Imaging Findings of Intragastric Gallstone and Bouveret's Syndrome

Gallstone ileus is a well-known complication of cholelithiasis, but is relatively rare. Most ectopic gallstones are located in the small bowel; they are rarely found in the stomach and duodenum. We describe the imaging findings of a case of intragastric gallstone, as well as a case in which duodenal obstruction was caused by a large gallstone (Bouveret's syndrome).

Laryngeal Schwannoma: A Case Report

Laryngeal schwannoma is extremely rare. We report the CT and MRI findings of a case occurring in a 65-year-oldwoman, and describe the pathologic correlation. Pre-contrast CT scanning revealed a right supraglot-tic mass witha slightly hyperdense central part and a hypodense peripheral part. Post-contrast CT scanning re-vealed anenhanced hyperdense central part and a rim-like hypodense peripheral part. The density of the pe-ripheral part waslower than that of muscle. The mass showed homogeneous low signal intensity on T1-weighted MR images, homogeneoushigh signal intensity on T2-weighted MR images, and an enhanced high signal intensity central part and a lowsignal intensity peripheral part on gadolinium enhanced T1-weighted images. The enhanced central part correlatedwith Antoni A areas and the peripheral part, showing low attenuation, correlated with Antoni B areas.

Color Doppler Imaging of Hepatic Tumors

PURPOSE: To evaluate the color Doppler imaging patterns of hepatoma, hemangioma, and metastasis. MATERIALS AND METHODS: The study comprised 37 patients with liver mass lesions: 12 patients had hepatoma, 15 had hemangiomas and10 had metastatic liver cancers. All 37, who showed hepatic mass on gray scale ultrasonogrphy, were analyzed prospectively. Color mapping of tumors was performed for these patients, and the fastest or next fastest vessel was spectrally analysed to show blood pattern and to measure peak velocity. RESULTS: In all the 12 patients with hepatoma, spectral analysis revealed exteusive pulsating arterial blood flow within the tumor ; peak velocities were 7~65cm/sec(mean 34cm/sec). In ten hemangiomas(66%) color mapping revealed blood flow within the tumor and spectral analysis revealed this possibility in eight of the ten tumors. In none of these patients was a pulsating continous wave observed ; peak velocity was 5~21cm/sec(mean 12.8cm/sec). In no mestastatic tumors was blood flow observed. CONCLUSION: Color Doppler imaging is helpful in the differentiation of hepatoma, hemangioma, and metastatic tumor in the liver.

CT Findings of the Chronic Sinonasal Inflammatory Disease

PURPOSE: Recently, paranasal sinus(PNS) CT has increasingly been used because of the wide applications of a functional endoscopic sinonasal surgery(FESS) as one of the therapeutic modalities of the chronic sinonasal inflammatory disease. MATERIALS AND METHODS: We retrospectively analyzed PNS CT findings in 76 patients with chronic sinonasal inflammatory disease who had undergone the PNS CT from April 1991 to July 1992. RESULTS: There were 5 sinonasal patterns of inflammation ;4 cases of infundibular type(5.3%), 14 cases of ostiomeatal unit(OMU) type(18%), one case of sphenoethmoidal(SER) type(1%), 56 cases of sinonasal polyposis type(74%), and one case of sporadic type(1%). The mucosal abnormality was seen in 74 OMU cases, 71 maxillary sinus cases, 69 ethmoidal sinus cases, 55 frontal sinus cases, 49 SER, and 46 sphenoidal sinus cases. The normal bony variant included ethmoid bulla(25 cases, 335), concha bullosa (20 cases 25%), Hailer cells(10 cases, 13%), paradoxical curvature of middle turbinate (4 cases, 5%), lateral deviation of uncinate process(3 cases, 4%), and deviation of nasal septurn(31 cases, 41%). CONCLUSION: The PNS CT is an excelleht imaging method providing detailed informations about the mucosal abnormality, pathological pattern, the anatomical structure and landmark, and bony variants prior to an operation.

Minocycline Hydrochloride Sclerotherapy of Renal Cysts

PURPOSE: To report the effectiveness of Minocin sclerotherapy in the treatment of renal cysts. MATERIALS AND METHODS: We performed minocin sclerotherapy to 19 patients with 21 renal cysts composed of 17 cases of solitary renal cyst and three cases of multiple renal cyst and one case of polycystic kidney comfirmed by ultrasound and CT. After aspiration of cyst fluid, if the amount was less than 50ml, 500mg of minocin was mixed with 3ml of normal saline,if more than 50ml, 1000mg of minocin mixed with 5ml of normal saline were injected, and each case was followed-up over 3 months by ultrasound. RESULTS: Of all 21 renal cysts, 14 cases were followed-up three months after minocin sclerotherapy. In 12 of 14 cases, the size of the cysts decreased by 10% or collapsed completely. Of the remaining two cases, one collapsed after 6 months while the other recurred after 6months. Three cases were followed up after 20 months and only one of them recurred. 19 of all 21 cases(91%) were cured, and two of 21 cases(9%) were recurred. Pain was the only complaint. and four of 10'cases needed analgesics. CONCLUSION: Sclerotherapy with minocin has low recurrence-rate and low complication, and relatively early high cure-rate.

A Clinical Experience of the Ileocecal Conduit / 대한비뇨기과학회지

Ileocecal conduit diversion was performed in five patients. Although the follow up period is still too short to obtain any conclusive data, satisfactory results were so far observed on the whole. Encountered post-operative complications were wound infection in two cases and ileus in one. They were however transient. IVP, retrograde conduitography, urinalysis and culture, blood chemistry and arterial blood gas analysis were examined on the patients. The retrograde conduitography showed that the contrast medium was blocked at the ileocecal valve under the retrograde low pressure irrigation, and no reflux was observed in the ileal portion or ureter. Under the high pressure irrigation, however, the contrast medium passed beyond the ileocecal valve on 2 of 4 cases, but did not flowed back to the ureter. Some anatomic and functional advantages of the ileocecal intestinal conduit are discussed. Because the ileocolic vessels are less in variation and easily mobilized, the isolation procedure of the intestinal segment is simpler and the stoma is also easily constructed without any undue tension. The stromal stenosis is expected to be fewer in comparison with the ileal conduit case. This operation is considered to be further examined extensively as one of the conduit type urinary diversion.

Primary Psoas Abscess: A Case Report / 대한비뇨기과학회지

We report a case of primary psoas abscess which is a relatively rare condition. The etiology of this disease remain uncertain, but the hematogeneous seeding have been proposed as initiating factors. The clinical presentation and review of literature are discussed.

Congenital Posterior Urethral Valves / 대한비뇨기과학회지

A clinical observation was made on 5 cases of congenital posterior urethral valves admitted recently to the Department of Urology, Busan National University Hospital. The results were following: 1. Age distribution showed; 1 case (20%) under 6 months, 2 cases (40%) between 6 and 12 months, 2 cases (40%) over 6 years old. 2. The symptoms of urinary dribbling, weak stream, frequency and difficult urination were observed in all 5 cases. Abdominal mass, abdominal pain, fever, vomiting and failure to thrive were observed in 4 cases (80%) . Enuresis was observed in 2 cases (40%) . Hypertension and gross hematuria were observed in 1 case (20%) . 3. IVP revealed bilateral hydronephrosis and hydroureter in all cases. Vesicoureteral reflux was observed in 3 cases (60%) , in which 2 cases were unilateral and the other 1 case was bilateral and bladder diverticulum appeared in 3 cases (60%). Voiding cystourethrogram was performed on 4 cases, and in all of these 4 cases (100%) dilatation of posterior urethra and cut-off at the membranous level and a thin stream in the bulb and 2 cases (50%) bladder neck contracture due to congenital posterior urethral valves had developed. 4. Endoscopic examination was performed on 5 cases, in which 3 cases (60%) were young's type I, and remaining 2 cases 140%) were Young's type III. 5. All 5 cases were treated by transurethral electrofulguration of the valves and one case of them was performed bilateral ureteroneocystostomy 3 years after valve ablation but in the case with marked bilateral hydronephrosis and vesicoureteral reflux a cystostomy was also performed. 6. The follow up study was performed in 4 cases with the follow-up period from five months to 36 months and mean duration of 2 years. All 4 cases had excellent results with much improved urinary stream and Renal condition after operation, but in 2 cases intermittent incontinence occurred for 3 years and 1 year respectively. In all 4 cases much diminished hydronephrosis and urethral dilation on IVP were observed. The posterior urethral dilatation became nearly normalized and abnormal findings of bladder improved on voiding cystourethrogram, but in 2 cases with bladder diverticulum 1 showed nonspecific interval changes during 3 years and the other 5 months. In 2 cases with vesicoureteral reflux, 1 showed loss of vesicoureteral reflux spontaneously 1 month after the operation and the other showed persistent vesicoureteral reflux for 1 year, which was observed to be improving.

Congenital Posterior Urethral Valves / 대한비뇨기과학회지

A clinical observation was made on 5 cases of congenital posterior urethral valves admitted recently to the Department of Urology, Busan National University Hospital. The results were following: 1. Age distribution showed; 1 case (20%) under 6 months, 2 cases (40%) between 6 and 12 months, 2 cases (40%) over 6 years old. 2. The symptoms of urinary dribbling, weak stream, frequency and difficult urination were observed in all 5 cases. Abdominal mass, abdominal pain, fever, vomiting and failure to thrive were observed in 4 cases (80%) . Enuresis was observed in 2 cases (40%) . Hypertension and gross hematuria were observed in 1 case (20%) . 3. IVP revealed bilateral hydronephrosis and hydroureter in all cases. Vesicoureteral reflux was observed in 3 cases (60%) , in which 2 cases were unilateral and the other 1 case was bilateral and bladder diverticulum appeared in 3 cases (60%). Voiding cystourethrogram was performed on 4 cases, and in all of these 4 cases (100%) dilatation of posterior urethra and cut-off at the membranous level and a thin stream in the bulb and 2 cases (50%) bladder neck contracture due to congenital posterior urethral valves had developed. 4. Endoscopic examination was performed on 5 cases, in which 3 cases (60%) were young's type I, and remaining 2 cases 140%) were Young's type III. 5. All 5 cases were treated by transurethral electrofulguration of the valves and one case of them was performed bilateral ureteroneocystostomy 3 years after valve ablation but in the case with marked bilateral hydronephrosis and vesicoureteral reflux a cystostomy was also performed. 6. The follow up study was performed in 4 cases with the follow-up period from five months to 36 months and mean duration of 2 years. All 4 cases had excellent results with much improved urinary stream and Renal condition after operation, but in 2 cases intermittent incontinence occurred for 3 years and 1 year respectively. In all 4 cases much diminished hydronephrosis and urethral dilation on IVP were observed. The posterior urethral dilatation became nearly normalized and abnormal findings of bladder improved on voiding cystourethrogram, but in 2 cases with bladder diverticulum 1 showed nonspecific interval changes during 3 years and the other 5 months. In 2 cases with vesicoureteral reflux, 1 showed loss of vesicoureteral reflux spontaneously 1 month after the operation and the other showed persistent vesicoureteral reflux for 1 year, which was observed to be improving.

A Clinical Observation on 11 Patients of Postrenal Acute Renal Failure / 대한비뇨기과학회지

A clinical evaluation was done on Il patients with postrenal acute renal failure who were admitted to the Busan National University Hospital during the period of 6 years and 8 months from Jan. 1976 to Aug. 1982. The results were as follow. 1. The patients were mean ages of 44.3 years, being thought somewhat older than other cause of renal failure. And the male was more frequently affected than the female. 2. The 2 most common causes of postrenal acute renal failure in 11 patients were malignant neoplasms (5 patients; 1 bladder Ca. 3 cervical Ca. and 1 retroperitoneal metastatic Ca.) and ureteral calculi (5 patients; 2 bilateral and 3 unilateral in solitary renal unit). 3. Ureteral obstructions were bilateral in 7 patients (14 ureters) and unilateral in 4 patients (4 ureters) in the solitary kidney. The involved site of ureteral obstructions were bilateral lower ureters in 5 patients (10 ureters), bilateral upper ureters in 1 patient (2 ureters), unilateral right upper ureter and left lower ureter in 1 patient 12 ureteral, and unilateral lower ureter in 4 patients (4 ureter). 4. Seven patients were treated with urinary diversion, 3 with ureteral catheterization and 1 with ureterolithotomy. Among 7 patients of urinary diversion, nephrotomy was done in 6 patients and double-barreled ureterocutaneostomy in 1 patient. 5. The prognosis was excellent in 10 patients and 1 patient was expired due to uremia and generalized marasmus following malignant neoplasm.