[Large left ventricular aneurysm after silent myocardial infarction. Documentation by serial non-invasive imaging]

HISTORY AND CLINICAL FINDINGS

A 60-year-old man had a workup for atypical angina. Noninvasive investigations, including computed tomography, showed no evidence for coronary artery disease. A few months later the patient was hospitalized because of severe epileptic seizures. Thyrotoxicosis was diagnosed and emergency thyroidectomy was performed. Two months after discharge the patient was again referred because of exercise-induced angina pectoris.

INVESTIGATIONS AND DIAGNOSIS

Echocardiography and cardiac magnetic resonance imaging (MRI) showed a large aneurysm of the lateral wall of the left ventricle with a thrombus adhering to the wall. Coronary angiography and levocardiography confirmed the aneurysm and detected an occlusion of the distal part of the circumflex artery.

TREATMENT AND COURSE

Surgical aneurysm resection with thrombectomy and endoventricular circular plasty (Dor procedure) was performed without postoperative complications. Six months after surgery the patient was in good general condition without any angina. Follow-up echocardiography as well as cardiac MRI gave proof of an excellent postoperative result.

CONCLUSIONS

Noninvasive preoperative diagnosis and documentation as well as postoperative monitoring with modern imaging modalities, such as echocardiography and MRI are of great value in patients with left ventricular aneurysm.

Klassische Geflügelpest H5N1

Die aktuell durch das hochpathogene aviäre Influenzavirus vom Subtyp H5N1 Asia“ (HPAIV H5N1) verursachte Klassische Geflügelpest bedroht seit 1997 zunehmend Geflügelbestände weltweit. Aufgrund seines zoonotischen Potentials gefährdet dieser Erreger bei direkter, massiver Exposition auch den Menschen sowie empfängliche Haussäugetiere (Katzen). Der Nachweis des Virus in Wildvogelpopulationen, drei streunenden Hauskatzen sowie in einzelnen Hausgeflügelbeständen (Huhn, Pute, Pekingenten) in Deutschland seit 2006 hat einen nachhaltigen Eindruck von der Problematik und Brisanz solcher Ausbruchsszenarien vermittelt. Infektionen des Menschen wurden bislang in Europa nicht beobachtet. Der Artikel fasst das HPAIV-H5N1-Seuchengeschehen der Jahre 2006–2007 unter besonderer Berücksichtigung der Situation in Deutschland in einer Übersicht zusammen.

[High-resolution MRI for the quantitative evaluation of subendocardial and subepicardial perfusion under pharmacological stress and at rest]

PURPOSE

MR stress perfusion imaging of the heart allows the quantification of myocardial perfusion and the evaluation of myocardial perfusion reserve (MPR) and the ratio of subendocardial to subepicardial perfusion at rest and under adenosine stress. The aim of this study was to evaluate a high-resolution GRAPPA sequence for quantitative MR first pass perfusion imaging in healthy volunteers.

MATERIALS AND METHODS

First pass stress and rest perfusion studies were performed on 10 healthy volunteers using a 1.5 T MR scanner with a multislice SR-TrueFISP first pass perfusion sequence with a GRAPPA algorithm (acceleration factor 3) in prebolus technique and an image resolution of 1.8 x 1.8 mm. For the comparison group, we examined 12 different healthy volunteers with a standard first pass perfusion SR-TrueFISP sequence using a resolution of 2.7 x 3.3 mm. Myocardial contours were manually delineated followed by an automatic division of the myocardium into two rings with an equal thickness for the subendo- and subepicardial layer. Eight sectors per slice were evaluated using contamination and baseline correction.

RESULTS

Using the GRAPPA sequence, the ratio of subendo- to subepimyocardial perfusion was 1.18 +/- 0.32 for the examination at rest. Under pharmacologically induced stress, the ratio was 1.08 +/- 0.27. For the standard sequence the ratio was 1.15 +/- 0.28 at rest and 1.11 +/- 0.33 under stress. For the high resolution sequence higher mean values for the subendo- to subepimyocardial ratio were obtained with comparable standard deviations. The difference between the sequences was not significant.

CONCLUSION

The evaluation of subendomyocardial and subepimyocardial perfusion is feasible with a high-resolution first pass perfusion sequence. The use of a higher resolution to avoid systematic error leads to increased image noise. However, no relevant reduction in the quantitative perfusion values under stress and at rest was able to be depicted.

Long-term experience with integral photodynamic therapy of TIS bladder carcinoma

Fifteen patients in whom superficial bladder tumours (TIS GII-III) recurred after the unsuccessful application of other treatments were treated by photodynamic therapy (PDT) and observed for 24-54 months. The results of therapy were evaluated by regular three-monthly check-ups (endoscopy, cytology, bladder mapping, renal ultrasonography) as well as by computed tomography (CT) examination at 8- to 13-month intervals. In nine patients treated by PDT no tumour recurrence has been found over the whole observation period. Two patients have remained free of tumour (12 and 14 months) after repeated transurethral resection (TUR) and Nd-YAG laser therapy after PDT. Two patients required a second application of PDT before the treatment goal was achieved. In one of these cases a circumscribed dysplasia which appeared at the left ostium 26 months after PDT was treated by TUR and Nd-YAG laser. Further observations showed it had been successfully removed. In six patients slight mucosal atypia persisted for at least 2.5 years. In the short-term course of further cases (n = 12) one cystectomy has to be performed because of bladder shrinkage. According to these preliminary results, PDT (with strict patient selection--worst-case situation with recommended cystectomy) is justified for recurrent superficial TIS bladder carcinoma.