T1 gadolinium enhancement of intracranial atherosclerotic plaques associated with symptomatic ischemic presentations

BACKGROUND AND PURPOSE

Contrast enhancement of intracranial atherosclerotic plaques has recently been investigated using high field and high resolution MR imaging as a risk factor in the development of ischemic stroke. We studied the reliability of conventional MR imaging at 1.5T in evaluating intraplaque enhancement and its relationship with acute cerebrovascular ischemic presentations in patients with severe intracranial atherosclerotic disease.

MATERIALS AND METHODS

We retrospectively identified and analyzed 19 patients with 22 high-grade intracranial atherosclerotic disease plaques (>70% stenosis) in vessels cross-sectionally visualized by neuroanatomic MR imaging. Atherosclerotic plaques were classified as asymptomatic or symptomatic. Two blinded neuroradiologists independently ranked each lesion for the presence of intraplaque enhancement by use of a 5-point scale (1-5). Furthermore, plaque enhancement was quantified as the relative change in T1WI spin-echo signal intensity (postcontrast/precontrast) in the vessel wall at the site of each intracranial atherosclerotic disease lesion.

RESULTS

Intraplaque enhancement was observed in 7 of 10 (70%) symptomatic plaques, in contrast to 1 of 12 (8%) asymptomatic plaques. Interobserver reliability correlated well for intraplaque enhancement (κ = 0.82). The degree of relative plaque enhancement in symptomatic versus asymptomatic lesions (63% versus 23%) was statistically significant (P = .001, t test).

CONCLUSIONS

In this pilot study, we determined that intraplaque enhancement could be reliably evaluated with the use of cross-sectional imaging and analysis of vessels/plaques by use of conventional neuroanatomic MR imaging protocols. In addition, we observed a strong association between intraplaque enhancement in severe intracranial atherosclerotic disease lesions and ischemic events with the use of conventional MR imaging. Our preliminary study suggests that T1 gadolinium-enhancing plaques may be an indicator of progressing or symptomatic intracranial atherosclerotic disease.

Pregnancy outcome in a case of non-obstructive hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is a relatively common genetic disorder (1:500) inherited as an autosomal dominant trait. It is caused by mutations in any one of 10 genes encoding protein components of cardiac sarcomere. Some theoretically calculated risks exist when patients with HCM become pregnant. The physiologic increase of cardiac output and increased stroke volume may be impaired due to the non-compliant ventricular walls. In the first trimester, the physiologic hypervolemia of pregnancy to some extent counteracts the natural decrease in peripheral vascular resistance which would have otherwise provoked an obstruction gradientin systolic flow. As pregnancy advances, the vena caval compression may decrease venous return causing cardiac compromise, whereas the stress of labour may precipitate arrhythmia. We report our experience of a pregnancy with co-existant non-obstructive hypertrophic cardiomyopathy and nodal bradycardia ultimately resulting in pre-term delivery, neonatal death and maternal death in puerperium from overt cardiac failure after a relatively uneventful gestation.

Successful pregnancy outcome with coexisting primary epithelial ovarian carcinoma

Maternal epithelial ovarian cancer (EOC) is rare. EOC is reported to occur in 1:12,000 to 1:50,000 pregnancies. We report a case of Stage IA epithelial ovarian cancer detected in the first trimester managed by laparotomy at 13 weeks followed by left sided salpingo-oophorectomy and infra-colic omentectomy. Histopathology revealed papillary mucinous cystadenocarcinoma (well differentiated with negative peritoneal cytology for malignancy). Chemotherapy was not warranted due to early stage disease and she had an uneventful gestation ending in vaginal delivery of a 2.5 kilogram male baby at term. During the period of follow up she developed no clinical or biochemical evidence of tumour recurrence or relapse.

Mechanical characterization of sintered piezo-electric ceramic material using scanning acoustic microscope

Lead Zirconate Titanate (PZT) is a piezo-electric ceramic material that needs to be characterized for its potential use in microelectronics. Energy dispersive X-ray analysis (EDX) is conducted to determine the chemical composition of the PZT ceramics. The scanning electron microscope (SEM) is performed to study the surface morphology, grain structure and grain boundaries. The SEM image helps us to understand the surface wave propagation and scattering phenomena by the PZT and the reason for its anisotropy and inhomogeneity due to the grain structure. In this paper scanning acoustic microscopy at 100 MHz excitation frequency is conducted for determining mechanical properties of PZT. Earlier works reported only the longitudinal wave speed in PZT while in this paper longitudinal, shear and surface acoustic wave speeds of sintered PZT are measured from its acoustic material signature (AMS) curves, also known as V(z) curves. AMS or V(z) curve is the variation of the output voltage as a function of the distance between the acoustic lens focal point and the reflecting surface. The average velocities of longitudinal, shear and surface acoustic waves in a PZT specimen are determined from its V(z) curve generated at 100 MHz excitation frequency and found to be over 5000 m/s, over 3000 m/s and between 2500 and 3000 m/s, respectively. From these velocities all elastic constants of the specimen are obtained.

Spectrum of skin lesions of post-kala-azar dermal leishmaniasis in kala-azar endemic areas of Bangladesh

Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis (VL) and serves as a potential reservoir for Leishmania parasite. The study was aimed to evaluate the spectrum of skin lesions of PKDL in kala-azar endemic areas in Bangladesh. This cross sectional study was carried out to observe the characteristics of skin lesions among 250 PKDL cases. The suspected PKDL patients in highly endemic villages of Fulbaria Upazilla of Mymensingh district.were subjected to a dipstick test (rK39) for kala azar. The median time interval between diagnosing kala-azar and PKDL was 23 month (m-21, r- 0-60 months). The most common skin lesions were multiple symmetrical hypopigmented macules with irregular margins in 179(71.6%) cases followed by erythematous facial induration in 74(29.6%), papular in 33(13.2%), nodular in 28(11.2%) cases, combination of macules, papules, nodules and plaques in 88(35.2%) cases, annular in 7(2.8%) cases and Papillomatous mucosal growth in 2(0.8%) cases. Sites of involvement were mostly in face (92.4%), Trunk (84.8%), extremities (33.2%), oral mucosa and tongue (0.8%) and Genitalia (1.2%). Suspicion of PKDL on the basis of skin lesions will lead to early diagnosis and prompt treatment will impart an important role in prevention and eradication of Leishmaniasis in Bangladesh.

Krukenberg tumor: report of two cases

Krukenberg tumor (KT) is a metastatic signet-ring adenocarcinoma of the ovary with variants of gastro-intestinal primary either detected synchronously or metachronously. Here two cases of Krukenberg tumor are reported with detected primary sites, one arising from the stomach and the second from the pancreas. The first case, a 35 year old multiparous woman with a past history of endoscopically proven gastric ulcer was diagnosed as a case of advanced gastric carcinoma with concomitant right adnexal mass. Endoscopic biopsy from the gastric growth revealed adenocarcimona (signet ring variety). As the primary gastric growth was not feasilble for surgical resection, palliative total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathology of the ovary revealed metastatic adenocarcinoma with negative peritoneal cytology. After 4 cycles of chemotherapy, the patient died due to progression of primary cancer. The second patient, a 55 year old menopausal lady was diagnosed as a case of metastatic ovarian tumour with recurring ascitis upon chemotherapy. Comprehensive scanning revealed a thick walled lesion in the left side of the body and tail of the pancreas along with a left adnexal mass. Upon surgical exploration a vascular solid mass was identified in the pancreas which was not feasible for any sort of resection. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Poorly differentiated adenocarcinoma was found in the apparently shriveled up right ovary with positive peritoneal cytology. She succumbed to death due to reappearance of epigastric pain and haemorrhagic ascitis.

An ergonomic evaluation of infant life jackets: Donning time & donning accuracy

Canada is considering the development of a new standard for infant/child life jackets. Eight currently available (approved and non-approved) infant/child life jackets were procured for evaluation. Fifty-six participants were chosen as a sample of convenience from the general public for testing. The life jackets were divided into two groups of four, which were donned on a soft infant manikin procured from the Red Cross. In 224 attempts at donning, only 43 (19%) attempts resulted in the life jacket being donned correctly in less than 1 min. Only one life jacket came close to a good design and passed the life jacket standard for donning time and accuracy. Failure rates were observed across all the participants irrespective of age, gender, experience with children and experience with recreational marine equipment. Accuracy and speed of donning the life jacket were hampered as the number of donning sub-tasks increased. It was concluded that it is possible to design a life jacket that can be donned correctly in under 1 min. The life jacket must be of simple, intuitive design and fall naturally into the anatomical shape of the child. A minimum number of ties, zips and clips should be used in the design, and if such connectors are used they should be color coded or of different shapes and sizes to avoid confusion.

Use of N-butyl-2-cyanoacrylate tissue glue in thoracic duct injury during neck dissection surgery

Although thoracic duct injury is an uncommon complication of neck dissection, it can have a significant physiological and immunological impact on the patient's recovery as well as having more serious effects. We report a novel technique of using cyanoacrylate tissue glue for managing thoracic duct damage when this is noted at the time of neck dissection surgery. We have used this technique in four patients with no post-operative chyle leak or added complications.