Large Brunner's gland hamartoma with annular stricture causing gastric outlet obstruction

No abstract available.

Early Detection of Anterior Cervical Osteophytes Causing Dysphagia by Esophagogastroduodenoscopy

Anterior cervical osteophytes affecting the cervical spine are a rare cause of dysphagia. They may affect the patient's life by compressing the larynx. A 66-year-old male patient complained of dysphagia during swallowing that started five months earlier. During esophagogastroduodenoscopy, the endoscopist felt outside pressure and severe resistance, and a protruded lesion at the posterior wall of the hypopharynx was found. A cervical spine x-ray showed prominent anterior osteophytes at the C-spine 2-5 level. In addition, computed tomography showed esophageal luminal narrowing related to prominent anterior cervical osteophytes at the C-spine 3-4 level. Due to the absence of any effective medical therapy and rapid progression of dysphagia, surgery was recommended to relieve the symptoms. Clinical improvement occurred after surgical resection of the osteophytes through an anterior cervical approach. So we report here on a rare case of anterior cervical osteophytes with dysphagia with review of the relevant literature.

Unusually High Number of Eschars on the Face of a Patient with Scrub Typhus

No abstract available.

Chemoembolization through Intercostal Arteries in Hepatocellular Carcinoma' Report of A Case of Transient Spinal Cord Injury

Liver has a dual blood supply from portal vein and hepatic artery. Hepatocellular carcinoma receive their blood supply almost exclusively from hepatic artery. Thus, the concept of treating hepatocellular carcinoma by chemoembolization through these arteries is very effective. However, there may be several collateral or parasitic vessels feeding them in case of huge tumor or previous chemoembolization. We experierced a case of huge tumor involving right upper posterior portion of liver fed by 9th, 10th, 11th right posterior intercostal arteries and an anomalous hepatic artery. We tried chemoembolization with Adriamycin-Lipiodol suspension and Gelfoam material through the right posterior intercostal arteries to treat the lesion. After the procedure, the patient(55 years old female) became paraplegic with voiding and defecation difficulty which could be due to spinal cord infarction .by anterior spinal arteri. al occlusion caused by embolic material through the artery of Adamkiewicz from a posterior intercostal artery. She recovered completely after 20 days of treatment.

Injection Method of Contrast Medium in Chest Spiral CT

PURPOSE: Authors studied the injection method of contrast medium in routine chest spiral CT scan to obtain the best image in the mediastinum. MATERIALS AND METHODS: Dynamic static scan had been performed in 5 normal volunteers as a pilot study. In consideration of the result of pilot study, Chest spiral CT was performed in 217 patients by three different methods. We used 100cc nonionic contrast medium. Average attenuation of great vessels in the mediastinum were assessed in various injection methods. Image quality was graded with three levels of score by two radiologists. RESULTS: Peak enhancement time of the great vessels on pilot at dynamic static scan were as follows :52 sec at ascending aorta, 45 sec at pulmonary artery, and 40 sec at SVC. In the study of spiral CT, the highest attenMarion in the great vessels was obtained after injection of 100cc of contrast medium(2cc/sec, with 35-40 second scan delay), althrough artifact from highly enhancing SVC was most common in this method. Image quality were highest in the scans obtained with other methods(3-2-1cc/sec for 10-15-40 seconds, with 40 second scan delay). CONCLUSION: For chest spiral CT, authors recommend that scans should be obtained after infusion of 70--80cc of contrast medium during 35--40sec to obtain maximal vascular enhacement of mediastinum.

Dynamic Liver Scan with Sprial CT

PURPOSE: Dynamic liver scan with spiral CT during a single breath hold was performed for To determing the optimal timing of scanning and the degree of the enhancement of liver and vessel. MATERIALS AND METHODS: Liver spiral CT was performed on 143 patients and dynamic sequence scan on 2 normal volunteers. After baseline spiral CT without contrast enhancement, spiral CT was performed after administration of a bolus of 100 ml of nonionic contrast material intravenously with mechanical power injector at the constant injection rate of 2 ml/sec. Cephalocaudal scanning was started 45 seconds after the beginning of injection. In the majority of cases we employed 16-24 continuous scanning with table feed of 10 mm, slice thickness of 10 mm, and reconstructed in 5 or 10 mm section increments. We measured degree of enhancement of aorta, IVC, and liver parenchyma in all images. RESULTS: We have achieved bolus phase at all images from the following measured date; 170-250 H. U at aorta, 110-150 H. U at IVC, 80-125 H. U at liver parenchyma, 100-130 H. U at spleen, which shown contrast difference between aorta and IVC at least 45 H. U. At the dynamic sequence scan, aortic and vascular CT atternuation reaches a peak at 55-60sec and peak hepatic enhancement occurred at 70-75 sec with relative plateau achieve at 45 sec. Spiral CT also showed elimination of variation in diaphragmatic excursion. CONCLUSION: We could get the disirable phase imaging at overall examination from the dynamic liver scan around 45-60 seconds after injection of contrast media.