Acute Pulmonary Embolism and Chronic Thromboembolic Pulmonary Hypertension: Clinical and Serial CT Pulmonary Angiographic Features

In acute pulmonary embolism (PE), circulatory failure and systemic hypotension are important clinically for predicting poor prognosis. While pulmonary artery (PA) clot loads can be an indicator of the severity of current episode of PE or treatment effectiveness, they may not be used directly as an indicator of right ventricular (RV) failure or patient death. In other words, pulmonary vascular resistance or patient prognosis may not be determined only with mechanical obstruction of PAs and their branches by intravascular clot loads on computed tomography pulmonary angiography (CTPA), but determined also with vasoactive amines, reflex PA vasoconstriction, and systemic arterial hypoxemia occurring during acute PE. Large RV diameter with RV/left ventricle (LV) ratio > 1.0 and/or the presence of occlusive clot and pulmonary infarction on initial CTPA, and clinically determined high baseline PA pressure and RV dysfunction are independent predictors of oncoming chronic thromboembolic pulmonary hypertension (CTEPH). In this pictorial review, authors aimed to demonstrate clinical and serial CTPA features in patients with acute massive and submassive PE and to disclose acute CTPA and clinical features that are related to the prediction of oncoming CTEPH.

Relationship between Metabolic Syndrome and Aging Male Symptoms in Middle-Aged Males in Korea / 가정의학회지

BACKGROUND: Metabolic syndrome is regarded as a risk factor of cardiovascular disease. We observed and compared aging males symptoms (AMS) between healthy and metabolic syndrome patients in middle-aged Korean men to evaluate clinical significance of AMS. METHODS: From May 2009 to July 2009, 171 middle-aged men (over 40 years-old) who visited a health promotion center of a university hospital in Gyeonggi Province were enrolled in study. The subjects were divided into two groups; metabolic syndrome (N = 87) vs. control (N = 84) and measured the aging male symptoms (AMS) scale. AMS were also grouped according to its severity. RESULTS: There were no significant differences except, weight, body mass index between two groups. In AMS severity, 'severe' group show higher prevalence of metabolic syndrome. And the group of metabolic syndrome gets higher AMS score than control. Among the five constitutive factors of metabolic syndrome, the prevalence of fasting blood sugar (> or = 100 mg/dL) and triglyceride (> or = 150 mg/dL) level is higher 'moderates' and 'severe' groups in AMS severity. In the subscale analysis of AMS, there are significant differences between two groups in sexual and somato-vegitative axis, but are not in psychological axis. With age-adjusted analysis, the results still show same trend. CONCLUSION: It might be necessary to approach aging males symptoms comprehensively during the management of metabolic syndrome in middle-aged men. And it could be helpful in treatment to recognize and control metabolic syndrome factors for the patients with severe aging males symptoms.

Assessment of Bone Metastasis using Nuclear Medicine Imaging in Breast Cancer: Comparison between PET/CT and Bone Scan / 핵의학분자영상

PURPOSE: Bone metastasis in breast cancer patients are usually assessed by conventional Tc-99m methylene diphosphonate whole-body bone scan, which has a high sensitivity but a poor specificity. However, positron emission tomography with 18F-2-deoxyglucose (FDG-PET) can offer superior spatial resolution and improved specificity. FDG-PET/CT can offer more information to assess bone metastasis than PET alone, by giving a anatomical information of non-enhanced CT image. We attempted to evaluate the usefulness of FDG-PET/CT for detecting bone metastasis in breast cancer and to compare FDG-PET/CT results with bone scan findings. MATERIALS AND METHODS: The study group comprised 157 women patients (range: 28~78 years old, mean+/-SD=49.5+/-8.5) with biopsy-proven breast cancer who underwent bone scan and FDG-PET/CT within 1 week interval. The final diagnosis of bone metastasis was established by histopathological findings, radiological correlation, or clinical follow-up. Bone scan was acquired over 4 hours after administration of 740 MBq Tc-99m MDP. Bone scan image was interpreted as normal, low, intermediate or high probability for osseous metastasis. FDG PET/CT was performed after 6 hours fasting. 370 MBq F-18 FDG was administered intravenously 1 hour before imaging. PET data was obtained by 3D mode and CT data, used as transmission correction database, was acquired during shallow respiration. PET images were evaluated by visual interpretation, and quantification of FDG accumulation in bone lesion was performed by maximal SUV(SUVmax) and relative SUV(SUVrel). RESULTS: Six patients(4.4%) showed metastatic bone lesions. Four(66.6%) of 6 patients with osseous metastasis was detected by bone scan and all 6 patients(100%) were detected by PET/CT. A total of 135 bone lesions found on either FDG-PET or bone scan were consist of 108 osseous metastatic lesion and 27 benign bone lesions. Osseous metastatic lesion had higher SUVmax and SUVrel compared to benign bone lesion(4.79+/-3.32 vs 1.45+/-0.44, p=0.000, 3.08+/-2.85 vs 0.30+/-0.43, p=0.000). Among 108 osseous metastatic lesions, 76 lesions showed as abnormal uptake on bone scan, and 76 lesions also showed as increased FDG uptake on PET/CT scan. There was good agreement between FDG uptake and abnormal bone scan finding (Kendall tau-b: 0.689, p=0.000). Lesion showed increased bone tracer uptake had higher SUVmax and SUVrel compared to lesion showed no abnormal bone scan finding (6.03+/-3.12 vs 1.09+/-1.49, p=0.000, 4.76+/-3.31 vs 1.29+/-0.92, p=0.000). The order of frequency of osseous metastatic site was vertebra, pelvis, rib, skull, sternum, scapula, femur, clavicle, and humerus. Metastatic lesion on skull had highest SUVmax and metastatic lesion on rib had highest SUVrel. Osteosclerotic metastatic lesion had lowest SUVmax and SUVrel. CONCLUSION: These results suggest that FDG-PET/CT is more sensitive to detect breast cancer patients with osseous metastasis. CT scan must be reviewed cautiously skeleton with bone window, because osteosclerotic metastatic lesion did not showed abnormal FDG accumulation frequently.

Outbreak of Scabies at Geriatric Long-Term Care Facilities in Korea / 한국역학회지

OBJECTIVES: To investigate an outbreak of scabies that occurred in geriatricfacilities located in Kyounggi-province, Korea, between September 2004 and September 2005. METHODS: We carried out an epidemiologic investigation on the scabies outbreak. All workers except two were interviewed and the charts of the patients were reviewed. RESULTS: Among workers, the attack rate was 58.6% (17/29). The rate was 86.0%(37/43) in patients. Secondary cases also occurred among the family members of workers, with a secondary attack rate of 15.8%. The 95% confidence interval was 6%~31.3%. The transmission of scabies began from one index case who had scabies and moved from another facility. She was hospitalized on the 4th floor of this facilitywhere dependent patients resided. After the activities (picnic and yard sale) in May 2005, and the ward rotation of care givers between the 3rd and 4th floor in July 2005, the incidence of scabies increased. The last cases occurred in Sep. 2005. CONCLUSIONS: This outbreak investigation has importance because it is the first report of ascabies outbreak in geriatric long-term care facilities in Korea. Recently, the reports on a scabies epidemic are increasing with the augmentation of geriatric long-term care facilities. It is important to educate and inform workers and staff in long-term care facilities about scabies and other contagious skin diseases. More facilities for senility and dementia will be opened and we need to lookinto contagious diseases in long-term care facilities.

The Optimization of Galvanic Vestibular Stimulation according to Evoked Nystagmus

BACKGROUND AND OBJECTIVES:The aim of this study were to observe the nystagmus of normal general populations on galvanic vestibular stimulation, to set a new korean standard for galvanic vestibular stimulation. MATERIALS AND METHOD:We recruited 10 healthy adults and they were stimulated by 1,2,3 mA monaural monopolar, monaural bipolar, binaural monopolar, binaural bipolar galvanic vestibular stimulation through carbon-rubber electrode and Ag-AgCl electrode. We evaluated galvanic stimulating nystagmus and after galvanic stimulating nystagmus on sitting position through Frenzel goggle and video-nystagmography. RESULTS:We detect stimulating and after-stimulating nystagmus on 1,2,3 mA monaural monopolar, monaural bipolar, binaural monopolar, binaural bipolar galvanic vestibular stimulation. The nystagmus on galvanic vestibular stimulation was directed to the negative electrode side and after-galvanic stimulating nystagmus was directed to opposite side. The greater current, the more occurrence of nystagmus was found. We detect nystagmus mostly on monaural bipolar vestibular stimulation through carbon-rubber electrode. We thought most effective Galvanic vestibular stimulation was 2 mA monaural bipolar vestibular stimulation through carbon-rubber electrode in consideration of increased pain and discomfort on 3 mA monaural bipolar vestibular stimulation in spite of high occurrence of nystagmus. CONCLUSION:Galvanic vestibular stimulation evoked different nystagmus according to stimulation, stimulated site. We thought 2 mA monaural bipolar vestibular stimulation through carbon-rubber electrode was most effective, stable galvanic stimulation. Specifity and sensitivity of 2 mA monaural bipolar vestibular stimulation were 100%, 100% respectively. Galvanic vestibular stimulation is useful to evaluate vestibular function.

Assessment of Perirenal Fat Infiltration in Renal Cell Carcinoma by CT / 영남의대학술지

Forty-two preoperative CT scans with renal cell carcinoma were reviewed and compared with pathologic findings to evaluate the differential points between stage I and II. Regardless of whole body staging, perirenal fat infiltrations were seen in 9 cases and the other 33 cases showed no infiltration onto perirenal fat tissue. We retrospectively reviewed them by comparing tumor size and CT findings, following three view points, lobulating contour of tumor margin, thickening of Gerota's fascia and strands in perirenal fat tissue. The size of them was 2-15 cm, size of the stage I tumors was 2-15 cm and that of stage II was 6-15 cm. In stage I(n=33), 25 cases(76%) showed smooth margin, and the others(n=8) showed lobulating contours. Thickening of Gerota's fascia was observed in 7 cases(21%) and strands in perirenal fat tissue in 14(42%). Of these, only one positive finding was seen in 7 cases(21%), 2 findings in 6(18%), 3 findings in 3(9%) and nothing in 17cases(51%). In stage II(n=9), 3 cases(34%) showed smooth margin, and the others(n=6) showed lobulating contours. Thickening of Gerota's fascia were observed in 5 cases(55%) and strands in perirenal fat tissue in 9(100%). Of these, one finding was seen in 2 cases(22%), 2 findings in 3(33%), 3 findings in 4(44%). In conclusion, it is insufficient to evaluate the perirenal fat infiltration in renal cell carcinoma with only one positive finding of 3 view points; lobulation of tumor margin, thickening of Gerota's fascia, strands in perirenal fat tissue. But if all these findings are shown, it is helpful to determinate perirenal fat infiltration of renal cell carcinoma.

Dynamic CT Findings of Eosinophilic Hepatic Abscess and Its Clinical Course

PURPOSE: To evaluate dynamic CT features and its clinical courses of eosinophilic hepatic abscess. MATERIALS AND METHODS: Two-phase dynamic CT findings and the clinical courses of 13 pathologically proven cases of eosinophilic abscess were reviewed. All patients showed peripheral eosinophilia, and diagnoses were confirmed by ultrasound-guided biopsy(n=9) or operation(n=4). In two of the four patients who underwent segmental hepatectomy, worms of the species Fasciola hepatica were detected. Follow-up CT scans after treatment with antibiotics or praziquantel were available in seven and eight patients, respectively. RESULT: All hepatic lesions were found ina subcapsular location or in contact with Glisson's capsule around the bile duct. Arterial-dominant phase CT(n=11)demonstrated clusters of ill-defined low density masses without rim enhancement. Late-phase CT(n=13) more clearly depicted clustering lesions with enhancing rims and diminution of the low-density area. Follow-up CT scans aftertreatment with antibiotics(n=7) showed no change in the lesions in three patients and slight shrinkage of the mainmass with additional new lesions in four. On CT scans of nine patients performad after praziquantel therapy, hepatic masses were seen in all patients to be very slightly smaller after improvement of peripheral hypereosinophilia. CONCLUSION: Two-phase dynamic CT features appear to be helpful for the diagnosis ofeosinophilic hepatic abscess in patients with peripheral eosinophilia. Parasitic infestation by Fasciola hepaticafor example, is the presumed cause of such abscesses, though further studies are required.

CT findings of Desmoid tumor arising at Abdominai Wall / 영남의대학술지

Desmoid tumor is a type of fibromatosis usually arise in deep musculo-aponeurotic structures, primarily of the trunk and extremities. It is characterized by proliferation of fibroblastic tissue and does not metastasize but may be locally aggressive. Eventhough the surgical margin reveals clean, recurrence often occurs. To analyze the extent of the tumor and homodynamic characteristics exactly, we performed IV bolus CT. Desmoid tumors show peripheral rim enhancement on early phase scan and more strong, central enhancement on late phase IV bolus CT, which reflects abundant fibroblastic components of the tumor. We report two cases of pathologically confirmed desmoid tumor performed IV bolus CT.