The purpose of this article is to review the characteristics of computed tomography (CT) and magnetic resonance imaging (MRI) of the pericardium and pericardial diseases. Because patients with pericardial diseases usually present with nonspecific symptoms, these diseases may not be detected until they have reached an advanced stage. It is therefore important to distinguish between normal pericardial structure and disease. Multiplanar reconstruction images of CT and MRI are useful for evaluating faint changes of the pericardium. The specific pericardial diseases described in this article include pericardial cyst, constrictive pericarditis, pericarditis with radiation pericarditis, postoperative pericardial hematoma, and cardiac tamponade due to a paracardiac mass (lymphoma).
miodarone is a unique anti-arrhythmic drug originally developed for angina. 1 Because of its clinically proven effectiveness, amidodarone is now used to control atrial and ventricular arrhythmias. [2][3][4] Unfortunately, many adverse effects are related to the use of this agent, especially pulmonary toxicity, so called amiodarone-induced pulmonary toxicity (APT). 5,6 The condition of APT is extremely serious and difficult to diagnose, with an incidence of up to 13%. Patients with APT may have an associated mortality rate of 10% to 23%. 5 The toxic effects of amiodarone seem to be related to dose and duration of therapy. However, a meta-analysis of studies using lowdose amiodarone revealed that the risk of experiencing pulmonary adverse effects was increased by twofold (1.9% vs 0.7%) compared with placebo treatment. 7 APT can be difficult to diagnose clinically, but early recognition of APT is important because discontinuation of amiodarone could prevent its progression. In clinical practice, despite all radiological tests such as chest X-ray or computed tomography (CT), the diagnosis of APT is often reached by a therapeutic test: corticotherapy, given after the discontinuation of amiodarone.Since the first report describing the patterns of CT findings in cases of APT 15 years ago, several studies on CT findings have been carried out. [8][9][10][11][12][13] Kulhman et al have established the value of CT using standard techniques that provide a means of identifying patients with significant pulmonary accumulation of amiodarone. 13 High-resolution computed tomography (HRCT) is well established for noninvasive evaluation of the thin structural details of the normal and pathological pulmonary parenchyma. 14 Recently, HRCT findings of reversible APT 15 and symptomatic patients with APT 16 were reported.The technique of HRCT is usually performed in a supine position. Atelectasis is commonly seen in the dependent lung in both healthy and diseased subjects on ordinal HRCT in supine positions, resulting in a 'dependent density' or 'subpleural line'. However, there have been several reports claiming that HRCT in prone positions can be a useful modality to exclude the effect of gravity in patients with asbestosis. 17 Volpe et al reported the usefulness of HRCT in prone positions when chest radiographs show normal findings, possibly abnormal findings, or minimal abnormalities indicative of diffuse lung disease. 18 Therefore, an additional HRCT in prone positions may add important information by countering the effects of gravity on pulmonary vascularity. However, there is no study to evaluate APT by HRCT using a combination of supine and prone positions. The aim of the current study was to describe the effectiveness and feasibility of HRCT in patients in supine and prone positions to detect APT. Serum KL-6 could be a useful maker of APT. Background The aim of the present study was to describe the effectiveness and feasibility of high-resolution computed tomography (HRCT) in patients in supine and prone positions to detect am...
SUMMARYMechanical stress by pressure overload due to hypertension or valvular heart disease such as aortic valve stenosis induces cardiac hypertrophy. It has been well established that the mechanical stretch of cardiac myocytes in vitro induces hypertrophic responses such as the expression of immediate early response genes including c-fos. However, it remains uncertain whether the mechanical forces due to pure atmospheric pressure can induce similar responses in cardiac myocytes. We thus cultured rat neonatal cardiac myocytes in an atmospheric pressure chamber apparatus and determined the effects of pure pressure stress on c-fos gene expression. Pressures greater than 80 mmHg enhanced c-fos mRNA after 30 minutes. These results suggest that pure atmospheric pressure overload can also induce early hypertrophic responses in cardiac myocytes. (Int Heart J 2007; 48: 359-367) Key words: Experimental technique, Hypertrophy, Immediate early gene, Molecular experiment, Pressure stress CARDIAC hypertrophy is an independent risk factor for cardiovascular events and death. 1) Hemodynamic overload caused by hypertension or valvular heart disease such as aortic valve stenosis produces cardiac hypertrophy. The mechanical stretch of cultured cardiac myocytes has been shown to stimulate hypertrophic responses including the expression of immediate early genes and fetal contractile protein genes as well as protein synthesis.2-4) This model of stretching cells in vitro has been described as mechanical stress-induced cardiac hypertrophy. 5,6) However, it is possible that the stretch of myocytes cultured on deformable silicone dishes differs from the stress due to pressure overload. Mechanical single stretch produces static, but not dynamic, forces on cardiac myocytes. In contrast, hemodynamic forces include not only static stretching but also dynamic pressure stress. Our previous studies have demonstrated that pure pressure overload could From the
In a 54-year-old woman with liver cirrhosis who underwent orthotopic liver transplantation, the postoperative course was complicated by aneurysm formation in the hepatic artery. Abdominal ultrasonography showed a daily increase in size of the aneurysm in spite of careful management including strict rest and continuous intravenous infusion of antihypertensive agents. Since the patient's poor systemic status was a major obstruction to operative resection, transcatheter therapy was though more preferable. We evaluated the lesion with intravascular ultrasonography as an adjunct to angiography and dissection with a flap was well visualized. The aneurysm was covered with a commercially available stent-graft, designed for treatment of the coronary artery. This is a rare case in which a Jostent was implanted into the hepatic artery after liver transplantation.
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