1,721,036 research outputs found
Magnetic Resonance Imaging in Primary and Secondary Septorhinoplasty
No full textThe authors emphasize the importance of MRI as a means to functionally evaluate patients in primary (PR) and secondary (SR) rhinoseptoplasty. Forty-eight subjects were appraised who underwent various types of corrective nose surgery: 31 PR, 12 SR, 4 introgenic perforations, and 1 dermoid cyst of the nasal dorsum. MRI allows the nasal structures at the level of the valve to be visualized, as well as the medial and lateral walls of the nasal fossa in all of its components. MRI studies improve pre-surgical evaluation (alar cartilages, iaterdomal distance, and valvular configuration), and the exam of structures and anomalies which are hard to evaluate by the rhinoscopy (turbino-septal-synchias, perforations, losses of bone-cartilaginous substance). Moreover, through MRI the nasal respiratory surface (NRS) is determined and used by the authors to quantify the improvement of the postsurgical nasal respiratory function. All of these points gain importance during the planning of primary, secondary, and/or corrective surgery
Magnetic resonance imaging fails to show evidence of reduced endolymphatic hydrops in gentamicin treatment of Ménière's disease.
No full textOBJECTIVE:
To verify the hypothesis that intratympanic (IT) gentamicin (Gent) treatment in Ménière's disease (MD) is capable of reducing endolymphatic hydrops (EH), as evaluated by 3-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequence in a 3-Tesla magnetic resonance imaging (MRI) unit, after IT gadolinium administration.
PATIENTS:
A total of 8 patients (5 men and 3 women; aged 40-78 yr; median, 60 yr) with definite MD participated in the investigation. The duration of the disease ranged from 1 to 10 years (median, 4 yr), with a prevalence of vertigo spells of 1 to 6 per month (median, 3.1), as calculated in the last 6 months.
INTERVENTION:
A 3D-FLAIR MRI was performed 24 hours after IT injection of diluted gadobutrol. Intratympanic Gent injection was performed in a period variable from 1 to 3 weeks after 3D-FLAIR MRI. A single-shot administration protocol was attempted with additional injections administered on demand in the case of relapsing vertigo spells. MRI was repeated after 3 to 12 months (median, 8 mo) after treatment.
MAIN OUTCOME MEASURE:
The degree and extension of EH as evaluated by 3D-FLAIR MRI was compared from images obtained pre- and post-ITGent administration.
RESULTS:
After ITGent administration, 4 patients did not show any MRI modification, 3 patients showed a worsening of EH in one site, and 1 patient showed a worsening in two sites. No subjects presented reduction of EH.
CONCLUSION:
No evidence of reduced EH following ITGent treatment has been shown in the present imaging investigation
A dehiscent superior semicircular canal may be plugged and resurfaced via the transmastoid route.
No full textTo evaluate the results obtained in treating superior semicircular canal dehiscence by plugging and resurfacing the defect via the transmastoid approach.Six patients (30-70 yr old) who had disabling semicircular canal dehiscence syndrome underwent surgery.After a wide mastoidectomy and skeletonization of the semicircular canals, a shell of bone covering the middle fossa lateral to the superior semicircular canal was removed. The exposed dura was gently retracted and the canal skeletonized. Bone dust mixed with fibrine glue and bone wax were pressed to plug the dehiscent portion of the canal, and a slice of cortical bone was inserted to resurface it.Recovery from vestibular and auditory symptoms was evaluated.No intraoperative or postoperative complications occurred. Patients experienced an immediate relief of symptoms attributable to the dehiscence.A superior semicircular canal dehiscence may be plugged and resurfaced via the transmastoid approach, thus avoiding the more invasive middle fossa craniotomy
Updates in the determination of brain death
No full textThe concept of brain death must be accurately determined and defined, especially in the light of the latest legislation on brain blood flow measurements
MRI performed after intratympanic gadolinium administration in patients with Ménière's disease: correlation with symptoms and signs.
No full textThe objective of the study was to compare the outcomes of a series of diagnostic parameters in Ménière's disease (MD) patients with the extent of endolymphatic hydrops (EH) as shown by magnetic resonance imaging (MRI) performed after intra-tympanic gadolinium administration using 18 patients (13 males and 5 females, age 25-78 years, median age 54.3 years) with definite MD. A 0.6-ml solution of Gadobutrol (1 mmol/ml) diluted 1:7 in saline was injected through the inferior-posterior quadrant of the tympanic membrane, using a 22-gauge spinal needle. The patient was kept with the head rotated 45° contralaterally for 30 min after the injection. Twenty-four hours later, three-dimensional fluid-attenuated inversion recovery MRI, using a 3-Tesla unit, was performed. Prevalence and extension of EH in MD patients was evaluated and correlated with age, duration and stage of the disease, frequency of attacks, time interval from the last attack, functional level scale, tinnitus, aural fullness, caloric stimulation, electrocochleography, and vestibular evoked myogenic potentials. All patients showed impaired enhancement of the inner ear of variable degree with the vestibular portion of the labyrinth more frequently involved than the cochlea. Abnormal vestibular evoked myogenic potentials, duration, and stage of the disease were significantly correlated to the number of inner ear sites involved. Modern imaging makes possible the identification of the endolymphatic hydrops in MD patients, improving diagnostic accuracy. The role of hydrops in the clinical manifestations and its correlation with most of the diagnostic parameters remain, however, not completely clear
HASTE diffusion-weighted 3-Tesla magnetic resonance imaging in the diagnosis of primary and relapsing cholesteatoma.
No full textTo evaluate the value of half-Fourier acquisition single-shot turbo-spin-echo diffusion-weighted magnetic resonance imaging (HASTE DW MRI) using a 3-Tesla (3T) unit in the diagnosis of primary and relapsing cholesteatoma.Retrospective observational investigation.Tertiary referral center.Seventeen patients suspected of having a primary cholesteatoma without clear clinical evidence of the lesion, and 13 patients who were candidates to a second-stage tympanoplasty to rule out a relapsing cholesteatoma or reconstruct the ossicular chain were investigated.All patients were scanned in a 3T scanner with a 4-channel head coil using T2 HASTE DW MRI technique sequences in axial and coronal planes covering the middle ear and mastoid regions.Images were considered positive for cholesteatoma in the presence of a hyperintense, patchy-like lesion in the petrous bone.Images showed a high signal intensity suggestive of primary cholesteatoma in 10 of 17 patients and of relapsing cholesteatoma in 7 of 13 patients. Of the 17 subjects, 15 with positive MRI findings were operated on, and the presence of cholesteatoma (ranging from 2 to 20 mm in size) was confirmed at surgery. Of the 13 subjects shown to be negative on HASTE DW MRI for cholesteatoma, 11 were operated on and were all confirmed to be cholesteatoma-free.Half-Fourier acquisition single-shot turbo-spin-echo diffusion-weighted magnetic resonance imaging technique, using a 3T unit, may be a diagnostic tool for a rapid and highly reliable discrimination between cholesteatomatous and noncholesteatomatous tissue in the middle ear, with 100\% of positive and negative predictive values
Reliability of magnetic resonance imaging performed after intratympanic administration of gadolinium in the identification of endolymphatic hydrops in patients with Ménière's disease.
No full textOBJECTIVE:
To evaluate the reliability of magnetic resonance imaging performed after intratympanic gadolinium administration in evidencing endolymphatic hydrops in patients with Ménière's disease (MD).
PATIENTS:
A total of 26 patients (18 male and 8 female subjects, aged 25-78 yr; median age, 56 yr) with definite MD and 12 subjects (8 male and 4 female subjects, aged 31-75 yr; median age, 51 yr) with various unilateral non-MD disorders of the inner ear were examined.
INTERVENTION:
A 0.6-ml solution of gadobutrol (1 mmol/ml), diluted 1:7 in saline, was injected in the affected ear through the inferior-posterior quadrant of the tympanic membrane, using a 22-gauge spinal needle. In 9 MD patients, the contralateral ear also was injected. The patient was kept with the head rotated 45 degrees contralaterally for 30 minutes after each injection. Twenty-four hours later, a 3-dimensional fluid-attenuated inversion recovery magnetic resonance imaging using a 3 Tesla unit was performed.
MAIN OUTCOME MEASURE:
Perilymphatic enhancement was evaluated in different portions of the labyrinth in MD ears and compared with the outcomes obtained in the non-MD ears.
RESULTS:
All MD ears showed impaired perilymphatic enhancement of variable degrees. No enhancement defects could be observed in all examined contralateral unaffected ear of the patients with MD, as well as in 11 of the 12 ears of the subjects with various unilateral non-MD disorders.
CONCLUSION:
Perilymphatic enhancement defect of variable degrees is observed in the pathologic ear of every patient with MD. The consistency of this phenomenon in MD ears and the complete enhancement in most of the ears without MD safely enable to attribute these findings to endolymphatic hydrops. It is likely in the near future that imaging may be used to achieve a certain diagnosis of MD in life
Variability in the perilymphatic diffusion of gadolinium does not predict the outcome of intratympanic gentamicin in patients with Ménière's disease.
No full textOBJECTIVES/HYPOTHESIS:
To assess the utility of imaging in planning intratympanic (IT) gentamicin (Gent) treatment in Ménière's disease (MD), we compared the dosage and outcomes of ITGent with the severity and extent of endolymphatic hydrops (EH), as evaluated by three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequence in a 3-T magnetic resonance imaging (MRI) unit, after IT gadolinium administration.
STUDY DESIGN:
Retrospective review.
METHODS:
A total of 18 patients (10 males and 8 females; age, 28-78 years; median age, 53.2 years) with definite MD participated in the investigation. The duration of the disease ranged from 8 months to 9 years (median, 2 years), with a prevalence of vertigo spells ranging from 0.8 to 8 per month (median, 2.2), as calculated in the last 6 months. A 3D-FLAIR MRI was performed 24 hours after IT injection of diluted gadobutrol. ITGent injection was performed within a variable period of time, from 1 week to 3 weeks after 3D-FLAIR MRI. The degree and extension of EH as evaluated by 3D-FLAIR MRI were compared with the number of injections necessary to cure vertigo attacks. Vertigo results, functional level scale modifications, variations in caloric excitability, and pure-tone average modifications.
RESULTS:
No statistically significant correlation was observed between severity of EH and outcomes of ITGent administration.
CONCLUSIONS:
The hypothesis of a reduced effect of Gent administered intratympanically in the presence of severe EH, owing to obstacled diffusion along the perilymphatic compartments, has not been confirmed in the present investigation
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