The authors analyzed 38 consecutive cases with an occipital arteriovenous malformation(AVM) in regard to visual field defect. The incidence of occipital AVM was 10.4% among 367 patients with a cerebral AVM treated between 1975 and 1994 in our institute. Bleeding rate of occipital AVM in this series was 86.8%(EE cases) and it was significantly higher than that of AVM in other locations. Of 38cases, 15 patients(39.5%) had a visual field defect on admission and all of them were accompanied by intracerebral hematomas caused by the rupture of AVMs. The presence of visual field defect did not correlate with angioarchitecture in reference to pattern of nidus, feeding artery, and draining vein. Of 15 patients with visual field defect. 10 patients showed homonymous hemianopsia and five patients, homonymous quadrantanopsia. The size and location of intracerebral hematoma correlated well with hemispheric approach : 11, parietooccipital approach : 10, with six preoperative embolization and 1 postoperative gamma knife surgery. Fifteen patients underwent gamma knife surgery with five preoperative embolization. One patient underwent embolization only. The results of treatment were as follows : There were no mortality and morbidity except for visual field defect. We confirmed complete resection or obliteration of malformed vessels in 25 patients and reduction of the nidus size in eight patients. Five patients were not followed. After gamma knife surgery, two patients showed rebleeding during the follow up period. Among 23 patients who had no visual field defect before treatment, three patients showed visual field defect after treatment(one after microsurgical resection using occipital interhemispheric approach, two after preoperative embolization). In 15 patients with visual field defect before treatment, four patients showed improvement in their visual field defect after treatment(three after microsurgical resection using occipital interhemispheric approach, one after gamma knife surgery). The parietooccipital approach did not change the status of visual field in any of the ten parients. In occipital AVM, visual field defect was the most srious morbidity. Ruptured occipital AVM had a higher incidence of hemorrhage causing a visual field defect and had a higher indication of direct surgical approach than AVM of other location. In planning surgery of occipital AVM, one has to count microsurgical anatomy based on the visual pathway as well as clinical findings such as the angioarchitecture, location of intracerebral hematoma, and preopeative visual field.
Arteries ; Arteriovenous Malformations* ; Follow-Up Studies ; Hematoma ; Hemianopsia ; Hemorrhage ; Humans ; Incidence ; Mortality ; Occipital Lobe ; Rupture ; Veins ; Visual Fields* ; Visual Pathways

No abstract available.
Diagnosis* ; Hemangioma*

BACKGROUND: Exercise testing is a standard noninvasive method used in the evaluation and management of patients with suspected coronary artery disease. However, patients with lower limb impairment are unable to undergo a standard bicycle or treadmill test. Alternative methods of exercise testing are needed for patients with vascular, orthopedic or neurologic conditions who cannot perform leg exercise. This study was aimed to determine the diagnostic accuracy of arm exercise thallium-201 SPECT for evaluating chest pain in patients unable to perform leg exercise. METHOD: Twenty-five anginal patients performed arm ergometry testing in conjunction with thallium-201 SPECT. Thereafter all underwent coronary angiography. RESULT: Significant coronary artery disease (> or =50% stenosis) in at least one vessel was present in 22 (88%) of the 25 patients. The sensitivity of thallium-201 SPECT for detecting coronary artery disease was 91%, which was significantly higher than the 32% sensitivity found with the electrocardiographic response alone (p <0.001). Thallium-201 SPECT yielded a sensitivity of 88, 86 and 100% for one, two, and three vessel diseases, respectively, and an 84% sensitivity and 81% specificity for detecting individual vessel stenosis. CONCLUSION: Arm exercise thallium-201 SPECT is useful for detecting coronary artery disease in patients unable to perform leg exercise. In addition, it provides an information regarding exercise tolerance. Therefore, this test appears to be reliable and useful and should be considered in the detection of coronary artery disease in nonambulatory patients.
Angina Pectoris ; Arm* ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Electrocardiography ; Exercise Test ; Exercise Tolerance ; Humans ; Leg ; Lower Extremity ; Orthopedics ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

OBJECTIVES: Glide path preparation is recommended to reduce torsional failure of nickel-titanium (NiTi) rotary instruments and to prevent root canal transportation. This study evaluated whether the repetitive insertions of G-files to the working length maintain the apical size as well as provide sufficient lumen as a glide path for subsequent instrumentation. MATERIALS AND METHODS: The G-file system (Micro-Mega) composed of G1 and G2 files for glide path preparation was used with the J-shaped, simulated resin canals. After inserting a G1 file twice, a G2 file was inserted to the working length 1, 4, 7, or 10 times for four each experimental group, respectively (n = 10). Then the canals were cleaned by copious irrigation, and lubricated with a separating gel medium. Canal replicas were made using silicone impression material, and the diameter of the replicas was measured at working length (D0) and 1 mm level (D1) under a scanning electron microscope. Data was analysed by one-way ANOVA and post-hoc tests (p = 0.05). RESULTS: The diameter at D0 level did not show any significant difference between the 1, 2, 4, and 10 times of repetitive pecking insertions of G2 files at working length. However, 10 times of pecking motion with G2 file resulted in significantly larger canal diameter at D1 (p < 0.05). CONCLUSIONS: Under the limitations of this study, the repetitive insertion of a G2 file up to 10 times at working length created an adequate lumen for subsequent apical shaping with other rotary files bigger than International Organization for Standardization (ISO) size 20, without apical transportation at D0 level.
Dental Pulp Cavity ; Silicones ; Transportation

OBJECTIVES: Glide path preparation is recommended to reduce torsional failure of nickel-titanium (NiTi) rotary instruments and to prevent root canal transportation. This study evaluated whether the repetitive insertions of G-files to the working length maintain the apical size as well as provide sufficient lumen as a glide path for subsequent instrumentation. MATERIALS AND METHODS: The G-file system (Micro-Mega) composed of G1 and G2 files for glide path preparation was used with the J-shaped, simulated resin canals. After inserting a G1 file twice, a G2 file was inserted to the working length 1, 4, 7, or 10 times for four each experimental group, respectively (n = 10). Then the canals were cleaned by copious irrigation, and lubricated with a separating gel medium. Canal replicas were made using silicone impression material, and the diameter of the replicas was measured at working length (D0) and 1 mm level (D1) under a scanning electron microscope. Data was analysed by one-way ANOVA and post-hoc tests (p = 0.05). RESULTS: The diameter at D0 level did not show any significant difference between the 1, 2, 4, and 10 times of repetitive pecking insertions of G2 files at working length. However, 10 times of pecking motion with G2 file resulted in significantly larger canal diameter at D1 (p < 0.05). CONCLUSIONS: Under the limitations of this study, the repetitive insertion of a G2 file up to 10 times at working length created an adequate lumen for subsequent apical shaping with other rotary files bigger than International Organization for Standardization (ISO) size 20, without apical transportation at D0 level.
Dental Pulp Cavity ; Silicones ; Transportation

Familial Mediterranean fever (FMF) is an auto-inflammatory disease characterized by periodic episodes of fever and recurrent polyserositis. It is caused by a dysfunction of pyrin (or marenostrin) as a result of a mutation within the MEFV gene. It occurs mostly in individuals of Mediterranean origin; however, it has also been reported in non-Mediterranean populations. In this report, we describe the first case of FMF in a Korean child. As eight-year-old boy presented recurrent febrile attacks from an unknown cause, an acute scrotum and renal amyloidosis. He also showed splenomegaly, lymphadenopathy, pleural effusion, ascites and elevated acute phase reactants. After MEFV gene analysis, he was diagnosed as FMF combined with amyloidosis.
Amyloidosis/*diagnosis ; Child ; Familial Mediterranean Fever/*diagnosis ; Humans ; Kidney Diseases/*diagnosis ; Korea ; Male

PURPOSE: The status of estrogen receptor (ER), progesterone receptor (PR) and HER2 is critical in patients undergoing breast cancer treatment. We performed this study to evaluate the QuantiGene Reagent System as a clinical test for detecting ER, PR, and HER2 RNA levels in formalin-fixed, paraffin-embedded (FFPE) tissue. METHODS: The RNA levels of ER, PR and HER2 were measured using the QuantiGene2.0 assay in FFPE tissue from breast cancer patients (n=40) and compared with ER and PR immunohistochemistry results and HER2 fluorescence in situ bybridization (FISH) results. RESULTS: When the cut-off values for ER, PR, and HER2 RNA levels were 5.0, 7.2, and 50, respectively, the sensitivity, specificity, and positive and negative predictive value of the QuantiGene 2.0 Assay were 96.6%, 90%, 96.7%, and 90%, for ER; 89.7%, 81.8%, 92.9%, and 75% for PR; and 83.3%, 96.4%, 90.9%, and 93.1% for HER2, respectively. The Allred scores for ER and PR as well as the HER2 FISH ratio were correlated with RNA levels (p=0.046, r=0.32; p<0.001, r=0.61; p<0.001, r=0.75, respectively). CONCLUSION: We demonstrated that the ER, PR, and HER2 RNA levels as measured by the QuantiGene 2.0 assay were reproducible and correlated well with immunohistochemistry and FISH results. Measuring ER, PR, and HER2 RNA levels from formalin-fixed, paraffin-embedded tissue using the QuantiGene 2.0 assay, which was a relatively simple technique easily performed in a usual laboratory, appeared to a helpful adjunct in determining the status of ER, PR, and HER2 in breast cancer.
Breast ; Breast Neoplasms ; Estrogens ; Fluorescence ; Humans ; Immunohistochemistry ; Receptor, erbB-2 ; Receptors, Estrogen ; Receptors, Progesterone ; RNA ; Sensitivity and Specificity

PURPOSE: Fluorouracil (5-FU) and leucovorin combination therapy have shown synergistic or additive effect against advanced colorectal cancer, but the frequency of mucositis and diarrhea is increased. Most previous studies have used high dose leucovorin (300~500 mg/m2). However, some studies of oxaliplatin and 5-FU with low-dose or high-dose leucovorin in Korea have shown similar response rates. Therefore, we studied the necessity of leucovorin and evaluated the objective tumor response rates and toxicities of a regimen of oxaliplatin and 5-FU without leucovorin every 2 weeks in metastatic colorectal cancer patients. MATERIALS AND METHODS: Twenty-four patients with metastatic colorectal cancer were enrolled between January 2002 and March 2003. Patients received 85 mg/ m2 of oxaliplatin on day 1, a bolus 5-FU 400 mg/m2 on day 1 and a continuous 5-FU infusion at 600 mg/m2/ 22 hours days 1 and 2, every 2 weeks. RESULTS: Of the 24 patients treated, 17 patients received previous 5FU with leucovorin and/or other chemotherapy. Three patients could not be evaluated. Five partial responses were observed with overall response rate of 21% (n=24). Of the previous chemotherapy group (n= 17), 4 partial responses were observed with response rate of 24%. Median overall survival was 18 months (range 4~32 months) and median progression free survival was 4 months (range 2~6 months). This regimen was well tolerated and only 1 grade 3 anemia was observed. CONCLUSION: Oxaliplatin/5-FU combination therapy without leucovorin achieved a relatively high response rate even in patients resistant to the previous 5-FU chemotherapy, and toxicity was minimal.
Anemia ; Colorectal Neoplasms* ; Diarrhea ; Disease-Free Survival ; Drug Therapy* ; Fluorouracil ; Humans ; Korea ; Leucovorin* ; Mucositis

PURPOSE: We want to validate the use of the silver-enhanced in situ hybridization (SISH) technique as comparised with fluorescence in situ hybridization (FISH) technique for assessing the HER2 gene amplification of breast carcinoma. METHODS: Tissue microarray (TMA) blocks from 58 breast cancer specimens were prepared and the concordance between HER2 gene amplification in breast cancer was determined by the FISH (PathVysion(R), Abbott/Vysis) technique and the automated silver in situ hybridization (SISH, INFORMtrade mark, Ventana) technique. For comparison, all the specimens were stained by immunohistochemistry (Ventana-PATHWAY(R)4B5). Evaluation was performed by two pathologists and with following the instructions of the manufacturers and the guidelines of the American Society of Clinical Oncology/College of American Pathologists. RESULTS: The results of SISH and FISH were identical in all 58 cases; 17 cases showed HER2 amplification, and on the other hand, 41 cases didn't show HER2 amplification. Five weakly positive (2+) cases in immunohistochemistry staining revealed one HER2 amplification and four no HER2 amplification on both SISH and FISH. The SISH results of the HER2/CEP17 ratio were well correlated with the FISH results of the HER2/CEP17 ratio (correlation coefficient r=0.745, Linear regression r2=0.555, p<0.001). CONCLUSION: The results of the SISH technique for assessing the HER2 status of excised breast carcinoma is comparable to the result obtained by FISH. However, SISH has the advantage of having permanent end result that can be visualized by an ordinary light microscope and less laborious preparation and time is needed than is required by FISH. SISH seems to be more feasible than FISH for assessing HER2 amplification of breast cancer.
Breast ; Breast Neoplasms ; Fluorescence ; Genes, erbB-2 ; Hand ; Imidazoles ; Immunohistochemistry ; In Situ Hybridization ; Light ; Linear Models ; Nitro Compounds ; Silver

PURPOSE: To determine the hepatic and vascular enhancement profiles with nonionic dimeric, iodixanol, contrast agent in the rabbit and to compare them with nonionic monomeric, ioversol, contrast agent. MATERIALS AND METHODS: Seven rabbits initially underwent hepatic dynamic CT scan with either iodixanol or ioversol, followed by repeated CT scan with other unused contrast agent with one week interval between scans. Pre and post contrast attenuation values of hepatic parenchyma, aorta and portal vein were measured sequentially. The mean enhancement of the hepatic parenchyma, aorta and portal vein were compared between two agents. The mean peak enhancement and peak enhancement time of the liver, aorta, and portal vein were also compared. RESULTS: The attenuation values of ioversol showed a greater mean hepatic enhancement than iodixanol from 18 seconds to 39 seconds after injection (from late arterial phase to early portal venous phase) with a statistical significance (p<0.05). The mean peak enhancement of hepatic parenchyma, aorta and portal vein was also greater using ioversol than iodixanol, but the mean peak enhancement times of ioversol and iodixanol were nearly identical. CONCLUSION: Ioversol may have the greater effects than iodixanol on hepatic tumor conspicuity, especially from late arterial phase to early portal veneous phase.
Aorta ; Contrast Media* ; Liver ; Portal Vein ; Rabbits* ; Tomography, X-Ray Computed