Congenital ossification of the stapedius tendon: diagnosis with CT

PURPOSE

To describe the features of congenital ossification of the stapedius tendon at thin-section computed tomography (CT).

MATERIALS AND METHODS

Thin-section CT scans, clinical records, and surgical findings were retrospectively evaluated in nine ears of five patients with surgically proved congenital ossification of the stapedius tendon. Thin-section CT scans of 50 control ears were also reviewed.

RESULTS

On thin-section CT scans, a linear area of soft-tissue attenuation was demonstrated between the monopod stapes and the pyramidal eminence (nine ears), as well as thickening of the stapes footplate (two ears). In the 50 control ears, the normal stapes tendon was not clearly seen on thin-section CT scans.

CONCLUSION

At CT, a linear area of soft-tissue attenuation that extends from the pyramidal eminence to the monopod stapes is suggestive of congenital ossification of the stapedius tendon or a bony bar adjacent to it.

[Perceived quality of life and social factors in elderly hypertensive patients]

We conducted a cross-sectional study of elderly outpatients with hypertension to examine the relationship between quality of life (QOL) scores and social background factors. The subjects consisted of 516 outpatients (267 females), age of 60 or over, at nine clinics of major hospitals which participated in the National Cardiovascular Center Research Project. The perceived QOL was evaluated by the QOL scale originally based on Japanese patients with cardiovascular diseases. The scale consisted of the following 5 subscales; difficulty due to disease, psychological stability, independence, satisfaction in daily living and vitality. The background factors included family structure, socioeconomic factors and work status, and physical activity of daily living (ADL). After adjusting for age, sex, administered drugs and complicating conditions such as ischemic heart disease and/or apoplexy, a significant odds ratio of a low score of difficulty due to disease, psychological stability, satisfaction in daily living and vitality was found in the impaired physical ADL group with low socioeconomic class, and a significant odds ratio of low score of independence were found in the impaired physical ADL group who had lost jobs due to illness and had no children.

Gianturco stent placement in malignant caval obstruction: analysis of factors for predicting the outcome

PURPOSE

To determine the factors that may be used to predict outcome of stent placement in patients with malignancies obstructing the superior or inferior vena cava.

MATERIALS AND METHODS

Gianturco stents were placed in 39 patients with malignant obstruction of the superior (n = 16) or inferior (n = 23) vena cava. Thirteen patients with obstruction of the superior vena cava received radiation therapy and/or chemotherapy at some time in their course of treatment. Computed tomographic (CT) scans were obtained in all patients. The authors analyzed treatment outcome with the location, length, and CT appearance of obstruction.

RESULTS

Venous congestive symptoms disappeared after stent placement in 35 patients and remained in four. Symptoms did not recur during 1-13-month follow-up in 32 of the 35 patients in whom the symptoms disappeared. Nonfatal complications were observed in nine patients. Results of multivariate analysis showed that the outcome of stent placement is best predicted by the appearance of obstructions on CT scans irrespective of the location and length of the lesions.

CONCLUSION

Good results can be expected from placement of Gianturco stents except when CT shows the obstruction to be totally enveloped by tumor.

[Spatial and temporal alteration of the dual supply of the hepatic circulation with transient occlusion of the hepatic veins: spiral volumetric CT during arterial portography and arteriography]

To elucidate the contribution of hepatic veins to the blood flow of liver, CT arterial portography and/or arteriography was performed in eight patients having hepatocellular carcinoma with transient occlusion of the hepatic vein and eight without occlusion. In each patient with occlusion of the hepatic vein, CT showed a well-demarcated fan-shaped area of low density during arterial portography and increased density during arteriography in the corresponding area. Hepatic vein occlusion could result in the pooling of arterial blood in the liver parenchyma. Transient segmental hepatic venous occlusion might improve the results of transcatheter arterial infusion and transcatheter arterial embolization for liver tumors.

Acute effects of exercise on muscle MRI in peripheral arterial occlusive disease

The midcalf muscles of eight patients who had peripheral arterial occlusive disease were evaluated by exercise MRI before and after bypass surgery or percutaneous transluminal angioplasty. MRI showed a high intensity of these muscles, especially the posterior muscles, after exercise in all patients before intervention. The mean T2 relaxation time was maximal immediately after exercise (tibialis anterior, T2 = 30.8 ms; soleus, T2 = 36.2 ms; gastrocnemius, T2 = 32.8 ms) and then gradually decreased to the preexercise level. The difference in the T2 relaxation time of the soleus between immediately after exercise and at rest was smaller along with improvement of ankle pressure indices (API) after successful intervention (mean T2 difference: 4.91 and 0.72 ms (p < .001); mean API: 0.54 and 0.86 (p < .001) before and after intervention, respectively). The mean resting midcalf T2 relaxation time was significantly higher after intervention (tibialis anterior, T2 = 28.4 and 29.5 ms (p < .05); soleus, T2 = 31.4 and 32.9 ms (p < .05); gastrocnemius, T2 = 29.5 and 31.1 ms (p < .01) before and after intervention, respectively). T2 relaxation time may be a useful quantitative parameter in peripheral arterial occlusive disease as well as in other muscle studies.

Cardiac implications of the morning surge in blood pressure in elderly hypertensive patients: relation to arising time

Although morning surge in blood pressure has been shown to be associated with the occurrence of myocardial ischemic events and stroke, few studies have been done regarding its pathogenesis, probably because of a lack of method for the quantitative assessment of awakening time. We conducted an echocardiographic study and ambulatory blood pressure monitoring in 23 elderly hypertensive patients to evaluate the relationship between the hypertensive cardiac change and morning surge in blood pressure. Of note was that the time of arising from bed was assessed quantitatively by an activetracer equipped with an internal acceleration sensor to monitor the physical activity. The change in systolic blood pressure after arising from bed was correlated significantly with the left ventricular mass index (r = 0.51, P < .02) and the A/E ratio, which represents the diastolic function (r = 0.70, P < .01). In contrast, the change in systolic blood pressure before rising from bed was not correlated with any echocardiographic parameters. We conclude that the magnitude of morning surge in blood pressure after arising from bed was related with the severity of hypertensive target organ damage.

Effect of perindopril on 24-hour blood pressure levels and hemodynamic responses to physical and mental stress in elderly hypertensive patients

This study assessed the effects of an angiotensin-converting enzyme (ACE) inhibitor, perindopril, on the 24-hour blood pressure (BP) profile and hemodynamic responses to isometric exercise and mental stress in elderly hypertensive patients. We performed ambulatory BP monitorings and echocardiographic studies during hand-grip exercises and a mental stress test before and after the 10-week administration of perindopril in 11 elderly patients (mean age, 71.8 years). Office BP was significantly decreased by perindopril treatment. Both daytime and nighttime systolic BP decreased significantly without any change in circadian pattern (P < 0.05). Daytime diastolic BP was also significantly decreased by perindopril (P < 0.05); nighttime diastolic pressure was decreased, but this result was not statistically significant. The reduction in 24-hour BP was associated with a decreased left ventricular end-systolic dimension (P < 0.01) and an increased fractional shortening (P < 0.01), suggesting reduced afterload due to arterial dilatation. The left ventricular mass index was not changed by perindopril therapy, and neither were systolic and diastolic BP responses to the handgrip exercises. The increases in systolic BP during mental stress was augmented after perindopril therapy, although systolic BP during mental stress after treatment was significantly lower than before treatment (P < 0.05). These results indicate that perindopril is effective in reducing ambulatory 24-hour BP levels and is associated with improved systolic function caused by dilatation of resistance vessels.

[Effect of warm bathing on short-term and 24-hour blood pressure in bedridden elderly patients]

The effects of the bathing on short-term and ciracadian blood pressure (BP) in bedridden elderly patients were investigated in 10 bedridden patients (4 male: 6 female) living in a community home. The mean age of the subjects was 78.7 years old and causes of bedridden status were cerebrovascular disease in 9 and spinal damage in one. To study the short-term hemodynamic effect of bathing, BP and pulse rate were measured every 2 minutes from 10 minutes before bathing to 14 minutes after. Blood samples were collected before and after bathing for measurements of plasma catecholamine and plasma renin activity. To study the effect of warm bathing on circadian, BP, ambulatory BP was non-invasively monitored every 15 minutes for 24 hours on days with and without bathing. In the short-term phase, BP temporally elevated when washing the body outside the bathtub accompanied with a decline soaking in warm water (38 degrees C). Plasma catecholamine did not change after warm bathing. In the study of circadian change of BP, systolic BP on days of warm bathing remained at a lower level for 12 hours after bathing compared to days without bathing. In conclusion, hypotensive effects after bathing were prolonged in the bedridden elderly patients.

The efficacy of monatepil, a new calcium antagonist, in the treatment of essential hypertension

A multicenter, open-label trial in Japan examined the efficacy, safety, and optimal dose of monatepil (AJ-2615) as monotherapy and in combination therapy with angiotensin-converting enzyme (ACE) inhibitors or beta-blockers. Patients with essential hypertension who had never been treated or had been refractory to conventional antihypertensive agents were enrolled in the trial. During a 4-week control period patients assigned to monotherapy received placebo and those assigned to combination therapy received an ACE inhibitor or beta-blocker and placebo. Patients with systolic blood pressure (BP) > or = 160 mm Hg and diastolic BP > or = 95 mm Hg at the end of the control period were enrolled in the study. The initial dose of monatepil was 30 mg/day in monotherapy and 15 mg/day in combination therapy; the daily dose was titrated to 60 mg/day according to the antihypertensive response. The treatment period was 8 to 12 weeks. Blood pressure decreased from 168 +/- 8/100 +/- 6 to 142 +/- 9/85 +/- 7 mm Hg (SD) with monatepil monotherapy, from 171 +/- 11/102 +/- 6 to 141 +/- 9/84 +/- 6 mm Hg in combination with ACE inhibitors, and from 175 +/- 13/102 +/- 7 to 153 +/- 21/91 +/- 9 mm Hg in combination with beta-blockers (P < .001). When patients in whom mean BP decreased by > or = 13 mm Hg were defined as responders, the response rate was 80.4%, 78.1%, and 51.6% in the respective groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of elderly hypertensives in Japan: National Intervention Cooperative Study in Elderly Hypertensives. The National Intervention Cooperative Study Group

PREVALENCE OF HYPERTENSION IN ELDERLY JAPANESE PATIENTS: Data collected from post-mortem information at the Tokyo Metropolitan Geriatric Hospital showed that the overall prevalence of hypertension in Japanese patients aged over 60 years was 53%; one-third of these elderly hypertensives had isolated systolic hypertension. Isolated systolic and systolodiastolic hypertension were each associated with a similar degree of increased atherosclerosis and cardiovascular complications. In a placebo-controlled study antihypertensive treatment produced a reduction in withdrawal from treatment in elderly patients with mild hypertension. INTERIM TRIAL RESULTS: Some interim results have been obtained from a new trial which is currently under way in Japan, the National Intervention Cooperative Study for the Treatment of Elderly Hypertensives, a long-term study comparing the effects of a calcium antagonist (nicardipine) and a thiazide diuretic (trichlormethiazide) on cardiovascular complications in elderly patients with mild to moderate hypertension.

CT and MRI in detection of intrahepatic portosystemic shunts in patients with liver cirrhosis

OBJECTIVE

Our goal was to determine the prevalence and anatomic location of intrahepatic portosystemic shunts (IPSs) in patients with hepatic cirrhosis as shown by CT and MRI.

MATERIALS AND METHODS

We retrospectively reviewed CT and MR scans of 33 cirrhotic patients who had IPSs. In addition, two series of 100 consecutive CT or MR were reviewed to determine the prevalence of IPSs and the percentage of intrahepatic and extrahepatic paraumbilical veins.

RESULTS

Intrahepatic portosystemic shunts were divided into three groups according to the intrahepatic course: paraumbilical shunt between the left portal vein and the paraumbilical vein anterior to the liver (n = 29); inferior vena caval shunt between the posterior branch of the right portal vein and the inferior vena cava (n = 2); and miscellaneous (n = 2). Shunts of the paraumbilical type ran through the medial (n = 23), lateral (n = 3), or both medial and lateral (n = 3) segments of the left lobe of the liver. Twenty-five patients had one shunt, and four had more than one. Six cases were also associated with extrahepatic paraumbilical veins.

CONCLUSION

Intrahepatic portosystemic shunts, especially the paraumbilical type, were not infrequently visualized in patients with hepatic cirrhosis.

Improved detection of small insulinomas with intravenous dynamic CT

OBJECTIVE

To evaluate the usefulness of intravenous dynamic CT in demonstrating angiographically negative insulinomas.

MATERIALS AND METHODS

Two patients with endocrinologic evidence of insulinoma were examined with intravenous bolus-dynamic CT.

RESULTS

Angiographically negative insulinomas as small as 5-7 mm were demonstrated unequivocally as enhancing nodules.

CONCLUSION

Intravenous dynamic CT using larger amounts of contrast material can improve detection of small (< 1.0 cm) insulinomas.

[Examinations to detect left atrial thrombus and blood coagulation test analyses in aged patients with atrial fibrillation]

To screen for risk of embolism, we investigated the association between the presence of left atrial (LA) thrombus by transesophageal echocardiography (TEE) and blood coagulation tests, including thrombin-antithrombin III complex (TAT), plasminogen activator inhibitor 1 (PAI-1), plasmin-alpha 2-plasmin inhibitor complex (PIC), D-dimer, tissue plasminogen activator (tPA), free tPA, tPA.PAI-1 complex, prothrombin fragment 1+2 and fibrin degradation product E (FDP-E) in 40 patients with atrial fibrillation (Af) (13 males, 27 females, mean age 76 +/- 8 yrs). Blood coagulation tests were performed in 21 control subjects with sinus rhythm (12 males, 9 females, mean age 75 +/- 4 yrs). LA thrombi were detected in the appendage of 8 patients and in the atrium of 6 patients. Severe atherosclerotic plaque with thrombi in the thoracic aorta were detected in 6 patients without LA thrombi. FDP-E, D-dimer and PIC increased significantly in patients with LA thrombi or aortic plaque in comparison with controls with sinus rhythm. In patients with Af, 25 of them (group A) has more than 4 abnormal coagulation values out of 9 tests and 15 of them (group B) had abnormalities in less than 3 tests. LA thrombi or aortic plaque were detected in 18 patients in group A and 2 patients in group B (72% vs 13%, p < 0.01). In 4 of 6 patients with large LA thrombi, the thrombi were resolved after administration of warfarin. Before administration of warfarin, tPA, PA-1 and tPA.PA-1 complex levels were higher in the two patients whose thrombi did not resolve.(ABSTRACT TRUNCATED AT 250 WORDS)

Age-related changes in cytoskeletal components of the BDF1 mouse Sertoli cell

Age-related changes in mouse Sertoli cell cytoskeletal components (F-actin, vimentin and cytokeratin) were investigated by light and transmission electron microscopy and immunofluorescence using BDF1 mice from 3-33 months of age. In old mice (30 and 33 months of age), the testicular seminiferous epithelia were extremely thin, containing scarce round spermatids and spermatocytes with no elongated spermatids. In these epithelia, the Sertoli cells had lost their polarity and had become flattened. F-actin was detectable at the junction between adjoining Sertoli cells and around the spermatid head in young mice. In old mice, F-actin was distributed at the junction between adjacent Sertoli cells, around the spermatid head, and at the luminal side of the Sertoli cell cytoplasm. Vimentin was detected around the Sertoli cell nucleus and extended into the Sertoli cell trunk towards the tubular lumen in young mice. In old mice testes, however, vimentin was recognized around the Sertoli cell nucleus, but not in the Sertoli cell trunk. Additionally, sheet-like reactions of vimentin, running parallel to the basement membrane, were detected near the luminal surface. Although cytokeratin was not detected in the Sertoli cells of mice until 27 months of age, it was obvious in the extremely thin seminiferous epithelia of older mice. Cytokeratin was randomly distributed within the Sertoli cell cytoplasm. In these Sertoli cells, the expression of vimentin was concurrently detected. Detection of cytokeratin in the extremely thin seminiferous epithelia is one of the most characteristic phenomena of age-related testicular changes in Sertoli cells of older mice.

Ovarian dysgerminoma: MR and CT appearance

OBJECTIVE

We determined the MR and CT appearance of ovarian dysgerminoma and correlated our findings with the pathologic features.

MATERIALS AND METHODS

CT and MR findings of three patients with ovarian dysgerminoma were retrospectively reviewed and compared with the pathologic findings.

RESULTS

The tumors were divided into lobules by septa that were hypointense or isointense on T2-weighted imaging and showed marked enhancement on Gd-diethylene triamine pentaacetic acid enhanced T1-weighted imaging and contrast-enhanced CT. These septa corresponded to fibrovascular bundles at histologic examination.

CONCLUSION

CT and MR findings characteristic of fibrovascular septa within solid ovarian masses should raise the possibility of dysgerminomas.

Metastatic tumors in irregular fatty liver mimicking focal sparing

Two cases of hepatic metastatic tumor occurring in irregular fatty liver are reported. These metastatic tumors appeared as irregularly shaped hyperdense areas and were difficult to distinguish from focally spared areas of irregular fatty liver. Even if areas of focal sparing are irregular in shape, hepatic tumors should be carefully ruled out in patients at high risk for liver tumors.

Is white coat hypertension innocent? Structure and function of the heart in the elderly

To evaluate the morphological and functional characteristics of the heart in elderly patients with white coat hypertension, we performed an echocardiographic study in 67 elderly individuals older than 60 years: 17 patients with white coat hypertension, 34 patients with true hypertension, and 16 normotensive control subjects. White coat hypertension was defined as a mean 24-hour ambulatory systolic blood pressure of less than 140 mm Hg associated with office hypertension. Cardiac responses to an isometric handgrip exercise test were used to evaluate left ventricular functional reserve. Left atrial dimension and left ventricular mass index were significantly greater in the white coat hypertension group than in the normotension group (P < .05) but were similar to values in the true hypertension group. Left ventricular diastolic function, expressed by peak late-early filling ratio of diastolic mitral flow, showed increasing impairment in the order of the normotension, white coat hypertension, and true hypertension groups (analysis of variance, P < .05); the ratio in the white coat hypertension group tended to be higher than that in the normotension group (unpaired t test, P = .054). The relation between fractional shortening and end-systolic stress did not shift downward after handgrip exercise in the white coat hypertension group, indicating that functional reserve in the left ventricle was maintained. Thus, patients with white coat hypertension had a moderately increased left atrial dimension and left ventricular mass in association with a tendency for disturbed diastolic function, although systolic functional reserve remained the same. These findings suggest that white coat hypertension in the elderly may not be innocent.

[The evaluation of lung cancers hidden by the mediastinal and hilar shadows on the plain chest film]

We retrospectively evaluated the plain chest frontal radiographs in four cases in which the lung cancers were quite difficult to observe prospectively on plain chest frontal radiographs in spite of the relatively large size of tumors (over 3 cm in diameter). Three of four cases were central-type lung cancers, two squamous cell carcinomas and one adenosquamous cell carcinoma. Since there was no associated atelectasis or obstructive pneumonia in these cases, wall thickening and indistinctness of the lumen of the central bronchi were the significant findings for diagnosis. One case proven to be adenocarcinoma was located in the periphery of S6. A focally increased radiopacity behind the descending pulmonary artery was the only finding to pointed out. Since tumors were not demonstrated directly in the aerated lungs, the condition of the central bronchi as well as the degree radiopacity of the pulmonary artery should be carefully interpreted.

Systemic arterial supply to normal basal segments of left lower lobe: CT findings

OBJECTIVE

The purpose of this study was to evaluate the usefulness of CT in making a diagnosis of systemic arterial supply to normal basal segments of the left lower lobe.

MATERIALS AND METHODS

We retrospectively reviewed chest radiography (three cases), CT (three cases), and angiography (two cases).

RESULTS

An anomalous systemic artery arising from the descending aorta was shown as a retrocardiac density on posteroanterior radiography and as a nodular density behind the heart on lateral radiography. Contrast enhanced CT revealed the vascular nature of the density adjacent to the descending aorta. Dynamic CT in one patient demonstrated that the nodular density was composed of an anomalous systemic artery and a prominent inferior pulmonary vein. High-resolution CT showed the interlobar artery distal to the origin of the superior segmental artery to be absent. The bronchial system of the left basal segments was normal as was the pulmonary parenchyma on CT.

CONCLUSION

Characteristic CT findings consist of absence of the interlobar artery distal to the origin of the superior segmental artery and origination of an anomalous artery from the descending aorta that gives off branches to normal left basal segments. With a constellation of these CT findings, angiography would be obviated for definite diagnosis of this anomaly.

[Long-term follow-up study after permanent pacemaker implantation in patients aged 60 years or over with sick sinus syndrome]

Ninety-five patients aged 60 years or over with a permanent pacemaker implanted for sick sinus syndrome were divided into two groups: 32 patients with physiological pacing (group P) and 63 patients with ventricular pacing (group V). The mean follow-up period was 45.0 +/- 36.6 months in group P and 50.3 +/- 37.8 months in group V. Paroxysmal atrial fibrillation (Af) occurred in 28% of group P and 71% of group V (p < 0.05). The incidence of stable Af was also lower in group P than in group V (9% vs. 30%, p < 0.05). None of group P with only bradyarrhythmia had stable Af. However, 6 of 21 patients (29%) in group V with bradyarrhythmia showed stable Af. There was no significant difference in stable Af between group P with bradycardia-tachycardia syndrome (BTS) and group V with BTS (19% vs. 31%). A lower incidence of embolic events was also observed in group P (3% vs. 25%, p < 0.05). Nine of 16 patients with embolic events in group V died of complications following embolism (8 patients; cerebral embolism, one patients: renal and superior mesenteric arterial embolism). The survival rates at 5 and 10 years were 80% and 69%, respectively, for group P and 56% and 33% for group V (p < 0.01). Thus, with regard to permanent pacing for patients with sick sinus syndrome, physiological pacing should be selected for control of morbidity and total mortality.

Age-related morphological changes in the testis of the BDF1 mouse

Age-related morphological changes in the testis of the BDF1 mouse were studied by light and transmission electron microscopy. No apparent changes were detected until 12 months of age. After 18 months of age, vacuoles firstly appeared in the seminiferous epithelium. These vacuoles were gradually increased in number and showed a tendency to cluster with each other in accordance with age. While, germ cells were decreased in number. The sloughing of germ cells caused a thin seminiferous epithelium. In the tubule with a thin epithelium, spermatogenesis was severely interrupted. After 30 months of age, extremely thin seminiferous epithelia were observed. In these epithelia, most of spermatids and spermatocytes disappeared, and most of Sertoli cells lost their polarity to be flattened. On the other hand, in the interstitial region, PAS-positive cells (mononuclear phagocytes) tended to increase in number after 24 months of age. PAS-positive extracellular matrix newly appeared at 27 months of age. In the cytoplasm of Leydig cells, a whorl of sER was frequently found. Degeneration of testes proceeded with age. The regressive tubules occupied only 2.2% at 18 months of age, but extended to 63.0% at 33 months.