M-mode, pulsed Doppler and Doppler color flow mapping, in addition to two-dimensional echocardiography, have greatly improved imaging of the fetal heart through identification of abnormal cardiac anatomy and rhythm in utero. The early detection of cardiac disturbance in utero permits alteration in obstetric management such as delivery in a high-risk center for optimal neonatal care and/or decision in optimal delivery time. We report two cases of the neonatal arrhy-thmia which were observed by fetal echocardiography. In the first case, female baby showed neonatal arrhythmias including tachycardia and brady-cardia until 3 days after birth, and then turned to bradyarrhythmia due to non-conducted atrial bigeminy. These events lead us to review the fetal echocardiographs of the patient carefully. Premature atrial contractions were observed in her fetal echocardiography. At 2 months after birth, the patient's electrocardiogram showed normal sinus rhythm. Severe neonatal bradycardia of the second case was due to congenital complete heart block, identified clearly by electrocardiogram after birth. This case also showed complete heart block in her fetal echocardiography. After insertion of the temporary pacemaker, cardiomegaly was improved. Both the neonate and the mother had positive anti-SSA/Ro autoantibody. But any other symptoms and signs of neonatal lupus did not appear in the neonate. Patient's mother also did not show any symptoms and signs of systemic lupus erythematosus. Since the prognosis depends upon the cause of bradyarrhythmia in fetus and neonates, differential diagnosis is important in obstetric management and optimal neonatal treatment.
Arrhythmias, Cardiac* ; Atrial Premature Complexes ; Bradycardia ; Cardiomegaly ; Diagnosis, Differential ; Echocardiography* ; Electrocardiography ; Female ; Fetal Heart ; Fetus ; Heart Block ; Humans ; Infant, Newborn ; Lupus Erythematosus, Systemic ; Mothers ; Parturition ; Prognosis ; Tachycardia

No abstract available.

No abstract available.
Fatigue* ; Sciatica*

We report a case of cerebral lymphomatoid granulomatosis in a 50-year-old man. Lymphomatoid granulomatosis is an unusual condition which usually presents as a pulmonary manifestation, which occasionally affects the brain, and causes focal inflammatory lesions. Primary cerebral lymphomatoid granulomatosis is very rare. We describe a case of lymphomatoid granulomatosis in the left frontal lobe without pulmonary involvement.
Brain ; Frontal Lobe* ; Humans ; Lymphomatoid Granulomatosis* ; Middle Aged

We present a study on the systemic insults in the early death(within one week) after head injury. The patient population consisted of 192 patients who were admitted to the Soonchunhyang University Chonan Hospital from August 1986 to May 1990 after head injury. We collected clinical features and systemic insults including blood pressure, arterial pH, PaO2, PaCO2, hematocrit, and serum concentration of Na, retrospectively. The most common cause of injury was road traffic accident(77.6%). More than half(57.8%) were under the age of 40 years. The interval from injury to admission was within one hour in 63.2%, and within four hours in 91.4%. The mean interval was 1.8 hours. However, in 154(80.2%) patients, we found the evidence of systemic insults on admission. We found hypotension(ststolic less than 90mmHg) in 22.9%, acidemia(pH<7.35) in 71.3%, arterial hypoxemia(PaO2<60mmHg) in 42.7%, hypercarbia(PaCO2>45mmHg) in 28.7%, anemia(hematocrit<30%) in 13.0%, hyponatremia(Na<135mEq/L) in 10.7%, and hypernatremia(Na>145mEq/L) in 11.2%. These results imply that the prehospital emergency care system useful at the scene of accident and during the transportation is more important than the simple quick-transport-system.
Arterial Pressure ; Chungcheongnam-do ; Craniocerebral Trauma* ; Emergency Medical Services ; Head* ; Hematocrit ; Humans ; Hydrogen-Ion Concentration ; Retrospective Studies ; Transportation

A retrospective study of 90 cases of small-sized (less than 3 mm on the printed CT film) acute (within 24 hours) subdural hematoma (SASDH) is presented. From March 1985 to December 1986, the SASDH were immediately operated on (operation rate: 86.0%). From January 1988 to December 1989, we attempted to treat them conservatively (operation rate: 49.1%). The patient population for this study consisted of 38 surgically-treated patients in the first period (Group I), 26 surgically-treated patients in the second period (Group IIs), and 26 conservatively-treated patients in the second period (Group IIc). We compared the clinical features, radiologic findings, and outcome of these 3 groups. The clinical features of Group I, including age, sex, Glasgow Coma Scale (GCS) score on admission, pupillary status on arrival, and interval from injury to the CT, did not differ significantly from those of Group II (P greater than 0.01). The only difference was the timing of the operation. In Group I, 20 patients (52.6%) received an operation within 4 hours, while in Group IIs, only 7 patients (26.9%) underwent surgery within 4 hours (P less than 0.05). The radiologic findings of Group I, including the thickness and volume of the hematoma, the degree of midline shift, and the frequency of skull fracture, also did not differ from those of Group II (P greater than 0.1). However, the outcome of Group II strikingly differed from that of Group I. The mortality rate was 76.3% in Group I, while it was 44.2% in Group II (P less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
Acute Disease ; Adult ; Female ; Glasgow Coma Scale ; Hematoma, Subdural/mortality/pathology/radiography/*therapy ; Humans ; Male ; Time Factors ; Treatment Outcome

Our objective was to evaluate the clinical feasibility of spatial domain filtering as an alternative to additional image reconstruction using different kernels in CT. Kernels were grouped as H30 (head medium smooth), B30 (body medium smooth), S80 (special) and U95 (ultra sharp). Derived from thin collimated source images, four sets of images were generated using phantom kernels. MTF (50%, 10%, 2%) measured with H30 (3.25, 5.68, 7.45 lp/cm), B30 (3.84, 6.25, 7.72 lp/cm), S80 (4.69, 9.49, 12.34 lp/cm), and U95 (14.19, 20.31, 24.67 lp/cm). Spatial resolution for the U95 kernel (0.6 mm) was 33.3% greater than that of the H30 and B30 (0.8 mm) kernels. Initially scanned kernels images were rated for subjective image quality, using a five-point scale. Image scanned with a convolution kernel led to an increase in noise (U95), whereas the results for CT attenuation coefficient were comparable. CT images increase the diagnostic accuracy in head (H30), abdomen (B30), temporal bone and lung (U95) kernels may be controlled by adjusting CT various algorithms, which should be adjusted to take into account the kernels of the CT undergoing the examination.
Abdomen ; Head ; Image Processing, Computer-Assisted ; Lung ; Noise ; Temporal Bone

Recurrent alternating stroke, i.e., one time ischemic and the other hemorrhagic or vice versa, is an uncommon event. We report a series of eight patients who had recurrent alternating strokes, which were diagnosed by CT scans during the last four years. Infarcts preceded hemorrhage in six patients. In the remaining two patients, hemorrhage developed first and infarct followed. All ischemic strokes were the lacunar infarcts. The lesions of the two attacks were located in different sites in all cases except one. The mean age of the patients was 56.6 years at the time of the first attack and 57.5 years at the time of the second. The mean interval between attacks was 11.8 months. All patients were hypertensive on admission. After the first attack, the outcome was favorable in all patients. However, after the second attack the outcome deteriorated to moderate disability in three, severe disability in one and death in four. We discuss some possible reasons for the rarity of recurrent alternating stroke.
Brain Ischemia/*complications ; Cerebral Hemorrhage/*complications ; Cerebrovascular Disorders/*radionuclide imaging ; Female ; Humans ; Hypertension/complications/radionuclide imaging ; Male ; Middle Aged ; Prognosis ; Recurrence ; Tomography, X-Ray Computed

No abstract available.
Lung*

Recent advent of 64-multidetctor (MD) CT enables more coverage of Z-axis in the perfusion imaging. The purpose of this study was to evaluate the clinical usefulness of perfusion CT by using 64-MD CT in detecting the lesion in patients with acute stroke. The perfusion CT was performed by using 64-MD CT in 62 consecutive patients who were initially suspected to have subacute ischemic stroke symptoms during the period of recent 9 months. These patients had subacute stroke (n=62). CT scanning was conducted with Jog Mode which provided 16 imaging slices with 5 mm of slice thickness, and 8 cm of coverage in Z-axis. Scan interval was 1 seconds for each imaging slice and total 15 scans were repeated. After CT scanning, perfusion maps (CBV, CBF, MTT and TTP) were created at Extended Brilliance Workstation. The CBV and CBF maps showed that lesions were smaller images. While on the MTT and TTP map lesions were seen to be larger fifty-one were large than they appeared on these images. Two slices of perfusion maps obtained at the level of the basal ganglia were chosen to simulate conventional older perfusion CT with 8 cm of coverage in Z-axis. TTP and MTT maps may be clinically useful for evaluation of the penumbral zone in cases of aubacute cerebral ischemic stroke. The perfusion CT is useful in the assessment of acute stroke as an initial imaging modality.
Basal Ganglia ; Humans ; Perfusion Imaging ; Perfusion* ; Stroke* ; Tomography, X-Ray Computed