BACKGROUND/AIMS: To investigate the diagnostic performance of diffusion-weighted imaging (DWI) for hepatic neuroendocrine tumors (NET) compared with combined DWI and contrast-enhanced magnetic resonance imaging (MRI). METHODS: Fifteen patients with hepatic NET (n=128) underwent enhanced MRI and DWI with multiple-b values. We analyzed three different sets: Precontrast set; DWI set (added DWI); combined set (added enhanced image). Two reviewers rated possibility of NET using a 5-point scale for each image set. Their diagnostic performance was compared using Jackknife alternative free-response ROC (JAFROC). RESULTS: Diagnostic performance was better on the combined set (figure of merit [FOM]=0.852, 0.761) than the precontrast set (FOM=0.427, 0.572, P〈0.05) and the DWI set (FOM=0.682, 0.620, P〈0.05). However, DWI improved performance compared with precontrast set without statistical difference. In small NETs (〈1 cm), all sets showed low sensitivity (10.7-65.9%) with high specificity (95.4-100%). Interobserver agreement was moderate in all image sets (k=0.521 to 0.589). CONCLUSIONS: Combined DWI and enhanced MRI were more useful for detecting NET. Although statistically insignficant, there was a trend in improved diagnostic performance with DWI.
Humans ; Magnetic Resonance Imaging* ; Neuroendocrine Tumors* ; Sensitivity and Specificity

No abstract available.
Gamma Cameras* ; Head*

Anaphylactic reactions to muscle relaxants have been increasingly reported during recent 30 years. An adequate investigation of patient's history and avoidance of the muscle relaxant responsible for the previous reaction would reduce the risk of second reaction. A 56-year-old woman was admitted for laparoscopic cholecystectomy. She had a history of serious anaphylactic reaction to vecuronium. Preoperative intradermal skin test against muscle relaxants showed positive reactions to succinylcholine, atracurium and rocuronium. General anesthesia was induced with midazolam, fentanyl, 8 vol% sevoflurane mixed with 50% oxygen. Laryngeal mask airway was inserted without muscle relaxant and anesthesia was maintained with 4-6 vol% sevoflurane, air and oxygen without muscle relaxant. The anesthesia and postoperative course of this patient were uneventful.
Anaphylaxis ; Anesthesia ; Anesthesia, General ; Atracurium ; Cholecystectomy, Laparoscopic ; Female ; Fentanyl ; Humans ; Laparoscopy ; Laryngeal Masks ; Midazolam ; Middle Aged ; Oxygen ; Skin Tests ; Succinylcholine ; Vecuronium Bromide

OBJECTIVES: Late-onset schizophrenia (LOS, age at first onset ≥40 years) is characterized by including predominance of women, better premorbid social adjustment and lower severity of positive/negative symptoms. However, few studies have been conducted on LOS, especially in Asian countries. This study aimed to examine the clinical features of LOS in comparison with early-onset schizophrenia (EOS). METHODS: By retrospectively reviewing medical records, we assessed demographic data and clinical features of 76 LOS (20 males) and 357 EOS (144 males) who admitted to the psychiatric ward of a general hospital. RESULTS: The mean ages of onset were 47.3±5.1 (LOS) and 25.7±6.5 (EOS) years. There were significantly more women in LOS (73.7%) than EOS (59.6%). Significantly more LOS patients had a marital (88.2% vs. 25.8%) and employment history (28.9% vs. 13.1%) than EOS. Patients with LOS had fewer negative (14.3±9.0 vs. 19.9±9.3), general psychopathology score (36.9±11.1 vs. 42.3±13.9) than EOS patients. CONCLUSION: In line with previous studies, this study demonstrated that LOS patients have better premorbid social adjustment. Our finding also replicates previous findings that LOS patients differ from EOS in predominance of women and relative lack of negative symptoms. These results suggest that LOS may be a distinct subtype of schizophrenia.
Age of Onset ; Asian Continental Ancestry Group ; Employment ; Female ; Hospitals, General ; Humans ; Korea ; Medical Records ; Psychopathology ; Retrospective Studies ; Schizophrenia ; Sex Ratio ; Social Adjustment

PURPOSE: This experimental study was conducted to determine serial morphological changes of rat's kidney with chronic puromycin aminonucleoside (PAN) nephropathy. Special emphasis was given to the occurrence of glomerular hypertrophy and its relationship to the subsequent development of focal segmental glomerulosclerosis(FSGS). METHODS: Sprague-Dawley rats weighing 200-230g were used and divided into control(n=9) and experimental group(n=15). Rats were given subcutaneous injections of PAN at a dose of of 2mg/100g body weight, or an equivalent volume of normal saline and six injection were given over a period of 9 weeks, at weeks 0, 1, 3, 5, 7 and 9. At weeks 4, 8 and 11, rats were sacrificed and kidney weight, kidney weight/body weight(%) and various laboratory tests including serum protein and albumin were determined. Renal tissues were prepared with Histochoice(R) fixative and paraffin embedding for morphologic study. RESULTS: Kidney weight and kidney weight/body weight(%) were increased significantly in experimental group compared to controls at 4, 8 and 11 weeks. Heavy proteinuria along with lowering of serum protein and albumin and elevation of serum cholesterol was seen in experimental group at week 4 and this change became more marked on weeks 8 and 11. The frequency of FSGS in experimental animal, at week 4, 8 and 11 were 0.6%, 10.6% and 26.2% respectively(p<0.05) and the development of FSGS was more marked in juxtamedullary glomeruli compared to cortical glomeruli. Glomerular surface area showed significant increase in experimental animals compared to controls(p<0.01), the percentage of increase being 12.0, 14.7 and 12.3% at week 4, 8 and 11. And the surface areas of juxtamedullary glomeruli were larger than those of cortical glomeruli throughout the study period. CONCLUSION: In summary, present study indicates that glomerular hypertrophy occurs and precedes the development of FSGS in rats with chronic PAN nephropathy and juxtamedullary glomeruli are more susceptible to developing FSGS compared to cortical glomeuli.
Animals ; Body Weight ; Cholesterol ; Hypertrophy* ; Injections, Subcutaneous ; Kidney ; Paraffin Embedding ; Proteinuria ; Puromycin Aminonucleoside* ; Puromycin* ; Rats* ; Rats, Sprague-Dawley ; Sclerosis*

Many studies have cited occurrences of severe and long-lasting emotional disturbances of almost every kind after surgical procedures, particularly due to the sedatives or narcotics which were administered to control the post-operative pain. In order to control this post-operative pain, pediatric caudal analgesia was performed in 15 infants and children from the age 2 months to 6 years, who were to undergo lower abdomen, perineum and lower extremity surgery. They were induced with inhalation anesthoeia, using nitrous oxide, oxygen and halothane by mask before and during the block. Following the block, infants and children were turned to supine position and the initial concentration of halothane was reduced. All cases were given 10mg/kg of 1% solution of lidocaine. On examination of the level of the analgesia, 13 out of 15 cases had spread higher level than T10, with effective block for surgical procedures. The identification of the sacral cornu is easy and technical failureis lees in comparison than with the lumbar epidural block for infants and children. Thus we can perform this block successfully for infants and children without any complications or accidents. It is especially helpful in the management of postoperative cases due to the effect in control of the postoperative pain. Thus it gives satisfaction to their parents, nurses and doctors. Despite no follow-up study on postoperative emotional reactions, it was considered that there were minimal occurrences of emotional and behavioral sequelae following the hospital and surgical experiences.
Abdomen ; Affective Symptoms ; Analgesia ; Anesthesia, Caudal* ; Child ; Follow-Up Studies ; Halothane ; Humans ; Hypnotics and Sedatives ; Infant ; Inhalation ; Lidocaine ; Lower Extremity ; Masks ; Narcotics ; Nitrous Oxide ; Oxygen ; Pain, Postoperative ; Parents ; Perineum ; Supine Position

PURPOSE: Whereas continuous renal replacement therapy (CRRT) has been utilized during liver transplantation (LT), there was a lack of evidence to support this practice. We investigated the adverse events at the perioperative periods in recipients of LT who received preoperative CRRT without intraoperative CRRT. METHODS: We retrospectively reviewed medical records of adult patients (age ≥ 18 years) who received LT between December 2009 and May 2015. Perioperative data were collected from the recipients, who received preoperative CRRT until immediately before LT, because of refractory renal dysfunction. RESULTS: Of 706 recipients, 42 recipients received preoperative CRRT. The mean (standard deviation) Model for end-stage liver disease score were 49.6 (13.4). Twenty-six point two percent (26.2%) of recipients experienced the serum potassium > 4.5 mEq/L before reperfusion and treated with regular insulin. Thirty-eight point one percent (38.1%) of recipients were managed with sodium bicarbonate because of acidosis (base excess <−10 mEq/L throughout LT). All patients finished their operations without medically uncontrolled complications such as severe hyperkalemia (serum potassium > 5.5 mEq/L), refractory acidosis, or critical arrhythmias. Mortality was 19% at 30 day and 33.3% at 1 year. CONCLUSION: Although intraoperative CRRT was not used in recipients with severe preoperative renal dysfunction, LT was safely performed. Our experience raises a question about the need for intraoperative CRRT.
Acidosis ; Adult ; Arrhythmias, Cardiac ; Humans ; Hyperkalemia ; Insulin ; Liver Diseases ; Liver Transplantation ; Liver* ; Medical Records ; Mortality ; Perioperative Period ; Potassium ; Renal Replacement Therapy ; Reperfusion ; Retrospective Studies ; Sodium Bicarbonate ; Transplant Recipients*

PURPOSE: This study aimed to investigate the safe medication utilization and the education demands during pregnancy and it further reported the development of educational materials for pregnant women. METHODS: A survey was conducted in two tertiary care university hospitals and one community hospital specialized in obstetrics and gynecology from July 2 to 29 2014. The survey questionnaires included the usage of medications and the unmet needs on medication use during pregnancy. Ad ditionally, pregnant women's requests regarding to medication use were collected through group interviewing of community pharmacists. Based on these results, educational materials were de veloped and implemented. After implementing the education sessions, the satisfaction was evaluated. RESULTS: A total of 152 pregnant women answered completely the questionnaire. Among them, 130 participants (42.8%) were given the medication information from their physicians. Exposure to a teratogenic drug during pregnancy was a major concern for most pregnant women (79.6%). The majority (90.1%) of subjects reported a necessity of medication-related education during their pregnancy. The interview with 48 pharmacists indicated that the most commonly used OTC drugs in pregnancy were vitamins (25.2%), iron supplements (23.7%), and the most frequently used prescription drugs were antiinflammatory-analgesics (25.3%), followed by antibiotics (20.9 %). Based on the results, booklets of drug therapy during pregnancy, leaflet of pregnancy category index were made. Also, on-line flash and presentation materials for instructors were prepared. Through the trial education with the developed materials, it was confirmed that the contents of education materials were well understood and satisfied by the pregnant women. CONCLUSIONS: This study showed the need of the medication-related education for the pregnant women. The developed education materials would be helpful sources to provide accurate and reliable medication-related information to health professionals and pregnant women.
Anti-Bacterial Agents ; Drug Therapy ; Education ; Female ; Gynecology ; Health Occupations ; Hospitals, Community ; Hospitals, University ; Humans ; Interviews as Topic ; Iron ; Nonprescription Drugs ; Obstetrics ; Pamphlets ; Pharmacists ; Pregnancy* ; Pregnant Women ; Prescription Drugs ; Tertiary Healthcare ; Vitamins

BACKGROUND: Impulse Oscillometry is a noninvasive and effort-independent test used to characterize the mechanical impedance of the respiratory system. The clinical potential of the 105 is rapid and demands only passive cooperation which makes it especially appealing for children, for epidemiologic surveys and for conditions in which quiet breathig instead of forced expiratory maneuvers are preferred. However, several studies have shown conflicting results that the role of 108 about detection of smoking induced small airway diseases or early airway obstruction METHODS: Study was to evaluate the clinical ability of the 108 to detect about smoking induced early airway obstruction in persons with normal spirometry test. Respiratory asymptomatic study groups were formed that one is non-smoking group, another is smoking group. RESULTS: The parameters of spirometry were not significantly differences between non-smoking group and smoking group. Among the parameters of 108, total resistance(non-smoking group: smoking group= 2.22 +/-1.20 : 2.58 +/-1.71), peripheral resistance( 1.25 +/-0.62 : 1.47 +/-0.10), bronchial compliance(0.44 +/-0.12: 0.47 +/-0.16) were not statistically significant different (p<0.05), but central resistance and lung compliance were not statistically significant different (unit ; resistance= hPa/l/s, compliance= 1/hPa). Resistance(Rrs) was not statistically significant different with changes of frequences(5, 10, 15, 20, 25, 30, 35Hz), but Reactance(Xrs) was statistically significant differenct with low frequences that X5(non-smoking group : smoking group= -0.62 +/-0.28 : - 0.76 +/-0.48, p<0.001) and X10(-0.06 +/-0.19 : -0.15 +/-0.33, p<0.013) (unit; hPa/l/s, hPa=cmH2O) CONCLUSION: Impulse oscillometer(IOS) is clinically available method to detect about smoking induced early airway obstruction. And clinically potential parameters of IOS were considers that total resistance, peripheral resistance, bronchial resistance, and reactance of low frequency at 5Hz, 10Hz.
Airway Obstruction* ; Child ; Electric Impedance ; Humans ; Lung Compliance ; Oscillometry ; Respiratory System ; Smoke* ; Smoking* ; Spirometry ; Vascular Resistance

Spinal cord stimulation (SCS) has become an established clinical option for treatment of refractory chronic pain. Current hardware and implantation techniques for SCS are already highly developed and continuously improving, however equipment failures over the course of the long-term treatment are still encountered in a relatively high proportion of treated cases. Percutaneous SCS leads seem to be particularly prone to dislocation and insulation failures. We describe our experience of lead breakage in implanted SCS which was inserted to a complex regional pain syndrome patient who obtained satisfactory pain relief after the revision of SCS.
Chronic Pain ; Dislocations ; Equipment Failure ; Humans ; Spinal Cord ; Spinal Cord Stimulation