The Study of pH in Nasal Secretion in Normal and Chronic Rhinosinusitis

BACKGROUND AND OBJECTIVES: Nasal mucosal pH have a direct effect on the alteration of the physio-chemical characteristics of the nasal mucosa. Previous studies have reported the normal mucosal pH to be within the range of 5.3-7.0, mucosal pH with sinusitis to be within 6.8-7.6 and mucosal pH with rhinitis to be within 7.2-8.3. However, no consideration was paid to the conditions that influence the pH and there were no measured pH value by different methods. This study was therefore designed with the latest trend method in pH measurement with the purpose of evaluating pH in nasal secretion and creating an objective parameter for a beneficial manifestation of mucosa. MATERIALS AND METHODS: We measured the pH values from 30 normal control group (group 1), 30 patients with chronic sinusitis (group 2), and 30 patients with allergic rhinitis (group 3). Nasal secretion was obtained through filter paper absorption method and, using a micro pH electrode with pH meter, pH was measured in nasal secretion. RESULTS: pH in nasal secretion in this study was higher than the nasal mucosal pH from previously reported studies. pH values in nasal secretion showed a significant difference between three groups (group 1:7.86, group2:8.06, group 3:8.24) in this study (p<0.01). CONCLUSION: The measurement of pH in nasal secretion seems to be a useful parameter for monitoring and assessing the state of nasal mucosa. And we recommend this study as a method for obtaining an objective parameter for pH measurement in nasal cavity.

Discrete Hypoechoic Ring in Hepatic Cavernous Hemangioma Resembling a Malignant Tumor: Correlation with Histologic Features

Differential diagnoses of hepatic nodules include hepatocellular carcinoma, focal nodular hyperplasia, hepatic adenoma, regenerative nodule, focal fatty changes, and hemangioma. However, differentiation of these nodules can often be difficult. Hemangiomas are frequently encountered during ultrasonogram incidentally and can be diagnosed easily because they have an almost distinctive sonographic appearance: a homogeneous hyperechogenicity and discrete posterior acoustic enhancement. They also sometimes have atypical findings, for example an internal echogenicity including hypoechogenicity, heterogeneous echogenicity, hyperechoic rim, central hypoechogenicity due to various changes (e.g., internal hemorrhage, necrosis, thrombosis, myxomatous change, and fibrosis), and (rarely) calcification. We report herein the case of an atypical hemangioma presenting with a hypoechoic peripheral ring, mimicking a hepatic malignancy. To our knowledge, there have been no other reports demonstrating a cavernous hemangioma with a discrete hypoechoic ring and without a pseudocapsule.

Splenic Arteriovenous Malformation Manifestated by Thrombocytopenia in Hereditary Hemorrhagic Telangiectasia: A Case Report

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant inherited disease characterized by epistaxis, telangiectases and visceral arteriovenous malformations (AVMs). The involvement of the gastrointestinal tract, liver, lung and cerebrum for HHT has been described, whereas little is known about AVMs of the spleen. We report here the radiological findings of a case of a splenic AVM manifested by thrombocytopenia in HHT.

A Phase I/II Trial of DCVac/IR(R) Dendritic Cell Immunotherapy Combined with Irradiation in Cases of Refractory Colorectal Cancer with Multiple Liver Metastases / 대한방사선종양학회지

PURPOSE: To assess the toxicity and tumor response induced by DCVac/IR(R) dendritic cell (DC) immunotherapy combined with irradiation for refractory colorectal cancer patients with multiple liver metastases. MATERIALS AND METHODS: Between May 2004 and November 2006, applicants from a pool of refractory colorectal cancer patients with multiple liver metastases were enrolled. The patients were registered after having signed the informed consent form, which had been approved by the Institutional Review Board from the Dong-A University and Busan National University Hospital. DCs were obtained from peripheral blood of each patient, and then cultured in vitro. A total of 6x10(6) DCs were packed into a vial (DCVac/IR(R), 0.5 ml) at the convenience of each patient's schedule. On the day before and on the day of each vaccination, each patient received a 4 Gy radiation dose to the target tumor. On the day of vaccination, the indicated dose of autologous DCs was injected into the irradiated tumor using ultrasound-guided needle injection procedures. A total of four vaccinations were scheduled at three 2-week intervals and one 4 week interval at the Dong-A University and Busan National University Hospital. If the tumor status was deemed to be stable or responding to therapy, an additional vaccination dose or two was approved at 4 week intervals beyond the fourth immunization. A tolerance test for DCs was conducted by injecting a range of doses (3x10(6) to 12x10(6) DCs) after the 3rd injection. Moreover, the maximal tolerable dose was applied to additional patients. Treatment safety was evaluated in all patients who had at least one injection. Treatment feasibility was evaluated by the 10th week by assessing the response of patients having at least 4 injections. For systemic toxicities, the evaluation was performed using the National Cancer Institute Common Toxicity Criteria, whereas adverse effects were recorded using common WHO toxicity criteria. RESULTS: Of the 24 registered patients, 22 received the DCs injections. Moreover, of the 14 patients that applied for the tolerance test, only 11 patients completed it because 3 patients withdrew their testing agreement. A grade 3 or more side effect, which was possibly related to the DC injection, did not occur in additional patients. The 12x10(6) DC injection was identified as the maximum tolerable dose, and was then injected in an additional 8 patients. Patients tolerated the injection fairly well, with no fatal side effects. In order to assess the feasibility of DC immunotherapy, the response was evaluated in other hepatic lesions outside of the targeted hepatic lesion. The response evaluation was performed in 15 of the 17 patients who received at least 4 injections. Stable and progressive disease was found in 4 and 11 patients, respectively. CONCLUSION: The DC-based immunotherapy and radiotherapy is theoretically synergistic for the local control and systemic control. The DCVac/IR(R) immunotherapy combined with irradiation was tolerable and safe in the evaluated cases of refractory colorectal cancer with multiple liver metastases. Future work should include well designed a phase II clinical trials.

An Airway Tube for Minimizing Nasal Obstruction Following Intranasal Packing

BACKGROUND AND OBJECTIVES: Nasal packing after nasal surgery is commonly practiced for various purposes including hemostasis, stabilization of nasal structure, and synechia prevention. However, the use of nasal packing has led to the development of uncomfortable symptoms such as nasal obstruction. In this study, therefore, we have devised a new method of nasal packing involving the use of an airway tube for reducing nasal obstruction and discomforts in association with post-surgical nasal obstruction. Materials and METHODS: An airway tube was made by cutting the distal end of a 1cc syringe. It was inserted between the nasal septum and the packing material. Nasal cavities of 20 patients (Group 1) who underwent nasal surgery were packed using packing materials and the devised airway tubes following nasal surgery. We evaluated the symptoms of nasal obstruction after the postoperative nasal packing in this study group and compared them with those of the 20 patients (Group 2) who received packing with existing merocel nasal stents and 20 patients (Group 3) who were given packing with only merocel without airway tubes after nasal surgery. RESULT: In this study, nasal obstruction and discomforts in association with post-surgical nasal obstruction were significantly improved among patients given packing material and devised airway tubes (Group 1) comparative to other patient groups. CONCLUSION: Devised airway tube is useful in minimizing the symptoms of nasal obstruction and discomforts as well as in reducing surgical expense.

Evaluation of Predictive Value of Okuda, TNM, CLIP and JIS Staging Systems for Hepatocellular Carcinoma Patients / 대한간학회지

BACKGROUND/AIMS: The aims of this study were to validate the prognostic value of the JIS score for HCC and to compare discriminatory ability and predictive power with other staging systems such as Okuda, TNM and CLIP. METHODS: We analyzed the clinical records of 210 patients who were diagnosed as HCC from 2000 to 2002. Univariate and multivariate survival analyses were done to find out factors to affect survival. To validate prognostic value of those staging systems, survival curve was obtained and analyzed by the Kaplan-Meier's method, and to compare discriminatory ability and predictive power, Homogeneity LR chi-square test and AIC score were used. RESULTS: The median survival was 19.5 months (19.1+/-14.9). The number of patients and 3-year survival rate for those staging systems were Okuda 1(126, 57.7%), 2(63, 9.0%) and 3(21, 0.0%) (p<0.001); TNM I (34, 63.1%), II (71, 59.4%), III (50, 22.4%), IV-A (6, 14.3%) and IV-B (1, 6.5%) (p<0.001); CLIP 0 (79, 68.5%), 1 (39, 34.2%), 2 (36, 16.7%), 3 (25, 20.0%), 4 (18, 5.1%), 5 (9, 11.1%) and 6 (4, 0.0%) (p<0.001) and JIS 0 (26, 78.9%), 1 (65, 65.3%), 2 (43, 21.9%), 3 (40, 25, 8.0%) and 5 (11, 2.0%)(p<0.001) in univariate analysis using Kaplan-Meier analysis. Homogeneity LR chi-square test showed more stratification power in JIS (Okuda, 102.8; TNM, 128.2; CLIP, 148.4 and JIS, 185.6) and AIC score showed superior predictive power in JIS system (Okuda, 1228.5; TNM, 1130.3; CLIP, 1117.1 and JIS, 1093.6). CONCLUSIONS: The proposed JIS system is useful system to predict survival of HCC patients. The discriminate ability of the JIS score is much better than other staging systems and has better prognostic predictive power compared to other staging systems.

Prognostic Factors for Survival in Patients with Hepatocellular Carcinoma after Radiofrequency Ablation / 대한소화기학회지

BACKGROUND/AIMS: Currently there is no consensus on which staging system is the best in predicting the survival of patients with hepatocellular carcinoma (HCC). The aim of this study was to identify independent factors to predict survival and to compare 4 available prognostic staging systems in patients with early HCC after radiofrequency ablation. METHODS: We retrospectively studied 100 Korean patients with early HCC. Prognostic factors for survival were analysed by univariate and multivariate analysis using the Kaplan-Meier method and Cox proportional hazard regression models. Okuda, Cancer of the Liver Italian Program (CLIP), TNM and Japanese integrated staging score (JIS score) were evaluated before the treatments. RESULTS: Overall survival rates of 12, 24 and 36 months were 89%, 76%, and 64% respectively and the mean survival duration was 45 months. Multivariable analysis showed that albumin, total bilirubin and size of tumor were independent prognostic factors. Multivariate analysis showed that TNM and JIS score staging systems were significant staging systems for the prediction of prognosis. CONCLUSIONS: Both TNM and JIS score are more effective than the Okuda and CLIP staging systems in stratifying patients into different risk groups with early HCC. However, JIS score gives better prediction of prognosis in patients with HCC after radiofrequency ablation.

Clinical Significance of Nasal Secretory Proteins in Chronic Sinonasal Diseases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many studies report changes in the expressions of nasal secretory proteins which play important roles in the evaluation of sinonasal mucosal status. The biomarkers in nasal secretions provide valuable information on pathophysiological status of the rhinosinusitis. We have monitored the level and ratio of nasal secretion markers, especially secretory IgA (sIgA) and lactoferrin as markers of sinonasal submucosal glands to evaluate mucosal status for chronic sinonasal diseases and allergic rhinitis. SUBJECTS AND METHOD: Samples were obtained with the filter paper absorption method from 20 normal healthy controls (Group I), 20 patients with chronic rhinosinusitis (Group II), 20 patients with allergic rhinitis (Group III), 20 normalized persons of chronic rhinosinusitis patients treated with antibiotics, previously (Group IV). We estimated concentrations of sIgA and lactoferrin determined by enzyme-linked immunosorbent assay method. RESULTS: The concentration of sIgA and lactoferrin in nasal secretion showed a significant difference between the control group and other groups (p<0.05). The sIgA/lactoferrin ratio was more highly significant in the normal group and normalized in chronic rhinosinusitis patients treated with antibiotics (Group IV) than other groups (p<0.05). CONCLUSION: In this study, sIgA and lactoferrin are useful secretion markers and the levels of sIgA, lactoferrin and sIgA/lactoferrin ratios in nasal secretions seem to be very useful parameters for monitoring and assessing the conditions of the sinonasal mucosal diseases.

A Case of Empty Sella Syndrome with Cerebrospinal Fluid Rhinorrhea / 대한이비인후과학회지

The empty sella syndrome is defined as the intrasella herniation of the chiasmal cistern resulting from a congenitally incompetent diaphragma sellae. In idiopathic or primary empty sella syndrome, sella remodelling occurs as a result of an anatomical variation in the diaphragma sella. The secondary empty sella syndrome occurs following surgery or irradiation of an intrasellar lesion. Empty sella syndrome is known to be rarely associated with Cerebrospinal fluid (CSF) rhinorrhea. We experienced a case of secondary empty sella symdrome with CSF rhinorrhea in a 56-year old female who complained of persistent rhinorrhea through the roof of the sphenoid sinus after brain surgery due to meningioma. The CSF rhinorrhea was treated successfully with transseptal trans-sphenoidal approach.

Anti-tumoral Effect of Recombinant Vaccinia Virus through US Guided Injection in a Rabbit Model of Hepatic VX2 Carcinoma

PURPOSE: The purpose of this study was to evaluate the anti-tumoral effect of recombinant vaccinia virus (rVV) (Thymidine kinase (-)/GM-CSF (+)) that was administered as a US guided intratumoral injection in a rabbit model of hepatic VX2 carcinoma. MATERIALS AND METHODS: VX2 carcinoma was implanted in the livers of 12 rabbits. US was performed at every week interval to detect hepatic mass after the implantation of VX2 carcinoma. The accurate tumor size and volume was evaluated with CT when the tumor was detected on US. US guided injection of rVV (109 pfu/ml) was preformed in three rabbits, intravenous injection of the same dose of rVV was done in two rabbits and another seven rabbits that were without any treatment were selected as a control group. We evaluated the change of the hepatic tumor size and extrahepatic metastasis on serial CT. Tumor specimens were harvested from rabbits that were killed at 8 weeks after VX2 implantation. These tissues were histoimmuopathologically compared to each other (the virus injection group and the control group). The differences between these groups were statistically assessed with student t-tests. RESULTS: Tumor growth was significantly suppressed in the US guided injection group compared with the intravenous injection group or the control group (p< 0.01). The intravenous injection group showed statistically significant tumor suppression compared to the control group (p< 0.01) until 2 weeks after virus injection. Quantification of the pulmonary metastatic nodules was performed in view of both the number and volume. The average number or volume of the pulmonary metastatic nodules in the US injection group was much smaller than these in the control group. Histopathologically, the tumors of the US guided injection group showed less extensive necrosis than those of the control group. Immunohistochemically, the tumor of the US guided injection group showed more prominent infiltration of CD4 (+) and CD8 (+) lymphocytes than did the tumors of the other group. CONCLUSION: rVV was markedly effective in suppressing hepatic tumor growth and extrahepatic metastasis in a rabbit model of hepatic VX2 carcinoma. US guided intra-tumoral injection was more effective than systemic intravenous injection.

Histologic Change of the Septal Cartilage with the Respect to Trauma History and Age at the Trauma in Nasal Septal Deviation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The histologic difference of the traumatic nasal septal cartilage from that of non-traumatic has not been extensively studied. The aim of this study was to identify histologic difference in the nasal septal cartilage between traumatic and non-traumatic nasal septal deviation and to find its implication for surgical intervention. SUBJECTS AND METHOD: Nasal septal cartilage was obtained from 23 patients who had undergone septoplasty or septorhinoplasty for the nasal septal deviation. The septal cartilage without trauma (7 patients, Group I) and with the history of the trauma at the age under 10-15 years old (8 patients, Group II), and over 25 years old (8 patients, Group III) between May 2003 to February 2005 were included in this study. An approximately 1 x 1 cm sized piece of the septal cartilage was harvested from the site deviated the most. The histologic difference of the septal cartilage by hematoxylineosin staining under a light microscope was performed. RESULTS: The chondrocyte densities were significantly higher in the convex side than in the concave side of the septal cartilage in Group I, II, III. Especially, the increased chondrocyte ratio (convex/concave) were more evident in the septal cartilage traumatized at the age of 10 to 15 years, and the cartilage plate was thicker than the other groups (p<0.001). Also, dystrophic changes of the chondrocytes as representing the chondrocyte differentiation and chondroblast ratio (convex/concave) were significantly higher in the group II than in the other groups (p<0.005). CONCLUSION: This study demonstrated that age dependent changes in septal cartilage with nasal trauma showed distinctive histologic characteristics. We suggest that these observations will help determine surgical treatment modality for cases of nasal septal deviations with and without trauma.

Utility of Vascular Enhancement Technique (ClarifyTM) in Ultrasonographic Evaluation of Abdominal Vessels

PURPOSE: Vascular enhancement (VE) technology(ClarifyTM) is a new technique in vascular, B-mode imaging. The purpose of this study was to evaluate the value of VE technology in ultrasonographic diagnosis of abdominal vasculature. MATERIALS and METHODS: Seventy-one adult patients (39 men and 32 women; age range, 25-89 years; mean age, 56 years) who had undergone abdominal ultrasonography were included in this study. The imaging was performed with a 1.8-4.0 MHz convex array transducer (SONOLINE, Antares, Siemens Medical Solutions, WA) by an abdominal radiologist. The radiologist obtained images of the same vascular area with each of conventional ultrasonography imaging (CUS), tissue harmonic imaging (THI), CUS plus VE technique and THI plus VE technique. Images were divided into normal (56) and abnormal (15) groups. The vessel visibility, conspicuity of the vascular wall and contrast resolution with adjacent structures were evaluated in the normal group, and the lesion conspicuity and border sharpness were evaluated in the abnormal group. On the PACS monitor, the images were graded into four grades by two radiologists in consensus. Statistical analysis was performed using Wilcoxon signed rank test. RESULTS: In the normal group, all parameters of the ultrasonographic imaging which applied the VE technique were superior to those of the imaging without VE technique (p < 0.05). In the abnormal group, combined use of VE technique with CUS or THI provided better results than CUS or THI alone in terms of lesion conspicuity and border sharpness (p < 0.05). THI combined with VE technique provided the best image quality among the 4 ultrasonographic methods examined in this study for the evaluation of both normal and abnormal abdominal vessels (p < 0.05). CONCLUSION: VE technology was a helpful technique to evaluate the abdominal vasculature. Furthermore, VE technique combined with THI provided better image quality than other ultrasonographic methods in the evaluation of abdominal vessels.

Congenital Hepatoportal Arteriovenous Fistula associated with Intrahepatic Portal Vein Aneurysm and Portohepatic Venous Shunt: Case Report

A congenital hepatoportal arteriovenous fistula associated with an intrahepatic portal vein aneurysm is a rare type of arteriovenous malformation. Only 14 pediatric cases have been reported to the best of the authors' knowledge. An intrahepatic shunt between the portal and systemic veins is also relatively rare. We report a case of a congenital hepatoportal arteriovenous fistula associated with an intrahepatic portal vein aneurysm and a portohepatic venous shunt in a neonate who presented with tachypnea and melena.

Correlations between the Modified Observer's Assessment of Alertness/Sedation Scale, Bispectral Index and Propofol Effect Site Concentrations in Sedated Elderly Patients under Regional Anesthesia / 대한마취과학회지

BACKGROUND: To maintain an adequate sedation level in elderly patients (over 65 years) under regional anesthesia, we evaluated the correlations between the modified observer's assessment of alertness/sedation (OAA/S) scale, bispectral index (BIS), propofol effect site concentrations. METHODS: In elderly patients (over 65 years) scheduled for transurethral resection of a bladder tumor or prostate, we measured BISs and started propofol infusion using the target controlled infusion (TCI) method to sedate patients after regional anesthesia. OAA/S composite scores, measured BISs propofol effect site concentrations and vital signs were determined. RESULTS: When the OAA/S composite score was 5, mean BIS was 97.2 +/- 1.1; when the OAA/S was 4, mean BIS was 84.3 +/- 4.6 and mean propofol effect site concentration was 0.8 +/- 0.3microgram/ml; when the OAA/S was 3, mean BIS was 78.4 +/- 4.3 and mean propofol effect site concentration was 1.2 +/- 0.3microgram/ml; and when the OAA/S was 2, mean BIS was 73.2 +/- 5.9 and mean propofol effect site concentration was 1.5 +/- 0.4microgram/ml. The OAA/S scale was found to be well correlated with BIS (Pearson's r = 0.973) and the propofol effect site concentration (Pearsons's r = -0.968). BIS was also well correlated with propofol effect site concentration (Pearson's r = -1.0). CONCLUSIONS: BIS was found to be a good tool for monitoring sedation level in elderly patients under regional anesthesia with propofol sedation.

Intrahepatic Transneedle Inoculation of VX2 Particles for Obtaining a Solitary Hepatic Tumor in an Animal Model

PURPOSE: The purpose of this study was to develop a large animal (rabbit) model which has a proper solitary intrahepatic tumor with lower leakage rates through less traumatic methods. Consequently, we evaluated tumor progression following the intrahepatic inoculation of VX2 cells into New Zealand white rabbits to acquire baseline data on the progression of a VX2 tumor. MATERIALS AND METHODS: Twenty New Zealand white rabbits, each weighting 2.5-3 kg, were selected for this study. A 1 mm3 VX2 tumor fragment was created and then minced to enable the particles to pass through a 21 G needle mounting in a tuberculin syringe with 0.1 ml of normal saline. The minced VX2 tumor particles were injected into the subcapsular parenchyma of the left hepatic lobe. A 21 G needle was used to avoid penetrating large hepatic vessels. In order to prevent hemorrhage or leakage of the VX2 tumor cells through the injection route, a purse-string suture around the puncture site was made using black silk 4-0. The tumor particles were then injected through the center of the suture. While removing the needle, the suture was tightened to prevent hemorrhage or leakage of the VX2 tumor cells through the injection route. Finally, the injection site was covered with a Surgicel(R) patch. The inoculated intrahepatic VX2 tumors were then imaged with a 16 channel multidetector CT every week for the duration of the study. The CT images covered from the lung apex to the pelvic floor. Two radiologists evaluated the size, location, and peritoneal seeding of the tumors as well as metastasis of other organs. Three rabbits were sacrificed at random beginning in the second week, and this process continued on a weekly basis for the duration of the study. The CT images and pathologic findings for the sacrificed rabbits were correlated. RESULTS: The inoculated intrahepatic VX2 tumors were not visible in the first week. By the second week 66.7% were visible on CT images and by the third week all tumors were visible. Of the twenty rabbits, three (15%) had tumor growth both in the liver and the peritoneal cavity, suggesting tumor leakage from the injection site into the peritoneal cavity. The remaining rabbits (n=17) had successful inoculation in the liver parenchyma as a solitary mass. Three of twenty rabbits (15%) showed tumor regression after successful inoculation. Tumor metastasis in extratumoral regions, including the liver and peritoneal seeding, increased beginning in the fourth week and more than 12x103 mm3 in volume after the initial inoculation of the VX2 tumors. CONCLUSION: This new technique using innoculated intrahepatic VX2 tumor particles seems to be a simple and effective method for obtaining a solitary hepatic tumor in animal models. Results of this study suggest that a solitary intrahepatic tumor model without metastasis can be maintained. However, the evaluation of any therapeutic effects or any planned intervention should not occur until the fourth week following innoculation or less than 12x103 mm3 in volume after the inoculation of the VX2 tumor. The second highlighted section does not seem to fir with the rest of the sentence. Consider rephrasing the last part of the sentence.

Hypertrophic Scar with Chronic Pain after Acute Herpes Zoster: A case report / 대한통증학회지

The most common and cumbersome complication of herpes zoster is postherpetic neuralgia, which typically presents as neuropathic pain. However, the painful symptoms of the postherpetic period might be associated with other causes, such as skin lesions of the herpes zoster. We report a case of a hypertrophic scar that developed in the lesion of an acute herpes zoster patient and was accompanied by pain.

The Hemodynamic Effects of Ropivacaine Infiltration at the Skull-pin Insertion Sites and the Incision Site in Craniotomy / 대한마취과학회지

BACKGROUND: Several drugs have been used to reduce the hemodynamic responses evoked by skull-pin head-holder application and skin incision in neurosurgery. This study evaluated the effects of ropivacaine infiltration on hemodynamics followed by the skull-pin head-holder application and the skin incision. METHODS: Sixty-six patients who had been scheduled for neurosurgery under general anesthesia were randomly divided into five groups. Saline or different concentrations of ropivacaine (0.1, 0.2, 0.5, 0.75%) were infiltrated into skull-pin head-holder insertion sites and the skin incision site. Systolic and diastolic blood pressure, and heart rate were measured just before skull-pin head-holder application and 30 sec, 1 min, 3 min, and 5 min after skull-pin head-holder application and skin incision. Changes in hemodynamics were compared. RESULTS: The systolic blood pressure (SBP) significantly increased on 30 sec and 1 min after skull-pin head-holder application, and on 30 sec, 1 min, 3 min, and 5 min after skin incision in the saline group and in the 0.1% ropivacaine group, respectively. Increased SBP was attenuated by 0.75% ropivacaine over the entire observation period. Increased diastolic blood pressure was reduced by 0.5% and 0.75% of ropivacaine at all times. The heart rate significantly increased on 30 sec and 1 min after skull-pin head-holder application in the saline group and in the 0.1% group. This increased heart rate was suppressed by 0.2%, 0.5%, and 0.75% ropivacaine. CONCLUSIONS: These results indicate that ropivacaine attenuates the hemodynamic responses evoked by skull-pin head-holder application or skin incision in craniotomy. Ropivacaine was most active at 0.75%.

Spontaneous Rupture of Choledochal Cyst: Case Report

Spontaneous rupture of a choledochal cyst leading to biliary peritonitis is a rare complication which can be fatal if not promptly diagnosed. The authors report the ultrasound and CT findings of two cases of spontaneous choledochal cystic rupture and the biliary peritonitis which ensued.

Shrinkage Rate of Necrotic Lesion after Radiofrequency (RF) Ablation of Hepatocellular Carcinoma: Correlation with Marginal Recurrence and Influencing Factors

PURPOSE: To compare the CT findings of hepatocellular carcinomas (HCCs) immediately after radiofrequency (RF) ablation with those obtained at six months' follow-up, to analyse the relationship between degree of shrinkage of a necrotic lesion and marginal recurrence, and to evaluate the factors influencing shrinkage. MATERIALS AND METHODS: We retrospectively evaluated 54 patients with 62 HCCs who underwent only RF ablation between May 1999 and July 2000. For six months after ablation, all had been free from marginal recurrence ad new-growth tumors. The findings of six-month follow-up CT were compared with those obtained immediately after RF ablation, and the volume of each necrotic lesion was calculated and compared. In terms of degree of shrinkage, tumors were classified as belonging to either group I (below 50%), group II (50-80%) or group III (above 80%). Each tumor was analysed in terms of its Child-Pugh classification, vascularity at CT, size, treatment details, the post-ablation appearance of its margins, and the presence, during necrosis, of peritumoral vessles and air bubbles. For statistical evaluation, Fisher's exact test was used. Shrinkage after ablationwas correlated to marginal recurrence during a period of more than one year. RESULTS: The Follow-up CT at six months showed that since immediately after ablation, necrotic lesions had shrunk by an average of 72%. Peritumoral vessels were seen in 12 of 14 cases in group I (86%), three of 13 in cases of group II (23%), and 11 of 35 in group III (31%)(p=0.001). Immediate CT revealed the presence of air bubbles in two cases in group I (14%), five in group II (38%), and 24 in group III (69%)(p<0.05). At follow-up CT performed during a period of more than one year, marginal recurrence was noted in four cases in group I, two in group II and two in group III (p<0.05). CONCLUSION: When a necrotic lesion contains no peritumoral vessels but does contain air bubbles, the degree of post-RFablation shrinkage increases. The greater the shrinkage, the less the marginal recurrence rate.

CT Findings of Acinar Cell Carcinoma of the Pancreas: Focused on Spiral CT Findings

PURPOSE: To evaluate the CT findings (in particular, those of dual-phase spiral CT) of acinar cell carcinoma of the pancreas. MATERIALS AND METHODS: We retrospectively reviewed the CT findings of pathologically confirmed pancreatic acinar cell carcinoma in seven patients (M:F = 4:3) aged 26 -57 (average,46) years. Serum amylase and lipase were clinically checked, and concomitant subcutaneous nodules or osteolytic bony lesions were evaluated. Contrast-enhanced CT scanning. was performed in seven cases, and in four of these, dual-phase spiral CT scans were also obtained. Tumor size and location, the extent of intratumoral necrosis, calcification, contour, margin, capsule, adjacent organ invasion, lymphadenopathy, hepatic metastasis and enhancement pattern were analyzed. RESULTS: Serum lipase was elevated in three cases, but in all, the serum amylase range was normal. In no case were subcutaneous nodules or osteolytic bony lesions observed. The size of the mass was 5 -18 (mean 8.4 cm), and tumors were located in the tail (n=3), body (n=2) and head (n=1), with one involving both the body and tail. Intratumoral necrosis was noted in six of seven cases and calcification in two. A lobulated contour with capsule was observed in six, and in two there was splenic invasion. In three of four cases in which dual-phase spiral CT was performed, the enhancement pattern was high during the arterial phase and isodense with normal pancreatic parenchyma during the venous phase. In two cases involving spiral CT, multiple hyperattenuated hepatic metastasis was observed during the arterial phase. In three cases in which conventional post-contrast CT was performed, the tumor showed low enhancement. CONCLUSION: Pancreatic acinar cell carcinoma is rare, but if a large, well encapsulated, strongly enhanced pancreatic mass showing central necrosis is observed during the arterial phase of dual-phase spiral CT, and metastatic nodules are also present, pancreatic acinar cell carcinoma should be differentiated from other pancreatic neoplasms.