Heoung-Keun Kang

ORIGINAL RESEARCH—PHYSIOLOGY: Assessment of Cerebrocortical Areas Associated with Sexual Arousal in Depressive Women Using Functional MR Imaging

INTRODUCTIONnMental illness is closely related with sexual dysfunction. A number of investigators have reported that depressive women have difficulties in sexual arousal.nnnAIMnThe purpose of this study was to compare the cerebrocortical regions associated with sexual arousal between the healthy and depressive women using functional magnetic resonance imaging (fMRI) based on the blood-oxygenation-level-dependent (BOLD) technique.nnnMETHODSnTogether with nine healthy women (mean age: 40.3), seven depressive women (mean age: 41.7 years, mean Beck Depression Inventory: 35.6, mean Hamilton Rating Scale Depression-17: 34.9) underwent fMRI examinations using a 1.5T MR scanner (Signa Horizon; GE Medical Systems, Milwaukee, WI, USA). The fMRI data were obtained from seven oblique planes using gradient-echo EPI. Sexual stimulation paradigm began with a 1-minute rest and then 4-minute stimulation using an erotic video film. The brain activation maps and their resulting quantification were analyzed by the statistical parametric mapping (SPM99) program. The number of pixels activated by each task was used as brain activity, where the significance of the differences was evaluated by using independent t-test.nnnMAIN OUTCOME MEASURESnWe measured brain activation areas using BOLD-based fMRI with visual sexual stimulation in healthy volunteers and depressive patients.nnnRESULTSnHealthy women were significantly (P < 0.05) activated in the regions of middle occipital gyrus, middle temporal gyrus, inferior frontal gyrus, insula, hypothalamus, septal area, anterior cingulate gyrus, parahippocampal gyrus, thalamus, and amygdala by erotic visual stimulation. In comparison with the healthy women, the depressive women gave lower activity, especially in the brain regions of hypothalamus (55.5:3.0), septal area (49.6:8.6), anterior cingulate gyrus (23.5:11.0), and parahippocampal gyrus (18.2:5.8).nnnCONCLUSIONSnThis preliminary study performed by fMRI gives valuable information on differentiation of the activated cerebral regions associated with visually evoked sexual arousal between healthy and depressive women. In addition, these findings might be useful to understand neural mechanisms for female sexual dysfunction in depressive women.

ORIGINAL RESEARCHORIGINAL RESEARCH—PHYSIOLOGY: Assessment of Cerebrocortical Areas Associated with Sexual Arousal in Depressive Women Using Functional MR Imaging

INTRODUCTIONnMental illness is closely related with sexual dysfunction. A number of investigators have reported that depressive women have difficulties in sexual arousal.nnnAIMnThe purpose of this study was to compare the cerebrocortical regions associated with sexual arousal between the healthy and depressive women using functional magnetic resonance imaging (fMRI) based on the blood-oxygenation-level-dependent (BOLD) technique.nnnMETHODSnTogether with nine healthy women (mean age: 40.3), seven depressive women (mean age: 41.7 years, mean Beck Depression Inventory: 35.6, mean Hamilton Rating Scale Depression-17: 34.9) underwent fMRI examinations using a 1.5T MR scanner (Signa Horizon; GE Medical Systems, Milwaukee, WI, USA). The fMRI data were obtained from seven oblique planes using gradient-echo EPI. Sexual stimulation paradigm began with a 1-minute rest and then 4-minute stimulation using an erotic video film. The brain activation maps and their resulting quantification were analyzed by the statistical parametric mapping (SPM99) program. The number of pixels activated by each task was used as brain activity, where the significance of the differences was evaluated by using independent t-test.nnnMAIN OUTCOME MEASURESnWe measured brain activation areas using BOLD-based fMRI with visual sexual stimulation in healthy volunteers and depressive patients.nnnRESULTSnHealthy women were significantly (P < 0.05) activated in the regions of middle occipital gyrus, middle temporal gyrus, inferior frontal gyrus, insula, hypothalamus, septal area, anterior cingulate gyrus, parahippocampal gyrus, thalamus, and amygdala by erotic visual stimulation. In comparison with the healthy women, the depressive women gave lower activity, especially in the brain regions of hypothalamus (55.5:3.0), septal area (49.6:8.6), anterior cingulate gyrus (23.5:11.0), and parahippocampal gyrus (18.2:5.8).nnnCONCLUSIONSnThis preliminary study performed by fMRI gives valuable information on differentiation of the activated cerebral regions associated with visually evoked sexual arousal between healthy and depressive women. In addition, these findings might be useful to understand neural mechanisms for female sexual dysfunction in depressive women.

Human brain activation in response to visual stimulation with rural and urban scenery pictures: a functional magnetic resonance imaging study.

Human brain activation was assessed in terms of eco-friendliness while viewing still photographs depicting rural and urban surrounding environments with the use of a functional magnetic resonance imaging technique. A total of 30 subjects who had both rural and urban life experiences participated in this study. In order to explore the common and differential activation maps yielded by viewing two extreme types of scenery, random effect group analysis was performed with the use of one-sample and two-sample t-tests. Activation of the anterior cingulate gyrus, globus pallidus, putamen and head of the caudate nucleus was dominant during rural scenery viewing, whereas activation of the hippocampus, parahippocamus and amygdala was dominant during urban scenery viewing (p<0.01). These findings allow better characterization of neural activation, suggesting an inherent preference towards nature-friendly living. Such a theoretical acquisition may have an important practical impact in view of potential applications for bio-housing and the development of environmental psychology-related areas.

Multimodal imaging evaluation in staging of rectal cancer.

Rectal cancer is a common cancer and a major cause of mortality in Western countries. Accurate staging is essential for determining the optimal treatment strategies and planning appropriate surgical procedures to control rectal cancer. Endorectal ultrasonography (EUS) is suitable for assessing the extent of tumor invasion, particularly in early-stage or superficial rectal cancer cases. In advanced cases with distant metastases, computed tomography (CT) is the primary approach used to evaluate the disease. Magnetic resonance imaging (MRI) is often used to assess preoperative staging and the circumferential resection margin involvement, which assists in evaluating a patients risk of recurrence and their optimal therapeutic strategy. Positron emission tomography (PET)-CT may be useful in detecting occult synchronous tumors or metastases at the time of initial presentation. Restaging after neoadjuvant chemoradiotherapy (CRT) remains a challenge with all modalities because it is difficult to reliably differentiate between the tumor mass and other radiation-induced changes in the images. EUS does not appear to have a useful role in post-therapeutic response assessments. Although CT is most commonly used to evaluate treatment responses, its utility for identifying and following-up metastatic lesions is limited. Preoperative high-resolution MRI in combination with diffusion-weighted imaging, and/or PET-CT could provide valuable prognostic information for rectal cancer patients with locally advanced disease receiving preoperative CRT. Based on these results, we conclude that a combination of multimodal imaging methods should be used to precisely assess the restaging of rectal cancer following CRT.

Assessment of brain metabolites change during visual sexual stimulation in healthy women using functional MR spectroscopy.

INTRODUCTIONnNumerous functional magnetic resonance imaging (fMRI) studies demonstrated the key brain areas associated with visual sexual arousal. However, the changes in brain metabolites involved in sexual stimuli have not been reported.nnnAIMnThis study utilized functional MR spectroscopy (fMRS) to evaluate the changes in brain metabolites associated with sexual arousal induced by stimulation with erotic video clips in healthy women.nnnMETHODSnTwenty-three healthy, right-handed women (38.4u2009±u200910.0u2009years) participated in (1) H-fMRS and fMRI studies. T1 and T2 MR images were used for voxel localization of the anterior cingulate gyrus, which is one of the most important key centers associated with sexual arousal.nnnMAIN OUTCOME MEASURESnThe changes of brain metabolites were measured using (1) H-fMRS during time-course activation: before, during, and after visual sexual stimulation. The time-course variation of the brain metabolites was analyzed by the repeated-measures analysis of variance.nnnRESULTSnThe CVmean of all the metabolites had <30% (range, 9-29%). The ICCs of α-glutamine-glutamate (Glx), choline (Cho), β·γ-Glx, N-acetylaspartate (NAA) and lactate (Lac) all exceeded 0.6. However, myo-inositol (mI) and lipid (Lip) were <0.6. The concentration of brain metabolites including α-Glx, β·γ-Glx, Cho, and Lac comparatively increased significantly during visual sexual stimulation.nnnCONCLUSIONSn(1) H-fMRS, for the first time, was applied to assess the brain metabolic changes during visually-evoked sexual arousal. The fMRS outcomes in relation to functional MRI data will be useful to understand the neural mechanism associated with sexual arousal.

Metabolic change in the right dorsolateral prefrontal cortex and its correlation with symptom severity in patients with generalized anxiety disorder: Proton magnetic resonance spectroscopy at 3 Tesla.

A few neuroimaging studies have demonstrated the key brain areas associated with generalized anxiety disorder (GAD). However, the brain metabolic changes in the dorsolateral prefrontal cortex (DLPFC) of patients with GAD are unclear. This study utilized 3‐Tesla proton magnetic resonance spectroscopy (1H‐MRS) to assess the DLPFC metabolic change and its correlation with symptom severity in patients with GAD.

Case of mucinous adenocarcinoma with porcelain gallbladder

Abstract Histologically, the majority of gallbladder cancers are adenocarcinomas. Among the adenocarcinomas, the mucinous adenocarcinoma is relatively uncommon. Porcelain gallbladder is a rare finding and the risk of gallbladder cancer is significantly increased in porcelain gallbladder. We describe a rare case of mucinous adenocarcinoma with porcelain gallbladder. A 46‐year‐old man was admitted to Chonnam National University Hospital with a 2‐week history of right upper quadrant pain. Three and 2u2003years previously, he had two episodes of cholecystitis with gallstones. An abdominal computed tomography revealed a contracted gallbladder with circumferential mural calcification, and the possibility of gallbladder cancer and porcelain gallbladder were considered. At laparotomy, cholecystectomy, liver wedge resection, and radical lymph node dissection were performed. The resected gallbladder showed thickened wall, luminal narrowing and mucosal irregularity. A histological examination of the resected gallbladder showed a mucinous adenocarcinoma composed of poorly differentiated glandular cells with mucin lakes. Porcelain gallbladder may be an end result of a chronic inflammatory reaction, and this change is associated with the development of gallbladder cancer.

Transarterial embolization for postoperative hemorrhage after abdominal surgery

The study goal was to evaluate the efficacy, safety, and clinical outcome of transarterial embolization for postoperative hemorrhage after abdominal surgery. Thirty-three patients were referred for angiography because of gastrointestinal or intra-abdominal bleeding after abdominal surgery. Urgent angiography and transarterial embolization was performed in all 33 patients. The clinical and angiographic features were retrospectively reviewed. Angiography revealed a discrete bleeding focus in 26 (79%) of 33 patients. Transarterial embolization was technically successful in 24 (92%) of 26 patients with a discrete bleeding focus. Rebleeding occurred in four (17%) of 24 patients. They were successfully managed with repeat embolization. There was no procedure-related complication during follow-up period. Angiography has a high detection rate of bleeding site in patients with postoperative hemorrhage after abdominal surgery. Transarterial embolization is considered to be an effective and safe means in the management of postoperative hemorrhage.

Primary stent placement for recanalization of iliac artery occlusions: using a self-expanding spiral stent.

AbstractPurpose: To report the clinical results for recanalizations of an occluded iliac artery by a self-expanding spiral stent.n Methods: We attempted to recanalize 36 iliac artery occlusions in 34 patients [33 men, 1 woman, aged 51–75 years (average 61.6 years)]. The average lesion length was 6.92 cm (range 1–14 cm). The patients’s chief complaints were intermittent claudication and resting pain. Fontaine classification was assigned before and after the procedure. Technical and clinical success were also analyzed.n Results: Forty-five stents were successfully deployed in 34 patients. All 36 lesions (13 in the external iliac artery, 12 in the common iliac artery, and 11 in both) were patently recanalized on angiography. The follow-up period ranged from 6 months to 36 months (mean 11.9 months). Fourteen stents (39%) with incomplete expansion were dilated with a balloon catheter. Good technical (100%) and clinical (94%) results were obtained. The only complication was one hematoma at the puncture site. Reocclusions were noted in two lesions (5%) at 1 week and 15 months, respectively.n Conclusion: A self-expanding spiral stent is a safe and effective device for recanalization of an iliac artery occlusion as the primary stent without any previous intervention.

Brain Activation in Response to Visually Evoked Sexual Arousal in Male-to-Female Transsexuals: 3.0 Tesla Functional Magnetic Resonance Imaging

Objective This study used functional magnetic resonance imaging (fMRI) to contrast the differential brain activation patterns in response to visual stimulation with both male and female erotic nude pictures in male-to-female (MTF) transsexuals who underwent a sex reassignment surgery. Materials and Methods A total of nine healthy MTF transsexuals after a sex reassignment surgery underwent fMRI on a 3.0 Tesla MR Scanner. The brain activation patterns were induced by visual stimulation with both male and female erotic nude pictures. Results The sex hormone levels of the postoperative MTF transsexuals were in the normal range of healthy heterosexual females. The brain areas, which were activated by viewing male nude pictures when compared with viewing female nude pictures, included predominantly the cerebellum, hippocampus, putamen, anterior cingulate gyrus, head of caudate nucleus, amygdala, midbrain, thalamus, insula, and body of caudate nucleus. On the other hand, brain activation induced by viewing female nude pictures was predominantly observed in the hypothalamus and the septal area. Conclusion Our findings suggest that distinct brain activation patterns associated with visual sexual arousal in postoperative MTF transsexuals reflect their sexual orientation to males.