Hemodynamical Assessment of Cavernous Hemangioma in Cavernous Sinus Using MR-DSA and Conventional DSA

We report a hemodynamical assessment of the blood turnover pattern as well as the imaging of cavernous hemangioma in a cavernous sinus using time-resolved contrast enhanced 2D projection MRA, also known as MR-DSA, and conventional digital subtraction angiography (DSA), before and after radiotherapy. MR-DSA showed very fast dynamical images of a contrast turnover pattern and was well matched with the findings obtained from DSA. MR-DSA is a non-invasive study, and can replace DSA in examining a vascular tumor for the initial work-up and follow-up examination.

Quantitative Assessment on Properties of LASER and CCD-based Film Digitizer / 대한의료정보학회지

Picture archiving and communication systems (PACS) has widely been used in many hospitals. Film digitizer has been used in order to create digital image file from conventional plain radiographic films for PACS. In this study, we quantitatively assessed the characteristics of film digitizer for both laser and CCD camera-based type used in Severance hospital. We created three test films to measure the quality of digitized images. The test films were then digitized by both laser and CCD camera-based film digitizer. Finally, the image files were transferred to the PC in which spatial resolution, contrast, and uniformity were evaluated. We also measured digitization time to evaluate the speed of digitizer. Modulation transfer function (MTF) was measured to evaluate the spatial resolution. Contrast was evaluated by measuring of useful range of optical density (OD). Contrast uniformity was calculated by the percentage of difference between minimum and maximum pixel values on the digitized images. Spatial resolution of laser digitizer was ~~5.0cycles/mm, while that of CCD-based unit was ~~1.5cycles/mm of spatial resolution at 10% of MTF. Useful range of OD for CCD unit was ~~77%, while that for laser unit was 100%. Contrast uniformities of laser unit were better than those of CCD-based unit. Digitization time was ~~10sec/film using CCD unit, and ~~60sec/film using LASER unit at film size of 17x14 inches. Laser digitizer can provide relatively higher image quality, while CCD-based unit has the advantage of higher speed than laser unit.

Migration of Digital Medical Image Data Stored through Mini-PACS to Full-PACS / 대한의료정보학회지

The purpose of this study was to evaluate the migration of medical image data stored thorough mini-PACS to full-PACS at Yonsei University Medical Center (YUMC). The image data to be migrated were 2.7 TB stored through approximately 4,500 CD archives at Yongdong Severance hospital and 4.7 TB (2:1 compression) stored through 196 digital linear tape (DLT) archives at Severance hospital. Prior to carrying out the migration, principles, methods and expected practical affairs for the migration were discussed and planned to optimize the migration work by considering the cost and the effectiveness of migration work. Migration gateway workstations were set up and a migration software tool was developed. Real migration works were performed based on the results of several migration simulations. Severance hospital decided to migrate all stored image data. The CD image data of 2.7 TB were estimated total 2,250 hr (about 94 days) migration time, but the practical migration work was completed within 3 months by using maximum 5 workstations. The DLT data of 4.7 TB were estimated total 100 days migration time by applying 16 hr working time per day with single workstation, however, the practical migration work was taken 5 months. Meanwhile, 20% of the DLT image data were not able to migrate because the DLT were partially damaged due to frequent access. In conclusion, a migration plan should be carefully prepared by considering the individual hospital environments because the server system, archival media, the network, and the policy of data management may be unique.

Non-Invasive Follow-up Evaluation of Post-Embolized AVM with Time-Resolved MRA: A Case Report

We report the hemodynamic assessment in a patient with cerebral arteriovenous malformation using time-resolved magnetic resonance angiography (TRMRA), a non-invasive modality, and catheter-based digital subtraction angiography (DSA), before and after embolization. Comparison of the results showed that TR-MRA produced very fast dynamic images and the findings closely matched those obtained at DSA. For initial work-up and follow-up studies in patients with vascular lesions, TR-MRA and DSA are therefore comparable.

Manangement of Massive Hemoptysis during Cardiopulmonary Bypass: A case report / 대한마취과학회지

A 56-year old female who had an atrial septal defect with tricuspid regurgitation received a patch repair and tricuspid annuloplasty. During weaning from cardiopulmonary bypass (CPB), bright red blood filled the endotracheal tube and breathing circuit. We suctioned the blood through the endotracheal tube. The bleeding was massive (about 400 ml) but the airway could be cleared with endotracheal suction. We irrigated endotracheal tube with normal saline with phenylephrine. The weaning of CPB was done and protamine was administered. The bleeding ceased when protamine was administered. Weaning from CPB was accomplished uneventfully. We found a little bleeding in the right main stem bronchus by flexible bronchoscopy but did not do any more procedures. In the intensive care unit, the patient had stable vital signs and good respiratory function. The patient was extubated without any problems at postoperative 1 day and transferred to ward without any complications.

A Spinal Cord Tumor Found in the Patient with Herpes Zoster Radiculopathy / 대한마취과학회지

Herpes zoster is primarily a disease of sensory portion of the nervous system and one of motor portion as well. Herpes zoster radiculopathy can be usually easily diagnosed in the presence or previous history of the characteristic cutaneous eruptions. Motor involvement dose not always coincide in location with the cutaneous lesions. Along with the radicular distribution of pain, motor neuron involvement can mimic other clinical conditions such as disc herniation, tumor infiltration, or infection. Even if the diagnosis of herpes zoster radiculopathy may be delayed, it must be put off until any other diseases or underlying causes are ruled out, especially in case motor symptoms and signs are major clinical features, or there is a topographic dissociation between dermatomes and myotomes involved. We report a patient with spinal cord tumor revealed in the evaluation and management of herpes zoster-related radiculopathy.

A Spinal Cord Tumor Found in the Patient with Herpes Zoster Radiculopathy / 대한마취과학회지

Herpes zoster is primarily a disease of sensory portion of the nervous system and one of motor portion as well. Herpes zoster radiculopathy can be usually easily diagnosed in the presence or previous history of the characteristic cutaneous eruptions. Motor involvement dose not always coincide in location with the cutaneous lesions. Along with the radicular distribution of pain, motor neuron involvement can mimic other clinical conditions such as disc herniation, tumor infiltration, or infection. Even if the diagnosis of herpes zoster radiculopathy may be delayed, it must be put off until any other diseases or underlying causes are ruled out, especially in case motor symptoms and signs are major clinical features, or there is a topographic dissociation between dermatomes and myotomes involved. We report a patient with spinal cord tumor revealed in the evaluation and management of herpes zoster-related radiculopathy.

The Duration of Action of Additional Doses of Pipecuronium is not affected by the Size of the Initial Dose / 대한마취과학회지

The neuromuscular blocking effect of pipecuronium was evaluated in 35 patients under N2O-O2-isoflurane anesthesia with visual and/or tactile counts for the twitch of the adductor pollicis muscle in response to train-of-tour(TOF) stimulation of the ulnar nerve at the wrist. Group I, II and III were classified according to the initial dose of pipecuronium of 50, 80 and 100ug/kg, respectively. The additional dose, 30 ug/kg, was given in all three groups when the first twitch of TOF(T) reappeared. The onset time in Group I, II and III was 361.4+/-98.6, 218.7+/- 80.8 and 239.0+/-73.7 seconds, respectively. The onset time in Group I was significantly slower(p<0.005) than those in the other groups. All three doses of pipecuronium provided good to exceUent intubating condition in about 4 to 6 minutes after the administration of the initial dose. The time interval from the disappearance of T1 to the reappearance of T1 was 39.0+/-20.8 min in Group I, which was significantly longer(p<0.05) in Group II(67.7+/-26.4 min) or III(63.8+/-20.8 min). The cumulative effect of pipecuronium was evaluated by comparing the mean time intervals of an additional dose to the succeeding ones. The intervals between additional doses were independent of the size or duration of the initial dose. There were no significant differences in the intervals between additional doses. Heart rates, rhythms and mean arterial blood pressures were not significantly changed in any groups following the administration of pipecuronium In conclusion, pipecuronium bromide can be recommended as a long-acting neuromuscular blocking agent with an absence or minimum of cumulative and cardiovascular effects for patients in whom a long operation is scheduled and the cardiovascular stability is required.

Intrathecal Injection of Morphine with Fentanyl for the Relief of Pain in Labor / 대한마취과학회지

Intrathecal morphine can provide goad analgesia for the first stage of labor. However, a long latency, high incidence of side effects, and lack of perineal anesthesia limit its usefulness. We wished to make a short the latency and reduce the dose of morphine, administered morphine 0.2 mg, 0.3 mg, combined with fentanyl 25 micrograms intrathecally. Forty-five laboring patients were studied and randomly divided into two groups' group I (n=24) received intrathecal morphine 0.2 mg with fentanyl 25 ug; group II (n=21) received intrathecal morphine 0.3 mg with fentanyl 25 ug; We compared the analgesia and side effects of group I to those of group II. Analgesia was assessed using the 100 mm visual linear analog(VLA) as the time elapsed from the drug administration to the delivery. The onset of analgesia was rapid(within 5 minutes) in both groups and VLA scores did not differ at any observation point between the groups. The effect of analgesia was lasted until the perineum was distended by the fetus. The incidence of nausea or vomiting was 41.7%(10/24) in group I, and 33.3%(7/21) in group II. Pruritus occured 87.5%(21/24)) in group I and 90.5%(19/21) in group II. The majority of pruritus occured soon after administration of study drug. There were more instances of urinary retention in group II (61.9%) than in group I(37.5%). No patient developed postdural puncture headache, vital sign alteration or respiratory depression. Most of all the patients in this study said that they were satisfied with this analgesic technique and would like to receive intrathecal narcotic analgesia for future labor. With the above results we conclude that intrathecal morphine 0.2 mg with fentanyl 25 ug for labor pain provides rapid and effective analgesia as 0.3 mg intrathecal morphine with fentanyl 25 ug.