The Nephrometry Score: Is It Effective for Predicting Perioperative Outcome During Robot-Assisted Partial Nephrectomy?

PURPOSE: Robot-assisted partial nephrectomy (RPN) has emerged as an alternative treatment for the management of small renal masses. This study was designed to investigate parameters that predict perioperative outcomes during RPN. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 113 patients who underwent RPN between September 2008 and May 2012 at the Seoul National University Bundang Hospital. Clinical parameters, including warm ischemia time (WIT), estimated blood loss (EBL), and R.E.N.A.L and PADUA scores, were evaluated to predict perioperative outcomes. RESULTS: Of the 113 patients, 81 were men and 32 were women. The patients' mean age was 53.5 years, and their mean body mass index was 22.3 kg/m2. Age, gender, and mass laterality had no effect on perioperative complications, WIT, or EBL. Univariate analysis revealed that a distance between the tumor and the collecting system of 4 cm were associated with adverse profiles of complications, WIT, and EBL. However, multivariate analysis showed no association between the predictive parameters and tumor complexity as assessed by nephrometry scores. Tumor size of >4 cm increased the risk of blood loss >300 mL (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.3.9.7; p=0.016). A distance between the tumor and the collecting system of < or =4 mm was associated with increased risk of WIT exceeding 20 minutes (OR, 2.8; 95% CI, 1.3.6.3; p=0.012). CONCLUSIONS: Tumor size and proximity of the mass to the collecting system showed significant associations with EBL and WIT, respectively, during RPN. The R.E.N.A.L and PADUA nephrometry scoring systems did not predict perioperative outcomes.

Effect of ulinastatin on perioperative organ function and systemic inflammatory reaction during cardiac surgery: a randomized double-blinded study / 대한마취과학회지

BACKGROUND: This study evaluated the efficacy of ulinastatin for attenuating organ injury and the release of proinflammatory cytokines due to cardiopulmonary bypass (CPB) during cardiac surgery. METHODS: Patients undergoing valvular heart surgery employing CPB were assigned to receive either ulinastatin (group U, n = 13) or a placebo (group C, n = 11) before the commencement of CPB. Hemodynamic data, parameters of major organ injury and function, and proinflammatory cytokines were measured after the induction of anesthesia (T1), after CPB (T2), at the end of anesthesia (T3), and at 24 hours after surgery (POD). RESULTS: The demographic data, CPB duration, and perioperative transfusions were not different between the groups. PaO2/FiO2 in group U was significantly higher than that in group C at T3 (3.8 +/- 0.8 vs. 2.8 +/- 0.7, P = 0.005) and at POD (4.0 +/- 0.7 vs. 2.8 +/- 0.7, P < 0.001). Creatine kinase-MB at POD in group U was significantly lower than that in group C (17.7 +/- 8.3 vs. 33.7 +/- 22.1, P = 0.03), whereas troponin I at POD was not different between the groups. Creatinine clearance and the extubation time were not different between the groups at POD. The dopamine infusion rate during the post-CPB period in group U was significantly lower than that in group C (1.6 +/- 1.6 vs. 5.5 +/- 3.3 microg/kg/min, P = 0.003). The interleukin-6 and tumor necrosis factor-alpha concentrations at T1, T2, and T3 as well as the incidences of postoperative cardiac, pulmonary and kidney injuries were not different between the groups. CONCLUSIONS: Ulinastatin pretreatment resulted in an improved oxygenation profile and reduced inotropic support, probably by attenuating the degree of cardiopulmonary injury; however, it did not reduce the levels of proinflammatory cytokines.

Treatment of Urethral/Bladder Neck Stricture After High-Intensity Focused Ultrasound for Prostate Cancer With Holmium: Yttrium-Aluminium-Garnet Laser / 대한배뇨장애요실금학회지

PURPOSE: To evaluate the efficacy and safety of the Holmium: yttrium-aluminium-garnet (YAG) laser for the treatment of urethral/bladder neck strictures after high-intensity focused ultrasound for prostate cancer. METHODS: Between February 2007 and July 2010, Holmium: YAG laser urethrotomies were performed in eleven patients for bladder neck strictures or prostatic urethral strictures. The laser was used with a 550-microm fiber at 2 J and frequency 30 to 50 Hz. The medical records were retrospectively reviewed for medical history, perioperative and postoperative data, uroflowmetry, International Prostate Symptoms Score/quality of life, and stricture recurrence. RESULTS: At a median follow-up of 12.0 months (range, 4 to 35 months), the mean postoperative maximal flow rate and residual volume were improved significantly (P<0.05). The mean postoperative total, voiding and quality of life of international prostate symptom score were improved significantly (P<0.05). Of the 11 patients, 7 patients required one treatment, 4 patients two treatment, and 1 patients three treatment. 2 patients who had a documented urinary incontinence prior to the laser treatment subsequently required artificial urinary sphincter implantation and reported satisfaction without developing any recurrent strictures or artificial urinary sphincter erosion. All patients exhibited well-healed strictures and could void without difficulty. CONCLUSIONS: Holmium: YAG laser therapy represents a safe, effective and minimally invasive treatment for urethral/bladder neck strictures occurring secondary to high-intensity focused ultrasound for prostate cancer.

Effects of Ulinastatin on Postoperative Blood Loss and Hemostasis in Atrioventricular Valve Surgery with Cardiopulmonary Bypass

BACKGROUND: Cardiopulmonary bypass (CPB) induces variable systemic inflammatory reactions associated with major organ dysfunction via polymorphonuclear neutrophils (PMNs). Ulinastatin, a urinary trypsin inhibitor, inhibits PMN activity and reduces systemic inflammatory responses. The aim of this study is to evaluate the effect of ulinastatin on postoperative blood loss and laboratory changes in patients undergoing open heart surgery. MATERIALS AND METHODS: Between January 2008 and February 2009, 110 patients who underwent atrioventricular valve surgery through right thoracotomy were divided into two groups. Patients received either 5,000 U/kg ulinastatin (ulinastatin group, n=41) or the equivalent volume of normal saline (control group, n=69) before aortic cross clamping. The primary end points were early coagulation profile changes, postoperative blood loss, transfusion requirements, and duration of intubation and intensive care unit stay. RESULTS: There were no statistically significant differences between the two groups in early coagulation profile, other perioperative laboratory data, and postoperative blood loss with transfusion requirements. CONCLUSION: Administration of ulinastatin during operation did not improve the early coagulation profile, postoperative blood loss, or transfusion requirements of patients undergoing open heart surgery. In addition, no significant effect of ulinastatin was observed in major organs dysfunction, systemic inflammatory reactions, or other postoperative profiles.

Effects of Ulinastatin on Postoperative Blood Loss and Hemostasis in Atrioventricular Valve Surgery with Cardiopulmonary Bypass

BACKGROUND: Cardiopulmonary bypass (CPB) induces variable systemic inflammatory reactions associated with major organ dysfunction via polymorphonuclear neutrophils (PMNs). Ulinastatin, a urinary trypsin inhibitor, inhibits PMN activity and reduces systemic inflammatory responses. The aim of this study is to evaluate the effect of ulinastatin on postoperative blood loss and laboratory changes in patients undergoing open heart surgery. MATERIALS AND METHODS: Between January 2008 and February 2009, 110 patients who underwent atrioventricular valve surgery through right thoracotomy were divided into two groups. Patients received either 5,000 U/kg ulinastatin (ulinastatin group, n=41) or the equivalent volume of normal saline (control group, n=69) before aortic cross clamping. The primary end points were early coagulation profile changes, postoperative blood loss, transfusion requirements, and duration of intubation and intensive care unit stay. RESULTS: There were no statistically significant differences between the two groups in early coagulation profile, other perioperative laboratory data, and postoperative blood loss with transfusion requirements. CONCLUSION: Administration of ulinastatin during operation did not improve the early coagulation profile, postoperative blood loss, or transfusion requirements of patients undergoing open heart surgery. In addition, no significant effect of ulinastatin was observed in major organs dysfunction, systemic inflammatory reactions, or other postoperative profiles.

Can 80 W KTP Laser Vaporization Effectively Relieve the Obstruction in Benign Prostatic Hyperplasia?: A Nonrandomized Trial

PURPOSE: There is little data evaluating the changes of severity of bladder outlet obstruction after 80 W-potassium-titanyl-phosphate (KTP) photoselective laser vaporization prostatectomy (PVP) by pressure-flow study. We evaluated the efficacy of PVP to relieve the obstruction in benign prostate hyperplasia (BPH) compared with transurethral resection of the prostate (TURP). MATERIALS AND METHODS: This is a prospective, non-randomized single center study. The inclusion criteria were as follows: Men suffering from lower urinary tract symptoms (LUTS) secondary to BPH, age > or =50 years, International Prostatic Symptom Score (IPSS) > or =13, maximum flow rate (Qmax) or =40 was decreased from 64% to 4% in the PVP group and from 86% to 14% in the TURP group. CONCLUSIONS: PVP could reduce the prostate volume effectively and relieve bladder outlet obstruction similar to TURP by the 6-month follow up in men with BPH.

Removal of Bone Cement through Right Anterolateral Thoracotomy

A 55-year-old woman who had a history of percutaneous vertebroplasty was referred to our institution with sudden onset of chest pain. Computed tomography (CT) scan demonstrated a long, linear, highly-attenuated segment in the right side of the heart and fragmented pieces in the right pulmonary artery. The CT scan and echocardiogram revealed no pericardial effusion or hemopericardium. Based on these findings, we performed surgery through right anterolateral thoracotomy without cardiac arrest. As a result, we safely removed the foreign body. This approach may be a feasible and effective procedure for selected cases.

Mid-term Outcomes of Total Arterial Revascularization Versus Conventional Coronary Surgery in Isolated Three-Vessel Coronary Disease

Whether arterial conduits are superior to venous grafts in coronary artery bypassing has been debated. The aim of this study was to investigate clinical outcomes after total arterial revascularization versus conventional coronary bypassing using both arterial and venous conduits in isolated three-vessel coronary disease. Between 2003 and 2005, 503 patients who underwent isolated coronary artery bypass grafting for three-vessel coronary disease were enrolled. A total of 117 patients underwent total arterial revascularization (Artery group) whereas 386 patients were treated with arterial and venous conduits (Vein group). Major adverse outcomes (death, myocardial infarction, stroke and repeat revascularization) were compared. Clinical follow-up was complete in all patients with a mean duration of 6.1 +/- 0.9 yr. After adjustment for differences in baseline risk factors, risks of death (hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.51-1.82, P = 0.90), myocardial infarction (HR 0.20, 95% CI 0.02-2.63, P = 0.22), stroke (HR 1.29, 95% CI 0.35-4.72, P = 0.70), repeat revascularization (HR 0.64, 95% CI 0.26-1.55, P = 0.32) and the composite outcomes (HR 0.83, 95% CI 0.50-1.36, P = 0.45) were similar between two groups. Since the use of veins does not increase the risks of adverse outcomes compared with total arterial revascularization, a selection of the conduit should be more liberal.

Short-term Outcomes of Aortic Wrapping for Mild to Moderate Ascending Aorta Dilatation in Patients Undergoing Cardiac Surgery

BACKGROUND: The adequate management of mild to moderate dilatation of the ascending aorta during cardiac operations remains controversial. In this study, we present the short-term outcomes of 90 patients undergoing ascending aortic wrapping with a Dacron graft during other cardiac operations. MATERIALS AND METHODS: From March 2008 to January 2011, 90 consecutive patients underwent treatment for ascending aortic aneurysm using the external wrapping technique during the concomitant procedure. The study group consisted of 49 male and 41 female patients with a mean age of 58.7+/-13 years. The primary cardiac surgical procedures were coronary artery bypass grafting (CABG) in 3, aortic valve replacement in 2, and aortic valvuloplasty in 85 patients (isolated in 62 and combined with CABG or mitral valvuloplasty in 23). The ascending aorta diameter was measured using a computed tomography scan within 4 weeks after surgery, and was compared with the preoperative value. RESULTS: The diameters of the ascending aorta wrapped with the Dacron graft were significantly reduced within a month after surgery from 46.4+/-4.3 mm to 33.0+/-3.5 mm (p<0.05). There was no early mortality or major surgical complication. During the mean follow-up period of 15.4+/-5.2 months, there was only one late death caused by septic multiorgan failure. CONCLUSION: Dacron wrapping of the ascending aorta offers excellent results with very low mortality and morbidity, and it can be regarded as a safe and effective method for the treatment of moderately dilated ascending aorta in selected patients.

Non-invasive Hemoglobin Measurement in Emergency Patients

PURPOSE: At present, the hemoglobin count is one of the most commonly performed clinical laboratory tests in the emergency department. However, the conventional method is invasive and permits only intermittent assessments. The aim of this study was to determine whether non-invasive hemoglobin measurements (SpHb) produce comparably accurate results to laboratory hemoglobin tests (tHb) in patients presented to the emergency department. METHODS: From May to July 2009, 217 patients who required hemoglobin tests after presenting to the emergency department of a hospital were enrolled. We measured hemoglobin values using the conventional method (tHb), and the non-invasive method (SpHb). The study population was classified into two groups: 'non-bleeding' and 'bleeding'. The concordance between tHb and SpHb was analyzed by the Pearson's correlation coefficient. RESULTS: A total of 217 data pairs were collected from 217 subjects, 193(88.9%) non-bleeding patients, 24(11.1%) bleeding patients. A total of 114 subjects were male (52.5%). The Pearson's correlation coefficient between tHb and SpHb was 0.814(p=0.000). In the 'non-bleeding' and 'bleeding' groups, the Pearson's correlation coefficients between tHb and SpHb were 0.779(p=0.000) and 0.788(p=0.000) respectively. CONCLUSION: Non-invasive SpHb measurement provides clinically acceptable accuracy compared to the conventional laboratory method (tHb) in the setting of the emergency department.

CABG for Treating Unstable Angina with Multivessel Coronary Artery Aneurysms: A case report / 대한흉부외과학회지

Coronary artery aneurysm is an uncommon disease. The optimal medical or surgical treatment for this disease remains obscure. The causes of coronary artery aneurysms include atherosclerosis, Kawasaki disease, infectious vascular disease, connective tissue disorder and congenital malformation. A 50 year old man visit our institution for chest pain that had started 3 days previously. After coronary angiography, multiple coronary aneurysms were diagnosed and successful surgical intervention was performed.

Multi-vessel Small Thoracotomy (MVST) CABG with Robot-assisted Bilateral ITA Harvesting: A case report / 대한흉부외과학회지

The da Vinci telemanipulator system (Intuitive Surgical, Sunnyvale, CA USA) is the most advanced robotic surgical system and has been increasingly used for cardiac surgical procedures. We report out first clinical experience of use of the da Vinci telemanipulator system for endoscopic harvesting of the bilateral thoracic artery and multi-vessel small thoracotomy off pump CABG for 3-vessel disease. The da Vinci telemanipulator system has been previously utilized primarily for mitral valve surgery.

Patients' Satisfaction and Quality of Sex Life in Patients Undergoing Long-term Intracavernous Injections with Trimix / 대한남성과학회지

PURPOSE: Intracaverous injections (ICI) are the standard treatment for erectile dysfunction (ED) when oral phosphodiesterase 5 inhibitors (PDE5I) fail or are contraindicated. However, many patients are wary of ICI because of aversion to the injection. We assessed patients' satisfaction and the quality of the sex life in patients undergoing long-term ICI with trimix. MATERIALS AND METHODS: One hundred five patients with ED who had used ICI with trimix for at least 6 months were enrolled in the study. We investigated the Erectile Dysfunction Inventory of Treatment Satisfaction Questionnaire (EDITS), quality of sex life, and pain on injection and erection. The EDITS questions were scored on a 0 to 4-point scale and the mean scores were multiplied by 25 to normalize the scores to a 100-point scale and to create the EDITS index. A total score > 50 was defined as "satisfied with treatment" and a score of < 50 was defined as "not satisfied with treatment." RESULTS: The mean age of the patients was 70+/-8.2 years, the mean duration of ED was 6.4+/-3.3 years, and the mean duration of ICI treatment was 50.3+/-32.6 months. Of the 105 patients, 48.5% had received PDE5I treatment prior to ICI treatment. Among the 51 patients who had received PDE5I, 72.5% (37/51) and 19.6% (10/51) discontinued PDE5I due to inefficacy and side effects, respectively. Four patients used PDE5I in combination with ICI. The mean number of injections was 2.99+/-1.26 per month and the mean dose of trimix was 0.33+/-0.14 ml per injection. The mean EDITS index was 73.7+/-14.5, and 93% of the patients were classified in the satisfaction group according to the EDITS index criteria. Patients noted an improvement in their sex life (78.1%), their relationship with their partner (68.6%), and their quality of life (65.7%) after using ICI with trimix; 92.3% of patients responded that they were ready to recommend ICI with trimix to their friends. The mean scores for pain on injection and erection were 1.04/10 and 0.98/10, respectively. CONCLUSIONS: In spite of long-term treatment, ICI with trimix met the expectations of patients. ICI with trimix is revealed as easy, effective, and tolerable treatment. ICI with trimix should be positively recommended when PDE5I fails or is contraindicated.

Efficacy and Safety of Doxazosin GITS over 4 weeks for the Treatment of Non-neurogenic Voiding Dysfunction in Females: Short-term Outcomes

PURPOSE: We administered doxazosin gastrointestinal therapeutic system (GITS) to women with non-neurogenic voiding dysfunction to evaluate its therapeutic effects. MATERIALS AND METHODS: Women who had voiding dysfunctions for at least 3 mo were included. Inclusion criteria were age > or =18yr, an International Prostate Symptom Score (IPSS) > or =15, and a maximum flow rate (Qmax) or =150mL. Patients with neurogenic voiding dysfunction or anatomical bladder outlet obstruction were excluded. All patients were classified according to the Blaivas-Groutz nomogram. After 4 weeks, treatment outcomes were evaluated. RESULTS: Sixty-two patients were evaluated of mean age 53.8 (32-78)yr. According to the Blaivas-Groutz nomogram, 24 patients had no or mild obstruction (group A) and 38 had moderate or severe obstruction (group B). After treatment, mean IPSS decreased significantly and by more than 5 points in 42 (67.7%). Mean bother scores, Qmax, and PVR also changed significantly. Thirty-seven (59.7%) showed Qmax increases of more than 50%. No significant difference were observed between the groups in terms of IPSS, bother score, Qmax, PVR, micturition frequencies, or functional bladder capacity changes. Adverse effects related to medication were de novo stress urinary incontinence (SUI) (1 case) and underlying SUI aggravation (1 case). By satisfaction assessments, 16 patients (25.8%) were 'mainly satisfied', 31 (50%) were 'slightly satisfied', and 15 (24.2%) were 'dissatisfied'. CONCLUSION: Doxazosin GITS was found to be effective in female patients with voiding dysfunction regardless of obstruction grade. The alpha-adrenoceptor antagonists should be viewed as initial treatment option for women with a non-neurogenic voiding dysfunction.

Pathologic Features of Renal Masses, 4cm or Less in Diameter: The Prevalence of Benign Tumors / 대한비뇨기과학회지

PURPOSE: We examined the clinical and pathologic findings of small renal masses that were suspected to be malignant. We investigated the prevalence and the predictors of benign tumors. MATERIALS AND METHODS: We retrospectively reviewed the medical records of the patients who underwent surgeries for renal lesions between September 1994 and June 2007. We analyzed the pathologic reports and medical records of 586 patients who had a renal mass that was 4cm or less. The mean patient age was 53 years(age range: 15-82). There were 418 male patients(71.3%) and 168 females(28.7%). Multiple logistic regression analysis was done to determine the clinical factors associated with benign renal masses, including the radiological tumor size, a cystic versus solid appearance, gender, age and the presenting symptoms. RESULTS: Of the 586 renal masses, 62(10.6%) were benign, 520(88.7%) were renal cell carcinoma and 4(0.7%) were other malignancies. The proportion of benign lesions was significantly higher in the females than that in the males(21.4% vs. 6.2%, respectively, p<001) and the proportion of benign lesions was significantly higher for the smaller masses(0-2cm) than for the 2.1-4cm sized tumors(14.7% vs. 9.1%, respectively, p=0.048). On multivariate analysis, gender and tumor size were significantly associated with malignant histology with the males having an odds ratio(OR) of 4.16 (95% CI 2.41-7.19, p<0.001) and the tumor size more than 2cm having an OR of 1.93(95% CI 1.08-3.44, p=0.03). CONCLUSIONS: A considerable number(10.6%) of benign lesions 4cm or less in the radiological diameter were operated on based on suspicious preoperative imaging. The results of this study seem to help not only for counseling the patients, but also for deciding on a therapeutic modality preoperatively.

Efficacy and Safety of Sacral Neuromodulation (Interstim(R)) for the Treatment of Refractory Overactive Bladder Symptoms and Chronic Pelvic Pain / 대한비뇨기과학회지

PURPOSE: We evaluated the efficacy and safety of sacral neuromodulation for treating the patients suffering with an overactive bladder(OAB) or chronic pelvic pain(CPP) that was refractory to conservative therapies. MATERIALS AND METHODS: Between November 2002 and May 2006, a total of 30 patients underwent testing with sacral nerve modulation via either a traditional percutaneous approach or a staged procedure to predict the efficacy of this treatment for refractory OAB and/or CPP. 17 patients had 50% or greater improvement in their presenting symptoms and they underwent a procedure to implant a permanent sacral nerve stimulator. The results of the treatment were evaluated according to the 3 day-voiding records, the severity of pain, the patients' perception of their bladder condition and the benefits of the treatment. RESULTS: Twelve patients had CPP and 5 had OAB. The number and severity of their urgency episodes were improved. However, the number of times they passed urine was not significantly changed. The number of incontinence episodes was reduced for the 7 patients who suffered with urge incontinence. For 12 patients with CPP, the severity of their average pain was significantly decreased. There was a reduction in the number of the patients with a moderate or more severe bladder condition, from 17 to 10, after sacral neuromodulation. The overall rate of the patients' perceiving treatment benefit was 53%. The complications were lower limb numbness in 2 cases, wound infection in 1, foreign body sensation in 1, anal pain in 1 and lead migration in 1. CONCLUSIONS: Sacral Neuromodulation using Interstim(R) significantly improves the OAB symptoms and CPP in the patients who did not respond to other therapies.

Hetzer Technique for Surgical Correction of Ebstein's Anomaly / 대한흉부외과학회지

BACKGROUND: The Hetzer procedure for the correction of Ebstein's anomaly has the advantages of technical feasibility and incorporation of the atrialized right ventricle (RV) into the functional RV. MATERIAL AND METHOD: We preformed a retrospective review of 11 patients with Ebstein's anomaly and they had undergone a Hetzer procedure between March 2002 and December 2006. RESULT: The median age at operation was 19.8 years (range: 6 months~56 years). There were 4 males and 7 females. All patients showed severe tricuspid regurgitation (TR) preoperatively, and arterial desaturation (<95%) was present in 3 patients. The original Hetzer technique was employed in 6 patients with the Carpentier type A anomaly. In the remaining 5 patients with the Carpentier type B or C anomalies, valve competence was restored at the level of the displaced tricuspid valve mechanism. Adjunct bidirectional cavo-pulmonary shunt, or one and a half ventricle repair strategy was employed for all the patients. The median follow-up was 8.6 months (range: 0.8~51.9 months). There was no early or late death, and the immediate postoperative TR was trivial to mild in 8 patients. The median cardio-thoracic ratios on chest X-ray at the preoperative period and at postoperative 0, 1 and 6 months were 65%, 62%, 55% and 55%, respectively. CONCLUSION: The original or modified Hetzer procedure for Ebstein's anomaly shows excellent intermediate-term outcomes.

Recurred Right Atrial Myxoma after Resection of Left Atrial Myxoma (Recurred Myxoma): A case report / 대한흉부외과학회지

A 33-year-old man presented to the physician with epigastric discomfort. Computed tomography of the chest and echocardiography showed a mass in the left atrium; this mass was resected and diagnosed as myxoma. 12 months later, myxoma recurred in the right atrium, and it was resected without recurrence for 10 months until now. As there are only a few reports on recurred right atrial myxoma after left atrial myxoma, we report here on successful surgical removal of a recurred right atrial myxoma after resection of left atrial myxoma.

CT Findings of Increased Attenuation of the Liver Adjacent to the Hemangioma

PURPOSE: The purpose of this study was to evaluate the frequency, location, and appearance of increasedattenuation of the liver adjacent to a mass during arterial-phase spiral CT in patients with hemangioma. Thecharacteristics of the mass associated with these findings were also evaluated. MATERIALS AND METHODS: Usingspiral CT, 153 lesions in 114 hepatic hemangioma patients were retrospectively reviewed. We evaluated thefrequency, location, and appearance of increased hepatic attenuation adjacent to the hemangioma, and determinedwhether lesion size varied according to whether or not there was increased hepatic attenuation. RESULTS: Areas ofincreased hepatic attenuation adjacent to the hemangioma were identified in 10.5% of cas-es(16/153) and seen inmasses which showed a homogeneously hyperdense (11/16, 69%) or peripherally hy-perdense pattern (5/16, 31%). Thelocation of increased hepatic attenuation was commonly the peripheral por-tion (9/16, 56%), and increased hepaticattenuation was frequently wedge shaped of the mass (11/16, 69%). Lesion size did not vary according to whether ornot there was increased hepatic attenuation. CONCLUSION: Increased hepatic attenuation adjacent to a hemangiomais not rare, and is usually located periph-eral to the mass. It is common in a mass showing a homogeneouslyhyperdense pattern.

CT Findings of Portal Vein Aneurysm

PURPOSE: To describe the CT findings of portal vein aneurysm in eight patients. MATERIALS AND METHODS: Allpatients included in this study (two men and six women) under went CT examinations between October 1996 and June1998. Of these eight, three were suffering from hepatic disease and portal hypertension. We determined thelocation, shape, size, and characteristics of the lesions, and the presence or ab-sence of portal vein anomaly. RESULTS: S even patients had intrahepatic portal vein aneurysm (at the umbilical por-tion of the left portal veinin five patients, between the transverse and umbilical por-tion of the left portal vein in one, and at thebifurcation of the anterior and posterior branch of the right portal vein in one), while extrahepatic portal veinaneurysm, at the confluence of the superior mesenteric and splenic vein was found in only one. Lesions werecyst-shaped in seven cases and saccular in one, and showed well - circum scribed, markedly enhanced mass, whichcommunicated with the portal vein and/or gives off major branches. Portal vein anomaly, in which the rightanterior segmental portal vein originated from the umbilical portion of the left portal vein, was seen in threepatients. In all three, intrahepatic portal vein aneurysm was present at the umbilical portion of the left portalvein, and in one, the umbilical portion of the left portal vein was located to the right of the Cantlie line. CONCLUSION: CT examination can help reveal portal vein aneurysm by detectinga well - circumscribed, markedlyenhanced mass which communicates with the portal vein and/or gives off major branches.