PURPOSE: To assess the effect of lordotic curve change of the cervical spine on disk bulging and spinal stenosis by means of functional cervical MR imaging at the flexion and extension position. MATERIALS AND METHODS: Using a 1.5T imager, kinematic MR examinations of 25 patients with degenerative spondylosis (average age, 41 years) were performed at the neutral, flexed and extended position of the cervical spine. Sagittal T2-weighted turbo spin-echo images were obtained during each of the three phases. Lordotic an-gle, bulging thickness of the disk, AP diameter of the spinal canal, and distance between the disk and spinal cord were measured on the workstation at each disk level. After qualitative independent observation of disk bulging, one of four grades(0, normal; 1, mild; 2, moderate; 3, marked) was assigned at each phase, and after further comparative observation, one of five scores (-2, prominent decrease; -1, mild decrease; 0, no change; 1, notable increase; 2 prominent increase) was also assigned. In addition, bulging thickness of the disk was measured and compared at the neutral, flexed, and extended positions. RESULTS: Average angles of the cervical spine were 160.5+/-5.9 degrees (neutral position, lordotic angle); 185.4+/-8.5 degrees (flexion, kyphotic angle); and 143.7+/-6.7 degrees (extension, lordotic angle). Average grades of disk bulging were 0.55 at the neutral position, 0.16 at flexion, and 0.7 at extension. Comparative observation showed that average scores of disk bulging were -0.39 at flexion and 0.31 at extension. The bulging thickness of the disk decreased by 24.2% at flexion and increased by 30.3% at extension, while the diameter of the spinal canal increased by 4.5% at flexion and decreased by 3.6% at extension. The distance from the posterior margin of the disk to the anterior margin of the spinal cord decreased at both flexion(6.6%) and extension(19.1%). CONCLUSION: Functional MRI showed that compared with the neutral position, disk bulging and spinal stenosis are less prominent at flexion and accentuated at extension. The results demonstrate the need to consider the extent to which changes in the cervical lordotic curve affect the degree of disk bulging and spinal stenosis.
Animals ; Humans ; Lordosis* ; Magnetic Resonance Imaging* ; Spinal Canal ; Spinal Cord ; Spinal Stenosis* ; Spine ; Spondylosis

PURPOSE: To determine the usefulness of fluid attenuated inversion recovery(FLAIR) imaging for the in detection of high signal intensity of hippocampus or amygdala in mesial temporal sclerosis (MTS), compared with that of turbo spin-echo T2-weighted imaging. MATERIALS AND METHODS: Two neuroradiologists independently analyzed randomly mixed MR images of 20 lesions of 17 patients in whom MTS had been diagnosed, and ten normal controls. All subjects underwent both who performed both FLAIR and turbo spin-echo T2-weighted imaging, in a blind fashion. In order to determine hippocampal morphology, oblique coronal images perpendicular to the long axis of the hippocampus were obtained. The detection rate of high signal intensity in hippocampus or amygdala, the radiologists 'preferred imaging sequence, and intersubject consistency of detection were evaluated. Signal intensity in hippocampus or amygdala was considered high if substantially higher than signal intensity in the cortex of adjacent temporo-parietal lobe. RESULTS: In all normal controls, FLAIR and spin-echo T2-weighted images showed normal signal intensity in hippocampus or amygdala. In MTS, the mean detection rate of high signal intensity in hippocampus or amyg-dala, as seen on FLAIR images was 93%, compared with 43% on spin-echo T2-weighted images. In all cases in which signal intensity on FLAIR images was normal, signal intensity on spin-echo T2-weighted images was also normal. The radiologists preferred the contrast properties of FLAIR to those of spin-echo T2-weighted images. CONCLUSION: In the diagnosis of MTS using MRI, FLAIR images are more useful for the detection of high signal intensity of hippocampus or amygdala than are spin-echo T2-weighted images. In the diagnosis of MTS, FLAIR imaging is therefore a suitable alternative to spin-echo T2-weighted imaging.
Amygdala ; Axis, Cervical Vertebra ; Diagnosis ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Sclerosis

A 34-year old man presented with syncope, a transient right lower extremity weakness and positional blindness of the left eye. Upon admission, the patients pulse and blood pressure was checked asymmetrically on both sides. A CT and MRI revealed no active lesions. A few days later, the patient was administered a diagnostic coronary-aortic angiogram to evaluate his cardiovascular system. A severe aortic dissection was revealed on the angiogram and an emergency operation for the dissection was done.We report a case of painless aortic dissection as a manifestation of TIA. (J Korean Neurol Assoc 19(5):526~528, 2001)
Adult ; Blindness ; Blood Pressure ; Cardiovascular System ; Emergencies ; Humans ; Ischemic Attack, Transient* ; Lower Extremity ; Magnetic Resonance Imaging ; Syncope

Short bowel syndrome in children, most commonly results after extensive bowel resection for necrosis of the bowel. It may be caused by several intestinal catastrophes such as volvulus, hernia and necrotizing enterocolitis. The risk factors on short bowel syndrome are the remaining length of the bowel, the age of onset, the absence of the ileo-cecal valve and the time after resection. Macro and micronutritional deficiencies are the most significant complications of short bowel syndrome. We report a 5 year-old girl, who had a strangulated congenital transmesenteric hernia leading to short bowel syndrome accompanied by iron deficiency anemia.
Age of Onset ; Anemia, Iron-Deficiency ; Child* ; Child, Preschool ; Enterocolitis, Necrotizing ; Female ; Hernia* ; Humans ; Intestinal Volvulus ; Necrosis ; Risk Factors ; Short Bowel Syndrome*

PURPOSE: To compare the usefulness of combined fat- and fluid-suppressed selective partial inversion recovery-fluid attenuated inversion recovery(SPIR-FLAIR) images in the detection of high signal intensity of the optic nerve in optic neuritis with that of fat-suppressed selective partial inversion recovery(SPIR) or short inversion time inversion recovery(STIR) images. MATERIALS AND METHODS: Two radiologists independently analyzed randomly mixed MR images of 16 lesions in 14 patients (M:F=7:7; mean age, 40years) in whom optic neuritis had been clinically diagnosed. All subjects underwent both SPIR-FLAIR and fat-suppressed SPIR or STIR imaging, in a blind fashion. In order to evaluate the optic nerve, coronal images perpendicular to its long axis were obtained. The detection rate of high signal intensity of the optic nerve, the radiologists' preferred imaging sequences, and intersubject consistency of detection were evaluated. 'High signal intensity' was defined as the subjective visual evaluation of increased signal intensity compared with that of the contralateral optic nerve or that of white matter. RESULTS: The mean detection rate of high signal intensity of the optic nerve was 90% for combined fat- and fluid-suppressed SPIR-FLAIR images, and 59% for fat-suppressed SPIR or STIR images. In all cases in which the signal intensity observed on SPIR-FLAIR images was normal, that on fat-suppressed SPIR or STIR images was also normal. The radiologists preferred the contrast properties of SPIR-FLAIR to those of fat-suppressed SPIR or STIR images. CONCLUSION: In the diagnosis of optic neuritis using MRI, combined fat- and fluid-suppressed SPIR-FLAIR images were more useful for the detection of high signal intensity of the optic nerve than fat-suppressed SPIR or STIR images. For the evaluation of optic neuritis, combined fat- and fluid-suppressed SPIR-FLAIR imaging is superior to fat-suppressed SPIR or STIR imaging.
Axis, Cervical Vertebra ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Optic Nerve ; Optic Neuritis*

OBJECTIVE: To compare the low frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) with high frequency (20 Hz) rTMS on motor functional improvement of the affected upper extremity in subacute stroke patients. METHODS: Forty patients with subacute ischemic stroke participated in this study. The first group received 10 sessions of 20 Hz rTMS at ipsilesional M1 area and the other group received 10 sessions of 1 Hz rTMS at contralesional M1 area. Motor training of the hemiparetic hand was conducted after each rTMS train. All the patients received conventional occupational therapy immediately after each rTMS session. Manual function test (MFT), Fugl-Meyer Assessment scale (FMS), Modified Barthel Index (MBI), Brunnstrom recovery stage, and grip strength were used to assess motor function before, at the end of, and one month after the last session of rTMS. RESULTS: No adverse side effects were reported during the course of the experiment using rTMS. No significant difference in motor function of the affected upper extremity was observed between the two groups before rTMS. Significant improvements in MFT, FMS, MBI, and Brunnstrom stage were observed in the both groups at the end of the last rTMS session and one month later (p<0.05). No significant difference was found between the two groups (p>0.05). CONCLUSION: There was no significant difference in motor function of the affected upper extremity between 1 Hz and 20 Hz rTMS during the subacute period of ischemic stroke. Thus, we cannot conclude which has a greater effect.
Hand ; Hand Strength ; Humans ; Occupational Therapy ; Stroke* ; Transcranial Magnetic Stimulation ; Upper Extremity

BACKGROUND: The purpose of this study was to compare the long term effect of the cholesterol lowering diet education provided by physicians with the education provided by dieticians on serum lipid profiles of hypercholesterolemic patients. METHODS: Among 248 ambulatory patients who had mean baseline serum total cholesterol (TC) level > or = 200mg/dL and received cholesterol lowering diet education from physicians or dieticians, 41 patients who checked serum lipid profiles three times during the mean of 403 days after education were included as subjects. The differences in means of all serum lipid profiles associated with education methods after controlling for follow up duration, differences in means of all serum lipid profiles associated with follow up duration after controlling for education methods, any interaction between education methods and follow up duration on serum lipid profiles were analysed by using repeated measures of analysis of variance. The difference between the baseline lipid levels and the third lipid levels after education were analyzed by using Wilcoxon signed ranks tests in each group. Correlations between baseline serum lipid profiles and the last changes in serum lipid profiles were analyzed. RESULTS: There were no significant differences in means of all serum lipid profiles associated with education methods or follow up duration except LDL cholesterol (LDL C). The first LDL C level after education was significantly lower in the group educated by physicians compared with the baseline LDL C, but there was no such change in the group educated by dieticians. There were no interactions between education methods and follow up duration on all serum lipid profiles. The last change of total cholesterol in both groups and LDL C only in the group educated by dieticians were significant. Correlation coefficients between baseline triglyceride (TG) and change in TG, baseline LDL C and change in LDL C, baseline total cholesterol (TC) and change in TC in patients with TC > or = 240mg/dL were 0.500 (P=0.002), 0.597 (P<0.001), and 0.578 (P=0.001), respectively. CONCLUSION: The changes of serum lipid profile during more than 1 year after education were not significantly different according to diet education methods, but total cholesterol level was significantly decreased in both groups.
Cholesterol ; Cholesterol, LDL ; Diet* ; Education* ; Follow-Up Studies ; Humans ; Hypercholesterolemia ; Nutritionists* ; Triglycerides

PURPOSE: To determine the clinical and mammographic characteristics of primary lymphoma of the breast. MATERIALS AND METHODS: The clinical and mammographic records of five patients (six breasts; bilateral involvement in one patient) with histologically-proven lymphoma of the breast were retrospectively reviewed. RESULTS: All patients had complained of a palpable tender mass with relatively rapid growth over a period of about 3 months. In five cases, the mass was located in the right breast and in one case in the left. Mammography revealed diffuse increased opacity of the entire breast in three cases, a homogeneous well-defined mass in one, multiple well-defined masses in one, and ill-defined lobulated opacity in one. Skin thickening and architectural distortion was seen in one case, and axillary lymphadenopathy in two. In no case was microcalcification and nipple retraction seen. CONCLUSION: In primary breast lymphoma, mammographic finding are non-specific. When a breast grows rapidly and is tender, however, and mammography shows a relatively large well defined mass and associated axillary lymphadenoapathy, the possibility of primary lymphoma should be considered.
Breast* ; Humans ; Lymphatic Diseases ; Lymphoma* ; Mammography ; Nipples ; Retrospective Studies ; Skin

In acute phase, cerebral infartion is usually hypodense on CT and hyperintense on T2-weighted MR image. This hyperintensity on T2-weighted MR image gradually approaches an isointensity stage after 2 or 3 weeks of onset. In the later stage, cerebral infarction is observed hyperintense on T2-weighted MR image. This sequential phenomenon is so-called "fogging effect". We experienced two cases of "fogging effect". The first case did not show abnormal signal intensity on TI or T2 weighted MR images taken after 14 days of onset and the second case also did not show abnormal signal intensity after 17 days of onset. Each case revealed hyperintense in T2-weighted image with contrast enhancement taken after 20 weeks and 8 weeks of onset, respectively. We present two cases with MRI and brief review of literatures.
Cerebral Infarction ; Magnetic Resonance Imaging ; Weather*

The airway management of patients with subglottic stenosis poses many challenges for the anesthesiologists. Many anesthesiologists use a narrow endotracheal tube for airway control. This, however, can lead to complications such as tracheal mucosal trauma, tracheal perforation or bleeding. The ASA difficult airway algorithm recommends the use of supraglottic airway devices in a failed intubation/ventilation scenario. In this report, we present a case of failed intubation in a patient with subglottic stenosis successfully managed during an i-gel(TM) supraglottic airway device. The device provided a good seal, and allowed for controlled mechanical ventilation with acceptable peak pressures while the patient was in the beach-chair position.
Airway Management ; Constriction, Pathologic ; Hemorrhage ; Humans ; Intubation ; Respiration, Artificial