Preoperative Assessment of Mesorectal Fascial Involvement in Patients with Rectal Cancer: The Diagnostic Value of MDCT for Measuring the Mesorectal Fascial Thickness

PURPOSE: To assess the diagnostic value of the use of multi-detector row computed tomography (MDCT) in evaluating mesorectal fascial (MRF) involvement in patients with T3 stage rectal cancer. MATERIALS AND METHODS: From September 2005 to June 2006, we enrolled 21 patients with T3 stage rectal cancer. In addition, 21 healthy patients were enrolled in a control group. Two radiologists measured the mean MRF thickness independently. We considered positive MRF involvement when the MRF thickness exceeded 4 mm, and then we measured the MRF thickness of patients with T3 rectal cancer. We analyzed interobserver agreement for the measured MRF thickness of the control group and assessed the diagnostic value of 4 mm, 5 mm and 6 mm as references in predicting MRF involvement. RESULTS: The mean MRF thickness of the control group was 3.24+/-0.50 mm (radiologist 1) and 3.04+/-0.51 mm (radiologist 2). Using 4 mm, 5 mm and 6 mm as a reference thickness in predicting MRF involvement, sensitivity was 100%, 100% and 28.57%, specificity was 71.43%, 85.71% and 92.86%, the false negative rate (FNR) was 0%, 0% and 71.43%, the false positive rate (FPR) was 28.57%, 14.29% and 7.14%, the negative predictive value (NPV) was 100%, 100% and 72.2%, the positive predictive value (PPV) was 63.64%, 77.78% and 66.7%, and the accuracy was 80.95%, 90.48% and 71.43%. CONCLUSION: Preoperative assessment of the MRF thickness on MDCT is beneficial in predicting MRF involvement in patients with advanced rectal cancer and a value of 5 mm as a reference MRF thickness was established.

Peritoneal Lymphomatosis: Case Report

Peritoneal lymphomatosis is a rare manifestation of high grade lymphomas. Although it is difficult to differentiate peritoneal lymphomatosis from other peritoneal diseases such as peritoneal carcinomatosis and leiomyomatosis clinically and radiologically, it should be included in differential diagnosis because the disease is curable with chemotherapy. Consequently, radiologic diagnosis plays a very important role in the detection of this disease. We experienced two cases of peritoneal lymphomatosis with primary gastrointestinal lymphomas in the distal ileum. The two patients were 25 and 50-year-old males. Abdominal CT, ultrasound and barium study were performed on both patients. Both patients had non-Hodgkin's lymphoma confirmed with open or sonographically guided biopsies. Although radiologic appearances overlapped, characteristic findings of long-segmental circumscribed annular mass, aneurysmal luminal dilatation, small to moderate amount of ascites without septation or loculation, diffuse involvement of mesentery, omentum and peritoneum, and enlarged lymph nodes were helpful in narrowing the range of possible diagnoses.

Usefulness of Combined Fat- and Fluid-Suppressed SPIR-FLAIR Images in Optic Neuritis: Comparison with Fat-Suppressed SPIR or STIR Images or STIR images

PURPOSE: To compare the usefulness of combined fat- and fluid-suppressed selective partial inversion recovery-fluid attenuated inversion recovery(SPIR-FLAIR) images in the detection of high signal intensity of the optic nerve in optic neuritis with that of fat-suppressed selective partial inversion recovery(SPIR) or short inversion time inversion recovery(STIR) images. MATERIALS AND METHODS: Two radiologists independently analyzed randomly mixed MR images of 16 lesions in 14 patients (M:F=7:7; mean age, 40years) in whom optic neuritis had been clinically diagnosed. All subjects underwent both SPIR-FLAIR and fat-suppressed SPIR or STIR imaging, in a blind fashion. In order to evaluate the optic nerve, coronal images perpendicular to its long axis were obtained. The detection rate of high signal intensity of the optic nerve, the radiologists' preferred imaging sequences, and intersubject consistency of detection were evaluated. 'High signal intensity' was defined as the subjective visual evaluation of increased signal intensity compared with that of the contralateral optic nerve or that of white matter. RESULTS: The mean detection rate of high signal intensity of the optic nerve was 90% for combined fat- and fluid-suppressed SPIR-FLAIR images, and 59% for fat-suppressed SPIR or STIR images. In all cases in which the signal intensity observed on SPIR-FLAIR images was normal, that on fat-suppressed SPIR or STIR images was also normal. The radiologists preferred the contrast properties of SPIR-FLAIR to those of fat-suppressed SPIR or STIR images. CONCLUSION: In the diagnosis of optic neuritis using MRI, combined fat- and fluid-suppressed SPIR-FLAIR images were more useful for the detection of high signal intensity of the optic nerve than fat-suppressed SPIR or STIR images. For the evaluation of optic neuritis, combined fat- and fluid-suppressed SPIR-FLAIR imaging is superior to fat-suppressed SPIR or STIR imaging.

MR Findings of Calvarial Eosinophilic Granuloma

PURPOSE: The purpose of this study was to evaluate the MR findings of calvarial eosinophilic granuloma. MATERIALS AND METHODS: We reviewed the MR imaging studies of nine patients [M:F=3:6, aged 6 -35 (mean, 20.5) years] with pathologically proven eosinophilic granuloma in the calvaria. The findings were evaluated for involvement of the diploic space, changes in adjacent bone marrow, distinction of the transitional zone, pattern of bone destruction, signal intensity and contrast enhancement of the tumor, and contrast enhancement of the adjacent dura. RESULTS: All lesions involved the diploic space, showed no change in adjacent bone marrow, and had a distinct transitional zone. In most (8/9) cases there was asymmetric bony destruction. On T1-weighted images, signal intensities of the tumors varied, while on T2-weighted images, hyperintensity was observed in seven cases, isointensity in one, and hypointensity in one. After the administration of contrast material, enhancement was homogeneous in four cases and inhomogeneous in five. Enhancement of the adjacent dura was demonstrated in all nine cases. CONCLUSION: The characteristic MR findings of calvarial eosinophilic granuloma are variable signal intensity on T1WI, high signal intensity on T2WI, and marked contrast enhancement; in addition, there is a distinct transitional zone, asymmetrical bony destruction, and associated dural enhancement.

The Use Contrast-Enhanced Color Doppler Ultrasonography in the Detection of Hepatocellular Carcinoma-Related Vessels

PURPOSE: To assess the value of contrast-enhanced color Doppler ultrasonography(US) in the detection of ves-sels related to hepatocellular carcinoma(HCC). MATERIALS AND METHODS: Between July 1997 and April 2000, 76 HCCs in 70 patients (50 men and 20 women; mean age, 57.8 years) were confirmed histologically or clinically. Tumor site and size at gray scale US, and afferent, intratumoral and efferent color signals at precontrast and postcontrast color Doppler US were deter-mined. Afferent signals were classified as basket or penetrating type, and intratumoral signals as spotty, linear or mixed. Efferent signals were categorized as signal to portal vein or signal to hepatic vein, and postcontrast color signal changes as focal, general or marginal spotty type. We also measured the color percentage of intra-tumoral signals as seen during precontrast and postcontrast study. RESULTS: The detection rate changed from 41(53.9%) to 60(78.9%) in cases with afferent signals, from 50(65.8%) to 64(84.2%) in those with intratumoral signals, and from 6(7.9%) to 9(11.8%) in those with efferent signals. Overall, 74(97.4%) cases showed positive findings at postcontrast color Doppler US. The most common enhancing pattern was general, occurring in 33(43.4%) cases. The color percentage of intratumoral signals increased from an average of 8.2% to 34.9%. The detection rate of intratumoral signals from tumors less than 3 cm in diameter increased from 56.8% to 100%, and that of deeply-located tumor-related signals (17 cas-es) increased from 47.1% to 94.1%. CONCLUSION: The use of contrast enhanced color Doppler US increased the detection rate of afferent, intratumoral, and efferent signals, especially that of intratumoral signals from tumors less than 3 cm in diameter and signals from deeply located tumors. In addition, the modality can aid the diagnosis of HCC by evaluating tumor dynamics.

The Use of Contrast-Enhanced Color Doppler Ultrasound in the Differentiation of Retinal Detachment from Vitreous Membrane

OBJECTIVE: To compare the clinical utility of contrast-enhanced color Doppler US in the differentiation of retinal detachment (RD) from vitreous membrane (VM) with that of various conventional US modalities, and to analyze the enhancement patterns in cases showing an enhancement effect. MATERIALS AND METHODS: In 32 eyes examined over a recent two-year period, RD (n=14) and VM (n=18) were confirmed by surgery (n=28) or clinical follow-up (n=4). In all cases, gray-scale, color Doppler, and power Doppler US were performed prior to contrast injection, and after the intravenous injection of Levovist (Schering, Berlin) by hand for 30 seconds at a dose of 2.5 g and a concentration of 300 mg/mL via an antecubital vein, contrast-enhanced color Doppler US was performed. At Doppler US, the diagnostic criterion for RD and VM was whether or not color signals were visualized in membranous structures. RESULTS: Diagnostic accuracy was 78% at gray-scale US, 81% at color Doppler US, 59% at power Doppler US, and 97% at contrast-enhanced color Doppler US. The sensitivity of color Doppler US to color signals in RD increased from 57% to 93% after contrast enhancement. The enhancement patterns observed were signal accentuation (n=3), signal extension (n=2), signal addition (n=3), and new signal visualization (n=5). CONCLUSION: Contrast-enhanced color Doppler US was the most accurate US modality for differentiating RD from VM, showing a significantly increased signal detection rate in RD.

Evaluation of Therapeutic Effect of Acoustic Schwannoma After Gamma-Knife Radiosurgery using Follow-up MRI

PURPOSE: To evaluate, using short-term follow-up MR imagings, the usefulness of gamma-knife radiosurgery in patients with acoustic schwannoma. MATERIALS AND METHODS: In 34 patients (M:F=11:23, aged 11 -69 years) with acoustic schwannoma, eleven of whom had undergone microsurgical resection prior to gamma-knife radiosurgery, we retrospectively reviewed the serial MR imaging findings obtained before and after this procedure. Analysis focused on post-surgical changes in tumor volume and intratumoral enhancement, and the follow-up period ranged from 3 to 44 months. RESULTS: Follow-up imaging revealed that after radiosurgery, tumor size had decreased in 17 cases (50%), was unchanged in 14 (41.2%), and had increased in three (8.8%). Local tumor control was achieved in 31 of 34 cases (91.2%). Objectively defined tumor shrinkage was seen within 3 to 24 (median, 12) months of treatment, the rate of shrinkage increasing with longer follow-up. Three to 16 (median, 6) months after treatment, loss of central tumor enhancement was evident in 28 cases(82.4%). In 25 of 28 patients with intratumoral necrosis (89.3%), tumors were either smaller of their size was unchanged. Three to six (mean, 3.6) months after treatment, five cases demonstrated a transient size increase. CONCLUSION: Gamma-knife radiosurgery effectively controlled the growth of acoustic schwannoma, and intra-tumoral necrosis appears to be a predictable sign for decreased tumor size.

Evaluation of Therapeutic Effect of Acoustic Schwannoma After Gamma-Knife Radiosurgery using Follow-up MRI

PURPOSE: To evaluate, using short-term follow-up MR imagings, the usefulness of gamma-knife radiosurgery in patients with acoustic schwannoma. MATERIALS AND METHODS: In 34 patients (M:F=11:23, aged 11 -69 years) with acoustic schwannoma, eleven of whom had undergone microsurgical resection prior to gamma-knife radiosurgery, we retrospectively reviewed the serial MR imaging findings obtained before and after this procedure. Analysis focused on post-surgical changes in tumor volume and intratumoral enhancement, and the follow-up period ranged from 3 to 44 months. RESULTS: Follow-up imaging revealed that after radiosurgery, tumor size had decreased in 17 cases (50%), was unchanged in 14 (41.2%), and had increased in three (8.8%). Local tumor control was achieved in 31 of 34 cases (91.2%). Objectively defined tumor shrinkage was seen within 3 to 24 (median, 12) months of treatment, the rate of shrinkage increasing with longer follow-up. Three to 16 (median, 6) months after treatment, loss of central tumor enhancement was evident in 28 cases(82.4%). In 25 of 28 patients with intratumoral necrosis (89.3%), tumors were either smaller of their size was unchanged. Three to six (mean, 3.6) months after treatment, five cases demonstrated a transient size increase. CONCLUSION: Gamma-knife radiosurgery effectively controlled the growth of acoustic schwannoma, and intra-tumoral necrosis appears to be a predictable sign for decreased tumor size.

MR Findings of Dural Arteriovenous Fistula in Cavernous Sinus

PURPOSE: To evaluate the MR findings of dural arteriovenous fistula(DAVF) in the cavernous sinus and to determine the most useful imaging method for the diagnosis of DAVF. MATERIALS AND METHODS: We evaluated the MR findings of 12 patients in whom DAVF was diagnosed in the cavernous sinus on the basis of angiographic findings. Axial T1- and T2-weighted, and axial and coronal Gd-enhanced T1-weighted images with 3-6mm slice thickness had been obtained, and the findings of DAVF on three pulse sequences were examined and compared. On the basis of the detection of DAVF on three pulse sequences, the MR findings were graded as excellent, fair or poor, and the location of DAVF in the cavernous sinus was analysed. We also classified DAVFs as group A or B on the basis of MR findings (group A: lesions in the cavernous sinus were as large as or larger than the cavernous internal carotid artery; group B: these were smaller than the cavernous internal carotid artery) and compared with cognard type on angiogram. RESULTS: Multiple tortuous signal voids were found in all DAVFs. The signal voids were located mainly in the middle and posterior one third of the cavernous sinus, as seen on axial images, and the middle and inferior one third, as seen on coronal images. Axial and coronal enhanced T1-weighted images showed an excellent grade in 11 of 12 cases and a fair grade in 1 of 12. Axial T2-weighted images showed an excellent grade in 6 of 12 cases and a fair grade in 4 of 12. T1-weighted images showed an excellent grade in 4 of 12 cases and a fair grade in 6 of 12. Six cases were group A, and 5 of the 6 were Cognard type IIa or IIb; The other 6 cases were group B, 5 of the 6 were Cognard type I. CONCLUSION: MR findings of multiple tortuous signal voids in the cavernous sinus, especially in the posterior or inferior portion, suggest DAVF, and enhanced T1-weighted imaging could be the most useful sequence for its diagnosis.

CT-Guided Au tomated Needle Biopsy of Pulmonary Lesions: Analysis of Successful Biopsy Rate and Frequency of Pneumothorax and Hemorrhage using an 18-Gauge Cutting Needle

PURPOSE: To determine the rate of successful biopsy and frequency of post-biopsy pneumothorax and hemorrhage using an 18-gauge cutting needle in CT-guided automated needle biopsies according to lesion size, and the distance between lesion and pleura. MATERIALS AND METHODS: Ninety-four patients with focal lung lesion who had undergone CT-guided automated needle biopsies using an 18-gauge cutting needle were retrospectively reviewed. We evaluated the relationship between successful biopsy rate and pneumothorax and hemorrhage according to lesion size and distance between lesion and pleura. For the purposes of this study, size and distance were grouped as follows : 3cm . RESULTS: Biopsy was successful in 78 of 94 patients(83%). When lesions were larger than 2cm in size the diagnostic rate increased (P=0.002), but the distance between lung lesion and pleura was not statistically related to successful biopsy (P>0.005). Where there were post-biopsy complications, the pneumothorax rate was higher in lesions less than 2 cm in size (P=0.041) and in those separated by more than 2 cm from the pleura (P= 0.006). Where separation was of this order, the hemorrhage rate was higher (P=0.021), but statistically, this was not affected by lesion size (P>0.05). CONCLUSION: When 18-gauge cutting needle is used in CT-guided automated needle biopsies of pulmonary lesions, the rate of successful biopsy is affected by lesion size ; the pneumothorax rate is also affected by lesion size, as well as by the distance between lesion and pleura; the hemorrhage rate is influenced only by the distance between lesion and pleura.

CT-Guided Au tomated Needle Biopsy of Pulmonary Lesions: Analysis of Successful Biopsy Rate and Frequency of Pneumothorax and Hemorrhage using an 18-Gauge Cutting Needle

PURPOSE: To determine the rate of successful biopsy and frequency of post-biopsy pneumothorax and hemorrhage using an 18-gauge cutting needle in CT-guided automated needle biopsies according to lesion size, and the distance between lesion and pleura. MATERIALS AND METHODS: Ninety-four patients with focal lung lesion who had undergone CT-guided automated needle biopsies using an 18-gauge cutting needle were retrospectively reviewed. We evaluated the relationship between successful biopsy rate and pneumothorax and hemorrhage according to lesion size and distance between lesion and pleura. For the purposes of this study, size and distance were grouped as follows : 3cm . RESULTS: Biopsy was successful in 78 of 94 patients(83%). When lesions were larger than 2cm in size the diagnostic rate increased (P=0.002), but the distance between lung lesion and pleura was not statistically related to successful biopsy (P>0.005). Where there were post-biopsy complications, the pneumothorax rate was higher in lesions less than 2 cm in size (P=0.041) and in those separated by more than 2 cm from the pleura (P= 0.006). Where separation was of this order, the hemorrhage rate was higher (P=0.021), but statistically, this was not affected by lesion size (P>0.05). CONCLUSION: When 18-gauge cutting needle is used in CT-guided automated needle biopsies of pulmonary lesions, the rate of successful biopsy is affected by lesion size ; the pneumothorax rate is also affected by lesion size, as well as by the distance between lesion and pleura; the hemorrhage rate is influenced only by the distance between lesion and pleura.

The characteristics of the five cases of hepatic eosinophilic abscess / 대한내과학회지

Hepatic eosinophilic abscess is a very rare disease which has been reported in fascioliasis, and some gastrointestinal malignancy. We experienced 5 cases with hepatic eosinophilic abscesses which were caused by unknown etiology, confirmed by liver biopsy, from 1990 to 1994. The chracteristics of the cases including clinical menifestations, serologic findings, ultrasonography and abdominal computerizes tomogram(CT) were summerized. They had no characteristic findings except eosinophilia in clinical menifestations and they showed various ultrasonographic and CT findings which are different from the radiologic findings of liver abscesses by bacterial or amebic infection. We think that hepatic eosinophilic abscess must be included in differential diagnosis of all hepatic tumors.

Color Doppler Sonography in Thickened Gallbladder Wall

PURPOSE: The thickening of the gallbladder wall is a valuable finding for the diagnosis of cholecystitis, butmay be seen in non-cholecystic disease as well as in acute or chronic cholecystitis. The purpose of this study isto determine the value of color Doppler sonography in differentiating the causes of thickened gallbladder wall. MATERIALS AND METHODS: Ninety eight patients with thickened gallbladder wall(more than 3mm) which was not due to gallbladder cancer were prospectively evaluated with color Doppler sonography. Sixty-six cases, confirmed bypathologic reports and clinical records, were analyzed for correlation between thickened gallbladder wall andcolor flow signal according to the underlying causes. RESULTS: Of the 66 patients, 28 cases were cholecystitisand 38 cases had non-cholecystic causes such as liver cirrhosis, ascites, hepatitis, pancreatitis, renal failure,and hypoalbuminemia. Of the 28 patients with cholecystitis(12 acute, 16 chronic), 23(82%) had color Doppler flowsignals in the thickened gallbladder wall. Of the 38 patients with non-cholecystic causes, eight(21%) had color Doppler flow signals. There was a statistically significant difference of color Doppler flow signals between the cholecystitis and non-cholecystic groups(p=0.0001). No significant difference of color Doppler flow signals was found between cases of acute and chronic cholecystitis. Of the 23 patients with color Doppler flow signals in 28cases of cholecystitis, 18(78.3%) showed a linear pattern and five(21.7%) showed a spotty pattern. Of the eight patients with color Doppler flow signals in the 38 non-cholecystic cases, four(50%) showed a linear pattern andfour(50%) showed a spotty pattern. In cholecystitis, a linear color Doppler flow signal pattern is a much more frequent finding than a spotty pattern. CONCLUSION: Color Doppler sonography is a useful and adequate method for determining whether a thickened gallbladder wall is the result of cholecystitis or has non-cholecystic causes.

Effect of Percutaneous Aspiration and Repeated Sclerotherapy of the Simple Renal Cyst / 대한비뇨기과학회지

Recently the percutaneous aspiration and sclerotherapy has become the most advocated procedure for the symptomatic, large, and simple renal cyst because of its minimal invasiveness and high effectiveness. But the recurrence rate of the simple aspiration and sclerotherapy was reported highly (30-70%). We analysed the effect of percutaneous aspiration and repeated sclerotherapy of the renal cyst in 42 patients from Nov. 1989 to Apr. 1995. Sclerosing agent were 99% ethanol in 33 cases, minocycline in 4 cases, and only aspiration was done in 6 cases. The method of repeated sclerotherapy was achieved about 2.2 times as which aspiration and instillation of sclerosing agent in standing of 8.3 Fr. pigtail catheter during average 2.5 days. After follow up for 17.4 (6-59) months, the complete collapse rate of the renal cyst was 78.7% in the using group of 99% ethanol. 25% in minocycline, 16.696 in the aspiration only. The complete collapse rate according to the times of sclerotherapy was 45.5% in one times, 78.6% in two times, 92% in three times. In conclusion, the sclerotherapy of the simple renal cyst with 99% ethanol was most effective, and we can be expect that the rate of complete collapse has been increased in the repeated sclerotherapy.

A case of the vein of Galen malformation

The vein of Galen malformation is a rare midline intracranial arteriovenous malformation. The majority of themalformations were seen in neonate, infancy and childhood, and the clinical symptoms and prognosis depended on ageof presentation. The authors report a case of the vein of Galen malformation in 17 month-old female withhydrocephalus, which is confirmed by CT and digital subtraction angiography.

Plain film analysis of acetabular fracture

Acetabular fracture can result in severe limitation of the motion of the hip joint, which supports totalweight of human body. Beause of different methods of surgical approach a ccording to fracture type, preciseinterpretation of X-ray films of acetabular fracture is required. We reviewed 38 cases of simple X-ray filmsshowing acetabular fracture. The results were as follows: 1. Almomst 60% of the cases-were in their 2nd and 3rddecades. 2. Twenty cases were male, and 18 cases were female. 3. The most common cause of the injury was trafficaccident(33 cases, 86.8%), followed by fall down (4 ases, 10.5%) and slip down(1 case, 2.7%). 4. Elementaryfractures were 21 cases(55.3%) and associated fractures were 17 cases(44.7%). 5. Among elementary fractures,posterior wall fractures were 9 cases(23.7%), followed by anterior column fractures(8 ases, 21.1%), anterior wallfractures(4 cases, 10.5%). 6. Among associated fractures, T-shaped fractures were 8 cases(21.1%), followed by bothcolumn fractures(6 cases, 15.8%), anterior and hemitransverse fractures(3 cases, 7.8%). 7. Other pelvic bonefractures associated with the acetabular fracture were as follows: farcture of contralateral pubic rami(6 ases,15.8%) contralateral iliac bone (1 case, 2.6%) and ipsilateral iliac bone (1 case, 2.6%). 8. Injuries of otherorgans adjacent to the acetabulum were as follows: rupture of the bladder (3 cases, 7.9%), urethra(2 cases, 5.3%)and uterus (1 cases, 2.6%).

Primary Hyperparathyroidism by Parathyroid Gland Adenoma (Report of 2 cases with Review of the Literature)

The primary hyperparathyroidism is a complex endocrine disease caused by neoplasm or diffuse hyperplasia of parathyroid gland in which excessive paratyroid hormon is secreted. This results in chemical abnormalities of serum, and exerts major influences on the bone, kidney and gastrointestinal tract. The authors report 2 cases of primary hyperparathyroidism with review of the literature.

A clinical and radiological observation of shoulder arthrography

The authors analyzed 23 cases of shoulder arthrography performed at Busan National University Hospital and Inje Medical College Paik Hospital for about 2.5 years from March 1981 to Sept. 1983, both clinically and radiologically. The results obtained were as follows; 1. Of the 23 cases, 20 cases (87.0%) were male and 3 cases(13.0%) were female, and the most prevalent age group was second decade. 2. Right shoulder arthrography was performed in 16 cases (69.6%), and left in 7 cases (30.4%). 3. The number of cases which had had certain historyof trauma was 13(56.5%), and remainder of 10 cases (43.5%) had no history of trauma. 4. Frequent symptoms andsigns were pain in shoulder region in 16 cases (69.6%) and limitation of motion in 14 cases (60.9%). 5. On plainfilm findings, 18 cases(78.3%) were normal, and 5 cases (21.7%) were abnormal. 6. On shoulder arthrographicfindings, 16 cases (69.6%) were normal, and 7 cases (30.4%) were abnormal, Those abnormal cases were consisted of2 case (8.7%) of adhesive capsulitis, 2 cases (8.7%) of chronic shoulder dislocation, 1 case(4.3%) of rotator cuff tear, 1 case(4.3%) of loose bodies in joint cavity, and 1 case(4.3%) of rupture of biceps tendon sheath. 7. Among routine views of shoulder arthrography of normal cases, the external rotation view revealed axillary recess &biceps tendon more distinctly, and the internal rotaion view revealed subscapular bursa more clearly. In case of double-contrast shoulder arthrography, the contour & thickness of the medial segment of the contrast

Percutaneous hepatic arterial catheterization for infusion chemotherapy in treatment of primary hepatoma

Chemotherapy offers palliative treatment to patient with advanced nonresectable hepatoma. The usefulness of systemic chemotherapy is limited becaused of serious side reaction and low concentration of drug at tumor. Butthis problem may be overcome by intraarterial infusion. Nonsurgical percutaneous hepatic arteiral catheterizationwas done in 21 patients with primary hepatoma, and infusion chemotherapy was done in 19 patients who were successful in catherization. The results were as follows; 1. Selective catheterization of hepatic artery proper,common hepatic artery, and celiac artery were seccessful in 4, 9 and 4 patients, respectively. The success rate ofselective catheterization is 80.9% including celiac artery among 21 patients with hepatoma. 2. Simple catherization method was applied in 14 patients, and catheter exchange and Loop methods were applied in 2 and 1patient respectively. 3. Complications related to catheterization, such as infection and bleeding on punctured site, intimal injury and dislodgement of catheter were not serious. 4. Drugs were well tolerated without serioustoxicity or complication. 5. 3 patients showed objective response and median survival time of treated patients is 2.5 months.

A roentgenographic study of the posterior urethral injury associated with pelvic bone fracture in male

The author analyzed detailed pattern of pelvic bone fracture in 52 cases of posterior urethral injuryassociated with pelvic bone fracture in male. The relationship between fracture and urethral injury was reviewed n38 cases who received retrograde urethrography at the time of injury. The pattern of urethral injury due to pelvicbone fracture was newly classified. The results were as follows; 1. In age distribution, the most common was 5thdecade(26.9%). 2. The most freqent type of pelvic rami fracture was two rami fracture(52%). 3. There was no casewith only the superior ramus fracture, and all cases were associated with inferior ramus fracture with or withoutsuperior ramus fracture. 4. In inferior ramus fracture, the ratio of ischial ramus fracture to pubic ramusfracture was 46.1:17.4. 5. In cases with only the ischial ramus or pubic ramus fracture, unilateral fractureexceeded bilateral fracture(44.2:19.3). 6. The bladder rupture was found in 10 among the total 52 cases, 9 ofwhich were associated with superior ramus fracture, and 8 were extraperitoneal type. 7. The most common type ofurethral injury was Type III(73.7%), and followed by Type II(10.5%), Type I(7.9%), and Type IV(7.9%). 8. Theseresults strongly suggested that the superior ramus frature was related to bladder rupture, and inferior ramusfracture to urethral injury.