Analysis of the Surgical Outcome and Quality of Life after Pancreaticoduodenectomy for Nonneoplastic Disease

PURPOSE: Pancreaticoduodenectomy for mass-like lesions that are suspicious of malignancy sometimes reveals only nonneoplastic disease, especially in those cases where adequate tissues for biopsy are unavailable. In this study, we evaluated the outcomes and quality of life (QOL) after pancreaticoduodenectomy for treating nonneoplastic disease. METHODS: The clinical data of 28 patients who underwent pancreaticoduodenectomy for nonneoplatic disease and trauma from Jan. 1992 to Feb. 2006 were reviewed retrospectively. The QOL was evaluated using the FACT-Hep questionnaire. The patients who underwent laparoscopic cholecystectomy for benign gallbladder disease were utilized as the control group. RESULTS: 13.8% (28/203) of all the pancreaticoduodenectomized patients had nonneoplatic disease and trauma. Male patients were predominant (25/28) and all the trauma patients were male. The mean age was 48 (23~72) years old. The indications for surgery included lesions suspicious for malignancy (16 cases), pancreaticoduodenal artery aneurysm (1 case), and pancreatoduodenal injury (11 cases). The histologic findings of the nonneoplastic lesions revealed benign inflammation of the bile duct (6 cases), chronic pancreatitis (8 cases), pancreatic pseudocyst (1 case), and fibrosis of the Ampulla of Vater (1 case). No surgical mortality occurred. However, the trauma patients group had higher morbidity (72.7% Vs 23.5%, respectively, P=0.01) and a longer hospital stay (68.0 days Vs 32.6 days, respectively, P=0.02) after surgery compared to the nonneoplastic disease patient group. The QOL of the patient who underwent pancreaticoduodenectomy for nonneoplatic disease was not different from that of the control group. CONCLUSION: Since pancreaticoduodenectomy for nonneoplastic disease was safe and the QOL of the patients was acceptable, it should be performed more often when malignancies can not be excluded from the differential diagnosis.

High Signal Intensity on T1-Weighted MR Image Related to Vacuum Cleft in the Intervertebral Disk: Clinical and Phantom Study

PURPOSE: To determine the possible mechanism by which an area of high signal intensity appears on T1-weighted MR images adjacent to a vacuum cleft in intervertebral disks. MATERIALS AND METHODS: We analyzed a total of 14 disks in nine patients in whom a vacuum cleft with T1-signal hyperintensity was observed. Lesions were present from T11-12 to L5-S1 using a 1.5-T whole-body imager, sagittal spine-echo T1-weighted and gradient-echo images (flip angle, 20 'and 60 ) were obtained. In order to identify the vacuum cleft, using plain radiographs in all patients and CT scans in two were also obtained. A 3% agar-gel block containing empty slits to form a magnetic susceptibility difference, a phantom was designed. The air spaces were 1.6 mm in thickness, 25 mm in width, and 20 to 25 mm in depth with 1.6-mm spacing. RESULTS: In all patients, vacuum clefts were confirmed by plain radiographs and CT scans. At the level containing air, T1-weighted images (both spin-echo and gradient-echo) showed a signal void resulting from the intervertebral disk vacuum cleft. A hyperintense band adjacent to the vacuum cleft was, however, observed. A gradient-echo image with a 60 'flip angle showed a brighter signal intensity than one with a 20 'angle. Our phantom study gave the same results. CONCLUSION: The magnetic susceptibility artifact may be responsible for the T1-signal hyperintensity observed adjacent to the vacuum cleft in intervertebral disks. In addition, in order to generate signal hyperintensity, the desiccating disk material must contain a certain amount of water molecules.

High Signal Intensity on T1-Weighted MR Image Related to Vacuum Cleft in the Intervertebral Disk: Clinical and Phantom Study

PURPOSE: To determine the possible mechanism by which an area of high signal intensity appears on T1-weighted MR images adjacent to a vacuum cleft in intervertebral disks. MATERIALS AND METHODS: We analyzed a total of 14 disks in nine patients in whom a vacuum cleft with T1-signal hyperintensity was observed. Lesions were present from T11-12 to L5-S1 using a 1.5-T whole-body imager, sagittal spine-echo T1-weighted and gradient-echo images (flip angle, 20 'and 60 ) were obtained. In order to identify the vacuum cleft, using plain radiographs in all patients and CT scans in two were also obtained. A 3% agar-gel block containing empty slits to form a magnetic susceptibility difference, a phantom was designed. The air spaces were 1.6 mm in thickness, 25 mm in width, and 20 to 25 mm in depth with 1.6-mm spacing. RESULTS: In all patients, vacuum clefts were confirmed by plain radiographs and CT scans. At the level containing air, T1-weighted images (both spin-echo and gradient-echo) showed a signal void resulting from the intervertebral disk vacuum cleft. A hyperintense band adjacent to the vacuum cleft was, however, observed. A gradient-echo image with a 60 'flip angle showed a brighter signal intensity than one with a 20 'angle. Our phantom study gave the same results. CONCLUSION: The magnetic susceptibility artifact may be responsible for the T1-signal hyperintensity observed adjacent to the vacuum cleft in intervertebral disks. In addition, in order to generate signal hyperintensity, the desiccating disk material must contain a certain amount of water molecules.

A Relationship Between Amount of Joint Effusion, Disk Displacement and Presence of Pain in theTemporomandibular Joint: MR Imaging

PURPOSE: To correlate MR findings of amount of temporomandibular joint effusion with joint pain and disk displacement. MATERIALS AND METHODS: In 57 patients, 114 temporomandibular joints with symptoms of disorder(presence of clinical pain) were imaged. Closed and open mouth sagittal spin echo (SE) T1-weighted images (WI) and fast spin echo (FSE) T2-WI were obtained. We classified the amount of joint effusion into grades. Joint effusion was classified as either Grade I, II or III, as follours : in sagittal FSE T2-WI, a long diameter of joint effusion shorter than 1/3 of the diameter of the convex margin of temporal eminence was grade I; longer than 2/3 was grade III; between grade I and III was grade II. Disk displacement was classified as either with or without reduction in the open mouth position. These findings were correlated with one another and statistically analyzed. RESULTS: In 29 cases with joint pain (37%) and in 34 cases without pain (63%) there was no evidence of joint effusion; there were, however, more grade I joint effusion cases with pain (14 ; 60.9%) than without pain (9 : 39.1%). Cases of joint pain increased in proportion to grade of joint effusion, which was statistically significant (p<0.05). In joints without disk displacement, the largest grouping was that which showed no effusion (39 ; 72.2%) ; no joints showed grade III effusion. Cases of joint effusion decreased in proportion to grade of effusion. In joints with disk displacement, cases of joint effusion tended to increase in proportion to the grade of effusion. CONCLUSION: MR findings of amount of temporomandibular joint effusion correlate with joint pain and anterior disk displacement.