PURPOSE: The purpose of this study was to evaluate and compare the scintigraphic findings and diagnostic accuracy of double-phase Tc-99m sestamibi scan in primary and secondary hyperparathyroidism (HPT). MATERIALS AND METHODS: We retrospectively reviewed 16 cases of primary (18 lesions) and 11 cases of secondary HPT (44 lesions) who underwent Tc-99m-sestamibi scan before the surgical intervention. Scan was performed using LEM camera (Siemens, Germany) after the injection of 740MBq of Tc-99m sestamibi. Routine image consisted of baseline and 3-hour delayed images and each image was obtained using both parallel and pine hole collimator. The study population was 27 patients (male/female=5/22, age: 49.1+/-10.8). RESULTS: Eighteen lesions of primary HPT consisted of 13 adenomas and 5 hyperplasias, while all lesions of secondary HPT were hyperplasias. Among the case of primary HPT, we could detect all the lesions of 13 adenomas but only 2 lesions of 5 hyperplasias (40%) could be detected by double phase scintigraphy. Three cases of primary lesion showed decreased uptake in delayed images compared with baseline. The sensitivity, specificity, positive predictive value and accuracy of primary and secondary HPT were 58.8% (10/17), 83.3% (10/12), 83.3% (10/12), 75.9% (22/29), and 37.5% (15/40), 50% (2/4), 88.2% (15/17), 38.6% (17/44), respectively. Overall sensitivity, specificity, positive predictive value and accuracy were 43.9% (25/57), 75% (12/16), 86.2% (25/29), and 53.4% (39/73). There were no statistical difference between the weight of primary and secondary HPT lesion (p>0.05). CONCLUSION: Tc-99m sestamibi scan is fairly good modality to detect parathyroid lesion in patient with primary HPT before the surgical intervention. However, since some of cases may reveal decreased uptake in delayed image, a careful attention to the findings of baseline images may be helpful. Still the low accuracy of sestamibi scan in diagnosis of secondary HPT prohibits routine use of it for this disease.
Adenoma ; Diagnosis ; Humans ; Hyperparathyroidism, Primary ; Hyperparathyroidism, Secondary* ; Hyperplasia ; Parathyroid Glands ; Radionuclide Imaging* ; Retrospective Studies ; Sensitivity and Specificity

Computerized tomography has been used in the evaluation of the intracranial lesions. Recently the usage of computerized tomography has progressively widened in many fields of clinical practice. In orthopedics computerized tomography has been tried in the diagnosis and the determination of treatment of tumors, spinal disorders, hip disorders and knee problem. Four problem cases in which concentric reduction could not be obtained after closed reduction of hip dislocations were evaluated by computerized tomography from Apr, 1, 1983 to Mar. 31, 1984 in the Capital Armed Forces General Hospital and following conclusiions were obtained: 1. Open reduction revealed that muscles(adductor and pyriformis muscles), joint capsule and osteocartilaginous loose bodies (femoral and acetabular) were interposed to hinder concentric reduction. Large posterior acetabular fragment induced instability and redislocation of the hip. 2. When there were 2-3 mm lack of symmetry of the two femoral heads or any abnormal findings(breakage of Shenton's line etc.) in plain roentgenography, computerized tomography was recommanded, and muscles, osteocartilaginous loose bodies and instability were found. 3. Computerized tomography is an easy simple method and has a great diagnostic value in the evaluation of asymmetry and instability after closed reduction of traumatic hip dislocations.
Acetabulum ; Arm ; Diagnosis ; Head ; Hip Dislocation ; Hip ; Hospitals, General ; Joint Capsule ; Knee ; Methods ; Muscles ; Orthopedics ; Radiography

The idiopathic osteonecrosis of femoral head is one of the orthopaedic dilemma in regarding the treatment and various trials to preserve the femoral head were known to be effective in the early stage of the disease process. The conventional methods of core decompression and bone graft were not usually indicated in the progressed cases that disclose the subchondral fracture or collapse of the femoral head. Authors reviewed 15 cases of the free fibular strut grafts performed for the progressed idopathic osteonecrosis of femoral head since 1983 at the Department of Orthopaedic Surgery, Daegu Fatima Hospital with follow-up periods from 2 years and 2 months to 4 years and 6 months except for 2 cases who had secondary procedures because of progressive collapse of the femoral head after the bone grafting and the following results were obtained; 1. The cases were 14 males and a female aging from 28 years to 56 years and revealed crescent signs in 9 cases and early collapses in 6 cases on the pre-operative x-rays with involvement in the other sides in 10 cases. 2. The successful results in clinical and roentgenological evaluations were obtained in 8 cases(53%) and progressive collapse was prevented in 10 cases(67%). 3. The exact insertion of the graft up to the subchondral level through the necrotic bone was essential and no weight bearing for 1 year was neccessary for success. 4. The free fibular strut grafts were effective to prevent the progressive collapse in progressed idiopathic osteonecrosis of the femoral head.
Aging ; Bone Transplantation ; Clinical Study ; Daegu ; Decompression ; Female ; Follow-Up Studies ; Head ; Humans ; Male ; Osteonecrosis ; Transplants ; Weight-Bearing

A retrospective study was undertaken to define the factors that cause the neurogenic symptoms in 18 cases of spondylolytic spondylolisthesis who were operated for leg pain and neurologic deficits of motor functions documented by neurologic examination or electromyographic findings in the Department of Orthopaedic Surgery, Fatima Hospital, Daegu for three years since June, 1986. The cases having other combined pathology to cause neurogenic symptoms were excluded. The causes were predetermined by preoperative x-rays, myelograms, electromyograms, and computerized tomograms and the causes were explored at surgery regarding the preoperative findings. The findings were compared with the avilable findings of 13 cases who were operated for low back pain only without any neurogenic pain in the leg during the same period. The cases were quite older and had narrower disc spaces than the back pain group but there were no significant differences in the degree of slipping and stability of slipped level between the two groups. The foraminal stenosis was found in all of the cases and a central stenosis was combined in a case. The intervertebral foramens were narrowed up-down in most of the cases between the bony prominence of proximal pars interarticularis above and the disc and vertebral body below but three cases had soft tissue mass only at the isthmic defect encroaching the foramen. There were hypertrophy of bone and/or soft tissue at the pars interarticularis in all cases. The nerve roots were mainly compressed up-down below pars interarticularis in the foramen in 8 cases and impinged at the anterior foramen in front of the pars interarticularis in 10 cases. The central stenosis was due to marked bony hypertrophy of pars interarticularis and osteophyte of vertebral body. The causes of neurogenic symptoms in spondylolytic spondylolisthesis were foraminal stenosis due to hypertrophy of bone and/or soft tissue at the pars interarticularis combined with narrowing of disc and seemed to be a process of degenerative changes occurring at the motion segment of slipped level.
Back Pain ; Constriction, Pathologic ; Daegu ; Hypertrophy ; Leg ; Low Back Pain ; Neurologic Examination ; Neurologic Manifestations ; Osteophyte ; Pathology ; Pheniramine ; Retrospective Studies ; Spondylolisthesis

Congenital complete atrioventicular block is uncommon which has a heterogenous etiology. According to recent studies, about one-third of the mothers of the patients who were diagnosed as congenital complete atrioventricular block, had symptoms or signs of connective tissue disease. Even though the outlook is usually regarded as favorable, the mortality is highest in the neonatal period, much lower during childhood and adolescence and increases slowly later in life. In the neonatal period the predominant indication for pacing was heart failure. It is difficult to make a prognosis in the individual patient. A slow, fixed or decreasing venticular rate neonatally and a prolonged QT interval seem to be bad prognostic sign. We report a case of congenital complete atrioventricular block who was diagnosed by fetal echocardiography. Her mother was asymptomatic, but had positive serologic test to anti-Ro antibody and anti-La antibody. We report a case of congenital complete atrioventricular block with a brief review of related literatures.
Adolescent ; Atrioventricular Block* ; Connective Tissue Diseases ; Echocardiography* ; Heart Failure ; Humans ; Mortality ; Mothers ; Prognosis ; Serologic Tests

OBJECTIVE: To evaluate the effects of gabapentin and clonidine on neuropathic pain in an experimental pain model. METHOD: 24 male adult rats were anesthetized and the sciatic nerve was exposed. Each exposed nerve was electrically injured with 10 volts for 10 seconds by two needle electrodes. Rats were divided into three groups by treating with gabapentin, clonidine and sham. Gabapentin and clonidine were given orally from post operation day 3 to 7 in gabapentin and clonidine groups respectively. To evaluate the presence of mechanical allodynia, withdrawal frequency was tested by Von Frey hair in the same days. After post operation day 7, all the medications were discontinued and mechanical allodynia was evaluated at post operation day 14. RESULT: Neuropathic pain was developed after electrical injury in all the rats. Withdrawal frequency is more decreased in gabapentin and clonidine groups than sham group in post operation day 4 to 7. The withdrawal frequency was 2.88+/-0.83, 2.75+/-0.89, 3.13+/-0.99, 3.25+/- 1.28 in gabapentin group and 3.38+/-0.92, 4.50+/-2.20, 3.25+/-1.17, 3.50+/-0.93 in clonidine group in post operation day 4, 5, 6, 7, respectively. In post operation day 14, withdrawal frequency was increased and showed no difference compared to the sham group. CONCLUSION: Gabapentin and clonidine can suppress the neuropathic pain in an experimental pain model. There was no different effect on the neuropathic pain suppression between gabapentin and clonidine.
Adult ; Animals ; Clonidine* ; Electrodes ; Hair ; Humans ; Hyperalgesia ; Male ; Needles ; Neuralgia* ; Rats ; Sciatic Nerve

PURPOSE: Hypereosinophilic syndrome (HES) is an infiltrative disease of eosinophils affecting multiple organs including the lung. F-18 2-fluoro-2-deoxyglucose (F-18 FDG) may accumulate at sites of inflammation or infection, making interpretation of whole body PET scan difficult in patients with cancer. This study was to evaluate the PET findings of HES with lung involvement and to find out differential PET features between lung malignancy and HES with lung involvement. MATERIAL AND METHODS: F-18 FDG PET and low dose chest CT scan was performed for screening of lung cancer. Eight patients who showed ground-glass attenuation (GGA) and consolidation on chest CT scan with peripheral blood eosinophilia were included in this study. The patients with history of parasite infection, allergy and collagen vascular disease were excluded. CT features and FDG PET findings were meticulously evaluated for the distribution of GGA and consolidation and nodules on CT scan and mean and maximal SUV of abnormalities depicted on F-18 FDG PET scan. In eight patients, follow-up chest CT scan and FDG PET scan were done one or two weeks after initial study. RESULTS: F-18 FDG PET scan identified metabolically active lesions in seven out of eight patients. Maximal SUV was ranged from 2.8 to 10.6 and mean SUV was ranged from 2.2 to 7.2. Remaining one patient had maximal SUV of 1.3. On follow-up FDG PET scan taken on from one to four weeks later showed decreased degree of initially noted FDG uptakes or migration of previously noted abnormal FDG uptakes. CONCLUSIONS: Lung involvement in the HES might be identified as abnormal uptake foci on FDG PET scan mimicking lung cancer. Follow-up FDG PET and CT scan for the identification of migration or resolution of abnormalities and decrement of SUV would be of help for the differentiation between lung cancer and HES with lung involvement.
Collagen ; Eosinophilia ; Eosinophils ; Fluorodeoxyglucose F18 ; Follow-Up Studies ; Humans ; Hypereosinophilic Syndrome* ; Hypersensitivity ; Inflammation ; Lung ; Lung Neoplasms ; Mass Screening ; Parasites ; Positron-Emission Tomography* ; Tomography, X-Ray Computed ; Vascular Diseases

PURPOSE: Attention deficit hyperactivity disorder (ADHD) has been known as psychiatric disorder in childhood associated with dopamine dysregulation. In present study, we investigated changes in dopamine transporter (DAT) density of the basal ganglias using I-123 N- (3-iodopropen-2-yl) -2-carbomethoxy-3beta- (4-chlorophenyl) tropane [I-123 IPT] SPECT in children with ADHD before and after methylphenidate treatment. MATERIALS AND METHOD: Nine drug-naive children with ADHD and seven normal children were included in the study. We performed brain SPECT two hours after the intravenous administration of I-123 IPT and made both quantitative and qualitative analyses using the obtained SPECT data, which were reconstructed for the assessment of specific/nonspecific DAT binding ratios in the basal ganglia. All children with ADHD reperformed [123I]IPT SPECT after treatment with methylphenidate (0.7mg/kg/d) during about 8 weeks. SPECT data reconstructed for the assessment of specific/nonspecific DAT binding ratio of the basal ganglia were compared between before and after treatment methylphenidate. We investigated correlation between the change of ADHD symptom severity assessed with ADHD rating scale-IV and specific/nonspecific DAT binding ratio of basal ganglia. RESULTS: Children with ADHD had a significantly greater specific/nonspecific DAT binding ratio of the basal ganglia comparing to normal children (Right: z = 2.057, p = 0.041; Left: z = 2.096, p = 0.032). Under treatment with methylphenidate in all children with ADHD, specific/nonspecific DAT binding ratio of both basal ganglia decreased significantly greater than before treatment with methylphenidate (Right: t = 3.239, p = 0.018; Left: t = 3.133, p = 0.020). However, no significant correlation between the change of ADHD symptom severity scores and specific/nonspecific DAT binding ratio of the basal ganglia were found. CONCLUSIONS: These findings support the complex dysregulation of the dopaminergic neurotransmitter system in children with ADHD.
Administration, Intravenous ; Attention Deficit Disorder with Hyperactivity* ; Basal Ganglia* ; Brain ; Child* ; Dopamine Plasma Membrane Transport Proteins* ; Dopamine* ; Humans ; Methylphenidate ; Neurotransmitter Agents ; Tomography, Emission-Computed, Single-Photon

BACKGROUNDS: In the absence of distant metastasis, small cell lung cancer (SCLC) patients presenting with supraclavicular lymph node (SCLN) involvement and pleural effusion can benefit from thoracic radiotherapy. But there are some debate as to the prognostic significance of both SCLN involvement and pleural effusion. The purpose of this study was to determine the prognostic significance of SCLN involvement and pleural effusion in SCLC. METHODS: Two Hundred and fifteen patients with histologically confirmed small cell lung cancer, who were treated either at the Keimyung university Dongsan hospital and Kyungpook national university hospital from January 1994 to June 1998, were evaluated retrospectively. The patients were classified as having either limited or extensive stage using the Veterans Administration staging system. RESULTS: SCLN was presented in 10.5% of patients(n=21). The median survival was 247 days for patients with SCLN(n=21) and 264 days for patients without(n=194) (p=0.52). After treatment, the median survival was 298 days for patients with SCLN(n=13) and 348 days for patients without(n=115) (p=0.52). SCLN involvement was not correlated with the presence of distant metastases. Medican survival was 459 days for patients with a limited stage without SCLN(n=66), 650 days for those with a limited stage with SCLN (n=7) (p=0.96). Pleural effusion was presented in 24.7% of patients(n=52). The median survival was 198 days for patients with pleural effusion(n=52) and 275 days for patients without(n=163) (p<0.05). After treatment, the median survival was 294 days for patients with a pleural effusion(n=25) and 286 days for patients without(n=103) (p=0.39). The presence of pleural effusion was not correlated with that of distant metastases. The median survival was 395 days for patients with a limited stage without a pleural effusion(n=63), 451 days for those with a limited stage with pleural effusion(n=10) (p=0.92). CONCLUSIONS: In this study, SCLN involvement does not explain the poor survival rate and the relevance to extensive staged disease. Furthermore, the existence of a pleural effusion did not correlated with the presence of distant metastases. However, the presence of a pleural effusion appears to be a minor prognostic factor in our study. Therefore supraclavicular lymph node justify any amendment to the staging system currently used.
Gyeongsangbuk-do ; Humans ; Lymph Nodes* ; Neoplasm Metastasis ; Pleural Effusion* ; Radiotherapy ; Retrospective Studies ; Small Cell Lung Carcinoma* ; Survival Rate ; United States Department of Veterans Affairs

A study has been conducted to see the relationship between Q-oTc interval and neonatal hypocalcemia study group consists of 75 Newborns(full-Term 57, premature 18), whose conditions were Known to be susceptable to the development of hypocalcemia and all of them were admitted to the newborn service of Kyungpook National University Hospital during 6 months period from February to August, 1978. Following results were obtainod: 1. Overall incidence of hypocalcemia was 32%, with highest rate of 70% occurring in high-risk premature group, and 3 out of 4 cases with sever hypocalcemia, defined as serum calcium level below 5mg% were noted inpremature group. There was no sexual difference. 2. cardinal sympotoms were irritability and convulsion,. Convlsion was seen in all cases with severe hypocalcemiam compared to 41% with serum calcium level above 5mg%, subtle type of seizure was the commoest form, occurring in 8 cases, followed by generalized tonic type and multifocal type 3. O-oTc interval was prolonged in 83.4% of hypocalcemia and Q-Tc interval only in 37.5%, There was statistically significant correlation between Q-oTc and serum calcium level, showing = -0.41(P<0.01) in premature and = -0.47(P<0.01)in full term. In summary, we recommend Q-oTc interval as a quick and reliable screening test to detect hypocalcemia in newborn period.
Calcium ; Gyeongsangbuk-do ; Humans ; Hypocalcemia* ; Incidence ; Infant, Newborn ; Mass Screening ; Seizures