No abstract available.
Abdomen* ; Humans

PURPOSE: The purpose of this study was to compare non-breath-hold T2-weighted turbo spin-echo (TSE) MR imaging with three types of breath-hold T2-weighted MR imaging (breath-hold TSE [BHTSE], half-Fourier single- shot TSE [HASTE], and true-fast imaging with steady-state precession [FISP]) for hepatic lesion detection. MATERIALS AND METHODS: T2-weighted MR images obtained using the above with the four sequences in 38 patients with 53 solid malignant and 90 non-solid benign hepatic lesions were retrospectively analyzed. Images were compared quantitatively (lesion-to-liver contrast-to-noise ratio and lesion detectability) and qualitatively (conspicuity of lesion and artifact). Statistical analysis involved the paired t-test for quantitative evaluation and Wilcoxon's signed rank test for qualitative evaluation. RESULTS: The values of lesion-to-liver contrast-to-noise ratios and lesion conspicuity for solid malignant hepatic lesions were better with non-breath-hold TSE imaging than with the three breath-hold T2-weighted sequences (p<.05); similarly, lesion detectability was higher using the former system (75 %, 68 %) than with breath-hold imaging (57 %, 57%). There was, however, no statistically significant difference in the conspicuity of non-solid benign lesions between non breath-hold and breath-hold sequence (p > .05), and lesion detectability for non-solid benign lesions was similar (94% and 98%, compared with 91% and 96 %). CONCLUSION: In the cases of solid malignant hepatic lesions, the three breath-hold T2-weighted sequences were inferior to non-breath-hold TSE with regard to lesion-to-liver contrast-to-noise ratio and lesion detectability. Non-breath-hold TSE imaging should thus not be replaced by breath-hold T2-weighted imaging.
Evaluation Studies as Topic ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies

PURPOSE: The purpose of this study was to compare non-breath-hold T2-weighted turbo spin-echo (TSE) MR imaging with three types of breath-hold T2-weighted MR imaging (breath-hold TSE [BHTSE], half-Fourier single- shot TSE [HASTE], and true-fast imaging with steady-state precession [FISP]) for hepatic lesion detection. MATERIALS AND METHODS: T2-weighted MR images obtained using the above with the four sequences in 38 patients with 53 solid malignant and 90 non-solid benign hepatic lesions were retrospectively analyzed. Images were compared quantitatively (lesion-to-liver contrast-to-noise ratio and lesion detectability) and qualitatively (conspicuity of lesion and artifact). Statistical analysis involved the paired t-test for quantitative evaluation and Wilcoxon's signed rank test for qualitative evaluation. RESULTS: The values of lesion-to-liver contrast-to-noise ratios and lesion conspicuity for solid malignant hepatic lesions were better with non-breath-hold TSE imaging than with the three breath-hold T2-weighted sequences (p<.05); similarly, lesion detectability was higher using the former system (75 %, 68 %) than with breath-hold imaging (57 %, 57%). There was, however, no statistically significant difference in the conspicuity of non-solid benign lesions between non breath-hold and breath-hold sequence (p > .05), and lesion detectability for non-solid benign lesions was similar (94% and 98%, compared with 91% and 96 %). CONCLUSION: In the cases of solid malignant hepatic lesions, the three breath-hold T2-weighted sequences were inferior to non-breath-hold TSE with regard to lesion-to-liver contrast-to-noise ratio and lesion detectability. Non-breath-hold TSE imaging should thus not be replaced by breath-hold T2-weighted imaging.
Evaluation Studies as Topic ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies

No abstract available.
Female ; Ovary* ; Teratoma*

PURPOSE: To report three cases of LASIK (Laser in situ keratomileusis) for myopia and astigmatism after PKP (penetrating keratoplasty). METHODS: We performed LASIK in three eyes with myopic astigmatism following PKP which could not be corrected with spectacles or contact lens due to high anisometropia and contact lens intolerance. Visual acuity with or without correction, manifest refraction, corneal topography were checked before and after LASIK. The surgical complications were also monitored intraoperatively and postoperatively. RESULTS: There was no remarkable complications concerning LASIK. Mean follow-up period after LASIK was 8.7 months. Spherical equivalent was reduced from -11.5, -10.3, -5.5 D to -6.5, +0.62, -2.0 D and astigmatism was also reduced from -3.0, -4.5, -8.0 D to -1.0, -1.25, -3.0 D in each case. Uncorrected visual acuity was improved in all three cases and best spectacle-corrected visual acuity was not reduced in all cases. Postoperative corneal topography showed reduced central keratometric powers and astigmatism, but there was a tendency toward irregular astigmatism compared with that of normal LASIK eyes. CONCLUSIONS: LASIK can be a relatively safe and effective procedure in treating high myopia and astigmatism following PKP when contact lenses are not indicated. Further investigations are required for the timing of surgery, different nomogram compared with normal eyes, tendency toward irregular astigmatism and long-term follow-up results.
Anisometropia ; Astigmatism* ; Contact Lenses ; Corneal Topography ; Eyeglasses ; Follow-Up Studies ; Keratomileusis, Laser In Situ* ; Keratoplasty, Penetrating* ; Myopia* ; Nomograms ; Visual Acuity

BACKGROUND: Antimicrobial resistance of Helicobacter pylori is considered as the main cause of failure of eradication therapy. Because resistance to metronidazole has been reported in 25.8% to 66.2% of H. pylori, a combination of proton pump inhibitors (PPI), amoxicillin, and clarithromycin is currently recommended as a primary therapy. We investigated the prevalence of antimicrobial resistance to the primary drugs and the impact of antimicrobial resistance on eradication rates. METHODS: Between May and August 2005, H. pylori isolates from 93 patients were tested for antimicrobial susceptibility at Asan Medical Center. Susceptibility tests of clarithromycin and amoxicillin were performed by the disk diffusion method and those of metronidazole and tetracycline by Etest (AB Biodisk, Solna, Sweden). The medical records of the patients were reviewed to collect the data such as demographic findings, previous and current eradication therapies, and bacteriological outcome. The appropriate therapy was defined as three-drug-combination including susceptible drugs only, or four-drug-combination including metronidazole in the case of metronidazole-resistance. RESULTS: Resistance rates to clarithromycin and metronidazole were 17.2% and 33.3%, respectively, but there was no resistance to tetracycline and amoxicillin. The eradication was successful in 32 of the 36 patients (88.9%) who received the appropriate therapy, but none of 4 patients who received an inappropriate therapy (P<0.01). CONCLUSIONS: Resistance to clarithromycin seemed to increase and contribute to the failure of eradication therapy. For the appropriate therapy of H. pylori infection, the susceptibility results should be reported before initiation of the eradication therapy.
Amoxicillin ; Chungcheongnam-do ; Clarithromycin ; Diffusion ; Helicobacter pylori* ; Helicobacter* ; Humans ; Medical Records ; Metronidazole ; Prevalence ; Proton Pump Inhibitors ; Tetracycline

BACKGROUND: The regional cerebral oxygen saturation (rSO2) decreases significantly during ordinary anesthetic recovery in pediatric patients anesthetized with sevoflurane or desflurane. The present study examined the relationship between rSO2 and the clinical parameters associated with the degree of anesthetic recovery. METHODS: Twelve pediatric patients with American Society of Anesthesiologists physical status 1 were assigned randomly to receive anesthesia with sevoflurane or desflurane. All children underwent general anesthesia for minor surgery. After surgery, the rSO2, the age-adjusted MAC fraction of anesthetic concentration (F(E)), and the bispectral index (BIS) were recorded over a 10-minute period. The correlations between rSO2 and candidate predictors, such as F(E), BIS, anesthetic, and duration of anesthesia, were analyzed. RESULTS: All children recovered uneventfully. The lowest observed rSO2 reached 63% and the maximum decrease in rSO2 was 24%. The mean blood pressure and heart rate were maintained within clinical ranges. The decrease in rSO2 correlated positively with the F(E) (r = 0.25, P = 0.00) and the duration of anesthesia (r = 0.24, P = 0.01), and inversely with the use of sevoflurane (r = -0.30, P = 0.00). CONCLUSIONS: Despite normal parameters, cerebral desaturation occurred during the emergence of ordinary general anesthesia even without hemodynamic compromise or arterial desaturation. Cerebral desaturation might be associated with the degree of anesthetic recovery and the use of sevoflurane.
Anesthesia ; Anesthesia, General ; Blood Pressure ; Child ; Heart Rate ; Hemodynamics ; Humans ; Isoflurane ; Methyl Ethers ; Oxygen ; Pediatrics ; Surgical Procedures, Minor

BACKGROUND/AIMS: The Barrett's esophagus is confirmed by performing a biopsy when the gastroesophageal junction (GEJ) and Z-line do not coincide. In Japan, the GEJ is at the distal end of the palisading vessel while Western countries define it as the proximal tip of the gastric fold. However, there is little data on the prevalence of an endoscopic Barrett's esophagus and the inter-observer variation. METHODS: Four experienced endoscopists reviewed the endoscopic still images of 111 consecutive patients. The level of inter-observer agreement was expressed as a kappa value. RESULTS: The average percentage of patients with an endoscopically confirmed esophagus was 34.2%. The level of inter-observer agreement was substantial (kappa=0.698). CONCLUSIONS: The prevalence of an endoscopic confirmed Barrett's esophagus was high, and the inter-observer variation was substantial when the GEJ was defined as the distal end of the palisading vessel. Considering the low incidence of esophageal adenocarcinoma and the risk of hemorrhage from a biopsy, a more specific marker is needed in this high-risk group.
Adenocarcinoma ; Barrett Esophagus* ; Biopsy ; Esophagogastric Junction ; Esophagus ; Hemorrhage ; Humans ; Incidence ; Japan ; Observer Variation* ; Prevalence*

PURPOSE: Nodular lesions of the thyroid gland, composed predominantly of Hürthle cells, are so rare as to be difficult for pathologists to interpret properly and, consequently, for surgeons to treat appropriately. Our intent in evaluating these lesions was to try to establish pathologic and clinical criteria that could be used to differentiate more accurately between malignant and benign tumors. METHODS: We retrospectively evaluated 5 patients presenting with Hürthle cell tumors over the past 10 years. We focused on the clinicopathological analysis correlated with the tumor size, the type of operation and the prognosis. RESULTS: Five female patients were included in the study, their average age was 48.8 years (19~69 years). One case was carcinoma and the other 4 were adenomas. Average size of the tumor was 3.34 cm in diameter. Total thyroidectomy was performed in two cases including the carcinoma case. None of them died as a result of the disease, nor had a recurrence. No preoperative study was useful in differentiating between malignancy and benignancy. CONCLUSION: Many more cases need to be evaluated to determine the exact biological behavior of the Hürthle cell tumor of the thyroid gland. Clinical and pathological factors are required for surgeons to decide the type of operation appropriate in order to avoid compromising the therapeutic goals. We recommend total thyroidectomy for tumors with the intraoperative frozen section raising the suspicion of malignancy and for those with diameters over 2.5 cm.
Adenoma ; Adenoma, Oxyphilic* ; Female ; Frozen Sections ; Humans ; Prognosis ; Recurrence ; Retrospective Studies ; Surgeons ; Thyroid Gland* ; Thyroidectomy

OBJECTIVE: To investigate the clinical efficiency of the cervical cerclage for preventing preterm birth in asymptomatic women who showed a shortened cervix at the second trimester ultrasound METHODS: From January 1996 to December 2005, we retrospectively reviewed the medical records of pregnant women who received routine second trimester ultrasound (16~24 gestational weeks) without abdominal pain or bleeding at Cheil general hospital. Women with a short cervical length < or =25 mm were classified into cerclage and expectant group. Women who received cervical cerclage within 1 week after detection of cervical shortening without any change of cervical length and shape were included in cerclage group. Primary outcome was the frequency of delivery before 34 weeks' gestation. Secondary outcome was the most important risk factor for preterm delivery in pregnant women with short cervix. Chi-square test, t-test, and multiple logistic regression analysis were used for statistical analysis. P<0.05 was considered statistically significant. RESULTS: The mean gestational age at ultrasound was 21.6 weeks' gestation. A total of 111 women had short cervix, including 26 that were treated by cerclage and 85 managed expectantly. The proportion of preterm delivery before 34 weeks' gestation was higher in the cerclage group [38% (10 of 26)] than that of the expectant group [20% (17 of 85)], but there was no significant difference (P=0.069). In the univariate analysis, funneling (38% vs 16%, P=0.012) and cervical length < or =15 mm (47% vs 15%, P=0.069) were associated with preterm delivery before 34 weeks' gestation. In the multiple logistic regression analysis, a cervical length < or =15 mm had an adjusted odd ratio of 3.7 (95% CI 1.3~10.6) for preterm delivery before 34 weeks's gestation. CONCLUSIONS: These data suggest that cerclage in asymptomatic woman with a short cervix in the second trimester ultrasound does not prevent preterm delivery before 34 weeks of gestation. Woman with extremely shortened cervical length < or =15 mm needs intensive management for prevention of preterm delivery.
Abdominal Pain ; Cerclage, Cervical ; Cervical Length Measurement ; Cervix Uteri ; Female ; Gestational Age ; Hemorrhage ; Hospitals, General ; Humans ; Logistic Models ; Medical Records ; Pregnancy ; Pregnancy Trimester, Second ; Pregnant Women ; Premature Birth ; Retrospective Studies ; Risk Factors