Clinical Aspects and Surgical Methods in Perianal Hidradenitis Suppurativa

PURPOSE: Hidradenitis suppurativa is a chronic suppurative and cicatricial inflammatory disease involving apocrine gland- bearing areas including the axilla, groin, and anogenital regions. Recurrence after surgery is not rare, and there is much debate about operative methods. This study analyzed the clinical characteristics and the relationship between different surgical methods and recurrences of perianal hidradenitis suppurativa. METHODS: A retrospective study of 20 patients with perianal hidradenitis suppurativa was done. The clinical characteristics were examined. The patients were divided into several groups (acute, chronic regional, chronic extensive) according to lesion status; then, different operative methods and recurrence rates were compared. RESULTS: All of the patients were male smokers. The mean age of onset was 28.4 years. The mean duration of disease was 10 years. The total number of operations, including incision and drainage, was 29 cases. Only 4 patients were overweight or obese. The most common symptom was pus discharge (52%). The recurrence rate after final surgery was 30.0%. After incision and drainage in the acute group, 7 of 8 cases (87.5%) recurred. In the chronic regional group, 5 of 9 cases (55.6%) experienced recurrence after excision and primary repair. After excision and healing by secondary intention, 1 of 7 cases (14.3%) had recurrence. In the case of one unroofing and marsupialization, there was no recurrence. In the chronic extensive group, 1 recurrence was noted in 4 unroofings and marsupializations. CONCLUSIONS: In the case of abscess, proper incision and drainage is needed, but further definitive surgery must be done. In the case of chronic disease, if the lesions are regional, excision and healing by secondary intention is more ideal for decreasing the recurrence rate. If the lesions are extensive, unroofing and marsupialization is recom-mended.

An experimental study about efficacy of drain catheters

Although percutaneous abscess drainage has become and accepted alternative from of therapy for selected patients with abscess, it is well known that there are several factors in the failure of adequate drainage such as pre-and post- procedural management, technique itself, various features of abscess, and selection and application of catheters. Among these factors, we made an experiment about drain efficacy of commonly used various catheters with different viscosities of water-glycerin solution under the two different pressure gradients. The experimental values of flow rate were lower than than the calculated values. An efficacy of experimental value was 4-14%. Because the inner diameter of fittings and stopcocks was usually smaller than the inner diameter of catheters, these factors also affected the drain efficacy. Finally, we though that it will be very helpful to the treatment of patients as well as to study about the catheter drainage, if the drain efficacy of individual catheters has been notified.

The predictability of the Tc-99m pyrophosphate scan and statistical evaluation of the trade-off point

The technetium (Tc)-99m pyrophosphate scans have been used to diagnose acute myocardial infarctions and to confirm the equivocal cases. Many articles have been reported about its diagnostic performance and pitfalls. But there has been no evaluation of its predictability according to the grades of the radioactivity land statistical evaluation of the trade-off point, i.e., grade 2 and the area under the receiver operating characteristic curve. To achieve the goals, we reviewed 252 cases of Tc-99m pyrophosphate scans (acute transmural infarction [n=99], acute subendocardial infarction [n=7], unstable angina[n=16], old myocardial infarction [n=19] others [n=111]). The predictabilities of the scan are 98% in grade 4, 84% in grade 3, 83% in grade 2, 53% in grade 1 and 18% in non-uptake. The usual trade-off point, grade 2 is not statistically significant(Z=1.945, P=0.0259>0.01). The area under the receiver operating characteristic curve(Az) is 0.885. Our study shows that the probable main cause of the false negative cases is the time interval between the onset of symptoms and the test.

Intrahepatic biliary duct anatomy and its variations

No abstract available.

Menetrier's disease accompanied thrombosis of the iliac vein: A case report

Menetrier's disease is a rare cause of thickened gastric wall. The differential diagnosis of diffuse gastricwall thickening such as lymphoma and adenocarcinoma should be expanded to include Menetrier's disease. The authorsexperienced a case of Menetrier's disease accompanied deep vein thrombosis, which was proved by operation andpathology. We carried out double cntrast upper G-I series and computed tomography , and report with review ofliteratures.

Chest radiographic findings of leptospirosis

1. A study on chest radiographic findings of 54 cases with pneumonia like symptoms was performed. Of 54 cases,8 cases were confirmed to be leptospirosis and 7 cases were leptospirosis combined with Korean hemorrhagic fever.2. Of 8 cases of leptospirosis, 4 cases showed abnormal chest radiographic findings: acinar nodular type 2,massive cofluent consolidation type 2. Of 7 cases of leptospirosis combined with Korean hemorrhagic fever: acinarnodular type 3, massive confluent consolidation type1, and increased interstitial markings type 1 respectively. 3.It was considered to be difficult to diagnose the leptospirosis on chest radiographic findings alone, especiallythe case combined with Korean hemorrhagic fever.

Diagnosis of choledocholithiasis by computed tomography

In order to determine the value of CT in the diagnosis of choledocholithiasis, the authors retrospectivelystudied 33 cases of choledocholithiasis proven by surgery from January 1983 to June 1985. Among them, 15 caseswere examined by both CT and ultrasonography. The results were as follows: 1. There were 12 men and 21 women withmean age of 57 years. 2. CT correctly diagnosed choledocholithiasis in 29(88%) of total 33 cases. There were 4false negative diagnoses and there were no false positive. 3. In 15 cases which were examined by both CT andultrasonography, 13(86%) cases were correctly diagnosed by CTand 7(46%) by utrasonography. 4. The majority(88%) ofcholedocholithiasis were demonstrated as calcific density and 4 cases(12%) were nearly isodense to pancreas. 5.Most cases were shown as homogenous density and 5 cases(16%) as ringlike structure with low density center andhigh density periphery. 6. Additional findings, such as intrahepatic and/or GB stones, pericholangitic abscess, GBempyema, ascites, and liver cirrhosis were also identified by CT. 7. CT is effective for noninvasive and accuratedetection of choledocolithiasis. So invasive cholangiography, such as E.R.C.P or P.T.C can be reserved in manycases of choledocholithiasis.

Computed tomography of the breast cancer

The indication of CT for the breast lesions are 1) Unusually extensive or small breast caused technicaldifficulties in performing mammograms. 2) Questionable mammographic findings, especially in dense proliferativebreast parenchyme, 3) Microcancer. 4) Suspicious regional lymph node enlargement of invasion of the chest wall bybreast cancer. The diagnosis of breast CT in breast cancer is based on pathologic anatomic change andcharacteristic increase of mean CT No. of lesion following contrast enhancement. Authors analysed CT of the 34patients who were clinically suspected breast cancer, and compared with mammography. The results are as follows:1. Pathological diagnosis of 34 cases were 27 cases of breast cancer, 4 cases of fibrocystic disease, 2 cases offibroadenoma, and 1 case of intraductal pupilloma. The diagnostic accuracy of CT in 27 breast cancer was 93%(25cases) and mammography 71%(19 cases). 2. Corect diagnosis of CT in 7 benign breast disease is in 5 cases andmammography in 5 cases. 3. The most importment finding of CT in breast cancer is characteristic increase of CT No.of lesion following contrast enhancement (200ml, 65%): over average 50HU in 19 cases of 27 breast cancers, 30-50HUin a 6 cases, 20-30HU in 2 cases with tumor necrosis. 4. Compared with mammography, other more valuable CTfindings of breast cancer are axillary lymph node enlargement and adjacentic pectoral muscle invasion. 5. Inconclusion, Breast CT is considered as a valuable diagnostic tool in evaluation of breast cancer, but not of benign breast disease.

Experimental study on quantitative analysis of fatty liver by computed tomography in rabbit

For the study of correlation of CT number and fatty content of the liver, total 35 rabbits were used. Therabbits were divided into one control and three experimental groups according to the amount of carbonetetra choloride, administered 1ml, 2ml and 3ml per kg lf body weight respectively. The carbone tetrachloride wasadministered via intragastric route. CT was performed 72 hours following administration of carbone tetrachloride,and immediately prior to CT scan each rabbit was anesthetized by means of IM injection of ketamine and IV injection of succinylcholine to stop motion and respiration. CT numbers were measured and histological study forthe deposition of fat in the liver tissue was done. Also biochemical analysis of lipid in the blood and in theextraction of liver tissue was performed. Comparison of CT number with biochemical and histological data was done.The results were as follows: 1. In each experimental group, the degree of accumulation of fat in the liver was proportional to the amount of carbone tetrachloride. 2. Degree of decreaseing CT number was correlated with theincrease in the accumlation of fat in the liver. 3. In the control and experimental (1,2,3) groups, when theamount of carbone tetrachloride increased, the amount of total lipid, cholesterol and triglyceride on biochemical analysis of the liver increased. Also increase in the amount of plasma lipids on biochemical analysis and a greatdegree of increase in accumulation of fat in the liver on histological examination were see. But no changes in theamounts of phospholipid and protein on biochemical analysis of the liver were noticed. 4. Increase in the amountof total lipid could make a change in the CT number of the liver remakably(r=−0.63). As the amount of cholesteroland triglyceride increased, the CT number of the liver decreased (r=−0.61 and r=−0.76 respectively). But there wasno significant correlation between the amount of protein and phospholipid and the degree of decrease in CT number.5. Mean values of CT number in normal, grade 1, grade 2, grade 3 and grade 4 according to the degree ofhistological changes were 67.46±2.24, 58.53±3.06, 49.43±6.91, 39.49±9.69, 20.62±8.04 respectively. Thereduction of CT number was correlated with the accumulation of fat on histological examination.

Ultrasonographic study of gallbladder wall thickness in acute viral hepatitis

Prospective study of gallbladder wall thickness by utrasonography was performed in 38 patients of acute viral hepatitis and 50 normal subjects as a control group from June 1983 to April 1984. The results were as follows; 1.In normal population, the range of gallbladder wall thickness is from 1mm to 3mm with peak incidence in 2mm(66%,33 case). Mean thickness of gallbladder wall is about 1.9±0.6mm. 2. In acute viral hepatitis, the range of gallbladder wall thickness is from 2mm to 8mm with peak incidence in 3mm(34%, 13 case), second peak in 4mm (29%,11 case). Mean thickness of gallbladder wall is about 3.6±1.6mm, which is thicker than normal with statistical signifiance. (p<0.005) 3, In acute viral hepatitis , the mean thickness of glabladder wall is about 4.4±1.8mm in the group of SGOT/ SGPT level above 400 IU, and 2.8±0.8mm in the group of SGOT/SGPT level below 400 IU. This difference is significant statistically. (p<0.05).

Ultrasonography in obstructive jaundice : a comparison with percutaneous transhepatic cholangiography

The value of ultrasonography and percutaneous transhepatic cholangiography in determining the site and etiology of biliary obstruction with surgical jaundice was studied in 30 patients. All diagnoses were subsequently made by surgery and pathology. The results were as follows; 1. In ultrasonography, the site of obstruction was delineated in 46%, while the etiology of the lesion was established in 40%, In comparison, percutaneous transhepatic cholangiography delineated the site in 100% and the etilogy in 93%. 2. Although the percutaneous transhepatic cholangiography is invasive to the human body, it is considered to be the single procedure of choicein the managment of the patient with biliary obstructive jaundice because of its diagnostic accuracy, technical simplicity and relative safety.

Ultrasonographic ejection fraction of normal gallbladder

Real-time ultrasongraphy is a simple, accurate, noninvasive and potentially valuable means of studying gallbladder size and emptying. The authors calculated ultrasonographically the ejection fraction of 80 cases of normally functioning gallbladder on oral cholecystography, from June 1983 to April 1984, at the department of radiology, Hangang Sacred Heart Hospital. The results were obtained as follows; 1. Ultrasongraphic Ejection Fraction at 30 minutes after the fatty meal was 73.1+-16.85. 2. There was no significant difference in age and sex, statistically.

Percutaneous transhepatic cholangiography in obstructive jaundice

Although many invasive studies in the biliary tract disase are replaced by noninvasive techniques such asultrasonography and CT, PTC does still play an important role indiagnosis of obstructive jaundice. Authors hadperformed 42 patients of PTC with Chiba needle at the department of radiology, Han Gang Sacred Heart Hospital for4 years from Jan. 1978 to April 1982. And we reviewed literatures. The results were as follows; 1. Forty twopatients of PTC were 22 males and 20 females. The success rate was 90.5%(38/42). The failed 4 cases of PTC werenonobstructive hepatobiliary diseases. 2. The PTC diagnosis of 38 cases were biliary stone (21 cases),cholangiocarcinoma(7 cases), pancreatic carcinoma (2 cases), hepatoma (2 cases), ascariasis(2 cases), andclonorchiasis(1 case), and the remainders were normal. 3. We made 2 cases of misdiagnosis on the basis of PTCfindings. They were one case of distal CBD stone with severe cholangitis diagnosed as ampullary carcioma andanother case of proximal CBD stone with cholangitis diagnosed as pancreas carcinoma. 4. We experienced 2 cases ofcomplication such as sepsis and severe hypotension, but they were recovered.

A study on reliability of the abdominal plain film diagnosis in pediatric patients with suspected intussusception

1. The plain abdominal films of 246 cases of intussusception preceding hydrostatic barium enema were analysedin order to reassess the diagnostic reliability of the abdominal plain film examination. Then, these were comparedwith 42 cases in which the diagnosis had been rejected by means of barium enema. 2. It was found that diagnosis ofthe intussusception was possible in 80% of 246 cases on the basis of plain film findings alone. 3. The most commonand reliable findings of intussusception in plain film diagnosis are those of sparse faecoloid bowel content andsparse amount of intestinal gas. 4. The loops of distended small bowel in cecal or ascending colon area andintraabdominal soft tissue mass are considered to be relatively reliable findings. 5. In 42 cases in which thediagnosis had been rejected by means of barium enema, intussusception was excluded in 745 of the cases on thebasis of plain film findings alone.

A case of pulmonary edema developed after intraarterial injection of iodinated contrast medium

Pulmonary edema is a rare adverse reaction to the iodinated contrast medium. Complaining of huge abdominal mass, a 52 years-old female was admitted to the Hangang Sungsim Hospital. On physical examination, the patient appeared to be healthy. She had stable vital Signs, i.e. BP: 120/80 mmHg, pulse rate: 80/min. etc. An adult head sized mass was palpated in the left mid and lower abdomen. Otherwise nonspecific. On laboratory studies, the positive findings were 8-10 WBC/HPF in urine, 25.6 mg/dl for BUN and PVC in EKG. It was negative for urine protein, serum creatinine and liver function test. We injected 100ml and 30 ml for Urografin 60 through the abdominal aortadividing 3 times and major branches of the abdominal aorta, respectively. Immediately after completing angiography, interstitial pulmonary edema was found, showing blurring of the vascular margins, perivascular haziness and thickening of the interiobular septal lines in the both lower lung fields. The blood pressure was dropped to 80/60 mmHg, but pulse rate was normal. She did not complian of dyspnea, and cyanosis was not developed. The urine volume was normally maintained. She was treated for pulmonary edema, which was completely absorbed after 20 hours. And the blood pressure was also normalized. We has experienced a case of pulmonary edema developed after intraarterial injection of the iodinated contrast medium without underlying cardiac, renal and hepatic problems, and reviewed the literatures on mechanisms of pulmonary edema caused by intravascular injection of the iodinated contrast materials.

A study on diagnostic value of oblique lumbar spine radiographs

A retrospective study was designed to determine the diagnostic contribution of oblique view in 740 consecutive lumbar spine examinations done in adults. In 12 cases (1.62%) there was a change in the radiographic interpretation when the oblique views were used for diagnosis. Considering the significant gonadal radiation, additional cost, and limited diagnostic value, the authors feel that the oblique view should not be a routine part of the initial lumbar spine examination in adults.