PURPOSE: The purpose of this study is to illustrate MR patterns of bone marrow of calvarium and vertebral body in normal subjects according the age distribution and to understand the course of the fatty replacement from red marrow. METHODS AND MATERIAL: We retrospectively evaluated MR examinations of the calvaria(n=71), cervical spine(n=71), thoracic spine(n=65), Imbar spine(n =68) in subjects without bone marrow abnormality whose age ranged 3 weeks to 74 years. Three distinctive patterns were categorized on Tl-weighted images of the skull. In pattern 1, uniformly low signal intensity with or without very small areas of high intensity in frontal and occipital bones is noted. In pattern 2, frontal and occipital bones have uniformly high signal intensity, and patchy area of high intensity appears in parietal bone. In pattern 3, the entire skull has uniformly high signal intensity. In the spine, four patterns were categorized on Tl-weighted MR images. In pattern 1, the vertebral body has uniformly low signal intensity except for linear areas of high intensity superior and inferior to basivertebral vein. In pattern 2, bandlike and triangular areas of high signal intensity are found in the periphery. Pattern 3 and 4 have diffusely distributed areas of high signal intensity; pattern 3 consist of numerous indistinct dots measuring a few millimeter or less, and pattern 4 consist of fairly well marginated areas ranging in size from 5 to 1.5cm. RESULT:In the calvaria, 73% of pattern 1 were younger than 20 years, pattern 2 were evenly distributed, and 86% of pattern 3 were older than 40 years. In the spine, 87% of pattern 1 were younger than 40 years, 72% of pattern 3 were in 40 to 50 years, and 87% of pattern 4 were older than 50 years. Pattern 2 were evenly distributed in the cervical and thoracic spine, but in the thoracic spine 62% were younger than 30 years. CONCLUSION:It is concluded that younger age group shows mainly pattern 1, whereas elderly group has pattern 3 or 4 in the calvarial and vertebral body marrow. This suggests that conversion to fatty marrow begin locally and progress diffusely with age.
Age Distribution* ; Aged ; Bone Marrow* ; Humans ; Occipital Bone ; Parietal Bone ; Retrospective Studies ; Skull* ; Spine ; Veins

Gallbladder carcinoma is the most common primary hepatobiliary carcinoma and the fifth most common malignancy of the GI tract. The most common type of gallbladder carcinoma is adenocarcinoma. Squamous cell carcinoma of the gallbladder is rarer and is responsible for up to 12.7% of gallbladder tumors. A 78-year-old man was incidentally suspected of having a gallbladder mass on an abdominal CT scan and underwent laparoscopic cholecystectomy. Pathology results confirmed the mass as a squamous cell carcinoma. Here we report a case of keratinizing squamous cell carcinoma of the gallbladder and review the literature.
Adenocarcinoma ; Aged ; Carcinoma, Squamous Cell ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Gallbladder ; Gastrointestinal Tract ; Humans ; Keratins

Diagnosing pseudoaneurysms of the popliteal artery is usually straightforward in physical examinations and imaging findings. However, when a pseudoaneurysm shows a soft tissue mass with adjacent osseous change, it can mimic a bone tumor or a soft tissue sarcoma. We present a case of a 65-year-old man who had a pseudoaneurysm of the popliteal artery showing soft tissue mass and insinuating into the intramedullary cavity of the tibia. This presented case emphasizes the importance of considering pseudoaneurysms in the differential diagnosis of an apparent soft tissue mass with pressure erosion in adjacent bone.
Aged ; Aneurysm, False ; Diagnosis, Differential ; Humans ; Hydrazines ; Physical Examination ; Popliteal Artery ; Sarcoma ; Tibia

OBJECTIVE: Ovarian failure is often common complication by the conditioning protocol used for bone marrow transplantation (BMT). To determine the frequency of recovery of ovarian function after allo-BMT and the major factor that predict recovery, we monitored ovarian function in 24 premenopausal women METHOD: Twenty-four women met the inclusion criteria, which were (1) moderate to severe aplastic anemia before BMT, (2) disease-free at least 18 month after transplantation, (3) age younger than 40 years and more than 3 years after menarche at transplantation and (4) regular menstrual periods before transplantation. Recovery of ovarian function was determined by regular menses without menopausal symptom and sign. we divided conditioning regimen to two groups, Group I : cytoxan alone(n=17), Group II : cytoxan plus total body irradiation (TBI)(n=7). RESULTS: All women became amenorrhea after BMT and the clinical characteristics were not significant between two groups. 17 patients who received only cytoxan all recovered ovarian function between 1 to 14 months(median : 7.28) after BMT. The median age at BMT of women with regained ovarian function was 26 years (range, 21 to 33) versus 30 (range, 21 to 37) for those who did not. The age at transplantation was not significant between two groups in our study and the most predictive independent factor in ovarian recovery is the presence of total body irradiation. None of women who received TBI regained ovarian function during 19-49 month follow up. CONCLUSION: Gonadal insufficiency due to pre-BMT conditioning is more severe in radiation based regimen than cytoxan alone. therefore, we recommend early hormone replacement therapy in radiation treated women to prevent the complication of premature menopause.
Amenorrhea ; Anemia, Aplastic* ; Bone Marrow Transplantation* ; Bone Marrow* ; Cyclophosphamide ; Female ; Follow-Up Studies ; Gonads ; Hormone Replacement Therapy ; Humans ; Menarche ; Menopause, Premature ; Whole-Body Irradiation

PURPOSE: Isosulfan blue has been traditionally used as a tracer to map the lymphatic system during identification of the sentinel lymph node (SLN). However, this vital dye is difficult to obtain in Korea. Radioisotopes such as technetiumlabeled sulfur colloid or albumin colloid are also expensive and complex to use. The purpose of this study is to evaluate usefulness of a sentinel lymph node biopsy (SLNB) using methylene blue dye in breast cancer patients. METHODS: We evaluated the sentinel node mapping experience using methylene blue dye from July 2003 to January 2007. Fifty-eight patients with clinical T1-T2 breast cancer without palpable axillary lymph nodes were enrolled. All SLNs were submitted for intraoperative frozen section and hematoxyline and eosin (H & E) stain analysis. For the negative SLNs, serial sections of each SLN specimen were examined by permanent H & E staining and by immunohistochemical techniques (IHC) using cytokeratin. Regardless of the results of a frozen section for the SLNs, a backup level II or III axillary lymph node dissections (ALND) was performed. RESULTS: Of the 58 patients that underwent a SLNB using methylene blue dye, an SLN was identified in 56 patients (96.6%), and metastatic SLNs were detected in 14 cases. Axillary lymph node metastasis found in 18 out of 58 patients. Thus, the false negative rate for a SLNB was 22.2% (4/18). Two patients had a micrometastasis (pN1mi) and two patients had clusters of isolated tumor cells (pN0[i+]) that were identified in the SLNs by IHC with the additional use of cytoketatin. The sensitivity, specificity, and accuracy of the SLNBs were 77.8%, 100%, and 92.9%, respectively. The false negative rate improved with the accumulation of experience for performing a SLNB (12.5% vs 30.0%). The sensitivity, specificity, positive predictive value, and accuracy of preoperative ultrasonography (USG) for an axillary lymph node metastsis were 50.0%, 95.5%, 81.8% and 81.0% respectively. CONCLUSION: Based on our initial experience, methylene blue dye is safe, inexpensive, and a readily available tracer for the SLN mapping, and it could be an effective alternative to the use of isosulfan blue dye for accurately identifying SLNs in early breast caner patients. We expected that the findings of preoperative USG could serve as useful adjuncts to a SLNB.
Biopsy* ; Breast Neoplasms* ; Breast* ; Colloids ; Eosine Yellowish-(YS) ; Frozen Sections ; Hematoxylin ; Humans ; Keratins ; Korea ; Lymph Node Excision ; Lymph Nodes* ; Lymphatic System ; Methylene Blue* ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Radioisotopes ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy ; Sulfur ; Ultrasonography

BACKGROUND/OBJECTIVES: Vascular dementia (VaD) caused by reduced blood supply to the brain manifests as white matter lesions accompanying demyelination and glial activation. We previously showed that arabinoxylan consisting of arabinose and xylose, and arabinose itself attenuated white matter injury in a rat model of VaD. Here, we investigated whether larch arabinogalactan (LAG) consisting of arabinose and galactose could also reduce white matter injury. MATERIALS/METHODS: We used a rat model of bilateral common carotid artery occlusion (BCCAO), in which the bilateral common carotid arteries were exposed and ligated permanently with silk sutures. The rats were fed a modified AIN-93G diet supplemented with LAG (100 mg/kg/day) for 5 days before and 4 weeks after being subjected to BCCAO. Four weeks after BCCAO, the pupillary light reflex (PLR) was measured to assess functional consequences of injury in the corpus callosum (cc). Additionally, Luxol fast blue staining and immunohistochemical staining were conducted to assess white matter injury, and astrocytic and microglial activation, respectively. RESULTS: We showed that white matter injury in the the cc and optic tract (opt) was attenuated in rats fed diet supplemented with LAG. Functional consequences of injury reduction in the opt manifested as improved PLR. Overall, these findings indicate that LAG intake protects against white matter injury through inhibition of glial activation. CONCLUSIONS: The results of this study support our hypothesis that cell wall polysaccharides consisting of arabinose are effective at protecting white matter injury, regardless of their origin. Moreover, LAG has the potential for development as a functional food to prevent vascular dementia.
Animals ; Anoxia ; Arabinose ; Brain* ; Carotid Arteries ; Carotid Artery, Common ; Cell Wall ; Corpus Callosum ; Dementia, Vascular* ; Demyelinating Diseases ; Diet ; Functional Food ; Galactose ; Larix* ; Models, Animal* ; Optic Tract ; Polysaccharides ; Rats* ; Reflex ; Silk ; Sutures ; White Matter ; Xylose

PURPOSE: The clinical value of macrocalcifications as an indicator that predicts malignancy of thyroid nodules is controversial. The purpose of this study was to investigate additional ultrasonographic findings accompanying macrocalcifications for predicting malignancies in thyroid nodules. METHODS: Between January 2005 and April 2008, 315 patients who had thyroid nodules with FNAB resulting in suspicious malignancies underwent thyroidectomy at the Wallace Memorial Baptist Hospital. Three hundred fifteen nodules, which were confirmed to be papillary thyroid carcinoma, and 192 nodules, which were confirmed to be benign, were reviewed retrospectively. We analyzed the malignancy rates according to calcification patterns and US findings of the associated solid nodules. RESULTS: Among the 165 papillary thyroid carcinomas with microcalcifications, 161 accompanied solid nodules, and 4 were found with microcalcifications, but without solid nodules. Of the 161 papillary thyroid carcinomas with microcalcifications and solid nodules, 85.7% showed signs suggestive of malignancy. The remaining 14.3%, where only microcalcifications were present, showed indications of predicting malignancy. When solid nodules were found with macrocalcifications, there were indicators of predicting malignancy (100%). Also, for situations in which benign nodules were accompanied by solid nodules, 29% had signs of predicting malignancy. For situations in which benign nodules did not accompany solid nodules, 21% showed suspicious signs of predicting malignancy, but were all confirmed as benign. CONCLUSION: CFor nodules that accompany microcalcifications, there can be indicators that predict malignant conditions separate from other opinions that accompany microcalcifications. However, for macrocalcifications, it would be more effective to set up future treatment plans based on ultrasonographic features of solid nodules accompanying calcifications rather than the calcification itself.
Humans ; Protestantism ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Thyroidectomy ; Ultrasonography

PURPOSE: To evaluate the treatment outcomes of the three-dimensional conformal radiotherapy (3D-CRT), in conjunction with induction chemotherapy, for the treatment of stage III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Between November 1998 and March 2003, 22 patients with histologically proven, clinical stage III NSCLC, treated with induction chemotherapy, followed by 3D-CRT, were retrospectively analyzed. There were 21 males (96%) and 1 female (4%), with a median age of 68.5 (range, 42~79). The clinical cancer stages were IIIA and IIIB in 41 and 59%, respectively. The histologies were squamous cell carcinoma, adenocarcinoma and others in 73, 18 and 9%, respectively. Twenty patients (91%) received induction chemotherapy before radiation therapy. The majority of the chemotherapy regimen consisted of cisplatin and gemcitabine. Radiation was delivered with conventional anteroposterior/ posteroanterior fields for 36 Gy, and then 3D-CRT was performed. The total radiation dose was 70.2 Gy. The median follow-up period was 17 months (range, 4~59 months). RESULTS: The median overall survival was 19 months. The two and four-year overall survival rates were 37.9 and 30.3%, respectively. The median progression-free survival was 21 months. The two and four-year progression-free survival rates were 42.1 and 21%, respectively. The prognostic factors for overall survival by a univariate analysis were age, histology and T stage (p<0.05). Acute radiation toxicities, as evaluated by the RTOG toxicity criteria, included two cases of grade 3 lung toxicity and one case of grade 2 esophagus toxicity. CONCLUSIONS: The radiation dose could be increased without a significant increment in the acute toxicities when using 3D-CRT. It also seems to be a safe, well- tolerated and effective treatment modality for stage III NSCLC.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Cisplatin ; Disease-Free Survival ; Drug Therapy ; Esophagus ; Female ; Follow-Up Studies ; Humans ; Induction Chemotherapy ; Lung ; Male ; Radiotherapy, Conformal* ; Retrospective Studies ; Survival Rate

BACKGROUND: Osteoporosis after menopause is known as a disease that needs preventive measures before medical treatment. Many patients, however, do not undergo hormone therapy to prevent it. This paper investigates some obstacles to hormone replacement therapy (HRT). METHOD: A total of 85 menopausal women who under went bone-mineralodensitometry (BMD) examination at Chuncheon Sungshim Hospital Health Care Clinic from May, 1995 to April, 1997 were the subjects of our study. We interviewed them by telephone, examined their medical records including their BMD results. We also examined what the obstacles were for them to receive HRT for osteoporosis. RESULTS: The average age of the subjects was 55.8years. Only 40 women (47%) replied that they knew beforehand the purpose of the BMD examination. The rest of the subjects replied that they simply went through the examination because it was inclusive to health items. Those who had heard of HRT for osteoporosis were only 43 people because(50.1%), and those who did not currently receive HRT amounted to 32 (74.4%). The reasons why they do not undergo the therapy were fear of cancer, no symptoms related to osteoporosis, financial difficulty, and weight gain. Among the 32 subjects, only 1 person replied that she would not receive the HRT even if the above obstacles were removed. Therefore, it seems that most of our subjects would receive HRT if such obstacles removed. Those who were currently receiving HRT were 11 people(12.9%). According to the open questionnaire, many of them replied that they do not feel any inconvenience while receiving the HRT, but some of them complained of epigastric pain, dysmenorrhea, or mastalgia. They replied that after the HRT they felt no arthralgia and felt far better in body and mind than before treatment. All the 11 people replied that they will continue to receive the HRT. CONCLUSION: The main reason why so few people received HRT for osteoporosis proved to be the lack of knowledge of the therapy. Even those who had heard of HRT complained about the negative aspects, which in fact can be overcome, and as a result a considerable number of them do not receive HRT. Therefore we conclude that in order to increase the number of patients who will undergo HRT for osteoporosis after menopause we need to strengthen education about the merits of this therapy rather than just performing BMD examination.
Arthralgia ; Delivery of Health Care ; Dysmenorrhea ; Education ; Female ; Gangwon-do ; Hormone Replacement Therapy* ; Humans ; Mastodynia ; Medical Records ; Menopause ; Osteoporosis ; Osteoporosis, Postmenopausal* ; Telephone ; Weight Gain ; Surveys and Questionnaires

BACKGROUND/OBJECTIVE: Myocardial cell death due to occlusion of the coronary arteries leads to myocardial infarction, a subset of coronary heart disease (CHD). Dietary fiber is known to be associated with a reduced risk of CHD, the underlying mechanisms of which were suggested to delay the onset of occlusion by ameliorating risk factors. In this study, we tested a hypothesis that a beneficial role of dietary fiber could arise from protection of myocardial cells against ischemic injury, manifested after occlusion of the arteries. MATERIALS/METHODS: Three days after rats were fed apple pectin (AP) (with 10, 40, 100, and 400 mg/kg/day), myocardial ischemic injury was induced by 30 min-ligation of the left anterior descending coronary artery, followed by 3 hr-reperfusion. The area at risk and infarct area were evaluated using Evans blue dye and 2,3,5-triphenyltetrazolium chloride (TTC) staining, respectively. DNA nicks reflecting the extent of myocardial apoptosis were assessed by TUNEL assay. Levels of cleaved caspase-3, Bcl-2, and Bax were assessed by immunohistochemistry. RESULTS: Supplementation of AP (with 100 and 400 mg/kg/day) resulted in significantly attenuated infarct size (IS) (ratio of infarct area to area at risk) by 21.9 and 22.4%, respectively, in the AP-treated group, compared with that in the control group. This attenuation in IS showed correlation with improvement in biomarkers involved in the apoptotic cascades: reduction of apoptotic cells, inhibition of conversion of procaspase-3 to caspase-3, and increase of Bcl-2/Bax ratio, a determinant of cell fate. CONCLUSIONS: The findings indicate that supplementation of AP results in amelioration of myocardial infarction by inhibition of apoptosis. Thus, the current study suggests that intake of dietary fiber reduces the risk of CHD, not only by blocking steps leading to occlusion, but also by protecting against ischemic injury caused by occlusion of the arteries.
Animals ; Apoptosis* ; Arteries ; Biomarkers ; Caspase 3 ; Cell Death ; Coronary Disease ; Coronary Vessels ; Dietary Fiber* ; DNA Breaks, Single-Stranded ; Evans Blue ; Immunohistochemistry ; In Situ Nick-End Labeling ; Ischemia ; Models, Animal* ; Myocardial Infarction ; Rats ; Risk Factors