Strong Contrast Stagnation of Unilateral Vertebral Artery on Three-Dimensional Black Blood-Enhanced MRI Predicts Acute Medulla Infarction / 신경중재치료의학

Purpose@#This study aimed to evaluate angiographic and contrast enhancement (CE) patterns on three-dimensional (3D) black blood (BB) contrast-enhanced MRI in patients with acute medulla infarction. @*Materials and Methods@#From January 2020 to August 2021, we retrospectively analyzed stroke 3D BB contrast-enhanced magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) findings of patients visiting the emergency room for symptom evaluation of acute medulla infarction. In total, 28 patients with acute medulla infarction were enrolled in this study. Four types of 3D BB contrast-enhanced MRI and MRA were classified as follows: 1=unilateral contrast-enhanced vertebral artery (VA)+no visualization of VA on MRA; 2=unilateral enhanced VA+hypoplastic VA; 3=no enhanced VA+unilateral complete occlusion of VA; 4=no enhanced VA+normal VA (including hypoplasia) on MRA. @*Results@#Of the 28 patients with acute medulla infarction, 7 (25.0%) showed delayed positive findings after 24 hours on diffusion-weighted imaging (DWI). Of these patients, 19 (67.9%) showed CE of the unilateral VA on 3D BB contrast-enhanced MRI (type 1 and 2). Of the 19 patients with CE of VA on 3D BB contrast-enhanced MRI, 18 showed no visualization of enhanced VA on MRA (type 1), and 1 showed hypoplastic VA. Of the 7 patients with delayed positive findings on DWI, 5 showed CE of the unilateral VA and no visualization of the enhanced VA on MRA (type 1). Symptom onset to door time or initial MR check time was significantly shorter in the groups with delayed positive findings on DWI (P<0.05). @*Conclusion@#Unilateral CE on 3D BB contrast-enhanced MRI and no visualization of the VA on MRA are related to the recent occlusion of the distal VA. These findings suggest that the recent occlusion of the distal VA is related to acute medulla infarction, including delayed visualization on DWI.

Transformation of CD5-Negative Follicular Lymphoma into CD5-Positive Diffuse Large B-Cell Lymphoma: A Case Report / 대한내과학회지

Diffuse large B-cell lymphoma (DLBCL) is the most frequent subtype of aggressive lymphomas. Approximately 10% of DLBCL cases express CD5 as a surface antigen. CD5-positive DLBCL can occur as the de novo or secondary type. De novo CD5-positive DLBCL arises without previous lymphoproliferative disease, and secondary CD5-positive DLBCL may or may not manifest as Richter syndrome. The transformation of follicular lymphoma (FL) into DLBCL occurs in approximately one-third of all cases. The transformation of CD5-negative low-grade B-cell lymphoma to CD5-positive DLBCL is extremely rare. We report the clinical features of a rare case that presented with a transformation from CD5-negative FL to CD5-positive DLBL over 11 years. This is the second such case published in the English literature.

True Posterior Communicating Artery Aneurysm / 대한뇌혈관외과학회지

A case with a true posterior communicating artery aneurysm is reported, who had been managed by early surgical neck clipping and post-operative intensive cares for numerous complications. The small saccular aneurysm was located at the proximal posterior communicating artery and directed superiorly. A lacunar infarct developed at right anterior thalamus post-operatively, which had resulted probably from the occlusion of a fine posterior communicating arterial perforator. Aneurysms of the posterior communicating artery itself are saccular or fusiform. Great cares should be taken in surgical aneurysmal neck clipping to avoid any injury of the perforators and the oculomotor nerve;trapping of the posterior communicating artery to treat fusiform or wide-necked aneurysms will result in unpredictable outcomes.

Accidental Insertion of Entire Catheter in the Right Femoral Vein during Central Venous Catheterization: A case report / 대한마취과학회지

This is a case report of the accidental insertion of an entire catheter into the right femoral vein during central venous catheterization through the right femoral vein. The risks of accidental guide wire or catheter breakage and migration of resulting fragments to the heart or intravascular or extravascular space has been increased with the frequent diagnostic and therapeutic use of central venous catheters. We used a single lumen polyurethane central venous catheter (SECALON UNIVERSAL, Viggo-Spectramed, UK). During central venous catheterization under general anesthesia, the catheter was disconnected from its hub and accidentally inserted into the right femoral vein. The catheter was retrieved by using a snare under fluoroscopic guidance without any complications.

The Effects of Flumazenil and Verapamil on the Relaxation of Midazolam in Isolated Guinea-pig Tracheal Smooth Muscle / 대한마취과학회지

BACKGROUND: Midazolam relaxes airway smooth muscle. The aim of this study is to evaluate the influence of flumazenil or verapamil on the relaxation effects of midazolam in tracheal smooth muscle of guinea pig. METHODS: After isolating guinea-pig tracheal preparations, the maximal tracheal tones were induced by 2 10(-7) M carbachol. When tracheal tones stabilized, midazolam was added cumulatively (10(-6), 3 10(-6), 10(-5), 3 10(-5), 10(-4) M, n=14) with or without flumazenil (10(-6) M, n=15) and verapamil (10(-5) M, n=13) to obtain the concentration-relaxation curves, and then the ED50 and ED95 calculated. RESULTS: Midazolam decreased maximal tracheal smooth muscle tones in concentration-dependent manners. Pretreatment with flumazenil had no effect on the midazolam-induced relaxation. Verapamil enhanced the relaxation effect of midazolam. CONCLUSIONS: Midazolam relaxes airway smooth muscle and has synergistic effect with calcium channel blocker, verapamil.