In the condition of diabetic retinopathy, the vascular changes are localized primarily in the retinal capillaries and are presumed to promote angiogenesis. To investigate the change of retinal blood flow velocities and morphological parameters in diabetic retinopathy, we measured perifoveal capillary blood velocities(v) and the size of foveal avascular zones(FAZ). Thirteen patients with diabetic maculopathy and nine healthy volunteers were included in this study. The scanning laser technique in conjunction with an image analysing system were used to assess the morphological and hemodynamic changes in diabetic retinopathy. Diabetic maculopathy group showed a slower capillary blood velocity than normal group(2.44+/-0.39mm/sec vs2.75+/-0.61 mm/sec, p>0.18). The foveal avascular zone was significantly larger in diabetic maculopathy group than in normal group(313.5+/-64.6micrometervs. 238.9+/-93.8micrometer, p<0.05). This results indicate that the retinal microcirculation is altered in diabetic patients compared with healthy subjects. These alterations may be due to the change of the capillary wall and blood viscosity in diabetic patients. The determination of these parameters can be utilized in monitoring the progress of diabetic maculopathy.
Blood Flow Velocity ; Blood Viscosity ; Capillaries ; Diabetic Retinopathy ; Healthy Volunteers ; Hemodynamics ; Humans ; Microcirculation ; Retinaldehyde

Cranial mononeuropathies, manifesting particulary as opthalmoplegia or facial palsy, are common entities in the dia-betic population. However, sequential multiple cranial neuropathies due to diabetes are much less common. It is often associated with other conditions such as a brain tumor or head trauma. A 61-year-old diabetic man presented with ptosis, opthalmoplegia, and facial palsy which were manifestations of multiple cranial neuropathies involving the left 3rd, 4th, 6th, and 7th cranial nerves throughout five weeks. The pupils were not involved. The neurologic evaluation included a CSF study and a brain MRI with MRA. None of them produced any significant results. Blink reflexes revealed evidence of a left facial nerve lesion. The blood glucose was strictly controlled and steroid therapy was administered. The ptosis of the patientanjx left eyelid improved during treatment and he was discharged after 13 days. In a follow-up examination 3 months after onset, focal neurological deficits including opthalmoplegia and facial palsy on the left side were greatly improved and barely noticeable.
Blinking ; Blood Glucose ; Brain ; Brain Neoplasms ; Cranial Nerve Diseases* ; Cranial Nerves ; Craniocerebral Trauma ; Diabetes Mellitus* ; Eyelids ; Facial Nerve ; Facial Paralysis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Mononeuropathies ; Pupil

BACKGROUND: Although a magnetic resonance imaging (MRI) is highly sensitive for changes associated with ischemic stroke, the detection of an acute ischemic lesion is usually impossible within 6 hours of the stroke onset on a conventional MRI. The perfusion MRI is a new imaging technique for diagnosing acute ischemic stroke. We evaluate the clinical usefulness of the perfusion MRI in predicting the final infarct extent in 18 patients with acute middle cerebral artery (MCA) territory ischemic stroke. METHOD: The perfusion MRI was performed within 6 hours after the stroke onset in all patients with a single-section dynamic contrast-enhanced T2*-weighted imaging in conjunction with a conventional routine MRI and MR angiography. Time-concentration curves and cerebral blood volume (CBV) maps were calculated from the dynamic MR imaging data by using numerical integration techniques. We compared findings of CBV maps with infarction on a follow-up CT or MRI. RESULTS: In 14 of 18 patients, the CBV in the occluded MCA territory were decreased. In the remaining 4 patients with a reversible ischemic neurologic deficit (RIND) or transient ischemic attack (TIA), the CBV were increased in 3 and normal in 1. Out of 14 patients with a decreased CBV, two had focal regions of increased CBV within the affected territory, indicating reperfusion hyperemia. The regions of increased or decreased CBV were eventually converted to infarction on follow-up images in all 14 patients. Out of 4 patients with RIND or TIA, one showed focal infarction in centrum semiovale on a follow-up image. CONCLUSIONS: The perfusion MRI was useful for the assessment of hemodynamic change about cerebral perfusion and may predict the extent of final infarction in acute MCA territory ischemic stroke. These results suggest that the perfusion MRI may play an important role in the diagnosis and management of acute ischemic stroke.
Angiography ; Blood Volume ; Diagnosis ; Follow-Up Studies ; Hemodynamics ; Humans ; Hyperemia ; Infarction ; Ischemic Attack, Transient ; Magnetic Resonance Imaging* ; Middle Cerebral Artery* ; Neurologic Manifestations ; Perfusion* ; Reperfusion ; Stroke*

Most intussusceptions occur in children under 1 year of age whereas 5%~10% occurs in adults. Although intussusception has an acute occurrence in children, symptoms in adults may be subacute or chronic, and the diagnosis is often delayed. In contrast to adults, intussusception in children is the most common cause of intestinal obstruction, and one of the most frequent causes of surgical emergencies. While idiopathic cases account for more than 90% of those seen in children, many cases in adults are generally related to neoplasm. However, intussusception due to a primary malignant lymphoma of the small intestine is a rare clinical condition. There is little information on the role of colonoscopy in colonic intussusception. Two cases are herein reported, of malignant lymphoma in the ileocecal region causing intussusceptions in which the diagnosis and reduction of intussusception were made by colonoscopy. Colonoscopy plays a useful role in the diagnosis and management of intussusception. The clinical, radiographic, endoscopic, and pathologic findings are described with brief reviews of related literature.
Adult ; Child ; Colon ; Colonoscopy* ; Diagnosis* ; Emergencies ; Humans ; Ileum* ; Intestinal Obstruction ; Intestine, Small ; Intussusception* ; Lymphoma*

BACKGROUND/AIMS: Colonoscopic polypectomy should be performed on the five to seven hour of clock (standard position). However, outcomes of polypectomy at non-standard positions have not yet been investigated. This study was to compare the clinical outcomes of colonoscopic polypectomy including procedure time, status of resection margin and complications between standard and non-standard position. METHODS: Patients who underwent screening colonoscopy were prospectively recruited from Oct 2011 to Feb 2012 at Dongguk University Ilsan Hosptial, Goyang, Korea. Standard position was defined as polyps which were located from 5 to 7 hour of clock on colonoscopic view. RESULTS: A total of 168 adenomatous polyps of 114 patients were investigated. Mean size of polyp was 7.1+/-3.2 mm. The most common shape of polyps was sessile in 77 cases (45.8%). Mean overall procedure time per patient was 25.5+/-12.3 min. 130 adenomatous polyps were resected in standard position (77.4%) and 38 polyps were in non-standard position (22.6%). Overall complete resection rate was 63.7% and immediate bleeding rate was 9.8%. There was no significant difference in overall polypectomy time per polyp (2.9+/-1.3 min vs. 3.0+/-1.8 min, P=0.32). Complete resection rates and complication were not statistically different. CONCLUSIONS: There was no difference according to procedure time, status of resection margin and complications between standard position and non-standard position. Colonoscopic polypectomy is thus safe and feasible on any position.
Adenomatous Polyps ; Colonic Polyps ; Colonoscopy ; Hemorrhage ; Humans ; Korea ; Mass Screening ; Polyps ; Prospective Studies

Objective: : High precision and accuracy are expected in gamma knife radiosurgery treatment. Because of the requirement of clinically applying complex radiation and dose gradients together with a rapid radiation decline, a dedicated quality assurance program is required to maintain the radiation dosimetry and geometric accuracy and to reduce all associated risk factors. This study investigates the validity of Leksell Gamma plan (LGP)10.1.1 system of 5th generation Gamma Knife Perfexion as modified variable ellipsoid modeling technique (VEMT) method. Methods: : To verify LGP10.1.1 system, we compare the treatment plan program system of the Gamma Knife Perfexion, that is, the LGP, with the calculated value of the proposed modified VEMT program. To verify a modified VEMT method, we compare the distributions of the dose of Gamma Knife Perfexion measured by Gafchromic EBT3 and EBT-XD films. For verification, the center of an 80 mm radius solid water phantom is placed in the center of all sectors positioned at 16 mm, 4 mm and 8 mm; that is, the dose distribution is similar to the method used in the x, y, and z directions by the VEMT. The dose distribution in the axial direction is compared and analyzed based on Full-Width-of-Half-Maximum (FWHM) evaluation. Results: : The dose profile distribution was evaluated by FWHM, and it showed an average difference of 0.104 mm for the LGP value and 0.130 mm for the EBT-XD film. Conclusion : The modified VEMT yielded consistent results in the two processes. The use of the modified VEMT as a verification tool can enable the system to stably test and operate the Gamma Knife Perfexion treatment planning system.

PURPOSE: We investigated whether Cyclosporin A (CsA) had the anti-proteinuric effect in diabetic rats and whether it was associated with the alteration of P-cadherin expression. METHODS: Sprague-Dawley rats were injected with diluent (C, N=16) or streptozotocin intraperitoneally (DM, N=16). Eight rats in each group were treated with 10% ethanol or with 1.5 mg/kg/day of CsA (C+CsA and DM+CsA) for 6 weeks. Immortalized mouse podocytes were cultured in media with 5.6 mM glucose (LG), LG+CsA (10-8 M), LG+TGF-beta1, 30 mM glucose (HG), or HG+CsA. Real time-PCR and Western blot were performed for P-cadherin and TGF-beta1 mRNA and protein expression, respectively, with sieved glomeruli and cell lysates. RESULTS: Urinary albumin excretion was significantly higher in DM compared with C rats, and CsA treatment inhibited the increase in albuminuria in DM rats. Glomerular P-cadherin mRNA and protein expression in DM were decreased compared with C rats, and these decreases were significantly inhibited by CsA. Glomerular TGF-beta1 mRNA and protein expression were higher in DM than C rats, and CsA treatment inhibited the increase in TGF-beta1 expression in DM. P-cadherin mRNA and protein expression in HG and LG+TGF-beta1 podocytes were lower than LG cells, and these HG-induced decrements were restored by CsA. CONCLUSION: CsA treatment reduces urinary albumin excretion in DM rats. P-cadherin expression is decreased under diabetic conditions, which is ameliorated by CsA. In addition, inhibition of the increase in glomerular TGF-beta1 expression under diabetic conditions by CsA seems to restore the P-cadherin expression, resulting in the decrease in albuminuria.
Albuminuria ; Animals ; Blotting, Western ; Cadherins* ; Cyclosporine* ; Diabetic Nephropathies* ; Ethanol ; Glucose ; Mice ; Podocytes* ; Proteinuria ; Rats ; Rats, Sprague-Dawley ; RNA, Messenger ; Streptozocin ; Transforming Growth Factor beta1

Pancreatic arteriovenous malformation (AVM) is an extremely rare condition with various clinical manifestations. We report herein a case of recurrent acute pancreatitis due to pancreatic AVM in a 49-year-old man. This patient presented with epigastric pain that had developed after consuming alcohol 2 days prior to admission. Serum amylase and lipase levels were elevated and computed tomography revealed focal low-attenuation lesions with peripancreatic infiltrations in the pancreatic tail and multiple collateral vessels around the low-attenuation lesions. He was diagnosed with acute pancreatitis and pancreatic AVM. Although he had stopped drinking after the first attack of acute pancreatitis, his pancreatitis recurred twice within 3 months. He underwent a distal pancreatectomy after the third attack of acute pancreatitis. He was free of symptoms for 2 years after the pancreatectomy.
Amylases ; Arteriovenous Malformations ; Drinking ; Humans ; Lipase ; Middle Aged ; Pancreatectomy ; Pancreatitis