Letter: Correcting Shape and Size Using Temporary Filler after Breast Augmentation with Silicone Implants

No abstract available.

Sonographic Findings of Calcific Tendinitis around the Hip

PURPOSE: To evaluate the sonographic findings of calcific tendinitis around the hip. MATERIALS and METHODS: Ten patients (7 women and 3 men; mean age, 42 years; age range, 34-52 years) with a diagnosis of calcific tendinitis around the hip were evaluated. All the patients underwent radiography and sonography (color Doppler sonography in 6 patients). The sonographic findings were analyzed to determine the level of tendon thickening compared with the contralateral side as well as the shape and posterior acoustic shadowing of the calcification, and vascularity on color Doppler sonography. RESULTS: In all cases, sonography showed a thickening of the tendon compared with the contralateral normal tendon as well as hyperechoic calcific shadows within the thickened tendon. Intratendinous calcifications were mainly observed as a homogeneous ovoid hyperechoic shadow with or without acoustic shadowing. Color Doppler sonography showed increased vascularity within or around the thickened tendon in four of the six patients. CONCLUSION: Sonography is effective in detecting a thickening of the tendon as well as intratendinous calcification, and can be used to diagnose calcific tendinitis around the hip.

Parachordoma of the Chest Wall: Case Report

We report radiologic findings in a case of chest wall parachordoma in a 32-year-old male with right upper back pain. The plain radiograph and CT scan of the chest revealed a soft tissue mass in the right lateral chest wall with rib erosion. En-bloc surgical resection with chest wall reconstruction was performed.

Pulmonary Embolism Related with Catheter Directed Thrombolysis in Acute Deep Vein Thrombosis

PURPOSE: Catheter directed thrombolytic dissolution (CDT) of deep vein thrombus (DVT) is in widespread use, yet the complications especially pulmonary embolism (PE), associated with the procedure remains ill defined. To assess the incidence of PE we reviewed the clinical course of acute DVT patients treated by CDT. METHOD: From January 2000 to September 2003, 25 patients were treated by CDT. To define the new development of PE, patients had a technetium 99m lung scan before and just after CDT-, and clinical symptoms were recorded. All patients underwent ascending venogram and CT scan initially to define DVT extension. CDT with urokinase was done by a the same intervention radiologist. RESULT: Proximal thrombus extension level was the femoral vein in 8 patients, iliac vein in 12-, and inferior vena cava (IVC) in 5. Complete thrombolysis was achieved in 16 patients, partial lysis in 2 and no lysis in 7. PE was detected in 7 patients with initial lung scan whose thrombus proximal level was IVC 2, iliac vein 4, femoral vein 1 in each, and no changes in lung scan after CDT. In 17 patients with normal findings at intial lung scan, there were also no changes after CDT. One patient with normal lung scan showed high probable scan defects in lung scan after CDT. Because he also complained of sudden onset dyspnea with cough, we diagnosed him as newly developed, PE-related CDT. CONCLUSION: Only one (4%) case of PE was developed in our study. No prediction factor of PE such as CDT results, or thrombus proximal extent could be defined. These findings suggest that routine usage of temporary IVC filter is unnecessary during CDT.

Effect of Estrogen on Fibroblast Proliferation and Collagen Synthesis

Estrogen is a sex steroid hormone which is known to be helpful in preventing aging process in various ways. It is frequently used in hormone replacement therapy (HRT). Basically wound healing is likely to have same process on the view of cell proliferation and extracellular matrix formation. However, it is not determined yet whether estrogen up-regulates or down-regulates wound healing. This study was designed to determine the effect of estrogen on proliferation of human dermal fibroblasts and collagen synthesis in vitro which are most important in wound healing. Fibroblasts were isolated from the dermis of adults and cultivated in the presence of either one of 5 concentrations of estrogen(0, 0.01, 0.1, 1.0, 10microgram/ml). The fibroblasts were seeded at 5.0x103cell/well in Dulbecco's Modified Eagle's Medium/Ham's F-12 nutrient including 10% fetal bovine serum with either one of 5 different concentration of estrogen in 96-well plates. The cells were incubated for 3 days. For fibroblast proliferation MTT assay method was used. To measure the production of collagen, the collagen type I carboxy- terminal propeptide enzyme immunoassay was carried out. All concentrations of estrogen stimulated the proliferation of fibroblasts. The best proliferation and maximum stimulation of collagen synthesis was seen at supplementation of 1.0microgram/ml of estrogen. The collagen synthesis per cell was also maximal at concentration of 1.0microgram/ml estrogen. These results demonstrate that estrogen influences human dermal fibroblast proliferation and the estrogen concentration is critically important factor in vitro.

Endovascular Management of Iliac Vein Compression Syndrome Associated with Thrombosis

PURPOSE: We report our early experience, and the feasibility, of an endovascular technique for treating iliac vein compression syndrome, which is known to be caused by a chronic pulsating irritation of the iliac artery. METHODS: Five patients presented with acute deep vein thromboses in their left legs, diagnosed by computed tomography (CT), and treated with a catheter-directed thrombolysis. The residual stenosis was treated by angioplasty, followed by stent placement. The results were evaluated, followed with duplex ultrasound. RESULTS: The CT scan of the left iliac vein was compressed by the right iliac artery, with the thrombosis shown distal of the venous segment of the crossover point in all five cases. Success with the endovascular technique was achieved in all 5 patients. In the follow up, the duplex scan stent site and patency were examined. During the follow up period all the stents were patent, and no thrombosis recurred. CONCLUSION: A CT scan is helpful in diagnosing iliac vein compression syndrome, with a thrombosis. The endovascular approach for its treatment should be considered affirmative due to its safety and simplicity.

Adverse Effect of Absolute Alcohol Embolization in a Patient with Pelvic Arteriovenous Malformation: A case report / 대한마취과학회지

Generally, absolute alcohol embolization has been commonly used for treatment of arteriovenous malformation (AVM) because complete surgical extirpation of AVM can be an extremely hazardous and difficult. Even if absolute alcohol is safe embolic agent, it can result in pain, pulmonary hypertension, pulmonary embolism and post-embolization syndrome such as nausea, vomiting, hemolysis and myoglobinuria. So, general anesthesia is needed for alcohol embolization. In this case, anesthesia was induced with intravenous (IV) propofol 110 mg and succinylcholine 60 mg and maintained with propofol and vecuronium. The pulmonary artery pressure was monitored with a Swan-Ganz catheter. After alcohol injectons, systolic pulmonary artery pressure was increased, ranging 35-40 mmHg. And cola-colored urine was noticed. For treatment of pulmonary hypertension, nitroglycerine was given IV. The IV fluid rate was increased and furocemide was given IV to increase the urine output. After general anesthesia, the patient was awake but appeared to be alcohol-intoxicated. Blood alcohol level was 42 mg/dl. Urinalysis showed large amounts of myoglobin, hemoglobin and albumin. So, anesthesiologists have to keep in mind of such complications when absolute alcohol embolization is done.

Adrenal Collision Tumor Consisted of Adrenocortical Carcinoma and Myelolipoma: A Case Report

The identification of fat density by unenhanced CT within an adrenal mass is highly suggestive of myelolipoma. Adrenal collision tumors which involve a myelolipoma are uncommon, though the involvement of adenomas and pheochromocytomas has been reported. We describe a case in which an adrenal collision tumor consisting of an adrenocortical carcinoma and myelolipoma, presented as a large fat-containing adrenal soft tissue mass.

MR Imaging of Slow-flow Using a Flow Phantom

Purpose : To find sensitivity of MRI imaging methods to slow flow phantom study was performed with conventional Spin-Echo, gradient echo based Phase Contrast, fast GLASS, and heavily T2-weighted Fast Spin Echo pulse sequences. MATERIALS AND METHODS: A siphon driven flow phantom was constructed with a ventriculo-peritoneal shunt catheter and a GE phantom to achieve continuous variable flow. Four different pulse sequences including Spin-Echo, Phase Contrast, GRASS and Heavily T2-weighted Fast Spin Echo were evaluated to depict slow flow in the range from 0.08 ml/min to 1.7 ml/min and to compare signal intensities between static fluid and flowing fluid. RESULTS: In the slow flow above 0.17 ml/min conventional Spin-Echo showed superior apparent contrast between static and flowing fluid while GRASS was more sensitive to the very slow flow below 0.17 ml/min. It was not accurate to calculate flow and velocity below 0.1 ml/min with a modified PC imaging. CONCLUSION: Four different MR pulse sequences demonstrated different sensitivity to the range of slow flow from 0.08 ml/min to 1.7 ml/min. This finding may be clinically useful to measure CSF shunt flow or detecting CSF collection and thrombosis.

MR Imaging Findings of Intraosseous Lipoma

PURPOSE: To evaluate the MR imaging findings of intraosseous lipoma. MATERIALS AND METHODS: The MR imaging findings of 12 cases of intraosseous lipoma were retrospectively analyzed with regard to internal signal intensity, enhancement patterns, the presence of calcification and the status of the margin. The findings relating to these last two features were compared with those of plain films and CT. RESULTS: Six tumors were located in the calcaneus, three in the tibia, two in the ilium, and one in the carpal lunate. A fat component was clearly identified in all cases, but no lesion was purely fatty. Cyst formation was noted in four cases, and hyperintense portions different from the cystic area were seen on T2WI in ten. Contrast enhancement was observed in four patients, and although plain film and CT images revealed, in all cases, the presence of calcification, in two cases this was not demonstrated by MRI. In all cases, however, MRI showed well-defined tumoral margins. CONCLUSION: MRI clearly depicts fat and other components related to the involutional changes occurring in cases of intraosseous lipoma. The information these images provide is useful for the diagnosis and histologic classification of intraosseous lipoma.

Percutaneous Transluminal Angioplasty of Subclavian Artery Stenosis

PURPOSE: Proximal subclavian artery stenosis is relatively uncommon and usually asymptomatic. It is well known that the retrograde flow through ipsilateral vertebral artery is not related with onset of clinical symptom and not a definite indication of treatment. METHOD: We reviewed six patients including four patients who underwent percutaneous transluminal angioplasty to correct the difference of blood pressure between arms. RESULT: Nobody shows marked clinical improvement even though there was definite technical success. CONCLLUSION: It is considered that angioplasty could be done for the treatment in most of subclavian artery stenosis.

Distal Femoral Cortical Irregularity in Adult: MR Imaging and Pathologic Correlation

PURPOSE: To correlate the pathologic and MR findings of distal femoral cortical irregularity(DFCI) in adult. MATERIALS AND METHODS: We retrospectively reviewed knee MR images of 120 adult patients(25-62 years old) without infection, tumor, or fracture. Five femoral specimens of adult cadaver were used to correlate pathologic and MR findings. A double cortical line' on MR images was interpreted as DFCI, and MR findings were analyzed to determine the thickness, internal signal intensity, location of the DFCI, shape of the external cortex, and clarity of the inner cortex. The outer cortex was classified as either convex or flat, and the inner cortex was classified according to its thickness and continuity as one of three types. RESULTS: One hundred and sixteen patients(97%) had DFCI, which in all cases was observed at the attachment site of the medial head of the gastrocnemius muscle. Mean thickness was 3.7mm and DFCI was thicker in men than in women(p<0.05). The outer cortex was convex in 75 cases(65 %) and flat in 41(35 %). The inner cortex was thick and continuous in 47cases(41 %, mean age 31), thin and continuous in 54(47 %, mean age 38), and thin and discontinuous in 19(16 %, mean age 47). Clarity tended to diminish with age. The internal area of DFCI showed signal intensity equal to that of adjacent bone marrow and was pathologically proven to be normal marrow tissue. CONCLUSION: DFCI was observed in most adults and was considered to be a normal variation. Its MR and pathologic findings were different to those observed during periods of growth.

A Case of Bleeding Vascular Malformation of the Jejunum

Vascular malformations are known by several names, such as angiodysplasia, vascular ectasia, arteriovenous malformation, and telangictasia. Arteriovenous malformations may occur anywhere in the gastrointestinal tract. The large intestine is the most commonly involved location, usually on the right side. Arteriovenous malformations, which consist of enlarged, tortuous and dilated, often thin-walled blood vessels, usually occur in the submucosa or mucosa. Occasionally, they can cause recurrent and even massive hemorrhage. The authors treated a case of angiodysplasia in the upper jejunum, which caused massive bleeding. A 67-year-old female patient was admitted because of massive lower gastrointestinal bleeding. The bleeding point was found by angiography, injection of methylene-blue dye, and intraoperative endoscopy. The bleeding lesion in jejunal segment was resected, and end-to-end anastomosis was performed. The postoperative course was uneventful, and the patient was discharged on the 10th postoperative day.

Single-voxel Proton MR Spectroscopy of the Basal Ganglia in Patients with Neurofibromatosis Type 1

PURPOSE: To demonstrate the proton MR spectroscopic characteristics of non-neoplastic focal basal ganglialesions with high signal intensity on long TR MR images in patients with neurofibromatosis type 1(NF-1), and tocompare them with those of normal-appearing basal ganglia in patients without focal lesions. MATERIALS AND METHODS: Single-voxel proton MR spectroscopy was performed in six patients with NF-1 from two families(three with andthree without non-neoplastic focal brain lesions). All six individual spectra were obtained from basal gangliawith voxel sizes of about 1 x 1 x 1 cm, three from focal pallidal lesions in patients with focal lesions and threefrom normal-appearing basal ganglia in patients without focal lesions. Spectra were acquired using a 1.5T clinicalMR imager and stimulated echo acquisition mode sequence, with the following parameters: 30 ms of echo time, 13.7ms of mixing time, and 2560 ms of repetition time. Zero and first-order phase correction was performed. RESULTS:N-acetyl aspartate(NAA)/creatine(Cr) ratios were similar between focal basal ganglia lesions and normal-appearingbasal ganglia, though the former showed slightly lower choline(Cho)/Cr ratios and slightly higher NAA/Cho ratiosthan the latter. Relatively enhanced resonances around 3.75 ppm, assigned as glutamate/glutamine, were observed inthe spectra of three focal lesions. Lipid resonances around slightly different positions were observed in all sixpatients, regardless of the presence or absence of focal lesions. CONCLUSION: Slightly decreased Cho levels andrelatively enhanced glutamate/glutamine resonances are thought to characterize the focal basal ganglia lesions ofNF-1. Different mobile lipids appear to be present in the basal ganglia of NF-1 patients, regardless of thepresence of focal lesions.

Utility of Diffusion-weighted MR Imaging in Acute Stage of Small Cerebral Infarction

PURPOSE: To demonstrate the usefulness of diffusion-weighted MR imaging(DWI) in patients with small acuteinfarction by comparing it with fast spin-echo T2-weighted MR imaging(FSE T2WI). MATERIAL AND METHOD: Weretrospectively analyzed the results of FSE T2WI in 26 consecutive patients who on DWI showed small discretehyperintensities of less than 1.5cm and whose final clinical diagnosis, within one week of clinical attack, wasacute inforction. Lacunar infarcts accounted for 24 cases and 2 small cortical infarcts for two. The onset ofsymptoms occurred within 12 hours (hyperacute stage) in two patients, within 24 hours in seven, within 3 days innine, and within one week in eight. Infarcts as seen on FSE T2WI were categorized as follows : (-) for cases ofimpossible localization with non-visualization ; (+/-) for cases of equivocal localization with faint visualizationand/or poor differentiation from combined chronic infarcts and chronic ischemic changes, or from subarachnoid CSFin cases of cortical infarction ; and (+) for cases of adequate localization with clear visualization andmoderately good differentiation from the associated brain changes, or from subarachnoid CSF in cases of corticalinfarction. These infarcts were analyzed according to the time of onset of symptoms. RESULT: For the localizationof small acute infarctions, DWI was markedly superior to the category(-), moderately superior to the category(+/-).With regard to the onset of symptoms, DWI was markedly or moderately superior to FSE T2WI in 2/2 (100%) ofhyperacute stage diagnosed within 12 hour of clinical attack, in 4/7(57%) diagnosed within 24 hours, in 5/9 (56%)diagnosed within 3 days, and in 1/8 (13%) diagnosed within 1 week(p<0.05). In 12/26 cases(46%), small acuteinfarcts were localized by DWI better than by FSE T2WI. CONCLUSION: Because the signal was unchanged or itsintensity was poor, small infarcts at the acute stage were frequently difficult to localize by FSE T2WI. Inaddition, differentiation of these from combined chronic infarcts and chronic ischemic change was poor. DWI canlocalize small acute infarcts even when the results of FSE T2WI are negative or inconclusive.

A case of acute disseminated encephalomyelitis

Acute disseminated encephalomyelitis(ADEM) is an uncommon acute inflammatory disease of the CNS which follows viral infections or Vaccination. ADEM is thought to be an immune mediated disease. The classic featues of ADEM include an antecedent event, commonly a viral illness, followed after a latent period by acute onset of multifocal or diffuse CNS signs, the potential for extensive or even complete recovery, and pathologic evidence of perivascular inflammation and demyelination. We experienced a 43-year-old patient with ADEM and reviewed literatures.

The Effects of Steroid on Acute Lung Injury in the Mouse Induced by Whole Lung Irradiation / 대한치료방사선과학회지

PURPOSE: To investigate ultrastructural changes of the mouse lung induced by whole lung gamma irradiation and to evaluate the effect of prophylactic administration of steroid against acute lung injury. MATERIALS AND METHODS: One hundred and twenty ICR mice were used and whole lung was irradiated with telecobalt machine. Whole lung doses were 8 and 12Gy, and 10mg of methyl prednisolone was administrated intraperitoneally for two and four weeks. At the end of the observation period, mice were sacrificed by cervical dislocation. The lungs were removed and fixed inflated. Histopathological examination of acute radiation injuries were performed by light microscopic and transmission electron microscopic examination. RESULTS: Control group with 8Gy is characterized by damage to the type I pneumocyte and the endothelial cell of the capillary, edema of alveolar wall and interstitium, and fibroblast proliferation. Control group with 12Gy is characterized by more severe degree of type I pneumocyte damage and more prominant inflammatory cell infiltration. Destructed cell debris within the alveolar space were also noted. After steroid administration, 8Gy experimental group showed decreased degree of inflammatory reactions but fibroblast proliferation and basal lamina damages were unchanged. Experimental group with 12Gy showed lesser degree of inflammatory reactions similar to changes of 8Gy experimental group. CONCLUSION: These studies suggest that the degree of interstitial edema and inflammatory changes were related to radiation dose but proliferation of the fibroblast and structural changes of basal lamina were not related to radiat- ion dose. Experimental administration of steroid for 2 to 4 weeks after whole lung irradiation suggest that steroid can suppress alveolar and endot- helial damages induced by whole lung irradiation but proliferation of the fibroblast and structural changes of basal lamina were not related to administration of steroid.

Redundant Nerve Roots of the Cauda Equina: MR Findings

PURPOSE: To evaluate MR findings of redundant nerve roots (RNR) of the cauda equina. MATERIALS AND METHODS: 17 patients with RNR were studied; eight were men and nine were women, and their ages ranged from 46 to 82 (mean63) years. Diagnoses were established on the basis of T2-weighted sagittal and coronal MRI, which showed a tortuous or coiled configuration of the nerve roots of the cauda equina. MR findings were reviewed for location, magnitude, and signal intensity of redundant nerve roots, and the relationship between magnitude of redundancy and severity of lumbar spinal canal stenosis (LSCS) was evaluated. RESULTS: In all 17 patients, MR showed moderate or severe LSCS caused by herniation or bulging of an intervertebral disc, osteophyte from the vertebral body or facet joint, thickening of the ligamentum flavum, degenerative spondylolisthesis, or a combination of these. T2-weighted sagittal and coronal MR images well clearly showed the location of RNR of the cauda equina; in 16 patients (94%), these were seen above the level of constriction of the spinal canal, and in one case, they were observed below the level of constriction. T2-weighted axial images showed the thecal sac filled with numerous nerve roots. The magnitude of RNR was mild in six cases (35%), moderate in five cases (30%), and severe in six cases (35%). Compared with normal nerve roots, the RNR signal on T2-weighted images was iso-intense. All patients with severe redundancy showed severe LSCS, but not all cases with severe LSCS showed severe redundancy. CONCLUSION: Redundant nerve roots of cauda equina were seen in relatively older patients with moderate or severe LSCS and T2-weighted MR images were accurate in identifying redundancy of nerve roots and evaluating their magnitude and location.

RECONSTRUCTION OF DISTAL LEG AND FOOT USING DISTALLY BASED ADIPOFASCIAL TURN-OVER FLAP

Reconstruction of soft tissue dejects on the lower leg and foot remains a difficult challenge for surgeons. If the deject was large and complicated by bone defects, an excellent result could be obtained with free tissue transfer. In case of no bony problem, no major infection and relatively small defect, a local flap is more Convenient and economic than free tissue transfer because of its simple, one-stage and reliable operation. The vascularization of the subcutaneous tissue reveals the predominance of the vascular network in this layer with regard to the dermal or fascial plane. The dermal vascular network at the donor site is sufficient to let the skin survive without its underlying subcutaneous vascular support. Distally based adipofascial flaps, nourished by the lower perforator originating from the major vessel as link pattern were. used successfully for reconstruction of the bone and/or tendon exposure of the lower leg and foot in 10 patients. Between February 1992 and December 1995, ten cases underwent this procedure to reconstruct soft tissue defect on the lower leg and foot. The average age of the patients was 50.6 years (range 5 - 73years). Follow-up was from 10 months to 38 months (mean 21 months). The average time of the operation was about 2 hours 18 minutes. The length to width ratio of adipofascial flap was 2.4 - 5.0 : 1 (mean 3.4 : 1). The advantages of this method are easy dissection, short operation, preservation of the major vascular pericles of the lower limb, skin preservation at the donor site, thus preserve the shape of the limb and minimize donor site scar, and versatility (it is supple and can adapt to every surface, and it can be grafted on the deep or the superficial side). In conclusion, this technique is an useful and alternative method for reconstruction of soft tissue defects on the lower leg and foot in selected cases.

Imaging of the Jaw Cysts with a Dental CT Software Program: Distinction of Odontogenic Keratocysts from Other Cysts

PURPOSE: To evaluate the usefulness of a dental CT software program in the assessment of jaw cysts and in the differentiation of odontogenic keratocysts and other cysts. MATERIALS AND METHODS: Seventeen patients with proven jaw cysts (8 maxillae & 9 mandibles) were evaluated with a dental CT software program for location, locularity, the presence or absence of marginal scalloping, and height to length ratio. For the delineation of involvement or displacement of neurovascular bundles, cortical erosion, perforation or expansion, and tooth root resorption by the jaw cysts, images from this program were compared to conventional images. RESULTS: Seventeen lesions icomprised 15 odontogenic cysts (five odontogenic keratocysts, five radicular, three residual and two dentigerous cysts) and two non-odontogenic cysts (one nasopalatine duct cyst and one postoperative maxillary cyst). Images of jaw cysts obtained with the dental CT software program delineated much more clearly than conventional images the status of neurovascular bundle and cortical bone, but there was no clear difference between the two modalities in delineating tooth root erosion. Dental CT findings of five mandibular odontogenic keratocysts were scalloped margin in all, mandibular ramus involvement in four, height to length ratio below 60% in four, and multilocularity in two. The findings of the other 12 cysts (eight maxillae and four mandibles) were unilocularity in all, smooth inner margin in ten, height to length ratio below 60% in only two, and ramus involvement in none. CONCLUSION: Adental CT software program is an improved imaging modality for assessing jaw cysts ; and findings which tend to indicate odontogenic keratocysts are marginal scalloping, mandibular ramus involvement, prominent spread along the marrow space and multilocularity.