RESUMEN
Cardiac computed tomography (CCT) is a relatively new imaging modality which allows high quality imaging of the coronary vessels and various cardiac structures. Together with the advances in scanner technology and the more frequent use of the technology in clinical practice, there is a need to better define the appropriate indications for the use of CCT. This review summarizes the appropriateness criteria for the use of CCT as were defined by a joint committee of the Israeli Heart Society and the Israeli Society of Radiology.
Asunto(s)
Técnicas de Imagen Cardíaca/normas , Cardiología/normas , Tomografía Computarizada por Rayos X/normas , Cardiopatías/diagnóstico por imagen , Humanos , Israel , Sociedades MédicasRESUMEN
OBJECTIVE: To provide new evidence of the existence of basal forebrain amnesia, as a different entity from hippocampal or diencephalic amnesia. BACKGROUND: Some authors consider that the characteristics of amnesia do not depend on lesion site, although others claim there are neuropsychologic differences between amnesias due to hippocampal, diencephalic, and basal forebrain lesions. As to the latter, literature is scarce and controversial. The opportunity to thoroughly study J.S., a man with a high IQ and amnesia, enabled us to reinforce the second hypothesis. METHODS: J.S. is a 47-year-old man who underwent surgery for a pituitary adenoma, the resulting lesion involving only the basal forebrain. We gave him a complete neuropsychologic battery for amnesia and executive functions. RESULTS: J.S. showed severe amnesia with a flat learning curve, a rapid forgetting rate and good recognition, a temporal gradient of several years for remote memory, preserved semantic and procedural memory. Most of the tests for executive functions were normal, although he did have a significant personality change after surgery. CONCLUSIONS: This patient is different from patients with hippocampal or diencephalic lesions, and is similar to other patients reported with basal forebrain lesions. The main difference is the relation between his flat learning curve and preserved recognition, both for visual and verbal material.
Asunto(s)
Amnesia/clasificación , Amnesia/patología , Ganglios Basales/patología , Retención en Psicología , Aprendizaje Verbal , Adenoma/complicaciones , Adenoma/cirugía , Amnesia/etiología , Aprendizaje por Asociación , Ganglios Basales/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Reconocimiento Visual de Modelos , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/cirugía , Reconocimiento en Psicología , Valores de ReferenciaRESUMEN
BACKGROUND: Multi-detector spiral computed tomography with retrospective electrocardiography-gated image reconstruction allows detailed anatomic imaging of the heart, great vessels and coronary arteries in a rapid, available and non-invasive mode. OBJECTIVES: To investigate the spectrum of findings in 32 consecutive patients with chest pain who underwent CT coronary angiogram in order to determine the clinical situations that will benefit most from this new technique. METHODS: Thirty-two patients with chest pain were studied by MDCT using 4 x 1 mm cross-sections, at 500 msec rotation with pitch 1-1.5, intravenous non-ionic contrast agent and a retrospectively ECG-gated reconstruction algorithm. The heart anatomy was evaluated using multi-planar reconstructions in the axial, long and short heart axes planes. Coronary arteries were evaluated using dedicated coronary software and the results were compared to those of conventional coronary angiograms in 12 patients. The patients were divided into four groups according to the indication for the study: group A--patients with high probability for coronary disease; group B--patients after CCA with undetermined diagnosis; group C--patients after cardiac surgery with possible anatomic derangement; and group D--symptomatic patients after coronary artery bypass graft, before considering conventional coronary angiography. RESULTS: Artifacts caused by coronary motion, heavy calcification and a lumen diameter smaller than 2 mm were the most frequent reasons for non-evaluable arteries. Assessment was satisfactory in 83% of all coronary segments. The overall sensitivity of 50% stenosis was 74% (85% for main vessels) with a specificity of 96%. Overall, the CTCA results were critical for management in 18 patients. CONCLUSIONS: Our preliminary experience suggests that CTCA is a reliable and promising technique for the detection of coronary artery stenosis as well as for a variety of additional cardiac and coronary structural abnormalities.
Asunto(s)
Dolor en el Pecho/diagnóstico , Angiografía Coronaria/métodos , Estenosis Coronaria/diagnóstico , Electrocardiografía , Tomografía Computarizada Espiral , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Dolor en el Pecho/diagnóstico por imagen , Dolor en el Pecho/etiología , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Programas InformáticosRESUMEN
Both the increasing usage of intratympanic medication to the inner ear through the round window and the popularity of cochlear implantation have raised interest in the anatomy of the round-window niche (RWN). The objectives of this study were to measure the RWN and to standardize a computed tomographic projection for measuring it. We included patients of all ages who underwent computed tomography for various reasons. We measured computed tomographic images acquired from 214 patients aged 4-85 years and included 414 ears and excluded 14 inflamed "wet" ears. We measured depth, width, and shape of the RWN and skull width. The RWN dimensions did not change with age, whereas the skull width increased with age in both genders throughout the patients' entire life. Folds and soft tissue could not be demonstrated in computed tomographic imaging. In conclusion, a special oblique projection that clearly demonstrates the RWN was reconstructed, and this reconstruction allows for standardized measuring.