First results of balloon dacryoplasty in dacryostenosis

Background. Outpatient care is not widely spread in modern dacryology. At the same time, its necessity increases. There are no evidences of balloon dacryoplasty (BDP) application in Russian periodical literature. Material and methods. 50 surgical procedures in 30 patients with partial nasolacrimal duct obliteration were performed, among them 30 BDP without lacrimal pathways intubation (group 1) and 20 with bicanalicular Ritleng intubation of lacrimal pathways (group 2). Lacrimal scintigraphy, single photon emission computed tomography, combined with X-ray computed tomography, subjective tearing estimation in points, and health depending quality of life evaluation wre performed in all cases. Same tests were repeated in 3 months after surgery. Results. A positive outcome rate was 90 % in both groups. There were no complications in group 1. A single case of stent dislocation was recorded in group 2. Conclusion. BDP is an effective procedure in dacryostenosis of the lacrimal pathways vertical part obliteration. This procedure helps to avoid complications associated with long stent retention. It is possible to get good functional results even at short term after BDP surgery, and there is a possibility for this procedure to be carried out in an outpatient setting.

Download Full-text

Shifting of global aphasia to Wernicke’s aphasia in a patient with intact motor function: a case report

BMC Neurology ◽

10.1186/s12883-021-02131-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ya-Chi Chuang ◽

Chuan-Ching Liu ◽

I-Ching Yu ◽

Yu-Lin Tsai ◽

Shin-Tsu Chang

Keyword(s):

Computed Tomography ◽

Right Hemisphere ◽

Single Photon ◽

Ct Perfusion ◽

Single Case ◽

Photon Emission ◽

Emission Computed Tomography ◽

Speech Fluency ◽

Language Functions ◽

The Right

Abstract Background Global aphasia without hemiparesis (GAWH) is a rare stroke syndrome characterized by the dissociation of motor and language functions. Here, we present a case of GAWH with the patient later regaining speech fluency. Case presentation A 73-year-old man was admitted to our emergency department immediately after an episode of syncope. On arrival, we noted his global aphasia but without any focal neurologic signs. Computed tomography (CT) perfusion scans showed a large hypodense region over his left perisylvian area. Under the impression of acute ischaemic stroke, he received recombinant tissue plasminogen activator (rtPA) injection and was treated as an inpatient. The patient was later discharged with GAWH status and received regular speech rehabilitation. After 14 months of rehabilitation, the patient gradually recovered his language expression ability. The degree of aphasia was evaluated with the Concise Chinese Aphasia Test (CCAT), and we obtained brain single photon emission computed tomography (SPECT) scans to assess cerebral blood flow. Conclusion A patient with severe impairments of Broca’s and Wernicke’s areas was able to talk fluently despite being unintelligible. SPECT revealed relative high level of radioactivity uptake in the right frontal lobe, suggesting the deficits in speech fluency could have been compensated by the right hemisphere. Although this is a single case demonstration, the results may strengthen the role of the right hemisphere in GAWH patients and suggests additional study that examines the possible benefits of stimulating activity at right homologous regions for recovering language function after global aphasia.

Download Full-text

Neurologic Deterioration in Patients With Moyamoya Disease During Pregnancy, Delivery, and Puerperium

Neurosurgery ◽

10.1093/neuros/nyz310_500 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Wonhyoung Park ◽

Minwoo Kim ◽

Jae Sung Ahn

Keyword(s):

Single Photon ◽

Photon Emission ◽

Emission Computed Tomography ◽

Single Photon Emission ◽

Cerebrovascular Reserve ◽

Neurologic Deterioration ◽

Single Photon Emission Computed ◽

Group 2 ◽

Photon Emission Computed Tomography ◽

Group 1

Abstract INTRODUCTION We reviewed our clinical experience of patients with moyamoya disease (MMD) who gave birth and assessed characteristics of those experiencing neurologic deterioration. METHODS The patients were classified into patients diagnosed with MMD during pregnancy and puerperium (group 1) and those diagnosed before pregnancy (group 2). We retrospectively reviewed patient characteristics, MMD treatment, neurologic symptoms before and during pregnancy and/after puerperium, obstetrical history, and delivery type in groups 1 and 2. RESULTS Group 1 included 2 patients with a deterioration of preexisting transient ischemic attacks (TIAs) and acute cerebral infarction and 1 patient with seizures and newly developed TIAs during pregnancy and/or puerperium. Group 2 included 20 patients with 23 pregnancies. In group 2, 4 patients had deterioration of TIAs during pregnancy and puerperium. There were significant differences between the cases without neurologic deterioration and with deterioration in group 2 (TIAs ! 10 before pregnancy, 0% vs 75%, P = .002; severely reduced regional cerebrovascular reserve on single-photon emission computed tomography, 10.5% vs 100%, P = .002; and surgical revascularization before pregnancy, 75% vs 15.8%, P = .04). In groups 1 and 2, 6 of the 7 cases in which TIAs occurred or worsened during pregnancy or puerperium recovered to prepregnancy TIA levels after puerperium. CONCLUSION Patients with severely reduced regional cerebrovascular reserve on single-photon emission computed tomography and frequent TIAs before pregnancy may experience neurologic deterioration during pregnancy, delivery, and puerperium. Surgical revascularization before pregnancy may decrease neurologic deterioration during these periods.

Download Full-text

Difficulties of Diagnostics of Obstructive Coronary Artery Lesions in Patients with Stable Ischemic Heart Disease and Possibilities of Single-Photon Emission Computed Tomography

Kardiologiia ◽

10.18087/cardio.2019.1.10226 ◽

2019 ◽

Vol 59 (1) ◽

pp. 28-35

Author(s):

A. N. Sumin ◽

E. V. Korok ◽

A. A. Korotkevitch ◽

E. N. Kachurina ◽

A. N. Kokov ◽

...

Keyword(s):

Coronary Artery ◽

Single Photon ◽

Photon Emission ◽

Spect Imaging ◽

Emission Computed Tomography ◽

Single Photon Emission ◽

Single Photon Emission Computed ◽

Group 2 ◽

Photon Emission Computed Tomography ◽

Group 1

Purpose: to assess diagnostic capabilities of single-photon emission computed tomography (SPECT) in the detection of obstructive coronary artery (CA) lesions, depending on the meeting appropriate use criteria. Materials and Methods: We used in this retrospective analysis data from 107 patients with previously diagnosed ischemic heart disease (IHD) or in need to exclude it, who were hospitalized in inpatient departments of the Research Institute for Complex Issues of Cardiovascular Diseases in the period from 2012 to 2015. All patients underwent coronary angiography (CAG) and SPECT (the time interval between the studies did not exceed 3 months) for detection of hemodynamically significant CA stenoses. Patients were distributed into two groups according SPECT imaging appropriateness score: group 1–88 patients with score 7–9 (in whom SPECT imaging was appropriate), group 2–19 patients with score 1–6 (in whom SPECT imaging was uncertain, possibly appropriate, or inappropriate. Results. Clinical signs and symptoms of angina pectoris were predominantly found in group 1 patients (p=0.499). Asymptomatic patients were more likely to be found in group 2 (p<0.001). Group 1 patients commonly had high pretest probability (PTP) (over 90 %, p<0.001), whereas group 2 patients commonly had low PTP (5–10 %, p<0.001). Mean PTP was 77 and 58 % in groups 1 and 2, respectively (p=0.003). According to positive SPECT imaging, significant CA lesions were more often found in group 1 compared to group 2 (31.8 and 10.5 %, respectively, p=0.060). Two- and three-vessel disease prevailed in group 1 (25 % and 14.7 %) according the analysis of prevalence and location of hemodynamically significant CA lesions, although the data did not reach statistical significance (p=0.057 and p=0.073). Stenoses >70 % were more commonly detected in group 1, compared to group 2: in anterior descending artery 52.3 vs. 5.3 % (p<0.001), circumflex artery 35.2 vs. 10.5 %; (p=0.034), right coronary artery 34.1 vs. 10.5 % (p=0.041). The sensitivity in both groups was rather low (40 % vs. 25 %), whereas specificity was 83 % in group 1 and 93 % in group 2. Conclusion. According to clinical examination, patients with IHD and indications for SPECT imaging more often had obstructive CA lesions (63.6 %), than patients with questionable or no indications (21.1 %). However, rate of positive findings during stress tests with SPECT imaging was low in both groups and did not differ significantly (p=0.06). Despite high specificity of SPECT imaging, its sensitivity was low in both groups.

Download Full-text

Influence on Therapeutic Decision Making of SPECT-CT for Different Regions of the Foot and Ankle

BioMed Research International ◽

10.1155/2014/927576 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 14

Author(s):

Leif Claassen ◽

Theodor Uden ◽

Max Ettinger ◽

Kiriakos Daniilidis ◽

Christina Stukenborg-Colsman ◽

...

Keyword(s):

Computed Tomography ◽

Pain Relief ◽

Photon Emission ◽

Treatment Decision ◽

Emission Computed Tomography ◽

Foot And Ankle ◽

Predictive Values ◽

Group 2 ◽

The Impact ◽

Group 1

Background. Single-photon emission computed tomography and computed tomography (SPECT-CT) has a high impact on diagnosis and treatment decision of different joints. The aim of this study was to evaluate whether there is a different gain of SPECT-CT for different foot regions.Material and Methods. We retrospectively identified 86 patients who received a SPECT-CT of the foot and ankle between April 2011 and December 2012. We divided all patients into the following subgroups: ankle (group 1), subtalar (group 2), Chopart (group 3), and Lisfranc (group 4). The local ethical committee approved the study.Results. The clinical treatment decision was changed based on SPECT-CT results in 64.5% of group 1, 65.2% of group 2, and 75% each of groups 3 and 4. Eighty patients (93%) had pain relief after treatment based on SPECT-CT. The overall SPECT-CT sensitivity was 0.94 and the specificity was 0.57. The positive and negative predictive values were 0.87 and 0.75, respectively.Conclusion. The impact of SPECT-CT on treatment decision is slightly higher in diseases of the Chopart and Lisfranc joints than in the upper ankle and subtalar joints. The additional information has a clinical relevance due to the high rate of pain relief by treatment based on SPECT-CT diagnosis.

Download Full-text