Basilar Portion Research Articles

Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation

Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation

Echocardiographic Assessment of Mitral Annular Disjunction With Cross-Correlation by Computed Tomography and Magnetic Resonance Imaging: A Case Series

Mitral valve (MV) pathology, along with its associated peripheral anatomy, is one of the most common categories of heart disease. Two-dimensional (2D) transthoracic echocardiography (TTE) plays a prominent role in the detection and management of various types MV disease, specifically mitral annular disjunction (MAD). MAD is defined as a structural abnormality of the mitral annulus fibrosus, causing a noticeable gap between the atrial wall-mitral valve junction and the basilar portion of the left ventricular free wall (LV). The integral role that cardiac sonographers play in identifying MAD cannot be underscored, as well as the risk of easily overlooking this unique abnormality. Often associated with mitral valve prolapse (MVP), accurate documentation of MAD amid an echocardiographic study can have positive implications on patient prognosis. This case series highlights the echocardiographic characteristics of MAD, to raise awareness of this often forgotten feature of myxomatous mitral valves, which can indeed cause adverse patient outcomes. It is important to demonstrate correlational features with additional imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT).

78-Year-Old Woman With Intermittent Chest Pain and Palpitations

78-Year-Old Woman With Intermittent Chest Pain and Palpitations

Clinical and radiological findings in Brazilian patients with mucolipidosis types II/III.

The present study aims to provide orientation for clinicians and radiologists to recognize the most prevalent findings leading to diagnosis in mucolipidosis from a description of the natural history of five Brazilian cases. We conducted an observational and retrospective study of five patients with clinical and radiological diagnosis of mucolipidosis. Clinical evaluation consisted of information obtained from records and including physical, neurologic, and dysmorphic evaluations. Radiologic studies consisted of complete skeletal radiographs of all patients. Enzyme assessment was performed for confirmation of the diagnosis. The five patients were referred for genetic evaluation due to disproportionate short stature with short trunk accompanied by waddling gait. Age at referral varied from 11months to 28years. The most prevalent findings were joint restriction (4/5 patients), neuropsychomotor developmental delay (3/5), coarse facies (2/5), hypertrophic cardiomyopathy (2/5), and mental retardation (1/4 patients). The most common radiological findings were anterior beaking of the vertebral bodies (5/5), shallow acetabular fossae (5/5), epiphyseal dysplasia (5/5), platyspondyly (4/5), pelvic dysplasia (4/5), decreased bone mineralization (4/5), scoliosis (3/5), wide and oar-shaped ribs (3/5), generalized epiphyseal ossification delay (3/5), and hypoplasia of basilar portions of ilea (3/5). Enzyme assessment showed α-iduronidase, α-mannosidase, β-glucuronidase, hexosaminidase A, and total hexosaminidase increased in plasma and normal glycosaminoglycans concentration. One patient was clinically classified as ML II and four patients as ML III. The follow-up of five patients showed the typical clinical and radiological findings allowing the diagnosis, thus improving clinical management and providing adequate genetic counseling. Clinicians and radiologists can take advantage of the information from this work, enhancing their differential diagnosis ability.

Cerebellar herniation demonstrated by the occipitum-dens line: Ultrasonography assessment of normal fetuses, fetuses with myelomeningocele, and fetuses that underwent antenatal myelomeningocele surgery.

To establish a method to quantify the position of the cerebellum by ultrasonography in normal fetuses, fetuses with myelomeningocele (MMC), and fetuses that underwent in utero MMC repair. Reference points identifiable on ultrasound were established. The basilar portion of the occipital bone and upper portion of the odontoid process were considered as the external and internal limits, respectively, of the level zero of a line that was designated the occipitum-dens line (ODL). Eighty-three normal fetuses were assessed 1 occasion (cross-sectional study) in addition to 25 fetuses with MMC and 25 fetuses that underwent in utero MMC repair. The groups were compared using analysis of variance or the Kruskal-Wallis test. The intraclass correlation coefficient (ICC) was used to determine intra- and interobserver reproducibility. The analysis of ODL indicated that all normal fetuses had the cerebellar tonsil above level zero at a mean distance of 2.8±1.1mm (P=0.125). The fetuses with MMC had the cerebellar tonsil below level zero, except in 2 cases of myelocystocele. All the fetuses that underwent in utero MMC repair exhibited regression of the cerebellar herniation (0.5mm per week, P<0.005). Herniation increased gradually (1.0mm per week, P<0.005) in fetuses that did not undergo MMC repair. ICC indicated good intra- and interobserver reproducibility (0.996 and 0.983, respectively). The reference points for ODL may be used to assess cerebellar height. ODL allowed the demonstration of the regression of cerebellar herniation in fetuses that underwent in utero MMC repair.

Response to González et al.’s comment upon “Basilar portion porosity: A pathological lesion possibly associated with infantile scurvy”

A discrete dysplastic lesion of the mandible found in a skeleton of a young adult male of the Middle Bronze Age in the Northern Caucasus/Russia is described. The periapical lesion of the right lower canine alveolus was examined by digital microscopy, plain radiology, and plain and polarizing microscopy. Its macroscopic, radiologic and microscopic characteristics are discussed in reference to different fibro-osseous lesions arising from the odontogenic apparatus and maxillofacial skeleton. Periapical osseous dysplasia was considered to be the most likely diagnosis.

Comment upon “Basilar portion porosity: A pathological lesion possibly associated with infantile scurvy”

Comment upon “Basilar portion porosity: A pathological lesion possibly associated with infantile scurvy”

Basilar portion porosity: A pathological lesion possibly associated with infantile scurvy

Recent analysis of the juvenile (≤12 years) human remains from a 19th century site in Wolverhampton, England revealed a relatively high level of nutritional deficiency diseases within the population. Indeed, 41.7% of the 48 juvenile skeletons analysed exhibited a combination of porous and proliferative bone lesions consistent with the pathological alterations associated with nutritional stress. This paper describes a pathological lesion on the inferior surface of the basilar portion of the occipital bone, not previously reported in association with infantile scurvy, but which was exhibited by 90% (N=9) of the 10 scorbutic individuals identified during this study.

Endoscopic approach to the upper cervical spine and clivus: an anatomical study of the upper limits of the transoral corridor.

Recent advances in endoscopic techniques have allowed minimally invasive approaches to the cranio-vertebral junction (CVJ) through the oropharynx (ETA) in addition to the transnasal approach (EEA). These minimally invasive endoscopic techniques allow for increased surgical exposure using no visible incisions, with a potential less morbidity. The ability to know preoperatively the limit of the ETA is vital for the surgical planning in order to better address CVJ pathology. The aim of the present study is to determine the anatomical limits of endoscopic dissection of the skull base and upper cervical spine through the transoral corridor and the superior limit reached by adopting this approach. Six fresh-frozen adult cadaver heads were dissected adopting ETA preserving the hard and soft palate. The most superior extent of the exposure was dissected. Post-operative CT scans were performed to confirm the superior extent. The superior most limit of dissection corresponded to the sphenoid-occipital junction, where the basilar portion of the occipital bone joins with the sphenoid bone's body. This ranged from 12.7 to 18.9mm above the line of the hard palate. This was achieved without having to transgress any of the palatine structures. The sphenoid-occipital junction represents the rostral limit of endoscopic transoral approach to the lower skull base and CVJ area. This approach is limited superiorly by the orientation of the hard palate and mouth aperture and lower dentition due to the linear nature of the endoscope. Using the endoscope for this approach can allow for a more superior exposure than the traditional open transoral approach.

CT AND MRI FEATURES OF CAROTID BODY PARAGANGLIOMAS IN 16 DOGS.

Carotid body tumors (paragangliomas) arise from chemoreceptors located at the carotid bifurcation. In imaging studies, this neoplasm may be confused with other neck neoplasms such as thyroid carcinoma. The purpose of this retrospective, cross-sectional study was to describe computed tomographic (CT) and magnetic resonance imaging (MRI) characteristics of confirmed carotid body tumors in a multi-institutional sample of dogs. A total of 16 dogs met inclusion criteria (14 examined using CT and two with MRI). The most common reason for imaging was a palpable cervical mass or respiratory signs (i.e., dyspnea or increased respiratory noises). The most commonly affected breed was Boston terrier (n = 5). Dogs were predominantly male castrated (n = 10) and the median age was 9 years [range 3-14.5]. Most tumors appeared as a large mass centered at the carotid bifurcation, with poor margination in six dogs and discrete margins in ten dogs. Masses were iso- to hypoattenuating to adjacent muscles in CT images and hyperintense to muscles in T1- and T2-weighted MRI. For both CT and MRI, masses typically showed strong and heterogeneous contrast enhancement. There was invasion into the adjacent structures in 9/16 dogs. In six of these nine dogs, the basilar portion of the skull was affected. The external carotid artery was entrapped in seven dogs. There was invasion into the internal jugular vein in three dogs, and into the external jugular, maxillary, and linguo-facial veins in one dog. Imaging characteristics helped explain some clinical presentations such as breathing difficulties, Horner's syndrome, head tilt, or facial nerve paralysis.

Anatomic and craniometric factors in differentiating roe deer (Capreolus capreolus) from sheep (Ovis aries) and goat (Capra hircus) skulls

This study was carried out to investigate the bony structures relevant to skull of roe deer, sheep and goat. The skull of five sheep weighing 45-50 kg, three goat weighing 50-60 kg and five roe deer weighing 20-25 kg were used in this study. Macerations of the cranium were performed by the boiling method. The skull of the roe deer was notably similar to that of sheep with the presence of external lacrimal fossa, and to the goat with due to the presence of two points (lateral and medial) on the septal process and a significant fissure formed between the nasal, lacrimal, frontal and maxillary bones. In addition to these similarities, the formations which were specific to the roe deer were structures such as the number and position of the lacrimal foramen and presence of an uncertain muscular tubercle in the basilar portion of the occipital bone. In addition, the craniometric parameters specific to the roe deer's skull were determined as the zygomatic, interor- bital, neurocranium and nasal lengths.

Complete atrioventricular block secondary to cardiac lymphoma in a dog

Third degree atrioventricular (AV) block was observed in a patient with a roughly spherical mass measuring approximately 1 × 1 × 1 cm, visible in the basilar portion of the interventricular septum on 2-dimensional transthoracic echocardiographic examination. The patient had a brief history of lethargy and episodic collapse, and the owner elected to euthanize the dog after the mass lesion was discovered. Necropsy revealed multiple masses within the interventricular septum, ventricular free walls and atrial myocardium. The final diagnosis was large cell (T-cell) lymphosarcoma.

Beyond gastritis and before cancer: the strange case of Ménétrier’s disease

A 73-year-old man complained of epigastric discomfort, dysphagia, and weight loss of 8 kg over the prior 2 months; he denied hematemesis, hematochezia, melena, diarrhea, fever, or any other symptoms. The patient had severe leg weakness with intermittent bladder and bowel incontinence caused by a spinal cord compressing D6 fracture, hypertension, a repaired abdominal aortic aneurysm, and recurrent venous thromboembolism, for which a filter was inserted in the inferior cava vein. There was neither personal and family history of allergy, nor any gastrointestinal disorders, including cancer and peptic ulcer disease. The physical examination was unrevealing: the vital signs were normal and stable, and laboratory studies were normal except for a hemoglobin 9.8 g/dl, hematocrit 38.8%, total protein 6.9 g/dl, and albumin 3.0 g/dl. A computed tomography of the abdomen showed thickened gastric walls, an air fluid level in the lower esophagus, and abundant intraperitoneal fluid around the liver and the spleen, and in the pelvis. Endoscopy of the upper gastrointestinal tract revealed an almost complete obstruction of the gastric lumen by giant folds of the mucosa with rugae closely resembling cerebral convolutions with a finely nodular (cobblestone) appearance (Fig. 1). There was abundant and thick mucus, and an ulcerated mass was partially obstructing the pyloric outlet (not shown). Microscopy of multiple biopsies of gastric giant folds showed mucosal and foveolar hypertrophy, elongated crypts, dilated gastric glands, some of which were lined by a large number of mucous cells, and glandular cysts extending into the submucosa. There was no evidence of mucosal or submucosal inflammation, ulcers, or granulomata and no eosinophilic infiltration throughout the entire thickness of specimens. The stains for mycobacteria and fungi were negative, and cultures grew no organisms. We considered all these histological findings diagnostic of Menetrier’s disease. Microscopy of biopsies of the pyloric mass showed a poorly differentiated carcinoma. Proton pump inhibitors, corticosteroids, and parenteral nutrition were started; the patient refused surgery and was discharged to a hospice. Hypertrophic gastropathy can be caused by a wide spectrum of disorders ranging from Zollinger–Ellison syndrome to sarcoidosis, syphilis, and eosinophilic gastroenteritis; however, giant gastric folds associated with foveolar hyperplasia are more likely due to Menetrier’s disease than other causes of hypertrophic gastropathy [1]. Menetrier’s disease is a rare disease, characterized by enlargement of the gastric mucosal folds that primarily affect the body of the stomach, whereas the gastric antrum is usually saved [1]. Microscopy shows proliferation of the gastric glands with preservation of nuclear polarity and cystic dilatation of their basilar portion. In extensive cases, the mucous-secreting cells are present in the glands deep in the mucosa and replace the normal chief and parietal cells. Inflammation in the lamina propria is modest although the enlarged folds are subject to erosion and can show superficial ulcers with granulation tissue and an influx of neutrophils into the lamina propria. A patchy accumulation of eosinophils in the lamina propria is an under appreciated feature of Menetrier’s disease even though eosinophils are sometimes the predominant inflammatory cells; lamina propria lymphocytes may also be mildly increased. The muscularis mucosa is thickened and disorganized, with strands of smooth muscle extending into the lamina propria, as well as prolapse of the enlarged folds. G. Famularo (&) M. R. Sajeva L. Gasbarrone Department of Internal Medicine, San Camillo Hospital, Circonvallazione Gianicolense, 00152 Rome, Italy e-mail: gfamularo@scamilloforlanini.rm.it

Role of eosinophils and cell adhesion molecules in the asthmatic response to allergen

To evaluate the eosinophil infiltration in lung tissues in asthmatic responses of Brown-Norway rats and guinea pigs, both of which were sensitized with ovalbumin (OA), the time course of changes in respiratory impedance (Zrs) and eosinophil influx after aerosol challenge with OA were measured. The effect of treatment with monoclonal antibody (MoAb) 1A29 against rat intercellular adhesion molecule-1 (ICAM-1) alone and a mixture of MoAb 1A29 and MoAb WT-3 against rat CD18 on asthmatic responses of the rats was studied. Finally, these expressions in lung tissues of the rats were recognized. The number of eosinophils in the subepithelial area was counted in sections of lung tissue stained with Giemsa's solution, using an Interaktive Build-Analyse System (IBAS). All of the rats and 80% of the guinea pigs developed an increase in Zrs 6-7 hours after challenge, indicating that these animals showed a late asthmatic response (LAR). The rats and the guinea pigs with a LAR had higher eosinophil counts than those with an immediate asthmatic response and sensitized, non-challenged animals (p < 0.01). The rats treated with MoAb 1A29 alone (n = 5) and a mixture of MoAb 1A29 and MoAb WT-3 (n = 8) developed significantly smaller increases in Zrs and a smaller eosinophil influx than the control animals treated with phosphate buffered saline (n = 15): 147.3 +/- 3.5, 134.8 +/- 11.6 versus 158.8 +/- 6.3% of baseline; 734 +/- 21, 545 +/- 108 versus 1006 +/- 147 cells/mm2 (p < 0.01). Immunoperoxidase staining of rat lung tissues using MoAb 1A29 or MoAb WT-3 was performed ICAM-1 immunoreactivity was positive in the basilar portion of the epithelium, in the vascular endothelium of the trachea and in the pulmonary vascular endothelium. ICAM-1 immunoreactivity was revealed to be upregulated after challenge. The number of CD18-positive cells in the trachea and in the subepithelial area increased after challenge. These results show that eosinophil infiltration corresponds closely to bronchoconstriction in LAR and that treatment with MoAbs to ICAM-1 and CD18 may be effective in reducing asthmatic symptoms.

Expression of Cdc25B mRNA in Duodenal Mucosa of Chicken

Cdc25B is a mitotic regulator that might act as a starter phosphatase to initiate the positive feedback loop at the entry into mitotic (M) phase. In the present study, distribution of Cdc25B mRNA in duodenal mucosa of the chicken was demonstrated by means of in situ hybridization histochemistry (ISHH) using sense and antisense digoxigenin (DIG)-labeled RNA probes. The results showed that there were many labeled cells distributing in the duodenal mucosa of the adult chicken. Of these labeled cells, 81.60±9.63% of Cdc25B mRNA positive cells was distributed in the basilar part and mid-portion of the intestinal gland and 36.21±8.81% in the middle and basilar portion of villi of the small intestine of the chicken, respectively. Most of these labeled cells were positive in the regions of the stem cell and proliferation. The signals of ISHH decreased from basilar to upper part in the crypt of Lieberkuhn and weakened in the inferior villi of the duodenum. Moreover, the positive signals were both in the cytoplasm and cell nucleus. However, the labeled cells were negative in both the lamina muscularis mucosae and muscular layer. The results of ISHH suggested the existence of Cdc25B mRNA and vigorous proliferation activities in the duodenal mucosa of adult chicken, replenishing the cells which had sloughed off from the superior part of the villus. Our results provide some molecular evidence for a regular pattern of avian intestinal epitheliosis and functional partition and provide an approach to further study of the locations of Cdc25B in the chicken.

Cardiac hydatid cysts: Echocardiographic findings

Cardiac hydatid disease is rare. Many patients are asymptomatic, hence cardiac involvement is often discovered incidentally. Diagnosis is also difficult because of a long period between parasitic infection and the manifestation of disease. Rupture of a cardiac cyst is a serious complication. Diagnosis of cardiac hydatid cysts is often made using transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) provides details of the cysts. We present the cases of 3 patients with nonspecific symptoms of their endemic parasitic disease. The results of sonographic examinations in all patients strongly suggested the presence of cardiac hydatid cysts. One patient had a cyst in the external surface of the left ventricular apical-lateral wall visualized with TTE and TEE. Parasitic serology was negative. She underwent surgery, which confirmed a cyst located in the pericardium, and then was treated with albendazole. Another patient had a cyst in the left ventricle demonstrated by TTE and TEE and confirmed with serology. Color Doppler sonography verified that her cardiac cyst was in communication with the left ventricle. She was not a surgical candidate and was treated with albendazole. The final patient had a septated cyst in the media basilar portion of the interventricular septum demonstrated using TTE, and CT. He refused surgical treatment and albendazole was prescribed. Chest radiographs in 3 patients failed to show the cysts, and serology in 1 patient failed to indicate a hydatid cyst. Follow-up at 1-2 years revealed no recurrence in any patient. In all 3 cases, cysts could be visualized from the subcostal view via echocardiography. Imaging is critical for the early diagnosis, assessment, and follow-up of patients with this disease.

Echocardiographic and Radiographic Changes Associated with Systemic Hypertension in Cats

The purpose of this study was to assess the effects of systemic hypertension (SHT) on echocardiographic and radiographic cardiovascular variables in affected cats compared with healthy geriatric cats. Secondary objectives were to determine whether there were any relationships between these findings and age or systolic blood pressure (SBP). Fifteen healthy cats (&lt;8 years of age with normal SBP) and 15 hypertensive cats (SBP &gt; 180 mm Hg) were studied. Each cat was evaluated for standard echocardiographic parameters and 4 different aortic root dimensions. Seventeen variables were measured from right lateral and dorsoventral radio‐graphic views. Left ventrical wall thickness was greater in the SHT group (5.1 ± 0.9 mm) than in the healthy cats (4.2 ± 0.5 mm). Left ventricular hypertrophy in the SHT cats often was not severe, and mean measures were considered normal. Some cats had asymmetrical septal hypertrophy (ASH) in the basilar portion of the septum as determined from the 2‐dimensional view of the left ventricular outflow tract. ASH was greater in cats with SHT. Comparisons of the proximal ascending aorta indicated the presence of dilatation in the SHT cats, and comparison of the ascending aorta to the aortic annulus was helpful in differentiating between the 2 groups. The distal aortic root measurements and ratios evaluated by echocardiography were significantly different between the 2 groups of cats (P= .0001) and were significantly correlated with SBP (P= .0001) but not age (P &gt; .3).

Echocardiographic and radiographic changes associated with systemic hypertension in cats.

The purpose of this study was to assess the effects of systemic hypertension (SHT) on echocardiographic and radiographic cardiovascular variables in affected cats compared with healthy geriatric cats. Secondary objectives were to determine whether there were any relationships between these findings and age or systolic blood pressure (SBP). Fifteen healthy cats (>8 years of age with normal SBP) and 15 hypertensive cats (SBP > 180 mm Hg) were studied. Each cat was evaluated for standard echocardiographic parameters and 4 different aortic root dimensions. Seventeen variables were measured from right lateral and dorsoventral radiographic views. Left ventricle wall thickness was greater in the SHT group (5.1 +/- 0.9 mm) than in the healthy cats (4.2 +/- 0.5 mm). Left ventricular hypertrophy in the SHT cats often was not severe, and mean measures were considered normal. Some cats had asymmetrical septal hypertrophy (ASH) in the basilar portion of the septum as determined from the 2-dimensional view of the left ventricular outflow tract. ASH was greater in cats with SHT. Comparisons of the proximal ascending aorta indicated the presence of dilatation in the SHT cats, and comparison of the ascending aorta to the aortic annulus was helpful in differentiating between the 2 groups. The distal aortic root measurements and ratios evaluated by echocardiography were significantly different between the 2 groups of cats (P = .0001) and were significantly correlated with SBP (P = .0001) but not age (P > .3).

Histomorphometry of the aging human patella: histologic criteria and controls

Objective: A histomorphometric analysis of patellae from necropsies on persons between the third and tenth decades of life was carried out to trace the natural history of osteoarthritis.Design: Minutiae of the histological changes in the surface and basilar portions of the articular cartilage were developed as criteria for the quantitation. A total of 99 patellas were harvested in the stated age range. The present study reports the results of ten grossly and radiologically normal specimens from subjects 23–32 years old served as controls.Results: None of the control patellae were entirely histologically normal. Abnormality of the cartilage surface did not consistently proceed remodeling at the attachment to the subchondral plate.Conclusions: This observtion throws into question the concept that osteoarthritis has a single histogenesis or always arises in articular cartilage.

Surgical treatment of ventricular tachycardia by balloon electric shock ablation

We have previously described a new surgical technique for control of arrhythmogenic foci in patients with recurrent ventricular tachycardia that we call balloon electric shock ablation. With this method sequential shocks are delivered to a grid of electrodes on a balloon that can be introduced across the mitral valve into the intact ventricle. A series of experiments was undertaken to investigate possible deleterious effects of balloon electric shock ablation when shocks are delivered directly to the mitral valve apparatus. In six animals shocks totaling 1200 joules were given through a closely spaced electrode grid applied to the area of the mitral valve. Nine to 12 weeks later, left ventricular and mitral valve function were assessed. Balloon electric shock ablation in the basilar portion of the ventricle was associated with decreased myocardial performance, as evidenced by ejection phase indices. In five of six animals balloon ablation led to minor thickening of the valve leaflets and chordal attachments plus necrosis of adjacent myocardium, including papillary muscles. In these animals there was no significant dysfunction of the valve observed. In the remaining animal, however, ablation was centered on the posterior papillary muscle and resulted not only in necrosis of the base of the papillary muscle but also in full-thickness scarring and thinning of the adjacent left ventricular wall. In this dog, mitral regurgitation was seen on long-term follow-up. We conclude that when balloon electric shock ablation is used to destroy a localized area of myocardium in the basilar portion of the intact ventricle, the procedure results in decreased myocardial performance. When shocks were directly applied to the mitral valve apparatus in five of six animals, ablation did not result in significant negative effects on the structure and function of the valve. In the sixth dog, however, shock delivery resulted in transmural necrosis and thinning at the site of papillary muscle insertion and was associated with severe mitral regurgitation with volume loading. Therefore caution should be used when considering clinical application of this technique if the area to be ablated is in the basal portion of the heart.