No abstract available.
Female ; Humans ; Vaginosis, Bacterial*

PURPOSE: To evaluate the diagnostic efficacy of three-dimensional(3D) short-range MR angiography(MRA) andmultiplanar reconstruction(MPR) imaging in hemifacial spasm(HS). MATERIALS AND METHODS: Two hundreds patientswith HS were studied using a 1.5T MRI system with a 3D time-of-flight(TOF) MRA sequence. To reconstructshort-range MRA, 6-10 source images near the 7-8th cranial nerve complex were processed using a maximum-intensityprojection technique. In addition, an MPR technique was used to investigate neurovascular compression. We observedthe relationship between the root-exit zone(REZ) of the 7th cranial nerve and compressive vessel, and identifiedthe compressive vessels on symptomatic sides. To investigate neurovascular contact, asymptomatic contralateralsides were also evaluated. RESULTS: MRI showed that in 197 of 200 patients there was vascular compression orcontact with the facial nerve REZ on symptomatic sides. One of the three remaining patients was suffering fromacoustic neurinoma on the symptomatic side, while in two patients there were no definite abnormal findings. Compressive vessels were demonstrated in all 197 patients; 80 cases involved the anterior inferior cerebellarartery(AICA), 74 the posterior cerebellar artery(PICA), 13 the vertebral artery(VA), 16 the VA and AICA, eight theVA and PICA, and six the AICA and PICA. In all 197 patients, compressive vessels were reconstructed on one 3Dshort-range MRA image without discontinuation from vertebral or basilar arteries. 3D MPR studies providedadditional information such as the direction of compression and course of the compressive vessel. In 31 patientsthere was neurovascular contact on the contralateral side at the 7-8th cranial nerve complex. CONCLUSION: Inpatients with HS, 3D short-range MRA and MPR images are excellent and very helpful for the investigation ofneurovascular compression and the identification of compressive vessels.
Angiography* ; Basilar Artery ; Cranial Nerves ; Facial Nerve ; Hemifacial Spasm* ; Humans ; Inpatients ; Magnetic Resonance Imaging ; Neurilemmoma ; Pica

One case of Tachycardia-Bradycardia Syndrome was reported with brief review. A 42 year old woman was admitted to Seoul national University Hospital because of palpitation and dizziness. She had had the intermittent episodes of such attacks for 4 years. The electrocardiogram checked 3 days prior to admission showed atrial fibrillation but the electrocardiogram at admission revealed irregular bradycardia with wandering pacemaker. The patient had complained palpitation and dizziness throughout the hospital days, but only one attack of Adams-Stokes Syndrome was developed. She was improved symptomatically by isoproterenol infusion during the hospital course.
Adams-Stokes Syndrome ; Adult ; Atrial Fibrillation ; Bradycardia ; Dizziness ; Electrocardiography ; Female ; Humans ; Isoproterenol ; Seoul

PURPOSE: To evaluate the risk of vertebral compression fracture (VCF) after conventional radiotherapy (RT) for colorectal cancer (CRC) with spine metastasis and to identify risk factors for VCF in metastatic and non-metastatic irradiated spines. MATERIALS AND METHODS: We retrospectively reviewed 68 spinal segments in 16 patients who received conventional RT between 2009 and 2012. Fracture was defined as a newly developed VCF or progression of an existing fracture. The target volume included all metastatic spinal segments and one additional non-metastatic vertebra adjacent to the tumor-involved spines. RESULTS: The median follow-up was 7.8 months. Among all 68 spinal segments, there were six fracture events (8.8%) including three new VCFs and three fracture progressions. Observed VCF rates in vertebral segments with prior irradiation or pre-existing compression fracture were 30.0% and 75.0% respectively, compared with 5.2% and 4.7% for segments without prior irradiation or pre-existing compression fracture, respectively (both p < 0.05). The 1-year fracture-free probability was 87.8% (95% CI, 78.2-97.4). On multivariate analysis, prior irradiation (HR, 7.30; 95% CI, 1.31-40.86) and pre-existing compression fracture (HR, 18.45; 95% CI, 3.42-99.52) were independent risk factors for VCF. CONCLUSION: The incidence of VCF following conventional RT to the spine is not particularly high, regardless of metastatic tumor involvement. Spines that received irradiation and/or have pre-existing compression fracture before RT have an increased risk of VCF and require close observation.
Colorectal Neoplasms* ; Follow-Up Studies ; Fractures, Compression* ; Humans ; Incidence ; Multivariate Analysis ; Neoplasm Metastasis ; Radiotherapy ; Retrospective Studies ; Risk Factors ; Spinal Fractures ; Spinal Neoplasms ; Spine*

Cyclosporin A-induced central neurotoxicity has been rarely reported in patients with nephrotic syndrome. We report a pediatric patient who developed acute leukoencephalopathy diagnosed by MRI during CsA therapy for nephrotic syndrome.
Cyclosporine* ; Humans ; Leukoencephalopathies* ; Magnetic Resonance Imaging ; Nephrotic Syndrome*

Posterior fossa injury is a relatively infrequent in all craniocerebral injuries, which may be a rapidly fatal disease unless the diagnosis and prompt treatment are made. Delay in operation or failure to make the diagnosis early may result in death from medullary decompensation. An injury to the occipital region, followed by signs and symptoms of cerebellar or medullary nerve dysfunction, should cause one to suspect the existence of this lesion. It is well to remember that neither the surgically demonstrated presence of a supratentorial clot nor the roentgenological failure to demonstrate an occipital fracure excludes the presence of a mass lesion in the posterior fossa. Authors studied 104 cases of posterior fossa injury admitted at Department of Neurosurgery, Kyung Hee Medical Center from October 5 th, 1971 to August 30 th, 1974. The results were as follows: 1) The incidence of posterior fossa injury was 5.7% of all craniocerebral injuries. 2) The age incidence was greatest in the age group between 10 and 20. 27.9% of all cases were belonged in this group. 3) Common causes were traffic accident(82 cases:78.8%), falls from(14 cases:13.5%) and direct blow(6 cases:5.8%). 4) Male outnumbered female by almost 2 to 1. 5) Common symptoms were disturbance of consciousness(67 cases:64.4%), headache(43 cases:41.3%) and vomiting(24 cases:21.3%). 6) Scalp injuries were demonstrated in 95 cases and occipital, bone fracture in 58 cases under gross and radiological examination of posterior fossa. 7) Time interval between injury and operation was greatest at 3 to 6 hours. 8) In 30 cases of operation, massive cerebellar contusion was 13 cases, extradural hematoma was 7 cases and subdural hematoma was 2 cases and negative exploration was 6 cases. 9) The overall mortality rate was 25%.
Contusions ; Craniocerebral Trauma ; Diagnosis ; Female ; Fractures, Bone ; Hematoma ; Hematoma, Subdural ; Humans ; Incidence ; Male ; Mortality ; Neurosurgery ; Scalp

BACKGROUND AND OBJECTIVES: The mechanism responsible for the generation of ectopic beats in pulmonary veins (PVs) remains to be well defined. The present study examines the electrophysiological characteristics of the PVs and other regions of the canine left atrium (LA) under low dose (300 micrometer) caffeine condition. MATERIALS AND METHODS: Transmembrane action potentials were recorded from the left superior PVs, PV-LA junctions (PLJ, atrium <5 mm from the PV ostium), LA appendage (LAA) or Bachmann's bundle (BB) in arterially perfused canine LA-PV preparations, using floating glass microelectrodes. Rapid atrial pacing (cycle lengths 140-300 ms, 10 sec) was used to induce delayed afterdepolarizations (DAD) at the baseline and under low dose (300 micrometer) caffeine conditions. RESULTS: Spontaneous diastolic depolarization or triggered activity (TA) was not observed in any of the recording area under the baseline condition. DAD and TA were induced by caffeine in 4/8 PVs and in 3/8 PLJs, but in no LAA (0/6) or BB (0/5). These TA and DAD were also observed after termination of pacing-induced atrial tachyarrhythmia. DAD was abolished by pretreatment of the atria with verapamil or propranolol (1.0 micrometer). CONCLUSION: Spontaneous diastolic depolarization was not present in perfused canine left atria or proximal PV. Pulmonary veins and adjacent areas displayed an increased susceptibility to develop DAD-induced TA under low dose caffeine condition. This distinctive electrophysiological property of the PV and PLJ area may contribute to the arrhythmogenic substrate responsible for the ectopic activity that initiates atrial fibrillation.
Action Potentials ; Atrial Fibrillation ; Caffeine ; Calcium ; Glass ; Heart Atria ; Microelectrodes ; Propranolol ; Pulmonary Veins* ; Tachycardia ; Verapamil

BACKGROUND: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates. METHODS: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. RESULTS: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital, 101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). CONCLUSION: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.
Death Certificates* ; Education ; Emergencies ; Mortality ; Retrospective Studies ; Seoul

Only a few years following its original development by the English Physicist G.N. Hounsfield at 1971, cranial computed tomography has proved to be of revolutionary importance for the diagnosis of brain disorders. This is reflected not least by the almost immediate and worldwide acceptance of the diagnostic method. First in Korea, The EMI Scanner(CT 5005/7, 160(160 matrix) was introduced at Kyung Hee University Hospital on October 1977. Since then, we reviewed 444 CT scans for 1 year. 216 representative examples of abnormal CT findings among these have been chosen from this group of cases for more detailed discussion and illustration. The results were as follows; 1) 216 abnormal CT findings were subdivided into brain neoplasm 50, orbital tumor 6, AVM 1, intracerebral hemorrhage 44, occlusive CVD 30, craniocerebral trauma 46, cerebral abscess 3, meningoencephalitis 8, hydrocephalus 13, atrophy 16, parasite 4. 2) In most brain tumor cases the tissue undergoes a change of density. Vascularized tumors were enhanced after contrast infusion. Solid tumor area are well differentiated against cystic area and necrosis, and hemorrhage in tumor is also well visualized. Tumor type is often surmised, exact classification is not possible. Thus a glioblastoma multiforme of the ring type cannot be differentiated from a metastatic tumor with central necrosis. But tumor density, appearance of contrast enhancement, predilection site of tumor, relation to adjacent structure, a degree of perifocal edema and clinical data are aid to identify the tumor type. 3) Spontaneous intracerebral hemorrhage can be identified with certainty because of high absorption values. Extent of hemorrhage and invasion of the ventricle are usually exactly visualized. Blood filling of basal cisterns and interhemispheric fissure is also well demonstrated. As opposed to spontaneous intracerebral hemorrhage, cerebral infarction shows as a region of low absorption values as early as 6 to 8 hours after ictus, which is often poorly defined with irregular borders and having mass effect during the 1st week thereafter. Sharper margins and more homogenous low density are developed 1 to 2 weeks after ictus and surrounding edema subsides with shrinking of hypodense area. Ipsilateral ventricular dilatation, homogenous low density area and sharp margins are usually found in older infarcts. 4) CT is the best method of assessing craniocerebral injuries. Since extravascular blood is set off by its high density and edematous tissue by its lower density from normal brain tissue, sequelae from injuries whose existence could only be suspected on account of the clinical symptoms but escaped detection regardless of the method used, can now be visualized directly in the CT. 5) Brain abscess has a characteristics but non specific appearance as CT, consisting of a ring configuration of the abscess capsule which shows marked enhancement after injection of contrast material. In acute stage of the meningoencephalitis, routine CT scan may be normal. During the couse of illness, diffuse enhancement of the basal cisterns and varying degree of ventricular dilatation may be found. 6) Brain atrophy is diagnosed by an enlargement of internal and external CSF spaces. Using standard sections a classification of the grade and form of the atrophy is made. The diagnosis of cysticercosis is made primarily calcification and multiple solid dense mass or cystic lesion surrounded by edema which may become enhanced following infusion of contrast media.
Abscess ; Absorption ; Atrophy ; Brain ; Brain Abscess ; Brain Diseases ; Brain Neoplasms ; Cerebral Hemorrhage ; Cerebral Infarction ; Classification ; Contrast Media ; Craniocerebral Trauma ; Cysticercosis ; Diagnosis ; Dilatation ; Edema ; Glioblastoma ; Hemorrhage ; Hydrocephalus ; Korea ; Meningoencephalitis ; Necrosis ; Orbit ; Parasites ; Tomography, X-Ray Computed ; United Nations

Arachnoid cysts are usually classified as developmental anomaly, inflammatory and traumatic in origin. Arachnoid cyst in posterior fossa occur frequently in the midline posterior to the cerebellum. These cyst usually present symptoms and signs due to increased intracranial pressure and may be confused with cerebellar or fourth ventricular tumor. Recently we had experienced a case of multiple retrocerebellar arachnoid cysts coexisted with pathologically confirmed desmoplastic medulloblastoma in eight months lod infant and reviewed the literatures.
Arachnoid Cysts* ; Arachnoid* ; Cerebellum ; Humans ; Infant ; Intracranial Pressure ; Medulloblastoma*