No abstract available.
Diverticulum*

PURPOSE: Thallim-201 (201Tl) brain SPECT and proton (1H) magnetic resonance spectroscopy (MRS) have been used to evaluate tumor grade and viability of glioma. We assessed the correlations between 201Tl brain index or spectrum of metabolites of 1H MRS and grade of glioma or histopathologic findings. MATERIALS AND METHODS: We studied 17 patients (4 astrocytoma, 7 anaplastic astrocytoma and 6 glioblastoma). On 201Tl Brain SPECT, 201Tl index was measured as the ratio of average counts for region of interest to those for the contralateral normal brain. On 1H MRS, we calculated choline (Cho) /creatine (Cr) ratio and N-acetylaspartate (NAA)/Cr ratio in ROI defined as tumor center. Histopathologic findings were graded by Ki-67 index, cellularity, mitosis, pleomorphism, necrosis and endothelial proliferation. An unpaired t test and statistical correlations were performed to evaluate these data. RESULTS: Tl-index showed the best correlation with Ki-67 index (p<0.01), less correlations with cellularity, mitosis, and endothelial proliferation, but no correlation with results of MRS, pleomorphism, or necrosis. The findings of MRS did not correlate with all of the above. The cases of glioblastoma demonstrated a higher Tl-index, Cho/Cr ratio, Ki-67 index and lower NAA/Cr ratio, albeit without statistical significance. CONCLUSION: Even though 201Tl brain SPECT did not correlate directly with grade of malignancy, it may still be useful in determining biological aggressiveness of tumor and prognosis of patients because it correlated well with Ki-67 index, a growth fraction of glioma, cellularity, mitosis and endothelial proliferation.
Astrocytoma ; Brain* ; Choline ; Glioblastoma ; Glioma* ; Humans ; Magnetic Resonance Spectroscopy* ; Mitosis ; Necrosis ; Pathology* ; Prognosis ; Protons ; Tomography, Emission-Computed, Single-Photon*

Circling mouse (C57BL/6J-cir/cir) deleted the transmembrane inner ear (Tmie) gene is an animal model for human non-syndromic recessive deafness, DFNB6. In circling mouse, hair cells in the cochlea have degenerated and hair bundles have become irregularity as time goes on. Tmie protein carries out a function of the mechanoelectrical transduction channel in cochlear hair cells. Myosin7a (MYO7A) protein has key roles in development of the cochlear hair bundles as well as in the function of cochlear hair cells. To find whether Tmie protein interacts with MYO7A proteins in the cochlea postnatal developmental stage, we investigated expression of the MYO7A proteins in the cochlear hair cells of circling mice by western blot analysis and whole mount immunofluorescence at postnatal day 5 (P5). The expression of MYO7A showed statistically significant increase in the cochlea of C57BL/6J-+/cir and C57BL/6J-cir/cir mice than that of C57BL/6J-+/+ mice. The MYO7A intensity of the cochlear hair cells also increased in C57BL/6J-+/cir and C57BL/6J-cir/cir mice compared with those of C57BL/6J-+/+ mice. Taken together, the results indicate that Tmie protein may have an important role with MYO7A protein in the development and maintenance of the stereociliary bundles during postnatal developmental stage of the cochlea.
Animals ; Blotting, Western ; Cochlea ; Deafness ; Ear, Inner ; Fluorescent Antibody Technique ; Hair ; Hair Cells, Auditory* ; Humans ; Mice* ; Models, Animal

PURPOSE: Despite the advocation of a breast conserving approach to the treatment of breast cancer, many women continue to surgically require or choose mastectomy for the treatment of breast cancer. In many cases, breast reconstruction after mastectomy is being performed using tissue expander, implants or a myocutaneous flap. In recent years, immediate free transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction has become an cosmetically and economically attractive alternative, compared to other types of reconstruction, although the technique is not easy. The author's experience with 25 successful immediate free TRAM flap reconstructions is reviewed. METHODS: We analyzed 25 cases of immediate free TRAM reconstruction that were performed at the Department of Surgery, Hanyang University Hospital, from August 1995 to June 2000, for age, histologic type, stage and estimated degree of patient satisfaction. RESULTS: The patient age distribution ranged from 26 to 58 years old, the mean age was 38.3, and the majority of tumors were invasive ductal carcinoma (13 cases) and intraductal carcinoma (8 cases). All tumor sizes were less than 3 cm (Tis: 8 cases, T1: 8 cases, T2: 7 cases) with the exception of the phyllodes tumors (8 cm and 6 cm). The stage was from 0 to IIB (0: 7 cases, I: 7 cases, IIA: 8 cases, IIB: 1 case, phyllodes tumor: 2 cases). Immediate posto-perative complications included 3 cases of bleeding and 1 case of wound infection at the donor site. According to the patients' expressed opinions, almost all patients were pleased with the result. There was no local recurrence during the follow-up period except for one case of bone metastasis that developed. CONCLUSION:This technique undoubtedly can play a major role in the so called "onco-plastic" surgical management of breast cancer.
Age Distribution ; Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Mammaplasty ; Mastectomy* ; Middle Aged ; Myocutaneous Flap ; Neoplasm Metastasis ; Patient Satisfaction ; Phyllodes Tumor ; Rectus Abdominis ; Recurrence ; Tissue Donors ; Tissue Expansion Devices ; Wound Infection

PURPOSE: Despite the advocation of a breast conserving approach to the treatment of breast cancer, many women continue to surgically require or choose mastectomy for the treatment of breast cancer. In many cases, breast reconstruction after mastectomy is being performed using tissue expander, implants or a myocutaneous flap. In recent years, immediate free transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction has become an cosmetically and economically attractive alternative, compared to other types of reconstruction, although the technique is not easy. The author's experience with 25 successful immediate free TRAM flap reconstructions is reviewed. METHODS: We analyzed 25 cases of immediate free TRAM reconstruction that were performed at the Department of Surgery, Hanyang University Hospital, from August 1995 to June 2000, for age, histologic type, stage and estimated degree of patient satisfaction. RESULTS: The patient age distribution ranged from 26 to 58 years old, the mean age was 38.3, and the majority of tumors were invasive ductal carcinoma (13 cases) and intraductal carcinoma (8 cases). All tumor sizes were less than 3 cm (Tis: 8 cases, T1: 8 cases, T2: 7 cases) with the exception of the phyllodes tumors (8 cm and 6 cm). The stage was from 0 to IIB (0: 7 cases, I: 7 cases, IIA: 8 cases, IIB: 1 case, phyllodes tumor: 2 cases). Immediate postoperative complications included 3 cases of bleeding and 1 case of wound infection at the donor site. According to the patients' expressed opinions, almost all patients werepleased with the result. There was no local recurrence during the follow-up period except for one case of bone metastasis that developed. CONCLUSION: This technique undoubtedly can play a major role in the so called "onco-plastic" surgical management of breast cancer.
Age Distribution ; Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Mammaplasty ; Mastectomy* ; Middle Aged ; Myocutaneous Flap ; Neoplasm Metastasis ; Patient Satisfaction ; Phyllodes Tumor ; Postoperative Complications ; Rectus Abdominis ; Recurrence ; Tissue Donors ; Tissue Expansion Devices ; Wound Infection

BACKGROUND: Aging is an important factor to determine transmitral inflow velocity pattern. Cardiac geometry such as left ventricular (LV) volume, mass and left ventricular outflow tract (LVOT) was also changed with age. The aim of this study was to assess the impact of geometric change of LVOT on transmitral inflow velocity pattern excluding a factor of age. METHODS: Healthy 115 (61 men, 37+/-15 years) individuals were enrolled. Echocardiography was performed to measure LV mass, thickness, left atrial (LA) size, aortoseptal angle (ASA), early (E) and late (A) transmitral inflow velocity, and deceleration time (DT). ASA was measured at mid-diastole in apical long-axis view according to a method as the open angle between the edge of the interventricular septum and axis perpendicular to the aortic annulus. The relation between transmitral inflow velocity pattern and LV geometric parameters was analyzed by regression analysis. RESULTS: Simple regression analysis demonstrated a significant correlation between transmitral inflow parameters with age and geometric parameters (ASA, LA size and LV mass index). Multiple regression analysis, taking into consideration age, ASA, LA size and LV mass index showed that only age was an independent predictor for E, A, DT, and E/A ratio (r2=0.210, Beta coefficient (beta)=0.459, p<0.001;r2=0.427, beta=0.654, p<0.001;r2=0.227, beta=-0.476, p<0.001;r2=0.436, beta=-0.661, p<0.001, respectively). But, excluding age, ASA was an independent predictor for E, A, DT, and E/A ratio (r2=0.151, beta=0.389, p<0.001;r2=0.294, beta=0.542, p<0.001;r2=0.227, beta=-0.476, p<0.001;r2=0.260, beta=0.509, p<0.001, respectively). CONCLUSION: ASA, a parameter of LVOT geometry, might be an important factor related to transmitral inflow velocity pattern excluding a factor of age.
Aging ; Axis, Cervical Vertebra ; Deceleration ; Diastole ; Echocardiography ; Heart Ventricles ; Humans ; Male

Early post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) prediction may allow safe same-day outpatients discharge after ERCP and earlier proper management. This study aimed to assess the usefulness of the 4-hour post-ERCP serum amylase and lipase levels for PEP early prediction and to investigate predictive cut-off values for 4-hour post-ERCP serum amylase and lipase levels for safe discharge and urgent initiation of resuscitation. The data of 516 consecutive patients with native papilla who underwent ERCP between January 2013 and August 2014 were retrospectively reviewed. Serum amylase and lipase levels were measured before, and 4 and 24 hours after ERCP. PEP occurred in 16 (3.1%) patients. The receiver-operator characteristic curve for 4-hour post-ERCP serum amylase and lipase levels showed that the areas under the curve were 0.919 and 0.933, respectively, demonstrating good test performances as predictors for PEP (both P values < 0.001). The amylase level > 1.5 × the upper limit of reference (ULR) was found useful for PEP exclusion with a sensitivity of 93.8%, while 4 × ULR was found useful to guide preventive therapy with the best specificity of 93.2%. Similarly, the lipase level 2 × ULR showed best sensitivity, while 8 × ULR had the best specificity. Logistic regression analysis showed that 4-hour post-ERCP amylase level > 4 × ULR, lipase level > 8 × ULR, precut sphincterotomy, and pancreatic sphincterotomy were significant predictors for PEP. In conclusion, 4-hour post-ERCP amylase and lipase levels are useful early predictors of PEP that can ensure safe discharge or prompt resuscitation after ERCP.
Amylases* ; Cholangiopancreatography, Endoscopic Retrograde ; Humans ; Lipase* ; Logistic Models ; Outpatients ; Pancreatitis* ; Resuscitation ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND AND OBJECTIVES: The prevention of sudden death in patients with a myocardial infarction (MI) remains the therapeutic target. T-wave alternans is as a heart rate dependent measure of repolarization, which correlates with ventricular arrhythmia vulnerability. The goals of this study were to clarify whether microvolt-level T-wave alternans (mTWA) can predict lethal arrhythmic events, and compare their role with other risk indices in predicting lethal events following a MI. SUBJECTS AND METHODS: The mTWA was analyzed in 78 MI patients, using a power-spectral method during bicycle exercise testing. Additionally, the left ventricular ejection fraction (EF), late potentials (LP) and heart rate variability were also measured. RESULTS: The mTWA was positive in 16 patients (21%), negative in 36 (46%) and indeterminate in 21 (33%). Lethal arrhythmic events developed in 7 patients (3 sudden deaths, 3 ventricular tachycardia and 1 ventricular fibrillation), during a mean follow-up of 12+/-3 months. The event rate was significantly higher in patients with a positive mTWA (relative risk 12.0, 95% CI 1.2 to 118.1, p=0.01) or lower EF (<40%)(relative risk 11.0, CI 1.9 to 65.0, p=0.002). The mTWA test exhibited the highest sensitivity, relative risk and negative predictive value, but the lowest specificity; positive predictive values were observed compared with the EF or a combination of the two indices. CONCLUSION: mTWA was closely related to the occurrence of lethal arrhythmic events in patients with a MI. Therefore, mTWA with a lower EF could be a useful screening test for the prediction of potentially lethal arrhythmic events following a MI.
Arrhythmias, Cardiac ; Death, Sudden ; Death, Sudden, Cardiac ; Exercise Test ; Follow-Up Studies ; Heart Rate ; Humans ; Mass Screening ; Myocardial Infarction* ; Sensitivity and Specificity ; Stroke Volume ; Tachycardia, Ventricular ; Ventricular Fibrillation

BACKGROUND: Ventilator-associated pneumonia (VAP) requires prompt and appropriate treatment. Since methicillin-resistant Staphylococcus aureus (MRSA) is a frequent pathogen in VAP, rapid identification of it, is pivotal. Our aim was to evaluate the utility of quantitative polymerase chain reaction (qPCR) as a useful method for etiologic diagnoses of MRSA pneumonia. METHODS: We performed qPCR for mecA, S. aureus-specific femA-SA, and S. epidermidis-specific femA-SE genes from bronchoalveolar lavage or bronchial washing samples obtained from clinically-suspected VAP. Molecular identification of MRSA was based on the presence of the mecA and femA-SA gene, with the absence of the femA-SE gene. To compensate for the experimental and clinical conditions, we spiked an internal control in the course of DNA extraction. We estimated number of colony-forming units per mL (CFU/mL) of MRSA samples through a standard curve of a serially-diluted reference MRSA strain. We compared the threshold cycle (Ct) value with the microbiologic results of MRSA. RESULTS: We obtained the mecA gene standard curve, which showed the detection limit of the mecA gene to be 100 fg, which corresponds to a copy number of 30. We chose cut-off Ct values of 27.94 (equivalent to 1x10(4) CFU/mL) and 21.78 (equivalent to 1x10(5) CFU/mL). The sensitivity and specificity of our assay were 88.9% and 88.9% respectively, when compared with quantitative cultures. CONCLUSION: Our results were valuable for diagnosing and identifying pathogens involved in VAP. We believe our modified qPCR is an appropriate tool for the rapid diagnosis of clinical pathogens regarding patients in the intensive care unit.
Adenosine ; Bronchoalveolar Lavage ; Coat Protein Complex I ; DNA ; Humans ; Critical Care ; Intensive Care Units ; Limit of Detection ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia ; Pneumonia, Ventilator-Associated ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction ; Sprains and Strains ; Stem Cells

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial ischemia, which frequently presents as sudden death. The pathophysiology and treatment of SCAD have not been fully determined. Herein, a case of SCAD, manifesting as variant angina, which rapidly progressed during an ergonovine test, in which 3 drug-eluting stents were deployed using intravascular an ultrasound guidance, with an excellent immediate result, is reported.
Coronary Vessels* ; Death, Sudden ; Drug-Eluting Stents ; Ergonovine* ; Myocardial Ischemia ; Stents* ; Ultrasonography* ; Ultrasonography, Interventional