BACKGROUND: Primary stenting as a direct reperfusion procedure after acute myocardial infarction might reduce recurrent myocardial infarction and target vessel revascularization. However, result of long or multiple stenting in the long or tandem lesions were not known. METHOD: From Jan. 1996 to Dec. 1998, patients with acute myocardial infarction including cardiogenic shock were undergone primary stenting using long or multiple stent. The clinical end points were death, recurrent infarction, subsequent bypass surgery, or repeat angioplasty of the infarct-related vessel. The results were compared with age, sex, lesion, and risk matched standard stenting group. RESULT: Baseline characteristics were similar for the 20 patients who underwent standard length stenting and the 13 patients who underwent long or multiple stenting. Stent diameter was similar in two group (3.4+/-0.3 mm vs. 3.5+/-0.4 mm, p=0.65), but total stent length was longer in long or multiple stenting group (15.5+/-1.8 mm vs. 40.18.4 mm, p=0.01). Average numbers of stent using in multiple stenting were 1.5+/-0.7. Stenting in the infarct-related artery was successful in all patients randomized to stent treatment. At 6 months, the incidence of the primary end point was 25% (5/20) in the standard stent group and 31%(4/13) in the long or multiple stent group (p=0.5). CONCLUSION: Outcomes of long or multiple stenting including mortality, recurrent myocardial infarction and target vessel revascularization was similar to standard stenting. Long or multiple stenting after acute myocardial infarction may possible procedure in some selective cases having long or tandem lesion.
Angioplasty* ; Arteries ; Humans ; Incidence ; Infarction ; Mortality ; Myocardial Infarction ; Reperfusion ; Shock, Cardiogenic ; Stents*

OBJECTIVE: Many studies have showed that excess or lack of sexual hormones, such as prolactin and testosterone, induced the sexual dysfunction in humans. Little, however, is known about the role of sexual hormones showing normal range in, especially, the basal state unexposed to any sexual stimulation. We hypothesized sexual hormones in the basal state may affect sexual behavior. METHODS: We investigated the association of the sexual hormones level in the basal hormonal state before visual sexual stimulation with the sexual response-related brain activity during the stimulation. Twelve heterosexual men were recorded the functional MRI signals of their brain activation elicited by passive viewing erotic (ERO), happy-faced (HA) couple, food and nature pictures. Both plasma prolacitn and testosterone concentrations were measured before functional MR scanning. A voxel wise regression analyses were performed to investigate the relationship between the concentration of sexual hormones in basal state and brain activity elicited by ERO minus HA, not food minus nature, contrast. RESULTS: The plasma concentration of prolactin in basal state showed positive association with the activity of the brain involving cognitive component of sexual behavior including the left middle frontal gyrus, paracingulate/superior frontal/anterior cingulate gyri, bilateral parietal lobule, right angular, bilateral precuneus and right cerebellum. Testosterone in basal state was positively associated with the brain activity of the bilateral supplementary motor area which related with motivational component of sexual behavior. CONCLUSION: Our results suggested sexual hormones in basal state may have their specific target regions or network associated with sexual response.
Brain ; Cerebellum ; Dopamine ; Heterosexuality ; Humans ; Magnetic Resonance Imaging ; Male ; Plasma ; Prolactin ; Reference Values ; Sexual Behavior ; Testosterone

OBJECTIVES : A neural circuit including amygdala, the hippocampal complex and prefrontal cortex was associated with deficits in facial processing in schizophrenia. These deficits have a significant impact on social functioning in schizophrenia. Both neuropsychological deficits and brain structural abnormalities in first-degree relatives of schizophrenia patients suggest that they may also have the deficit in facial information processing as genetic factors. The purpose of this study was to explore the dysfunction of facial information processing in first-degree relatives of schizophrenia patients using functional magnetic neuroimaging (fMRI). METHODS : Ten non-affected siblings of schizophrenic patients and 10 normal comparison subjects having no schizophrenic siblings underwent fMRI during the d ynamic facial change procedure consisting of presentations of facial emotion and gender discrimination stimuli. The emotion discrimination condition consisted of the presentation of 12 happy faces and 12 disgust/fear faces. The gender discrimination condition consisted of the presentation of 12 male faces and 12 female faces. Condition-specific brain activations were compared between non-affected siblings and normal comparison subjects RESULTS : The facial information processing related brain regions including fusiform gyrus, several areas of frontal, temporal, occipital, and cerebellar regions exhibited more activation during gender discrimination than emotion discrimination tasks in each group. During gender discrimination task, siblings of schizophrenic patients showed less activation in right fusiform gyrus, both middle and superior frontal gyrus, left cuneus, and left inferior frontal gyrus, compared with normal comparison subjects. CONCLUSION : Dysfunctional facial information processing, such as a deficit in gender discrimination, might be an endophenotype of schizophrenia.
Amygdala ; Automatic Data Processing ; Brain ; Discrimination (Psychology) ; Endophenotypes ; Female ; Humans ; Magnetic Resonance Imaging ; Magnetics ; Magnets ; Male ; Neuroimaging ; Prefrontal Cortex ; Schizophrenia ; Siblings

PURPOSE: To correlate the findings of perfusion-weighted imaging (PWI) with clinical outcomes in patients with acute lacunar infarction. MATERIALS AND METHODS: Eleven patients (7 males and 4 females) with acute lacunar infarction who were examined within 50 (mean, 29) hours of the onset of symptoms underwent conventional MRI, diffusion-weighted imaging (DWI) and PWI. Gadolinium (0.2 mmol/kg) was injected at a rate of 2 ml/sec, and PWI was performed using a gradient-echo EPI pulse sequence and the following parameters: TR/TE, 2000/60; flip angle, 90 degree; matrix size, 128X128. Relative cerebral blood volume (rCBV) maps were derived from gadolinium bolus perfusion-weighted images where rCBV ratios between infarcted areas were detected by DWI, and contralateral control areas were obtained. In each case, the resulting rCBV ratio at a lesion site was compared with the clinical outcome determined on the basis of the difference between National Institute Health Stroke Scale (NIHSS) scores at admission and discharge. RESULTS: With the aid of the time-intensity curve obtained at PWI, the rCBV maps revealed a hypoperfused area in 10 of 11 patients, and there was positive correlation (r=0.81) with clinical outcome. CONCLUSION: Although PWI has a lower detection rate than DWI, it may be a useful modality for helping determine prognosis in cases of acute lacunar infarction.
Blood Volume ; Diagnosis* ; Gadolinium ; Humans ; Magnetic Resonance Imaging* ; Male ; Perfusion* ; Prognosis ; Stroke ; Stroke, Lacunar*

Neonatal Hemangioendothelioma (HE) is the most common type of hepatic vascular tumor that presents in infancy. HE generally undergo spontaneous regression within a year, but it may become symptomatic and be associated with life-threatening complications including congestive heart failure, consumptive coagulopathy and hepatic rupture. We report five cases of neonatal hepatic HE with brief review of the literatures. The report include a case of HE associated with AV malformation complicated by congestive heart failure who was successfully treated by hepatic artery embolization, a case of HE associated with transposition of great artery (TGA), and three cases of asymptomatic HE with spontaneous involution.
Arteries ; Heart Failure ; Hemangioendothelioma* ; Hepatic Artery ; Rupture

BACKGROUND: Myocardial ischemia is known to depress systolic and diastolic functions for a prolonged period of time. Dobutamine and epinephrine are frequently administered to improve myocardial function during cardiac surgery. The vascular response to vasopressors might be altered by ischemia and reperfusion, since alterations in vascular control mechanisms have been demonstrated even after a short period of ischemia. The present study was aimed to investigate the effects of dobutamine and epinephrine on regional and global myocardial functions, coronary blood flow (CBF) and myocardial oxygen consumption (MVO2) in normal and stunned myocardium in an open-chest canine model. METHODS: Forty-eight dogs were acutely instrumented under enflurane anesthesia to measure aortic and left ventricular pressures, and pulmonary (cardiac output) and left anterior descending (LAD) blood flows via a Doppler flowmeter, and a subendocardial segment length in the region supplied by the LAD. In series 1, incremental doses of dobutamine (1, 2, 5, 10microgram/kg/min, n = 9) or epinephrine (0.02, 0.04, 0.1, 0.2microgram/kg/min, n = 10) were infused intravenously (IV) for 10 min before (normal) and after 15 min of LAD occlusion and subsequent 1 hr-reperfusion (stunned). In series 2, incremental doses of dobutamine (50, 125, 250, 375 ng/mL of LAD flow, n = 14) or epinephrine (4, 10, 20, 30 ng/mL of LAD flow, n = 15) were infused directly into the LAD (IC) for 3 5 min before (normal) and after myocardial ischemia (stunned). Segment shortening (%SS), as an index of regional myocardial contractility, and the peak segment lengthening rate (dL/dt max), as an index of regional diastolic function, were evaluated. Simultaneous arterial and coronary venous contents of oxygen and lactate were measured to calculate MVO2 and oxygen (EO2) and lactate extraction (Elac) ratios during IV or IC infusions of epinephrine or dobutamine. Effectiveness of metabolic vasodilation was determined from EO2. RESULTS: IV or IC infusions of dobutamine or epinephrine before ischemia resulted in dose-dependent increases in mechanical functions (%SS and dL/dt max) and MVO2. These changes were accompanied by parallel increases in CBF resulting in unaltered EO2 with an infusion of dobutamine, while CBF increased more than MVO2 with epinephrine, resulting in decreased EO2. After the ischemia and reperfusion, %SS and dL/dt max were depressed and Elac was reduced, but similar mechanical responses (%SS and dL/dt max) to both dobutamine & epinephrine were observed. Also, in the stunned myocardium, CBF increased in parallel with mechanical function and MVO2 with either IC or IV dobutamine, resulting in an unaltered EO2. However, IC but not IV epinephrine did not affect EO2, suggesting abolishment of its direct vasodilating effect in stunned myocardium. In addition, IC epinephrine infusion further decreased Elac, while IC dobutamine did not affect it in stunned myocardium. During IV infusions, dobutamine caused a dose-dependent increase in the heart rate but epinephrine did not affect it, despite the comparable increase in cardiac index and mean aortic pressure. CONCLUSIONS: The results indicate that dobutamine and epinephrine exert similar positive inotropic and lusitropic effects in normal and stunned myocardium in dogs. However, epinephrine causes direct coronary vasodilation in normal myocardium, but it does not directly affect coronary vascular tone in stunned myocardium. In addition, epinephrine infusion dose-dependently depresses Elac in stunned myocardium. In contrast, dobutamine affects neither direct coronary vascular tone nor Elac regardless of ischemia and reperfusion injury.
Anesthesia ; Animals ; Arterial Pressure ; Dobutamine* ; Dogs* ; Enflurane ; Epinephrine* ; Flowmeters ; Heart Rate ; Ischemia ; Lactic Acid ; Myocardial Ischemia ; Myocardial Stunning* ; Myocardium ; Oxygen Consumption ; Oxygen* ; Reperfusion ; Reperfusion Injury ; Thoracic Surgery ; Vasodilation ; Ventricular Pressure

No abstract available.
Tuberculosis, Meningeal*

BACKGROUND: Although the superior reperfusion and improved clinical outcome following angioplasty for acute myocardial infarction (AMI) have been well known, 10 to 15% of reinfarction and recurrent ischemia in hospital are main limitation of primary percutaneous transluminal coronary angioplasty (PTCA). This study was undertaken to examine the safety and feasibility of stent-supported primary angioplasty in acute myocardial infarction. METHODS: Between July 1995 and Jun. 1997, 32 patients underwent direct or rescue PTCA, including patients with cardiogenic shock. After PTCA, stenting was attempted in patient with dissection or having more than 30% of residual stenosis. Result: In patient with direct PTCA, angiographic success rate was obtained in 91% (30/32). Stenting was attempted in 15 of 30 patients. These patients had suboptimal results (8 patients), non-occlusive dissection (3 patients) and acute occlusion (2 patient). Thrombolysis in myocardial infarction (TIMI) grade 3 flow was restored in 28 patients (93%). In one patient no-reflow phenomena was observed following stent insertion. Despite intra-aortic balloon pumping, there was one death during the hopitalization due to cardiogenic shock following PTCA. Subacute stent thrombosis developed in two patients. 27 patients (90%) were event-free and clinically improved through out the follow up period (11.5+/-5.2 month). Quantitative angiography showed excellent angiographic result after stenting compared with balloon PTCA (2.4+/-0.6 mm vs. 3.4+/-0.3 mm p<0.01). CONCLUSION: After failure of initial angioplasty, coronary stenting can be a supportive therapeutic strategy. Coronary stenting results in a high degree of angiographic success, a low incidence of subacute thrombosis.
Angiography ; Angioplasty* ; Angioplasty, Balloon* ; Angioplasty, Balloon, Coronary ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Incidence ; Intra-Aortic Balloon Pumping ; Ischemia ; Myocardial Infarction* ; Reperfusion ; Shock, Cardiogenic ; Stents ; Thrombosis

PURPOSE: To evaluate MRI findings of malignant ovarian tumors. MATERIALS AND METHODS: MRI findings were retrospectively reviewed in 25 patients with surgically confirmed 30 malignant ovarian tumors(common epithelial tumor;23, sex cord stromal tumor;2, endodermal sinus tumor ; 1, metastatic tumor ;4). The findings evaluated were the lesion size, solid and/or cystic component, wall thickness, septal thickness, necrosis, invasion of adjacent organ, ascites, and adenopathy. RESULTS: MRI findings of the malignant ovarian tumors were as follow:Size of lesion was 5-35cm(mean 14cm) ;solid component was present in 80%(24/30);wall thickness was more than 3ram in 90%(27/30);septal thickness was more than 3ram in 70%(21/30);tumor necrosis was present in 40%(12/30%) ;invasion of adjacent organ was present in 76%(19/25);ascites was present in 56%(14/25);lymphadenopathy was present in 24% (6/25). MRI findings of absence of solid component(6/6), even wall and septal thickness(7/7, 19/19) were found only in epithelial tumors. Uneven septal thickness more than 3mm(7/11) was a predominant MRI findings of non-epithelial tumors. Well-defined cystic lesion within solid component was seen in Krukenberg tumors. CONCLUSION: Evaluation of the lesion size, internal architecture, invasion of adjacent organ, ascites, and lymphadenopathy in MRI would enable diagnosis of malignant ovarian tumors and could lead to possible differential diagnosis of epithelial tumors from non-epithelial tumors.
Ascites ; Diagnosis ; Diagnosis, Differential ; Endodermal Sinus Tumor ; Humans ; Krukenberg Tumor ; Lymphatic Diseases ; Magnetic Resonance Imaging* ; Necrosis ; Retrospective Studies

OBJECTIVE: Emoticon as well as face is a tool for the communication of emotion. However, little is known about behavioral response to emoticon, unlike face. To explore the characteristics of behavioral response of emoticon and face, we measured both response time and accuracy in healthy young subjects. METHODS: The 29 subjects were asked to respond to emoticons or faces which contained one among happy, sad, angry/fearful or neutral emotion. Using univariate analysis of variance, behavioral responses were analyzed for three main effects of stimulation (face, emoticon), emotion (happy, sad, angry/fearful, neutral), gender (male, female) and also their interactions. RESULTS: The response to face was faster and more accurate than that to emoticon. Female's response to face, not to emoticon, was faster than male. A common finding of face and emoticon stimuli was that their responses were slower and less accurate in angry/fearful condition than in the rest emotional ones. There was not any interaction among three factors. The different finding was that neutral condition was less informative in only emoticon, not in face, condition. CONCLUSION: Our results demonstrated emoticon is different from face in terms of the characteristics in the transfer ability of emotion and in gender effect.
Humans ; Male ; Reaction Time ; Transfer (Psychology)