A Rare Case of Spinal Epidural Abscess Following Urinary Tract Infection Caused by Escherichia coli in a Patient with Pre-existing Stress Fractures of the Lumbar Spine / 가정의학회지

Spinal epidural abscess (SEA) caused by Escherichia coli is an uncommon condition. It usually occurs secondary to urinary tract infection (UTI), following hematogenous propagation. Disruption of spinal anatomic barriers increases susceptibility to SEA. Although rarely, such disruption can take the form of lumbar spine stress fractures, which can result from even innocuous activity. Here, we describe a case of SEA secondary to UTI in a patient with pre-existing stress fractures of the lumbar spine, following use of an automated massage chair. Successful treatment of SEA consisted of surgical debridement and a six-month course of antibiotic therapy.

Current Concepts in Cardiac CT Angiography for Patients With Acute Chest Pain

This article presents specific examples of delayed diagnosis of acute coronary syndrome, acute aortic dissection, and pulmonary embolism resulting from evaluating patients with nonspecific acute chest pain who did not undergo immediate dedicated coronary CT angiography (CTA) or triple rule-out protocol (TRO). These concrete examples of delayed diagnosis may advance the concept of using cardiac CTA (i.e., dedicated coronary CTA versus TRO) to triage patients with nonspecific acute chest pain. This article also provides an overall understanding of how to choose the most appropriate examination based on the specific clinical situation in the emergency department (i.e., dedicated coronary CTA versus TRO versus dedicated pulmonary or aortic CTA), how to interpret the CTA results, and the pros and cons of biphasic versus triphasic administration of intravenous contrast material during TRO examination. A precise understanding of various cardiac CTA protocols will improve the diagnostic performance of radiologists while minimizing hazards related to radiation exposure and contrast use.

US Findings of Biceps Tendinitis: Cross Sectional Area Measurements of Long Head of Biceps Brachii

PURPOSE: The purpose of this study was to describe typical sonographic findings in patients with biceps tendinitis. MATERIALS AND METHODS: Seventy five patients who had been clinically diagnosed with biceps tendinitis were included. Of the 75, 37 were male, 38 were female, and their mean age was 56 +/- 9.74. The patients complained of shoulder pain and ultrasonography was performed for bilateral shoulders in all patients. The cross sectional area of the biceps tendon was measured. The status of fluid collection around the biceps tendon and accompanying rotator cuff disease were also investigated. RESULTS: The cross sectional areas of the diseased biceps tendon were 0.18 +/- 0.09 cm2 (range: 0.07-0.42), and the areas of the normal side was 0.11 +/- 0.05 cm2 (0.03-0.24). The cross sectional area of the diseased biceps tendon was 0.075 +/- 0.062 cm2 greater, on average, than the uninvolved site (p < 0.01). Thirty six patients (48%) had fluid collection around the inflamed biceps tendon, and 30 patients had accompanied rotator cuff disease. CONCLUSIONS: During US examination of the shoulder in patients complaining of shoulder pain, if the cross sectional area of the biceps tendon in the painful shoulder is asymmetrically and larger than the contralateral tendon, biceps tendonitis is suggested.

Differences in CT Findings According to Sputum Smear Results in Patients with Active Pulmonary Tuberculosis Having a Single Cavity / 결핵및호흡기질환

Background: The purpose of this study was to evaluate the differences in CT findings according to sputum smear- positive or -negative results in patients with active pulmonary tuberculosis having a single cavity. Methods: A total of 32 patients with active pulmonary tuberculosis having a single cavity on CT were classified into two groups: smear-positive (n=19) and smear-negative (n=13). The CT findings were reviewed retrospectively. The presence of consolidation, the number of lobes showing consolidation, ground-glass opacity, micronodules and nodule, the maximum diameter of the cavity, and the shape and maximum thickness of the cavity wall were assessed. Result: The maximum diameter of the cavity was 33.84 +/- 13.65 mm and 27.08 +/- 9.04 mm in the smear-positive and -negative groups, respectively (p>0.05). The amount of consolidation and the number of lobes with consolidation were found to be 89.5% and 30.8% (p=0.01) and 1.37 +/- 0.90 and 0.31 +/- 0.48 (p=0.0002) in the smear-positive and -negative groups, respectively. Consolidations in two or more lobes were only noted in 31.6% of in the sputum smear- positive group (p< 0.05). There were no other significant differences between the two groups. The sensitivity, specificity, positive and negative predictive values for the presence of consolidation were 89.5%, 69.2%, 73.9%, and 81.8%, respectively. Conclusion: While the absence of consolidation on CT may be associated with sputum smear-negative results in patients with active pulmonary tuberculosis having a single cavity, the presence of consolidation in two or more lobes on CT may be associated with spear-positive results in these patients.

Comparison of the CT and Pathologic Findings of Pulmonary Fat Embolism Induced by Triolein and Oleic Acid in Rabbits

PURPOSE: The aim of this study was to evaluate the CT findings of pulmonary fat embolism syndrome that was induced by triolein and oleic acid, along with its pathologic correlation. MATERIALS AND METHODS: 16 rabbits were included in this study. The rabbits in group I (n=8) were embolized with 0.2 mL triolein and the rabbits of group II (n=8) were embolized with 0.2 mL oleic acid through ear veins. HRCT scans were done prior to embolization and at 0.5, 4, 24, 48 and 72 hours post-embolization. The pathologic correlations were determined at 0.5, 24, 48 and 72 hours. RESULTS: At 24 hours, one group I rabbit showed abnormal CT findings that were composed of several 2-3 mm nodules and multiple ill-defined peripheral ground glass opacities. The pathologic finding of this rabbit at 48 hours was mainly intraarveolar edema. All the group II rabbits (n=8/8) showed ill-defined bilateral and peripheral ground glass opacities with (n=6/8) or without consolidations (n=2/8) on the 0.5 hour CT. All the rabbits (n=7/7) showed that the new ground glass opacities and ground glass opacities noted on the 0.5 hour CT were changed into consolidation. The margins of the ground glass opacities and consolidations were more sharpened on the 24 hours CT. All 6 rabbits (n=6/6) showed consolidations without ground glass opacities and the margins of the consolidations were more sharpened on the 48 hours CT. There was no significant interval change on the 72 hours CT. The pathologic findings of ground glass opacities were interstitial edema or mild intraalveolar edema. The pathologic findings of consolidation were intraalveolar edema, hemorrhage and coagulation necrosis. CONCLUSION: The CT findings after fat embolization using triolein and oleic acid were ill-defined peripheral ground glass opacities with/without consolidations. These findings occurred in only one triolein group with the time lag, but these findings were immediately and extensively seen in all group II rabbits. These CT findings may be important for making a diagnosis of pulmonary fat embolism syndrome.

Diffusion-Weighted MR Imaging in Acute Wernicke's Encephalopathy Associated with Pseudomembranous Colitis: A Case Report and Review of the Literature

Wernicke's encephalopathy is a common complication of thiamine deficiency among chronic alcoholics. However, there have been few reports about MR imaging findings, including the diffusion-weighted changes of this neurologic disorder, in nonalcoholic patients. We present here a rare case of acute Wernicke's encephalopathy that developed in a patient who received prolonged total parenteral nutrition for his pseudomembranous colitis. The MR imaging, including the diffusion-weighted imaging, was performed at the onset of disease and during follow-up. The diagnosis was made by the characteristic MR imaging findings and it was supported by the clinical features. The initial and follow-up MR imaging findings with diffusion-weighted imaging changes are described and correlated with the clinical status.

A Case of Nonsecretory Multiple Myeloma with Atypical Imaging Features

Multiple myeloma usually shows homogeneous enhancement on contrast-enhanced Magnetic Resonance imaging (MRI), and is accompanied by a monoclonal gammopathy in serum or urine. We report a case of nonsecretory myeloma, the diagnosis was difficult due to the absence of a monoclonal gammopathy and the presence of atypical imaging features.

Intradural Extramedullary Capillary Hemangioma with Long Segment of Transient Cord Edema: A Case Report

We present a case of intradural extramedullary capillary hemangioma of the thoracic spine with a long segment of transient cord edema. Spinal capillary hemangiomas are extremely rare vascular tumors and only a few cases have been reported. On the MR images, the mass showed hypointensity on the T1-weighted images, hyperintensity on the T2-weighted images relative to the spinal cord, and strong homogeneous enhancement on the contrast-enhanced T1-weighted images. The T2-weighted images showed a long segment of ill-defined hyperintense area in the spinal cord which was completely resolved after surgery.

Ultrasound-Guided Radiofrequency Ablation of Thyroid Gland: A Preliminary Study in Dogs

PURPOSE: The purpose of this study was to evaluate the possibility of using radiofrequency ablation as the treatment modality for the benign or malignant thyroid nodules in humans. Therefore, we examined the results of using radiofrequency ablation on the thyroid glands in dogs, in respect of the extent of the ablated tissue and the complications. MATERIALS AND METHODS: Five dogs (10 lobes of the thyroid glands) were included in this study. US-guided radiofrequency ablation was undertaken with a 10mm, uncovered 17 gauge cool-tip needle. The power and duration was 20 wattage and 1 minute in five thyroid lobes (group 1) and 20 wattage and 2 minutes in another 5 thyroid lobes (group 2). The ultrasound scans and the pre-and post-enhancement CT scans were undertaken before and immediately after the procedures, and at 24 hours, 72 hours and 1 week later. The US and CT findings of the ablated tissue and complications were evaluated. Blood sampling was done at the pre-procedure time and 1 week later for evaluating the functional status of the thyroid gland. Laryngoscopy was done at the pre-procedure and post-procedure times, and at 24 hours, 72 hours and 1 week later for the evaluation of any recurrent laryngeal nerve palsy. RESULTS: The echo pattern of the ablated thyroid gland at immediately after the radiofrequency ablation appeared as poorly marginated and hyperechoic. On the US obtained 24 hours after radiofrequency ablation, the echo pattern of the ablated thyroid gland was hypoechoic. The maximum diameters after RFA were 9.4+/-0.5 mm in group I and 11.4+/-0.5 mm in group II. The pre-enhanced CT scan taken at immediately after the radiofrequency ablation showed ill defined hypodense areas in the ablated thyroid gland. Differentiation between the normal and abnormal portions of the thyroid gland was difficult on the contrast enhanced CT scan. Complications induced by radiofrequency ablation were one recurrent laryngeal nerve palsy, two perforations of esophagus and five thickenings of the esophageal wall. In summary, the radiofrequency ablation therapy for the benign or malignant thyroid nodules located in anterior aspect (within a 5 mm radius) of the thyroid gland in human suggests this is an effective treatment, through this was an animal study performed on dogs.

Ultrasonographic Findings of Chronic Lateral Epicondylitis with Partial Tear before and after Prolotherapy

OBJECTIVE: To compare the ultrasonographic findings of chronic lateral epicondylitis of elbow with partial tear of common extensor tendon before and after prolotherapy. METHOD: The subjects were 12 cases of chronic lateral epicondylitis with partial tear of common extensor tendon, which were confirmed by ultrasonography. We examined the common extensor tendon with ultrasonography at initial visit. After injecting 15% dextrose solution monthly for five times, follow up ultrasonography was performed one month after last injection. RESULTS: Before prolotherapy, every case had anechoic focus without normal fibrillar pattern, which represented partial tear of tendon. Seven cases showed focal or diffuse hypoechoic foci with loss of normal fibrillar pattern of tendon, which represented tendinosis. After prolotherapy, initial anechoic foci were changed to smaller size with diffuse fibrillar pattern inside in 6 cases, to the same the sized hypoechoic foci with diffuse fibrillar pattern inside in 2 cases. And a few fibrillar pattern were seen within the initial anechoic focus in 1 case and most of anechoic foci were filled with fibrillar pattern except small anechoic foci in 3 cases. CONCLUSION: Prolotherapy can help the recovery process of chronic lateral epicondylitis. And ultrasonography can be a useful method to evaluate the therapentic effect of lateral epicondylitis.

Middle Cranial Fossa Epidermoid Cyst: A Case Report of Unusual CT and MR Findings

Intracranial epidermoid cysts usually show homogeneous hypodensity on CT scans, hypointensity on T1-weighted MR images and hyperintensity on T2-weighted MR images. Most of them arise in the cerebellopontine angle and parasellar areas. We report a case of middle cranial fossa epidermoid tumor with unusual image findings. The entire tumor mass showed inhomogeneous low density, without any enhancing solid portion on the CT scans. The lateral portion of the tumor showed homogeneous T1 low signal intensity and T2 high signal intensity. The medial portion of the tumor showed heterogeneous T1 and T2 intermediate to high signal intensity. On the gadolinium enhanced MR images, enhancement of the thickened dura was observed behind the tumor. Surgery and pathologic examination revealed the presence of an extradural epidermoid cyst.

Inflammatory Pseudotumor Involving the Pulmonary Artery: Case Report

Pulmonary inflammatory pseudotumor is the most common primary lung mass seen in children, but extraparenchymal involvement is relatively rare. We report here on a case of inflammatory pseudotumor involving the mediastinum and the pulmonary artery. A 48-year-old man presented with enlargement of the right hilum on a simple chest radiograph. He had a history of exertional dyspnea for 1 year. A non-homogeneous enhancing mass was noted in the right pulmonary artery on computed tomography. Mediastinotomy and pulmonary artery angiography with a forcep biopsy revealed inflammatory pseudotumor of the mediastinum and pulmonary artery.

A Comparative Study of Intra-arterial and Intramuscular Administration of phVEGF165 in a Chronic Ischemic Model of Rabbit Hindlimb

PURPOSE: To obtain phVEGF165 for angiogenesis and to compare the effects of its intra-arterial and intramuscular administration in a chronic ischemic rabbit hindimb model. MATERIALS AND METHODS: Chronic ischemic models were constructed in the left hindlimb of rabbits and divided into control (n=6), intra-arterial (n=7) and intramuscular groups (n=5). Plasmid DNA (phVEGF165) expressing vascular endothelial growth factor (VEGF) was obtained from HL60 cells, and transfection into CHO cells and western blot analysis of the medium, as well as proliferation assay of CPAE cells were performed. Two weeks after construction of the models, 500 mug phVEGF165 was injected into both the left common iliac artery and thigh muscles. Angiography was performed and the number of vessels counted, and ELISA was used to determine the quantity of VEGF in blood samples. Wilcoxon signed rank test was employed for statistical analysis. RESULTS: VEGF165 was expressed on western blot of the culture medium. Proliferation assay showed that optical densities were 0.73+/-0.043 in the control study and 1.09+/-0.015 in phVEGF165. The angiographic scores were 1.32+/-0.13 (pre-gene therapy) and 1.30+/-0.07 (post-gene therapy) in the control group, 1.42+/-0.15 and 1.59+/-0.09 in the intra-arterial group, 1.59+/-0.27 and 1.14+/-0.12 in the intramuscular group. The differences were not statistically significant. In the intra-arterial group, serum VEGF levels were 39.96+/-1.08 pg/ml (pregene therapy), 44.99+/-2.13 pg/ml (4th day), 48.18+/-1.49 pg/ml (1st week), 45.70+/-3.77 pg/ml (2nd week), and 46.54+/-5.47 pg/ml (3rd week), but in the control and intramuscular groups there were no increases. CONCLUSION: phVEGF165 affected the proliferation of CPAE cells. There was no difference in angiographic scores and serum VEGF levels between intra-arterial and intramuscular administrations.

Radial Artery Approach for Transcatheter Arterial Chemoembolization in Patients with Hepatocellular Carcinoma

PURPOSE: To evaluate the feasibility and usefulness of the transradial approach for intra-arterial chemoembolization therapy in patients with hepatocellular carcinomas. MATERIALS AND METHODS: Twenty-nine patients with hepatocellular carcinoma who underwent intra-arterial chemoembolization via the radial artery approach were involved in this study. All underwent Allen's test to check ulnar arterial patency. In all cases, we used the radial approach hepatic artery (RHA) catheter designed by ourselves, evaluating the selection ability of the hepatic artery using an RHA cathter, the number of punctures, the procedure time, and compression time at the puncture site as well as complications occurring during and after the procedure. RESULTS: Except for three in which puncture failure, brachial artery variation or hepatic artery variation occurred, all procedures were successful. The mean number of punctures was 3.5, and the average duration of the whole procedure was one and half hours. This gradually decreased as the number of procedures increased. The average duration at a compression of puncture site was 12 minutes. There were no major complications. Minor complications included minimal intimal dissection of the radial artery (3.8%), reversible vasospasm of the radial artery (7.7%), hematoma at a puncture site (7.7%) and transient neurologic deficit (3.8%). CONCLUSION: The transradial approach using an RHA catheter for intra-arterial chemoembolization therapy in patients with hepatocellular carcinomas was technically feasible, with acceptable levels of safety. It may be a good alternative to absolute bed rest with a sand bag after the femoral approach.

Magnetic Resonance Imaging on Posterior Cruciate Ligament Injury: Can the PCL hea

PURPOSE: The aim of this study was to elucidate the continiuty of ligament in chronic injury of the pos- terior cruciate ligament(PCL). MATERIALS AND METHODS: Magnetic resonance imaging(MRI#) of twenty-six PCL injury patients with grade II or III laxity and more than 5mm side to side difference on stress radiographs were reviewed in terms of ligamentous continuity and thickness of the ligament at average 7.2 months(range:1-36) after injury. RESULTS: Eighteen PCLs(69%) showed continuity of PCL. When thickness of the ligament in cases without continuity was rated as zero, the average thickness of the PCLs as compared to intact portion of the ligament increased as the time from injury elapsed; 16.4% in 0 2 months group(7 cases), 30.0% in 3- 5 months group(6 cases), 53.8% in 6-8 months group(9 cases) and 80.0% in over 9 months group(4 cases). CONCLUSTION: More than two thirds of PCLs in symptomatic chronic injury showed ligamentous continuity on MRI. The longer the interval from injury was, the thicker the PCL was.

CT Findings of Post Urinary Dive rsion: Normal Findings and Detection of Cancer Recurrence

PURPOSE: To determine normal postoperative CT findings and tumor recurrence in patients who have under-goneradical cystectomy and urinary diversion. MATERIALS AND METHODS: We retrospectively reviewed the postoperative CTscans of 51 patients who had un-dergone radical cystectomy with urinary diversion, and in analysis speciallyemphasised normal postoperative CT findings and recurrent cancer in the surgical bed. Among these 51 patients, 43had undergone incontinent urinary diversion(Bricker operation), while for six, diversion had been continent (Kockprocedure). Attempts were also made to characterise the CT findings of each procedure according to the location ofthe ileal pouch, the pattern of contrast collection within the pouch, and the morphology of the ileocutaneostomysite. RESULTS: Each urinary diversion procedure demonstrated characteristic postoperative CT appearances. TheBricker procedure revealed a contrast-filled ileal conduit in the right lower quadrant excreting into theileocu-taneostomy site, while the Kock procedure demonstrated layering of contrast and urine within the pouch aswell as artificially intussuscepted afferent and efferent ileal loops at the anastomotic sites. Thirty-three smallsoft tissue density lesions in the surgical bed were seen in 19 patients (37%). Thirty one were bilateral (n=28)or unilateral (n=3) triangular or oval shaped soft-tissue-density lesions and two were unilateral irregular shapedlesions. Follow-up CT scans showed that all triangular or oval-shaped lesions were smaller (n=8) or show no changein size (n=23) ; they were thought to represent postoperative fibrosis or granulation tissue. Two cases ofirregular-shaped soft-tissue-density lesions were seen on follow-up CT scans to be larger, and these wereconfirmed by percutaneous biopsy to be recurrent cancer. CONCLUSION: It is important for the radiologist to befamiliar with normal postoperative CT findings of various urinary diversion procedures as well as to recognize arelatively high incidence (37%) of small soft tissue den-sity lesions in a surgical bed. In our study, smalltriangular or oval-shaped soft-tissue-density lesions in the sur-gical bed (especially when these were bilateral)were thought to represent postoperative fibrosis or granulation tissue, and close follow-up by means of CTscanning rather than an invasive procedure is therefore warranted.

Interstitial Laser Photocoagulation with Diode Laser Unit in Bovine Liver

PURPOSE: To evaluate the extent of tissue coagulation during interstitial laser photocoagulation (ILP) innormal bovine liver, using a diode laser unit and various parameters, and to determine whether the procedure isapplicable to clinical practice.. MATERIALS AND METHODS: Using an 18-gauge needle, experimental interstitiallaser photocoagulation (ILP) was carried out in normal bovine liver. On the basis of differing parameters, threegroups were established. For group I, a single photofiber with laser power of 1, 3 and 5 watts and an exposuretime of 60, 180, 300, 420 or 600 seconds was used. For groups II and III, four needles were fixed at a distance of1cm and 1.5cm ; in each case a needle fixation device was used, as well as a laser distributor for simultaneouslaser exposure of photofibers. As a control, four photofibers were placed as for groupIII, but to compare groups IIand III, each photofiber was exposed to a laser of 3 watts 300 seconds, without using a laser distributor. Toevaluate the range of tissue coagulation, specimens were analyzed both with regard to cross-sectional grossfindings and histopathologically . RESULTS: The largest diameter of thermal coagulation necrosis in Group I was15x15mm, and this was ball-shaped. Coalescence of coagulation between each photofiber was observed in Group II,and this was up to 25 mm in diameter. In Group III and controls, coalescence was not found, though the extent oftissue coagulation increased with increasing wattage and exposure time. The extent of charring at the center ofcoagulation also increased with increasing wattage. Smoke bubbles emanating from the coagulation area wereobserved, and during ILP involving a single photofiber, increased from 3 watts, applied for 300 seconds.CONCLUSION: Using an 8-gauge needle and a diode laser ILP, we have shown that a range of tissue coagulationacutely ablates normal bovine liver. In selective cases, the procedure could be applied to clinical trials.

Intra-arterial Port Implantation for Intra-arterial Chemotherapy: Comparison between PIPS(Pe rcutaneouslyImplantable Port System) and Port System

PURPOSE: To compare the techniques and complications of intra-arterial port implantation for intra-arterialchemotherapy between PIPS and the port system. MATERIALS AND METHODS: For intra-arterial port implantation, 27cases in 27 patients were retrospectively evalu-ated using PIPS(PIPS-200, William Cook Europe, Denmark) while for21 cases in 19 patients a pediatric ve-nous port system(Port-A-Cath, 5.8F, SIMS Deltec, U.S.A.) was used. Allintra-arterial port implantation was performed percuteneously in an angiographic ward. Hepatocellular carcinomawas diagnosed in 18 patients and hepatic metastasis in 16. Peripheral cholangiocarcinoma, and pancreatic gastric,ovarian, renal cell and colon carcinoma were included. We compared the techniques and complications between PIPSand the port system. The follow up period ranged from 23 to 494(mean, 163) days in PIPS and from 12 to 431(mean,150) days in the port system. RESULTS: In all cases, intra-arterial port implantations were technicallysuccessful. Port catheter tips were locat-ed in the common hepatic artery(n=8), proper hepatic artery(n=7), righthepatic artery(n=5), gastroduodenal artery(n=2), left hepatic artery(n=1), pancreaticoduodenal artery(n=1),inferior mesenteric artery(n=1), lum-bar artery(n=1), and renal artery(n=1) in PIPS, and in the proper hepaticartery(n=6), gastroduodenal artery(n=6), common hepatic artery(n=3), right hepatic artery(n=4), inferiormesenteric artery(n=1), and in-ternal iliac artery(n=1) in the port system. Port chambers were buried ininfrainguinal subcutaneous tissue. Using PIPS, complications developed in seven cases(25.9%) and of these, four(57.1%) were catheter or cham-ber related. In the port system, catheter or chamber related complications developedin four cases(19.0%). CONCLUSION: Because PIPS and the port system have relative merits and demetrits, successfulintra-arterial port implantation is possible if equipment is properly selected.

Shoulder Impingement Syndrome: Evaluation of the Causes with MRI

PURPOSE: Various mechanical causes which induce shoulder impingement syndrome have been identified with the help of MRI. The aim of this study is to evaluate the incidence of such causes. MATERIALS AND METHODS: A total of 54 patients with clinically confirmed shoulder impingement syndrome and a normal control group(n=20) without symptoms were included. We evaluated the incidence of hook shaped acromion, low lying acromion, downward slope of the acromion, subacromial spur, acromioclavicular joint hypertrophy, coracoacromial ligament hypertrophy, high cuff muscle bulk, and os acromiale. RESULTS: Among the 54 patients, the following conditions were present: acromioclavicular joint hypertrophy(n=36), coracoacromial ligament hypertrophy(n=20), subacromial spur(n=18), downward sloping of the acromion(n=16), hook shaped acromion(n=11), relatively high cuff muscle bulk(n=6), low lying acromion relative to the clavicle(n=3), and os acromiale(n=1). In the normal control group there were nine cases of acromioclavicular joint hypertrophy, nine of coracoacromial ligament hypertrophy, nine of downward sloping acromion, and three of low lying acromion, but hook shaped acromion, high cuff muscle bulk, and os acromiale were not found. Among 54 patients, the syndrome was due to five simultancous causes in one patient, four causes in two, three causes in 12, two causes in 22, and one cause in 17. CONCLUSION: Hook shaped acromion and subacromial spur are the statistically significant causes of shoulder impingement syndrome. In 69 % of patients, the condition was due to more than one cause.

Transjugular Intrahepatic Portosystemic Shunt with PTFE-Covered Spiral Z-stent: An Experimental Study in Swine

PURPOSE: To improve TIPS patency by inserting polytetrafluoroethylene(PTFE)-covered spiralZ-stents in swine. MATERIALS AND METHODS: Using PTFE covered spiral Z-stents lined with TIPS tract from theportal vein wall to the inferior vena caval orifice of the right hepatic ve i n , TIPS were created in seven youngswine. The animals were followed up by portal ve n o g r a p hy and venous pressure was measured at two - weekintervals for 12 weeks or until shunt occlusion. After sacrifice, resected liver was examined grossly andpre-pared for histology. RESULTS: The fifty percent patency rate using lifetime analysis was 83 % at 4 weeks, 33%at 6 weeks, 17 % at 8 weeks and 0% at 10 weeks. Venography demonstrated that the predominant sites of stenosiswere the portal vein wall(2/6), the TIPS tract(2/6) and the IVC orifice of the right hepatic vein(2/6). One swinedied 11 days after TIPS due to illness, and bile leaks were discovered in two of the seven animals. Histologicstudy demonstrated intimal hyperplasia in either the portal vein wall or the end of the stent at which the IVCorifice was located, as well as thrombus and pseudointimal hyper-plasia in the TIPS tract. CONCLUSION: P T F E -c overed spiral Z-stents were easily placed and significantly im-proved TIPS patency.