PURPOSE: We performed this study to evaluate the usefulness and the limitation of magnetic resonance angiography in imaging portal vein and hepatic vein. MATERIALS AND METHODS: Magnetic resonance portography was performed in five normal subjects and seven patients with hepatomas, two patients with Budd-Chiari syndromes, one patient with liver cirrhosis and one patient with hepatic metastasis from stomach cancer. Magnetic resonance angiography was done with a 1.5-T Scanner. Breath-hold two-dimensional time-of flight images with spoiled gradient echo technique were acquired. Scan parameters were 34/8/40degrees(TR ms/TE ms/flip angle). The portal vein and the hepatic vein were selectively imaged by applying two presaturation bands. These images were then postprocessed by a maximum intensity projection algorithm. MRA findings were compared with ultrasonography in all cases of the hepatic disease, and conventional angiography (SMA portography) in four cases. RESULTS: In normal subjects, the splenic vein, intrahepatic and extrahepatic portions of the portal vein, and the hepatic veins were well visualized. In the patients with hepatic diseases, the varices (4 cases), the splenorenal shunts (2 cases), and the recanalized umbilical vein (1 case) were demonstrated. There were portal vein thrombosis in the cases of hepatomas and hepatic metastasis. In the cases of Budd-Chiari syndrome, the hepatic veins were not visualized and there were inferior vena cava obstructions with multiple collateral vessels. CONCLUSION: Compared with ultrasonography, MRP may be useful in evaluation of varices, splenorenal shunts, and other collaterals, though less accurate than conventional angiography. MRP can be useful as a noninvasive screening alternative in the evaluation of portal vein and hepatic veins.
Angiography ; Budd-Chiari Syndrome ; Carcinoma, Hepatocellular ; Hepatic Veins ; Humans ; Liver Cirrhosis ; Magnetic Resonance Angiography ; Mass Screening ; Neoplasm Metastasis ; Portal Vein ; Portography* ; Splenic Vein ; Splenorenal Shunt, Surgical ; Stomach Neoplasms ; Ultrasonography ; Umbilical Veins ; Varicose Veins ; Vena Cava, Inferior ; Venous Thrombosis

PURPOSE: The purpose of this study is to assess the usefulness of dynamic MR imaging after contrast enhancement with Gd-DTPA in the differential diagnosis of hepatic focal lesions. MATERIALS AND METHODS: The population consists of 22 cases of hepatocellular carcinoma, 44 cases of hemangioma, and five cases of metastasis. Diagnosis of hepatocellular carcinoma was made by surgery, fine needle biopsy, ultrasonography, CT and conventional angiography. Hemangioma was diagnosed on the basis of ultrasonography, CT, conventional spin-echo MRI and clinical data. Diagnosis of metastasis was done by fine needle aspiration biopsy. Dynamic and delayed images were obtained using 1.5T superconductive magnetom after Gd-DTPA(0.1mmol/kg) intravenous injection. Quantitative and qualitative evaluation was done for each lesion. RESULTS: Early contrast enhancement with rapid or gradual washout was noted in 15 lesions of hepatocellular carcinoma(68.2%) ;on the delayed images, no contrast enhancement was noted in 18 lesions(81. 8%). Peripheral contrast enhancement pattern was predominantly(86.4%) observed in hemangiomas during dynamic phase. On the delayed images, homogeneous and persistent contrast enhancement of masses were noted in all hemangiomas. Characteristic centripetal fill-in pattern was observed in 32 lesions of hemangioma (72.7%). Contrast inversion of masses during contrast enhancement study was noted in all hemangiomas, while continuous negative contrast was noted in hepatocellular carcinomas and metastases. CONCLUSION: Dynamic MR imaging after contrast enhancement with Gd-DTPA is an useful method in the differential diagnosis of hepatic focal lesions.
Angiography ; Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Hepatocellular ; Diagnosis ; Diagnosis, Differential* ; Evaluation Studies as Topic ; Gadolinium DTPA ; Hemangioma* ; Injections, Intravenous ; Magnetic Resonance Imaging* ; Neoplasm Metastasis ; Ultrasonography

PURPOSE: The most frequent complication in vascular access for hemodialysis is the stenosis of venous anastomosis site and resultant thrombosis. And it has been suggested that the correction of stenosis before thrombosis can prolong graft survival. We compared the outcomes of surgical repair between stenosed group and thrombosed group. METHODS: From March 2003 to July 2007, 155 cases of stenosed graft-venous anastomosis (GVA) of arteriovenous graft (AVG) underwent salvage operation; 53 elective revisions for stenosis (group A), and 102 emergency open thrombectomies with jump grafts (group B). Outcomes were compared by post-intervention primary patency (PIPP) and post-intervention secondary patency (PISP). RESULTS: The mean follow-up duration was 24.8+/-15.2 months. Surgical success rate was 100% for elective revision group and 98% for emergency operation group. Elective revision of symptomatic GVA stenosis improved PIPP compared to emergency operation of thrombosed graft (mean 13.0 vs. 8.6 months, P=0.018). But PISP was not extended (mean 24.2 vs. 23.2 months, P=0.359). The electively revised GVA stenosed graft had fewer subsequent thrombotic events (0.3 vs 0.7 thrombosis/patient year, P=0.027) and fewer interventions (0.6 vs. 1.2 interventions/patient year, P=0.06). The proportion of other stenoses for group A and group B was 35.8% and 38.2%, respectively. CONCLUSION: The frequency of subsequent thrombotic events and total number of postoperative interventions decreased significantly after elective revision. Elective revision of GVA stenosis in PTFE graft prolongs PIPP, and should be considered before the occurrence of thrombosis.
Constriction, Pathologic ; Emergencies ; Follow-Up Studies ; Graft Survival ; Polytetrafluoroethylene ; Renal Dialysis ; Thrombectomy ; Thrombosis ; Transplants

Chronic prostatitis has various symptoms and many problems in management. Recently a lipidosterolic extract of Serenoa Repens, Permixon has been reported to reveal potential antiandrogenic and anti inflammatory activities on prostate. Then we used Permixon on chronic prostatitis and following results were obtained. Permixon is administered orally in dose of 160mg., b.i.d. for 60 days in 31 cases of chronic prostatitis in 1st group, Permixon 160mg, with Cipro-floxacin 500mg, b.i.d. in 35 cases in 2nd group and Placebo 2 tablets, b.i.d. in 30 cases in 3rd group. In 1st group 36 cases(77.4%) were improved, 29 cases(82.8%) in 2nd group and 7 cases (23.3 %) of 3rd group were improved. Permixon is an effective drug in chronic prostatitis and there was no changes in laboratory findings and negligible side effects were noticed
Prostate ; Prostatitis* ; Serenoa* ; Tablets

PURPOSE: To investigate the arterial rupture, we evaluated the 15 victims of high tension injury. METHOD: The review included clinical course of injured limbs (entrance vs exit), site of spontaneous ruptures (subeschar: G1 vs zone of ischemia: G2), causes (spontaneous vs iatrogenic: G3, inflammatory vs associated thrombi), time and consequences of rupture (site of ligature, vascular manipulation). RESULT: 1) There were 18 spontaneous (G1, G2) and 4 iatrogenic ruptures (G3). 2) The G1 were 8 in 5 patients on the 19.6 +/- 8.1 (6-29)th post burn day: princeps pollicis/dorsalis indicis, dorsalis pollicis/superficial radial, radial, ulnar/radial and posterior tibial artery. The G2 were 10 in 8 patients on the 18.4 +/- 7.2 (9-31)th post burn day: brachial, ulnar, radial, ulnar/radial and branch/trunk of popliteal artery. 3) The G3 were superficial femoral/superficial femoral (at clamping site/anastomosis), subclavian (at clamping site) and princeps pollicis (at ligature) artery by inflammation 2-8 days after surgery. 4) The initial wound of limbs or fasciotomy cannot predict the possible ruptures. 5) The entrance had more ruptures than exit. 6) Five patients had multiple ruptures 1-13 days after first episode (3 at different, 2 at the same limb). 7) There was no difference of rupture time between G1 and G2. The G2 occurred at 2-7 cm apart from burn eschar. 8) Nine among 18 spontaneous ruptures were caused by inflammation. The rest 9 thrombotic ruptures occurred at the arterial wall over (2), at the margin (6) and 2 cm near (1) the thrombi. There was no time difference between inflammatory and thrombotic rupture [19.2 +/- 7.2 (9-31) vs 19.0 +/- 8.0 (6-29) days]. 9) There was no rupture after proximal 2-4 cm ligature at superficial arteries. The thrombi were formed finally in superficial femoral artery at 9 cm proximal to the rupture site. CONCLUSION: We recommend that timely decision to amputate must be made to reduce spontaneous ruptures. Also careful attention should be paid to select the safe distance, at least 10 cm in deep arterial injures, in vascular procedures.
Arteries* ; Burns* ; Constriction ; Extremities ; Femoral Artery ; Humans ; Inflammation ; Ischemia ; Ligation ; Popliteal Artery ; Rupture* ; Rupture, Spontaneous ; Tibial Arteries ; Wounds and Injuries

The effects of a fermentation filtrate of Ganoderma lucidum (FGL) on carbon tetrachloride (CCl4)-induced hepatic fibrosis were investigated in rats. Male Sprague-Dawley rats were orally administered with FGL (20 or 100 mg/kg) for 33 days, and orally administered with CCl4 (1.0 mL/kg; 2 mL/kg of 50% in corn oil) at 3-day intervals 1 h after FGL treatment. Body and liver weights, blood and histopathological findings in accordance with hydroxyproline concentrations were analyzed. Chronic exposure to CCl4 reduced the body weight gain, but increased liver weights and fibrosis, resulting in 3.35-fold increase in hydroxyproline level. Although FGL did not significantly reduce the CCl4-induced body and liver weight changes, it attenuated the increases in the hepatic fibrosis and hydroxyproline contents. Taken together, it is suggested that FGL might prevent hepatic fibrosis, and that FGL or its ingredient could be a potential candidate for the prevention of chronic hepatic disorders.
Animals ; Body Weight ; Carbon Tetrachloride ; Fermentation ; Fibrosis ; Ganoderma ; Humans ; Hydroxyproline ; Liver ; Male ; Rats ; Rats, Sprague-Dawley ; Reishi ; Weights and Measures ; Zea mays

Antioxidative and aldose reductase (AR)-inhibitory effects of a fermentation filtrate of Rubus coreanus (FRC) were investigated using corneal/retinal homogenate and lens cytosol, respectively. Rat corneal/retinal homogenate was treated with 50 microM FeCl3 in the presence of FRC (3.2-100 microg/mL) for 30 min at 37degrees C, and thiobarbituric acid-reactive substances (TBARS) was quantified as a lipid peroxidation parameter. FRC markedly suppressed the TBARS production in a concentration-dependent manner, leading to 50% (IC50) and 100% (IC100) inhibitory concentrations of 20 and 95 microg/mL, respectively, which was similar to the effect of butylated hydroxyanisole. Activity of AR from rat lens was assayed in the presence of FRC (1-31.6 microg/mL) at 25degrees C using glyceraldehyde as a substrate. FRC inhibited lens AR by 50% (IC50) and 90% (IC90) at approximately 2 and 31.6 microg/mL, respectively, comparable to the effect of quercetin. The results indicate that ERC could be a promising candidate for the improvement of eye injury and visual dysfunction of dry eye and diabetic patients.
Aldehyde Reductase ; Animals ; Butylated Hydroxyanisole ; Cytosol ; Eye ; Eye Injuries ; Fermentation ; Glyceraldehyde ; Humans ; Lipid Peroxidation ; Quercetin ; Rats ; Thiobarbituric Acid Reactive Substances

BACKGROUND/AIMS: The caudal anesthsia is most commonly used for benign anorectal surgery, The combination of long-acting anesthetics and opiates has been used for longer duration and successful control of postoperative pain. But the side effects of peridural anesthesics and morphine have commonly occured in caudal anesthesia. This study was performed to assess the difference in clinical effects between peridural mepivacaine and bupivacaine with morphine. METHODS: We evaluated the clinical effects in 60 patients who had anal operation with Jack-Knife position under caudal anesthesia. We divided randomly these 60 patients into two groups, M and B groups (in each group, 30 patients included). Group M (n=30) was given 2% mepivacaine 20 ml with morphine 2 mg caudally, and Group B (n=30) was given 0.5% bupivacaine 20 ml with morphine 2 mg in the same manner. We measured the onset time, duration, postoperative analgesia, and side effects including urinary retention. RESULTS: The onset time for analgesia was significantly shorter in group M than in group B. The duration of postoperative pain complaints was significantly longer in group M than in group B. The postoperative analgesic effects and side effects were not significantly different between two groups. CONCLUSIONS: Caudal mepivacaine and morphine mixture is effective for control of postoperative pain without significant side effects.
Analgesia ; Anesthesia, Caudal* ; Anesthetics ; Bupivacaine* ; Humans ; Mepivacaine* ; Morphine* ; Pain, Postoperative ; Urinary Retention

Ancient schwannoma is a variant of schwannoma and is characterized slowly growing tumor with degenerative change. And it is reported that schwannoma is relatively rare in extensor area. As a rare cause of solitary ancient schwannoma in extensor area of upper arm, we report it.
Arm ; Neurilemmoma

There have been cases reported of pneumocephalus, spinal cord and nerve root compression associated with the use of air in the loss of resistance technique during epidural block. However, the manual loss of resistance technique is still widely used by anesthesiologists for identifying the epidural space. A 65-yr-old female requested epidural steroid injection for her low leg radiating pain. A 22-guage Tuohy needle was placed in the L3-4 interspace with the loss of resistance technique using 4 ml air. Aspiration yielded no cerebrospinal fluid. After injection of 1% lidocaine 5 ml as a test dose, 0.25% lidocaine 10 ml with 40 mg triamcinole was infused and she did not show any abnormal signs. After changing to sitting position, however, the patient complained of increasing headache and nausea. After vomiting, she was obtunded. CT scan showed brainstem compression by the air. The patient lost conscioussness for 20 minutes. Four hours later, her neurologic examination was normal except for the headache. She was discharged on the third day after the accident and the headache subsided by the fifth day. As far as we know, this is the first case reported of a brain stem compression by air after epidural technique that induced serious neurologic symptoms.
Brain Stem* ; Cerebrospinal Fluid ; Epidural Space ; Female ; Headache ; Humans ; Leg ; Lidocaine ; Nausea ; Needles ; Neurologic Examination ; Neurologic Manifestations ; Pneumocephalus ; Radiculopathy ; Spinal Cord ; Tomography, X-Ray Computed ; Vomiting