PURPOSE: To determine the value of bilobate anterior epidrual extension(AEE) on MRI in differential diagnosis of tuberculous spondylitis, pyogenic spondylitis and malignant tumor. MATERIALS AND METHODS: SE TI-,T2- and Gd-DTPA enhanced Tl-weighted, sagittal and axial MR images of 39 patients(40 vertebral lesions), including 16 tuberculous spondylitis, 7 pyogenic spondylitis(8 lesions, consisting of 2 separate lesion of 1 patient), and 16 malignant vertebral tumors(15 metastases,1 lymphoma) with an AEE were reviewed. The frequency of bilobate AEE shown as double-convexity in the anterior epidural space on axial scans was evaluated in the above vertebral diseases. RESULTS: The bilobate AEE on the axial scans was seen in 12 out of the 16 tuberculous spondytitis(75%) and 1 out of 8 pyogenic spondylitis(13%), and 10 out of the 16 malignant tumor including 15 metastasis and 1 lymphoma(63%). CONCLUSION: The bilobate' ^EE of vertebral lesions is suggestive of tuberculous spondylitis or malignant tumor rather than pyogenic spondylitis. This pattern seems to be related with the preservation of the structures, including midline septurn, F~LL(Posterior longitudinal ligament), lateral membrane and fibrous membrane, limiting and surrounding the extension of the tuberculous spondylitis and malignant tumor, and with the early penetration or disruption of PLL, midline septurn, lateral & fibrous membranes in the pyogenic spondylitis.
Diagnosis, Differential ; Epidural Space ; Gadolinium DTPA ; Magnetic Resonance Imaging* ; Membranes ; Neoplasm Metastasis ; Spondylitis

Sarcoidosis can affect two or more members of the same family, and the reported occurrence of such familial sarcoidosis is variable from 0.5 to 14%. Recently we have experienced familial sarcoidosis affected mother and daughter, for the first time in Korea. Mother was diagnosed as Stage II sarcoidosis 4 years ago by transbronchial lung biopsy and cervical lymph node biopsy with compatible BAL finding in our hospital. This time, the daughter was admitted with bilateral hilar enlargement and anterior uveitis. Even though she had positive tuberculin skin test and atypical BAL finding(lymphocyte: 61%, CD4/CD8: 1.22). Transbronchial lung biopsy and mediastinal lymph node biopsy revealed noncaseating epithelioid granulorna without AFB. Slit lamp examination of the eyes showed severe anterior uveitis. Systemic steroid therapy was started due to progressive uveitis with antituberculous medication.
Biopsy ; Humans ; Korea* ; Lung ; Lymph Nodes ; Mothers ; Nuclear Family ; Sarcoidosis* ; Skin Tests ; Tuberculin ; Uveitis ; Uveitis, Anterior

PURPOSE: To correlate MR findings with histologic findings in avascular necrosis(AVN) of the femoral head. MATERIALS AND METHODS: MR imaging was performed with 8 femoral head specimens using T1- and proton density weighted coronal SE sequences, and compared with contact radiography and histologic sections. RESULTS: In each specimen, necrotic zone in the superior portion of femoral head, repair zone located inferior to the necrotic zone, and rim adjacent to normal bone marrow could be defined. Necrotic zone showed high signal intensity on both T1- and proton density- weighted images in 3 cases which were composed of necrotic bone and marrow, and low signal intensity on both sequences in 2 cases which were composed of necrotic bone marrow with amorphous cellular debris. Mixed high and low signal intensities were seen in 3 cases. The repair zone showed low signal intensity on Tl-weighted image and high signal intenisty on proton density weighted image in 5 cases which were composed of thickened trabecular bone and meSenchymal tissue and also showed intermediate signal intensity on T1 weighted image and high signal intensity on proton density weighted image in 3 cases which were composed of osteoid, chondroid and undifferentiated mesenchymal cells. Rim shown as the low signal intensity on T1 weighted image in all cases was corresponded to viable thickened trabecular bone. CONCLUSION: MR imaging would be the best modality in the diagnosis of avascular necrosis of fernoral head and when used in conjuction with degree and location of signal intensity, the prediction of histologic finding may be possible.
Bone Marrow ; Diagnosis ; Head* ; Magnetic Resonance Imaging* ; Necrosis* ; Protons ; Radiography

No abstract available.
Smoking* ; Tobacco Products*

Fibromatosis is generally a benign tumor that arises from the musculoaponeurotic tissues of the body, rarely occurring in the head and neck region. This can be treated with a good prognosis, but sometimes recurs as a local invasion. Preoperative core needle biopsy and MR images are necessary to diagnose preoperatively and outline the tumor extent. The mainstay of treatment is complete surgical excision. Nonetheless, an excision is often difficult because of the complex anatomy or proximity of the tumor to vital structures in the head and neck region. We report a rare case of desmoid-type fibromatosis that occurred in the neck, closely attached to the transverse process of the cervical vertebra. The present article covers an extensive analysis of the case with a review of the related literature.
Biopsy, Large-Core Needle ; Cervical Vertebrae ; Female ; Fibroma* ; Fibromatosis, Aggressive ; Head ; Neck ; Prognosis ; Spine*

No abstract available.
Interleukin-6* ; Kidney Transplantation* ; Kidney*

BACKGROUND: RpoB gene mutations have been found in about 96-98% of rifampicin (RMP)-resistant Mycobacterium tuberculosis. Recent reports confirm that the in laboratory settings a rpoB gene mutation can be used as a surrogate marker for multi-drug resistant tuberculosis. However, its usefulness in clinical applications has not been evaluated. This study was performed to confirm whether mutation analysis of the rpoB gene of M.tuberculosis is useful in clinical settings. METHODS: The medical records of 33 patients in whom rpoB gene analysis was conducted using an INNOLiPA Rif. TB assay (LiPA) from June, 1998, to July, 2000, at the Asan Medical Center were retrospectively reviewed in 33 patients. the clinical characteristics in addition to the drug susceptibility and LiPA results were analyzed. The drug susceptibility test was considered as a gold standard method for M/ tuberculosis susceptibility and these results were compared with those of the rpoB gene study and sequencing analysis. sequencing analysis of the rpoB gene was done in cases where there was a discrepancy between the results of the drug susceptibility and rpoB gene study. RESULTS: The mean age and sex ratio was 42±18, and 24:9(M:F), respectively. there were 19 RMP susceptible (58%) and 14 RNP-resistant cases (42%) according to the rpoB gene study. The mean time from the request to reporting the results of the rpoB gene study was 5.2±2.6 days. The mean gap from reporting the rpoB gene study to reporting the susceptibility was 56±35 days. Twenty-eight cases (85%) showed identical results compared with the drug susceptibility results, wheres five cases (15%) showed contradictory results. When compared with the sequencing analysis, of the five cases that showed contradictory results, two had LiPA analysis errors and the remaining three were identical to the sequencing results. The rpoB gene study was of assistance in choosing the appropriate drugs in 28 cases (85%). CONCLUSIONS: An rpoB gene study using an LiPA assay was useful in rapidly diagnosing RMP-resistant tuberculosis, which enabled a proper choice of the appropriate drugs in clinical practices. However, an LiPA assay always should be performed in conjunction with microscopy, culture, and susceptibility tests.
Biomarkers ; Chungcheongnam-do ; Humans ; Medical Records ; Mycobacterium tuberculosis ; Retrospective Studies ; Rifampin ; Sex Ratio ; Tuberculosis* ; Tuberculosis, Multidrug-Resistant

BACKGROUND: Since endotracheal tube is the most important factor involved in the imposed work of breathing during mechanical ventilation, extubation of endotracheal tube is supposed to reduce respiratory work of patient. However, some patients show labored breathing after extubation despite acceptable blood gases. We investigated the changes of work of breathing before and after extubation and the factors involved in the change of WOB after extubation. METHODS: The subjects were 34 patients(M : F = 20 : 14, mean age = 61 l7yre) who recovered from respiratory failure after ventilatory support and were considered to be ready for extubation. The patients with clinical or radiologic evidences of upper airway obstruction before endotracheal intubation for mechanical ventilation were excluded. Vital sign, physical examination, chest X-ray, work of breathing and other respiratory mechanic indices were measured prior to, immediately, 6, 24 and 48 hours after extubation serially. Definition of weaning failure after extubation was resumption of ventilatory support or reintubation of endotracheal tube within 48 hour after extubation because of respiratory failure. The patients were classified into group I (decreased work of breathing), group 2(unchanged work of breathing) and group 3(increased work of breathing) depending on the statistical difference in the change of work of breathing before and after extubation. RESULTS: Work of breathing decreased in 33%(11/34, group 1), unchanged in 41%(14/34, group 2) and increased in 26% (9/34, group 3) of patients after extubation compared with before extubation. Weaning failure occurred 9%(1/11) of group, 1, 28.67(4/14) of group 2 and 44.4%(4/9) of group 3 after extubation(p = 0.07). The change of work of breathing after extubation was positively correlated with change of mean airway resistance(mRaw). (r = 0.794, p> 0.01) In three cases of group 3 whose respiratory indices could be measured until 48 hr ater extubation, the change in work of breathing paralleled with the sequential change of mRaw. The work of breathing was peaked at 6 hr after extubation, which showed a tendency to decrease thereafter. CONCLUSIONS: Reversible increase of work of breathing after extubation may occur in the patients who underwent extubation, and the increase in mRaw could be responsible for the increase in work of breathing. In addition, the risk of weaning failure after extubatuion may increase in the patients who have increased WOB immediately after extubation.
Airway Obstruction ; Gases ; Humans ; Intubation, Intratracheal ; Physical Examination ; Respiration ; Respiration, Artificial ; Respiratory Insufficiency ; Respiratory Mechanics ; Thorax ; Vital Signs ; Weaning ; Work of Breathing*

BACKGROUND: Home ventilation can decrease hospital-acquired infection, increase physical activity, improve nutritional status, enhance quality of life, and reduce medical costs. The number of patient using home ventilators has been increasing, particularly in Europe and United States. Although the number of patients with home ventilation has been increasing in Korea, the current status of these patients is not well known. This study was undertaken to obtain basic information upon these patients in additon to evaluating any problems related to patients' home care in our country. METHODS: A register of 92 patients with home ventilators in Seoul and Kyunggi province were obtained from commercial ventilator supply companies. The patients were contacted by phone and 29 of them accepted our visit. Information concerning education about home care before discharge, equipment cost, and problems related to home care were documented. The mode and preset variables of the home ventilator were checked; tidal volume (TV), peak airway pressure, and oxygen saturation were measured. RESULTS: There were 26 males (90%) and their mean age was 48.0(±20.1 years. The underlying diseases were: 21 neuromuscular disorders, 2 spinal cord injuries, 6 chronic lung diseases. Among the caregivers, spouses (n=14) predominated. Education for home care before discharge was performed primarily by intensive care unit nurses and the education for ventilator management by commercial companies. Twenty-five of the 29 patients had tracheostomies. Volume targeted type (VTT;n=20, 69%) was more frequently used than the pressure targeted type(PTT). Twenty-three of the 29 patients purchased a ventilator privately, which cost 7,450,000(±3,290,000) won for a PTT, and 14,280,000(±3,130,000) won for a VTT. Total cost for the equipment was 11,430,000(±634,000) won. The average cost required for home care per month was 1,120,000(±1,360,000) won. CONCLUSION: The commonest underlying disease of the patients was neuromuscular disease. The VTT ventilator was primarily used with tracheostomy. Patients and their families considered the financial difficulties associated with purchasing and maintaining equipment for home care an urgent problem. Some patients were aided by a visiting nurse, however most patients were neglected and left without professional medical supervision.
Caregivers ; Education ; Europe ; Gyeonggi-do* ; Home Care Services ; Humans ; Intensive Care Units ; Korea ; Lung Diseases ; Male ; Motor Activity ; Neuromuscular Diseases ; Nurses, Community Health ; Nutritional Status ; Organization and Administration ; Oxygen ; Quality of Life ; Seoul* ; Spinal Cord Injuries ; Spouses ; Tidal Volume ; Tracheostomy ; United States ; Ventilation ; Ventilators, Mechanical*

An application of the multi-detector computed tomography (MDCT) for cardiac imaging is the non-invasive CT angiographic assessment of the cardiac morphology and the coronary arteries. The most important application is for the non-invasive diagnosis of coronary artery disease, and this includes assessment of coronary artery anomaly and stenosis, the evaluation of non-calcified atherosclerotic plaque and the follow-up examinations after stent deployment and bypass surgery. In the study, we have illustrated a variety of diseases of the coronay artery by using MDCT. These may facilitate the understanding of MDCT features of coronary artery lesions.
Arteries ; Constriction, Pathologic ; Coronary Angiography* ; Coronary Artery Disease ; Coronary Vessels ; Diagnosis ; Follow-Up Studies ; Multidetector Computed Tomography* ; Plaque, Atherosclerotic ; Stents