Kissing aneurysms associated with a proximal basilar artery fenestration are an exceedingly rare and unique therapeutic challenge due to anatomical complexity. This report describes double-barrel stent-assisted technique with dual closed-cell stents for the successful endovascular coiling of kissing aneurysms from a proximal basilar artery fenestration.
Aneurysm* ; Basilar Artery* ; Embolization, Therapeutic ; Stents*

Immunoperoxidase method was used to study carcinoembryonic antigen in tissue sections of 75 patients with transitional cell carcinoma, inflammation and normal mucosa of the bladder. Transitional cell carcinomas were divided into 3 grades by the degree of cellular differentiation and 4 groups (A: superficial tumors without recurrence, B: superficial tumors with recurrence, C: superficial tumors with recurrence and up-staging and D: initially invasive tumors) according to recurrence and invasiveness. Overall positive rate of CEA for transitional cell carcinomas was 38% and 5 normal and 5 inflammatory vesical mucosas were negative for CEA in the cytoplasm of the cell. The positive rates of A, B, C and D were 25%, 57%, 30% and 50%, respectively and those of grade I, II and III were l9%, 34 % and 73%, respectively. The positive rate of CEA was well correlated with the grade but not with the recurrence or invasiveness. These conflicting data suggest that further extensive study will be necessary whether immunoperoxidase detection of CEA in tissue sections could be of prognostic value in patients with transitional cell carcinoma of the bladder.
Carcinoembryonic Antigen* ; Carcinoma, Transitional Cell* ; Cytoplasm ; Humans ; Inflammation ; Mucous Membrane ; Recurrence ; Urinary Bladder*

Purpose: To validate the value of Duplex Color Doppler Ultrasonography (DDU) for the incidence and location of postoperative deep vein thrombosis (DVT) that developed after hip surgery Materials and Methods: 260 consecutive patients who did not undergo any preventive treatment for DVT and underwent hip surgery (osteosynthesis for femoral neck and intertrochanteric fracture, acetabular fracture, and hip joint arthroplasty) from July, 2003 to May, 2005 were evaluated for the incidence of DVT. DDU was carried out on 7th postoperative day in all cases. Results: DVT was detected in 16 cases (6.2%) with 7 being in the femoral vein and 3 in the calf vein. Only two cases showed clinical symptoms such as pain and edema but no pulmonary embolism developed. Conclusion: The incidence of DVT obtained from DDU after hip surgery was 6.2 %, and no serious complications developed due to the early diagnosis. DDU is valuable as a screening test for postoperative DVT as well as for the prevention of serious complications such as pulmonary embolism.
Acetabulum ; Early Diagnosis ; Edema ; Femoral Vein ; Femur Neck ; Hip Joint ; Hip* ; Humans ; Incidence ; Mass Screening ; Pulmonary Embolism ; Ultrasonography, Doppler, Color ; Veins ; Venous Thrombosis*

No abstract available.
Tibia*

PURPOSE: To evaluate the safety and efficacy of Hickman catheter placement via the subclavian vein under fluoroscopic guidance with intravenous contrast injection. MATERIALS AND METHODS: During an eleven-month period, 187 Hickman catheters were percutaneously placed in 167 consecutive patients in an interventional radiology suite. Subclavian venous puncture was made with injection of contrast medium into the peripheral venous line. After subclavian venous access had been obtained, a subcutaneous tunnel was created using a peel-away sheath or a tunneler. The Hickman catheters were inserted through a peel-away sheath, the distal tip of which was at the junction of the right atrium and the superior vena cava. RESULTS: One hundred and eighty-six Hickman catheters were successfully placed; the one failure was due to an atomical tortuosity of the vein(0.53%). Complications included one case of subclavian vein occlusion (0.53%); three of line occlusion by thrombus (1.6%); one of oozing at the suture site (0.53%); six of infection or inflammation (3.2%); eight of natural removal (4.2%); one case of air embolism (0.53%) and two of malposition (0.1%). Major complications such as pneumothorax or arterial puncture leading to mediastinal hemorrhage did not, however, occur. CONCLUSION: The authors concluded that radiologic Hickman catheter placement offers advantages over traditional approaches in terms of safety, convenience, and time and cost savings.
Catheters ; Cost Savings ; Embolism, Air ; Heart Atria ; Hemorrhage ; Humans ; Inflammation ; Pneumothorax ; Punctures ; Radiology, Interventional ; Subclavian Vein* ; Sutures ; Thrombosis ; Vena Cava, Superior

PURPOSE: To determine the usefulness of microbubble contrast enhanced power Doppler ultrasonography (PDUS)for the detection of residual tumor in hepatocellular carcinomas (HCCs) treated by transcatheter arterialchemoembolization (TACE). MATERIALS AND METHODS: Fourteen nodular HCCs (size range: 1 - 7.3 cm, mean: 3.5) intwelve patients treated by TACE, and on the basis of follow-up liver CT, thought to have a residual tumor, wereincluded in this study. Between July 1997 and April 1998, PDUS examinations were performed with a 2-4 MHz convextransducer before and after intravenous injection of a microbubble contrast agent (Levovist(, Schering AG, Berlin,Germany). Real-time power Doppler ultrasonographic images were recorded on videotape and representative imageswere color-printed. Tumor vascularity was analyzed on real-time images with regard to its presence or absence, andchanges, and two observers reached a consensus. The results were compared with those of other diagnostic tests(three-phase helical CT, conventional angiography, percutaneous biopsy, and/or surgical pathology). RESULTS: Contrast-enhanced PDUS revealed intratumoral vascularity in ten of 14 tumors, none of which showed vascularity onunenhanced PDUS. In the remaining four tumors, both unenhanced and enhanced PDUS showed intratumoral tumorvascularity, which in all cases was more pronounced on enhanced than on unenhanced PDUS. Other diagnostic testsrevealed residual tumors in eleven lesions. CONCLUSION: Microbubble contrast-enhanced PDUS was more sensitivethan non-enhanced PDUS in depicting vascularity within a residual tumor and could be a useful method for thedetection of residual tumor in HCCs treated by TACE.
Angiography ; Biopsy ; Carcinoma, Hepatocellular* ; Consensus ; Follow-Up Studies ; Humans ; Injections, Intravenous ; Liver ; Microbubbles ; Neoplasm, Residual ; Tomography, Spiral Computed ; Ultrasonography, Doppler* ; Videotape Recording

PURPOSE: To assess the outcome of tunneled central venous catheter placement via the right internal jugular vein. MATERIALS AND METHODS: Between June 2001 and May 2002, 670 consecutive Hickman catheters were placed in 654 patients via the right internal jugular vein. The procedural complications arising and follow-up data obtained from May to July 2002 were evaluated. RESULTS: The technical success rate for catheter placement was 99.9% (669/670). Procedural complications were limited to eight cases (1.2%), including three pneumothoraces, one early migration of the catheter, one clinically unimportant air embolism, one catheter injury, one catheter kinking and one primary malpositioning in the azygos vein. Catheter dwelling time ranged from 1 to 407 (mean 107.1) days. During the follow-up period, 416 catheters were removed for various reasons: treatment had ended (n=334), patients declined treatment or their drug regimen was changed (n=16), late complications arose (n=53), or other circumstances intervened (n=13). Late complications included 44 cases of catheter-related infection (6.6%), five of catheter migration (0.7%), two of catheter occlusion (0.3%), one of thrombophlebitis (0.15%), and one of catheter-related right atrial thrombosis (0.15%). Only one instance of symptomatic venous thrombosis or stenosis was noted , namely the one case of thrombophlebitis. CONCLUSION: Because the incidence of subsequent symptomatic venous thrombosis or stenosis is lower, the preferred route for tunneled central venous catheter placement is the right internal jugular vein.
Azygos Vein ; Catheter-Related Infections ; Catheters* ; Central Venous Catheters ; Constriction, Pathologic ; Embolism, Air ; Follow-Up Studies ; Humans ; Incidence ; Jugular Veins* ; Thrombophlebitis ; Thrombosis ; Venous Thrombosis

A fracture of the skull occurred during the infancy and childhood ordinarily heals without difficulty. Rarely, however, such a fracture enlarges progressively to form a permanent cranial defect with pulsating mass. Patients usually have a history of head trauma and skull fracture and show pulsating soft mass with underlying bony defect. Pulsation of the brain is transmitted through the cysts to the inner table of the skull, and erosion of the bone ordinarily occurs in a localized area overlying the cysts. Enlargement of skull fractures has been reported at least 4 months after the accident. The existence of a dura defect in this syndrome has been amply verified by operative and autopsy observation, and appears to be a requisite for enlargement of the fracture. Ideal is early diagnosis and preventive treatment before it develops into a growing skull fractrue. Repeated simple radiology and color doppler sonography are very useful for evaluation of growing skull fracture. Also an early and aggressive operation is strongly recommended in young children. We experienced 4 cases of the growing skull fracture, which were reconstructed with cranioplasty and duraplasty. Clinical findings and management of the growing skull fracture are discussed, a review of the relevant literature is presented.
Autopsy ; Brain ; Child ; Craniocerebral Trauma ; Early Diagnosis ; Humans ; Skull Fractures* ; Skull*

We present two very interesting cases of acute graft-versus-host disease (GVHD), whose skin rashes initially appeared on the localized area of total nodal irradiation (TNI) performed previously to prevent graft rejection and/or GVHD. The histopathologic findings showed some dyskeratotic cells in the epidermis and perivascular mononuclear cell infiltration in the upper dermis. The immunohistochemical studies revealed that HLA-DR was diffusely strongly positive in a number of keratinocytes, whereas both CD4 and CD8 were focally weakly positive in the perivascular lymphocytes in the upper dermis. Later on, liver dysfunction and diarrhea developed and skin rashes began to spread over the other parts of the body in those two patients.
Dermis ; Diarrhea ; Epidermis ; Exanthema ; Graft Rejection ; Graft vs Host Disease* ; HLA-DR Antigens ; Humans ; Keratinocytes ; Liver Diseases ; Lymphocytes ; Skin*

BACKGROUND: To pass through the microcirculation, erythrocytes need to undergo considerable deformation. We performed an experiment to investigate the erythrocyte deformability in healthy adults and in patients with uncontrolled hypertension and controlled hypertension. METHODS: 5ml of whole blood is anticoagulated with 2mg ethylenediaminotetra-acetic acid(EDTA). 1ml graduated plastic syringe, without its plunger, is filled with anticoagulated whole blood to the 1ml mark, And the syringe is put into the assembled membrane holder. Under standard condition, whole blood is passed through a 5micro polycarbonate membrane filter under negative pressure of 20cm H2O. The studies are performed at roon temperature and within two hours of venipuncture. RESULTS: Erythrocyte deformability was observed in 91 normal healthy adults and 25 patients with uncontrolled hypertension and 18 patients with controlled hypertension. Following results were obtained. 1) In male control age group I, II, III, the erythrocyte deformability indices were 0.776+/-0.125, 0.792+/-0.189, and 0.714+/-0.172 respectively and in female the indices were 0.880+/-0.138, 0.865+/-0.182 and 0.796+/-0.170 accordingly. 2) THe RBC deformability indices in female control troup were significantly higher than the male group in statistics(p<0.05). 3) No significant differences were observed among each age group in control. 4) In patients with uncontrolled hypertension, each age group I, II and III, the erythrocyte deformability indices were 0.785+/-0.050, 0.775+/-0.122, and 0.692+/-0.133 respectively and in control group, the indices were 0.8365+/-0.140, 0.8252+/-0.186 and 0.7534+/-0.173 accordingly. And in patients with controlled hypertension, the indices were 0.820+/-0.00, 0.788+/-0.135 and 0.716+/-0.141 accordingly. 5) The erythrocyte deformability inddex in patients with uncontrolled hypertension were significantly lower than the control group(p<0.05), and no significant differences were observed among each age group between male and female in patients with uncontrolled hypertension. 6) There was no significant statistical difference of deformability indices between uncontrolled group and controlled group(p>0.05). CONCLUSION: This study reveals that the erythrocyte deformability in patients with essential hypertension is significantly lower than the healthy adults.
Adult ; Erythrocyte Deformability* ; Erythrocytes* ; Female ; Humans ; Hypertension* ; Male ; Membranes ; Microcirculation ; Phlebotomy ; Plastics ; Syringes