Suspicious T1 colon cancer with synchronous liver metastasis not detected by preoperative imaging study

Colorectal carcinoma invading the submucosa but not the muscularis propria (pT1) represents the earliest form of clinically relevant colorectal cancer in most patients. T1 colorectal cancer with synchronous liver metastasis is considered to be rare. We report a rare case of T1 colon cancer with synchronous liver metastasis not detected by preoperative imaging study. A 54-year-old male patient presented to our department for treatment of sigmoid colon cancer following an endoscopic submucosal dissection. Histopathological examination revealed the pedunculated mass was moderately differentiated adenocarcinoma without lymphovascular invasion and the depth of submucosal invasion was 2,000 µm, the resection margin was not involved. We performed a laparoscopic anterior resection with lymph node dissection. After the 3 months, the patient's carcinoembryonic antigen level elevated from 1.4 to 7.26 ng/mL (normal level: <1.5 ng/mL) and the abdominal computed tomography and FDG-PET/CT (positron emission tomography-computed tomography) showed multiple hepatic metastases in both hepatic lobes (SUVmax: 5.6) without evidence of local recurrence or lymphadenopathy. We strongly suspected a synchronous liver metastasis not detected by imaging study as opposed to a systemic recurrence. Therefore, evaluation and follow-up protocol of T1 colorectal cancer should be changed for discovery and prediction of synchronous liver metastasis; because we cannot exclude the possibility of synchronous liver metastasis.

Imaging study and applied research of the puncture angle in unilateral percutaneous vertebroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To clarify the abduction angle and needle insertion point of unilateral percutaneous vertebroplasty by measuring the related parameters of lower thoracic spine and lumbar vertebrae.</p><p><b>METHODS</b>Forty normal adults were included in the study, there were 17 males and 23 females. They were scanned by CT with thickness of 1 mm on T10-L5. The coross-section figures of pedicle of vertebral arch, zygapophysial joints, transverse process were choosed, and the maximal and minimal angle of transpedicular puncture, the puncture distance to posterior midline were measured by the image processing software of CT.</p><p><b>RESULTS</b>The data of pucturing angle and point distance had a increasingly trend from T10 to L5 in overall, including a slight decrease from T10 to T12, then was gradually increased until L5, where the maximum was got. According to the measurement, the unilateral percutaneous vertebroplasty were performed, and postoperative Cobb angle of 60 patients were obviously corrected, VAS had significantly decreased(<0.05).</p><p><b>CONCLUSIONS</b>Preoperative measurement of relevant parameters can guide the operation, improve the successful rate of unilateral puncture.</p>

Establishment of a mouse model of early lung adenocarcinoma / 中国实验动物学报

Objective To establish a mouse model of early lung adenocarcinoma to serve the imaging studies of early lung adenocarcinoma .Methods Two-hundred and ten 4-week old SPF female Kunming mice were randomly divided into 5 experimental groups (40 mice per group) and 1 control group (10 mice).The mice of experimental groups were subcutaneously injected with a dose of 0.2 ml 1-methyl-3-nitro-1-nitroso-guanidine ( MNNG) solution in concentration of 2.0 mg/mL weekly for 1, 2, 4, 8, 12 weeks (group A-E), respectively, while the mice of control group was subcutane-ously injected with 0.2 mL saline weekly for 12 weeks.Ten mice were randomly sacrificed from each experimental group at the 60th, 80th, 100th and 120th days after initial injection ( group A60 , group A80 , group A100 , group A120; group B60 ,……and so on) , and the bilateral lungs were dissected .The tumor occurrence rate , number and size of lung tumors were observedandrecorded.Results 1.Thetumoroccurrencerateandnumberoflungtumorswerepositivelyproportionalto the time and dose of MNNG injection .No tumor was found in any group at the 60th day.2.At the 80th day, the tumor oc-currence rate in the groups A, B, C, D and E was 0, 10%, 30%, 40%and 50%, respectively.The number of tumors in each group was 0, 4, 42, 60 and 81, respectively.The number of tumors smaller than 0.5 mm in diameter was 0, 4, 25, 31 and 40, respectively.3.At the 100th day, the tumor occurrence rate was 20%, 40%, 100%, 100%and 100%, re-spectively.The number of tumors was 6, 19, 187, 223 and 301, respectively, and the number of tumors smaller than 0.5 mm in diameter was 5, 16, 132, 124 and 123, respectively.4.At the 120th day, the tumor occurrence rate was 30%, 50%, 100%, 100%and 100%, respectively.The number of tumors was 30, 124, 302, 351 and 362 per group, respec-tively.The number of tumors smaller than 0.5 mm in diameter was 21, 98, 123, 140 and 108, respectively.The induced lung adenocarcinomas were confirmed by pathology .Conclusions MNNG solution 0.2 mL (2.0 mg/mL) subcutaneously injected weekly for 4 weeks can produce 100%occurrence rate of lung adenocarcinoma in mice and most tumors are smaller than 0.5 mm in diameter at 100th day after initial injection .It is a most suitable model for imaging studies of mouse early lung adenocarcinoma .

Imaging study about distribution sites of lesion areas of pulmonary fibrosis induced by paraquat / 中华急诊医学杂志

Objective To analyze the distribution of main lesion areas in pulmonary fibrosis induced by paraquat in rats by means of radiographic imaages and varied CT value by using MicroCT. Methods A total of 15 male Sprague Dawley rats were randomly (random number) divided into control group and paraquat poisoned group. group. The rats in exposure group were treated with dilute solution of paraquat (4mg/ mL) in dose of 14mg/kg injected intraperitoneally, and the rats in control group were treated with the same volume of saline instead. The lung tissues of all rats were scanned in vivo by using MicroCT on the 3rd, 7th , 14th and 28th days after paraquat or saline administration, respectively. The data from scanned images, rates of observable signs of pulmonary fibrosis and average CT value variation in given regions (region of interest, ROI) were compared between groups and different durations after poisoning by using statistical methods as one factor analysis of variance (t-test). Results Compared with the control group, the rats with acute paraquat poisoning appeared varying degrees of the signs of pulmonary fibrosis. Most of the lesion areas predominantly spread over the lateral regions of the lower lobe of lung, and appeared mainly one week after paraquat poisoning. The opacity of lung shadow seen on the radiograph was significantly increased with time extended after exposure to PQ as a consequence of CT value variation in ROI, and there was no difference in the development of pulmonary fibrosis between right lung and left lung ( P > 0. 05), but there were differences in the extent of fibrosis at different areas in lung (P <0.05 or P < 0.01). Conclusions The signs of pulmonary fibrosis predominantly appeared one week after poisoning. The opacity of lung shadow was increasing gradually during the course of pulmonary fibrosis developed in rats in paraquat poisoning group, and lesion areas predominantly spread over the lateral regions of the lower lube of lung.

Is Computerized Tomography Angiographic Surveillance Valuable for Prevention of Tracheoinnominate Artery Fistula, a Life-Threatening Complication after Tracheostomy?

OBJECTIVE: The aim of this study was to evaluate the utility of volume-rendered helical computerized tomography (CT) angiography focusing tracheostomy tube and innominate artery for prevention of tracheoinnominate artery fistula. METHODS: The authors retrospectively analyzed 22 patients with tracheostomy who had checked CT angiography. To evaluate the relationship between tracheostomy tube and innominate artery, we divided into three categories. First, proximal tube position based on cervical vertebra, named "tracheostomy tube departure level (TTDL)". Second, distal tube position and course of innominate artery, named "tracheostomy tube-innominate artery configuration (TTIC)". Third, the gap between the tube and innominate artery, named "tracheostomy tube to innominate artery gap (TTIG)". The TTDL/TTIC and TTIG are based on 3-dimensional (3D) reconstruction around tracheostomy and enhanced axial slices of upper chest, respectively. RESULTS: First, mean TTDL was 6.8+/-0.6. Five cases (23%) were lower than C7 vertebra. Second, TTIC were remote to innominate artery (2 cases; 9.1%), matched with it (14 cases; 63.6%) or crossed it (6 cases; 27.3%). Only 9% of cases were definitely free from innominate artery injury. Third, average TTIG was 4.3+/-4.6 mm. Surprisingly, in 6 cases (27.3%), innominate artery, trachea wall and tracheostomy tube were tightly attached all together, thus have much higher probability of erosion. CONCLUSION: If low TTDL, match or crossing type TTIC with reverse-L shaped innominate artery, small trachea and thin TTIG are accompanied all together, we may seriously consider early plugging and tube removal.

Classification and Imaging Study of the Lumbar Disc Herniation / 대한척추외과학회지

It is known that the lifetime prevalence of low back pain approximates 80%, with long standing low back problems in roughly 10% to 20% of the population. The symptoms of sciatica due to nerve root compression most often relate to aberration of the lumbar intervertebral disc. Lumbar disc herniation is defined as herniation of nucleus and/or anulus fibrosus through the tear of the anulus fibrosus. According to the degree, it has been classified as a bulging disc, a protruded disc, a extruded disc, and a sequestrated disc. Also it has been classified as central, posterolateral, and foraminal herniation by the location of the herniation. The four imaging studies most frequently ordered to evaluate lumbar disc herniation are plain x-ray films, myelography, computed tomography, and magnetic resonance imaging. Each test provides useful information about lumbar disc herniation. However, before the selection of a test, the category of the clinical problem must be defined and imaging abnormalities must be correlated with historical and physical findings. Many errors in decision making with imaging studies of lumbar disc herniation do not come from misinterpretation of what in seen on the images; instead, they are related to how the imaging information is used and integrated into the clinical decision-making process.

A Study on the Clinical Significance of Periodic Lateralized Epileptiform Discharges and Relation to Brain Imaging Study in Children

PURPOSE: Periodic lateralized epileptiform discharges (PLEDs), initially described by Chatrian et al in 1964, are an EEG phenomenon characterized by lateralized or focal spike-and-wave complexes with moderate to high voltage which occur in a periodic or semiperiodic pattern. This study was performed to assess the clinical significance of PLEDs and its relation to an imaging study of the brain. MEHTODS: Twenty children (10 males and 10 females), from 2 days to 14 years of age, who had been hospitalized at Hanyang University Hospital were studied retrospectively. Their medical records, EEG results and brain imaging study were reviewed. RESULTS: Of the 20 patients studied, 15 patients showed unilateral PLEDs and 5 had bilateral PLEDs in EEG. Brain imaging studies were done for 18 of the patients, revealing abnormalities in 15 patients in this order of frequency: intracranial hemorrhage, diffuse cerebral atrophy, leukomalacia, cerebral infarctions, cerebral edema and hydrocephalus. PLED sites were not significantly correlated with the results of the imaging study. Finally, 3 patients died and 17 patients survived, and among the surviving 17 patients, 5 had recurrent seizures, 1 had recurrent seizures with mental regression, 3 had neurologic sequelae without seizures and 8 had no neurologic sequelae. CONCLUSION: We conclude that children who show PLEDs in EEG are more commonly associated with acute cerebral lesions and there is a high incidence of subsequent seizures and/or other neurological sequelae in surviving children with PLEDs.

A Study on the Clinical Significance of Periodic Lateralized Epileptiform Discharges and Relation to Brain Imaging Study in Children

PURPOSE: Periodic lateralized epileptiform discharges (PLEDs), initially described by Chatrian et al in 1964, are an EEG phenomenon characterized by lateralized or focal spike-and-wave complexes with moderate to high voltage which occur in a periodic or semiperiodic pattern. This study was performed to assess the clinical significance of PLEDs and its relation to an imaging study of the brain. MEHTODS: Twenty children (10 males and 10 females), from 2 days to 14 years of age, who had been hospitalized at Hanyang University Hospital were studied retrospectively. Their medical records, EEG results and brain imaging study were reviewed. RESULTS: Of the 20 patients studied, 15 patients showed unilateral PLEDs and 5 had bilateral PLEDs in EEG. Brain imaging studies were done for 18 of the patients, revealing abnormalities in 15 patients in this order of frequency: intracranial hemorrhage, diffuse cerebral atrophy, leukomalacia, cerebral infarctions, cerebral edema and hydrocephalus. PLED sites were not significantly correlated with the results of the imaging study. Finally, 3 patients died and 17 patients survived, and among the surviving 17 patients, 5 had recurrent seizures, 1 had recurrent seizures with mental regression, 3 had neurologic sequelae without seizures and 8 had no neurologic sequelae. CONCLUSION: We conclude that children who show PLEDs in EEG are more commonly associated with acute cerebral lesions and there is a high incidence of subsequent seizures and/or other neurological sequelae in surviving children with PLEDs.

The Clinical Study on the Epileptiform Discharges and Imaging Study in Newborn with Seizures / 대한소아신경학회지

PURPOSE: Neonatal seizures are mostly symptomatic and have variable atypical clinical features with very different EEG findings from those of post-neonatal period. This study was performed to determine the common types of epileptiform discharges and their relationship with abnormalities in imaging study in neonates with seizures. METHODS: Fourty one neonates under 7 days of age who had been hospitalized at the Hanyang university hospital from June 1993 to May 1997 were studied retrospectively. Their medical records, results of EEG and brain imaging study were reviewed. RESULTS: 1) The types of neonatal seizures were subtle, generalized tonic, multifocal clonic, focal clonic, myoclonic in order of frequency. 2) The most common epileptiform discharge was excessive sharp transients recorded in 28 cases and the rest showed multifocal spikes, sharp waves, repetitive alpha, repetitive theta in order. Epileptiform discharges appeared on the both hemisphere in 24 cases, right hemisphere in 9 cases and left hemisphere in 8 cases. 3) Imaging study showed no abnormal findings in 27 cases and abnormal findings in 14 cases such as brain edema, intracranial hemorrhage, leukomalacia, subarachnoid hemorrhage, cephalhematoma, craniosynostosis. 4) Among 14 cases with radiological abnormalities, 5 cases had localized abnormalities and 3 of them had the abnormal EEG discharges on the same area concomittantly. But in total only 3 cases of 17 cases with localized epileptiform discharges had abnormalities in imaging study on the same site and so significant relationship between two studies was not observed. 5) As for the prognosis of seizures, subsided in 23 cases without any antiepileptic drugs, 13 cases had no seizure after taking medicine for few days and 5 cases needed continuous antiepileptic drug. CONCLUSION: This study showed no meaningful relationship between abnormal EEG findings and localization by imaging study in neonatal seizure but we concluded that brain imaging study was needed to determine degree of encephalopathy in neonatal seizures.

Measurement of Morphological Changes in Schizophrenic Patients using Brain Magnetic Resonance Imaging / 대한정신약물학회지

OBJECTIVES: This study was peformed to compare and measure the changes of corpus callosum of the schizophrenic patients with those of controls, to compare according to clinical symptoms, onset age. METHOD: Brain magnetic resonance imaging study was performed in 38 schizophrenic patients and 28 controls, and the authors measured cerebral area, anterior, middle, posterior callosal areas, vertical width, perpendicular width and maximal horizontal callosal length. The schizophrenic patients were assessed by the PANSS. To correct cerebral areas, ANCOVA was used with cerebral areas as covariants. And two-tailed t-test, ANOVA were used to compare callosal measurements according to subgroups. RESULTS: The schizophrenic patients, compared with controls, were significantly wider in posterior callosal area and thinner in anterior vertical width. The schizophrenic patients with prominent positive symptoms were significantly wider and thicker in middle callosal area, anterior middle vertical width than controls, and those with prominent negative symptoms were significantly thinner in posterior vertical width than those with prominent positive symptoms and wider in anterior area than controls. Early onset patients were significantly thicker in middle perpendicular area than controls. CONCLUSIONS: There were various controversial findings about corpus callosal pathology of the schizophrenic patients. This study, after correction of cerebral area, revealed increased sizes of several parts of callosal regions, and then it suggested neurodevelopmental abnormalities. And also significant differences in callosal regions according positive and negative symptoms suggested that these reflected the heterogeneities of schizophrenia.

Computerized Assessment of Neurocognitive function for Traumatic Brain Injury Patients / 신경정신의학

Irrespective of focal lesion in brain imaging study, the deficits in cognitive function have been reported in mild traumatic brain injury patients. Therefore, they have been asked sensitive and objective assessment tools measuring cognitive deficits. In this study, traumatic brain injury patients were classified into lesion group and non-lesion group by presence of focal lesion in brain imaging study. At the same time, Results of Bender-Gestalt test, Standard Progressive Matrices, Cognitrone, and Signal Detection were analyzed among the groups. We assessed usefulness of Standard Progressive Matrices as assessment tool of intelligence in traumatic brain injury patients by correlation coefficients between KWIS and Standard Progressive Matrices intelligence quotients. 1) Most lesion group showed severe deficits in cognitive function, and most non-lesion group showed severe somatic symptoms. 2) The lesion group showed higher Bender-Gestalt test total error score than non-lesion group. 3) There was no difference in HWIS intelligence quotients between lesion and non-lesion group. 4) The lesion group showed lower performance than normal control and non-lesion group as increasing complexity of Standard Progressive Matrices subset. 5) The lesion group showed poor performance than normal control group in Cognitrone. 6) There were higher correlation coefficients than normal control group between Standard Progressive Matrices intelligence quotients and KWIS intelligence quotients in traumatic brain injury patients. According to the above results, lesion group showed deficits in space-construction ability, fine-motor coordination ability, form-memory ability, and delayed response-time. Although there are no statistical significance, comparing with normal control group, non-lesion group showed different response-trend in Cognitrone. Considering somatic symptoms in most non-lesion group and contribution of psychological factors in maintenance of symptoms in mild traumatic brain injury patients, the differences in Cognitrone must be interpreted carefully. These result suggest than Standard Progressive Matrices can be a useful tool for assessment of intelligence in traumatic brain injury patients who showed deficits in cognitive function.

Use of Renal Scan(DTPA) for Clinical Follow-up of Renal Function after Extracorporeal Shock Wave Lithotripsy of Renal Stones / 대한비뇨기과학회지

Patients treated by extracorporeal shock wave lithotripsy are usually evaluated by excretory urography within 1 month after treatment to determine the clearance of stone debris and rule out asymptomatic obstruction. In an attempt to obtain more precise functional information, we used 99m-Tc-DTPA renal scan as the initial follow-up study after ESWL in 10 patients. GFR checked by renal scan shows no difference in pre and post ESWL. Our experience suggests that follow up after ESWL by radionuclide renal imaging studies provides specific functional information and also particular value in the management of patients with obstructing stone debris and diminished renal function. Radionuclide renal imaging studies may also reveal unexpected obstruction and functional impairment after ESWL of stones, and is recommended as routine follow-up study after ESWL.