PURPOSE: To find out the characteristic MR findings of reversible posterior leukoen-cephalopathy syndrome (RPLS) due to various causes in children. MATERIALS AND METHODS: Eight children with RPLS underwent MR imaging, and the findings were retrospectively analyzed. All eight were acutely hypertensive at the time of a neurotoxic episode. Three had intra-abdominal tumors (one adrenal pheochromo-cytoma, one para-aortic paraganglioma and one para-aortic ganglioneuroma encasing the left renal artery); three were being treated with cyclosporine; one was being treat-ed with steroid; and one had hemolytic uremic syndrome. Initial cranial MR images were analyzed with particular emphasis on the distribution of the lesions. To assess possible sequelae, follow-up MR images were obtained in seven patients at least one week after the treatment of hypertension. Four underwent proton MR spectroscopy. RESULTS: Characteristic distribution of lesions in the occipital and posterior parietal lobes was identified in all cases regardless of the causes of RPLS. The cerebellum, basal ganglia, anterior parietal, and frontal lobe were involved in four, two, one, and one case, respectively. Cortical gray matter involvement was predominant in six and subcortical white matter involvement predominated in two patients. The distribution of lesions was bilateral and asymmetric. Gyriform enhancement was identified in six cases, and small hemorrhage was noted in one. In seven patients, the clinical and MR findings improved without sequelae on follow-up study. In one, proton MR spectroscopy demonstrated a high lactate peak at the time of the neurologic event. Nearnormal spectra were noted in three children who underwent proton MR spectroscopy after recovery. CONCLUSION: The MR findings of RPLS are characteristic in that lesions are distributed in the posterior region of the brain and they are reversible on follow-up study. In children with RPLS due to unknown causes, the possibility of intra-abdominal tumors should also be considered.
Basal Ganglia ; Brain ; Cerebellum ; Child* ; Cyclosporine ; Follow-Up Studies ; Frontal Lobe ; Ganglioneuroma ; Hemolytic-Uremic Syndrome ; Hemorrhage ; Humans ; Hypertension ; Lactic Acid ; Magnetic Resonance Imaging* ; Magnetic Resonance Spectroscopy ; Paraganglioma ; Parietal Lobe ; Posterior Leukoencephalopathy Syndrome* ; Protons ; Rabeprazole ; Retrospective Studies

Arrhythmogenic right ventricular dysplasia is a rare heart muscle disorder of unknown cause that primarily involves the right ventricle. It is characterized pathologically by fibrofatty replacement of the right ventricular myocardium. Clinical manifestations include structural and functional abnormalities of the right ventricle, electrocardiographic depolarization/repolarization changes, and presentation with sudden death or ventricular arrhythmias of right ventricular origin. It is one of the important causes of the ventricular arrhythmia or sudden death among apparently healthy young people. We report a case of arrhythmogenic right ventricular dysplasia with the review of the literature.
Arrhythmias, Cardiac ; Arrhythmogenic Right Ventricular Dysplasia* ; Death, Sudden ; Electrocardiography ; Heart Ventricles ; Myocardium

The coronary artery cross sectional area (CSA) is proportional to LV mass. We have measured the cross sectional area of the left and right coronary arteries in patients with ischemic heart disease to see whether it is related to the change in the LV mass. The following results were obtained ; 1) There were no significant difference in mean CSA of coronary arteries and LV mass determined by echocardiography and cineangiography between control and ischemic heart disease. 2) There were significantly increased ratio of left ventricular mass by cineangiogram to CSA of left anterior descending coronary artery in patients with myocardial infarction as compared with control group. 3) A linear relation between LV mass by cineangiogram and CSA of left coronary artery was noted in control group (r=0.53, P<0.05) and ischemic heart disease group (r=0.51, P<0.05). 4) A linear relation between LV mass determined by echocardiography and CSA of left coronary artery was noted in control group (r=0.55, P<0.05).
Cineangiography ; Coronary Vessels* ; Echocardiography ; Humans ; Myocardial Infarction ; Myocardial Ischemia

PURPOSE: Brain damage resulting from a combination of hypoxia and ischemia in the newborn infant remains a major cause of perinatal death, cerebral palsy, mental retardation and epilepsy. Metabolic stress, including ischemia, hypoxia and seizures, induces the expression of a variety of stress proteins including nuclear proto-oncogene c-fos. The induction of c-fos can be considered a biomarker of events resulting from ischemia-hypoxia. However, it has been suggested that the mechanism for c-fos activation in the fetal brain is not mature prior to postnatal day 13-21. This study was undertaken to determine the induction of c-fos in neonatal rat brain by hypoxia-ischemia and the regions of brain most vulnerable to hypoxia-ischemia. MEHTODS: Ten-day-old postnatal rat pups, subjected to unilateral carotid artery dissection combined with 2-hour hypoxia, were killed at 2 hours and 6 hours after hypoxia-ischemia, and their brains were examined by immunohistochemistry. RESULTS: Hypoxia-ischemia induced prominent expression of c-fos in the cingulate cortex and hippocampus in the postnatal rats 2 hours after the insult. CONCLUSION: Hypoxia-ischemia results in increased c-fos expression in 10-day-old rat pups. The results of this experiment also demonstrate that the neonatal rat hippocampus and cortex are the most sensitive brain regions to the induction of c-fos following hypoxia-ischemia.
Animals ; Anoxia ; Brain* ; Carotid Arteries ; Cerebral Palsy ; Epilepsy ; Gyrus Cinguli ; Heat-Shock Proteins ; Hippocampus ; Humans ; Immunohistochemistry ; Infant, Newborn ; Intellectual Disability ; Ischemia ; Proto-Oncogenes ; Rats* ; Seizures ; Stress, Physiological

PURPOSE: Brain damage resulting from a combination of hypoxia and ischemia in the newborn infant remains a major cause of perinatal death, cerebral palsy, mental retardation and epilepsy. Metabolic stress, including ischemia, hypoxia and seizures, induces the expression of a variety of stress proteins including nuclear proto-oncogene c-fos. The induction of c-fos can be considered a biomarker of events resulting from ischemia-hypoxia. However, it has been suggested that the mechanism for c-fos activation in the fetal brain is not mature prior to postnatal day 13-21. This study was undertaken to determine the induction of c-fos in neonatal rat brain by hypoxia-ischemia and the regions of brain most vulnerable to hypoxia-ischemia. MEHTODS: Ten-day-old postnatal rat pups, subjected to unilateral carotid artery dissection combined with 2-hour hypoxia, were killed at 2 hours and 6 hours after hypoxia-ischemia, and their brains were examined by immunohistochemistry. RESULTS: Hypoxia-ischemia induced prominent expression of c-fos in the cingulate cortex and hippocampus in the postnatal rats 2 hours after the insult. CONCLUSION: Hypoxia-ischemia results in increased c-fos expression in 10-day-old rat pups. The results of this experiment also demonstrate that the neonatal rat hippocampus and cortex are the most sensitive brain regions to the induction of c-fos following hypoxia-ischemia.
Animals ; Anoxia ; Brain* ; Carotid Arteries ; Cerebral Palsy ; Epilepsy ; Gyrus Cinguli ; Heat-Shock Proteins ; Hippocampus ; Humans ; Immunohistochemistry ; Infant, Newborn ; Intellectual Disability ; Ischemia ; Proto-Oncogenes ; Rats* ; Seizures ; Stress, Physiological

clinical and radiologic findings that mainly involve the white/gray matter of the parieto-occipital lobes. The purpose of this study was to determine its clinical and radiological characteristics. METHODS: A total of 15 pateints were involved in the study. Their medical records and radiological features of brain MRI were retrospectively reviewed and analyzed. RESULTS: Fifteen pateints were involved. (9 males and 5 females). The patients' ages ranged from 2-20 years (mean age:10 years). The brain MRI revealed fairly symmetric areas of increased T2 signal involving both white and gray matter of parieto-occipital regions. The condition seemed to be associated with cyclosporin A and steroid therapy or a variety of other conditions in which blood pressure rises acutely. CONCLUSION: Reversible posterior leukoencephalopathy syndrome is a complicated neurological condition, but a better understanding of this complex syndrome may obviate unnecessary investigations and lead to prompt and appropriate management of the associated problems.
Blood Pressure ; Brain ; Child* ; Cyclosporine ; Humans ; Leukoencephalopathies ; Magnetic Resonance Imaging ; Male ; Medical Records ; Posterior Leukoencephalopathy Syndrome* ; Retrospective Studies ; Seizures

PURPOSE: We retrospectively reviewed the cases of ureteroscopic stone removal at our institution to define the efficiency of ureteroscopy for treatment of ureteral calculi. MATERIALS AND METHODS: Ureteroscopic stone removal was performed in 376 cases of ureteral stone from August, 1989 to December, 1997. There are 241 males and 135 females, and mean age was 45.6 years. Nine stones were located in the upper ureter, 27 in the mid ureter, 340 in the lower ureter. The stone size was less than 5mm in 125 cases, from 5 to 10mm in 185 cases and more than 10mm in 66 cases. Ureteroscopy was performed with 9.5Fr, 10Fr or 12.5Fr rigid ureteroscope under spinal, general or epidural anesthesia. RESULTS: Overall success rate of ureteroscopic stone removal was 95.1 percent. The success rates of upper, mid and lower ureteral stones were 55.6, 88.9 and 97.1 percents, respectively. According to the stone size, the success rates was 97.6 percent in stones less than 5mm, 94.6 percent in stones of 5 to 10mm and 92.4 percent in stones more than 10mm. Over all complication rate was 9.6 percent. Complications consisted of severe ureteral mucosal tearing(20 cases), ureteral perforation(8 cases), gross hematuria(3 cases), infection(3 cases) and urethral stricture(2 cases). All complications were treated successfully with conservative treatment except 2 cases of urethral stricture that required visual urethrotomies. CONCLUSIONS: Ureteroscopic stone removal could offer rapid relief of obstruction and colic due to mid and lower ureteral calculi with high success rate and minimal complications.
Anesthesia, Epidural ; Calculi ; Colic ; Female ; Humans ; Lithotripsy ; Male ; Retrospective Studies ; Ureter ; Ureteral Calculi ; Ureteroscopes ; Ureteroscopy ; Urethral Stricture

BACKGROUND: Apoptosis, as opposed to necrosis, is a active and regulated mode of cell death. Persistent myocardial ischemia results in necrosis. The most effective method to limit ischemic myocardial injury is reperfusion, however, reperfusion itself may be associated with tissue injury. The pathophysiologic findings of myocardial ischemia-reperfusion are well known. However, involvement of apoptosis, as a form of tissue damage, has not neen well defined. Recently apoptosis has been suggested as a specific feature of myocardial reperfusion injury leading to late cell death. This study was performed to investigate whether reperfusion induces apoptosis irrespective of reperfusion time, and the pattern of distribution and the extent of apoptosis in rabbit myocardium. METHOD: New Zealand white rabbits weighing 1.8-2.9kg underwent 20 or 30 minutes left anterior descending(LAD) or left circumflex coronary artery occlusion followed by reperfusion for 30 minutes(n=1), 1 hour(n=1), 3 hours (n=2), and 4 hours (n=3). Ventricles were excised immediately after intervention. Tissues were fixed in 10% buffered formalin and embedded in paraffin. Apoptosis was examined by hematoxylin and eoisin(H & E) staining, in situ nick end labeling, and transmission electron microscopy. Number of apoptotic cells was evaluated semiquantitatively on H & E stained section. Myocardial tissues of ischemia only(LAD occlusion for 30 minutes, n=2) and normal rabbits(n=2) were also examined. RESULTS: Evidence of apoptosis was detected in every ischemia-reperfused myocardium irrespective of reperfusion time of 30 minutes to 4 hours. Apoptotic cells were found in the non-necrotic myocardium near necrotic areas and in islets of the non-necrotic myocarium inside necrotic areas. In the areas where apoptotic cells were distributed, the average number of apoptotic cells ranged from 1.0(30 minutes and 1 hour reperfused myocardium) to 1.1(3 hours and 4 hours reperfused myocardium) per high power field(X400)(the proportion ; less than 1% of cardiomyocytes at specific time point of reperfusion). Apoptotic cells were not detected in ischemia only and normal myocardium. CONCLUSION: These fingings suggest that apoptosis is involved as a form of cell death and it may contribute to cardiomyocyte loss not to a large extent in ischemia-reperfusion injury of rabbit myocardium.
Apoptosis* ; Cell Death ; Coronary Vessels ; Formaldehyde ; Hematoxylin ; In Situ Nick-End Labeling ; Ischemia ; Microscopy, Electron, Transmission ; Myocardial Ischemia ; Myocardial Reperfusion Injury ; Myocardium* ; Myocytes, Cardiac ; Necrosis ; Paraffin ; Rabbits ; Reperfusion ; Reperfusion Injury

PURPOSE: The purpose of this study is to compare the two prosthesis that used for total ankle arthroplasty. MATERIALS AND METHODS: From Sept. 2003 to Jun 2006, 13 patients and 14 ankles that could be follow up more than 1 months. Semiconstrained type (Group I, 7 cases) and Unconstrained type (Group II, 7 cases) were used for total ankle arthroplasty. Mean age was 63.2 year-old, 12 ankles are men and 2 ankles were women. Mean follow up periods were 29 months. The criteria to compare the clinical result were postoperative range of motion, AOFAS score and residual bone stock of medial malleolus. RESULTS: Postoperative range of motion of group I was 43.6+/-9.4 degrees and of group II was 50.7+/-7.3 degrees (p=0.115). Postoperative AOFAS score of group I was 77.1+/-13.0 points and of group II was 86.0+/-5.7 points (p=0.094). Resected bone stock in medial malleolus of group I was 10.7+/-2.5 mm and of group II was 5.1+/-1.2 mm (p=0.003). Total number of complication in our study was 9 cases. 3 cases were a malleolar fracture, two occurred at intra-operation, the other at follow-up period. Re-operation was done in 6 cases, 3 cases were calcaneal corrective osteotomy, 2 cases were resection of a heterotopic bone and one case was pedicular flap operation for skin problem. CONCLUSION: In our hospital, mobile bearing type prosthesis shows good result than a semiconstrained type in respect of residual bone stock in medial malleolus. Postoperative range of motion and AOFAS score between two groups shows no significant difference. But small number of patients and short term follow up period is a defect in our study, afterward more population and long term follow up period are needed.
Ankle* ; Arthroplasty* ; Female ; Follow-Up Studies* ; Humans ; Male ; Mobile Health Units ; Osteotomy ; Prostheses and Implants ; Range of Motion, Articular ; Skin

BACKGROUND: Methotrexate (MTX) is an antifolate antagonist that is widely used for treating various malignancies and non-malignant diseases. MTX levels should be monitored when used in high concentration to determine when to start leucovorin rescue. In this study, we evaluated the analytical performance of the EMIT Methotrexate Assay on a 200FR NEO Chemistry Analyzer (Toshiba Medical System Co., Japan) and compared it with Viva-E Drug Testing System (Siemens Healthcare, Germany). METHODS: According to the Clinical Laboratory and Standards Institute (CLSI) Evaluation Protocol (EP) 5-A2, three concentrations of the Liquichek Therapeutic Drug Monitoring Control (Bio-Rad Laboratories, USA) were analyzed twice a day for 20 days to monitor assay precision. The 200FR NEO and Viva-E instruments were compared using 40 patients' sera, according to CLSI EP9-A2. The linearity and carry-over rate were also evaluated. RESULTS: Between-run CVs for low-, medium-, and high-level controls were 4.9%, 0.9%, and 2.0%, respectively, whereas between-day CVs for low-, medium-, and high-level controls were 8.1%, 1.3%, and 3.5%, respectively. In the linearity test, the coefficient of determination (R2) was 0.98 (0.06-1.92 micromol/L). In the comparison study, R2 was 0.955, showing good correlation between the 200FR NEO and Viva-E instruments. The carry-over rate was 0.9%. CONCLUSIONS: The EMIT assay showed good precision, linearity, and carry-over rate on the Toshiba 200FR. An excellent correlation was observed when comparing results obtained using the Toshiba and Viva-E instruments. In conclusion, the Syva EMIT MTX assay can be readily used for MTX monitoring on the Toshiba 200FR NEO.
Chemistry ; Delivery of Health Care ; Drug Monitoring ; Leucovorin ; Methotrexate*