The purpose of this study was to identify the branching patterns and the distribution of the cortical branches of the middle cerebral artery (MCA) in 100 cerebral hemispheres of Korean adults. The intracranial arteries were perfused with red latex compounds. The territory of the MCA was divided into 12 areas: orbitofrontal, prefrontal, precentral, central, anterior parietal, posterior parietal, angular, temporo -occipital, posterior temporal, middle temporal, anterior temporal and temporopolar. Branching pattern of the main trunk of the MCA was divided into five types: Type I: a single -trunk type of MCA in 34% of cases; Type II: bifurcation (57%); Type III: trifurcation (5%); Type IV: quadrifurcation (1%); Type V: two MCAs originated from the internal carotid artery (3%). The MCA of the bifurcation type was classified into equal bifurcation (20%), superior trunk dominant (11%) and inferior trunk dominant (26%) according to the cortical area. The superior trunk of the equal bifurcation supplied from the orbitofrontal to posterior parietal area. The outer diameter of the main trunk of the MCA was 3.15 +/-0.52 mm on average. The anatomical types of the MCA were discussed with the related symptoms in disease of the MCA.
Adult ; Arteries ; Carotid Artery, Internal ; Cerebrum ; Humans ; Latex ; Middle Cerebral Artery* ; Rabeprazole

PURPOSE: Usually papillary microcarcinoma (PMC) grows very slowly with a good prognosis, although it frequently metastasizes to regional lymph nodes and shows multiple tumor formation in the thyroid. Therefore, how to treat papillary microcarcinoma has been controversial. Recently several studies reported that some ultrasonographic features may potentially reflect the biological aggressiveness of a lesion. We investigated which ultrasonographic findings can reflect aggressive characteristics and whether US can helpful in selecting the appropriate surgical treatment of PMC. METHODS: We retrospectively reviewed the preoperative ultrasonographic findings and pathologic risk factors of 68 patients who had undergone surgical treatment for PMC at the Wallace Memorial Baptist Hospital from January 2004 to December 2005. RESULTS: The incidences of multifocality, extrathyroidal extension, and lymph node metastasis of PMC were 42.6%, 48.5% and 20.6%, respectively. The Mean sizes of PMC were no significant differences according to age, multifocality, extrathyroidal extension, lymph node metastasis, stage and AMES risk group, and tumor size more than 5 mm was not linked to pathologic prognostic factors. Cases demonstrating multiple nodules in the unilateral or bilateral lobes, as well as those with fine strong calcifications in the tumor on US, were directly linked to multifocality on pathologic finding. US is insensitive technique for detecting lymph node metastasis and it's sensitivity was only 14.3%, but it's positive predictive value and specificity were high (100%). CONCLUSION: The date suggested that complete surgery with appropriate nodal dissection should be performed in patients with PMC which their US demonstrating multiple nodules in the unilateral or bilateral lobes, fine strong calcifications echoes in tumor and US-detected node metastasis.
Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Protestantism ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity ; Thyroid Gland* ; Ultrasonography*

Feeding gastrostomy is widely used for children with feeding impairment. The replacement of gastrostomy tube is known as an easy and safe procedure. However, various complications associated with replacement of gastrostomy tube were reported, including fistula disruption and colo-cutaneous fistula. For replacement of gastrostomy tube in small children with small stomach, special cautions are needed. Here, we report a rare case of duodenal perforation as an acute complication after the replacement of gastrostomy tube for a 33-month-old girl.
Child ; Child, Preschool ; Female ; Fistula ; Gastrostomy* ; Humans ; Stomach

PURPOSE:To investigate long-term endothelial changes in phakic eyes implanted with iris-claw phakic intraocular lens (IOL) (Artisan(R) lens Ophtec, Groningen, Netherlands) and to identify the associated factors. METHODS: Thirty-one eyes of 18 patients underwent Artisan phakic IOL implantation and were followed up for over 1 year. The authors retrospectively examined the endothelial cell density, percentage of hexagonal cells and coefficient of variation using the result of non-contact specular microscope. RESULTS: The mean endothelial cell loss was 0.9% at 23.9+/-9.44 months of the mean follow-up period. There was no statistically significant decrease in endothelial cell density (p=0.445). There was no statistically significant change in pleomorphism and polymegathism of the endothelial cells after the surgery. There was no statistically significant correlation between endothelial cell loss and anterior chamber depth (r2=0.0488, p=0.377). CONCLUSIONS: No clinically significant endothelial damage occurred after iris-claw phakic IOL implantation. However, special attention should be given to patients with shallow anterior chamber depth for iris-claw phakic IOL insertion to avoid unintended endothelial damage and long-term endothelial checkups using a specular microscope are critical for long-term protection of endothelial cells.
Anterior Chamber ; Endothelial Cells ; Endothelium, Corneal ; Eye ; Follow-Up Studies ; Humans ; Myopia ; Phakic Intraocular Lenses ; Retrospective Studies

PURPOSE: The cytotoxicities and anti-fibrotic effects of mitomycin C and pirfenidone on human dermal fibroblast were evaluated. METHODS: Initially, 24-hour cell cultures were exposed to transforming growth factor (TGF)-beta1, different concentrations of mitomycin C, and pirfenidone solutions in order to evaluate cytotoxicity. Expressions of fibronectin, collagen type 1, alpha smooth muscle, and beta-actin were evaluated by real-time reverse transcription-polymerase chain reaction (RT-PCR) and western blot in mitomycin C solutions at concentrations of 4 microg/mL and 20 microg/mL, and in pirfenidone solutions at 250 microg/mL and 500 microg/mL. RESULTS: In comparison to cell cultures exposed to TGF-beta1 solutions, cytotoxicities were increased in solutions of mitomycin C at 4 microg/mL, 20 microg/mL, 40 microg/mL and pirfenidone at 500 microg/mL, 750 microg/mL, 1,000 microg/mL (p < 0.05, Mann Whitney U-test). The results of real-time RT-PCR show that expressions of fibronectin, collagen type 1, and alpha smooth muscle were significantly more decreased in all concentrations of mitomycin C and pirfenidone compared to those in TGF-beta1 solution. In western blot analysis, expressions of fibronectin and alpha smooth muscle were decreased in all concentrations of mitomycin C and pirfenidone compared to TGF-beta1 solution. CONCLUSIONS: Both drugs have cytotoxicities and anti-fibrotic effects, but pirfenidone was found to have less cytotoxicity and mitomycin C was found to have more anti-fibrotic effects when compared to each other.
Actins ; Blotting, Western ; Cell Culture Techniques ; Collagen ; Fibroblasts* ; Fibronectins ; Humans ; Mitomycin* ; Muscle, Smooth ; Transforming Growth Factor beta1 ; Transforming Growth Factors

True primary mediastinal ectopic goiters are quite rare, and they occur in less than 1% of all goiters. We report here on a case in which a primary mediastinal ectopic goiter was accompanied with papillary microcarcinoma of the cervical thyroid. The mediastinal ectopic goiter was not connected to the cervical thyroid and its blood was supplied from intrathoracic vessels, which necessitated a thoracotomy or sternotomy for removal rather than a standard cervical collar incision. We performed total thyroidectomy for the papillary microcarcinoma of the cervical thyroid gland and transsternal removal for the mediastinal goiter; this resulted in a favorable outcome.
Goiter* ; Sternotomy ; Thoracotomy ; Thyroid Gland* ; Thyroidectomy

PURPOSE: Febrile seizure is a common neurological disorder in children and it has been reported that it may progress to epilepsy in a few cases. We have set forth to carry out a prospective study of patients who developed epilepsy after febrile seizures to determine their clinical characteristics. METHODS: The subjects of this research were 104 patients who met WHO's definition of epilepsy after at least 6 months had passed since their first seizure of the 612 patients admitted to the pediatrics department of Kyung-hee Medical Center during 5 years from January of 1993 to January of 1998 for their first febrile seizure. Epilepsy was categorized as epileptic seizure according to ILAE(1981). RESULTS: 1) The incidence of epilepsy was highest in children from 3 years to 5 years. 2) Of 104 children who developed epilepsy, 60 children were males and 44 were females. 3) Of children who eventually developed epilepsy, 37% of them had the family history of seizure. 4) Of 612 cases of first attack febile seizure, generalized tonic-clonic type was the most frequent type and at the time of diagnosis of epilepsy, generalized tonic-clonic type was also the most frequent type. 5) The abnormal EEG findings are found in 95% of children who developed epilepsy. CONCLUSIONS: We observed the clinical characteristics of patients who developed epilepsy after febrile seizures, but we feel that continuous research is necessary in establishing a correlation between the two disorders.
Child ; Diagnosis ; Electroencephalography ; Epilepsy* ; Epilepsy, Generalized ; Female ; Humans ; Incidence ; Male ; Nervous System Diseases ; Pediatrics ; Prospective Studies ; Seizures ; Seizures, Febrile*

PURPOSE: To evaluate regional differences of 1H magnetic resonance(MR) spectral patterns in normal adulthuman brains. MATERIALS AND METHODS: A total of 44 1H MR spectra in 25 volunteers aged 27-45 were obtained infive regions including the frontal lobe(10), parietal lobe(10), temporal lobe(5), basal ganglia(10) and thalamus(9). 1H MR spectroscopy(MRS) was performed using a PRESS sequence with a TR of 2000ms and a TE of 270msfrom a volume of cm on a 1.5T clinical MR unit. Relative metabolite ratios of NAA/Cho, NAA/Cr and CR/Cho in eachregion were measured and compared. RESULTS: A total of 44 reliable spectra were successfully obtained in allregions. NAA/Cho, NAA/Cr and Cr/Cho ratios varied considerably, ranging from 1.09 +/-0.2 to 2.46 +/-0.25, from1.72 +/-0.35 to 2.45 +/-0.25 and from 0.64 +/-0.1 to 1.01 +/-0.12, respectively. Significant regional difference sin metabolite ratios were observed; higher NAA/Cho and NAA/Cr ratios in the parietal lobe, lower NAA/Cho ratios inthe temporal lobe, and lower Cr/Cho ratios in the temporal lobe compared to those of other regions(p<0.05). Differences in metabolite ratios between the right and left frontal lobes, and between the right and left basalganglias were not significant. CONCLUSION: 1H MR spectra of the normal adult human brains using in vivo singlevoxel 1H MRS represented significant regional differences in metabolite ratios of NAA/Cho, NAA/Cr and Cr/Cho. Our1H MR spectroscopic results are a useful ueference for assessing the 1H MRS pattern of various intracranial diseases.
Adult* ; Brain* ; Frontal Lobe ; Humans ; Parietal Lobe ; Rabeprazole ; Temporal Lobe ; Volunteers

Animals ; Colon ; pathology ; Dogs ; Female ; Graft Survival ; Intestinal Mucosa ; pathology ; transplantation ; Mouth Mucosa ; pathology ; transplantation ; Reconstructive Surgical Procedures ; Urethra ; surgery

PURPOSE: To assess the metabolite ratios in gliomas to determine whether the metabolic information obtained by using by using in vivo single vexel 1H magnetic resonance spectroscopy(MRS) can be used as a marker for the grading of malignancy. MATERIALS AND METHODS: A total of 28 1H MR spectra from brain tumors in 27 patients with pathologically-proven gliomas were recorded. Seven patients had low grade gliomas (grade II astrocytoma in three, oligodendroglioma in three and mixed glioma in one), six had anaplastic gliomas (grade III astrocytoma in three and oligodendroglioma in three), and 14 had glioblastoma multiformes (grade IV), 1H MRS was performed on a 1.5T MRunit using PRESS sequence with a TR of 2000ms, a TE of 270 or 135ms and a voxel size of cm for all spectra. Relative lactate levels, NAA/Cho, NAA/Cr and Cho/Cr ratios were measured based on the peak heights of each resonance and compared among gliomas. RESULTS: Most tumors demonstrated decreased NAA, elevated Cho and lactate. Relatively high lactate and Cho levels and markedly decreased NAA level were more frequently observed in the high grade gliomas than in low grade gliomas. Marked elevation of lactate level in the solid component of the tumor was mostly observed in high grade gliomas. In a patient with gliomatosis cerebri, 1H MRS demonstrated a spectral pattern of tumor in filtration in an area that on MR images was apparently normal. However, NAA/Cr, NAA/Cho and Cho/Cr ratios did not significantly correlate, however, with the histologic grading of malignancy. Because of the partial volume effect, the heterogeneity of tumors containing solid and cystic or necrotic components within avoxel limited the interpretation of 1H MRS data for the grading of malignancy. CONCLUSION: The results suggest that in some patients in vivo single voxel 1H MRS may be useful for grading the malignancy of gliomas and evaluating the exact extent of tumors. In solid gliomas, the relative level of lactate appears to be a good markerfor the grading of malignancy.
Astrocytoma ; Brain Neoplasms ; Filtration ; Glioblastoma ; Glioma* ; Humans ; Lactic Acid ; Magnetic Resonance Spectroscopy* ; Neoplasms, Neuroepithelial ; Oligodendroglioma ; Population Characteristics