PURPOSE: To determine the value of magnetic resonance imaging(MR) and magnetic resonance angiography(MRA) inassessing collateral vessels of moyamoya disease. MATERIALS AND METHODS: Twenty-four patients with moyamoyadisease who underwent MR, 3D TOF MRA, and conventional angiography participated in this study. Two radiologistsworking independently and with no knowledge of the angiographic findings, interpreted the MR and MRA images. Todetermine the presence of parenchymal and leptomeningeal collaterals(48 hemispheres) and transdural collaterals(38hemispheres in 19 patients were depicted by angiography of the external carotid), the findings were compared withthose of angiography. RESULTS: Parenchymal, leptomeningeal, and transdural collaterals were depicted byconventional angiography in 34(71%), 32(67%), and 11(29%) hemispheres respectively. The sensitivity andspecificity of MR/MRA for collateral vessels were 79.1/ 88.1% for parenchymal collaterals, 72.1/ 88.1% forleptomeningeal collaterals, and 0.1/18.1% for transdural collaterals, respectively. Respective sensitivity andspecificity of MR/MRA were 88.94/94.1% for leptomeningeal collaterals, and 18.93/55.1% for transdural collaterals,when the prominent posterior cerebral and external carotid artery were regarded as secondary signs ofleptomeningeal and transdural collateral vessels. CONCLUSION: In moyamoya disease, MR and MRA are useful imagingmodalities for the assessment of collateral vessels. The prominent posterior cerebral artery and external carotidartery can be useful secondary signs of leptomeningeal and transdural collateral vessels.
Angiography* ; Carotid Artery, External ; Cerebral Angiography ; Humans ; Moyamoya Disease* ; Posterior Cerebral Artery

No abstract available.
Breast Neoplasms* ; Breast* ; Diagnosis*

OBJECTIVE: This study was performed to determine the anatomical landmarks and optimal dissection points of the facial nerve (FN) and the hypoglossal nerve (HGN) in the submandibular region to provide guidance for hypoglossal-facial nerve anastomosis (HFNA). METHODS: Twenty-nine specimens were obtained from 15 formalin-fixed adult cadavers. Distances were measured based on the mastoid process tip (MPT), common carotid artery bifurcation (CCAB), and the digastric muscle posterior belly (DMPB). RESULTS: The shortest distance from the MPT to the stylomastoid foramen was 14.1+/-2.9 mm. The distance from the MPT to the FN origin was 8.6+/-2.8 mm anteriorly and 5.9+/-2.8 mm superiorly. The distance from the CCAB to the crossing point of the HGN and the internal carotid artery was 18.5+/-6.7 mm, and that to the crossing point of the HGN and the external carotid artery was 15.1+/-5.7 mm. The distance from the CCAB to the HGN bifurcation was 26.6+/-7.5 mm. The distance from the digastric groove to the HGN, which was found under the DMPB, was about 35.8+/-5.7 mm. The distance from the digastric groove to the HGN, which was found under the DMPB, corresponded to about 65.5% of the whole length of the DMPB. CONCLUSION: This study provides useful information regarding the morphometric anatomy of the submandibular region, and the presented morphological data on the nerves and surrounding structures will aid in understanding the anatomical structures more accurately to prevent complications of HFNA.
Adult ; Cadaver ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Artery, Internal ; Facial Nerve ; Humans ; Hypoglossal Nerve ; Mastoid ; Muscles

PURPOSE: This study was conducted to improve the Korean influenza management system and to determine the status of influenza vaccination in some community health centers through a survey of the officers in charge of influenza vaccination. METHODS: The authors conducted a questionnaire survey by e-mail for the officers in charge of influenza vaccination of 8 community health centers in Daegu-si, 5 community health centers in Ulsan-si and 25 community health centers in Gyeongsangbuk-do. The authors developed a questionnaire including selection methods of the influenza vaccination objects, results of influenza vaccination in 2002, problems of influenza vaccination, the population within the respondents`jurisdiction and so on. RESULTS: The proportion of influenza vaccination at community health centers among all residents in the 2002-2003 influenza season was 3.8% in Daegu-si, 14.8% in Ulsan-si, 15.1% in urban Gyeongsangbuk-do and 24.9% in rural Gyeongsangbuk-do. The proportion of influenza vaccination at community health centers among priority cases for vaccination was 12.9% in Daegu-si, 43.1% in Ulsan-si, 39.3% in urban Gyeongsangbuk and 41.6% in rural Gyeongsangbuk-do. The officers in charge of influenza vaccination stated that the problems of influenza vaccination were deficiencies in preparatory examination such as manpower shortage. Twenty-five persons stated as a problem that influenza vaccinations conducted in the hospitals were hardly reported, and fifteen of these clarified that this was due to hospital indifference. CONCLUSIONS: The authors examined all community health centers of Daegu-si, Ulsan-si, and Gyeongsangbuk-do, and investigated the vaccination states and problems that health officers were dealing with. Therefore, this study is meaningful with its basic data for the management of domestic influenza vaccination.
Community Health Centers* ; Electronic Mail ; Gyeongsangbuk-do ; Humans ; Influenza, Human* ; Seasons ; Vaccination* ; Surveys and Questionnaires

PURPOSE: To access the usefulness of magnetic resonance(MR) in the evaluation of orbital blowout fracture. MATERIALS AND METHODS: Fourteen patients with orbital blow out fractures diagnosed by plain radiography(n = 8) or computed tomography(CT)(n = 6) were examined with MR. Twenty blowout fractures including six patients with two lesions were presented and the fracture site of the orbit was the medial wall in 11 cases and the orbital floor innine cases. MR images in nine cases of six patients could be compared with CT scans. On MR images, were trospectively evaluated the presence of fracture, herniation of orbital fat, abnormality of extraocular muscle, intraorbital hematoma and intrasinus hemorrhage. In nine cases we also compared these findings with CT scans. RESULTS: Eighteen orbital blowout fractures with fat herniation could be diagnosed on MR images. In only nine of these 18 cases, the fracture itself could be seen on MR images as a disruption of the orbital wall, which produce a signal void. But two blow out fractures without orbital fat herniation, seen on CT, were not detected on MRimages. Twenty abnormalities of extraocular muscle in 18 cases were depicted on MR images. There were nosignificant differences between MR and CT in the evaluation of orbital fat herniation and extraocular muscle abnormality ; however, in one case oblique sagittal MR images provided more useful information about the status ofthe inferior rectus muscle. Intraorbital hematoma was detected by MR in three patients. We were able to establish the presence of intraorbital hematoma by using the different signal intensities from fat or muscle on T1- and/or T2-weighted images. MR was found to be superior to CT in one case of intraorbital hematoma because of the iso-density of hematoma compared to muscle. MR also detected intrasinus hemorrhage which on T1-weighted images revealed high signal intensity in ten cases. MR was more valuable in demonstrating intrasinus hemorrhage in onecase where a CT scan showed only hypodense fluid. CONCLUSION: MR is a useful diagnostic modality in the evaluation of orbital blowout fracture with orbital fat herniation. Compared with CT, it also provides more valuable information about associated extraocular muscle abnormality, subacute hemorrhage in the orbit and paranasal sinus.
Hematoma ; Hemorrhage ; Humans ; Orbit* ; Tomography, X-Ray Computed

PURPOSE: To determine whether Ultravist(R) test can enable the surgeon to differentiate complete from partial small bowel obstruction in patients with adhesive small bowel obstruction and whether partial small bowel obstruction can be treated nonoperatively. METHODS: Ninety-two patients who had postoperative small bowel obstructions without any toxic signs underwent Ultravist(R) test. Ultravist(R) (40 ml) mixed with 40 ml of distilled water was administrated either orally or via nasogastric tube to each patient. Serial plain abdominal radiographs were taken 4, 6, and 8 hours later. RESULTS: A total of 58 patients (63%) whose contrast medium reached the colon within the first 8 hours were considered to have partial obstruction (test positive) and were successfully treated with intravenous hydration and nasogastric decompression. The remaining 34 patients (36.9%), in whom the contrast medium failed to reach the colon within the first 8 hours (test negative), were regarded as having complete obstruction. Twenty-three of those patients (67.6%) underwent surgery and the other 11 (32.4%) received conservative treatment. Adhesion bands with complete bowel obstruction were observed in all 23 surgical patients during laparotomy. All the patients with partial bowel obstruction were treated successfully with nonoperative methods. Positive Ultravist(R) test as an indicator for nonoperative treatment had a sensitivity of 84.5%, a specificity of 100%, an accuracy of 88% and a false negative rate of 12%. CONCLUSION: Ultravist(R) can be used to differentiate partial from complete intestinal obstruction. All patients with evidence of Ultravist(R) reaching the colon within 8 hours were treated successfully with non-operative methods.
Adhesives ; Colon ; Decompression ; Humans ; Intestinal Obstruction ; Laparotomy ; Sensitivity and Specificity ; Water

In this study we present a case of an angiocentric T-cell lymphoma (ACTL) which involve the esophagus. A 37-year-old male was admitted with dysphagia, odynophagia, and weight loss for 3 months. Two months before his admission, he had undergone on endoscopy with a biopsy. The first endoscopic findings revealed a large ulcerative lesion on the esophagus, although there had been no evidence of lymphoma upon microscopic examination. On the follow up endoscopic examination, this ulcerative lesion revealed progressive and destructive change. Histopathology of the third biopsied specimens showed large atypical lymphocyte infiltrates with angiocentric and angioinvasive features. Immunohistochemical studies revealed that the atypical (large) lymphocytes had T-cell phenotypes (CD3+, CD5+, and CD43+) and contained few reactive B-cells (CD20+), We assume that this is the first case of ACTL involving the esophagus and larynx.
Adult ; B-Lymphocytes ; Biopsy ; Deglutition Disorders ; Endoscopy ; Esophagus* ; Follow-Up Studies ; Humans ; Larynx ; Lymphocytes ; Lymphoma ; Lymphoma, T-Cell* ; Male ; Phenotype ; T-Lymphocytes* ; Ulcer ; Weight Loss

OBJECTIVES: Even though several epidemiological studies have observed positive associations between blood lead levels and homocysteine, no study has examined whether this association differs by the levels of micronutrients, such as folate, vitamin B6, and vitamin B12, which are involved in the metabolism of homocysteine. In this study, we examined the interactions between micronutrients and blood lead on homocysteine levels. METHODS: This study was performed with 4089 adults aged > or =20 years old in the US general population using the National Health and Nutrition Examination Survey 2003-2004. RESULTS: There were significant or marginally significant interactions between micronutrients and blood lead levels on mean homocysteine levels. Positive associations between blood lead and homocysteine were clearly observed among subjects with low levels of folate or low vitamin B6 (p-trend <0.01, respectively). However, in the case of vitamin B12, there was a stronger positive association between blood lead and homocysteine among subjects with high levels of vitamin B12, compared to those with low levels of vitamin B12. In fact, the levels of homocysteine were already high among subjects low in vitamin B12, irrespective of blood lead levels. When we used hyperhomocysteinemia (homocysteine>15 micromol/L) as the outcome, there were similar patterns of interaction, though p-values for each interaction failed to reach statistical significance. CONCLUSIONS: In the current study, the association between blood lead and homocysteine differed based on the levels of folate, vitamin B6, or vitamin B12 present in the blood. It may be important to keep sufficient levels of these micronutrients to prevent the possible harmful effects of lead exposure on homocysteine levels.
Adult ; Aged ; Female ; Folic Acid/blood ; Homocysteine/*blood ; Humans ; Lead/*blood ; Male ; Micronutrients/*blood ; Middle Aged ; Nutrition Surveys ; Odds Ratio ; United States ; Vitamin B 12/blood ; Vitamin B 6/blood

Backgroud/Aims: Endoscopic stent placement is widely used to treat an unresectable malignant gastric outlet obstruction. The covered stent has the disadvantage of an increased risk of migration, and the uncovered stent has an increased risk of ingrowth. This study examined the technical and clinical efficiency of stent placement of a double-layered combination pyloric stent that was newly designed to reduce tumor ingrowth and stent migration. METHODS: Fifteen patients with a gastric outlet obstruction caused by unresectable stomach cancer were treated with the endoscopic placement of a double-layered combination pyloric stent (an outer uncovered stent to reduce migration and an inner PTEF-covered stent to prevent tumor ingrowth). The technical success, clinical success, and complication especially tumor ingrowth and stent migration were analyzed. RESULTS: Technical success was achieved in 15 out of 15 (100%) patients. Among the 15 patients in whom endoscopic stenting was placed successfully, the clinical success rate was 93.3%, the incidence of tumor ingrowth was 0%, the rate of migration was 6.7%, and tumor overgrowth was observed in 13.3%. The median stent patency period was 105 days. CONCLUSIONS: The placement of a double- layered pyloric combination stent appears to be effective in overcoming the disadvantage of the increased migration observed for a covered stent and the increased ingrowth observed for the uncovered stent.
Gastric Outlet Obstruction* ; Humans ; Incidence ; Stents* ; Stomach Neoplasms* ; Stomach*

Scedosporium(S.) apiospermum has been isolated from polluted water, soil, sewage and potted plants in a hospital with low virulence. The localized skin infection due to S. apiospermum is rare and usually results from traumatic implantation of contaminated material due to a penetrating injury. We report a case of skin infection due to S. apiospermum in a 78-year-old female. She had multiple nodules, pustules and exudative ulcerative lesions at the right forearm. Cultured isolation for definitive diagnosis showed typical S. apiospermum. Treatment was started with itraconazole effectively, but skin lesions were recurred after 4 months, and then cured with voriconazole with no recurrence.
Aged ; Female ; Forearm ; Humans ; Itraconazole ; Pyrimidines ; Recurrence ; Scedosporium ; Sewage ; Skin ; Soil ; Triazoles ; Ulcer