Left Deviation Research Articles

Utility of the Pentax-AWS Airwayscope and Macintosh laryngoscope for airway management during chest compressions in 27° left-lateral tilt: a manikin simulation study of maternal cardiopulmonary resuscitation

American Heart Association (AHA) 2010 cardiopulmonary resuscitation guidelines recommend high-quality chest compressions (minimum interruption, a pace >100 compressions/min, and a depth more than 5 cm). They propose minor changes for pregnant women: manual left deviation of the uterus or a left-lateral incline of 27°-30° to alleviate pressure on the inferior vena cava. We examined the performance of the Pentax-AWS Airwayscope (AWS) and Macintosh laryngoscope (McL) for airway management during chest compressions on a 27° left-lateral tilt (27 LLT) operating table. The study included 18 novice doctors in our anesthesia department. They performed tracheal intubation on a manikin positioned on a 27 LLT operating table using the AWS or McL with or without chest compressions. We measured the intubation time and success rate for tracheal intubation. Intubation success rate with the McL decreased with chest compressions compared to without chest compressions (12/18 vs. 18/18, P < 0.05). Intubation time with the McL was lengthened with chest compressions compared to without chest compressions (18.9 ± 4.0 s vs. 11.1 ± 1.0 s, P < 0.05). Intubation success rate was the same for the AWS with and without chest compressions (18/18 in both cases), and intubation time did not increase significantly without compressions compared to with compressions (11.6 ± 1.4 s vs. 12.6 ± 1.2 s, NS). The AWS is an effective tool for airway management during chest compressions in 27 LLT in a manikin, suggesting that the AWS may be a useful device for airway management during maternal resuscitation.

The effect of nasal septal deviation on maxillary sinus volumes and development of maxillary sinusitis

The purpose of this study was to determine the possible role of nasal septal deviation on volume of maxillary sinuses and its relationship with development of maxillary sinusitis. Between May 2010 and September 2012, paranasal sinus computed tomography (CT) findings of 825 patients (470 males, 355 females), who admitted to Ear Nose and Throat Department of Bozok University Medical Faculty were retrospectively analyzed. By excluding the other co-existent sino nasal pathologies, 109 consecutive patients (47 males, 62 females mean age 36 ± 13.4 years; range 18-71 years) with isolated nasal septal deviations were recruited for the study. The convex side of the septal curvature was accepted as the direction of deviation. The findings were grouped according to the radiologically measured angle of nasal septal deviations. The deviation angle of the nasal septum was described as; mild (<9°), moderate (the angle between 9° and 15°), or severe (15° and up). The volume of each maxillary sinus (ipsi- and contralateral to the deviation side) was also calculated using the computer program. Sinusitis was defined as any evident thickening of the maxillary sinus mucosa. There were 62 females and 47 males with a mean age of 36 ± 13.4. Nasal septal deviation angles were found to range between 5° and 27.2° (mean 13° ± 3.4°). The right sided deviations included 19 mild (<9°, Group I), 16 moderate (9°-15°, Group II), and 16 severe (15° and up, Group III) cases. The left sided deviations included 19 mild (<9°, Group I), 19 moderate (9°-15°, Group II), and 20 severe (15° and up, Group III) subjects. Maxillary sinus volumes were compared between right and left sided deviation groups. We could not demonstrate a statistically significant difference between the right maxillary sinus volumes of Groups I and II in left sided deviation cases (p = 0.77). In the same side, comparison of Groups I-III and Groups II-III, the maxillary sinus volume differences were found to be significantly meaningful (p = 0.001 and p = 0.013, respectively). Identical results were yielded in the right sided septal deviation group related to the maxillary sinus volumes of Groups I and II and Groups I-III and Groups II-III compartments (p = 0.99, p = 0.004 and p = 0.003, respectively). In both right and left deviation groups, ipsi and contralateral maxillary sinus volume comparements produced statistically significant results (p = 0.002 and p = 0.04, respectively). The presence of maxillary sinusitis findings were significantly increased in both group (p = 0.00). Statistical significance was set at p < 0.05. Our findings suggest that maxillary sinus volumes tend to be higher at the contralateral side of the severe septum deviations. In addition, the chance of finding maxillary sinusitis findings on ipsilateral to the severe septum deviation was significantly increased.

Isolated hypoglossal nerve palsy due to spontaneous carotid artery dissection: a neuroimaging study

Internal carotid artery dissection (ICAD) is a common cause of ischemic stroke in young patients. It usually presents with neck pain or headache, ipsilateral Horner Syndrome, followed by signs of cerebral ischemia. Palsy of XIIth nerve, alone or in combination with involvement of nerves IX, X or XI, may occur in about 5 % of patients with extracranial ICAD [1, 2]. Two mechanisms have been proposed to explain lower cranial nerves (LCN) involvement in the setting of ICAD, i.e., compression or stretching of nerves below the jugular foramen by an expanded or aneurysmatic ICA, or impairment (mechanical, embolic or hemodynamic) of the blood supply to the LCN [1]. Herein, we report a patient with ICAD presenting XIIth nerve palsy, in whom the MRI revealed compression of such nerve in parapharyngeal space. A previously healthy 37-year-old man presented to the emergency room with 6-day-history of left mandibular angle pain, followed by dysarthria 24 h after onset. No major neck trauma was reported. Neurological examination only revealed left deviation of protruded tongue (Fig. 1). Brain CT angiography scan revealed mild narrowing of the artery vessel with surrounding hematoma. MRI and time-of-flight magnetic resonance angiography (TOF-MRA) showed left ICAD with intramural hematoma surrounding the artery with a semilunar shape with mild narrowing of the arterial lumen; ICAD clearly expanded into parapharyngeal space (Fig. 2). MRI including the diffusion-weighted imaging (DWI) showed no brain or brainstem lesion. Patient was then given anticoagulant treatment with partial regression of symptoms at 1-month follow-up. We presented a young man with isolated XIIth nerve palsy. Isolated hypoglossal palsy may recognize different etiologies including base skull tumor, infections, injury, and carotid artery surgery, but often no etiology may be found [3]. In our patient, we considered that the isolated XIIth nerve palsy was due to the compression by ICAD in the parapharyngeal space. In the same patient, the supposed role of the reduction of blood supply to XII nerve [1] remains questionable. We also showed that both MRI and TOF-MRA are useful to visualize intramural hematoma with surrounding tissues, clarifying the pathogenesis of nerve palsy. The absence of brain ischemic lesion in our patient could probably be explained by the fact that hematoma was likely located in subadventitial layer, without significantly narrowing the lumen [3]. On the contrary, when hematoma locates in subintimal layer, with significant lumen narrowing or occlusion, embolism may easily lead to ischemic brain lesions [3]. Our report highlights the importance of looking for ICAD and to perform E. Ferlazzo S. Gasparini U. Aguglia Regional Epilepsy Centre and Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy

The chameleon syndrome: acute convergence paralysis

A 78-year-old female patient without vascular risk factors presented with sudden left eye deviation at awakening. Neither diplopia nor other symptoms were reported. On admission, left eye exotropia at primary...

Intra- and Interday Reliability of Spine Rasterstereography

To determine intra- and interday reliability of spine rasterstereographic system Formetric 4D with and without reflective markers. Twenty-six healthy volunteers (M group) had two markers placed in correspondence of vertebra prominens and intergluteal cleft, and 24 volunteers (NM group) were assessed without markers. All participants were analyzed two times in the same day and one time on a separate day. Trunk length, kyphotic angle, lordotic angle, pelvic inclination, kyphotic and lordotic apex, right and left lateral deviation, flèche cervicale and lombaire, trunk imbalance, pelvic tilt, inflection point, rotation correction, right and left surface rotation, pelvic torsion, and trunk torsion were measured. Intraclass correlation coefficient (ICC) and Cronbach Alpha (Cα) were calculated. In M group, for intra-, interday, and overall evaluations, the higher reliability coefficients were 0.971, 0.963, and 0.958 (ICC) and 0.987, 0.983, and 0.985 (Cα) for trunk length, kyphotic angle, and lordotic apex, respectively; while in NM group, they were 0.978, 0.982, and 0.972 and 0.989, 0.991, and 0.991 for trunk length. In M group, the lower values were 0.598, 0.515, and 0.534 (ICC) and 0.742, 0.682, and 0.784 (Cα) for trunk and pelvic torsion and in NM group 0.561, 0.537, and 0.461 and 0.731, 0.695, and 0.729 for left lateral deviation. The reliability of most parameters was excellent.

Autonomic dysfunction and beta blocker therapy in Chagas heart disease

In a hamster model of Chagas disease, Pimentel et al. (1) recently found that 1) carvedilol decreased mortality in the acute, but not in the chronic stage and 2) in the chronic stage, carvedilol neither changed the left ventricular diameter and/or function, nor attenuated changes in the resting electrocardiogram (ECG), nor decreased the myocardial collagen content. In contrast, we did not observe a decrease in the mortality rate of rats that were infected with Trypanosoma cruzi and then received metoprolol to treat the ensuing acute Chagas disease (2). Conceivably, both the animal model and the T. cruzi strain might account for this disparity. Furthermore, we found that chronic metoprolol administration reversed the ECG abnormalities in the T. cruzi-infected rats at the chronic stage of the disease. Left axis deviations and intraventricular conduction delays have been observed in almost half of rats chronically infected with T. cruzi, which we believe supports the theory that the different animal models used in the two studies were responsible for the different results. Pimentel et al. (1) did not observe any effects of the chronic use of carvedilol on myocardial function and left ventricular remodeling in their hamster model of chronic Chagas heart disease. Although there are no other studies for comparison, we agree with the assertion of Pimentel et al. (1) that intense myocarditis, extensive myocardial fibrosis, and sympathetic denervation may have overshadowed the beneficial effects of the beta blocker therapy in this animal model. Our message is that the absence of a beneficial effect of carvedilol use in a hamster model should not preclude the use of beta blockers in Chagas disease patients, particularly in the following two clinical settings. First, beta blockers may be appropriate for patients with chronic systolic heart failure because the activation of the autonomic nervous system in these patients is similar to that observed in heart failure patients without Chagas disease (3) and because beta blocker therapy has produced good preliminary results in this group of patients (4-)(7). Second, beta blocker therapy may be suitable for patients receiving implantable cardioverter-defibrillator therapy for the secondary prevention of sudden cardiac death due to the high recurrence rate of malignant arrhythmias in this patient group in the absence of beta blocker therapy (8).

Solitary paraganglioma of the hypoglossal nerve: A case report with magnetic resonance imaging findings

Patient: Female, 58Final Diagnosis: Solitary paraganglioma of the hypoglossal nerveSymptoms: Neck painMedication: —Clinical Procedure: Surgical resectionSpecialty: OtolaryngologyObjective:Rare diseaseBackground:Paragangliomas are rare neuroendocrine tumors originating in the neural crest. Only a few cases of hypoglossal paraganglioma have been reported in the published literature. The localization of hypoglossal paragangliomas close to the carotid artery precludes determination of tumor origin preoperatively.Case Report:A 58-year-old female patient was admitted due to neck pain. During physical examination, a significant mass could not be palpated in the upper left part of the neck, despite sensitivity during palpation. Atrophy and left deviation of the left half of the tongue was observed. MRI of the neck revealed a lesion located superior to the carotid bifurcation between the left internal carotid artery and external carotid artery. There was atrophy in the left half of the tongue. The neck mass displaced the left internal carotid artery anteriorly and medially. The operation was performed with left lateral cervical access. This lesion, which derived from the hypoglossal nerve, was excised. Following histopathological evaluation, the lesion was diagnosed as paraganglioma.Conclusions:Hypoglossal paraganglioma is quite rare and there are no established criteria for preoperative diagnosis. Hypoglossal paraganglioma must be considered to determine treatment options if a lateral neck mass and ipsilateral tongue atrophy are present at the level of the 12th cranial nerve tract.

The Effect of Keyboard Key Spacing on Typing Speed, Error, Usability, and Biomechanics

In this study, we evaluated the effects of key spacing on a conventional computer keyboard on typing speed, percentage error, usability, and forearm muscle activity and wrist posture. International standards that specify the spacing between keys on a keyboard have been guided primarily by design convention because few studies have evaluated the effects of key spacing on productivity, usability, and biomechanical factors. Experienced male typists (N = 37) with large fingers (middle finger length > or = 8.7 cm or finger breadth of > or = 2.3 cm) typed on five keyboards that differed only in horizontal and vertical key spacing (19 x 19 mm, 18 x 19 mm, 17 x 19 mm, 16 x 19 mm, and 17 x 17 mm) while typing speed, percentage error, fatigue, preference, extensor carpi ulnaris and flexor carpi ulnaris muscle activity, and wrist extension and ulnar deviation were recorded. Productivity and usability ratings were significantly worse for the keyboard with spacing of 16 x 19 mm compared with the other keyboards. Differences on these measures between the other keyboards were not significant. Muscle activity tended to increase in the left forearm and decrease in the right with decreasing horizontal key spacing. There was also a trend for left wrist extension to increase and left ulnar deviation to decrease with decreasing horizontal key spacing. Reducing vertical key spacing from 19 to 17 mm had no significant effect on productivity or usability ratings. The study findings support key spacing on a computer keyboard between 17 and 19 mm in both vertical and horizontal directions. These findings may influence keyboard standards and the design of keyboards.

The Effect of Keyboard Key Spacing on Productivity, Usability, and Biomechanics in Touch Typists with Large Hands

International standards that specify the spacing between keys on a keyboard have been guided primarily by design convention. Experienced typists (N=37) with large hands typed on five keyboards with different horizontal and vertical key spacing (19x19, 18x19, 17x19, 16x19, and 17x17mm) while productivity, comfort ratings, left and right extensor carpi ulnaris (ECU) and flexor carpi ulnaris (FCU) muscle forces, and right and left wrist extension and ulnar deviation were recorded. Productivity and usability ratings were significantly worse for the 16x19 keyboard. There was a trend for muscle activity to increase in the left forearm and decrease in the right forearm with decreasing horizontal key spacing. There was also a trend for left wrist extension to increase and left ulnar deviation to decrease with decreasing horizontal key spacing. The study findings support key spacing on a keyboard between 17 and 19mm. These findings may influence keyboard standards and design of keyboards.

The value of RV(6) > RV(5) of ECG in diagnosis of pneumocardiac disease complicated by left ventricular hypertrophy in coal-workers with pneumoconiosis

This thesis will discuss the value of RV(6) > RV(5) of ECG in diagnosis of pneumocardiac disease complicated by left ventricular hypertrophy in coal-workers with pneumoconiosis through the analysis of the ECG characteristics in the postmortem examination of coal-workers with pneumoconiosis. Three data groups will be formed on the basis of the ECG data in the case 47 postmortem examination of coal-workers with pneumocardiac disease complicated by left ventricular hypertrophy, and they are right deviation group with ECG cardiac electric axis more than 90 degrees (case 16), no deviation group with ECG cardiac electric axis between 30 degrees and 90 degrees (case 16) and left deviation group with ECG cardiac electric axis between 30 degrees and -30 degrees (case 15). The method that this thesis adopted is to compare the thickness of the right and left ventricle walls of the three groups, their ratio and the detectable ratio of ECG RV(6) > RV(5). The detectable rate of the thickness of right ventricle front wall, the thickness of the left ventricle wall, the thickness of the left ventricle wall to the thickness of right ventricle wall and ECG RV(6) > RV(5) in left deviation group is obviously higher than those of the no deviation group and right deviation group. The differences between the three groups are of statistics significance (P < 0.01); the detectable rate of the thickness of right ventricle front wall, the thickness of the left ventricle wall, the thickness of the left ventricle wall to the thickness of right ventricle wall and ECG RV(6) > RV(5) in no deviation group is obviously higher than those of the right deviation group. The differences are of statistics significance (P < 0.01). In case 47 that pneumocardiac disease complicated by left ventricular hypertrophy in coal-workers with pneumoconiosis, the ECG shows 20 cases of ECG RV(6) > RV(5). There are altogether 3 kinds of ECG types: (1) 14 cases of ECG RV(6) > RV(5); (2) 4 cases of left ventricular hypertrophy; (3) 2 cases of right ventricular hypertrophy. The left deviation of ECG cardiac electric axis and ECG RV(6) > RV(5) can be used as indications to diagnosis of pneumocardiac disease complicated by left ventricular hypertrophy in coal-workers with pneumoconiosis.

Analyzing the ranking method for L–R fuzzy numbers based on deviation degree

Ranking fuzzy numbers based on their left and right deviation degree (L–R deviation degree) has attracted the attention of many scholars recently, yet most of their ranking methods have two systematic shortcomings that are usually ignored. This paper addresses these shortcomings and proves them through mathematical proofs instead of providing counter-examples. Applying our analyses will help other authors avoid some common errors when building their own ranking index functions. We use Asady’s ranking index function (2010) as an example when we present our arguments and proofs and provide fully detailed analyses of two of the ranking index functions herein. Based on these analyses, an algorithm for detecting inconsistencies in ranking results is proposed, and numerical examples are given to illustrate our arguments.

Benefits of High-Pitch 128-Slice Dual-Source Computed Tomography for Planning of Transcatheter Aortic Valve Implantation

Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment for high-risk and inoperable patients. Advanced multimodality imaging, including computed tomography (CT), plays a key role for optimized planning of TAVI. Forty-nine patients (25 women; age, 82.3±8.8 year) with severe aortic stenosis scheduled for TAVI were examined with 128-slice high-pitch dual-source prospective aortoiliac CT angiography (CTA). The 3-coronary-sinus-alignment (3-CSA) plane, comprising left and right anterior oblique and craniocaudal projection, was defined from three-dimensional volume-rendered technique data sets and compared with the intraoperative angiographic plane (deployment plane) used for device implantation. A tolerance level of ±5-degree deviation was acceptable. Volume of intraoperative iodine contrast agent was compared before and after the implementation of the 3-CSA plane estimation by CT. All 49 patients underwent TAVI, during which 6 CoreValves (Medtronic, Minneapolis, MN) and 43 Sapien valves (Edwards Lifesciences, Irvine, CA) were successfully implanted using transapical (n=29), transfemoral (n=17), and transaxillary access (n=4). No severe complications occurred. In 47 patients (96%), CTA correctly predicted the 3-CSA plane used for device implantation. Mean left anterior oblique by CTA was 5.3±6.5 degrees and craniocaudal was -1.3±10.1 degrees. Mean left anterior oblique deviation between CTA and the intraoperative projection was 2.1±2.7 degrees and craniocaudal was 1.7±3.0 degrees. Ostium heights of the right and left coronary arteries were 12±1.9 and 12.9±3.3 mm. No over-stenting occurred in left coronary artery ostia of 8 mm or more. Contrast volume was reduced from 81.8±25.6 to 59.4±40.2 mL (p=0.05) when using 3-CSA plane estimation by CT for final prosthesis implantation plane. Aortoiliac high-pitch 128-slice dual-source CT contributes to TAVI planning, including reliable prediction of the 3-CSA valve deployment plane, which saves contrast volume during the procedure and may facilitate correct valve placement.

Conservative Approach to Unilateral Condylar Fracture in a Growing Patient: A 2.5-Year Follow Up

Condylar fractures in children are especially important because of the risk of a mandibular growth-center being affected in the condylar head, which can lead to growth retardation and facial asymmetry. The purpose of this article is to follow up the two and half year clinical and radiological evaluation of the conservative treatment of a 10 year-old patient, who had a unilateral green-stick type fracture. The patient presented with painful facial swelling localized over the left condylar region, limited mouth-opening and mandibular deviation to the left. Panoramic radiography and computed tomography confirmed the diagnosis of incomplete fracture on the left condyle with one side of the bone fractured and the other bent. Closed reduction was chosen to allow for initial fibrous union of the fracture segments and remodeling with a normal functional stimulus. A non-rigid mandibular splint was applied in order to remove the direct pressure on the fracture side of the mandible. Clinical and radiologic examination after 30 months revealed uneventful healing with reduction of the condylar head and remodeling of the condylar process following conservative treatment.

Agenesis of the left pulmonary artery accompanied by right aortic arch anomaly: CT angiography findings of a case

Unilateral absence of the pulmonary artery is a rare congenital anomaly that is encountered at a rate of 1/200,000. 1,2 Pulmonary artery agenesis can occur on either side, frequently on the right side, and usually co-exists with cardiac anomalies such as tetralogy of Fallot and septal defects. 3 This condition is frequently diagnosed in the neonatal period or in early childhood in patients suffering from shortness of breath, coughing, and frequent pulmonary infections. A 21-year-old male patient without significant medical history had been suffering from shortness of breath and mild thoracic pain for 2 months. The patient was evaluated by conventional radiography and computed tomography (CT) angiography of the chest. Postero-anterior chest radiography demonstrated decreased volume and radiolucency of the left hemithorax, the superiorly located left hemidiaphragm, the deviation of the mediastinal structures to the left, and an abnormal convex right mediastinal contour (black arrow), absence of the aortic contour on the left side (white arrow) and deviation of the trachea (*) to the left, consistent with a right-sided aortic arch (Panel A). To clearly demonstrate the lung parenchyma and thoracic vascular structures, a thorax CT angiography examination was performed (Panels B1-B4). On CT angiography images, the right aortic arch (AA) anomaly and a mirror-image branching pattern of the aortic arch were observed. First, a leftsided brachiocephalic artery (large white arrow), then a right-sided common carotid artery (narrow black arrow), and finally a right-sided subclavian artery (narrow white arrow) were arising from the aortic arch. While the main pulmonary trunk (PA), right pulmonary artery (large black arrow) and vascular distribution of the right lung were normal, the left pulmonary artery was absent. Enlarged bronchial and intercostal arteries (white arrowheads) originating from the descending aorta and collateral vascular structures (black arrowheads) originating from the left costocervical trunk were supplying the left lung. The bronchial branching pattern and the pulmonary venous structures (PV) of both lungs were normal. Echocardiography showed no associated cardiac pathology. In our patient, there was no history of recurrent pulmonary infection or associated cardiac anomaly, and pulmonary artery pressure at rest was measured as 21 mmHg, which is within normal limits. Routine follow-up every 6 months for possible complications such as pulmonary hypertension was recommended.

CIRNE III Abstracts: Congresso Internacional de Reabilitação Neuromusculoesquelética e Esportiva, May 18–21, 2011, Vitória, Brazil

CIRNE III Abstracts: Congresso Internacional de Reabilitação Neuromusculoesquelética e Esportiva, May 18–21, 2011, Vitória, Brazil

Characterization of mechanical dyssynchrony measured by gated single photon emission computed tomography phase analysis after acute ST-elevation myocardial infarction

BackgroundLeft ventricular dyssynchrony is an adverse consequence of ST-elevation myocardial infarction (STEMI) and bears an unfavorable prognosis. Mechanical dyssynchrony as measured by phase analysis from gated single photon emission computed tomography (GSPECT) correlates well with other imaging methods of assessing dyssynchrony but has not been studied in STEMI. We hypothesized that systolic dyssynchrony as measured by GSPECT would correlate with adverse remodeling after STEMI. MethodsIn 28 subjects suffering STEMI, GSPECT with technetium-99m sestamibi was performed immediately after presentation (day 5) and remotely (6 months). Parameters of left ventricular dyssynchrony (QRS width, histogram bandwidth (HBW) and phase standard deviation (PSD)) were measured from GSPECT using the Emory Cardiac Toolbox. Left ventricular volumes, ejection fraction (LVEF) and infarct size were also assessed. ResultsAfter successful primary percutaneous coronary intervention to the infarct-related artery, subjects had an LVEF of 46.4% ± 11% and a resting perfusion defect of 27.4% ± 16% at baseline. Baseline QRS width was normal (91.5 ± 17.5 ms). Subjects with STEMI had dyssynchrony compared with a cohort of 22 normal subjects (age 57.2 ± 10.6 years, <5% perfusion defect) by both HBW (100.3° ± 70.7° vs 26.5° ± 5.3°, P < .0001) and PSD (35.3° ± 16.9° vs 7.9° ± 2.1°, P < .0001). Baseline HBW correlated with resting perfusion defect size (r = 0.67, P < .001), end-systolic volume (r = 0.72, P < .001), end-diastolic volume (r = 0.63, P = .001), and inversely with LVEF (r = −0.74, P < .001). HBW and PSD improved over the follow-up period (−24.1 ± 35.9 degrees, P = .003 and −8.7° ± 14.6°, P = .006, respectively), and improvement in HBW correlated with reduction in LV end-systolic volumes (r = 0.43, P = .034). Baseline HBW and PSD, however, did not independently predict LVEF at 6 months follow-up. ConclusionsAfter STEMI, subjects exhibit mechanical dyssynchrony as measured by GSPECT phase analysis without evidence of electrical dyssynchrony. Improvement in mechanical dyssynchrony correlates with beneficial ventricular remodeling. The full predictive value of this measure in post-infarct patients warrants further study.

Radiofrequency catheter ablation of paediatric idiopathic left ventricular tachycardia by P potential mapping under sinus rhythm

ObjectiveTo investigate the feasibility and effectiveness of P potential mapping in radiofrequency catheter ablation (RFCA) of paediatric idiopathic left ventricular tachycardia (ILVT) in difficult to be induced or uninducible case...

Scintigraphic spectrum of a patient population with suspected arrhythmogenic right ventricular dysplasia

Gated radionuclide ventriculography (RNV), combined with inter- and intraventricular dyssynchrony measurement by phase analysis, is able to evidence right and left ventricular mechanical cardiac disorders and may contribute to the diagnosis of arrhythmogenic right ventricular dysplasia (ARVD). Nevertheless, the patients referred for suspicion of ARVD on the basis of symptoms, electrical abnormalities or family history of sudden death, are very heterogeneous and the examination findings spread out from strictly normal to severely abnormal. In order to describe the patient population encountered in "real life" we propose to use an automatic clustering method based on RNV results in order to segment the overall population into subgroups with coherent scintigraphic data in each one. A series of 130 consecutive patients presenting with various criteria suggestive of ARVD has been studied over a 3-year period. Seven variables have been extracted from gated RNV: left and right ejection fractions, visual semi-quantitative assessment of left and right ventricular volumes, left and right phase standard deviations and inter-ventricular dyssynchrony (IVD) measured from the phase histograms. The Self Organizing Map (SOM) clustering method has been applied to these data with various numbers of variables (right ventricular values only or values from both ventricles) and an increasing number of classes from two to nine. Including left ventricular variables and IVD in the analysis results in significant changes in classification compared to right ventricular data alone. Clustering into nine classes seems to be the most pertinent one and separates patients into four groups of normal result or insignificant left, right or bilateral abnormalities, two groups of isolated right ventricular abnormalities of increasing severity and three groups of severe bilateral abnormalities, right predominant with and without IVD, and left predominant. Automatic clustering of patients on the basis of scintigraphic results helps to understand the signification of the large spectrum of results encountered in clinical practice for patients whose common characteristic is to present some abnormalities or risk factors leading to investigations in the context of suspicion of ARVD. Although the final diagnosis remains questionable in a large proportion of patients, the knowledge of the various profiles of gated blood pool phase analysis may help for stratification of patients at risk of ARVD.

A small pontine infarct on DWI as a lesion responsible for wall-eyed bilateral internuclear ophthalmoplegia syndrome

A 64-year-old man presented with alternating exotropia and bilateral medial longitudinal fasciculus (MLF) syndrome known as wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome. Diffusion-weighted imaging showed a small localized lesion in the median dorsal pons, and high-resolution T2-weighted imaging revealed slight left deviation of the lesion. A small penetrating artery was assumed to be occluded at the level of the MLF decussation. The median dorsal pons appears to be a location for the lesions causing WEBINO syndrome.

Maxillofacial characteristics affecting chin deviation between mandibular retrusion and prognathism patients

To examine and compare the maxillofacial characteristics affecting chin deviation three-dimensionally in facial asymmetry patients with mandibular retrusion and mandibular prognathism. Maxillofacial computed tomography (CT) scan data were obtained from 48 orthognathic surgery patients (24 cases of mandibular retrusion and 24 cases of mandibular prognathism) with facial asymmetry. Although chin deviation was assessed on the basis of the ANS-to-menton line on frontal cephalograms, its contributing factors were evaluated on three-dimensional CT images. Maxillary height, ramus length, frontal ramal inclination, lateral ramal inclination, mandibular body length, and body height were defined on each side, and right-left differences were calculated and analyzed. In an assessment of chin deviation, subjects in this study showed predominantly left side deviation regardless of the group, and the degree of menton deviation did not reveal significant differences between groups. In a comparison of right-left differences in contributing factors, all values were noted to be greater in the retrusion group, except for body height, which showed no difference between chin-deviated and contralateral sides. In particular, ramus length presented a statistically significant difference between the two groups. Based on the same degree of chin deviation in mandibular prognathism and retrusion in this study, results of right-left differences in contributing factors indicate that chin deviations are expressed easily in mandibular prognathism, whereas they occur only with significant right-left differences in relevant maxillofacial structures in individuals with mandibular retrusion.