Metaphyseal cysts are common findings in Legg-Calv Perthes(LCP) disease, though usually disappear within 6-12 months. Several studies have described the MR imaging findings of these cysts, though serial MRI findings have not been documented. In this report, therefore, we report the serial MRI results of metaphyseal cyst in LCP patients.
Humans ; Magnetic Resonance Imaging

PURPOSE: To determine the prevalence and characteristics of the hypoechoic halo sign in peripheral cholangiocarcinoma. MATERIALS AND METHODS: Seventeen sonograms of 17 patients with peripheral cholangiocarcinoma histologically proven by either percutaneous needle biopsy (n=16) or surgical biopsy (n=1) were retrospectively reviewed. The size, margin, homogeneity and internal echogenicity of the masses as well as their peritumoral ductal dilatation and intratumoral calcification were ascertained, and the presence of a hypoechoic halo, and if present, its thickness and type, were also determined. We arbitrarily defined a 'thin' and 'thick' halo respectively, as one with a thickness less than of less than 3 mm, and 3 mm or more, and classified halos as 'intratumoral', 'extratumoral', or 'mixed'. RESULTS: Tumor diameter ranged from 4 to 13.5 (mean, 7.3) cm, and the margin was well-defined in 15 cases (smooth: n=2; lobulated: n=13) and irregular in two. Echogenicity was slightly heterogeneous in 11 cases, severely heterogeneous in three, and homogeneous in three, while the central portion was hyperechoic in eight cases, isoechoic in seven, and hypoechoic in only two. A hypoechoic halo was detected in 10 of 15 tumors(67%) with isoechoic centers. In evaluating the halo, two cases in which the mass was hypoechoic were excluded. All ten hypoechoic halos were at least 3 (range, 4-13; mean, 8.3) mm thick; in two cases the presence of a halo was equivocal, and in three there was no halo. Eight of ten halos were the mixed type, two were intratumoral, and none were extratumoral. Peritumoral ductal dilatation was seen in four cases (24%), but no internal calcification was observed. CONCLUSION: US showed that the margins of peripheral cholangiocarcinomas were mostly well-defined and smooth (12%) or lobulated (76%), and that masses were mainly heterogeneous (64%). A hypoechoic halo, which in all cases was thick and in 80% of cases was mixed, was noted in 67% of tumors with a hyper (47%) or isoechoic (41%) center. A halo of this kind may be useful in isoechoic mass detection and also in the differentiation of hyperechoic peripheral cholangiocarcinoma from hepatic hemangioma, the most common hyperechoic benign tumor.
Biopsy ; Biopsy, Needle ; Cholangiocarcinoma* ; Dilatation ; Hemangioma ; Humans ; Prevalence ; Retrospective Studies

PURPOSE: The purpose of this study was to identified the male nurses' encounter in adapting themselves in the hospital settings dominated by the female nurses in number. METHOD: Data were collected through the in-depth interview of 16 male nurses and analysed through the grounded theory methodology. RESULT: The behaviors of male nurses for job-adaptation can be summarized as a series of struggles to consolidate their own ground. They have made tremendous efforts to hold their own ground in the nursing profession composed of a large numbers of female nurses, while they have experienced many difficulties and problems as minorities. They have struggled to adapt themselves professionally through efforts such as; challenging the social and professional barriers, identifying the job identity, empowering themselves through self-development and dedication, expanding their influence among colleagues. In spite of these efforts, they had the perception that nursing is not a lifelong occupation for them. Thus, they had tendency to find outlets of change to occupations. CONCLUSION: A specific strategy is needed to provide an environment that is helpful for males in integrating into and adapting to the nursing profession.

PURPOSE: This study aimed at uncovering the experience of adaptation of the new nursing staff in hospital setting. METHODS: For this study, 15 new graduate nurses participated. The data was collected through the in-dept interviews and analysed in terms of Strauss and Corbin's grounded theory methodology. RESULTS: The core category was identified with "entering orbit". The new graduate nurses, who experienced the taeoom because of their unskilled professions, tried to enter orbit by overcoming difficult situations through reducing stress, maintaining good interpersonal relationship, grasping, compensating, persisting, and introspecting. Noticeably, in the process of adaptation, negative image of nursing, conflict of interpersonal relationship and the educational program for the new nursing staff had effect on the intervening factors. Finally, this study confirmed that the processes of new nurses' adaptation are confusing, confrontating, becoming a member and settling in hospital setting. CONCLUSION: Therefore, the educational programs reflecting new nursing staffs' experiences should be developed.
Hand Strength ; Humans ; Nursing Staff* ; Nursing* ; Orbit

PURPOSE: To determine the metaphyseal changes occurring in Legg-Calve-Perthes(LCP) disease using MRI. MATERIALS AND METHODS: Between 1992 to 1999, 80 LCP patients (87 hips) underwent MR imaging and plain radiography. All MR images were reviewed, bone marrow signal intensity, the size and location of the metaphyseal cyst and its epiphyseal necrosis grade determined. RESULTS: Metaphyses were abnormal in 43hips (49%), while bone marrow edema was present in 28 (32%) and a metaphyseal cyst in 30 (34%). Metaphyseal cysts were classified as either 'true' (n=9) or 'false' (n=21) according to the enhancement pattern. The maximum diameters of true and false cysts were 1.1+/-0.3 cm and 1.1+/-0.4 cm, respectively. Their most commom location was the anterior column; a true cyst occurred there in 7cases (78%), and false cyst in 16 (76%). Using the Waldenstrom classification, seven of the nine hips wih a true cyst (78%), were found to be at the avascular stage and 15 of the 21 with a false cyst (71%) were at the fragmentation stage. Seven of these nine (78%) and 19 of these 21 (90%) were Catterall grade IV. CONCLUSION: According to the findings of MR imaging, the metaphyseal changes occurring in LCP disease were bone marrow edema and metaphyseal cyst. This latter was visualized mainly in the anterior column and severely affected hip, and was classified as 'true' or 'false'.
Bone Marrow ; Classification ; Edema ; Hip ; Humans ; Legg-Calve-Perthes Disease* ; Magnetic Resonance Imaging ; Necrosis ; Radiography

PURPOSE: To report three various cases of retinal hemorrhages caused by Plasmodium vivax malaria. CASE SUMMARY: Two 55-year-old male patients and a 52-year-old male patient with cyclic high fever were admitted to the department of internal medicine. Three of the patients were diagnosed with malaria caused by P. vivax based on a peripheral blood smear. The patients were treated with hydroxychloroquine and premaquine but complained of decreased visual acuity. The patients were examined with funduscopy, fluorescein angiography, and optical coherence tomography. The first case showed 2 areas of retinal hemorrhages on the macular in the right eye and 1 area of retinal hemorrhage in the left eye. The second case showed many cotton-wool spots along with a number of small retinal hemorrhages and tortuous blood vessels in both eyes. The third case showed 1 area of retinal hemorrhage in the right eye and many cotton-wool spots in both eyes. CONCLUSIONS: P. vivax malaria rarely causes retinal hemorrhage. Manifestations of retinal hemorrhage and degree of visual acuity loss may vary among patients. P. vivax malaria should be considered when patients with unexplained high fever present with retinal hemorrhage, even without a history of overseas travel.
Blood Vessels ; Eye ; Fever ; Fluorescein Angiography ; Humans ; Hydroxychloroquine ; Internal Medicine ; Malaria ; Malaria, Vivax ; Male ; Middle Aged ; Plasmodium ; Plasmodium vivax ; Retinal Hemorrhage ; Retinaldehyde ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: Intravaginal slingplasty(IVS) is a alternative technique in the treatment of stress urinary incontinence in women. The author reports the long-term results of IVS procedure and compares to the long-term results of tension-free vaginal tape(TVT) procedure. MATERIALS AND METHODS: 25 women treated with IVS were compared to 25 women treated with TVT. The follow up period of all patients was mean of 30 months. All patients were preoperatively evaluated with detailed history, physical exam, 1 hour pad test and urodynamic study. Operation was carried out under general anesthesia. Operation time, hospitalization time, perioperative complication, cure rate and long-term follow-up data were evaluated. Long-term follow-up data was obtained from questionnaires on whether or not continuation of stress incontinence and subjective satisfaction. RESULTS: Two groups were similar in their mean ages, body mass index and mean parities. No patient demonstrated uninhibited detrusor contraction in cystometry. Mean operation time were 29.4 minutes(20~40), 31.6 minutes(25~40), and mean hopitalized duration were 3.3 days, 4.0 days for IVS and TVT, respectively. Perioperative bladder injury were 0 case(0%) and 2 cases(8%) and hemoglobin decrease were 1.5 gm/dl and 1.7 gm/dl for IVS and TVT, respectively. Vaginal erosion and infection were 1 case(4%) and 0 cases(0%) for IVS and TVT, respectively. Objectively, 3 months postoperative cured/improved/failed rates were 88%/12%/0%, 84%/16%/0% for IVS and TVT, long-term follow-up cured/improved/failed rates were 76%/20%/4%, 80%/12%/8% for IVS and TVT, respectively. Subjective satisfaction rates with the procedure were 80% and 88%, respectively. CONCLUSION: Both procedures had equally high rate of long-term cure, satisfaction and perioperative complication in the surgical treatment of stress urinary incontinence. IVS is simple, safe and effective treatment.
Anesthesia, General ; Body Mass Index ; Female* ; Follow-Up Studies* ; Hospitalization ; Humans ; Surveys and Questionnaires ; Surgical Mesh ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urodynamics

BACKGROUND: Although nucleotides -like Adenosine Triphosphate (ATP) and its derivatives Adenosine, were known to induce growth inhibition and apoptosis in diverse cell lines, little is known about their effects on trophoblast. OBJECTIVE: To elucidate the effects of extracellular ATP and adenosine on trophoblast cell growth and to delineate if apoptosis is involved in this mechanism. MATERIALS AND METHODS: We used TL cell line, derived from human term placenta. The cells were cultured for 24, 48, and 72 hours after being treated with ATP and adenosine, each. Also, cell growth according to different concentrations of ATP and adenosine was evaluated. To test whether apoptosis was induced by each nucleotide, DNA fragmentation and nuclear condensation by Hoechst 33258 stain and P53 protein expression were evaluated. RESULTS: Cell growth was inhibited by ATP and adenosine in time and dose-dependent manner. Furthermore, the growth inhibitory effect of adenosine was stronger than ATP, whereas signs of DNA fragmentation and nuclear condensation were observed in ATP treated cells, but not in adenosine treated ones. CONCLUSION: Our results shows that ATP and adenosine exert inhibitory effect on growth in TL cell line. These findings suggest that pathological production of ATP or its metabolites, adenosine, may lead to a pathologic status such as preeclampsia or intrauterine growth restriction.
Adenosine Triphosphate* ; Adenosine* ; Apoptosis* ; Bisbenzimidazole ; Cell Line* ; DNA Fragmentation ; Humans* ; Nucleotides ; Placenta ; Pre-Eclampsia ; Trophoblasts

BACKGROUND AND AIMS: Endoscopic stent placement has become accepted palliative therapy for malignant biliary tract obstruction (MBTO). The main problem of plastic stent are the clogging or migration. The new self expandable super-elastic metallic coil stent (Endo-coilTM, Instent Inc.) is claimed to allow large lumen and prolong biliary-stent patency. In a prospective randomised trial, we compared the efficacy and frequency of stent dysfunction of EndocoilTMand plastic stent (PercuflexR, Microvasive Co.). METHOD: Between Aug. 1994 and Mar. 1995, we assigned 29 patients (21 males and 8 females, mean age 63 years) with unresectable MBTO due to cancer of bile duct (17), pancreas (6) periampullary (3), gallbladder (2) and perichoedochal LN (1). Thirteen of patients under-went EndocoilTMstents (24 Fr) and other 16 patients underwent plastic stents (12 Fr) insertion via transpapillary route. Successful insertion of stents was attained all cases and no serious complication occured. RESULTS: All patients with EndocoilTM stents and 11 (68%) patients with plastic stents were relieved completely from jaundice (T. bilirubon <3.0 mg/dl). There was no differences in decreasement of bilirubin between two groups after 7 days and 30 days after stents insertion. Median patency of the stents was significantly prolonged in patients with EndocoilTM stents compared with those with plastic stents(205 days vs 92 days). The stent dysfunction was noted 2 cases (15%) in EndocoilTM due to tumor ingrowth. In contrast, stent dysfunction was occured in 10 cases (62%) of plastic stents due to clogging (7 cases) and migration (3 cases). The patients' overall median survival was not different significantly between two groups (EndocoilTM250 days vs plastic 196 days). CONCLUSIONS: Both ndocoilTMand plastic stents offer effective bile drainage in MBTO. However EndocoilTM stents may be more effective for providing longer periods of drainage due to lower frequency of stent dysfuction than plastic stents.
Bile ; Bile Duct Neoplasms ; Biliary Tract* ; Bilirubin ; Drainage ; Female ; Gallbladder ; Humans ; Jaundice ; Male ; Palliative Care ; Pancreas ; Plastics* ; Prospective Studies ; Stents*

Cortical lesions of the supplementary motor area (SMA) are important in balance control and postural recovery in stroke patients, while the role of subcortical lesions of the SMA has not been studied. This study aimed to investigate the subcortical projections of the SMA and its relationship with ataxia in supratentorial stroke patients. Thirty-three patients with hemiparesis were divided into 3 groups (severe ataxia, n = 9; mild to moderate ataxia, n = 13; no ataxia, n = 11). Ataxia severity was assessed using the Scale for Ataxia Rating Assessment. Diffusion tensor imaging analysis used the fractional anisotropy (FA) values and tract volume as parameters of white matter tract degeneration. The FA values of regions related to ataxia were analyzed, that is the SMA, posterior limb of the internal capsule, basal ganglia, superior cerebellar peduncle, middle cerebellar peduncle, inferior cerebellar peduncle, and cerebellum. Tract volumes of the corticostriatal tract and cortico-ponto-cerebellar (CPC) tract originating from the SMA were evaluated. There were significant differences among the 3 groups in FA values of the subcortical regions of the CPC tract. Furthermore, the volume of the CPC tract originating from the SMA showed significant negative correlation with ataxia severity. There was no correlation between ataxia and corticostriatal tract volume. Therefore, we found that subcortical lesions of the CPC tract originating from the SMA could contribute to ataxia severity in stroke patients with ataxic hemiparesis.