Treatment Case of Asymptomatic Prostate Tuberculosis That Developed After Bacillus Calmette-Guerin Intravesical Therapy in a Patient With Nonmuscle Invasive Bladder Cancer

Intravesical Bacillus Calmette-Guerin (BCG) therapy after transurethral resection of bladder tumor is considered the most effective treatment for prophylaxis against the recurrence of high risk nonmuscle invasive bladder cancer, and generally well tolerated and infectious complication are rare. We reported a case of granulomatous prostatitis is a patient who had undergone intravesical BCG therapy due to nonmuscle invasive bladder cancer. This patient was diagnosed by prostate biopsy because of prostate-specific antigen elevation without any other voiding symptoms and abnormal abscess pocket in transrectal ultrasonography.

Nontuberculous Mycobacterial Tenosynovitis in the Hand: Two Case Reports with the MR Imaging Findings

Nontuberculous mycobacterial infections can cause destructive tenosynovitis of the hand. We report on and discuss the clinical course and distinctive radiologic findings of two patients with hand tenosynovitis secondary to M. marinum and intracellulare infection, which are different from those of the nontuberculous mycobacterial infections reported in the previous literature.

Slot-Scan Digital Radiography of the Lower Extremities: a Comparison to Computed Radiography with Respect to Image Quality and Radiation Dose

OBJECTIVE: To compare the slot-scan digital radiography (SSDR) of the lower extremity region and the computed radiography (CR) method with respect to the image quality and radiation exposure. MATERIALS AND METHODS: We enrolled 54 patients who underwent both the SSDR and CR of the lower extremities. The study evaluated and statistically compared the image quality of four features (outer cortex, inner cortex, trabeculae and intermuscular fat) at six different levels (pelvis, hip, femur, knee, tibia and ankle) between each method. The image quality was evaluated using a visibility scale, and the entrance skin dose was measured using a dosimeter at three different levels of a phantom (hip, knee, and ankle). RESULTS: The mean image visibility scale values for the SSDR method were significantly higher than for the CR method. The entrance skin dose for the SSDR method was 278 micro Gy at each level, compared to the entrance skin doses of the CR method, which were 3,410 micro Gy for the hip, 1,152 micro Gy for the knee, and 580 microGy for the ankle. CONCLUSION: Both the image quality and patient entrance skin dose data suggest that the SSDR method is superior to the CR method for the lower extremity musculoskeletal examination.

The Effect of Intensive Oral Hygiene Care on Gingivitis and Periodontal Destruction in Type 2 Diabetic Patients

PURPOSE: This study aimed to investigate the effects of oral hygiene care by oral professionals on periodontal health in type 2 diabetes mellitus patients. MATERIALS AND METHODS: Diabetic participants were recruited at a university hospital and matched at a 1:1 ratio by age and gender, and randomly allocated into intervention (40 people) and control groups (35 people). Tooth brushing instruction, oral health education, and supra-gingival scaling were implemented in all patients at baseline. This program was repeatedly conducted in intervention patients every month for 6 months, and twice at baseline and the sixth month in the control. Oral health was measured by decayed, missing, and filled teeth (DMFT), plaque index, calculus index, bleeding index, patient hygiene performance (PHP) index, tooth mobility, Russel's periodontal index, and community periodontal index (CPI). Diabetes-related factors, oral and general health behaviors, and sociodemographic factors were interviewed as other confounding factors. An analysis of covariance (ANCOVA) was used with SPSS for Windows 14.0. RESULTS: At baseline, there were no significant differences between the two groups in average of periodontal health (calculus index, bleeding index, Russel's periodontal index, CPI, and tooth mobility), diabetes-related factors (fasting blood glucose, postprandial blood glucose, and HbA1c), and in distribution of sociodemographic factors and health behaviors. In intervention group, plaque index, dental calculus index, bleeding index, and PHP index were reduced fairly and steadily from the baseline. There were significant differences in plaque index, dental calculus index, bleeding index, PHP index, and Russel's periodontal index between the two groups at sixth month after adjusted for baseline status. CONCLUSION: Intensive oral hygiene care can persistently improve oral inflammation status and could slow periodontal deterioration.

Obturator Externus Bursitis: Cases report

The obturator externus bursa has been described as a potential bursa between the tendon of the obturator externus muscle and the posterior hip capsule. Although pathologic involvement of the iliopsoas bursa by intraarticualr hip disease has been extensively described, obturator externus bursa has not been fully investigated. We describe a patient who presented with hip pain and limited range of motion. Her magnetic resonance imaging of pelvis revealed an enhancing cystic lesion that extends inferomedially displacing obturator externus muscle and mild synovitis of the right hip. She was diagnosed as having obturator externus bursitis, and after symptomatic treatment pain and limited range of motion disappeared. The obturator externus bursa is a potential communication of the hip joint, can be a site of disease spread from the hip joint, and can be identified with magnetic resonance imaging.

Non-Functional Retroperitoneal Paraganglioma Mimicking an Ovary Mass: A Case Report

The paraganglioma is rare neuroendocrine tumor arising from paraganglionic tissue and most cases show characteristic endocrinological symptoms that are caused by catecholamine secretion. We report here on a case of nonfunctioning retroperitoneal paraganglioma that did not show any neuroendocrine symptoms, and this was misdiagnosed as ovarian tumor by ultrasonography and CT.

Non-Functional Retroperitoneal Paraganglioma Mimicking an Ovary Mass: A Case Report

The paraganglioma is rare neuroendocrine tumor arising from paraganglionic tissue and most cases show characteristic endocrinological symptoms that are caused by catecholamine secretion. We report here on a case of nonfunctioning retroperitoneal paraganglioma that did not show any neuroendocrine symptoms, and this was misdiagnosed as ovarian tumor by ultrasonography and CT.

Ultrasonographic Diagnosis of the Hand and Wrist Joint

the hand and wrist. This action during sonographic examination not only help to diagnosis to examiner to the anatomic structures, but also localize the pathologic process to a target organ. This chapter will describe the sonographic findings associated with the most common hand and wrist pathologic conditions.

Double Contrast Media enhanced MRI with Ferumoxides-Gadolinium on Hepatocellular Carcinoma

PURPOSE: To evaluate the effects of Ferumoxides on Gadolinium (Gd) enhanced dynamic liver magnetic resonance imaging (MRI) in cirrhotic patients and also for the diagnosis of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: 29 patients with liver cirrhosis were examined at 1.5T. 12 patients had HCC. The imaging protocol included GE T1 in and opposed phases, and a breath-hold TSE T2 before and 30-60 min following 0.05 ml/kg Ferumoxides. Four dynamic in-phase GE series were also acquired after an injection of 20 ml of Gd at 2 ml/sec. SNR and CNR were calculated for liver lesion relative to the muscle and background liver respectively. Statistical analysis was performed using the paired t-test. RESULTS: The SNR of the liver decreased by 8.6+/-1.20 (p<0.001) after Ferumoxides injection. At the peak of the Gd effect, the liver increased by 6.09+/-1.15 relative to the post Ferumoxides, but it was not significantly different from the pre-Ferumoxides study (p<0.01). Although there was no significant change in post Ferumoxides SNR of HCC, CNR of HCC relative to the liver increased by 7.54+/-1.61 (p<0.05). After the Gd injection, CNR of HCC increased by 15.6+/-3.87 (p<0.05). CONCLUSION: The administration of Ferumoxides made HCC CNR increase, and it canceled the effect of Gd enhancement of the cirrhotic liver. The combination of Ferumoxides and Gd makes HCC CNR increase.

MR Imaging with Gd-DTPA Enhancement in the Testicular Ischemia in Rat Model: Evaluation of Testicular Viability

PURPOSE: To find the magnetic resonance (MR) imaging patterns and to determine the viability in normal, infracted and reversible ischemic testis of the rat. MATERIALS AND METHODS: Fifteen Sprague-Dawley rats were examined and they were divided into four groups. Group 1 was the control group, group 2 had a complete testicular artery ligation, group 3 had a complete ligation with reperfusion after 1 hour and group 4 had a complete ligation with reperfusion after 12 hours. All four groups were imaged every 5 minutes for 30 minutes. Delayed MR imaging was obtained every 30 minutes for 90 minutes. Two follow-up MR images were performed in all groups at a one-week interval. The signal intensity was measured in the normal testis, ischemic testis, and in muscle, water and fat in every rat at each time, with the phantom attached near the scrotum during the scanning. The signal intensities were analyzed statistically. RESULTS: On initial and 2-week follow-up examinations, the pattern of change differed among four groups (p<0.001). Group 1 and Group 3 did not show any marked change over time at each examination. Group 3 showed strong enhancement at the first week follow-up. Group 2 showed steadily delayed enhancement at each examination. Group 4 had same pattern with the Group 2 with higher enhancement intensity in parallel. CONCLUSION: MR images with Gd-DTPA could be useful for the diagnosis of damaged testicular tissue and for the determination of testicular viability.

Usefulness of Multidetector-row CT in the Evaluation of Reperfused Myocardial Infarction in a Rabbit Model

OBJECTIVE: To evaluate the usefulness of multidetector-row computed tomography (CT) in the evaluation of reperfused myocardial infarction. MATERIALS AND METHODS: Eleven rabbits were subjected to 90-min occlusion of the left anterior descending coronary artery followed by reperfusion. Multidetector-row CT was performed 31 hours+/-21 after the procedure and preand post-contrast multiphase helical CT images were obtained up to 10 min after contrast injection. The animals were sacrificed after 30 days and histochemical staining of the resected specimens was perfomed with 2'3'5-triphenyl tetrazolium chloride (TTC). RESULTS: In all 11 cases, the areas of myocardial infarction demonstrated with TTC-staining were identified on the CT images and the lesions showed hypoenhancement on the early phases up to 62 sec and hyperenhancement on the delayed phases of 5 min and 10 min compared with normal myocardial enhancement. The percentage area of the lesion with respect to the left ventricle wall on CT was significantly correlated with that of the TTC-staining results (p < 0.001 for both early and delayed phase CT) according to the generalized linear model analysis. The areas showing hypoenhancement on early CT were significantly smaller than those with hyperenhancement on delayed CT (p < 0.0001). CONCLUSION: Multidetector-row CT may be useful in the detection and sizing of reperfused myocardial infarction.

The Oxidation Process of Red Blood Cells and the Molecules Involved in their Binding to Macrophage

BACKGROUND AND OBJECTIVES: Controversy exists about the characteristics of the lipid-oxidizing process, and the molecules in oxidized lipids that are involved in the binding and uptake to macrophages, in atherosclerosis. The aim of this study was to find answers to these questions using oxidized red blood cells (ox-RBCs). MATERIALS AND METHODS: The RBCs were oxidized in the presence of various concentrations of CuSO4, and the degree of oxidation evaluated by the semiquantitative measurement of the thiobarbituric acid reactive substance (TBARS). The ox-RBC was characterized using annexin-V and flow cytometry. The relationships between the CuSO4 concentration, the degree of oxidation, characteristics of the ox-RBC and it's binding to macrophages transformed from THP-1 cells, were evaluated. RESULTS: The RBCs were oxidized, not by their gradual changes, but by the sudden transformation of a proportion of the RBCs in relation to the CuSO4 concentration. There were few RBCs between oxidized and non-oxidized groups. The annexin-V bound only to the ox-RBC, with a similar degree of binding in all ox-RBCs. The binding of ox-RBC to macrophages was completely inhibited by oxidized low density lipoprotein, which was directly related to the CuSO4 concentration, the TBARS and the proportion of ox-RBC. CONCLUSION: These results suggest that the oxidation of lipids might be an on-off phenomenon process. Molecules that have the ability to bind annexin-V, presumptively phosphatidyl serine, may be involved in the process of binding the ox-lipids to macrophages. Further study will be needed to clarify these molecules.

Metastatic Tumor of the Pancreas: Helical CT Findings

PURPOSE: To analyze the helical computed tomographic (CT) findings of distant metastatic tumors to the pancreas and to determine the differential points between these and primary pancreatic carcinomas. MATERIALS AND METHODS: We surveyed 22 patients with metastatic tumor of the pancreas, proven on the basis of clinical and pathological findings. Seventeen patients were men, and five and five were women, and their ages ranged between 36 and 83 years. Their primary conditions were lung cancer (n=15), rectal cancer (n=2), melanoma of the foot, chondrosarcoma of the sacrum, cervical cancer, leiomyosarcoma of the uterus, and ex-tragonadal choriocarcinoma of the mediastinum. We retrospectively reviewed the abdominal helical CT findings, analysing the number, location, size and attenuation of masses, as well as secondary change, which included dilatation of the pancreatic and biliary ducts and invasion of peripancreatic tissue or vessels. We also evaluated the differential findings of primary pancreatic cancer. RESULTS: Sixteen patients had a solitary focal mass, while in five, two masses. were present. Among the 22 patients, low-density nodular masses were present in 21; in the other, in whom multiple metastasis from chon-drosarcoma had occurred, there was dense calcification. The size of metastatic masses varied, ranging from 0.6 to 6 cm in diameter. The pancreatic duct proximal to the mass was dilated in ten cases, while the bile duct was dilated in six. The metastatic masses demonstrated no peripancreatic or vascular invasion, though they showed a discrete margin and contour bulging. CONCLUSION: Single metastasis to the pancreas was most common, and metastatic masses had a discrete margin, with contour bulging. There was no peripancreatic or vascular invasion. If the metastasis involved a single low-attenuated mass, however, with pancreatic or biliary dilatation, it was difficult to differentiate this from primary pancreatic cancer.

Adenomatous Hyperplasia of the Liver: Triple-phase Helical CT Findings

PURPOSE: To evaluate the triple-phase helical CT findings of adenomatous hyperplasia of the liver. MATERIALS AND METHODS: Forty-seven cases of adenomatous hyperplasias (size range: 8 -45 mm, mean: 14mm) in nineteen patients were confirmed by histologic examination following surgery (n=32) or gun biopsy (n=15) and formed the basis of this study. All patients underwent helical CT scanning involving the injection of 100mL nonionic contrast material at a rate of 3mL/sec. Hepatic arterial, portal venous, and equilibrium phase CT images were obtained 30, 60, and 180 seconds, respectively, after the start of contrast injection. The attenuation of each nodule (hyper-, iso-, hypo-, or mixed) was retrospectively determined and the detection rate according to lesion size (> or =14mm or or =14mm) and 76 % (16/21) in the large size group(< 14mm). This rate was thus significantly higher in the large size group than in that in which lesions were small. CONCLUSION: Triple -phase helical CT revealed that in cases of adenomatous hyperplasia, attenuation was variable,with iso-attenuation the most frequent type. Seventy-six percent of nodules larger than 14 mm were detected. Adenomatous hyperplasia may be seen during the hepatic arterial phase as a hyper-attenuated nodule.

Interventional Radiologic Placement of Tunneled Central Venous Catheters: Results and Complications in 557Cases

PURPOSE: To evaluate prospectively the results of interventional radiologic placement of tunneled centralve-nous catheters, and subsequent complications. MATERIALS AND METHODS: Between April 1997 and April 1998, a totalof 557 tunneled central venous catheters were percutaneously placed in 517 consecutive patients in aninterventional radiology suite. The indications were chemotherapy in 533 cases, total parenteral nutrition in 23and transfusion in one. Complications were e-valuated prospectively by means of a chart review, chest radiography,central vein angiography and blood/catheter culture. RESULTS: The technical success rate for tunneled centralvenous catheter placement was 100% (557/557 cases). The duration of catheter placement ranged from 4 to 356 (mean,112 +/-4.6) days; Hickman catheters were re-moved in 252 cases during follow-up. Early complications included 3cases of pneumothorax(0.5%), 4 cases of local bleeding/hematoma(0.7%), 2 cases of primary malposition(0.4%), and 1case of catheter leakage(0.2%). Late complications included 42 cases of catheter-related infection(7.5%), 40 casesof venous thrombosis (7.2%), 18 cases of migration (3.2%), 5 cases of catheter / pericatheter of occlusion(0.8%),and 1 case of pseudoa-neurysm(0.2%) . The infection rate and thrombosis rate per 1000 days were 1.57 and 1.50,respectively. CONCLUSIONS: The technical success rate of interventional radiologic placement of tunneled centralvenous catheters was high. In comparison to conventional surgical placement , it is a more reliable method andleads to fewer complications.

Bronchiectasis: Diagnostic Accuracy of Chest Computed Radiography

PURPOSE: The aim of this study was to assess the diagnostic accuracy of chest comput-ed radiography for thedetection of bronchiectasis diagnosed by high-resolution CT. MATERIALS AND METHODS: Our study included 100consecutive patients with bronchiec-tasis and 20 normal subjects, all seen on high-resolution CT. Two independentobservers analyzed chest computed radiographs and recorded the presence and type of bronchiectasis, and the invo lved lobe. RESULTS: On high-resolution CT, bronchiectasis was seen in one lobe in 29 patients, two lobes in 29,three lobes in 16, four lobes in 14, five lobes in 10, and six lobes in t wo. The bronchiectasis was tubular in 55patients, mixed tubular and cystic in 29, and cystic in 16. For observer 1, the sensitivity, specificity, andaccuracy of chest com-puted radiography was 95%, 85%, and 93%, respective l y, while for observer 2, thecorresponding figures were 93%, 85%, and 92%. Sensitivity and specificity for observ-er 1 were 33% and 96% for theright upper lobe (46% and 95% for observer 2), 68% and 86% for the right middle lobe (76% and 86%), 70% and 78%for the right lower lobe (48% and 83%), 50% and 100% for the left upper lobe (50% and 97%), 63% and 90% for thelingular segment (49% and 93%), and 87% and 75% for the left lower lobe (75% and 90%), respective l y. Tubularbronchiectasis involving a single lobe was the most common source of false negative readings based on the findingsof chest com-puted radiography. CONCLUSION: Because chest computed radiography is not inferior to high-resolutionCT for the detection of bronchiectasis, the routine use of chest computed radiography in screening forbronchiectasis is feasible. Howeve r, due to its low sensitivity in detect-ing bronchiectasis in a specific lobe,preoperative high-resolution CT examination may be needed.

Value of MR Imaging after CT in Patients with Focal Hepatic Lesion

PURPOSE: To determine the usefulness of magnetic resonance imaging (MRI) after computed tomography (CT) inpatients with focal hepatic lesion. MATERIALS AND METHODS: We evaluated 100 patients with 103 focal hepaticlesions. The diagnosis of each lesion was made pathologically (n=19), or radiologically and clinically (n=84), andthe findings were as follows: he-mangioma (n=53), hepatocellular carcinoma (n=17), metastasis (n=10), cyst (n=5),regenerative nodule (n=3), and adenomatous hyperplasia (n=3). The patients underwent conventional CT (n=25),two-phase spi-ral CT (n=17) or three-phase spiral CT (n=61). MRI was performed using conventional T1- andT2-weighted imaging and dynamic contrast enhancement. The value of MRI after CT was assigned to one of fourgrades, according to the consensus of three radiologists: grade I (decisive), grade II (helpful), grade III (notadditional), or grade IV (confused). RESULTS: The outcome of MRI of 103 lesions was grade I in 14 cases(14%), IIin 34 (33%), III in 49 (48%), and IV in 6 (6%). MRI was not helpful (grade III or IV) in 40% (10/25), 47% (8/17),and 61%(31/61) of lesions after conventional, two-phase spiral, and three-phase spiral CT, respectively. Grade IIIor IV lesions were present in 45% of hemangiomas (24/53), 59% of hepatocellular carcinomas (10/17), and 80% ofcases in which metastasis had occurred(8/10). CONCLUSION: MRI after CT in patients with focal hepatic lesion washelpful in less than half of all cases. It was particularly valuable for patients who did not undergo three-phasespiral CT and in whom hemangioma was suspected.

Estimation of Kidney Size by Ultrasonography in Normal Korean Adults / 대한신장학회잡지

BACKGROUND: The kidney size is important in differentiating many renal diseases. Some studies have been reported about the normal kidney size in the foreign countries. However, no studies were performed by using ultrasonography in Korea. Therefore, we investigated the normal kidney length, the factors affecting the kidney length and the relationship of each other. METHODS: One thousand three hundred eighty eight healthy Koreans were scanned for the kidney length by ultrasonography and were measured for their body index(height, weight, body surface area, total body water, and fat free mass). We analyzed the association between kidney length and body index. RESULTS: Eight hundred four male and five hundred eighty four female were involved in this study and their mean age was 47.8+/-10.3 in male, 48.1+/-9.5 in female. 1) The average value of left and right kidney was 10.65+/-0.80cm, 10.50+/-0.78cm respectively, and the left kidney was greater than right one(P<0.01). 2) The difference between male and female was 10.77+/-0.79cm, 10.49+/-0.78cm respectively in the left kidney and 10.66+/-0.76cm, 10.27+/-0.75cm in the right kidney(P<0.01). 3) The aging process nearly does not affects the kidney size from 4th decade to 7th decade. However, the kidney size is getting smaller after 8th decade. 4) The correlation coefficient between the kidney size and height, weight, body surface area, total body water, fat free mass was 0.37, 0.41, 0.43, 0.37, 0.38(P<0.01) respectively. CONCLUSION: The kidney length showed normal distribution in normal Korean adult and the length greater than 12.36cm, smaller than 8.76cm means out of its range of normal(+/-2SD) irrespective of sex and position. The body surface area has the largest correlation with kidney size in both sex(r=0.38/0.44; left/right, P<0.01).

Hepatic Abscess: Three-Phase Helical CT Appearance

PURPOSE: The purpose of this study was to evaluate the enhancement patterns and morphologic features ofhepatic abscesses, as seen on three-phase helical CT images. MATERIALS AND METHODS: Three-phase helical CT imagesof 22 clinically and pathologically proven hepatic abscesses more than 3 cm in diameter in 21 patients wereretrospectively reviewed. Three-phase helical CT scans were obtained at 30 sec(hepatic arterial phase, AP), 70sec(portal venous phase, PP) and 3 min(equilibrium phase, EP) after the start of intravenous infusion of contrastmaterial. We analyzed the number of abscess layers and their enhancement patterns during each phase, and evaluatedthe size and shape of abscess, the CT attenuation and presence of septae in the abscess cavity, and the thicknessand maturation of the granulation layer and collagenous wall. RESULTS: AP images showed that 13 abscesses(59%)had four layers; on PP images, half the abscesses were seen to have three layers, while EP images showed thattwo-thirds had two layers. Among the 13 abscesses with four layers seen on AP images, all abscess cavities andgranulation layers were hypo- and hyperattenuating, respectively, during all three phases. Most hypoattenuatingcollagenous walls seen on AP images became iso- or hyperattenuating on EP images, while hyperattenuatinghyperperfusion zones seen on AP images became isoattenuating during later phases. The degree of maturation of thecollagenous wall correlated with the number of abscess layers. CONCLUSION: As seen on AP, PP and EP three-phasehelical CT images, hepatic abscess frequently had four, three, or two layers respectively. More mature collagenouswalls tended to have more abscess layers.

Clinical significance of gastroptosis in functional dyspepsia / 대한내과학회지

The purposes of this study were to assess the relationship between functional dyspepsia (FD) and the gastroptosis which was considered as one of the causes of FD by some physicians in Korea and to evaluate the possibility that gastroptosis was directly related to the relatively decreased abdominal fat content. METHODS: 442 subjects taken upper gastrointestinal barium series (UGIS) for routine check-up were interviewed about symptoms of FD by physicians on the basis of Rome criteria. Various parameters of obesity were also collected from 366 subjects. Gastroptosis was diagnosed by radiologists when the gastric angle was located below the Jacobys line. RESULTS: Gastroptosis was found in 23 (5.2%) of 442 subjects. Relationship between gastroptosis and FD was rejected statistically because 3 (5.8%) of 52 subjects with FD had gastroptosis but 20 (5.1%) of 390 subjects without FD also showed gastroptosis. Various parameters of obesity such as body mass index (20.6+/-2.6, 23.8+/-2.8), % body fat (23.4+/-6.1%, 28.2+/-6.6%), % ideal body weight (97.9+/-12.6%, 112.6+/-14.0%), waist to hip ratio (0.855+/-0.096, 0.900+/-0.070) and weight (53.5+/-8.2 kg, 62.5+/-9.6 kg) in subjects with and without FD showed that the gastroptosis was more frequent in subjects with low values in parameters of obesity. But on multivariate analysis, only body mass index was the independent factor related to gastroptosis. CONCLUSION: Gastroptosis is not a cause of FD but is thought to be a constitutional problem related to low values in parameters of obesity.