PURPOSE: We performed this study to describe the findings of MR Myelography(MRM) of herniated disc disease, spinal stenosis and spinal tumor and to evaluate the usefulness of the MRM in comparison to MRI. MATERIALS AND METHODS: MRI and MRM were performed in 31 patients with herniated disc disease(12 patients), spinal stenosis(11 patients) and spinal tumor(8 patients). MRI and MRM were done with 1.5-T Signa MR, using fat suppressed heavily T2-weighted fast spin echo technique. We retrospectively analyzed MRM images about the thecal sac indentation, compression or displacement of the nerve root, extent and degree of narrowing of spinal canal, relationship between spinal tumor and spinal cord. MRM findings were compared with MRI in all cases. RESULTS: In 18 herniated disc cases of 12 patients, focal filling defect with cutoff or displacement of the nerve root in eight cases of paracentral herniated disc was seen. Cutoff and displacement of the nerve root were more clearly delineated on MRM than rvlRI. In the patients of spinal stenosis(11 cases), hourglass deformity of the thecal sac or complete spinal block of the subarachnoid space was clearly demonstrated. The extent and severity of spinal stenosis were more accurately evaluated on MRM than MRI. MRM finding of intramedullary tumor(3 cases) was enlargement of spinal cord. Five cases of intradural extramedullary tumor showed intradural filling defect, which caused contralateral displacement of the spinal cord with meniscus sign on inferior margin of the mass. CONCLUSION: MRM shows characteristic findings of herniated disc disease, spinal stenosis and spinal tumor. MRM yields excellent definition of the thecal sac, nerve roots and nerve root sleeves in relation to herniated disc and may be more accurate in evaluation of the degree and extent of spinal stenosis than MRI.
Congenital Abnormalities ; Constriction, Pathologic ; Humans ; Intervertebral Disc Displacement ; Magnetic Resonance Imaging ; Myelography* ; Retrospective Studies ; Spinal Canal ; Spinal Cord ; Spinal Diseases ; Spinal Stenosis ; Subarachnoid Space

PURPOSE: To assess the usefulness of MRI in preoperative diagnosis of congenital anorectal malformation MATERIALS AND METHODS: MR findings of 11 cases with surgically proved anorectal malformations were retrospectively reviewed and compared with operative findings, according to the level of atresia, the development of sphincter muscle, fistula and associated anomalies of other organs. RESULTS: Four of 11 cases were low type of anorectal atresia, 3 cases were intermediate type, and 3 cases were high type. There was one case of Currarino triad with low type of anorectal stenosis. MRI demonstrated the levels of atresia correctly in all cases and revealed fistulas in all high type of anomalies. Degrees of the development of the sphincter muscles were good in all cases of low types and fair in a case of intermediate type and an anorectal stenosis, whereas the development was poor in 2 cases of intermediate type and all 4 cases of high type. The associated anomalies in anorectal malformation were renal agenesis, congenital hip dysplasia and sacral defect with presacral teratoma in Currarino triad. CONCLUSION: MRI was a simple and useful study to confirm the level of atresia, fistula and associated anomalies in the diagnosis of the congenital anorectal malformation.
Constriction, Pathologic ; Diagnosis ; Fistula ; Hip Dislocation, Congenital ; Magnetic Resonance Imaging ; Muscles ; Retrospective Studies ; Teratoma

A 36-year-old female patient with aplastic anemia developed massive hemoptysis and was placed on ventilator support. However, airway obstruction by blood clots triggered desaturation and ventilator malfunction. Manual ventilation was initiated to improve oxy-genation, and emergency flexible bronchoscopy was performed to clear the airway. Nevertheless, the patient developed extensive subcutaneous emphysema, pneumothorax, and pneumomediastinum.
Adult ; Airway Obstruction ; Anemia, Aplastic ; Barotrauma* ; Bronchoscopy ; Emergencies ; Female ; Hemoptysis* ; Humans ; Mediastinal Emphysema ; Pneumothorax ; Subcutaneous Emphysema ; Ventilation* ; Ventilators, Mechanical

OBJECTIVES: To assess the clinical efficacy and safety of Hyruan(sodium hyaluronate) in patients with osteoarthritis of the knee. METHODS: A 12-week open study of Hyruan was conducted in 48 patients with osteoarthritis(OA) of the knee. Hyruan was injected into knee joints weekly for 5 weeks. Clinical evaluations were performed using visual analog scale(VAS) for pain, Lequesne's index, tenderness and swollen joint counts weekly for the first 5 weeks and then monthly up to 3 months post-injection. RESULTS: Significant improvements in VAS, Lequesne's index, tenderness and swollen joint counts were noted from the first week and maintained until the end of 3 month follow-up period. At 3 months post-injection, 68.8% of patients had >20mm reduction in the VAS. The patients with Kellgren stage lIl showed significant response in VAS and Lequesne's index as patients with Kellgren stage I and II. The clinical improvement after treatment was slower in patients(n=16) with late(>5 years) OA than in patients(n=32) with early(<5 years) OA, but it was statistically significant in either groups, compared to baseline. There were no severe adverse reactions to Hyruan therapy and laboratory examinations revealed no evidence of toxicity. CONCLUSION: Hyruan has been shown to be effective and safe in the treatment of patients with osteoarthritis of the knee.
Follow-Up Studies ; Humans ; Hyaluronic Acid ; Joints ; Knee Joint ; Knee* ; Osteoarthritis*

BACKGROUND: BK virus is a polyomavirus associated with a range of clinical presentations from asymptomatic viruria with pyuria to ureteral ulceration with ureteral stenosis in renal transplant patients. BK viral Infection of renal allografts has been associated with diminished graft function in some individuals. We tried to detect BK virus in urine and plasma from Korean renal transplant recipients, renal transplant candidates, and healthy donors. METHODS: To detect BK virus in urine and plasma, we used PCR-RFLP (polymerase chain reaction and restriction fragments length polymorphism) with BamHI. The study was performed from 118 renal transplant recipients, 18 renal transplant candidates, and 25 healthy donors. RESULTS: BK virus DNAs were detected in 21.2% of urine and 0.9% of plasma from renal transplant recipients. BK virus DNA was detected in neither urine nor plasma from healthy donors and renal transplants candidates. Among a total of eight patients who were clinically suspected of having BK nephropathy, three were PCR positive for BK virus and two were decoy-cell cytology positive. Six patients were diagnosed as BK nephropathy by tissue pathology. Among them, BK virus was detected by PCR in urine from five patients, and decoy cells were shed from five patients, respectively. CONCLUSIONS: BK virus detection by polymerase chain reaction in urine may be a non-invasive and sensitive tool for diagnosing and monitoring BK nephropathy.
Allografts ; BK Virus* ; Constriction, Pathologic ; DNA ; Humans ; Kidney Transplantation ; Pathology ; Plasma ; Polymerase Chain Reaction* ; Polyomavirus ; Pyuria ; Tissue Donors* ; Transplantation* ; Transplants ; Ulcer ; Ureter

OBJECTIVES: Menopause is a natural aging process causing estrogen deficiency, accelerating atherogenic processes including dyslipidemia. Prevalence of thyroid dysfunction is also high in postmenopausal women, and it is known to elevate the risk of cardiovascular disease (CVD). Therefore, we are to study on the associations in between serum thyroid stimulating hormone (TSH) and prevalence of CVD in postmenopausal women who have normal thyroid function. METHODS: We performed a retrospective review of 247 Korean postmenopausal women who visited the health promotion center from January, 2007 to December, 2009. Postmenopausal women with normal serum TSH were included in the study. Coronary atherosclerosis was assessed by 64-row multidetector computed tomography. RESULTS: In multiple linear regression analysis, serum TSH was associated with serum triglyceride (TG) (β = 0.146, P = 0.023). In multiple logistic regression analysis, increasing age and serum TSH were associated with an increased risk of coronary atherosclerosis in euthyroid postmenopausal women (odds ratio [OR] = 1.107 [1.024-1.197], P = 0.011 and OR = 1.303 [1.024-1.658], P = 0.031, respectively). CONCLUSIONS: It revealed that significant predictor of serum TSH was serum TG, and increasing age and TSH were found to have associations with an increased risk of coronary atherosclerosis in euthyroid postmenopausal women. Screening and assessing risks for CVD in healthy postmenopausal women would be helpful before atherosclerosis develops.
Aging ; Atherosclerosis ; Cardiovascular Diseases ; Coronary Artery Disease* ; Dyslipidemias ; Estrogens ; Female ; Health Promotion ; Humans ; Linear Models ; Logistic Models ; Mass Screening ; Menopause ; Multidetector Computed Tomography ; Postmenopause ; Prevalence ; Retrospective Studies ; Thyroid Gland* ; Thyrotropin* ; Triglycerides

A 36-year-old female patient with aplastic anemia developed massive hemoptysis and was placed on ventilator support. However, airway obstruction by blood clots triggered desaturation and ventilator malfunction. Manual ventilation was initiated to improve oxy-genation, and emergency flexible bronchoscopy was performed to clear the airway. Nevertheless, the patient developed extensive subcutaneous emphysema, pneumothorax, and pneumomediastinum.
Adult ; Airway Obstruction ; Anemia, Aplastic ; Barotrauma ; Bronchoscopy ; Emergencies ; Female ; Hemoptysis ; Humans ; Mediastinal Emphysema ; Pneumothorax ; Subcutaneous Emphysema ; Ventilation ; Ventilators, Mechanical

The intensive use of chemotherapeutic agents for the treatment of cancer has resulted in the cure or improved survival of many patients. But unfortunately, many cancers including human hepatocellular carcinoma (HCC) don't respond to chemotherapy. One of the major mechanisms for the drug resistance in the HCC is an elevated MDR1 RNA expression which makes cells become multidrug resistant. To overcome the multidrug resistance (MDR) phenotype, a high dose of verapamil is required both clinically and experimentally. Accordingly we have examined the MDR modulating effects with combinations of tamoxifen, cyclosporin A, and verapamil in vitro with the physiologically achievable concentrations of each agent, i.e., 2.0 microM/L for tamoxifen, 1.6 microM/L for cyclosporin A, and 2.5 microM/L for verapamil respectively in HCC lines. As expected, verapamil alone with the physiologically achievable concentration at which we tested didn't enhance the doxorubicin cytotoxicity in the HCC lines. Furthermore, any verapamil combination with cyclosporin A or tamoxifen was not effective in overcoming the doxorubicin resistance in the high MDR1 expressor (Hep-G2) line. However tamoxifen reduced the IC50 of doxorubicin by a factor of 1.9 in the low MDR1 expressor (SK-Hep1) and 1.1 in the high MDR1 expressor line (p< 10(-5) respectively). Of interest, combinations of tamoxifen and cyclosporin A showed a significant reduction in the IC50 of doxorubicin in both HCC lines. The IC50 of doxorubicin was reduced by a factor of 3.9 and 1.3, i.e., from 0.023943 micrograms/ml to 0.006157 micrograms/ml (p< 10(-5)) in the SK-Hep1 cell line, and 0.068819 micrograms/ml to 0.052442 micrograms/ml (p< 10(-5)) in Hep-G2 respectively when tamoxifen and cyclosporin A were administered together. Both the estrogen and progesterone receptors in the SK-Hep1 and Hep-G2 lines were less than 0.01 fmol/mg of cytosol protein, respectively. It is therefore suggested that the reversal of doxorubicin resistance is unrelated to their anti-estrogenic activity in the HCC lines. Three modulator combinations of tamoxifen, cyclosporin A, and verapamil were not more effective than the combination of tamoxifen and cyclosporin A on the sensitivity to doxorubicin. MDR modulators of tamoxifen, cyclosporin A, and verapamil didn't reduce the IC50 of cisplatin to the clinically achievable concentration range in HCC lines. In summary, the combination of tamoxifen and cyclosporin A at the concentrations normally seen after clinical administration of these modulators showed significant synergism on the sensitivity to doxorubicin in both low and high MDR1 expressor HCC lines. These data indicate the need for in vivo trials.
Antineoplastic Agents/*pharmacology ; Carcinoma, Hepatocellular/*physiopathology ; Cyclosporine/*pharmacology ; Drug Resistance ; Human ; Liver Neoplasms/*physiopathology ; Support, Non-U.S. Gov't ; Tamoxifen/*pharmacology ; Tumor Cells, Cultured/drug effects ; Verapamil/*pharmacology

PURPOSE: It is difficult to differentiate BKV nephritis (BKVN) from acute rejection. We diagnosed 8 cases of BKVN in renal transplantation recipients. Herein, we report the clinical nature of BKVN in terms of diagnosis, treatment and prognosis. METHODS: Between June 1998 and September 2002, 8 cases of BKVN were confirmed by H and E stain, immunohistochemical study against SV40, and electron microscopy in renal allograft biopsy samples. Additionally, between April and September 2002, we obtained urine sample for urine cytology from 49 potential donors, 40 end-stage renal failure patients awaiting renal transplantation, and 140 renal transplant recipients who were hospitalized with variable causes and 32 renal transplants as a routine follow-up. RESULTS: In 7 male and 1 female patients, BKVN was diagnosed mean of 20.4 months after transplantation. The kind of immunosuppression they had been on were mycophenolate mofetil (6/8), azathioprine (1/8), cyclosporin (4/8), tacrolimus (4/8). Range of whole blood levels of cyclosporine and tacrolimus at the time of diagnosis of BKVN were 187.5~252.5 ng/ml and 11~16.5 ng/ml, respectively. Four patients had treated acute rejection episode, and in 6 patients, pathologically proven acute rejection was found concomitantly with BKVN. After reduction of net immunosuppression (discontinuation of MMF and AZA, dose reduction of cyclosporine or tacrolimus, and switch from tacrolimus to cyclosporine), renal function of 3 patients was fully recovered. However, 4 patients with delayed diagnosis lost grafts. In urine cytologic examination, 15 patients (one in end-stage renal failure patient, 10 in renal transplant recipients with elevated serum creatinine, 2 in patients with other infection, and 2 in other situation) were found to secrete decoy cell through urine. CONCLUSION: BKVN should be considered in the differential diagnosis of renal allograft dysfunction. Early diagnosis of BKVN and reduction of net immunosuppression can rescue the grafts. Monitoring of decoy cell in the urine cytology is a simple diagnostic tool both for screening of graft with dysfunction and follow-up of grafts after diagnosis and treatment of BKVN.
Allografts ; Azathioprine ; Biopsy ; BK Virus* ; Creatinine ; Cyclosporine ; Delayed Diagnosis ; Diagnosis* ; Diagnosis, Differential ; Early Diagnosis ; Female ; Follow-Up Studies ; Humans ; Immunosuppression ; Kidney Failure, Chronic ; Kidney Transplantation ; Male ; Mass Screening ; Microscopy, Electron ; Nephritis ; Nephritis, Interstitial* ; Prognosis* ; Tacrolimus ; Tissue Donors ; Transplantation ; Transplants

An atrial septal aneurysm is well recognized abnormality of uncertain clinical relevance. An intraatrial aneurysm was demonstrated in the fossa ovalis of a 41-year-old woman who suffered an episode of cerebellar infarction with recurrent atrial fibrillation. The disorder is rarely treated surgically. Most patients with this condition are given life-long anticoagulation, a treatment that may have serious complications. We report a rare case of atrial septal aneurysm with recurrent atrial fibrillation and cerebellar infarction which receiving an appropriate diagnosis and curative treatment.
Adult ; Aneurysm* ; Atrial Fibrillation* ; Diagnosis ; Female ; Humans ; Infarction*