Modified Daggett's technique for early repair of postinfarct posterior ventricular septal rupture

A surgical modification for safe early repair of posterior septal rupture is described. This technique is based on the method described by Daggett, but adds one internal patch, plus the application of fibrin glue between the internal and external patch for minimizing bleeding. This modification is a simple and reliable one for repairing posterior ventricular septal rupture.     

Successful treatment of Novacor pump pocket infection by omental transposition

Device-related infection remains a major factor restricting the long-term use of left ventricular assist systems. Severe pocket infection is especially difficult to manage and removal of the device has been the only curative treatment in most cases. We report a case of a Novacor device pocket infection treated successfully with continuous local irrigation and transposition of omental flap. This procedure provides another option for the management of pocket infection, which is mandatory for destination therapy the permanent usage of LVAS for the purpose of circulatory supports in patients with end-stage heart failure, who are not indicated for heart transplantation.     

Optimal scan time for evaluating pancreatic disease with positron emission tomography using F-18-fluorodeoxyglucose

OBJECTIVE: Image interpretation in positron emission tomography (PET) using F-18-fluoro-2-deoxy-D-glucose (FDG) is usually performed for images obtained at 1 h postinjection (PI) of FDG, but it remains unknown whether this is the optimal time for imaging patients with pancreatic disease. The aim of this study was to assess the optimal scan time for FDG-PET for patients suspected of having pancreatic cancer. PATIENTS AND METHODS: Forty-four patients with suspected pancreatic cancer underwent FDG-PET scans at both 1 h and 2 h PI. Tracer uptake in the pancreatic lesions and possible liver metastasis was interpreted qualitatively, using a 5-point grading system (0 = normal, 1 = probably normal, 2 = equivocal, 3 = probably abnormal, and 4 = definitely abnormal) by 4 nuclear medicine physicians independently, who were blind to all clinical information. Detection performance with each image was compared using receiver operating characteristic (ROC) analysis. An average score of the 4 readers for each patient was also defined as consensus average index (CAI) and compared between the two images. RESULTS: ROC results indicated no significant differences in detection performance (Averaged areas under ROC curves of 1 h vs. 2 h were 0.92 vs. 0.90 for primary tumor, and 0.81 vs. 0.85 for liver metastases). There were no significant differences in CAIs between 1 h and 2 h PI images in interpreting primary tumor and positive liver metastases, but a significant difference was observed for cases without liver metastases (p < 0.05). CONCLUSIONS: The certainty of excluding liver metastases was increased when the 2h image was used, although ROC analysis did not establish a difference between 1 h and 2 h imaging for differentiating malignant and benign lesions in primary pancreatic cancer or its liver metastases.     

Determination of time of biologic fixation after anterior cruciate ligament reconstruction with hamstring tendons

BACKGROUND: It has been unclear when a hamstring tendon graft becomes biologically fixed in the bone tunnel after anterior cruciate ligament reconstruction. HYPOTHESIS: Postoperative biomechanical testing and magnetic resonance images can indicate biologic fixation of the graft in the femoral bone tunnel. STUDY DESIGN: Prospective cohort study. METHODS: Sixty-four patients were evaluated by serial biomechanical testing, magnetic resonance imaging, and second-look arthroscopy 2 years after surgery. Biologic fixation of the graft was confirmed radiographically by injecting a contrast medium into the femoral bone tunnel. RESULTS: Forty-two stable knees with graft fixation maintained a high stiffness (120% of normal) and showed low signal intensity in an early postoperative magnetic resonance image (12 +/- 8 months). Fourteen stable knees without graft fixation had gradually increased anterior displacement with nearly normal stiffness and high signal intensity. Five unstable knees with graft fixation retained low stiffness (70%) and showed late low signal intensity at 20 +/- 9 months. Three unstable knees without biologic fixation had rapidly increased anterior displacement, with half the stiffness of a normal knee. CONCLUSION: Postoperative low stiffness and high signal intensity might indicate late biologic graft fixation, predicting a possibility of postoperative anterior knee instability.     

The significance of prostate-specific antigen alpha-1-antichymotrypsin complex and its indices for the detection of prostate cancer

We examined the usefulness of prostate specific antigen alph-1-antichymotrypsin complex (PSA-ACT) and its indices for the detection of prostate cancer in patients with a prostate specific antigen (PSA) level between 2.1 and 10.0 ng/ml. Between July 1999 and October 2001, 151 patients with a PSA level between 2.1 and 10.0 ng/ml underwent a systematic biopsy under transrectal ultrasound (TRUS) guidance. The clinical values of total PSA, PSA-ACT, PSA density (PSAD), PSA-ACT density (PSA-ACTD), PSA transition zone density (PSATZD) and PSA-ACT transition zone density (PSA-ACTTZD) for the detection of prostate cancer were compared by using receiver operating characteristic (ROC) curve analysis. Of the 151 patients, 36 (23.8%) were histologically confirmed as having prostate cancer. The differences between patients with prostate cancer and benign prostatic disease were significant with respect to the PSA and PSA-ACT related parameters examined in this study. According to ROC curve analysis, the area under the curve (AUC) of PSA-ACTTZD was the greatest of all the parameters. The differences was significant between the AUC of PSA-ACTTZD and total PSA (p < 0.05). The cutoff value of PSA-ACTTZD with 0.20 ng/ml2 showed the highest sum of sensivitity (90%) and specificity (55%). Also, in 86 patients with a PSA level between 2.1 and 6.0 ng/ml, the AUC of PSA-ACTTZD was the greatest of all the parameters. Measuring the level of PSA-ACT and its indices may provide a better differentiation of prostate cancer and benign prostatic disease than total PSA alone in patients with intermediate PSA levels. PSA-ACTTZD is the most useful indicator among PSA-ACT and its volume indices.     

Anesthetic management of a patient with suspected pseudothrombocytopenia

A 74-year-old male was operated for sigmoid colon cancer. Because of an agglutination of the patient's platelet, it was difficult to measure his platelet count under ethylene diamine tetra acetate (EDTA), heparin or citrate as anticoagulants with an automated cell counter. Even though there was a strong possibility of pseudothrombocytopenia, anesthetic management for the patient was safely conducted. His condition was stable throughout the perioperative course and no bleeding tendency was observed. Nitrous oxide, oxygen, sevoflurane, propofol and pancuronium were useful in this case.     

Accelerated dynamic MR imaging with a parallel imaging technique for hypervascular hepatocellular carcinomas: usefulness of a test bolus in examination and subtraction imaging

PURPOSE: To assess the impact of the accelerated dynamic MR imaging (ADMRI) approach using parallel imaging for detecting hypervascular hepatocellular carcinomas (HCCs) and to evaluate the usefulness of a test bolus in examination and subtraction imaging in this setting. MATERIALS AND METHODS: Thirty patients with 135 HCCs underwent ADMRI using a two-dimensional gradient-recalled echo sequence with parallel imaging. Seventeen patients were evaluated without a test bolus and 13 patients with a test bolus. The detectability of HCCs was calculated between the groups with and without a test bolus. ADMRI was evaluated regarding the signal-to-noise ratio (SNR) of the lesion and the liver, the contrast-to-noise ratio (CNR) of the lesion vs. the liver, and the feasibility of subtraction images. RESULTS: ADMRI with and without a test bolus had almost equal sensitivity (92.5% and 92.6%). No significant difference was seen in the SNR of lesions and the CNR of lesions vs. livers between both groups. With a test bolus, ADMRI could depict the peak enhancement of nodules on the 2nd or 3rd dynamic phases and optimized the timing of peak lesion enhancement. Subtraction images could be obtained regarding minimal slice misregistration. CONCLUSION: ADMRI had high detectability of HCCs with and without a test bolus.     

Accuracy of image fusion of normal upper abdominal organs visualized with PET/CT

Although PET/CT scanners have the potential for precise fused registration of structures visualized on both PET and CT, physiological motion during the acquisition of both studies may alter the appearance of organ shape, size or location. The degree of possible mismatch in abdominal organ size and position between PET and CT has not been evaluated. The aim of this study was to assess the consistency in location and measured size of upper abdominal organs with PET and CT using a combined PET/CT system. Forty-six consecutive inpatients who underwent clinical PET/CT scans for suspected cancer were evaluated. CT and PET images attenuation corrected by both CT and germanium-68 transmission scans were obtained, and we separately determined the location of the top and bottom (height), anterior and posterior margins (thickness), and right and left margins (width) for each organ, including liver, spleen, and bilateral kidneys, using CT and both sets of PET images. Differences between the two modalities in terms of location and measured organ size were investigated. In the upper margin of the liver and lower margin of the spleen, more than 10% of the cases showed a larger discrepancy (>20 mm) between CT-based and Ge-corrected PET-based measurements, although the differences in the positions of the edges were less than 10 mm in most cases. The center of the liver tended to be located cephalad and to the right of the body, and that of the spleen tended to be cephalad and posterior on PET, as compared with CT. Moreover, the center of both kidneys tended to be seen cephalad, posterior, and to the right on PET. The liver appeared slightly larger on PET than CT in thickness (CT vs CT-corrected PET vs Ge-corrected PET = 156 mm vs 162 mm vs 162 mm) and width (186 mm vs 189 mm vs 188 mm). By contrast, the spleen appeared slightly smaller on PET than CT in height (84 mm vs 77 mm vs 80 mm) and width (85 mm vs 81 mm vs 80 mm). A similar tendency was observed in the left kidney (105 mm vs 100 mm vs 99 mm in height, and 64 mm vs 59 mm vs 58 mm in width) and the right kidney (99 mm vs 93 mm vs 93 mm in height, and 64 mm vs 59 mm vs 60 mm in width). These differences between the two modalities were statistically significant ( P<0.05). In conclusion, minor mismatches in location and organ size were found to exist between CT and PET images, in part due to physiological motion. Although these differences could potentially affect the quality of the image registrations, they were generally of a modest nature.     

Temporal changes in posterior laxity after isolated posterior cruciate ligament injury: 35 patients examined by stress radiography and MRI

We examined the temporal changes in posterior laxity and MRI findings in acute isolated posterior cruciate ligament (PCL)-injured knees. 35 patients with acute isolated PCL injuries who attended our clinic within 10 weeks of an injury underwent nonoperative treatment, and were chronologically evaluated for posterior laxity and MRI. We divided them in 3 groups, as regards the evolution of laxity and MRI findings. In 20 patients, the degree of posterior laxity was slight throughout the observation periods. In 9 patients, who had severe posterior laxity on their initial visit, the laxity had improved markedly 6 months after injury and did not deteriorate. In 6 patients the severe posterior laxity did not improve during the study. 4 patients whose PCL on MRI was seen as a continuous swollen band having high signal intensity and showed consistently good stability or even an improvement. We conclude that acute isolated PCL injuries with a continuous swollen band on MRI should be treated conservatively for at least 6 months after injury, even if the posterior laxity is severe initially.