The first experience with the high-resolution multi-slice CT-angiography in pediatric cardiology in Slovakia.

OBJECTIVES: The high-resolution multi-slice computed tomography angiography (HRMS-CTA) is a new imaging method characterized by a precise isotropic imaging of any cardiovascular system structure. The purpose of this study was to review the first experience with the high-resolution multi-slice HRMS-CTA in pediatric patients with congenital heart defects as well as with acquired cardiac diseases in the Slovak Republic. METHODS: We retrospectively reviewed benefits of HRMS-CTA and its influence on the subsequent choice of the most appropriate management in 20 patients with pulmonary atresia with ventricular septal defect and multiple aortopulmonary collaterals (PA, VSD, MAPCAs) and in 15 patients with different diagnoses with expected benefit from HRMS-CTA in terms of an exact delineation of extra-cardiac vascular structures. RESULTS: The delineation of the examined extra-cardiac structures was very detailed and clear in all 35 patients. All findings definitely contributed to the choice of the most appropriate management not only in PA, VSD, MAPCAs patients (20), but also in 15 patients with different diagnoses. CONCLUSIONS: HRMS-CTA is a new complementary imaging method with the potential to replace invasive catheterization procedures in large number of patients who need extra-cardiac vascular structure imaging (Fig. 1, Ref. 18). Full Text (Free, PDF) www.bmj.sk.

Partial tear of the flexor hallucis longus at the knot of Henry: presentation of three cases.

The flexor hallucis longus (FHL) tendon is susceptible to injury along its entire course from the posterior aspect of the ankle to its insertion into the base of the distal phalanx of the great toe. Various lacerations, ruptures, longitudinal splits, and stenosing tenosynovitis have been noted. This report documents three cases of longitudinal split of the FHL at the knot of Henry. The diagnosis of this entity is based solely on history and physical examination. Patients with this problem have experienced either an acute or chronic repetitive hyperextension of the hallux metatarsophalangeal joint. They complain of pain with prolonged walking and running and have tenderness with palpation of the knot of Henry (the anatomical crossover between the FHL and the flexor digitorum longus) about one thumb-breadth lateral to the tuberosity of the navicular. Noninvasive imaging studies, including ultrasound and magnetic resonance imaging, are not helpful in establishing this diagnosis. Surgical treatment includes release of the knot of Henry, debridement and repair of the longitudinal split in the FHL, and excision of the interconnecting tendon between the FHL and the flexor digitorum longus. All three patients presented in this report have obtained long-term satisfactory relief of their symptoms with surgical treatment.

Ultrasound in the diagnosis of posterior tibial tendon pathology.

We retrospectively evaluated the effectiveness of ultrasonography as a diagnostic tool for investigating pathology in the posterior tibial tendon by comparing the preoperative ultrasonograms for 17 patients with their recorded surgical findings. In all cases, the surgical findings confirmed the ultrasonographic diagnoses: 3 inflammations, 4 partial tears, and 10 ruptures. Interestingly, two ruptures had been undiagnosed by magnetic resonance imaging. Ultrasonography, which seems to be a reliable means of visualizing the extent of pathology of the symptomatic posterior tibial tendon, may be a valuable tool in surgical planning.

[Abnormal CT brain scan during acute lymphoblastic leukemia in children]. / Abnormálne obrazy pocítacovej tomografie mozgu v priebehu akútnej lymfoblastickej leukémie u detí.

The results of CT brain scans were evaluated in 96 children with acute lymphoblastic leukemia in different stages of the disease. Practically normal findings were recorded at establishing the diagnosis (17 children), with the exception of infiltration of the brain and meninges in one patient. Examinations performed after induction chemotherapy (31 children) revealed abnormal CT scans in 55% of the children concerning most frequently dilatation of the cerebrospinal fluid pathways and exhibiting less frequently hypodense foci in the white matter. At check-up examinations after 9 months (following prophylaxis of CNS leukemia) these deviations from the norm had disappeared in some patients, in others they persisted and in the rest of the patients they were found to be aggravated. Examinations carried out several years after treatment completion (40 patients) showed abnormal CR scans in 43% of the patients. These involved particularly derangements in the density of the white matter which were of leuko-dystrophic type and atrophic changes characterized by dilatation of the cerebrospinal fluid pathways. The recorded changes in the CT brain scans were more pronounced in patients with high-risk forms of leukemia and intensive prophylaxis of CNS leukemia.

Disorders in neuropsychological development and their relation to computed tomography brain scan in children with acute lymphoblastic leukemia in long-term remission.

In a group of 71 children with acute lymphoblastic leukemia in long-term remission lasting 4 to 15 years different disorders in their neuropsychological development were found. The disturbances observed were as follows: Emotional disorders in 88%, personality development disorders in 65%, mental retardation in 58%, signs of CNS dysfunction in 54%, and neurological disorder in 31% of children. Abnormal computed tomography brain scans were present in 49% of patients. They consisted mainly of two types: Hypodense areas of the white matter were observed in 23% and widening of the ventricular system and subarachnoidal spaces was present in 26% of children. Statistical evaluation showed significant relations between CT brain scan abnormalities (mainly hypodense changes) and neurological disorders as well as the presence of signs of CNS dysfunction and disorders of personality development. Emotional and mental changes did not correlate with abnormalities of CT brain scan findings.

Acute lateral ankle ligament injuries: a literature review.

The average general orthopaedic surgeon examines and treats a considerable number of acute lateral ankle ligament sprains in a busy office practice. A cursory review of recent articles published on this subject will present a confusing picture regarding diagnosis and treatment of Grade III injuries. An air of controversy surrounds the interpretation of diagnostic x-rays, and the management of these common ankle problems. This review article is presented to summarize current thoughts on the anatomy, biomechanics, diagnosis, and treatment of acute lateral ankle ligament sprains.

[Intracerebral hemorrhage in hypertensives: diagnosis, therapy and prognosis]. / Intracerebrálne krvácanie u hypertonikov: diagnóza, liecba a prognóza.

The authors analyzed 98 cases of intracerebral haemorrhage in hypertonic subjects from the aspect of the clinical course, CT findings and therapeutic results. Thirty-seven patients were treated by surgery and 61 had medicamentous treatment. The acute mortality rate in operated patients was 57% in non-operated ones 30%. The patients with haemorrhage in the putamen formed the majority of the group and had a higher mortality rate than patients with other sites of haemorrhage. The state of consciousness on admission and the size of haematomas influenced in a significant way the acute mortality rate of patients. Fifty-nine patients were followed up for an average period of 34 months. Of those 19% died and 54% attained a fair restoration of the clinical condition. Only 5% returned to work.