A case of metastatic adrenal cortical carcinoma in which partial remission was achieved with transarterial embolization is presented as probably the first reported case in the literature to date. A 29-year-old woman was admitted because of adrenal cortical carcinoma which had not responded to mitotane. A left adrenalectomy with segmentectomy of the involved liver had been done previously. Abdominal computerized tomography demonstrated multiple large metastatic tumors in the liver. Transarterial embolization with Gelfoam and 20 mCi of 131I-labeled lipiodol was performed and resulted in a decrease in tumor size and biochemical parameters. Transarterial embolization can be one of the therapeutic modalities for metastatic adrenal cortical carcinomas.
Adrenal Cortex Neoplasms/metabolism/*therapy ; Adult ; *Embolization, Therapeutic ; Female ; Gelatin Sponge, Absorbable ; Hepatic Artery ; Humans ; Hydrocortisone/metabolism ; Iodine Radioisotopes ; Iodized Oil ; Liver Neoplasms/metabolism/*secondary/*therapy

Gastritis cystica polyposa (GCP) is a lesion characterized by all the histological features described for hyperplastic polyps, And there is s marked proliferation of muscular elements and entrapment of numerous epithelial cysts. These lesions have been described at gastroenterostomy stomas, at peptic ulcer edges, and in association with carcinoma. It is rare that GCP presenting as a submucosal tumar-like lesion develops in the absence of above mentioned associated conditions. We had experienced a 69 year-old man with GCP. Barium X-ray and endoacopic findings showed submucosal tumor in antrum, and endoscopic ultrasonograpic findings showed markedly thickened mucosal layer with scattered hypoechoeic areas and the submucosal layer well preserved. GCP was confirmed by histological examination of resected stomach.
Aged ; Barium ; Gastritis* ; Gastroenterostomy ; Humans ; Peptic Ulcer ; Polyps ; Stomach

43 cases of neonatal hepatitis were clinicallt evaluated, who were admitted to the pediatric department of Severance hospital furing period from April, 1956 to Februart, 1976. The following results were obtained. There was little difference in sex incidence, and most of them were admitted at the age of 1 month to 3 months after birth. Clinical symptoms and signs on admission were jaundice(95%), hepatomegaly(95%), splenom-egaly(41%), fever(41%), and cough(20%). Clay-colored stool was found in 34 cases(79%), and jaundice was found within 6 weeks after birth in most patients. In laboratory studies, total bilirubin, SGOT, SGPT, and Al. phosphatase were all elevated, and return to normal level at 5 weeks after admission. For the precise diagnosis, needle biopsy of the liver was done in 18 cases, among which 14cases showed multinucleated giant cells in specimen, but in 4 cases, giant cells were not observed, and only intrabepatic cholestasis was seen. As complication, bronchopneumonia(9 cases), sepsis(6 cases), rickets(3 cases), and bleeding(4 cases) developed, but which did not influence the prognosis. Most patients were recovered completely, but 6 patients died during admission and 7 patients were discharged in a hopeless condition.
Alanine Transaminase ; Aspartate Aminotransferases ; Bilirubin ; Biopsy, Needle ; Cholestasis ; Diagnosis ; Giant Cells ; Hepatitis* ; Humans ; Incidence ; Jaundice ; Liver ; Parturition ; Prognosis

PURPOSE: To evaluate the usefulness of functional MR imaging(fMRI) for language mapping and determination of language lateralization. MATERIALS AND METHODS: Functional maps of the language area were obtained during word generation tasks and decision task in ten volunteers(7 right handed, 3 left-handed). MR examination were performed at 1.5T scanner with EPI BOLD technique. Each task consisted of three resting periods and two activation periods with each period of 30 seconds. Total acquisition time was 162sec. SPM program was used for the postprocessing of images. Statistical comparisons were performed by using t-statistics on a pixel-by-pixel basis after global normalization by ANCOVA. Activation areas were topographically analyzed(p<0.001) and activated pixels in each hemisphere were compared quantitatively by lateralization index. RESULTS: Significant activation signals were demonstrated in 9 of 10 volunteers. Activation signals were found in the premotor and motor cortices, the inferior frontal, inferior parietal, and mid-temporal lobes during stimulation tasks. In the right handed seven volunteers, activation of language areas was lateralized to the left side. Verb generation task produced stronger activation in the language areas and higher value of lateralization index than noun generation task or decision task. CONCLUSION: fMRI could be a useful non-invasive method for language mapping and determination of language dominance.
Brain ; Hand ; Magnetic Resonance Imaging* ; Rabeprazole ; Volunteers

Bell's palsy is a relatively common, unilateral facial paralysis of unknown etiology. The purpose of this study was to evaluate the prognostic value of several electrophysiologic tests in Bell's palsy. Blink reflex (BR), side-to-side compound muscle action potential (CMAP) amplitude comparison, and side-to-side nerve excitability test (NET) threshold differ once have been studied during the first 2 weeks in 66 patients with Bell's palsy. According to the early response of BR(Rl), the patients were divided into 3 groups: Rl< or = 13ms(17cases) ; Rl>13ms(22cases), and absent BR(27cases). There was a remarkable tendency towards a satisfactory recovery from paralysis if BR occurred during the first 2 weeks from onset(p<0.001). In patients with normal BR, 88.2% had a satisfactory recovery, when the reflex was absent a bad prognosis was given in 59.3% of the patients. According to side-to-side CMAP amplitude comparison, the patients were divided into 2 groups; CMAP amplitude comparison > or = 25% (35cases), and CMAP amplitude comparison <25% (31cases). There was a tendency towards a satisfactory recovery from paralysis if side-to-side CMAP amplitude comparison was more than 25% (p < 0,003). In patients with more than 25% of CMAP amplitude comparison, 82.9% of the patients had a satisfactory recovery, but in patients with less than 25% of CMAP amplitude comparison, 51.6% of the patients had a bad prognosis. According to side-to-side NET threshold difference, the patients were divided into 2 groups, NET threshold difference < or = 3.5mA(43cases), and NET threshold difference >3.5mA (23cases). When the threshold of electrical excitability on both sides differs 3.5mA or more an unsatisfactory recovery has strongly to expected(p<0.001). In patients with less than 3.5mA of NET threshold, 81.4% had a satisfactory recovery, but in patients with more than 3.5mA of NET threshold, 60.9% had a bad prognosis. BR, side-to-side CMAP amplitude comparison, and side-to-side NET threshold difference seem to be useful independent indices for predicting the prognosis an early stage of the paralysis.
Action Potentials ; Bell Palsy* ; Blinking ; Facial Paralysis ; Humans ; Paralysis ; Prognosis ; Reflex

Hereditary spastic ataxia is a familial neurological disorder which exhibit the features of a progressive combined pyramidal tract and cerebellar deficiency. The main features are progressive gait disturbance, incoordination, nystagmus, visual impairment, hyperreflexia, extensor plantar response, peripheral neuropathy, and pes cavus. A 27-year-old male patient with spastic ataxic gait was evaluated. He showed characteristic features of hereditary spastic ataxia. There were another twelve affected members in four generations of his family which may be inherited by autosomal dominant pattern. One of them is reported with review of the literature on familial spastic ataxia.
Adult ; Ataxia* ; Family Characteristics ; Foot Deformities ; Gait ; Humans ; Male ; Muscle Spasticity* ; Nervous System Diseases ; Peripheral Nervous System Diseases ; Pyramidal Tracts ; Reflex, Abnormal ; Reflex, Babinski ; Vision Disorders

The spontaneous hematomyelia is an uncommon event and its predisposing conditions are vascular malformation, syringomyelia, pregnancy and delivery, angioma, hemophilia, anticoagulant therapy, etc. We have recently experienced the patient with spontaneous onset and resolving hematomyelia in the cervical spinal cord. A 30-year-old male patient with non-traumatic spinal shock was evaluated. On MRI, a hematomyelia along cervical spi-nal cord was revealed. A suspicious AV malformation was noticed at C3-4 level. Fol-low-up MRIs showed spontaneous resolution of the hematoma.
Adult ; Hemangioma ; Hematoma ; Hemophilia A ; Humans ; Magnetic Resonance Imaging ; Male ; Pregnancy ; Shock ; Spinal Cord ; Spinal Cord Vascular Diseases* ; Syringomyelia ; Vascular Malformations

BACKGROUND: A retrospectiye study was done for understanding morbidity and mortality after major lung resection. MATERIAL AND METHOD: From June 1994 to August 1998, 203 patients received major lung resections for various causes. There were 142 males and 62 females with a mean age of 47.5 years. Initial complains were cough in 47.8%, sputum in 33.0%, hemoptysis or blood-tinged sputum in 23.2%, dyspnea in 18.2%, chest pain in 15.3%, weight loss in 10.8%, fever and chill in 4.9%. There were no complaints in 5.9% of the total patients. The underlying diseases were lung tumor(102 cases/50.2%), bronchectasis(28 cases/13.8%), aspergillosis(24 cases/1.8%), tuberculosis(20 cases/9.9%) and others (29 cases/66.5%) and pneumonectomy(68 cases/33.5%). The postoperative complications were classified as : empyema, BPF, respiratory problem, persistent air leakage over 7 days, arrhythmia, ventilator applied over 24 hours, bleeding, wound infection and chylothorax. The postlobectomy complications were revealed as follow: empyema(3.7%), BPF(2.2%), respiratory problem(5.2%), persistent air leakage over 7days(8.9%), arrhythmia(2.2%), ventilator applied over 24 hours(2.2%), bleeding(1.5%), wound infection(2.9%), chylothorax(0.7%). The postpneumonectomy complications were revealed as follow : empyema(5.9%), BPF (5.9%), respiratory problem(17.6%), persistent air leakage over 7days(0%), arrhythmia(5.4%), ventialtor apply over 24 hours(7.4%), bleeding (7.4%), wound infection(2.9%) and chylothorax(1.5%). Reoperation was done in 8 cases (4.0%). There were 5.8% operative mortalities in pneumonectomy and 0.7% in lobectomy.
Arrhythmias, Cardiac ; Chest Pain ; Chylothorax ; Cough ; Dyspnea ; Empyema ; Female ; Fever ; Hemoptysis ; Hemorrhage ; Humans ; Lung* ; Male ; Mortality* ; Pneumonectomy ; Postoperative Complications ; Reoperation ; Retrospective Studies* ; Sputum ; Ventilators, Mechanical ; Weight Loss ; Wound Infection ; Wounds and Injuries

PURPOSE: To determine the electronic spin relaxation times, T1e, of three commercially available Gd-chelated MR contrast agents, Gd-DTPA, Gd-DTPA-BMA and Gd-DOTA, using Electron Paramagnetic Resonance(EPR) technique. Material and Methods: The paramagnetic MR contrast agents, Gd-DTPA(Magnevist), Gd-DTPA-BMA(OMNISCAN) and Gd-DOTA(Dotarem), were used for this study. The EPR spectra of these contrast agents, which were prepared 2:1 methanol/water solution, were obtained at low temperatures, from-160degrees C~-20degrees C. The glassy-state EPR spectra for these contrast agents were then fitted by the simulation spectra generated with different zero-field splitting (ZFS) parameters by a computer simulation program 'GE N', which generates the EPR powder spectrum using a given ZFS in 3X3 tensor. Finally, the spin relaxation times of the contrast agents were then determined from the T2e, D, and E values of the best simulation spectra using the McLachlan's theory of average relaxation rate. Results: The electronic transverse spin relaxation times, T2e's, of Gd-DTPA, Gd-DTPA-BMA and Gd-DOTA were 0.113ns, 0.147ns and 1.81ns respectively. The g-values were 1.9737, 1.9735 and 1.9830 and the electronic spin relaxation times, T1e's, were 18.70ns, 33.40ns and 1.66micros, respectively. Conclusion: The results of these studies reconfirm that the paramagnetic MR contrast agents with larger ZFS parameters should have shorter T1e's. Among three contrast agents used for this study, Gd-DOTA chelated with cyclic ligand structure shows better electronic property then the others with linear structure. Thus, it is concluded that the exact determination of ZFS parameters is the important factor in evaluating relaxation enhancement effect of the agents and in developing new contrast agents.
Computer Simulation ; Contrast Media* ; Gadolinium DTPA ; Magnetic Resonance Imaging* ; Relaxation*

We observed clinically 150 cases who were admitted with complaing of purpura at the Pediatric Department of Severance Hospital Yonsei University College of Medicine during a period of 9 years from July, 1966 to June, 1975. In 150 cases, leukemia, 33 cases (22.0%), was most common disease, followed by I.T.P., allergic purpura, meningococcemia, aplastic a nemia, sepsis in order aqnd the incidence was 20.0% (30 cases), 19.3% (29 cases), 19.3% (29 cases), 14.0% (21 cases), 4.0% (6 cases) respectively. And we observed 1 case of thrombocytopenic purpura complicated with scarlet fever and primary hypersplenism respectively. The highest incidence was between the age of one and six years, and males were affected more frequently than females. Clinical manifestations were anemia, fever, abdominal pain, vomiting, joint pain in general symptoms and nasal bleeding, melena, gum bleeding in hemorrhagic symptoms. Major symptoms were fever, abdominal pain, anemia, na sal bleeding, melena, gum bleeding in thrombocytopenic purpura, and fever, abdominal pain, vomiting, meningeal irritation signs in non-thrombocytopenic purpura. I the laboratory findings, mean value of platelet count was below 40,000/mm(3) in thrombocytopenic purpura, but 190,000/mm(3) in non-thrombocytopenic purpura. And bleeding time was prolonged above 5 minutes in thrombocytopenic purpura, but was below 1 minute in non-thrombocytopenic purpura.
Abdominal Pain ; Anemia ; Arthralgia ; Bleeding Time ; Epistaxis ; Female ; Fever ; Gingiva ; Hemorrhage ; Humans ; Hypersplenism ; Incidence ; Leukemia ; Male ; Melena ; Platelet Count ; Purpura* ; Purpura, Schoenlein-Henoch ; Purpura, Thrombocytopenic ; Scarlet Fever ; Sepsis ; Vomiting