A Case of Sebaceous Eipthelioma on the Lower Palpebral Conunctiva

PURPOSE: Sebaceous epithelioma which developed on the conjunctiva is a very rare benign skin and adnexal tumor. No case has been reported in the Republic of Korea. We report a case of sebaceous epithelioma on the lower palpebral conjunctiva. METHODS: A 69 year old man had visited with asymptomatic mass on lower palpebral conjunctiva. The mass was resected and biopsied for histological examination. RESULTS: Sebaceous epithelioma was diagnosed by histological examination.

The Preventive Effect of Porous Polyethylene Sheet on the Slippage of Prolene(R) Loop Placed in the Subcutaneous Tissue of Rabbits

PURPOSE: To investigate the role of porous polyethylene sheet in preventing the recurrence of ptosis after frontalis sling with Prolene(R) and the safety of porous polyethylene sheet. METHODS: Prolene(R) was placed subcutaneously in the thigh of white rabbits. In one group, Prolene(R) was placed with porous polyethylene sheet (treated group) and in the other group, Prolene(R) was placed without porous polyethylene sheet (control group). Prolene(R) was tightened and the loosening of the skin was evaluated at 1, 2, 4 and 8 weeks postoperatively. At the same time, the occurence of complications such as infection, granuloma formation was observed. Histologic examination was done at 2, 4 and 8 weeks postoperatively. RESULTS: In the treated group, skin loosening was progressed significantly for 2 weeks (p<0.05, Mann-Whitney U test) but thereafter there was no significant progression. In control group, skin loosening was progressed for 8 weeks (p<0.05, Mann-Whitney U test). Skin loosening was more severe in the control group at each follow-up evaluation (p<0.05, Wilcoxon signed ranks test). No complication was observed during the follow-up period of 8 weeks. On histologic examination, inflammatory reaction and fibrosis ere seen around Prolene(R) in the control group and fibrovascular ingrowth into the pores of porous polyethylene sheet was seen in the treated group. CONCLUSIONS: This study shows that porous polyethylene sheet can be safely used to prevent the slippage of Prolene(R) and the use of porous polyethylene sheet will be helpful in preventing the recurrence of ptosis after frontalis sling with Prolene(R).

Temporal Bone CT Findings of Tuberculous Otitis Media: Comparison with Chronic Otitis Media

PURPOSE: To compare the differential findings of tuberculous otitis media(TOM) with those of chronic suppurative otitis media with or without cholesteatoma, as seen on high resolution temporal bone CT. MATERIALS AND METHODS: We retrospectively reviewed 14 cases of TOM, 30 cases of chronic suppurative otitis media(CSOM), and 30cases of chronic otitis media with cholesteatoma(Chole). All had been pathologically confirmed. We evaluated thepreservation of mastoid cells without sclerotic change, the location and extension of soft tissue to the externalauditary canal, the erosion of ossicles, the tegmen tympani, scutum, bony labyr inth, facial nerve canal andsigmoid sinus, and the presence of intracranial co mplications. RESULTS: Soft tissue in the mastoid antrum wasseen in all cases of TOM(100%), 29 cases of CSOM(96.7%), and 26 cases of Chole(86.7%). In contrast, the softtissue in the entire middle ear cavity was noted in 13 cases of TOM(92.8%), 7 cases of CSOM(23.3%), and 12 casesof Chole(40%). Soft tissue extended to the superior aspect of the external auditory canal in 4 cases of TOM(28.6%) and 5 cases of Chole (16.7%). Mastoid air cells were seen in 9 cases of TOM (64.3%), 4 cases of CSOM(13.3%), and 3 cases of Chole(10%). Ossicular erosion was noted in 6 cases of TOM (42.9%), 12 cases of CSOM (40%),and 26 cases of Chole(86.7%), while in one case of TOM (7.1%), 5 cases of CSOM (16.7%), and 15 cases of Chole(50%)there was erosion of the scutum. In one case of TOM, follow-up CT study after 9 months of antituberculousmedication without surgery revealed complete clearing of previously noted soft tissue in the middle ear cavity. CONCLUSION: Specific CT findings of TOM were not seen, but if there were findings of soft tissue in the entiremiddle ear cavity, soft tissue extension to the external auditory canal, preservation of mastoid air cells withoutsclerotic change, and intact scutum, TOM may be differentiated from other chronic otitis media.

Value of Noncontrast Spiral CT for Suspected Acute Appendicitis

PURPOSE: To assess the diagnostic accuracy and clinical efficacy of noncontrast spiral CT in patients withsuspected acute appendicitis. MATERIALS AND METHODS: Over a six-month period, 100 patients with suspected acuteappendicitis were prospectively evaluated with noncontrast spiral CT. All scans were obtained from the lower bodyof L3 to the symphysis pubis, with 5mm or 10mm collimation and pitich of 1 or 1.5, and without intravenous or oralcontrast material. Diagnosis was established by means of surgical or clinical follow-up. Prospective diagnosisbased on CT findings was compared with surgical results and clinical follow-up. RESULTS: Acute appendicitis wasconfirmed in 47 of 100 patients. On the basis of the basis of the CT findings, SI patients were prospectivelyinterpreted as positive for appendicitis, but in six the diagnosis was false-positive. Two of the 47 with acuteappendicitis were prospectively interpreted as normal. The preoperative diagnosis of acute appendicitis was, thus,45 true-positive, 47 true-negative, six falsepositive and two false-negative, yielding a sensitivity of 96%, aspecificity of 89%, an accurace of 92%, a positive predictive value of 88%, and a negative predictive value of96%. Using CT, an alternative diagnosis was established in 14 patients. CONCLUSION: Noncontrast spiral CT is auseful technique for diagnosing acute appendicitis.

Ngiodysplasia in Gaint Diverticulum of Transverse Duodenum Causing Massive Gastrointestinal Bleeding: A Case Report

The incidence of duodenal diverticulum found incidentally during upper gastrointestinal roentgenographicexamination varies between 2% and 5%. The majority of cases occur along the medial aspect of the second portion of the duodenum, within 2.5cm of the ampulla of Vater. The majority of duodenal diverticula are asymptomatic, but insome cases, complications such as diverticulitis, hemorrhage, perforation, and fistula formation occur in thethird and fourth portions of the duodenum. We describe a case of giant diverticulum of the transverse duodenum,revealed by UGI and angiography, massive gastrointestinal bleeding in a 80-year-old patient.

Ultrasound-Guided Renal Biopsy with Automated Biopsy Gun Technique: Efficacy and Complications

PURPOSE: To evaluate the diagnostic yield and complications of percutaneous ultrasound-guided renal biopsyusing a biopsy gun in patients with diffuse renal disease. MATERIALS AND METHODS: Using an automated biopsy gunmounted with a 16G needle, biopsies were performed on 90 patients with diffuse renal disease. In a total of 95biopsies, diagnostic yield, the mean number of glomeruli and frequency of complication were retrospectivelyanalysed. RESULTS: Tissue adequate for histological diagnosis was obtained in 92% of procedures. Mean glomerularyield was 8.3, and complications were seen in 26% of the procedures, 25% of these were minor, and 1% were major. CONCLUSION: For the diagnosis of diffuse renal disease, utrasound-guided percutaneous renal biopsy using anautomated biopsy gun is accurate and safe.

CT and Angiographic Analysis of Posterior Communicating Artery Aneurysms: What Factors Influence the Amount of Subarachnoid Blood?

PURPOSE: To determine how clinical and angiographic factors relate to the amount of subarachnoid blooddetected by computerized tomography in patients with a ruptured aneurysm. MATERIALS AND METHODS: Between January1996 and December 1997, 22 patients with a posterior communicating artery aneurysm were retrospectively evaluated. RESULTS: Oval(three of four cases), funnel(both cases), and daughter-sac (four of five cases) types of aneurysmalsac were found among the 13 patients with a large amount of subarachnoid blood ; eight of these had a past historyof hypertension or diabetes. Seven of eleven cases of cylindrical-type aneurysmal sac were found among the 9patients with a small amount of sularachnoid blood ; eight of these had no past history of hypertension ordiabetes. The average S/N ratio (ratio of maximum sac length to neck diameter) of patients with a small amount ofblood was higher than that of patients with a large amount of blood(2.72 vs 2.07). CONCLUSION: Although manyfactors influence the amount of subarachnoid blood in an aneurysmal rupture, we found that a large amount of bloodwas frequently present in the oval, funnel and daughter sac types of aneurysm, when S/N ratio was low, and when anunderlying disease such as hypertension or diabetes was present. Conversely, a small amount of blood was presentin the cylindrical type, when S/N ratio was high, and where there was no of underlying disease.

CT and MR Findings of Ovarian Fibroma

PURPOSE: To evaluate the charateristic CT and MR findings of primary ovarian fibromas. MATERIALS AND METHODS: We retrospectively reviewed 11 cases which had undergone precontrast and postcontrast scanning, and two in which cases T1-weighted (WI) and postcontrast T1WI and T2WI images had been done. All cases were pathologically confirmed after surgical resection. These masses were analysed on the basis of clinical symptom, age, size (longest diameter), laterality, margin, attenuation (unenhanced and enhanced), signal intensity (SI), calcification, and amount of the ascites. RESULTS: The patients' mean age was 46.6 (range, 22-81) years, and the longest diameter was 14.8 (range, 8-28)cm. All tumors were unilateral, and eight were located in the left ovary and five in the right ovary. In all cases, the tumor margin was well-defined; seven were lobulated, four were oval, one was round, and one was nodularly marginated. On CT scan, the masses showed mildl to moderate heterogenous enhancement with irregular lower density portions. The amount of the ascites was marked in three cases (23%) mild in two (15%), and minimal in three cases. Calcifications were seen in 3 of 11 CT cases (27%), and in one, this was extensive. On MR scans, signal intensity (SI) of the masses on T1WI was isoSI, relativetive to the uterine myometrium, and heterogeneously enhanced after infusion of contrast media. On T2WI, SI was slightly lower that of the uterine myometrium with internal high SI portions. CONCLUSION: The characteristic finding of ovarian fibroma is a unilateral, well-defined, oval or lobulated, solid mass with or without ascites and calcification. On CT scan, tumor has mild to moderate heterogeneous enhancement. On MR scan, SI of mass is isoSI on T1WI with heterogeneous enhancement, and low SI on T2WI due to fibrous component.

Aspergillus Osteomyelitis of the spine: A Case Report

We report a case of Aspergillus osteomyelitis of the spine in a 52-year-old female with back pain. Anteroposterior and lateral roentgenograms showed narrowing of the intervertebral disc space of T12-L1 with irregular vertebral endplates. MRI showed spondylodiscitis at T12-L1. Although tuberculous spondylitis is far more prevalent that fungal spondylitis, it is difficult to differentiate one from the other radiographically.

CT-Guided Percutaneous Automated Gun Biopsy of Pulmonary Lesions: Complications and Diagnostic Accuracy

PURPOSE: To determine the frequency of complications and diagnostic accuracy of CT-guided percutaneous automated gun biopsy, and to compare the results with those reported for fine needle aspiration. MATERIALS AND METHODS: Using automated biopsy devices, 118 CT-guided percutaneous biopsies of pulmonary lesions were performed. An 18-gauge needle was used. Final diagnosis was made with operation or other methods. We retrospectively analyzed the frequency of complications and diagnostic yields of 118 biopsies. RESULT: Four of 118(3.3%) patients developed pneumothorax and two of these required chest tube insertion. Other complications were resolved spontaneously. 106 biopsies (89.8%) yielded sufficient tissue for pathologic evaluation. For cases of malignant and of benign disease, sensitivity was 91.8% and 87.7% respectively ; the corresponding figures for diagnostic accuracy were 88.5% and 78.9%. CONCLUSION: CT-guided automated gun biopsy of the pulmonary lesions is safe, witha pneumothorax rate comparable to that of fine needle aspiration. In the absence of a trained cytologist at the time of biopsy, the diagnostic accuracy of automated gun biopsy of pulmonary lesions compared favorably with the reported accuracy of fine needle aspiration.

MRI of Cauda Equina Syndrome in Ankylosing Spondylitis: A Case Report

Cauda equina syndrome is a rare neurologic complication in patient with long-standing ankylosing spondylitis. Authors report a case of cauda equina syndrome. in ankylosing spondylitis. On plain radiographs, typical "bamboo spine" and fusion of sacroiliac joints were noted. MRI of the lumbar spine revealed arachnoid diverticulae which were isointense to cerebrospinal fluid on all spin echo sequences, and showed bony erosion and scalloping of posterior arches.