This study investigated whether significant coronary artery stenosis in 231 consecutive unstable angina patients can be diagnosed by thoroughgoing history-taking initial electorocardiography and symptom- or sign-limited treadmill exercise ECG after medication. The unstable angina patients were divided into those with accelerated angina, those with new-onset effort angina and those with angina at rest based on the findings of detailed inquiry. Initial ECG showed that the sensitivity and specificity of detecting significant coronary artery stenosis in all patients were 55.2% and 63.2%, respectively. In accelerated angina, sensitivity and specificity were 52.2% and 50.0%, respectively. In new-onset effort angina, sensitivity and specificity were 46.7% and 57.1%, respectively. In angina at rest, sensitivity and specificity were 69.0% and 68.3%, respectively. Initial ECG provided valuable diagnostic information about angina at rest. Treadmill exercise ECG offered 66.0% sensitivity and 89.2% specificity in all patients, respectively. In accelerated angina, sensitivity and specificity were 80.0% and 66.7%, respectively. In new-onset effort angina, sensitivity and specificity were 70.8% and 87.8%, respectively. In angina at rest, sensitivity and specificity were 48.3% and 91.4%, respectively. Thus, treadmill exercise electrocardiograms provided valuable diagnostic information in the case of unstable angina, especially accelerated angina and new-onset effort angina. For patients with angina at rest, this testing was very useful for excluding significant coronary artery stenosis.
In conclusion, detailed inquiry, initial ECG and symptom- or sign-limited treadmill exercise ECG after medical stabilization proved to be of great value for diagnosing unstable angina patients with significant coronary artery stenosis.

INTRODUCTIONComplex regional pain syndrome (CRPS) patients show impaired visuospatial perception in the dark, as compared to normal patients with acute nociceptive pain. The purpose of this study is 2-fold: (i) to ascertain whether this distorted visuospatial perception is related to the chronicity of pain, and (ii) to analyse visuospatial perception of CRPS in comparison with another neuropathic pain condition.

MATERIALS AND METHODSWe evaluated visual subjective body-midline (vSM) representation in 27 patients with post-herpetic neuralgia (PHN) and 22 with CRPS under light and dark conditions. A red laser dot was projected onto a screen and moved horizontally towards the sagittal plane of the objective body-midline (OM). Each participant was asked to direct the dot to a position where it crossed their vSM. The distance between the vSM and OM was analysed to determine how and in which direction the vSM deviated.

RESULTSUnder light condition, all vSM judgments approximately matched the OM. However, in the dark, CRPS patients, but not PHN patients, showed a shifted vSM towards the affected side.

CONCLUSIONWe demonstrated that chronic pain does not always impair visuospatial perception. The aetiology of PHN is limited to the peripheral nervous system, whereas the distorted visuospatial perception suggests a supraspinal aetiology of CRPS.

Adult ; Aged ; Complex Regional Pain Syndromes ; complications ; etiology ; Darkness ; Female ; Functional Laterality ; physiology ; Humans ; Male ; Middle Aged ; Neuralgia, Postherpetic ; complications ; Perceptual Disorders ; etiology ; physiopathology ; Peripheral Nervous System ; physiopathology ; Task Performance and Analysis

We evaluated the efficacy of evoked spinal potential (ESP) monitoring during thoracoabdominal aortic replacement to prevent intra-operative spinal ischemia. Nine patients underwent intraoperative ESP monitoring. The ESP was unchanged in 5 patients and decreased in 4 patients. However, ESP recovered in 2 of them by the following techniques: (1) perfusion of intercostal arteries, (2) elevation of distal bypass perfusion pressure, (3) slight hypothermia. Postoperative paraplegia occurred only 1 patient of the 2 whose ESP was not restored. The sensitivity and specificity of the efficacy of ESP monitoring were 100% and 87.5%, respectively. We concluded that ESP is the most useful monitoring for prevention of operative spinal ischemia during thoracoabdominal aortic replacement.

A 67-year-old woman had left lateral chest pain. CT scan and digital subtraction angiography revealed coarctation of the abdominal aorta just distal from the renal artery and a fusiform aneurysm of the descending thoracic aorta with a maximum diameter of 60mm. The meandering mesenteric artery was significantly dilated as a collateral vessel from the superior mesenteric artery to the inferior mesenteric artery. Aortitis syndrome was suspected from the angiographic findings although inflammatory changes in laboratory data were not observed. She underwent aneurysmectomy followed by prosthetic graft replacement of the descending thoracic aorta under femoro-femoral bypass and an extraanatomical bypass grafting from the replaced graft to the abdominal aorta proximal to the aortic bifurcation via the retroperitoneal space. She was discharged on the 42nd day after operation without any complications and in the past year has returned to her usual daily life without any anastomotic site trouble.

Congenital fetal abnormalities, typically structural abnormalities, are found about 3-5% of all pregnancies. The prenatal detection of these abnormalities are especially important in providing optimal perinatal management for neonates. In many obstetric hospitals and clinics in Japan, fetal ultrasound screening is provided by obstetricians at regular pregnancy checkups. There were few reports on fetal ultrasound performed by medical technologists. Therefore, we conducted a retrospective investigation to determine the efficacy and accuracy of fetal ultrasound performed by medical technologists in our hospital. In total, 2,289 pregnancy women underwent fetal ultrasound screening. We excluded cases that were a second or subsequent scan, had gestational age of <22 weeks at the time of ultrasound screening, or had missing perinatal and neonatal outcomes. The remaining of 2,186 cases, including 65 cases of twins, were investigated. Abnormal findings were noted in 79 cases (3.6%): 31 for the heart, 14 for head, and 11 for urogenital organs. In those cases, congenital abnormalities were found in 39 neonates (1.8%). There were 95 cases (4.3%) in which abnormal finding were absent in fetal ultrasound screening but congenital abnormalities were diagnosed in neonates, including ventricular aneurysm, interruption of the vena cava, cerebellar medulloblastoma, atrial septal defect, and cleft palate. In conclusion, for detecting structural abnormalities, fetal ultrasound screening performed by medical technologists is an important alternative to ultrasound screenings performed by obstetricians. To increase the accuracy of fetal ultrasound screening, continuous improvement of fetal ultrasound skills is important.