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An intensive 72 hour study of the cardiovascular effects of severe diffuse brain injury was made in seven patients. No other major injury was present. Patients received optimal care very rapidly after injury and intracranial pressure, which was continuously monitored, was maintained at or just above normal by elective positive pressure ventilation techniques. Three patients showed evidence of progressive myocardial ischaemia on continuous electrocardiographic monitoring. Two of these patients died. Ventricular arrhythmias were uncommon but one of the patients with ischaemia developed ventricular tachycardia. Heart rate patterns were very abnormal but did not predict complications. Blood pressure did not vary greatly and cardiac outputs were usually normal. Pronounced excesses of urinary catecholamines and serum creatine kinase 2 isoenzyme (CK MB) as well as total creatine kinase were found. Histological evidence of myocardial damage could be shown at necropsy in the one case whose heart was available for study. This study shows that the cardiac effects of isolated diffuse cerebral injury may be harmful and even fatal despite correction of secondary factors such as anoxia and raised intracranial pressure. The findings suggest that evaluation of the potential benefits of sympathetic blockade is warranted. Cardiac complications of cerebral damage deserve wider recognition by intensive care personnel, neurologists, and neurosurgeons. [ABSTRACT FROM PUBLISHER]

In eleven patients with Parkinsonism there was a strong inverse relationship between the frequency of spontaneous activity of the arms and the degree of fatiguing of repetitive finger movements made upon command. The prevalence of spontaneous arm movement was related inversely (but more weakly) to the time taken to complete a pegboard test or to move clothespegs by hand; it had little association with the speed of linear movement or with simple motor reaction time involving the arm. [ABSTRACT FROM AUTHOR]

This article presents description of the procedure related to presumption of legitimacy and criminal investigations and information regarding several recent events and developments in the field of law. In a divorce action, in the case "Schulse v. Schulz," in which husband challenged legitimacy of wife's second child, testimony of a qualified physician that blood grouping tests revealed that husband could not be the father of the child was admissible. Concerning the case which was also related to presumption of legitimacy, the Supreme Court of Monroe County, New York, has referred the U.S. Civil Practice Act. The article further presents information about the membership criteria of the Medical Correctional Association, an affiliate of the American Prison Association, which is, reportedly, interested in establishing contact with all professional personnel who are specially concerned with the medical aspect of crime and interested in it. In a recent decision, the Act of Assembly in New York State, to identify criminals by blood grouping tests, has became a law on April 17, 1943. The article also presents information about the Annual Conference of the National Probation Association which began April 8, 1943, at Saint Louis, Missouri.

The article presents the case study of a 78-year-old male patient with age-related macular degeneration (AMD). It states that the patient expressed symptoms such as macular hole (MH) formation, subfoveal choroidal neovascularization (CNV), and Vitreomacular attachment (VMA) that result from posterior vitreous detachment (PVD). It demonstrates that biomicroscopy and or Fluorescein angiography could not ascertain small MH in AMD patients.

A response by the author to a letter to the editor regarding his article "Preclinical aspects of anti-VEGF agents for the treatment of wet AMD: ranibizumab and bevacizumab" is presented.

Purpose: To demonstrate the cross-sectional anatomy in acute commotio retinae., Methods: A 27-year-old male with unilateral decreased vision after acute blunt ocular trauma, was examined by optical coherence tomography (OCT)., Results: Visual acuity was 20/20 OD and 20/50 OS. Fundus examination OS demonstrated a mild edema in the papillomacular and foveal area. OCT confirmed a separation of the neurosensory retina and the retinal pigment epithelium (RPE). The thickness of the retina was normal and the contour of the foveola intact. The uncommon hyperreflective band at the outer retina may present the traumatic disruption of photoreceptors., Conclusions: In vivo investigations by OCT confirmed previous histological studies, a commotio retinae consists a disruption and fragmentation at the level of the foveal photoreceptor segments and RPE.

Objectives: The purpose of this study was to validate cardiac measurements derived from real-time cardiac magnetic resonance imaging (MRI) as compared with well-validated conventional cine MRI., Background: Although cardiac MRI provides accurate assessment of left ventricular (LV) volume and mass, most techniques have been relatively slow and required electrocardiogram (ECG) gating over many heart beats. A newly developed real-time MRI system allows continuous real-time dynamic acquisition and display without cardiac gating or breath-holding., Methods: Fourteen healthy volunteers and nine patients with heart failure underwent real-time and cine MRI in the standard short-axis orientation with a 1.5T MRI scanner. Nonbreath-holding cine MRI was performed with ECG gating and respiratory compensation. Left ventricular end-diastolic volume (LVEDV), left ventricular endsystolic volume (LVESV), ejection fraction (EF) and LV mass calculated from the images obtained by real-time MRI were compared to those obtained by cine MRI., Results: The total study time including localization for real-time MRI was significantly shorter than cine MRI (8.6 +/- 2.3 vs. 24.7 +/- 3.5 min, p < 0.001). Both imaging techniques yielded good quality images allowing cardiac measurements. The measurements of LVEDV, LVESV, EF and LV mass obtained with real-time MRI showed close correlation with those obtained with cine MRI (LVEDV: r = 0.985, p < 0.001; LVESV: r = 0.994, p < 0.001; EF: r = 0.975, p < 0.001; LV mass: r = 0.977, p < 0.001)., Conclusions: Real-time MRI provides accurate measurements of LV volume and mass in a time-efficient manner with respect to image acquisition.

A graphical user interface (GUI) has been developed which enables interactive feedback and control to the real-time diminishing variance algorithm (DVA). This interactivity allows the user to set scan parameters, view scan statistics, and view image updates during the course of the scan. In addition, the DVA has been extended to simultaneously reduce motion artifacts in three dimensions using three orthogonal navigators. Preliminary in vivo studies indicate that these improvements to the standard DVA allow for significantly improved consistency and robustness in eliminating respiratory motion artifacts from MR images, particularly when imaging the coronary arteries.

Objectives: We conducted an initial clinical trial of a newly developed cardiac magnetic resonance imaging (CMRI) system. We evaluated left ventricular (LV) function in 85 patients to compare the clinical utility of the CMRI system with echocardiography, the current noninvasive gold standard., Background: Conventional CMRI systems require cardiac-gating and respiratory compensation to synthesize a single image from data acquired over multiple cardiac cycles. In contrast, the new CMRI system allows continuous real-time dynamic acquisition and display of any scan plane at 16 images/s without the need for cardiac gating or breath-holding., Methods: A conventional 1.5T Signa MRI Scanner (GE, Milwaukee, Wisconsin) was modified by the addition of an interactive workstation and a bus adapter. The new CMRI system underwent clinical trial by testing its ability to evaluate global and regional LV function. The first group (A) consisted of 31 patients with acceptable echocardiography image quality. The second group (B) consisted of 31 patients with suboptimal echocardiography image quality. The third group (C) consisted of 29 patients with severe lung disease or congenital cardiac malformation who frequently have suboptimal echo study. Two independent observers scored wall motion and image quality using the standard 16-segment model and rank-order analysis., Results: CMRI evaluation was complete in less than 15 min. In group A, no significant difference was found between ECHO and CMRI studies (p = NS). In group B, adequate visualization of wall segments was obtained 38% of the time using ECHO and 97% of the time using CMRI (p < 0.0001). When grouped into coronary segments, adequate visualization of at least one segment occurred in 18 of 30 patients (60%) with ECHO and in all 30 patients (100%) with CMRI (p < 0.0001). In group C, adequate visualization of the wall segments was obtained in 58% (CI 0.53-0.62) of the time using echocardiography and 99.7% (CI 0.99-1.0) of the time using CMRI (p < 0.0001)., Conclusions: The new CMRI system provides clinically reliable evaluation of LV function and complements suboptimal echocardiography. In comparison with the conventional CMRI, the new CMRI system significantly reduces scan time, patient discomfort and associated cost.

In the technique known as gridding, the data samples are weighted for sampling density and convolved with a finite kernel, then resampled on a grid preparatory to a fast Fourier transform. The authors compare the artifact introduced into the image for various convolving functions of different sizes, including the Kaiser-Bessel window and the zero-order prolate spheroidal wave function (PSWF). They also show a convolving function that improves upon the PSWF in some circumstances.

When time-varying gradients are used for imaging, the off-resonance behavior does not just cause geometric distortion as is the case with spin-warp imaging, but changes the shape of the impulse response and causes blurring. This effect is well known for projection reconstruction and spiral k-space scanning sequences. The authors introduce a reconstruction and homogeneity correction method to correct for the zeroth order effects of inhomogeneity using prior knowledge of the inhomogeneity. In this method, the data are segmented according to collection time, reconstructed using some fast, linear algorithm, correlated for inhomogeneity, and then superimposed to yield a homogeneity corrected image. This segmented method is compared to a conjugate phase reconstruction in terms of degree of correction and execution time. The authors apply this method to in vivo images using projection-reconstruction and spiral-scan sequences.

Daily estimations of hemispheral cerebral blood flow using the xenon-133 inhalation technique was made in 116 patients during the first three weeks after subarachnoid haemorrhage. The patients' cerebral perfusion on average remained less than the normal perfusion expected for their age (based on a single estimation of cerebral blood flow in 67 volunteers). On each separate day after subarachnoid haemorrhage cerebral blood flow was inversely related to the patient's age. Older patients seem especially at risk of developing cerebral ischaemia after subarachnoid haemorrhage. The clinical outcome was more often unfavourable in older patients--that is, in those who tended to have the lowest cerebral blood flow. Present results support the view that episodes of low cerebral blood flow lead to a poor outcome after subarachnoid haemorrhage. Because of the risk of inducing cerebral ischaemia great care should be exercised by physicians administering hypotensive drugs to older patients after subarachnoid haemorrhage.

National and local codes and regulations help ensure emergency power systems keep critical hospital functions up and running during utility power outages.