In the mid 1980's, the ITA(internal thoracic artery) graft was clearly recognized to be superior to the sapheonous vein graft in respect to long term patency. Therefore, there has been growing interest in the arterial conduit with the possibility of improving the long term result. We have been performing CABG with GEA since 1998 with the same purpose. For mid-term and long-term follow up, we have been performing postoperative coronary angiography. In this paper, a case of GEA spasm, a purported drawback of this conduit, during postoperative coronary anigiography and relieved by direct infusion of 200 microgram isoket into the GEA is reported. The current case which exemplifies the spastic nature of RGEA is accompanied with coronary angiography.
Coronary Angiography* ; Follow-Up Studies ; Gastroepiploic Artery* ; Isosorbide Dinitrate ; Muscle Spasticity ; Spasm* ; Transplants ; Veins

OBJECTIVE: The gyrus rectus (GR) is known as a non-functional gyrus; hence, its resection is agreed to be a safe procedure frequently practiced to achieve a better surgical view during specific surgeries. This study aimed at comparing the cognitive outcomes following GR resection in patients who underwent surgery for ruptured anterior communicating artery (ACoA) aneurysms. MATERIALS AND METHODS: From 2012 to 2015, 39 patients underwent surgical clipping for ruptured ACoA aneurysms. Mini-mental state examinations (MMSE) were performed in 2 different periods. The statistical relationship between GR resection and MMSE results was evaluated, and further analysis of MMSE subgroup was performed. RESULTS: Twenty-five out of the 39 patients (64.19%) underwent GR resection. Mean initial and final MMSE scores in the GR resection group were 16.3 ± 9.8 and 20.8 ± 7.3, respectively. In the non-resection group, the mean initial and final MMSE scores were 17.1 ± 8.6 and 21.9 ± 4.5, respectively. Neither group's scores showed a significant change. Subgroup analysis of initial MMSE showed a significant difference in memory recall and language (p = 0.02) but not in the final MMSE scores. CONCLUSION: There was no significant relationship between the GR resection and cognitive outcomes in terms of total MMSE scores after surgery for ruptured ACoA aneurysm. However, subgroup analysis revealed a temporary negative effect of GR resection in the categories of language and memory recall. This study suggests that GR resection should be executed superficially, owing to its close anatomical relationship with the limbic system.
Aneurysm ; Arteries ; Cognition Disorders* ; Humans ; Intracranial Aneurysm* ; Limbic System ; Memory ; Prefrontal Cortex* ; Surgical Instruments

Intracranial hemangiopericytoma (HPC) is a rare brain tumor with aggressive biologic behavior associated with high recurrence rate and often with extracranial metastasis. The most common sites of extracranial metastasis of the intracranial HPC are the long bones, lung, liver and abdominal cavity in the order of frequencies. Extracranial metastases usually occur long after the initial diagnosis of the primary tumor. Metastatic intracranial HPC to the vertebra has been rarely reported. We present a case of intracranial HPC metastasized to the L2 vertebral body 13 years after multiple surgical resections and radiotherapy of the primary intracranial HPC.
Abdominal Cavity ; Brain Neoplasms ; Diagnosis ; Hemangiopericytoma* ; Liver ; Lumbar Vertebrae ; Lung ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Spine*

PURPOSE: To know the normal CT appearance of the anterior skull base and nasal septum after birth. MATERIALS AND METHODS: Coronal CT scans with a helical mode were performed from the nasal bone to the sphenoid sinus in 99 children whose ages ranged from 27 days to 14 years. We investigated the CT appearance of the developing anterior skull base and nasal septum with particular attention to the anteroposterior length of the anterior skull base and the ossification patterns of the cribriform plate, perpendicular plate, crista galli, and vomer. RESULTS: The anteroposterior length of the anterior skull base statistically significantly increased with age. The cribriform plate showed partial or complete ossification in at least one segment at more than 3 months of age and in all three segments at more than 6 months of age. Ossification of the cribriform plate occurred earlier in the middle segment than in the anterior and posterior segments. It began exclusively in the region of the lateral mass of the ethmoid and proceeded medially toward the crista galli. Partial ossification of the perpendicular plate was noted as early as 9 months of age, and complete ossification as early as 13 months of age. All children at 18 months and older showed at least partial ossification of the perpendicular plate. Partial ossification of the crista galli was noted as early as 27 days of age, and complete ossification as early as 3 months of age. CT showed complete ossification of the crista galli in all but two children at 6 months and older. The superior aspect of the vomer exhibited a V- or Y-shape on all CT scans in 66%(65/99) of children at any age. It appeared as an undivided single lump anteriorly and a V or Y posteriorly in 34%(34/99). CONCLUSION: Knowledge of the normal developing patterns of ossification of the anterior skull base and nasal septum could help prevent errors in interpreting CT scans in this region, especially in infants and young children.
Child ; Ethmoid Bone ; Humans ; Infant ; Nasal Bone ; Nasal Septum* ; Parturition ; Skull Base* ; Skull* ; Sphenoid Sinus ; Tomography, X-Ray Computed ; Vomer

PURPOSE: To evaluate the usefulness of MR imaging for the follow-up of vessels in which a stainless steel ornitinol stent has been placed. MATERIALS AND METHODS: Stents were made with either stainless steel or nitinol,and inserted in a vascular-shaped rubber tube; this was then placed in an acryl bath. MR images of stainless steeland nitinol stents in the water-filled tube, both with and without flow, were obtained. As MRI pulse sequences, SET1WI, FSE T2WI, heavily T2WI, SE EPI, FMPSPGR, GRASS, FLAIR, 3D SSFP, 2D PC MRA and 2D TOF MRA were used. The MRimages obtained with each pulse sequence were compared, with special attention to the presence and location ofartifact and the ability to discriminate the stent from the wall of the vascular phantom or water. RESULTS: Inour study without water flowing, the stainless steel stent produced images with severe artifacts in all pulsesequences, but the nitinol stent produced excellent images without artifact in SE T1WI, FSE T2WI and heavily T2WI.With water flowing, the stainless steel stent produced a less severe artifact at the distal end of the stent on SET1WI, FSE T2WI, heavily T2WI, GRASS and FLAIR ; the nitinol stent produced excellent images without artifact in SET1WI, FSE T2WI, GRASS, FLAIR and 2D TOF MRA. CONCLUSION: For follow-up study of Patients with a nitinol stent,MRI can be useful.
Artifacts ; Baths ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Poaceae ; Rubber ; Stainless Steel* ; Stents* ; Water

PURPOSE: To evaluate the developmental patterns of the sutures and synchondroses in the central skull base. MATERIALS AND METHODS: We evaluated the CT scans of 109 children(age range, 29 days to 15 years) with no skull base abnormality who had undergone axial CT of the skull base with 1-mm collimation. Using a five-tier scheme, we analyzed the developmental patterns of the 18 sutures and synchondroses related to the sphenoid and occipital bones. RESULTS: Fusion of the sutures and synchondroses related to the sphenoid bone progressed rapidly during the first two years. Thereafter, changes in the sphenoid bone were dominated by pneumatization of the sphenoid sinus. Fusion of the synchondroses within the sphenoid body, including intersphenoidal, intrapresphenoidal, and intrapostsphenoidal synchondrosis occurred early and in most cases was graded <=4. Fusion of the sphenosquamosal, sphenoethmoidal, and frontosphenoidal sutures was delayed, and residual sclerosis was a common finding. Except for Kerckring-supraoccipital synchondrosis, fusion of the six sutures and synchon-droses related to the occipital bone occurred more gradually than that of those related to the sphenoid bone. Among these, fusion of the occipitomastoidal suture and petro-occipital synchondrosis was the last to occur. CONCLUSION: A knowledge of the developmental patterns of sutures and synchondroses can help differentiate normal conditions from those such as fracture, osseous dysplasia, or congenital malformation, which are abnormal. Our results provide certain basic informations about skull base maturity in children.
Child ; Humans ; Occipital Bone ; Sclerosis ; Skull Base* ; Skull* ; Sphenoid Bone ; Sphenoid Sinus ; Sutures* ; Tomography, X-Ray Computed

PURPOSE: To evaluate the magnetization transfer ratio(MTR) of various normal structures and pathologiclesions, as seen on magnetization transfer T2-weighted images (MT+T2WI). MATERIALS AND METHODS: In ten normalvolunteers, T2-weighted images without MT (MT-T2WI) and with MT(MT+T2WI) were obtained. Off-set pulses used inMT+T2WI were 400, 600, 1000, 1500, and 2000Hz. In 60 clinical cases infarction(n=10), brain tumors(n=5), traumatichematomas(n=5), other hematomas(n=3) vascular malformation(n=2) white matter disease(n=2) normal(n=31) andothers(n=2), both MT-T2WI and MT+T2WI images were obtained using an off-set pulse of 600 Hz. In all volunteers andpatients, MTR in various normal brain parenchyma and abnormal areas was measured. RESULT: The MTRs of white andgray matter were 48% and 45% respectively at 400 Hz, 26% and 22% at 600Hz, 12% and 11% of 1000Hz, 10% and 9% 1500HZ, and 9% and 8% at 2000Hz of RF. The MTR of CSF was 43% at 400 Hz of off-resonance RF, while the contrastresolution of T2WI was poor. An off-resonance of 600Hz appeared to be the optimal frequency. In diseased areas,MTRs varied but were usually similar to or lower than those of brain parenchyma. CONCLUSION: The optimaloff-resonance RF on MT+T2WI appears to be 600 Hz for relatively high MTR of brain parenchyma and low MTR of CSF,in which MTRs of white and gray matter were 26% and 22%, respectively, of 600Hz off-set pulse. The MTRs ofcerebral lesions varied and further studies of various cerebral lesions are needed.
Brain* ; Volunteers

PURPOSE: In order to furnish basic information prior to their use, the physical properties of variousself-expandable metallic stents and their MR characteristics were evaluated. MATERIALS AND METHODS: Fourcommercially available self-expandable metallic stents - Gianturco-the R sch, Hanaro, Memotherm, and Wallstent -were used in this study. For evaluation of the physical properties of each, hoop strengths and changes in radiiaccording to the degrees of longitudinal flexion were compared. Stent characteristics seen on MR images wereevaluated by measuring magnetic torque and by comparing images obtained in the vascular phantom using SE T1WI, FSET2WI, and FMPSPGR sequences. These images were analyzed with special emphasis on artifact size and the apparantshepe of the stent. RESULTS: Hoop strength was greatest in the Gianturco-R sch stent, followed by the Memotherm,Hanaro, and Wallstent. When flexed in the longitudinal axis, the radius of the Hanaro and Memotherm stentdecreased slightly as a larger flexion angle was applied. When this was 90degree, however, the connection of theGianturco-R sch stent collapsed. In contrast, the radius of the Wallstent became larger as a larger flexion anglewas applied. At the portal of the MR imaging unit, neither the Memotherm nor Wallstent showed deflection ; exceptfor a thin hyperintense rim at both ends, their images were excellent, and the lumina of these stents were alsoclearly seen. In contrast, the Gianturco-R sch and Hanaro stent demonstrated large deflexion and showed a severeblack-hole artifact. As a result, visualization of the stents themselves and their lumina was impossible. CONCLUSION: The Gianturco-R sch stent showed greater hoop strength than the others. The Wallstent showed goodlongitudinal flexibility and was thought to be effective in tortuous vessels. For follow-up after placement,especially when the nonferromagnetic Memotherm and Wallstent are used, MR imaging appears to be safe and useful.
Artifacts ; Axis, Cervical Vertebra ; Magnetic Resonance Imaging* ; Pliability ; Radius ; Stents* ; Torque

BACKGROUND: Mantle cell lymphoma/leukemia (MCL) is a distinctive disease entity that has been characterized by specific histopathologic, immunologic, and cytogenetic features. The characteristic cytogenetic abnormality of MCL is t(11;14)(q13;q32), that results in cyclin D1 overexpression. We have experienced 12 MCL cases with bone marrow involvement that were lacking evidence of t(11;14). We tried to review the cases. METHODS: We reviewed the bone marrow findings, immunophenotypic, cytogenetic studies including fluorescent in situ hybridization (FISH) analysis using IGH/CCND1 probes and medical records of 12 patients that were diagnosed with MCL based on immunophenotypic results during the period 1997 to 2001. RESULTS: The patients had a median age of 63 (50-70) years with male-to-female ratio of 3:1. All patients showed hepatosplenomegaly with varying degrees of peripheral blood involvement (2-93%), and lymphocytosis was found in 7 cases. Other presenting features were palpable lymph nodes (83%) and B symptoms (25%). The malignant cells were quite heterogenous in morphology from centrocytic to blastic variants. Most cases showed typical immunophenotypes-expression of CD19, bright CD20, FMC7, CD5 and bright-light chains with negative CD23. Immunohistochemical staining with cyclin D1 on marrow biopsies showed mostly negative results. Among the eleven cases in which cytogenetic studies were possible, four cases showed complex karyotypes, and three that involved 14q32. Strikingly, no one showed t(11;14) in G-banding analysis and only 2 cases showed IGH/CCND1 rearrangement by FISH. CONCLUSTIONS: Most MCL cases with typical immunophenotypic findings did not show evidence of specific cytogenetic features. Although further workups for molecular pathogenesis and clinical follow-up of the above cases need to be done, we suggest a new disease entity, t(11;14)-negative MCL.
Biopsy ; Bone Marrow* ; Chromosome Aberrations ; Cyclin D1 ; Cytogenetics ; Follow-Up Studies ; Humans ; In Situ Hybridization, Fluorescence ; Karyotype ; Lymph Nodes ; Lymphocytosis ; Lymphoma, Mantle-Cell ; Medical Records

BACKGROUND: During 2009 pandemic period, many Koreans were infected and admitted with Influenza A/H1N1. The primary aim of this study was to evaluate whether the structures of an intensive care unit (ICU) were associated with the outcomes of critically ill patients. METHODS: This retrospective observational study examined critically ill adult patients with influenza A/H1N1, who were admitted to 24 hospitals in Korea, from September 2009 to February 2010. We collected data of ICU structure, patients and 90 days mortality. Univariate and multivariate logistic regression analysis, with backward elimination, were performed to determine the most significant risk factors. RESULTS: Of the 239 patients, mortality of 90 days was 43%. Acute physiology and chronic health evaluation (APACHE) II score (p < 0.001), sequential organ failure assessment (SOFA) score (p < 0.0001), nurse to beds ratio (p = 0.039) and presence of intensivist (p = 0.024) were significant risk factors of 90 days mortality. Age (p = 0.123), gender (p = 0.304), hospital size (p = 0.260), and ICU type (p = 0.409) were insignificantly associated with mortality. In a multivariate logistic regression analysis, patients with less than 6 SOFA score had significantly lower mortality, compared with those with more than 10 SOFA score (odds ratio 0.156, p < 0.0001). The presence of intensivist had significantly lower mortality, compared with the absence (odds ratio 0.496, p = 0.026). CONCLUSIONS: In critically ill patients with influenza A/H1N1, the severity of the illness and presence of intensivist might be associated with 90 days mortality.
Adult ; APACHE ; Critical Illness ; Health Facility Size ; Humans ; Influenza, Human ; Critical Care ; Intensive Care Units ; Korea ; Logistic Models ; Pandemics ; Retrospective Studies ; Risk Factors