Determination of Language Dominance Using Functional MRI in Patients with Intractable Seizure: Comparison with Wada Test

PURPOSE: To investigate the efficiency or potency of functional MRI (fMRI) for the determination of language dominance by comparing the results of fMRI with those of the Wada test. MATERIALS AND METHODS: Among 34 patients with intractable seizure who underwent both fMRI and the Wada test, we analyzed the results of 30 (men:women=19:11; mean age=29.7 years). Using echoplanar imaging and the blood oxygen level dependent technique, fMRI was performed using a 1.5 T MR imager with a standard head coil. The language task consisted of two parts: reading words and generating words. For fMRI, a multi-event multi-task paradigm consisting of two sets of activation, rest, and alternative periods was used. Image processing involved the use of the Z test (Z threshold = 1.0 -1.2). To determine the lateralization index, we calculated the activation pixels within the whole frontal cortex., and to ascertain the discrepancy between the two tasks, the clustering grade of activation pixels was measured. After the injection of thiopental, language dominance was determined by means of a modified Wada test. The results of this and the findings of fMRI were compared with the results of Fisher 's exact test (p 0.05). CONCLUSION: For the determinaton of language dominance, fMRI showed good correlation with the Wada test. The word generation task was more efficient than the reading task. fMRI which is non-invasive and repeatable, is therefore more efficient and useful than the invasive Wada test.

Early Esophageal Cancer

BACKGROUND: Early esophageal cancer has a good prognosis compared with advanced esophageal cancer, so early detection of the cancer is emphasized. Early esophageal cancer is considered as esophageal cancer located within the submucosal layer and without metastasis in the operative specimen. Despite this criterion, evidence has accumulated suggesting that submucosal tumors have a very different prognosis from intra-epithelial and intramucosal lesions. The purpose of this study is to define the characteristics of and the appropriate operative method for esophageal cancer. METHODS: Medical records of 19 patients who had received an esophagectomy and who had been diagnosed as having early esophageal cancer between 1981 and 1996 at this hospital were reviewed. RESULTS: There was 17 cases of submucosal lesions and 2 cases of mucosal lesions. 74% of the patients had alcohol or smoking history. When endoscopic findings were classified according to the endoscopic classification of JSED, there were 5 cases of type 0-I, 4 cases of type 0-III, 4 cases of type 1, and others. Type 0-I and 0-III were common. The accuracy of the endoscopic ultrasonographic finding was 39% compared with the postoperative pathologic finding. The mean duration of follow-up was 21 months, and there were 2 recurrences during follow-up. One recurred 13 months after the operation and the other 23 months after the operation. Both of them were submucosal lesions and received a transhiatal esophagectomy. CONCLUSIONS: Annual endoscopic examination with lugol staining may be needed for early detection of esophageal cancer. Submucosal lesions of early esophageal cancer should be managed with an esophagectomy and lymph node dissection. Also, expertness of the endoscopist is very important in deciding on an of operative method.

The thrombolytic effect of lumbrokinase is not as potent as urokinase in a rabbit cerebral embolism model

The purpose of the present study is to determine whether lumbrokinase has an in vivo thrombolytic effect in a rabbit cerebral embolism model. In our previous studies, we found that lumbrokinase, an extract from Korean earth worms, has a strong in vitro fibrinolytic effect without the presence of plasminogen and significant in vivo thrombolytic effects of lumbrokinase in a rat human-clot-induced cerebral embolism model. We established the cerebral embolism model in rabbits by injecting a piece of human clot into the internal carotid artery via the external carotid artery and confirmed the occlusion with angiography. Twenty one rabbits were divided into three groups and 5cc of saline, urokinase of 50,000 u/ml, and equipotent LK were injected intraarterially for 30 minutes into each group of 7 animals. Ten minutes after the end of infusion, an angiogram was performed to confirm the recanalization. Clot lysis occurred in one, six, and one animals in the saline, urokinase and lumbrokinase treated groups respectively. With regard to its in vitro effect, lumbrokinase is not as potent in vivo. Further investigation should be performed to determine the cause of its weakened in vivo effect and to develop a method to potentiate it.

Thrombolytic Effect of Lumbrokinase in Rat Cerebral Thromboembolism Model: a preliminary study

In the previous studies, we found that lumbrokinase an, extract from Korean earthworm, had a strong in vitro thrombolytic effect, and that when added to thrombin had a significant effect in reducing fatality rate in thrombin-induced lung infarction mice model. To determine whether it also has in vivo thrombolytic effect in cerebral embolism model using 9 Spraw Dawly male rats of 200 to 300gm, we cannulated the extemal carotid artery lene tubes and occluded the pterygopalatine arteries. Via the extemal carotid artery, we injected 1 mm3 of human blood clots which were previously mixed with Tc-99m sulfur colloid. After confirming the intracranially situated clot by camera, we injected 3cc of following fiuids to each group of three rats: saline, urokinase, lumbrokinase fraction m Then using Gamma camera of 64*64 m obtained for 1 minute in every 30 minutes. After 150 minutes radioactivities of the clots in the brain were 3.02%, 21 02% urokinase, and lumbrokinase treated animals respectively. In the liver, the uptake of radioactivities was accordingly increased. Brain sections showed no Significant intracranial bleeding in any of the treated animals. Therefore, we conclude that lumbrokinase has in vivo thromboembolism model without producing significant intracranial bleeding. However, compared with its in vitro effects the in vivo effects appear to be less potent. Futher experiments with better designed animal models are warranted.

Contralateral Trochlear Palsy and Facial Sensory Change Due to Probable Brain Stem Vascular Malformation

No abstract available.