Authors presented the serial changes of brain MRI findings in two cases of cryptococcal meningitis. The MRI findings of the first patient (53-year-old female) consisted of dilated Virchow-Robin spaces, leptomeningeal enhancement, cryptococcomas and hydrocephalus. Dilated Virchow-Robin spaces were noted on the first MR obtained 33 days after symptom onset. The size and number of dilated Virchow-Robin space gradually decreased since 119 days after symptom onset (62 days after treatment). Faint leptomeningeal enhancement was found at cerebellar region on the first MRI, which became more distinct and intense on the day 119, probably due to improper treatment. The leptomeningeal enhancement decreased on the day 156. Mild hydrocephalus was noted on MRI obtained 70 days after symptom onset, which markedly aggravated on the day 119. It decreased after steroid therapy alone. Enhancing crytococcomas of variable size were noted at the right temporal lobe and cerebellum on MRI of the day 119, which decreased in size and number on the day 156. On the day 295 MRI showed nearly disppearance of the dilated Virchow-Robin space, but faint leptomeningeal enhancement, cerebellar crytococcomas and hydrocephalus still remained. The MRI findings of the second patient (36-year-old female) showed the findings similar to those of the first patient. Initial MRI obtained 18 days after symptom onset showed no abnormal findings. Dilated Virchow-robin spaces were noted on the day 36 (13 days after treatment onset), which nearly disappeared on the day 109. Enhancing cryptococcomas in both basal ganglia and cerebral cortex and leptomeningeal enhancement were noted on MRI of the day 136. Both cryptococcomas and leptomeningeal enhancement decreased in size and enhancing degree on the day 157. Hydrocephalus was noted on the day 109.
Basal Ganglia ; Brain ; Cerebellum ; Cerebral Cortex ; Follow-Up Studies* ; Humans ; Hydrocephalus ; Magnetic Resonance Imaging* ; Meningitis, Cryptococcal ; Temporal Lobe

Authors presented the serial changes of brain MRI findings in two cases of cryptococcal meningitis. The MRI findings of the first patient (53-year-old female) consisted of dilated Virchow-Robin spaces, leptomeningeal enhancement, cryptococcomas and hydrocephalus. Dilated Virchow-Robin spaces were noted on the first MR obtained 33 days after symptom onset. The size and number of dilated Virchow-Robin space gradually decreased since 119 days after symptom onset (62 days after treatment). Faint leptomeningeal enhancement was found at cerebellar region on the first MRI, which became more distinct and intense on the day 119, probably due to improper treatment. The leptomeningeal enhancement decreased on the day 156. Mild hydrocephalus was noted on MRI obtained 70 days after symptom onset, which markedly aggravated on the day 119. It decreased after steroid therapy alone. Enhancing crytococcomas of variable size were noted at the right temporal lobe and cerebellum on MRI of the day 119, which decreased in size and number on the day 156. On the day 295 MRI showed nearly disppearance of the dilated Virchow-Robin space, but faint leptomeningeal enhancement, cerebellar crytococcomas and hydrocephalus still remained. The MRI findings of the second patient (36-year-old female) showed the findings similar to those of the first patient. Initial MRI obtained 18 days after symptom onset showed no abnormal findings. Dilated Virchow-robin spaces were noted on the day 36 (13 days after treatment onset), which nearly disappeared on the day 109. Enhancing cryptococcomas in both basal ganglia and cerebral cortex and leptomeningeal enhancement were noted on MRI of the day 136. Both cryptococcomas and leptomeningeal enhancement decreased in size and enhancing degree on the day 157. Hydrocephalus was noted on the day 109.
Basal Ganglia ; Brain ; Cerebellum ; Cerebral Cortex ; Follow-Up Studies* ; Humans ; Hydrocephalus ; Magnetic Resonance Imaging* ; Meningitis, Cryptococcal ; Temporal Lobe

In 10 cases with intracranial arterivenous malformation (AVMs) diagnosed by MR spin echo images, MR angiography was evaluated and compared with conventional angiography in regard to depiction of nidus, arterial feeders, and draining veins. Spin echo images demonstrated the nidus of the AVM in all cases, but displayed the feeding vassels inadequately. These vessels were directly visualized with 3 dimensional STAGE(small tip angle gradient echo) MR angiography using rephasing/dephasing pulse sequences. In 5 cases MR angiography and conventional angiography showed the same results. However, in the others, MR angiography showed lower resolution than conventional angiography. MR angiography is useful in preangiographic evaluation of intracranial AVM but improvement in image resolution, which is dependent on MR hard ware and pulse sequence, is still to be desired.
Angiography* ; Intracranial Arteriovenous Malformations* ; Veins

No abstract available.
Coronary Aneurysm* ; Mucocutaneous Lymph Node Syndrome*

PURPOSE: Complete resection of the tumor nodule(mural nodule or solid portion of the tumor) is the essential goal of surgical treatment for heman-gioblastoma. The purpose of this study was to classify the morphologic types of intracranial hemangioblastoma on MRI and to compare the location and contour of tumor nodule on MRI with those on angiography. MATERIALS AND METHODS: The MRI findings of 34 lesions(38 lesions if 4 spinal cord lesions were included) in 26 patients(17 males and 9 females, range of age, 18-67 years, mean, 39 years) with surgically and histopathologically proved intracranial hemangioblastomas were reviewed. Seventeen patients underwent CT scanning in a short interval. Contrast-enahnced T1 -weighted imaging pa- tterns of hemangioblastoma were classified according to Ho's morphologic types. The location and contour of tumor nodule were compared between MRI and angiography in 15 patients(24 lesions). RESULTS: By location, cerebellar hemisphere was predominated(55%), followed by cerebellar vermis(26%), supratentorial region(5%), and medulla oblongata (3%). Spinal cord lesions(11%) were seen in 3 patients of 5 von HippeI-Lindau diseases. The frequency of morphologic types was as follows; Type 1 (purely cystic), 3%, Type 2(mural nodule), 50%, Type 3(cyst with wall enhancement), 3%, Type 4 (cystic nodule), 15%, Type 5(solid with internal cyst), 9%, and Type 6(solid), 20%. All tumor nodules(33 lesions) enhanced intensely with intravenous contrast material on MRI, of which 24 lesions(in 15 patients) revealed hypervascular masses fed by pial arteries on angiography. They were superficial and abutted pia mater partially or in large portion on both MR I and angiography. CONCLUSION: Over 70% of intracranial hemangioblastomas had a surrounding cyst, and superficial, pial-based location and number of the tumor nodules on MRI was correlated well with those on angiography. MRI is the examination of choice for preoperative evaluation of intracranial hemangioblastoma.
Angiography ; Arteries ; Female ; Hemangioblastoma* ; Humans ; Magnetic Resonance Imaging* ; Male ; Medulla Oblongata ; Pia Mater ; Spinal Cord ; Tomography, X-Ray Computed

The kidney and balances of fluid and volume are the basic components of bloocl pressure control, and the kidney is the primary site that initiates the hypertensive process and is affected by hypertensive vascular disease. In the kidney, the dopamine is a potent natriuretic and vasodilating agent, participat- ing in renal sodium excretion and maintenance of cardiovascular homeostasis. And the dopamine receptors in central nervous system and peripheral organs were identified by physiological, biochernical and radioligand binding techniques. Rut previous morphological and biochemical studies have been unable to characterize or determine the tissue distribution of the dopamine receptor subtypes because no selective ligands are available yet. Furthermore, the cellular distribution of the dopamine receptor subtypes in the rat kidney is not demonstrated well. In the SHR, the ability of exogenous and endogenous renal dopamine to engender a natriuresis is impaired. Since renal dopamine levels in genetic models of hypertension are not lower than their normotensive controls, the impaired intrarenal paracrine effect of dopamine in these animal models of hypertension appears to be receptor or postreceptor mediated. And renal dopamine derives mainly from renal tubular dopamine production and to a lesser extent from dopaminergic nerves. The present study utilizes imrnunohistochemistry with specific antibodies to characterize the renal distribution of dopamine receptor subtypes and recognize the role of dopamine receptor defect in the pathogenesis of hypertension in 14-week-old WKY (mean HP 108+/-5mmHg) and SHR (mean RP 174+/-7 mmHg) kidneys. Also it utilizes antibody of tyrosine hyclroxylase (TH) to recognize the site of the dopamine production mediated by TH using light microscopic immunohistochemistry. In the immunohistochemistry of the WKY kidney, dopamine D1 receptor protein is localized to glomerulus, proximal tubule, distal tubule, renal vessels, cortical and medullary collecting duct. And in the SHR kidney, dopamine D1 receptor protein is localized to glomerulus, distal tubule, renal vessels, cortical and medullary collecting duct, and juxtaglomerular apparatus (JGA). But there is no demonstrable positive reaction in the proximal tubule and weakly positive reactions in the renal arterioles of SHR compared with WKY kidney. In the immunohisto-chemistry of the WKY kidney, dopamine D1 receptor protein is localized to glomerulus, proxirnal tubule, distal tubule, renal vessels, cortical and rnedullary collecting duct. And in the SHR kidney, dopamine D2 receptor protein is localized to glomerulus, distal tubule, renal vessels, cortical and medullary collecting duct, and JGA. So, there is no demonstrable positive reaction in the proximal tubule of SHR compared with WKY. In the glomerulus of the WKY and SHR kidneys, both dopamine D1 and D2 receptors are localized. In the in situ hybridization of the WKY and SHR kidneys, dopamine D and D receptors are only demonstrated at the renal vessels. The positive reaction to TH immunohistochemistry of the WKY and SHR kidneys is only observed in the renal medulla compared with negative reaction on the renal cortex. Considering the excretion of sodium up to 65-70% with volume expansion may be mediated by dopamine D1-like receptors in the proximal tubule, our immunohistochemistry findings for the dopamine receptors may support the failure of natriuretic response in the SHR due to an abnormal dopamine receptor. Also our results rnay mean that the glornerular filtration rate is mediated by both dopamine D1 and Dz receptors comparing with the previous studies that the glomerular filtration rate was mediated by dopamine D2 receptor. I'here are some differences in the receptors expressing sites on the previous radioligand binding and pharmacologic studies, but our results suggest that at least some of the renal dopamine DA and DAz receptors correspond structurally to the central dopamine D1 and D2 receptors. Finally the result of TH immunohisto-chemistry suggests that the production of dopamine in the proximal tubule is not mediated by TH.
Animals ; Antibodies ; Arterioles ; Central Nervous System ; Dopamine* ; Filtration ; Glomerular Filtration Rate ; Homeostasis ; Hypertension ; Immunohistochemistry* ; In Situ Hybridization ; Juxtaglomerular Apparatus ; Kidney* ; Ligands ; Models, Animal ; Models, Genetic ; Natriuresis ; Rats* ; Rats, Inbred SHR* ; Receptors, Dopamine ; Receptors, Dopamine D1 ; Receptors, Dopamine D2 ; Sodium ; Tissue Distribution ; Tyrosine ; Vascular Diseases

To evaluate of the relationship between basal ganglia lesion and portal-systemic encephalopathy, eleven patients who had clinically proved liver cirrhosis with superior mesenteric vein larger than 10mm in diameter on ultrasonogram underwent brain MR imaging. No evidence of clinical or neuropsychiatric disturbance was observed in any patient at the time of the MR examination. Brain MR imaging revealed basal ganglia lesion characterized by bilateral, symmetric, high signal intensity without edema or mass effect on spin echo T1-weighted images in nine patients which included three patients with the past history of portal-systemic encephalopathy. It was concluded that excepted in the circumstances of other causes of the high signal intensity in basal ganglia on T1-weighted images such as fat, methemoglobin, melanin, neurofibromatosis, dense calcification, and parenteral nutrition, bilateral and symmetric high signal intensity lesion, in basal ganglia would be a useful MR finding of subclinical portal-systemic encephalopathy in liver cirrhosis patients with no clinical or neuropsychiatric symptoms and larger than 10mm diameter of superior mesenteric vein in ultrasonography.
Basal Ganglia* ; Brain ; Edema ; Hepatic Encephalopathy* ; Humans ; Liver Cirrhosis* ; Liver* ; Magnetic Resonance Imaging* ; Melanins ; Mesenteric Veins ; Methemoglobin ; Neurofibromatoses ; Parenteral Nutrition ; Ultrasonography

BACKGROUND/AIMS: Sleep duration affects health in various ways. The objective of this study was to investigate the associations of sleep duration with chronic kidney disease (CKD) in a Korean adult population. METHODS: This cross-sectional analysis was conducted for total of 1,360 participants who completed baseline health examinations for the Korean Genome and Epidemiology Study-Kangwha study in 2010 to 2011. Sleep habits were measured by an interviewer-assisted questionnaire. Sleep duration was calculated based on the number of hours per day participants had slept over the past 1 year. CKD was defined as either proteinuria or estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m². Multiple logistic regression models were applied to examine associations between sleep duration and CKD. RESULTS: Women with very long sleep duration (≥ 9 hours/day) were at significantly increased odds for having high serum creatinine (odds ratio [OR], 2.936; 95% confidence interval [CI], 1.176 to 7.326), low eGFR (OR, 3.320; 95% CI, 1.372 to 8.034), and CKD (OR, 3.112; 95% CI, 1.315 to 7.363), compared those with a typical sleep duration (7 to < 8 hours/day), after adjusting for sociodemographic status, socioeconomic status, health behaviors, comorbidities, and sleep quality. Among women, for every 1 hour increase in sleep duration per day, there was a 24.6% increase in the presence of CKD (OR, 1.246; 95% CI, 1.019 to 1.523). However, among men, sleep duration was not significantly associated with CKD. CONCLUSIONS: Very long sleep duration was independently associated with a higher prevalence of CKD among Korean women. Gender may influence this association.
Adult ; Comorbidity ; Creatinine ; Cross-Sectional Studies ; Epidemiology* ; Female ; Genome* ; Glomerular Filtration Rate ; Health Behavior ; Humans ; Logistic Models ; Male ; Prevalence ; Proteinuria ; Renal Insufficiency, Chronic* ; Social Class

BACKGROUND AND OBJECTIVES: Low-density lipoprotein cholesterol (LDL-C), an established cardiovascular risk factor, can be generally determined by calculation from total cholesterol, high-density lipoprotein cholesterol, and triglyceride concentrations. The aim of this study was to compare LDL-C estimations using various formulas with directly measured LDL-C in a community-based group and hospital-based group among the Korean population. SUBJECTS AND METHODS: A total of 1498 participants were classified into four groups according to triglyceride concentrations as follows: <100, 100–199, 200–299, and ≥300 mg/dL. LDL-C was calculated using the Friedewald, Chen, Vujovic, Hattori, de Cordova, and Anandaraja formulas and directly measured using a homogenous enzymatic method. Pearson's correlation coefficients, intraclass correlation coefficients (ICC), Passing & Bablok regression, and Bland-Altman plots were used to evaluate the performance of six formulas. RESULTS: The Friedewald formula had the highest accuracy (ICC=0.977; 95% confidence interval 0.974-0.979) of all the triglyceride ranges, while the Vujovic formula had the highest accuracy (ICC=0.876; 98.75% confidence interval 0.668–0.951) in people with triglycerides ≥300 mg/dL. The mean difference was the lowest for the Friedewald formula (0.5 mg/dL) and the percentage error was the lowest for the Vujovic formula (30.2%). However, underestimation of the LDL-C formulas increased with triglyceride concentrations. CONCLUSION: The accuracy of the LDL-C formulas varied considerably with differences in triglyceride concentrations. The Friedewald formula outperformed other formulas for estimating LDL-C against a direct measurement and the Vujovic formula was suitable for hypertriglyceridemic samples; it could be used as an alternative cost-effective tool to measure LDL-C when the direct measurement cannot be afforded.
Cardiovascular Diseases* ; Cholesterol* ; Humans ; Lipoproteins* ; Methods ; Risk Factors ; Triglycerides

BACKGROUND AND OBJECTIVES: We investigated the inter-arm difference in blood pressure of the general Korean population to identify associated factors. SUBJECTS AND METHODS: A total of 806 participants aged 30 to 64 years without history of major cardiovascular disease were analyzed in this cross-sectional study. They participated in the Cardiovascular and Metabolic Disease Etiology Research Center cohort study that began in 2013. Brachial blood pressure was measured simultaneously for both arms using an automated oscillometric device equipped with two cuffs in seated position. After five minutes of rest, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured three times. The average of the three measurements was used for analysis. Multivariate logistic regression models were used to identify factors associated with inter-arm differences in blood pressure. RESULTS: The mean inter-arm difference was 3.3 mmHg for SBP and 2.0 mmHg for DBP. Large inter-arm differences (≥10 mmHg) in SBP and in DBP were found in 3.7% and 0.9% of subjects, respectively. A large inter-arm difference in SBP was associated with mean SBP (p=0.002) and C-reactive protein (p=0.014) while a large inter-arm different in DBP was only associated with body mass index (p=0.015). Sex, age, and anti-hypertensive medication use were not associated with differences in inter-arm blood pressure. CONCLUSION: Large inter-arm difference in blood pressure is only present in a small portion of healthy Korean adults. Our findings suggest that high SBP, chronic inflammation, and obesity may be associated with larger difference in inter-arm blood pressure.
Adult ; Arm ; Blood Pressure* ; Body Mass Index ; C-Reactive Protein ; Cardiovascular Diseases ; Cohort Studies ; Cross-Sectional Studies ; Humans ; Inflammation ; Logistic Models ; Metabolic Diseases ; Obesity ; Posture