patient, an anomalous coronary anatomy was readily identified and confirmed by conventional angiography. The average lengths of the imaged segments of the right, left main, left anterior descending, and left circumflex coronary arteries were 58 +/- 13 mm, 9 +/- 5 mm, 59 +/- 16 mm, and 24 +/- 10 mm, respectively. Overall sensitivity for the detection of stenoses was low (38%), with a specificity of 95%. Interobserver agreement was 0.92, with a kappa value of 0.65. CONCLUSION: Respiratory-gated 3D MR angiography allows accurate identification of proximal coronary arteries and may be valuable for 3D imaging of coronary anomalies. Further technical improvements are required to enhance the value of the technique in detecting stenoses.     

Aortic and lower-extremity arterial disease: evaluation with MR angiography versus conventional angiography

BACKGROUND: Few data are available regarding the impact of improved depression treatment on daily functioning and disability. METHODS: In two studies of more intensive depression treatment in primary care, patients initiating antidepressant treatment were randomly assigned to either usual care or to a collaborative management programme including patient education, on-site mental health treatment, adjustment of antidepressant medication, behavioural activation and monitoring of medication adherence. Assessments at baseline as well as 4 and 7 months included several measures of impairment, daily functioning and disability: self-rated overall health, number of bodily pains, number of somatization symptoms, changes in work due to health, reduction in leisure activities due to health, number of disability days and number of restricted activity days. RESULTS: Average data from the 4- and 7-month assessments in both studies, intervention patients reported fewer somatic symptoms (OR 0.68, 95% CI 0.46, 0.99) and more favourable overall health (OR 0.50, 95% CI 0.28, 0.91). While intervention patients fared better on other measures of functional impairment and disability, none of these differences reached statistical significance. CONCLUSIONS: More effective acute-phase depression treatment reduced somatic distress and improved self-rated overall health. The absence of a significant intervention effect on other disability measures may reflect the brief treatment and follow-up period and the influence of other individual and environmental factors on disability.