Assessment of the calcification of the nuchal ligament and osteophytes of the cervical spine in obstructive sleep apnoea subjects and snorers.

The previous reports suggest that obstructive sleep apnoea (OSA) is related to metabolic syndrome, mineral metabolism disorders and cardiovascular disease. In addition, a possible relationship between obesity and the calcification of ligaments has been implied. However, the potential link between OSA and the calcification of ligaments has not been directly studied. In this present study, to investigate the potential link between OSA and the calcification of ligaments, we examined the prevalence of the calcification of ligaments in OSA patients and the relationship between these findings and OSA severity. Eighty consecutive patients (60 males, 20 females) diagnosed as OSA or a heavy snorer based on full-night polyso-mnography were retrospectively recruited from May 2006 to July 2008. Each patient underwent cephalometric imaging examination before the arrangement of an oral appliance. One calibrated observer (YS) reviewed the cephalometric images for the presence of calcification of the nuchal ligament and osteophytes of the cervical spine. The prevalence of calcification of the nuchal ligament in OSA patients and snorers was 46.3% (males: 52%, females: 30%) There was a significant positive correlation between the severity of OSA (AHI) and the calcification of the nuchal ligament before and after adjusting for BMI. The prevalence of the calcification of the nuchal ligament in OSA subjects and snorers was higher than in previous studies with non-OSA subjects. In addition, it is suggested that the severity of OSA correlates with the presence of calcification of the nuchal ligament.

Changes in three dimensional simulation models of the airway which are due to increases in age or body mass index.

The aim of this study was to model the changes in the soft and hard tissues that occur around the upper airway with increasing age and weight, and to visually gauge them through the use of 3D simulation models. We created two standard 3-dimensional models, with one set to represent a healthy subject model and the other serving as an OSA model. The results of the regression models in our anatomical variables were attached to each 3D model. We compared our data with the data of previous studies to recognize the validity of our regression model. In both models the pharyngeal length increased as age increased. We observed an increase in the fat tissue, soft palate length, and a thickening of the soft palate as BMI increased. As age and BMI increased, the narrowing of the airway appeared more severe in the OSA model.

False aneurysm of the left ventricle due to a penetrating chest wound.

A 24-year-old white man had a knife chest wound, and four months after this event, manifested progressive dyspnea. A false aneurysm of the left ventricle was diagnosed by 2D echocardiogram. Surgical resection of the aneurysmal sac with closure of the orifice of the lateral wall of the left ventricle was performed successfully.

Double mitral valve orifice. Two-dimensional and Doppler echocardiographic diagnosis.

The purpose of this study was to demonstrate the usefulness of two-dimensional and Doppler echocardiography for diagnosing double mitral valve orifices (DMVO) in addition to identifying associated pathologies. We report five cases, three male and two female with an age ranging from 4 to 44 years old (mean age: 17 years), with the diagnosis of DMVO according to the following characteristics: using two-dimensional echocardiography on the short parasternal axis, both orifices were observed; apical in which the "seagull sign" was identified in both chambers, in addition to identifying the flows of each orifice by pulsed and codified color Doppler obtaining the corresponding gradients. With respect to the associated pathologies, all patients presented some type of malformation, such as subaortic ring, patent ductus arteriosus, coarctation of the aorta, bicuspid aorta and pulmonary stenosis. Using the color Doppler echocardiography allows an adequate anatomical and functional definition of DMVO.

The heart in the primary antiphospholipid syndrome.

Twenty consecutive female patients (mean age 30.1 years) with Primary Antiphospholipid Syndrome (PAPS) were studied cardiologically through noninvasive methods and compared with 20 age-and sex-matched healthy subjects. On physical examination 13/20 patients (65%) with PAPS had a valvular abnormality. In 12/20 (60%) patients with PAPS the ECG was abnormal, mainly due to sinus tachycardia in 5 (25%) and acute myocardial infarction in 3 (15%). In 7/20 patients with PAPS (35%) abnormal pulmonary findings were detected by X-ray and in 6 (30%) they were related to dilated pulmonary arch and pulmonary hypertension. In 14/20 cases (70%) with PAPS, abnormal echocardiographic findings were present; 13/20 patients (65%) had valvular complications attributable to PAPS: mitral insufficiency in six cases; mitral valve prolapse in three and aortic insufficiency in three. Two had pulmonary artery hypertension and two, tricuspid regurgitation (one attributable to PAPS). All valve diseases were regurgitant with mild to moderate hemodynamic repercussion. No stenotic lesions were detected. The mean mitral thickness in patients with mitral valve involvement was 7.0 +/- 1.6 mm, compared to 2.8 +/- 0.7 mm in patients with normal valves and 3.1 +/- 0.9 mm in the control group (p < 0.001). The mean aortic valve thickness in patients with aortic valve involvement was 3.6 +/- 0.5 mm compared to 1.5 +/- 0.3 mm in patients with normal valves and 1.4 +/- 0.4 in the control group (p < 0.001). None of the patients from the control group had valve disease (p < 0.0001). Three cases (15%) had pericardial effusion diagnosed by echo. Two patients with PAPS died during the 4.7 +/- 1.2 years of cardiological follow up, due to acute myocardial infarction and embolic cerebrovascular accident, respectively. In conclusion, cardiologic complications are common in PAPS, including left side regurgitant lesions that might be hemodynamically significant, acute myocardial infarction, pericardial effusion and pulmonary hypertension.

Acute myocardial infarction during pregnancy and puerperium: a review.

The purpose of this review is to analyze the possible parameters that lead to the development of what is a rare event--acute myocardial infarction (AMI) during pregnancy and puerperium. Through the Index Médicus, 109 publications on the subject were obtained. Since the first well-documented case by Katz in 1922, 136 patients have been reported, and from these reports the following data have been gathered: the average age was 32.1 years. This event is more frequent during the third trimester and puerperium of the first and second pregnancies. In 42.6% of the patients no coronary risk factors were observed, but when present, hypertension and cigarette smoking were the most common. The anterior wall along or in combination with any other anatomic area was affected in 73% of cases. Coronary angiograms, when taken, appeared normal in 47%. The maternal mortality rate was 26/136 (19.1%) and was higher during the third trimester, labor, and puerperium. Eight patients (8/26) (30.7%) had sudden death. In 5 of these, (62.5%) coronary thrombosis was found. In 18/26 deaths, an autopsy was performed; 9/18 (50%) had coronary thrombus formation and in 7/18 (39%) variable degrees of atherosclerosis were detected. On the other hand, the fetal mortality rate was 16.9%; however, in only 52% was death coincidental with that of the mother. Coronary artery spasm associated with a probable hypercoagulability state was the most likely mechanism in the majority of these patients, followed by atherosclerotic heart disease and coronary dissection-the last being secondary most likely to hormonal changes. During the AMI these patients should be studied by a medical team composed of a cardiologist, gynecologist, and anesthesiologist. A complete cardiologic work-up should be made to decide individually about further pregnancies.

Traumatic coronary arteriovenous fistula communicating the left main coronary artery to pulmonary artery, associated with pulmonary valvular insufficiency and endocarditis: case report.

The authors present a case of a seventeen-year-old white male who suffered from a knife chest wound and secondarily developed a traumatic coronary arteriovenous fistula communicating the left main coronary artery to the pulmonary artery, associated with pulmonary valvular insufficiency and endocarditis.

Ventricular tachycardia as a first manifestation of right ventricular myxoma--a case presentation.

The authors present a case of a thirty-nine-year-old white man in good health who developed episodes of ventricular tachycardia as a first manifestation of a right ventricular myxoma, which was diagnosed by two-dimensional echocardiogram and then resected with no complications and total disappearance of the cardiac arrhythmia. After reviewing the literature they consider the present case as a rare manifestation of an infrequent location of an uncommon disease.

Silent giant left atrium. A case report.

A sixty-two-year-old white woman with a 14.5 cm (145 mm) silent giant left atrial enlargement secondary probably to rheumatic heart disease is presented. Aside from mild progressive shortness of breath during the past year, the patient had been asymptomatic all her life. Her clinical picture was manifested for the first time by syncope secondary to slow atrial fibrillation, for which a permanent pacemaker was required. The correct diagnosis of the enlarged chamber was not possible through the routine chest roentgenogram. In this case, the echocardiogram, nuclear angiogram, and computed tomography were the pertinent studies needed to reach the diagnosis.

Acute myocardial infarction during pregnancy and puerperium in athletic women. Two case reports.

The authors present 2 cases: 1 of a thirty-two-year-old woman and another of a thirty-eight-year-old woman, both Hispanic and athletic, with no identifiable precipitating or coronary risk factors, such as previous heart disease, hypertension, diabetes mellitus, cigarette smoking, hyperlipoproteinemia, oral contraceptive use, coagulation disorders, thyroid disease, collagen tissue disorder, or family history of premature myocardial infarction, who both developed an acute posteroinferior wall myocardial infarction with normal coronary arteries, one during pregnancy, from which normal twin girls were born, and another, during the postpartum period. After reviewing the literature the authors consider the present cases as unique due to the rare association of pregnancy with intrapartum and postpartum acute myocardial infarction with normal coronary arteries in athletic women.

Heart block in dextrocardia with situs inversus. A case report.

The authors report a case of a forty-one-year-old white woman with dextrocardia with situs inversus who presented episodes of prolonged sinus arrest and syncopal episodes secondary to possible idiopathic degeneration of the conduction system, managed successfully with a permanent bicameral pacemaker. In their literature review they found that this case represents a very rare association.

Cholera and myocarditis--a case report.

The authors describe the case of a fifty-nine-year-old white man, previously in good health, who initiated his present illness with acute episode of enterocolitis characterized by mild fever and, in the next eight hours, twenty-four episodes of watery diarrhea, nausea and vomiting, as well as generalized sweating and severe weakness secondary to hypovolemia and electrolyte disorder. These complications were corrected in seventy-two hours in the intensive care unit. Two days later, when the patient was stable hemodynamically, under cardiac monitoring and with normal laboratory studies including serum electrolytes, he developed electrocardiographic changes characterized by trifascicular block (prolonged P-R interval, complete right bundle branch block [CRBBB] and left posterior hemiblock [LPH]) with a cardiac rate of thirty beats per minute, for which a temporary pacemaker was inserted. Endomyocardial biopsy showed histopathologic signs of myocarditis and the immunologic study of the cardiac tissue revealed positive polymerize chain reaction (PCR+) with the presence of antitoxine choleric antibodies (AcTCA). After three weeks, the same conduction disturbances remained, for which a permanent pacemaker was inserted. On top of intravenous fluid replacement and electrolyte supplements, the patient was managed with tetracycline 2 g a day for one week and sulfamethoxazole-trimethoprim 800/160 mg a day for two weeks. The purpose of this study is to present a rare and very well-documented myocarditis by cholera in a patient with enteric disease, in whom several cardiac complications occurred.

Pulmonary valvular stenosis associated with Takayasu's Disease. Favorable response to corticosteroids. A case report.

The authors describe the first reported case of type IV Takayasu's arteritis with pulmonary valve stenosis. After thirty months under corticosteroid therapy the disappearance of the pulmonary valve stenosis signs was observed in the patient. In the same patient coarctation of the aorta, aortic insufficiency, stenosis of both pulmonary arteries, and left coronary artery stenosis were observed. This case illustrates the extensive cardiovascular involvement that can occur in Takayasu's arteritis and suggests that pulmonary valvular stenosis could be secondary to the same inflammatory process.

Performance-driven facial animation: basic research on human judgments of emotional state in facial avatars.

Virtual reality is rapidly evolving into a pragmatically usable technology for mental health (MH) applications. As the underlying enabling technologies continue to evolve and allow us to design more useful and usable structural virtual environments (VEs), the next important challenge will involve populating these environments with virtual representations of humans (avatars). This will be vital to create mental health VEs that leverage the use of avatars for applications that require human-human interaction and communication. As Alessi et al.1 pointed out at the 8th Annual Medicine Meets Virtual Reality Conference (MMVR8), virtual humans have mainly appeared in MH applications to "serve the role of props, rather than humans." More believable avatars inhabiting VEs would open up possibilities for MH applications that address social interaction, communication, instruction, assessment, and rehabilitation issues. They could also serve to enhance realism that might in turn promote the experience of presence in VR. Additionally, it will soon be possible to use computer-generated avatars that serve to provide believable dynamic facial and bodily representations of individuals communicating from a distance in real time. This could support the delivery, in shared virtual environments, of more natural human interaction styles, similar to what is used in real life between people. These techniques could enhance communication and interaction by leveraging our natural sensing and perceiving capabilities and offer the potential to model human-computer-human interaction after human-human interaction. To enhance the authenticity of virtual human representations, advances in the rendering of facial and gestural behaviors that support implicit communication will be needed. In this regard, the current paper presents data from a study that compared human raters' judgments of emotional expression between actual video clips of facial expressions and identical expressions rendered on a three-dimensional avatar using a performance-driven facial animation (PDFA) system developed at the University of Southern California Integrated Media Systems Center. PDFA offers a means for creating high-fidelity visual representations of human faces and bodies. This effort explores the feasibility of sensing and reproducing a range of facial expressions with a PDFA system. In order to test concordance of human ratings of emotional expression between video and avatar facial delivery, we first had facial model subjects observe stimuli that were designed to elicit naturalistic facial expressions. The emotional stimulus induction involved presenting text-based, still image, and video clips to subjects that were previously rated to induce facial expressions for the six universals2 of facial expression (happy, sad, fear, anger, disgust, and surprise), in addition to attentiveness, puzzlement and frustration. Videotapes of these induced facial expressions that best represented prototypic examples of the above emotional states and three-dimensional avatar animations of the same facial expressions were randomly presented to 38 human raters. The raters used open-end, forced choice and seven-point Likert-type scales to rate expression in terms of identification. The forced choice and seven-point ratings provided the most usable data to determine video/animation concordance and these data are presented. To support a clear understanding of this data, a website has been set up that will allow readers to view the video and facial animation clips to illustrate the assets and limitations of these types of facial expression-rendering methods (www. USCAvatars.com/MMVR). This methodological first step in our research program has served to provide valuable human user-centered feedback to support the iterative design and development of facial avatar characteristics for expression of emotional communication.

Intracranial physiological calcifications evaluated with cone beam CT.

OBJECTIVES: The purpose of this study was to evaluate cone beam CT (CBCT) scans for the presence of physiological and pathological intracranial calcifications. METHODS: CBCT scans from male and female patients that met our ascertainment criteria were evaluated retrospectively (n=500) for the presence of either physiological or pathological intracranial calcifications. RESULTS: Out of the 500 patients evaluated, 176 had evidence of intracranial physiological calcification (35.2% prevalence), and none had evidence of pathological calcification. There was a 3:2 male-to-female ratio and no ethnic predilection; the ages of affected patients ranged from 13 years to 82 years with a mean age of 52 years. The majority of calcifications appeared in the pineal/habenular region (80%), with some also appearing in the choroid plexus region bilaterally (12%), and a smaller subset appearing in the petroclinoid ligament region bilaterally (8%). CONCLUSIONS: Intracranial physiological calcifications can be a common finding on CBCT scans, whereas pathological intracranial calcifications are rare.

Three-dimensional visualization of the craniofacial patient: volume segmentation, data integration and animation.

The research goal at the Craniofacial Virtual Reality Laboratory of the School of Dentistry in conjunction with the Integrated Media Systems Center, School of Engineering, University of Southern California, is to develop computer methods to accurately visualize patients in three dimensions using advanced imaging and data acquisition devices such as cone-beam computerized tomography (CT) and mandibular motion capture. Data from these devices were integrated for three-dimensional (3D) patient-specific visualization, modeling and animation. Generic methods are in development that can be used with common CT image format (DICOM), mesh format (STL) and motion data (3D position over time). This paper presents preliminary descriptive studies on: 1) segmentation of the lower and upper jaws with two types of CT data--(a) traditional whole head CT data and (b) the new dental Newtom CT; 2) manual integration of accurate 3D tooth crowns with the segmented lower jaw 3D model; 3) realistic patient-specific 3D animation of the lower jaw.

[Assessment of the ejection fraction of the right ventricle with echocardiography]. / Evaluación de la fracción de expulsión del ventrículo derecho por ecocardiografía.

The purpose of this article is to evaluate and compare the right ventricular ejection fraction (RVEF) as parameter of right ventricular function by means of echocardiography. We studied 16 patients (15 male, 1 female) from 48 to 82 years of age (mean 58 years) from whom 8 had history of myocardial infarction (MI) with extension to the right ventricle (RV) in a period of time no longer than 7 days. The MI was diagnosed clinically as well as by enzymes, electrocardiogram and cardiac gammagram with 99mTc-pyrophosphate. The other 8 patients were healthy subjects or patients with stable angina pectoris. In all patients a two dimensional echocardiogram was performed with and apical four and two chamber view according to Simpson's rule; a subcostal approach was performed for the area-length method of Dodge. The values obtained of RVEF with each method were compared with those obtained by nuclear medicine. The apical views were obtained in 14 patients (87%) and the RV outflow tract was seen in 15 patients (93%). There were no significant statistical difference between the two methods. The highest correlation for RVEF respect to nuclear medicine was obtained with the area-length method with r = 0.85 and p less than 0.001 while for the Simpson method we obtained r = 0.79 and a p less than 0.001. We conclude that the determination of the RVEF is achievable in patients with MI of the RV and area-length method is the most useful.

[Circadian rhythm in myocardial infarct]. / Ritmo circadiano en el infarto del miocardio.

In order to determine if the beginning of the Myocardial Infarction (MI) is at random along the day or if it follows a circadian rhythm, we analyzed the clinical charts of 819 patients admitted to the Coronary Care Unite. Among them, 645 were male and 174 female. It was established that the beginning of the MI follows a circadian rhythm with maximal frequency between 8 and 9 a.m. and minimal at 0 hours (p greater than 0.01). This rhythm is sex independent. In patients younger than 45 years as well as those who received beta-block agents in less than 24 hours previous the MI no circadian rhythm was observed.

[Correlation of the transaortic gradient determined with doppler echocardiography versus catheterization in patients with aortic stenosis]. / Correlación del gradiente transaórtico determinado por eco-Doppler vs. cateterismo en pacientes con estenosis aórtica.

The purpose of this report is to evaluate the reliability of a non-invasive estimation of a transaortic gradient in patients with valvular aortic stenosis by doppler echocardiography. We compared the transvalvular gradients obtained by cardiac catheterization (invasive) versus the estimation by non-invasive technique such as continuous-wave doppler in 30 consecutive patients with valvular aortic stenosis. When compared the peak velocity (Vmax) of the aortic jet versus the gradient obtained by cardiac catheterization we found a correlation coefficient (r) of 0.83 and when compared the gradient obtained by both methods we found an r value of 0.85. These results show that the calculations of aortic gradient by echo-doppler, are reliable. Besides this method allowed us to establish the correct diagnosis and to follow up these patients.

[Spontaneous aneurysm of the patent ductus arteriosus with endarteritis. A case report]. / Aneurisma espontáneo del conducto arterioso permeable, con endarteritis. Presentación de un caso.

The spontaneous aneurysm of the ductus arteriosus is an extremely rare disease. From a total of 24 adult cases reported in the literature up to 1987, only in one case the ductus was open and other, was recanalized after being closed. We described the second case in the literature in a patient with totally permeable ductus arteriosus who developed a spontaneous aneurysm and endarteritis, showing the great importance of the diagnostic procedures such as echocardiogram, tomography and angiogram, as well as the surgical treatment which was successful in our patient. The probable etiology of this disease is discussed.