OBJECTIVE: Unfolding is a rendering method to visualize organs at a glance by virtually incising them. Although conventional methods exploit gray-scale volume datasets such as CT or MR images, we use the Visible Korean Human dataset preserving actual color. This can be helpful for the study of anatomical knowledge. Segmented images of Visible Korean Human dataset store the boundary of organs. Since medical experts manually perform the segmentation from anatomical color images, it is very time-consuming. In general, therefore, some images selectively sampled with interval from entire color images are segmented. When we generate a segment volume dataset with the selected images, final results are deteriorated due to lack of segmentation information for missed images. In this paper, we solve this problem by generating intermediate images without performing a manual segmentation. METHODS: Firstly, after comparing differences of organ's contours in between two consecutive segmented images, we represent the differences as a user-defined value in the intermediate images. This procedure is repeated for all pairs of manually segmented images to reconstruct entire volume data consist of manually segmented images and their intermediate images. In rendering stage, we perform the radial volume ray casting along with the central path of target organ. If a ray reaches to a region having the user-defined values, we advance over the region without compositions to the boundary of that region. Then the color composition is begun by performing backtracking, since the advanced region is regarded to the thickness of it. RESULTS: As a result, we can produce high quality unfolding images for the stomach, colon, bronchus, and artery of the Visible Korea Human dataset. CONCLUSION: Since our approach can be applied to virtual dissection including actual human colors, it is helpful for the endoscopy and anatomy studies.
Arteries ; Bronchi ; Colon ; Endoscopy ; Humans ; Korea ; Stomach

A 31-years-old female presented with left eyelid, canalicular, and conjunctival lacerations after struck by a glass bottle.She had left hypertropia and limitation of depression.Primary repairs of left eyelid, canalicular, and conjunctival laceration were performed that day.After two weeks, the explorative operation was done because of the inability of depression of left eye. We identified the transection of inferior rectus muscle, and repaired it.Three months after second operation, there were 12 prism diopters of left hyper-tropia, 12 prism diopters of left exotropia in the primary position, and 20 prism diopters of left hypertropia in left down gaze.Double Maddox rod testing revealed 6degrees of left incyclotropia, and she presented head tilt to the left. Four months after second operation, 5 mm recession of left superior rectus muscle was done.Postoperatively, she had nearly orthotropia in primary position, but 10 prism diopters in left downgaze.She had only 2 degrees of left incyclotropia, and showed the improvement of ocular torticollis.
Depression ; Exotropia ; Eyelids ; Female ; Glass ; Head ; Humans ; Lacerations ; Ocular Motility Disorders* ; Strabismus

No abstract available.

This report concerns a child who developed left ; Iung collapse during induction of anesthesia for suture ligation of patent ductus arteriosus. Acute massive collapse of a lobe, a whole lung or even both lungs in the space of a few minutes without apparent cause is said to be a rare elinical entity. Clinically this condition is manifested by difficulty in breathing or in inflation of the lung. On auscultation, there may be rhonchi or no sound of any air entry into the lung. If unrelieved, this condition will progress, with hypoxia and cardiac arrest. " We observed that the affected lung expanded during inflation with very high pressure ventilation, and then the collapsed lung was smoothly inflated after suture ligation of patent ductua arteriosus without any specific management. It appears that the development of lung collapse is not through the wrong choice of agents or technics of anesthesia, but from failure to appreciate the hemodynamics of ductus arteriosus or unknown factors. We could not find a definite mechanism of lung collapse, but there are contributing factors including compression of a main brobchus, bronchial secretion, decrease of surfactant and others. The operation was successful and she recovered satisfactorily.
Anesthesia* ; Anoxia ; Auscultation ; Child ; Ductus Arteriosus ; Ductus Arteriosus, Patent ; Heart Arrest ; Hemodynamics ; Humans ; Inflation, Economic ; Ligation ; Lung ; Pulmonary Atelectasis ; Respiration ; Respiratory Sounds ; Sutures ; Ventilation

PURPOSE: Bile acids (especially deoxycholate) was known to be toxic and mutagenic on colon epithelium. They proposed at least four mechanisms for the bile acid toxicity. It is the one of these mechanisms that bile acid inhibits the xenobiotic metabolizing enzyme activity (esp glutathione S-transferase, GST). So we measured the cytosolic GST level of colon carcinoma cell lines after deoxycholate exposure whether or not the deoxycholate lowered the cytosolic GST activity. METHODS: Three colon cancer cell lines (LoVo, SW480, HT29) were used for this study. We calculated the cellular toxicity by MTS method. And cytosolic GST activity was measured according to the method as Habig described. For total GST activity, 2.5 mM 1-chloro-2,4-dinitrobenzene was used for substrate, and measured as absorbance in 340 nm. RESULTS: Basal cytosolic GST level for LoVo, SW480, HT29 cell line was 514.59+/-27.01, 291.63+/-38.44 and 344.58+/-47.92 nmol/min/mg cytosol protein. GST level did not changed significantly after 5 days culture without DCA. But GST level was decreased significantly to 128.63+/-21.35, 134.33+/-41.76 and 163.10+/-22.73 nmol/min/mg cytosol protein each cell line after 5 days deoxycholate exposure (p<0.005). CONCLUSION: Cytosolic GST level was lowered significantly after deoxycholate exposure for 5 days. One of the mechanisms of bile acid toxicity for colon cancer cell is proposed to inhibit cytosolic GST activity.
Bile ; Bile Acids and Salts ; Cell Line* ; Colon* ; Colonic Neoplasms* ; Cytosol* ; Deoxycholic Acid* ; Dinitrochlorobenzene ; Epithelium ; Glutathione Transferase* ; Glutathione* ; HT29 Cells ; Humans

We report three cases of neuroendocrine tumors of the lung characterized by large pleomorphic cell with frequent mitosis, which show neuroendocrine differentiation by both light microscopy or electron microscopy and iminunohistochemistry. These tumors have been categorized as large cell neuroendocrine carcinoma by Travis et al.(1991) in contrast with non-small cell lung cancer with neuroendocrine differentiation. In the latter, neuroendocrine differentiation is not evident by light microscopy and must be demonstrated by imunohistochemstry or by electron microscopy. The prognosis of large cell neuroendocrine carcinoma, together with non-small cell lung cancer with neuroendocrine differentiation, appears to be worse than cancer without neuroendocrine differentiation and intermediate between atypical carcinoid and small cell lung cancer. Larger numbers of patients will be needed to demonstrate significant differences in survival.
Lung Neoplasms

To evaluate the typical appearance and the influence in the image interpretation of the metallic artifact which is known as one of the patient-related field artifacts, we analysed the magnetic resonance (MR) images of 40 patients (the total number of metallic materials were 45) acquired at MR 1.5T unit. All patients were screened for the presence of metal. The metallic implants were surgical wires and clips, orthopedic devices, and the other miscellaneous materials. The artifacts produced by metallic objects can be seen on MRI as the focal loss of signal and/or the local distortion of the image. Regardless of their ferromagnetic properties, metallic implants created regional artifacts in their images. Ferromagnetic materials, such as a lead fragment, showed severe artifacts and nonferromagnetic metals showed mild to moderate artifacts. The conspicuity of artifact was related tot he composition, mass, shape, orientation, and the location of the metallic objects in the body. Under high magnetic field strength, there were no significant differences between the various pulse sequences. Artifacts are particularly prominent on gradient-echo images. Our findings indicate that MR imaging of patients with standard nonferromagnetic metallic materials can be successfully performed and usefully interpretated.
Artifacts* ; Humans ; Magnetic Fields ; Magnetic Resonance Imaging* ; Magnets ; Metals ; Orthopedics

BACKGROUND: Conventional echocardiography provides fundamental information about mitral valve morphology and function but is often subjective and has a relatively low specificity in evaluating valve calcific deposit, which is critical information for the preoperative decision. We hypothesized that mitral valvular calcification could be detected in standard two-dimensional echocardiograms of mitral valve in vivo by evaluating regional gray level(echo amplitude) using computerized image analysis so that we could overcome the subjectivity and low specificity of conventional echocardiography. METHODS: We tested this hypothesis by performing standard 2.5MHz two-dimensional echoes on mitral valve and myocardium in 30 patients with mitral stenosis, scheduled to undergo mitral valve replacement. We compared gray level of each region of interest in mitral valve and myocardium in stop-frame images with the degree of calcifications identified by pathologic and radiographic examinations. RESULTS: Ratio of mean gray level of mitral valve to mean gray level of myocardium was the most reliable value in evaluating degree of calcification. Quantitatively, region of calcification displayed the ratio of significantly higher value than that of no calcification. In case of anterior mitral valve, the ratio of the evident calcified region was greater than 3.11, that of the region without calcification was less than 2.42 and that of microcalcification was betwwn 2.42 and 3.11. For posterior mitral valve, the ratio of the evident calcified region was greater than 3.50, that of the region without calcification was less than 2.19 and that of microcalcification was between 2.19 and 3.50. The sensitivity and specificity of this method for assessment of degree of calcification was 75% and 100% for anterior mitral valve and 9% and 87.5% for posterior mitral valve. CONCLUSION: Mitral valvular calcification could be detected quantitatively in standard two dimensional echocardiograms of mitral valve in vivo by evaluating regional gray level(echo amplitude) using computerized image analysis.
Echocardiography ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Myocardium ; Sensitivity and Specificity

Retinal hamartomas are the most common ocular abnormalities in up to 50% of patients with tuberous sclerosis. Other ocular lesions are retinal pigment epitheliallesions and salmon-colored nodules in the eyelid and conjunctiva. We have experienced two cases of tuberous sclerosis. The first patient was a 13 year-old female with type 1 and type 2 of retinal hamartomas and retinal pigment epithelial lesion. The second patient was a 19-year-old male with type 1 and type 3 of retinal hamartomas and intracranial calcifications.
Adolescent ; Conjunctiva ; Eyelids ; Female ; Hamartoma ; Humans ; Male ; Retinaldehyde ; Tuberous Sclerosis* ; Young Adult

PURPOSE: This study is aimed to investigate perceptions of caregivers and medical staff toward do not resuscitate (DNR) and advance directives (AD). METHODS: Participants were 141 caregivers and 272 medical staff members from five general hospitals. A questionnaire used for the study consisted of 20 items: 14 about DNR perceptions, three about AD, one each for age, gender and employment. RESULTS: Both medical staff and caregivers strongly recognized the need for DNR and AD, and the level of recognition was higher with medical staff than caregivers (DNR chi2=44.56, P=0.001; AD chi2=16.23, P=0.001). The main reason for the recognition was to alleviate sufferings of patients in the terminal phase. In most cases, DNR and AD were filled out when patients with terminal conditions were admitted, and patients made the decisions by consulting with their guardians. Medical staff better recognized the need and for growing demand for guidelines for the DNR and AD decision making process than caregivers (chi2=7.41, P=0.0025). CONCLUSION: This study showed that patients highly rely on their caregivers when making decisions for DNR and AD. Thus, it is important that patients and caregivers are provided with objective information about the decisions. Since participants' strong support for DNR and AD was mainly aimed at alleviating patients' suffering, further study is needed in the association with hospice care. Medical staff also needs to understand the different views held by caregivers and fully consider the disparity when informing patients/caregivers to make the DNR and AD decisions.
Advance Directive Adherence ; Advance Directives ; Caregivers* ; Decision Making ; Employment ; Hospice Care ; Hospitals, General ; Humans ; Medical Staff* ; Personnel, Hospital ; Resuscitation Orders ; Surveys and Questionnaires