Dieulafoys lesion consists of abnormally large gastric submucosal artery which ruptures into the stomach causing massive or recurrent intragikstric bleeding. The lesion is very small and easily overlooked even at laparatomy and aan only be correctly diagnosed by endoscopy or arteriography if the patient is actively bleeding. Three patients who were admitted with bleeding of upper gastrointestinal tract and eventually diagnosed as having Dieulafoys lesions were analysed. All were men with age range of 44 to 55 years. All patient were asymptomatic before presenting with hematemesis. Two of the three patients had had history of upper Gl bleeding. One patient used analgesics daily for ureteral colic and two patient drank alcohol excessively. Gastroscopy was performed during the bleeding episode in all three patients. Dieulafoy's lesion was seen in all three cases and in the second case, there was concomittent diffuse petechia in the whole stomach. The lesion was situated on the posterior wall of upper body in one, on anterior wall of upper body in another, lesser curvature side of gastric fundus in the other case. All three patient underwent laparotomy for persistent bleeding and the lesion was suture ligated only in two patients while in one patient vagotomy and pyloroplasty was added. Resection biopsy was performed in two cases and both revealed only normal gastric mucosa. All patients discharged after complete recover.
Analgesics ; Angiography ; Arteries ; Biopsy ; Endoscopy ; Gastric Fundus ; Gastric Mucosa ; Gastroscopy ; Hematemesis ; Hemorrhage ; Humans ; Laparotomy ; Male ; Renal Colic ; Rupture ; Stomach ; Sutures ; Upper Gastrointestinal Tract ; Vagotomy

PURPOSE: To evaluate the tibia osteotome angle and whole leg alignment in total knee replacement arthroplasty using intramedullary tibia guide. MATERIALS AND METHODS: Amongst 343 cases of TKA using an intramedullary tibial cutting guide from November 1998 to August 2001, 160 cases who took a standing whole leg AP simple roentgenography within 1 year were selected. Post-operatively, the angle formed by the tibial anatomical axis and tibial component, along with the angle formed between the femoral anatomical axis and tibial anatomical axis were measured. RESULTS: The average angle between the tibial anatomical axis and tibial component was 89.5 degrees (84 degrees~94 degrees), 133 cases(83.1%) were within the range of 90 degrees +/- 2 degrees and amongst these 66 cases(41.3%) were 90 degrees. The average angle formed between the femoral anatomical axis and tibial anatomical axis was 5.6 degrees(0 degrees~11 degrees). CONCLUSION: When used properly, an intramedullary tibial cutting guide in TKA result in satisfactory tibial osteotome angle and whole leg alignment in TKA.
Arthroplasty* ; Arthroplasty, Replacement, Knee ; Axis, Cervical Vertebra ; Knee* ; Leg ; Radiography ; Tibia

PURPOSE: To assess the efficacy of two-dimensional breath-hold coronary magnetic resonance angiography (coronary MRA) in normal rolunteers. MATERIALS AND METHODS: During a four-month period, 11 volunteers underwent MRA of the major coronary branches using a 2-D multiphase breath-hold spiral fast-gradient echo sequence. The proximal diameter of each visualized coronary artery was measured, and visibility and image quality were also determined. RESULTS: Adequate visualization was achieved in 82-100% of proximal coronary arterial branches and in 36-55% of the middle, distal branches. In general, the diameter of the proximal coronary artery correlated closely with that measured from conventional coronary angiography and using previous coronary MRA data. However, visibility and image quality in the left circumflex coronary artery were limited. CONCLUSION: In the majority of subjects, 2-D coronary MRA provides adequate visualization of the proximal segments of the major coronary arterial branches.
Adult* ; Angiography* ; Coronary Angiography ; Coronary Vessels ; Humans ; Magnetic Resonance Angiography ; Volunteers

OBJECTIVE: To identify and evaluate the lateral border zone by comparing the size and distribution of the abnormal signal area demonstrated by MR imaging with the infarct area revealed by pathological examination in a reperfused myocardial infarction cat model. MATERIALS AND METHODS: In eight cats, the left anterior descending coronary artery was occluded for 90 minutes, and this was followed by 90 minutes of reper-fusion. ECG-triggered breath-hold turbo spin-echo T2-weighted MR images were initially obtained along the short axis of the heart before the administration of contrast media. After the injection of Gadomer-17 and Gadophrin-2, contrast-enhanced T1-weighted MR images were obtained for three hours. The size of the abnormal signal area seen on each image was compared with that of the infarct area after TTC staining. To assess ultrastructural changes in the myocardium at the infarct area, lateral border zone and normal myocardium, electron microscopic examination was performed. RESULTS: The high signal area seen on T2-weighted images and the enhanced area seen on Gadomer-17-enhanced T1WI were larger than the enhanced area on Gadophrin-2-enhanced T1WI and the infarct area revealed by TTC staining; the difference was expressed as a percentage of the size of the total left ventricle mass (T2= 39.2 %; Gadomer-17 =37.25 % vs Gadophrin-2 = 29.6 %; TTC staining = 28.2 %; p < 0.05). The ultrastructural changes seen at the lateral border zone were compatible with reversible myocardial damage. CONCLUSION: In a reperfused myocardial infarction cat model, the presence and size of the lateral border zone can be determined by means of Gadomer-17- and Gadophrin-2-enhanced MR imaging.
Animal ; Cats ; Contrast Media ; Gadolinium ; Magnetic Resonance Imaging/*methods ; Mesoporphyrins/diagnostic use ; Metalloporphyrins/diagnostic use ; Myocardial Infarction/*pathology ; Myocardial Reperfusion ; Myocardium/pathology ; Support, Non-U.S. Gov't