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: The type of the infiltrating cells in alveolitis may be determined by the chemokines in the lesion. MIP-1alpha, a C-C type chemokine, stimulates proliferation and cytokine secretion from macrophages and induces early neutrophilic and later monocytic inflammation in vivo. IL-8, a C-X-C type chemokine is known to attract neutrophils and T-lymphocytes. This study is performed to find out the relative role of two different chemokines in diffuse interstitial lung disease. SUBJECT AND METHOD: We measured the secretion of MIP-1alpha and IL-8 from alveolar macrophages(AM), and their level in BAL fluid of 26 patients with DILD (10 IPF, 4 collagen disease, 10 sarcoidosis, and 2 hypersensitivity pneumonitis) and 7 normal control. RESULT: IL-8 secretion was significantly increased in patients with DILD (8.15+/-4.58 ng/ml) than in normal (1.10+/-0.93 ng/ml, p=0.0003). Significant correlation was found between IL-8 secretion and total cell number in BAL fluid (r=0.484, p=0.0068), %(r=0.592, p=0.0004) and No. (r=0.516, p=0.0042) of lymphocyte, and % of AM (r=-0.505, 0.0032). MIP-1alpha secretion was also increased in DILD (2.41+/-1.45 ng/ml) compared to control (0.63+/-0.30 ng/ml, p=0.0031), and showed a tendency of correlation with total cell number (r=0.368, p=0.0456) and No. of alveolar macrophages (r=0.356, p=0.0579) in BAL fluid. The concentration of IL-8 in BAL fluid was significantly increased in the patients with DILD (40.4+/-34.5 pg/ml) compared to control (3.90 +/- 2.47 pg/ml, p=0.0094) and it showed a significant correlation with the total cell number(r=0.484, p=0.0068), %(r=-0.505, p=0.0032) of AM, and % (r=0.592, p=0.0004) and No. (r=0.516, p=0.0042) of lymphocyte in BAL fluid. But there was a no significant difference in MIP-1alpha concentration in BAL fluid between normal control group and the patients with DILD. Conclusion: From the above results, we concluded that AM of DILD releases increased amount of both IL-8 and MIP-1alpha but IL-8 has better correlation with the type of alveolitis.
Cell Count ; Chemokine CCL3 ; Chemokines ; Collagen Diseases ; Humans ; Hypersensitivity ; Inflammation ; Interleukin-8 ; Lung Diseases, Interstitial ; Lung* ; Lymphocytes ; Macrophages ; Macrophages, Alveolar* ; Neutrophils ; Sarcoidosis ; T-Lymphocytes

BACKGROUND: Pressure rise time (PRT) is the time in which the ventilator aclieves the set airway pressure in pressure-targeted modes, such as pressure control ventilation (PCV). With varying PRT, in principle, the peak inspiratory flow rate of the ventilator also varies. And if PRT is set to a shorter duration, the effective duration of target pressure level would be prolonged. which in turn would increase inspiratory tidal volume(Vti) and mean airway pressure(Pmean). We also postulated that the increase in Vti with shortening of PRT may relate inversely to the patients' basal airway resistance. METHODS: In 13paralyzed patients on PCV(pressure control 18±9.5cm H2, FIO2 0.6±0.3, PEEP 5±3cm H2O, f20/min, I : E, 1 : 2) with Servo 300(Siemens-Elema, Solna, Sweden)from various causes of respiratory failure, PRT of 10%, 5% and 0% were randomly applied. At 30min of each PRT trial, peak inspiratory flow (PIF, L/sec), Vti(ml), Pmean(cm H2O) and ABGA were determined. RESULTS: At PRT 10, 5% and 0%, PIF were 01.69±0.13, 0.77±0.19, 0.83±0.22, respectively(p<0.001). Vti were 425±94, 439±101, 456±106, respectively(p<0.001), and Pmean were 11.2±3.7, 12.0±3.7, 12.5±3.8, respectively(p<0.001). pH were 7.40±0.08, 7.40 ±0.92, 7.41±0.96, respectively (p=0.004) ; PaCO2 (mm Hg) were 47.4±15.8, 47.2±15.7, 44.6±16.2, respectively (p=0.004) ; PAO2 - PaO2 (mm Hg) were 220±98, 224±95, 227±94, respectively(p=0.004) ; and Vd/Vt as determined by (PaCO2 - P CO2/PaCO2 were 0.67±0.07, 0.67±0.08, 0.66 ±0.08, respectively(p=0.007). The correlation between airway resistance and change of Vti from PRT 10% to 0% were r=-0.243(0.498). CONCLUSION: Shortening of pressure rise time during PCV was associated with associated with increased tidal volume, increased mean airway pressure and lower PaCO2.
Airway Resistance ; Humans ; Hydrogen-Ion Concentration ; Respiratory Insufficiency ; Tidal Volume* ; Ventilation* ; Ventilators, Mechanical

A non-traumatic, spontaneous hemothorax is rare. The most common causes are coagulopathy, due to anticoagulation treatment, and cancers with a metastasis to the pleural surface. Other unusual causes include thoracic endometriosis, ruptured aortic aneurysm, pulmonary arterio-venous malformation, coagulopathy, Osler-Rendeu-Weber syndrome, Ehlers-Danlos syndrome et cetera. A type 1 neurofibromatosis(Von Recklinghausen's disease) is an autosomal dominant disease that is characterized by multiple skin tumors(neurofibroma) and abnormal skin pigmentation(cafe-au-lait spots). Some are accompanied by vasculopathy, and are present with a spontaneous hemothorax. Such cases are unusual but fatal. We have recently experienced a case where a young male patient with neurofibromatosis initially presented with hypovolemic shock due to a spontaneous hemothorax. Later, aortography revealed that the cause of the hemothorax was a rupture of a pseudoaneurysm of the right internal mammary artery and as a result, an embolization was performed. Here we report this case with a review of the appropriate literature.
Aneurysm, False* ; Aortic Rupture ; Aortography ; Ehlers-Danlos Syndrome ; Endometriosis ; Female ; Hemothorax* ; Humans ; Male ; Mammary Arteries ; Neoplasm Metastasis ; Neurofibromatoses ; Neurofibromatosis 1* ; Rupture* ; Shock ; Skin

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