BACKGROUND: Although a magnetic resonance imaging (MRI) is highly sensitive for changes associated with ischemic stroke, the detection of an acute ischemic lesion is usually impossible within 6 hours of the stroke onset on a conventional MRI. The perfusion MRI is a new imaging technique for diagnosing acute ischemic stroke. We evaluate the clinical usefulness of the perfusion MRI in predicting the final infarct extent in 18 patients with acute middle cerebral artery (MCA) territory ischemic stroke. METHOD: The perfusion MRI was performed within 6 hours after the stroke onset in all patients with a single-section dynamic contrast-enhanced T2*-weighted imaging in conjunction with a conventional routine MRI and MR angiography. Time-concentration curves and cerebral blood volume (CBV) maps were calculated from the dynamic MR imaging data by using numerical integration techniques. We compared findings of CBV maps with infarction on a follow-up CT or MRI. RESULTS: In 14 of 18 patients, the CBV in the occluded MCA territory were decreased. In the remaining 4 patients with a reversible ischemic neurologic deficit (RIND) or transient ischemic attack (TIA), the CBV were increased in 3 and normal in 1. Out of 14 patients with a decreased CBV, two had focal regions of increased CBV within the affected territory, indicating reperfusion hyperemia. The regions of increased or decreased CBV were eventually converted to infarction on follow-up images in all 14 patients. Out of 4 patients with RIND or TIA, one showed focal infarction in centrum semiovale on a follow-up image. CONCLUSIONS: The perfusion MRI was useful for the assessment of hemodynamic change about cerebral perfusion and may predict the extent of final infarction in acute MCA territory ischemic stroke. These results suggest that the perfusion MRI may play an important role in the diagnosis and management of acute ischemic stroke.
Angiography ; Blood Volume ; Diagnosis ; Follow-Up Studies ; Hemodynamics ; Humans ; Hyperemia ; Infarction ; Ischemic Attack, Transient ; Magnetic Resonance Imaging* ; Middle Cerebral Artery* ; Neurologic Manifestations ; Perfusion* ; Reperfusion ; Stroke*

No abstract available.
Female ; Fertilization* ; Humans ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Pregnancy, Twin*

Metabolomics has been used as a powerful tool for the analysis and quality assessment of the natural product (NP)-derived medicines. It is increasingly being used in the quality control and standardization of NP-derived medicines because they are composed of hundreds of natural compounds. The most common techniques that are used in metabolomics consist of NMR, GC-MS, and LC-MS in combination with multivariate statistical analyses including principal components analysis (PCA) and partial least squares-discriminant analysis (PLS-DA). Currently, the quality control of the NP-derived medicines is usually conducted using HPLC and is specified by one or two indicators. To create a superior quality control framework and avoid adulterated drugs, it is necessary to be able to determine and establish standards based on multiple ingredients using metabolic profiling and fingerprinting. Therefore, the application of various analytical tools in the quality control of NP-derived medicines forms the major part of this review. Veregen® (Medigene AG, Planegg/Martinsried, Germany), which is the first botanical prescription drug approved by US Food and Drug Administration, is reviewed as an example that will hopefully provide future directions and perspectives on metabolomics technologies available for the quality control of NP-derived medicines.
Chromatography, High Pressure Liquid ; Dermatoglyphics ; Metabolomics* ; Prescriptions ; Quality Control* ; United States Food and Drug Administration

PURPOSE: We compared neovascularity with needle biopsies and definitive prostatectomy specimens to examine whether the measurement of microvessel density(MVD) has an ability to predict extracapsular extension with limited tissue sample. MATERIALS AND METHODS: We evaluated total 11 pathologically proven stage T3 lesions. The paraffin embedded tissues from needle biopsies and definitive prostatectomy specimens were sectioned serially. Of the serial sections obtained from prostatectomy specimens 2 showing a relatively uniform histology grade; one identical grade with biopsy sample, another the worst grade within the tumor or different grade from biopsy, and 2 from specific sites of the tumor; center and periphery, selected for examination. MVD determinations were performed immunohistochemically using monoclonal antibodies directed at the CD34 antigens. RESULTS: MVD of total 11 needle biopsies with grade 2-5 (score 4-8) ranged from 73.7 to 170.8 (median 106.7 +/- 10.6). The grade (score 5-9) distributions of prostatectomy specimens were different from those of needle biopsies and the MVD obtained from definitive prostatectomy specimens exhibited a heterogeneity within the individual tumor. The variation in densities between different grade group proved statistically different (p< 0.01, paired t-test). Also, the MVD count in the center of the tumor was higher than that in the periphery of the tumor and the difference between two group of the specific sites was statistically significant (p = 0.015, paired t-test). Finally, although MVD of biopsy sample did not correlated exclusively to that of definitive prostatectomy specimen, there would be a significant correlation of MVD between two groups if their distribution of histological grade were identical (p< 0.01, r2 = 0.889). CONCLUSIONS: Prior to surgical extirpation in the patients of clinically localized prostatic carcinomas, MVD determination of needle biopsies of the prostate would not correlate with that of definitive prostatectomy specimen. Given the limited tissue sampling from a biopsy, understanding of the site specificity of vasculature and analyzing the relationship of angiogenesis and other biologic factors of which histologic grade seems to be involved most importantly, are critical to developing a consistent and effective methodology of microvessel quantification.
Antibodies, Monoclonal ; Antigens, CD34 ; Biological Factors ; Biopsy ; Biopsy, Needle* ; Humans ; Microvessels* ; Needles* ; Paraffin ; Population Characteristics ; Prostate* ; Prostatectomy* ; Sensitivity and Specificity

Pigmented villonodular synovitis (PVNS) is a rare, benign, soft tissue neoplasm affecting the synovium of joints, classified as localized and diffused type. Localized type is more common, arising from synovium of joints, bursae, and tendon sheaths. Diffused type is relatively rare, frequently arising from an extra-articular lesion, and sometimes from an intramuscular or subcutaneous lesion. Although the cause of occurrence is not yet clear, recently it has been known as a benign neoplasm rather than an inflammatory or reactive process. We performed a total excision of the PVNS in a pretibial lesion and achieved a good result. We report on the case with a review of the literature.
Giant Cell Tumors* ; Giant Cells* ; Joints ; Soft Tissue Neoplasms ; Synovial Membrane ; Synovitis, Pigmented Villonodular ; Tendons ; Tenosynovitis* ; Tibia

Heterotopic pancreas is a tissue histologically similar to normal pancreatic tissue found in a location other than the usual place, and having no anatomic or vascular connection with the pancreas itself. Heterotopic pancreas is usually asymptomatic and found incidentally. However, it can cause problems such as abdominal pain, melena, anemia, and severe bleeding. We report a case of a 29-year-old woman with obscure gastrointestinal bleeding caused by heterotopic pancreas located in Meckel's diverticulum. Gastroduodenoscopy and colonoscopy showed no bleeding focus. By capsule endoscopy and double balloon enteroscopy, a bleeding focus was suspected in the ileum. The patient received a laparoscopic resection of the Meckel's diverticulum. Pathologic examination revealed heterotopic pancreatic tissue within the muscular layer of the diverticulum. The patient recovered well without further bleeding.
Abdominal Pain ; Adult ; Anemia ; Capsule Endoscopy ; Colonoscopy ; Diverticulum ; Double-Balloon Enteroscopy ; Female ; Hemorrhage ; Humans ; Hypogonadism ; Ileum ; Meckel Diverticulum ; Melena ; Mitochondrial Diseases ; Ophthalmoplegia ; Pancreas

Nephrotic syndrome causes a hypercoagulable state, leading to both venous and arterial thrombosis. Thromboembolic events occur frequently in patients with nephrotic syndrome. However, central venous thrombosis occurs less frequently as a complication of minimal change nephrotic syndrome. The pathogenic mechanisms are not yet unclear, but various alterations in coagulant and anti-coagulant factors may be responsible. We report a case of cerebral venous thrombosis associated with minimal change nephrotic syndrome. A 27-year-old man was admitted due to sudden, severe headache with nausea and vomiting. He complained of a continuous throbbing-type headache in bifrontal area. One month prior to the symptoms, he was diagnosed as having nephrotic syndrome based on clinical manifestations and biopsy findings. The routine laboratory findings showed that he had hyperlipidemia, hypoalbuminemia and proteinuria. In clotting factor analysis, fibrinogen, factor VII, VIII and von Willebrand factor were increased and factor XII, antithrombin III and protein S were decreased. The unenhanced brain CT scan showed a triangle-shape high density in a superior sagittal sinus and gadolinium enhanced brain MRI showed unenhanced blood clot in a superior sagittal sinus. Initial brain MR venography showed a lack of filling of a superior sagittal sinus and poor visualization of cortical veins.
Adult ; Antithrombin III ; Biopsy ; Brain ; Factor VII ; Factor XII ; Fibrinogen ; Gadolinium ; Headache ; Humans ; Hyperlipidemias ; Hypoalbuminemia ; Magnetic Resonance Imaging ; Nausea ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Phlebography ; Protein S ; Proteinuria ; Superior Sagittal Sinus ; Thrombosis ; Tomography, X-Ray Computed ; Veins ; Venous Thrombosis* ; Vomiting ; von Willebrand Factor

Pulmonary artery pseudoaneurysm (PAP) is a rare complication of septic pneumonia. It is potentially fatal because of the risk of massive hemoptysis. Treatment of PAP involving massive hemoptysis is by embolization or surgery. However, the progression of PAP after embolization has not been reported. A 59-year-old male who was recovering from septic pneumonia experienced massive hemoptysis. Computed tomography (CT) revealed PAP of the right pulmonary artery with surrounding consolidation, suggesting active hemorrhage. The patient was successfully treated with embolization of the right pulmonary artery. During outpatient follow-up, the amount of radiopaque embolized material gradually decreased on chest radiography. At 14 months after embolization, both the PAP and embolized material had disappeared on chest CT.
Aneurysm, False ; Follow-Up Studies ; Hemoptysis ; Hemorrhage ; Humans ; Male ; Middle Aged ; Outpatients ; Pneumonia ; Pulmonary Artery ; Thorax

Choroid plexus cysts (CPCs) are the most commom neuroepithelial cysts, occuring in more than 50% of some autopsy series. They are typically small and asymptomatic and are discovered incidentally in older patients, usually in the trigone of the lateral ventricle. Symptomatic CPCs (usually exceptionally large, 2-8 cm) are rare. The authors report a case of large symptomatic choroid plexus cyst, located in the trigone of the right lateral ventricle in a 26-yr-old man who presented with headache and vomiting. The patient underwent endoscopic removal through a burr hole placed 3 cm from the midline and just behind the hair line. The histological examination of the cyst wall was consistent with choroid epithelium. Despite of postoperative intraventricular hemorrhage and catheter infection, he discharged home without neurologic deficits. The endoscopic fenestration rather than excision should be considered as the first surgical procedure because the goal of treatment is shrinkage of the cyst until normal cerebrospinal fluid flow is restored.
Adult ; Brain Diseases/diagnosis/pathology/*surgery ; *Choroid Plexus ; Cysts/diagnosis/pathology/*surgery ; Endoscopy ; Humans ; Male