Comparison of Peak Plantar Pressure between Bare Foot and In-shoe in Diabetic Patients

OBJECTIVE: To investigate the efficiency of custom-made diabetic shoes through the measurement of peak plantar pressure, compared between bare foot and in-shoe in diabetic patients METHOD: Seventeen diabetic patients participated in this study. It used diabetic shoes manufactured by Apex and P.W. minor & son. The foot was divided into 6 different areas, and peak plantar pressures of bare foot and in-shoe were measured during walking by EMED system and PEDAR , respectively. RESULTS: There were significant decreases in peak plantar pressures of all plantar areas in all types of diabetic shoes. Especially, peak plantar pressures of diabetic shoes manufactured by P.W. minor & son in medial metatarsal and big toe areas were more decreased than by Apex. CONCLUSION: The custom-made diabetic shoes can effectively reduce plantar pressures in all palntar areas of the foot, and also can prevent the development or recurrence of foot ulcers at specific areas according to the variable physical constitution of diabetic shoes.

Usefulness of Intra-arterial Embolization Method Using Gelfoam Particles in Effective Gene Transduction of Adenoviral Vector for Liver-directed Gene Therapy: an Preliminary Animal Study in Dogs

PURPOSE: Liver-directed gene therapy is being actively pursued and developed as a method of treating various liver diseases. A number of aspects, including gene intervention, an efficient gene delivery system, and stable transgene expression are key to the success of the chosen strategy, and to overcome problems in these areas, several tactics can be used. In this study, we assess the utility of transarterial embolization using gelfoam particles soaked in an adenovirus vector as a gene-delivery method. MATERIALS AND METHODS: Using the angiographic approach, three dogs each weighing 9.5-11 kg were superselectively catheterized at the left hepatic artery using a 3-F microcatheter and the coaxial method. Two of the dogs were embolized at the left hepatic artery using 3x2x2-mm and 2x1x1-mm gelfoam particles soaked in 2x1011 particles/kg of recombinant adv.CMV.LacZ (LacZ-adv). The left hepatic artery of the remaining animal, used as a control, was infused with the same dose of lacZ-adv in the same way as before but without embolization of the left hepatic artery. Three days after embolization or the infusion of LacZ-adv, the dogs were sacrificed prior to harvest of the entire liver for the evaluation of gene transduction. RESULTS: X-gal staining of the liver tissue obtained was positive for hepatocytes, but the pattern and degree of gene transduction differed according to gelfoam particle size. Where this was 3x2x2 mm, gene transduction along the liver hilum varied, but where 2x1x1-mm particles were used, transduction was more even. No pathologic hepatic tissue injury or inflammation was apparent, and control liver tissue was not stained by Xgal. Serum SGOT and SGPT levels were slightly higher one day after the procedure, but had normalized by day 3. CONCLUSION: Intrahepatic transarterial embolization using gelfoam particles soaked in LacZ-adv appears to be a good method for effective liver-targed gene therapy.

Comparison of High-resolution CT Findings between Miliary Metastases and Miliary Tuberculosis

PURPOSE: To compare the findings of high-resolution computed tomography (HRCT) between patients with miliary metastases and miliary tuberculosis. MATERIALS AND METHODS: Between May 1998 and April 2002, 11 patients with miliary metastases and 18 with miliary tuberculosis underwent HRCT, and we reviewed the findings. In miliary metastases, the primary lesions were adenocarcinoma of the lung (n=2), stomach (n=1), or pancreas (n=1), or of unknown origin (n=5), and papillary carcinoma of the thyroid (n=2). Two radiologists blinded to the clinical and pathologic data reached a consensus regarding nodule size and margin, their distribution and coalescence, interstitial involvement, and other ancillary HRCT findings. Data were analyzed using the chi-square test. RESULTS: CT scans showed numerous 1 to 5-mm nodules randomly distributed throughout both lungs of all patients. Nodules larger than 1.5 mm in diameter were more often seen in miliary metastases (81.9%). In six (54.5%) patients with miliary metastases and in three (16.7%) with miliary tuberculosis, nodule size varied (p<0.05). Pleural effusion occurred in three (27.3%) patients with miliary metastases and three (16.7%) with miliary tuberculosis. Interlobular septal thickening (100%) and peribronchovascular thickening (63.6%) were more common in miliary metastases than in miliary tuberculosis (p<0.01). Lymph node enlargement was seen in 11 (100%) patients with miliary metastases and five (27.8%) with miliary tuberculosis (p<0.001). CONCLUSION: At HRCT, lymph node enlargement and both interlobular and peribronchovascular thickening are more commonly observed in miliary metastases than in miliary tuberculosis.

Primary Liposarcoma of the Mediastinum: Computed Tomographic (CT) Findings

PURPOSE: To describe the CT findings of primary liposarcoma of the mediastinum, and to correlate these with the pathologic findings. MATERIALS AND METHODS: We retrospectively reviewed the medical records, chest radiographs and CT scans of four male patients with histopathologically proven primary liposarcoma of the mediastinum treated between September 1996 and April 2002. The CT scans were analyzed by two radiologists, and final decisions were reached by consensus. They were analysed in terms of tumor size and location, enhancement pattern, the pattern of the fat component, calcification, mass effect, pleural effusion, lymph node enlargement, pericardial effusion, tumor extension to the costophrenic junction, and adjacent organ invasion. RESULTS: All patients presented with dyspnea and chest pain. Pathologic subtypes, which were well-differentiated and pleomorphic, were myxoid (n=2) and mixed (n=2). The transverse diameter of the mass ranged from 10.5 to 21 cm. All tumors were located in the anterior mediastinum, and all had lobulated margins. Soft-tissue attenuation predominance (n=2) occurred in the myxoid type, and roughly equal amounts of fat and soft-tissue attenuation (n=2) were present in the mixed type. A small area at calcification was seen in the mixed type (n=1). Mass effect on mediastinal structures was demonstrated in all patients. In three patients, the tumor draped around and conformed to the shape of the costophrenic junction. Chest wall invasion occurred in one patient. CONCLUSION: Findings of an anterior mediastinal location, fat attenuation, mass effect, the invasion of adjacent organs, and a lobulated margin strongly suggested mediastinal liposarcoma. CT attenuation of the lesions correlated closely with the degree of histologic differentiation.

Pulmonary Embolism Caused by Acrylic Cement: Report of Two Cases Developed as a Complication of Percutaneous Vertebroplasty

Percutaneous vertebroplasty is an effective, minimally invasive procedure for the treatment of vertebral compression fractures, and is a technique for treating lower back pain that appears to be increasingly popular throughout the world. We experienced two cases involving a rare complication of percutaneous vertebroplasty, namely pulmonary embolism caused by acrylic cement. One patient showed no subjective symptoms after vertebroplasty, while the other experienced chest pain. In the former, fluoroscopy demonstrated perivertebral venous leakage during vertebroplasty, and at chest radiography, tubular or branching high-density linear structures were observed. In addition, intravascular emboli were identified at CT. In the second patient, symptomatic therapy led to reduced chest pain.

Hemoptysis and Hemoperitoneum due to Metastatic Gestational Choriocarcinma: Bronchial Artery Embolization and Superselective Splenic Artery Embolization: A Case Report

Gestational choriocarcinoma is easily disseminated hematogenously and its hypervascular nature places the patient at risk of significant hemorrhage both at the sites of metastatic lesions and in the uterus. In addition, its tends to give rise to pseudoaneurysm formation. Treatment of the condition by percutaneous embolization has been reported in several published articles, and hemoperitoneum secondary to rupture of splenic metastasis of gestational choriocarcinoma has also been reported, as has angiographic embolization. Hemoptysis resulting from pulmonary metastasis and treatment by means of embolization of the bronchial artery have not been reported, however. In this article, we describe a case of hemoptysis and hemoperitoneum due to pulmonary and splenic metastasis of gestational choriocarcinoma. Treatment of the condition involved embolization of the bronchial artery and superselective embolization of the splenic artery.

Angiomyolipoma of the Perinephric Space: Case Report

Angiomyolipomas commonly originate from renal parenchyma but extremely rarely from perinephric space. We report a case of angiomyolipoma of the perinephric space confirmed by radical nephrectomy. A 13-year-old boy presented with left flank pain and abdominal distension, first experienced five months earlier. Ultrasonography and CT indicated that in the space surrounding the left kidney, a huge fat-containing mass with linear strands was present.

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.

Neuro-Behcet's Disease: Initial and Follow-up MR Imaging Findings

PURPOSE: The purpose of this study was to evaluate initial and follow-up MR imaging(MRI) findings ofneuro-Behcet's disease. MATERIALS AND METHODS: MRI of seven clinically diagnosed cases of neuro-Behcet's diseasewere retrospectively analysed in terms of involved site, pattern, signal intensity, contrast enhancement patternand changes seen on follow-up. Using a 0.35T or 1.0T unit T2- and T1-weighted spin-echo contrast-enhanced imageswere obtained in six patients. Follow-up MRI after steroid therapy lastion between two weeks and 16 months wasperformed in six patients. RESULTS: Lesions involved the midbrain(6/7), pons(5/7), thalamus(4/7), medullaoblongata(3/7), tegmentum(3/7), internal capsule(3/7), middle cerebellar peduncle(2/7), dentate nucleus(1/7),basal ganglia(1/7) and temporal lobe(1/7). They were 1-3cm in size, and their shape was ill-defined and patchy.Inhomogeneous high and low signal-intensity was seen on T2-weighted and T1-weighted images, respectively. In twoof six cases there was focal mild patchy enhancement. Euring follow-up lasting for between two weeks and 16 monthsafter steroid therapy, the lesions decreased in extent(n=5) or disappeared(n=1), and in the brainstem, focal brainatrophy occurred in three cases. CONCLUSION: Although MRI findings of neuro-Behcet's disease are nonspecific,common involvement of the brainstem, tegmentum and internal capsule, as well as improvement on follow-up MRI, maybe helpful diagnostic indicators of this condition.

Treatment of Single Nodular Hepatocellular Carcinoma Using Combination Methods of Percutaneous Ethanol Injection Therapy and Subsequent Transcatheter Arterial Chemoembolization

PURPOSE: To evaluate the usefulness of combination therapy composed of percutaneous ethanol injection treatment and subsequent transarterial chemoembolization in the treatment of single nodular hepatocellular carcinoma(HCC). MATERIALS AND METHODS: A total of eight patients with single nodule hepatocellur carcinoma (+/-5cm)were treated with a combination of initial percutaneous ethonol injection therapy(PEIT) and, a week later, transcatether arterial embolization(TAE). CT was performed 3 weeks after TAE to assess whether or not lipidol uptake had occurred. If lipiodol was accumulated in the nodule, the necrotic rate of the tumor was calculated by the following equation: (initially observed tumor volume - volume of nodule in which lipidol uptake occurred)x100/Initially observed tumor volume. Follow-up CT scan was performed every third or fourth month to evaluate tumor growth or recurrence. RESULTS: A nodule in which lipidol uptake occurred was seen in four of the eight patients; in one of these, a tumor-confirmed by angiogaphic examination and laboratory data-recurred twelve months later. The mean necrotic rate of a tumor treated PEIT alone was 83%(range, 37%-100%). CONCLUSION: Although limited in numbers of cases we studied, use of combination therapy composed of PEIT and subsequent TAE, appears to be effective in achieving the high rate of tumor necrosis as well as in the evaluation of the tumor during follow-up.