The effect of lumboperitoneal(LP) shunt and the prognostic factors of 40 cases of communicating hydrocephalus confirmed by brain computerized tomography(CT) and/or magnetic resonance imaging(MRI) and radioisotope cisternography(RI) were analyzed. Possible prognostic factors such as disease entity, CT or MRI findings, and the type of radioisotope cisternography were compared to improvement of clinical status after LP shunt. The etiology of communicating hydrocephalus in the analyzed 40 cases included trauma in 13 cases(32.5%), subarachnoid hemorrhage(SAH) in 12 cases(30%), intracerebral hemorrhage(ICH) in 10 cases(25%), and idiopathic in 5 cases(12.5%). An overall clinical improvement after LP shunt was seen in 22 cases(55%). However, in 17 cases of SAH and idiopathic group, improvement after LP shunt was seen in 13 cases(75%), indicating that LP shunt is more effective in SAH/idiopathic group than trauma/ICH group(p<0.05). Many findings of brain CT/MRI such as Evan's index, periventricular low density, 3rd ventricular width, obliteration of cerebral sulci, rounding of frontal horn, and cortical atrophy were analyzed as prognostic factors. Except for the absence of cortical atrophy(p<0.05), none of the factors were related to the patient's outcome. The type of abnormal RI cisternography findings(Typ I, II, III) also did not show any relationship with the effectiveness of LP shunt. These findings suggest that SAH/idiopathic group were more favorable candidates for LP shunt than trauma/ICH group, and that there are no reliable brain CT/MRI findings indicating a good prognosis after LP shunt except for the absence of cortical atrophy. RI cisternography findings are also not a reliable diagnostic tool in evaluating the indication of LP shunt in communicating hydrocephalus.
Animals ; Atrophy ; Brain ; Horns ; Hydrocephalus* ; Magnetic Resonance Imaging ; Prognosis

No abstract available.
Carcinoma, Hepatocellular* ; Survival Rate*

The prognosis of severe head injured patients (Glasgow coma scale 3 to 8) was assessed through clinical prognostic factors in 209 cases, retrospectively. Severe head injured patients were 9.1% of all head trauma and 55% of cases were diffuse brain injury. Mechanism of injury were motorvehicle accident, falls, bicycle, and others. The patients with normal pupillary reaction had a significantly higher percentage of good outcome (77%) than the patient with bilateral 3rd nerve palsy (14.2%)(p<0.0001), 79% of good motor responsive patients had a good outcome compared to none of patients with poor motor response(p<0.0001). The patients with short duration of unawareness(within 30days) significantly higher percentage of good outcome(98%) than the patients with long duration of unawaereness(24%)(p<0.0001). The patients with initial high GCS score(6-8 score) had a significantly higher good outcome(58%) than the patients with low GCS score(3-5 score)(p<0.0001), 87% of pediatric patients had a good outcome compared to 38% of adults(p<0.0001). The diffuse head injured patients without basal cistern compression had a significantly hgher percentage of good outcome(83%) than the patients with basal cistern compression(41%)(p<0.0001), 62% of patients with skull fracture had a good outcome compared to 39% of patients without skull fracture(39%)(p<0.0017). Individual prognostic factors affect to patient's outcome and utilize to be powerful tool for assessing the relative efficacy of alternative treatments as well as patient's prognosis.
Brain Injuries ; Coma ; Craniocerebral Trauma ; Head* ; Humans ; Paralysis ; Prognosis ; Retrospective Studies ; Skull ; Skull Fractures

Obstruction on the urinary tract eventually results in damage to the kidneys and loss of function. The questions that concern the clinician are the degree of nephron loss in that kidney and the potential for recovery following the relief of obstruction. 99mTc DMSA accumulates in tubule cells and has been proposed as a marker of the tubular mass. The authors estimated the renal uptake ratio of 99mTc DMSA for the degree of nephron loss corresponding to duration of hydronephrosis following left ureteral ligation in 5 NewZealand white rabbits and the potential for recovery following percutaneous nephrostomy of hydronephrosis in 24 rabbits. While the renal uptake ratio of 99mTc DMSA of the kidney with unilateral hydronephrosis following ureteral ligation reduced dramatically within 24 hour, that of the opposite healthy kidney increased, and the total renal uptake ratio was same as normal functioning kidneys before ureteral ligation. Upon ureteral release, there was no evidence of definite recovery or impairment in the experimental kidneys for 5 days. The authors conclude that a combination of ureteral release and administration of some drugs such as renal vasodilator or diuretics is an appropriate treatment for the recovery of function in unilateral hydronephrosis.
Diuretics ; Hydronephrosis* ; Kidney ; Ligation ; Nephrons ; Nephrostomy, Percutaneous* ; Rabbits ; Recovery of Function ; Technetium Tc 99m Dimercaptosuccinic Acid* ; Ureter ; Urinary Tract

Evaluations of residual renal function and the therapeutic effectiveness in renal tuberculosis have largely been dependent on intravenous pyelogram or Contrast-CT scan, even though, exact renal function are not evaluated with there methads. 99mTc-DMSA is a radiopharmaceutical that is trapped in the functioning tubular cells of the kidney and therefore, quantitative renal function could be evaluoted by ineasuring the counts of renal radioactivity and concomittant evaluation of renal morphology could be passible with the analog imapes of the radioactivity. The authors retrospectively analyzed 99mTc-DMSA scans of 75 kidndys of 67 patients with confirmed renal tuberculosis. We classified the morphologies of tuberculous kidneys as 6 types. We classified the morphologies of tuberculous kidneys as 6 types such as the type with small cortical defect, with parenchymal ulcerocavernous lesions, ulcerocavernous fistula to pelvis, mass-like defects, contracted kidney with ureter visualization, and the type with nonvisualization of kidney, corresponding to the characters of renal tuberculous pathogenesis with abscess formation, ulcerocavernous fistula, and fibrosis, and correspondings to the renal anatomy with parenchyma, and pelvocalyceal collecting system. Their mean residual renal functions measured with 99mTc-DMSA uptake rates were 19.0%, 18.4%, 7.9%, 12%, 4.1%, 3.4% respectively.
Abscess ; Fibrosis ; Fistula ; Fluspirilene ; Humans ; Kidney ; Pelvis ; Radioactivity ; Retrospective Studies ; Succimer* ; Technetium Tc 99m Dimercaptosuccinic Acid ; Tuberculosis, Renal* ; Ureter

No abstract available.
Technetium Tc 99m Dimercaptosuccinic Acid*

Upper gastrointestinal(UGI) bleeding was critical disease that was commonly found in emergency department and needed more early diagnosis and rapid treatment for decreasing mortality and morbidity. It's causes and frequencies here affected by many factors, but the majorities were caused by peptic ulcers and esophageal-gastric varices. With development of economy and medical services, new drugs and endoscopic interventions, the treatment of patients with UGI bleeding was more improved. So I would like to evaluate the change of causes and frequencies of UGI bleeding and the associated clinical findings. A total of 1,546 patients presented with UGI bleeding in emergency department of Yeungnam university hospital during the five years from Jan. 1991 to Dec. 1995 were clinically reviewed by charts and compared with previous seven years report from Jan. 1984 to Dec. 1990 in the same hospital. The ratio of male to female was 6.1:1 and slightly increased in comparison with previous seven years. The incidences in 6th and 5th decades were highest(54.4%) as like as previous seven years. Age distribution of duodenal ulcer bleeding, Mallory-Weiss tear and acute gastric mucosal lesion were developed in lower decades than the others. The causes of UGI bleeding were caused by esophageal varix(45.4%), peptic ulcer(38.8%), Mallory-Weiss tear(4.3%), gastric cancer(3.8%), others(3.1%), acute gastric mucosal lesion(2.7%), undetermined causes(1.8%) in defending order of frequencies. The proportion of esophageal varices was increased from 36.6% to 45.4%, but that of peptic ulcer was relatively decreased from 47.6% to 38.8%. And the annual distribution of varices was increased, however the annual distribution of peptic ulcers was increased. Although the ranking of annual distribution of gastric ulcers and duodenal ulcers were not changed compared to previous study and the frequency of gastric ulcers was increased since 1992, but additional follow-up was needed. Seasonal variations were found that upper gastrointestinal bleeding was increased in fall and peptic ulcer bleeding was increased significantly in summer and fall, however, varix bleeding was less frequent in summer time as like as previous seven years. Emergency endoscopic examination was performed within 6 hours far 54.5%, 24 hours for 90.8% and this reacts were to be like previous results, 57.5% and 90.7% respectively. Findings of emergency endoscopic examination were active bleeding focus(21.2%), blood clot(7.9%), exposed vessels(13.3%), flat blood spot(6.4%) and lesion without evidence of bleeding(51.3%). Endoscopic findings of active bleeding were easily seton when examination was perfomed within 24 hours. Blood transfusion was performed in 67.3% with average 2.1 units. When the causes of bleeding were due to varix and marginal ulcer, more amounts of blood were transfused than the others. In previous seven years, blood transfusions were performed in 71.2% with average 5 units and more amounts of blood were transfused in gastric cancer and varix bleeding.
Age Distribution ; Blood Transfusion ; Duodenal Ulcer ; Early Diagnosis ; Emergencies ; Emergency Service, Hospital ; Esophageal and Gastric Varices ; Female ; Follow-Up Studies ; Hemorrhage* ; Humans ; Incidence ; Male ; Mallory-Weiss Syndrome ; Mortality ; Peptic Ulcer ; Seasons ; Stomach Neoplasms ; Stomach Ulcer ; Varicose Veins

PURPOSE: The authors investigated the ability of cardiac blood pool clearance rates(CBCR) of 99mTc-DiSiDA in the measure merit of functioning hepatocyte mass. MATERIALS AND METHODS: We measured the volume of Iobectomized liver after completion of postoperative scanning with CBCR of 99rnTc-DISIDA in 5 rabbits who the functional hepatic Iobectomy performed by ligation of hepatic artery, portal vein and biliary tracts. Regarding the measurement of CBCR of 99mTc-DISIDA, we set the time which was decreased to the half of the clearance amount of the cardiac radioactivity by hepatic extraction of 99mTc-DISIDA at the point of 50 sec after the renal peak of the radioactivity to prevent confusing with the blood dilution of the radioactivity, that have called DI-K50. RESULTS: The results were followed that the volumes of the functional hepatic Iobectomy in 5 rabbits were 25%, 25%, 41%, 52%, 75% and the residual functioning hepatocyte masses measured by CBCR of 99rnTc-DISIDA were preserved to 75. 1%, 70. 8%, 63. 0%, 52. 2%, 30. 8% respectively. CONCLUSION: we made decision that CBCR of 99rnTc-DISlDA was useful to evaluate the functioning hepatocyte mass.
Biliary Tract ; Hepatic Artery ; Hepatocytes* ; Ligation ; Liver ; Portal Vein ; Rabbits ; Radioactivity ; Technetium Tc 99m Disofenin*

No abstract available.

PURPOSE: To compare the suppressive effects in hepatocellular carcinoma patients of transhepatic arterial chemoembolization by the infusion of adriamycin-lipiodol emulsion and of this plus 10ml of cisplatin solution. MATERIALS AND METHODS: In a total of 151 cases, the frequency of intrahepatic recurrence was compared with follow-up angiographic findings after the first and second transhepatic arterial chemoembolization with adriamycin-lipiodol emulsion and adriamycin-lipiodol emulsion plus 10ml of cisplatin solution, respectively. RESULTS: Among 46 patients whose first single infusion was after mean 119 days, the recurrence rate was 22% ; for 42 who were given their first multiple infusion after mean 76 days this rate was 5% ; for 35 whose second single infusion was administered after mean 147 days, the rate was 34%, and among 28 whose second multiple infusion was after mean 110 days, the rate was 43%. CONCLUSION: During the first trial of transcatheter arterial chemoembolization with adriamycin-lipiodol plus cisplatin solution, hepatocellular carcinoma recurred much less frequently, but during the second trial with cisplatin, recurrence was not suppresed.
Carcinoma, Hepatocellular* ; Cisplatin* ; Follow-Up Studies ; Humans ; Recurrence*