Dysembryoplastic neuroepithelial tumor(DNET) is a recently described rare tumor that occurs most frequently in the temporal lobe of the brain and is characterized by long-standing, intractable complex partial seizures in children. The authors experienced one case of DNET occurring in a 13-year old boy, who had refractory complex partial seizure for 7 years. CT scan revealed nonenhancing low density mass in the left temporal lobe. MR images demonstrated a well-marginated cortical mass with very low signal intensity on TIWI and multinodular appearance of high signal intensity on T2WI. A few small enhancing foci within the mass were noted on contrast enhanced MR images. DNET, a rare tumor, should be considered in the differential diagnosis of neoplasm which causes seizure and is distinguished from other tumors because of its benign course. Differentiation between DN ETand other tumors by CT and MR findings is very difficult. But, our case showed the multinodular pattern on T2W image, which may be helpful feature in the differential diagnosis.
Adolescent ; Brain ; Child ; Diagnosis, Differential ; Humans ; Male ; Neoplasms, Neuroepithelial* ; Seizures ; Temporal Lobe ; Tomography, X-Ray Computed

BACKGROUND: Conventional visual assessment of coronary arteriogram is fraught with large interobserver variance and disagreement with pathologic findings. Thus quantitative coronary angiography had been recently developed to meet the requirement of more reproducible measurement of severity of coronary artery disease. This study was designed to evaluate the interobserver variability of quantitative coronary angiography and its usefulness in clinical application. METHODS: Three independent observers analysed coronary angiogram of 31 consecutive patients by visual assessment and quantitative measurement using computer based algorithm. RESULTS: 1) There was considerable disagreement between 3 observers in the identification of significant coronary stenosis. Complete agreement was achieved in only 29/61 (47%) coronary lesion and agreement of more than 2 observers in 41/61(67%) lesion. 2) In visual assessment, the largest interobserver variance was found in acute marginal artery and distal circumflex artery, whereas the least variance was observed in proximal right coronary artery. 3) The average interobserver variance was 13.1% in visual assessment, 14.9% in geometric analysis, and 10.5% in video densitometric analysis. There was no significant difference between these values. 4) Visual assessment was noted to overestimate the severity of stenotic lesion, by 5.6% compared to geometric analysis and by 11.8% compared to video-densitometric analysis. CONCLUSION: These findings suggest that identifying significant lesion is major source of interobserve variability in both visual and quantitative analysis of coronary arteriogram. In addition, suboptimal image quality was responsible for the inability of quantitative analysis to reduce the variance. These factors seem to be major limitation of quantitative coronary arterirogam.
Arteries ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Humans ; Observer Variation*

BACKGROUND: The initial history, physical examination, and ECG assessment should focus on identification of potentially serious noncardiac or cardiac disorders, including coronary artery disease, congestive heart failure, and electrical instability at the emergency room. additionally, it is essential to define disease severity, stability and need for emergency therpy. echocardiography is a useful tool for this purppose. especially Doppler echocardiography may be more sensitive and time-saving diagnostic tool for the evaluation of patients presenting with cardiogenic symptoms. So we evaluate the feasibility of the echocardiographic measurement by emergency physicain after short-term course. METHOD AND RESULTS: Twenty volunteers(10 male, 38.8+/-9.3 years) were included in the study for measurement of myocardial performance index and established parameters of ventricular function using conventional echo-Doppler methods. Myocardial performance index: (ICT+IRT)/ET, was obtained by subtracting ejection time(ET) from the interval between cessation and onset of the mitral inflow velocity to give the sum of isovolumic contraction time(ICT) and isovolumic relaxation time(IRT). The most of mean values of echocardiogrphic parameters were not significantly different between those of cardiologist and those of emergency physicians(p<0.01). The duration for measuring myocardial performance index was shortest among echocardiographic parameters. the validity of echocardiographic parameters measured by emergency physicians was proved relatively good. CONCLUSION: It is proved to be feasible for emergency physician to perform echocardiographic evaluation of ventricular function after short-term course.
Coronary Artery Disease ; Curriculum* ; Echocardiography* ; Echocardiography, Doppler ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Heart Failure ; Humans ; Male ; Physical Examination ; Relaxation ; Ventricular Function*

PURPOSE: Lymphedemas are tissue fluid swellings, usually on the arms or legs, and occur as a result of impaired lymphatic drainage. Presently, the most effective treatment available is complete decongestive physiotherapy (CDP). However, this therapy is ineffective in some patients and surgery may be indicated. Herein, we examined the efficacy of minimally invasive needle aspiration of the most enlarged areas in hypodermic adipose tissues, of patients who had failed CDP. METHODS: We included 21 patients who were diagnosed with lymphedema stage II-III in the upper or lower extremities and visited the lymphedema clinic at a university hospital from September 1, 2003 to February 28, 2004. All patients had been treated with CDP at least once, but had failed to respond to the therapy for more than one year. Nine patients had breast cancer and 12 had cervical cancer. We identified the area with the most severe edema by using MRI and performed a 16-gauge angio-needle aspiration on the area. The patients were followed up for 3 months. Effectiveness of the treatment was evaluated by comparing the volume of edema before and after the treatment using Wilcoxon signed rank-test. RESULTS: The mean reduction ratio of the volume of edema comparison normal volume was 41.1+/-35.3% (P=0.001). There were no major or minor operative complications except localized hemorrhage. CONCLUSION: We conclude that a needle aspiration prior to other surgical treatments is relatively safe and effective for those patients who are unresponsive to CDP.
Arm ; Breast Neoplasms ; Cytidine Diphosphate ; Drainage ; Edema ; Hemorrhage ; Humans ; Leg ; Lower Extremity ; Lymphedema ; Needles ; Uterine Cervical Neoplasms

PURPOSE: Osteosarcoma is one of the most common juvenile malignant tumors in Korea. Combined modality treatment [pre-operative chemotherapy + surgery (limb salvage or amputation) + adjuvant chemotherapy] had improved the overall survival and quality of life. To improve the local control rate, we introduced pre-operative chemotherapy combined with intra-arterial (IA) cisplatin and continuous intravenous infusion (CI) of adriamycin. We evaluated the efficacy and feasibility, such as limb salvage rate, recurrence pattern and the survival impact, based on the histologic response of pre-operative chemotherapy. MATERIALS AND METHODS: Fourty-one patients with histologically-proven high grade osteosarcoma of the extremities were enrolled from January 1990 to June 1996. Pre-operative chemotherapy, cisplatin 120 mg/m2 IA and adriamycin 75 mg/m2/72hrs CI, was administered for 3 cycles with 3 week interval, followed by surgery. Post-operative chemotherapy was applied by the tumor necrosis rate. If the tumor necrosis of the specimen was more than 90%, the same regimen af the preoperative one was administered for 3 cycles. A salvage regimen (Ifosfamide 7.5 gm/m2/5d IV + high dose MTX 10 gm/m2 IV VP-16 360 mg/m2/3d IV) was administered every 3 weeks for 6 cycles if the tumor necrosis was <90%. RESULTS: Of 41 patients, 37 were evaluable for efficacy and toxicities, because 4 refused further chemotherapy after 1 or 2 cycles. Twenty-one patients were male and 16 female, with the median age of 16 years (8-41). The tumor locations were as follows: distal femur 20, proximal tibia 8, humerus 6, distal tibia 2 and 1 in proximal femur. All but one patient, who died of neutropenic sepsis, completed the planned pre-operative therapy. Of the 36 patients who received surgery, limb salvage surgery was possible in 30 patients (83.3%) and 27 patients (75%) showed a good response (10 with grade III, 27.8%; 17 with grade IV, 47.2%). With a median follow-up of 23 months, 3-year disease-free survival rate was 54.7% and overall survival rate was 78.3%. Of the 15 patients who recurred, the major metastatic site was the lungs. No operation-related mortality was observed. Most patients experienced grade III-IV nausea, vomiting and hematologic toxicities, which were reversible with supportive care. CONCLUSION: Pre-operative chemotherapy combined with IA cisplatin and CI adriamycin induced higher good response rate without survival benefits. To improve the survival rate, the design of good salvage chemotherapy with a non-cross resistant regimen should be considered.
Cisplatin* ; Disease-Free Survival ; Doxorubicin* ; Drug Therapy ; Etoposide ; Extremities ; Female ; Femur ; Follow-Up Studies ; Humans ; Humerus ; Infusions, Intravenous ; Korea ; Limb Salvage ; Lung ; Male ; Mortality ; Nausea ; Necrosis ; Osteosarcoma* ; Quality of Life ; Recurrence ; Sepsis ; Survival Rate ; Tibia ; Vomiting