Echographic Detection of Latent Severe Thrombotic Stenosis of the Superior Vena Cava and Innominate Vein in Patients with a Pacemaker: Integrated Diagnosis Using Sonography, Pulse Doppler, and Color Flow

Thrombosis of the innominate vein and SVC is a serious complication in patients with pacemakers, inducing puhnonary embolism or SVC syndrome. Venography is the definitive method for its diagnosis; however, it is too invasive for related studies. The purpose of this study was to validate sonography, pulse Doppler, and color flow in detecting noninvasively innominate vein or SVC thrombosis in patients with pacemakers. In 53 patients with pacemakers, the 1 severe SVC stenosis and 18 severe innominate vein stenoses due to thrombosis were diagnosed by digital subtraction angiography. Sonography accurately showed the severe SVC stenosis due to thrombosis, but had limitations on the innominate vein thrombosis. Color flow demonstrated mosaic flow, indicating poststenotic turbulence due to stenosis of the innominate vein and SVC caused by thrombosis in 15 of 16 patients, and pulse Doppler disclosed absence of flow due to complete occlusion of the innominate vein in 2 of 2 patients. Sensitivity and specificity for detecting severe innominate vein stenosis due to thrombosis using combined color flow and pulse Doppler was 94% and 100%, respectively. In conclusion, sonography, pulse Doppler, and color flow allow accurate detection of severe innominate vein or SVC stenosis due to thrombosis, and are therefore useful for the follow-up of patients with a pacemaker.     

Usefulness of contrast-enhanced ultrasound for the diagnosis of recurrent renal cell carcinoma in contralateral kidney

We studied contrast-enhanced ultrasound (CEU) for recurrence of renal cell carcinoma (RCC) at the contralateral kidney during postoperative follow up of localized renal cell carcinoma. CEU successfully detected all recurring cases, despite the fact that 5/6 cases were observed using conventional ultrasound; the remaining one case was not detected using conventional ultrasound. CEU using Levovisto successfully revealed renal tumors as RCC. Lesions were diagnosed as cystic renal tumors by Bosniac classification, and pathological findings demonstrated RCC, in accordance with the prior tumor.     

Catheter Ablation of Ventricular Tachycardia in Patients with Right Ventricular Dysplasia: Identification of Target Sites by Entrainment Mapping Techniques

Objective: To identify target sites for radiofrequency ablation of ventricular tachycardia (VT) by entrainment mapping techniques in patients with arrhythmogenic right ventricular dysplasia. Methods: Entrainment mapping and radiofrequency ablation of eight VTs was performed in seven patients. Radiofrequency ablation was applied at 31 reentry circuits sites that were classified based on findings during entrainment. Results: By entrainment criteria the 31 sites were classified as: exit sites (n = 12), proximal sites (n = 6), and outer loop sites (n = 13). Radiofrequency current application terminated VT at 7 of 31 sites: 2 of 12 exit sites (17%), 4 of 6 proximal sites (67%), and 1 of 13 outer loop sites (8%). Conclusion: Radiofrequency ablation terminated VTs most often at sites proximal to the exit as opposed to outer loop sites and exit sites (P = 0.05). The critical isthmus for ablation of VT in right ventricular dysplasia often may be distant to the exit.     

Comparison of Restenosis Rate in Various Devices for Coronary Intervention: Analysis Using Vessel Diameter and Lesion Length

The purpose of this study was to retrospectively compare the restenosis rates related to vessel diameter and lesion length among plain old balloon angioplasty (POBA), cutting balloon (CB) angioplasty, Palmaz-Schatz (PS) stems, Gianturco-Roubin (GR) stents, and directional coronary atherectomy (DCA). In 909 consecutive successfully treated cases, target lesion dimensions were divided into diameters of ± 2.5 mm and lengths of ± 20 mm to compare the restenosis rates obtained by the individual devices. Quantitative angiographic analysis was performed before the procedure, after the procedure, and at FU angiography at a mean FU time of 6 ± 3 months. Restenosis was defined as %DS > 50 at FU angiography. Patients with acute myocardial infarction, chronic total occlusions, left main lesions, ostial as well as venous graft lesions, severe calcifications, severe coronary thrombosis, and bleeding complications were excluded. The overall restenosis rate was 32%, with the CB it was 29%, with the PS stent it was 27%, and with DCA it was 39%. Each of these restenosis rates was significantly lower than that with POBA. The overall restenosis rate with short lesions at small vessels was 35%, while CB angioplasty yielded 29%, being significantly lower compared to that obtained by POBA. The overall restenosis rate with long lesions at small vessels was 53%. With those lesions there was no significant difference among the devices. The overall restenosis rate with short lesions at large vessels was 27%, with CB angioplasty it was 24%, with the PS stent it was 22%, and with DCA it was 25%. These restenosis rates were significantly lower compared to POBA. With long lesions at large vessels, the overall restenosis rate was 44%. In this subgroup, there was again no significant difference among the devices. Our study suggests that restenosis rates with short lesions are lower after CB angioplasty, stenting, and DCA, when compared to POBA. However, in the presence of long lesions, no difference was found among the devices.     

Sagittal spinal alignment in patients with Legg-Calve-Perthes disease

BACKGROUND: Legg-Calve-Perthes disease (LCPD) is an avascular necrosis of the capital femoral epiphysis in children. Several studies found a pathophysiological relationship between LCPD and juvenile Scheuermann's kyphosis, suggesting an abnormal spinal condition related to osteochondrogenesis. In the present study sagittal spinal alignment of the patients with LCPD was analyzed to examine associated spinal involvement. METHODS: A standing lateral radiograph of the spine was evaluated in 78 patients who had a history of LCPD. Various parameters of sagittal spinal alignment, including thoracic kyphosis (TK), lumbar lordosis (LL), sacral inclination (SI), apex of thoracic kyphosis (TK-apex) and lumbar lordosis (LL-apex), and sagittal balance (SB; positive SB values represent a sagittal balance in front of the sacrum) were measured and compared between the patients with and without vertebral abnormalities. RESULTS: Compared to previously published normative data, relatively decreased LL was evident in LCPD. Most of the patients (65%) had negative SB, which was correlated with decreased SI, more proximal TK-apex, and more distal LL-apex. Vertebral abnormalities including end-plate irregularities and wedging vertebrae were observed in 20 patients. Decreased SI, more distal LL-apex, and more negative SB were remarkable in the patients with vertebral abnormalities. CONCLUSIONS: The patients tended to stand in greater negative sagittal balance associated with decreased LL. The characteristic sagittal alignment was prominent especially in the patients with vertebral abnormalities. Wedging vertebrae, probably due to growth disturbance of the vertebral bodies, could result in decreased LL, which leads to posterior pelvic tilt and posterior shift of sagittal balance.