Bilateral and subcutaneous palmar nodules in a 2-year-old child suggesting deep granuloma annulare

Granuloma annulare is a benign, relatively common dermatosis in childhood. The subcutaneous form is rare, and lesions typically occur on the legs, buttocks and scalp. We report a case of a deep granuloma annulare confined to the palms of the hands in a 2-year-old child.     

Location of myocardium at risk in patients with first-time ST-elevation infarction: comparison among single photon emission computed tomography, magnetic resonance imaging, and electrocardiography

Background

The amount of myocardium at risk (MaR) during acute coronary occlusion and the duration of occlusion are important determinants of final infarct size. The main goal of early reperfusion therapy is to salvage ischemic myocardium, thereby preserving left ventricular function. The aims of the present study were to test the feasibility of developing polar plot representations of MaR, for perfusion single photon emission computed tomography (SPECT), regional wall thickening by magnetic resonance imaging (MRI), and distribution of ST-segment changes. A second aim was to test the hypothesis that these different modalities display similar localization of the MaR in patients with reperfused first-time myocardial infarction.

Methods

Eleven patients with first-time myocardial infarction with ST-elevation received ^99mTc tetrofosmin before primary percutaneous coronary intervention, SPECT imaging within 3 hours, and cardiac MRI of the left ventricle within 24 hours. The results for SPECT, MRI, and electrocardiogram (ECG) were developed into polar plots, and two expert observers designated the culprit coronary artery as assessed by angiography.

Results

The perfusion SPECT, MRI wall thickening, and ST changes are presented in side-by-side polar plots. In total, the culprit artery, based on the location of the MaR, was correctly designated in 91%, 82%, and 91% of cases by SPECT, MRI, and ECG, respectively.

Conclusions

Polar representation for localization of the MaR by SPECT perfusion, MRI wall thickening, and ECG ST-segment deviation is feasible. All 3 modalities have the potential to be used for indirect visual designation of the culprit artery in patients with first-time acute coronary occlusion.     

Development of an automated method for display of ischemic myocardium from simulated electrocardiograms

Background

Knowledge of the size and location of ischemic myocardium during acute coronary occlusion could provide decision support before reperfusion therapy. Electrocardiogram (ECG) scores based on the number of leads and the sum of ST-segment elevation have been unreliable in quantifying ischemia. We aimed to develop a new method to graphically display ischemic myocardium from simulated ECGs (DIMS-ECG) associated with known ischemic regions.

Methods

Twenty-one patterns of ischemia based on normal coronary anatomy were programmed into the freely available program ECGSIM (www.ecgsim.org). Minor variations of these patterns and 5 levels of ischemia severity produced 45 455 ECGs; 1000 normal ECGs were also added. Given a de novo ECG (an ECG from a patient), ST-segment and T-wave measurements are compared with ECG measurements in the database. The closest 200 matches are selected, and the corresponding ischemic areas are “averaged” to create a graphical display of the ischemic myocardium.

Results

Three patients are presented who underwent elective coronary angioplasty with continuous ECG recording and scintigraphically defined ischemic myocardium. Based on ECG analysis, the program graphically displays the ischemic myocardium with close agreement to the scintigraphic images. The program's source code and the ECG database will be made freely available.

Conclusions

The DIMS-ECG method graphically displays ischemic myocardium from information contained in the 12-lead ECG based on a novel approach to use a large simulated database instead of rule- or score-based method. After further development and testing, the DIMS-ECG method could be used to risk stratify patients with acute myocardial infarction.     

The effects of 50 Hz magnetic fields on opioid peptide mediated inhibition of guinea pig ileum

Strips of guinea pig ileum were mounted in a tissue bath within the poles of a magnet capable of generating a 50 Hz field of intensity up to 1 mT. In the absence of magnetic field the preparations were stimulated transmurally at tetanic frequency (10 Hz). The post-tetanic inhibition was antagonised by naloxone. When this inhibitory phase was repeated in the presence of a magnetic field of 0.5 mT there was a small but significant increase in the inhibition when compared with paired controls.