Metastasis of Renal Cell Carcinoma to the Bladder

Renal cell carcinoma is an uncommon source of bladder metastases. Here we report a case of renal cell carcinoma that metastasized to the bladder. A 73-year-old woman complained of gross hematuria. Abdominopelvic computerized tomography showed a bladder mass and a heterogenous enhancing mass in the lower pole of the left kidney with left vein thrombosis. The pathological analysis of the resected bladder specimen revealed metastatic renal cell carcinoma of the clear cell type.

Skeletal Muscle Metastases from Urothelial Cell Carcinoma

Hematogenous metastasis to skeletal muscle from urothelial carcinoma is extremely rare and metastatic disease to skeletal muscle tends to be found in people with advanced-stage neoplasm. We report in this paper a case of left sartorius muscle metastasis from urothelial cell carcinoma. A left nephroureterectomy with bladder cuff excision was performed and revealed a high-grade papillary transitional cell carcinoma (TCC) of the pelvis. And 6 month later, recurrent bladder cancer was found regular cystoscopy and then treated with transurethral resection of the bladder. After 6 times resection of bladder, an invasion into the bladder muscle layer was found. We recommended additional radical cystectomy to prevent the disease from advancing. However, the patient refused additional surgery. 6 month later, the patient complained of left thigh pain, so ultrasonography-guided biopsy of the nodular mass lesion in the left sartorius muscle was performed. The pathological analysis of the biopsy specimen revealed poorly differentiated metastatic urothelial carcinoma.

Use of Cystoscopic Tattooing in Laparoscopic Partial Cystectomy

PURPOSE: During laparoscopic partial cystectomy (LPC), lesion identification is essential to help to determine the appropriate bladder incisions required to maintain adequate resection margins. The inability to use tactile senses makes it difficult for surgeons to locate lesions during laparoscopic surgery. Endoscopic India ink marking techniques are often used in laparoscopic gastroenterological surgery. We present our experience with performing LPC with India ink during the surgical resection of various bladder lesions. MATERIALS AND METHODS: LPC with cystoscopic fine needle tattooing was performed on 10 patients at our institute. Tattooing was performed at 1- to 2-cm intervals approximately 1 cm away from the outer margin of the lesion with enough depth (the deep muscle layer) under cystoscopic guidance. LPC was performed by the transperitoneal approach. The clinical courses and pathologic results were analyzed. RESULTS: All LPC with cystoscopic tattooing cases were performed successfully. The mean patient age was 39.1 years. The mean operative time was 130.5 minutes, and the mean estimated blood loss was 93 ml. The mean hospital stay was 13.1 days, and the mean duration of indwelling Foley catheterization was 10.7 days. There were no significant intraoperative or postoperative complications except 1 case of delayed urinary leak and 1 case of delayed wound healing. The pathological diagnosis included 1 urachal cancer, 1 urachal remnant, 4 urachal cysts, 2 pheochromocytomas, and 2 inflammatory masses. All specimens showed adequate surgical margins. CONCLUSIONS: Cystoscopic tattooing in LPC is a simple and effective technique to assist in locating pathological bladder lesions intraoperatively. This technique can help to determine appropriate resection margins during LPC without incurring additional complicated procedures.

Neovesical-Urethral Anastomotic Stricture Successfully Treated by Ureteral Dilation Balloon Catheter

Neovesical-urethral anastomotic stricture is a complication of orthotopic neobladder, with a reported incidence of 2.7% to 8.8%. Strictures of the neovesico-urethral anastomotic site can be treated with regular self-dilation, but high-grade strictures require a surgical procedure involving incision by electrocautery or cold knife. Here we describe a grade III neovesical-urethral anastomotic stricture after an orthotopic bladder substitution that was successfully treated by use of a ureteral dilation balloon catheter.

Acute Scrotum due to Gallbladder Perforation after a Percutaneous Liver Biopsy

Acute scrotum can occur as a complication of various procedures, such as open, laparoscopic surgeries or diagnostic procedures. We present an unusual case of acute hemiscrotum due to inadvertent gallbladder injury following an ultrasound-guided liver biopsy

Areas of Decreased Parenchymal Attenuation Associated with Bronchiectasis: Correlation between Severity and Extent of Bronchiectasis on HRCT with Pulmonary Function Test

PURPOSE: To determine the correlation between areas of decreased parenchymal attenuation seen in cases of bronchiectasis, and the severity and extent of the condition, as revealed by HRCT and the plmonary function test (PFT). MATERIALS AND METHODS: The findings of forty-five patients with bronchiectasis who had undergone PFT and HRCT were retrospectively analysed. CT scores were calculated according to the severity and extent of the condition, and areas of low attenuation, and the correlation coefficients between these were determined. Bronchiectasis was classified as either cylindrical or cystic, and using Student's t test, the statistical significance of the results of the PFT were determined. RESULT: The severity and extent of bronchiectasis correlated with the extent of areas of low attenuation (r > .45, p .44, p < .01). The functional parameters of the PFT which help differentiate between cylindrical and cystic bronchiectasis are FEV1, FVC, MMEF, DLCO (p < .01), RV, and TLC (p < .05). CONCLUSION: In patients with bronchiectasis, the extent of the condition correlated closely with the extent of low attenuation, and the latter, especially in cases of cylindrical bronchiectasis, showed significant correlation with the extent of abnormalities revealed by the pulmonary function test.

MR Findings of Sturge-Weber Syndrome : Emphasis on Vascular Abnormality

PURPOSE: To observe MR findings of vascular abnormality in Sturge-Weber syndrome and to determine the value of MRI in diagnosis. MATERIALS AND METHODS: Ten patients with Sturge-Weber syndrome (age : 3 months-32 years)were evaluated by MR imaging ; in six and four cases, respectively, the results were correlated with those of CT and angiography. We retrospectively analysed changes in the cortical vein and deep venous system, including the medullary and subependymal vein, as well as an largement of the choroid plexus, leptomeningeal enhancement, and changes in diploic space. RESULTS: In all cases except one, in which non-contrast enhanced study had been performed, varying degrees of leptomeningeal enhancement were seen. In nine cases the cortical vein became smaller; enlargement of the choroid plexus was seen in eight cases, change in the diploic space in seven (including three in which there was angiomatous involvement), and enlargement of the deep venous system in seven. In younger patients, collateral pathways were less developed and leptomeningeal angiomatous changes were more pronounced than in those who were older. CONCLUSION: MRI is a useful modality for the evaluationn of vascular changes in Sturge-Weber syndrome. These changes vary according to a patient's age and the duration of the disease.

Nasal Non-Hodgkin's Lymphoma: CT Findings

PURPOSE: To describe the characteristics of CT findings in nasal lymphoma. MATERIALS AND METHODS: We retrospectively reviewed CT findings and pathologic findings of eight patients (six males and two females) aged between 24 and 68 years with pathologically-proven nasal lymphoma. We analyzed mass location, laterality, size, margin, mass effect, adjacent bony change and contrast enhancement pattern. RESULTS: All eight cases werenon-Hodgkin's lymphoma, intermediate grade, diffuse large cell type. Seven cases were B-cell type and one was T-cell. In all cases, tumors were located in the medial wall of the inferior turbinate. In four cases, they were also found in the anterior ethmoidal sinus, and in one case, in the nasal septum. The mean size of the main mass was 3.3 cm. In seven cases, tumors were unilateral (one on the right; six on the left), and in the remaining case, bilateral. In six cases tumor margin was smooth and in two cases focal nodularity was seen. In two cases there was no bony change, and in four, there was mucosal thickening along the nasal septum; in one of these four, minimal bony erosion was also found. In the other two cases, bony destruction was seen, and tumors were very large (7 cm in diameter) or bilterally located. In three cases, the nasal septum was displaced by the mass. In all cases with bony change, the nasal septum was involved. All tumors were homogeneously well enhanced after IV contrast administration. CONCLUSION: The main CT findings of nasal non-Hodgkin's lymphoma were smooth margin, unilateral location (mainly in the medial wall of the inferior turbinate and growing to the medial side without bony destruction) mucosal thickening along the nasal septum and clear homogeneous enhancement after IV contrast administration. These characteristics will help diagnosis, help determine the appropriate region for radiation and other appropriate therapy, and facilitate prognosis in patients with nasal non-Hodgkin's lymphoma.

A Digital Imaging Teaching File by Using the Internet, HTML and Personal Computers

PURPOSE: A film-based teaching file takes up space and the need to search through such a file places limitson the extent to which it is likely to be used. Furthermore it is not easy for doctors in a medium-sized hospitalto experience a variety of cases, and so for these reasons we created an easy-to-use digital imaging teaching filewith HTML(Hypertext Markup Language) and downloaded images via World Wide Web(WWW) services on the Internet. This was suitable for use by computer novices. MATERIALS AND METHODS: We used WWW Internet services as a resource for various images and three different IMB-PC compatible computers(386DX, 486DX-II, and Pentium) in downloading theimages and in developing a digitalized teaching file. These computers were connected with the Internet through ahigh speed dial-up modem(28.8Kbps) and to navigate the Internet. Twinsock and Netscape were used. HWP 3.0, Korean word processing software, was used to create HTML(Hypertext Markup Language) files and the downloaded images were linked to the HTML files. In this way, a digital imaging teaching file program was created. RESULTS: Access to aWeb service via the Internet required a high speed computer(at least 486DX II with 8MB RAM) for comfortabel use ;this also ensured that the quality of downloaded images was not degraded during downloading and that these were good enough to use as a teaching file. The time needed to retrieve the text and related images depends on the sizeof the file, the speed of the network, and the network traffic at the time of connection. For computer novices, adigital image teaching file using HTML is easy to use. CONCLUSION: Our method of creating a digital imaging teaching file by using Internet and HTML would be easy to create and radiologists with little computer experience who want to study various digital radiologic imaging cases would find it easy to use.

Angiographic Demonstration of External Carotid-Vertebral Arteries Anastomosis

PURPOSE: The aim of the study is to evaluate collateral circulations between external carotid and vertebral arteries in the individuals with no occlusive cerebro vascular diseases. METHODS AND MATERIALS: Vertebral angiography was performed in 20 patients with subarachnoid hemorrhage, with temporal occlusion of the ipsilateral common carotid artery by finger pressure compression. In each case, the following were analyzed in each case :presence or absence of collateral channels ; pattern of collateral channels ; level of anastomosis. RESULTS: The anastomotic channels were as follows : occipital artery by posterior radicular artery : 15 cases ; ascending pharyngeal artery by musculospinal artery : 16 cases ; odontoid arterial arch : ten cases ; proximal external carotid artery by anterior radicular artery three cases. CONCLUSION: Awareness of external carotid - vertebral arteries anastomosis as described above can be helpful for effective and safe embolization.

Tuberculous Pleural Effusion vs Empyema: It is Possible to Differentiate Based on CT Findings?

PURPOSE: To describe radiologic differences between tuberculous pleural effusion and empyema on the basis of computed tomography(CT). MATERIALS AND METHODS: We reviewed retrosepectively CT findings of 50 patients with pathologically and grossly proved empyema. Twenty-two patients had empyema, and 28 patients had tuberculous pleurisy. RESULTS: CT findings known to be useful in differentiating tuberculous pleural effusion from empyema (1) contour and extent of pleural thickening, (2) mediastinal pleural involvement, (3)accumulation of extrapleural tissue and (4) change of ipsilateral thoraic volume of empyema. However, none of the above findings were helpful in the differential diagnosis of empyema. CONCLUSION: The differentation of tubrculous pleurisy from pyogenic empyema may be not possible with CT findings only.

MR imaging of lumbar disc disease: correlation with CT and myelography

No abstract available.

Chronotropic Actions of Higenamine in the Isolated Right Atrium of the Rabbit

Higenamine is known to possess stimulatory activity on beta-receptor of the heart. Chronotropic actions of higenamic were studied in spontaneously beating right atrial muscle isolated from rabbits. The frequency of spontaneous beating and the relative threshold voltage of the right atrium were examined. The relative threshold voltage was defined as the minimal voltage of the given impulse above which the right atrium could be paced at the frequency of 20% of higenamine was also observed. Higenamine caused the postive chronotropic effect. This response became prominent as the ca2+ concentration in the bathing solution lowered. When tetrodotoxin was added to the bathing solution, the effect of higenemine altered and became similar to that of epinephrine. Higenamine reduced the relative threshold voltage of the right atrium in the bathing solution with [ca2+] of 0.5mM. Such effect was abolished by tetrodotoxin. The effects of verapamill on the spontaneous rate and the relativel threshold voltage were inhibited by higenemine. The above results suggest that, aithough the main action og higenamine is on the Ca channel, higenamine also have a minor effect of augmenting the Na channel.