In order to discover difference that may exist in quantity of medical care services, length of stay and hospital changes between insured and non-insured patients, records for primary Cesarean section patients discharged between July 1978 and June 1980 from a university hospital were examined. In addition, Cesarean section rates among the total deliveries for a two-year period between the groups were studied. The results showed that volume of services was greater and length of stay was longer among the insured, however, charges were higher among the non-insured. Cesarean section rates were statistically significantly different between insured and non-insured patients for every age group except the group of 35 or more.
Cesarean Section* ; Female ; Humans ; Length of Stay ; Pregnancy

PURPOSE: The solid variety of cerebella r tumors in adult is relatively uncommon. This study is to describe the characteristic MR findings of various solid cerebellar tumors in adult. METHODS: Twenty three cerebellar solid tumors from 22 consecutive patients over age of 15 with surgical confirmations were retrospectively evaluated with MR imaging. H istologic diagnosis included hemangioblastoma (n=6), metastasis (n=6), high-grade astrocytoma (n=3), and medulloblastoma (n=8). The MR findings were reviewed with attention to the size, the signal intensity of the tumors, pattern of enhancement, tumoral margin, degree of peritumoral edema, signal void vascular structures within and/or around the tumor, and location in relation to attachment to the pial surface of the tumor. RESULTS: Solid hemangioblastomas consistently showed slightly low or iso signal intensity on T1 -weighted images and high intensity on T2-weighted images, dense homogeneous enhancement, and signal void vessels within and/or around the mass. Metastatic tumors showed various find ings with predominantly low or iso signal intensity on T2-weighted images. Medulloblastomas was midline and/or paramidline in location, and had larger mass formation. High-grade astrocytomas revealed nonspecific MR findings with no signal void vessels. CONCLUSION: Hemangioblastoma, metastasis, malignant astrocytoma, and medulloblastoma should be included in differential diagnosis of solid cerebellar tumors in adult. Dense homogeneous enhancement and signal void vessels are characteristic of hemangioblastoma. The signal intensity of the tumor, and presence of signal void vessels, location and enhancement pattern can be some value in differential diagnosis of solid cerebellar tumors in adult.
Adult* ; Astrocytoma ; Cerebellar Neoplasms* ; Diagnosis ; Diagnosis, Differential ; Edema ; Hemangioblastoma ; Humans ; Magnetic Resonance Imaging ; Medulloblastoma ; Neoplasm Metastasis ; Retrospective Studies

OBJECTIVES: This study aims to analyze the association between the severity of sleep apnea, sleep and mood related scales, and activity during sleep in obstructive sleep apnea syndrome (OSAS) patients. METHODS: One hundred seventy six drug-free male patients confirmed as OSAS (average age=43+/-11 years) were selected through nocturnal polysomnography (NPSG). OSAS was diagnosed with apnea-hypopnea index (AHI) >5, mean AHI was 39.6+/-26.0. Sleep related scales were Stanford Sleepiness Scale (SSS), Epworth Sleepiness Scale (ESS), Pittsburg Sleep Quality Index (PSQI) and Morningness-Eveningness Scale (MES). Mood related scales were Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), State-Trait Anxiety Inventory (STAI) I, II and Profile of Mood States (POMS). NPSG was performed overnight with both wrist actigraphy (WATG). Parameters produced from WATG were total activity score, mean activity score and fragmentation index. We analyzed the correlation between each scale, AHI scored from NPSG and activity score analyzed from WATG. RESULTS: ESS showed significant positive correlation with PSQI, BDI, BAI and STAI I, II, respectively (p<0.01). SSS showed significant positive correlation with PSQI and BAI (p<0.05, p<0.01). BAI showed significant positive correlation with total activity score, mean activity score and fragmentation index (p<0.05, p<0.01, p<0.05). Total activity score showed significant positive correlation with ESS and BAI, respectively (p<0.05). Fragmentation index showed significant positive correlation with ESS, PSQI and BAI (p<0.05, p<0.01, p<0.05). AHI, indicator of sleep apnea is showed no significant correlation with each sleep and mood related scale. CONCLUSION: The degree of daytime sleepiness tends to be associated with night sleep satisfaction, depression and anxiety, and the activity during sleep rather than the severity of sleep apnea.
Actigraphy ; Anxiety ; Depression ; Humans ; Male ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Weights and Measures ; Wrist

Cavernous hemangioma is a benign tumor composed of vascular structures and connective tissue. Typical imaging findings of cavernous sinus cavernous hemangioma are a well-defined contour-bulging mass, with homogeneous high signal intensity on T2-weighted images (T2WI), marked homogeneous enhancement of the cavernous sinus, and some sellar extension on magnetic resonance images. However, we experienced an unusual case of cavernous hemangioma, with central filling defects on delayed contrast-enhanced T1-weighted images and central, dark signal intensities on T2WI, which made the diagnosis difficult. The central portion of the lesion was pathologically consistent with central thrombosis. We present the clinical and imaging findings of this unusual case of cavernous hemangioma.

PURPOSE: To evaluate the feasibility of functional MR imaging (fMRI) with a 1.0 T scanner, fMRI of normal cerebral motor cortex at 1.0 T was compared with that at 1.5 T. MATERIALS AND METHODS: FMRI of bilateral cerebral motor cortices (left, seven; right, six) was performed in seven healthy male volunteers aged 26-34 (mean 29) years, with BOLD contrast at both 1.0 T and 1.5 T units (Siemens MR scannners). Using both these systems, two-dimensional (2D) FLASH images were obtained with TR/TE of 90/56, flip angle of 40degrees, matrix size 128*128, slice thickness of 5 mm, and FOV 23 cm. A sequence consisting of five-image-off phase (rest phase) followed by five-image-on phase (activation with finger movement) was repeated four times without pause at a single plane. The same study was performed for the contralateral motor cortex in each volunteer. Using the z-test, activation images were obtained for the signal difference between on- and off-phases (p < 0.05) and were then superimposed on 2D FLASH anatomic images at the same plane. Percentage changes of signal intensities (PCSIs) and numbers of activated pixels were compared, using the non-parametric t-test, and periodicity of signal changes was compared, using the Mantel-Haenszel Chi-square test. RESULTS: Mean PCSIs at 1.5 T and 1.0 T in the left motor cortex were 3.13 +/-1.20% and 1.43 +/- 0.56%, respectively (p = 0.009), and in the right, 1.78 +/- 0.95% and 1.34 +/- 0.28%, respectively (p = 0.32). The mean number of activated pixels at 1.5 T and 1.0 T in the left cortex was 21.14 +/- 10.67 and 19.86 +/- 11.36, respectively (p = 0.83), and in the right, 22.5 +/- 6.47 and 16.8 +/- 8.47, respectively (p= 0.22). At 1.5 T, periodicity of signal changes was seen in the left cortex in six of seven volunteers, and in the right cortex, in four of six. At 1.0T, all showed periodicity (left : p = 0.32 ; right : p = 0.14). CONCLUSION: PCSIs in the dominant hemispheres were significantly higher at 1.5 T, but no other indicators showed significant differences between 1.0 T and 1.5 T. Acceptable fMRI can therefore be carried out with a 1.0 T field strength scanner.
Fingers ; Humans ; Magnetic Resonance Imaging* ; Male ; Motor Cortex* ; Periodicity ; Volunteers

PURPOSE: To describe the detailed technique for producing experimental carotid aneurysms in dogs and the success rate, cause of failure and remedy, based on our experience. MATERIALS AND METHODS: Fourteen male dogs weighing 12-15kg were anesthetized with inhalation of 1-2% halothane and 50% nitrous oxide. Each surgical procedure was performed under sterile condition with the aid of an operating microscope. A paramidline incision 7-8 cm in length was made parallel to and medial to the external jugular vein in the dog's neck. The externaljugular vein was harvested as a 1cm vein pouch by ligation and division of the proximal and distal ends. The ipsilateral common carotid artery was exposed and clamped at both ends by a vascular clamp. A 5-mm long elliptical arteriotomy was made at the mid portion of the artery, and then end to side anastomosis between the artery andvein sac was performed by using interrupted 7-0 monofilament prolene sutures. Carotid arteriography or Doppler sonography was performed 1-6 weeks after aneurysm construction. RESULTS: Twenty experimental aneurysms we reconstructed, and 17 aneurysms were patent on follow up study, but one dog with two aneurysms died from hemorrhagicpneumonia 17 days after surgery. The overall patency rate was 75%. CONCLUSION: We demonstrated the feasibility of creating experimental aneurysm models in the dog and expect that the technique presented will help to avoidfailure in the construction of aneurysms.
Aneurysm* ; Angiography ; Animals ; Arteries ; Carotid Arteries* ; Carotid Artery, Common ; Dogs* ; Follow-Up Studies ; Halothane ; Humans ; Inhalation ; Jugular Veins ; Ligation ; Male ; Models, Theoretical* ; Neck ; Nitrous Oxide ; Polypropylenes ; Sutures ; Veins

PURPOSE: It is important to diagnose paragonimiasis in early active stage because it can be dured by chemotherapy. However, it is difficult to make a correct diagnosis of cerebral paragonimiasis in the early active stage, and the radiographic findings of cerebral paragonimiasis have been rarely reported. Thus, this experimental study was designed to produce early active cerebral paragonimiasis and to demonstrate radiologic-pathologic correlations. MATERIALS AND METHODS: In 8 cats, 7-8 metacercariae of Paragonimus westerrnani were directly introduced into the brain parenchyma of each cat's after trephination of the skull. In anogher 16 cats, the juvenile worms and the adult worms that had developed for varying periods (2 weeks, 4 weeks, 6 weeks, 8 weeks and 12 weeks) in the lunges of another cats were introduced into the brain parenchyma of each cat's with the same procedures described above. Follw-up MR images and chest radiographs were obtained at 2 days, 1 weeks, 2 weeks, 4 weeks and 8 weeks after innoculation. The autopsies and histopathological examinations of the cat's brain were undertaken in 22 cats. In 9 cats that were suspected with pulmonary lesions on chest radiograph, the soft tissue radiographs of inflated-fixed lungs were obtained. RESULTS: In one cat with innoculation of adult worm, acute suppurative inflammation of the brain parenchyma was demonstrated. But the other cats with innoculction of adult worm or juvenile worm and the cats with innoulation of metacercaris did not reveal any evidence of acute cerebral paragonimiasis. More than half of the introduced metacercariae(5 out of 8 cats) were found in the lung parenchyma, while only 25%(4 out of 16 cats) of the adult worm innoculated cats were. CONCLUSION: Acute suppurative inflammation suggesting acute stage cerebral paragonimiasis was obtained in one case of adult worm innoculated cat. Most of the innoculated metacercariae and some of the juvenile worms or adult worms were migrated to the lungs.
Adult ; Animals ; Autopsy ; Brain ; Cats* ; Diagnosis ; Drug Therapy ; Humans ; Inflammation ; Lung ; Metacercariae ; Paragonimiasis* ; Paragonimus ; Radiography, Thoracic ; Skull ; Trephining

PURPOSE: To evaluate ethanolamine oleate (EAO)-microfibrillar collagen (MFC) mixture as a new scleroembolic material for the interventions requiring both permanent obliteration of vascular lumen and atrophy of mass, such as for the facial AVM and other hypervascular soft tissue masses. MATERIALS AND METHODS: Twenty-nine transcatheter transarterial embolizations of renal arteries were performed in six groups of rabbits classified by the EAO concentration and the addition of MFC. Postembolization angiography, gross morphological and microscopic examinations of embolized kidneys were performed immediately, 3 days, 2 weeks and 4 weeks after embotization. Analysing points were the usefulness as a scleroembolic material (endovascular retention, thrombogenic-sclerosing effect, perivascular fibrosis and inflammatory reaction), effects of the EAO concentration and the addition of MFC. RESULTS: EAO-MFC mixture satisfied all ideal conditions of scleroembolic agent;persistent endovascular retention, good thrombogenic-sclerosing effect with a mild inflammatory reaction and significant atrophy of kidney. The effect of increasing concentration of EAO was proximal embolization. The effects of MFC were promotion of proximal embolization, endovascular retention and sclerosing effect. CONCLUSION: EAO-MFC mixture can be used as a new effective scleroembolic material for the various hemodynamic situations in which embolic level can be controlled by EAO concentration and the addition of MFC.
Angiography ; Atrophy ; Collagen* ; Ethanolamine* ; Fibrosis ; Hemodynamics ; Kidney ; Oleic Acid* ; Rabbits* ; Renal Artery

We studied the ultrastructural alteration of glomerular anionic sites in 6 patients with minimal change nephrotic syndrome, 5 patients with membranous glomerulonephritis, 4 patients with focal segmental glomerulosclerosis, and 4 patients with IgA nephropathy by staining with polyethyleneimine (PEI) as a cationic probe. The control study was examined by using a nephrectomy specimen of non-glomerular disease which had no proteinuria. This method seems to selectively stain heparan sulphate in the basement membranes and has been widely used to evaluate changes in basement membrane charge in various human diseases as well as in experimental studies. The anionic sites in the lamina rara interna and lamina densa of normal glomerular basement membrane were always less numerous and less regularly distributed than those in the lamina rara externa. Characteristic common findings in these glomeruli showed a marked decrease of glomerular anionic sites in the regions with immune-complex deposits and normal distribution in the regions with focally those being absorbed and newly forming glomerular basement membrane. They were not detected in the gap of the basement membrane and on the area of the detached overlying epithelium using the PEI method. But the foot process fusion of epithelial cells seems not to influence the loss of anionic sites on the glomerular basement membrane.
Basement Membrane ; Epithelial Cells ; Epithelium ; Foot ; Glomerular Basement Membrane* ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental ; Humans ; Nephrectomy ; Nephrosis, Lipoid ; Polyethyleneimine ; Proteinuria

Methods: Patients aged 65 years who had undergone either multilevel ACDF, LP, or PCF for the treatment of DCM were analyzed. Additional analysis was performed by standardizing the data for the American Society of Anesthesiologists classification scores and preoperative functional status. Results: A total of 23,129 patients were identified. Patients with ACDF were younger, more often female, and preoperatively healthier than those in the other two groups. The estimated postoperative mortality and morbidity, mean operation time, and length of hospital stay were the lowest for ACDF, second lowest for LP, and highest for PCF. The readmission and reoperation rates were comparable between ACDF and LP; however, both were significantly lower than PCF. Conclusions PCF is associated with the highest risk of mortality, morbidity, unplanned reoperation, and unplanned readmission in the short-term postoperative period in patients aged 65 years. In contrast, ACDF carries the lowest risk. However, some disease-specific factors may require posterior treatment. For these cases, LP should be included in the preoperative discussion when determining the ideal surgical approach for geriatric patients.