PURPOSE: The study evaluated elastography, a technique that allows differentiation between pathological and normal tissue by determination of tissue hardness. METHODS: From March 2009 to April 2010, 25 consecutive patients with thyroid nodules who were referred for surgical treatment were examined in this prospective study. Thirty nodules in these patients were examined by conventional ultrasound, ultrasound elastography, and fine needle aspiration cytology. Lesions were scored (1~3) according to hardness based on the Ueno classification system. The final diagnosis was based on histopathologic results. RESULTS: Of the 30 thyroid nodules, four were classified as benign and 26 were malignant. Two of the nodules with an elastography score of 1 were benign and 17 nodules whose elastography score was 3 were malignant. Two benign nodules and nine malignant nodules had an elastography score of 2. Applying an elastography score exceeding 2 as a indicator for malignancy determined that the sensitivity and specificity of the ultrasound elastography was 100.0% and 50.0%, respectively, the positive and negativepredictive values were 92.9% and 100.0%, respectively, and the accuracy of the technique was 93.3%. CONCLUSION: Ultrasound elastography may be a useful adjunct to ultrasonography in the identification of indeterminate thyroid nodules for which tissue diagnosis is required.
Biopsy, Fine-Needle ; Classification ; Diagnosis ; Diagnosis, Differential* ; Elasticity Imaging Techniques* ; Hardness ; Humans ; Prospective Studies ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

BACKGROUND: In the western hemisphere, resistance to activated protein C (APCR) is the most common risk factor for venous thromboembolic disease. A one-point mutation in the coagulation factor V that renders it APCR is found in more than 90% of patients with APC-resistant venous thrombosis. In Hispanic and Caucasian patients with arterial ischemic stroke, the prevalence of APC-R is approximately 10%. To determine the prevalence of APC resistance and its causative factor V mutation (Arg 506 Gln) in Koreans, we screened a group of Korean ischemic stroke patients. METHODS: We evaluated 60 Korean patients with arterial ischemic stroke diagnosed by either magnetic resonance neu-roimaging, conventional angiogram, or both, after 2 weeks of symptom onset. The mean age of the subjects was 59.2 years (13-82 years). APC resistance was expressed as a ratio of the activated partial thromboplastin time (aPTT) with and without adding APC to the subject's plasma. The presence of the factor V Leiden (Arg 506 Gln) mutation was determined by a direct polymerase chain reaction-based assay on peripheral blood leukocytes. RESULTS: Only one patient (n=1/60, 1.6%) had APC resistance and none were found to have the factor V Leiden (Arg 506 Gln) mutation. CONCLUSIONS: APCR and the factor V Leiden mutation do not seem to be a significant genetic risk factor for arterial ischemic stroke in Koreans.
Activated Protein C Resistance* ; Factor V* ; Hispanic Americans ; Humans ; Leukocytes ; Partial Thromboplastin Time ; Plasma ; Prevalence ; Protein C ; Risk Factors ; Stroke* ; Venous Thrombosis

OBJECTIVE: To analyze morphologic differences between only spondylolysis group and mild spondylolisthesis one in young-aged persons and to find useful parameters for radiological assessment of mild spondylolisthesis. METHOD: Twenty patients with only lumbar spondylolysis, 18 patients with mild lumbar spondylolisthesis and 19 normal subjects were recruited in this study. Their radiological findings were examined. The films of subjects were evaluated with respect to variables describing wedging of the spondylolytic vertebra, relative thickness and lengths of the transverse processes. The evaluation was made with attention to possible signs which could mean vertebral slipping. The lumbar index reflects the degree of wedge deformity of the spondylolytic vertebra. RESULTS: Lumbar index was significantly lower in spondylolisthesis group than only spondylolysis group. There was no significant difference in relative thickness of L5 transverse process between two groups. The incidence of a midline lumbar or sacral defect in the spondylolisthesis group was higher than other groups. CONCLUSION: Our results support the usefulness of lumbar index as a supplement parameter for radiological assessment of mild spondylolisthesis.
Congenital Abnormalities ; Humans ; Incidence ; Spine ; Spondylolisthesis* ; Spondylolysis

We report the case of a 77-year-old woman who presented with periumbilical pain from perforation of jejunal diverticula. The patient underwent surgery and multiple jejunal diverticula were found distributed from 30 cm to 60 cm distal to the ligament of Treitz. A segment of the jejunum containing all diverticula was resected and end-to-end anastomosis was performed. The postoperative course was uneventful. The patient continued to do well at last follow-up, 26 months after operation. Diverticulum of the jejunum is uncommon and the majority of patients are asymptomatic. Symptoms indicating diverticulum are few and often nonspecific; they may present either as generalized abdominal pain associated with intestinal disturbances or in more serious case, they can lead to complications requiring emergency surgery. In light of these considerations, we thought it useful to report a case of complicated multiple jejunal diverticula and draw attention to its complications that can be a source of gastrointestinal symptoms.
Abdominal Pain ; Aged ; Diverticulum* ; Emergencies ; Female ; Follow-Up Studies ; Humans ; Jejunum ; Ligaments ; Peritonitis*

PURPOSE : To evaluate MR image qualities we developed a new MRI phantom with the fixation structures necessary to position it into coil firmly. MATERIALS AND METHODS : We designed MRI phantom for eight evaluation items such as slice thickness accuracy, high contrast spatial resolution, low contrast object detectability, geometry accuracy, slice position accuracy, image intensity uniformity, percent signal ghosting and signal to noise ratio. For the positioning of phantom at coils, the fixation structures were set up on the surface of phantom. Six different MRI units were used for test the possibility for the clinical application and their image qualities were evaluated. RESULTS : We acquired appropriate MR image qualities enough for the evaluation on all used MR units and confirmed that their evaluations were within reliable values compared to real ones for some items. The positioning of our phantom into head coils with fixation structures worked well for proper imaging. CONCLUSION : We found that our prototype of MRI phantom had the possibility of clinical application for MR image quality assessment.
Head ; Magnetic Resonance Imaging* ; Quality Control ; Signal-To-Noise Ratio

BACKGROUND: Perfusion imaging (PI) of magnetic resonance imaging (MRI) uses the signal loss that occurs during dynamic tracking of the first pass of intravenous paramagnetic contrast agent. Then different hemodynamic measurements can be calculated and displayed as perfusion maps. Diffusion-weighted imaging (DWI) measures diffusional movement of water molecules within the brain and it can identify acute ischemic injury or cytotoxic edema. We evaluated clinical usefulness of PI and DWI in acute ischemic stroke. METHODS: Fifteen patients with clinical diagnosis of acute cerebral infarction were imaged with PI, DWI, and magnetic resonance angiogram (MRA) including FLAIR within 24 hours after onset. Comparisons were made between infarct volumes measured by DWI and PI using the parameters including relative mean transit time (rMTT) map, relative cerebral blood volume (rCBV) map, and relative cerebral blood flow (rCBF) map. RESULTS: Two patterns were found. rMTT map in PI lesion is larger than in the DWI lesion (n=7/15), and rMTT map in PI lesion is the same size or smaller than in DWI lesion (n=8/15). The former pattern was shown in cases with severe stenosis or occlusion of the major cerebral artery (MCA, PCA, or ICA) on MRA. The majority of latter pattern was lacunes (n=6/8). Also, we found presence of infarction cores surrounded by hypoperfused areas in rMTT map in acute largearterial territorial infarction. CONCLUSIONS: Perfusion- and Diffusion- weighted MRIs may be useful in differentiating large-arterial territorial infarction from lacunes.
Blood Volume ; Brain ; Cerebral Arteries ; Cerebral Infarction ; Constriction, Pathologic ; Diagnosis ; Diffusion ; Diffusion Magnetic Resonance Imaging ; Edema ; Hemodynamics ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Passive Cutaneous Anaphylaxis ; Perfusion ; Perfusion Imaging ; Stroke*

A carcinoid tumor of the stomach is a neuroendocrine tumor originating from enterochromaffin cells in the submucosa of the stomach and has no specific clinical symptoms. They are uncommon, accounting for no more than 0.3% of all gastric tumors. However, this frequency has increased markedly due to endoscopic screening. Herein, the case of a 47-year-old man with a polypoid lesion (2 cm diameter) detected on endoscopic examination is reported. It was diagnosed as a carcinoid tumor before an operation. Although the tumor size was slightly larger than 2 cm in diameter, the lesion was treated by wedge resection as there was no lymph node involvement or other distant metastasis. The postoperative has course was uneventful. The patient has continued to do well for over 15 months of follow up.
Carcinoid Tumor* ; Enterochromaffin Cells ; Follow-Up Studies ; Humans ; Lymph Nodes ; Mass Screening ; Middle Aged ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Stomach*

PURPOSE: To evaluate the usefulness of functional MR imaging(fMRI) for language mapping and determination of language lateralization. MATERIALS AND METHODS: Functional maps of the language area were obtained during word generation tasks and decision task in ten volunteers(7 right handed, 3 left-handed). MR examination were performed at 1.5T scanner with EPI BOLD technique. Each task consisted of three resting periods and two activation periods with each period of 30 seconds. Total acquisition time was 162sec. SPM program was used for the postprocessing of images. Statistical comparisons were performed by using t-statistics on a pixel-by-pixel basis after global normalization by ANCOVA. Activation areas were topographically analyzed(p<0.001) and activated pixels in each hemisphere were compared quantitatively by lateralization index. RESULTS: Significant activation signals were demonstrated in 9 of 10 volunteers. Activation signals were found in the premotor and motor cortices, the inferior frontal, inferior parietal, and mid-temporal lobes during stimulation tasks. In the right handed seven volunteers, activation of language areas was lateralized to the left side. Verb generation task produced stronger activation in the language areas and higher value of lateralization index than noun generation task or decision task. CONCLUSION: fMRI could be a useful non-invasive method for language mapping and determination of language dominance.
Brain ; Hand ; Magnetic Resonance Imaging* ; Rabeprazole ; Volunteers

PURPOSE: TATA box mutation/polymorphism in the promoter region of the bilirubin uridinediphosphoglucuronate glucuronosyltransferase 1A1 (UGT-1A1) gene is known to be an etiology of hyperbilirubinemia. This study examined if a TATA box mutation/polymorphism in UGT-1A1 gene promoter could be associated with the development of severe early neonatal jaundice in Korean infants. METHODS: Thirty-nine neonatal jaundice patients and 40 controlled infants were analyzed for UGT-1A1 promoter genotypes by using DNA sequencing. RESULTS: The homozygote for (TA)7TAA mutation was not found in this study. Comparison of the prevalence of UGT-1A1 promoter (TA)7TAA heterozygotes revealed no difference between the group with jaundice and the controlled group (15.4% vs. 10%). The peak bilirubin level was higher and the onset of jaundice was earlier in the jaundice group with (TA)7TAA heterozygote compared to the jaundice group without (TA)7TAA heterozygote (23.2+/-1.0 mg/dL vs. 19.7+/-2.4 mg/dL, P=0.004, 5.0+/-1.5 days vs. 8.3+/-4.1 days, P= 0.057). CONCLUSION: The results of this study showed that TATA box polymorphism in UGT-1A1 gene promoter did not increase the prevalence of severe early neonatal jaundice in Korean infants.
Bilirubin ; Genotype ; Glucuronosyltransferase ; Heterozygote ; Homozygote ; Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Neonatal* ; Infant ; Infant, Newborn ; Jaundice ; Jaundice, Neonatal ; Prevalence ; Promoter Regions, Genetic ; Sequence Analysis, DNA ; TATA Box

BACKGROUND AND OBJECTIVES: Immunoglobulin E (IgE) production in adenoid has been debated and the role of adenoid in development of allergy remains largely unknown. To examine the production of local IgE in adenoid involved with IgE-mediated sensitization, we evaluated IgE production and the expression of the transcription factor B cell leukemia/lymphoma-6 (BCL-6) and B lymphocyte inducer of maturation program 1 (Blimp-1) in adenoids. SUBJECTS AND METHOD: Ten children with allergic rhinitis (AR) and ten children without any history of AR were enrolled. Immunohistochemical studies of adenoid for IgE, BCL-6 and Blimp-1 were performed. RESULTS: IgE was stained mainly in the germinal center and submucosal area and the stainingscores of antibody to IgE did not differ signigicantly between children with AR and control. BCL- 6 was mainly stained in mucosa and germinal center and Blimp-1 in mucosa. The scores of antibody to BCL-6 and Blimp-1 in children with AR and control did not show significant differences. CONCLUSION: We found that allergic rhinitis was not involved in the production of IgE nor the expression of the transcription factor BCL-6 and Blimp-1 in adenoid
Adenoids ; Child ; Germinal Center ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; Lymphocytes ; Mucous Membrane ; Rhinitis ; Rhinitis, Allergic, Perennial ; Transcription Factors