No abstract available.
Mitral Valve*

BACKGROUND AND OBJECTIVES: Intracardiac pathology results in 15 - 20% of ischemic stroke, but transthoracic echocardiography (TTE) has a number of limitations because of suboptimal precordial windows or ultrasound interference with prosthetic materials. Transesophageal echocardiography (TEE) provides superior resolution of basal structures such as the left atrium, left atrial appendage, mitral valvular apparatus, atrial septum, and aorta. The purpose of this study was to describe the various TEE findings which were sources of cerebral emboli. MATERIALS AND METHOD: The study population was comprised of 122 patients (mean age:54.5, male 83, female 39) who were admitted to Severance Hospital because of ischemic stroke from 1991 to 1997. All patients underwent TEE with agitated saline contrast administration. Patients without a definitive cardiac source of embolism underwent Holtor monitoring, internal carotid and cerebral angiography, as well as transcranial Doppler. RESULTS: 1) The number of patients diagnosed as cardioembolic stroke was 55 (45.1%). Atrial fibrillation was noted in 31 patients of cardioembolic stroke and it was the most frequent finding. Among these patients, 16 did not have any other cardiac problem. 2) We were able to find the possible source of embolism in 49 (40.2%) patients with TEE. Among these patients, 12 did not have dysrhythmia or any known previous heart problem. We found spontaneous echo contrast in the left atrium and left atrial appendage in 33 cases. There were 8 patients who had intracardiac thrombus. Among these patients, 6 patients had thrombi in the left atrial appendage, 1 in left atrium and 1 in left ventricular apex. We found patent foramen ovale in 3 cases and atrial aneurysm in 1 case. We found atheromatous plaque and/or thrombi of the aorta in 16 cases, while there were 4 cases where lesions located in the ascending aorta and aortic arch and which were considered as the source of embolism. Small thrombi in the left atrial appendage and left atrium were only detectable with TEE. CONCLUSIONS: We described TEE findings in ischemic stroke patients. And we assert TEE is a useful diagnostic tool in detecting the source of cardioembolic stroke and it may be used as a primary diagnostic tool in patients who are being evaluated for ischemic stroke.
Aneurysm ; Aorta ; Aorta, Thoracic ; Atrial Appendage ; Atrial Fibrillation ; Atrial Septum ; Cerebral Angiography ; Dihydroergotamine ; Echocardiography ; Echocardiography, Transesophageal* ; Embolism ; Female ; Foramen Ovale, Patent ; Heart ; Heart Atria ; Humans ; Intracranial Embolism ; Male ; Pathology ; Stroke* ; Thrombosis ; Ultrasonography

Cervical pregnancy is a rare and dangerous form of ectopic pregnancy in which the blastocyst implants within the cervical canal below the internal os of the uterine cervix. The characteristic clinical sign is a severe asymptomatic uterine bleeding in early pregnancy or during curettage. Most cervical pregnancies result in early spontaneous abortion, complicated by severe hemorrhage from the eroded blood vessels within the cervical tissue. Because of uncontrolled profuse vaginal bleeding, total hysterectomy has been the mostly necessitated to control life-threatening bleeding. Transvaginal sonography allows early diagnosis, and conservative treatment (two-time treatment : first treatement with systemic or intraamnionic methotrexate, secondly with curettage or ligature of the uterine arteries) improves the patient's fertility. Successful treatment is defined as elimination of the cervical pregnancy with preservation of the uterus. We report two cases of cervical pregnancy managed, successfully with methotrexate, leucovorin and curettage.
Abortion, Spontaneous ; Blastocyst ; Blood Vessels ; Cervix Uteri ; Curettage ; Cytochrome P-450 CYP1A1 ; Early Diagnosis ; Female ; Fertility ; Hemorrhage ; Humans ; Hysterectomy ; Leucovorin ; Ligation ; Methotrexate ; Pregnancy* ; Pregnancy, Ectopic ; Uterine Hemorrhage ; Uterus

No abstract available.
Glomus Tumor*

Metabolic encephalopathy is a critical condition that can be challenging to diagnose. Imaging provides early clues to confirm clinical suspicions and plays an important role in the diagnosis, assessment of the response to therapy, and prognosis prediction. Diffusion-weighted imaging is a sensitive technique used to evaluate metabolic encephalopathy at an early stage.Metabolic encephalopathies often involve the deep regions of the gray matter because they have high energy requirements and are susceptible to metabolic disturbances. Understanding the imaging patterns of various metabolic encephalopathies can help narrow the differential diagnosis and improve the prognosis of patients by initiating proper treatment regimen early.

PURPOSE: Details on the hemodynamic differences among Fontan operations remain unclear according to respiratory and cardiac cycles. This study was undertaken to investigate hemodynamic characteristics in different types of Fontan circulation by quantification of blood flow with the combined influence of cardiac and respiratory cycles. MATERIALS AND METHODS: Thirty-five patients [10 atriopulmonary connections (APC), 13 lateral tunnels (LT), and 12 extracardiac conduits (ECC)] were evaluated, and parameters were measured in the superior vena cava, inferior vena cava (IVC), hepatic vein (HV), baffles, conduits, and left and right pulmonary artery. Pulsatility index (PIx), respiratory variability index (RVI), net antegrade flow integral (NAFI), and inspiratory/expiratory blood flow (IQ/EQ) were measured by intravascular Doppler echocardiography. RESULTS: The PIx between APC and total cavopulmonary connection (TCPC; LT and ECC) showed significant differences at all interrogation points regardless of respiratory cycles. The PIxs of HVs and IVCs in APC significantly increased, compared with that in LT and ECC, and the RVI between APC and TCPC showed significant differences at all interrogation points (p < 0.05). The NAFI and IQ/EQ between APC and TCPC showed significant differences at some interrogation points (p < 0.05). CONCLUSION: Patients with different types of Fontan circulation show different hemodynamic characteristics in various areas of the Fontan tract, which may lead to different risks causing long-term complications. We believe the novel parameters developed in this study may be used to determine flow characteristics and may serve as a clinical basis of management in patients after Fontan operations.
Circulatory and Respiratory Physiological Phenomena ; Echocardiography, Doppler ; Fontan Procedure ; Hemodynamics ; Hepatic Veins ; Humans ; Pulmonary Artery ; Vena Cava, Inferior ; Vena Cava, Superior

For young children with scoliosis before growth spurt, suhcutaneous lengthening without fusion was designed by Harrington and modified by Moe and Luque. However, many problems including spontaneous fusion, rod breakage, and hook disloclgement have been ohserved. CotrelDubousset(CD) instrumentation was sometimes used, but it usually resulted in failure due to soft tissue adhesion around the rough surface of ordinary CD rod. We tried to use the smooth CD rod, transvcrse-pedicle clawing on the upper part, and pedicle screw inscrtion on upper and lower part of the curve to reduce the hardware failures. Among 8 patients in whom suhcutaneous lengthening with smooth CD rod was carried out hetween October l992 and Suly 1996. 4 cases perfomed with final spinal fusion were analysed. There were I central core disease, 1 multicore disease and 2 idiopathic scoliosis(infantile and juvenile type). Mean age at the first operation was l0.0(8.8-11.8) years, and the Risser sign was all grade 0 except one with grade 1. Suhcutaneous lengthening was performed every 5 or 6 months Mean lengthening duration was 22(9-39) months and mean age at spinal fusion was 11.7(9.6-13.8) years. Mean Cobb angle decreased from 7ldegrees (55degrees-88degrees) at preoperative stage to 32 (10degrees-59degrees) at the last follow-up. There were 5 complications during 21 operations, and three hardware failures comprised 2 hook dislodgcment and 1 screw pull-out. Crankshaft phenomenon happened in I case who had had a posterior fusion in young age(9.6 years) due to laminar fracture. The suhcutaneous lengthening with smooth CD rod can he another option of treatment for young children with severe scoliosis. prescrving the powth potential of involved vertebrae with few complications.
Animals ; Child* ; Follow-Up Studies ; Hoof and Claw ; Humans ; Myopathy, Central Core ; Scoliosis* ; Spinal Fusion ; Spine ; Tissue Adhesions

Small cell carcinoma of the gallbladder is a type of neuroendocrine tumor and very rare. We report ultrasound, CT and MR findings of a small cell carcinoma of the gallbladder that was confirmed by pathology. Small cell carcinoma of the gallbladder was seen as a well-defined mass with peripheral rim enhancement in the gallbladder. In spite of the large size of the mass, direct and extensive invasion of the liver was not detected. However, there were many metastatic lymph nodes.
Carcinoma, Small Cell ; Gallbladder ; Liver ; Lymph Nodes ; Neuroendocrine Tumors