Six patients with twenty histologically proven neurilemmomas of the extremities were studied using magnetic resonance(MR) imaging. The size, number, signal intensity on spin-echo T1WI(TR 500-650ms/TE 14-25ms)and gradient -echo (TR 200-600ms/TE 14-20ms; flip angle 25-30)image, enhancement pattern, detectability of nerve of origin, nerve-lesion relationship, and presence of a capsule were analyzed. The masses ranged from 1 to 12cm in longitudinal diameter and originated from the median nerve, ulnar nerve, sciatic nerve, radial nerve, and tibial nerve. All the nerve tracts except for those of 5 lesions, which could not be detected due to their small diameter, were visualized as low intensity tubular structures. All visible nerve tracts were situated along the periphery of the lesion and this finding was considered to be specific for neurilemmona. All neurilemmomas were isointense with the surrounding muscle on spin-echo T1WI and hyperintense on gradient-echo image. After a GD-DTPA injection, all masses showed moderate or marked enhancement and more prominent inhomogeneity than that on nonenhanced scan. In 19 out of 20 lesions(95%), a low signal intensity capsule surrounding the masses could be seen. Four of the six patients showed multiple masses, which was unusual as neurilemmoma usually arises as a solitary mass. In conclusion, the MR findings, especially the eccentric location of the mass lesion from the nerve of origin and the presence of a capsule, were useful in making a diagnosis of neurilemmoma of the extremity and that multiple neurilemmomas were not uncommon.
Diagnosis ; Extremities* ; Gadolinium DTPA ; Humans ; Median Nerve ; Neurilemmoma* ; Radial Nerve ; Sciatic Nerve ; Tibial Nerve ; Ulnar Nerve

To verify the accuracy and reproducibility of corneal thickness measurements obtained with Orbscan (Orbtek, Inc., Salt Lake City, USA), the measurements were compared with those taken with an ultrasound pachymeter (Omega Compuscan, Storz). Central corneal thickness was measured by each method in 100 eyes of 50healthy subjects. The averages by the two methods were compared. One examiner took the measurements twice by each method in 20 eyes of 10 subjects, and intraexaminer reproducibility was evaluated. Two examiners measured the thickness in 20 eyes of 10 subjects and interexaminer reproducibility was assessed. The average corneal thickness was 550.27+/-3.56 micrometer in the Orbscan measurements and 526.62+/-3.70 micrometer in the ultrasound pachymetry: There was a statistically significant difference between the two methods. Significant difference was noticed but this showed a constant corresponding correlation with the Orbscan showing a 4.4%lower average. The intraexaminer and interexaminer reproducibility showed high reliability(Guttman split-half point<0.99). The Orbscan pachymetry is a highly reliable method and may be widely used in clinical practice.
Corneal Pachymetry* ; Lakes ; Ultrasonics* ; Ultrasonography

To evaluate the reproducibility in measuring the velocities of perifoveal hyperfluorescent dots, we analyzed fluorescein angiographs of 24 eyes[24 patients]which had central serous retinopathy. Fluorescein angiography was performed with a scanning laser ophthalmoscope[SLO, Rodenstock, Mnchen, Germany]Distances between 5 moving hyperfluorescent dots in a perifoveal capillary were measured at each consecutive frame[interval 1/30 sec]. And then velocities of 5 fluorescent dots were measured with image analysis program by converting the distances to real retinal size using the Littmann's curve in 20 eyes. In the other 4 eyes, the velocities between 5 fluorescent dots of each 2 to 4 capillaries were measured. Perifoveal capillary mean blood flow velocity and standard deviation were 2.08 +/-0.36 mm/sec, and mean coefficient of variation of the velocities measured in a vessel of one patient was 12.58%. However, reliability of the velocities of 2 to 4 capillaries on the 4 eyes was relatively low. In conclusion, the measurement of velocities between perifoveal fluorescent dots with scanning laser ophthalmoscope may be a reproducible method for a perifoveal capillary. However, reliability of measuring velocities was not sufficient enough to use the velocity of one perifoveal capillary as macular blood flow.
Blood Flow Velocity ; Capillaries ; Central Serous Chorioretinopathy ; Fluorescein Angiography* ; Fluorescein* ; Humans ; Ophthalmoscopes* ; Retinaldehyde

On video fluorescein angiogram, it is known that arm-to-retinal circulation(ART)influences retinal macrocirculation and arterio-venous passage time(AVP)influences microcirculation.In diabetic retinopathy(DR), midperiphery involved earlier than posterior pole.However, there has been no study on the circulation of the entire retinal circulation including the peripheral retina. The authors conducted a prospective study by performing fluorescein angiography on 19 controls and 19 DR patients in order to measure the ART, AVP and venous filling time(VFT). The VFT correspond to the circulation of the peripheral retina. In the DR group, the retina circulation time was compared with the existence of proliferative diabetic retinopathy(PDR), distribution of nonperfusion area and beading vessels. There was no significant difference between diabetic group and the control group in the ART.AVP was 1.8+/-0.7sec in the control group and 2.5+/0.7sec(p=0.04)in the DR group and venous filling time was 6.4+/-2.4sec and 8.9+/-1.5sec(p=0.006)respectively. Patients with PDR showed prolongation only in VFT compared to patients with non-proliferative diabetic retinopathy(NPDR). In addition, patients presenting with nonperfusion areas and beading of vessels showed longer prolongation of VFT than of AVP. In conclusion, the VFT is delayed in DR compared to control group and in PDR compared to NPDR. The VFT can be utilized as an indicator of DR to measure the retinal circulation including the peripheral retina.
Diabetic Retinopathy* ; Fluorescein Angiography* ; Fluorescein* ; Humans ; Microcirculation* ; Prospective Studies ; Retina ; Retinaldehyde*

This study was performed to develop a new method, fluorecent leukocyte angiography(FLAG), to measure retinal circulation. Fluorescein-stained leukocytes can be seen in all the retinal vessels during fluorescein angiography using Scanning Laser Ophthalmoscope(SLO FAG) and retinal blood flow can be measured by using leukocyte velocities in the retinal vessels. Methods were followings. Firstly, blood was withdrawn from vein, mixed with fluorescein(10%) and anticoagulant and then centrifuged. The yellowbrown coat layer containing fluorescin-stained leukocytes was selected and injected into the vein while performing SLO FAG. The image of FLAG displayed circulating hyperfluorescent leukocytes clearly in all retinal vessels, and allowed the measurement of leukocyte velocities. In conclusion, FLAG is a new method to measure blood flow in all the retinal vessels simultaneously and can be a useful tool for studying animal and human retinal circulation.
Angiography* ; Animals ; Fluorescein Angiography ; Humans ; Leukocytes* ; Retinal Vessels ; Retinaldehyde* ; Veins

To investigate the retinal hemodynamics in chronic primary open angle glaucoma (POAG), high-quality video fluorescein angiograms using a scanning laser ophthalmoscope(SL0 101, Rodenstock, Munich, Germany) were obtained from 22 eyes of 16 patients with POAG and 14 eyes of 14 healthy subjects. From these angiograms, the arm to retinal time (ART), arteriovenous passage time (AvFT), venous fulling time(VFT) and arteriovenous fulling time (AvFT) were quantified. And these parameters of retinal circulation of the group of patients with POAG were compared with those of the age-matched group of healthy subjects. There were no significant differences in the ART between two groups (p=0.09). But significant prolongations of the AvPT, VFT and AvFT of the group of patients with POAG(2.5 +/- 1.1, 8.4 +/- 1.8 and 10.9 +/- 2. sec, respectively) were observed compared to the values (1.8 +/- 0.7, 6.4 +/- 2.2 and 8.1 +/- 2. 4 sec, respectively) obtained among the healthy subjects (p=0.04, p=0.007 and p=0.0008, respectively). These results indicate that a significant retinal microcirculatory deficit exists in the eyes of POAG, and the VFT and AvFT may be good indices of retinal microcirculatory deficit in the eyes of POAG.
Arm ; Fluorescein ; Glaucoma, Open-Angle* ; Hemodynamics ; Humans ; Retinaldehyde

To compare the diagnostic yields and complication rates of transthoracic fine needle aspiration cytology(FNAC) and gun biopsy in the diagnosis of pulmonary mass, a retrospective review was performed in 125 cases. Under the fluoroscopic guide, FNAC was performed by 20G Chiba needle in 91 cases, core biopsy was done by 18.5 G vaccum needle attached with automated biopsy gun in 74 cases and both procedures were done together in 37 cases. Overall sensitivity was 88.4% in FNAC and 87.5% in gun biopsy. For malignant pulmonary tumors, correct type correlation with final diagnosis was obtained in 33(76.7%) out of 43 cases by FNAC and 30(75.0%) out of 40 cases by gun biopsy. For benign pulmonary lesions, there were correct type correlation in 14(35.0%) out of 40 cases by FNAC and 14(53.8%) out of 26 cases by gun biopsy. The complication was pneumothorax and hemoptysis. Pneumothorax occured in 11.1% of FNAC, 10.9% of gun biopsy and 10.9% of both technique, among which chest tube drainages were necessary in one patient by gun biopsy and in three patients by both technique. Although no significant difference of diagnositc accuracy and complication rate was found between FNAC and gun biopsy, gun biopsy was more helpful in the diagnosis of pulmonary benign lesions than FNAC.
Biopsy* ; Biopsy, Fine-Needle* ; Chest Tubes ; Diagnosis ; Hemoptysis ; Humans ; Needles ; Pneumothorax ; Retrospective Studies

BACKGROUND: Intravenous patient controlled analgesia (IV-PCA) is a most common used delivery system for intravenous administration of opioids during acute post operative pain management. The objective of this study is to compare the rate of opioid induced adverse reactions and effectiveness among two IV-PCA opioids, morphine, fentanyl, in laparoscopic cholecystectomy pain management. METHODS: Sixty patients in ASA physical status 1 and 2 scheduled for laparoscopic cholecystectomy were allocated randomly to either morphine IV-PCA used (n = 30, Group M) group or fentanyl IV-PCA used (n = 30, Group F) group. In each group, numerical rating scale (NRS) score, sedation score and incidence of side effect were checked. RESULTS: NRS score of Group F showed lower than that of Group M during PACU and 3 hrs after the recovery room (P < 0.05). There were no significant differences in sedation score among two groups. The incidences of adverse reactions were similar in the two groups, though the incidence of nausea and pruritus were higher in the Group M. CONCLUSIONS: Fentanyl IV-PCA is more advantageous than morphine IV-PCA for laparoscopic cholecystectomy in view of early pain control and adverse reaction incidences.
Administration, Intravenous ; Analgesia, Patient-Controlled ; Analgesics, Opioid ; Cholecystectomy, Laparoscopic ; Fentanyl ; Humans ; Incidence ; Morphine ; Nausea ; Pain Management ; Pruritus ; Recovery Room

Carney complex is an autosomal dominant disease that displays such characteristic features as cardiac and cutaneous myxomas and spotty pigmentation of the skin. We report here on a case of Carney complex that was accompanied by increased myxoid fibroadenomas in the breast and multiple intracranial aneurysms.
Adult ; Breast Neoplasms/*complications/diagnosis ; Female ; Fibroadenoma/*complications/diagnosis ; Humans ; Intracranial Aneurysm/*complications ; Magnetic Resonance Imaging ; Pigmentation Disorders/*complications ; Syndrome

PURPOSE: To evaluate the accuracy and safety of ultrasound-guided biopsy of the thickened peritoneal reflections and to determine the efficacy and diagnostic role of this procedure in the differential diagnosis of peritoneal tuberculosis and peritoneal carcinomatosis. MATERIALS AND METHODS: Twenty-seven patients with only mildly thickened (25 mm or less) peritoneal reflections without apparent mass formations, and in whom imaging findings were not diagnostic, underwent ultra-sound-guided biopsy. Five-MHz linear or convex linear array transducers were used for ultrasound guidance,and an automated gun with 18-gauge (n = 23) or 20-gauge (n = 4) needles for tissue sampling. Biopsies were performed on the thickened parietal peritoneum (n = 9), greater omentum (n = 11), and small bowel mesentery (n = 7), and the results were compared with the final diagnosis determined by adiologic/clinical follow-up (n = 17) or laparoscopic biopsy (n = 10). Complications and changes in hemoglobin and hematocrit levels after the procedure were evaluated. RESULTS: Specimens adequate for pathologic examination were obtained in all 27 patients. The histopathologic results were metastatic carcinomatosis (n = 15), peritoneal tuberculosis (n = 8), and chronic granulomatous inflammation (n = 4). Specific pathologic diagnosis was obtained in all patients except the four with chronic granulomatous inflammation. Differentiation between benignancy and malignancy was possible in all patients and the histopathologic specific accuracy rate was 100%. No clinically significant complications were observed. In 24 patients with ascites at the site of the biopsy, transient bleeding was observed immediately after the procedure, but this stopped spontaneously within a few minutes. Post-procedural hemoglobin and hematocrit levels were only minimally lower (mean values of 0.9g/dL and 3.0%, respectively) than pre-procedurally. CONCLUSION: Ultrasound-guided biopsy of thickened peritoneal reflections is a safe and effective diagnostic procedure and is useful in the differential diagnosis of peritoneal tuberculosis and peritoneal carcinomatosis.
Ascites ; Biopsy* ; Carcinoma* ; Diagnosis ; Diagnosis, Differential* ; Follow-Up Studies ; Hematocrit ; Hemorrhage ; Humans ; Inflammation ; Mesentery ; Needles ; Omentum ; Peritoneum ; Peritonitis, Tuberculous* ; Transducers ; Tuberculosis ; Ultrasonography