Impact of high-grade obstruction on outcomes in patients with appendiceal inflammatory masses managed by nonoperative treatment

PURPOSE: To retrospectively assess the impact of high-grade obstructions identified on initial CT on outcomes of patients with appendiceal inflammatory masses managed by nonoperative treatment. METHODS: Institutional Review Boards approved this retrospective study and informed consent was waived. Included were 52 consecutive patients diagnosed with appendiceal inflammatory masses by CT scan and managed by nonoperative treatment. The main outcome measure was treatment failure and secondary outcomes were complications and initial and total hospital stay. Patient demographics, inflammatory markers, and CT findings for presence of an appendiceal inflammatory mass and high-grade obstruction were assessed. Patients with and without high-grade obstruction were compared for patient characteristics and outcomes using Fisher exact test and Student t-test. RESULTS: Among 52 patients, 14 (27%) had high-grade obstruction on CT examination at presentation. No significant differences were observed in patient characteristics (P > 0.05), treatment failure (P = 0.33), complications (P = 0.29), or initial (P = 0.73) or total (P = 0.72) hospitalization between patients with and without high-grade obstruction. CONCLUSION: For patients who were managed by nonoperative treatment for appendiceal inflammatory masses, the presence of high-grade obstruction identified on initial CT scan did not significantly affect outcomes of treatment failure, complications, and initial and total hospitalization.

The Usefulness of US-guided Vacuum-Assisted Breast Biopsy for Probably Benign Lesions

PURPOSE: We wished to determine the usefulness of ultrasound-guided vacuum-assisted biopsy (mammotome) for the removal of the breast lesions that had displayed benign evidence on sonography. METHODS: During an 11 month period, vacuum-assisted breast biopsy was performed for 186 probably benign lesions on sonography using 11-gauge (127 cases) and 8-gauge (59 cases) devices. The age of the patients ranged from 19 to 65 years, and the size of the lesions ranged from 0.4 to 3 cm. We retrospectively analyzed the clinical findings and medical history of the patients who underwent vacuum- assisted breast biopsy, and we then evaluated the complications, the histopathologic results, and the follow-up US findings. RESULTS: Of the 186 cases, the lesions were palpated in 95 cases (51%), and lesions were detected in women during a screening examination in 40 cases (36%), and lesions were detected in women having a history of benign breast biopsy or having a cancer operation in the remaining 18 cases (10%). Severe bleeding during or after the procedures was noted in 4 cases (2.2%). The lesions were pathologically proved as benign in 185 cases and malignant in 1 case. With vacuum-assisted breast biopsy, high-risk benign disease was found in 7 cases, but none of the lesions was pathologically upgraded on the subsequent open surgical biopsy. On the 3-month follow-up US, variable sized hematomas were observed in 6 of 24 cases (25%). We performed incidental treatment on four of the vacuum- assisted breast biopsy patients for nipple discharge that was caused by intraductal papilloma. CONCLUSION: US-guided vacuum-assisted breast biopsy is a minimally invasive, fast and convenient biopsy technique. In addition, it is safe and accurate to use for the histological diagnosis because it would remove all the sonographically demonstrated evidence of a probable benign lesion. This technique can potentially be a useful alternative to some forms of surgical biopsy for the properly selected patients.

Correlation of Contrast-Enhanced MR Findings and Tumor Microvessel Density of Breast Masses

PURPOSE: To compare the contrast-enhanced dynamic MR findings of solid breast masses with their histopathologic tumor angiogenesis. MATERIALS AND METHODS: Thirty-two cases of pathologically proved breast lesions (8 benign and 24 malignant lesions) examined with contrast-enhanced MRI were retrospectively reviewed, focusing on the tumor size, the maximum amount of contrast enhancement (% Signal Intensity Change, SIC), the time to peak (early or late peak) and the type of time-signal intensity curve (TSC). We compared the characteristic MR findings of breast cancer with the microscopic maximum microvessel density (MVD). RESULTS: Among the total of 11 small lesions ( or = 20). On the other hand, among the 21 large lesions (> 2 cm, 15 malignant and 6 benign), only two cases of malignant and five cases of benign lesions showed high MVD. More than 100% SIC was observed in a total of 11 malignant and two benign lesions, but 8 of these 11 malignant lesions showed low MVD (< 20), whereas the two benign lesions showed high MVD. Early time to peak (< or = 3 min) was observed in 18 (17 malignant and 1 benign) lesions, and 11 of these 17 malignant lesions showed low MVD. An early high peak and early or slow wash-out pattern, which is typical of the malignant type, was seen in 18 (17 malignant and 1 benign) lesions, but 12 of these 17 malignant lesions showed low MVD. There is no statistically significant correlation between the characteristic MR findings of breast cancer and the MVD. CONCLUSION: Although high MVD indicated malignancy in the case of the small lesions, the histopathologic MVD was not significantly correlated with either the increased amount of enhancement, early time-to peak or the malignant pattern of the TSC.

Three Dimensional Digital Rotational Imaging in the Evaluation of the Fractures

PURPOSE: To evaluate the usefulness and the application of three dimensional digital rotational imaging (3D DRI) by the evaluation of fractures. MATERIALS AND METHODS: Sixteen patients with clinically diagnosed or suspicious fracture were involved in this study. The lesion or suspicious sites of all 16 cases were spines (n=7), pelvis (n=3) and so on (n=6; knee, elbow, ankle, wrist and foot). In all cases, conventional radiography, multiplanar 2D (slice thickness/pitch=3 or 5 mm/1:1)and volume rendering 3D reconstructed single detector helical CT (HiSpeed Advantage, GE Medical Systems, Milwaukee, WIS) scans and 3D DRI (Integris V-5000,Philips Medical Systems, The Netherlands) with multiplanar intersection and gray scaling as postprocessing technique were performed. 3D DRI was evaluated and compared with conventional radiography, multiplanar 2D CT and volume rendering 3D CT. RESULTS: 3D DRI provided more detail and additional information in 14 cases (88%), comparing with 2D and 3D CT scans. Two fractures were revealed only on 3D DRI other than conventional radiography and CT scans and one case was revealed on 2D CT and 3D DRI. In all cases, we could acquired more detail and additional information from 3D DRI than from 3D CT in the acquisition of 3D imaging. 3D DRI didn't change the classification of fracture in 12 of 13 cases (92%),which revealed the fracture on the conventional radiography or CT. CONCLUSION: 3D DRI can diagnose and evaluate the fracture rapidly and easily with anatomical and spatial resolution by acquisition of 3D imaging with postprocessing using DRI.

A Survey of the Nutrients and a Price Comparison of Korean Style Full Course Meals: Based on Korean Restaurants in Changwon City and in Luxurious Hotels in Seoul / 대한지역사회영양학회지

The objectives of this study were to conduct preliminary research to investigate full course meals in Korean style restaurants in order: i) to analyze the nutrient contents of full course meals per servings, and ii) by analyzing the above, to examine the amount and the quality of the foods served in the full course meals by two different types of Korean style restaurants. A total of 27 restaurants participated in this study, 7 restaurants from the luxurious hotels in Seoul and 20 restaurants from the City of Changwon. A key finding was that restaurant patrons tended to overconsume nutrients as compared to the Korean Recommended Daily Allowance (RDA), and restaurants generated large amounts of food wastes due to the excess food served. Other findings were as follows: 1) Compared with 1/3 or the Korean RDA, all the nutrients were oversupplied. The average nutrient ratios were about 3.7 times higher than 113 of the Korean RDA in calories, about 9 times higher in proteins, 10 times higher in phosphorus, 7 times higher in Vitamin Bl, and 12 times higher in Vitamin E. 2) Seventy-five percent (n = 20) of the restaurants served within the range of thirty to forty dishes, whereas most of the hotel restaurants (70%) served twenty dishes or fewer. 3) The average carbohydrate: protein: fat (CPF) ratio of caloric nutrients was 40:26:34. This study concluded that: i) Korean style full course meals provide too much food, nutrients, and calories, resulting in an over- or unbalanced nutrient intake, and ii) the Korean style full course meals consisted of a high-protein, high-fat and high-caloric intake, which is similar to a westernized caloric nutrient pattern. Such over -or unbalanced nutrient intake could cause chronic degenerative problems such as cancer and cardiovascular disease. These findings indicate that restaurants serving Korean style full course meals should carefully plan their menus in order to provide their customers with balanced meals. They should also be strongly encouraged to play an active role in improving their customers' nutritional status, as well as reducing the restaurants wastage of food. Lastly, further research should be conducted to improve the quality of the menus in Korean restaurants.

The Usefulness of STIR Image in Breast MRI

PURPOSE: To assess the usefulness of STIR (short tau inversion recovery) imaging in breast MRI (magnetic resonance imaging). MATERIALS AND METHODS: We retrospectively reviewed T1- and T2-weighted (T1WI, T2WI), STIR, and dynamically enhanced images of 44 pathologically confirmed breast lesions (benign, 13; malignant, 31) in 36 patients. We selected the dynamically image which best depicted a particular lesion, and then made hard copy of the corresponding T1WI, T2WI, and STIR images. Using the dynamically enhanced image as a standard, we analysed these in terms of parenchymal pattern, lesion detectability, differentiation between benign and malignant lesions, extent, multifocality, and the ductal system. The results were statistically analyzed. RESULTS: In 33 of 44 cases (75%), detectability was greater at STIR imaging than at T1- and T2WI, especially in fibrofatty or fatty breast (14/14 cases, p<0.05). STIR images did not always differentiate between benign and malignant lesions, and extent (50%) and multifocality (46%) were commonly exaggerated compared with T1- and T2WI. In 18 of 44 cases (41%), STIR images suggested the presence of ductal structures. CONCLUSION: For the detection of lesions, STIR imaging was more useful than T1- and T2WI, though STIR did not differentiate between benign and malignant lesions. The extent and multifocality of a lesion were exaggerated on STIR images, compared with T1- and T2WI.

The Diagnostic Value of Contrast Enhanced Power Doppler US on Small Breast Lesions

PURPOSE: To evaluate the usefulness of contrast-enhanced power Doppler ultrasonography (PDUS) in differentiating small benign from small malignant breast lesions. MATERIALS AND METHODS: Thirty-one solid breast lesions (<2 cm in size; 17 benign and 14 malignant) prospectively underwent US and PDUS before and after the injection of contrast agent (SH U 508A). Morphologic analysis involved independent assessment of the findings of US and the patterns of Doppler signals before and after contrast enhancement at PDUS, and sensitivity and specificity were thus evaluated. The diagnostic accuracy of US accompanied by PDUS was also determined before and after contrast enhancement. Hemodynamic analysis involved measurement of the time lapse between contrast injection at PDUS and observed change in Doppler signals. For this, a sonic VIOR computer-assisted program was used and the results were correlated with the pathologic findings. RESULTS: The sensitivities of US before and after contrast enhanced PDUS were 100%, 35.7%, and 57%, with specificities of 47%, 88.2% and 76%, respectively. The diagnostic accuracy of US was 35% with noncontrast PDUS, and 77% before and after contrast enhanced PDUS. The recorded time lapse between contrast injection at PDUS and observed change in Doppler signals did not correlate closely with the pathologic findings. CONCLUSION: In that it improved visualization of the morphology of vascular Doppler signals, microbubble contrast-enhanced PDUS complemented US and PDUS in differentiating between small benign and small malignant breast lesions.

A Case of Intraluminal Gallbladder Hematoma after Percutaneous Liver Biopsy / 대한간학회지

Percutaneous liver biopsy is valued in the diagnosis of diffuse or localized liver disease. Serious complications after ultrasonography-guided liver biopsy are rare. We report a case of a 69-year-old man who underwent a percutaneous liver biopsy for the evaluation of his underlying liver disease with subsequent late complication of intraluminal gallbladder hematoma.

Magnetic Resonance Imaging for Differentiating of Torsion of the Ovarian Tumor With or Without Necrosis

PURPOSE: The purpose of this study is to determine whether MRI is helpful for differentiating torsion of ovarian tumor, with or without necrosis MATERIALS AND METHODS: We retrospectively evaluated the MRI findings of nine patients with surgically confirmed torsion of the ovarian tumor, comparing them with the surgical and pathologic findings. The MRI findings were analyzed for contrast enhancement of twisted tumor, and the presence, signal intensity and contrast enhancement of twisted vascular pedicle. RESULTS: In all nine patients, MRI revealed a twisted vascular pedicle. Six patients with necrotic ovaries showed either no enhancement (n=4) or linear peripheral enhancement of twisted tumors (n=2), and lack of enhancement (n=5) or peripheral enhancement(n=1) of twisted vascular pedicles. In four of six patients with necrosis, T1-weighted MR images demonstrated a hyperintense pedicle; in three without necrosis, postcon-trast T1-weighted MR images revealed well-enhanced twisted tumors (n=2) and twisted vascular pedicles (n=3). CONCLUSION: By depicting a lack of contrast enhancement and high signal intensity within a twisted vascular pedicle, MRI can help differentiate torsion of ovarian tumor with or without necrosis.

A Case of Carcinoid Tumor of the Rectum / 대한소화기내시경학회지

Carcinoid tumor primarily affects the intestinal tract, which arise from the Kulchitsky cells found at the base of the crypts of Lieberk hn. Rectal carcinoids are relatively uncommon lesions, representing only 1.3 percent of all rectal tumors. Rectal carcinoids have benign course and are usually asymptomatic. While their prognosis is generally favorable, it is known that about 15% of these tumors metastasize. Rectal carcinoid tumors should be treated appropriately and aggressively when indicated. Present-day treatment programs call for radical cancer resection only for lesions larger than 2 cm in diameter and local resection for all others. We have experienced a case of carcinoid tumor of the rectum treated by endoscopic polypectomy.

Imaging Findings of Perineal Disease

The perineum is defined as the region of body below the pelvic diaphragm that lies within the boundaries of the pelvic outlet. It is the region which is home to pathologic conditions which include primary tumors, neoplasms of adjacent organs with secondary invo l vement, congenital or acquired cystic lesions and inflammatory lesions. In this article, we describe CT and MR imaging anatomy and various pathologic processes that affect this anatomic region, with a brief discussion. Emphasis is give n to imaging features that help to characterize specific lesions.

MRI of Bucket-Handle Tears of the Meniscus of the Knee

PURPOSE: To determine the frequency of the MRI signs of meniscal bucket - handle tears already known as the double PCL sign, the flipped meniscus sign, the absent bow-tie sign, and the fragment-in-notch sign, and to compare the sagittal with the coronal images. MATERIALS AND METHODS: We retrospectively rev i ewed the MR findings of 37 patients in whom an initial interpretation of MR images had suggested meniscal bucke t - handle tears. All underwent subsequent arthroscopic evaluation and in 28, bucke t - handle tears were confirmed. Sagittal double-echo and coronal fat-suppressed double-echo T 2 - weighted images were obtained. Sagittal images were evaluated to determine whether or not signs of bucket-handle tear were evident, and coronal images we r e checked for a torn meniscus with displaced fragment. We also evaluated the MR findings of the nine false positive cases. RESULTS: The prevalence rate of absent bow-tie, double PCL, fragment-in-notch, and flipped meniscus signs was 96.4%, 53.6%, 17.9%, and 10.7%, respective l y. The detection rate for displaced fragment was higher with coronal images (92.9%) than with sagittal images (78.6%). Among the nine false positive cases, a longitudinal tear in the discoid meniscus was most common. A false-positive diagnosis was much more frequent on sagittal than on coronal images. CONCLUSION: The prevalence rate of absent bow-tie sign was very high, but was accompanied by a relatively high rate of misinterpretation. Coronal fat-suppressed T2- weighted images provided more reliable clues for the diagnosis of bucket-handle tears, with a high detection rate of displaced fragment.

MRI of Bucket-Handle Tears of the Meniscus of the Knee

PURPOSE: To determine the frequency of the MRI signs of meniscal bucket - handle tears already known as the double PCL sign, the flipped meniscus sign, the absent bow-tie sign, and the fragment-in-notch sign, and to compare the sagittal with the coronal images. MATERIALS AND METHODS: We retrospectively rev i ewed the MR findings of 37 patients in whom an initial interpretation of MR images had suggested meniscal bucke t - handle tears. All underwent subsequent arthroscopic evaluation and in 28, bucke t - handle tears were confirmed. Sagittal double-echo and coronal fat-suppressed double-echo T 2 - weighted images were obtained. Sagittal images were evaluated to determine whether or not signs of bucket-handle tear were evident, and coronal images we r e checked for a torn meniscus with displaced fragment. We also evaluated the MR findings of the nine false positive cases. RESULTS: The prevalence rate of absent bow-tie, double PCL, fragment-in-notch, and flipped meniscus signs was 96.4%, 53.6%, 17.9%, and 10.7%, respective l y. The detection rate for displaced fragment was higher with coronal images (92.9%) than with sagittal images (78.6%). Among the nine false positive cases, a longitudinal tear in the discoid meniscus was most common. A false-positive diagnosis was much more frequent on sagittal than on coronal images. CONCLUSION: The prevalence rate of absent bow-tie sign was very high, but was accompanied by a relatively high rate of misinterpretation. Coronal fat-suppressed T2- weighted images provided more reliable clues for the diagnosis of bucket-handle tears, with a high detection rate of displaced fragment.

Uterine Didelphys with Blind Hemivagina, Hematocolpos, Ipsilateral Renal Agenesis (UD-BHRA) and BilateralOvarian Tumors: A Case Report

Uterine didelphys is a congenital malformation characterized by the presence of two separated hemiuteri andhemivaginas, due to lack of midfusion of the Mullerian ducts. We report a case of UD-BHRA(uterine didelphys withblind hemivagina and ipsilateral renal agenesis), a rare type of uterine didelphys charaterized by symptomaticunilateral hematocolpos due to blind hemivagina after menarche and ipsilateral renal agenesis. The MRI findings in22-year-old woman with bilateral ovarian tumors demonstrated two separated uterine horns and cervical and vaginalcanals, with left hematocolpos and left renal agenesis.

MRI of Breast Implant-related Complications

PURPOSE: To assess the usefulness of MRI in the preoperative diagnosis of breast implant-relatedcomplications. MATERIALS AND METHODS: Thirty four breast implants in 17 patients were examined. Eight breasts hada history of repeated surgery due to rupture and in eight others, simultaneous interstitial silicone injection hadbeen performed. MR images of the 34 implants were prospectively analyzed for implant-related complications,without prior clinical information, and the findings were compared with the results of surgery. RESULTS: Theimplant-related complications seen on MRI were infections in three cases, seromas in two, and implant malpositionin two. The linguine sign was seen in eight cases and intraparenchymal silicone in 17. Among the 32 removedimplants, rupture was genuine in ten cases (nine, extracapsular; one, intracapsular). In evaluating the MRfindings of implant rupture, the linguine sign showed 80% sensitivity, 100% specificity and 93.8% accuracy.Intraparenchymal silicon also revealed high sensitivity (90%), but relatively low specificity and accuracy (63.7%and 71.9%, respectively); this was due to the difficulty of differentiating granulomas still present after aprevious rupture from injected silicone material. MRI was useful for visualization of implant migration, thedirect relationship of extended or extruded silicone in extracapsular rupture and the localization of siliconegranulomas, as seen on multiplanar images. The extent of infection was clearly demonstrated on contrast enhancedscan. There was relatively good correlation between the degree of contracture seen on physical examination andthat seen on MRI. CONCLUSION: MRI was an effective and useful method for the preoperative evaluation ofimplant-related complications; degree of contracture was successfully predicted.

The Value of Intrarenal Resistive Index in Autosomal Dominant Polycystic Kidney Disease

PURPOSE: The purpose of this study was to determine the value of the intrarenal resistive index (RI),measured by Doppler sonography, in order to assess intrarenal vascular resistance in autosomal dominant polycystickidney disease (ADPKD) patients. MATERIALS AND METHODS: In 26 patients with ADPKD, RI was measured by Dopplersonography and correlated with the presence of hypertension, renal function (creatinine clearance) and anatomicalrenal severity index (RSI), thus indicating renal morphologic abnormalities during B-mode sonography . RESULTS:RI was significantly higher in 18 hypertensive ADPKD patients (0.64+/-0.65) (Mean+/-1SD; range: 0.52-0.74) than ineight normotensive patients (0.59+/-0.50) ( 0.48-0.64) (p<0.05). Statistically significant inverse correlation wasfound between RI values and creatinine clearance (r=-0.45, p<0.05), and statistically significant correlation wasfound between RI values and RSI, indicating the degree of renal parenchymal involvement. CONCLUSION: RIcorrelates with the development of hypertension, renal function and renal morphologic abnormality scoring by RSIduring B-mode Doppler sonography, and measured in this way may thus be used to assess renal vaseular resistance inADPRD patients.

Solid Breast Lesions: Evaluation with Power versus Conventional Color Doppler Sonography

PURPOSE: To compare power and conventional color Doppler sonography for depiction of the vasculature of solidbreast lesions, and to evaluate the usefulness of power Doppler sonography for differential diagnosis of malignantbreast lesions. MATERIALS AND METHODS: In order to detect vascularity, 82 cases of solid breast lesions wereevaluated by power and color Doppler sonography. Fifty-eight pathologically proven cases (37 benign and 21malignant lesions) were analyzed for the amount and patterns of Doppler signals, morphology of vessels, and thediagnostic accuracy. RESULTS: In 45 of 82 cases, power Doppler sonography depicted flow better than did colorDoppler sonography, while in 37 cases, depiction was equal. On power Doppler sonography, the incidence of markedblood flow in malignant lesions was three times higher than in benign lesions. The pattern of vasculature was morepredominantly central (85.5 %) and penetrating (61.9 %) in malignant lesions than in benign lesions. Branching(57.1 %) and disordered vessels (33.3 %) were more frequent in malignant lesions than in benign. For the diagnosisof malignancy, sensitivity for power Doppler sonography was 65 %, specificity was 79 % and diagnostic accuracy was74.1 % ; for color Doppler sonography, the corresponding figures were 76.9 %, 75.6 % and 75.9 %. CONCLUSION: Power Doppler sonography was more sensitive than color Doppler sonography for the detection of flow in solidbreast lesions. For the differentiation of benign from malignant lesions, however, there was no difference indiagnostic accuracy between the two modalities. findings of central and penetrating distribution patterns ofDoppler signals, and branching and disordered shapes of vessels, along with other sonographic criteria, arehelpful for predicting malignancy.

CT Findings of Diffuse Pleural Diseases: Differentiation of Malignant Diseases from Tuberculosis

PURPOSE: To evaluate whether or not previously known CT criteria for differentiating malignant and benign pleural diseases are useful in the differentiation of diffuse malignant pleural diseases and tuberculosis. MATERIALS AND METHODS: We retrospectively analyzed CT scans of 42 patients comprising 20 cases of malignant pleural diseases and 22 cases of tuberculous pleural diseases, according to previously known CT criteria for differentiating malignant and benign pleural diseases. RESULTS: The most common shape of pleural effusion was crescentic in malignant pleural diseases and loculated in tuberculosis. The aggressive nature of pleural effusion, pleural rind, and pleura thickenign was 1.5 times more frequently observed in malignant pleural diseases than in tuberculosis. Smooth thickening or smooth nodular pleural thickening and extrapleural deposition of fat were 1.5 times more frequently found in tuberculous than in malignant pleural diseases. Interruption of pleural thickening was found twice as frequently in malignant pleural diseases as in tuberculosis. Decreased lung volume was found twice as frequently in tuberculous as in malignant pleural diseases. Anatomical mediastinal pleural involvement was three times, and irregular nodular pleural thickening nine times more frequent in malignant pleural diseases than in tuberculosis. The sensitivity and specificity of CT findings above 70%, and thus suggesting malignant pleural diseases, were as follows: 1) aggressive nature of pleural fluid collection extending to the azygoesophageal recess or tongue of the lung (51.5%, 75%); 2) involvement of anatomical mediastinal pleura (69.2%,73.7%); 3) irregular nodular pleural thickening (87.5%, 69%). CONCLUSION: Although there in overlap between previously known CT criteria for the differentiation of benign and malignant pleural diseases, the aggressive nature of pleural fluid collection extending to the azygoesophageal recess or tongue of the lung, the involvement of anatomical mediastinal pleura and irregular nodular pleural thickening may suggest malignant pleural diseases.

Cystinuria 3 Cases

We report three cases of cystinuria, presenting with urinary stones. A 2-year-old girl presented with urinary difficulty, hematuria, dysuria of sudden onset, and her 7-month-old younger brother also was presented with urinary difficulty, irritability on urination & stone passage. Other 6-month-old boy was admitted due to sudden onset anuria. They had radioopague renal & ureter stones and stone analysis revealed mixed cystine stones. The diagnosis of cystinuria was confirmed metabolic studies and stone analysis. Lrinary amino acid analysis showed excessive excretion of dibasic amino acids(cystine, ornithine, lysine, arginine). And they all had hypercalciuria and hyperuricosuria. They were treated with combination of percutaneous lithotripsy for large obstructing senes a nd an oral drug therapy with sodium bicarbonate for rendering the urine more alkaline, and alpha-mercaptopropionylglycine(ThiolaR). This form of treatment was sucessful in our three cases with elimination of recurrent nephrolithiasis, but in one patient, nephrotic syndrome possibly caused by ThiolaR was developed. The nephrotic syndrome was recovered spontaneously after cessation of Thiola. A review of literatures was also attempted briefly.

Ureteral jets in patients with unilateral ureteral calculi: Using color doppler ultrasonography

Sonographic detection of ureteral jets entering the urinary bladder is a well-known procedure. Color Doppler ultrasound was used to image the ureteral jets in 28 patients with unilateral ureteral calculi proved by intravenous urography. Three major findings of ureteral jets were obtained in the affected ureter with a stone: less frequency (26 patients), weak reflection (20 patients), and lower grade in length (27 patients) that were significantly different from the unaffected side in the same patient. No significant differences were found between the ureteral jets and the degree of hydronephrosis or the location of a stone. In conclusion, these results suggest that ureteral jets should be checked routinely during the procedure of color Doppler ultrasonogram in patients with possible unilateral ureteral obstruction. Color Doppler examination of ureteral jets may be a important adjunct in routine pelvic ultrasonogram especially in patients who have absolute or relative contraindications of intravenous urography.