A 69-year-old male presented with several painful erythematous patches on both palms and trunk several days after receiving iopromide (Ultravist(R), Shering, Berlin, Germany). A fixed drug eruption (FDE) due to iopromide was suspected clinically. However, at that time, the patch test with iopromide at the lesion site gave negative results. Three years later, the patient was mistakenly administered iopromide again and patches with vesicles recurred on the same sites as well as on the genitalia. This episode was repeated once again after 1 year. In all episodes, the skin lesion resolved after application of topical steroids. Although a patch test with iopromide was negative in our case, we made a diagnosis of FDE due to iopromide because the skin lesions occurred again at the previously involved area after re-exposure to iopromide. To date, only three cases of FDE caused by non-ionic monomers have been documented in the English literature. Herein, we report on an interesting case of FDE caused by iopromide.
Aged ; Berlin ; Contrast Media ; Drug Eruptions ; Genitalia ; Humans ; Iohexol ; Male ; Patch Tests ; Skin ; Steroids

PURPOSE: To compare, in terms of their feasibility and normal range, 99mTc-DTPA renal perfusion imaging and renal perfusion imaging using harmonic ultrasound (US) with a microbubble contrast agent for the evaluation of renal perfusion after renal transplantation. MATERIALS AND METHODS: During a six-month period, thirty patients who had received a renal transplant underwent both 99mTc-DTPA renal perfusion imaging and renal perfusion imaging using harmonic US with a microbubble contrast agent. Sonographic renal perfusion images were obtained before and after a bolus injection of the microbubble contrast agent LevovistTM (SH U 508A; Schering AG, Berlin, Germany) every 3 seconds for 3 minutes. Sonographic renal perfusion images were converted into a renal perfusion curve by a computer program and Tpeak of the curve thus obtained was compared with that of the 99mTc-DTPA curve. RESULTS: Average Tpeak of the 99mTc-DTPA renal perfusion curve was 16.2 seconds in the normal group and 39.6 seconds in the delayed perfusion group, while average Tpeak of the sonographic renal perfusion curve was 23.7 seconds and 46.2 seconds, respectively. Tpeak of the sonographic renal perfusion curve showed a good correlation with that of the 99mTc-DTPA curve (correlation coefficient=0.8209; p=0.0001). The cut-off value of Tpeak of the sonographic renal perfusion curve was 35 seconds (sensitivity=90%, specificity=95%). CONCLUSION: In patients who have received a renal transplant, the findings of renal perfusion imaging using harmonic US with a microbubble contrast agent show close correlation with those of 99mTc-DTPA renal perfusion imaging. The optimal cut-off value of Tpeak of the sonographic renal perfusion curve was 35 seconds.
Berlin ; Humans ; Kidney Transplantation ; Microbubbles ; Perfusion Imaging ; Perfusion* ; Reference Values ; Ultrasonography*

PURPOSE: To assess the value of enteral contrast media for the evaluation of pelvic masses by MR imaging. MATERIALS AND METHODS: Between April and July 1998, 16 women with pelvic masses were examined by MRI. The origin of the lesion was the ovary in twelve cases, the uterus in three, and the sigmoid in one. Using a 1.5T scanner(Magnetom Vision, Siemens), T1-weighted axial spin echo(SE), T2-weighted turbo spin echo(TSE), two-dimensional fast low-angle shot(FLASH 2D), and half-Fourier TSE(HASTE) images were obtained in all patients after the administration of Magnevist Enteral (Shering, Berlin, Germany). In each MR imaging sequence, distinction between the lesion and adjacent bowel (1, not distinguished; 2, partly distinguished; 3, clearly distinguished), artifact (0, absent; 1, mild; 2, severe), image quality (1, poor; 2, fair; 3, good), were compared before and after the use of enteral contrast media. Changes in MRI impression after the use of enteral contrast media were also evaluated. Two radiologists reached a consensus after reviewing the images. Statistical significance was determined by Wilcoxon's signed ranked test. RESULTS: For distinguishing lesions, SE T1WI and FLASH 2D with enteral contrast media were significantly superior to SE T1WI without enteral contrast media (p<0.05). With regard to image quality, FLASH 2D and HASTE, both with enteral contrast media, were significantly superior to SE T1WI and TSE T2WI, respectively, both without enteral contrast media (p<0.05). Artefacts were more frequently found after the application of enteral contrast media in conventional sequences but were not present in breathhold sequences. In two patients, MRI impression changed after the appilication of enteral contrast media. CONCLUSION: In a limited number of cases, enteral contrast media improved lesion detection, image quality and diagnostic accuracy when breathhold fast MR imaging was applied.
Artifacts ; Berlin ; Colon, Sigmoid ; Consensus ; Contrast Media* ; Female ; Gadolinium DTPA ; Humans ; Magnetic Resonance Imaging ; Ovary ; Uterus

PURPOSE: This study was aimed to compare the radiopacity of four kinds of currently available resin based implant cements using digital radiography. MATERIALS AND METHODS: Four resin-based implant cements ((Estemp Implant(TM) (Spident, Incheon, Korea), Premier(R) Implant (Premier, Pennsylvania, USA), Cem-Implant(TM) (B.J.M lab, Or-yehuda, Israel), InterCem(TM) (SCI-PHARM, California, USA)) and control group (Elite Cement 100(TM) (GC, Tokyo, Japan)) were mixed and cured according to the manufacturer's instructions on the custom made split-type metal mold. A total of 150 specimens of each cement were prepared and each specimen (purity over 99%) was placed side-by-side with an aluminum step wedge for image taking with Intraoral X-ray unit (Esx, Vatech, Korea) and digital X-ray sensor (EzSensor, Vatech, Korea). For the evaluation of aluminum wedge equivalent thickness (mm Al), Image J 1.47 m (Wayne Rasband, National Institutes of Health, USA) and Color inspector 3D ver 2.0 (Interaktive Visualisierung von Farbraumen, Berlin, Germany) programs were used. RESULT: Among the 5 cements, Elite cement 100(TM) (control group) showed the highest radio-opacity in all thickness. In the experimental group, InterCem(TM) had the highest radio-opacity followed by Premier(R) Implant Cement(TM), Cem-Implant(TM) and Estemp Implant(TM). In addition, InterCem(TM) showed radio-opacity that met the ISO No. 4049 standard in all the tested specimen thickness. Cem-Implant on 0.5 mm thickness showed radiopacity that met the ISO No. 4049 standard. CONCLUSION: Among the implant resin-based cements tested in the study, Premier(R) Implant Cement and Estemp Implant(TM) did not show appropriate radio-opacity. Only InterCem(TM) and Cem-Implant(TM) 0.5 mm specimen had the proper radiopacity and met the experiment standard.
Aluminum ; Berlin ; California ; Fungi ; Incheon ; National Institutes of Health (U.S.) ; Pennsylvania ; Peri-Implantitis ; Radiographic Image Enhancement

Ehlers-Danlos syndrome (EDS) is a group of related conditions that commonly share the decrease of the tensile strength and integrity of the skin, joints and other tissues. We report three cases of EDS. All patients were male, and their presenting symptoms and signs included hyperelasticity and fragility of skin and hypermobility of joints. All cases belonged to type II and classical type. Earlier classification of EDS included up to 11 disorders. Recently, however, a simple classification has been proposed in an attempt to eliminate the confusion associated with the former classification. Till now, 30 cases of EDS have been reported in Korea. The review of the Korean cases revealed that, according to Villefranch classification and Berlin classification, the most common type was type II and classical type, respectively.
Berlin ; Classification ; Ehlers-Danlos Syndrome* ; Humans ; Joints ; Korea ; Male ; Skin ; Tensile Strength

PURPOSE: To compare the clinical outcomes between refractive-type multifocal intraocular lenses (IOL) (Lentis Mplus(R) LS 313, Oculentis GmbH., Berlin, Germany) and diffractive-type multifocal IOL (Acrysof Restor(R); SN6AD1, Alcon Lab., Fort Worth, TX, USA) with same near added. METHODS: We evaluated 30 eyes implanted with Lentis Mplus(R) IOL and 33 eyes implanted with Acrysof Restor(R) IOL after phacoemulsification. The distant, intermediate, and near uncorrected visual acuities of the 2 groups were evaluated at 2 weeks and 1, 3, and 6 months postoperatively. Optical quality obtained using the Optical Quality Analysis System II (OQAS II(R), Visiometrics, Castelldefels, Barcelona, Spain), higher-order aberrations (HOAs), and patient satisfaction questionnaire of the 2 groups were evaluated at 3 months postoperatively. RESULTS: The visual acuity of intermediate 100 cm was statistically better in the Lentis Mplus(R) group (p < 0.05). There were no significant differences between the 2 groups with distant, intermediate 63 cm, and near vision. At the 3-month postoperative follow-up, objective scatter index, modulation transfer function (MTF) cutoff value, and pseudo-accommodation range measured by OQAS II(R) showed no differences between the 2 groups, but Strhel ratio was higher in the Acrysof Restor(R) group. HOAs of 5 mm and 6 mm increased significantly in the Lentis Mplus(R) group. No significant differences were found in the patient satisfaction questionnaire. CONCLUSIONS: Both refractive and diffractive-type multifocal IOL implantation in patients with cataracts and presbyopia offered good and comparable visual acuity at distance and near. However, the Lentis Mplus(R) IOL provided better intermediate vision than the Acrysof Restor(R) IOL.
Berlin ; Cataract ; Follow-Up Studies ; Humans ; Lenses, Intraocular* ; Patient Satisfaction ; Phacoemulsification ; Presbyopia ; Surveys and Questionnaires ; Visual Acuity

Acute respiratory distress syndrome (ARDS) is a common disorder associated with significant mortality and morbidity. The American-European Consensus Conference (AECC) definition of ARDS, established in 1994, has advanced the knowledge of ARDS by allowing the acquisition of clinical and epidemiological data, which in turn have led to improvements in care for patients with ARDS. However, after 18 years of applied research, a number of issues regarding various criteria of AECC definition have emerged. For these reason, and because all disease definitions should be reviewed periodically, the European Society of Intensive Care Medicine convened an international expert panel to revise the ARDS definition from September 30 to October 2, 2011, Berlin, Germany, with endorsement from American Thoracic Society and the Society of Critical Care Medicine. This consensus discussion, following empirical evaluation and consensus revision, addressed some of the limitations of the AECC definition by incorporating current data, physiologic concepts, and clinical trials to develop a new definition of ARDS (Berlin definition). The Berlin definition should facilitate case recognition and better match treatment options to severity in both the research trials and clinical practice.
Acute Lung Injury ; Berlin ; Consensus ; Critical Care ; Germany ; Humans ; Critical Care ; Respiratory Distress Syndrome, Adult

BACKGROUND AND PURPOSE: The literature indicates that obstructive sleep apnea (OSA) increases the risk of ischemic stroke. However, the causal relationship between OSA and ischemic stroke is not well established. This study examined whether preexisting OSA symptoms affect the onset of acute ischemic stroke. METHODS: We investigated consecutive patients who were admitted with acute ischemic stroke, using a standardized protocol including the Berlin Questionnaire on symptoms of OSA prior to stroke. The collected stroke data included the time of the stroke onset, risk factors, and etiologic subtypes. The association between preceding OSA symptoms and wake-up stroke (WUS) was assessed using multivariate logistic regression analysis. RESULTS: We identified 260 subjects with acute ischemic strokes with a definite onset time, of which 25.8% were WUS. The presence of preexisting witnessed or self-recognized sleep apnea was the only risk factor for WUS (adjusted odds ratio=2.055, 95% confidence interval=1.035–4.083, p=0.040). CONCLUSIONS: Preexisting symptoms suggestive of OSA were associated with the occurrence of WUS. This suggests that OSA contributes to ischemic stroke not only as a predisposing risk factor but also as a triggering factor. Treating OSA might therefore be beneficial in preventing stroke, particularly that occurring during sleep.
Berlin ; Humans ; Logistic Models ; Risk Factors ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Stroke*

PURPOSE: This study was conducted to identify the factors associated with obstructive sleep apnea (OSA) risk in patients with metabolic syndrome (MS). METHODS: Patients with MS between 30 and 74 years of age were recruited in an outpatient clinic of a cardiovascular center in Seoul, South Korea. MS and the risk of OSA were evaluated by Berlin questionnaire survey, the medical records of the participants were reviewed and a comprehensive lifestyle survey was performed. SPSS WIN 21.0 was used for statistical analysis. RESULTS: BMI (OR: 1.31, CI: 1.14-1.51, p<.001) and lifestyle score (OR: 0.96, CI: 0.93-0.99, p=.028) were associated with the risk of OSA. Physical activity, weight control and diet were specifically associated with the risk of OSA after controlling for age, gender and BMI. CONCLUSION: This study demonstrated that lifestyle was an important factor associated with OSA risk in patients with MS.
Ambulatory Care Facilities ; Berlin ; Diet ; Humans ; Korea ; Life Style ; Medical Records ; Motor Activity ; Seoul ; Sleep Apnea, Obstructive*

PURPOSE: To compare the usefulness of contrast-enhanced voiding ultrasonography(US) with that of radiographic voiding cystourethrography(VCUG) for the diagnosis of vesicoureteral reflux(VUR) in children. MATERIALS AND METHODS: Ninety-five kidney-ureter units of 47 patients referred for investigation of VUR underwent contrast-enhanced voiding US followed by radiographic VCUG. After baseline US examination of the urinary tract, residual urine in the bladder was drained through an inserted Foley catheter and the bladder was gravity filled at a height of 1 m with normal saline. A galactose-based, microbubble-containing echo-enhancing agent (Levovist; Schering, Berlin, Germany) was then administered. The amount of this was approximately 10% of bladder capacity, and VUR was diagnosed when microbubbles appeared in the ureter or pelvo-calyceal system. Using radiographic VCUG as a reference point, the accuracy with which contrast-enhanced voiding US detected VUR was calculated. RESULTS: In 87 of 95 kidney-ureter units (91.6%), the two methods showed similar results regarding the diagnosis or exclusion of VUR, which was detected by both in 12 units, but by neither in 75. VUR was shown to occur in a total of 20 units, but in eight of these by one method only. In two units, VUR detected by contrast-enhanced voiding US was not demonstrated by radiographic VCUG; in six units, the reverse was true. In the detection of VUR, contrast-enhanced voiding US showed a sensitivity of 66.7%, a specificity of 97.4%, a positive predictive value of 85.7%, and a negative predictive value of 92.6%. CONCLUSION: Contrast-enhanced voiding US is highly specific and has high positive and negative predictive values; its sensitivity, however, is not sufficiently high. The modality appears to be a useful diagnostic tool for the detection of VUR without exposure to ionizing radiation, though to be certain of its value, more experience of its use is first required.
Berlin ; Catheters ; Child* ; Diagnosis ; Gravitation ; Humans ; Microbubbles ; Radiation, Ionizing ; Sensitivity and Specificity ; Ultrasonography* ; Ureter ; Urinary Bladder ; Urinary Tract ; Vesico-Ureteral Reflux*