Right-to-left shunts as a cause of juxtacortical spots in patients with migraine.

BACKGROUNDS: Juxtacortical spots on fluid-attenuated inversion recovery (FLAIR) images can be frequently detected in patients with migraine. However, the origins of the cerebral lesions (including juxtacortical spots on FLAIR images) found in the previous studies are not known. We sought to investigate the association between juxtacortical spots on FLAIR images and right-to-left shunt (RLS) in migraine patients. METHODS: Juxtacortical spots on FLAIR images were arbitrarily defined as small areas of hyperintensities in the juxtacortex and cortico-subcortical junction. The presence of RLS was examined by a transcranial Dopper (TCD) with the agitated saline test. The degree of RLS was categorized into four grades according to the number of microemboli: no shunt, <10 microbubbles (MB), >10 MB single spots pattern, and >10 MB shower/curtain pattern. We compared the results for migraine patients (n = 49) with those for healthy controls (n = 49). RESULTS: Juxtacortical spots on FLAIR images occurred in 38/98 subjects; of them, 27/49 (55.1%) had migraines and 11/49 (22.2%) were healthy controls (P = 0.002). The independent factors associated with juxtacortical spots on FLAIR images were female, migraine patients, and RLS by multivariate analysis. In migraine patients, RLS was independently associated with juxtacortical spots on FLAIR images. CONCLUSION: Our results suggest that juxtacortical spots on FLAIR images were frequently found in migraine patients and might be associated with the presence of RLS in those patients. Further studies are needed to assess whether juxtacortical spots have clinical implications in patients with migraine.

Development of a custom designed TAH using rapid prototyping.

The failure of the orthotopic implantation of a totally implantable artificial heart (TAH) was due mainly to anatomic mismatches in the conduits of the conventional TAH system. To overcome this anatomic incompatibility, a custom design and fabrication process was designed using the rapid prototyping (RP) technique. After three dimensional reconstruction of magnetic resonance imaging of the thoracic cavity and vascular remnants of the recipient, study of anatomic fit was done using the reconstructed thoracic model and three dimensional computer aided design (CAD) model. The direction of the inflow and outflow conduits of the blood sac was changed with a Unigraphics CAD. The RP model of the designed chamber was fabricated and examined for anatomic compatibility. Through this approach, the minute directional mismatch of the inflow and outflow conduits was improved. Thus, a new custom designed moving actuator Korean TAH with CAD and RP techniques was developed.