OBJECTIVE: To evaluate the short-term clinical effects of intra-articular shoulder injection with botulinum toxin type A (BoNT-A) in acute hemiplegic stroke patients with complex regional pain syndrome type I (CRPS I). METHOD: Fifty patients were assigned at random to receive intra-articular shoulder injection. The treatment groups were divided into two groups: BoNT-A group, 200 IU of BoNT-A and 2 ml of normal saline; triamcinolone acetonide (TA) group, 20 mg of triamcinolone and 2 ml of 2% lidocaine. Uptake ratio of quantitative three phase bone scintigraphy (QTPBS) was calculated by dividing the radioactivity count on the affected side by that on the unaffected side. Shoulder pain was assessed by visual analogue scale (VAS) and neuropathic pain scale (NPS). Range of motion (ROM) of shoulder joint and functional independence measurement (FIM) of upper limb were evaluated. All of them were measured before injection, and 4 weeks after injection. RESULTS: After 4 weeks, the uptake ratio of blood pool phase was significantly decreased in hands of BoNT-A group than TA group. VAS, ROM and upper extremity FIM was similarly improved in both groups. Pain intensity and cold pain of NPS were similarly decreased in both groups. Hot pain and dull pain of NPS decreased more significantly in BoNT-A group than TA group. CONCLUSION: In the short-term, intra-articular BoNT-A shoulder injection maybe has the therapeutic effect on acute CRPS I related stroke. And the uptake ratio of blood pool phase of the hand of QTPBS may be useful to assess the therapeutic effect of CRPS after acute stroke.
Botulinum Toxins ; Botulinum Toxins, Type A ; Cold Temperature ; Hand ; Humans ; Lidocaine ; Neuralgia ; Radioactivity ; Range of Motion, Articular ; Shoulder ; Shoulder Joint ; Shoulder Pain ; Stroke ; Triamcinolone ; Triamcinolone Acetonide ; Upper Extremity

Acromegaly is a chronic condition resulting from the excessive secretion of growth hormone and insulin like growth factor 1, generally from pituitary adenoma. Although there have been several reports suggesting the possible association of hematologic malignancies with acromegaly, myelofibrosis with acromegaly is very rare. Here we report 54-year-old male patient with myelofibrosis accompanied with acromegaly. We treated this patient with low dose thalidomide (50 mg/day) and prednisone (30 mg/day). We reported this case with literature review.
Acromegaly* ; Growth Hormone ; Hematologic Neoplasms ; Humans ; Insulin ; Male ; Middle Aged ; Pituitary Neoplasms ; Prednisone ; Primary Myelofibrosis* ; Thalidomide

Acromegaly is a chronic condition resulting from the excessive secretion of growth hormone and insulin like growth factor 1, generally from pituitary adenoma. Although there have been several reports suggesting the possible association of hematologic malignancies with acromegaly, myelofibrosis with acromegaly is very rare. Here we report 54-year-old male patient with myelofibrosis accompanied with acromegaly. We treated this patient with low dose thalidomide (50 mg/day) and prednisone (30 mg/day). We reported this case with literature review.
Acromegaly* ; Growth Hormone ; Hematologic Neoplasms ; Humans ; Insulin ; Male ; Middle Aged ; Pituitary Neoplasms ; Prednisone ; Primary Myelofibrosis* ; Thalidomide

BACKGROUND: Prophylactic stenosis correction is important in the durability of the vascular access, and routine surveillance for the detection of stenosis has been widely recommended to allow preemptive intervention before thrombotic occlusion. The ultrasound dilution technique has been considering not only a popular and validated in vascular access surveillance, but also useful in the measurement of access recirculation and cardiac output. METHODS: Access flow, recirculation, and cardiac output of seventy-six hemodialysis patients with arteriovenous fistulae were measured by ultrasound dilution technique, followed by access flow measurement by color doppler ultrasound in sixty-four patients. Access stenosis was defined as 50% and more reduction in the diameter of vessels by color doppler ultrasound. Cardiac output of thirty-seven patients by echocardiography within a year was also analyzed. RESULTS: Access stenosis was diagnosed in six of sixty-four patients by color doppler ultrasound (9.4%). Access flow in the group with stenosis (621+/-322 mL/min) was lower than the group without stenosis (1, 005+/-633 mL/min), but no statistical significance was found. The access flow measured by ultrasound dilution technique was significantly correlated with color doppler ultrasound (r=0.436, p= 0.01). The cardiac output measured by ultrasound dilution technique was also significantly correlated with echocardiography (r=0.660, p=0.01). CONCLUSION: The data did not provide statistical significances for the detection of stenosis by ultrasound dilution technique. But this study suggests that ultrasound dilution technique is a useful method in the measurement of access flow, cardiac output and recirculation. We hope further prospective studies based on our data will be performed.
Arteriovenous Fistula ; Cardiac Output ; Constriction, Pathologic ; Echocardiography ; Hope ; Humans ; Indicator Dilution Techniques ; Renal Dialysis* ; Ultrasonography*

PURPOSE: To evaluate the feasibility and clinical efficacy of transrectal drainage of a deep pelvic abscess using combined transrectal sonographic and fluoroscopic guidance. MATERIALS AND METHODS: From March 1995 and August 2004, 17 patients (9 men; 8 women; mean age, 39years) suffering from pelvic pain, fever and leukocytosis were enrolled in this retrospective study. Ultrasound (US) or computed tomography (CT), which was obtained prior to the procedure, showed pelvic fluid collections that were deemed unapproachable by the percutaneous transabdominal routes. Transrectal drainage of the pelvic abscess was performed under combined transrectal sonographic and fluoroscopic guidance. The causes of the deep pelvic abscess were postoperative complications (n=7), complications associated with radiation (n=3) and chemotherapy (n=1) as well as unknown causes (n=6). A 7.5-MHz end-firing transrectal US probe with a needle biopsy guide attachment was advanced into the rectum. Once the abscess was identified, a needle was advanced via the biopsy guide and the abscess was punctured. Under US guidance, either a 0.018"or 0.035" guidewire was passed through the needle in the abscess. Under fluoroscopic guidance, the tract was dilated to the appropriate diameter with sequential fascial dilators, and a catheter was placed over the guide wire within the abscess. Clinical success of drainage was determined by a combination closure of the cavity on the follow up images and diminished leukocytosis. The technical and clinical success rate, complications, and patient's discomfort were analyzed. RESULTS: Drainage was technically successful in all patients and there were no serious complications. Surgery was eventually performed in two cases due to fistular formation with the rectum and leakage of the anastomosis site. The procedure was well tolerated in all but one patient who complained of discomfort while the catheter was inserted. The catheter did not interfere with defecation and there was no incidence of catheter expulsion by defecation. CONCLUSION: Transrectal drainage of deep pelvic abscesses using ultrasound and fluoroscopic guidance is a safe, feasible procedure that is well tolerated by patients and is relatively easy to perform.
Abscess* ; Biopsy ; Biopsy, Needle ; Catheters ; Defecation ; Drainage* ; Drug Therapy ; Female ; Fever ; Follow-Up Studies ; Humans ; Incidence ; Leukocytosis ; Male ; Needles ; Pelvic Pain ; Postoperative Complications ; Rectum ; Retrospective Studies ; Ultrasonography*

Familial idiopathic striopallidodentate calcification is a disorder radiologically characterized by bilateral calcifications of the brain without abnormalities in the serum calcium level and related endocrinological parameters. We report a 70-year-old woman presented with slowly progressive gait disturbance, dementia and Parkinsonism. She had bilateral and symmetric calcifications of the basal ganglia, thalamus, dentate nucleus, and subcortical white matter on the brain CT. One son and two granddaughters also showed calcifications of the basal ganglia, suggesting an autosomal dominant inheritance.
Aged ; Basal Ganglia ; Brain ; Calcium ; Cerebellar Nuclei ; Dementia ; Female ; Gait ; Humans ; Parkinsonian Disorders ; Thalamus ; Wills

PURPOSE: To evaluate the effectiveness and safety of a new liquid embolic agent in renal arterial embolization in the rabbit, and its clinical applicability. MATERIALS AND METHODS: A new embolic agent, Embol, was obtained by partial hydrolysis of polyvinyl acetate and dissolved in a mixture of 45% ethanol and 55% non-ionic contrast medium. Its radioopacity was therefore good. An average of 0.8 cc(0.5-0.9 cc) of Embol was used to embolize the renal artery of one kidney in 15 rabbits. The immediate effect of this was examined angiographically 5 minutes after the procedure. To permit histologic examination, five rabbits in each group were sacrificed 3 days (I), 2 weeks (II), and 4 weeks (III) after embolization: prior to embolization and prior to sacrifice, one rabbit in each group underwent renal scanning, and prior to sacrifice all underwent follow-up angiography. In three rabbits, blood urea nitrogen (BUN), creatinine, sodium(Na), and potassium(K) levels were measured before and 1, 3, 5, 7 and 14 days after embolization. RESULTS: Embol was easy to use and its radiopacity was good. Five minutes after embolization, angiography showed that total occlusion of the main renal or interlobar artery had been achieved in all rabbits. Serum BUN, creatinine, Na and K levels were within normal limits. Follow-up angiogram obtained in each group showed persistent occlusion of the renal artery in all but one rabbit in group I and one in group III. Renal scans revealed no evidence of radionuclide uptake in embolized kidneys, which were slightly enlarged in group I but became gradually smaller in groups II and III. In all animals, histologic examination showed diffuse coagulation necrosis of the embolized kidneys and in group III the cortex of these was extensively calcified. In group I the renal artery showed an apparently fresh occluding thrombosis, and in groups II and III a completely organized thrombosis was present. In group III this was calcified. CONCLUSION: Because of its good radioopacity, Embol is easy to controa, and is effective for renal artery embolization. As a permanent embolic agent, it appears suitable for clinical applications.
Angiography ; Animals ; Arteries ; Blood Urea Nitrogen ; Creatinine ; Ethanol ; Follow-Up Studies ; Hydrolysis ; Kidney ; Necrosis ; Polyvinyls ; Rabbits ; Renal Artery* ; Thrombosis

No abstract available.
Arteries* ; Humans ; Quadriplegia*

Takayasu arteritis is a chronic non-specific inflammatory arteriopathy that involves primarily the first branches of aortic arch but may also affect the aorta and any of its primary branches. A characteristic trait of the disease is that most of the patients are young females of mainly Asian and South American origin. Recently, we experienced a rare case of Takayasu arteritis which showed a cord-like atresia of abdominal aorta just below renal arteries in 52-year-old woman. We performed a side to side bypass graft from descending thoracic aorta to abdominal aorta just above the aortic bifurcation with a 18mm PTFE(polytetrafluoroethylene) vascular graft. The postoperative course was uneventful.
Aorta ; Aorta, Abdominal* ; Aorta, Thoracic ; Asian Continental Ancestry Group ; Female ; Humans ; Middle Aged* ; Renal Artery ; Takayasu Arteritis* ; Transplants

PURPOSE: When MRI and CT of the oral cavity utilize the traditional closed-mouth approach, direct contact between the tongue and surrounding structures may give rise to difficulty in recognizing the anatomy involved and demonstrating the possible presence of pathologic features. we describe a more appropriate scan technique, involving open-mouthed imaging, which may be used to demonstrate the anatomy of the oral cavity in detail. MATERIALS AND METHODS: Axial and coronal MR imaging and axial CT scanning were performed in 14 healthy volunteers, using both the closed and open-mouth approach. For the latter, a mouth-piece was put in place prior to examination. In all volunteers, open-mouth MR and CT examinations involved the same parameters as the corresponding closed-mouth procedures. The CT and MR images obtained by each method were compared, particular attention being paid to the presence and symmetry of motion artifact of the tongue and the extent of air space in the oral cavity. Comparative imaging analysis was based on the recognition of 13 structures around the boundaries of the mouth. For statistical analysis, Student 's t test was used and a p value < 0.05 was considered significant. RESULTS: Due to symmetry of the tongue, a less severe motion artifact, and increased air space in the oral cavity, the open-mouth method produced excellent images. The axial and coronal MR images thus obtained were superior in terms of demarcation of the inferior surface and dorsum of the tongue, gingiva, buccal surface and buccal vestibule to those obtained with the mouth closed (p<0.05). In addition, axial MR images obtained with the mouth open showed better demarcation of structures at the lingual margin and anterior belly of the digastric muscle (p<0.05), while coronal MR images of the base of the tongue, surface of the hard palate, soft palate, and uvula, were also superior (p<0.05). Open-mouth CT provided better images at the lingual margin, dorsum of the tongue and buccal surface than the closed-mouth approach (p<0.05). CONCLUSION: Open-mouth MRI and CT are both practical and useful for evaluation of the structures of the oral cavity. The images thus obtained are superior to those acqhired with the month closed.
Artifacts ; Gingiva ; Healthy Volunteers ; Humans ; Magnetic Resonance Imaging* ; Mouth* ; Palate, Hard ; Palate, Soft ; Tomography, X-Ray Computed ; Tongue ; Uvula ; Volunteers