Pancreatic Arteriovenous Malformation Combined with Pseudocysts / 대한췌담도학회지

Pancreatic arteriovenous malformation (PAVM) is very rare anomaly. It occurs most commonly in the pancreatic head portion and gastrointestinal bleeding is the most common symptom. The management of PAVM is rather complex, with complete treatment usually accomplished by a total extirpation of the affected organ or at least its involved portion. We report the clinical presentation and management of 64 year-old male patient with PAVM, which was developed in pancreatic tail portion with sudden abdominal pain. Pancreatic computed tomography and magnetic resonance cholangiopancreatography were consistent with a vascular formation on pancreatic tail portion and simultaneously revealed with pseudocysts beside it. A subsequent superior mesenteric artery angiographic findings depicted PAVM on pancreatic tail portion. The patient underwent laparoscopic distal pancreatectomy and splenectomy and had a favorable outcome.

Traumatic Oculomotor Nerve Palsy

No abstract available.

Primary Intraosseous Hemangioma in the Frontal Bone

No abstract available.

Primary Intraosseous Hemangioma in the Frontal Bone

No abstract available.

Sodium Iodide Symporter and Phosphatase and Tensin Homolog Deleted on Chromosome Ten Expression in Cholangiocarcinoma Analysis with Clinicopathological Parameters

BACKGROUND/AIMS: This study was performed to investigate the correlation of sodium iodide symporter (NIS) expression with the functionality and loss of phosphatase and tensin homolog deleted on chromosome ten (PTEN) expression in human cholangiocarcinoma (CCA). METHODS: Immunohistochemistry for the expression of NIS and PTEN was performed in 60 biopsy specimens of CCA. The clinicopathological parameters were retrospectively identified from medical records. The expression pattern of NIS and loss of PTEN expression were analyzed in association with the clinicopathological characteristics, including survival. RESULTS: Normal biliary trees displayed NIS expression, but hepatocytes did not. NIS expression was divided into two patterns: cytoplasmic and membranous. Fifty-nine cases, all except for one case, displayed NIS expression in tumor cells. Twenty-two cases (33.3%) were mixed pattern, and 39 cases (65.05%) were cytoplasmic pattern; the pure membranous pattern was not noted. There was no association between the NIS expression pattern and clinicopathological parameters, including age, sex, differentiation grade, T stage and tumor, node, metastasis stage (p>0.05). The survival rates were similar among various NIS expression patterns. Normal hepatocytes and biliary trees exhibited PTEN expression in the nucleus and cytoplasm. CCA cells displayed nuclear staining. Thirty-six (60.0%) of 60 cases displayed a loss of PTEN expression. The loss of PTEN expression was observed in the advanced T-stage group (p=0.0036), but there was no association between the loss of PTEN expression and other clinicopathological parameters (p>0.05). No association between the loss of PTEN expression and survival was noted. CONCLUSIONS: NIS is expressed in most types of human CCA. The expression pattern suggests a role in cancer development. PTEN loss expression is common in the context of human CCA, especially in the advanced T stage.

The Predictive Value of Laser Doppler for Flap Survival

If we could predict the necrosis of the flap caused by reperfusion injury, we can minimize the necrosis of the flap by taking appropriate action before necrosis begins. In this study, we examined whether we can predict the survival of flap under reperfusion injury or not, by measuring laser doppler flow meter values. We divided the group into the control and experimental groups corresponding to 6, 8, 9, 10, and 12hours after reperfusion(hours after ligation of auricular central artery). In each group, we examined necrotic change, perfusion unit (PU), serum superoxide dismutase (SOD), glutathione peroxidase, angiography and pathologic findings. No necrosis was observed in the 6 and 8 hours group but 8, 18, 20 hours after ligation, necrosis was observed, Also in each of 9, 10 and 12 hours group (each group consisted of 20 flaps), necrosis were noted. According to the above data, the critical time of necrosis in the auricular skin flap model lies between about 8 to 9 hours. Comparing the PU between the necrosis and non-necrosis groups, the former group showed a mean 39.57 PU increase after 60 min of reperfusion, and the latter group showed a mean increase of 21.21 PU. We can conclude that better flow can dilute oxygen free radical into systemic circulation, and this means less injuries are caused on vessels. Our study implies that if blood flow increase is less than 30 PU, intensive care is needed to save the flap. Additionally, we found significant decrease of serum SOD and glutathione peroxidase in the necrotic group. Therefore, monitoring these serum markers will be helpful in predicting reperfusion injury and supplementing these enzymes could be helpful to save the flap. The laser doppler flow meter is thought to be helpful in clinical circumstances for evaluating the circulation of the flap after the operation. However, more accumulation of clinical studies should be necessary establishing useful clinical data.

Hepatopulmonary Syndrome Induced by Common Bile Duct Ligation in a Rabbit Model: Correlation between Pulmonary Vascular Dilatation on Thin-Section CT and Angiography and Serum Nitrite Concentration or Endothelial Nitric Oxide Synthase (eNOS) 1 Expression

OBJECTIVE: To investigate the correlation between radiologic vascular dilatation and serum nitrite concentration and eNOS expression in the endothelial cell and pneumocyte in a rabbit model of hepatopulmonary syndrome induced by common bile duct ligation (CBDL). MATERIALS AND METHODS: Thin-section CT scans of the lung and pulmonary angiography were obtained 3 weeks after CBDL (n=6), or a sham operation (n=4), and intrapulmonary vasodilatation was assessed. The diameter and tortuosity of peripheral vessels in the right lower lobe by thin-section CT and angiography at the same level of the right lower lobe in all subjects were correlated to serum nitrite concentration and eNOS (endothelial nitric oxide synthase) expression as determined by immunostaining. RESULTS: The diameters of pulmonary vessels on thin-section CT were well correlated with nitrite concentrations in serum (r = 0.92, p < 0.001). Dilated pulmonary vessels were significantly correlated with an increased eNOS expression (r = 0.94, p < 0.0001), and the severity of pulmonary vessel tortuosity was found to be well correlated with serum nitrite concentration (r = 0.90, p < 0.001). CONCLUSION: The peripheral pulmonary vasculature in hepatopulmonary syndrome induced by CBLD was dilated on thin-section CT and on angiographs. Our findings suggest that peripheral pulmonary vascular dilatations are correlated with serum nitrite concentrations and pulmonary eNOS expression.

Hemoptysis and Hemoperitoneum due to Metastatic Gestational Choriocarcinma: Bronchial Artery Embolization and Superselective Splenic Artery Embolization: A Case Report

Gestational choriocarcinoma is easily disseminated hematogenously and its hypervascular nature places the patient at risk of significant hemorrhage both at the sites of metastatic lesions and in the uterus. In addition, its tends to give rise to pseudoaneurysm formation. Treatment of the condition by percutaneous embolization has been reported in several published articles, and hemoperitoneum secondary to rupture of splenic metastasis of gestational choriocarcinoma has also been reported, as has angiographic embolization. Hemoptysis resulting from pulmonary metastasis and treatment by means of embolization of the bronchial artery have not been reported, however. In this article, we describe a case of hemoptysis and hemoperitoneum due to pulmonary and splenic metastasis of gestational choriocarcinoma. Treatment of the condition involved embolization of the bronchial artery and superselective embolization of the splenic artery.

Multiple Bone Metastases on Radionuclide Bone Scans Distributed to Batson's Plexus

PURPOSE: Multiple bone metastases that appear on 99mTc-MDP bone scans tend to be distributed in the axialskeleton, including the proximal humeri and femora;this is similar to the distribution seen in Batson'sparavertebral plexus. The purpose of this study was, therefore, to evaluate- by examining the anatomicdistribution of metastases- the metastatic mechanism of cancer cells of various primary tumors in Batson's plexus. MATERIALS AND METHODS: Three hundred and forth-five known cases of primary tumors and multiple bone metastaseswere confirmed by bone scan imaging. The axial skeleton was divided into seven parts: skull, ribs, scapulas,spine, pelvis, proximal humeri, and proximal femora. In addition, the spine was divided into cervical, thoracicand lumbar areas. RESULTS: Among the 345 cases, bony metastases were distributed as follows: ribs, 186 (53.9%);spinal areas, 172 (49.9%); pelvis, 94 (27.2%); proximal femora, 85 (24.6%); skull, 63 (18.3%); proximal humeri, 45(13%); and scapulas, 31 (9%). Among the 243 primarily thoracic cancer cases (e.g. lung, breast or esophagus),distribution was as follows: ribs, 142 (58.4%); spinal areas 111 (45.7%); and pelvis, 54 (22.2%). Among the 69cancers which were primarily of the upper abdomen (e.g. stomach or liver), distribution spinal areas, 44 (63.8%);ribs, 33 (47.8%); and pelvis, 26 (37.7%). While the 33 primarily pelvic cancers (e.g. prostate, uterine cervix orbladder), were distributed between spinal areas (17, 51.5%), the pelvis (13, 39.4%), and the ribs (11, 33.3%).There were no statistically significant differences in the distribution of bony metastases according to primarycancers. CONCLUSION: Multiple bone metastases, as seen on bone scan images, coincided with the distribution ofBatson's plexus. We therefore conclude that although pelvic tumors can metastasize to the axial skeleton bydirectly anastomosing into Batson's plexus, other primary tumors metastasize from systemic veins to Batson'splexus as a result of the occurrence of venous reflux when intrathoracic or intra-abdominal pressure is increased.

Factors Related to Recurrence of Bladder Transitional Cell Carcinoma after Transurethral Resection of BladderTumor(TUR-BT)

PURPOSE: To evaluate factors related to the recurrence of TCC(transitional cell carcinoma) in the urinarybladder after transurethral resection of bladder tumor(TUR-BT). MATERIALS AND METHODS: We retrospectivelyreviewed 54 patients in whom TCC(transitional cell carcinoma) after TUR-BT had been confirmed. Recurrence wasevaluated by US, CT, cystoscopy and urine smear during the follow-up period of 6 months. The multiplicity, shape,size, and calcification of TCC, as revealed by radiologic studies, were evaluated retrospectively before TUR-BT.After TUR-BT, the histologic grade and pathologic stage of TCC were evaluated. RESULTS: According to themultiplicity of TCC, the recurrence rate was 66.7% in the multiple type and 28.6% in the single type(p=0.039) ;according to shape, this rate was 61.5% in the sessile type and 29.3% in the pedunculated type(p=0.0505), andaccording to mass size, the rate was 41.7% in tumors more than 3cm in diameter and 35.7% in tumors less than3cm(p=0.706). In the presence of calcification, the recurrence rate was 40.0% and in its absence, this rate was36.7%(p=0.885). Pathologically, the higher the grade and stage of TCC, the higher the recurrence rate(respectivelyp=0.010 and 0.041). CONCLUSIONS: Radiologically, multiple and/or sessile type TCC had a higher recurrence ratethan the single and/or pedunculated type. Pathologically, when the grade and stage of bladder tumor were higher,recurrence rates were higher.

Correlation Between Contrast Enhancement of Portal Vein and Spleen Size in Dual-phase Spiral CT

URPOSE: To evaluate using spiral CT the effect of spleen size on blood flow in the portal venous system andto know the usefulness of this evaluation. MATERIALS AND METHODS: Fifty-one patients without evidence on spiralCT scan of abnormality thought to affect portal venous flow presented between December 1994 and June 1995. We measured spleen size and Hounsfield units of portal vein in dual-phase, and calculated the ratio of the unit inthe portal phase to that in the arterial phase. Spleen size was measured, using the length of X-axis by that of Z-axis on spiral CT scan. We then measured the correlation between the two values. CT was performed with a Somatom Plus-S scanner(Siemens, Erlangen, Germany). A total dose of 120ml of non-ionic contrast material(Ultravist) was administered at a rate of 3ml/sec. Arterial and portal phase were obtained after 30 seconds and 60 seconds fromthe beginning of the contrast agent injection. RESULTS: The correlation between spleen size and contrast enhancement of the portal vein was relatively significant(Pearson's correlation coefficient(r)=0.41801). CONCLUSIONS: Spleen size significantly affects portal venous flow on spiral CT scan. The evaluation of spleensize and contrast enhancement of the portal vein could be useful in the differential diagnosis of diseases which affect portal venous flow.

Multiple Bile-duct Hamartoma: Two Case Report

Authors report the radiologic findings of two cases of multiple bile-duct hamartoma in the liver. Ultrasonography and computed tomography of the liver were performed in two female patients. In one patient, ERCP was performed. Ultrasonography and computed tomography showed scattered multiple hypoechoic and low attenuated lesions, measuring up to 2cm in both lobe and ERCP showed communication of these lesions with the biliary system. Multiple bile-duct hamartoma should be included in the differential diagnosis of multiple small cystic lesions in the liver.

Embryonal Rhabdomyosarcoma of the Biliary Tree: A Case Report

Rhabdomyosarcoma are reportedly the most common soft tissue sarcoma occuring in childhood, but the biliary tree is a rare site of origin for this tumor. Recently we experienced a case of embryonal rhabdomyosarcoma of the biliary tree in a 30-month-old child. UItrasonography showed hypoechoic mass filling the dilated left. intrahepatic & extrahepatic bile ducts, and CT showed hypodense mass with heterogeneous enhancement after contrast infusion. Intraoperative cholangiography showed filling defects within the dilated left. intrahepatic & extrahepatic bile ducts. Postoperative MRI showed residual mass within the left. intrahepatic duct which was hypointense on T1WI and hyperintense on T2WI.

Embryonal Rhabdomyosarcoma of the Biliary Tree: A Case Report

Rhabdomyosarcoma are reportedly the most common soft tissue sarcoma occuring in childhood, but the biliary tree is a rare site of origin for this tumor. Recently we experienced a case of embryonal rhabdomyosarcoma of the biliary tree in a 30-month-old child. UItrasonography showed hypoechoic mass filling the dilated left. intrahepatic & extrahepatic bile ducts, and CT showed hypodense mass with heterogeneous enhancement after contrast infusion. Intraoperative cholangiography showed filling defects within the dilated left. intrahepatic & extrahepatic bile ducts. Postoperative MRI showed residual mass within the left. intrahepatic duct which was hypointense on T1WI and hyperintense on T2WI.

Three-dimensional CT reconstruction of the surface of the sinonasal cavities, pharynx and larynx: Normal anatomy

Simulated three-dimensional (3D) imaging represents reformation of conventional sectional imaging data into a series of images that closely resemble the original studied structure. We tried to make 3D mucosal surface images of the sinonasal cavities, pharynx and larynx, and evaluated the feature of normal anatomy in 28 subjects. In the sinonasal cavities, 3D imaging was capable of demonstrating the inner wall of paranasal sinuses and its openings, and general status status of the nasal cavity. In the nasal cavity. In the nasopharynx, 3D imaging provided an easy concept of sectional images as 3D picture and displayed anatomic subsites and lesions comparable to that in fiberscope. In addition, 3D imaging had advantages in overcoming the technical limitations in fiberscope. In the larynx and hypopharynx, 3D imaging gave a 3D concept of the laryngeal structures and presented additive information not seen in axial iamges thus enabling access to regions beyond the scope of fiberscope. In conclusion, 3D imaging allows an easy conceptualization of transaxial CT images in complex anatomic areas and provides additional in formations undetectable in transaxial CT. We believe that the spaces of the sinonasal cavities, pharynx and larynx would be a new field of application of 3D image.

Three-dimensional CT reconstruction of the surface of the sinonasal cavities, pharynx and larynx: Normal anatomy

Simulated three-dimensional (3D) imaging represents reformation of conventional sectional imaging data into a series of images that closely resemble the original studied structure. We tried to make 3D mucosal surface images of the sinonasal cavities, pharynx and larynx, and evaluated the feature of normal anatomy in 28 subjects. In the sinonasal cavities, 3D imaging was capable of demonstrating the inner wall of paranasal sinuses and its openings, and general status status of the nasal cavity. In the nasal cavity. In the nasopharynx, 3D imaging provided an easy concept of sectional images as 3D picture and displayed anatomic subsites and lesions comparable to that in fiberscope. In addition, 3D imaging had advantages in overcoming the technical limitations in fiberscope. In the larynx and hypopharynx, 3D imaging gave a 3D concept of the laryngeal structures and presented additive information not seen in axial iamges thus enabling access to regions beyond the scope of fiberscope. In conclusion, 3D imaging allows an easy conceptualization of transaxial CT images in complex anatomic areas and provides additional in formations undetectable in transaxial CT. We believe that the spaces of the sinonasal cavities, pharynx and larynx would be a new field of application of 3D image.

MRI findinga of multiple sclerosis

Nine patients of clinically definite multiple sclerosis (MS) were examined by magnetic resonance imaging (MRI) at 1.0T. The MS plaques were seen in the brain and spinal cord in eight and three patients. respectively. The frequent sites of MS plaques were periventricular white matter, brain stem, and cervical cord. The shape of most brain MS plaques was round or finger-like configuration. The MS plaques showed high signal intensity on R2 weighted images and low or iso signal intensity on T1 weighted images in all nine cases. Contrast enhancement was seen in 4 cases. Mild brain atrophy was noted in 2 cases and mass effect in 1 case. The sites of cord MS plaques in three patients were C2-C4, C2-C5, and C4-C6 levels respectively. The cord MS plaques showed high signal intensity on T2 weighted image and contrast enhancement on Gd-DTPA enhanced T1 weighted images in all 3cases with mild cord expansion in 2 cases. In conclusion, MRI is a useful diagnostic tool in evaluationg the MS plaques involving central nervous system.

Computed tomographic evaluation on ossification of posterior longitudinal ligament and ligamentum flavum ofspine

Ossification and calcification of the spinal ligaments frequently cause pressure upon the spinal cord andnerve roots. Authors reviewed 150 cases of C-spine CT, 80 cases of T-spine CT, and 725 cases of L-spine CT whichwere carried out a Pusan Natina University Hospital for 2 years from May 1983 to May 1985. We analysed 34 caseswhich showed ossification of posterior longitudinal ligament (OPLL) and ligamentum flavum (OLF) of these 955cases. The results are follows: 1. The male ot female ratio of spinal ligamentous ossification was 26:8. The 5thdecade group (24.41%) was the most prevalent age group. 4th decade(26.4%), 6th decade(23.52%), 7th decade(11.76),3rd decade (8.8%), and 8th decade(2.94%) in that order. 2. Of 955 cases of spine CT, the incidence of OPLL was 25cases(21.51%) and that of OLF was 10 ases(1.05%). 3. Regional incidence of spinal ligamentous ossification was asfollows. 1) In case of OPLL, cervical area was 19/150(12.67%) and lumbar area was 6/725 (0.83%). 2) In cases ofOLF, Thoracic area was 3/80(3.75%) and lumbar area was 8/725(1.10%). 4. The most frequent length of OPLL was 4body length (32%) and the most frequent locations are C4 and C5(68%). The types fo OPLL were 15 cases(60%) ofsegmental type, 8 cases(32%) of continuous type, and 2 cases(8%) of mixed type in that order. All segmental typeswere degree 1 or 2 and most continuous and mixed type (80%) were degree 2 or 3 dural sac effect. 5. The number ofinvolved interlaminar spaces in OLF was 1 to 5 interspaces and most of OLF were found at low thoracic and lumbararea. 6. There could be noted high correlation between the spinal ligamentous ossification and degenerative discdisease, The incidence of associated disc disease was 18/25(72%) in OPLL and 8/10(80%) in OLF.