No abstract available.
Arthroscopy* ; Bupivacaine* ; Injections, Intra-Articular* ; Knee*

Acute mountain sickness is an illness caused by climbing to a high altitude without prior acclimatization. Neurological consequences, like parkinsonism following acute mountain sickness without lesion of brain MRI have been reported rarely. A healthy 56-year-old man presented with dysarthria and gait disturbance. Neurological examination revealed tremor of hands, limb rigidity, and bradykinesia. The symptoms developed approximately 30 days following a 3,500 m climb of the Annapurna in the Himalayas. Brain MRI did not reveal any abnormalities including globus pallidus. The parkinsonism symptoms persisted for about 3 months before a complete recovered was made. We suggest that parkinsonism can develop after climbing to a high altitude but that the symptoms can be transient if a brain MRI detects no abnormalities.

Heat treatment which removes internal stress enhances the mechanical properties of the orthodontic arch wire. The main purpose of this experiment was to investigate the effects of the heat treatment on the mechanical properties of the Elgiloy wire. The Elgiloy wire, 0.016" X 0.022" and 0.018" X 0.025", were heat treated in an electric oven for 5, 10 and 15 minutes at selected temperatures between 300 and 900degreesC. Tensile strength and load deflection rate were measured to reveal the changes of mechanical property at various con?ditions, and each specimen was observed under metallurgic microscope. Also to trace the precipitation material due to overheat treatment, a qualitative analysis was carried out with EDS system. It was found that heat treatment at a low temperature caused an increase in the tensile strength and bending resistance, and a maintenance in the fibrous in the tensile strength and bending resistance, and a maintenance in the fibrous structure of both sizes of wire. The changes observed in properties and appearance were probably due to the relief of internal stresses incurred in the metal during cold working. In both sizes of wire the tensile strength and the bending resistance continued to decrease at high temperature, and the fibrous structure continued to disappear then was not observed at 900degreesC. The carbide precipitation founded in grain boundary at 750degreesC probably was other elements carbide (Ni, Co) except Cr. The grain growth was observed at 1100degreesC. Optimum heat treatment for the 0.016" X 0.022" Elgiloy wire was 10 minutes at 500degreesC, and for the 0.018" X 0.025" Elgiloy wire it was 5 to 15 minutes at 500degreesC.
Edible Grain ; Hot Temperature* ; Tensile Strength

Isolated pulsatile tinnitus is a rare condition in patients with neurological disorders but can be the only clue to a potentially life-threatening disease such as intracranial vascular malformation. We report a patient with pulsatile tinnitus caused by an arteriovenous fistula of the external carotid artery, which was successfully treated with coil embolization.
Angiography ; Arteriovenous Fistula ; Carotid Artery, External ; Humans ; Nervous System Diseases ; Tinnitus ; Vascular Malformations

Acute mesenteric infarction is a catastrophic illness representing a diverse spectrum of pathologic conditions which ultimately lead to necrosis of the intestine and which is uniformly fatal if left untreated. Despite better understanding of the disease process, acute mesenteric infarction continues to be a lethal disorder with high mortality rate. We experienced two cases of acute mesenteric infarction due to superior mesenteric arterial and venous branch occlusion, respectively, in recent years: One case was focal segmental ischemia with normal radiologic finding including angiography, successfully treated with segmental resection of the necrotized ileum, another case was mesenteric venous thrombosis, also treated with resection of necrotized small intestine followed by second look operation.
Angiography ; Catastrophic Illness ; Ileum ; Infarction* ; Intestine, Small ; Intestines ; Ischemia ; Mortality ; Necrosis ; Venous Thrombosis

PURPOSE: To evaluate the clinical value of the multi-detector row computed tomography (MDCT) in the quantitative assessment of lung volumes and to assess the relationship between the MDCT results and disease severity as determined by a pulmonary function test (PFT) in Chronic Obstructive Pulmonary Disease (COPD) patients. MATERIALS AND METHODS: We performed a PFT and MDCT on 39 COPD patients. Using the GOLD classification, we divided the patients into three groups according to disease severity; stage I (mild, n=10), stage II (moderate, n=15), and stage III (severe, n=14). Using the pulmo-CT software program, we measured the proportion of lung volumes with attenuation values below -910 and -950 HU. RESULTS: The mean FEV1 (% of predicted) and FEV1/FVC was 82.2+/-2% and 66.2+/-3% in stage I, 53.5+/-11% and 52+/-6% in stage II, and 32.3+/-7% and 44.2+/-13% in stage III, respectively. Differences in lung volume percentages at each of the thresholds (-910 and -950 HU) among the 3 stages were statistically significant (p<0.01, p<0.01) and correlated well with the FEV1 and FEV1/FVC (r=-0.803, r=-0.766, r=-0.817, and r=-0.795, respectively). CONCLUSION: The volumetric measurement obtained by MDCT provides an accurate means of quantifying pulmonary emphysema.
Humans ; Lung ; Lung Volume Measurements ; Pulmonary Disease, Chronic Obstructive ; Pulmonary Emphysema ; Respiratory Function Tests ; Thorax

PURPOSE: To assess the effect of a rectal enema on interfraction prostate movement in bone alignment (BA) for prostate radiotherapy (RT), we analyzed the spatial difference in prostates in a bone-matched setup. MATERIALS AND METHODS: We performed BA retrospectively with data from prostate cancer patients who underwent image-guided RT (IGRT). The prostate was identified with implanted fiducial markers. The setup for the IGRT was conducted with the matching of three fiducial markers on RT planning computed tomography images and those on two oblique kV x-ray images. Offline BA was performed at the same position. The coordinates of a virtual prostate in BA and a real prostate were obtained by use of the ExaxTrac/NovalisBody system, and the distance between them was calculated as the spatial difference. Interfraction prostate displacement was drawn from the comparison of the spatial differences. RESULTS: A total of 15 patients with localized prostate cancer treated with curative hypofractionated IGRT were enrolled. A total of 420 fractions were analyzed. The mean of the interfraction prostate displacements after BA was 3.12+/-2.00 mm (range, 0.20-10.53 mm). The directional difference was profound in the anterior-posterior and supero-inferior directions (2.14+/-1.73 mm and 1.97+/-1.44 mm, respectively) compared with the right-left direction (0.26+/-0.22 mm, p<0.05). The required margin around the clinical target volume was 4.97 mm with the formula of van Herk et al. CONCLUSIONS: The interfraction prostate displacement was less frequent when a rectal enema was performed before the procedure. A rectal enema can be used to reduce interfraction prostate displacement and resulting clinical target volume-to-planning target volume margin.
Enema* ; Fiducial Markers ; Humans ; Prostate* ; Prostatic Neoplasms ; Radiotherapy* ; Retrospective Studies

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

Lipomas are the most common benign tumors of adipose tissue among adults. Lipomas can occur almost anywhere in the trunk, extremities, mediastinum, and pelvis, but retroperitoneal lipomas are extremely rare. It should be distinguished from well differentiated liposarcoma in order to provide the appropriate treatment and follow up. We experienced a case of 60-year-old patient with large retroperitoneal lipoma mimicking liposarcoma causing palpable abdominal mass and pain. Abdominal computerized tomography (CT) showed 33x22 cm sized bulky fat-containing mass with contrast enhanced solid portion in right retroperitoneum. Positron emission tomograpgy (PET) revealed increased 18F-FDG uptake at solid portion shown in abdominal CT. Imaging studies confirmed a high index of suspicion on liposarcoma. Laparotomy showed a large encapsulating tumor arising from retroperitoneum with fat necrosis. Pathologic examination of resected specimen revealed normal mature adipocytes without atypical cells, compatible with lipoma.
Fluorodeoxyglucose F18/diagnostic use ; Humans ; Lipoma/*diagnosis/pathology ; Liposarcoma/diagnosis ; Male ; Middle Aged ; Positron-Emission Tomography ; Retroperitoneal Neoplasms/*diagnosis/pathology ; Tomography, X-Ray Computed

PURPOSE: To assess the usefulness of implanted fiducial markers in the setup of hypofractionated radiotherapy for prostate cancer patients by comparing a fiducial marker matched setup with a pelvic bone match. MATERIALS AND METHODS: Four prostate cancer patients treated with definitive hypofractionated radiotherapy between September 2009 and August 2010 were enrolled in this study. Three gold fiducial markers were implanted into the prostate and through the rectum under ultrasound guidance around a week before radiotherapy. Glycerin enemas were given prior to each radiotherapy planning CT and every radiotherapy session. Hypofractionated radiotherapy was planned for a total dose of 59.5 Gy in daily 3.5 Gy with using the Novalis system. Orthogonal kV X-rays were taken before radiotherapy. Treatment positions were adjusted according to the results from the fusion of the fiducial markers on digitally reconstructed radiographs of a radiotherapy plan with those on orthogonal kV X-rays. When the difference in the coordinates from the fiducial marker fusion was less than 1 mm, the patient position was approved for radiotherapy. A virtual bone matching was carried out at the fiducial marker matched position, and then a setup difference between the fiducial marker matching and bone matching was evaluated. RESULTS: Three patients received a planned 17-fractionated radiotherapy and the rest underwent 16 fractionations. The setup error of the fiducial marker matching was 0.94+/-0.62 mm (range, 0.09 to 3.01 mm; median, 0.81 mm), and the means of the lateral, craniocaudal, and anteroposterior errors were 0.39+/-0.34 mm, 0.46+/-0.34 mm, and 0.57+/-0.59 mm, respectively. The setup error of the pelvic bony matching was 3.15+/-2.03 mm (range, 0.25 to 8.23 mm; median, 2.95 mm), and the error of craniocaudal direction (2.29+/-1.95 mm) was significantly larger than those of anteroposterior (1.73+/-1.31 mm) and lateral directions (0.45+/-0.37 mm), respectively (p<0.05). Incidences of over 3 mm and 5 mm in setup difference among the fractionations were 1.5% and 0% in the fiducial marker matching, respectively, and 49.3% and 17.9% in the pelvic bone matching, respectively. CONCLUSION: The more precise setup of hypofractionated radiotherapy for prostate cancer patients is feasible with the implanted fiducial marker matching compared with the pelvic bony matching. Therefore, a less marginal expansion of planning target volume produces less radiation exposure to adjacent normal tissues, which could ultimately make hypofractionated radiotherapy safer.
Enema ; Fiducial Markers ; Glycerol ; Humans ; Incidence ; Pelvic Bones ; Prostate ; Prostatic Neoplasms ; Rectum