Contrary to ventricular mural thrombi, left atrial appendage thrombi are extremely rare in cerebral infarction correlated with acute myocardial infarction but they can be easily detected by transesophageal echocardiography(TEE). We expierienced a case of cerebral infarction which was suspected to be caused from the thrombi in left atrial appendage in a patient with acute myocardial infarction. The cerebral infarction was developed 2 days after myocardial infarction had been occurred and any source of the thrombi could not be detected except in left atrial appendage. The diagnosis was established by TEE and also aided by transthoracic echocardiography, brain computed tomography.
Atrial Appendage* ; Brain ; Cerebral Infarction* ; Diagnosis ; Echocardiography ; Humans ; Myocardial Infarction*

OBJECTIVE: To evaluate the safety and efficacy of the laparoscopic incidental appendectomy during gynecologic laparoscopic operation. Methods: This study was evaluated for the clinical analysis of 118 patients who underwent laparoscopic assisted vaginal hysterectomy(LAVH group, 65 cases) and LAVH with laparoscopic incidental appendectomy(LAVH + IA group, 53 cases) at the Wallace Memorial Baptist Hospital from Oct. 1996 to Nov. 1998. RESULTS: The following results were obtained: 1) There was no significant difference between two groups in regard to age. The mean age was 45.7 years in LAVH group and 43.8 years in LAVH + IA group. 2) There was no significant difference between two groups in mean operative time. The mean operative time was 90.4 minutes in LAVH group and 97.5 minutes in LAVH + IA group. 3) The mean appendectomy time was 7.1 minutes. 4) The mean time recovering normal bowel activity was 46.2 hours in LAVH group and 45.8 hours in LAVH + IA group. There was no significant difference between two groups. 5) The mean hospital stay was 6.4 days in LAVH group and 5.7 days in LAVH + IA group. There was no significant difference between two groups. 6) The postoperative complications occurred in 11 cases(9.3 %). The serious complications of appendectomy was not found. 7) Of the 53 appendices removed, 5(9.4 %) were abnormal pathologic findings. CONCLUSION: Laparoscopic incidental appendectomy during laparoscopic operation was not found to influence the operation time, hospital stay, gas passing time, but there is one case of wound infection due to incidental appendectomy. Therefore, a large number of study should be performed to evaluate the safety and efficacy of laparoscopic incidental appendectomy during laparoscopic operation.
Appendectomy* ; Humans ; Length of Stay ; Operative Time ; Postoperative Complications ; Protestantism ; Wound Infection

PURPOSE: To evaluate changes in total cerebral blood flow (tCBF) with aging, parenchymal volume changes and vascular abnormalities, using 2 dimensional (D) phase-contrast magnetic resonance imaging (PC MRI). MATERIALS AND METHODS: Routine brain MRI including T2 weighted image, time-of-flight (TOF) MR Angiography (MRA) and 2D PC MRI were performed in 73 individuals, including 12 volunteers. Normal subjects (12 volunteers, and 21 individuals with normal MRI and normal MRA) were classified into groups according to age (18 -29, 30 -49 and 50 -66 years). For the group with abnormalities in brain MRIs, cerebral parenchymal volume changes were scored according to the T2 weighted images, and atherosclerotic changes were scored according to the MRA findings. Abnormal groups were classified into 4 groups: (i) mild reduction in volume, (ii) marked reduction in volume by parenchymal volume and atherosclerotic changes, and (iii) increased volume and (iv) Moya-moya disease. Volumetric flow was measured at the internal carotid artery (ICA) and vertebral artery bilaterally using the velocity-flow diagrams from PC MRI, and combined 4 vessel flows and tCBF were compared among all the groups. RESULTS: The age-specific distribution of tCBFs in normal subjects were as follows: 12.0 +/- 2.1 ml/sec in 18 -29 years group, 11.8 +/- 1.9 ml/sec in 30 -49 years group, 10.9 +/-2.2 ml/sec in 50 -66 years group. The distribution of tCBFs in the different subsets of the abnormal population were as follows: 9.5 +/-2.5 ml/sec in the group with mild reduction in volume, 7.6 +/-2.0 ml/sec in the group with marked reduction in volume, and 7.3 +/-1.2 ml/sec and 7.0 +/- 1.1 ml/sec in the increased parenchymal volume and Moya-moya disease groups respectively. CONCLUSION: Total cerebral blood flow decreases with increasing age with a concomitant reduction in parenchymal volumes and increasing atherosclerotic changes. It is also reduced in the presence of increased parenchymal volume and Moya-moya disease. 2D PC MRI can be used as a tool to evaluate tCBF with aging and in the presence of various conditions that can affect parenchymal volume and cerebral vasculature.
Aging* ; Angiography ; Brain ; Carotid Artery, Internal ; Magnetic Resonance Imaging* ; Moyamoya Disease ; Vertebral Artery ; Volunteers

The presence of serum antibodies to various gangliosides, such as anti-GQ1b, is closely related to the clinical features of Guillain-Barre syndrome. However, the phenotype associated with anti-GT1a IgG has not yet been determined, although it has been detected in some cases of the pharyngeal-cervical-brachial variant. We report herein two patients harboring anti-GT1a IgG who both presented with profound dyspnea, dysphagia, and quadriparesis. The findings of this report suggest that the anti-GT1a antibody specifies a clinical feature of oropharyngeal palsy.
Antibodies ; Deglutition Disorders ; Dyspnea ; Gangliosides ; Guillain-Barre Syndrome ; Humans ; Immunoglobulin G ; Paralysis ; Phenotype ; Quadriplegia

Drug-induced sleep endoscopy (DISE) is used to identify areas of upper airway obstruction, which occurs when patients with obstructive sleep apnea (OSA) snore. DISE enables effective diagnosis and appropriate treatment of the obstruction site. Among surgical treatment methods for OSA, maxillomandibular advancement surgery (MMA) is performed to move a jaw forward; the surgery has a high success rate for OSA treatment. In DISE, anesthetics such as propofol and midazolam must be administered to induce snoring while the patient is deeply sedated for an accurate diagnosis to be made. When inducing deep sedation in a patient with OSA, airway obstruction may increase, causing oxygen saturation to drop; airway interventions are necessary in such cases. Effective DISE and MMA surgery can be performed by administering propofol through target-controlled infusion while monitoring the bispectral index (BIS).
Airway Obstruction ; Anesthetics ; Deep Sedation ; Diagnosis ; Endoscopy* ; Humans ; Jaw ; Midazolam ; Oxygen ; Propofol ; Sleep Apnea, Obstructive* ; Snoring

Gestational choriocarcinoma is easily disseminated hematogenously and its hypervascular nature places the patient at risk of significant hemorrhage both at the sites of metastatic lesions and in the uterus. In addition, its tends to give rise to pseudoaneurysm formation. Treatment of the condition by percutaneous embolization has been reported in several published articles, and hemoperitoneum secondary to rupture of splenic metastasis of gestational choriocarcinoma has also been reported, as has angiographic embolization. Hemoptysis resulting from pulmonary metastasis and treatment by means of embolization of the bronchial artery have not been reported, however. In this article, we describe a case of hemoptysis and hemoperitoneum due to pulmonary and splenic metastasis of gestational choriocarcinoma. Treatment of the condition involved embolization of the bronchial artery and superselective embolization of the splenic artery.
Aneurysm, False ; Bronchial Arteries* ; Choriocarcinoma ; Female ; Hemoperitoneum* ; Hemoptysis* ; Hemorrhage ; Humans ; Neoplasm Metastasis ; Pregnancy ; Rupture ; Splenic Artery* ; Uterus

Idiopathic retroperitoneal fibrosis (IRF) is a rare disease characterized by inflammatory and fibrous tissue proliferation in the retroperitoneum, which often surrounds the adjacent retroperitoneal structure to cause compressive complications such as hydronephrosis. Its pathogenesis is still unknown, but recently the association with autoimmune disease is being suggested. Although the prognosis is generally good, if diagnosis or treatment is delayed, the disease can progress to acute or chronic renal failure. In the past, surgical procedures such as ureterolysis or transpositioning of the involved ureter were the mainstay of the treatment. But recent studies using steroids, immunosuppressants and tamoxifen have reported generally good results. However, the adequate dose or duration of medical treatment and the treatment for recurred disease have not been established yet. We report a case of that retroperitoneal fibrosis recurred 1 year after 2-weeks steroids therapy. It was successfully treated with combination therapy of steroids and tamoxifen.
Autoimmune Diseases ; Diagnosis ; Hydronephrosis ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Prognosis ; Rare Diseases ; Recurrence ; Retroperitoneal Fibrosis* ; Steroids* ; Tamoxifen* ; Ureter

A congenital hepatoportal arteriovenous fistula associated with an intrahepatic portal vein aneurysm is a rare type of arteriovenous malformation. Only 14 pediatric cases have been reported to the best of the authors' knowledge. An intrahepatic shunt between the portal and systemic veins is also relatively rare. We report a case of a congenital hepatoportal arteriovenous fistula associated with an intrahepatic portal vein aneurysm and a portohepatic venous shunt in a neonate who presented with tachypnea and melena.
Aneurysm* ; Angiography ; Arteriovenous Fistula* ; Arteriovenous Malformations ; Humans ; Infant, Newborn ; Melena ; Portal Vein* ; Tachypnea ; Veins

OBJECTIVE: The aim of this study was to examine the feasibility of perfusion imaging of the brain using the Z-score and subtraction dynamic images obtained from susceptibility contrast MR images. MATERIALS AND METHODS: Five patients, each with a normal MRI, Moya-moya, a middle cerebral artery occlusion, post-trauma syndrome, and a metastatic brain tumor, were selected for a presentation. A susceptibility-contrast echo-planar image after a routine MRI was taken as the source image with a rapid manual injection of 0.1 mmol/kg of Gd-DTPA. The inflow and washout patterns were observed from the time-signal intensity curve of the serial scans using the standard program of an MRI machine. The repeated Z-score images of the peak and late phases were made using the threshold Z-score values between 1.4 and 2.0 in four to five studies of the pre-contrast, peak, and late phases. Dynamic subtraction images were produced by subtracting sequential post-contrast images from a pre-contrast image and coloring these images using a pseudocolor mapping method. RESULTS: In the diseases with perfusion abnormalities, the Z-score images revealed information about the degree of perfusion during the peak and late phases. However, the quality varied with the Z-score threshold and the studies selected in a group. The dynamic subtraction images were of sufficient quality with no background noise and more clearly illustrated the temporal changes in perfusion and delayed perfusion. CONCLUSION: The Z-scores and dynamic subtraction images illustrated the degree of perfusion and sequential changes in the pattern of perfusion, respectively. These images can be used as a new complimentary method for observing the perfusion patterns in brain diseases.
Adult ; Brain/*blood supply/radionuclide imaging ; Child ; Contrast Media ; Feasibility Studies ; Female ; Gadolinium DTPA/diagnostic use ; Humans ; *Magnetic Resonance Angiography ; Male ; Middle Aged ; Research Support, Non-U.S. Gov't ; *Subtraction Technique

Multicentric reticulohistiocytosis (MRH) is a rare systemic disease, characterized by severe rapidly destructive polyarthritis and erythematous papulonodular skin lesions. This disorder involves primarily skin and joints, but it has been reported to affect nearly every organ system. Histological analyses of skin, mucosa and synovia reveal that multinucleated giant cells and proliferating histiocytes have smooth eosinophilic ground-glass cytoplasm. We report a case of a 46-year-old woman who was presented with multiple arthritis and erythematous patch on the V-neck and hard nodules on both hands, elbows, great toes, and auricles. About 25% of the reported patients with MRH have been associated with cancer, but MRH is not considered to be a paraneoplastic disorder. She has not been found any other malignant disease. She has been treated with NSAIDs, corticosteroid, alendronate, hydroxychloroquine, and low-dose methotrexate. Cyclosporin A was added to achieve complete remission later on. After 6 months, she was more improved in symptoms of multiple arthritis and skin nodules.
Alendronate ; Anti-Inflammatory Agents, Non-Steroidal ; Arthritis ; Cyclosporine ; Cytoplasm ; Elbow ; Eosinophils ; Female ; Giant Cells ; Hand ; Histiocytes ; Humans ; Hydroxychloroquine ; Joints ; Methotrexate ; Middle Aged ; Mucous Membrane ; Skin ; Synovial Fluid ; Toes