Azithromycin* ; Doxycycline* ; Scrub Typhus*

OBJECTIVE: To compare the effect of imaging time delay on the MR detection of intracerebral metastases using single dose gadobutrol. MATERIALS AND METHODS: Twenty-one patients with intracerebral metastases underwent contrast-enhanced MR with three-dimensional T1-weighted sequence at 1 minute, 5 minutes and 10 minutes after a single dose injection of gadobutrol. One hundred index metastatic lesions (1 to 30 mm; median, 7 mm) were chosen for the analysis. For the qualitative analysis, lesion conspicuity were assessed on a 1 (worst) to 5 (best) scale of the index lesions by an expert reader. For the quantitative analysis, signal intensity (SI) of enhancing lesions and normal parenchyma was measured to determine the contrast rate (CR, %) ([postcontrast SI lesion - postcontrast SI white matter] x 100 / postcontrast SI white matter) and the enhancement rate (ER, %) ([postcontrast SI lesion - baseline SI gray matter] x 100 / baseline SI gray matter). Statistical comparisons were made between three different time delays. RESULTS: Lesion conspicuity did not differ significantly among the three time delays (p = 0.097). Although the SI, CR and ER of lesions did not reveal any significant difference between 1 minute and 5 minutes delayed images, both the 1 minute and 5 minutes delayed images showed significantly higher CRs of lesions compared with the 10 minutes delayed images (p = 0.004 and p = 0.001, respectively). CONCLUSION: With single dose gadobutrol, imaging time delay did not have an effect on lesion conspicuity. Both 1-minute and 5-minute-delayed imaging after gadobutrol injection appears to be effective for the detection of intracerebral metastases.
Adult ; Aged ; Aged, 80 and over ; Brain Neoplasms/*diagnosis/*secondary ; Contrast Media/administration & dosage/*diagnostic use ; Female ; Humans ; Image Enhancement/methods ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Observer Variation ; Organometallic Compounds/administration & dosage/*diagnostic use ; Time Factors

Wide-necked aneurysms of the posterior inferior cerebellar artery (PICA) are infrequently encountered in cerebrovascular practice, and endovascular treatment is difficult or impossible even with the use of several neck remodeling techniques. We present the case of a patient with a wide-necked aneurysm of the PICA, which was treated by the retrograde stenting through the contralateral vertebral artery and vertebrobasilar junction with antegrade coil embolization.
Cerebellar Diseases/radiography/*therapy ; Cerebral Angiography ; Embolization, Therapeutic/instrumentation/*methods ; Humans ; Intracranial Aneurysm/radiography/*therapy ; Male ; Middle Aged ; *Stents ; Tomography, X-Ray Computed

OBJECTIVE: To clarify the prognosis of the patients with intra-sylvian hematoma (ISH) and intracerebral hematoma (ICH) in ruptured middle cerebral artery (MCA) aneurysms. METHODS: We categorized hematoma into ISH and ICH by the presence of intra-hematomal contrast enhancing vessel (IHCEV) on computed tomography angiography (CTA). Forty-four ruptured MCA aneurysm patients with ICH or ISH were grouped by the grading system proposed by the authors in our previous study. We investigated the relevance of the following factors: patient's age, gender, Hunt-Hess grade, Glasgow outcome scale (GOS) and changes in Glasgow coma scale (GCS) between pre-operation and 7 days after operation. RESULTS: There were no significant differences statistically in age, gender, Hunt-Hess grade, and GOS between the ISH and ICH groups. In their peri-operative GCS change, the ICH group showed greater improvement compared to the ISH group (p = 0.0391). The hematoma grade had a significant relevance with the patients' GOS. CONCLUSION: Although there were no significant statistic differences in the GOS of the 2 hematoma groups, there were prominent improvements of post-operative GCS in the ICH group. Unlike in the ISH group, effective removal of hematoma was possible in most patients of the ICH group. Thus although there is no difference in the prognosis of the 2 groups, early surgical evacuation of hematoma seems to be effective in improving the short-term GCS score in peri-operative period.
Aneurysm ; Angiography ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Glycosaminoglycans ; Hematoma ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Prognosis

OBJECTIVE: To clarify the prognosis of the patients with intra-sylvian hematoma (ISH) and intracerebral hematoma (ICH) in ruptured middle cerebral artery (MCA) aneurysms. METHODS: We categorized hematoma into ISH and ICH by the presence of intra-hematomal contrast enhancing vessel (IHCEV) on computed tomography angiography (CTA). Forty-four ruptured MCA aneurysm patients with ICH or ISH were grouped by the grading system proposed by the authors in our previous study. We investigated the relevance of the following factors: patient's age, gender, Hunt-Hess grade, Glasgow outcome scale (GOS) and changes in Glasgow coma scale (GCS) between pre-operation and 7 days after operation. RESULTS: There were no significant differences statistically in age, gender, Hunt-Hess grade, and GOS between the ISH and ICH groups. In their peri-operative GCS change, the ICH group showed greater improvement compared to the ISH group (p = 0.0391). The hematoma grade had a significant relevance with the patients' GOS. CONCLUSION: Although there were no significant statistic differences in the GOS of the 2 hematoma groups, there were prominent improvements of post-operative GCS in the ICH group. Unlike in the ISH group, effective removal of hematoma was possible in most patients of the ICH group. Thus although there is no difference in the prognosis of the 2 groups, early surgical evacuation of hematoma seems to be effective in improving the short-term GCS score in peri-operative period.
Aneurysm ; Angiography ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Glycosaminoglycans ; Hematoma ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Prognosis

This study was designed to evaluate the efficacy of dynamic parameters, such as correlation dimension D2, by comparing spectral electroencephalographic (EEG) parameters. These parameters are used to estimate the depth of halothane anesthesia as defined by the presence of body movement in response to a tail clamp. Six rats were used and each of them was exposed to halothane sequentially at the concentrations of 0%, 0.5%, 1.0% and 1.5% for 30 min. A tail clamp was applied every five min and the movements were recorded at each concentration level. The spectral parameters and the dynamic parameters were derived from 20-sec and 10-sec segments, respectively, from the last 5-mins of EEG recording at each concentration level. Correlation coefficients between the parameters and the movements were calculated. Standardized values of three parameters, betaL power, median power frequency (MPF), and D2 were derived by calculation based on the number of animals showing the movement in response to a tail clamp. The betaL power had the largest correlation coefficient to spontaneous movement and to the response to a tail clamp than any other band parameter. MPF had a better correlation with the movement than 90% spectral edge frequency. Among the dynamic parameters, D2 on the parietal cortex had a better correlation with the movement. The level of deviation and variation of standardized D2, MPF, and betaL were significant (p < 0.01). The order of deviation and variation was; betaL power > MPF > D2. The correlation dimension serves as a better index for the depth of halothane anesthesia defined in forms of a response to external stimulation.
Anesthesia ; Animals ; Electroencephalography ; Halothane* ; Rabeprazole ; Rats

OBJECTIVE: To evaluate the usefulness of time-resolved contrast enhanced magnetic resonance angiography (4D MRA) after stent-assisted coil embolization by comparing it with time of flight (TOF)-MRA. MATERIALS AND METHODS: TOF-MRA and 4D MRA were obtained by 3T MRI in 26 patients treated with stent-assisted coil embolization (Enterprise:Neuroform = 7:19). The qualities of the MRA were rated on a graded scale of 0 to 4. We classified completeness of endovascular treatment into three categories. The degree of quality of visualization of the stented artery was compared between TOF and 4D MRA by the Wilcoxon signed rank test. We used the Mann-Whitney U test for comparing the quality of the visualization of the stented artery according to the stent type in each MRA method. RESULTS: The quality in terms of the visualization of the stented arteries in 4D MRA was significantly superior to that in 3D TOF-MRA, regardless of type of the stent (p < 0.001). The quality of the arteries which were stented with Neuroform was superior to that of the arteries stented with Enterprise in 3D TOF (p < 0.001) and 4D MRA (p = 0.008), respectively. CONCLUSION: 4D MRA provides a higher quality view of the stented parent arteries when compared with TOF.
Adult ; Aged ; Cerebral Arteries/pathology ; *Contrast Media ; *Embolization, Therapeutic ; Female ; Humans ; *Imaging, Three-Dimensional ; Intracranial Aneurysm/*diagnosis/therapy ; *Magnetic Resonance Angiography/methods ; Male ; Middle Aged ; Sensitivity and Specificity ; *Stents ; Young Adult

OBJECTIVE: To determine the prevalence of thyroid incidentalomas detected by time-resolved magnetic resonance angiography (TRMRA) and to evaluate their clinical significance by using an ultrasonographic (US) and cytologic correlation. MATERIALS AND METHODS: We retrospectively reviewed 2010 consecutive TRMRA examinations performed at our institution between August 2006 and April 2010. The TRMRA findings of thyroid incidentalomas were analyzed according to location, size, as well as vascularity, and were correlated with the US findings and cytologic results. Each nodule was classified as suspiciously malignant, indeterminate or probably benign according to the US criteria recommended by the Korean Society of Thyroid Radiology. RESULTS: A total of 102 incidentalomas were detected in 90 of 2010 patients (5%). TRMRA showed homogenous hypervascularity in 48 (47%), inhomogeneous hypervascularity in 46 (45%), and hypovascularity in 8 (8%) thyroid nodules. At follow-up study, out of 26 patients with 30 incidentalomas on TRMRA, 27 nodules were identified on US. Of the 27 nodules, 24 (89%) nodule were classified as indeterminate, two (7%) as probably benign, and one (4%) as suspiciously malignant. Among the 16 nodules with available cytopathologic results, 14 (82%) were benign, one (6%) was indeterminate, and one (6%) was malignant. CONCLUSION: Thyroid incidentalomas are found in 5% of TRMRA examinations. Although their presence does not necessarily indicate malignancy, nonspecific findings of detected incidentalomas on TRMRA require further evaluation by US.
Adult ; Aged ; Aged, 80 and over ; Contrast Media/diagnostic use ; Female ; Humans ; Incidental Findings ; Magnetic Resonance Angiography/*methods ; Male ; Middle Aged ; Organometallic Compounds/diagnostic use ; Prevalence ; Retrospective Studies ; Thyroid Neoplasms/*diagnosis/epidemiology/ultrasonography ; Thyroid Nodule/*diagnosis/epidemiology/ultrasonography

Idiopathic bronchiolitis obliterans with organizing pneumonia (BOOP) is a specific clinicopathologic syndrome characterized by a pneumonia-like illness, with excessive proliferation of granulation tissue within bronchioles, alveolar ducts and alveoli. The changes are most numerous in alveolar ducts. The presence of intraluminal tufts of organizing connective tissue in alveolar ducts and more distal airspaces has been termed organizing pneumonia The radiologic manifestations are distinctive with bilateral, diffuse alveolar opacities predominantly in the subpleural and lower lung zone. Patchy migratory pneumonic foci or solely nodular infiltrates are rarely present in BOOP. BOOP is a diagnosis of importance because of its dramatic response to steroids.
Bronchioles ; Bronchiolitis Obliterans ; Connective Tissue ; Cryptogenic Organizing Pneumonia* ; Diagnosis ; Granulation Tissue ; Lung ; Pneumonia ; Steroids

Tetanus is a neurologic disorder caused by a tetanospasmin released from Clostridium tetani and usually occurs following a stab wound or dirty abrasion. Tetanus is uncommon in Korea due to the introduction of vaccination programs. Furthermore, tetanus associated with a gangrenous perforation of the small bowel is extremely rare. We report a case of tetanus developed in a patient who was diagnosed with a gangrenous perforation of the small bowel. This is the first reported case in Korea.
Clostridium tetani ; Digestive System Surgical Procedures ; Humans ; Intestinal Perforation ; Korea ; Metalloendopeptidases ; Nervous System Diseases ; Tetanus ; Tetanus Toxin ; Vaccination ; Wounds, Stab