The purpose of this study is to describe the magnetic resonance imaging (MR) findings of metastatic brain tumors with emphasis on the signal intensities of the lesion on MR. Thirty four patients with intracranial metastases were studies with MR imaging. The diagnosis was established on the basis of either brain biopsy or combination of brain MR findings and the presence of primary tumors. The primary tumors include lung cancer (n=18), breast cancer (n=3), stomach cancer (n=3), rectal cancer (n=1), renal cell carcinoma (n=1), hepatocellular carcinoma(n=1), ovarian cancer (n=1), thyroid cancer (n=1), melanoma (n=1) and unknown primary sites (n=4). The parenchymal lesions were solitary in 35% (12/34) and multiple in 65% (22/34). The size of the lesions was variable, ranging from several millimeters to 5cm in diameter. The corticomedullar junction of the cerebral heispheres was the most common location of the lesions (68%). The signal intensity of solid portion of the lesions was usually either isointense (44%) or hypointense (29%) on T1-weighted images, whereas it appeared in isointense (47%), hypointense (8%) or hyperintense (11%) on proton density-weighted or T2-weighted images. The remaining cases showed mixed signal intensities. The enhancement patterns were variable including nodular (<1cm) (6%), homogenous (19%), heterogeneous (10%), ring-like enhancement (22%) or mixed pattern(43%). The size of surrounding edema was larger than the tumor diameter in 76%. In conclusion, although there are no specific MR findings of intracranial metastasis except multiplicity, intracranial metastasis should be included in differential diagnosis with high priority, when a solitary mass showing isointensity on boty T1-and T2-weighted images with massive surrounding edema, especially in the corticomedullary junction of the cerebral hemispheres is encountered.
Biopsy ; Brain Neoplasms* ; Brain* ; Breast Neoplasms ; Carcinoma, Renal Cell ; Cerebrum ; Diagnosis ; Diagnosis, Differential ; Edema ; Humans ; Lung Neoplasms ; Magnetic Resonance Imaging ; Melanoma ; Neoplasm Metastasis ; Ovarian Neoplasms ; Protons ; Rectal Neoplasms ; Stomach Neoplasms ; Thyroid Neoplasms

The purpose of this study is to describe the magnetic resonance imaging (MR) findings of metastatic brain tumors with emphasis on the signal intensities of the lesion on MR. Thirty four patients with intracranial metastases were studies with MR imaging. The diagnosis was established on the basis of either brain biopsy or combination of brain MR findings and the presence of primary tumors. The primary tumors include lung cancer (n=18), breast cancer (n=3), stomach cancer (n=3), rectal cancer (n=1), renal cell carcinoma (n=1), hepatocellular carcinoma(n=1), ovarian cancer (n=1), thyroid cancer (n=1), melanoma (n=1) and unknown primary sites (n=4). The parenchymal lesions were solitary in 35% (12/34) and multiple in 65% (22/34). The size of the lesions was variable, ranging from several millimeters to 5cm in diameter. The corticomedullar junction of the cerebral heispheres was the most common location of the lesions (68%). The signal intensity of solid portion of the lesions was usually either isointense (44%) or hypointense (29%) on T1-weighted images, whereas it appeared in isointense (47%), hypointense (8%) or hyperintense (11%) on proton density-weighted or T2-weighted images. The remaining cases showed mixed signal intensities. The enhancement patterns were variable including nodular (<1cm) (6%), homogenous (19%), heterogeneous (10%), ring-like enhancement (22%) or mixed pattern(43%). The size of surrounding edema was larger than the tumor diameter in 76%. In conclusion, although there are no specific MR findings of intracranial metastasis except multiplicity, intracranial metastasis should be included in differential diagnosis with high priority, when a solitary mass showing isointensity on boty T1-and T2-weighted images with massive surrounding edema, especially in the corticomedullary junction of the cerebral hemispheres is encountered.
Biopsy ; Brain Neoplasms* ; Brain* ; Breast Neoplasms ; Carcinoma, Renal Cell ; Cerebrum ; Diagnosis ; Diagnosis, Differential ; Edema ; Humans ; Lung Neoplasms ; Magnetic Resonance Imaging ; Melanoma ; Neoplasm Metastasis ; Ovarian Neoplasms ; Protons ; Rectal Neoplasms ; Stomach Neoplasms ; Thyroid Neoplasms

BACKGROUND: The anticoagulant efficacy of low molecular weight heparin (LMWH) as an alternative substitute for standard heparin (SH) was evaluated by measuring thrombin-antithrombin complex (TAT) and tissue factor pathway inhibitor (TFPI). METHODS: Twenty-two patients with coronary artery disease (CAD) were divided into three groups and plasma heparin concentration, platelet count, aPTT, TAT and TFPI before and after injection of SH and LMWH were measured. RESULTS: Plasma heparin concentrations were well correlated after the injection of heparin in group B (LMWH 200 U/kg) and C (LMWH 240 U/kg), but not in group A (SH). Platelet counts were not decreased in most patients and life-threatened bleeding was not observed in any patients. APTT prolongations were observed in all patients of SH group, but not in any patients of B and C. TAT levels were not significantly different between groups. TFPI levels were not significantly different between groups. Heparin levels were well correlated with TFPI levels, but not with TAT levels. CONCLUSION: The anticoagulant effect of LMWH up to 240 U/kg/D was not superior over SH in CAD patients, although it has several merits such as no requirement of aPTT monitoring or better predictability.
Coronary Artery Disease* ; Coronary Vessels* ; Hemorrhage ; Heparin ; Heparin, Low-Molecular-Weight* ; Humans ; Plasma* ; Platelet Count ; Thromboplastin*

Stings due to jellyfish, sea anemones, and corals are the most common envenomations encountered with humans in the marine environment. The first case was a 36-year-old female who presented with multiple whiplike linear, dark reddish bullous eruptions on the right forearm after she was stung by a jellyfish in the Philippines 15 days previously. The patient was treated with oral antibiotics for 10 days, but severe pruritus persisted and new papular lesions developed on her hand. Antibiotic therapy was discontinued and oral and topical corticosteroid therapy was applied instead. The skin lesions disappeared without recurrence after about 4 weeks. The second case was a 29-year-old male who visited our department with linear, reddish patches and necrotizing blisters on both the arms, left thigh, and trunk after he was stung by a jellyfish in Thailand. We treated him with oral and topical corticosteroids for 10 days and the lesions cleared. We describe two typical cases of jellyfish sting that are rare in Korea.
Adrenal Cortex Hormones ; Adult ; Anthozoa ; Anti-Bacterial Agents ; Arm ; Bites and Stings* ; Blister ; Female ; Forearm ; Hand ; Humans ; Korea ; Male ; Philippines ; Pruritus ; Recurrence ; Sea Anemones ; Skin ; Thailand ; Thigh

Mixed Connective Tissue Disease(MCTD) is an overlap syndrome characterized by a combination of clinical features similar to those of systemic lupus erythematosus(SLE), scleroderma, polymyositis, and rheumatoid arthritis and unusually high titers of circulating antibody to a nuclear ribonucleoprotein antigen. The mean age of presentation is 37 years and 80% of patients are female. Cardiac involvement is less common in adults but may be more frequent in children. Pericarditis is the most common finding,' other findings include mitral valve prolapse, myocarditis and congestive heart failure. We experienced a case of pericarditis and asymmetric LV hypertrophy in a 33-yr-old postpartum woman with mixed connective tissue disease, who admitted to our hospital because of fever, dyspnea and chest discomfort, which was diagnosed by echocardiography and selorogic study. She was treated with oral prednisolone and aspirin and presented symptoms improved and pericardial effusion was disappeared.
Adult ; Arthritis, Rheumatoid ; Aspirin ; Child ; Connective Tissue ; Dyspnea ; Echocardiography ; Female ; Fever ; Heart Failure ; Humans ; Hypertrophy ; Mitral Valve Prolapse ; Mixed Connective Tissue Disease* ; Myocarditis ; Pericardial Effusion ; Pericarditis ; Polymyositis ; Postpartum Period* ; Prednisolone ; Ribonucleoproteins ; Thorax

BACKGROUND: Clinical trials have shown that b-adrenergic blocking drugs are effective and well tolerated in patients with mild to moderate congestive heart failure. Carvedilol is a mild b1-selective adrenergic blocking agent with vasodilating properties due to a blocker and antioxidant and anti-proliferative properties. This study assessed the efficacy and safety of carvedilol in patients with moderate to severe congestive heart failure caused by idiopathic dilated cardiomyopathy. METHODS: We enrolled 27 patients with moderate to severe congestive heart failure with a left ventricular ejection fraction of 35% by MUGA scan. Each patient was randomly assigned to either control (n-9) or carvedilol (n-18, target dose 25 mg bid) for 6 months while background therapy with digoxin, diuretics, and ACE inhibitor remained constant. RESULTS: Compared to the control group, patients in the carvedilol group showed significant increase of left ventricular ejection fraction (p<0.05). In addition, patients in the carvedilol group had a tendency to show a decrease in left ventricular end-diastolic dimension and heart rate. Also, the carvedilol group had a greater frequency of symptomatic improvement than the control group. There was neither serious side effects nor hospitalization. CONCLUSION: These finding indicate that carvedilol produces important clinical benefits in patients with moderate to severe heart failure treated with digoxin, diuretics, and ACE inhibitor without serious side effects.
Cardiomyopathy, Dilated ; Digoxin ; Diuretics ; Heart Failure* ; Heart Rate ; Hospitalization ; Humans ; Stroke Volume

PURPOSE: The purpose of this study is to investigate the correlation between hemodynamics on three-phase CT and ultrasonography echogenecity of small hepatic cavernous hemangiomas (0.5 - 3 cm). MATERIALS AND METHODS: A total of 158 hepatic cavernous hemangiomas in 139 patients with normal liver parenchyma, who underwent ultrasonography and dynamic CT, were analyzed retrospectively over a six-year period. Two radiologists performed independent analysis of the echogenecity (hyperechoic to hypoechoic) on ultrasonography and hemodynamics (slow to rapid) on CT images using five-grade scales. Correlation between ultrasonography echogenecity scores and CT hemodynamics scores was examined using Spearman's correlation analysis. CT hemodynamics scores were also evaluated with respect to the size of the hepatic cavernous hemangiomas using Spearman's correlation analysis. RESULTS: The ultrasonography echogenecity scores showed significant correlation with the CT hemodynamics scores (r=0.364, p<0.001 for Reviewer 1; r=0.567, p<0.001 for Reviewer 2). The size of the cavernous hemangiomas did not show significant correlation with the CT hemodynamics scores (p>0.05). CONCLUSIONS: More rapid filling of contrast materials in small hepatic cavernous hemangiomas on dynamic CT suggests a greater decrease in echogenecity on ultrasonography and the echogenicity of small hepatic cavernous hemangiomas on ultrasonography can be predicted based on their hemodynamics on dynamic CT.
Caves ; Contrast Media ; Hemangioma, Cavernous ; Hemodynamics ; Humans ; Liver ; Retrospective Studies ; Weights and Measures

Most type I and II perforations are predominately caused by hydrophilic and stiff wires, often presented in the delayed form, and do not require pericardial drainage or surgical interventions. However, we report a type III delayed coronary artery perforation at the site of stent implantation after intervention without any evidence of immediate perforations. To the best of our knowledge, this is the first case report of angiographic documentation and treatment of delayed coronary perforation at the site of stent, presented as a cardiac arrest.
Angioplasty, Balloon, Coronary ; Cardiac Tamponade ; Coronary Vessels ; Drainage ; Drug-Eluting Stents ; Heart Arrest ; Stents

Sparganosis is an infection caused by sparganum, the generic term for the migrating plerocercoid larva of tapeworm which belongs to the species Spirometra. We experienced two cases of sparganosis. The first patient was a 49-year-old woman. She visited our hospital because of a painful subcutaneous nodule on her left forearm, which had developed on her left shoulder at first and migrated to the medial aspect of the forearm. She had drunk fresh water 12 years ago at a mountain. The second patient was a 39-year-old man who showed a subcutaneous nodule on the right lower leg. He had eaten raw snake about 20 years ago. Sparganosis was confirmed after the larval worms were found in the excised tissues in both cases.
Adult ; Cestoda ; Female ; Forearm ; Fresh Water ; Humans ; Larva ; Leg ; Middle Aged ; Shoulder ; Snakes ; Sparganosis* ; Sparganum ; Spirometra

A 32-year-old Korean man was stung by a jellyfish on his right lower leg while scuba diving at the Philippine seashore. The stung lesion rapidly became painful, erythematous and swollen. Seven days later, an irregular shaped ulcer developed at the pervious sting site. The histopathological findings showed focal perivascular infiltration of chronic inflammatory cells in the upper and mid dermis, fibrosis and focal necrosis in the subcutis. The patient had been treated with antibiotic ointment, topical application of tetrachlordecanoic acid solution and 800mg pentoxifylline for 2 months. During treatment, leg swelling had recurred intermittently. After 2 months, the lesion healed leaving an erythematous atrophic scar. We report a rare case of delayed cutaneous reactions with prolonged skin ulceration and chronic recurrent swelling due to lymphatic obstruction.
Adult ; Bites and Stings* ; Cicatrix ; Dermis ; Diving ; Fibrosis ; Humans ; Leg ; Necrosis ; Pentoxifylline ; Skin Ulcer* ; Skin* ; Ulcer