Spontaneous submucosal dissection of the entire esophagus in a healthy man / 대한내과학회지

Esophageal submucosal dissection can be caused by foreign bodies and endoscopic procedures. It rarely develops spontaneously. If a submucosal hematoma and false lumen are observed at esophagogastroduodenoscopy, the lesion will heal after 7 to 10 days of conservative treatment. A 71-year-old man with sudden-onset chest pain, dyspnea, and a small amount of hematemesis was examined using chest computed tomography (CT) and esophagogastroduodenoscopy. He was diagnosed with submucosal dissection of the esophagus. After 13 days of conservative treatment, esophagogastroduodenoscopy showed mucosal exfoliation and a healing ulcer, and he was discharged without complications.

A Case of Peritoneal Seeding from a Ruptured Hepatocellular Carcinoma with Direct Invasion into the Stomach Causing Gastrointestinal Hemorrhage / 대한소화기학회지

Hepatocellular carcinoma (HCC) rarely invades the gastrointestinal (GI) tract. It occurs in 0.7% to 2% of clinical HCC cases. Moreover, gastric invasion with GI hemorrhage via peritoneal seeding is very rare. We report the case of 67-year-old woman who had a history of HCC rupture and was admitted due to left upper quadrant abdominal pain. The patient was diagnosed with three omental metastatic masses and underwent hepatic segmentectomy and omental tumorectomy. Two months later, the patient had massive melena, and an esophagogastroduodenoscopy showed very large ulcerated friable mass on the gastric body. The histology was consistent with the diagnosis of metastatic HCC. The patient died from persistent GI hemorrhage 93 days after the admission. This case illustrates the very rare event of peritoneal seeding of a ruptured HCC causing direct invasion of the stomach, followed by GI hemorrhage.

A Case of Hemorrhagic Cerebral Infarction in Ulcerative Colitis

Ulcerative colitis is associated with a number of extraintestinal complications, including the infrequent occurrence of thromboembolic disease. Cerebral venous thrombosis is an extremely rare and fatal complication of ulcerative colitis. A 38-year-old woman presented with sluggish mentation and left hemiplegia. Ulcerative colitis had been diagnosed 3 years earlier by colonoscopy and biopsy, and had been controlled with a mesalazine. On admission, a brain computed tomography revealed a high density area in the right frontal lobe, and T2-weighted magnetic resonance imaging demonstrated an abnormal signal in the right frontal area, suggestive of a hemorrhagic cerebral infarction. She was managed with a decompressive craniectomy and conventional treatment for ulcerative colitis.

Lipid profiles in patients with systemic lupus erythematosus / 대한내과학회지

BACKGROUND: The aims of this study were the identification of the abnormalities in lipid profiles and the correlations between serum lipid profiles and inflammatory parameters in patients with systemic lupus erythematosus. METHODS: The subjects were 50 patients with systemic lupus erythematosus who have been treated in rheumatology clinic, Yeungnam University Hospital. Serum lipids and apolipoproteins were measured and compared with those of age- and sex-matched controls. In systemic lupus erythematosus group, disease activities were assessed by systemic lupus erythematosus disease activity index and erythrocyte sedimentation rate. RESULTS: All lipid profiles were within normal range but most of lipoprotein levels were higher in patients with systemic lupus erythematosus than controls. Triglyceride, low-density lipoprotein and very-low-density lipoprotein were statistically significant (p=0.001, p=0.023, and p=0.001 respectively). Total cholesterol and low-density lipoprotein were significantly increased in systemic lupus erythematosus patients with proteinuria (>or=100 mg/dL/24hr) than in patients without proteinuria. Total cholesterol and low-density lipoprotein had positive correlations and apolipoprotein A-II had negative correlation with systemic lupus erythematosus disease activity index. Low-density lipoprotein and apolipoprotein B had positive correlations, high-density lipoprotein and apolipoprotein A-II had negative correlations with erythrocyte sedimentation rate. But differences of lipid profiles according to the duration of disease and total doses of steroid were not significant. CONCLUSION: This study showed that triglyceride, low-density lipoprotein, and very-low-density lipoprotein in patients with systemic lupus erythematosus were higher than controls. Total cholesterol and LDL in patients with SLE had positive correlations with disease activities.

Teleradiology: Detectability of Pneumothorax and Miliary Tuberculosis

PURPOSE: To evaluate the clinical utility of the teleradiology system using the information super highway communication network. MATERIALS AND METHODS: Two radiologists selected 101 cases of pneumothorax and 20 cases ofmiliary tuberculosis. There were scanned and transmitted to our hospital at a speed of 640 Kbps and displayed on avideo monitor with a resolution of 1280 pixels/line x 1024 lines. Four radiologists divided into three groups :read the images group A read the images without image processing ; group B read the images with image processing, group C read the radiographic films on the view box. The authors compared sensitivity and specificity between thegroups and checked their statistical significance using the Chi-square test. According to the location of thepleural line, we divided the pneumothorax into four types : continve on this live type 1, pleural line confined tothe apex ; type 2, to the upper half ; type 3, to the lower half ; type 4, to the upper through lower half. We then compared sensitivity between the Three groups. RESULTS: In the pneumothorax group, the average sensitivity of group A, B and C was 79%, 90% and 96%, and average specificity was 99%, 99% and 94%, respectively. There were statistically significant differences in seasitivity between group A and B and between group B and C (p<0.017). There were no statistically significant difference in specificity between group A and B or between group B and C.In the miliary tuberculosis group, the average sensitivity of group A, B and C was 73%, 78% and 90%, and average specificity was 95%, 95% and 100%, respectively. With regard to sensitivity and specificity, there was no statistically significant difference between group A and B or between group B and C but there was a statistically significant difference between group A and C (p<0.017). According to the location of the pneumothorax, for alltypes, the sensitivity of group A was less than that of group B and group B was less than that of group C. CONCLUSION: All groups showed reduced observer performance in the detection of pneumothorax and miliary tuberculosis when reading a transmitted image on the monitor-workstation compared with reading conventional radiographs on the view box. To improve the clinical utility of the teleradiology system, a higher resolution workstation and adequate image processing are required.

Ultrasonographic Findings of Benign Soft Tissue Tumors

PURPOSE: To clarify the chracteristic sonographic features of benign soft tissue tumors and to evaluate the usefulness of sonographic imaging. MATERIALS AND METHODS: We retrospectively reviewed ultrasonographic images of 70 cases in 68 patients with histologically proved benign soft tissue tumors. RESULTS: The tumors included 33 lipomas, 11 hemangiomas. 11 lymphangiomas, 7 neurilemmomas, 4 epidermold cysts, 2 fibromas, 1 mesenchymoma, and 1 myxoma. The SOhographic appearances of the lesions were mainly solid in 53 cases(33 lipomas, 8 hemangiomas, 2 lymphangiomas, 7 neurilemmomas, 2 fibromas and 1 mesenchymoma), mainly cystic in 14 cases(1 hemangioma, 8 lymphangiomas, 4 epidermoid cysts, and 1 myxoma), and mixed in 3 cases(2 hemangiomas and 1 lymphangioma). Although an accurate histologic prediction could not be made in most cases, certain patterns appeared to be characteristic of specific tumor types. 26 cases(78%) of lipoma were seen as lentiform, iso- or hyperechoic, solid mass. Hemangioma had variable appearance and chacteristic calcifications were seen in 3 cases. Unicameral or multiseptated cystic mass with variable thickness of echogenic septa and solid portion was the characteristic finding of lymphangioma. Neurilemmoma showed Iobulated, oval to round, relatively hypoechoic mass with or without internal cystic portion. CONCLUSION: Sonographic evaluation of benign soft tissue tumros is useful in demonstrating the location, size, extent, and internal characteristics of the mass. A relatively confident diagnosis can be made when the characteristic features of the benign soft tissue tumor are present on sonographic imaging.

Evaluation of pneumoreduction in intussusception with sign of frank intestinal obstruction

Intussusception is the most common cause of acquired intestinal obstructions during infancy and early childhood. Barium reduction and pneumoreduction have been sued widely as nonsugical method of treatment in radiologic department. In the past, attempts at barium reduction of intussusception were contraindicated in the presence of frank intestinal obstruction, shock, fever, dehydration, bowel perforation, peritonitis and longstanding symptoms. At present, however, there is no agreement on the contraindications, except for shock, peritonitis and bowel perforation. Especially, there is no consensus regarding its application on patient presenting with sign of frank intestinal obstruction. The authors analyzed the effect of pneumoreduction in the intussusception with sign of frank intestinal obstruction. Pneumoreduction was attempted in 53 cases of intussusception with sign of frank intestinal obstruction. Reduction was successful in 43 cases(81%). The mean fluroscopic time was 15.1 minutes and mean maximal pressure was 121.8mmHg in successful reduction. As complications, two cases of bowel perforation were observed, but could be treated surgically without any significant problem. In conclusion, pneumoreduction is a useful substitute for barium reduction in the management of pediatric intussusception with sign of frank intestinal obstruction.

A Case of Unilateral Multilocular Cystic Kidney / 대한비뇨기과학회지

Multilocular renal cyst is an uncommon entity of uncertain nature. By recent years only n few cases had reported in the literature. The difficulties encountered in distinguishing this entity from the Wilms' tumor indicate that this disease warrants great emphasis. We have experienced a case of unilateral multilocular cystic kidney treated with nephrectomy.

A Uric Acid Stone Radiographically Simulating Renal Pelvis Tumor / 대한비뇨기과학회지

Since the development of ultrasonography and computerized topography scanning, the diagnosis of uric acid stone the urinary system has not been difficult. But recently, we experienced a case of uric acid stone that was misdiagnosed as renal pelvis tumor.

A Comparative Study of Catheter-tip Culture with Foley Catheters of Different Materials / 대한비뇨기과학회지

In the recent 2 years, we performed 116 Foley catheter-tip(48 cases of latex, 35 cases of 100% silicone, 33 cases of Silastic) cultures from the male patients who did not have lower urinary tract infection before catheterization. The following result were obtained: 1. The overall positive culture rate of rather-tip culture was 35.3%, and the positive culture rate of urine aspirated from proximal catheter wall just before removal of catheter was 20.6%. 2. The most common microorganism was E-coli in 29.3% and followed by Proteus spp. in 14.7%, Pseudomonas aeruginosa in 12.2%, Klebsiella pneumoniae in 9.8%, Staphylococcus aureus in 7.3%, Candida tropical in 7.3% in orders. 3. In comparison with duration of catheterization, the positive culture rates of catheter-tip of 3 different materials removed within one day were similarly low from 0 th 12%. However, the positive culture rate was much increased in latex-tip (70%) than silicone-tip (23%) and Silastic-tip (14.3%) which were removed between 2 to 4 days. More than 5 days of indwelling catheterization, the positive culture rates were latex-tip in 100%, silicone-tip in 47% and Silastic-tip in 57.1%.