BACKGROUND & PURPOSE: Fibrinoeptide-A (FpA) and D-dimer have been well known as hematologic parameters for activation of the coagulation and the endogeneous fibrinolysis system during acute phase of ischemic stroke. We measured the levels of FpA and D-dimer in acute progressive and non-progressive ischemic strokes to assess whether these markers are valuable as a predictor of stroke progression during acute phase. METHODS: FpA (RIA method) and D dimer (ELISA method) were determined in 54 patients, 9 with acute progressive and 45 with non-progressive within acute stage(< 48 hours of onset) of cerebral infarction. RESULTS: Levels of FpA in patients with acute progressive stroke were significantly higher than those in patients with non-progressive stroke, indicating activation of the coagulation system (P = 0.013). And, levels of D-dimer in patients with acute progressive stroke were also higher than those in patients with non-progressive stroke but statistically insignificant(P-0.071). CONCLUSIONS: These findings suggest that the coagulation system is more enhanced in progressive stroke than non-progressive one during acute stage of ischemic stroke. Higher levels of FpA are thought to be useful markers to predict stroke in progression.
Cerebral Infarction ; Fibrinolysis ; Humans ; Stroke*

No abstract available.

Objectives: The purpose of study is to evaluate serial MR imaging of myocardial infarction using non-surgical model of myocardial infarction after percutaneous transcatheter coronary arterial embolization in dogs. MATERIALS AND METHODS: We evaluated serial pre- and post-contrast MR images with Gd-DTPA (gadolinium-diethylenetriamine-pentaacetic acid) of heart of the eleven mongrel dogs (immediate group (n=3), one week group (n=3), three weeks group (n=5)) after making non-surgically induced myocardial infarction. We confirmed the infarct with TTC staining and microscopically. The location and extents of the myocardial infarction were correlated. RESULTS: A total of 24 MR images were archived; 11 images of the immediate post-embolic period, 8 images of one-week follow-up, and five of 3-week follow-up images. Comparing with the signal intensity of normal myocardium, immediate post-embolic MR images showed low or iso signal intensities (SI) of the infarct area on T1-weighted images (T1WI) and high SI on T2-weighted images (T2WI). No contrast enhancement with Gd-DTPA was made in all cases of the immediate post-embolic MRI. One-week and 3-week follow-up MR images showed low or iso SI on T1WI and slight high or iso SI on T2WI. Contrast enhancement images in both one-week and 3-week follow-up MRI showed denser enhancement of infarct area in one-week follow-up. The myocardial wall thinning was seen in 5 of eight dogs after one week and in 3 of five after 3 weeks. CONCLUSION: In non-surgical animal models of myocardial infarction, MR images showed low or iso SI on T1WI, and high SI on T2WI in various stages, and contrast enhancement was maximum after one week and gradual decrease to 3 weeks. The myocardial wall thinning was seen in one-to 3-week follow-up MR images.
Animals* ; Dogs ; Follow-Up Studies ; Gadolinium DTPA ; Heart ; Magnetic Resonance Imaging* ; Models, Animal* ; Myocardial Infarction* ; Myocardium

BACKGROUND AND SIGNIFICANCE: Neck manipulation or trauma uncommonly be associated with serious and even fatal vascular complications. We presented the clinical and radiologic findings in 3 patients of brainstem and/or cerebellar infarct with basilar artery occlusion and extracranial vertebral artery stenosis or occlusion,. Cases : In the patient 1, the infarction of pons and lsft cerebellar hemisphere outbroke just after being seized by the collar. The angiographic findings were complete occlusion of basilar artery and left vertebral artery on C1 level and vertebrobasilar junctional occlusion of right vertebral artery. In the patient 2, extensive infarction of pons and left cerebellar hemisphere developed just after chiropractic manipulation of the neck. The angiographic findings were occlusions of left vertebral artery and distal portion of the basilar artery. In the patient 3, right cerebellar and medullary infarction of posteroinferior cerebellar artery territory occurred just after autobicycle accident. The angiographic finding was complete occlusion of left vertebral artery on C1 lever. They had not another risk factor of the stroke. CONCLUSIONS: We experienced and presented 3 cases of posterior circulation infarctio with vertebrobasilar stenoocclusion just following cervical manipulation or neck trauma.
Arteries ; Basilar Artery ; Brain Stem ; Humans ; Infarction* ; Manipulation, Chiropractic ; Manipulation, Spinal* ; Neck ; Pons ; Risk Factors ; Stroke ; Vertebral Artery ; Vertebrobasilar Insufficiency

PURPOSE: Cross-modality coregistration of positron emission tomography (PET) and magnetic resonance imaging (MR) could enhance the clinical information. In this study we propose a refined technique to improve the robustness of registration, and to implement more realistic visualization of the coregistered images. MATERIALS AND METHODS: Using the sinogram of PET emission scan, we extracted the robust head boundary and used boundary-enhanced PET to coregister PET with MR. The pixels having 10% of maximum pixel value were considered as the boundary of sinogram. Boundary pixel values were exchanged with maximum value of sinogram. One hundred eighty boundary points were extracted at intervals of about 2 degree using simple threshold method from each slice of MR images. Best affined transformation between the two point sets was performed using least square fitting which should minimize the sum of Euclidean distance between the point sets. We reduced calculation time using pre-defined distance map. Finally we developed an automatic coregistration program using this boundary detection and surface matching technique. We designed a new weighted normalization technique to display the coregistered PET and MR images simultaneously. RESULTS: Using our newly developed method, robust extraction of head boundary was possible and spatial regishation was successfully performed. Mean displacement error was less than 2.0mm. In visualization of coregistered images using weighted normalization method, structures shown in MR image could be realistically represented. CONCLUSION: Our refined technique could practically enhance the performance of automated three dimensional coregistration.
Brain* ; Head ; Magnetic Resonance Imaging ; Positron-Emission Tomography

Endoscopic retrograde biliary drainge is a useful method of palliative treatment of malignant biliary obstruction with respect to safety, rapidity in decompression of obstruction. However, despite of efforts to prolong patency of the stents, the main long term complication of current-widely used plastic endoprosthesis is to tendency for the stents to become clogged by sludge leading to recurrent jaundice and cholangitis, finally, obstruction of stents. Recently, in an effort to improve the patency of stent, variety of self-expandable metallic endoprosthesis have developed and which can be compressed into and inserted through small lumen catheter with large-bored lumen in expandable state. However, most of these open mesh of self-expandable stents allows tumor in growth which causes reobstruction, and additionally it is nearly impossible to retrieve the inserted prosthesis. Recently developed coil metal stent(Endocoil, Intent Co.), which, unlikely other previous metallic stent, has possibility of retrieving prosthesis and prevention of tumor ingrowth. We experienced a case of 52-year old male sufferd from malignant biliary obstruction due to recurrence of cancer at peripancreatic lymph nodes and combined with common bile duct stones on both proximal and distal side of the stricture, in whom Endocoil was implanted with sucessful decompression of obstruction and simultaneous removal of biliary stones located at both side of stricture.
Catheters ; Cholangitis ; Common Bile Duct ; Constriction, Pathologic* ; Decompression ; Humans ; Jaundice ; Jaundice, Obstructive* ; Lymph Nodes ; Male ; Middle Aged ; Palliative Care ; Plastics ; Prostheses and Implants ; Recurrence ; Sewage ; Stents*

The safety of endoscopic retrograde cholangiopancreatography(ERCP) in patients with acute pancreatitis(AP) was confirmed in the past decade. Especially in ease of acute gallstone panereatitis, early ERCP/EST(endoscopic sphincterotomy) may reduce the incidence of complications by removing gallstone which causes acute attack of pancreatitis. To assess clinical usefulness of ERCP/EST in the setting of AP, we reviewed clinical records of 58 patients with AP who had undergone ERCP /EST during the same period of admission.(continue...)
Cholangiopancreatography, Endoscopic Retrograde* ; Gallstones ; Humans ; Incidence ; Pancreatitis*

Although variation is the rule with pancreatic duct morphology, certain variants occur as a result of altered embroological development. These ductal configurations, most striking deviations from the normal configuration, may be classfied according to alterations of embryological development. These congenital variants of pancreatic duct may be important for several reasons. First, the pseudomass effect of ductal anomalies can be mistaken for carcinoma by the inexperienced radiologists. Second, whether or not the anomaly is important, it is present in many patients with recurrent pacreatitis. Original descriptions were based on small sampling of postmortem studies and surgical specimen, but more recently the advent of endoscopic retrograde cholangiopancreatography(ERCP) has confirmed of the work of early anastomists and increased awareness of these variants. To evalute of frequency, characteristics of associated disease and clinical significance of pancreatic anomalies, we have reviewed of 5330 case of ERCP filmes which were undertaken between July, 1973 and August, 1993. Having reviewed of ERCP filmes, we found out 9 case of pancreatic duct variants. Among them, 7 cases were classified as ductal duplication anomalies, 4 cases of number variation, most, bifuricaiton and 3 cases of form variation, which were composed of loop, spiral and terminal N. Three cases of fusion anomalies were also noted, which were 2 cases of panceratic divisum and 1 case of incomplete pancreatic divisum. The associated diseases were 6 cases of bile duct and galbladder stones and 3 cases of pancreatic cancer. We could not find out the case of congenital anomalies as cause of obstructive pain and pseudomass effect.
Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde* ; Humans ; Pancreatic Ducts* ; Pancreatic Neoplasms ; Pancrelipase ; Strikes, Employee

This study is verifying the hypothesis that distraction followed by recompression may promote fracture healing of the osteoporotic bone on the assumption that distraction induces increased callus formation at the distracted gap and recompression results in fusiform callus, having biomechanically stronger fracture stiffness. Sixty-six Sprague-Dawley rats, in which osteoporosis were induced 6-8 weeks after oophorectomy, were separated into two groups. Group I was control group that had fracture healing by simple external fixation. Group II was experimental group that had fracture healing by monofocal distraction-compression. Radiomorphometric study revealed that there was significantly increased amount of callus and ensuing bone formation, which becehe obvious from 20 days after osteotomy in group II compared with group I. Biomechanical study also showed that tensile break strength was significantly higher in group II compared with group I with time. It is concluded that monofocal distraction-compression method may be one of the useful method to promote fracture healing of the estrogen deficient osteoporotic bone.
Animals ; Bony Callus ; Estrogens ; Female ; Fracture Healing* ; Osteogenesis ; Osteoporosis* ; Osteotomy ; Ovariectomy ; Rats* ; Rats, Sprague-Dawley

Primary gallbladder cancer is a highly malignant tumor and is characterized by early metastasis and rapid progression of disease. Since the majority of patients have unresectable disease, laparotomy, instead of providing relief of symptoms, often adds to the morbidity and needs to be avoided in patients with advanced disease. Clinical features, peritoneoscopic findings, and comparison of peritoneoscopy with radiologic studies were reviewed in 29 patients, who underwent peritoneoscopy, with primary gallbladder cancer at Severaace Hospital, College of Medicine, Yonsei University between Aug. 1982 and Mar. 1994. (continue...)
Gallbladder Neoplasms* ; Gallbladder* ; Humans ; Laparoscopy* ; Laparotomy ; Neoplasm Metastasis