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Biomedical subjects

D I Kim

Publications and source records attributed to D I Kim.

At least 73 records · Page 4Linked to original sources
PubMed1998

Cerebral cavernous malformations: serial magnetic resonance imaging findings in patients with and without gamma knife surgery.

To classify the cerebral cavernous malformations and to investigate the natural history of cavernous malformations according to the classification, 41 patients with 61 cavernous malformations (40 cavernous malformations from 22 patients treated with gamma knife surgery) were regularly followed up using magnetic resonance (MR) imaging for a mean period of 25.5 months in treated cavernous malformations and 20.7 months in untreated cavernous malformations, respectively. Cavernous malformations were classified into four types: type I, extralesional gross hemorrhage beyond cavernous malformation; type II, mixture of subacute and chronic hemorrhage; type III, area of hemosiderin with small central core; and type IV, area of hemosiderin deposition without central core. Follow-up MR images were analyzed to evaluate changes in size, signal intensity, rebleeding, and perilesional adverse reaction of irradiation. A total of 61 cavernous malformations including 17 in type I, 23 in type II, 10 in type III, and 11 in type IV showed usual degradation of blood product in 22 cavernous malformations, no change in shape and signal intensity in 31 cavernous malformations, and eight cavernous malformations with rebleedings in the serial MR images. In these eight cavernous malformations with rebleedings, six occurred in type II and two in type III, but none in type I or IV. Rebleedings were more frequent in type II than in other types (p = 0.044). Adverse reaction of irradiation was observed in five of 22 patients treated with gamma knife surgery. Although most cerebral cavernous malformations showed evolution of hemorrhage or no change in size or shape on follow-up MR images, cerebral cavernous malformations represented as mixture of subacute and chronic hemorrhage with hemosiderin rim (type II) have a higher frequency to rebleed than other types of cerebral cavernous malformations. Cerebral cavernous malformations represented as hemosiderin deposition without central core (type IV) have a lower tendency to rebleed than other types and do not need any treatment. Most of the adverse reaction of irradiation after gamma knife surgery around cavernous malformations are transient findings and are considered to be perilesional edema.

Adolescent↗
PubMed1998

Ipsilateral thalamic hypoperfusion on interictal SPECT in temporal lobe epilepsy.

UNLABELLED: Interictal brain SPECT is useful for the localization of a seizure focus. Concomitant hypoperfusion of the ipsilateral thalamus on interictal SPECT has been noted for temporal lobe epilepsy. In this study, we aimed to evaluate the prevalence of thalamic hypoperfusion ipsilateral to temporal hypoperfusion (ipsilateral thalamic hypoperfusion) and to assess the usefulness of this finding for the lateralization of epileptic foci on interictal SPECT for temporal lobe epilepsy patients. METHODS: Forty-six patients with refractory temporal lobe epilepsy underwent interictal brain SPECT after intravenous injection of 555-740 MBq of 99mTc-ECD. Perfusion impairments in the brain, especially the temporal lobe and thalamus, were evaluated. The localization of seizure foci was determined in conjunction with scalp, ictal and cortical electroencephalography, MRI and clinical outcomes. Ictal SPECT was performed for 5 of the 12 patients. RESULTS: Concomitant decreased perfusion in both the temporal lobe and the ipsilateral thalamus was observed for 12 (26%) of 46 temporal lobe epilepsy patients on interictal brain SPECT. Seven patients showed hypoperfusion in the left temporal lobe and ipsilateral thalamus. Five patients showed hypoperfusion in the right temporal lobe and ipsilateral thalamus. In addition, hypoperfusion in the ipsilateral basal ganglia (ten patients) or contralateral cerebellum (four patients) was observed. CONCLUSION: Ipsilateral thalamic hypoperfusion is not uncommon in temporal lobe epilepsy. The exact mechanism causing ipsilateral thalamic hypoperfusion is uncertain; however, corticothalamic diaschisis may be an important factor. This finding may aid in the lateralization of seizure foci on interictal brain SPECT.

Adolescent↗
PubMed1998

Technetium-99m-ECD brain SPECT in cerebral palsy: comparison with MRI.

UNLABELLED: Hypoxic brain injury is one of the major causes of cerebral palsy. Therefore, this study was performed to evaluate cerebral perfusion impairments in these patients using 99mTc-ECD brain SPECT. METHODS: Fifty-one patients (31 boys, 20 girls; age range 6 mo to 6 yr, 11 mo) with clinical manifestations of cerebral palsy underwent brain SPECT after intravenous injection of 99mTc-ECD. The clinical subtypes of cerebral palsy were spastic diplegia (n = 35), spastic quadriplegia (n = 11), spastic hemiparesis (n = 2), choreoathetoid (n = 2) and mixed (n = 1). Transaxial, coronal and sagittal images obtained with a brain-dedicated annular crystal gamma camera were qualitatively analyzed and compared with the findings of magnetic resonance imaging (MRI). RESULTS: In SPECT, thalamic hypoperfusion was seen in all patients except one (98%), followed by hypoperfusion in the temporal lobe (52.9%, n = 27), basal ganglia (41.2%, n = 21), cerebellum (39.2%, n = 20) and extratemporal cortices (21.6%, n = 11). However, MR imaging demonstrated thalamic abnormality in seven (13.7%), basal ganglia in two (3.9%), extratemporal cortical defect in five (9.8%) and cerebellar atrophy in one (1.9%). Instead, white matter changes such as periventricular leukomalacia or ischemia (56.9%, n = 25) and thinning of corpus callosum (49%, n = 25) were the major findings. CONCLUSION: Brain SPECT is useful in the diagnosis of cerebral palsy and is more sensitive in the detection of cortical, subcortical nuclei and cerebellar abnormalities. MRI is superior in the detection of white matter changes.

Brain↗
PubMed1998

Cerebral perfusion impairment in a patient with toluene abuse.

We report the case of a 17-yr-old man diagnosed as a toluene abuser. He had an 8-mo history of toluene inhalation exposure and was admitted to this hospital with symptoms of auditory and visual hallucination. Magnetic resonance imaging (MRI) revealed no structural abnormalities both on T1- and T2-weighted images, whereas SPECT using 99mTc-ethyl cysteinate dimer (ECD) showed multifocally decreased perfusion in the cerebral cortex, basal ganglia and thalami. Our case indicates that SPECT detects early central nervous system injury from toluene inhalation even when neurological examination and neuroanatomic imaging such as MRI are normal.

Adolescent↗
PubMed1998

Excision of subcutaneous tissue and deep muscle fascia for advanced lymphedema.

In advanced peripheral lymphedema particularly involving the legs, complex physical therapy (massage/bandage-wrapping compression, remedial exercises, and maintenance use of a low stretch elastic compression garment), is not uniformly successful. In six patients with morbid lymphedema of the legs, we described our positive experience using a modified Auchincloss/Homans excisional operation.

Adipose Tissue↗
PubMed1997

Large cerebral infarction during praziquantel therapy in neurocysticercosis.

BACKGROUND: Large cerebral infarction is a rare complication of neurocysticercosis. Endarteritis by inflammation of the leptomeninges is known to be its cause. CASE DESCRIPTION: A 59-year-old man with known neurocysticercosis developed a large cerebral infarction during praziquantel therapy. A follow-up MRI obtained immediately after his cerebral infarction demonstrated notable decrease in the size of the cysts and more prominent enhancement around the peripheral margins of the cysts and the major vessels in comparison with the initial MRI. Cerebral angiography disclosed occlusions and narrowing of both internal carotid arteries at the supraclinoid portions, where multiple cysts were found on the MRI. CONCLUSIONS: Findings in our patient strongly suggest that a secondary inflammation reaction caused by the destruction of the cysts might have enhanced the process of endarteritis. The possible deleterious effects of praziquantel therapy should be considered in the treatment of patients with subarachnoid cysticerci.

Antiplatyhelmintic Agents↗
PubMed1997

Cells in pseudointimal hyperplasia is migrated from extravascular space.

BACKGROUND: The aim of this study was to investigate the origin of the pseudointima (PI) formed in polytetrafluoroethylene (PTFE) tube grafts after implantation into the inferior vena cava (IVC) of rabbits. METHODS: A segment of the IVC of rabbits was replaced by PTFE tube graft (3 cm long, 3 mm inner diameter, 30 microns internodal distance, 0.3 mm thickness). The experimental group was divided into two groups as follows: (Group A) non-wrapped, (Group B) wrapped the outer wall of PTFE with impermeable vinyl. RESULTS: Grafts were harvested at three weeks after implantation and subjected to the following studies: patency, ultrastructural studies by light microscopy (LM) and immunostaining, scanning and transmission electron microscopy (SEM & TEM). The grafts were patient but the lumen of the control group was narrowed by PI. LM and immunostaining studies revealed the presence of thick PI composed of spindle-type cells in Group A, bust almost no PI in Group B. Only few erythrocytes, macrophage and protein-fibrin matrix was found in Group B. Endothelial like cell coverage, judged by SEM, was observed in only Group A. Only some macrophages and platelets were shown in the graft surface in Group B. TEM of PI revealed the presence of VSMCs, myofibroblasts and outer surface of grafts revealed the presence of myofibroblast in Group A. CONCLUSIONS: The formation of PI suppressed by blocking the cellular migration from perigraft space suggest that PI was mainly originated by myofibroblast located in the perigraft space.

Animals↗
PubMed1997

Conservative management of superior mesenteric and portal vein thrombosis associated with protein C and S deficiency. Case report.

Protein C and S, vitamin K-dependent proteins, are blood coagulation inhibitors. Their deficiency causes systemic thrombosis. A 35-year-old man who developed superior mesenteric venous thrombosis and portal vein thrombosis showed markedly decreased protein C and S levels. The therapeutic modality of this thrombosis associated with protein C and S deficiency is still debated. We treated this patient with systemic anticoagulation and long term total parenteral nutrition without surgical intervention.

Adult↗
PubMed1996

Pseudointimal hyperplasia of ridged outer wall polytetrafluoroethylene vascular prostheses.

In addition to the polytetrafluoroethylene (PTFE) vascular graft (G) with its conventionally smooth surface, a unique PTFE graft with a ridged outer wall (T) is now also currently available for clinical use. Although an excellent antikinking property is provided by this unique outer structure, the possible influence of the structure on the formation of pseudointima has not yet been investigated in detail. Four kinds of T grafts (3 mm inner diameter, 3 cm long) with various fibril lengths (FL, T-15, T-30, T-60, T-90) and a G graft with 30 microns FL (G-30) were implanted into the inferior vena cava of rabbits. The patency of the grafts at 4 weeks were as follows: 6/8(T-15), 6/8(T-30), 5/8(T-60), 0/8(T-90) and 4/6 (G-30). Pseudointimal hyperplasia (PH) of the T grafts advanced as the FL increased, judging by the thickness of the pseudointima, cellular density, and maturity of fibroblasts. In addition, the maturity of endothelial-like cells on the luminal surface increased as the FL increased. The degree of pseudointimal hyperplasia in G-30 was comparable to that of T-15, although the maturity of the endothelial-like cells was similar to that of T-60. Microscopically, there was a micro-heterogeneity of cellular density in T grafts probably due to the uneven outer structure. In conclusion, not only FL but also the outer structure of PTFE may thus influence the formation of the pseudointima.

Animals↗
PubMed1996

High-resolution CT of the pterygopalatine fossa and its communications.

The pterygopalatine fossa is an important space because it communicates with the middle cranial fossa, orbit, nasal cavity, oral cavity, pharynx, foramen lacerum, and the infratemporal fossa via eight foramina and canals. We studied the pterygopalatine fossa, foramen rotundum, inferior orbital fissure, sphenopalatine foramen, pterygoid canal, greater and lesser palatine foramen, palatinovaginal canal, and the pterygomaxillary fissure with high-resolution CT to characterise the anatomy and variants of these structures. These structures were evaluated using axial and coronal planes. In the morphometric study, the distance between the foramina rotunda did not show statistically significant differences between the anterior and posterior segments. The pterygoid canal was slightly narrower in the anterior segment (23.9 mm) than in the posterior segment (25.2 mm). The pterygoid canal narrowed in the anterior (1.8 mm) to posterior (1.2 mm) direction (P < 0.01). The distance between the pterygoid canal and the lower wall of the sphenoid sinus was 2.2 mm anteriorly and 2.8 mm posteriorly (P < 0.01). The pterygoid canal showed various relationships with the sphenoid and ethmoid sinuses. In addition, a previously unreported situation, where the foramen rotundum was surrounded by the spheroid sinus, was observed.

Adult↗
PubMed1996

In vivo evaluation of DX-9065a, a synthetic factor Xa inhibitor, in experimental vein graft.

An in vivo effect of a novel synthetic Xa inhibitor, DX-9065a, was evaluated in a highly thrombogenic venous graft model. A woven Tetron tube graft was interposed in the inferior vena cava of rabbits. All the grafts were completely occluded within 5 hours after a bolus injection of heparin (50 U/kg) given just prior to the grafting. The following agents were continuously given to the respective group of rabbits for 2 h after the bolus injection of heparin; heparin (50 U/kg/h, UFH-group), DX-9065a (0.05 mg/kg/h, DX-group) and argatroban (32 microG/kg/h, MD-group). During a 5-h observation period, the anti-Xa activity in circulating blood between the UFH- and DX-group and the anti-thrombin activity between the UFH- and MD-group were not significantly different. The graft patency in the DX-group (4/4) and MD-group (4/4) was significantly better than that in the UFH-group (3/10). Ultrastructural analysis of the luminal surface of the harvested graft by scanning electron microscopy revealed the reduced formation of fibrin networks entrapping erythrocytes in the DX- and MD-group in comparison with the patent UFH-group. In conclusion, a novel synthetic Xa inhibitor DX-9065a exerts a potent in vivo antithrombotic effect, which was comparable with argatroban, a synthetic thrombin inhibitor.

Animals↗
PubMed1996

HMPAO SPECT to assess neurologic deficits during balloon test occlusion.

UNLABELLED: The purpose of this study was to determine if one could objectively and preoperatively predict the safety of permanent occlusion of an internal carotid artery with 99mTc-HMPAO brain SPECT. METHODS: Twenty-four patients underwent balloon test occlusion of the internal carotid arteries because of neck and skull base tumors. We assessed the uptake of both middle cerebral artery territories before and during balloon test occlusion with 99mTc-HMPAO brain SPECT using the semiquantitative analysis. The results were compared with other factors, including neurologic examination, arterial stump pressure and electroencephalogram. RESULTS: Nineteen patients experienced no neurological deterioration or any problem during balloon test occlusion. The comparative uptake of their middle cerebral artery territories was 95%-101% of the pre-balloon test occlusion state. The remaining five patients showed severe neurologic symptoms, such as transient hemiplegia and unconsciousness. The comparative uptake of their middle cerebral artery territories was 77%-85% of the pre-balloon test occlusion state and was well matched with other factors. CONCLUSION: Technetium-99m-HMPAO brain SPECT before and during balloon test occlusion seems to be a simple and objective method for predicting permanent neurologic deficits when the comparative uptake of middle cerebral artery territories during balloon test occlusion is less than 85% of that before balloon test occlusion.

Adolescent↗
PubMed1995

Suppression of pseudointimal hyperplasia by a novel prostacyclin analogue: beraprost.

The aim of this study was to evaluate the effect of a novel prostaglandin I2 analogue, beraprost (BPT), on the pseudointimal hyperplasia (PIH) of polytetrafluoroethylene (PTFE) prostheses. A total of 12 rabbits were equally divided into three groups. The control group was given a placebo daily, group 1 was given BPT orally 2 mg/kg per day, and group 2 was given BPT orally 4 mg/kg b.i.d. Exactly 1 cm of the inferior vena cava was resected and replaced by a 3-cm PTFE tube graft. All the grafts were patent when harvested 4 weeks after implantation, but the lumens were narrowed to various extents by PIH. PIH, determined by the dry weight of the intraluminal tissue deposit, was significantly (P < 0.01) suppressed in groups 1 and 2 compared with the control group. High-magnification light microscopy with various staining methods revealed the PIH to be composed mainly of smooth muscle cells (SMCs) and collagen fibrils in all three groups. Transmission electron microscopy revealed that the majority of SMCs in groups 1 and 2 were contractile in form, in contrast with the synthetic form seen in the control group. In conclusion, BPT attenuated the PIH of PTFE grafts by inhibiting the phenotype change in the SMCs.

Animals↗
PubMed1995

Chemical synthesis of 15-ketosterols and their inhibitions of cholesteryl ester transfer protein.

Described herein are the chemical syntheses of 3 beta-hydroxy-5 alpha-cholest-8(14)-en-15-one and 3 beta-hydroxy-5 alpha-cholest-8(14),16-dien-15-one from diosgenin and the examinations of their ability to inhibit the cholesteryl ester transfer protein (CETP). Clemmensen reduction of diosgenin gave cholest-5-ene-3 beta, 16 beta,26-triol. Tosylation of the latter compound gave cholest-5-ene-3 beta,16 beta,26-triol 26-tosylate which, upon reduction with LiAIH4, gave cholest-5-ene-3 beta,16 beta-diol. Hydrogenation-benzoylation of the latter to 5 alpha-cholest-3 beta,16 beta-diol 3 beta-benzoate followed by mesylation-elimination gave 5 alpha-cholest-16-ene-3 beta-ol 3 beta-benzoate. Controlled oxidation of the latter with CrO3-dimethylpyrazole gave 3 beta-hydroxy-5 alpha, 14 alpha-cholest-16-en-15-one 3 beta-benzoate. Oxidation of delta 16-15-one with SeO2 gave 3 beta-hydroxy-5 alpha-cholest-8(14),16-dien-15-one 3 beta-benzoate along with 3 beta-hydroxy-5 alpha, 14 beta-cholest-16-en-15-one 3 beta-benzoate. Selective hydrogenation of the delta 8(14),16-15-ketosteryl ester, followed by base hydrolysis gave 3 beta-hydroxy-5 alpha-cholest-8(14)-en-15-one. Hydrolysis of 3 beta-hydroxy-5 alpha-cholest-8(14),16-dien-15-one 3 beta-benzoate in basic media gave 3 beta-hydroxy-5 alpha-cholest-8(14),16-dien-15-one. The effects of the 15-ketosterols on the CETP activity were studied in vitro by incubating cholesteryl ester donor (HDL), cholesteryl ester acceptor (LDL) and human plasma as a CETP source at 37 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)

Anticholesteremic Agents↗
PubMed1995

Complications following Gamma Knife radiosurgery.

Between May 1992 and February 1994, 213 lesions in 183 consecutive patients were treated with Gamma Knife radiosurgery at Severance Hospital, Yonsei University, Seoul, Korea. During this period, we experienced 2 deaths, 1 directly and another indirectly related to irradiation. Nonfatal complications included 1 tumor bleeding, and 4 ventriculoperitoneal shunts had to be inserted due to aggravation of preexisting hydrocephalus. Radiation-induced imaging changes developed in 23.6% of the cases followed up for more than 6 months. Among 24 lesions of 8 cavernous hemangiomas, all 4 cases with lesions larger than 1.5 cm3 developed imaging changes.

Dose-Response Relationship, Radiation↗
PubMed1995

Huge Langerhans cell histiocytosis granuloma of choroid plexus in a child with Hand-Schüller-Christian disease. Case report.

In the literature, only two previous cases of presumed Langerhans cell histiocytosis (LCH) granuloma involving choroid plexus have been reported in patients with Hand-Schüller-Christian (HSC) disease, but those cases were not verified by immunohistochemistry or electron microscopy. The authors report a case of LCH granuloma of the choroid plexuses of bilateral lateral ventricles and the fourth ventricle in a child affected by HSC disease. This disease was confirmed by the presence of Birbeck granules on electron microscopy and positive reactivity to S-100 protein. Clinical, radiographic, and histological features are discussed. This case illustrates that LCH granuloma should be considered in the differential diagnosis of intraventricular masses.

Biopsy↗
PubMed1995

Transhiatal gastric transposition of a long gap esophageal atresia.

Transhiatal gastric transposition was performed in a long gap esophageal atresia without tracheoesophageal fistula. The patient was a 12 months old female infant with previous stamm-type gastrostomy. The stomach was mobilized preserving the right gastric artery, the right gastroepiploic artery and spleen. The proximal and distal blind pouches of esophagus were excised by transcervical and transhiatal route, respectively. The mobilized stomach was pulled up into the neck through esophageal hiatus and posterior mediastinal route. The esophagogastrostomy, the only one anastomosis of this procedure, was safely performed in the neck. There were neither anastomotic leak nor early anastomotic stricture. The oral feeding was quickly established. There was no clinical evidence of regurgitation, difficulty of gastric emptying, hoarseness or respiratory problem. The low morbidity combined with satisfactory functional result indicates that the transhiatal gastric transposition is a safe and easy alternative surgical procedure for esophageal replacement in long gap esophageal atresia.

Esophageal Atresia↗