الملخص
PURPOSE: Dynamic parameters, including end-tidal carbon dioxide (ETCO₂), peak velocity variation in the common carotid artery (pvvCCA), distensibility index of the internal jugular vein (dIJV), and distensibility index of the inferior vena cava (dIVC) have been used to predict fluid responsiveness in fully sedated patients under positive mechanical ventilation. We aimed to compare the cardiac output (CO) with all these dynamic parameters upon changing positions. METHODS: This prospective cohort study compared the changes in all parameters that alter CO after changing positions, including upper body at 60°and 30°, supine position, and lower body at 30°and 60°, as measured using ultrasonography, between June 2015 and September 2016. RESULTS: CO was correlated with parameters, including dIJV, pvvCCA, and ETCO₂, in positively ventilated patients with nonspontaneous breathing (p=0.001, p=0.014, and p=0.006, respectively). Among these parameters, ETCO₂ showed to have the best correlation with CO change after position change (coefficient 0.412). Correlations of CO with central venous pressure, blood pressure, and dIVC were not statistically significant. The mean value of CO in elevated lower body positions was slightly lower than the mean value of CO in supine position (5.231 vs. 5.752 L/min, p=0.516). CONCLUSION: Measuring the changes of ETCO₂ in patients with positive mechanical ventilation might allow the most accurate prediction of CO changes. The position change from elevated upper body to supine position could better induce CO changes than that performed similarly with passive leg raising.
الموضوعات
Humans , Blood Pressure , Carbon Dioxide , Cardiac Output , Carotid Arteries , Carotid Artery, Common , Central Venous Pressure , Cohort Studies , Critical Care , Hemodynamics , Intensive Care Units , Jugular Veins , Leg , Prospective Studies , Respiration , Respiration, Artificial , Supine Position , Ultrasonography , Vena Cava, Inferiorالملخص
PURPOSE: To validate the use of harmonic ultrasonography (US) in the detection of gallbladder microlithiasis. METHODS: From November 30, 2012, to January 18, 2014, fundamental US (FUS) and harmonic US with a high background noise (HUS-N) were performed for evaluation of gallbladder during the routine abdomen US. During the US, a dot-like stone (or stones) with Brownian motion was regarded as a positive finding of microlithiasis. Fifty-five patients with microlithiasis in the gallbladder detected on US were enrolled as the subjects of a retrospective review. With respect to the obtained images, two abdominal radiologists independently scored the conspicuity of gallbladder microlithiasis on FUS and HUS-N by using a 4-grade scale. The statistical analysis employed a kappa test and a Wilcoxon rank-sum test. RESULTS: For FUS, the conspicuity grades of gallbladder microlithiasis were G1 in 25 and 37, G2 in 21 and 9, G3 in 6 and 6, G4 in 3 and 3 patients, while HUS-N showed G1 in 0 and 0, G2 in 3 and 2, G3 in 12 and 15, and G4 in 40 and 38 patients, respectively, by each of the two radiologists. The kappa value was 0.633 for FUS between the two radiologists and 0.708 for HUS-N. HUS-N showed better conspicuity of gallbladder microlithiasis than FUS with significant P-values of less than 0.001 and 0.001 for the two radiologists, respectively. CONCLUSION: Compared with FUS, HUS-N enables better detection of microlithiasis in the gallbladder.
الموضوعات
Humans , Abdomen , Cholecystolithiasis , Gallbladder , Noise , Retrospective Studies , Ultrasonographyالملخص
OBJECTIVE: To evaluate scientific papers published by Korean radiologists in the Science Citation Index Expanded (SCIE) radiology journals, between 1986 and 2010. MATERIALS AND METHODS: The Institute for Scientific Information Web of Knowledge-Web of Science (SCIE) database was searched for all articles published by Korean radiologists, in SCIE radiology journals, between 1986 and 2010. We performed the analysis by typing "Korea" and "radiol" in the address section and selecting the subject area of "Radiology, Nuclear Medicine, and Medical Imaging" with the use of the general search function of the software. Analyzed parameters included the total number of publications, document types, journals, and institutions. In addition, we analyzed where Korea ranks, compared to other countries, in terms of the number of published articles. All these data were analyzed according to five time periods: 1986-1990, 1991-1995, 1996-2000, 2001-2005, and 2006-2010. RESULTS: Overall, 4974 papers were published by Korean radiologists, in 99 different SCIE journals, between 1986 and 2010, of which 4237 (85.2%) were article-type papers. Of the total 115395 articles, worldwide, published in radiology journals, Korea's share was 3.7%, with an upward trend over time (p < 0.005). The journal with the highest number of articles was the American Journal of Roentgenology (n = 565, 13.3%). The institution which produced the highest number of publications was Seoul National University (n = 932, 22.0%). CONCLUSION: The number of scientific articles published by Korean radiologists in the SCIE radiology journals has increased significantly between 1986 and 2010. Korea was ranked 4th among countries contributing to radiology research during the last 5 years.
الموضوعات
Bibliometrics , Biomedical Research/statistics & numerical data , Periodicals as Topic/statistics & numerical data , Radiology , Republic of Koreaالملخص
Porcelain gallbladder is regarded as a risk factor of gallbladder cancer. A porcelain gallbladder with calcified regional lymph nodes was found using computed tomography (CT) and magnetic resonance imaging (MRI) in a 43-year-old man who presented with nausea, vomiting, and abdominal pain. His cholecystectomy specimen showed diffuse wall thickening and contained small gallstones. Histological examination revealed diffuse infiltrative adenocarcinoma with extensive intratumoral calcification (calcified carcinoma). The majority of the calcified material was located within or replaced the tumor glands, and was not found in the stroma. A lymph node was totally replaced with a calcified metastatic adenocarcinoma. To the best of our knowledge, only one case of calcified lymph node metastasis from a calcified carcinoma of the gallbladder has been previously reported in the literature. We herein add a case of calcified carcinoma of the gallbladder with calcified lymph node metastasis, presenting as a porcelain gallbladder on CT and MRI.
الموضوعات
Adult , Humans , Abdominal Pain , Adenocarcinoma , Cholecystectomy , Dental Porcelain , Gallbladder , Gallbladder Neoplasms , Gallstones , Lymph Nodes , Magnetic Resonance Imaging , Nausea , Neoplasm Metastasis , Risk Factors , Vomitingالملخص
Toxic hepatitis has been reported as a major cause of acute hepatitis, but its potential induction by herbal remedies and/or health foods is usually neglected. We experienced a case of toxic hepatitis associated with Polygoni multiflori, a Chinese herb commonly known as Ho-Shou-Wu. A 54-year-old woman consumed Ho-Shou-Wu for 1 month, after which she experienced fatigue and overall weakness. A diagnosis of toxic hepatitis was made based on her clinical history, the findings for viral markers and other laboratory data, and ultrasonography. Her condition improved considerably after she stopped taking Ho-Shou-Wu. However, she resumed taking Ho-Shou-Wu immediately after discharge from hospital, which aggravated her symptoms and liver function. She was immediately readmitted and stopped taking Ho-Shou-Wu. Her relapse into hepatitis immediate after resuming consumption of the herb is strongly indicative of the validity of Koch's postulate in this case.
الموضوعات
Female , Humans , Middle Aged , Chemical and Drug Induced Liver Injury/diagnosis , Plant Extracts/toxicity , Polygonum/toxicityالملخص
Splenic arterial pseudoaneurysm is an uncommon life-threatening complication of acute and chronic pancreatitis. Pseudoaneurysm can lead to massive bleeding into the abdominal cavity and the retroperitoneum. Less commonly, it may rupture directly into the stomach, small bowel or pancreatic duct and may present as an acute gastrointestinal hemorrhage. It can be diagnosed by various imaging modalities including computerized tomography, ultrasound and angiography. Percutaneous transvascular embolization of the pseudoaneurysm is one of the alternative treatment methods. Here we present a case of splenic arterial pseudoaneurysmal rupture misrecognized as bleeding from a gastric submucosal tumor in patient with hematemesis. We also review the literature.
الموضوعات
Humans , Abdominal Cavity , Aneurysm, False , Angiography , Gastrointestinal Hemorrhage , Hematemesis , Hemorrhage , Pancreatic Ducts , Pancreatitis, Chronic , Rupture , Splenic Artery , Stomachالملخص
Fitz-Hugh-Curtis syndrome has been described as focal perihepatitis accompanying pelvic inflammatory disease caused by Neisseria gonorrhea and Chlamydia trachomatis. The highest incidence occurs in young, sexually active females. However, the syndrome has been reported to occur infrequently in males, according to the foreign literature. The predominant symptoms are right upper quadrant pain and tenderness, and pleuritic right sided chest pain. The clinical presentation is similar in men and women. In women, the spread of infection to liver capsule is thought to occur directly from infected fallopian tube via the right paracolic gutter. In men, hematogenous and lymphatic spread is thought to be postulated. Recently, we experienced a case of Fitz-Hugh-Curtis syndrome occurred in a man. As far as we know, it is the first report in Korea, and we report a case with a review of the literature.
الموضوعات
Adult , Humans , Male , Anti-Bacterial Agents/therapeutic use , Mycoplasma Infections/diagnosis , Mycoplasma genitalium , Ofloxacin/therapeutic use , Pelvic Infection/diagnosis , Tomography, X-Ray Computedالملخص
Gastric marginal zone B cell lymphoma of the MALT type (MALT lymphoma) is usually accompanied by a Helicobacter pylori (H. pylori) infection. Most gastric MALT lymphomas regress after the eradication of H. pylori. Therefore, H. pylori eradication therapy is an effective first-line treatment for gastric MALT lymphoma. A second-line treatment for patients who fail to respond to eradication therapy, including radiotherapy and chemotherapy, produces a good response and survival rate. We encountered 2 cases of H. pylori eradication-resistant gastric MALT lymphoma, which were treated with cyclophosphamide monotherapy. A complete response was obtained in both cases after a treatment duration of 3 months and remission continued for 15 and 18 months, respectively. Treatment-related toxicity was mild. Oral monochemotherapy might be an alternative, effective and safe treatment modality for patients with gastric MALT lymphoma who are resistant to H. pylori eradication therapy.
الموضوعات
Humans , Cyclophosphamide , Helicobacter pylori , Lymphoma, B-Cell, Marginal Zone , Stomach , Survival Rateالملخص
PURPOSE: To evaluate the effectiveness of the reaspiration or rebiopsy of pulmonary lesions (second PCNA) in cases where the pathologic results are inconclusive upon initial percutaneous needle aspiration biopsy (PCNA). MATERIALS AND METHODS: A total of 364 PCNA cases (350 initial PCNA, 14 second PCNA) were performed under CT or fluoroscopy guidance for all the 350 patients enrolled. The procedure was performed by either using an automated biopsy gun with a 20-G needle (298 cases) or a 20-G aspiration needle (66 cases). The pathologic agreement rates between the initial and second PCNA, as well as the causes for a second PCNA, were evaluated. Finally the type and rate of complication were also evaluated. RESULTS: The second PCNA rate was 4.0% (14/350). The causes for a second PCNA, following the initial PCNA included unexpected pathologic results (n = 7) and inconclusive pathologic results (n = 7). Of the seven cases which had unexpected pathologic results from their initial PCNAs, five had similar pathologic results after a second PCNA. Also, of the seven cases of inconclusive pathologic results, such as atypical cells, the scanty cellularity or necrosis upon an initial PCNA, six cases revealed a malignancy on a second PCNA. The overall complication rate, including both the initial and second PCNAs was 14.0% (51/364). CONCLUSION: A second PCNA was performed to help resolve the exact diagnosis for a pulmonary lesion in cases of inconclusive pathologic results upon an initial PCNA.
الموضوعات
Humans , Biopsy , Biopsy, Needle , Fluoroscopy , Lung Diseases , Necrosis , Needles , Proliferating Cell Nuclear Antigen , Tomography, X-Ray Computedالملخص
An fistula occurring between the stomach and other abdominal internal organs or to the surface of the body is usually encountered as a complication of stomach cancer or colon cancer, peptic ulcer disease, or other variable causes. The most common type of gastric fistula is a gastro-colic fistula that is mainly found as a complication of a gastric carcinoma or of a carcinoma of the transverse colon invading each other. Sometimes, a benign gastric ulcer perforation also can cause a gastro-colic fistula. However, as far as we know, a fistula occurring between the stomach and the umbilicus has not been reported. Here we present a case report of a gastro-umbilical fistula in a young woman that manifested as a umbilical discharge.
الموضوعات
Female , Humans , Abdomen , Colon, Transverse , Colonic Neoplasms , Fistula , Gastric Fistula , Peptic Ulcer , Stomach , Stomach Neoplasms , Stomach Ulcer , Ultrasonography , Umbilicusالملخص
Spindle cell hemangioma is an uncommon vascular lesion histologically resembling a cavernous hemangioma and Kaposi's sarcoma with a predilection for the extremities. There are no radiologic reports concerning cardiac spindle cell hemangioma in the current literature. We report here a case of cardiac spindle cell hemangioma.
الموضوعات
Extremities , Hemangioendothelioma , Hemangioma , Hemangioma, Cavernous , Sarcoma, Kaposiالملخص
Adenocarcinoma of the appendix is a rare neoplasm. Metastatic adenocarcinoma of the appendix from stomach adenocarcinoma is also a very rare finding. A 72-year-old man complained of right lower quadrant abdominal pain for 10 days, and he was diagnosed with acute appendicitis. Appendectomy was performed by a general surgeon. Adenocarcinoma was found on the postoperative biopsy. Subsequently, gastric adenocarcinoma was diagnosed on the gastroscopy with biopsy, and this was proven to be the original site of the appendiceal adenocarcinoma.
الموضوعات
Aged , Humans , Abdominal Pain , Adenocarcinoma , Appendectomy , Appendicitis , Appendix , Biopsy , Gastroscopy , Stomachالملخص
Cystic adventitial disease of the popliteal artery is rare condition, but it is an important cause of peripheral vascular insufficiency in young men. Conventional angiography or MR imaging has traditionally been considered as the study of choice to diagnose this disease. We experienced a case of cystic adventitial disease of the popliteal artery that was diagnosed by 16-slice MDCT angiography, and this imaging modality displayed an accurate diagnostic capability for this disease.
الموضوعات
Humans , Male , Angiography , Magnetic Resonance Imaging , Popliteal Arteryالملخص
Bronchioloalveolar carcinoma is a disease with an insidious onset and various radiologic manifestations. A solitary peripheral pulmonary nodule, multiple nodules and lobar or diffuse consolidation are the common radiological findings. We report here on a case of bronchioloalveolar carcinoma mimicking DILD (diffuse interstitial lung disease) in a 60 year-old male that manifested as multiple peripheral consolidations, ground-glass opacities, subpleural lines, pleural thickening and interlobular septal thickening on CT.
الموضوعات
Humans , Male , Middle Aged , Adenocarcinoma, Bronchiolo-Alveolar , Lung , Lung Neoplasms , Multiple Pulmonary Nodulesالملخص
Lemierre syndrome is a rare disease characterized by internal jugular vein thrombosis and septic emboli, and it primarily occurs in healthy young individuals; this disease usually follows an acute oropharyngeal infection. To the best of our knowledge, only a few reports about this disease have appeared in the radiologic literature. We report here the radiologic findings of a case of Lemierre syndrome in a young healthy female adolescent who had a history of acute pharyngotonsilitis. Chest radiographs showed lung nodules that displayed cavitary changes with rapid progression on the serial studies. High-resolution CT scan showed multi-focal patchy consolidations that connect with vessels, and this was suggestive of septic pulmonary embolism. Ultrasonography and CT scan of the neck revealed right internal jugular vein thrombosis.
الموضوعات
Adolescent , Humans , Jugular Veins , Lemierre Syndrome , Lung , Neck , Pulmonary Embolism , Radiography, Thoracic , Rare Diseases , Thrombosis , Tomography, X-Ray Computed , Ultrasonographyالملخص
The typical radiographic findings of bronchiolitis obliterans organizing pneumonia (BOOP) are known to be patchy air-space consolidation that is often subpleural, and with or without ground-glass opacities. However, there are scant radiologic reports about the micronodular pattern of BOOP. We report here on a case of BOOP that manifested as diffusely scattered ill-defined centrilobular micronodules on HRCT.
الموضوعات
Bronchiolitis Obliterans , Bronchiolitis , Cryptogenic Organizing Pneumoniaالملخص
PURPOSE: We wanted to evaluate the characteristics of those lesions showing insufficient results on ultrasound-guided core needle biopsy. MATERIALS AND METHODS: We retrospectively reviewed the pathologic results of 131 lesions from patients who underwent ultrasound-guided core needle biopsy following Mammotome or surgical excisional biopsy from January 2004 to December 2004. RESULTS: Compared with excisional biopsy, ultrasound-guided core needle biopsy showed 14 lesions with discordant results and 9 lesions with indeterminate results. 5 lesions were overestimated and 9 lesions were underestimated on the core needle biopsies. According to the histological tumor types, the papillary tumors showed 66.6% discordance or indetermination, and the phyllodes tumors showed 50% discordance or indetermination. CONCLUSION: On the results of core needle biopsy, discordant or indeterminate results were frequently reported for papillary and phyllodes tumor. Therefore, excisional biopsy is recommended for these types of tumor.
الموضوعات
Humans , Biopsy , Biopsy, Large-Core Needle , Breast , Phyllodes Tumor , Retrospective Studiesالملخص
The classic presentation of small cell carcinoma is hilar or mediastinal lymph node metastases while the primary tumor remains an occult tumor. Grossly enlarged hilar and mediastinal lymph nodes can be frequently seen on the chest radiographs and CT scans. We report here on a case of small cell carcinoma that manifested as a unilateral bulky thoracic mass in a pregnant woman.
الموضوعات
Female , Humans , Carcinoma, Small Cell , Lymph Nodes , Mediastinum , Neoplasm Metastasis , Pregnant Women , Radiography, Thoracic , Tomography, X-Ray Computedالملخص
PURPOSE: To differentiate tuberculous enteritis and Crohn's disease with barium study using Bayes theory. MATERIALS AND METHODS: The study group consisted of 34 patients with tuberculous enteritis (age range 16-86 years, mean age 43.3 years, M:F=19:15) and 36 patients with Crohn's disease (age range 19-78 years, mean age 35.2 years, M:F=18:18). These diagnoses were confirmed by therapeutic tests (tuberculous enteritis: 15, Crohn's disease:16) or histopathological examinations (tuberculous enteritis: 19, Crohn's disease: 20) conducted from January 1993 to May 2003. Three radiologists (two abdominal specialists and one trainee) analyzed each radiological finding of tuberculous enteritis and Crohn's disease by means of a barium enema and/or small bowel series. We used Fisher's exact test to verify the statistical significance of each radiological finding and p-values less than 0.05 were considered to be significant. We calculated the likelihood ratio (LR) of tuberculous enteritis versus Crohn's disease for each finding by employing Bayes theory. RESULTS: The radiological findings associated with a high likelihood ratio for tuberculous enteritis were the involvement of the cecum (LR=2.65) and ascending colon (LR=1.99), rigid narrowing (LR=1.94), shortening of the bowel (LR=1.99), haustral loss (LR=1.97) and sacculation (LR=3.88). The radiological findings associated with a high LR for Crohn's disease (low LR for tuberculous enteritis) were age between 20 and 29 years (LR=0.53), the involvement of the jejunum (LR=0.12), terminal ileum (LR=0.19), sigmoid colon (LR=0.30) or rectum (LR=0.17), and the presence of skip lesions (LR=0.19) or strictures (LR=0.21). With these LRs, the probability of the subject having tuberculous enteritis versus Crohn's disease could be calculated using Bayes theory. CONCLUSION: The analysis of a barium study using Bayes theory could provide an objective, easy and fast method of differentiating tuberculous enteritis and Crohn's disease.
الموضوعات
Humans , Barium , Bays , Cecum , Colon, Ascending , Colon, Sigmoid , Constriction, Pathologic , Crohn Disease , Diagnosis , Enema , Enteritis , Ileum , Intestine, Small , Jejunum , Rectum , Specialization , Tuberculosis, Gastrointestinalالملخص
BACKGROUND: Osteoporosis results from bone loss due to menopause [estrogen(E) deficiency] and aging. Initial skeletal effect of menopause is accelerated bone resorption with an increase in seurm calcium(Ca) and compensatory but inadequate bone formation. Secretion of parathyroid hormone(PTH) is suppressed at this time. Postmenopausal osteoporosis results in fractures predominantly of trabecular bone, i.e., vertebra. With aging, secondary hyperparathyroidism by low serum Ca and vitamin D deficiency superim poses. Senile osteoporosis produces hip fractures, area of cortical bone. The aim of this study was to- examine the association of vitamin D[25(OH)D] and intact(i) PTH with bone mineral density(BMD) after controlling for suggested confounding factors, and the possibility of low serum vitamin D and high serum iPTH concentration could impact bone loss in Korean postmenopausal women. METHODS: Data from 188 postmenopausal Korean women aged 42 to 69 were analyzed through BMD, serum 25(OH)D, iPTH, Ca, phosphorus(P), alkaline phosphatase(ALP) and clinical characteristics. Factors affecting BMD was determined by Pearson correlation and the relationship between lumbar and femoral neck BMD and vitamin D[25(OH)D] and iPTH was assessed by multiple regression analysis after adjus- ting for suggested confounding factors. RESULTS: Lumbar and femoral neck BMD, serum Ca, P were decresaed and serum iPTH was increased with aging. In Pearson`s correlation, significant contributing factors to lumbar BMD was age, height, weight, menarche, year since menopause(YSM) and ALP. And significant contributing factors to femoral neck BMD was age, height, weight, menarche, YSM and iPTH. No relationship could be demonstrated between serum vitamin D[25(OH)D] and lumbar and femoral neck BMD. How ever, after controlling for potential confounding factors, a correlation was found between vitamin D[25(OH)D] and both of lumbar (p=0.013) and femoral neck BMD(p=0.077). iPTH was inversely related to femoral neck BMD(p=0.004) only in multiple linear regression. CONCLUSION: Serum vitamin D[25(OH)D] was influencing both of vertebral and femoral neck BMD, which suggests a significant role of vitamin D deficiency in the pathogenesis of postmenopausal osteo- porosis. In age related remodeling and loss of bone, increased serum iPTH might have additive role in cortical bone of femur. These findings suggest that vitamin D is very important for optimal bone health and a deleterious effect of increased iPTH on cortical bone loss. Adequate calcium and vitamin D status have to be maintained to prevent osteoporosis in postmenopausal Korean women.