The Detectability of Hepatic Metastases in Candidates of Radiofrequency Ablation: Comparison for Helical CT Scanning and Late-Phase Pulse-Inversion Harmonic Imaging

PURPOSE: To compare dual-phase helical CT and pulse inversion harmonic US using microbubble contrast agents in the detection of hepatic metastases prior to radiofrequency (RF) ablation. MATERIALS AND METHODS: Twenty-one patients in whom hepatic metastases from colorectal cancer had been diagnosed by dual-phase CT scanning and who were considered to be candidates for RF ablation underwent pulse-inversion barmonic US examination. Images were obtained 5 minutes after the bolus injection of microbubble contrast agent SH U 508 A (4.0 g, 300 mg/mL). The number of metastatic tumors revealed by CT and US was determined, and the findings were statistically analysed. The influence of the results of US examination on treatment planning was also evaluated. RESULTS: In 21 patients, 48 metastatic lesions were detected by helical CT, and 56 lesions by US. These eight additional lesions revealed by US occurred in six patients (29%), and their diameter was 3-13 (mean, 7.2) mm. In three of these patients, RF ablation could not be performed, while in the other three, the additional lesions were ablated. CONCLUSION: Pulse-inversion harmonic US imaging using microbubble contrast agents may depict small hepatic metastatic tumors that were not apparent at CT. US-therefore appears to be useful in the planning of treatment prior to the RF ablation of hepatic metastases.

Second trimester selective termination in a dizygotic twin pregnancy with discordancy for Arnold-Chiari malformation: A case report / 대한산부인과학회잡지

A 38-year-old woman with twin pregnancy was referred after detection of hydrocephalus in one fetus at 23+1 weeks' gestation. Sonography showed hydrocephalus, a scalloping of the frontal bone giving a lemon-like configuration, and meningocele. The affected twin was terminated by ultrasonographically guided intracardiac injection of 4 ml (8 mEq/L) potassium chloride solution at 24+5 weeks' gestation. Chromosomal analysis of the other fetus showed normal findings (46, XX). Serial ultrasound scans and coagulopathy tests were unremarkable. Preterm premature rupture of the membrane was developed at 33+3 weeks' gestation, and emergency Cesarian section was done. A healthy 1360 g female was born, with Apgar scores of 7 and 8 at one and five minutes, respectively.

Two Cases of Early Medical Abortion for Patients with Huge Myoma Uteri / 대한주산의학회잡지

No abstract available.

Clinical usefulness of transabdominal cervicoisthmic cerclage in IIOC patients for whom transvaginal cervicoisthmic cerclage is unsuitable / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to review the clinical use of transabdominal cervicoishmic cerclage to determine whether it is a valid alternative to transvaginal cerclage. Study design : A retrospective review was carried out of transabdominal cerclage patients at our hospital from Jan. 1999 to May. 2001. Analysis of the clinical use of transabdominal rather than the vaginal approach in some IIOC patients was performed and fetal outcomes was evaluated. RESULTS: Fifteen patients underwent transabdominal cerclages. The primary indication for transabdominal cervicoisthmic cerclage was failed transvaginal cerclage in 9 patients and anatomic unsuitability for transvaginal cerclage in 6 patients. Follow-up was conducted for all except one patient. All patients were successfully delivered of live babies by Cesarean section. Complications including blood loss requiring transfusion did not occur. However one baby died at postpartal 1 day because of congenital Tetralogy of Fallot. CONCLUSION: All patients had histories compatible with incompetent cervix requiring cerclage, and none were suitable candidates for vaginal cerclage. Our results and review of the literature confirm that Transabdominal cervicoisthmic cerclage has an important role to play for carefully selected patients.

Deep Venous Thrombosis in the Lower Extremity: Catheter-Directed Thrombolysis

PURPOSE: To evaluate the efficacy of catheter-directed thrombolysis in treating symptomatic deep venous thrombosis (DVT) in lower limbs. MATERIALS AND METHODS: Twenty-six consecutive patients (16 male and 10 female; mean age, 55 years) with lower extremity DVT underwent thrombolytic therapy. The duration of symptoms was 1 -90 (mean, 17) days: 20 days or less in 16 cases (acute DVT) and less than 20 days in ten (chronic DVT). Catheter-directed infusions of urokinase were administered via ipsilateral popliteal veins, and angioplasty or stent placement was performed after the thrombolytic procedure. Oral medication of warfarin continued for six months, and for the evaluation of venous patency, follow-up ultrasonography was performed. The total dose of infused urokinase was 1,750,000 -10,000,000 (mean 4, 84,000) IU, and the total procedural time was 25 -115 (mean, 64) hours. RESULTS: Lysis was complete in 16 cases (62%, all acute DVT), partial in five (19%, chronic DVT), and failed in five (19%, chronic DVT). Eight patients with venous stenosis and two with occlusion were treated by means of angioplasty (n=4) or Wallstent placement (n=6). Minor bleeding occurred in six cases and major complications in two (one of pulmonary embolism, and one of multiorgan failure). CONCLUSION: Catheter-directed thrombolysis with urokinase is effective for the treatment of DVT in lower limbs.

Diagnostic Usefulness of Tc-99m Tetrofosmin Scintimammography in Patients with Primary Breast Cancer / 대한핵의학회잡지

PURPOSE: The purpose of this study was to evaluate the diagnostic usefulness of scintimammography performed with Tc-99m tetrofosmin in the detection of primary breast cancer. MATERIALS AND METHODS: Sixty-one patients underwent Tc-99m tetrofosmin scintimammography, plain-filrn mammography and ultrasonography. After intravenous injection of Tc-99m tetrofosmin (740 MBq), prone lateral and anterior scintimammograms were obtained. Scintimammogram was visually interpreted as positive, probably positive, probably negative and negative for malignancy. The tumor to background count ratio (T/B) was measured at 5 minutes and 1 hour. Plain-film mammogram was interprcted as one of 5 categories. Final diagnosis was achieved by surgical histology (58/61) or fine needle aspiration (3/61). Of 61 patients, 44 had cancer and 17 had benign lesion. Tumor size of malignant and benign lesions on ultrasonogram were 2.51+/-1.30 cm (range 1-8 cm), 2.50+/-1.35 cm (range 0.96-6 cm), respectively. RESULTS: The sensitivity of plain-film mammography was 88.6%, specificity 58.8%, positive predictive value 84.7%, and negative predictive value 66.7%. The sensitivity of Tc-99m tetrofosmin scintimammography was 90.9%; specificity, 88.2%; positive predictive value, 94.9%; negative predictive value, 78.9%. Of 25 patients with indeterminate degree of suspicion for malignancy on plain-film mammogram, 23 were correctly diagnosed by scintimamography. The T/B at 5 minutes and 1 hour were 3.78+/-2.21, 3.25+/-1.80 respectively. The T/B was decreased significantly at 1 hour (p<0.001). CONCLUSION: Tc-99rn tetrofosrnin scintimammography was useful diagnostic procedure in the detection of primary breast cancer, especially in patients with indeterminate degree of suspicion for malignancy on plain-film mammogram.

Inflammatory Pseudotumor of the Liver: CT Findings

PURPOSE: To evaluate the CT features of inflammatory pseudotumor of the liver with histopathologiccorrelation. MATERIALS AND METHODS: The CT features of 14 cases (ten patients) with pathologically proveninflammatory hepatic pseudotumor were retrospectively analyzed and correlated with resected and biopsy specimens. RESULTS: The size of lesions ranged between 2.0 and 7.0cm (mean, 3.7cm); On unenhanced CT, the masses were seenas ill-defined hypodense lesions, while on contrast-enhanced CT they were heterogeneous and multiseptated, withenhancement of internal septa and peripheral wall (n=10). In four lesions, central low density and peripheralhomogeneous enhancement were seen. On histopathological correlation, the central hypoattenuated area correspondedto chronic inflammalory cell infiltrates with foamy histiocytes, plasmacytes, and lymphocytes, while thehyperattenuated peripheral wall and internal septa represented dense fibrosis. CONCLUSION: In patients in whon CTshows a heterogeneous enhancing mass, inflammatory pseudotumor of the liver should be included in differentialdiagnosis.

Transcatheter Arterial Embolization for Control of Hemoptysis in Pulmonary Tuberculosis: Analysis of Prognostic Factors

PURPOSE: To evaluate the effectiveness of transcatheter arterial embolization(TAE) and the relationshipbetween therapeutic effect and prognostic factors after this procedure. MATERIALS AND METHODS: Fifty-fivepatients with hemoptysis caused by pulmonary tuberculosis(TB) underwent TAE. We reviewed medical records of thehistory and activity of pulmonary TB, and the extent of treatment, and assessed plain chest PA for the extent oflesions ; we also evaluated the angiographic findings of embolized arteries, and embolic agents. The initialsuccess rate, as shown by immediate response, and recurrence during follow-up, were then observed. Using theChi-square test, differences in these findings were analysed. RESULTS: Immediate control of hemoptysis wasachieved in 46 of 55 patients(84%); 24 of 46(52.2%), experienced recurrence. Initial failure and partial responserates were higher in patients with active pulmonary TB(p<0.05) than in those in whom the condition was inactive.The recurrence rate was higher among those who had had pulmonary TB for between one and ten years (p<0.05). Therewas, however, no significant correlation between therapeutic effect and the extent of anti-TB treatment, theextent of lesions seen on plain chest PA, angiographic findings, embolized arteries, and embolic agents. CONCLUSION: The initial success rate of TAE was 84% and the recurrence rate was as high as 52.2%. Both activityand duration of pulmonary TB were prognostic factors in immediate response and recurrence.