Rupture of anterior communicating artery aneurysm is one of the most important casuses of subarachnoid hemorrhage. Subarachnoid hemorrhage due to ruptured anterior communicating artery aneurysm shows characteristic CT findings, such as forntal hematoma or septum pellucidum hematoma. In some patients with the ruptured aneurysm, direct carotid angiography may be needed. particularly when transfemoral approach is not possible. However, not much have been known about the puncture site selection between the two carotid arteries in relation to the location of hematoma in CT scans. To determine the ideal puncture site of the direct carotid angiography, seventy-five cases of anterior communicating artery aneurysm confirmed by operation from May 1988 to April 1992, were analyzed in terms of relationship between location of hematoma on CT, direction of aneurysm and A1 artery on angiograms. Frontal lobar hematoma was more prevalent than septal hematoma, and was more common on the right side. In cases of lobar hematoma, aneurysm was directed to the ipsilateral side of the hematoma (67%) and was most commonly fed by contralateral A1 artery(75%). Septal bematoma consisted 36% of the cases and among there, midline directed aneurysm was most common, frequently fed by left A1 artery. In conclusion, when performing direct carotid angiography in patients with anterior communicating artery aneurysm, if forntal hematoma is observed on CT, it may be beneficial to puncture contralateral carotid artery. Meanwhile, if hemorrhage of septum pellucidum is observed, it may be better to puncture left carotid artery.
Aneurysm ; Aneurysm, Ruptured* ; Angiography ; Arteries* ; Carotid Arteries ; Hematoma ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Punctures ; Rupture ; Septum Pellucidum ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed

In spite of recent introduction of such highly sophisticated diagnostic modalities as computerized tomography,cardioangiography and polytomography the simple PA chest remaines as an essential and important method of chestdiagnosis especially in terms of vascular diseases of the lung and heart. Until recently, however, theinterpretation of chest x ray has been largely dependent on much subjective observation of roentgen anatomy of thechest. Several years ago Simon proposed a quantitative approach to interpretation of the chest in an attempt tomake the judgement more objective. In the present study we have carried out a clinical study on normalities of thestandard PA chest of Korean adults. The materials consisted of 216 normal chest films. Age ranged from 20 to 60years and sex distribution 103 males and 113 females, We counted the number of vessels in both lung fields,measured the diameter of the basal artery and investigated the level of hilum points as well as hilar distance.There were 9 to 11 vessels in the upper zone and 9 to 12 in the lower zone. There were no significant sexdifference. The number of vessels was not affected by aging. The average diameter of the basal artery was11.7±2.4mm in the right lower zone and 10±1.8mm in the left lower zone in female. There was significant sexdifference (p 0.01). Aging seemed not to be affected the size of the basal artery. The majority of hilum point waslocated at the level of 5-6th rib at axillary portion and the left hilar point is 0.3-2.0cm higher in locationthan the right. The hilar distance was 4.1±0.4cm on the right 5.0±1.1cm on the left in male and 4.0±0.7cm onthe right and 4.7±0.5cm on the left in female. There was significant sex difference (p 0.01). There wassignificant difference in size of the basal arteries and hilar distance between the Koreans and Englishmen but thenumbers of vessels were not significantly different.
Adult ; Aging ; Arteries ; Clinical Study ; Female ; Heart ; Humans ; Lung ; Male ; Methods ; Ribs ; Sex Characteristics ; Sex Distribution ; Thorax ; Vascular Diseases

Over the past 30 years, there has been an increase in the incidence of multifetal pregna-ncies, primarily because of the introduction of ovarian stimulants for ovulation induction and assisted reproductive technology ( ART ) in infertile patients. It is well established that multifetal pregnancies are associated with an increased frequency of the maternal complications and gre-ater perinatal morbidity and mortyality. The adverse outcome of multifetal pregnancies is dire-ctly proportional to the number of fetuses, primarily as an consequence of prterm delivery. Re-duction in the number of fetuses in multifetal pregnancies has been proposed as a way to impr-ove the perinatal outcome in this situation. Therefore, selective fetal reduction ( SFR ) is sugges-ted as a therapeutic option for continuation of pregnancy with fetuses mature enough to survi-ve. In this paper, we report our infertility clinic experiences with 6 patients who carried mult- ifetal pregnancies including 1 quintuplet, 1 quadruplet, and 4 triplets. from January, 1991 to May, 1996, transabdominal SFR was accomplished by fetal intrathoracic KCl injection at 9~10 weeks of gestation. After the prcedure, 4 patients remained as twin pregnancies, and 2 patients as single pregnancy. There have been 3 sets of twin deliveries and the 2 sets of single delivery. One case was aborted. Two patients were delivered after 37 weeks of gestation, 2 patients were at 35 weeks, and 1 patient at 24 weeks. All babies have been healthy after birth in patients after 35 weeks gestation. There was no fetal anomaly related to the procedure in the 6 cases. We concluded that transabdominal SFR is a rather safe and useful procedure that may improve the outcome of multifetal pregnancies.
Fetus ; Humans ; Incidence ; Infertility ; Ovulation Induction ; Parturition ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Pregnancy, Twin ; Quadruplets ; Quintuplets ; Reproductive Techniques, Assisted ; Triplets ; Twins

PURPOSE: To determine if ultrasonography is a reliable technique to assess masseter muscle sites within intra- and interobserver and the scanning level and/or the muscle condition affect local cross-sectional dismension (LCSD) measurements of masseter muscle. MATERIALS AND METHODS: 10 subjects without sign and symptom of temporomandibular disorders and missing posterior teeth were examined by ultrasonography. Bilateral ultrasonographic examinations were performed with a linear (B-scan) 7.5 MHz small-part transducer to register LCSDs of the masseter muscle on three different levels. Scans were made on relaxed and clenching condition. Three oral and maxillofacial radiologists measured at two sessions with a time interval of at least 5 minutes. RESULTS: Variables such as 'condition' and 'level' had a significant effect on muscle measurements (p< 0.05). There was no significant difference between 'sessions' (p> 0.05) and 'observers' (p> 0.05). LCSDs on lower scan level were significantly thinner than those on upper and middle level. Those on clenching condition were significantly thicker than those on relaxed condition (p< 0.05). The scanning level with the highest reproducibility was middle with clenching condition (ICC = 0.90, MSE = 0.55%). CONCLUSION: The data suggested that ultrasonography was a reliable method for measuring LSCD of masseter muscle in intra- and interobserver and middle scan level showed the most reliable data.
Masseter Muscle* ; Temporomandibular Joint Disorders ; Tooth ; Transducers ; Ultrasonography

PURPOSE: This study was designed to compare the effective doses from low-dose and standard-dose multi-detector CT (MDCT) scanning protocols and evaluate the image quality and the spatial resolution of the low-dose MDCT protocols for clinical use. MATERIALS AND METHODS: 6-channel MDCT scanner (Siemens Medical System, Forschheim, Germany), was used for this study. Protocol of the standard-dose MDCT for the orthodontic analysis was 130 kV, 35 mAs, 1.25 mm slice width, 0.8 pitch. Those of the low-dose MDCT for orthodontic analysis and orthodontic surgery were 110 kV, 30 mAs, 1.25 mm slice width, 0.85 pitch and 110 kV, 45 mAs, 2.5 mm slice width, 0.85 pitch. Thermoluminescent dosimeters (TLDs) were placed at 31 sites throughout the levels of adult female ART head and neck phantom. Effective doses were calculated according to ICRP 1990 and 2007 recommendations. A formalin-fixed cadaver and AAPM CT performance phantom were scanned for the evaluation of subjective image quality and spatial resolution. RESULTS: Effective doses in microSv (E(2007)) were 699.1, 429.4 and 603.1 for standard-dose CT of orthodontic treatment, low-dose CT of orthodontic analysis, and low-dose CT of orthodontic surgery, respectively. The image quality from the low-dose protocol were not worse than those from the standard-dose protocol. The spatial resolutions of both standard-dose and low-dose CT images were acceptable. CONCLUSION: From the above results, it can be concluded that the low-dose MDCT protocol is preferable in obtaining CT images for orthodontic analysis and orthodontic surgery.
Adult ; Cadaver ; Female ; Head ; Humans ; Neck ; Orthodontics ; Phantoms, Imaging

The glandular odontogenic cyst is a rare lesion described in 1987. It generally occurs at anterior region of mandible in adults over the age of 40 and has a slight tendency to recur. Histopathologically, a cystic cavity lined by a nonkeratinized, stratified squamous, or cuboidal epithelium varying in thickness is found including a superficial layer with glandular or pseudoglandular structures. A 21-year-old male visited Dankook University Dental Hospital with a chief complaint of swelling of the left posterior mandible. Radiographically, a huge multilocular radiolucent lesion involving impacted 3rd molar at the posterior mandible was observed. Buccolingual cortical expansion with partial perforation of buccal cortical bone was also shown. Histopathologically, this lesion was lined by stratified squamous epithelium with glandular structures in areas of plaque-like thickening. The final diagnosis was made as a glandular odontogenic cyst.
Adult ; Diagnosis ; Epithelium ; Humans ; Male ; Mandible* ; Molar ; Odontogenic Cysts* ; Radiography, Panoramic ; Tomography, X-Ray Computed ; Young Adult

PURPOSE: Tethered cord syndrome(TCS) is defined as low position of the conus medullaris by the abnormally fixed spinal cord with progressive neurologic deficit MATERIALS AND METHODS: To evaluate the findings of TCS at MRI and its diagnostic value, we performed a retrospective analysis of MRI of 30 patients with emphasis on clinical manifestation, level of conus medullaris, cause of tethering, and associated findings. RESULTS: Clinical presentation included back mass(26 cases), neurogenic bladder(5 cases), urinary incontinence(5 cases), progressive constipation(2 cases), skin dimpling(1 case), gait disturbance(1 case) and club foot (1 case). Neurologic deficit was developed in 11 cases(40% and mean age of these patients at the time of diagnosis was 8.6 years. The most common cause of tethering was lipoma(63%). The tips of conus medullaris were below the level of the second lumbar spine in all patients. The causes of tethering were lipomatous component(spinal lipoma and lipomyelomenigocele) in 67% myelomeningocele in 20%, presacral mass in 7%, thickened filum terminale in 3% and postoperative change in 3%. Associated anomalies included syringomyelia(20%) and hydrocephalus was associated in 3 out of 5 patients who underwent brain MRI. CONCLUSION: MRI clearly delineated the location of conus, tethering of the filum terminale with their causes and associated abnormalities. MRI examination is a very useful diagnostic tool for the early evaluation of TCS and the postoperative follow up.
Brain ; Cauda Equina ; Conus Snail ; Diagnosis ; Follow-Up Studies ; Foot ; Gait ; Humans ; Hydrocephalus ; Lipoma ; Magnetic Resonance Imaging ; Meningomyelocele ; Neural Tube Defects* ; Neurologic Manifestations ; Retrospective Studies ; Skin ; Spinal Cord ; Spine

PURPOSE: Magnetization transfer imaging(MTI) is a new imaging contrast technique. Our MT pulse sequence is designed as fixed time interval between echo and MT pulse. This study was peformed to evaluate the influence of variations in TR/TE on MTR in T1 weighted image of normal brain tissue on this kind of MT pulse sequence. MATERIALS AND METHODS: Seven healthy volunteers in twenties of age as the objectives, MRI was taken under various TR/TE(TR/TE ;700/14, 650/14, 750/14, 700/20 and 1500/20 msec). MTR was calculated from signal intensities measured at the same point in both pre and post MT images and statisticslly analyzed. The MR imager used in this study was 1.0T Magnetom 42SP(Siemens, Erlangen, Germany) and the parameters of additional MT pulse sequence were offset 1000Hz and bandwidth 250Hz, and posteriorly located to echo with 7.7 msec fixed interval. Offset of this MT pulse was variable. RESULT: In white matter of brain tissue from a normal person, MTR was 34-39%(average 37%) for TR and TE of 700/14 in T1WI and 33-36%(average 35%) for TR/TE of 650/14, and 34-38%(average 35%) for TR/TE of 750/14 which showed no statistical difference. However, in case of 1500/20 of TR/TE, MTR was 26-28%(average 26%) which is statistically significant. With TR/TE of 700/14 as the standrd value, the MTR of gray and white matter were 37% and 29% respectively, showing a definite difference of statistical means. Signal from CSF in ventricles is rarely influenced by MT pulse. CONCLUSION: Conclusively, a subtle variation in TR/TE in T1WI has little influence on MTR but wide range of variation in TR/TE as in proton density image induces significant difference in MTR on this kind of MT pulse sequence. Therefore, the exchangeable usage of MTR data would be possible in narrow range of TR/TE change but difficult in wide range of variation.
Brain* ; Healthy Volunteers ; Humans ; Magnetic Resonance Imaging ; Protons ; Reference Values*

From January 1995 to December 1997, a total of 219 cases pelviscopic surgery was performed at Il Sin Christian Hospital. To evaluate the safty and efficacy of pelviscopic surgery, we reviewed indication of operation, mean age, parity, history of abdominal operation, type of operation, duration of hospitalization and complication retrospectively. The number of pelviscopic surgery have risen from 33 cases in 1995 to 53 cases in 1996 and 133 cases in 1997. The most common indications were 118 cases for ectopic pregnancy (53.9%) and 42 cases for ovarian cyst (19.2%), 20 cases for infertility (9.1%) in order. Among the ovarian cyst, endometrioma was the most common. The mean age of patients was 31+/-6.7 years old and mean parity was 0.77. In most cases, mean blood loss was lesser than 100 cc except 500 cc in LAVH, 150 cc in CISH, 106.7 cc in ectopic mass removal. The postoperative hospital stay was varied from 0 day to 10 days, but usually 2 days. The 26 cases had complicated and the most common complication was fever above 38degrees C. In conclusion, it is evident that pelviscopic surgery is lesser invasive technique, has lower complication rate and shorter the length of hospitalization. So, we expect the number and indication of pelviscopic surgery will be increased in future.
Endometriosis ; Female ; Fever ; Hospitalization ; Humans ; Infertility ; Length of Stay ; Ovarian Cysts ; Parity ; Pregnancy ; Pregnancy, Ectopic ; Retrospective Studies

PURPOSE: To obtain magnetization transfer ratio(MTR) of the annulus fibrosus and nucleus pulposus and to assess the feasibility of utilizing the changes of these MTRs as an early indicator of disk degeneration. MATERIALS AND METHODS: MR images of lumbar spine with magnetization transfer(MT) technique in 42 patients were obtained. spin echo techniques (600/14) with same TR/TE with 1KHz off-resonance saturation were employed in 1.0T MR system. MTRs were calculated in two regions, anterior annulus fibrosus and nucleus pulposus, and the results were compared between the normal and degenerative disks, from grade I to IV, on T2-weighted images. RESULTS: MTRs of the nucleus pulposus were 17.6% in the normal disks, and 26.7%, 28.4%, 29.1%, 29.7% in degenerative disks, from grade I to IV, respectively, with a significant difference(P<0.05). On the other hand, MTRs in the annulus fibrosus were 30.2% in the normal disks and 31.5%, 33.2%, 32.1% and 35.6% in degenerative disks, from grade I to IV, respectively, without significant difference. CONCLUSION: Since MTRs are significantly higher in degenerative nucleus pulposus than those of the normal disks, increased MTRs in the nucleus pulposus can be used as an early sign of the degeneration of the nucleus pulposus.
Hand ; Humans ; Intervertebral Disc Degeneration* ; Magnetic Resonance Imaging* ; Spine