Coil embolization of a ruptured basilar tip aneurysm associated with bilateral cervical internal carotid artery occlusion: a case report and literature review.

We report here on a rare case of a ruptured basilar tip aneurysm that was successfully treated with coil embolization in the bilateral cervical internal carotid artery (ICA) occlusions with abnormal vascular networks from the posterior circulation. A 43-year old man with a familial history of moyamoya disease presented with subarachnoid hemorrhage. Digital subtraction angiography demonstrated complete occlusion of the bilateral ICAs at the proximal portion and a ruptured aneurysm at the basilar artery bifurcation. Each meningeal artery supplied the anterior cranial base, but most of both hemispheres were supplied with blood from the basilar artery and the posterior cerebral arteries through a large number of collateral vessels to the ICA bifurcation as well as the anterior cerebral and middle cerebral arteries. The perfusion computed tomography (CT) scans with acetazolamide (ACZ) injection revealed no reduction of cerebral blood flow and normal cerebrovascular reactivity to ACZ. An abdominal CT aortogram showed no other extracranial vessel abnormalities. A ruptured basilar tip aneurysm was successfully treated with coil embolization without complications. Endovascular embolization may be a good treatment option with excellent safety for a ruptured basilar tip aneurysm that accompanies proximal ICA occlusion with vulnerable collateral flow.

Results of a phase 4 trial of Tacrobell® in liver transplantation patients: a multicenter study in South Korea.

BACKGROUND/AIMS: This 26-week pilot study was performed in de novo liver transplant recipients to evaluate the efficacy of tacrobell capsule as an immunosuppressant drug after living donor liver transplant patients by determining the rate of acute cellular rejection after its use and evaluating its safety after transplantation. METHODOLOGY: From October 2005 to July 2007, 57 patients from four major medical centers in Seoul, South Korea were enrolled in the study. This open-label, noncomparative, multicenter pilot study lasted 26 weeks and assigned patients to receive tacrobell and corticosteroid after liver transplantation. Tacrobell (0.05mg/ kg/day, bid) and methylprednisolone were injected either on the day of the operation or on postoperative day one. A retrospective matched control group consisting of living donor liver transplant recipients at one center (Asan medical center) was used for comparison. RESULTS: The rate of acute cellular rejection with Tacrobell after 26 weeks of administration was 0.0% (95% CI, 0.0%-6.27%), which was below our hypothesized 36%. The most common drug-related adverse events included endocrine/nutritional disorders followed by gastrointestinal and hepatobiliary disorders. No patients died during the study period. The side effect profile of this drug was no different than other tacrolimus based immunosuppressants. CONCLUSIONS: Although our study was based on a low risk population and had a shortterm follow up, we conclude that tacrobell, as a generic tacrolimus, can be considered safe and effective in liver transplant patients.

Gadobenate dimeglumine-enhanced liver MRI as the sole preoperative imaging technique: a prospective study of living liver donors.

OBJECTIVE: The objective of our study was to determine whether gadobenate dimeglumine-enhanced MRI is practical as the sole preoperative imaging technique for the examination of living liver donors. SUBJECTS AND METHODS: Forty-four consecutive living donor candidates underwent liver MRI on a 1.5-T MR unit. The MR examination included in- and opposed-phase T1-weighted gradient-echo imaging, T2-weighted MR cholangiography, MR angiography (MRA) and parenchymal phase imaging after the administration of gadobenate dimeglumine, and 60-minute delayed T1-weighted MR cholangiography. Two abdominal radiologists analyzed the images regarding the depiction of the biliary duct anatomy and the hepatic vascular anatomy and for the presence of focal or diffuse liver disease. The findings were compared with intraoperative cholangiographic and surgical findings in 24 patients who underwent partial hepatectomy. RESULTS: In the 24 patients who underwent liver harvesting, 10 had biliary anatomic variants confirmed by intraoperative cholangiography. T2-weighted MR cholangiography allowed a correct diagnosis in 75% (n = 18/24) and T1-weighted MR cholangiography in 79% (n = 19/24) of these patients. When we evaluated the bile duct anatomy using the combined findings of T2- and T1-weighted MR cholangiographic images, the diagnostic accuracy increased to 92% (n = 22/24), but the difference was not statistically significant (p > 0.05). MRA showed a diagnostic accuracy of 79% (n = 19/24) for the hepatic arterial anatomy, 100% (n = 24/24) for the portal venous anatomy, and 96% (n = 23/24) for the hepatic venous anatomy. CONCLUSION: Gadobenate dimeglumine-enhanced MRI allows comprehensive assessment of the biliary and hepatic vascular systems and the hepatic parenchyma and can serve as the sole preoperative imaging test for living liver donor candidates.

Body size effect on brain volume in Korean youth.

The relationship between human body size and brain size is still controversial, although brain size increases with body size across taxonomic levels. The magnetic resonance imaging volumetric analysis of the brain was performed in healthy 20-year old Koreans to investigate the effect of body size on brain volume. The whole brain volume was significantly correlated with body height in male (r=0.37, P<0.05) but not in female participants. The height effect on whole brain volume was increased considerably when data from both male and female participants were combined (r=0.57, P<0.05). The cerebellum volume was moderately correlated with body height in female (r=0.43, P<0.05) but not in male participants. The difference between sexes of the effect of body size on the brain needs to be investigated further.