PURPOSE: There have been some efforts to diagnose intracranial aneurysm through a non-invasive method using MRA, although the process may be difficult when the lesion is less than 3mm. The present study prospectively compare the results of high resolution, fast speed slice interpolation MRA and DSA therapy examing the potentiality of primary non-invasive screening test. MATERIALS AND METHODS: A total of 26 cerebral aneurysm lesions from 14 patients with subarachnoid hemorrhage from ruptured aneurysm (RA) and 5 patients with unruptured aneurysm(UA). In all subjects, MRA was taken to confirm the vessel of origin, definition of aneurysm neck and the relationship of the aneurysm to nearby small vessels, and the results were compared with the results of DSA. The images were obtained with 1.5T superconductive machine(Vision, Siemens, Erlangen, Germany) on 4 slabs of MRA using slice interpolation. the settings include TR/TE/FA=30/6.4/25, matrix 160x512, FOV 150x200, 7minutes 42seconds of scan time, effective thickness of 0.7mm and an entire thickness of 102.2mm. The images included structures from foramen magnum to A3 portion of anterior cerebral artery. MIP was used for the image analysis, and multiplanar reconstruction(MPR) technique was used in cases of intracranial aneurysm. RESULTS: A total of 26 intracranial aneurysm lesions from 19 patients with 2 patients having 3 lesion, 3 patients having 2 lesions and the rest of 14 patients having 1 lesion each were examined. Among those, 14 were RA and 12 were UA. Eight lesions were less than 2mm in size, 9 lesions were 3-5mm, 7 were 6-9mm and 2 were larger than 10mm. On initial exams, 25 out of 26 aneurysm lesions were detected in either MRA or DSA showing 96% sensitively. Specificity cannot be estimated since there was no true negative of false positive findings. When MRA and MPR were used concurrently for the confirmation of size and shape, the results were equivalent to those of DSA, while in the confirmation of aneurysm neck and parent vessels, the concurrent use of MRA and MPR was far superior to the sole use of either MRA or DSA. CONCLUSION: High resolution MRA using slice interpolation technique showed equal results as those of DSA for the detection of intracranial aneurysm, and may be used as a primary nin-invasive screening test in the future.
Aneurysm ; Aneurysm, Ruptured ; Angiography* ; Angiography, Digital Subtraction* ; Anterior Cerebral Artery ; Foramen Magnum ; Humans ; Intracranial Aneurysm* ; Mass Screening ; Neck ; Parents ; Prospective Studies ; Sensitivity and Specificity ; Subarachnoid Hemorrhage

Necrotizing fasciitis is an uncommon severe infection involving the subcutaneous soft tissue, particularly the superficial and often deep fascia. It is usually associated with systemic toxicity, rapid progression and a mortality rate which varies between 20 and 60%. It can affect any part of the body but is most common on the extremities, especially the leg. Predisposing factors include diabetes mellitus, alcoholism, intravenous drug abusers, abdominal surgery, perineal infection. The prognosis for necrotizing fasciitis depends so heavily on early recognition and determination of the extent of necrosis. Whilist there are reports of acute renal failure occuring in the presence of necrotizing fasciitis, descriptions of the condition in patients with chronic renal failure are rare in the literature. Hence we report a case of necrotizing fasciitis, diagnosed by MRI(Magnetic Resonance Imaging) in chronic renal failure patient.
Acute Kidney Injury ; Alcoholism ; Causality ; Diabetes Mellitus ; Drug Users ; Extremities ; Fascia ; Fasciitis, Necrotizing ; Humans ; Kidney Failure, Chronic* ; Leg ; Magnetic Resonance Imaging ; Mortality ; Necrosis ; Prognosis

PURPOSE: Evaluation of sexual function is an important step for animal studies about sexual function. Male rats could display penile erection in the presence of an inaccessible estrous female. We examined the usefulness of observing non-contact erection (NCE) for the evaluation of sexual function in male rats. MATERIALS AND METHODS: Forty five Long-Evans male rats (8 weeks old) were used in this study. Tests for NCE were conducted in a glass chamber divided in half by 2 wire-mesh screens that prevented direct contact, but the rats freely passed other forms of stimulation. If at least 1 NCE could be observed during 45 minutes, we considered this as a positive response. In case of two or three positive responses in three NCE tests, that was considered as NCE (+). After NCE, copulation observations were noted to evaluate sexual function. If at least two ejaculations could be observed during 45 minutes, we considered that a positive response. In case of two or three positive responses in three copulation observations, that was considered as normal sexual function. RESULTS: Twenty one of 45 male rats (47%) were NCE (+) and 34 of 45 male rats (76%) had normal sexual function. In 21 NCE (+) rats, 20 rats had normal sexual function: only one was impotent. The positive predictive value of the NCE observation for the evaluation of sexual function was 95%. In 11 impotent rats, 10 rats were NCE (-). The specificity of the NCE observation was 91%. CONCLUSIONS: These results indicated that NCE observation could be a useful method for evaluating the sexual function of male rat.
Animals ; Copulation ; Ejaculation ; Female ; Glass ; Humans ; Male* ; Penile Erection ; Rats* ; Sensitivity and Specificity

PURPOSE: Cytogenetic studies molecular genetic studies, including loss of heterozygosity (LOH) studies, have shown that deletions on the short arm of chromosome 17 (17p) distal to TP53 locus are the most common genetic events in medulloblastoma, and that these occur in 30 to 50% of medulloblastomas. We examined the occurrences and frequencies of allelic deletions on chromosome 17p13.1-13.3 by LOH analysis to investigate the possible involvement of 17p13.1-13.3 in medulloblastoma development. We also performed survival analysis to determine whether LOH analysis of 17p13.1-13.3 can be used to predict prognosis in medulloblastoma. METHOD: LOH was analyzed by polymerase chain reaction (PCR) on chromosome 17p13.1-13.3 using 3 microsatellite markers, TP53 on 17p13.1, D17S796 on 17p13.1-13.2 and D17S1574 on 17p13.3, in 17 medulloblastoma DNAs extracted from archival tissue specimens (cases 1~15) or fresh frozen tissue specimens (cases 16 and 17). RESULTS: Allelic deletions were detected in 5 of 17 informative cases (29%) on TP53, 8 of 17 informative cases (47%) on D17S796, and 4 of 17 informative cases (24%) on D17S1574. Overall, 9 of 17 cases (53%) showed LOH on chromosome 17p13.1-13.3. The 5-year progression free survival (PFS) and 5-year overall survival (OS) rates were identical (59%). The 5-year PFS for 9 medulloblastoma patients with LOH on 17p13.1-13.3 was 56%, and the 5-year PFS for 8 medulloblastoma patients without LOH on 17p13.1-13.3 was 63%. In our survival analysis, we did not find a significant association between survival and LOH on 17p13.1-13.3. CONCLUSION: Our results support the notion that deletions of chromosome 17p13.1-13.3 may be involved in the pathogenesis of medulloblastoma. From survival analysis, we conclude that LOH on chromosome 17p13.1-13.3 may not be a significant predictor of prognosis in medulloblastoma.
Arm ; Chromosomes, Human, Pair 17 ; Cytogenetics ; Disease-Free Survival ; DNA ; Humans ; Loss of Heterozygosity* ; Medulloblastoma* ; Microsatellite Repeats ; Molecular Biology ; Polymerase Chain Reaction ; Prognosis

PURPOSE: Anti-D immunoglobulin has recently emerged as a theraputic option for the treatment of patients with idiopathic thrombocytopenic purpura (ITP). There is no report about anti-D treatment in our country. In this report, the efficacy and adverse reactions of anti-D immunoglobulin in children with ITP were evaluated. METHPDS: From August, 1997 to September, 1998, 7 courses of anti-D treatment were applied in 4 children who had persisting thrombocytopenia and frequent bleeding episodes despite use of intravenous immunoglobulin and corticosteroid. They were Rh-positive and non-splenectomized patients. They received 43~60 mug/kg/dose of anti-D (WinRho ) twice with 7 days interval at out patient department. To evaluate the efficacy and adverse reactions of anti-D, platelet, reticulocyte, hemoglobin, bilirubin and haptoglobin counts were observed weekly. RESULTS: Median age and pretreatment duration after diagnosis were 22 months (15~77 months) and 7 months (2~46 months), respectively. Bleeding decreased significantly after anti-D treatment. Platelet count increased median 4.11 folds (1.85~13.67 folds) and response was maximal at day 7. Duration of platelet increase more than 2 folds was 5 weeks (0~10 weeks). No significant adverse reactions other than mild hemolytic anemia was present. Hemoglobin decreased to minimal 88% (79.5~95.9%) of pretreatment value. Duration of hemoglobin lower than 90% of pretreatment value was 1 week (0~4 weeks). After 10 weeks, platelet and hemoglobin returned to pretreatment value. CONCLUSION: Although anti-D is not a curative treatment for ITP, it is safe and repeated infusions of anti-D can be used to maintain the platelet count at a level of sufficient to provide adequate hemostasis and may enable children to postpone or even avoid splenectomy.
Anemia, Hemolytic ; Bilirubin ; Blood Platelets ; Child ; Diagnosis ; Haptoglobins ; Hemorrhage ; Hemostasis ; Humans ; Immunoglobulins ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic* ; Reticulocytes ; Splenectomy ; Thrombocytopenia

PURPOSE: To analyze the enhancement patterns of adenomyosis and evaluate the usefulness of dynamic MR imaging in detecting adenomyosis. MATERIALS AND METHODS: Dynamic MR imaging finding in 46 women with adenomyosis were analyzed retrospectively. Dynamic MR imaging was obtained in each patient. Fifteen consecutive FLASH images were obtained before, immediately after and 15, 30, 45, 90 second and 5 minute after bolus injection of Gd-DOTA. Signal intensities of adenomyosis and outer myometrium and standard deviations of image noise were measured using an electronic cursor. Contrast-to-noise ratio (C/N) of the lesion to outer myometrium were calculated as follows ; (signal intensity of outer myometrium-signal intensity of adenomyosis)/(standard deviation) of noise signal intensity. RESULTS: The mean signal intensity of adenomyosis was higher than surrounding outer myometrium before and immediately after contrast injection. On 15, 30, 45, 90 second, and 5 minute after injection the signal intensity of adenomyosis was lower than that of surrounding outer myometrium (p < 0.05). The mean C/N values between adenomyosis and surrounding myometrium on precontrast scan, immediate postcontrast, and 15, 30, 45, 90 second and 5 minute delayed images were 3.20, 5.03, 6.14, 6.87, 7.13, 7.78, 38.59, respectively. On T2-weighted images, the mean C/N value between adenomyosis and surrounding myometrium was 16.7. Mean C/N value between adenomyosis and surrounding myometrium on delayed images was significantly higher than those of other dynamic & T2-weighted images(p<0.05). CONCLUSION: Dynamic MR imaging is very useful in the evaluation of the enhancement pattern and especially in detection of adenomyosis because the mean C/N value between adenomyosis and surrounding myometrium on delayed images are higher than that of T2-weighted images.
Adenomyosis* ; Animals ; Female ; Humans ; Magnetic Resonance Imaging* ; Mice ; Myometrium ; Noise ; Retrospective Studies ; Uterus*

BACKGROUND: It has been demonstrated that within 2 weeks following acute myocardial infarction (AMI), exercise-induced ST-segment depression (STD) indicates subendocardial ischemia in the viable myocardium within infarcted or remote area from the infarction. Exercise-induced ST-segment elevation (STE) in leads with abnormal Q wave is associated with left ventricular dysfunction or aneurysm rather than transmural ischemia. We studied whether each pattern of ST-segment shift on exercise ECG during recovery phase following AMI is correlated with the perfusion status of infarcted myocardium evaluated by myocardial contrast echocardiog-raphy (MCE), regardless of findings of coronary angiography (CAG). METHOD: Study population was consisted of 25 patients with AMI (anteior wall: 11 patients, inferior wall: 14 patients, mean age=57.3+/-8.9years). Patients underwent exercise ECG and coronary angiography at 10 days post-AMI. After CAG, sonicated Hexabrix was injected into both coronory arteries alternatively and 2-D echocardiography was taken in parasternal short axis, apical 4, and 2 chamber views. To analyze the echocardiographic image semiquantitively, left ventricle was divided into 20 segments and perfusion status was graded as good, partial, and no opacification. RESULT: All patients with exercise-induced STE (n=8) in Q-leads had patent infarcted-related artery and poor collaterals on CAG, which was associated with poor or no opacification of infarcted myocardium on MCE. Patients with exercise-induced STD (n=9) frequently had closed infarct-related artery (67%), but good opacification of infarcted myocardium was shown by retrograde perfusion via collaterals, which was commonly seen in patients with multivessel disease. CONCLUSION: In early recovery phase of acute myocardial infarction, exercise-induced ST elevation in Q leads was associated with poor perfusional status in infarcted myocardium, even with patent infarct-related artery on CAG, while exercise-induced ST depression was frequently seen in the good perfusional status despite of closed infarted-related artery, which was commonly observed in patients with multivessel disease.
Aneurysm ; Arteries ; Axis, Cervical Vertebra ; Coronary Angiography ; Depression ; Echocardiography ; Electrocardiography ; Heart Ventricles ; Humans ; Infarction ; Ioxaglic Acid ; Ischemia ; Myocardial Infarction* ; Myocardium* ; Perfusion* ; Ventricular Dysfunction, Left

BACKGROUND: It has been demonstrated that within 2 weeks following acute myocardial infarction (AMI), exercise-induced ST-segment depression (STD) indicates subendocardial ischemia in the viable myocardium within infarcted or remote area from the infarction. Exercise-induced ST-segment elevation (STE) in leads with abnormal Q wave is associated with left ventricular dysfunction or aneurysm rather than transmural ischemia. We studied whether each pattern of ST-segment shift on exercise ECG during recovery phase following AMI is correlated with the perfusion status of infarcted myocardium evaluated by myocardial contrast echocardiog-raphy (MCE), regardless of findings of coronary angiography (CAG). METHOD: Study population was consisted of 25 patients with AMI (anteior wall: 11 patients, inferior wall: 14 patients, mean age=57.3+/-8.9years). Patients underwent exercise ECG and coronary angiography at 10 days post-AMI. After CAG, sonicated Hexabrix was injected into both coronory arteries alternatively and 2-D echocardiography was taken in parasternal short axis, apical 4, and 2 chamber views. To analyze the echocardiographic image semiquantitively, left ventricle was divided into 20 segments and perfusion status was graded as good, partial, and no opacification. RESULT: All patients with exercise-induced STE (n=8) in Q-leads had patent infarcted-related artery and poor collaterals on CAG, which was associated with poor or no opacification of infarcted myocardium on MCE. Patients with exercise-induced STD (n=9) frequently had closed infarct-related artery (67%), but good opacification of infarcted myocardium was shown by retrograde perfusion via collaterals, which was commonly seen in patients with multivessel disease. CONCLUSION: In early recovery phase of acute myocardial infarction, exercise-induced ST elevation in Q leads was associated with poor perfusional status in infarcted myocardium, even with patent infarct-related artery on CAG, while exercise-induced ST depression was frequently seen in the good perfusional status despite of closed infarted-related artery, which was commonly observed in patients with multivessel disease.
Aneurysm ; Arteries ; Axis, Cervical Vertebra ; Coronary Angiography ; Depression ; Echocardiography ; Electrocardiography ; Heart Ventricles ; Humans ; Infarction ; Ioxaglic Acid ; Ischemia ; Myocardial Infarction* ; Myocardium* ; Perfusion* ; Ventricular Dysfunction, Left

BACKGROUND: Brief episodic ischemias prior to subsequent prolonged ischemia limit infarct size and attenuate the reperfusion arrythmia. But the effect of ischemic preconditioning on post-ischemic myocardial dysfunction, coronary flow and nitric oxide (NO) remains unclear. METHODS: To investigate the effect of ischemic preconditioning on myocardial function and coronary flow during reperfusion after 15 minutes of global myocardial ischemia, 30 isolated hearts of Sprague-Dowley rats were perfused under constant pressure. Two episodes of three minutes global ischemia followed by 12 minutes of reflow were employed to precondition the hearts. The hearts were randomized to one of three groups : group I had no preconditioning, group II had preconditioning, group III had preconditioning as well as L-arginine pretreatment. Left ventricular developed pressure (LVDP), LV dp/dt, perfused coronary flow, concentration of NO and heart rate were continuously measured. RESULTS: In preconditioning groups (Group II, Group III), LVDP decreased during reflow and was lower than that of the control group. LV dp/dt decreased after reflow and gradually recovered with time but recovered was less in preconditioning groups. Coronary flow increased in the first few minutes after reflow in all groups, but decreased gradually. The decrease of coronary flow was greater in preconditioning groups. NO increased during the first 10 minutes after reflow and then decreased. In preconditioning groups, NO tends to be lower than that in the non-preconditioning group. CONCLUSION: Ischemic preconditioning was not beneficial to post-ischemic myocardial dysfunction, coronary flow and NO concentration in the flow. Cummulative effect of stunning due to repetitive ischemia for preconditioning may be an explanation for worse post-ischemic myocardial dysfunction and coronary flow in preconditioning groups.
Animals ; Arginine ; Arrhythmias, Cardiac ; Heart Rate ; Heart* ; Ischemia ; Ischemic Preconditioning* ; Myocardial Ischemia ; Myocardial Stunning ; Nitric Oxide ; Rats* ; Reperfusion

BACKGROUND: Brief episodic ischemias prior to subsequent prolonged ischemia limit infarct size and attenuate the reperfusion arrythmia. But the effect of ischemic preconditioning on post-ischemic myocardial dysfunction, coronary flow and nitric oxide (NO) remains unclear. METHODS: To investigate the effect of ischemic preconditioning on myocardial function and coronary flow during reperfusion after 15 minutes of global myocardial ischemia, 30 isolated hearts of Sprague-Dowley rats were perfused under constant pressure. Two episodes of three minutes global ischemia followed by 12 minutes of reflow were employed to precondition the hearts. The hearts were randomized to one of three groups : group I had no preconditioning, group II had preconditioning, group III had preconditioning as well as L-arginine pretreatment. Left ventricular developed pressure (LVDP), LV dp/dt, perfused coronary flow, concentration of NO and heart rate were continuously measured. RESULTS: In preconditioning groups (Group II, Group III), LVDP decreased during reflow and was lower than that of the control group. LV dp/dt decreased after reflow and gradually recovered with time but recovered was less in preconditioning groups. Coronary flow increased in the first few minutes after reflow in all groups, but decreased gradually. The decrease of coronary flow was greater in preconditioning groups. NO increased during the first 10 minutes after reflow and then decreased. In preconditioning groups, NO tends to be lower than that in the non-preconditioning group. CONCLUSION: Ischemic preconditioning was not beneficial to post-ischemic myocardial dysfunction, coronary flow and NO concentration in the flow. Cummulative effect of stunning due to repetitive ischemia for preconditioning may be an explanation for worse post-ischemic myocardial dysfunction and coronary flow in preconditioning groups.
Animals ; Arginine ; Arrhythmias, Cardiac ; Heart Rate ; Heart* ; Ischemia ; Ischemic Preconditioning* ; Myocardial Ischemia ; Myocardial Stunning ; Nitric Oxide ; Rats* ; Reperfusion