OBJECTIVES: Rapidly progres s ive glomerulonephritis (RPGN) is a clinico- pathologic entity characterized by extens ive crescent formation(usually involving 50% or more of glomeruli) as the principal his tologic finding and a rapid deterioration of kidney function, which can lead to end s tage renal disease within a few weeks. T he etiology and incidence of RPGN has been well defined in Europe and North America, however, there has been no report of a large series in Korea. T he aim of the present s tudy was to analyze the etiology and clinico- pathologic features of 26 patients with RPGN, seen during 1983-1997. METHODS: T wenty-six patients with RPGN(crescents in > 50% of glomeruli) were obs erved during a period of las t 14 years. Male to female ratio was 1:1.4, and the mean age was 30(6-75) years. Mean time from the initial symptoms to the ESRD was 3.1 months . RESULTS: The incidence of RPGN in our series was 2.1% of primary glomerulonephritis. Immunecomplex mediated disease was presented in 14 cases (54%), including 6 sys temic lupus erythematos us, 3 post- streptococcal glomerulonephritis, 3 Henoch- Schonlein purpura, and 2 IgA nephropathy. Pauci- immune disease was presented in 12 cases (46%), including 3 Wegener' s granulomatos is, one necrotizing crescentic glomerulonephritis, and 8 idiopathic crescentic glomerulonephritis. However, there was none of anti-GBM- mediated disease in our s tudy. ANCA were found in 6 patients. All 3 patients with WG were C- ANCA pos itive, whereas one patient with PSGN, necrotizing cres centic GN, and idiopathic crescentic GN were P- ANCA pos itive, respectively. Initial clinical and laboratory features included edema(80%), hypertens ion(72%), oliguria(68%), a decreased renal function(serum creatinine > 5mg/dL, 35%), and gros s hematuria(36%). Renal biopsy showed large crescents more than 80% of the glomeruli in 14 cases (54%) which were predominantly fibrocellular. Fifteen patients (58%) were treated with prednis olone alone, and 12 of them received puls e doses of corticosteroids. Five patients were treated with prednisolone and cyclophos phamide IV pulse. Two cases received plasma exchange. During the mean follow-up of 31+/-37 months, 18 patients (69%) developed inexorable progression of renal failure, three(12%) showed recovery of renal function, and two(8%) showed partial improvement, which is followed by varying degrees of renal insufficiency. During follow-up, three patients died : two from res piratory failure with severe pulmonary hemorrhage and one from opportunistic pulmonary infection during immunosuppressive therapy. Poor prognos is is as sociated with hypertension, increased serum creatinine level at the time of diagnosis, large crescents more than 85% of glomeruli, and glomerular scleros is . CONCLUSION: We conclude that an earlier diagnos is including kidney biopsy and the more aggressive treatment are essential in the management of RPGN.
Adrenal Cortex Hormones ; Antibodies, Antineutrophil Cytoplasmic ; Biopsy ; Creatinine ; Diagnosis ; Europe ; Female ; Follow-Up Studies ; Glomerulonephritis* ; Glomerulonephritis, IGA ; Hemorrhage ; Humans ; Hypertension ; Immune System Diseases ; Incidence ; Kidney ; Kidney Failure, Chronic ; Korea ; Male ; North America ; Plasma Exchange ; Prednisolone ; Purpura ; Renal Insufficiency ; Systemic Vasculitis

Between 1977 and 1987, 20 patients with mesothelioma were treated at Severance Hospital. Data was gathered from medical charts at the time of hospitalization of mesothelioma patients and from a follow-up questionnaire by mail or telephone. The results acquired were as follows: 1. Among the 20 patients, 11 men and 9 women with mesothelioma were identified. The mean age at hospitalization was 47 years and 11 mesothelioma patients were known or presumed to be dead during the different observation periods. 2. Only one mesothelioma patient had a definite history of occupational asbestos exposure. 3. The sites of orgin of mesothelioma were the pleura(13), peritoneum(2), pericardium(2), mediastinum(2), and pelvis(1). Common symptoms included dyspnea, chest pain, abdominal distension, etc. 4. Pathologically, mesotheliomas were divided into 14 malignant types and 6 benign types ; and histologically, 8 fibrous mesotheliomas and 3 epithelial mesotheliomas were shown. 5. There was a statistically significant difference in survival rate according to pathologic type and smoking status. In the groups with malignant mesothelioma, 50% survival time from first symptoms was 18 months and that from diagnosis was 11 months. Also, 75% survival time from diagnosis was 6 months in the smoking groups and 19 months in the non-smoking groups.
Asbestos ; Chest Pain ; Diagnosis ; Dyspnea ; Female ; Follow-Up Studies ; Hospitalization ; Humans ; Male ; Mesothelioma* ; Postal Service ; Surveys and Questionnaires ; Smoke ; Smoking ; Solitary Fibrous Tumor, Pleural ; Survival Analysis* ; Survival Rate ; Telephone

No abstract available.
Pregnancy*

This is to report the technique of reversed iliac leg stent-graft in endovascular treatment for isolated internal iliac artery (IIA) aneurysm, which had significant size discrepancy between the common iliac artery (CIA) and external iliac artery (EIA) in 3 patients from different hospitals. Three patients were a 85- and two 82-year-old men. Treated were right IIA aneurysms, sized 6.5x6.2 cm, 5.0x4.0 cm, and 4.1 cm in longest diameter, respectively. The diameters of the right CIA and right EIA measured 21 mm/11 mm, 15 mm/11 mm, and 20 mm/10 mm, respectively. In all cases, reversed iliac leg stent-grafts were prepared on-site; unsheathed and mounted upside-down manually, and deployed in each right CIA. Post-stent-graft angiograms showed complete exclusion of the aneurysms, except for minimal type 1 endoleak in one case. This technique is a useful treatment option in patients with isolated IIA aneurysm.
Aged, 80 and over ; Aneurysm* ; Endoleak ; Endovascular Procedures ; Humans ; Iliac Aneurysm ; Iliac Artery* ; Leg* ; Male

No abstract available.
Animals ; Evoked Potentials* ; Rats*

PURPOSE: This study is designed to evaluate the reliability for studies of tensiomyography (TMG). TMG can evaluate muscle function noninvasively and selectively. METHODS: We measured 12 male volunteers (age, 26.5±7.6 years; height, 175.3±4.7 cm; weight, 78.8±13.3 kg) in this study and measured TMG during three occasions over 3 consecutive days. None of the participants has had any history of neuromuscular disorders or muscle diseases. Vastus lateralis, vastus medialis (VM), rectus femoris (RF) in quadriceps and biceps femoris, semitendinosus in hamstrings muscles were measured. Coefficient of variation (CV%) and intraclass correlation coefficient (ICC) have been calculated about maximal displacement (Dm, mm) and contraction time (Tc, ms) which are main parameters. RESULTS: Most of the ICC of Dm were over 0.8 and the highest among the muscles except both VM. And, most ICC of Tc was lower than Dm except both BF (right, 18.31; left, 15.03). But, the ICC of Tc was lower than Dm except left RF (0.890) and VM (0.859). CONCLUSION: This study has shown that the Dm is high levels of the ICC and CV(%) in thigh muscle except VM. In the future, we plan to establish the method of measurement more clearly for reducing the errors of measurements. The technique of correct palpation of measurable muscles using TMG devices is also necessary.
Humans ; Male ; Methods ; Muscles ; Palpation ; Quadriceps Muscle ; Thigh ; Volunteers

PURPOSE: The purpose of this study is to evaluate the characteristics of parotid gland tumors to help in the differentiation between benign and malignant lesions. MATERIAL AND METHODS: The CT findings of 22 patients with surgically proven parotid gland tumors were reviewed. Analysis was focused on the density and margin characteristics of the tumors, and the relationahip between the tumor and surrounding structures. RESULTS: Those tumors were pleomorphic adenoma (n=8), Warthin's tumor (n=5), basal cell adenoma (n=l), lipoma (n=l), dermold cyst (n=l), adenold cystic carcinoma (n=2), mucoepidermoid carcinoma (n=l), epidermold carcinoma (n=l), and carcinoma in pleomorphic adenoma (n=l). Most of benign and malignant tumors were heterogeneous in denstiy on contrast enhanced CT scans. In 5 of 6 malignant cases, the tumors had irregular or ill-defined margin and a tendancy to involve or cross the superficial layer of deep cervical fascia with obliteration of subcutaneous fat. Two malignant tumors invaded surrounding structures. CONCLUSION: Although the heterogeneous density of tumor is not a specific finding for malignancy at CT, following findings, such as, irregular or blurred margin of the lesion, the involvement of fascial plane, and the infiltration of surrounding structures may suggest the possibility of malignant parotid tumor.
Adenoma ; Adenoma, Pleomorphic ; Carcinoma, Mucoepidermoid ; Fascia ; Humans ; Lipoma ; Parotid Gland* ; Subcutaneous Fat ; Tomography, X-Ray Computed

A retrospective analysis of CT and MR findings was performed in five patients with histologically proved chordoma including one with chondroid chordoma. All tumors were mostly isodense to gray matter on unenhanced CT, and the single intensities were iso or low and high on T1 and T2-wgighted MR iages, respectively. The tumors had an increase in their density on enhanced CT and MR in four patients, but a chondroid chordoma was poorly enhanced after injection of contrast medicum on CT. Four tumors contained calcifications in CT images and two lesions showed hemorrhage in MR images. Cavernous sinus was involved in all patients, and brain stem and basilar artery were compressed by the tumors in three cases. Pituitary gland was only displaced upward in three patients. Clivus was destroyed in all cases, and sella turcica and sphenoid bone were involved in three patients. CT is better than MR in demonstrating calcifications and bone destruction. In defining the extension of tumor, MR appears to be superior to CT in evaluation of the relationship between the tumor and the surrounding structures.
Basilar Artery ; Brain Stem ; Cavernous Sinus ; Chordoma* ; Cranial Fossa, Posterior ; Gray Matter ; Hemorrhage ; Humans ; Pituitary Gland ; Retrospective Studies ; Sella Turcica ; Sphenoid Bone

STUDY DESIGN: Prospective controlled study. PURPOSE: The results of conventional open surgery was compared with those from minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for lumbar fusion to determine which approach resulted in less postoperative paraspinal muscle degeneration. OVERVIEW OF LITERATURE: MI TLIF is new surgical technique that appears to minimize iatrogenic injury. However, there aren't any reports yet that have quantitatively analyzed and proved whether there's difference in back muscle injury and degeneration between the minimally invasive surgery and conventional open surgery in more than 1 year follow-up after surgery. METHODS: This study examined a consecutive series of 48 patients who underwent lumbar fusion in our hospital during the period, March 2006 to March 2008, with a 1-year follow-up evaluation using MRI. There were 17 cases of conventional open surgery and 31 cases of MI-TLIF (31 cases of single segment fusion and 17 cases of multi-segment fusion). The digital images of the paravertebral back muscles were analyzed and compared using the T2-weighted axial images. The point of interest was the paraspinal muscle of the intervertebral disc level from L1 to L5. Picture archiving and communication system viewing software was used for quantitative analysis of the change in fat infiltration percentage and the change in cross-sectional area of the paraspinal muscle, before and after surgery. RESULTS: A comparison of the traditional posterior fusion method with MI-TLIF revealed single segment fusion to result in an average increase in fat infiltration in the paraspinal muscle of 4.30% and 1.37% and a decrease in cross-sectional area of 0.10 and 0.07 before and after surgery, respectively. Multi-segment fusion showed an average 7.90% and 2.79% increase in fat infiltration and a 0.16 and 0.10 decrease in cross-sectional area, respectively. Both single and multi segment fusion showed less change in the fat infiltration percentage and cross-sectional area, particularly in multi segment fusion. There was no significant difference between the two groups in terms of the radiologic results. CONCLUSIONS: A comparison of conventional open surgery with MI-TLIF upon degeneration of the paraspinal muscle with a 1 year follow-up evaluation revealed that both single and multi segment fusion showed less change in fat infiltration percentage and cross-sectional area in the MI-TLIF but there was no significant difference between the two groups. This suggests that as time passes after surgery, there is no significant difference in the level of degeneration of the paraspinal muscle between surgical techniques.
Follow-Up Studies ; Humans ; Intervertebral Disc ; Muscles ; Prospective Studies

Spinal dural arteriovenous fistulas are rare abnormal connections of artery and vein within the dura, at the level of the intervertebral foramen. A 57-year-old male developed weakness in both lower extremities and sphincteric dysfunction, which had stepwisely, progressive and fluctuating course since 6 months ago. He showed areflexia in both ankle & right knee. T-spine MRI showed high signal intensity with ill defined margin in T2WI and intensely enhanced by con-trast agent through lower thoracic and lumbosacral spinal cord. Selective spinal angiography revealed a dural arteriove-nous fistula with a nidus at thoracolumbar vertebral level, supplied by the internal iliac artery and enlarged medullary veins. Superselective angiographic embolization was done. Clinically, his symptoms has been ameliorated. We report a rare case of thoracic myelopathy due to spinal dural arteriovenous fistulas exclusively supplied by the branches of internal iliac artery.
Angiography ; Ankle ; Arteries ; Central Nervous System Vascular Malformations* ; Fistula ; Humans ; Iliac Artery* ; Knee ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Cord ; Spinal Cord Diseases* ; Veins