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Objective To determine the intrarater, interrater, and retest reliability of facial nerve grading of patients with facial palsy (FP) using standardized videos recorded synchronously during a self-explanatory patient video tutorial. Study design Prospective, observational study. Methods The automated videos from 10 patients with varying degrees of FP (5 acute, 5 chronic FP) and videos without tutorial from eight patients (all chronic FP) were rated by five novices and five experts according to the House-Brackmann grading system (HB), the Sunnybrook Grading System (SB), and the Facial Nerve Grading System 2.0 (FNGS 2.0). Results Intrarater reliability for the three grading systems was very high using the automated videos (intraclass correlation coefficient [ICC]; SB: ICC = 0.967; FNGS 2.0: ICC = 0.931; HB: ICC = 0.931). Interrater reliability was also high (SB: ICC = 0.921; FNGS 2.0: ICC = 0.837; HB: ICC = 0.736), but for HB Fleiss kappa (0.214) and Kendell W (0.231) was low. The interrater reliability was not different between novices and experts. Retest reliability was very high (SB: novices ICC = 0.979; experts ICC = 0.964; FNGS 2.0: novices ICC = 0.979; experts ICC = 0.969). The reliability of grading of chronic FP with SB was higher using automated videos with tutorial (ICC = 0.845) than without tutorial (ICC = 0.538). Conclusion The reliability of the grading using the automated videos is excellent, especially for the SB grading. We recommend using this automated video tool regularly in clinical routine and for clinical studies. Level of evidence 4 xsLaryngoscope, 129:2274-2279, 2019.

This article adds the Japanese perspective to our knowledge of shared decision-making (SDM) preferences by surveying patients with prostate cancer (PCA) and physicians in Japan. In 2015, 103 Japanese patients with PCA were asked about their SDM preferences by using an Internet-based 5-point-scale questionnaire. Concurrently, 127 Japanese physicians were surveyed regarding their perceptions of patient preferences on SDM. Drivers of preferences and perceptions were analyzed using univariable ordinal logistic regression and graphing the fitted response probabilities. Although 41% of both patients and physicians expressed and expected a desire for active involvement in treatment decisions (a higher rate than in a similar study for the United States in 2001), almost half the Japanese patients preferred SDM, but only 33% of physicians assumed this was their choice. That is, 29% of Japanese physicians underestimated patients’ preference for involvement in making treatment decisions. Patients with lower health-related quality of life (as measured by the Functional Assessment of Cancer Therapy-Prostate [FACT-P]) expressed a stronger preference for SDM. The study shows that the worse the medical situation, the more patients with PCA prefer to be involved in the treatment decision, yet physicians tend to underestimate the preferences of their patients. Perhaps in contrast to common assumptions, Japanese patients are as interested in being involved in decision making as are patients in the United States.

In contrast to secondary occlusion idiopathic thrombosis of the superior vena cava occurs rarely. With a good collateral flow through anatomically preformed venous channels the clinical picture may have an insidious course obscuring diagnosis. Collateral circulation via upper oesophageal varices is commonly overlooked. Anticoagulants should be given to prevent progression. Surgically vein transplants, by-pass operations, and thrombectomy have been tried. Follow-up in 4 patients shows that even without surgical intervention the prognosis is good despite the danger of haemorrhage from the varices.

Integrated assessment of selective coronary angiorgrams and perfusion scintigrams of 86 patients with coronary-artery insufficiency revealed anatomical and topographical details which could not be achieved with one of these methods alone. Pathological perfusion patterns were quite different from normal ones. The functional effects of single, centrally located stenoses, of more peripheral and multiple narrowings, as well as of anastomoses and collaterals were adequately demonstrated by selective coronary perfusion scintigraphy and prevented diagnostic errors. It is, therefore, an additional aid in the diagnosis of coronary-artery disease.

Secundum ASD was diagnosed in five members of three generations of one family. Three of them had prolonged A-V conduction. These findings and those reported in the literature suggest that the combination of secundum ASD with prolonged A-V conduction is an autosomal dominant hereditary disease.

Total lipid, free and esterified cholesterol and triglycerides significantly increase in concentration with increasing age. Palmitic, palmitoleic, oleic and linoleic acid behave in the same way. Free fatty acids, phospholipids and stearic acid show the same concentrations in all groups of age. C20 fatty acids demonstrate a competitive regulatory mechanism of desaturase activity in their age dependant distribution. While the 20:3(n-9), a product of the endogenous (n-9) family, increases, the 20:3(n-6) and 20:4(n-6), both desaturation and chain elongation products of the essential n-6 family, decrease. Such behavior has been demonstrated in many feeding studies (12, 13, 15, 16, 17, 29) and is interpreted as a result of competitive substrate interaction on desaturase activity.

Myocardial perfusion scintigraphy by means of the microsphere technique is a valuable method for detecting regional myocardial scars. The use of the microsphere technique is indicated in all patients who have had myocardial infarction and before coronary bypass operations. In a certain group of patients with severe but atypical angina pectoris and a normal coronary arteriogram and in some arrhythmias the perfusion scintigram can provide information on changes coronary microcirculation. The assessment of myocardial blood flow redistribution under pharmacological intervention is a further indication for the microsphere technique.

201Tl scanning demonstrated viable myocardium in the area supplied by the anterior interventricular branch (on frontal scanning) and viable myocardium in the interventricular septum and left ventricular lateral wall (scanning in the second oblique position) in 9 of 11 patients. Akinetic myocardial segments in the left ventricular anterior wall and left ventricular apex could be recognized by absent activity when scanning from in front. But hypokinetic segments, which contrary to the appearance with akinesia cannot be equated with myocardial scar, could not according to present experience be recognized by 201TL scanning. The special advantage of 201Tl scanning is is that, except for its intravenous injection, no further invasive procedure has to be undertaken, and it can be repeated. No side effects of complications have been observed.

While coronary angiography was within normal limits in three patients with recurrent severe attacks of angina and non-transmural postero-lateral wall myocardial infarction, myocardial perfusion scintigraphy demonstrated an abnormal distribution pattern. In addition to recanalised thrombosis, embolism or spasm, abnormalities in the microcirculation are possible causes of the discrepancy between the coronary arteriogram and the scintigram. Myocardial perfusion scintigraphy is of particular diagnostic significance in this group of patients with coronary heart disease but normal coronary angiography. Treatment in the presence of this finding consists of administration of platelet-aggregation inhibitors.

Significance and technique of roentgenologic and nuclear medicine methods for evaluation of coronary artery disease and myocardial perfusion are presented. Some routinely used methods in nuclear medicine are briefly discussed concerning the evaluation of left ventricular function.

Coronary artery fistulas are rare, inborn anomalies which will be diagnosed more often as the diagnostic method of coronary arteriography is increasing. This report concerns a preoperatively diagnosed coronary arteriovenous fistula of the right coronary artery to the sinus coronarius; Frequency, pathological physiology, clinical symptoms, differential diagnosis, prognosis and treatment are discussed. The importance of using selective coronary arteriography to outline the anatomy of these malformations is stressed. Surgical treatment is the only effective way of therapy and should be performed after diagnosis, even if in an early stage of the disease the ECG does not show any changes in spite of a large fistula.

Two patients with anomalous origin of the left coronary artery from the pulmonary artery are presented. Anatomy, embryology, the problem of the direction of blood flow in the anomalous vessel, and the clinical symptoms of this syndrome are discussed. In spite of large fibrotic areas in the myocardium, the ECG-changes were minimal. Therefore, a nearly normal ECG does not exclude this anomaly. In patients with sudden, unexpected death one should suspect an anomalous origin of a coronary artery. The classification in an "infantile" and "adult" type reflects the extent to which collateral vessels have developed. Ligation of the anomalous coronary artery at the side of its origin with concomitant aorto-coronary bypass appears to be a rational and the only effective way of therapy.

In patients aged 24 to 45 years with angina pectoris, pathological changes in the exercise electrocardiogram and a normal coronary angiogram, a disturbance of the pattern of myocardial perfusion could be demonstrated in addition by scintigraphy. The cause of this disturbance of myocardial perfusion is unknown. Myocardial scintigraphy is indicated (1) to demonstrate an otherwise undetectable disturbance in the blood flow of the myocardium with a morphologically normal coronary system, (2) in subtotal coronary stenosis before the decision to perform a coronary bypass operation is made, (3) in cases of anginal syndrome with normal coronary angiograms.

Congenitally corrected transposition of the great vessels is a cardiac anomaly in which the pulmonary artery and the aorta are transposed in relation to one another but in which the flow of blood is maintained in the physiologic direction. In this condition there is a concomitant inversion of the ventricular chambers. 8 patients--5 adults and 3 children--with this condition have been reviewed with special attention to clinical symptoms and electrocardiographic and roent-genologic features. The anomaly is of importance because it is much more common than formerly believed. Frequently associated cardiac defects are correctable by surgical procedures. Therefore a preoperatively firmly established disgnosis is necessary by angiocardiography and heart catheterization.

A supraventricular re-entry tachycardia was successfully treated in a patient with WPW and sick-sinus syndrome by permanent rapid atrial pacing and ventricular demand pacing. The use of a demand pacemaker with bipolar electrode avoided slow ventricular rates resulting from second degree A-V block during rapid atrial pacing. The trigger system of this pacemaker was not disturbed by unipolar atrial stimulation. Ventricular rates responded satisfactorily to physical and to emotional stress as a result of improved A-V conduction in these circumstances. Rapid atrial pacing has prevented the re-entry tachycardia. In an emergency the atrial pacemaker can be inhibited by a magnet, but otherwise discharges permanently at a constant rapid rate.

The influence of Dipyridamol and Oxyfedrin on regional myocardial precapillary microperfusion patterns was investigated in groups of 15 and 13 patients by means of selective double lable perfusion scintigraphy. Automatic impulse rate integration allows the comparison of different perfusion areas in the same scintigram as well as the comparison of different identical regions in different scintigrams. The scans were taken in two positions (frontal and l.a.o.). Microperfusion patterns were measured before and after the intravenous application of the drug. We found a typical shift of the microperfusion patterns with both medicaments. Under the influence of Oxyfedrin and Dipyridamol there was an increase of the relative microperfusion intensity in the vicinity of the major arteries but there were great differences as to the degree of their reaction maximum. Besides the results of the groups some typical cases are demonstrated. The method allows a satisfactory measurement of differences in the regional precapillary myocardial perfusion under the influence of coronary active drugs. We believe that statements on physiologic and pathologic functions are possible.

A numerical index was developed for reproducible and comparative judgement of the degree of coronary sclerosis. This graded index method takes into account the amount of stenosis as well as its distance from the ostium. 152 selective coronary angiograms were evaluated by this method. There was a close correlation between the degree of sclerosis and collaterals; the index of 63 patients with collaterals was 3.5 times that of patients without collaterals. Anastomoses and collaterals showed typical localisations depending on the antomical position of stenoses. For the evaluation of the clinical importance of collaterals, a classification into one, two and three vessel disease is not adequate; the reduction in perfusion cannot be reliably estimated and should be judged by a more detailed index method.