Indirect Inguinal Hernia Containing the Uterus, Both Ovaries, and Fallopian Tubes in an Infant: A Case Report

In female infants, an inguinal hernia containing an ovary with or without Fallopian tubes is not uncommon. However, an inguinal hernia containing the entire uterus and both ovaries is extremely rare. Herein, we report on a case of an inguinal hernia containing the uterus, both ovaries, and both Fallopian tubes, diagnosed by ultrasonography. We discuss the case and review the relevant literature.

Unilateral Hydronephrosis and Hydroureter by Foreign Body in Urinary Bladder: A Case Report

Foreign bodies inserted through the urethra are often found in the urinary bladder. We presently report the first case of hydronephrosis and hydroureter due to direct compression in the urinary bladder by silicon, which had been introduced by the patient himself 2 yr prior to presentation with severe right flank pain. Computed tomography indicated a convoluted, high-attenuation mass in the urinary bladder; unilateral hydronephrosis and hydroureter were also present due to direct compression by the mass. The foreign body was removed using a cystoscope. This foreign body was proven to be silicon.

Percutaneous Vertebroplasty: Considerations for the Safe Procedures / 신경중재치료의학

Percutaneous vertebroplasty, injection of bone cement into the vertebral body, is a very effective interventional technique to improve the pain intractable to the conservative treatment and to achieve the structural augmentation for the vertebral body fractures. The procedure has been widely performed to manage osteoporotic and other vertebral fractures because the technique is known as simple and low-risk. This review is about the several aspects of the percutaneous vertebroplasty for the sake of safe and effective procedure.

A Congenital Cystic Adenomatoid Malformation with Intact Pulmonary Vascularities

Congenital cystic adenomatoid malformation (CCAM) is a rare pulmonary disease. It is thought to represent the abnormal proliferation of immature alveoli and other mesenchymal components secondary to abrupt halting of terminal alveolus formation after 16 weeks of gestation. Radiographic parameters such as size, number, and content are variable. On grayscale ultrasound, anechoic, thin-walled cysts are usually noted in pleural or cardiodiaphragmatic locations. To our knowledge, there has been no report of a CCAM showing normal pulmonary vascularities. We report a case of CCAM with normal pulmonary vascularities found within the hypodense lesions on dynamic chest CT.

The Treatment of a Giant Mediastinal Bronchial Artery Aneurysm by Transarterial Coil Embolization: A Case Report

Cases of bronchial artery aneurysms (BAAs) are rare; to the best of our knowledge, only 50 cases have been reported in the literature to date. BAAs require optimal treatment due to the possibility of life-threatening hemorrhaging if the aneurysm was to rupture. BAAs are usually treated by surgical resection of the aneurysmal artery. However, when the patient is unstable due to massive or recurrent hemoptysis, a bronchial artery embolization is a useful alternative treatment method. We report a case of a giant mediastinal bronchial artery aneurysm that was treated by coil embolization.

Hidradenitis Suppurativa Presenting with a Posterior Neck Mass: A Case Report

Hidradenitis suppurativa is a rare disorder that is characterized by recurrent chronic skin infections and the formation of sinus tracts and considerable scaring. A 37-year-old man presented with a hard posterior neck mass. Multiple pus-producing sinuses were detected in the skin covering the mass. MRI demonstrated an ill-defined, soft tissue mass with multiple variable sized cystic lesions. The soft tissue mass measured 12x10x4 cm in the subcutaneous fat layer, it contained multifocal cystic lesions that revealed higher signal intensity on both the T1- and T2-weighted images, as compared with the adjacent neck muscles. The mass was not enhanced on the post-contrast T1 weighted images. Some of the cystic lesions extended to the skin. The mass was removed surgically and confirmed to be hidradenitis suppurativa.

Computed Tomographic Appearance of the Anterior Diaphragm: Evaluation with 64-slice MDCT

PURPOSE: To re-evaluate the appearance of the anterior diaphragm by the use of MDCT. MATERIALS AND METHODS: We performed a retrospective review of 81 consecutive patients that underwent chest CT by using 64 channel MDCT. We classified the anterior diaphragm as three types (types 1-3) based on 5 mm axial scans: a line behind the xiphoid, a discontinuity and opening anteriorly, and the presence of broad and poorly defined bands. We also classified the anterior diaphragm as three types (types A-C) using 2 mm sagittal reformation images, based on the shape of the anterior diaphragmatic fibers traveling from the base of the pericardium to the xiphoid: a downward slope, an upward slope, and a flat shape, and compared the two groups using a correlation determined by statistical analysis. RESULTS: We could classify the appearance of the anterior diaphragm for all cases on the axial scans and sagittal reformation images. The number of types 1, 2, 3 on the axial scans was 30.9%, 38.3%, and 30.9% and the number of types A, B, C on the sagittal reformation images was 33.3%, 22.2%, and 44.4%, respectively. Type A was seen for 92% of type 1 cases, type C was seen for 88% of type 3 cases, and type B was seen for 54.8% of type 2 cases. The types seen between the axial and sagittal reformation images showed a significant agreement (r=0.868, p < 0.01). CONCLUSION: The shape of the anterior diaphragm correlated with the relationship between the base of the pericardium and the xiphoid.

Ultrasound-Guided Fine-Needle Aspiration Biopsy of Multiple Thyroid Nodules

PURPOSE: To standardize the number of nodules which necessitates ultrasound-guided, fine-needle, aspiration biopsy in patients who have multiple thyroid nodules with the same sonographic characteristics as each other. MATERIALS and METHODS: From February, 2002 to March, 2004, among patients whose diagnosis was confirmed by ultrasound-guided, fine-needle, aspiration biopsy, 545 nodules of 203 patients were found in sonography with more than two thyroid nodules. Each thyroid gland nodule was classified on a score from 0 to 2 points on the basis of the following 5 characteristics: internal content, margin, echogenicity, shape and calcification in sonography. When the score of all characteristics was the same, by deciding on nodules with the same sonographic char-acteristics and with the score of at least one characteristic being different, we divided the nodules with different sonographic characteristics in a patient. By methods such as given in the preceding descriptions, patients with multiple thyroid nodules were separated into two groups: one in which all nodules had the same sonographic characteristics and another in which nodules have at least one different sonographic characteristic. Then, each pathologic result was searched for the same case and different case in each patient group. RESULTS: Among the 203 patients who were diagnosed with multiple thyroid nodules in ultrasonography, 79 patients (38.9%) had nodules with the same ultrasonographic characteristics and 124 patients (61.1%) had nodules with at least one different ultrasonographic characteristic. All 79 patients' nodules with the same ultrasono-graphic characteristics in each patient showed the same pathologic result in all cases (100.0%) and there was no case showing a different pathologic result. Otherwise, among the 124 patients' nodules with different ultrasono-graphic characteristics, each patient showed the same pathologic result in 111 (89.5%) and different pathologic result in 13 (10.5%). CONCLUSION: In patients who have multiple thyroid nodules, if a patient's nodules have the same sonographic characteristics, we can perform ultrasound-guided, fine-needle, aspiration biopsy about only one nodule and if a patient's nodules have different sonographic characteristics from each other, we must perform the biopsy for all nodules.

A Case of Primary Pancreatic T-cell Lymphoma

Primary pancreatic lymphoma is a rare extranodal manifestation of any histopathologic subtype of non-Hodgkin's lymphoma that predominantly involves the pancreas, and it comprises less than 0.5% of all pancreatic malignancies. Histopathologically, most primary pancreatic lymphomas are the B-cell phenotypes, and T-cell lymphomas are extremely rare. We describe here the ultrasonography and computed tomography (CT) findings of a pathologically confirmed pancreatic T-cell lymphoma in a 37-year-old female patient. Ultrasonography showed diffuse pancreatic enlargement and a slightly bulging mass in the head and tail of pancreas that had markedly heterogeneous echogeneity. The lesion abutted onto the adjacent vessels, but there was no evidence of luminal narrowing or obstruction. The CT scan showed diffuse enlargement of the pancreas and the bulging contoured mass at the pancreatic head and tail with inhomogeneous enhancement, including multiple hypodense areas. It also showed the patent peripancreatic vessels and multiple LN enlargements around the pancreas.

A Case of Primary Pancreatic T-cell Lymphoma

Primary pancreatic lymphoma is a rare extranodal manifestation of any histopathologic subtype of non-Hodgkin's lymphoma that predominantly involves the pancreas, and it comprises less than 0.5% of all pancreatic malignancies. Histopathologically, most primary pancreatic lymphomas are the B-cell phenotypes, and T-cell lymphomas are extremely rare. We describe here the ultrasonography and computed tomography (CT) findings of a pathologically confirmed pancreatic T-cell lymphoma in a 37-year-old female patient. Ultrasonography showed diffuse pancreatic enlargement and a slightly bulging mass in the head and tail of pancreas that had markedly heterogeneous echogeneity. The lesion abutted onto the adjacent vessels, but there was no evidence of luminal narrowing or obstruction. The CT scan showed diffuse enlargement of the pancreas and the bulging contoured mass at the pancreatic head and tail with inhomogeneous enhancement, including multiple hypodense areas. It also showed the patent peripancreatic vessels and multiple LN enlargements around the pancreas.

Differentiation of Benign and Malignant Thyroid Nodules: Sonographic Analysis and a New Scoring System

PURPOSE: To analyze the synthetically created sonographic features of thyroid nodules, we present here a new scoring system for the sonographic features that are suggestive of malignant thyroid nodules. We also evaluated the accuracy and clinical significance of this system. MATERIALS AND METHODS: In this study, we included 725 thyroid nodules of 405 patients that were pathologically proven by USG-guided percutaneous fine-needle aspiration biopsy (FNAB) or surgery. Two radiologists analyzed the sonographic features according to the internal content, margin, echogenecity, shape and calcification. We scored from 0 point to 2 point for each feature, and then we calculated the total scores and classified them as three groups according to the total score such as low risk (0-3), intermediate risk (4-6) or high risk (7-10). We demonstrated the difference of the frequency and the positive predictive value among the three groups by using the Chi-square test (p<0.005). RESULTS: For 725 nodules, 654 (90.2%) were benign and 71 (9.8%) were malignant. For 589 nodules classified as low risk, 10 (1.7%) were malignant. For 102 nodules classified as intermediate risk, 32 (31.4%) were malignant. For 34 nodules classified as high risk, 29 (85.8%) were malignant. There was a statistically significant difference in the frequency and positive predictive value of malignancy among the three groups (p<0.001). CONCLUSION: There was a statistically significant difference in the frequency and positive predictive value of malignancy among the three groups for the new scoring system presented in this study to analyze the synthetically sonographic features of thyroid nodules. So, we think that sonography can be helpful for making the differentiation between benign and malignant nodules. When we find thyroid nodules on sonography, we can reduce the unnecessary FNAB and we can diagnose malignant nodules at an earlier stage.

Anatomic Landmarks of Fluoroscopy Guided Puncture of the Pulseless Femoral Artery

PURPOSE: We wanted to improve puncturing the pulseless femoral artery by evaluating the anatomic landmarks that suggest the course of the femoral artery on fluoroscopy. MATERIALS AND METHODS: We analyzed 37 hemipelvis spot images that were centered on the arterial sheath after puncture of the femoral artery. The inguinal angles were measured between the inguinal line connecting the anterior superior iliac spine and the symphysis pubis, and the line of the arterial sheath. Inguinal ligament ratios were measured as the distance from the symphysis pubis to the arterial sheath to the length of the inguinal ligament on the inguinal line. The femoral head ratios were measured as the distance from the medial margin of the femur head to the arterial sheath to the transverse length of the femur head. RESULTS: The mean inguinal angle was 66.5degree (+/-7.8degree) and the mean inguinal ligament ratio was 0.42 (+/-0.03). The mean femoral head ratio was 0.08 (+/-0.18). In comparing the men and women, there was no significant difference in the inguinal angle and the femoral head ratio, but the inguinal distance ratio was larger in women (men: 0.41+/-0.033, women: 0.44+/-0.031, p < 0.05). CONCLUSION: The femoral artery generally courses just lateral to the medial margin of the femur head (femoral head ratio: 0.08) and the medial 40% of the inguinal ligament (inguinal ligament ratio: 0.42). So, consideration of these relations may be helpful for puncturing the pulseless femoral artery.

Ultrasound-Guided Fine Needle Aspirations of Thyroid Nodules: Assessment of Nondiagnostic Samples

PURPOSE: To determine the frequency of malignancy among the nondiagnostic specimens by ultrasound-guided, fine needle aspiration (US-FNA) and to analyze the factors which cause the nondiagnostic specimens of thyroid nodules. MATERIALS AND METHODS: Data were collected from 425 patients (58 male, 367 female) who underwent US-FNA of the thyroid nodule between February, 2002 and October, 2003. The study included 784 nodules from 425 patients. US-FNA was performed 1 to 3 times by two radiologists using a 10MHz linear probe and a 21-gauge fine needle. The percentage of total nondiagnostic specimens was obtained and the percentage of nondiagnostic specimens according to the thyroid nodule's size and nature was analyzed. Thyroid nodules were classified according to their sizes and natures. The nodules were divided by size as either 1cm or more, or less than 1cm in diameter. Each nodule was classified as cystic (pure cystic), mixed (solid portion of nodule2/3). The percentage of malignancy among nondiagnostic specimens was determined and compared to the malignancy rate among diagnostic specimens. Chi-square test and Fisher's exact test were used for statistical significance. RESULTS: Among the 784 nodules, 95 (12.1%) were nondiagnostic. The percentage of nondiagnostic specimens increased as the cystic content increased (p<0.0001). The malignancy rate of the diagnostic specimens was higher than that of the nondiagnostic specimens, but the difference was not significant. CONCLUSION: The cystic content of each nodule was the only significant predictor of nondiagnostic specimens. There was no significant difference in malignancy rate between nondiagnostic and diagnostic specimens. It is suggested that when evaluating an initially nondiagnostic US-FNA, repetitive US-FNA or follow-up USG should be performed.

Analysis of the Factor which Affect to Acquisiton Rate of Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodules

PURPOSE: The purpose of this study is to evaluate the acquisition rate of adequate specimens in the ultrasoundguided percutaneous needle aspiration biopsy (US-PCNB) of thyroid nodules and to find the factors influencing the acquisition rate. MATERIALS AND METHODS: We conducted a prospective study in 132 patients who had a total of 215 nodules. Aspiration biopsy was performed with 21-gauge fine needles for 111 nodules (62 patients) and with 20-gauge cutting needles for 104 nodules (70 patients). We calculated the overall acquisition rate of adequate specimens of US-PCNB and compared the acquisition rates according to the kind of needle, and the size, nature and palpability of the nodules. RESULTS: The total acquisition rate of adequate specimens was 87.4%. There was no difference in the acquisition rate between the 20-gauge cutting needle and the 21-gauge needle. The acquisition rate of the solid nodules (90.2%) was higher than that of the cystic nodules (78.8%). However, the size and palpability of the nodules did not significantly affect the acquisition rate of the specimens. CONCLUSION: The acquisition rate of adequate specimens in the US-PCNB of thyroid nodules was high. The acquisition rate of the solid nodules was higher than that of the cystic nodules. However, there was no statistically significant difference in the acquisition rate according to the kind of needle, or the size and palpability of the nodules.

Clinical Manifestations of Acute Renal Failure with Loin Pain Developed after the Anaerobic Exercise / 대한신장학회잡지

BACKGROUND: Rhabdomyolysis is a well known cause of the exercise induced acute renal failure (ARF), but the patch renal vasoconstriction with severe loin pain which developed after the anaerobic exercise is not. Although there are a few cases about ARF resulted from the patchy renal vasoconstriction in Korea, there are only a few reports about comparisons of their clinical manifestations. METHODS: Eight patients of ARF with severe loin pain after the exercise, were admitted to Chungbuk national university hospital from April 1994 to March 2004. For all patients, we obtained basic clinical findings and laboratory studies, and performed an enhanced computed tomography (CT) initially and delayed CT without contrast media at least 6 hours after. RESULTS: All the patients were previously healthy young men. The main symptom was loin pain in five patients and all patients experienced the anaerobic exercise before. Six patients took analgesics and fever was observed in seven patients. There was no marked elevation of creatinine phosphokinase (CPK). The initial mean creatinine (Cr) was 3.50+/-1.49 mg/dL and the maximum Cr was 8.8 mg/dL. All the patients fully recovered their renal function. We observed the typical patchy wedge-shaped contrast enhancement CT findings in seven patients. CONCLUSION: Differential diagnosis between rhabdomyolysis and the patchy renal vasoconstriction in newly developed ARF after exercise is important. Our eight patients showed typical clinical manifestations. In cases which implicate the pathy renal vasoconstriction by their typical clinical findings, the enhanced CT and the delayed postcontrast CT are helpful for diagnosis.

GABA, benzodiazepine receptors and their functions / 신경정신의학

No abstract available.

Usefulness of Manual Medicine Therapy in Adhesive Capsulitis of Shoulder

OBJECTIVE: The purpose of this study was to determine the usefulness of manual medicine therapy in adhesive capsulitis of shoulder. METHOD: Twelve patients with adhesive capsulitis of shoulder were treated with the muscle energy technique of Greenman in manual medicine therapy. The muscle energy technique of Greenman was repeated 6 times for each subject. The therapeutic effect of manual medicine therapy was assessed by the shoulder range of motion (ROM) and visual analogue scale (VAS) before and after the treatment. Two patients took the fluoroscopic examination before and after the treatment. RESULTS: After the manual medicine therapy, active range of shoulder motion were increased by 30.0degrees in forward flexion, by 21.2degrees in abduction, by 11.2degrees in external rotation, and by 18.7degrees in internal rotation, respectively. The visual analogue scale was decreased after treatment. None of the subjects complained pain during treatment. The mobility of shoulder joint was improved and the rhythm of scapulohumeral joint was restored. CONCLUSION: The manual medicine therapy is an effective, tolerable and noninvasive treatment method for the painful adhesive capsulitis of shoulder.

Ultrasonographic Evaluation of the Painful Hemiplegic Shoulder

OBJECTIVE: The aim of this study is to know the usefulness of ultrasonographic evaluation of hemiplegic shoulder pain. METHOD: For 20 hemiplegic patients with shoulder pain, the shoulder was evaluated by simple radiographic findings, physical examinations, visual analogue scale (VAS), manual muscle test (MMT), and finally the ultrasonographic examination to define shoulder pain nature. The ultrasonographic results were compared to the simple radiography, physical examination, VAS, and MMT. RESULTS: The ultrasonographic findings were variable. The positive ultrasonographic findings were 10 joint fluid collections, 3 tendinous thickenings, 4 high echogenic findings, 4 tendon surface defects, 2 tendinous gracilings, and 1 joint surface irregularity. The ultrasonographic interpretative conclusion included 6 tendon (or muscle) tears, 2 degenerative changes, 5 nonspecific simple joint fluid collections, and 7 normal shoulder joints. In comparison of ultrasonographic findings and subluxation, VAS, and fluid collection, VAS showed relatively higher correlation. CONCLUSION: The ultrasonography is very useful as a non-invasive, inexpensive, painless, and rapid screening diagnostic method for the evaluation of painful hemiplegic shoulder.

The study of immune function in the repeaters of college enterance examination / 신경정신의학

No abstract available.

Hrombosed Aortic Dissections and Aortic Aneurysms: MRI Findings and Differential Diagnosis

PURPOSE: MRI is known to be an effective imaging modality of the aorta and its role is steadily increasing in the evaluation of acquired aortic diseases including aortic dissections and aortic aneurysms. However, differentiation of the aortic dissections with thrombosed false lumen from the aortic aneurysm with mural thrombus in MRI has not been easy. Therefore, the authors tried to find the characteristic MR featrses which would to differentiate the two diseases. MATERIALS AND METHODS: MR images of 6 patients with thrombosed aortic dissection and 7 patients with thrombosed aortic aneurysms were reviewed retrospectively and compared in regand to shape and extent of thrombus, dimension of aorta, and luminal flow signal. RESULTS: Thrombosed aortic dissections showed sharply demarcated crescent shaped aortic wall thickening of even thickness involving long segment of the aorta, whereas thrombosed aortic aneurysms showed irregular aortic wall thickening of uneven thickness localized in the short dilated segment of the aorta. Characteristically aortic aneurysm with mural thrombus showed eccentric intraluminal slow flow signal. In contrast to the signal void of the true lumen in aortic dissections, the residual lumen of the aortic aneurysm with mural thrombus revealed intraluminal signal due to slow flow. CONCLUSION: Familiarity to these MRI findings of thrombosed aortic dissections and aortic aneurysms may lead to the accurate differential diagnosis in majority of cases.