PURPOSE: To determine the incidence of avascular necrosis (AVN) of the femoral head after renal transplantation, evaluate plain radiographic and MR findings, and compare known predisposing factors between the AVN group and the control group. MATERIALS AND METHODS: Between August 1990 and June 1998, 256 renal transplantations were carried out at the Maryknoll hospital. The incidence of AVN was determined clinically, and in the AVN group, plain radiographic and MR findings were evaluated. A control group of 29 cases was randomly selected from among the remaining 241 patients, and acute rejection, mean daily steroid dose and osteopenia were compared between the AVN group and the control group. RESULTS: The incidence of AVN of the femoral head was 5.9 %(15/256). Involvement was bilateral in nine cases and unilateral in six and 24 femoral heads were thus affected. The mean period required for diagnosis of this condition was 10.7 months(within 6 months: 2 hips, between 6 -12 months: 10, between 12 -24 months: 9, over 24 months: 3). Plain radiographs showed that three cases were Ficat stage I, five were stage II, seven were stage III, and nine were stage IV. MRI indicated that 15 cases were Mitchell class A, one was class C, and three were class D. Correlation between Ficat stage and the period required for diagnosis showed that the longer the latter, the higher the Ficat stage. A comparison of risk factors between the AVN group and the control group showed that the incidence of acute rejection and osteopenia, and the mean daily steroid dose, were higher in the AVN group than in the rejection group and that the difference was statistically significant. CONCLUSION: The incidence of AVN of the femoral head after renal transplantation was 5.9 %. The longer the period required for diagnosis of AVN, the higher the Ficat stage. A comparison of risk factors between the AVN group and the rejection group showed that the incidence of acute rejection and osteopenia as well as the mean daily steroid dose, were higher in the AVN group than in the rejection group, and these may thus be pre-disposing factors for AVN. In patients with these risk factors, even though plain radiographic findings are normal, MRI is necessary if AVN is to be diagnosed during its early stages.
Bone Diseases, Metabolic ; Causality ; Diagnosis ; Head* ; Hip ; Humans ; Incidence ; Kidney Transplantation* ; Magnetic Resonance Imaging ; Necrosis* ; Risk Factors

Angiolipomas are usually found in the soft tissues of the extremity, trunk, or neck. Spinal angiolipomas are rare, accounting for between 0.14% and 1.2% of spinal axis tumors, and the majority are extradural. We report a case of surgically proven extradural spinal angiolipoma with a high vascular content and involving the thoracic level.
Angiolipoma* ; Axis, Cervical Vertebra ; Extremities ; Neck

PURPOSE: To evaluate the usefulness of stereoscopic localization of nonpalpable breast lesions. MATERIALS AND METHODS: The authors retrospectively analyzed 60 cases of stereotactic localization performed for lesions whichwere mammographically visible but not palpable. Each case was reviewed for chief complaint, indication oflocalization on a mammograph, location of the lesion, pathological diagnosis, and complications during and afterthe procedure. RESULTS: Most patients(75%) had no specific complaint. Among the 60 cases, microcalcification,mass and combined lesions were found in 34(57%), 12(20%), and 14 cases(23%), respectively. The most commonlocation of the lesion was the upper outer quadrant(29 cases). A histopathologic report was available in 56 of 60cases. Among 43 benign cases(76.8%), fibrocystic disease was most common(38 cases, 67.9%), while among 13malignant cases, ductal carcinoma was most common(9 cases, 16.1%). In four of 56 cases(7.1%), failure to removethe target lesion was identified. Retrospective analysis suggests that movement of the patient during theprocedure is the most likely cause of failure. There were no major complications. CONCLUSION: Stereotacticlocalization is simple and accurate, and compared with the conventional method, requires less experience on thepart of the practitioner. Movement of the patient during the procedure may be the major cause of failure.
Breast* ; Carcinoma, Ductal ; Diagnosis ; Humans ; Retrospective Studies

Neonatal Hemangioendothelioma (HE) is the most common type of hepatic vascular tumor that presents in infancy. HE generally undergo spontaneous regression within a year, but it may become symptomatic and be associated with life-threatening complications including congestive heart failure, consumptive coagulopathy and hepatic rupture. We report five cases of neonatal hepatic HE with brief review of the literatures. The report include a case of HE associated with AV malformation complicated by congestive heart failure who was successfully treated by hepatic artery embolization, a case of HE associated with transposition of great artery (TGA), and three cases of asymptomatic HE with spontaneous involution.
Arteries ; Heart Failure ; Hemangioendothelioma* ; Hepatic Artery ; Rupture

Purpose: Pulsed magnetic technology has been developed for pelvic floor muscle strengthening in the treatment of stress urinary incontinence (SUI). This report includes a prospective multi-center study of pelvic floor magnetic stimulation (PMS) for SUI. Materials and Methods: Sixty-four women, with demonstrable SUI, were studied. Fifty-six completed the PMS therapy and were available for analyzed. Evaluations, both before and 6 weeks after treatment included bladder diaries, 1-hour pad weight test, perineometry and a quality-of-life survey. For the treatments the patients were seated, fully clothed, in a PMS system, with a magnetic field therapy head in the seat. The treatment sessions were for 20 minutes, twice a week, for 6 weeks. To compare the results, the patients were divided into pure SUI and mixed urinary incontinence groups. Results: Of the 56 patients, 13 were completely dry (23.2%). The mean weight of the used pad was reduced from 15.26 to 2g (p<0.01) after the PMS. The frequency of leak episodes was reduced from 2.04 to 0.94/day (p<0.001), and the number of micturition from 8.35 to 7.19/day, following the treatment (p<0.001). The number of frequent micturition (>8 times/day) was also reduced from 10.55 to 8.14/day following the treatment (p<0.001). The pressure of the pelvic muscle contractions increased from 30.3 to 36.95cmH2O (p<0.001). Forty-five patients (80.35%) were satisfied with the results of the PMS. At the baseline, the number of incontinence episodes, weight of used pads and pressure of the pelvic muscle contractions were significantly higher in the mixed incontinence (n=17) than in the pure SUI (n=39) group. There were no differences in the treatment results between the pure SUI and mixed urinary incontinence groups. No adverse events were reported during the study period. Conclusions: PMS therapy is effective for both stress and mixed urinary incontinence. A longer follow-up will be required to determine how long the benefits of treatment last, and whether retreatment will be required.
Female* ; Follow-Up Studies ; Head ; Humans ; Magnetic Field Therapy* ; Muscle Contraction ; Pelvic Floor* ; Prospective Studies ; Retreatment ; Urinary Bladder ; Urinary Incontinence* ; Urination

No abstract available.
Tuberculosis, Meningeal*

Background: Cyclosporine (CS) is widely used in various dermatological diseases, and its range of usage has been expanded to younger patients. However, data on the safety of CS in children and adolescents are limited. Objective: This study aimed to investigate the adverse events and safety of CS in pediatric and adolescent patients with dermatologic diseases. Methods: This retrospective study included 992 pediatric patients (≥12 and ＜19 years of age) having administered oral CS for dermatological reasons between 2010 and 2021. Results: Among the 992 patients, 57 (5.7%) reported adverse events at the clinic. Gastrointestinal symptoms were the most common adverse events (2.6%). Other adverse events included hypertrichosis (1.4%) and headaches (0.6%). During subgroup analysis, hypertrichosis was found more frequently in pediatric patients (age ＜12 years), and the cumulative dose of CS was higher (≥420 mg/kg). Of the 150 patients who underwent laboratory tests, 28 (18.7%) showed abnormal results, including an increase in serum creatinine (8.0%), hypercholesterolemia (6.7%), and urea (2.7%). Conclusion The use of CS in pediatric dermatoses resulted in a low frequency of adverse events, and all the patients showed reversible courses without serious complications. The study suggest that dermatologists should safely administer oral CS with detailed history taking and periodic laboratory tests.

PURPOSE: The purpose of this study was to determine, using in vivo and in vitro 1H MRS (MR spectroscopy), the characteristic biochemical metabolites related with breast cancer, and to assess the clinical usefulness and limitations of this modality. MATERIALS AND METHODS: For in vivo 1H MRS, nine patients with breast cancer and two normal volunteers were examined on a 1.5 T MR imager equipped with facilities for spectroscopy. In order to localize the breast lesion, axial and sagittal T1-weighted images and fat-suppressed T2-weighted images were obtained just prior to MRS; MR spectra were acquired at TR=3000 msec and TE=144 msec. For in vitro 1H MRS, breast tumor and adja-cent normal tissue were extracted from 13 patients with breast cancer, and in two of these, both in vivo and in vitro 1H MRS were performed. All in vitro 1H MRS specimens were immediately immersed in liquid nitrogen, and then in a preparation of perchloric acid. For quantitative analysis of the MR spectra of cancerous and normal breast tissue, the paired t-test was used (p < 0.05). RESULTS: At1H MRS in vivo, choline and two lipids were identified at 3.21 ppm, and 1.33 ppm and 0.9 ppm, re-spectively. The distinction between cancerous and normal breast tissue was based on the higher level of choline (3.21 ppm) present in the former. At 1H MRS in vitro, on the other hand, mean and standard deviation (% standard deviation) for the various metabolites in cancerous and normal breast tissue were as follows: choline, 30.195 +/- 2.448(8.108) and 22.648 +/- 1.938(8.556); trimethylamine, 3.425 +/- 0.335(9.769) and 0.640 +/- 0.066(10.325); sarcosine, 3.425 +/- 0.335(9.769) and 0.640 +/- 0.099(15.394); lactate, 16.388 +/- 1.134(6.922) and 9.715 +/- 0.385(3.965); inositol, 1.970 +/- 0.282(14.334) and 3.859 +/- 0.502(13.020); and taurine, 6.614 +/- 0.556(8.412) and 10.748 +/- 1.206(11.222). High levels of choline (p=0.026), trimethylamine (p=0.001), sarco-sine (p=0.009), and lactate (p=0.009), and lower levels of inositol (p=0.006) and taurine (p=0.008) were char-acteristic findings in cancerous as compared with normal breast tissue, with significantly different results. CONCLUSION: 1H MRS both in vitro and in vivo showed that increased choline levels were present in cancerous breast tissue, but that normal tissue does not contain choline. The presence of choline could therefore be used as a marker for malignancy in breast lesions. Information provided by in vitro 1H MRS, together with the development of in vivo 1H MRS with high field strength and high resolution, may be very useful for the diagnosis of breast cancer.
Breast Neoplasms* ; Breast* ; Choline ; Diagnosis ; Hand ; Healthy Volunteers ; Humans* ; Inositol ; Lactic Acid ; Magnetic Resonance Spectroscopy* ; Nitrogen ; Sarcosine ; Spectrum Analysis ; Taurine

BACKGROUND: Prior studies of p16, p53, and Ki-67 expression have suggested that these markers may be preferentially expressed in cervical neoplasms. The purpose of this study was to assess the expression and clinical significance of p16, p53 proteins, and the Ki-67 labeling index in the cervical lesions. METHODS: We analyzed 54 uterine cervical specimens obtained by surgical biopsy. The expression of p16, p53 proteins, and Ki-67 was evaluated by immunohistochemical methods. The immunohistochemical findings were then correlated with the histologic diagnosis. RESULTS: Positive scores for p16, p53, and Ki-67 were seen in 75% (6/8), 0% (0/8), and 13% (1/8) of low grade intraepithelial lesions (LSIL), respectively, and 100% (23/23), 17% (4/23), and 74% (17/23) of high grade intraepithelial lesions (HSIL), respectively, and 100% (10/10), 20% (2/10), and 70% (7/10) of invasive squamous cell carcinomas, respectively. Both normal epithelium and inflammatory lesions scored negative for these three markers in all of the 13 cases. p16 and Ki-67 expression correlated with the severity of uterine cervix lesions. CONCLUSIONS: p16 and Ki-67 are complementary surrogate biomarkers for cervical squamous intraepithelial neoplasia. However, immunohistochemical expression for p53 has no correlation with the grade of cervical squamous intraepithelial neoplasia.
Biomarkers ; Biopsy ; Carcinoma, Squamous Cell ; Cervix Uteri* ; Diagnosis ; Epithelium ; Female ; Immunohistochemistry ; Uterine Cervical Neoplasms