We report on three patients with transient focal neurologic deficits that completely resolved. In all cases, initial perfusion-weighted imaging (PWI) performed 1 hour after being free of symptoms showed a defect in the time-to-peak (TTP) map in the area with normal diffusion-weight imaging (DWI) findings. After 24 hours, DWI showed a high signal intensity in exactly the same area as the TTP defect. Therefore, early PWI provides a rapid evaluation of cerebral hemodynamics in transient ischemic attack.
Hemodynamics ; Humans ; Ischemic Attack, Transient ; Magnetic Resonance Angiography ; Neurologic Manifestations ; Perfusion ; Thymine Nucleotides

BACKGROUND: Recent studies show that the time to positivity (TTP) of peripheral blood culture is a useful marker for some clinical characteristics such as the source of infection and the clinical outcome in bacteremia caused by some virulent bacteria, since TTP has relationship with bacterial blood concentration. One recent study of candidemia also reported the usefulness of TTP in the differentiation between central venous catheter (CVC)-related candidemia and non-CVC-related candidemia. OBJECTIVE: We investigasted the clinical usefulness of TTP in the patients with candidemia. METHODS: Fifty-four admitted patients with candidemia were detected between March 2006 and July 2008. After the exclusion, we reviwed the medical records of 45 patients and investigasted the relationship of clinical characteristics of candidemia with TTP, which was recorded by the BACTEC 9240 system. RESULTS: Most episodes of candidemia developed in non-neutropenic patients, except 4 episodes. Majority of the patients with candidemia had the history of previous antibiotic use (88.6%) and CVCs (62.2%). CVC-related candidemia was observed in more thant a half (24/45, 53.3%) of the patients. However, only in 10 (41.7%) of them, CVCs were removed early. The persistence of candidemia (> or = 3 days) and the fatal outcome (within 30 days) were observed in 14 (31.3%) and 17 (37.8%) patients, respectively. TTP was shorter in CVC-related candidemia (31.3+/-13.2 hours) than that in non-CVCrelated candidemia (52.1+/-37.8 hours) (p=0.032). The patients with the persistence of candidemia had shorter TTP (28.9+/-11.2 hours) than those without the persistence (45.7+/-28.6) (p=0.012). The value of TTP cutoff predicting the CVC-related candidemia and the persistence of candidemia was 38 hours (area under the receiver-operator characteristic curve of 0.70 and 0.75, respectively). CONCLUSION: TTP may be helpful for the differentiation of the source of candidemia and the prediction of the persistence of candidemia in the patients without neutropenia. The early removal of CVC may prevent the persistence of candidemia in non-neutropenic patients with candidemia of short TTP (< or = 38 hours).
Bacteremia ; Bacteria ; Candida ; Candidemia ; Central Venous Catheters ; Fatal Outcome ; Humans ; Medical Records ; Neutropenia ; Thymine Nucleotides

PURPOSE: To assess the diagnostic value of dynamic perfusion MR imaging for differentiation between benign and malignant musculoskeletal lesions. MATERIALS AND METHODS: Dynamic perfusion MR imaging was performed using a 3.0 T system in 32 female and 30 male patients (aged 10-90 years, mean age, 43 years). Following the assessment of the precontrast imaging, a dynamic study was performed. This dynamic technique allowed for 638 images to be obtained at 11 levels throughout the lesion. Twenty-eight lesions originated within bone (8 benign, 20 malignant), whereas 34 lesions were of soft tissue origin (22 benign, 12 malignant). The final diagnosis was histopathologically confirmed in all patients. To differentiate between benign and malignant lesions, we analyzed the four parameters: (maximal relative enhancement (MRE), time to peak (TTP), wash in rate (WI), steepest slope (SS) and the distribution of time intensity curve (TIC) patterns. RESULTS: The TTP, WI, and SS values of malignant lesions were statistically significant from those of benign lesions (p < 0.05). However, the difference for the MRE values was not statistically significant. The distribution of TIC patterns was a helpful indicator of benign or malignant state, however the difference between the two states was not significant. CONCLUSION: Dynamic perfusion MR imaging is a helpful tool in differentiating benign and malignant musculoskeletal lesions.
Bone Neoplasms ; Female ; Humans ; Male ; Musculoskeletal Diseases ; Perfusion ; Soft Tissue Neoplasms ; Thymine Nucleotides ; Tics

Although thrombotic thrombocytopenic purpura (TTP) is a rare disease, when it develops in a post-cardiac surgery patient, it may have a fatal outcome. Since the frequency of early-onset thrombocytopenia in post-cardiac surgery patients is high, platelet concentrates are commonly transfused during postoperative management. However, when TTP is the likely diagnosis, platelet transfusion is not recommended. We experienced a postoperative TTP in a cardiac surgery patient and discovered the importance of identifying the etiology of postoperative thrombocytopenia. Here, we report the case with a brief review of the literature.
Blood Platelets ; Fatal Outcome ; Humans ; Platelet Transfusion ; Purpura, Thrombotic Thrombocytopenic ; Rare Diseases ; Thoracic Surgery ; Thrombocytopenia ; Thymine Nucleotides

Although thrombotic thrombocytopenic purpura (TTP) is a rare disease, when it develops in a post-cardiac surgery patient, it may have a fatal outcome. Since the frequency of early-onset thrombocytopenia in post-cardiac surgery patients is high, platelet concentrates are commonly transfused during postoperative management. However, when TTP is the likely diagnosis, platelet transfusion is not recommended. We experienced a postoperative TTP in a cardiac surgery patient and discovered the importance of identifying the etiology of postoperative thrombocytopenia. Here, we report the case with a brief review of the literature.
Blood Platelets ; Fatal Outcome ; Humans ; Platelet Transfusion ; Purpura, Thrombotic Thrombocytopenic ; Rare Diseases ; Thoracic Surgery ; Thrombocytopenia ; Thymine Nucleotides

BACKGROUND: Diffusion-perfusion mismatch (DPM) on MRI has been considered an ischemic penumbra. However, several reports have demonstrated limitation of DPM on MRI as a predictable marker of the ischemic penumbra. In this study, we investigated the relationship between DPM and the clinical progression in acute ischemic stroke patients. METHODS: We consecutively recruited fifty-seven patients showing acute ischemic stroke (within 24 hours) in the middle cerebral artery (MCA) territory. The clinical outcomes were determined by serial measurement of National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) during 30 days after their ischemic event. We also evaluated the relationship among the parameters of perfusion MRI and the clinical worsening in patients with DPM on initial MRI. RESULTS: Nineteen (33.3%) patients had DPM on MRI within 24 hours after stroke onset. Even though the frequency of clinical worsening for 30 days after stroke onset was higher in DPM group (26%) than in non-DPM group (11%), it did not reach statistical significance (p=0.143). However, extent of MCA stenosis (p<0.001) and time to peak (TTP) delay on MRI (p<0.001) were significantly greater in patients with DPM than in those without DPM. Among several parameters of the perfusion MRI, only relative cerebral blood volume (rCBV) was significantly related to the clinical worsening (62.9+/-24.7% vs 96.1+/-19.2%, p=0.007) in patients with DPM. CONCLUSIONS: This study shows that DPM on MRI does not always predict the clinical worsening in acute ischemic stroke. To overcome this problem, we should analyze rCBV map based DPM as well as TTP map based DPM.
Blood Volume ; Brain ; Constriction, Pathologic ; Diffusion ; Humans ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Perfusion ; Stroke ; Thymine Nucleotides

PURPOSE: To determine the quantitative parameters of breast MRI that predict tumor invasion in biopsy-proven DCIS. MATERIALS AND METHODS: From January 2009 to March 2010, 42 MRI examinations of 41 patients with biopsy-proven DCIS were included. The quantitative parameters, which include the initial percentage enhancement (E1), peak percentage enhancement (E(peak)), time to peak enhancement (TTP), signal enhancement ratio (SER), arterial enhancement fraction (AEF), apparent diffusion coefficient (ADC) value, long diameter and the volume of the lesion, were calculated as parameters that might predict invasion. Univariate and multivariate analyses were used to identify the parameters associated with invasion. RESULTS: Out of 42 lesions, 23 lesions were confirmed to be invasive ductal carcinoma (IDC) and 19 lesions were confirmed to be pure DCIS. Tumor size (p = 0.003; 6.5 +/- 3.2 cm vs. 3.6 +/- 2.6 cm, respectively) and SER (p = 0.036; 1.1 +/- 0.3 vs. 0.9 +/- 0.3, respectively) showed statistically significant high in IDC. In contrast, E1, Epeak, TTP, ADC, AEF and volume of the lesion were not statistically significant. Tumor size and SER had statistically significant associations with invasion, with an odds ratio of 1.04 and 22.93, respectively. CONCLUSION: Of quantitative parameters analyzed, SER and the long diameter of the lesion could be specific parameter for predicting invasion in the biopsy-proven DCIS.
Breast ; Carcinoma in Situ ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Diffusion ; Humans ; Lymphokines ; Magnetic Resonance Imaging ; Multivariate Analysis ; Odds Ratio ; Thymine Nucleotides

OBJECTIVE: Perfusion-computed tomography (CT) is useful and quick diagnostic tool for evaluating ischemic stroke patients. We evaluated three measurement maps, cerebral blood flow (CBF), cerebral blood volume (CBV) and time to peak (TTP) for their usefulness in deciding on revascularization surgery using CT parameters after single photon emission computed tomography (SPECT) findings in chronic steno-occlusive disease patients. METHODS: We retrospectively investigated 47 patients with unilateral internal carotid artery (ICA) or middle cerebral artery (MCA) steno-occlusive disease . All patients underwent digital subtraction angiography (DSA) as well as an acetazolamide challenge with SPECT and perfusion CT. Patients who showed decreased reserve capacity with a Diamox challenge were classified in the positive group, whereas patients who had no difference in reserve capacity were placed in the negative group. RESULTS: Thirty-one patients were positive and the remaining 16 were negative. Differences in rCBV and rCBF parameters between normal cerebral hemispheres and cerebral hemispheres with steno-occlusive disease did not correlate with SPECT results, but TTP values did. SPECT results seemed relevant when TTP differences between hemispheres with normal and steno-occlusive disease were more than 1.55 times. CONCLUSION: Perfusion CT is a useful tool for the rapid, adequate diagnosis of large territorial infarcts, and the TTP map of perfusion CT is a sensitive and reliable parameter to show the status of collateral circulation in chronic cerebrovascular ischemic disease.
Acetazolamide ; Angiography, Digital Subtraction ; Blood Volume ; Carotid Artery, Internal ; Cerebrum ; Collateral Circulation ; Hemodynamics ; Humans ; Middle Cerebral Artery ; Perfusion ; Retrospective Studies ; Stroke ; Thymine Nucleotides ; Tomography, Emission-Computed, Single-Photon

The introduction of plasma exchange has significantly improved the outcome of thrombotic thrombocytopenic purpura (TTP) and the survival rate was increased from 10 to 80-90%. TTP refractory to plasma exchange therapy, however, is still a therapeutic challenge. We describe here a patient who partially responded to plasma exchange therapy, but remained dependent on plasma infusions. To discontinue plasma therapy, several attempts using agents such as rituximab, vincristine, and cyclosporine A had been tried, but all failed. After splenectomy, serum LDH and blood platelet count were normalized. Plasmapheresis were we able to discontinue after 2 weeks of splenectomy. Steroid and cyclosporine were tapered off after 3 months and 5 months after splenectomy respectively, and the patient has been staying in remission ever since. We suggest that splenectomy is a worthwhile treatment option in patients with refractory TTP.
Antibodies, Monoclonal, Murine-Derived ; Cyclosporine ; Humans ; Plasma ; Plasma Exchange ; Plasmapheresis ; Platelet Count ; Purpura, Thrombotic Thrombocytopenic ; Splenectomy ; Survival Rate ; Thymine Nucleotides ; Vincristine ; Rituximab

Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy characterized by endothelial cell damage, resulting in microangiopathic hemolytic anemia, thrombocytopenia, and various degrees of neurological and renal impairment caused by microvascular thrombi. It is rare in children and frequently follows a fatal course. TTP is divided into 2 types: one is inherited and associated with ADAMTS-13 gene mutations and the other is acquired and associated with anti-ADAMTS-13 autoantibodies. The measurement of ADAMTS-13 activity in plasma, identification of ADAMTS-13 circulating inhibitor, anti-ADAMTS-13 IgG, and ADAMTS-13 gene sequencing are crucial to the diagnosis of TTP. Plasma exchanges are the first-line treatment for acquired TTP, combined with steroids and immunosuppressive drugs. Here, we describe the case of an adolescent patient with TTP, confirmed by decreased level of ADAMTS-13 activity and an increased level of ADAMTS-13 inhibitor, who was successfully treated by plasma exchanges.
Adolescent ; Anemia, Hemolytic ; Autoantibodies ; Child ; Endothelial Cells ; Humans ; Immunoglobulin G ; Plasma ; Plasma Exchange ; Purpura ; Purpura, Thrombotic Thrombocytopenic ; Steroids ; Thrombocytopenia ; Thrombotic Microangiopathies ; Thymine Nucleotides