99mTc-HMPAO-labelled Leucocyte Scintigraphy in the Diagnosis of Infection after Total Knee Replacement Arthroplasty / 대한핵의학회잡지

PURPOSE: This study was performed to evaluate the usefulness of 99mTc-HMPAO-labelled leucocyte scintigraphy for diagnosing prosthetic infection after total knee replacement arthroplasty without the aid of following bone marrow scintigraphy. MATERIALS AND METHODS: The study subjects were 25 prostheses of 17 patients (one man and 16 women, mean age: 65 years) who had total knee replacement arthroplasty. After injection of 99mTc-HMPAO-labelled leucocyte, the whole body planar and knee SPECT images were obtained in all patients. The subjects were classified into three groups according to clinical suspicion of prosthetic infection: Group A (n=11) with high suspicion of infection; Group B (n=6) with equivocal suspicion of infection, and Group C (n=8) with asymptomatic contralateral prostheses. Final diagnosis of infection was based on surgical, histological and bacteriological data and clinical follow-up. RESULTS: Infection was confirmed in 13 prostheses (11 in Group A and 2 in Group B). All prostheses in Group A were true positive. There were two true positives, one false positive and three true negatives in Group B, and six true negatives and two false positives in Group C. Overall sensitivity, specificity, and accuracy for diagnosis of the infected knee prosthesis were 100%, 75% and 88%, respectively. CONCLUSION: 99mTc-HMPAO-labelled leucocyte scintigraphy is a sensitive method for the diagnosis of infected knee prosthesis. However, false positive uptakes even in asymptomatic prosthesis suggest that bone marrow scintigraphy may be needed to achieve improved specificity.

A Case of a Bezoar Found in a Normal Duodenal Bulb / 대한소화기내시경학회지

A 50-year-old man who had suffered from chronic indigestion complained of upper abdominal pain and vomiting which had persisted for 4 days. Consequently, he had eaten two persimmons before sleeping detected each day for five days. An irregular multinodular villous filling defect was in the duodenal bulb on, the UGI series, which had its location and changed its position. It was difficult to differentiate a papillary gastric polyp or villous tumor from the duodenal bezoar, but the patient's history of having eaten persimmons was helpful. The endoscopic and pathologic study confirmed a phytobezoar which was located in the normal duodenal bulb. Subsequently we are reporting this case having reviewed the related literature of the phytobezoar which was found in the normal duodenal bulb.

Mucinous Adenocarcinoma of Ascending Colon Associated with Inflammatory Disease: 2 Case reports

Inflammatory and ischemic bowel disease commonly involve a longer segment than a maligant lesion. The characteristic findings of inflammatory bowel disease are mucosal nodular hypertrophy and luminal narrowing. It has recently been reported, however, that the features of mucinous adenocarcinoma are similar to those of inflammatory bowel disease with long segmental involvement. After a brief review of the literature, we describe two cases of mucinous adenocarcinoma of the ascending colon associated with inflammatory disease. Because of long segmental involvement of the ascending colon, mucosal nodular hypertrophy and luminal narrowing, one of these was thought to be multiple villous adenoma with colitis, but was confirmed as mucinous adnocarcinoma. The other case, thought to be tuberculous enterocolitis, was comfirmed as tuberculous enterocolitis associated with mucinous adenocarcinoma.

Endoanal Ultrasound in Benign Anal Disorders: Findings and Usefulness

PURPOSE: To evaluate the usefulness of endoanal ultrasonography and to determine the imaging features of patients with fecal incontinence, anal abscess or anal fistula. MATERIALS AND METHODS: Twenty five patients underwent endoanal ultrasonography between October 1995 and July 1996. Ten of these were fecal incontinence cases, eight had an anal abscess, and seven, an anal fistula. The incontinence grading scale (IGS) was used for clinical grading of fecal incontinence and pudendal nerve terminal motor latency (PNTML) for pudendal nerve injury. Endoanal ultrasonographic features and operative findings were retrospectively reviewed. RESULTS: Endoanal ultrasonography revealed defective sphincteric muscles in all three patients with myogenic fecal incontinence, but in six of seven cases with neurogenic fecal incontinence, these muscles were not defective. Myogenic and neurogenic incontience showed different findings (p=0.033). In comparison with surgical findings, endoanal ultrasonography was 88% accurate in anal abscess cases and 86% accurate in those of anal fistula. CONCLUSION: Endoanal ultrasonography in conjunction with PNTML was very useful for the detection of the site and severity of sphincteric muscle defect and diagnosis of the etiology of fecal incontinence. Through analysis of the site and type of lesion, the procedure can also serve as a guide to the surgical treatment of patients with anal abscess or fistula.

A Case of Xanthogranulomatous Pyelonephritis Associated with Xanthogranulomatous Epididymoorchitis

Xanthogranulomatous pyelonephritis is an atypical severe renal parenchymal infection, characterized macroscopically by a yellow lobulated mass, and microscopically by massive inflammatory cells and foamyhystiocytes. Preoperatively it can be confused with hypernephroma, pyonephrosis with stone or other renal inflammatory diseases, We present a case of xanthogranulomatous pyelonephritis associated with xanthogranulomatous epididymoorchitis. To our knowledge this is the first report of xanthogranulomatous pyelonephritis associated with xanthogranulomatous epididymo-orchitis.

Necrotizing Fasciitis: Plain Radiographic and CT Findings

PURPOSE: To evaluate the plain radiographic and CT findings of the necrotizing fasciitis. MATERIALS AND METHODS: We retrospectively reviewed the radiologic findings of 4 cases with necrotizing fasciitis. Three cases were proven pathologically. We evaluated pattern and extent of the gas shadows in plain films. CT findings were analysed, with emphasis on : (a) gas pattern, (b) extent, (c) location and involved site, (d) associated focal abscess, and (e) swelling of the adjacent muscles. RESULTS: On plain radiographs, four cases showed streaky or mottled gas densities in the pelvis, three cases in the perineum, one case in the abdomen, and two cases in the thigh. On CT images, gas pattern was mottled and streaky appearance with swelling of the adjacent muscles. Gasshadows located in the extraperitoneal space in four cases, fascial layer in four cases, and subcutaneous layer infour cases. There were gas shadows in pelvic wall, perineum, abdominal wall, buttock, thigh, and scrotum. Focallow density lesion suggestive of focal abscess was not visualized. CONCLUSION: Plain radiography is useful forearly diagnosis of the necrotizing fasciitis and CT is very useful for detection of precise location and extent of the disease. CT is also useful for differentiation of necrotizing fasciitis from focal abscess and cellulitis.