Pulmonary vasculitis due to infection with Mycobacterium goodii: A case report

A 57-year-old Caucasian woman suffered from dyspnea on exertion. One year following a supposed pulmonary embolism event, a chronic thromboembolic vasculopathy was diagnosed and a pulmonary thromboendarterectomy was performed. However, a granulomatous pulmonary arterial vasculitis was identified upon examination. DNA of Mycobacterium goodii was detected as the most likely causative agent. Anti-inflammatory and anti-mycobacterial therapy was initiated for more than 12 months. Regular PET-CT scans revealed improvement under therapy. The last PET-CT did not show any tracer uptake following 10 months of therapy.

Severe Leptospira interrogans serovar Icterohaemorrhagiae infection with hepato-renal-pulmonary involvement treated with corticosteroids

Key Clinical Message

The traditional concept of immediate antibiotic treatment in suspected leptospirosis seems to be especially important for patients up to day 4 of clinical illness. As immune mechanisms probably play a crucial role in advanced leptospirosis with presumed pulmonary hemorrhages, patients might benefit from corticosteroids or other immunosuppressive agents beside antibiotics.

[Training program for radiologic technologists for performing chest X-rays at inspiration in uncooperative children]

PURPOSE

A computer program was created to train technologists to perform chest X-rays in crying infants at maximum inspiration.

MATERIALS AND METHODS

Videos of 4 children were used. Using a computer program, the moment of deepest inspiration was determined in the video in the single frame view. During the normal running video, 14 technologists (3 with significant experience, 3 with little experience and 8 with very little experience in pediatric radiography) simulated a chest radiograph by pushing a button. The computer program stopped the video and the period of time to the optimal moment for a chest x-ray was calculated. Every technologist simulated 10 chest X-rays in each of the 4 video clips. The technologists then trained themselves to perform chest X-rays at optimal inspiration like playing a computer game. After training, the test was repeated. Changes were evaluated by t-test for unpaired samples (level of significance p < 0.05).

RESULTS

Although the differences improved in all children, minimal deviation from the optimal moment for taking an X-ray at inspiration occurred in the periodically crying child (0.21 sec before and 0.13 sec after training). In a non-periodically crying infant, the largest differences were shown. The values improved significantly from 0.29 sec to 0.22 sec. The group with substantial experience in pediatric radiology improved significantly from 0.22 sec to 0.15 sec. The group with very little experience in pediatric radiology showed worse results (improvement from 0.29 sec to 0.21 sec).

CONCLUSION

The ability of a technologist to take a chest X-ray at optimal inspiration in a crying child is improved by the tested computer program.

Isolation of Salmonella enterica serotype newport from a partly ruptured splenic abscess in a traveler returning from Zanzibar

Salmonella enterica subsp. enterica serotype Newport is a pathogen of growing importance because of its epidemic spread in dairy cattle and increasing rate of antimicrobial resistance. Human infections, however, are rare. We report a case of a splenic abscess in a young traveler returning from East Africa.

18F-FDG PET for assessment of therapy response and preoperative re-evaluation after neoadjuvant radio-chemotherapy in stage III non-small cell lung cancer

PURPOSE

The aim of this study was to evaluate FDG-PET for assessment of therapy response and for prediction of patient outcome after neo-adjuvant radio-chemotherapy (NARCT) of advanced non-small cell lung cancer (NSCLC).

METHODS

Seventy patients with histologically proven stage III NSCLC underwent FDG-PET investigations before and after NARCT. Changes in FDG uptake and PET findings after completion of NARCT were compared with (1) the histology of tumour samples obtained at surgery or repeat mediastinoscopy, and (2) treatment results in terms of achieved operability and long-term survival.

RESULTS

The mean average FDG uptake of the primary tumours in the patient group decreased significantly during NARCT (p = 0.004). Sensitivity, specificity and overall accuracy of FDG-PET were 94.5%, 80% and 91%, respectively, for the detection of residual viable primary tumour, and 77%, 68% and 73%, respectively, for the presence of lymph node metastases. A negative PET scan or a reduction in the standardised uptake value (SUV) of more than 80% was the best predictive factor for a favourable outcome of further treatment. Progressive disease according to PET (new tumour manifestations or increasing SUV) was significantly correlated with an unfavourable outcome (p = 0.005). In this subgroup, survival of patients who underwent surgery was not significantly different from survival among those who did not undergo surgery, whereas for the whole patient group, complete tumour resection had a significant influence on outcome.

CONCLUSION

FDG-PET is suitable to assess response to NARCT in patients with stage III NSCLC accurately. It was highly predictive for treatment outcome and patient survival. PET may be helpful in improving restaging after NARCT by allowing reliable assessment of residual tumour viability.

[Functional capacity of MRI-compatible biopsy needles in comparison with ferromagnetic biopsy needles. In vitro studies]

PURPOSE

Comparative evaluation of specimens obtained with different MR-compatible biopsy systems and a conventional ferromagnetic system.

METHODS

Biopsies of a pig liver were performed post-mortem with three different MR-compatible (Somatex; E-Z-EM; Daum) and one conventional biopsy system (Somatex), five with each device. The specimens were measured and the histopathological quality was graded on a scale from 0 (no tissue) to 9 (best). The tip of the needle was examined with an electron microscope before and after biopsy to demonstrate abrasion.

RESULTS

The histopathological score between the first and fifth specimen taken with one biopsy device showed no significant difference. The conventional system yielded significantly better results in nearly all categories (p < 0.05) than the MR-compatible biopsy systems. The areas of the specimens obtained with the MR-compatible biopsy systems (4.27-5.99 mm2) were significantly smaller than those from the conventional system (9.98 mm2). The needle tip abrasion of the different biopsy systems determined by electron microscopy showed no substantial difference.

CONCLUSION

Specimens obtained with MR-compatible biopsy systems compared to conventional biopsy systems are of lower histopathological quality. This might be caused by a smaller side notch of the MR-compatible biopsy devices. There was no difference in abrasion of the needle tip due to the softer, non-ferromagnetic alloys.

[Precision of MRI-guided needle placement--experimental results]

PURPOSE

To estimate the accuracy of the determination of tip position of MR compatible biopsy needles based on signal voids and artifacts in MR guided biopsies.

METHOD

In a nylon grid phantom an MR compatible 18G needle (E-Z-EM) was measured in a 1.0 T imager using TSE- and FFE-sequences of 20 s and 40 s duration in 34 different orientations of needle versus B0, frequency and slice selection gradient. 4 radiologists with no experience in the evaluation of signal void artifacts estimated the needle tip positions from needle tip artifacts. The readers determined the needle tip before and after a 15 minute training session based on high resolution images with explanation of size and shape of specific artifacts of biopsy needles in 12 different orthogonal or parallel orientations to B0 and frequency encoding gradient that are possible if the needle lies parallel to the slice, i.e. orthogonal to the slice selection gradient. The values obtained before and after the training session were compared to the real position of the needle tip.

RESULTS

Mean distance of actual needle tip and tip position as determined from images was 1.8 +/- 2.3 mm in TSE-versus 2.5 +/- 1.2 mm in FFE-images, with the needle length overestimated. After a 15 minute training session the positioning error decreased significantly to 0.2 +/- 1.8 mm for TSE-sequences and to 1.0 +/- 1.8 mm for FFE-sequences. A higher accuracy of tip localization was obtained with TSE sequences.

CONCLUSION

In MR guided biopsies using FFE- and TSE-sequences the needle position can be more accurately determined if the reader is familiar with the 12 orthogonal or parallel positions of the needle with respect to B0 and frequency encoding gradient and the corresponding artifacts.

[MRI-controlled preoperative wire marking of uncertain breast lesions]

PURPOSE

Small suspicious breast lesions that are only visible at MR imaging were preoperatively marked with a hook wire under MR-guidance to allow the removal of the lesion with tissue-sparing surgery.

METHOD

In all patients the suspicious lesions were marked preoperatively under MR guidance with a hook wire using a commercially available stereotactic device. Interventions were performed with MR guidance on a 1.0 T and on a 1.5 T system.

RESULTS

In 19 patients 22 lesions were localized. One lesion was missed and removed in a second procedure. The mean duration for localization was 66 +/- 20 min (range 38-119 min). In two patients two lesions were localized. The mean deviation of the wire tip to the lesion was 2.0 +/- 2.6 mm. In this series, 6 of 22 lesions were malignant. The mean diameter of the lesion was 7.6 +/- 2.6 mm (range 3-14 mm).

CONCLUSION

Suspicious breast lesions detectable only in MR imaging can be accurately localized with a hook wire preoperatively under MR control to remove the lesion with a tissue-saving surgery.

[MR-compatible and conventional marker wires in breast diagnosis--experimental studies on their dislocatability and artifact size in MRT]

PURPOSE

Localization of non-palpable suspicious breast lesions with tumor localization wires is commonly used before surgical excision. Dislocation of the wire is possible. The possibility of dislocation for different types of tumor localization wires was examined experimentally.

METHODS

22 different tumor localization wires were inserted into the subcutaneous fat-tissue of a pig. The wire tip was recorded under fluoroscopy. Traction was applied to the wire using a spring-balance. The artifact size of MR-compatible wires was examined in a 1.0 Tesla MR imager.

RESULTS

The localization wires with an X-configuration and long hook could not be dislocated by a force up to the maximum of 12 Newton. The retractable localization wires were easily dislocated at traction forces of 1 Newton. Other wires with only one hook could withstand a traction from 2 up to 7 Newton. The wires with a Z-configuration and wires with short hooks showed a highly variable rate of resistance. The artifact size of localization systems was between 10.1 and 11.0 mm for gradient-echo sequences and between 6.7 and 7.1 mm for spin-echo sequences.

CONCLUSION

Tumor localization wires with an X-configuration and long hooks were best anchored in the tissue. The advantage of repositioning retractable wires is confined by the high risk of accidental dislocation. No reliable fixation in the tissue could be achieved using wires with a Z-configuration and wires with short hooks. MR-compatible wires were comparable to non-MR-compatible wires concerning the rate of resistance. The size of the artifacts of MR-compatible systems showed no relevant differences.

[Complications of CT guided lumbar sympathectomy: our own experiences and literature review]

AIM

To review the complications of CT guided lumbar sympathicolysis (CTLS) on the basis of our own experience and the available literature.

METHODS

241 CTLS were performed by a standard technique according to Haaga's method. Clinical follow-up revealed 4 serious complications; these were analysed and compared with published cases.

RESULTS

Amongst our patients there were three fibrotic ureter stenoses and one retroperitoneal abscess. Analysis of the serious complications described in the literature indicates that introduction of CT guided lumbar sympathicolysis has reduced the severity and frequency of complications as compared with surgical and "blind" procedures. With CTLS, no deaths due to the procedure have been reported in the literature. The results indicate that damage to the ureters can be caused by substances used for the neurolysis.

CONCLUSION

Provided certain safeguards are obeyed, CTLS is a very save treatment. However damage to the ureter may follow even when the procedure was technically satisfactory. Therefore, sonographic control of the kidneys after three months is recommended.

[Computer-assisted control of CT-guided caudo-cranial puncture access route using the triangulation method]

PURPOSE

To control the position of a puncture needle on an access route, which is not parallel to the CT-scan, using control scans not showing start and target points.

METHODS

A software tool has been developed. After CT for biopsy planning x/y coordinates and table position of start and target points have to be determined on CT-scans. The software calculates x/y coordinates of the access route for every table position, which must be marked interactively on control scans. The accuracy of the programme was proven experimentally and the method was used in five patients.

RESULTS

There was no difference between the calculated and measured access route in the experiment. Four of five patients were punctured successfully using our method.

CONCLUSION

Our method is a promising procedure to control a CT-guided caudo-cranial biopsy access route.

[Localization of puncture needles in MRI: experimental studies on precision using spin-echo sequences at 1.0 T]

PURPOSE

To evaluate accuracy of needle localisation using and signal enhancement on a 1.OT MR imager for various needles for MR-guided biopsy.

METHODS

The differences between actual and virtual needle position of needles with different orientations were evaluated in a phantom for spin-echo including turbo-spin-echo sequences.

RESULTS

Artifacts depended on the orientation of the needle relative to the field B0, frequency-encoding gradients (Gf) and slice orientation. This resulted in different artifact shapes and sizes for left or right and cranial or caudal biopsy access routes. Applying turbo spin echo sequences feasible for biopsy, the signal void of a 18 G needle (Cook) parallel to Gf reached between 0.3 and. 4.6 mm further into the medium than the real needle tip, depending on needle orientation relative to B0. The diameter of the signal void around the needle varied, the needle shaft was right in the centre of the signal void. With Gf orthogonal to the needle the offset of signal void to needle tip ranged from 2.7 to 3.3 mm, while the actual position of the needle shaft was up to 3.3 mm lateral of the signal void center. While nominal echo times did not influence the size of the artifact in turbo-spin-echo sequences, the artifacts increased with smaller matrix and larger water-fat shift. Material and mass of the needle determined the size of the artifacts as well.

CONCLUSION

Localisation accuracy of the needle can be optimised by choosing optimal gradient directions depending on whether needle tip or shaft position should be displayed.

Artificial widening of the mediastinum to gain access for extrapleural biopsy: clinical results

PURPOSE

To assess the utility of artificial widening of the extrapleural space to gain an extrapleural biopsy access route to the anterior and posterior mediastinum.

MATERIALS AND METHODS

The authors retrospectively analyzed the findings in 20 patients who underwent biopsy of mediastinal masses after dilation of the extrapleural space with injection of approximately 20 mL of physiologic saline solution. The solution was injected to provide ventral (n = 6) or dorsal (n = 14) extrapleural access to the mediastinum. Biopsies were performed under computed tomographic guidance.

RESULTS

Right-sided paravertebral extrapleural access to the mediastinum was achieved in 11 of the 14 patients in whom a dorsal approach was used. The paravertebral extrapleural soft tissue was dilated from a mean of 0.2 cm to a mean of 0.9 cm. Extrapleural biopsy was performed in nine patients. The pleura was traversed in four patients, causing pneumothoraces in two. A parasternal access route was created in all six patients in whom a ventral approach was used, and biopsies were performed without complications. The minimal width of the anterior mediastinum in these six patients increased from a mean of 2.8 cm to a mean of 4.6 cm with dilation.

CONCLUSION

Artificial widening of the extrapleural space provides an access route to the anterior and posterior mediastinum for large-bore biopsy.

Diagnosis of infra-alveolar bony lesions in the dentate alveolar process with high-resolution computed tomography. Experimental results

RATIONALE AND OBJECTIVES

Conventional intraoral radiography was compared with axial computed tomography (CT) scans for identification and classification of bony pockets in dentate jaw segments.

METHODS

Fifty-five artificial bone defects were produced in six dentate jaw segments. The jaws were examined radiographically using a dental x-ray unit and by contiguous axial CT scans. Identification, classification, and vertical depth of the bony defects were compared among the specimens, radiographs, and CT scans.

RESULTS

On the intraoral radiographs, 38 (69%) bony lesions were identified, and the vertical depth was underestimated by a mean of 2.2 mm, compared with the objective measurements on the jaws. In contrast, all artificial bony lesions (100%) were identified and classified on the axial CT scans and the vertical depth was underestimated by a mean of 0.5 mm.

CONCLUSIONS

High-resolution CT improves the identification and metric assessment of the vertical dimension of infra-alveolar bony lesions compared with conventional intraoral x-ray films and allows these defects to be classified according to the number of existing walls into one-walled, two-walled, and three-walled bony pockets. In patients with apically extended metallic restorations, the image quality could be limited by artifacts.

Artificial displacement of kidneys, spleen, and colon by injection of physiologic saline and CO2 as an aid to percutaneous procedures: experimental results

PURPOSE

To determine whether displacement of the kidneys, spleen, or bowel with injection of fluids or CO2 can be used to create a direct and potentially safer access route to the retroperitoneum for large-bore needle biopsy or abscess drainage.

MATERIALS AND METHODS

In cadavers (n = 24), the kidneys were displaced laterally by means of computed tomography (CT)-guided paravertebral injection of 120 mL of physiologic saline solution (n = 18) and 120 cm3 of CO2 (n = 6). The spleen (n = 11) and retroperitoneal colon (n = 7) were also displaced with saline. Displacement of the organs from the needle tip was measured on CT scans.

RESULTS

After fluid injection the kidneys shifted 1.47 cm +/- 0.51, the spleen shifted 1.14 cm +/- 0.44, and the retroperitoneal colon shifted 1.38 cm +/- 0.37. The kidneys obstructed access to the para-aortic space in 17% of cases (four of 24 cases) and to the entire adrenal gland in 72% (13 of 18 cases) before saline injection and in 0% (zero of 24 cases) and 39% (seven of 18 cases), respectively, after injection. The result with fluid were significantly better than those with CO2 (P < .05).

CONCLUSION

Displacement of kidneys, spleen, or retroperitoneal colon with a saline injection is effective in gaining an access route for biopsy or abscess drainage. Potential for patient discomfort, decrease in target-lesion conspicuity, and adverse effects of absorbed fluid in patients with kidney or heart disease must be considered with use of this technique in the clinical setting.

Distension of extrapleural spaces with contrast medium or air: value in creating safe percutaneous access to the mediastinum in cadavers

OBJECTIVE

We artificially widened the extrapleural space with contrast medium or air in 33 cadavers to create a safe extrapleural route to the anterior mediastinum and the posterior mediastinum for large-bore needle biopsies.

MATERIAL AND METHODS

Under CT guidance, 120 ml of diluted contrast medium (10%) or 300 ml of air was injected percutaneously into the right paravertebral (n = 23) and left retroaortic (n = 5) or ventral parasternal (n = 5) extrapleural spaces.

RESULTS

In six of 18 cases, the paravertebral space was found to be wide enough to advance a 14-gauge cannula to the extrapleural paraesophageal space. After injection of 120 ml of diluted contrast medium, the width of the right paravertebral space at the level of the posterior rim of the vertebral body was dilated from a mean of 0.62 cm to 1.06 cm, and the width of the anterior rim was dilated from a mean of 0.91 cm to 1.97 cm. In 17 of 18 cases, the paravertebral space was wide enough to accommodate a 14-gauge cannula. A large osteophyte blocked the access route in one case. Artificial widening regresses within 7 min by an average of 33% at the level of the posterior rim of the vertebral body and by an average of 18% at the level of the anterior rim. Dilatation was significantly more effective with diluted contrast medium than with air. When 120 ml of diluted contrast medium was injected into the left retroaortic extrapleural space, the distance between the aorta and the vertebral column was widened from a mean of 0.40 cm to 1.50 cm. Using a ventral approach for injecting 120 ml of solution, we widened the parasternal access route from a mean of 0.42 cm to 1.90 cm.

CONCLUSION

In this cadaver study, artificial dilatation of the mediastinum with diluted contrast medium allowed extrapleural access from right paravertebral, left retroaortic, and parasternal directions for large-bore needle biopsies.

Assessment of the dentate alveolar process with high resolution computed tomography

The present study was undertaken to determine quantitatively the accuracy of modern high-resolution computed tomography (HR-CT) in imaging periodontal defects in vitro by means of comparative radiological and histological studies. The soft tissue and metallic restorations were removed from four mandibular and maxillary jaw segments. Eighteen lingual and buccal defects of different dimensions were artificially created over the roots of the teeth. Dental radiographs and 1.0 mm contiguous axial and coronal HR-CT scans were obtained. Histological specimens were prepared in the same plane as the CT scans. A quantitative analysis of the periodontal regions on the CT scans was feasible when the alveolar bone was 0.5 mm thick. A visible periodontal ligament space was found to improve the reliability of the measurement of buccal or lingual bone plates up to 0.2 mm thick or of the artificial dehiscences. In the axial HR-CT scans, 70% of the artificial defects could be identified. and in the coronal scans, 50%. In contrast, none of the defects could be evaluated on conventional dental radiographs. It is concluded that HR-CT scanning could be useful in assessing buccal and lingual alveolar bone morphology and in diagnosing larger dehiscences.

Comparative evaluation of digital radiography versus conventional radiography of fractured skulls

OBJECTIVES

The authors assessed the relative efficacy of conventional and digital storage-phosphor radiographs for the detection of skull fractures.

METHODS

Fifty conventional film-screen radiographs (FSR) and 50 digital storage-phosphor radiographs (DR) with 66 fractures were compared. Five radiologists evaluated image quality and fracture detectability. The results were analyzed by receiver operating characteristic (ROC) curve analysis.

RESULTS

With a standard exposure, the ability to evaluate skull fractures was equally good with either technique (ROC area for DR, 0.8954; for FSR, 0.8870). Digital radiography was superior in evaluating nasal bone. For petrosal bone, the DR image simulates an underexposure. This disadvantage compared with FSR can be compensated by image postprocessing.

CONCLUSION

In evaluation of skull fractures, radiologists performance with DR is equivalent to FSR.

Digital radiography versus conventional radiography for the detection of a skull fracture under varying exposure parameters

RATIONALE AND OBJECTIVES

The effect of varying exposure parameters on the detectability of a fracture with digital and conventional radiography were examined.

METHODS

A macerated fractured skull was imaged by film-screen radiography (FSR) and digital storage phosphor radiography (DR) with various exposure values. Five radiologists traced the course of a fracture line. The length of the fracture was reported and the results were analyzed by Student's t test for paired samples.

RESULTS

At 35% of the conventional radiation dose, the standard DR screen displayed an average of 48% of the fracture length. The difference from the conventional image (45%) was not significant in this case. An increase of the dose to ten times the conventional dose (250 mAs) yielded no significant improvement in the detectability of the length of the fracture (51%).

CONCLUSIONS

This experiment shows that with use of the DR with the standard screen, a dose reduction of approximately 35% appears to be possible without any resulting loss of image quality compared to FSR. Use of the high resolution screens should be avoided, since they require a higher incident image dose than standard screens without offering any diagnostic advantages. The image dose of digital radiographs can be roughly estimated based on the digital device sensitivity value. As a rule, the sensitivity value should range between 100 and 200.

[Diagnosis of complications of ventriculo-peritoneal and ventriculo-atrial shunts]

The value of imaging (cranial CT, cranial and abdominal sonography, plain film surveys) was examined retrospectively in 28 shunted children in whom 82 instances of suspected dysfunction arose. There were 23 obstructions, 12 dislocations, 1 disconnection, 6 infections, 3 overdrainages and 5 slit ventricle syndromes. Impaired absorption with ascites, a peritoneal liquor cyst and a seroma occurred in the peritoneal part of the shunt. Progressive dilatation of the ventricle system shown by CCT (89%) or ultrasound was the most sensitive sign of high-pressure hydrocephalus. Periventricular hypodensity and flattening of the gyri (15%) were found less often. An examination strategy in suspected shunt dysfunction is suggested on the basis of these findings.

[Limits for recognizing linear fractures of the cranial vault in radiologic diagnosis]

In case of failure to detect a vault fracture in fatal head injury the physician is often accused of medical negligence. The material for the study consisted of a macerated vault with fractures in different widths. In order to detect the threshold of perceptibility it underwent radiographic examination taking pictures under different projections. Our finding is that the presence or absence of a radiographic fracture depends on the width and direction of the fracture. Therefore it is impossible to detect every single linear fracture of the vault in routine skull examination. Clinical and medico-legal consequences are discussed.

[A calcified coronary artery aneurysm following Kawasaki syndrome]

On the chest X-ray of a 15-year-old patient, a round, egg-shell-like calcification was seen in projection into the left heart border. This finding was caused by a calcified coronary aneurysm following Kawasaki's disease. Although this has been described as a typical change, it is rarely found in daily clinical routine.

[Fracture diagnosis with digital luminescence radiography]

Conventional screen-film radiographs were compared with storage phosphorus images concerning diagnostic performance in traumatologic radiography. We used an image pool of 106 radiographs including 50 conventionally and 56 digitally recorded images. The images were reviewed by four experienced radiologists. Detectability of fractures was coded in a five-point scale of confidence and analysed by ROC statistics. Furthermore the image quality and the optical density was compared. Digital images are superior under difficult exposure conditions and offer advantages by additional image processing and documentation. For some indications (follow-up, functional examination), reduced x-ray exposure is tolerable. The detectability of subtle lesions, which is essential for the primary diagnosis of fractures was significantly better by conventional radiography.

[Vascular architecture of the skin in the postmortem microangiogram]

To demonstrate the detailed vascular architecture of the skin, barium sulphate suspension was injected into the arteries of nine amputated lower limbs. Sections of skin from the foot were fixed in formalin and embedded in paraffin and then examined by high resolution radiography. Subsequently histological sections were prepared and correlated with the micro-angiographic appearances. This technique provided demonstration of the detailed vascular structure of the skin with very little super imposition. The capillary loops in the papillae, the sub-papillary plexus, the glandular components (with the capillaries surrounding the sweat glands), the fine arteries and smallest veins in the cutis could be demonstrated over a prolonged course. Microangiographic and histologic sections were carried out in parallel. These eliminated artifacts and clarified the micro-angiographic appearances. The value of microangiography for demonstrating the vascularity of the skin under normal, pathological and experimental conditions is the subject of further studies.

[Conventional x-ray study and computed tomography in the diagnosis of orbital fractures]

37 cases of skull fractures with involvement of the orbit were reviewed retrospectively. The value of plain films, tomography and computed tomography was analysed. Combined use of 28 degrees Caldwell and water views revealed 96% of all orbital floor fractures. Orbital emphysema in facial bone fractures nearly almost (in 14 of 15 cases) indicated involvement of the medial orbital wall. CT--performed on a biplane basis--showed best diagnostic accuracy in evaluating orbital fractures. Axial CT scans revealed only 70% of all orbital floor fractures. Because of that coronal scans are especially necessary for evaluating the orbital floor and the orbital roof. CT is necessary for evaluating the medial orbital wall since conventional radiology only shows 15% of all medial orbital wall fractures.

Effects of heart rate changes on left ventricular volume and ejection fraction: a 2-dimensional echocardiographic study

The influence of heart rate on left ventricular (LV) volumes and ejection fraction (EF) using 2-dimensional (2-D) echocardiography during atrial pacing was analyzed. The study was performed in 13 normal control subjects, 23 patients with coronary heart disease and 8 patients with dilated cardiomyopathy. An electronic sector scanner (2.25 MHz, 84 degrees) was used. Under constant scanning of the left ventricle, heart rate was increased, in steps of 20 beats/min, from 80 to 140 beats/min. The 2-D echocardiograms were stored on videotape and analyzed off-line. The end-diastolic and end-systolic volumes (EDV and ESV) were determined using a disc method. Stroke volume (SV) and EF were calculated. Constant LV scanning was possible during atrial stimulation, as shown by the analysis of simultaneously recorded 2-D echocardiograms and cineventriculograms at different heart rates, revealing a constant position of the echocardiographic transducer. Simultaneous recordings of cineventriculography and 2-D echocardiography at 80 and 120 beats/min showed that despite differences in absolute values, percent changes of LV volumes and EF determined with both methods were similar. Thus, changes of LV function can be analyzed by 2-D echocardiography. In normal control subjects, an increase in heart rate of 10 beats/min reduced EDV by 4 ml, ESV by 2 ml, SV by 2 ml and EF by 1%, corresponding to percent reductions of 4, 2, 5 and -2%, respectively. In contrast, the absolute decreases in the patients were 6 ml, 1 ml, 5 ml and 2% and the percent changes 2%, 1%, 8% and 5%.(ABSTRACT TRUNCATED AT 250 WORDS)