OBJECTIVE: To compare the efficacy of suprapapillary and transpapillary meth-ods of transhepatic biliary metallic stent placement in malignant biliary strictures and to specify the indications of each method applied. MATERIALS AND METHODS: Stents were placed in 59 patients. Strictures were cat-egorized as type A (within 3 cm of the ampulla, n = 27), type B (over 3 cm from ampulla, n = 7), type C (within 3 cm of the bending portion, n = 9), or type D (over 3 cm above the bending portion, n=16). The stenting method was suprapapillary in 34 cases and transpapillary in 25. The rates of initial and long-term patency and of early recurrence were compared. RESULTS: Initial patency rates for the suprapapillary and transpapillary methods were 1/7 (14.3%) and 20/20 (100%) respectively for type A (p < 0.0001), 4/5 (80.0%) and 2/2 for type B, 3/7 (42.9%) and 2/2 for type C, and 15/16 (93.8%) and 0/0 for type D. Early recurrence rates were 7/30 (23.3%) using the suprapap-illary method and 4/29 (13.8%) using the transpapillary method (p = 0.51). The long-term patency rate did not differ significantly according to either type (p =0.37) or method (p = 0.62). CONCLUSION: For good initial patency, the transpapillary method is recommended for strictures of the distal extrahepatic duct near the ampulla and just above the bending portion. Long-term patency is not influenced by the stenting method employed.
Bile Duct Neoplasms/complications ; Bile Duct Obstruction, Extrahepatic/etiology/*therapy ; Cholangiography ; Comparative Study ; Digestive System Neoplasms/complications ; Female ; Human ; Male ; Middle Age ; Palliative Care/*methods ; *Radiology, Interventional ; Retrospective Studies ; *Stents ; Tomography, X-Ray Computed

OBJECTIVE: To compare the efficacy of suprapapillary and transpapillary meth-ods of transhepatic biliary metallic stent placement in malignant biliary strictures and to specify the indications of each method applied. MATERIALS AND METHODS: Stents were placed in 59 patients. Strictures were cat-egorized as type A (within 3 cm of the ampulla, n = 27), type B (over 3 cm from ampulla, n = 7), type C (within 3 cm of the bending portion, n = 9), or type D (over 3 cm above the bending portion, n=16). The stenting method was suprapapillary in 34 cases and transpapillary in 25. The rates of initial and long-term patency and of early recurrence were compared. RESULTS: Initial patency rates for the suprapapillary and transpapillary methods were 1/7 (14.3%) and 20/20 (100%) respectively for type A (p < 0.0001), 4/5 (80.0%) and 2/2 for type B, 3/7 (42.9%) and 2/2 for type C, and 15/16 (93.8%) and 0/0 for type D. Early recurrence rates were 7/30 (23.3%) using the suprapap-illary method and 4/29 (13.8%) using the transpapillary method (p = 0.51). The long-term patency rate did not differ significantly according to either type (p =0.37) or method (p = 0.62). CONCLUSION: For good initial patency, the transpapillary method is recommended for strictures of the distal extrahepatic duct near the ampulla and just above the bending portion. Long-term patency is not influenced by the stenting method employed.
Bile Duct Neoplasms/complications ; Bile Duct Obstruction, Extrahepatic/etiology/*therapy ; Cholangiography ; Comparative Study ; Digestive System Neoplasms/complications ; Female ; Human ; Male ; Middle Age ; Palliative Care/*methods ; *Radiology, Interventional ; Retrospective Studies ; *Stents ; Tomography, X-Ray Computed

OBJECTIVE: High-molecular-weight hydroxyethyl starch (HES) compromises blood coagulation more than does low-molecular-weight HES. We compared the effects of low- and high-molecular-weight HES for the treatment of vasospasm and investigated the dose relationship with each other. METHODS: Retrospectively, in a series of consecutive 102 patients with subarachnoid hemorrhage (SAH), 35 patients developed clinical symptoms of vasospasm of these fourteen patients were treated with low-molecularweight HES for volume expansion while the other 21 received high-molecular-weight HES as continuous intravenous infusion. Prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen level, and platelet count were all measured prior to initiation, during treatment and after termination of therapy for symptomatic vasospasm. The total dose of HES ranged from 5 L to 14 L and median infusion duration was 10 days. RESULTS: A more pronounced PTT prolongation was observed in high-molecular-weight HES group compared with low-molecular-weight HES group. No other coagulation parameters were altered. Dosage (=duration) shows a positive correlation with PTT. Clinically, significant bleeding episodes were noted in four patients who received high-molecular-weight HES. CONCLUSION: Coagulopathy was developed in direct proportion to molecular weight of starch and dosages. We propose the extreme caution in the administration of HES solution for the vasospasm treatment.
Blood Coagulation ; Fibrinogen ; Hemorrhage ; Humans ; Infusions, Intravenous ; Molecular Weight ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; Retrospective Studies ; Starch* ; Subarachnoid Hemorrhage

PURPOSE: To assess the clinical reliability of the Bosniak IIF category and to determine the proper radiologic follow-up duration and intervals for category IIF complex renal cysts. MATERIALS AND METHODS: We studied 201 patients with category IIF renal cysts from January 1996 to January 2011. Renal cyst progression to category III was defined as an increase in complexity of the cyst in follow-up radiologic studies. We monitored radiologic changes and progression of renal cysts during the follow-up period and analyzed the pathologic results of those patients who were treated surgically. RESULTS: At a mean follow-up of 20 months, only 14 cases (7%) showed evidence of progression to stage III, with a mean time to progression of 11 months (range, 3 to 65 months). There were no significant differences in age, gender, cyst size, or change in cyst size between the progressive and non-progressive groups. Of 12 cases treated surgically, 10 cases (83.3%) showed renal cell carcinoma with pT1 stage, and there was no recurrence during postoperative follow-up of 23 months. Of the 187 patients without radiologic progression, 23 cases were treated surgically, and all of them showed benign cysts. CONCLUSIONS: The IIF category showed significant clinical reliability by a low rate of radiologic progression and a high rate of malignancy in the radiologic progressive group but a low rate of malignancy in the non-progressive group. Although it is hard to decide on a proper follow-up duration because of the variable time to progression, too frequent follow-up study seems to be unnecessary considering that most malignant cases were of a low stage.
Carcinoma, Renal Cell ; Disease Progression ; Follow-Up Studies ; Humans ; Kidney ; Recurrence

OBJECTIVES: In this study, we investigated the influence of ionic strength and natural organic matter (NOM) on aggregation and soil adsorption of citrate-coated silver nanoparticles (AgNPs). METHODS: Time-resolved dynamic light scattering measurements and batch adsorption experiments were used to study their aggregation and soil adsorption behaviors, respectively. RESULTS: The aggregation rate of AgNPs increased with increasing ionic strength and decreasing NOM concentration. At higher ionic strength, the AgNPs were unstable, and thus tended to be adsorbed to the soil, while increased NOM concentration hindered soil adsorption. To understand the varying behaviors of AgNPs depending on the environmental factors, particle zeta potentials were also measured as a function of ionic strength and NOM concentration. The magnitude of particle zeta potential became more negative with decreasing ionic strength and increasing NOM concentration. These results imply that the aggregation and soil adsorption behavior of AgNPs were mainly controlled by electrical double-layer repulsion consistent with the Derjaguin-Landau-Verwey-Overbeek theory. CONCLUSIONS: This study found that the aggregation and soil adsorption behavior of AgNPs are closely associated with environmental factors such as ionic strength and NOM and suggested that assessing the environmental fate and transport of nanoparticles requires a thorough understanding of particle-particle interaction mechanisms.
Adsorption* ; Chemistry* ; Nanoparticles* ; Osmolar Concentration ; Silver* ; Soil* ; Water*

The high signal intensities in bilateral mesiotemporal lobes on T2-weighted images are typical findings of herpes encephalitis or paraneoplastic limbic encephalitis. We report a case of neurosyphilis with mesiotemporal involvement on MRI. Positive antibodies in the cerebrospinal fluid confirmed the diagnosis. The results suggest that neurosyphilis should be considered when MRI results indicate mesiotemporal abnormalities.
Adult ; Anti-Bacterial Agents/administration & dosage ; Biopsy, Needle ; Chancre/diagnosis/pathology ; Diagnosis, Differential ; Encephalitis, Herpes Simplex/diagnosis ; Follow-Up Studies ; Humans ; Limbic Encephalitis/diagnosis ; Magnetic Resonance Imaging/*methods ; Male ; Neurosyphilis/*diagnosis/drug therapy/pathology ; Penicillins/administration & dosage ; Rare Diseases ; Temporal Lobe/*pathology ; Tongue/pathology

PURPOSE: We investigated the operative outcome after bypass surgery in patients selected using viability criteria on F-18 FDG PET. MATERALS AND METHODS: Rest-24hr delay redistribution imaging of Tl-201 SPECT and F-18 FDG PET were performed in 11 patients. Seven of these 11 patients (6 men, 1 woman) were evaluated to have viable myocardium by F-18 FDG PET. Changes in symptoms and left ventricular ejection fraction (LVEF) after operation were evaluated. RESULTS: In seven of 11 patients, a significant amount of viable myocardium was found on F-18 FDG PET and Tl-201 SPECT. Severity of both chest pain and dyspnea improved markedly in all patients. Mean LVEF improved from 22% to 32%. CONCLUSION: F-18 FDG PET could be used to select the patients who will benefit from coronary artery bypass surgery.
Cardiomyopathies* ; Chest Pain ; Coronary Artery Bypass ; Dyspnea ; Humans ; Male ; Myocardium ; Positron-Emission Tomography ; Stroke Volume ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: Doxylamine, an antihistamine with sleep inducing property, is the most commonly intoxicated drug in the urban ED. This drug is relatively safe but is known to induce rhabdomyolysis in rare occasion. The purpose of this study is to determine the incidence of rhabdomyolysis after doxylamine overdose and prognostic factors that contributes to this complication. METHOD: This study was conducted from 26 patients admitted to our hospital after doxylamine intoxication during the period from April 1999 to June 1999. Using the protocol made beforehand, the amount ingested, past history, laboratory results were recorded. Rhabdomyolysis was defined as serum myoglobin over 300 ng/mL or serum creatine phosphokinase(CK) over 1,000 IU/L. Data were analyzed using SPSS program with t-test, Fisher's exact test and discriminant analysis. RESULTS: The rhabdomyolysis was diagnosed in 57.7% of patients. The amount ingested per body weight, prehospital vomiting and low arterial pCO2 predicted occurrence of rhabdomyolysis. The sensitivity of serum CK and myoglobin were 67% and 80% respectively and specificity was 100% for both. The diagnosis was possible for CK after an average of 14hr 20min time after ingestion and 8hr 12min for myoglobin. CONCLUSION: Rhabdomyolysis is a common complication of doxylamine intoxication and if the amount ingested was more than 1 tablet(25mg) per body weight, the incidence of rhabdomyolysis was higher. So, CK measurement after 14 hour postingestion and myoglobin after 8 hour is recommended to decide whether rhabdomyolysis occur.
Body Weight ; Creatine ; Diagnosis ; Doxylamine* ; Eating ; Humans ; Incidence* ; Myoglobin ; Rhabdomyolysis* ; Sensitivity and Specificity ; Vomiting

OBJECTIVE: Hydrocephalus and vasospasm are the common complications of aneurysmal subarachnoid hemorrhage (SAH). In spite of development of perioperative management and operative technique, hydrocephalus and vasospasm are the causes of the neurological deficit and poor prognosis. This study was designed to investigate whether the frequency of a shunt-dependent hydrocephalus in patient suffering from aneurysmal subarachnoid hemorrhage and delayed cerebral ischemia can be related to the duration and amount of cerebrospinal fluid drainage and medical history. METHODS: Retrospective analysis of consecutive 96 patients with aneurysmal subarachnoid hemorrhage was made from January 2000 to December 2002. Eighty one of these patients underwent the procedure for CSF drainage and 15 patients did not. 81 patients with aneurysmal SAH were divided into two groups which underwent shunt procedure and did not. In these two groups, we investigated and compared the incidence of shunt-dependent hydrocephalus and ischemia according to age, sex, aneurysmal site, H-H grade, Fisher grade, medical history and the amout of CSF drainage. RESULTS: The incidence of hydrocephalus following SAH was 53.1% and shunt-dependent hydrocephalus was 16.7% in 96 patients. The duration, total volume, and daily volume of CSF drainage were 6.9+/-3.3 days, 1542.3+/-982.5 ml, and 211.5+/-49.2 ml, respectively. The relationship between the daily volume of CSF drainage and shunt-dependent hydrocephalus was determined to to be statistically significant (p<0.05). Cerebral infarction and shunt-dependent hydrocephalus were found to be statistically associated (p<0.05). CONCLUSION: The continous drainage of cerebrospinal fluid in patients of aneurysmal subarachnoid hemorrhage increase chance of delayed hydrocephalus and they have not shown decrease cerebral infarction as a result of vasospasm.
Aneurysm ; Brain Ischemia ; Cerebral Infarction ; Cerebrospinal Fluid ; Drainage* ; Humans ; Hydrocephalus ; Incidence ; Ischemia ; Prognosis ; Retrospective Studies* ; Subarachnoid Hemorrhage*

OBJECTIVE: Hydrocephalus and vasospasm are the common complications of aneurysmal subarachnoid hemorrhage (SAH). In spite of development of perioperative management and operative technique, hydrocephalus and vasospasm are the causes of the neurological deficit and poor prognosis. This study was designed to investigate whether the frequency of a shunt-dependent hydrocephalus in patient suffering from aneurysmal subarachnoid hemorrhage and delayed cerebral ischemia can be related to the duration and amount of cerebrospinal fluid drainage and medical history. METHODS: Retrospective analysis of consecutive 96 patients with aneurysmal subarachnoid hemorrhage was made from January 2000 to December 2002. Eighty one of these patients underwent the procedure for CSF drainage and 15 patients did not. 81 patients with aneurysmal SAH were divided into two groups which underwent shunt procedure and did not. In these two groups, we investigated and compared the incidence of shunt-dependent hydrocephalus and ischemia according to age, sex, aneurysmal site, H-H grade, Fisher grade, medical history and the amout of CSF drainage. RESULTS: The incidence of hydrocephalus following SAH was 53.1% and shunt-dependent hydrocephalus was 16.7% in 96 patients. The duration, total volume, and daily volume of CSF drainage were 6.9+/-3.3 days, 1542.3+/-982.5 ml, and 211.5+/-49.2 ml, respectively. The relationship between the daily volume of CSF drainage and shunt-dependent hydrocephalus was determined to to be statistically significant (p<0.05). Cerebral infarction and shunt-dependent hydrocephalus were found to be statistically associated (p<0.05). CONCLUSION: The continous drainage of cerebrospinal fluid in patients of aneurysmal subarachnoid hemorrhage increase chance of delayed hydrocephalus and they have not shown decrease cerebral infarction as a result of vasospasm.
Aneurysm ; Brain Ischemia ; Cerebral Infarction ; Cerebrospinal Fluid ; Drainage* ; Humans ; Hydrocephalus ; Incidence ; Ischemia ; Prognosis ; Retrospective Studies* ; Subarachnoid Hemorrhage*