PURPOSE: To assess the efficacy of three-dimensional CT angiography (3D-CTA) using multi-detector row computed tomography (MDCT) in the evaluation of intracranial aneurysms in patients with non-traumatic acute subarachnoid hemorrhage and to describe those aneurysms which were not found 3D-CTA. MATERIALS AND METHODS: 3D-CTA was done in 40 patients with non-traumatic subarachnoid hemorrhage by using a 16-slice MDCT; conventional digital subtraction angiography (DSA) was done in 36 of those patients within 12 hours. The CT and DSA images were reviewed by two radiologists and the site, size and neck of the aneurysms were evaluated. The results from these two modalities were then compared with the operative findings. We calculated the detection rates by 3D-CTA and DSA and evaluated the size differences of aneurysms dignosed with 3D-CTA and those found at surgery. We also analyzed the locations and sizes of aneurysms missed by 3D-CTA and attempted to explain these false negatives. RESULTS: A total of 55 aneurysms were surgically confirmed in 40 patients. 48 of these were detected pre-operatively by 3D-CTA. Thus, the detection rate by 3D-CTA was 87%. The size difference of aneurysms as calculated by 3-D CTA and found operatively was as follows: less than 1 mm in 17 cases, within 1-2 mm in 15 cases, and more than 2 mm in 16 cases. Seven aneurysms were not detected by 3D-CTA. The major cause of these missed aneurysms was their small size. The undetected aneurysms were less than 2 mm in size, except for 2 instances of PCoA aneurysms. One case was not detected due to difficult image evaluation. A possible explanation of the one remaining missed aneurysm was the filling of the aneurismal sac by thrombosis. CONCLUSION: Though there were some limitations in the detection of aneurysms, 3D-CTA using 16-channel MDCT may provide sufficient pre-operative information for the management of patients with intracranial aneurysms in cases of emergency operations or DSA-failure.
Aneurysm ; Angiography ; Angiography, Digital Subtraction ; Emergencies ; Humans ; Intracranial Aneurysm* ; Neck ; Subarachnoid Hemorrhage ; Thrombosis

OBJECTIVES: This study was conducted in order to understand the cellular events associated with silica-induced pathogenesis of the rat lung. METHODS: Silicosis was induced by an intratracheal instillation of 50 mg of silica (SiO2, 0.15 - 10 micrometer) suspended in 500 microliter of a sterile saline solution in Sprague-Dawley rats weighing 200g. Silicotic nodules were excised from the rat lungs 4 weeks after silica instillation, then boiled for 4 days at 110 degrees in solution containing 2% SDS, 10 M urea and 40 mM DTT. The insoluble cellular encapsulates were electrophoresed on 4-12 % gradient SDS-PAGE, and the amino acid composition was analyzed. Affinity chromatographies of the homogenate supernatants of the control lung, silicotic nodule, and normal rat plasma were performed using rabbit IgG, anti-rat, cross-linked protein from the silicotic nodule. The amounts of N epsilon-(gamma-glutamyl) lysine cross-linked in the control lungs and silicotic nodules were determined using HPLC analysis. RESULTS: The remaining cross-linked protein was insoluble in the 10 M urea and 40 mM sulfhydryl reagents even under prolonged boiling conditions. The encapsulate revealed the retention of silica particles within the protein whose amino acid composition showed a high percentage of alanine, leucine and glycine. A 46 KDa protein was identified as a cross-linked protein in the silicotic nodule by affinity chromatography. The level of N epsilon-(gamma-glutamyl) lysine dipeptide in the nodule digest was prominently increased compared with that in the control lung. CONCLUSIONS: Transglutaminase (TGase)-catalyzed cross-linking appears to be involved in the silicotic nodule formation, and the 46 KDa protein may be cross-linked to itself and other extracellular matrix proteins during fibrosis and the formation of eventually insoluble nodule.
Alanine ; Animals ; Chromatography ; Chromatography, Affinity ; Chromatography, High Pressure Liquid ; Electrophoresis, Polyacrylamide Gel ; Extracellular Matrix Proteins ; Fibrosis ; Glycine ; Immunoglobulin G ; Leucine ; Lung* ; Lysine ; Plasma ; Rats* ; Rats, Sprague-Dawley ; Silicon Dioxide ; Silicosis ; Sodium Chloride ; Sulfhydryl Reagents ; Urea

OBJECTIVES: This study was performed to examine the immunohistochemical distribution of TGase 1, 2, 3, coagulation factor XIII and N epsilon-(gamma-glutamyl) lysine cross-link in the silicotic nodules formed after an intratracheal instillation of the silica. METHODS: The immunohistochemical examinations used antibodies against TGase 1, 2, 3, coagulation factor XIII and N epsilon-(gamma-glutamyl) lysine isopeptide in the silicotic nodules induced after an intratracheal instillation of 50 mg of size fractionated, crystalline silica. RESULTS: A high level of TGase 3 was related to the severity of fibrosis in silicotic nodules and extracellular coagulation factor XIII was detected around the nodules. Expressions of both membrane-bound TGase 1 and TGase 2 were barely detected in the nodules although high expressions were detected in the intact lung. Formation of N epsilon-(gamma-glutamyl) lysine cross-links was increased in severe fibrotic nodules. CONCLUSIONS: TGase 3 might contribute to the eventual stone-like fibrosis via formation of N epsilon-(gamma-glutamyl) lysine cross-links. Futhermore, coagulation factor XIII plays a role in the formation of a provisional matrix which results in fibrogenesis during silicotic nodule formation.
Antibodies ; Blood Coagulation Factors* ; Crystallins ; Factor XIII* ; Fibrosis ; Immunohistochemistry* ; Lung ; Lysine* ; Plasma* ; Silicon Dioxide

BACKGROUND: Pneumoperitoneum and head-down tilt during a laparoscopic hysterectomy causes significant alterations in the hemodynamics including decreased cardiac output. The aim of this study was to evaluate the effects of a crystalloid preload on the hemodynamics after a hysterectomy (LAVH). METHODS: The patients were randomized to receive either no crystalloid fluid preload (control group: 29 women) or 10 ml/kg of a crystalloid fluid preload over 10 min (preloading group: 30 women) before the pneumoperitoneum. The hemodynamic parameters were measured before inducing anesthesia, immediately after the tracheal intubation, before the skin incision, and 2, 5, 10, 20, and 30 min after the pneumoperitoneum with CO2 with noninvasive cardiac output measurements using the partial CO2 rebreathing method. RESULTS: The cardiac index (CI) was reduced 2 and 5 min after the pneumoperitoneum, and then returned to normal. There were no significant differences in the CI after the pneumoperitoneum between the two groups (P<0.05). CONCLUSIONS: The administration of a 10 ml/kg crystalloid preload did not attenuate the decrease in the CI after pneumoperitoneum.
Anesthesia ; Cardiac Output ; Female ; Head-Down Tilt ; Hemodynamics* ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Intubation ; Pneumoperitoneum* ; Skin

BACKGROUND: T-SPOT.TB is a sensitive test that detects interferon-gamma producing T-cells in tuberculosis patients following stimulation with tuberculosis-specific antigens. Our study was aimed to investigate the possible causes of false negative results of the test by analyzing the patients with positive acid-fast bacilli (AFB) culture and negative T-SPOT.TB results. METHODS: We investigated 138 patients with positive AFB culture results reported between January 2009 and April 2010. Medical records of these patients were reviewed for the results of T-SPOT.TB test, AFB culture, PCR for Mycobacterium tuberculosis (TB-PCR), chest X-ray, drug treatment, etc. Diagnosis of tuberculosis was confirmed by positive TB-PCR or identification of Mycobacterium tuberculosis (MTB). Sensitivity of T-SPOT.TB test was calculated and the possible causes of AFB culture positive and T-SPOT.TB negative results were analyzed. RESULTS: T-SPOT.TB test was performed in 63 of the 138 patients with AFB culture positive results. Fifty-six (88.9%) were positive and 7 patients (11.1%) were negative on T-SPOT.TB test. Of these 7 negative cases, 4 were confirmed as nontuberculous mycobacteria (NTM), 2 were suspected as NTM and diagnosis could not be confirmed in 1. Six of these 7 patients were over 70 yr old and 6 patients had lymphocytopenia. T-SPOT.TB negative results were not observed in any of the 44 patients confirmed to have active tuberculosis (sensitivity 100%). CONCLUSIONS: Our results suggest that T-SPOT.TB test is very sensitive for diagnosing active tuberculosis. NTM may be the main cause of AFB culture positive and T-SPOT.TB negative results, but MTB infection in immunocompromised patients also has to be considered.
Adult ; Aged ; Aged, 80 and over ; Bacillus/*isolation & purification ; Culture Media ; Female ; Humans ; Lymphocyte Count ; Lymphopenia/diagnosis/microbiology ; Male ; Polymerase Chain Reaction ; Reagent Kits, Diagnostic ; Sensitivity and Specificity ; Tuberculosis/*diagnosis/microbiology/radiography

OBJECTIVES: This study was conducted to be identify the effects oral hygiene improvement of the elderly by caregiver in a rural. METHODS: It recruited Fifty three elderly patients were recruited who admitted at a long-term hospital located in Mokchon city, Chungchungnam-do province. as the intervention group. Fifty two elderly patients group were selected another one long-term care hospital in Daegu city as control group. study was conducted for seven months. long-term care hospital. for seven months from Dec. 2007 to June 2008. For three months, the caregivers provide tooth brushing and cleaning artificial teeth once a day, to intervention group. once a day for three months. RESULTS: Before the program there was no significant difference between the control and the intervention groups in general characteristics, prevalence rates of diseases, oral sanitary condition. Dental plague score was decreased significantly (p<0.001) before and after intervention in the intervention group. Using analysis of covariance for evaluation of the effect of the intervention, a significant difference was observed between the intervention group and the control group (p<0.01). CONCLUSIONS: These results were thought to be used as important basic data to develop oral health management program for elderly patients who needed long-term care.
Aged ; Caregivers ; Humans ; Long-Term Care ; Oral Health ; Oral Hygiene ; Plague ; Prevalence ; Tooth ; Tooth, Artificial

No Abstract available.
Arthritis, Rheumatoid* ; Humans ; Osteoclasts*

BACKGROUND: Nausea and vomiting during regional anesthesia for a cesarean section are common and unpleasant complications. This study was designed to assess the efficacy of prophylactic low dose granisetron on nausea and vomiting of patients undergoing a cesarean section with epidural anesthesia in a prospective, randomized, and double blind manner. METHODS: Sixty obstetric patients not in labor received epidural anesthesia with 20 mL of 2% lidocaine plus epinephrine (1 : 100,000) and 4 mL of diluted morphine 2 mg was administrated for postoperative pain control. Maternal hypotension was prevented aggressively by fluid administration and an ephedrine injection. The patients were assigned randomly to one of four groups to receive a placebo (normal saline) or granisetron in a dose of 10micro gram/kg, 20micro gram/kg, or 30micro gram/kg i.v. before peritoneal closure. Emetic episodes and emetic scores rating from 0 to 4 were observed during the 24 hours after surgery. RESULTS: The emetic score was statistically lower in the granisetron 30micro gram/kg group than the other groups, and was lower in the granisetron 20micro gram/kg group than the placebo and granisetron 10micro gram/kg group. Adverse events were headache, dizziness, sedation and pruritus, which were not serious. CONCLUSIONS: Prophylactic use of low dose granisetron (20-30micro gram/kg) is effective in postoperative nausea and vomiting in a cesarean section with epidural anesthesia using lidocaine and morphine when hypotension as one of the contributing factors was minimized.
Anesthesia, Conduction ; Anesthesia, Epidural* ; Antiemetics ; Cesarean Section* ; Dizziness ; Ephedrine ; Epinephrine ; Female ; Granisetron* ; Headache ; Humans ; Hypotension ; Lidocaine ; Morphine ; Nausea ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Pregnancy ; Prospective Studies ; Pruritus ; Vomiting*

A randomized prospective study was performed on the anesthetic induction, maintenance, and recovery characteristics of sevoflurane-nitrous oxide, compaired to that of target- controlled propofol and fentanyl anesthesia, for forty day-case hysteroscopic surgery. The patients in the sevoflurane group (n = 20) received sevoflurane-nitrous oxide for both induction (8%) and maintenance (1 - 2%) of anesthesia, while the patients in the propofol group (n = 20) received target-controlled propofol (4 microgram/ml, 3-6 microgram/ml as occasion demanded) with fentanyl (1 microgram/kg). In both groups, the airway was maintained by a facemask with the patient breathing spontaneously during the surgery. The mean times to unconsciousness and readiness for surgery were similar in both groups, with those for the sevoflurane group, compared to the propofol group being 80.4 18.9 vs. 83.6 38.8 sec, and 220.1 76.9 vs. 231.0 95.4 sec, respectively. Propofol was associated with significantly higher incidences of involuntary movement (30% vs. 5%) and apnea (35% vs. 0%) during the induction period than with sevoflurane. Hemodynamic variables were similar with the exception of significantly lower blood pressures during the first 5 minutes of induction with propofol. Emergence times to eye opening, hand squeezing and orientation for sevoflurane compared to propofol were: 316.6 79.3 vs. 507.4 218.8 sec, 390.0 69.3 vs. 653.1 201.6 sec and 380.6 80.8 vs. 666.3 208.7 sec, respectively, all of these being significantly faster for sevoflurane than propofol. The postanesthetic Aldrete's recovery scores of the patients immediately after surgery were higher in the sevoflurane group. Propofol was associated with more drowsiness, with sevoflurane being associated with more nausea, in the recovery period; however, neither delayed the time to discharge (103.7 28.1 vs. 99.0 36.2 min). In conclusion, sevoflurane-nitrous oxide appears to be superior for day-case hysteroscopic surgery, than target-controlled propofol with fentanyl, with regards to the speed of recovery from anesthesia and the return to hemodynamic stability.
Adult ; Anesthesia ; Anesthetics/*pharmacology ; Comparative Study ; Female ; Fentanyl/*pharmacology ; Hemodynamics/drug effects ; Human ; *Hysteroscopy ; Methyl Ethers/administration & dosage/*pharmacology ; Nitrous Oxide/administration & dosage/*pharmacology ; Pain Measurement ; Propofol/administration & dosage/*pharmacology ; Prospective Studies

PURPOSE: To clarify the value of mass screening for thyroid cancer by ultrasonography. MATERIALS AND METHODS: We evaluated the incidence of thyroid nodules and the detection rate of malignant nodules in 2856 patients who underwent screening thyroid ultrasonography while undergoing breast ultrasonography. We also analyzed the ultrasonographic characteristics of nodules in the screening (34 patients) and clinical (48 patients) groups which were diagnosed with thyroid cancer. RESULTS: The incidence of thyroid nodules detected by ultrasonography was 39% and the detection rate of thyroid cancer was 1.19% in the screening group and 17% in the clinical group. The mean size of nodules in clinical group was larger than that in the screening group (p<0.05) and the prevalence of nodules with ill-defined margin in the screening group was higher than that in the clinical group (p<0.05). There was no significant difference in internal echogenicity, shape, presence of internal calcifications, lymph node metastasis and extrathyroidal extension between the two groups. CONCLUSION: Although the incidence of thyroid cancer was low, sonographic screening for thyroid cancer while undergoing breast ultrasonography could be valuable.
Breast* ; Early Detection of Cancer ; Humans ; Incidence ; Lymph Nodes ; Mass Screening* ; Neoplasm Metastasis ; Prevalence ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Ultrasonography ; Ultrasonography, Mammary*