The Significance of Inverted Tear-drop Sign in Cystography of Women with Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: A finding of only subtle open bladder neck unaccompanied by leakage at resting state, without any other symptoms suggesting overt intrinsic sphincter incompetence, is commonly observed during cystographic evaluation for women with stress urinary incontinence (SUI). We tried to define whether this finding has any clinical significance in aspect of intrinsic sphincter deficiency. MATERIALS AND METHODS: A retrospective study was undertaken in a series of women whose diagnoses were SUI in our hospital. The appearance of contrast medium in the proximal urethra at resting state without overt leakage on cystogram was named as inverted tear-drop (ITD) sign. Quantification of ITD sign was made by measuring vertical and anterior-posterior (AP) distances of this area. Various clinical and urodynamic parameters were compared between the patients who had inverted tear-drop sign (ITD group) and those not (non-ITD group). RESULTS: A total of 453 women underwent fluoroscopic cystography and ITD sign was observed in 273 (60.2%). Analyses were performed in a total of 290 women (ITD group 186, non-ITD group 104). There was a significant difference in mean age between non-ITD (47.0+/-9.4 years) and ITD group (51.7+/-9.5 years). Several clinical factors such as frequency, urgency, urge incontinence, duration of symptoms, parity, previous pelvic surgery, previous anti-incontinence surgery, urine leakage volume by one hour pad test were not significantly different between two groups. However, a ITD sign was significantly more likely to be in groups of patients with menopause and those with a low valsalva leak point pressure (VLPP). VLPP was significantly lower in ITD group (87.1+/-2.7cmH2O) than in non-ITD group (99.0+/-4.1cmH2O). VLPP in ITD group has a negative correlation with vertical (p=0.0001. r=-0.498) and AP length (p=0.0014, r=-0.23) of tear-drop area. Maximal urethral closure pressure was significantly lower in ITD group (48.2+/-1.4cmH2O) than in non-ITD group (56.2+/-2.0cmH2O). ITD group has more advanced types by Blaivas classification than non-ITD group. CONCLUSIONS: Our results suggest that cystographic ITD sign at rest might reflect some loss of intrinsic sphincter function. When surgeons are planning to operate SUI patients, ITD sign could be considered as an additional parameter in choosing operation method.

Analysis of Radiologic Findings to Predict the Histology of the Small Renal Tumors: A Retrospective Study / 대한비뇨기과학회지

PURPOSE: Recently, incidental small renal tumors detected by computerized tomography(CT) or ultrasonography(US) have been increasing. Differentiation between the small renal cell carcinoma and benign tumorous lesions is often difficult. To reduce the unnecessary surgical interventions for these small renal tumors, we anayzed the radiologic findings of surgically removed small renal tumors(less than 3cm in diameter) and evaluated whether radiologic studies would predict their histologic findings. MATERIALS AND METHODS: Radiologic findings of 28 renal cell carcinomas(RCC), 7 angiomyolipomas(AML), 4 cysts including 2 multilocular cysts and 1 oncocytoma were analyzed, retrospectively. Density, contour, and heterogenity of the tumors on CT were evaluated, while echogenecity, posttumoral enhancement, peritumoral hypoechoic rim, and intratumoral cystic change on US were evaluated. RESULTS: Tiny fat density on CT was found in 4 of 7 AMLs and 1 of 28 RCCs. On US, 3 of 6 AMLs and 1 of 24 RCCs showed marked hyperechogenecity identical to the renal sinus fat. AMLs showed fat density in 4 of 7(57.1%) on CT and marked hyperechogenecity in 5 of 7(71.4%) on US, respectively. Two AMLs which showed hypoechogenecity and no fat density had less than 5% of fat on histologic examination while others had more than 30% of fat. All AMLs, oncocytoma and most RCCs(73%) showed exophytically out-bulging growth pattern while all benign cysts showed endophytic growth. Posttumoral sonic enhancement was found in 3 of 4 cysts and 1 of 24 RCCs. Peritumoral hypoechoic rim and intratumoral cystic changes were identified in 8 of 24(33%) and 7 of 24(29%) RCCs, respectively, while no such findings were detected in other tumors and cysts. CONCLUSIONS: Fat density on CT or marked hyperechogenecity identical to renal sinus fat on US strongly suggest angiomyolipoma, whereas endophytic growth pattern and posttumoral enhancement on US favor benign cyst. In the meantime, absence of above findings combined with peritumoral halo and/or intratumoral cystic change indicate renal cell carcinoma which should be explored.

Analysis of Radiologic Findings to Predict the Histology of the Small Renal Tumors: A Retrospective Study / 대한비뇨기과학회지

PURPOSE: Recently, incidental small renal tumors detected by computerized tomography(CT) or ultrasonography(US) have been increasing. Differentiation between the small renal cell carcinoma and benign tumorous lesions is often difficult. To reduce the unnecessary surgical interventions for these small renal tumors, we anayzed the radiologic findings of surgically removed small renal tumors(less than 3cm in diameter) and evaluated whether radiologic studies would predict their histologic findings. MATERIALS AND METHODS: Radiologic findings of 28 renal cell carcinomas(RCC), 7 angiomyolipomas(AML), 4 cysts including 2 multilocular cysts and 1 oncocytoma were analyzed, retrospectively. Density, contour, and heterogenity of the tumors on CT were evaluated, while echogenecity, posttumoral enhancement, peritumoral hypoechoic rim, and intratumoral cystic change on US were evaluated. RESULTS: Tiny fat density on CT was found in 4 of 7 AMLs and 1 of 28 RCCs. On US, 3 of 6 AMLs and 1 of 24 RCCs showed marked hyperechogenecity identical to the renal sinus fat. AMLs showed fat density in 4 of 7(57.1%) on CT and marked hyperechogenecity in 5 of 7(71.4%) on US, respectively. Two AMLs which showed hypoechogenecity and no fat density had less than 5% of fat on histologic examination while others had more than 30% of fat. All AMLs, oncocytoma and most RCCs(73%) showed exophytically out-bulging growth pattern while all benign cysts showed endophytic growth. Posttumoral sonic enhancement was found in 3 of 4 cysts and 1 of 24 RCCs. Peritumoral hypoechoic rim and intratumoral cystic changes were identified in 8 of 24(33%) and 7 of 24(29%) RCCs, respectively, while no such findings were detected in other tumors and cysts. CONCLUSIONS: Fat density on CT or marked hyperechogenecity identical to renal sinus fat on US strongly suggest angiomyolipoma, whereas endophytic growth pattern and posttumoral enhancement on US favor benign cyst. In the meantime, absence of above findings combined with peritumoral halo and/or intratumoral cystic change indicate renal cell carcinoma which should be explored.

Supply and Demand of Radiologists in Korea: Is it adequate?

Department of Choong Ang University College of Medicine PURPOSE: To assess adequate supply and demand for diagnostic radiologists in Korea in the future. MATERIALS AND METHODS: We analysed previous supply for residents of diagnostic radiology during the last eight years, and evaluated the cause and problems of increasing numbers of residents in diagnostic radiology in Korea. The appropriate numbers of residents in diagnostic radiology in Korea were estimated. RESULTS: The number of diagnostic radiologists in Korea in 1998 increased three times as compared with that in mid-1980s. The number of diagnostic radiologists in Korea in 1999 increased eight times as compared with that in 1980s. Causes of increasing numbers of residents of diagnostic radiology were increasing demand of residents in each hospital in the past, and limitation of control of the number by the Korean Radiological Society as well as the Korean Hospital Association. Problems of increasing number of residents of diagnostic radiology was decreasing quality of education and oversupply of diagnostic radiologists. The appropriate number of residents in diagnostic radiology in the future would be about 100 per year. CONCLUSION: A new plan and strategy for the appropriate supply and demand of diagnostic radiologists in Korea are needed.

Clinical Significance of Multiple Defects on DMSA scan in Recurrent Acute Pyelonephritis / 대한내과학회지

OBJECTIVES: This study was undertaken to evaluate associated underlying disease and follow-up changes of multiple cortical defects(MCD) in recurrent acute pyelonephritis(APN) patients with MCD on DMSA scan. METHODS: DMSA scan was performed in 128patients who visited Asan Medical Center with recurrent APN and 80patients showed MCD. Intravenous pyelography(IVP), ultrasound of the kidney(US), voiding cystourethrography(VCUG) were performed to search associated underlying diseases and changes of MCD were studied with follow-up DMSA scan at least 6 months after initial DMSA scan. RESULTS: 1) Underlying diseases were detected in 34patients, including vesicoureteral reflux in 21, renal stone in 4, renal tuberculosis in 3, ureteral stenosis in 3, renal infarction in 1, megaureter in 1, neurogenic bladder in 1, 2) Follow up DMSA scan revealed no changes in 14patients, improvement in 2. CONCLUSION: The patients with multiple defects on DMSa scan have underlying abnormalities in 42%, so they need more radiologic studies such as VCUG, IVP, US. Multiple defects indicate irreversible damage in most patients.

Triple detector SPECT imaging with 99mTc-DMSA in adult patients with urinary tract infection / 대한핵의학회잡지

No abstract available.

CT features of carcinoma of the pancreas: relativity to tumor sites

No abstract available.

CT findings of the hydatidiform mole

Even though ultrasonography is a primary tool for evaluation of gynecological pelvic mass, CT can be helpful when ultrasonography is suboptimal either because of abundant intestinal gas or marked obesity. Authors experienced 3 cases of hydatidiform mole demonstrated by CT. The findings of hydatidiform mole are enlargement of uterus, low density in the uterine cavity, irregular soft tissue mass with small multiple cysts, and strong contrast enhancement of the soft tissue mass within the uterine cavity. CT can be a useful diagnostic tool for differentiation of hydatidiform mole from choriocarcioma because of good visualization of uterine wall and pelvic structures.

Photodensitometric tracing of mach bands and its significance

Mach bands, a visual phenomenon resulting from lateral inhibitory impulsess in the retina, are recognized aslucent or dense lines at the borders of different radiographic densities. A number of clinical situations have been described in which Mach bands may cause difficulty in radiographic diagnosis. Photodensitometric measurement of the film can differentiate the true change in film density from the Mach band which is an optical illusion. Authors present several examples of photodensitometric tracings of Mach bands, with the brief review of themechanism of their production.

Real time ultrasonography in obstructive jaundice

Ultrasonography is a predominantly accurate, relatively simple unique diagnsotic method of obstructive jaundice. The ultrasonographic findings of obstructive jaundice are dilated intra- and extrahepatic duct with intraluminal hyperreflective echo or mass in and/or around the bile duct. The superiority of high resolution real time ultrasonography for the diagnosis of obstructive jaundice is based on the easy detectability of extra-and intrahepatic bile ducts by its multiple sectional images in a short time, the flexibility of probe and the small crystal size. Author evaluated real time sonographic findings 46 obstructive jaundice patients confirmed by surgery or radiographical examinations. The results were: 1. Diameter of extrahepatic duct in obstructive jaundice were varied from normal to 4.0 cm, mostly 8 to 10 mm in diameter (26%). Degree of dilatation of biliary duct appeared more prominent in cancer patients than any other causes of obstruction. 2. The site of obstruction was detected in85% (39/46) and its common site was common bile duct in 63% (29/46). 3. The diagnostic accuracy of choledocholithiasis and cancer was 82% (22/27) and 44% (4/9), respectively. Diagnostic accuracy of the real time ultrasonography in obstructive jaundice was over all 75% (34/46).

Computed tomographic findings of the pancreatitis

Computed body tomography has become useful in the diagnosis of pancreatic disease. It was found to be are liable, often specific, and noninvasive method for detecting pancreatitis and extra-pancreatic extension of the pathology. Of eight hundred and seventy-two cases studied for abdominal pathology with EMI-CT 5005 whole body scanner form Oct. 1977 to August 1980, 21 cases were confirmed to be pancreatitis clinically or operatively. The authors reviewed the CT findings of the above cases and the results were as follows; 1. Among twenty-one cases, the acute pancreatitis was 12 cases and the chronic pancreatitis was 9 cases. The sex ratio as 17 males to females. 2. In acute pancreatitis, diffuse enlargement of pancreas (11/12), focal enlargement (1/12), loss of peripancreatic fat plane (9/12), thickening of anterior of pararenal fascia (6/12), and smooth margin ofpancreas (5/12) were observed. 3. In chronic pancreatitis, parenchymal atrophy (7/9), normal size (2/9), loss of peripancreatic fat plane (3/9), thickening of anterior pararenal fascia (1/9), calcification (1/9), smooth margin (2/9), and serrated margin (6/9) were observed. 4. The complications were associated with 7 cases of acute pancreatitis and 1 case of chronic pancreatitis; pseudocyst (6), abscess (2), and fat necrosis (3), The sites of the pseudocyst were lesser sac (2), anterior pararenal space (2), posterior pararenal space (1), subhepatic region (1), greater omentum (1), and intrapancreatic region (2). All of them were associated with acute pancreatitis except one in chronic pancreatitis.