A Case of Autoimmune Pancreatitis Combined with Extensive Involvement of Biliary Tract / 대한소화기학회지

Autoimmune pancreatitis is a distinct disease characterized by the presence of autoantibodies and hypergammaglobulinemia, inflammation of the pancreatic parenchyma, and irregular stricture of the pancreatic duct. The involvement of distal common bile duct is frequently observed, but intrahepatic bile duct involvement is very rare, which seem to have similar feature to primary sclerosing cholangitis. We report a case of the patient with autoimmune pancreatitis combined with extensive involvement of extrahepatic and intrahepatic bile duct, which had a favorable response to steroid therapy.

A Case of Primary Sigmoid Colon Mucosa-associated Lymphoid Tissue Lymphoma / 대한소화기학회지

The gastrointestinal (GI) tract is the most frequently involved site of mucosa-associated lymphoid tissue (MALT) lymphoma. Stomach is the most common site of involvement among the GI tract. However, MALT lymphoma of the large intestine is rare. A diagnosis is established by pathological examination of the surgical or endoscopic specimens. A 72-year-old man with low abdominal pain was diagnosed as a sigmoid MALT lymphoma, which was noted as an obstructing mass in a colonoscopic examination. A left hemicolectomy was performed, and the patient has had no recurrence postoperatively without any chemotherapy.

The Significance of Changes in Serum Prostate Specific Antigen Levels after a Transurethral Resection of the Prostate / 대한비뇨기과학회지

PURPOSE: The serum prostate specific antigen (PSA) level is known to be related with the total prostate and cancer volumes. After a transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH), a decrease in the serum PSA level is expected. We investigated the relationship between the resected prostate specimen weight and serum PSA level. MATERIALS AND METHODS: Between July 1998 and March 2003, 372 patients underwent a TURP for the treatment BPH. We performed studies, including digital rectal examination, urinary flow rate, international prostate symptom score, serum PSA levels, and transrectal ultrasound (TRUS) pre-and post-operatively. We compared the resected specimen weight of the prostate with the changes in the serum PSA level using correlation and regression tests as statistical methods. RESULTS: Removal of 1gm of BPH tissue decreased the serum PSA the average level by 0.45 0.25ng/ml. In patients with BPH, there was a strong statistical correlation and a direct proportionality between the resected specimen weight and changes in the serum PSA level (p<0.05). Using the above mentioned statistical methods, the formula y=2.389+0.158x (x= resected specimen weight, y=changes in serum PSA levels) was derived. However, there was no statistical correlation between the two factors in prostate cancer patients. CONCLUSIONS: An elevated serum PSA level in patients with BPH is mainly caused by the enlargement of the prostate transition zone. A statistically significant difference was noted between the pre-and post-operative serum PSA levels. However, in patients with prostate cancer, the serum PSA levels showed various postoperative changes. Some patients that underwent a TURP for BPH showed no match on the previously-mentioned formula, and these patients should be carefully followed up, with serum PSA level check-ups and/or a prostate biopsy considered.

Etiology and clinical course of secondary membranous nephropathy / 대한내과학회지

BACKGROUND: Membranous nephropathy (MN) is the most common cause of adult nephrotic syndrome worldwide. Although MN is commonly idiopathic, there are some secondary causes. In this article we describe the clinical courses of the patients with MN presumedly due to secondary causes. METHODS: Fifty-one patients with MN were retrospectively evaluated for possible etiologic factors as well as evaluated for their clinical courses after renal biopsy between March 1990 and December 2003 in the Dong-a University College of Medicine. RESULTS: There were 19 men and 32 women (M:F=1:1.6). The majority of the causes of secondary MN were SLE (31 cases, 60.8%) and hepatitis B (12 cases, 23.5%). The others included malignancy, hepatitis C, syphilis and MCTD. Twenty-nine of 31 cases with SLE which were treated with prednisolone and cyclophosphamide and 25 cases (86.4%) showed complete remission (CR) or partial remission (PR). Three of 12 cases associated with hepatitis B (HB) were treated with prednisolone over 6 months and showed CR or PR. Three of other 12 cases associated with HB which showed positivity to HBsAg and HBeAg were treated with interferon-alpha and represented complete seroconversion of HBeAg, but rapidly progressed to chronic renal failure. CONCLUSION: In our study, the most common causes of secondary MN are SLE, HB. HBeAg may be the important predictor in the prognosis of HBV-associated MN. The effect of interferon-alpha therapy in treating secondary MN is as yet inconclusive. HBV-associated MN progresses rapidly to CRF, therefore more extended study is required in Korea, an endemic area of HB.

Non-ischemic Priapism of Unknown Etiology in Child / 대한비뇨기과학회지

Priapism is defined as a prolonged erection of the penis unrelated to sexual desire or manual stimulation. Non-ischemic priapism frequently occurs as a result of penile or perineal trauma, but the unknown etiology is rare in boys. We report a case in a 6-year-old boy who was managed successfully with conservative treatment consisting of steroid tapering and perineal ice-pack compression therapy following blood gas analysis of the cavernosum and penile duplex ultrasonography. Complete detumescence was achieved after two weeks. Thus far, the patient has had no recurrence for 6 months.

A case of hepatic candidiasis: Successful treatment with fluconazole / 대한내과학회지

The frequency of invasive fungal infections has increased during the period of chemotherapy. Fungal infections are an increasing cause of morbidity and mortality in patients with hematological malignancies. The most common organism are Candida albicans. This report describes our experience in a 28-year-old woman who developed symptoms of hepatic candidiasis which were confirmed with liver biopsy after remission induction chemotherapy for acute myeloid leukemia. In our case, the patient did not improve clinically despite administration of 610 mg amphotericin B. Severe leukocytosis, increasing alkaline phosphatase and clinical deterioration developed rapidly, and then we switched to fluconazole, taking into consideration successful fluconazole treatment of patients with chronic disseminated candidiasis and acute hepatic candidiasis. She remains in clinically and radiological improving at the time of this report.

Imaging Findings of Hepatic Paragonimiasis: A Case Report

Hepatic paragonimiasis is a rare form of ectopic infestation caused by Paragonimus. We experienced a case of hepatic paragonimiasis that showed characteristic imaging findings. CT and MR images showed a cluster of small cysts with rim enhancement in the subcapsular area of the liver. This finding seems to be characteristic for hepatic paragonimiasis, considering imaging findings in paragonimiasis involving other organs.

Frequency Due to Bladder Amyloidosis in Patients with Rheumatoid Arthritis: Two Cases Reports / 대한류마티스학회지

Secondary amyloidosis is characterized by accumulation of an amorphous proteinous material in the various tissue and organs with infectious disease or inflammatory disease. Symptoms of the amyloidosis are variable according to the involved organs. Reactive amyloidosis of bladder in rheumatoid arthritis (RA) is a rare condition with hematuria in the most cases. However, we report two cases of patients with RA, who have frequency due to secondary amyloidosis of bladder without hematuria. Therefore secondary amyloidosis of urinary bladder should be considered as a possible cause of frequency in patients with long-term RA.

Pancreatic Adenocarcinoma: Dual-Phase Helical CT with Surgical and Histopathologic Correlation

PURPOSE: To determine the accuracy of dual-phase helical CT in assessing the resectability of pancreatic ductal adenocarcinoma, and to correlate the CT findings with the surgical and histopathologic findings. MATERIALS AND METHODS: Thirty patients with pathologically proven cancer of the pancreas underwent arterialand portal- phase helical CT scanning, and in two of these, single-level dynamic CT was performed during celiac and superior mesenteric arteriography. In 17 patients who underwent surgery for potentially resectable cancer of the pancreatic head, tumor resectability was assessed. The CT findings were analyzed and correlated with these of surgery and histopathology. RESULTS: In 13 (76%) of the 17 patients who underwent surgery, tumors were resectable. Their average size was 2.76 cm (arterial phase), 2.30 cm (portal phase), and 2.48 cm (pathologically determined) and the overall accuracy of helical CT for assessing resectability was 87%. In all patients, the central portion of the tumors exhibited hypoattenuation at both phases; the peripheral portion showed hypoattenuation at the arterial phase and iso- (n=10) or hyperattenuation (n=3) at the portal phase. Single-level dynamic CT depicted a persistently ypoattenuating central portion and progressive and prolonged enhancement of the periphery. CT-histopathologic correlation showed that central hypoattenuation indicated the presence of tumor cells, necrosis (n=3) and mucin (n=4), while the peripheral iso- or hyperattenuated areas seen at the portal phase represented fibrosis and inflammatory infiltration. Histopathologic examination revealed tumoral infiltration of peripancreatic fat tissue (n=11) and microvascular invasion of major peripancreatic vessels (n=7). CONCLUSION: The dual-phase helical CT is useful in the determination of resectability in pancreas cancer and CT findings represent well the histopathologic features of pancreas cancer.

Focal Hepatic Lesions: Contrast-Enhancement Patterns at Pulse-Inversion Harmonic US using a Microbubble Contrast Agent

OBJECTIVE: To analyze the contrast-enhancement patterns obtained at pulseinversion harmonic imaging (PIHI) of focal hepatic lesions, and to thus determine tumor vascularity and the acoustic emission effect. MATERIALS AND METHODS: We reviewed pulse-inversion images in 90 consecutive patients with focal hepatic lesions, namely hepatocellular carcinoma (HCC) (n=43), metastases (n=30), and hemangioma (n=17). Vascular and delayed phase images were obtained immediately and five minutes following the injection of a microbubble contrast agent. Tumoral vascularity at vascular phase imaging and the acoustic emission effect at delayed phase imaging were each classified as one of four patterns. RESULTS: Vascular phase images depicted internal vessels in 93% of HCCs, marginal vessels in 83% of metastases, and peripheral nodular enhancement in 71% of hemangiomas. Delayed phase images showed inhomogeneous enhancement in 86% of HCCs; hypoechoic, decreased enhancement in 93% of metastases; and hypoechoic and reversed echogenicity in 65% of hemangiomas. Vascular and delayed phase enhancement patterns were associated with a specificity of 91% or greater, and 92% or greater, respectively, and with positive predictive values of 71% or greater, and 85% or greater, respectively. CONCLUSION: Contrast-enhancement patterns depicting tumoral vascularity and the acoustic emission effect at PIHI can help differentiate focal hepatic lesions.

The Detectability of Hepatic Metastases in Candidates of Radiofrequency Ablation: Comparison for Helical CT Scanning and Late-Phase Pulse-Inversion Harmonic Imaging

PURPOSE: To compare dual-phase helical CT and pulse inversion harmonic US using microbubble contrast agents in the detection of hepatic metastases prior to radiofrequency (RF) ablation. MATERIALS AND METHODS: Twenty-one patients in whom hepatic metastases from colorectal cancer had been diagnosed by dual-phase CT scanning and who were considered to be candidates for RF ablation underwent pulse-inversion barmonic US examination. Images were obtained 5 minutes after the bolus injection of microbubble contrast agent SH U 508 A (4.0 g, 300 mg/mL). The number of metastatic tumors revealed by CT and US was determined, and the findings were statistically analysed. The influence of the results of US examination on treatment planning was also evaluated. RESULTS: In 21 patients, 48 metastatic lesions were detected by helical CT, and 56 lesions by US. These eight additional lesions revealed by US occurred in six patients (29%), and their diameter was 3-13 (mean, 7.2) mm. In three of these patients, RF ablation could not be performed, while in the other three, the additional lesions were ablated. CONCLUSION: Pulse-inversion harmonic US imaging using microbubble contrast agents may depict small hepatic metastatic tumors that were not apparent at CT. US-therefore appears to be useful in the planning of treatment prior to the RF ablation of hepatic metastases.

Paratesticular Rhabdomyosarcoma in an Adult / 대한비뇨기과학회지

Paratesticular rhabdomyosarcoma is a rare tumor arising from the mesenchymal tissues of the spermatic cord, epididymis, testis, and testicular tunics, and represents 7% of all rhabdomyosarcomas. This tumor occurs predominantly in children and adolescent, but rarely in adult. We report a case of a paratesticular embryonal rhabdomyosarcoma occurring in a 27-year-old man.

Assessment of Mural Invasion Depth of Gastric Carcinoma with High-Resolution Compound Sonographic Imaging in Vitro

PURPOSE: To evaluate whether the accuracy of invasion depth assessment in gastric carcinoma in vitro can be improved with high-resolution spatial compound sonographic imaging. MATERIALS AND METHODS: In sixteen fresh gastric specimens obtained from patients with preoperatively biopsyproven gastric carcinoma, normal and lesional areas were scanned using conventional and compound imaging technique with a 15-MHz linear transducer. Two radiologists independently compared the sharpness and the contrast of images obtained with two different modes and determined the layers invaded by cancer with consensus. The invasion depths by images were compared with histopathologic results. RESULTS: The sharpness and the contrast in normal and lesional areas were significantly higher in compound imaging (p0.05). CONCLUSION: High-resolution spatial compound sonographic imaging has improved image quality, compared with conventional imaging, but the accuracy of invasion depth assessment in gastric carcinoma was not significantly different.

A Comparison of the Efficacy and Safety of Tropisetron and Tropisetron Plus Dexamethasone as Antiemetics for Elective Thyroidectomy / 대한마취과학회지

BACKGROUND: Thyroidectomy is associated with a relatively high incidence of postoperative nausea and vomiting (PONV) ranging from 63% to 84%. In this study, we evaluated the safety and the antiemetic effects of tropisetron 30 microgram/kg or tropisetron 30 microgram/kg plus dexamethasone 5 mg in patients undergoing thyroidectomy under a standard anesthetic technique without narcotics. METHODS: Sixty-eight patients undergoing thyroidectomy were randomized to receive a placebo (Group C, n = 28), tropisetron 30 microgram/kg (Group T, n = 23) or tropisetron 30 microgram/kg plus dexamethasone 5 mg (Group T + D, n = 17) IV over 2 5 minutes immediately before the induction of anesthesia. The effects of these regimens on the development of PONV, adverse events and need for rescue antiemetics were analyzed for the 0 to 1 hour and 1 to 24 hours postoperative periods. RESULTS: In the 0 to 1 hour postoperative periods, the incidence of PONV in group C, T and T + D was 35.7%, 17.4% and 17.6% respectively, which showed no significant difference among the three groups (P > 0.05). In the same period, the incidence of retching or vomiting in Group C, T and T + D was 14.3%, 0% and 0% respectively, which showed a significantly lower incidence in Group T and T + D than Group C (P 0.05). During the first 24 hours postoperatively, the overall incidences of PONV was 67.9% for group C, 60.9% for group T and 58.8% for group T + D, which showed no siginificant difference among the three groups (P > 0.05). Group T + D patients had more headache compared to other groups, but there was no significant difference in theincidences of overall adverse events. CONCLUSIONS: Neither tropisetron or tropisetron plus dexamethasone was significantly different from the placebo for the prevention of PONV after thyroidectomy during the first 24 hour postoperative period. Only vomiting during the first 1 hour postoperatively was prevented in the tropisetron and combination of tropisetron plus dexamethasone groups compared to the control group.

Usefulness of High-Resolution Sonography for Assessement of Hepatocellular Carcinoma in the Transgenic Mice Expressing Hepatitis B Virus X-protein: A Preliminary Study

PURPOSE: To determine the value of high resolution ultrasonography (US) for the detection of hepatocellular carcinoma in the HBx transgenic mice. MATERIALS AND METHODS: Forty-two HBx transgenic mice aged 8-20 (mean, 14) months underwent high-resolution ultrasound using a 10 -12 MHz linear transducer. US findings indicating the presence or absence, number, size and echogenicity of each hepatic tumor were analyzed, and inaddition, color or power Doppler US was used to analyse tumoral vascularity. In each animal, sacrificed less than five hours after US examination, sonographic and pathologic findings were correlated. RESULT: On gross pathologic examination, 20 hepatocellular carcinomas measuring 1.5 -15 (mean, 4.7) mm in diameter were found in 16 mice; US revealed that 17 of the tumors were homogeneous hypoechoic nodules. With regard to tumor detection, sensitivity was 85%, specificity 96%, positive predictive value 0.944, negative predictive value 0.897, and overall accuracy 90%. Doppler US revealed that in three nodules, intratumoral vessels were present. Inthe other 26 mice, gross examination showed that no mass was present; microscopically, however, four nodules measuring 0.3 -1.2 mm were found in four of these animals. Tumoral vascularity detected by color Doppler US corresponded to the intratumoral vessel within the nodules. One peritoneal nodule, confirmed as a metastatic tumor, was found at the greater omentum. CONCLUSION: In HBx transgenic mice, high-resolution US is valuable for the detection of hepatocellular carcinoma.

CT Findings and Clinical Characteristics of Colorectal Mucinous Adenocarcinoma

PURPOSE: To establish the CT findings and clinical characteristics of colorectal mucinous adenocarcinoma. MATERIALS AND METHODS: The CT features of 26 surgically proven cases of colorectal mucinous adenocarcinoma were reviewed. The subjects were selected from among 262 patients with colorectal cancer, of whom 40 with non-mucinous adenocarcinoma were included as a control group. Contrast-enhaneed CT images were analyzed for tumor location, the presence or absence of tumoral calcification, tumor shape (circumferential or eccentric, polypoid or infiltrative), tumor thickness-to-length ratio, and attenuation and homogeneity. In each group, the TNM stage of pathologic specimens was compared. During follow-up, the incidence of recurrence, and outcome, were also compared. RESULTS: CT images of mucinous adenocarcinoma revealed intratumoral calcification in three patients (12%, p < 0.01). Tumors were eccentric and polypoid-shaped, with a high tumoral thickness/length ratio (p < 0.01). On contrast-enhanced images, most were seen as a heterogenous hypoattenvuted mass. No differences in T-NM stage were found in surgical specimens. In patients with mucinous adenocarcinoma, recurrence during the early follow-up period is more common than in patients with non-mucinous cancer. CONCLUSION: Contrast-enhanced CT reveals mucinous adenocarcinoma as an eccentric polypoid mass with heterogeneous hypoattenuation. In patients with mucinous colorectal cancer, careful follow-up is required because tumors tend to recur early in the follow-up period.

CT Findings and Clinical Characteristics of Colorectal Mucinous Adenocarcinoma

PURPOSE: To establish the CT findings and clinical characteristics of colorectal mucinous adenocarcinoma. MATERIALS AND METHODS: The CT features of 26 surgically proven cases of colorectal mucinous adenocarcinoma were reviewed. The subjects were selected from among 262 patients with colorectal cancer, of whom 40 with non-mucinous adenocarcinoma were included as a control group. Contrast-enhaneed CT images were analyzed for tumor location, the presence or absence of tumoral calcification, tumor shape (circumferential or eccentric, polypoid or infiltrative), tumor thickness-to-length ratio, and attenuation and homogeneity. In each group, the TNM stage of pathologic specimens was compared. During follow-up, the incidence of recurrence, and outcome, were also compared. RESULTS: CT images of mucinous adenocarcinoma revealed intratumoral calcification in three patients (12%, p < 0.01). Tumors were eccentric and polypoid-shaped, with a high tumoral thickness/length ratio (p < 0.01). On contrast-enhanced images, most were seen as a heterogenous hypoattenvuted mass. No differences in T-NM stage were found in surgical specimens. In patients with mucinous adenocarcinoma, recurrence during the early follow-up period is more common than in patients with non-mucinous cancer. CONCLUSION: Contrast-enhanced CT reveals mucinous adenocarcinoma as an eccentric polypoid mass with heterogeneous hypoattenuation. In patients with mucinous colorectal cancer, careful follow-up is required because tumors tend to recur early in the follow-up period.

CT Findings of Intrahepatic Cholangiocarcinoma Associated with Hepatolithiasis

PURPOSE: To assess the CT findings of intrahepatic cholangiocarcinoma associated with hepatolithiasis. MATERIALS AND METHODS: The CT features of 26 patients with cholangiocarcinoma and hepatolithiasis were reviewed and compared with those of 23 patients with intrahepatic stones alone, acting as control subjects. CT findings were analyzed for tumor appearance and adjacency to hepatolithiasis. We studied clinical findings, noting the presence or absence of wall thickening or soft tissue attenuation within the bile duct, the luminal diameter of dilated bile duct, and the presence of periductal enhancement, and compared these with the findings for control groups. RESULTS: CT images of the tumor revealed a hepatic low-attenuating mass with peripheral rim enhancement(n=14, 54 %), or periductal thickening, or low-attenuating lesions in segmental dilatation of intrahepataic bile ducts(n=12, 46%). Most hepatic tumors were seen in areas adjacent to hepatolithiasis, or in a bile duct. Compared with control groups, patients with cholangiocarcinoma were old (p0.05). CONCLUSION: When an intrahepatic low-attenuating mass, or peridutal thickening and low-attenuating lesions in segmental dilated intrahepatic duct are found associated in adjacent intrahepatic stones, intrahepatic cholangiocarcinoma should be considered.

Diagnostic Usefulness of Tc-99m Tetrofosmin Scintimammography in Patients with Primary Breast Cancer / 대한핵의학회잡지

PURPOSE: The purpose of this study was to evaluate the diagnostic usefulness of scintimammography performed with Tc-99m tetrofosmin in the detection of primary breast cancer. MATERIALS AND METHODS: Sixty-one patients underwent Tc-99m tetrofosmin scintimammography, plain-filrn mammography and ultrasonography. After intravenous injection of Tc-99m tetrofosmin (740 MBq), prone lateral and anterior scintimammograms were obtained. Scintimammogram was visually interpreted as positive, probably positive, probably negative and negative for malignancy. The tumor to background count ratio (T/B) was measured at 5 minutes and 1 hour. Plain-film mammogram was interprcted as one of 5 categories. Final diagnosis was achieved by surgical histology (58/61) or fine needle aspiration (3/61). Of 61 patients, 44 had cancer and 17 had benign lesion. Tumor size of malignant and benign lesions on ultrasonogram were 2.51+/-1.30 cm (range 1-8 cm), 2.50+/-1.35 cm (range 0.96-6 cm), respectively. RESULTS: The sensitivity of plain-film mammography was 88.6%, specificity 58.8%, positive predictive value 84.7%, and negative predictive value 66.7%. The sensitivity of Tc-99m tetrofosmin scintimammography was 90.9%; specificity, 88.2%; positive predictive value, 94.9%; negative predictive value, 78.9%. Of 25 patients with indeterminate degree of suspicion for malignancy on plain-film mammogram, 23 were correctly diagnosed by scintimamography. The T/B at 5 minutes and 1 hour were 3.78+/-2.21, 3.25+/-1.80 respectively. The T/B was decreased significantly at 1 hour (p<0.001). CONCLUSION: Tc-99rn tetrofosrnin scintimammography was useful diagnostic procedure in the detection of primary breast cancer, especially in patients with indeterminate degree of suspicion for malignancy on plain-film mammogram.

Biodistribution and Scintigraphy of Iodine-131-Iododeoxyadenosine in Rats Bearing Breast Cancer / 대한핵의학회잡지

PURPOSE: I-131 labeled (2'-deoxy-2-iodo-p-D-arabinofuranosyl) adenine (IAD) may be involved in DNA synthesis during active proliferation of tumor cells. We conducted this study to find out the biodistribution of IAD and its feasibility for scintigraphic tumor imaging. MATERIALS AND METHODS: Tosyl acetyl-adenosine was dissolved in acetonitrile, and I-131-NaI was added and heated to synthesize IAD. Female Fisher 344 rats innoculated with breast tumor cells were injected witb 0.27 MBq of IAD. Rats were sacrificed at 0.5, 1, 2, 4, 24h and the % of injected dose per gram of tissue (%ID/g) was determined. For scintigraphy, rats bearing breast cancer were administered with 1.11 MBq of IAD and imaging was perforrned after 2 and 24h. Then, rat body was fixed and rnicrotomized slice was placed on radiographic film for autoradiography, RESULTS: %ID/g of tumor wa.' 0.74 (0.5h), 0.73 (1h), 0.55 (2h), 0.38 (4h), and 0.05 (24h), respectively. At 1h after injection, %ID/g of tumor was higher than that of heart (0.34), liver (0.42), spleen (0.47), kidney (0,69), muscle (0.14), bone (0.33) and intestine (0.51). However, %1D/g of tumor was lower than blood (1.06), lung (0.77), and thyroid (177.71). At 4h, %ID/g of tumor in comparison with other tissue did not change. Tumor contrast expressed by tumor to blood ratio was 0.69 and tumor to muscle ratio was 5.11 at 1h. However, these ratios did not improve through 24h. On autoradiogram and scintigraphy at 2 and 24 hour, the tumor was well visualized. CONCLUSION: This results suggest that Ial) may have a potential for tumor scintigraphy. However, further work is needed to improve localization in tumor tissue.