A comparative study of short‐ and long‐TE 1H MRS at 3 T for in vivo detection of 2‐hydroxyglutarate in brain tumors

2‐Hydroxyglutarate (2HG) is produced in gliomas with mutations of isocitrate dehydrogenase (IDH) 1 and 2. The ¹H resonances of the J‐coupled spins of 2HG are extensively overlapped with signals from other metabolites. Here, we report a comparative study at 3 T of the utility of the point‐resolved spectroscopy sequence with a standard short TE (35 ms) and a long TE (97 ms), which had been theoretically designed for the detection of the 2HG 2.25‐ppm resonance. The performance of the methods is evaluated using data from phantoms, seven healthy volunteers and 22 subjects with IDH‐mutated gliomas. The results indicate that TE = 97 ms provides higher detectability of 2HG than TE = 35 ms, and that this improved capability is gained when data are analyzed with basis spectra that include the effects of the volume localizing radiofrequency and gradient pulses. Copyright © 2013 John Wiley & Sons, Ltd.     

Intraaortic balloon counterpulsation with and without reperfusion for myocardial infarction shock

Forty patients were treated for cardiogenic shock secondary to acute myocardial infarction. Twenty-one (group 1) were treated with intraaortic balloon counterpulsation and 19 (group 2) were treated with counterpulsation and coronary artery bypass grafting. The groups were similar in age, incidence of previous infarction, initial hemodynamics and coronary anatomy. The in-hospital mortality between group 1 (52.4%) and group 2 (42.1%) was not significantly different. The difference in long-term mortality between group 1 and group 2 was substantially different (71.4% vs 47.3%). The subset of group 2 (n = 12) that underwent reperfusion and counterpulsation within 16 hours from the onset of symptoms of infarction had a lower mortality (25.0%) than the subset (n = 7) that underwent operation more than 18 hours after the onset of symptoms (71.4%). The long-term mortality in the subset of group 2 patients operated on within 16 hours after the onset of infarction was significantly different from that in group 1 (25.0% vs 71.4%, p less than 0.03). The data suggest that reperfusion with counterpulsation is more effective when carried out early. Patients who develop shock more than 18 hours after the onset of symptoms of infarction appear to benefit most if treated with counterpulsation alone.     

Reversible cerebral vasoconstriction syndrome (RCVS): an interesting case report

BackgroundReversible Cerebral Vasoconstriction Syndrome is a condition of transient cerebral vascular spasms, which usually presents with recurrent thunderclap headaches and recovers within 3 months. Several probable triggers and underlying factors, such as sex hormones, vasoactive drugs, head trauma or surgery, and tumors, have been implicated.Case presentationIn this paper, we present a 53-year-old woman with thunderclap headaches and normal lab tests who was radio-clinically diagnosed with reversible cerebral vasoconstriction syndrome and treated accordingly. Then, she experienced the recurrence of RCVS after about 2 years and headaches after 1 year in association with high blood pressure, high blood sugar, hypothyroidism, hyperlipidemia, and a urine metanephrine level of 5 times higher than the normal limit, suggesting a diagnosis of pheochromocytoma. After confirmation of the diagnosis with further imaging studies, surgical removal of the tumor resolved all the signs and symptoms.ConclusionOften underdiagnosed, pheochromocytoma could be an important condition associated with RCVS. It is important for clinicians to bear this diagnosis in mind while dealing with similar cases of recurrent thunderclap headaches.     

Seroprevalence of Toxoplasma gondii infection in shepherd dogs from Sarab District,Northwest Iran

The aim of this study was to compile initial epidemiological data on the prevalence of Toxoplasma gondii antibodies in Sarab area. We evaluated the titers of anti-T. gondii antibodies by latex agglutination test (LAT; titer?>?1:64) serological test in 39 (10.1 %) serum samples from shepherd dogs exhibiting clinical signs of infectious diseases. The largest age group was 2–4 years, with 170 (44.3 %) dogs out of which only 21 dogs (12.3 %) were seropositive and the lowest age group was 4–6 years, with 87(22.6 %) out of which only 3 dogs (3.4 %) were seropositive. The highest rate of infection was seen in Ardaha village, with 11 (27.5 %) dogs. The lowest rate of infection was detected in Khaki and Asbfroshan villages, with only one dog. According to dog breed, the seropositivity rate of T. gondii was 14.3 % in pure breed dogs and 11.2 % in mongrel dogs. No sex or breed predispositions to T. gondii infection were detected during this serological assays (P?≤?0.05). The antibody titres of T. gondii ranged from 1:64 to 1:2,084. 39 Seropositive dogs with titers of 1:64 in 10, 1:128 in 13, 1:256 in 5, 1:512 in 6, 1:1,024 in 3, and 1:2,084 in 2 dog. In the present study, there was no correlation between antibody titers and, age or location. Our results show that presence and exposure of shepherd dogs to T. gondii in Sarab city confirm that dogs are exposed to T. gondii and play an important role in the epidemiology of T. gondii of this region.     

A rare sighting: left atrial appendage thrombus seen on transthoracic echocardiogram

The left atrial appendage(LAA)is the most common site of left atrial thrombus with more than 90％of thrombi formed within this structure.[1]Transesophageal echoc...     

Laparoscopic resection of cystic adenomyosis in a teenager with arcurate uterus

Whereas diffuse adenomyosis is a common finding in parous women, cystic adenomyosis causing severe dysmenorrhoea is very rarely reported and possibly under-diagnosed, particularly in adolescents. We report a case of juvenile cystic adenomyosis in a 19-year-old nulliparous patient presenting with secondary dysmenorrhoea and non-cyclical pain. A 20-mm adenomyotic cyst in the fundal myometrium was successfully excised laparoscopically by modified myomectomy. It is mandatory to take persistent primary and early secondary dysmenorrhoea seriously, especially after poor response to medical treatment and to have a low threshold for further investigations, because a diagnosis of cystic adenomyosis requires targeted therapeutic intervention.     

Robot-assisted catheter manipulation for intracardiac navigation

Objective  Manual navigation of intracardiac steerable catheters is inaccurate, requires dexterity for efficient manipulation of the catheter, and exposes the interventionalist to ionizing radiation. The objective of this research is to develop a system that replaces the interventionalists’s hands in catheter manipulation for accurate and semi-automatic tele-navigation of catheters. Methods  Based on a proposed kinematic model for the distal shaft of the catheter, a system has been developed for assisted navigation of intracardiac catheters. When the distal shaft of the catheter lies inside a cardiac chamber, a robotic apparatus is utilized for automatic steering of the catheter tip to reach designated targets within the chamber. Results  The catheter modeling was validated through the experiments on three swine. The robotic system could navigate the catheter tip to designated targets with a mean distance of 6.53 mm from the target. Conclusion  Preliminary in vivo studies demonstrate the feasible application of the system in catheter navigation and the validity of catheter modeling and control strategies.