Intentional delay of aftercoming siblings in multiple gestation is an infrequent occurrence in obstetrics. After delivery of an immature twin, conventional treatment calls for induction and delivery of the aftercoming sibling. However, several case reports have documented the feasibility of an expectant management. And also, as in our case, an aggressive treatment consisting of cerclage, tocolysis, and broad-spectrum antibiotics has been shown to prolong pregnancy. We experienced an unavoidable delivery of a nonviable first twin after premature rupture of membranes at 16 weeks' of gestation. The placenta was left undisturbed. Twin B was confirmed to be alive within the intact second sac. Tocolysis was started and cervical cerclage was done directly after delivery of twin A. Pregnancy was successfully prolonged, which enabled the second fetus to remain in utero and grow for another 145 days. To our knowledge, this was the longest interval between deliveries in a twin pregnancy reported in the literature. A healthy 3,050 gm male was delivered by cesarean section at 37 weeks' of gestation. Below we present this case in detail and discussed with respect to the aggressive approach undertaken to prolong gestation.
Anti-Bacterial Agents ; Cerclage, Cervical ; Cesarean Section ; Female ; Fetus ; Humans ; Male ; Membranes ; Obstetrics ; Placenta ; Pregnancy* ; Pregnancy, Twin ; Rupture ; Siblings ; Tocolysis ; Twins*

PURPOSE: To investigate the perfusion characteristics of VX2 carcinoma and liver parenchyma in an animal model, and to evaluate the usefulness of perfusion CT in assessing the angiogenesis of hepatic VX2 carcinoma. MATERIALS AND METHODS: Ten rabbits (control, 5; VX2 carcinoma, 5) weighing 2.5 to 3.5 (average, 3.1) Kg were involved in this study. Between 7 and 14 days after implanting VX2 carcinoma, ultrasonography and CT were performed for the purpose of detecting this. Using the cine mode and involving four simultaneous sections, four perfusion CT images were obtained every second for 60 seconds. One radiologist measured the size of the region of interest (ROI) at each liver location, and using the time-density curves for each tumor and normal liver, semi-quantitative perfusion parameters -namely blood volume, mean transit time (MTT), blood flow, and time-to-peak enhancement-were determined. The microvascular densities (MVD) of VX2 tumors and normal liver were correlated with the perfusion CT findings. RESULTS: In the control group, there were no significant differences in perfusion parameters between the left and right hepatic lobes. In the VX2 carcinoma group, there were significant differences between the lobe containing the tumor and adjacent hepatic lobes with respect to blood volume (34.80 vs. 27.2 ml/100 g), MTT (14.1 vs. 19.4 sec), blood flow (119.7 vs. 84.3 ml/100 g/min), and time-to-peak (32.4 vs. 36.9 sec) (p<0.05). The blood volume (27.2 ml/100g) of the hepatic lobe with the VX2 tumor was higher than that of normal liver (22.8 ml/100 g) (p< 0.05), but blood flow (84.3 vs. 66.8 ml/100 g/min), MTT (19.4 vs. 21.3 sec) and time-to-peak (36.9 vs. 38.7 sec) values were not different. The MVD of VX2 tumors was higher than that of normal liver (p<0.05), and significantly higher than that of adjacent and contralateral liver (p<0.05). CONCLUSION: At perfusion CT, blood volume and blood flow of VX2 carcinomas increased more than those of normal liver, as were both mean transit time and time-to-peak. It was confirmed histopathologically that the angiogenesis of VX2 carcinoma was higher than that of normal liver. In conclusion, perfusion CT may be a practically useful diagnostic tool capable of reflecting the neoplastic angiogenesis of the liver.
Blood Volume ; Liver ; Models, Animal ; Perfusion* ; Rabbits ; Ultrasonography

OBJECTIVE: The purpose of this study was to evaluate the MR spectrum and MR cholangiographic imaging findings of clonorchiasis. MATERIALS AND METHODS: We reviewed 26 patients with confirmed clonorchiasis by either stool tests (n=24) or surgery (n=2). MR imaging was performed on a 1.5 T system (GE Medical Systems, Milwaukee, WI) with a torso coil. Axial T1-and T2-weighted, gadolinium-enhanced dynamic images and MR cholangiography were obtained. Image analyses were used to identify abnormalities of the intrahepatic and extrahepatic bile ducts and the presence of hepatobiliary malignancy. All MR examinations were reviewed by the consensus of two abdominal radiologists. RESULT: Intrahepatic bile duct abnormalities were seen in 23 (89%) of the 26 patients. The most common finding was mild dilatation of the intrahepatic bile duct which was found in 21 (81%). "Too many intrahepatic ducts" were found in 16 (62%), wall enhancement and thickening in 21 (81%) and filling defects and ductal stricture in the intrahepatic bile duct in 6 (24%) and 3 (12%) patients, respectively. Extrahepatic ductal dilation was found in 5 (19%) and 9 (35%) revealed hepatobiliary malignancy. CONCLUSION: MR imaging revealed various findings of clonorchiasis, including dilatation, wall enhancement, stricture of the intrahepatic ducts and filling defect within the intrahepatic bile duct.
Adult ; Aged ; Cholangiography/methods ; Clonorchiasis/*diagnosis/radiography ; Female ; Human ; *Magnetic Resonance Imaging/methods ; Male ; Middle Aged

BACKGROUND: Primary stenting as a direct reperfusion procedure after acute myocardial infarction might reduce recurrent myocardial infarction and target vessel revascularization. However, result of long or multiple stenting in the long or tandem lesions were not known. METHOD: From Jan. 1996 to Dec. 1998, patients with acute myocardial infarction including cardiogenic shock were undergone primary stenting using long or multiple stent. The clinical end points were death, recurrent infarction, subsequent bypass surgery, or repeat angioplasty of the infarct-related vessel. The results were compared with age, sex, lesion, and risk matched standard stenting group. RESULT: Baseline characteristics were similar for the 20 patients who underwent standard length stenting and the 13 patients who underwent long or multiple stenting. Stent diameter was similar in two group (3.4+/-0.3 mm vs. 3.5+/-0.4 mm, p=0.65), but total stent length was longer in long or multiple stenting group (15.5+/-1.8 mm vs. 40.18.4 mm, p=0.01). Average numbers of stent using in multiple stenting were 1.5+/-0.7. Stenting in the infarct-related artery was successful in all patients randomized to stent treatment. At 6 months, the incidence of the primary end point was 25% (5/20) in the standard stent group and 31%(4/13) in the long or multiple stent group (p=0.5). CONCLUSION: Outcomes of long or multiple stenting including mortality, recurrent myocardial infarction and target vessel revascularization was similar to standard stenting. Long or multiple stenting after acute myocardial infarction may possible procedure in some selective cases having long or tandem lesion.
Angioplasty* ; Arteries ; Humans ; Incidence ; Infarction ; Mortality ; Myocardial Infarction ; Reperfusion ; Shock, Cardiogenic ; Stents*

PURPOSE: To investigate changes in the ovary revealed by MR imaging before and after radiotherapy in premenopausal patients with cervical carcinoma. MATERIALS AND METHODS: Thirty-three premenopausal patients with cervical carcinoma underwent radiation therapy at an average dosage of 11,279 (external: 5,352; internal: 5,927) cGy. Before and after this therapy, all underwent pelvic MR imaging using a 1.5T MR scanner (GE Medical Systems, Milwaukee, U.S.A.). The average interval of follow-up MR imaging was 7.2 months, and axial T1-weighted and axial and sagittal T2-weighted MR images were obtained. The presence, size number of follicles, and differentiation of the zonal anatomy of the ovary were determined by two radiologists, who reached a consensus. RESULTS: After radiation therapy, all patients ceased menstruation. For ovaries, the detection rates before and after radiation therapy were 94% (62/66) and 39% (26/66) (p<0.05), respectively, and average ovary size was 2.6x1.9x2.2 cm before and 1.7x1.3x1.4 cm after therapy (p<0.05). The average number of ovarian follicles before and after therapy was 5.1 and 3.1, respectively (p<0.05). T2-weighted imaging, demonstrated differentiation of zonal anatomy in 74% of cases (46/62) before radiotheraphy, and 15% (4/26) after (p<0.05). CONCLUSION: Our study has shown that after radiation therapy in premenopausal patients with cervical cancer, detection rates, average size, and the number of ovaries decreased, findings which are similar to those for normal postmenopausal ovary. MR imaging can reveal structural change in ovaries.
Cervix Uteri* ; Consensus ; Female ; Fluconazole ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Menstruation ; Ovarian Follicle ; Ovary* ; Radiotherapy* ; Uterine Cervical Neoplasms

A giant serpentine aneurysm (GSA) in the anterior cerebral artery (ACA) poses a technical challenge in treatment given its large size, unique neck, and dependent distal vessels. Here we report the case of a GSA in the ACA successfully treated with a combined surgical and endovascular approach. A 54-year-old woman presented with dull headache. On brain computed tomography (CT), a large mass (7 cm × 5 cm × 5 cm) was identified in the left frontal lobe. Cerebral angiography revealed a GSA in the left ACA. Bypass surgery of the distal ACA was performed, followed byocclusion of the entry channel via an endovascular approach. Follow-up CT performed 5 days after treatment revealed disappearance of the vascular channel and peripheral rim enhancement. Follow-up imaging studies performed 7 months after treatment revealed gradual reduction of the mass effect and patency of bypass flow. No complications were noted over a period of 1 year after surgery.
Aneurysm* ; Anterior Cerebral Artery* ; Brain ; Cerebral Angiography ; Cerebral Revascularization ; Female ; Follow-Up Studies ; Frontal Lobe ; Headache ; Humans ; Intracranial Aneurysm ; Middle Aged ; Neck

Development of de novo aneurysm or aneurysm regrowth after complete clipping of an intracranial aneurysm is rare. We report coiled cases of de novo aneurysm and aneurysm regrowth. We retrospectively reviewed 107 cases of intracranial aneurysm coiling performed in our hospital, identifying five cases of coiled aneurysm that were de novo aneurysm or aneurysm regrowth. In all the cases, total or near total occlusion was seen. There were no complications related to the procedure. In two of the three patients with ruptured aneurysms, consciousness level on admission was stupor. When the patient was discharged after the treatment, one of them had 4 of the modified Rankin Scale. The other one had 5 on discharge. The rest three patients had 0. As for a de novo aneurysm or a regrowth of aneurysm, coiling may be considered when clipping is difficult.
Aneurysm ; Aneurysm, Ruptured ; Consciousness ; Humans ; Intracranial Aneurysm ; Retreatment ; Retrospective Studies ; Stupor ; Subarachnoid Hemorrhage

PURPOSE: To correlate the findings of perfusion-weighted imaging (PWI) with clinical outcomes in patients with acute lacunar infarction. MATERIALS AND METHODS: Eleven patients (7 males and 4 females) with acute lacunar infarction who were examined within 50 (mean, 29) hours of the onset of symptoms underwent conventional MRI, diffusion-weighted imaging (DWI) and PWI. Gadolinium (0.2 mmol/kg) was injected at a rate of 2 ml/sec, and PWI was performed using a gradient-echo EPI pulse sequence and the following parameters: TR/TE, 2000/60; flip angle, 90 degree; matrix size, 128X128. Relative cerebral blood volume (rCBV) maps were derived from gadolinium bolus perfusion-weighted images where rCBV ratios between infarcted areas were detected by DWI, and contralateral control areas were obtained. In each case, the resulting rCBV ratio at a lesion site was compared with the clinical outcome determined on the basis of the difference between National Institute Health Stroke Scale (NIHSS) scores at admission and discharge. RESULTS: With the aid of the time-intensity curve obtained at PWI, the rCBV maps revealed a hypoperfused area in 10 of 11 patients, and there was positive correlation (r=0.81) with clinical outcome. CONCLUSION: Although PWI has a lower detection rate than DWI, it may be a useful modality for helping determine prognosis in cases of acute lacunar infarction.
Blood Volume ; Diagnosis* ; Gadolinium ; Humans ; Magnetic Resonance Imaging* ; Male ; Perfusion* ; Prognosis ; Stroke ; Stroke, Lacunar*

Neonatal Hemangioendothelioma (HE) is the most common type of hepatic vascular tumor that presents in infancy. HE generally undergo spontaneous regression within a year, but it may become symptomatic and be associated with life-threatening complications including congestive heart failure, consumptive coagulopathy and hepatic rupture. We report five cases of neonatal hepatic HE with brief review of the literatures. The report include a case of HE associated with AV malformation complicated by congestive heart failure who was successfully treated by hepatic artery embolization, a case of HE associated with transposition of great artery (TGA), and three cases of asymptomatic HE with spontaneous involution.
Arteries ; Heart Failure ; Hemangioendothelioma* ; Hepatic Artery ; Rupture

We report a case of an intraparenchymal schwannoma of the left parietal lobe. A 51-year-old woman was admitted to our hospital with complaints of intermittent headaches. Computed tomography and magnetic resonance images revealed a 1.3 cm sized intra-axial homogeneous enhancing mass in the left parietal lobe. The lesion was pathologically confirmed to be a schwannoma.
Brain Neoplasms ; Female ; Headache ; Humans ; Magnetic Resonance Spectroscopy ; Middle Aged ; Neurilemmoma ; Parietal Lobe