No abstract available.
Gynecology* ; Laparoscopy*

PURPOSE: To investigate the various ictal perfusion patterns and find the relationships between clinical factors and different perfusion patterns. MATERIALS AND METHODS: lnterictal and ictal SPECT and SPECT subtraction were performed in 61 patients with partial epilepsy. Bath positive images showing ictal hypoperfusion and negative images revealing ictal hypoperfusion were obtained by SPECT subtraction. The ictal perfusion patterns of subtracted SPECT were classified into focal hypoperfusion, hypoperfusion-plus, combined hypoperfusion-hypoperfusion, and focal hypoperfusion only. RESULTS: The concordance rates with epileptic focus were 91.8% in combined analysis of ictal hypoperfusion and hypoperfusion images of subtracted SPECT, 85.2% in hypoperfusion images only of subtracted SPECT, and 68.9% in conventional ictal SPECT analysis. Ictal hypoperfusion occurred less frequently in temporal lobe epilepsy (TLE) than extratemporal lobe epilepsy. Mesial temporal hypoperfusion alone was seen only in mesial TLE while lateral temporal hypoperfusion alone was observed only in neocortical TLE. Hippocampal sclerosis had much lower incidence of ictal hypoperfusion than any other pathology. Some patients showed ictal hypoperfusion at epileptic focus with ictal hypoperfusion in the neighboring brain regions where ictal discharges propagated. CONCLUSION: Hypoperfusion as well as hypoperfusion in ictal SPECT should be considered for localizing epileptic focus. Although the mechanisrn of ictal hypopertusion could be an intra-ictal early exhaustion of seizure focus or a steal phenomenon by the propagation of ictal discharges to adjacent brain areas, further study is needed to elucidate it.
Baths ; Brain ; Epilepsies, Partial* ; Epilepsy ; Epilepsy, Temporal Lobe ; Humans ; Incidence ; Pathology ; Perfusion* ; Sclerosis ; Seizures ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: The detection of epileptogenic lesion plays an important role in the management of patients with partial epilepsy. Although the development of MRI improved the examination of cerebral hemispheres greatly, many patients with neocortical temporal lobe epilepsy (TLE) or extratemporal lobe epilepsy (extra-TLE) still show no lesion in conventional two-dimensional (2D) images. To increase the yield of MRI in those patients, we performed three-dimensional (3D) surface-projection rendering (SPR) of the cerebral hemispheres. METHODS: Conventional 2D MRI (T1, T2, FLAIR, thin slice SPGR) and 3D SPR were performed in 24 patients with neocortical TLE and extra-TLE, and 20 normal subjects. Sulcogyral patterns were evaluated blindly to clinical information. The locations of the epileptogenic zone, ictal onset zone (IOZ) and irritative zone (IRZ) were determined by intracranial EEG monitoring and epilepsy surgery. RESULTS: The 2D MRI identified epileptogenic lesions in five of the 10 neocortical TLE (50%) and five of the 14 extra-TLE (35.7%). 3D SPR revealed abnormal sulcogyral patterns in 9 of the 10 neocortical TLE (90%) and 9 of the 14 extra-TLE (64.3%). Cortical deformation zones with sulcogyral anomalies included the whole area of IOZ in 10 (55.5%) and IRZ in 6 (33.3%), overlapped with IOZ in 7 (38.9%) and IRZ in 11 (61.1%), were connected to IOZ in 1 (5.6%) and IRZ in 1 (5.6%). CONCLUSION: 3D SPR of volumetric MRI data can detect epileptogenic structural lesions of neocortical epilepsy that are not visible in the conventional 2D images.
Brain* ; Cerebrum ; Electroencephalography ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Temporal Lobe ; Humans ; Magnetic Resonance Imaging*

OBJECTIVES: This study was performed to provide fundamental data to judge whether or not cerebro and cardiovascular diseases are work-related, by comparing the characteristics between approved and non-approved cases among the worker's compensation claims. METHODS: We collected 12,309 cerebro and cardiovascular disease claims based on the worker's compensation records of the Labor Welfare Corporation from 2000 to 2004. The approved and non-approved cases were analyzed according to factors such as the calendar year, industry, company size, occupation, gender, age group, classification of cerebro and cardiovascular diseases, fatality and underlying diseases. We used x2-test and multivariate logistic regression for the analysis. RESULTS: According to multivariate logistic regression, electricity gas and water supply (OR=4.18, 95% CI=1.43~12.17), construction (OR=2.39, 95% CI=1.22~4.69) and manufacturing (OR=2.10, 95% CI=1.08~4.07) industries had a higher approval rate than mining and quarrying industries. Service workers and sales & marketing department workers (OR=1.90, 95% CI=1.47~2.47), professionals (OR=1.83, 95% CI=1.50~2.23), technicians and associate professionals (OR=1.63, 95% CI=1.35~1.97) and legislators and senior officials and managers (OR=1.62, 95% CI=1.24~2.12) had a higher approval rate than plant and machine operators and assemblers. Female workers had a higher approval rate (OR=1.31, 95% CI=1.13~1.53) than male workers. Cerebrovascular diseases had a higher approval rate (OR=2.75, 95% CI=2.42~3.13) than cardiovascular diseases. Fatal cases had a higher approval rate (OR=6.01, 95% CI=4.89~7.38) than surviving cases. CONCLUSION: For cerebro and cardiovascular diseases, workers' compensation claims are increasing, approval rates are relatively high and factors such as industry, company size, occupation, gender and fatality are related. A remarkable difference in the approval rate was found according to industry and occupation, suggesting the need for further study to identify which factors influence the approval rate. The approval rate for intracerebral hemorrhage arising in the course of employment (COE) was significantly higher than that arising out of employment (AOE), suggesting the need to correct the approval criteria.
Cardiovascular Diseases* ; Cerebral Hemorrhage ; Classification ; Commerce ; Electricity ; Employment ; Female ; Humans ; Logistic Models ; Male ; Marketing ; Mining ; Occupations ; Plants ; Water Supply ; Workers' Compensation*

OBJECTIVE: The informed consent, in literal sense, is a medicolegal process that requires full explanation and clear disclosure about the illness, and thorough comprehension and autonomous consent to the respective medical services of the competent recipient. The authors review the theoretical background of the informed consent and investigate pertinent problems encountered in medical practice. METHODS: We gathered 153 consecutive cases of written form of the informed consent regarding diagnosis and treatment from Mar 2001 to Jun 2002. The authors evaluate the completeness of the process by looking into the possible omitted components in whole cases and degree of recall for the explained risk by telephone questionnaire in 128 available cases. RESULTS: In a total 153 cohort, 21 emergency operation cases invariably showed structural deficiencies of free-ended discussion due to short of time. Thorough past history taking and physical examination was necessary to perform reoperation for the postoperative hematoma in 3 cases and solid intimate relationship was necessary to treat previously disclosed complication in 7 cases of invasive diagnostic and minimum operative procedures, respectively. Among the available 128 patients, only 33(25%) ones could recall the given risks addressed at the consent approximately 6 weeks later. CONCLUSION: The informed consent is a process that dictates the free dialogue between the patient and the physician, not a simple paper expressed in published characters. However, to enhance the effectiveness of the consent process, both free discussion and writing down contents are prerequisite.
Cohort Studies ; Comprehension ; Diagnosis ; Disclosure ; Emergencies ; Hematoma ; Humans ; Informed Consent ; Physical Examination ; Surveys and Questionnaires ; Reoperation ; Surgical Procedures, Operative ; Telephone ; Writing

BACKGROUND: An endothelium derived vasoconstrictor peptide, endothelin, has been shown to be a potent coronary vascular constrictor. In the clinical settings of angina or myocardial ischemia, the endothelial injury of coronary artery can stimulate the endothelin production. In this study, the authors assessed the response to endothelin of the coronary artery in isolated rat heart and compared the relative effects of three vasodilators (nifedipine, adenosine, nitroprusside) on coronary vasospasm which was induced by endothelin. METHODS: The isolated rat heart preparations (Langendorff model) were obtained from fourty male Sprague-Dawley rats (350-400 gm). Preparations were perfusated with Krebs-Hanseleit solution of (mM): NaCl 115, NaHCO3 25, KCl 4.7, CaCl2 2H2O 2.5, MgCl2 6H2O 1.2, KH2PO4 1.2, glucose 10. The perfusate was maintained at 37oC and aerated with carbogen (oxygen 95% and carbon dioxide 5%). The coronary perfusion was maintained at 80 cmH20 pressure and Latex balloon was positioned in left ventricle. After the preparations were stabilized, endothelin (10(-9) M) was added to perfusate for 5 minutes and followed the perfusion without vasodilators (control, n = 10) or with vasodilators (nifedipine, adenosine and nitroprusside 10(-7) M to 10(-6) M, n = 10 each) for 45 minutes. The left ventricular developed pressure (LDP) and heart rate (HR) was recorded and the coronary effluent (VOL) was collected to measure the unit volume and the CPK isoenzyme (CK-MB). Effects of the interventions were assessed using analysis of variance. All values are presented as means +/- SE. RESULTS: VOL, HR and VDP were significantly reduced after infusion of 10(-9) M endothelin in 3 and 5 minutes. VOL was recovered efficiently after infusion of three vasodilators. Adenosine and nitroprusside groups showed superior recovery in the changes of rate pressure product (RPP) than in nifedipine group, which was significant reduced in VDP. CONCLUSIONS: These results suggest that in the situation of endothelin induced severe coronary vasospasm, adenosine and nitroprusside effectively reversed the coronary vasospasm without severe myocardial depression.
Adenosine ; Animals ; Carbon Dioxide ; Coronary Vasospasm* ; Coronary Vessels ; Depression ; Endothelins* ; Endothelium ; Glucose ; Heart Rate ; Heart Ventricles ; Heart* ; Humans ; Latex ; Magnesium Chloride ; Male ; Myocardial Ischemia ; Nifedipine ; Nitroprusside ; Perfusion ; Rats* ; Rats, Sprague-Dawley ; Vasodilator Agents*

Temperature changes during general anesthesia were studied in relation to age, the duration and type of operative procedure(gastrectomy versus tympanoplasty) and the type of anesthetic(halothane versus conflurane) in 41 patients undergoing surgery in our centrally air-conditioned operating room. Body temperatures were recorded every 15 minutes after intubation by measuring the esophageal temperature in adults and the nasopharyngeal temperature in children. A comparison of temperature changes between adults and children showed a significant temperature decreases in adults during general anesthesia(-0.6 degrees C, p<0.001), while the temperatures of children remained stable. Comparisons of gastrectomy versus tympanoplasty groups indicated the operative site had little effect on the patient's body temperature. Patients who underwent a gastrectomy showed an average fall in esophageal temperature of 0.8 degrees C, where as there was an average temperature decline of 0.5 degrees C in tympanoplasty. Body temperature decrease was dependent on the duration of the operative procedure. The longer the procedure, the greater change in temperature. There was no significant difference between the effects of the volatile anesthetic agents on patient's body temperatures.
Adult ; Anesthesia, General* ; Anesthetics ; Body Temperature ; Child ; Gastrectomy ; Humans ; Intubation ; Operating Rooms ; Surgical Procedures, Operative ; Tympanoplasty

PURPOSE: The aim of this study was to determine whether hyperechoic fatty tissue (HFT) at transabdominal and transvaginal ultrasonography in women with acute pelvic pain has a diagnostic role. MATERIALS AND METHODS: We studied 201 women (mean age, 32 years) with acute pelvic and lower abdominal pain; we performed ultrasonography (US) in all them. Of the 201, 94 with gynecological problems were included., They were divided into two groups: with pelvic inflammatory disease (PID; n = 45) and without PID (n = 49). We evaluated the presence and distribution of HFT and its role in differential diagnosis between PID and non-PID groups. RESULTS: We found, using US, HFT in 36/45 (80%) patients with PID by US. Of the 36, single-center HFT was observed in 12/36 (33.3%) patients and multicentric HFT was detected in 24/36 (66.7%). HFT was present adjacent to inflammatory foci, tuboovarian abscesses or inflamed salpinx in 30 women; HFT was present outside the pelvic cavity in 24. Among the latter 24, HFT was present only in the lower abdomen, and not in the pelvic cavity in 6. In the non-PID group, HFT was found in the lower abdomen and pelvic cavity in 7 women. Four of the seven were misdiagnosed with PID. One of seven women with a hemorrhagic corpus luteal cyst rupture with underlying PID and two with ectopic pregnancy with HFT were correctly diagnosed. CONCLUSION: The presence of HFT may be a reliable US finding for the diagnosis of PID. HFT distinguishes PID from other acute gynecological problems.
Abdomen ; Abscess ; Adipose Tissue ; Diagnosis, Differential ; Fallopian Tubes ; Female ; Humans ; Pelvic Inflammatory Disease ; Pelvic Pain ; Pelvis ; Pregnancy ; Pregnancy, Ectopic ; Rupture

Viruses present in the blood or blood products serve important infection source to transfusion patients or users of blood products. Human parvovirus B19 has been recognized as a new viral pathogen in human mainly transmitted via blood. Thus, detection of human parvovirus B19 has become an urgent problem to be solved. This study was intended to develop methods to detect human parvovirus B19 in the blood or blood products by nucleic acid amplification technique (NAT) or polymerase chain reaction (PCR). Five sets of primer DNAs were tested for the detection of human parvovirus B19 by PCR. A primer set amplifying 258 nucleotides corresponding Vp1 gene of human parvovirus B19 was chosen and further studies were done to determine the optimum condition to detect human parvovirus B19 from human blood or blood products. PCR detection of human parvovirus B19 was almost 1,000 times more sensitive than the receptor-mediated hemagglutination assay developed by the Japanese Red Cross Center. Although direct PCR of B19 virus without DNA extraction could detect B19 virus from PBS buffer, attempts to detect the virus from whole blood or plasma failed. PCR after DNA extraction from blood or plasma samples could detect B19 virus as little as 104 PFU/ml. Our results can further be applied for developing routine methods to identify human parvovirus B19 in human blood or commercial blood products.
Asian Continental Ancestry Group ; DNA ; Hemagglutination ; Humans* ; Nucleotides ; Parvovirus B19, Human* ; Plasma ; Polymerase Chain Reaction* ; Red Cross

OBJECTIVE: Cerebral aneurysm (CA) is an important acquired cerebrovascular disease that can cause catastrophic results. MicroRNAs (miRNAs) are small non-coding RNAs, playing essential roles in modulating basic physiologic and pathological processes. Currently, evidences have been established about biologic relationship between miRNAs and abdominal aortic aneurysms. However, biologic roles of miRNAs in CA formation have not been explained yet. We employed microarray analysis to detect and compare miRNA expression profiles in late stage of CA in rat model. METHODS: Twenty-six, 7-week-old male Sprague-Dawley rats underwent a CA induction procedure. The control animals (n=11) were fed a normal diet, and the experimental animals (n=26) were fed a normal diet with 1% normal saline for 3 months. Then, the rats were sacrificed, their cerebral arteries were dissected, and the five regions of aneurysmal dilation on the left posterior communicating artery were cut for miRNA microarrays analysis. Six miRNAs (miRNA-1, miRNA-223, miRNA-24-1-5p, miRNA-551b, miRNA-433, and miRNA-489) were randomly chosen for validation using real-time quantitative PCR. RESULTS: Among a set of differentially expressed miRNAs, 14 miRNAs were over-expressed more than 200% and 6 miRNAs were down-expressed lower than 50% in the CA tissues. CONCLUSION: The results show that miRNAs might take part in CA formation probably by affecting multiple target genes and signaling pathways. Further investigations to identify the exact roles of these miRNAs in CA formation are required.
Aneurysm ; Animals ; Aortic Aneurysm, Abdominal ; Apoptosis ; Arteries ; Cell Proliferation ; Cerebral Arteries ; Diet ; Humans ; Inflammation ; Intracranial Aneurysm ; Male ; Microarray Analysis ; MicroRNAs ; Pathologic Processes ; Rats ; Rats, Sprague-Dawley ; RNA, Small Untranslated