To determine whether are significant diastolic left ventricular dysfunctions in mild to moderate hypertensive patients with normal systolic function, radionuclide ventriculography by in vivo red cell labelling technique using 20 mCi of (99m)Tc pertechnetate was performed in 24 hypertensive patients(mean age: 50.6+/-12.4, mean blood pressure: 156.9+/-11.8/100.6+/-7.1 mmHg) and in 11 normal subjects (mean age: 42.7+/-13.5, mean blood pressure: 123.2+/-6.8/82.3+/-3.9 mmHg). The results were as follows: 1) Ejection fraction was similar in both hypertensive and control groups (0.70+/-0.06 versus 0.70+/-0.08). 2) Mean of the peak filling rate (PFR) was significantly lower in hypertensive group (2.07+/-0.45 EDV/sec) than in control group (2.42+/-0.30 EDV/sec) (p<0.05). 3) Mean of the time to peak diastolic filling (TPDF) in hypertensive patients was 189.0+/-30.4 msec and which was significantly longer than that of control subjects (164.5+/-22.4 msec)(p<0.02). 4) Mean of the first third filling fraction (1/3 FF) in hypertensive patients was 0.22+/-0.07 and which was significantly lower than that of control subjects (0.32+/-0.09)(p<0.01). 5) Decreased PFR and delayed TPDF were also demonstrated with advances in age in both groups. Above results suggest that the diastolic evaluation of left ventricle might be necessary in the hypertensive patients with normal systolic function, and that diastolic dysfunction may precede the systolic dysfunction and clinical deterioration.
Blood Pressure ; Heart Ventricles ; Humans ; Hypertension* ; Radionuclide Ventriculography* ; Sodium Pertechnetate Tc 99m ; Ventricular Dysfunction, Left

The aim of the present study was to evaluate the ability of Tl-201 abdominal SPECT to differentiate between chronic focal pancreatitis and pancreatic malignancy. Seventeen patients (12 men, 5 women; mean age, 56 years; 9 pancreatic cancer, 8 chronic pancreatitis) with pancreatic mass were prospectively investigated with Tl-201 abdominal SPECT. In all patients, CT and/or US could not clarify the nature of the pancreatic mass. Focal hot uptake was present in 8 of 9 patients with pancreatic cancer, while it was present in 2 of 8 patients with chronic pancreatitis. Therefore, the sensitivity and specificity of the present study were 89% and 75%, respectively. A significant difference of Tl-201 uptakes was noted between benign and malignant masses (p& 0.05). Therefore, we concluded that Tl-201 abdominal SPECT was a useful test in differentiation of malignant from benign pancreatic mass, especially when the differentiation could not be made by other imaging modalities
Abdomen/*radionuclide imaging ; Chronic Disease ; Diagnosis, Differential ; Evaluation Studies ; Female ; Follow-Up Studies ; Human ; Male ; Middle Age ; Pancreatic Neoplasms/*radionuclide imaging ; Pancreatitis/*radionuclide imaging ; Prospective Studies ; Reproducibility of Results ; Sensitivity and Specificity ; Support, Non-U.S. Gov't ; Thallium Radioisotopes/*diagnostic use ; Tomography, Emission-Computed, Single-Photon/methods

The vertebral artery injuries are rare in frequency and penetrating injuries are most likely to damage the vertebral artery as a sort of a collateral damage from striking the bony cervical spine. A 49-year-old man was struck in the face with a metal bar. The plain skull X-ray showed a long nail penetrating from the maxilla to the suboccipital area. Digital subtraction angiography revealed an injury of the left vertebral artery with a strong retrograde flow down the rostral segment and a filling with thrombus within the distal portion from injured segment. The patient underwent Guglielmi detachable coils embolization for complete isolation of the injured segment. The manual removal of the foreign body was attempted and was successfully completed.
Angiography, Digital Subtraction ; Embolization, Therapeutic ; Foreign Bodies ; Humans ; Maxilla ; Middle Aged ; Skull ; Spine ; Strikes, Employee ; Thrombosis ; Vertebral Artery*

PURPOSE: In the pediatric patients who have medically intractable epilepsy the callosotomy is useful to prevent the propagation of seizure from one hemisphere to the other. The indications of callosotomy are drop attack, life threatening primarily or secondarily generalized seizure, medically refractory mixed seizure types such as Lennox-Gastaut syndrome. In addition, the retarded children are not contraindicated. The anterior callosotomy is used to perform to control medically intractable epilepsy which is believed to have some advantages to total callosotomy. But, we propose that the anterior callosotomy does not seem to be superior to total callosotomy for the prevention of the propagation of seizure or complication. We describe a series of 21 patients with medically intractable epilepsy who underwent total callosotomy in one stage. METHODS: The diagnoses in these patients included Lennox-Gastaut syndrome, atonic seizure, infantile hemiplegia, and no obvious solitary seizure focus on chronic video/EEG monitoring to characterize seizures, electrographic activity, and postictal behaviors. Preoperatively 16 patients suffered from disabling drop attacks or intense head drop seizures which caused frequent physical injuries. Other types of seizures are 12 generalized tonic-clonic seizures, 7 complex partial seizures, 1 absence seizure, and 7 myoclonic seizures. Male:Female=14:7, Age: 2-22 years (Mean: 9.4 years). The follow-up period ranged from 0.8 to 3.8 years (median 2.4 years). Seizure outcome, parental assessment of daily function, and parental satisfaction with outcome were assessed postoperatively. RESULTS: Drop attacks disappeared completely during the entire follow-up period in 13 patients and decreased to less than 10% of baseline in five. The corpus callosum of the one patient were not completely sectioned in Diffusion Tensor Image, tractography. Other types of seizures resolved completely in 14 patients and decreased in 7. 2 patients experienced a transient disconnection syndrome, but completely resolved within four weeks. Overall daily function improved and parents were satisfied with the surgical outcome in all patients except three who experienced recurrent of drop attacks after operation. There was no sign of significant and persistent neurological deficits in any case. CONCLUSION: Results of total callosotomy in patients with medically intractable epilepsy with diffuse epileptic foci were favorable in most cases. The procedure was particularly effective against drop attacks causing physical injuries and impaired quality of life in these patients.
Child ; Corpus Callosum ; Diagnosis ; Diffusion ; Epilepsy* ; Epilepsy, Absence ; Follow-Up Studies ; Head ; Hemiplegia ; Humans ; Parents ; Quality of Life ; Seizures ; Syncope

OBJECTIVE: Stent-assisted angioplasty is an effective treatment modality in the coronary and peripheral arterial disease, however, its efficacy for intracranial atherosclerotic disease has not been verified. We assess the treatment outcome of stent-assisted angioplasty for symptomatic middle cerebral artery (MCA) stenosis. METHODS: We performed stent-assisted angioplasty in 12 patients with symptomatic high-grade stenosis(>60%) on the proximal portion of the MCA, who had either recurrent transient ischemic attacks (TIAs) resistant to medical therapy or perfusion problems. Patient records were analyzed for angiographic characteristic, degree of stenosis, preprocedural regimen of antiplatelet and/or anticoagulation agents, used devices, procedure-related complications, and clinical and radiographic outcomes. RESULTS: Stent-assisted angioplasty was successfully performed in 8 patients without any serious complications. Two patients had arterial rupture. One of two patients was rescued by an additional stenting and balloon tamponade, and the other patient was dead. Another complications among the 2 patients included thrombotic occlusion and distal thrombosis. Residual stenosis was less than 50% in diameter in all the patients. During follow-up period (mean, 11 months), stroke attacks including TIAs did not recur in 9 of 11 patients who had experienced intractable TIAs or strokes. All of 8 patients who underwent follow-up cerebral angiography had no restenosis. CONCLUSION: Stent-assisted angioplasty for refractory and symptomatic MCA stenosis is a relatively safe and effective procedure. It can be used to prevent recurrent TIAs or strokes in selected patients.
Angioplasty* ; Balloon Occlusion ; Cerebral Angiography ; Constriction, Pathologic* ; Follow-Up Studies ; Humans ; Ischemic Attack, Transient ; Middle Cerebral Artery* ; Perfusion ; Peripheral Arterial Disease ; Rupture ; Stents ; Stroke ; Thrombosis ; Treatment Outcome

Pelvic reconstruction after sacral resection is challenging in terms of anatomical complexity, excessive loadbearing, and wide defects. Nevertheless, the technological development of 3D-printed implants enables us to overcome these difficulties. Here, we present a case of sacral osteosarcoma surgically treated with hemisacrectomy and sacral reconstruction using a 3D-printed implant. The implant was printed as a customized titanium prosthesis from a 3D real-sized reconstruction of a patient's CT images. It consisted mostly of a porous mesh and incorporated a dense strut. After 3-months of neoadjuvant chemotherapy, the patient underwent hemisacretomy with preservation of contralateral sacral nerves. The implant was anatomically installed on the defect and fixed with a screw-rod system up to the level of L3. Postoperative pain was significantly low and the patient recovered sufficiently to walk as early as 2 weeks postoperatively. The patient showed left-side foot drop only, without loss of sphincter function. In 1-year follow-up CT, excellent bony fusion was noticed. To our knowledge, this is the first report of a case of hemisacral reconstruction using a custom-made 3D-printed implant. We believe that this technique can be applied to spinal reconstructions after a partial or complete spondylectomy in a wide variety of spinal diseases.
Drug Therapy ; Follow-Up Studies* ; Foot ; Humans ; Osteosarcoma* ; Pain, Postoperative ; Prostheses and Implants ; Sacrum ; Spinal Diseases ; Spinal Fusion ; Titanium ; Weight-Bearing