A Case of Idiopathic Myelofibrosis Associated with Acromegaly Patient / 대한내분비학회지

Acromegaly is a chronic condition resulting from the excessive secretion of growth hormone and insulin like growth factor 1, generally from pituitary adenoma. Although there have been several reports suggesting the possible association of hematologic malignancies with acromegaly, myelofibrosis with acromegaly is very rare. Here we report 54-year-old male patient with myelofibrosis accompanied with acromegaly. We treated this patient with low dose thalidomide (50 mg/day) and prednisone (30 mg/day). We reported this case with literature review.

A Case of Idiopathic Myelofibrosis Associated with Acromegaly Patient / 대한내분비학회지

Acromegaly is a chronic condition resulting from the excessive secretion of growth hormone and insulin like growth factor 1, generally from pituitary adenoma. Although there have been several reports suggesting the possible association of hematologic malignancies with acromegaly, myelofibrosis with acromegaly is very rare. Here we report 54-year-old male patient with myelofibrosis accompanied with acromegaly. We treated this patient with low dose thalidomide (50 mg/day) and prednisone (30 mg/day). We reported this case with literature review.

Transrectal Drainage of Deep Pelvic Abscesses Using a Combined Transrectal Sonographic and Fluoroscopic Guidance

PURPOSE: To evaluate the feasibility and clinical efficacy of transrectal drainage of a deep pelvic abscess using combined transrectal sonographic and fluoroscopic guidance. MATERIALS AND METHODS: From March 1995 and August 2004, 17 patients (9 men; 8 women; mean age, 39years) suffering from pelvic pain, fever and leukocytosis were enrolled in this retrospective study. Ultrasound (US) or computed tomography (CT), which was obtained prior to the procedure, showed pelvic fluid collections that were deemed unapproachable by the percutaneous transabdominal routes. Transrectal drainage of the pelvic abscess was performed under combined transrectal sonographic and fluoroscopic guidance. The causes of the deep pelvic abscess were postoperative complications (n=7), complications associated with radiation (n=3) and chemotherapy (n=1) as well as unknown causes (n=6). A 7.5-MHz end-firing transrectal US probe with a needle biopsy guide attachment was advanced into the rectum. Once the abscess was identified, a needle was advanced via the biopsy guide and the abscess was punctured. Under US guidance, either a 0.018"or 0.035" guidewire was passed through the needle in the abscess. Under fluoroscopic guidance, the tract was dilated to the appropriate diameter with sequential fascial dilators, and a catheter was placed over the guide wire within the abscess. Clinical success of drainage was determined by a combination closure of the cavity on the follow up images and diminished leukocytosis. The technical and clinical success rate, complications, and patient's discomfort were analyzed. RESULTS: Drainage was technically successful in all patients and there were no serious complications. Surgery was eventually performed in two cases due to fistular formation with the rectum and leakage of the anastomosis site. The procedure was well tolerated in all but one patient who complained of discomfort while the catheter was inserted. The catheter did not interfere with defecation and there was no incidence of catheter expulsion by defecation. CONCLUSION: Transrectal drainage of deep pelvic abscesses using ultrasound and fluoroscopic guidance is a safe, feasible procedure that is well tolerated by patients and is relatively easy to perform.

Familial Idiopathic Striopallidodentate Calcifications

Familial idiopathic striopallidodentate calcification is a disorder radiologically characterized by bilateral calcifications of the brain without abnormalities in the serum calcium level and related endocrinological parameters. We report a 70-year-old woman presented with slowly progressive gait disturbance, dementia and Parkinsonism. She had bilateral and symmetric calcifications of the basal ganglia, thalamus, dentate nucleus, and subcortical white matter on the brain CT. One son and two granddaughters also showed calcifications of the basal ganglia, suggesting an autosomal dominant inheritance.

Proatlantal Intersegmental Artery Type II Observed in a Patient with Locked-in Syndrome

No abstract available.

A New Liquid Embolic Agent(Embol) for Transcatheter Renal Artery Embolization: An Experimental Study in Rabbit

PURPOSE: To evaluate the effectiveness and safety of a new liquid embolic agent in renal arterial embolization in the rabbit, and its clinical applicability. MATERIALS AND METHODS: A new embolic agent, Embol, was obtained by partial hydrolysis of polyvinyl acetate and dissolved in a mixture of 45% ethanol and 55% non-ionic contrast medium. Its radioopacity was therefore good. An average of 0.8 cc(0.5-0.9 cc) of Embol was used to embolize the renal artery of one kidney in 15 rabbits. The immediate effect of this was examined angiographically 5 minutes after the procedure. To permit histologic examination, five rabbits in each group were sacrificed 3 days (I), 2 weeks (II), and 4 weeks (III) after embolization: prior to embolization and prior to sacrifice, one rabbit in each group underwent renal scanning, and prior to sacrifice all underwent follow-up angiography. In three rabbits, blood urea nitrogen (BUN), creatinine, sodium(Na), and potassium(K) levels were measured before and 1, 3, 5, 7 and 14 days after embolization. RESULTS: Embol was easy to use and its radiopacity was good. Five minutes after embolization, angiography showed that total occlusion of the main renal or interlobar artery had been achieved in all rabbits. Serum BUN, creatinine, Na and K levels were within normal limits. Follow-up angiogram obtained in each group showed persistent occlusion of the renal artery in all but one rabbit in group I and one in group III. Renal scans revealed no evidence of radionuclide uptake in embolized kidneys, which were slightly enlarged in group I but became gradually smaller in groups II and III. In all animals, histologic examination showed diffuse coagulation necrosis of the embolized kidneys and in group III the cortex of these was extensively calcified. In group I the renal artery showed an apparently fresh occluding thrombosis, and in groups II and III a completely organized thrombosis was present. In group III this was calcified. CONCLUSION: Because of its good radioopacity, Embol is easy to controa, and is effective for renal artery embolization. As a permanent embolic agent, it appears suitable for clinical applications.

Analysis of Normal Anatomy of Oral Cavity in Open-mouth View with CT and MRI: Comparison with Closed-mouth View

PURPOSE: When MRI and CT of the oral cavity utilize the traditional closed-mouth approach, direct contact between the tongue and surrounding structures may give rise to difficulty in recognizing the anatomy involved and demonstrating the possible presence of pathologic features. we describe a more appropriate scan technique, involving open-mouthed imaging, which may be used to demonstrate the anatomy of the oral cavity in detail. MATERIALS AND METHODS: Axial and coronal MR imaging and axial CT scanning were performed in 14 healthy volunteers, using both the closed and open-mouth approach. For the latter, a mouth-piece was put in place prior to examination. In all volunteers, open-mouth MR and CT examinations involved the same parameters as the corresponding closed-mouth procedures. The CT and MR images obtained by each method were compared, particular attention being paid to the presence and symmetry of motion artifact of the tongue and the extent of air space in the oral cavity. Comparative imaging analysis was based on the recognition of 13 structures around the boundaries of the mouth. For statistical analysis, Student 's t test was used and a p value < 0.05 was considered significant. RESULTS: Due to symmetry of the tongue, a less severe motion artifact, and increased air space in the oral cavity, the open-mouth method produced excellent images. The axial and coronal MR images thus obtained were superior in terms of demarcation of the inferior surface and dorsum of the tongue, gingiva, buccal surface and buccal vestibule to those obtained with the mouth closed (p<0.05). In addition, axial MR images obtained with the mouth open showed better demarcation of structures at the lingual margin and anterior belly of the digastric muscle (p<0.05), while coronal MR images of the base of the tongue, surface of the hard palate, soft palate, and uvula, were also superior (p<0.05). Open-mouth CT provided better images at the lingual margin, dorsum of the tongue and buccal surface than the closed-mouth approach (p<0.05). CONCLUSION: Open-mouth MRI and CT are both practical and useful for evaluation of the structures of the oral cavity. The images thus obtained are superior to those acqhired with the month closed.

Cord-like Atresia of the Abdominal Aorta Due to Takayasu Arteritis in Middle Aged Woman: A case Report / 대한흉부외과학회지

Takayasu arteritis is a chronic non-specific inflammatory arteriopathy that involves primarily the first branches of aortic arch but may also affect the aorta and any of its primary branches. A characteristic trait of the disease is that most of the patients are young females of mainly Asian and South American origin. Recently, we experienced a rare case of Takayasu arteritis which showed a cord-like atresia of abdominal aorta just below renal arteries in 52-year-old woman. We performed a side to side bypass graft from descending thoracic aorta to abdominal aorta just above the aortic bifurcation with a 18mm PTFE(polytetrafluoroethylene) vascular graft. The postoperative course was uneventful.

The Usefulness of Panoramic Radiography using a Lead Ruler for Dental Implant Planning

PURPOSE: If damage to the neurovascular bundle of the mandibular canal during dental implant surgery of the mandible is to be prevented, accurate measurement of the distance between the alveolar crest and the mandibular canal, as seen on panoramic radiographs, is important. The purpose of this study was to compare the accuracy of panoramic radiography using a lead ruler with that of computed tomography for the measurement of the distance between the alveolar crest and superior border of the mandibular canal and to evaluate the usefulness of panoramic radiography using a lead ruler. MATERIALS AND METHODS: For control study, panoramic radiography of the dry mandible was undertaken using a lead ruler, and computed tomography was added. The distances between the alveolar crest and the superior border of the mandibular canal and between the alveolar crest and the lowest border of the body of the mandible were measured at the level of the 2nd premolar to the 3rd molar. These measurements were compared with actual measurements of the dry mandible in the same areas. The cases of 87 patients[49 men, 38 women; age range, 20 -84 (mean, 42) years] who had undergone panoramic radiography using a lead ruler were reviewed. They were catergorized according to sex, the presence of teeth, and whether under or over 50 years of age. All measurements were compared and analyzed using the Student t-test. RESULTS: Measured values obtained from a panoramic radiograph using a lead ruler(magnification:100.32%+/-5.92) and from a computed tomograph(magnification:100.22%+/-5.55) deviated less from actual measurements on the dry mandible (p > 0.05). The distance from the 2nd premolar to the 3rd molar was greater in male adults (19.62 mm +/-3.95) than in female (17.54 mm +/-4.04) (p 0.05), except 2nd pre molar and 1st molar in the female. CONCLUSION: Panoramic radiography using a lead ruler is a simple and accurate modality for the presurgical planning of dental implant surgery. It is suggested that the successful long-term rate of dental implantation may be higher in dentulous male than in edentulous female molars.

Endobronchial Metastasis: CT Findings and Its Usefulness in Bronchoscopic Correlation

PURPOSE: To evaluate the CT findings of bronchial abnormalities in patients with endobronchial metastasis from extrapulmonary tumors, and to correlate these with the bronchoscopic findings. MATERIALS AND METHODS: The authors retrospectively reviewed the CT and bronchoscopic findings of 17 patients (M:F=9:8; mean age, 56 years) with histologically proven endobronchial metastasis from extrapulmonary primary tumors. Carcinoma of the uterine cervix (n = 5) was the most common primary site for endo-bronchial metastasis. CT findings of bronchial abnormalities with associated peribronchial and lung parenchymal lesions were analyzed and compared with the bronchoscopic findings. RESULTS: Among the 17 patients, 20 sites of bronchial abnormalities were visualized bronchoscopically. CT findings of bronchial abnormalities were smooth narrowing (n = 11), occlusion (n = 3), intraluminal mass (n= 4), and normal (n = 2). Peribronchial lesions(lymph node enlargement or parenchymal mass) were found in 12 cases. Bronchoscopy revealed bronchial narrowing due to a mucosal nodule or intraluminal polypoid mass in 16 cases, and total obstruction of the bronchus in four. With regard to the identification of bronchial abnormalities, the findings of CT and of bronchoscopy agreed in 17 cases and disagreed in three. While bronchoscopy was advantageous for detecting early mucosal abnormality, CT effectively evaluated the extent of a lesion beyond the stenosis or bronchial obstruction. CT was also useful for predicting the causes of bronchial abnormalities. CONCLUSION: CT is relatively accurate in evaluating bronchial abnormalities, and in patients with endo-bronchial metastases may be used as a complementary procedure to bronchoscopy for evaluating the extent of the lesion.

Central Neurocytoma Originated from Atrium with Malignant Trans formation: A Case Report

Central neurocytoma, a cerebral intraventricular tumor, is usually benign. It frequently develops in the area of the foramen of Monro, and is usually attached to the septum pellucidum. Mild to moderate contrast enhancement is common. We encountered a case of central neurocytoma in a 60-year-old woman; the tumor arose from the atrium of the lateral ventricle, and extraventricular extension and malignant transformation were apparent. CT and MRI revealed a well-defined, slightly heterogeneous mass measuring 2.5x3x5cm with surrounding edema. There was strong contrast enhancement of the mass.

Endovascular Stent-Graft Placement for the Treatment of the Aneurysm of the Superior Vena Cava: A Case Report

Venous aneurysm of the superior vena cava(SVC) is a rare congenital lesion and can be classified morphologically as either fusiform or saccular. Although there is a controversy with regard to the need for either conservative or surgical treatment, surgery is recommended for the saccular type as major complications of the aneurysm may occur. We report a case of saccular aneurysm of the SVC, treated by means of an endoluminal stent-graft.

Endovascular Stent-Graft Placement for the Treatment of the Aneurysm of the Superior Vena Cava: A Case Report

Venous aneurysm of the superior vena cava(SVC) is a rare congenital lesion and can be classified morphologically as either fusiform or saccular. Although there is a controversy with regard to the need for either conservative or surgical treatment, surgery is recommended for the saccular type as major complications of the aneurysm may occur. We report a case of saccular aneurysm of the SVC, treated by means of an endoluminal stent-graft.

Quantitative Morphologic Assessment of Thoracolumbar Vertebrae in Korean Women by Morphometric X-rayAbsorptiometry

PURPOSE: To compare the accuracy of lateral radiography of the spine with that of morphometric X-rayabsorptiometry(MXA) in vertebral morphometry, and to evaluate normal vertebral morphometry using MXA in Koreanwomen. MATERIALS AND METHODS: A spine phantom was constructed using copper pipe. Its anterior and posteriorheights were measured directly, with lateral radiographs and with MXA, and the values thus obtained were compared.Inter -and intra -observer variations were evaluated by three radiologists. The vertebral morphometry of 30 youngwomen volunteers were imaged using thoracic and lumbar lateral radiographs and MXA, and analysis included themeasurement of anterior and posterior heights from T4 to L4. We also obtained the vertebral morphometry of 200normal Korean women who underwent MXA between March 1995 and February 1996, though those with osteoporosis andother spinal lesions were excluded from this study. Thoracolumbar vertebral indexes were statistically correlatedwith age, height and bone mineral. RESULTS: There were no statistically significant differences in the heights ofspine phantom measured by MXA compared with actual size (mean difference=0.28mm). Simple radiographs weremagnified by 23.7% at a phantom-table distance of 15cm, and distortion ranged from 0.5% to 22.5%, depending onphantom level and phantom-table distance. In the study of volunteers, the magnification rate between a simpleradiograph and MXA was about 26.6%. Anterior height increased progressively from the thoracic to the lumbar spine,though posterior height peaked at L2, and L4 was less than anterior height. In Korean women, indices of vertebralmorphometry decreased significantly with aging, with the most prominent decrease occurring during the seventhdecade. The mineral density of spinal bone decreased markedly after the sixth decade. CONCLUSION: Radiographsshowed more magnification and distortion than did MXA, though between morphometric X-ray absorptiometry (MXA) andactual size, there was no significant difference. The vertebral morphometric indices of Korean women and referredbone mineral density may provide useful data for determining and evaluating follow-up changes in spinalmorphology.

CT Differentiation of Invasive thymoma and Thymic carcinoma

PURPOSE: In order to determine the differential points between them, we analyzed the CT findings of invasivethymoma and thymic carcinoma. MATERIALS AND METHODS: We retrospectively reviewed the CT scans of 14 patients withinvasive thymoma and 15 with thymic carcinoma, confirmed by surgery(n=19) or percutaneous needle aspiration (n=10)between 1988 and 1996. CT findings were evaluated in each group for intrathoracic spread (posterior, directposterior, and anterolateral), obliteration of the fat plane between the mass and vascular structures, vesselencasement, invasion of adjacent mediastinal structures, pleural implants, mediastinal nodes and distantmetastasis. RESULTS: Direct posterior spread was more common in thymic carcinoma than invasive thymoma ; it wasseen in one case (7%) of invasive thymoma and 12(80%) of thymic carcinoma(p=0.00). Posterior spread was seen insix cases (43%) of invasive thymoma and nine (60%) of thymic carcinoma. Anterolateral spread was seen only in twocases (13%) of thymic carcinoma. Obliteration of the fat plane was seen in nine cases (64%) of invasive thymomaand 14 (93%) of thymic carcinoma, while vessel encasement was seen in two cases (14%) of invasive thymoma and13(87%) of thymic carcinoma(p=0.00). Invasion of adjacent structures was seen in two cases (14%) of invasivethymoma and eight (53%) of thymic carcinoma. Pleural implants were more common in invasive thymoma than thymiccarcinoma, being seen in six cases (43%) of the former and one (7%) of the latter(p=0.04). Mediastinallymphadenopathy was seen in three cases (21%) of invasive thymoma and ten (67%) of thymic carcinoma. Distantmetastases were observed only in six cases (40%) of thymic carcinoma(p=0.02). CONCLUSION: Althoughdifferentiation between invasive thymoma and thymic carcinoma is difficult on the basis of CT findings, there arecertain differential points. Thymic carcinomas showed a higher rate of direct posterior intrathoracic spread,vessel encasement, mediastinal nodes and distant metastases than invasive thymomas. These, however, were morecommonly associated with pleural implants than were thymic carcinoma.

Expandable Metallic Stents in the Palliative Treatment of Malignant Tracheobronchial Stenosis

PURPOSE: To report the outcome of using expandable metallic stent in the management of malignanttracheobronchial stenosis with dyspnea. MATERIALS AND METHODS: Under fluoroscopic and bronchoscopic guidance,seven patients with malignant airway stenosis were treated with ten expandable metallic stents. The cause ofstenosis was metastasis from esophageal cancer in five patients, recurrent adenoid cystic carcinoma of the tracheain one, and primary lung cancer in one. The major sites of obstruction were the trachea in four patients, the leftmain bronchus in one, the trachea and left main bronchus in one, and the trachea and both bronchi in one. Chestradiography(n=7), bronchoscopy(n=5), pulmonary function test(PFT)(n=3), and spirometry(n=1) were performed beforeand after stent placement. RESULTS: In all seven patients, the stent was successfully placed at the lesion sitesand dyspnea began to improve immediately. After the procedure, chest radiography and bronchoscopy showed anincrease in airway diameter. After stent placement, forced vital capacity (FVC) and forced expiratory volume inone second(FEV1) improved 53% and 56%, respectively. Peak flow velocity also changed from 46 L/min to 200 L/min.During median follow-up of 67(41-1565)days, one stent migration occurred. In one patient, proximal tumorovergrowth occurred, and in one, tumor ingrowth was treated with balloon dilatation. CONCLUSION: For in thepalliative treatment of malignant tracheobronchial stenosis with dyspnea, placement of expandable metal steuts issafe and effective.

Inflammatory Pseudotumor of the Lung: CT Findings and Pathologic Correlation

PURPOSE: To define the CT findings of inflammatory pseudotumor of the lung, and determine pathologiccorrelation. MATERIALS AND METHODS: We retrospectively analyzed the CT scans of seven patients withpathologically-proven (surgery:n=6; automated gun biopsy:n=1) inflammatory pseudotumor of the lung. Postcontrastscans were obtained in six cases, while one underwent only precontrast scanning. In all cases, these resultscorrelated with pathologic findings. RESULTS: In five cases, CT showed that irregular, spiculated nodules ormasses contacted with the pleura; in one, a well-defined nodule contacted with the fissure; and in one, there wasconsolidation. On postcontrast CT images, all six cases showed enhancement, with a central, low-density component. In four cases, ground-glass opacity surrounding the lesion was identified, and in three focal pleural thickeningadjacent to the lesion was noted. The predominant pathologic composition of the enhanced portions of the lesion,as seen on CT, was chronic inflammatory or spindle cells, and the angiogenesis of small vessels was also noted.Non-enhanced, central, low-density areas were accounted for by hemorrhaging, necrosis and the focal aggregation ofacute and chronic inflammatory cells. Surrounding gound-glass opacity corresponded pathologically to organizingpneumonia, cellular infiltration along the alveolar wall, and alveolar collapse. CONCLUSION: The CT features ofinlammatory pseudotumor of the lung were mainly peripheral irregular, spiculated nodule or mass, withcontrast-enhancement and a central low-density component, combined with surrounding ground-glass opacity. Allthese findings correlated well with pathologic findings.

Transjugular Liver Biopsy: The Efficacy of Quick-Core Biopsy Needle System

PURPOSE: To evaluate the efficacy of the Quick-Core biopsy needle system in performing transjugular liverbiopsy. MATERIALS AND METHODS: Between December 1995 and June 1997, eight patients underwent transjugular liverbiopsy involving use of the Quick-Core biopsy needle system; the conditions involved were coagulopathy (n=4),thrombocytopenia (n=3), and ascites (n=1). Via the right internal jugular vein, the right hepatic vein wasselectively catheterized with a 7-F transjugular guiding catheter, and a 14-guage stiffening cannula was theninserted through this catheter; to obtain core tissue, a Quick-Core needle was then advanced into the liverparenchyma through the catheter-cannula combination. Eighteen- and 19-guage needles were used in three and fivepatients, respectively; specimen size, adequacy of the biopsy specimen and histologic diagnosis were determined,and complications were recorded. RESULTS: Biopsy was successful in all patients. The mean length of the specimenwas 1.4 cm (1.0-1.8 cm), and all were adequate for pathologic examinations; specific diagnosis was determined inall patients. There were two malignant neoplasms, two cases of veno-occlusive disease, and one case each ofcirrhosis, fulminant hepatitis, Banti syndrome and Budd-Chiari syndrome. One patient complained of neck pain afterthe procedure, but no serious procedural complications were noted. CONCLUSION: Our preliminary study shows thatthe Quick-Core biopsy needle system is safe and provides adequate core tissues with high diagnostic yields.

Epidermolysis Bullosa Dystrophica Associated with Multiple Esophageal Strictures: A Case Report

Epidermolysis bullosa dystrophica is a rare skin disease characterized by milia, nail dystrophy, andblistering of the skin and mucous membranes in response to minimal trauma. A forty years old man had typical skinlesions on the extremities, and the presence of distal phalangeal wedge deformity with soft tissue webbing wasnoted. multiple segmental strictures and ulceration involved the cervical and distal esophagus. Esophageal balloondilatation was therefore performed and dysphagia was relieved. The authors describe a case involving multipleesophageal strictures and musculoskeletal lesion, with clinically and radiologically documented epidermolysisbullosa dystrophica.

Correction of Malfunctioning peritoneal Dialysis Catheter with Guidewire and Stiffener Under fluoroscopic Guidance

PURPOSE: To determine the efficacy of correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance. MATERIALS AND METHODS: Between November 1994 and March 1997, we performed 15 manipulations in 12 patients in whom a dual-cuff, straight Tenckhoff peritoneal dialysis catheter had been implanted due to chronic renal failure. The causes of catheter malfunctioning were inadequate drainage of the dialysate (n=14) and painful dialysis (n=1). Under fluoroscopic guidance, adhesiolysis and repositioning of the malfunctioning catheter were performed with an Amplatz Super Stiff guidewire and the stiffener from a biliary drainage catheter. The results of procedures were categorized as either immediate or durable success, this latter being defined as adequate catheter function for at least one month after the procedure. RESULTS: Immediate success was achieved in 14 of 15 procedures (93%), and durable success in 7 of 15 (47%). The mean duration of catheter function was 157 (range, 30 to 578) days. After manipulation, abdominal pain developed in eight patients and peritonitis in two, but with conservative treatment, these symptoms improved. CONCLUSION: The correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance is an effective means of restoring catheter function and may be an effective alternative to surgical reimplantation of the catheter, or hemodialysis.