PURPOSE: The purpose of this study is to assess the clinical utility of multiplanar reformation images of helical CT in the evaluation of pancreatic diseases. MATERIALS AND METHODS: Helical CT scans of the pancreas were obtained in 30 patients with pancreatic diseases. Helical CT was performed with 5mm collimation at 5mm/sec table speed during rapid injection of intravenous contrast agent using power injector. After scanning, helical volume data were reconstructed at 2mm interval and then multiplanar reformation of the pancreas and adjacent structures was done. In both prospective reconstructed axial images and multiplanar reformation images, detection of pancreatic lesion, extent of lesion, and vascular and bile ductal changes were analyzed with a grading system of 1,2, 3. RESULTS: The mean grade of detection of pancreatic lesions was 2.37 in the prospective axial image and 2.83 in multiplanar reformation image, extent of diseases was 2.40 in prospective axial image and 2.97 in multiplanar reformation image, and vascular and bile ductal changes was 2.00 in the prospective axial image and 2.97 in multiplanar reformation image. All the differences were statistically significant (P<0.0001). CONCLUSION: Multiplanar reformation images of helical CT are useful in the evaluation of pancreatic diseases and especially in the demonstratibn of complex anatomic relationships between the pancreas and surrounding structures.
Bile Ducts ; Humans ; Pancreas ; Pancreatic Diseases* ; Prospective Studies ; Tomography, Spiral Computed*

PURPOSE: To evaluate characteristic MR findings of craniocerebral anomaly and its relationship with neurologic manifestations. MATERIALS AND METHODS: We retrospectively reviewed MR images of 36 patients with craniocerebral anomaly diagnosed by MRI and clinical courses. We correlated the characteristic MR findings in 41 lesions with neurologic manifestastions focusing on seizures and developmental delay. RESULTS: Twenty-three patients with seizures consisted of 14 patients(60%) with neuronal migration disorders and seven(30%) with phakomatosis, among which 18 patients(78%) had generalized type of seizures. Locations of the lesions were the parietal lobes in 11 patients(52%) and the subependymal or periventricular regions in seven(33%). Two patients with tuberous sclerosis had the lesions in both parietal and subependymal areas. Nine patients had the signs of developmental delay that were seen in the four(44%) with schizencephaly, two (22%) with tuberous sclerosis, two(22%) with heterotopia, and one(ll %) with pachygyria. CONCLUSION: Neuronal migration anomaly was relatively common lesion that presented neurologic manifestations such as seizures and developmental delay. Generalized type of seizures was common. We were able to diagnose these anomalies using the MRI that helped establish therapeutic plans.
Humans ; Lissencephaly ; Magnetic Resonance Imaging ; Malformations of Cortical Development ; Neurocutaneous Syndromes ; Neurologic Manifestations ; Neuronal Migration Disorders ; Neurons ; Parietal Lobe ; Rabeprazole ; Retrospective Studies ; Seizures* ; Tuberous Sclerosis

PURPOSE: To investigate the results of surgical treatment of the symptomatic accessory navicular in adolescent. MATERIALS AND METHODS: 11 patients who were 11~16 years old with symptomatic accessory navicular were identified between 2001 and 2009. Six cases were diagnosed after trauma and 8 cases were diagnosed by accident with painful bony protrusion on medial aspect of foot. In cases after at least 3 months of ineffective conservative treatment, patients were treated by resection of accessory navicular and reattachment of tibialis posterior tendon to the apex of the medial longitudinal arch using periosteum and ligamentous soft tissue without transposition of its course. And then short leg cast was applied for correction of the flat foot (if it is combined) which was molded into the longitudinal arch with the talonavicular joint released and foot inverted during about 6 weeks. RESULTS: All were type II accessory navicular without tibialis posterior tendon lesions. In most cases pain was improved, results were excellent in seven and good in four. Calcaneal pitch angle and talus-first metatarsal angle was improved about 4.64degrees and 5.79degrees in average. CONCLUSION: Symptomatic accessory navicular in adolescent might not be associated with the tibialis posterior tendon lesions. The surgical treatment composed of excision of the accessory navicular with simple replication of the tibialis posterior tendon without altering its course led to good results in most cases. The procedure has a low rate of complications. And it is easy to be performed with a good satisfaction.
Adolescent ; Flatfoot ; Foot ; Fungi ; Humans ; Joints ; Leg ; Ligaments ; Metatarsal Bones ; Periosteum ; Tendons

PURPOSE: To investigate the results of surgical treatment of the symptomatic accessory navicular in adolescent. MATERIALS AND METHODS: 11 patients who were 11~16 years old with symptomatic accessory navicular were identified between 2001 and 2009. Six cases were diagnosed after trauma and 8 cases were diagnosed by accident with painful bony protrusion on medial aspect of foot. In cases after at least 3 months of ineffective conservative treatment, patients were treated by resection of accessory navicular and reattachment of tibialis posterior tendon to the apex of the medial longitudinal arch using periosteum and ligamentous soft tissue without transposition of its course. And then short leg cast was applied for correction of the flat foot (if it is combined) which was molded into the longitudinal arch with the talonavicular joint released and foot inverted during about 6 weeks. RESULTS: All were type II accessory navicular without tibialis posterior tendon lesions. In most cases pain was improved, results were excellent in seven and good in four. Calcaneal pitch angle and talus-first metatarsal angle was improved about 4.64degrees and 5.79degrees in average. CONCLUSION: Symptomatic accessory navicular in adolescent might not be associated with the tibialis posterior tendon lesions. The surgical treatment composed of excision of the accessory navicular with simple replication of the tibialis posterior tendon without altering its course led to good results in most cases. The procedure has a low rate of complications. And it is easy to be performed with a good satisfaction.
Adolescent ; Flatfoot ; Foot ; Fungi ; Humans ; Joints ; Leg ; Ligaments ; Metatarsal Bones ; Periosteum ; Tendons

OBJECTS: We developed the Korean version of Hasegawa Dementia Scale(HDS-K) by translating the revised Hasegawa Dementia Scale(HDS-R) which is known to be a useful brief screening instrument for dementia. MATERIALS AND METHODS: The translation was carried out keeping the basic structure of Revised Hasegawa Dementia Scale(HDS-R). HDS-K, along with MMSE-KC, SBT-K and CDR, were administered to 174 dementia patients and 160 elderly control subjects. Cronbach alpha coefficient, inter-rator reliability, and test-retest reliability of HDS-K were examined. The correlations of MMSE-KC, SBT-K and CDR with HDS-K were also examined to confirm the validity of HDS-K. Cut-off scores for dementia were estimated by Receiver Operator Characteristic(ROC) curve anslyses. By comparing Area Under Curve(AUC), the diagnostic efficiency of HDS-K was compared with those of MMSE-KC and SBT-K. RESULTS: 1) HDS-K was found to have significantly high internal consistency(Cronbach alpha coefficient=0.948, <0.01), inter-rater reliability(Pearson correlation coefficient=0.999, <0.01) and test-retest reliability(Pearson correlation coefficient=0.848, <0.01). 2) All the correlations of HDS-K with MMSE-KC, SBT-K and CDR were significant indicating that HDS-K has good concurrent validity. Its optimal cut-off point for dementia was estimated as 15/16, where the sensitivity and specificity were 0.950 and 0.902, respectively. 3) The ROC curve analysis indicated that the diagnostic efficiency of HDS-K(AUC=0.972) was comparable with MMSE-KC(AUC=0.951) and SBT-K(AUC=0.963). CONCLUSION: We conclude that HDS-K is a reliable, valid, and useful screening instrument for dementia.
Aged ; Dementia* ; Humans ; Mass Screening* ; Reproducibility of Results* ; ROC Curve ; Sensitivity and Specificity ; Translating

OBJECTIVES: Entrapment of the suprascapular nerve is frequently overlooked in the differential diagnosis of shoulder pain. METHODS: Suprascapular entrapment neuropathy is a well-defined clinical entity and EMG and NCV is used to confirm a diagnosis. But the diagnosis is typically not considered until patients develop severe weakness secondary to atrophy of the spinous musculature that the nerve supplies. RESULTS: A narrow suprascapular notch has rarely been reported as a work-related factor of this entrapment neuropathy. Diagnosis of suprascapular entrapment neuropathy is based on the patients' clinical course, neurologic, radiologic, and electrophysiologic findings. One of the most helpful evaluations was the anteriorposterior projection with the X-ray tube angled 15-30 degree caudally. The suprascapular entrapment neuropathy is relatively uncommon entity of shoulder discomfort (pain, weakness, and atrophy). CONCLUSIONS: If the worker who used his shoulder joint repetitiously having the shoulder pain and muscle weakness, we must rule out the suprascapular entrapment neuropathy. And it is needed to evaluate the motions which cause suprascapular entrapment neuropathy as the ergonomic factor.
Atrophy ; Diagnosis ; Diagnosis, Differential ; Equipment and Supplies ; Humans ; Muscle Weakness ; Shoulder ; Shoulder Joint ; Shoulder Pain

Ruptured aneurysms of the sinus of Valsalva are relatively rare, and the incidence seems to be higher in oriental than in western countries. Valsalva sinus aneurysm consists of a separation or lack of fusion behveen the media of the aorta and the annus fibrosis of the aortic valve. Rupture usually occurs in the third or fourth decade of life, most often between the right coronary cusp and the right ventricle, but occasionally, when the noncoronary cusp is involved, the fistular drains into the right atrium. Abrupt rupture causes chest pain, bounding pulses, a continuous murmur, and volume overload of the heart. Associated cardiac lesions are common including VSD and AR. We experienced a typical case of ruptured aneurysm of the sinus of Valsalva into RA in a 31 year-old man presented sith sudden dyspnea, chest pain and palpitation. Diagnosis was made by 2D-echocardiography, cardiac catheterization and cine-angiogram. This case, the aneurysm was originated from the noncoronary sinus and ruptured into right atriurn. The ruptured aneurysm were repaired mth Dacron patch.
Adult ; Aneurysm ; Aneurysm, Ruptured* ; Aorta ; Aortic Valve ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Diagnosis ; Dyspnea ; Fibrosis ; Heart ; Heart Atria ; Heart Ventricles ; Humans ; Incidence ; Polyethylene Terephthalates ; Rupture ; Sinus of Valsalva*

Hemodialysis (HD) patients continually exposed to heparin are at risk of developing heparin-induced thrombocytopenia (HIT). However, HIT is very rare in chronic HD patients with end-stage renal disease (ESRD). The authors report the case of a chronic HD patient with ESRD who developed HIT complicated by recurrent thrombocytopenia and significant bleeding episodes. A 67-year-old man with diabetic ESRD on chronic HD suddenly developed recurrent acute bleeding episodes and severe thrombocytopenia (platelet count <1.0x10(3)/uL) 2 months prior to presentation. These bleeding episodes and the thrombocytopenia always occurred 1 week after initiating HD with heparin, and improved within 1 week of discontinuing heparin. HIT was confirmed by ELISA for anti-heparin/platelet factor 4 antibody. HD was conducted successfully and thrombocytopenia did not occur after switching argatroban for heparin. This case report suggests that clinicians must consider HIT in the differential diagnosis of thrombocytopenia during maintenance HD.
Aged ; Diagnosis, Differential ; Enzyme-Linked Immunosorbent Assay ; Hemorrhage ; Heparin ; Humans ; Kidney Failure, Chronic ; Pipecolic Acids ; Renal Dialysis ; Thrombocytopenia

No abstract available.
Lymphatic Diseases* ; Pericardial Effusion*

We describe here the case a patient with advanced cervix carcinoma and who developed idiopathic thrombocytopenic purpura (ITP). A 63-year-old woman with stage IV squamous cell carcinoma of the uterine cervix and that was complicated by hydronephrosis was treated palliatively with 45Gy of external beam radiation to the pelvis. About 3 years later, she developed hematochezia and severe thrombocytopenia. The laboratory examinations showed no evidence of thrombotic thrombocytopenic purpura or disseminated intravascular coagulopathy, and she was positive for serum anti-platelet antibodies. On the bone marrow examination, there was a normal number and morphology of megakaryocytes with no evidence of malignant cell infiltration. We made the clinical diagnosis of ITP, and the intravenous immunoglobulin and steroid therapy was successful. This case suggests the possibility that ITP can occur in association with advanced cervix carcinoma.
Antibodies ; Bone Marrow Examination ; Carcinoma, Squamous Cell ; Cervix Uteri ; Female ; Gastrointestinal Hemorrhage ; Humans ; Hydronephrosis ; Immunoglobulins ; Megakaryocytes ; Middle Aged ; Pelvis ; Purpura, Thrombocytopenic, Idiopathic ; Purpura, Thrombotic Thrombocytopenic ; Thrombocytopenia