No abstract available.
Diaphragm* ; Rupture*

Seventy-five patients with moyamoya disease were admitted at Kyung Hee University Hospital from 1978 to 1993. Of these, we followed up fourty-five cases who had been treated conservatively for the study of the natural history of moyamoya disease. Seven operated cases and six dead patients during admission were excluded in this study and sixteen cases were lost to follow-up. There were 16 males and 29 females. The hemorrhagic group was twenty-three cases and the non-hemorrhagic group was twenty-two cases. On angiographic findings, the typical type was twenty-eight cases and the atypical type was seventeen cases. Twenty-one cases(91%) of the hemorrhagic group were over twenty years old and sixteen cases(73%) of the non-hemorrhagic group were under twenty years old. The mean follow-up period was 66 months(range 6 months to 15 year 4 months). Nineteen cases had reattack, but most of them had good result except only two cases who died due to huge intracerebral hematoma. Of the sixteen cases, who were under twenty years old and manifested as transient ischemic attack, fifteen cases were improved only with conservative management. The good result of fourty-one cases out of fourty-five with conservative management. suggests that spontaneous collateral circulation had developed well to restore the function of ischemic brain in the natural course of moyamoya disease. Moyamoya disease seems to be not so worse in natural course than expected and further study about natural history will be necessary.
Brain ; Collateral Circulation ; Female ; Follow-Up Studies ; Hematoma ; Humans ; Ischemic Attack, Transient ; Lost to Follow-Up ; Male ; Moyamoya Disease* ; Natural History*

No abstract available.
Encephalitis ; Immunoglobulins

Microvascular decompression of the trigeminal nerve at it's zone of entry into the pons and/or selective partial sensory rhizotomy of the portio major were performed in 26 patients with typical trigeminal neuralgia. Recently, microvascular decompression, partial sensory rhizotomy and percutaneous radiofrequency technique are the most commonly used and effective methods of treatment of this troublesome disorder. Since May, 1986 to October, 1994, the authors performed 26 cases of neurovascular decompression and/or partial sensory rhizotomy for trigeminal neuralgia and 22 patients(85%) had relief from neuralgic pain, 2(8%) had mild pain recurrence, 1 had moderate relief of pain and 1 had no relief from neuralgic pain after 13 months of mean follow up period. The trigeminal nerves were compressed by blood vessels in 19 cases(73%) and by tumor in 3 cases(12%). There were no pathologic lesions compressing the trigeminal nerve at its root entry zone in 4 cases (25%). The offending vessels were the superior cerebellar artery in 12 cases(46%), and 7 cases(27%) were associated with the anterior inferior cerebellar artery. There were no significant persisting complications or death in those operative treatments in the above described series.
Arteries ; Blood Vessels ; Decompression ; Follow-Up Studies ; Humans ; Microvascular Decompression Surgery* ; Pons ; Recurrence ; Rhizotomy* ; Trigeminal Nerve ; Trigeminal Neuralgia*

The choroids plexus papillomas are rare neoplasms of central nervous system, constituting about 0.5% of intracranial tumors. They are most common in children, especially in the first two year of life. In adult, they usually occur within posterior fossa, but cerebellopontine(CP) angle choroids plexus tumor is extremely rare. The authors report two cases of 4th ventricle and CP angle choroids plexus papilloma in adult.
Adult* ; Central Nervous System ; Cerebellopontine Angle* ; Child ; Choroid Plexus* ; Choroid* ; Humans ; Papilloma ; Papilloma, Choroid Plexus*

The aim of the study was to evaluate the association between genetic polymorphisms of CYP2D6 and outcomes in breast cancer patients with tamoxifen treatment. We evaluated the CYP2D6 genetic polymorphisms in 766 breast cancer patients. Among them, 110 patients whose samples were prospectively collected before surgery and treated with tamoxifen were included to evaluate the association between CYP2D6 and outcomes. The genotypes of CYP2D6 were categorized as extensive metabolizer (EM), intermediate metabolizer (IM), and poor metabolizer (PM) according to the activity score. The clinicopathologic features of 110 patients were not significantly different among the three groups except for the T-stage and nodal status. The high T-stage and axillary metastasis were more frequent in the PM group. While recurrence-free and overall survival in the PM group was poorer than the other groups, there was no significant difference between the EM and the IM group. The difference between the PM and the other groups on univariate analysis disappeared on multivariate analysis. These conflicting results suggest that the clinical value of CYP2D6 polymorphisms is still unclear and more large-sized and comprehensively designed trials are necessary.
Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents, Hormonal/*therapeutic use ; Breast Neoplasms/drug therapy/*genetics/mortality ; Cytochrome P-450 CYP2D6/*genetics ; Female ; Genotype ; Humans ; Kaplan-Meier Estimate ; Middle Aged ; Neoplasm Staging ; *Polymorphism, Single Nucleotide ; Tamoxifen/*therapeutic use

The authors report 4 cases of epidermoid tumor in the cerebello-pontine angle that caused trigeminal neuralgia. Trigeminal neuralgia is mainly caused by vascular compression at the trigeminal root entry zone. In some patients however, the trigeminal nerve can be affected by multiple sclerosis and compressed by a mass within the cerebello-pontine angle(e.g., meningioma, acoustic neurinoma, epidermoid cyst), giant aneurysm, and arteriovenous malformation(AVM). Such benign cerebello-pontine angle tumors may be found in as many as 5 to 8 percent of patients who present with tic nervous system and the initial symptoms caused by this tumor is manifested as facial pain without any other neurological symptoms.
Aneurysm ; Facial Pain ; Humans ; Meningioma ; Microvascular Decompression Surgery ; Multiple Sclerosis ; Nervous System ; Neuroma, Acoustic ; Tics ; Trigeminal Nerve ; Trigeminal Neuralgia*

BACKGROUND AND OBJECTIVES: The pathologic Q wave was once considered to be a sign of transmural myocardial infarction (MI), but the exact meaning of the pathologic Q wave remains to be elucidated. To evaluate the meaning of the pathologic Q wave using magnetic resonance imaging (MRI) investigations, which has recently emerged as a state-of-the-art diagnostic modality within cardiology. SUBJECTS AND METHODS: Thirty eight consecutive patients with acute myocardial infarction were enrolled in this study. MRI and coronary angiography were performed in all patients during their admission. A 32 segment model was used to analyze the MRI findings. Just before MRI, the electrocardiograms of all the patients were checked and the presence of the pathologic Q wave evaluated. The ischemic territories in each patient were quantified by the number of dysfunctional segments. Myocardial necrosis was determined by the area of delayed hyperenhancement in contrast enhanced MRI, and the myocardial necrosis index per segment was defined as the ratio of the hyperenhanced area to that of the entire segment. The total necrosis index was defined as the sum of all the myocardial necrosis indices in a patient, and the average necrosis index of dysfunctional segment (ANI) was calculated from the total necrosis index/number of dysfunctional segments in a patient. The transmurality of infarction was also assessed. RESULTS: Of all 38 patients, 26 showed a pathologic Q wave on ECG (Group A), whereas the other 12 did not (Group B). The number of dysfunctional segments, total necrosis index and frequency of transmural infarction (defined by infarct transmurality> or = 75% of wall thickness) were no different between the two groups. The infarct transmurality over 25 or 50% and ANI were significantly different between the two groups. In a multivariate analysis, an infarct transmurality over 50% and ANI were significant factors in determining the presence of a pathologic Q wave. CONCLUSION: By an in vivo analysis of myocardial necrosis, as determined by MRI in acute myocardial infarction, an infarct transmurality over 50% and average necrosis index of dysfunctional segments (ANI) might be significant factors in the genesis of a pathologic Q wave.
Cardiology ; Coronary Angiography ; Electrocardiography ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Multivariate Analysis ; Myocardial Infarction* ; Necrosis

BACKGROUND AND OBJECTIVES: Cardiovascuar MR using contrast enhancement has recently been reported to be useful for diagnosing myocarditis. It is also well known that irreversible myocardial injury by epicardial coronary artery flow obstruction spreads from the endocardium to the epicardium in a wave-front pattern with a time-dependent manner. We investigated characteristics of the patterns of contrast-enhanced MR imaging according to the underlying myocardial injury mechanism. SUBJECTS AND METHODS: Of all 275 patients who underwent coronary angiogram at our hospital due to cheat pain and elevated cardiac enzymes between October, 2002 and August, 2003, 48 patients who underwent cardiac MR were enrolled in this study. We retrospectively analyzed the pattern of delayed hyperenhancement according to presence or absence of a documented infarct related artery. Endomyocardial biopsies were done in selected patients. RESULTS: Contrast MR images of all patients showed delayed hyperenhancement. The study group was divided into 2 groups according to whether the areas of hyper-enhancement were involved in the sub-endocardial portion (endocardial sparing pattern, ESP) or not. In 8 patients (Group A, 17%) who showed the endocardial sparing pattern on contrast MR, the findings of coronary angiogram were all normal. In 40 patients (Group B, 83%), who did not show the endocardial sparing pattern on contrast MR, 39 patients (97.5 %) had an infarct related artery on coronary angiogram (p=0.001). Endomyocardial biopsies were performed in 3 patients of group A. The findings of the 3 biopsies were 2 cases of definite myocarditis and 1 case of myocardial degeneration. CONCLUSION: The endocardial sparing pattern of myocardial injury demonstrated by delayed enhancement MR imaging was very useful to predict the presence of an infarct related artery in patients with myocardial necrosis that has been determined by elevated cardiac enzymes. This result can be a useful clue to determine the nature of the underlying injury mechanism such as ischemic or non-ischemic.
Arteries ; Biopsy ; Coronary Vessels ; Endocardium ; Humans ; Magnetic Resonance Imaging* ; Myocardial Infarction ; Myocarditis ; Necrosis ; Pericardium ; Retrospective Studies

BACKGROUND: Cardiovascular MR has recently been reported that it can determine the viable myocardium. We investigated this study to determine the usefulness of cardiovascular MR in prediction of wall motion recovery after revascularization in acute myocardial infarction METHODS: Both cardiovascular MR with contrast enhancement and coronary angiogram were performed in 19 patients with acute myocardial infarction who treated with precutaneous intervention or thrombolytic therapy. Six months follow-up angiogram and MR study were also preformed. Thirty two matched segments model of the left ventricle were used to analysis the wall motion change and the grade of transmural extent of hyperenhancement (TEI). RESULTS: Among 628 segments, 177 segments showed wall motion abnormality. In group of segments showing hypokinesia (68 segments), the proportion of segments showing wall motion improvement was not different from that of the akinetic segments group (109 segments) (50% vs 41.3%, p=0.26). The proportion of segments showing wall motion improvement were 60.5% in group of TEI grade 0, 58.9% in TEI grade I, 51.2% in TEI grade III, 29.4% in TEI grade IV, 8% in TEI grade V. If the groups were divided into two according to cut-off value of TEI 50%, In the group of TEI less than 50%, 67 out of 118 segments (56.8%) showed wall motion improvement in contrast with 12 out of 59 segments (20.3%) in the group of TEI above 50% (p<0.001). The status of baseline wall motion abnormality (hypokinesia or akinesia) did not effect on wall motion improvement after revascularization. CONCLUSIONS: The baseline wall motion abnormality (hypokinesia or akinesia) did not predict the wall motion improvement. But, TEI grade was significant factor to predict the wall motion improvement.
Follow-Up Studies ; Heart Ventricles ; Humans ; Hypokinesia ; Magnetic Resonance Imaging ; Myocardial Infarction* ; Myocardium ; Thrombolytic Therapy