PURPOSE: To evaluate the diagnostic value of radiologic studies in the Cushing's disease MATERIALS AND METHODS: We analyzed retrospectively the CT(n=19, dynamic CT was not perfomed), MR (n=23, dynamic MR in 2 cases), and the results of inferior petrosal sinus sampling(IPSS)(n=13) in 25 patients(19 women, 6men, age range 16-58, mean 32.2) with pathologically-confirmed ACTH secreting pituitary adenoma. We analyzed the radiologic findings and determined how accurately each method could detect and lateralize the lesion within the pituitary gland. The results were compared with the surgical findings and with each other. RESULTS: Seven patients(28%) out of 25 had macroadenomas and the lesions were detected and correctly diagnosed by CT and MR in all. Eighteen patients(72%) had microadenoma. In patients with microadenoma the sensitivity was 38.5%(5/13) in CT, 64.7%(11/17) in MR, 90.9%(10/11) in IPSS. In two patients with dynamic MR, in whom the conventional Gd-enhanced MR showed false negative results, the lesions were detected as low signal intensity mass and correctly lateralized. Considering the results of both MR and IPSS, the sensitivity increased up to 94.1%(17/18). CONCLUSION: Considering the invasiveness of IPSS, Gd-enhanced MR, preferably dynamic, seems to be an imaging modality of choice in Cushing's disease. Combined use of IPSS in selected patients further increases the accuracy of diagnosis and lateralization.
ACTH-Secreting Pituitary Adenoma ; Diagnosis ; Female ; Humans ; Pituitary Gland ; Retrospective Studies

We report a successful pregnancy in a woman who at the age of 31years received chemotherapy for mucinous cystadenocarcinoma of the right ovary. She was treated with multiple chemotherapy including cis-platinum, cyclophosphamide, adriamycin, and oral melphalan. She had microscopic residual cancer at the opposite ovary at second-look laparotomy. She developed secondary amenorrhea with symptoms of menopause after commencing treatment which persisted on its completion. Biochemical investigations were consistent with ovarian failure, which was assumed to be chemotherapy-induced. She was given hormonal replacement therapy with a conjugated equine estrogen/medroxyprogesterone acetate combination, resulting in regular withdrawal bleeding. The patient conceived 5 years after completing chemotherapy and gave birth a normal infant at term.
Amenorrhea ; Cisplatin ; Cyclophosphamide ; Cystadenocarcinoma, Mucinous ; Doxorubicin ; Drug Therapy* ; Female ; Hemorrhage ; Humans ; Infant ; Laparotomy ; Melphalan ; Menopause ; Neoplasm, Residual ; Ovarian Neoplasms ; Ovary ; Parturition ; Pregnancy*

PURPOSE: To determine the optimal parameters of abdominal HASTE imaging by means of a comparison of intermediate and long TE (echo time). MATERIALS AND METHODS: We evaluated 30 consecutive patients who had undergone liver MR during a three-month period. Twelve patients were diagnosed as normal, four as having liver cirrhosis, and 14 were found to be suffering form hepatic hemangioma. On the basis of measured signal intensity of the liver, spleen, pancreas and gallbladder, and of fat, muscle, hemangioma, and background, we calculated the ratios of signal to noise (S/N), signal difference to noise (SD/N), and signal intensity (SI). Image quality was compared using these three ratios, and using two HASTE sequences with TEs of 90 msec and 134 msec, images were qualitatively evaluated. RESULTS: S/N ratio of the liver was higher when TE was 90 msec(p<.05), though S/N, SD/N and SI rations of the spleen, gallbladder, and pancreas -and of hemangiom- were higher when TE was 134 msec (p<.05). However, in muscle, all these three ratios were higher at a TE of 90 msec. SD/N ratio and SI of fat were higher at a TE of 134 msec. Overall image quality was better at a TE of 134mesc than at one of 90msec. CONCLUSION: A HASTE sequence with a TE of 134msec showed greater tissue contrast and stronger T2-weighted images than one with a TE of 90msec.
Gallbladder ; Hemangioma ; Humans ; Liver ; Liver Cirrhosis ; Magnetic Resonance Imaging* ; Noise ; Pancreas ; Spleen

PURPOSE: To evaluate the usefulness of CT for determining the causes of intestinal obstruction followingsurgery for abdominal cancer. MATERIALS AND METHODS: CT scans were performed in 54 patients with benign (n = 25)or malignant (n = 29) bowel obstruction after surgery for abdominal malignancies ; the causes of obstruction wereconfirmed pathologically (n = 34) or clinically (n = 20). Three radiologists interpreted the CT scans andevaluated their accuracy, sensitivity, and specificity. Through analysis of CT findings, malignant and benignobstruction was compared with regard to the presence of mass or lymphadenopathy, bowel change, mesenteric change,ascites, and other ancillary findings. RESULTS: In distinguishing malignant from benign obstruction, thediagnostic accuracy achieved by three radiologists was 67%, 74%, and 78%. When there was a mass at the obstructedor prior surgical site, lymphadenopathy, an abrupt transitional zone, or irregular wall thickening at anobstructed site, malignant obstruction was suspected (P < .05) ; in the absence of a mass, CT findings ofmesenteric vascular engorgement, extensive ascites, a smooth transition zone and normal or smooth wall thickeningat the obstructed site suggested benign obstruction (P < .05). The presence of omental infiltration, mesentericinfiltration and metastatic lesions at other sites did not always indicate malignant obstruction. In addition,bowel wall thckness, luminal diameter and the interval between surgery and bowel obstruction were notstatistically significant. CONCLUSION: CT is useful for determining the causes of obstruction following surgeryfor abdominal cancer, though particularly when definite peritoneal mass is not demonstrated this usefulness inlimited.
Ascites ; Humans ; Intestinal Obstruction ; Lymphatic Diseases ; Phenobarbital ; Sensitivity and Specificity ; Tomography, X-Ray Computed

Microvilli are outer membrane organelles that contain cross-linked filamentous actin.Unlike well-characterized epithelial microvilli, T-cell microvilli are dynamic similar to those of filopodia, which grow and shrink intermittently via the alternate actin-assembly and -disassembly. T-cell microvilli are specialized for sensing Ags on the surface of Ag-presenting cells (APCs). Thus, these finger-shaped microprotrusions contain many signaling-related proteins and can serve as a signaling platforms that induce intracellular signals. However, they are not limited to sensing external information but can provide sites for parts of the cell-body to tear away from the cell. Cells are known to produce many types of extracellular vesicles (EVs), such as exosomes, microvesicles, and membrane particles. T cells also produce EVs, but little is known about under what conditions T cells generate EVs and which types of EVs are released. We discovered that T cells produce few exosomes but release large amounsts of microvilli-derived particles during physical interaction with APCs. Although much is unanswered as to why T cells use the same organelles to sense Ags or to produce EVs, these events can significantly affect T cell fate, including clonal expansion and death. Since TCRs are localized at microvilli tips, this membrane event also raises a new question regarding long-standing paradigm in T cell biology; i.e., surface TCR downmodulation following T cell activation. Since T-cell microvilli particles carry T-cell message to their cognate partner, these particles are termed T-cell immunological synaptosomes (TISs). We discuss the potential physiological role of TISs and their application to immunotherapies.

OBJECTIVE: Our purpose was to determine the effect of epidural analgesia on the first phase of labor and mode of delivery of nulliparous women. METHODS: We studied 170 nulliparous women at near-term who underwent spontaneous and induced labor at the Department of Obstetrics and Gynecology, Hanyang University Hospital from January 1999 to May 2000 prospectively. Eighty women who were received epidural analgesia for pain relief were compared to ninety women as control group. Cesarean delivery was performed when indicated. RESULTS: The demographic characteristics of the two groups were similar with respect to age, height, weight, gestational weeks, and gravida. The two groups had the same cervical dilatation at the time of analgesia. There were no statistically significant difference between two groups. The length of the first phase of labor was same between two groups(558.4+/-50.4 min. vs 452.1+/-46.7 min.). There were statistically significant differences in the instrument delivery and cesarean section rate between two groups(43 vs. 32, 8 vs. 16 respectively). CONCLUSIONS: Epidural analgesia provides safe and effective intrapartum pain control and may be administered without undesirable effects on the first phase of labor and delivery.
Analgesia ; Analgesia, Epidural* ; Cesarean Section ; Female ; Gynecology ; Humans ; Labor Stage, First ; Labor, Induced ; Obstetrics ; Pregnancy ; Prospective Studies

PURPOSE: To compare modified small bowel follow-through (SBFT) using methylcellulose after the administrationof barium suspension with a conventional series. MATERIALS AND METHODS: In order to evaluate small bowelpathology, modified SBFT was performed in 155 patients during a 15 month period. All patients received 600mL ofmethylcellulose ; 98 had taken 250mL of 40% wt/vol barium suspension and 57 had taken 150mL of 70% barium. For thegroup of 98, the barium suspension was prepared by mixing barium powder with water (n=46) or with methylcellulosein(n=52). For comparison with a modified series, 49 patients who underwent conventional SBFT using 500mL of 40%wt/vol barium were lso included. Image quality was rated by three radiologists as "poor", "fair", "good", or"excellent". We analyzed the relationship between image quality, transit time and small bowel pathology;the sensitivity and specificity of each technique was also determined. RESULT: Among the four techniques, modifiedSBFT with 250mL of 40% wt/vol barium suspension, prepared by mixing barium powder with methylcellulose, showed thebest image quality ["excellent" result in 33 of the 52 patients (63%)] and shortest transit time to the cecum. Thehigh image quality of this technique was not affected by the presence of small bowel pathology;its use resulted inthe lowest incidence and slowest development of flocculation. The sensitivity (91-95%) of the three modified SBFTprocedures was superior to that of a conventional series(76%), but there was no difference in specificity. CONCLUSION: Modified SBFT using methylcellulose after administering barium suspension with barium powder as amixing agent is a simple technique. Its use easily improves the image quality and diagnostic accuracy of peroralSBFT.
Barium* ; Cecum ; Flocculation ; Humans ; Incidence ; Methylcellulose* ; Sensitivity and Specificity ; Water