To investigate the relationship between psychological behavior and the development of central serous chorioretinopathy, we performed a study on stress and personality characteristics on 39 central serous chorioretinopathy patients and 38 healthy subjects as a control group. We used Life Change Inventory(MMPI) for personality characteristics. As a result, the mean stress scale in the patients group was significantly higher than in the normal control group(p<0.05) and the mean T-xcore of three neurotic scales such as hypochondriasis, depression and hysteria in the patients group were significantly higher than in the normal control group(p=0.029, 0.004, 0.012).
Central Serous Chorioretinopathy* ; Climacteric ; Depression ; Humans ; Hypochondriasis ; Hysteria ; MMPI ; Weights and Measures

Although extra-axial hematoma is a well known complication in ventricular shunting, epidural hematomas(EDH) are not common in this setting. This is the report of an unusual case of acute EDH in a patient with hydrocephalus caused by pineal germinoma treated by ventriculoperitoneal(V-P) shunt and radiotherapy. The formation of acute EDH has been rarely reported as a complication of V-P shunt. We would like to share our experience with a case of acute EDH after 4 months of V-P shunt and a review of the literature is also included.
Germinoma ; Hematoma* ; Humans ; Hydrocephalus ; Radiotherapy ; Ventriculoperitoneal Shunt*

Intraventricular hemorrhage(IVH) from any source is generally considered to be of grave prognostic significance. However, little is known about the prognostic effect of fourth IVH. The analysis of 65 patients with computerized tomography(CT)-documented fourth IVH treated between 1990 and 1994 is here in presented. The etiologies of the studied fourth IVH include hypertensive intracranial hemorrhage(39 cases), spontaneous subarachnoid hemorrhage(12 cases), primary IVH(9 cases), trauma(4 cases), Moyamoya disease(1 case). A 66.7% mortality rate was found in patients with a Glasgow coma scale(GCS) score of 3 to 5, 53.8% for those with a GCS score of 6 to 8, 28.6% for those patients with a GCS score of 9 to 12, and 9.5% for patients with a GCS score of 13 to 15. Admission status was significant outcome predictor(p<0.001). The mortality rate for patients with dilatation and fixed pupil was 64.7%. Pupillary reflex was also used as an outcome predictor(p<0.05). The mortality rate of patients with hemorrhagic dilatati on of the fourth ventricle was 70% while those with no hemorrhagic dilatation of the fourth ventricle was 28.9%. Hemorrhagic dilatation of the fourth ventricle was a potent predictor of outcome in fourth IVH(p<0.005). The mortality rate of patients with a ventriculocranial ratio(VCR) of 0.23 or more than 0.23, as calculated from initial CT scan, was 76.5% and those with a VCR of less than 0.16 was 26.7%. We have found that VCR is a potent prodictor of outcome in fourth IVH(p<0.005). The prognostic values of age, etiology of fourth IVH, lood pressure, the number of ventricle of hemorrhage presenting was found to be statistically insignificant. Patients with all ventricular hemorrhage and urokinase irrigation have a 64.5% mortality rate. Patients with fourth IVH and hemorrhagic dilatation of fourth ventricle, increased VCR, poor admission status, dilatation and fixed pupil are considered poor prognosis. Urokinase irrigation was the recommended management for these patients.
Coma ; Dilatation ; Fourth Ventricle ; Hemorrhage* ; Humans ; Mortality ; Prognosis ; Pupil Disorders ; Reflex, Pupillary ; Tomography, X-Ray Computed ; Urokinase-Type Plasminogen Activator

PURPOSE: We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. MATERIALS AND METHODS: 118 patients (M: F=66:52, 62.7+/-10.5 years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest T1-201/stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heart failure and unstable angina) were surveyed through perioperative periods (14.6+/-5.6 days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. RESULTS: Peri-operative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease. Multivariate analysis sorted` out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. CONCLUSION:: We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery.
Death ; Electrocardiography ; Heart Failure ; Humans ; Multivariate Analysis ; Myocardial Infarction ; Myocardial Ischemia ; Perfusion ; Perioperative Period ; Retrospective Studies ; Risk Factors ; Tomography, Emission-Computed, Single-Photon*

We report a case of necrotizing arteritis involving the gallbladder. This case was clinically diagnosed as cholelithiasis with cholecystitis, and necrotizing arteritis was found in the surgically resected specimen. Vascular changes were similar to those seen in classic polyarteritis nodosa, involving medium-sized muscular arteries and characterized by fibrinoid necrosis and panarterial and periarterial inflammation varying from active to resolving stages. Acute cholecystitis is a rare initial clinical manifestation of the systemic vasculitis. If acute cholecystitis is found in the absence of obvious cause, careful examination is essential. Since steroid therapy improves the prognosis in the systemic vasculitis, clinicians and pathologists should be aware of this unusual lesion.
Arteries ; Cholecystitis ; Cholecystitis, Acute ; Cholelithiasis ; Gallbladder* ; Inflammation ; Necrosis ; Polyarteritis Nodosa ; Prognosis ; Systemic Vasculitis ; Vasculitis*

PURPOSE: To evaluate CT findings of internal hernia. MATERIALS AND METHODS: Three patients with internal hernia had abdominal CT scans and two of them had small bowel follow through examinations. The CT features of two patients with retroanastomotic and one patient with left paraduodenal hernia were evaluated and correlated with small bowel follow through examinations, and surgical findings. Two patients with retroanastomotic hernia had a history of subtotal gastrectomy with antecolic gastrojejunostomy. The diagnosis of internal hernia was made on the basis of surgical find ings in two patients of retroanastomotic hernia, and characteristic barium study findings in one patient of left paraduodenal hernia. RESULTS: The small bowel follow through examination showed small bowel loops gathered in a circumscribed mass in the left mid abdomen, and delay in passage through these loops. In case of left paraduodenal hernia, abrupt narrowing of the distal duodenum could be identified. The characteristic CT findings of all three patients were whorling of the mesentery and mesenteric vessels in the left mid-abdomen. In the patient with left paraduodenal hernia, after resolution of the gastrointestinal symptoms, a follow-up CT scan showed spontaneous disappearance of whorling of the mesentery and mesenteric vessels suggesting spontaneous resolution of the hernia. In the other two cases, upon exploration of the abdomen, dilatation of afferent duodenum caused by adhesion between ligament of Treitz and adjacent bowel walls, and retro- anastomotic herniation of the efferent loops were found. CONCLUSION: The usual diagnosis of internal hernia is based on the appearance of the small bowel follow through examination. However, we consider that the whorling appearance(we call it whorling sign) of the mesentery and mesenteric vessels on CT scan is also suggestive of internal hernia in patients under clinical suspicion.
Abdomen ; Barium ; Diagnosis ; Dilatation ; Duodenum ; Follow-Up Studies ; Gastrectomy ; Gastric Bypass ; Hernia ; Humans ; Ligaments ; Mesentery* ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: Perfluorocarbon exposed sonicated dextrose albumin (PESDA) microbubbles has been suggested to facilitate thrombus disruption under the transcutaneous ultrasound (US). Thus, we investigated whether such a noninvasive approach could augment thrombolytic effect of fibrinolytic agent in an experimental thrombotic model. MATERIALS AND METHODS: Thrombus formation was induced with electrical injury in the rabbit iliofemoral arteries (n=20): Thrombus occlusion was documented by angiography in all arteries. In the control group, only tissue plasminogen activator (t-PA, 3 mg/kg) was administered intrav-enously in five rabbits. In the Group 1 (n=9), injured arteries were exposed to transcutaneous US (20 kHz, 30 W/cm2, continuous mode) with t-PA (3 mg/kg). In the Group 2 (n=6), the same treatment was given while administering PESDA continuously (10 ml/min, intravenous). Angiographic results were evaluated at 10 minute interval for 1 hour respectively. RESULTS: In the control group, two of five iliofemoral arteries (40.0%) were recanalized and one of nine iliofemoral arteries (11.1%) was recanalized in Group 1. In contrast, four of six iliofemoral arteries (66.7%) were recanalized angiographically in Group 2 (p=0.392 vs. control group: p=0.047 vs. Group 1). However, late reocclusion occurred in all iliofemoral arteries of Group 2. CONCLUSION: Although PESDA with transcutaneous US significantly enhanced initial angiographic patency rate of t-PA, it was associated with high rate of reocclusion. Further studies will be necessary for clinical application of this noninvasive method in acute arterial occlusion.
Angiography ; Arteries ; Glucose* ; Microbubbles ; Rabbits ; Thrombolytic Therapy* ; Thrombosis ; Tissue Plasminogen Activator ; Ultrasonography*

No abstract available.

PURPOSE: To evaluate the radiologic findings of alimentary anthrax. MATERIALS AND METHODS: 19 patients with alimentary anthrax, which was caused by ingestion of contaminated beef, were included in this study. The diagnosis was made .b.y demonstration of Bacillus anthracis in smear and culture of the contaminated meat. We evaluated the clinical manifestations and the findings of thoracic, abdominal radiographs, cervical, abdominal ultrasonograms and abdominal CT scans. RESULTS: Out of the 19 patients with the alimentary infection, 9 had oropharyngeal form, 18 had abdominal form and 8 had combination of oropharyngeal and abdominal form. The patients had general symptoms and signs such as fever, chill, myalgia. Clinical symptoms and signs were sore throat, throat injection, throat ulcer and patch in oropharyngeal form, and nausea, vomiting, abdominal pain, diarrhea, and gross GI bleeding in abdominal form. Radiologic findings included enlarged cervical lymph nodes(36%) in oropharyngeal form, and paralytic ileus(26%), ascites(26%), hepatomegaly(21%), enlarged mesenteric lymph nodes(26%), small bowel wall thickening(5%) in abdominal form. In two patients, late complications occurred as intestinal obstruction due to ileal stricture with perforation, and inflammatory changes of pelvic cavity due to ileovesical fistula. CONCLUSION: Radiologic findings of alimentary anthrax are difficult in differentiation from those of other inflammatory bowel disease, but those radiologic findings with clinical manifestations may be helpful in diagnosis and evaluation of disease process in patients with alimentary anthrax.
Abdominal Pain ; Anthrax* ; Bacillus anthracis ; Constriction, Pathologic ; Diagnosis ; Diarrhea ; Eating ; Fever ; Fistula ; Hemorrhage ; Humans ; Inflammatory Bowel Diseases ; Intestinal Obstruction ; Meat ; Myalgia ; Nausea ; Pharyngitis ; Pharynx ; Tomography, X-Ray Computed ; Ulcer ; Ultrasonography ; Vomiting

Agenesis of the dorsal pancreas is one of the rare congenital anomalies of the pancreas. Six cases of them have been reported. We have experienced an autopsy case of agenesis of the dorsal pancreas associated with fetal death in the uterus. Grossly, the body and tail of the pancreas and uncinate process were not found and those were partially replaced by adipose tissue. No abnormality was noted in the other organs. Microscopically, pancreatic tissue with autolytic change was identified only in the head portion of the pancreas.