Structural connectome of the human vestibular, pre-motor, and navigation network.

The aim of this study is to characterize modules and hubs within the multimodal vestibular system and, particularly, to test the centrality of posterior peri-sylvian regions. Structural connectivity matrices from 50 unrelated healthy right-handed subjects from the Human Connectome Project (HCP) database were analyzed using multishell diffusion-weighted data, probabilistic tractography (constrained spherical-deconvolution informed filtering of tractograms) in combination with subject-specific grey matter parcellations. Network nodes included parcellated regions within the vestibular, pre-motor and navigation system. Module calculation produced two and three modules in the right and left hemisphere, respectively. On the right, regions were grouped into a vestibular and pre-motor module, and into a visual-navigation module. On the left this last module was split into an inferior and superior component. In the thalamus, a region comprising the mediodorsal and anterior complex, and lateral and inferior pulvinar, was included in the ipsilateral navigation module, while the remaining thalamus was clustered with the ipsilateral vestibular pre-motor module. Hubs were located bilaterally in regions encompassing the inferior parietal cortex and the precuneus. This analysis revealed a dorso-lateral path within the multi-modal vestibular system related to vestibular / motor control, and a ventro-medial path related to spatial orientation / navigation. Posterior peri-sylvian regions may represent the main hubs of the whole modular network.

Coronary angioplasty in patients who were considered poor bypass surgery candidates.

In most patients who undergo coronary angioplasty (PTCA), coronary bypass surgery (CABG) is an alternative. Patients with severe symptoms secondary to coronary disease, amenable to PTCA, but who are poor CABG candidates are commonly seen. From April 1988 to December 1989 PTCA was performed in 751 patients. Patients with evolving infarction (47) were excluded. Of the remaining 704, 605 were considered candidates for CABG and they were compared to the 99 patients not felt to be candidates for CABG. The objective of this report was to compare these 2 patient groups. These salvage PTCA patients were older, had a higher incidence of heart failure, more prior CABG, higher left ventricular end-diastolic pressure and lower ejection fraction (all p less than 0.01). PTCA had a high success rate per lesion in both groups (96% CABG candidates vs. 95% salvage patients), but there were more patients whose culprit lesion could not be dilated in the salvage group (14% vs. 7%, p less than 0.02). Severe complications including Q wave infarction (2% vs. .3%) and in-hospital death (7% vs. 0.2%) were more common in salvage patients. As planned, emergency CABG was not performed on any salvage PTCA patient but on 2.6% of the other patients. Patients who may benefit from PTCA but were not felt to be operable made up 13% of our PTCA experience. PTCA can be performed in these patients but risks were increased.

Crohn's disease of the esophagus.

In this report we describe the case of a 50-year-old woman with Crohn's disease of the esophagus. She had severe distal stricture that necessitated distal esophagectomy, with esophagogastric anastomosis and Nissen fundoplication. Surgical treatment of esophageal Crohn's disease is associated with a number of complications; however, on the basis of our experience and a literature review, pyloroplasty and Nissen fundoplication in addition to surgical resection seems to be associated with fewer postoperative complications.

A valveless counterpulsation left ventricular assist pump in the descending aorta: hemodynamic benefit with a reduced risk of cerebral emboli.

Because of valve malfunction and cerebral embolism reported with use of the total artificial heart, the descending aorta was reexamined as a site for a valveless counterpulsation left ventricular assist pump. The pump was introduced into the thoracic aorta at the level of the eight thoracic vertebra in 11 canine right-heart bypass preparations. Heart rate (110 beats per minute), stroke volume (20 ml), and mean arterial pressure (80 or 100 mm Hg) were precisely controlled. The pump ejection volume was adjusted to equal 1 time or 2 times the stroke volume of the dog. A 20-ml ejection led to an 11% reduction in left atrial pressure, an 11% reduction in peak left ventricular pressure, and a 20% reduction in tension time index (all, p less than .05 at a mean arterial pressure of 80 mm Hg). Systolic shortening (ultrasonic crystals) increased by 5% (p less than .05 at a mean arterial pressure of 80 mm Hg). A 40-ml pump ejection led to an 11% reduction in mean left atrial pressure, a 17% reduction in peak left ventricular pressure, and a 21% reduction in tension time index (all, p less than .05 at a mean arterial pressure of 80 mm Hg). The systolic shortening increased by 15% (p less than .05). To assess the relative risk of cerebral embolism, albumin spheres (40 to 60 micrograms) labeled with technetium-99 were injected into the pump chamber in 5 dogs (40-ml ejection, 2.1 +/- 0.1 times the dog's stroke volume).(ABSTRACT TRUNCATED AT 250 WORDS)

Transdiaphragmatic adrenal biopsy.

The adrenal gland is a common site of metastasis from carcinoma of the lung. In selected patients, especially those in whom the adrenal mass is on the ipsilateral side of the lung lesion, the adrenal gland can be biopsied by a transthoracic transdiaphragmatic approach. Our technique of transdiaphragmatic adrenal biopsy in the staging of carcinoma of the lung is described.