A comparison of the BISAP score and serum procalcitonin for predicting the severity of acute pancreatitis

BACKGROUND/AIMS: The bedside index of severity in acute pancreatitis (BISAP) is a new, convenient, prognostic multifactorial scoring system. As more data are needed before clinical application, we compared BISAP, the serum procalcitonin (PCT), and other multifactorial scoring systems simultaneously. METHODS: Fifty consecutive acute pancreatitis patients were enrolled prospectively. Blood samples were obtained at admission and after 48 hours and imaging studies were performed within 48 hours of admission. The BISAP score was compared with the serum PCT, Ranson's score, and the acute physiology and chronic health examination (APACHE)-II, Glasgow, and Balthazar computed tomography severity index (BCTSI) scores. Acute pancreatitis was graded using the Atlanta criteria. The predictive accuracy of the scoring systems was measured using the area under the receiver-operating curve (AUC). RESULTS: The accuracy of BISAP (> or = 2) at predicting severe acute pancreatitis was 84% and was superior to the serum PCT (> or = 3.29 ng/mL, 76%) which was similar to the APACHE-II score. The best cutoff value of BISAP was 2 (AUC, 0.873; 95% confidence interval, 0.770 to 0.976; p < 0.001). In logistic regression analysis, BISAP had greater statistical significance than serum PCT. CONCLUSIONS: BISAP is more accurate for predicting the severity of acute pancreatitis than the serum PCT, APACHE-II, Glasgow, and BCTSI scores.

Comparison of Diagnostic Performance of US Elastography and Conventional B-mode US in Differentiation of Breast Lesions

PURPOSE: The purpose of this study was to compare the diagnostic performance of ultrasound (US) elastography and conventional B-mode US for discrimination between benign and malignant breast lesions. MATERIALS AND METHODS: During a 13-month period, 277 women with 335 sonographically visible breast lesions who were scheduled to undergo biopsy were examined with US elastography. Elastographic findings were classified as benign or malignant based on the area ratio, with 1.00 as the threshold. Findings on conventional B-mode US were classified according to the BI-RADS category, as follows: lesions of BI-RADS categories 2 and 3 were considered benign, while those in categories 4 and 5 were considered malignant. Statistical analysis included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and ROC curve analysis for comparison of the diagnostic performance of US elastography and conventional B-mode US. RESULTS: Of the 335 breast lesions, 85 (25.4%) showed malignancy on pathology. Findings on B-mode US showed malignancy in 264 (78.8%) and elastographic findings showed malignancy in 102 (30.4%). The sensitivity, specificity, PPV, NPV, and accuracy of B-mode US and elastography were 98.8%, 28.0%, 31.8%, 98.6%, and 79.4% and 69.4%, 81.2%, 57.8%, 88.8%, and 79.4%, respectively. Elastography showed significantly higher specificity and PPV and lower sensitivity and NPV, compared with B-mode US (p < 0.001). The area under the ROC curve (AUC value) was 0.761 for elastography, and 0.634 for B-mode US (p < 0.001). CONCLUSIONS: US elastography can improve specificity and PPV of B-mode US, but with significant sacrifice of sensitivity and NPV. Therefore, US elastography may complement B-mode US for differentiation of breast masses.

Radiologic Interventional Retrieval of Retained Central Venous Catheter Fragment in Prematurity: Case Report

The fracture of a central venous catheter is a rare but potentially serious complication. Moreover, removal of the broken catheter pieces is considerably challenging, especially for premature infants. We report 3 case studies of the percutaneous transcatheter retrieval of broken catheter parts in 3 premature infants. We confirmed the location of the catheter fragments via a DSA venogram with diluted contrast media. Using the minimum amount of contrast, and extreme caution, we made certain no contrast-induced nephrotoxicity or air embolism occured during catheter manipulation. In addition, when the broken fragment was curled or attached to the cardiac wall, we used a hook-shaped catheter to facilitate the capturing of the catheter with a loopsnare. This report demonstrates the feasibility of removing a retained catheter fragment in a premature infant using a percutaneous transcatheter approach.

Anti-tumoral Effect of Recombinant Vaccinia Virus through US Guided Injection in a Rabbit Model of Hepatic VX2 Carcinoma

PURPOSE: The purpose of this study was to evaluate the anti-tumoral effect of recombinant vaccinia virus (rVV) (Thymidine kinase (-)/GM-CSF (+)) that was administered as a US guided intratumoral injection in a rabbit model of hepatic VX2 carcinoma. MATERIALS AND METHODS: VX2 carcinoma was implanted in the livers of 12 rabbits. US was performed at every week interval to detect hepatic mass after the implantation of VX2 carcinoma. The accurate tumor size and volume was evaluated with CT when the tumor was detected on US. US guided injection of rVV (109 pfu/ml) was preformed in three rabbits, intravenous injection of the same dose of rVV was done in two rabbits and another seven rabbits that were without any treatment were selected as a control group. We evaluated the change of the hepatic tumor size and extrahepatic metastasis on serial CT. Tumor specimens were harvested from rabbits that were killed at 8 weeks after VX2 implantation. These tissues were histoimmuopathologically compared to each other (the virus injection group and the control group). The differences between these groups were statistically assessed with student t-tests. RESULTS: Tumor growth was significantly suppressed in the US guided injection group compared with the intravenous injection group or the control group (p< 0.01). The intravenous injection group showed statistically significant tumor suppression compared to the control group (p< 0.01) until 2 weeks after virus injection. Quantification of the pulmonary metastatic nodules was performed in view of both the number and volume. The average number or volume of the pulmonary metastatic nodules in the US injection group was much smaller than these in the control group. Histopathologically, the tumors of the US guided injection group showed less extensive necrosis than those of the control group. Immunohistochemically, the tumor of the US guided injection group showed more prominent infiltration of CD4 (+) and CD8 (+) lymphocytes than did the tumors of the other group. CONCLUSION: rVV was markedly effective in suppressing hepatic tumor growth and extrahepatic metastasis in a rabbit model of hepatic VX2 carcinoma. US guided intra-tumoral injection was more effective than systemic intravenous injection.

Congenital Hepatoportal Arteriovenous Fistula associated with Intrahepatic Portal Vein Aneurysm and Portohepatic Venous Shunt: Case Report

A congenital hepatoportal arteriovenous fistula associated with an intrahepatic portal vein aneurysm is a rare type of arteriovenous malformation. Only 14 pediatric cases have been reported to the best of the authors' knowledge. An intrahepatic shunt between the portal and systemic veins is also relatively rare. We report a case of a congenital hepatoportal arteriovenous fistula associated with an intrahepatic portal vein aneurysm and a portohepatic venous shunt in a neonate who presented with tachypnea and melena.

Intrahepatic Transneedle Inoculation of VX2 Particles for Obtaining a Solitary Hepatic Tumor in an Animal Model

PURPOSE: The purpose of this study was to develop a large animal (rabbit) model which has a proper solitary intrahepatic tumor with lower leakage rates through less traumatic methods. Consequently, we evaluated tumor progression following the intrahepatic inoculation of VX2 cells into New Zealand white rabbits to acquire baseline data on the progression of a VX2 tumor. MATERIALS AND METHODS: Twenty New Zealand white rabbits, each weighting 2.5-3 kg, were selected for this study. A 1 mm3 VX2 tumor fragment was created and then minced to enable the particles to pass through a 21 G needle mounting in a tuberculin syringe with 0.1 ml of normal saline. The minced VX2 tumor particles were injected into the subcapsular parenchyma of the left hepatic lobe. A 21 G needle was used to avoid penetrating large hepatic vessels. In order to prevent hemorrhage or leakage of the VX2 tumor cells through the injection route, a purse-string suture around the puncture site was made using black silk 4-0. The tumor particles were then injected through the center of the suture. While removing the needle, the suture was tightened to prevent hemorrhage or leakage of the VX2 tumor cells through the injection route. Finally, the injection site was covered with a Surgicel(R) patch. The inoculated intrahepatic VX2 tumors were then imaged with a 16 channel multidetector CT every week for the duration of the study. The CT images covered from the lung apex to the pelvic floor. Two radiologists evaluated the size, location, and peritoneal seeding of the tumors as well as metastasis of other organs. Three rabbits were sacrificed at random beginning in the second week, and this process continued on a weekly basis for the duration of the study. The CT images and pathologic findings for the sacrificed rabbits were correlated. RESULTS: The inoculated intrahepatic VX2 tumors were not visible in the first week. By the second week 66.7% were visible on CT images and by the third week all tumors were visible. Of the twenty rabbits, three (15%) had tumor growth both in the liver and the peritoneal cavity, suggesting tumor leakage from the injection site into the peritoneal cavity. The remaining rabbits (n=17) had successful inoculation in the liver parenchyma as a solitary mass. Three of twenty rabbits (15%) showed tumor regression after successful inoculation. Tumor metastasis in extratumoral regions, including the liver and peritoneal seeding, increased beginning in the fourth week and more than 12x103 mm3 in volume after the initial inoculation of the VX2 tumors. CONCLUSION: This new technique using innoculated intrahepatic VX2 tumor particles seems to be a simple and effective method for obtaining a solitary hepatic tumor in animal models. Results of this study suggest that a solitary intrahepatic tumor model without metastasis can be maintained. However, the evaluation of any therapeutic effects or any planned intervention should not occur until the fourth week following innoculation or less than 12x103 mm3 in volume after the inoculation of the VX2 tumor. The second highlighted section does not seem to fir with the rest of the sentence. Consider rephrasing the last part of the sentence.

Non-Surgical Gene Transfer to Rabbit Renal Glomeruli via Percutaneous Arterial Catheterization / 대한신장학회잡지

BACKGROUND: Transfer of foreign genes to the renal glomerular cells is an important step for the gene therapy of renal diseases in which the primary pathology is confined to the glomeruli. We developed a non-surgical method of gene transfer to rabbit renal glomeruli using percutaneous arterial catheterization without any laparatomy procedure. METHODS: The recombinant adenovirus type 5, containing a nuclear-targeted beta-galactosidase gene and driven by a cytomegalovirus promoter, was slowly infused into the unilateral renal artery via percutaneous arterial catheterization. The animals were sacrificed 3 days after virus infusion and lacZ staining was done on the fresh harvested tissue. RESULTS: Only the animals those received 6x10(12) particles/rabbit for 120 minutes show lacZ expression in 90.6+/-5% (n=3) of glomeruli. Mostly, it was the endothelial cells and mesangial cells those were positive for the stain. CONCLUSION: This non-surgical method for gene transduction of the renal glomeruli can be applied to human trials of glomerulus-directed gene therapy.

Transarterial Embolotherapy in Patients with Duodenal Hemorrhage Using Microcoils and Gelfoam Particles

PURPOSE: To assess the efficacy and safety of arterial embolotherapy in patients with massive duodenal hemorrhage. MATERIALS AND METHODS: Between January 1999 and June 2002, 25 patients (age: 34-81, mean 58, male: 19, female: 6) underwent arterial embolization for duodenal hemorrhage after failed endoscopic therapy. The hemorrhage originated from duodenal ulcer in sixteen patients, from cancer with duodenal invasion in five patients, from endoscopic sphincterectomy in two patients, and from pseudoaneurysm complicating acute pancreatitis in two patients. Hemorrhage was detected at endoscopy and an attempt was made to treat it endoscopically in all patients, but failed in each case. At angiography, direct bleeding signs such as contrast extravasation or pseudoaneurysm were demonstrated in nineteen patients. In the six patients without angiographic evidence of bleeding, blind embolization of the gastroduodenal artery was performed based on the endoscopic examination. Microcoil and gelfoam particles were used as embolic agents. RESULTS:Hemostasis was achieved immediately after embolotherapy in 21 patients (84%). Bleeding recurred in 4 patients (16%), and of these cases, one was successfully treated purely by endoscopic means, a second was reembolized three times due to bleeding from the collateral vessels of the tumor and the two others were treated by surgery. After the procedure, six patients died (24%). The causes of death were disseminated intravascular coagulopathy, multiorgan failure, sepsis and acute renal failure. The underlying diseases of the deceased patients were cancers with duodenal invasion (n=4) and abdominal aortic aneurysm with ischemic colitis (n=1). CONCLUSION: Transarterial embolotherapy in the case of massive duodenal hemorrhage is a safe and effective procedure. Even in the absence of angiographic evidence of bleeding, blind embolization of the gastroduodenal artery is effective for patients in the surgically high risk group.

Usefulness of Intra-arterial Embolization Method Using Gelfoam Particles in Effective Gene Transduction of Adenoviral Vector for Liver-directed Gene Therapy: an Preliminary Animal Study in Dogs

PURPOSE: Liver-directed gene therapy is being actively pursued and developed as a method of treating various liver diseases. A number of aspects, including gene intervention, an efficient gene delivery system, and stable transgene expression are key to the success of the chosen strategy, and to overcome problems in these areas, several tactics can be used. In this study, we assess the utility of transarterial embolization using gelfoam particles soaked in an adenovirus vector as a gene-delivery method. MATERIALS AND METHODS: Using the angiographic approach, three dogs each weighing 9.5-11 kg were superselectively catheterized at the left hepatic artery using a 3-F microcatheter and the coaxial method. Two of the dogs were embolized at the left hepatic artery using 3x2x2-mm and 2x1x1-mm gelfoam particles soaked in 2x1011 particles/kg of recombinant adv.CMV.LacZ (LacZ-adv). The left hepatic artery of the remaining animal, used as a control, was infused with the same dose of lacZ-adv in the same way as before but without embolization of the left hepatic artery. Three days after embolization or the infusion of LacZ-adv, the dogs were sacrificed prior to harvest of the entire liver for the evaluation of gene transduction. RESULTS: X-gal staining of the liver tissue obtained was positive for hepatocytes, but the pattern and degree of gene transduction differed according to gelfoam particle size. Where this was 3x2x2 mm, gene transduction along the liver hilum varied, but where 2x1x1-mm particles were used, transduction was more even. No pathologic hepatic tissue injury or inflammation was apparent, and control liver tissue was not stained by Xgal. Serum SGOT and SGPT levels were slightly higher one day after the procedure, but had normalized by day 3. CONCLUSION: Intrahepatic transarterial embolization using gelfoam particles soaked in LacZ-adv appears to be a good method for effective liver-targed gene therapy.

Hepatocellular Carcinoma after Radiofrequency Ablation: Recurrent Pattern and Influenting Factor

PURPOSE: To evaluate patterns of recurrence and factors which influence them in radiofreqency (RF) ablation for the treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Between May 1999 and March 2000, 69 patients with 82 HCCs underwent RF ablation for complete necrosis. They were diagnosed by tissue biopsy or tumor marker, and the results of triphasic spiral CT. The indications were that nodular lesions were clearly visualized at sonography, less than 5 cm in size and less than four in number, and that patients had no history of previous treatment. Local therapeutic efficacy such as complete necrosis and marginal recurrence, and new lesions were evaluated by means of triphasic spiral CT performed at least six months after the completion of ablation. We then analyzed the correlation between local therapeutic efficacy and various influential factors such as tumor size, whether the tumor was attached to the portal vein, gross morphology, Child-Pugh classification, and alpha- fetoprotein level before the procedure, as well as the correlation between new lesions and influential factors which included the alpha-fetoprotein level before the procedure, Child-Pugh classification, and multiplicity per person. RESULTS: During a mean follow-up period of 8.95 (range, 6-14) months after RF ablation, the rate of complete necrosis and of marginal recurrence was 91% and 12%, respectively. When a tumor was larger and was attached to a large branch of the portal vien, the incidence of incomplete necrosis and marginal recurrence was greater. The occurrence rate of new lesion was 19.4%. When the alpha-fetoprotien level before the procedure was higher and a tumor was multiple in number, new lesions occurred more frequently. CONCLUSION: Sufficient knowledge of patterns of recurrence and the factors which influence them might improve the therapeutic effects of RF ablation in patients with HCC.

The Induction of Hyperthermia in Rabbit Liver by means of Duplex Stainless Steel Thermoseeds

OBJECTIVE: To determine the heating characteristics of needle-shaped duplex stainless steel thermoseeds, and to evaluate their effectiveness in the induction of hyperthermia in rabbit liver. MATERIALS AND METHODS: Thermoseeds of the two different shapes, L-shaped for single doses of hyperthermia and I-shaped for in-vitro study and repeated hyperthermic induction, were prepared. For the in-vitro study, an I-shaped thermoseed 0.23 mm in diameter and 25 mm long was placed inside a plastic tube filled with water. Heat was applied for 30 minutes within an induction magnetic field, and during this time changes in temperature were recorded using three thermocouples. For the in-vivo study, fifteen New Zealand white rabbits were divided into five equal groups. An I-shaped or L-shaped thermoseed was inserted in each rabbit's liver, and then placed within the center of the magnetic induction coil during a 30-minute period of hyperthermia. The rabbits in the first group were sacrificed immediately after hyperthermia was induced once, while those in the other groups were sacrificed at 1, 3, and 7 days, respectively, also after one induction. The remaining three rabbits were sacrificed 4 days after three consecutive daily treatment sessions. The resected segments of liver were subsequently evaluated histopathologically for the extent of coagulation necrosis caused by heating of the thermoseed. RESULTS: The in-vitro study demonstrated that the temperature in the thermoseed, which was 25.9 degree C before heating and 54.8 degree C after heating, rose rapidly at first but progressively less rapidly as time elapsed. Light microscopic examination of the rabbits' livers revealed coagulation necrosis and infiltration by inflammatory cells around the insertion site of the thermoseed. The maximum diameter of coagulation necrosis was 2.81+/-1.68 mm, and this occurred in the rabbits that were sacrificed 7 days after heat induction. CONCLUSION: Needle-shaped duplex stainless steel thermoseeds show temperature-dependent-type heating characteristics, and in rabbit liver, induced coagulation necrosis of surrounding tissues after heat is applied for 30 minutes. These thermoseeds may thus be useful for the induction of interstitial hyperthermia.

Diffusion-weighted MR imaging findings of intracerebral hematoma

PURPOSE: To evaluate diffusion-weighted imaging findings of intracerebral hematoma according to the time sequence. MATERIALS AND METHODS: Seventeen patients with intracerebral hematoma were studied. Diffusion weighted images using 1.5 tesla MRI machine were obtained with b-value of 1000 sec/mm2. The patients were grouped as hyperacute stage(within 12 hours, 5 patients), acute stage(within 3 days, 4 patients), subacute stage(within 3 weeks, 4 patients), and chronic stage(after 3 weeks,4 patients). The signal intensities were analysed as bright, high, iso, low and dark at the central and peripheral portions of the hematoma in each stage, and compared with those of T2 and T1 weighted images. RESULTS: The signal intensities of the central and peripheral portion of the intracerebral hematoma on diffusion-weighted images were high and dark in hyperacute stage, dark and high-bright in acute stage, and high-bright and dark in subacute and chronic stages. The patterns of signal change of hematoma on diffusion-weighted image according to the time sequence were similar to those on T2-weighted image, but 1 early and prominently. CONCLUSION: The intracerebral hematoma on diffusion-weighted image showed unique central and peripheral signal intensity according to the time sequence. Central portions show high to bright signals in hyperacute, subacute and chronic stage, and dark signal in acute stage, and peripheral portions show dark signals in hyperacute, subacute and chronic stage, and high to bright signal in acute stage.

Shrinkage Rate of Necrotic Lesion after Radiofrequency (RF) Ablation of Hepatocellular Carcinoma: Correlation with Marginal Recurrence and Influencing Factors

PURPOSE: To compare the CT findings of hepatocellular carcinomas (HCCs) immediately after radiofrequency (RF) ablation with those obtained at six months' follow-up, to analyse the relationship between degree of shrinkage of a necrotic lesion and marginal recurrence, and to evaluate the factors influencing shrinkage. MATERIALS AND METHODS: We retrospectively evaluated 54 patients with 62 HCCs who underwent only RF ablation between May 1999 and July 2000. For six months after ablation, all had been free from marginal recurrence ad new-growth tumors. The findings of six-month follow-up CT were compared with those obtained immediately after RF ablation, and the volume of each necrotic lesion was calculated and compared. In terms of degree of shrinkage, tumors were classified as belonging to either group I (below 50%), group II (50-80%) or group III (above 80%). Each tumor was analysed in terms of its Child-Pugh classification, vascularity at CT, size, treatment details, the post-ablation appearance of its margins, and the presence, during necrosis, of peritumoral vessles and air bubbles. For statistical evaluation, Fisher's exact test was used. Shrinkage after ablationwas correlated to marginal recurrence during a period of more than one year. RESULTS: The Follow-up CT at six months showed that since immediately after ablation, necrotic lesions had shrunk by an average of 72%. Peritumoral vessels were seen in 12 of 14 cases in group I (86%), three of 13 in cases of group II (23%), and 11 of 35 in group III (31%)(p=0.001). Immediate CT revealed the presence of air bubbles in two cases in group I (14%), five in group II (38%), and 24 in group III (69%)(p<0.05). At follow-up CT performed during a period of more than one year, marginal recurrence was noted in four cases in group I, two in group II and two in group III (p<0.05). CONCLUSION: When a necrotic lesion contains no peritumoral vessels but does contain air bubbles, the degree of post-RFablation shrinkage increases. The greater the shrinkage, the less the marginal recurrence rate.

CT Findings of Acinar Cell Carcinoma of the Pancreas: Focused on Spiral CT Findings

PURPOSE: To evaluate the CT findings (in particular, those of dual-phase spiral CT) of acinar cell carcinoma of the pancreas. MATERIALS AND METHODS: We retrospectively reviewed the CT findings of pathologically confirmed pancreatic acinar cell carcinoma in seven patients (M:F = 4:3) aged 26 -57 (average,46) years. Serum amylase and lipase were clinically checked, and concomitant subcutaneous nodules or osteolytic bony lesions were evaluated. Contrast-enhanced CT scanning. was performed in seven cases, and in four of these, dual-phase spiral CT scans were also obtained. Tumor size and location, the extent of intratumoral necrosis, calcification, contour, margin, capsule, adjacent organ invasion, lymphadenopathy, hepatic metastasis and enhancement pattern were analyzed. RESULTS: Serum lipase was elevated in three cases, but in all, the serum amylase range was normal. In no case were subcutaneous nodules or osteolytic bony lesions observed. The size of the mass was 5 -18 (mean 8.4 cm), and tumors were located in the tail (n=3), body (n=2) and head (n=1), with one involving both the body and tail. Intratumoral necrosis was noted in six of seven cases and calcification in two. A lobulated contour with capsule was observed in six, and in two there was splenic invasion. In three of four cases in which dual-phase spiral CT was performed, the enhancement pattern was high during the arterial phase and isodense with normal pancreatic parenchyma during the venous phase. In two cases involving spiral CT, multiple hyperattenuated hepatic metastasis was observed during the arterial phase. In three cases in which conventional post-contrast CT was performed, the tumor showed low enhancement. CONCLUSION: Pancreatic acinar cell carcinoma is rare, but if a large, well encapsulated, strongly enhanced pancreatic mass showing central necrosis is observed during the arterial phase of dual-phase spiral CT, and metastatic nodules are also present, pancreatic acinar cell carcinoma should be differentiated from other pancreatic neoplasms.

High-resolution CT Features of Bleeding Foci in Patients with Massive Hemoptysis

PURPOSE: To compare the high-resolution CT features of bleeding foci in patients with massive hemoptysis during embolization with those revealed by angiography. MATERIALS AND METHODS: Between June 1997 and June 1999, we evaluated 25 patients who from among a total of 49 with arterial embolization due to massive hemoptysis underwent HRCT prior to embolization. We retrospectively analyzed medical records, and angiographic and HRCT findings. The time interval between HRCT and arterial embolization varied from two hours to six days. Angiography indicated that the bronchial, intercostal and internal mammary artery, and branches of the subclavian, were the foci of bleeding, and indicated the location of these in each pulmonary lobe. The HRCT findings were evaluated in terms of cavity, air-meniscus sign, bronchial dilatation, consolidation, ground-glass opacity, and fibrotic scar. We analyzed the corresponding sites of HRCT and the angiographic findings of the foci of bleeding. RESULTS: In 24 of 25 patients, the foci of bleeding were angiographically confirmed, their presence being noted in 28 pulmonary lobes. HRCT findings corresponding to the bleeding foci revealed by angiography were the air-meniscus sign (8 of 10 lobes, 80.0%), cavity (7 of 9 lobes, 77.8%), bronchial dilatation (21 of 30 lobes, 70.0%), and fibrotic scar (1 of 23 lobes, 4.3%). The findings in areas of consolidation and/or ground-glass opacity only did not correspond, however. CONCLUSION: As compared with those revealed by angiography, the HRCT features of bleeding foci in patients with massive hemoptysis during embolization are in order of frequency, the air-meniscus sign, cavity, and bronchial dilatation.

Helical CT Findings of Gastric Wall Thickening by Peptic Ulcer: Compared with Gastric Adenocarcinoma with Ulcer

PURPOSE: To compare on the basis of helical CT findings gastric wall thickening of peptic gastric ulcer with that of gastric adenocarcinoma with ulcer. MATERIALS AND METHODS: Thirty-eight patients with athologically proven gastric lesion [17 cases of peptic ulcer and 21 cases of ulcerative or ulceroinfiltrative gastric cancer (Borrman type II, III)] underwent helical CT, and the findings were retrospectively reviewed in terms of maximum abnormal wall thickness, preservation of the inner enhancing layer, the presence of three discriminate layers of gastric wall, and enhancment pattern. The enhancment pattern of abnormally thick wall was compared with that of the portal phase of back muscle, and was defined as low, iso, or high. The Chi-square test and Student t test were used for statistical analysis. RESULTS: In cases of peptic ulcer and gastric cancer with ulceration, maximum abnormal wall thickness was 7-30 (mean, 16.1)mm, and 11-33 (mean, 21.8)mm, respectively. The inner enhancing layer was preserved in 15 of 17 patients (88.2%) and one of 21 (4.8%); three discriminate layers of gastric wall were observed in 8 of 17 patients (47.0%), and one of 21 (4.8%). The enhancement pattern was low in 12 of 17 patients (70.5%), and 3 of 21 (14.3%); iso in 4 of 17 (23.5%), and 4 of 21 (19.0%), and high in one of 17 (5.9%), and 14 of 21 (66.7 % ). All figures refer, respectively, to the two distinct onditioins. In terms of preservation of the inner enhancing layer, three discriminate layers of gastric wall, and a low enhancement pattern, there were statistically significant differences between peptic ulcer and gastric adenocarcinoma with ulcer. Where the enhancement was high, however, the statistically significant difference between the two conditions was even greater. There was no statistically significant difference in terms of gastric wall thickness or iso-attenuation of thickened gastric. CONCLUSION: Helical CT findings of gastric wall thickening, preservation of the inner enhancing layer, and three discriminate layers of gastric wall, as well as the nature of the observed enhancement pattern, may help differentiate between peptic ulcer and gastric adenocarcinoma with ulcer.

The Effect of Embolotherapy for Acute Gastrointestinal Bleeding in Patient with Coagulopathy

PURPOSE: To analyse the causes of coagulopathy and determine the effect of embolotherapy on acute gastrointestinal(GI) bleeding coexisting with coagulopathy. MATERIALS AND METHODS: Between June 1991 and December 1998, 29 patients with acute GI bleeding (M:F =21:8, mean age, 57.8 years) underwent percutaneous embolotherapy and immediate cessation of bleeding was confirmed. The patients were divided into two groups: control (n =16) and those with coagulopathy (n =13), group membership being determined according to the criteria of >+/-2SD of normal prothrombin time (PT) and activated partial thromboplastin time (aPTT) ( PT >23 seconds, aPTT >40 seconds) at the time at which embolization was requested. Embolotherapy was, defined as clinically successful, if the patient was stable for at least three days, without bleeding, after technically successful embolization. The clinical success rate of embolization and the mortality rate were compared between the two groups, and the causes of coagulopathy statistically analysed. RESULTS: The clinical success rate of embolization was 75% (n =12) in the control group, compared with 38.5% (n =5) in the coagulopathic group (p < 0.05), while the mortality rate for the two groups was 6.3% (n =1) and 53.8% (n =7), respectively (p < 0.005). Statistically, massive transfusion and sustained shock before embolization were the causes of coagulopathy (p < 0.05). CONCLUSION: In coagulopathic patients with acute GI bleeding, embolotherapy induces transient bleeding control, but is unlikely to save lives.

Mesenchymal Chondrosarcoma Arising from the Intrascrotal Extratesticular Soft Tissue: A Case Report

Intrascrotal extratesticular malignancies are rare, and the radiologic findings of extraskeletal chondrosarcoma have not been reported. We describe the radiologic findings of a case of mesenchymal chondrosarcoma arising from intrascrotal extratesticular soft tissue and represented by a complex, cystic, solid mass containing calcifications and hematoma.

Spiral CT Findings of Inflammatory Pseudotumor of the Liver

PURPOSE: To assess the spiral CT findings of inflammatory pseudotumor of the liver (IPTL), in order todistinguish this tumor from hepatocellular carcinoma, hepatic abscess or other space liver occupying lesions. MATERIALS AND METHODS: The spiral CT findings of IPTL were retrospectively evaluated in six patients. All caseswere confirmed by ultrasonography-guided gun biopsy. Four patients were men and two were women, and they were agedbetween 37 and 74 (mean, 49) years. The site, size, and number of IPTL were assessed, and their enhancementpatterns were evaluated during the arterial, portal and delayed phases of spiral CT. RESULTS: Five casesinvolveda solitary mass and in one there were multiple masses with surrounding small nodules. Four cases occurredin the right lobe and two in the left lobe. Four of five surrounding nodules were in the left lobe. During thearterial phase of spiral CT scanning, three layers were separated from four of five cases of solitary mass ; theywere composed of central and peripheral portions of low attenuation, and an intermediate portion ofisoattenuation. Delayed enhancement of the peripheral portion was prominent during the delayed phase. In the caseinvolving multiple masses three layers were not seen during the arterial phase, but during the delayed phaseenhancement was noted. CONCLUSION: The features of three layers, as seen on spiral CT, is considered to be veryspecific for distinguishing IPTL from other hepatic focal lesions.

Measurement of Renal Cortical Thickness Using Spiral CT in Early Diabetic Nephropathy

PURPOSE: To compare the ratio of renal cortical thickness to renal parenchymal thickness in early diabetic nephropathy and in normal control group. MATERIALS AND METHODS: We performed spiral CT in 17 patients suffering from diabetic nephropathy without renal failure or renal atrophy. The normal control group consisted of 19 persons who were normal on renal function test and did not show any abnormality of the kidney. Renal cortical and parenchymal thicknesses were measured at renal hilum level perpendicular to the renal surface by electronic caliper on contrast-enhanced transverse scan demonstrating the cortical nephrogram phase. Using student's test, the difference in renal parenchymal and cortical thickness between the two groups was tested for statistical significance. RESULTS: There was no significant difference in renal parenchymal thickness between the two groups(P>0.05) ; the patient group had a thicker renal cortex than the normal control group however (P<0.05). The ratio of renal cortical thickness to parenchymal thickness in early diabetic nephropathy patients(Rt.:0.041+/-0.051, Lt.:0.382+/-0.053) was significantly higher than in the normal control group (Rt.:0.331+/-0.067, Lt.:0.323+/-0.064). CONCLUSION: The kidney of early diabetic nephropathy patients had a thicker renal cortex than normal kidney.