Zur Localisation der Aphasien

Ohne Zusammenfassung     

Comparative Study of Breast Implant Rupture Using Mammography,Sonography, and Magnetic Resonance Imaging: Correlation with Surgical Findings

Abstract: Purpose of this study was to evaluate the accuracy of mammography, ultrasonography, and magnetic resonance imaging (MRI), in the detection of breast implant rupture and to make a correlation with findings at explantation. The study population consisted of 63 women with 82 implants, undergoing surgical explantation. Implant rupture status was blindly determined obtaining diagnosis of rupture, possible rupture, or intact implant. Strictly predetermined rupture criteria were applied and compared with findings at surgery, which were considered the gold standard. False‐positives and false‐negatives were retrospectively evaluated to identify pitfalls in the investigation. All associations between imaging signs and surgical findings were evaluated by using chi‐square test. The respective sensitivity and specificity of investigations are reported. Our experience suggests that MRI is the more accurate method for identification of breast implant rupture, even if it should be performed following the diagnostic algorithm proposed.     

Neuroimaging follow-up in a case of Rasmussen's encephalitis with dyskinesias.

We describe a case of adult-onset biphasic Rasmussen's encephalitis who presented seizures and left dyskinesias at the onset and, after 1 year, language disorder. Serial MRI and [(18)F] FDG-PET scans were performed showing involvement of the right cerebral hemisphere in the first phase and of the contralateral one in the second.     

Small lesions detectability with the Biograph 16 Hi-Rez PET/CT scanner and fast imaging protocols: performance evaluation using an anthropomorphic thoracic phantom and ROC analyses

Objectives

The purpose of this study was to evaluate the impact on lesion detectability of fast imaging protocols using ¹⁸F-FDG and a 3-dimensional LSO-based PET/CT scanner.

Methods

An anthropomorphic thoracic phantom was used simulating the anatomical structures of radioactivity distribution for the upper torso of an underweight patient. Irregularly shaped targets of small dimensions, the zeolites, were located inside the phantom in an unpredictable position for the observers. Target-to background ratios and target dimensions were selected in order to sample the range of detectability. Repeated imaging was performed to acquire PET images with varying emission scan duration (ESD) of 1, 2, 3 and 4 min/bed and background activity concentrations of 10, 5 and 3 kBq/mL in the torso cavity. Three observers ranked the targets and a receiver operating characteristic analysis was performed for each acquisition protocol.

Results

Detection performances improved when passing from a short (ESD = 1 min) protocol to longer (ESD ≥ 2 min) protocols. This improvement was established with adequate statistical significance.

Conclusions

Short image acquisition times of 1 min/bed using ¹⁸F-FDG and the specific scanner model considered in the study lead to reduced lesion detectability and should be avoided also in underweight patients.     

Melkersson–Rosenthal syndrome associated with parvovirus b19 viraemia and haemophagocytic lymphohistiocytosis

We describe a 23‐year‐old patient who presented acutely with haemophagocytic lymphohistiocytosis (HL) and Melkersson–Rosenthal syndrome (MRS). MRS and HL are two unusual and complex clinical patterns that may present acutely and to our knowledge, an association between them has never been reported. The clinical investigations in this patient led to identification of parvovirus B19 (PB19) viraemia by PCR. Parvovirus infection has been reported as a cause of virus‐associated HL, but the presence of PB19 has never been sought or reported as a possible trigger for MRS. This observation suggests a possible association between PB19 and HL, and opens the possibility of its association also with acute‐onset MRS. Further investigations for the presence of PB19 in cases of MRS are warranted.     

Basal left anterior oblique projection in 2-dimensional echocardiography: its usefulness in defects of the atrioventricular septum

The defects of the A-V septum have been recently classified into classes with separate orifices and classes with common orifice on the basis of the presence or not of a tissue tongue which joins the two bridging anterior and posterior leaflets as single differential feature. The diagnostic usefulness of the subxiphoid projection by conventionally called left oblique anterior basal has been evaluated. It indicates in a single plan-section the two bridging leaflets together with the connecting tongue. In 18 cases of defect of A-V septum echo-angiographic correlation was made. The 2D-echo diagnosed in 10 cases a defect of A-V septum with common orifice and in 8 cases a defect of A-V septum with separate orifices. On the contrary the angiocardiography pointed out in 9 cases a defect of A-V septum with separate orifices. Ten of the eighteen patients examined underwent an operation, which has always confirmed the echocardiographical diagnosis; even in the unique case of echo-angio disagreement the diagnosis of 2D-echo was confirmed. Therefore we propose the above-mentioned projection in order to obtain a more accurate non invasive definition in the defects of A-V septum.     

Long-term results of the surgical treatment of chronic ischemic mitral regurgitation: comparison of repair and prosthetic replacement

BACKGROUND AND AIM OF THE STUDY: The optimal management of chronic ischemic mitral regurgitation (CIMR) remains controversial. Herein, the authors reviewed the past 10 years of their experience to compare the long-term results of mitral valve repair with prosthetic replacement. METHODS: Between January 1993 and January 2003, 102 patients (mean age 67.8 years; range: 51-80 years) with a preoperative diagnosis of CIMR, underwent mitral valve repair (n = 61; 59.8%) or prosthetic replacement (n = 41; 40.2%), along with myocardial revascularization (2.5 +/- 1.0 distal anastomoses per patients, internal thoracic artery used in 78.5%). A Carpentier Classic ring was always used in the repair procedures. The two groups were homogeneous for preoperative characteristics and comorbidities. RESULTS: Total operative mortality was 7.8% (repair 8.2%; prosthesis 7.3%; p = NS). The five-year actuarial survival (operative mortality included) was 66.6 +/- 7.4% for repair and 73.4 +/- 8.7% for prosthesis (p = NS). Cox multivariate analysis showed as independent risk factor for late survival a preoperative left ventricular ejection fraction (LVEF) < or = 30% (RR 3.91; 95% CI = 1.47-10.38) and a preoperative pulmonary artery pressure (PAP) > or = 35 mumHg (RR 2.74; 95% CI = 1.07-7.02), while the type of mitral procedure was not significant. Patients with annular dilation as a mechanism of regurgitation were significant more likely to undergo repair rather than receive a prosthesis. Their preoperative LVEF and PAP were significantly worse than patients who had altered leaflet motion as a regurgitation mechanism. CONCLUSION: Prosthetic mitral replacement and valve repair offer very similar results for CIMR. When a perfect repair is not easily feasible, cardiac surgeons should not hesitate to perform mitral valve replacement, as it is an excellent alternative therapy, though long-term outcome is mainly dependent on preoperative condition.