PURPOSE: We evaluated the hemodynamic statuses of patients after partial closure of atrial septal defects with fenestration due to pulmonary hypertension. MATERIALS AND METHODS: Seventeen adult patients underwent partial atrial septal defect closure and follow-up cardiac catheterization. We analyzed hemodynamic data and clinical parameters before and after closure. RESULTS: The median age at closure was 29 years old. The baseline Qp/Qs was 1.9+/-0.6. The median interval from the operation to the cardiac catheterization was 27 months. The CT ratio decreased from 0.55+/-0.07 to 0.48+/-0.06 (p<0.05). The mean pulmonary arterial pressure decreased from 50.0+/-11.5 mm Hg to 32.5+/-14.4 mm Hg (p<0.05), and the pulmonary resistance index decreased from 9.2+/-3.6 Wood units*m2 to 6.3+/-3.8 Wood units*m2 (p<0.05). Eleven patients (64.7%) continued to exhibit high pulmonary resistance (over 3.0 Wood units*m2) after closure. These patients had significantly higher pulmonary resistance indices and mean pulmonary arterial pressures based on oxygen testing before the partial closures (p<0.05). However, no significant predictors of post-closure pulmonary hypertension were identified. CONCLUSION: Despite improvement in symptoms and hemodynamics after partial closure of an atrial septal defect, pulmonary hypertension should be monitored carefully.
Adult ; Aged ; Cardiac Catheterization/*adverse effects ; Female ; Follow-Up Studies ; Heart Defects, Congenital/epidemiology/*physiopathology/*surgery ; Heart Septal Defects, Atrial/surgery ; Hemodynamics/*physiology ; Humans ; Hypertension, Pulmonary/diagnosis/epidemiology/*physiopathology ; Male ; Middle Aged ; Oxygen ; Postoperative Complications/diagnosis/epidemiology/*physiopathology ; Retrospective Studies ; Treatment Outcome ; Young Adult

Aortic coarctation is usually diagnosed and repaired in childhood and early adulthood. Survival of a patient with an uncorrected coarctation to more than 70 years of age is extremely unusual, and management strategies for these cases remain controversial. We present a case of a 75-year-old woman who was first diagnosed with aortic coarctation and severe aortic valve stenosis 5 years ago and who underwent a successful one-stage repair involving valve replacement and insertion of an extra-anatomical bypass graft from the ascending to the descending aorta.
Aged ; Aorta, Thoracic ; Aortic Coarctation ; Aortic Valve Stenosis ; Female ; Humans ; Thoracic Surgical Procedures ; Transplants

BACKGROUND: Despite the benefits of home oxygen therapy in patients suffering chronic respiratory failure, previous reports in Korea revealed lower compliance to oxygen therapy and a shorter time for oxygen use than expected. However, these papers were published before oxygen therapy was covered by the national insurance system. Therefore, this study examined whether there were some changes in compliance, using time and other clinical features of home oxygen therapy after insurance coverage. METHODS: This study reviewed the medical records of patients prescribed home oxygen therapy in our hospital from November 1, 2006 to September 31, 2008. The patients were interviewed either in person or by telephone to obtain information related to oxygen therapy. RESULTS: During study period, a total 105 patients started home oxygen therapy. The mean age was 69 and 60 (57%) were male. The mean oxygen partial pressure in the arterial blood was 54.5 mmHg and oxygen saturation was 86.3%. Primary diseases that caused hypoxemia were COPD (n=64), lung cancer (n=14), Tb destroyed lung (n=12) and others. After oxygen therapy, more than 50% of patients experienced relief of their subjective dyspnea. The mean daily use of oxygen was 9.8+/-7.3 hours and oxygen was not used during activity outside of their home (mean time, 5.4+/-3.7 hours). Twenty four patients (36%) stopped using oxygen voluntarily 7+/-4.7 months after being prescribed oxygen and showed a less severe pulmonary and right heart function. The causes of stopping were subjective symptom relief (n=11), inconvenience (n=6) and others (7). CONCLUSION: The prescription of home oxygen has increased since national insurance started to cover home oxygen therapy. However, the mean time for using oxygen is still shorter than expected. During activity of outside their home, patients could not use oxygen due to the absence of portable oxygen. Overall, continuous education to change the misunderstandings about oxygen therapy, more economic support from national insurance and coverage for portable oxygen are needed to extend the oxygen use time and maintain oxygen usage.
Anoxia ; Compliance ; Dyspnea ; Heart ; Humans ; Insurance ; Insurance Coverage ; Korea ; Lung ; Lung Neoplasms ; Male ; Medical Records ; National Health Programs ; Oxygen ; Partial Pressure ; Prescriptions ; Pulmonary Disease, Chronic Obstructive ; Respiratory Insufficiency ; Stress, Psychological ; Telephone

PURPOSE: The presence of epicanthal fold and the absence of supratarsal fold are characteristics of Korean eyelids. There has been many surgical procedures to eliminate medial epicanthal fold but those procedures focus on the lengthening of horizontal palpebral fissure and the shortening of intercanthal distance so that the shape of eye had tendency to be sharp. The authors suggest that the supermedial shifting of epicanthal fold enhance the aesthetic result. METHODS: From Sep 2006 to May 2007, total 17 women(mean age 22) with Type III epicanthal fold underwent epicanthoplasty using author's modified Uchida method. The design for epicanthoplasty was drawn superolaterally along epicanthal fold and split V-W plasty was done to shift the epicanthal fold superomedially. Also non-incisional double-eyelid operation was underwent. RESULTS: The epicanthal fold was shifted in superomedially, intercanthal distance was shortened and double-eyelid was achieved. The patients were satisfied with the result and no major complication was noted. CONCLUSION: This method can be effective in correcting the epicanthal fold of Korean eyelid by shifting the epicanthal fold superomedially to make the shape of eye aesthetically without noticeable scar.
Cicatrix ; Eyelids ; Humans ; Sterilization, Tubal*

PURPOSE: The purpose of this study was to determine whether in vitro proton (1H) magnetic resonance spectroscopy (MRS) is useful for distinguishing between abdominal types of fluids. MATERIALS AND METHODS: Thirty fluid samples that were obtained from patients who were undergoing diagnostic or therapeutic percutaneous drainage of abdominal fluids were examined in this study. According to their gross appearance and smell, each sample was classified as either purulent fluid (n=12) or non-purulent fluid (n=18). The non-purulent fluids were subdivided into hemorrhagic fluid (n=2), serosanguinous fluid with debris (n=2), and serosanguinous fluid without debris (n=14). In addition, according to the cytologic analysis, each sample was classified as either benign fluid (n=23) or malignant fluid (n=7). A set of humoral pathological examinations that included biochemical analysis and culture of the fluid were performed for all the fluid samples. In vitro 1H MRS was performed by using a 1.5T MR system and a birdcage head coil. MR spectra were obtained by using point-resolved spectroscopy (PRESS) (TR/TE=2000/30 msec) with water suppression. The MR spectra were analyzed on the basis of agreement between a radiologist and a physicist who worked in consensus. RESULTS: The MR spectra obtained from 30 samples could be classified into 8 different patterns, according to the presence of lipid (0.9/1.3 ppm), lactate (1.3 ppm), acetate (1.9 ppm), and succinate (2.4 ppm) peaks. The MR spectral patterns of the purulent fluids (n=12) were classified as follows: pattern-1 (n=7, 58%), pattern-2 (n=2, 17%), pattern-3 (n=1, 8%), pattern-6 (n=1, 8%) and pattern-8 (n=1, 8%). The MR spectral patterns of the non-purulent fluids (n=18) were classified as follows: pattern-4 (n=1, 6%), pattern-5 (n=5, 28%), pattern-6 (n=1, 6%), pattern-7 (n=3, 17%) and pattern-8 (n=8, 44%). The MR spectral patterns of the purulent fluids were significantly different from those of the non-purulent fluids (p < .05). The MR spectral patterns of benign fluids (n=23) were classified as follows: pattern-1 (n=7, 30%), pattern-2 (n=2, 9%), pattern-3 (n=1, 4%), pattern-4 (n=1, 4%), pattern-5 (n=3, 13%), pattern-6 (n=2, 9%), pattern-7 (n=1, 4%) and pattern-8 (n=6, 26%). The MR spectral patterns of malignant fluids (n=7) were classified as follows: pattern-5 (n=2, 29%), pattern-7 (n=2, 29%) and pattern-8 (n=3, 43%). No significant difference was found between the spectral patterns of the benign and malignant fluids (p= .300). CONCLUSION: In vitro 1H MRS could be useful for differentiating between purulent fluid and non-purulent fluid.
Abscess ; Body Fluids* ; Consensus ; Drainage ; Head ; Humans ; Lactic Acid ; Magnetic Resonance Spectroscopy* ; Protons* ; Smell ; Spectrum Analysis ; Succinic Acid ; Water

PURPOSE: This study was designed to evaluate the usefulness of 3T-TOF MR angiography (3T-TOF MRA) compared with transcranial Doppler sonography (TCD) and conventional angiography (CA) in patients with suspected cerebral infarction. MATERIALS AND METHODS: Fifty four patients with clinical symptoms of cerebral infarction were involved in this study, and had undergone 3T-TOF MRA and TCD, with CA in 11 patients. On the basis of divisions of the carotid artery, four groups were designated: group I, both vertebral arteries and basilar artery; group II, segment between 2 cm below bifurcation of common carotid artery and genu portion of internal carotid artery; group III, segment between petrous portion of internal carotid artery and bifurcation of anterior and middle cerebral artery; group IV, from bifurcation of anterior and middle cerebral artery to thier distal branches. Two radiologists retrospectively reviewed the vascular imaging and stenosis in 3T-TOF MRA, TCD, and CA. RESULTS: A total of 432 arteries, 108 in each group, were available. The assessment of vascular imaging quality in 3T-TOF MRA is scored 2.98, 2.96, 2.91, 2.88 in 4 groups, respectively. Agreement among 3TTOF MR angiography, TCD, and CA was high. CONCLUSION: 3T-TOF MR angiography may be useful method for the assessment of stenotic lesions of cranial vasculature in patients with cerebral infarction.
Angiography* ; Arteries ; Basilar Artery ; Carotid Arteries ; Carotid Artery, Common ; Carotid Artery, Internal ; Cerebral Infarction* ; Constriction, Pathologic ; Humans ; Middle Cerebral Artery ; Retrospective Studies ; Ultrasonography, Doppler, Transcranial ; Vertebral Artery

We report here on a case of peripheral T-cell lymphoma of the ovary as the initial manifestation of extranodal disease. A 45-year-old woman presented with an incidentally detected, ovarian mass. Contrast-enhanced CT scans showed a 6x5.3 cm diameter, heterogeneously enhancing mass in the right adnexa that invaded the adjacent uterus. An exploratory laparotomy revealed a solid mass in the right adnexa, which invaded the uterine cornus. Histological diagnosis was made as a peripheral T-cell lymphoma of the ovary.
Cornus ; Diagnosis ; Female ; Humans ; Laparotomy ; Lymphoma, T-Cell ; Lymphoma, T-Cell, Peripheral* ; Middle Aged ; Ovary ; Tomography, X-Ray Computed ; Uterus

PURPOSE: To evaluate the efficacy of transvenous embolization in patients with dural arteriovenous fistula (DAVF). MATERIALS AND METHODS: From October 2002 to July 2004, eight patients with angiographically confirmed DAVF underwent transvenous embolization of the affected dural sinuses. Concomitant transarterial embolization was performed in four patients. Patients included five men and three women aged 45-78 years (mean age, 55.4 years). The patient's medical records and angiographic features were retrospectively reviewed. Patients had follow-up periods ranging from 5 to 24 months (mean, 16.5 months). RESULTS: The locations of DAVF were transverse - sigmoid sinus in six patients and cavernous sinus in two patients. According to Cognard's classification, four of the DAVFs were Type I, two were type IIa, and two were Type IIb. Embolic materials used for the transvenous embolization were platinum detachable coils and fibered microcoils. After the transvenous embolization, there was complete obliteration of the DAVF in seven patients and significant flow reduction in one patient. All cases were clinically successful. There were no transient or permanent complications as a result of the endovascular procedures in any of the patients. One patient who had symptom recurrence 2 months after the initial treatment was successfully treated with repeated transvenous embolization. The remaining seven patients had no symptom recurrence during the follow-up period. CONCLUSION: Transvenous embolization is an effective and safe method in the treatment of patients with DAVF.
Arteriovenous Fistula ; Cavernous Sinus ; Central Nervous System Vascular Malformations* ; Classification ; Colon, Sigmoid ; Endovascular Procedures ; Female ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Platinum ; Recurrence ; Retrospective Studies

PURPOSE: To evaluate the usefulness of apparent diffusion coefficient (ADC) values using diffusion-weighted magnetic resonance imaging (DWI) in patients with ovarian cystic tumors. MATERIALS AND METHODS: During past 12 months, we studied 30 patients who were clinically suspected of having ovarian cystic tumors and who underwent DWI using a 1.5 T MR unit. Eight patients with small cystic ovarian lesions of less than 3 cm in diameter and insufficient DWI were excluded from the calculation of the ADC values. The remaining twenty-six cystic ovarian lesions in 22 patients were classified into four groups; ovarian cysts, cystadenomas, other benign tumors, and malignant tumors. DWI was obtained using single-shot spin echo planar imaging and two gradient steps (b values of 0, 800 sec/mm2). The ADC values were measured using regions-of-interest (ROI) in the cystic components of the DWI located in the same section as the T2-weighted image and away from the septation and solid components. RESULTS: The mean ADC values were 0.196+/-0.105x10(-3) mm2/sec in the ovarian cysts, 1.312+/-1.064x10(-3) mm2/sec in the cystadenomas, 0.274+/-0.124x10(-3) mm2/sec in the other benign tumors, and 1.011+/-0.080x10(-3) mm2/sec in the malignant tumors. The differences in the ADC values between the ovarian cysts and cystadenomas, the ovarian cysts and malignant tumors, the cystadenomas and other benign tumors, and the other benign tumors and malignant tumors were statistically significant (p < 0.01). There was no statistically significant difference in the ADC values between the ovarian cysts and other benign tumors, or between the cystadenomas and malignant tumors (p > 0.05). CONCLUSION: The calculated ADC values using DWI should be helpful in the differential diagnosis of cystic ovarian tumors.
Cystadenoma ; Diagnosis, Differential ; Diffusion* ; Echo-Planar Imaging ; Female ; Humans ; Magnetic Resonance Imaging* ; Ovarian Cysts* ; Ovary

The liver has a unique dual blood supply through the portal vein and the hepatic artery. There are several communications between these two vessels under various conditions such as in hepatic tumors, trauma and liver cirrhosis, vascular compromise, among others. When vascular compromise occurs, this dual blood supply system can cause changes in the volume of blood flow in individual vessels or even in the direction of blood flow. With rapid image acquisition and increased resolution available in multislice CT and MR imaging, hepatic perfusion disorders are now more frequently encountered than in the past. Familiarity with imaging findings of these perfusion disorders will be helpful in characterizing focal hepatic lesions and will also help to avoid false positive diagnoses.
Diagnosis ; Hepatic Artery ; Liver ; Liver Cirrhosis ; Magnetic Resonance Imaging* ; Perfusion* ; Portal Vein ; Recognition (Psychology)