Portal flow steal occasionally persists even after the liver transplantation, which may reduce the portal flow and thus threaten the patients' outcome. Therefore, pre- and peri-operative detection of portal steal phenomenon requiring radiological or surgical interruption is essential for the liver transplantation candidates as well as for the recipients.
Adult ; Hepatitis B, Chronic/complications ; Humans ; Liver Cirrhosis/etiology/*therapy ; *Liver Transplantation ; Male ; Mesenteric Veins/*ultrasonography

PURPOSE: Small uterine cervical tumors are often undetected on MRI, and undetectable tumors are usually regarded as being in their early stages. The purpose of this study was to evaluate morphological factors determining MRI detectability of uterine cervical tumors by comparing detected and undetected tumors using high resolution MRI units. MATERIALS AND METHODS: Sixty-six surgically-proven uterine cervical cancer patients were included in this study. Using a GE Signa 1.5T magnet (GE, U.S.A.) axial T1-weighted MR images and axial, sagittal, and coronal T2-weighted fast spin echo MR images were obtained with a 5 mm thickness/2 mm gap and a 512x256 matrix size. The patients were divided into two groups, tumor-detected and tumor-undetected. Maximal tumor dimension, depth of stromal invasion, and horizontal tumor spread, measured during histopathological examinations, as well as pathological stages, were compared between the two groups. RESULTS: In the tumor-detected group, the pathological stages were IB1 in 25, IB2 in 3, IIA in 10, and IIB in 5 patients; in the tumor-undetected group, the stages were IA1 in 8, IA2 in 2, and IB1 in 13 patients. Maximal tumor dimension, depth of stromal invasion and horizontal tumor spread for tumor-detected and -undetected groups were 27.4 (10-60) mm vs. 10.4 (3-40) mm (p=0.077), 11.1 (3-20) mm vs. 2.3 (0-5) mm (p<0.001), and 26.6 (8-60) mm vs. 10.4 (3-40) mm (p=0.057), respectively. CONCLUSION: Of the criteria studied, depth of stromal invasion is the most important factor in determining tumor detectability on MRI. All tumors in which this depth was more than 5 mm were thus detected; which are undetected on high resolution MRI can be regarded as early-stage tumors (stage IB1).
Humans ; Magnetic Resonance Imaging* ; Uterine Cervical Neoplasms

Purpose: To systematically compare the performance of liver imaging reporting and data system treatment response (LR-TR) with the modified Response Evaluation Criteria in Solid Tumors (mRECIST) for diagnosing viable hepatocellular carcinoma (HCC) treated with locoregional therapy (LRT). Materials and Methods: Original studies of intra-individual comparisons between the diagnostic performance of LR-TR and mRECIST using dynamic contrast-enhanced CT or MRI were searched in MEDLINE and EMBASE, up to August 25, 2021. The reference standard for tumor viability was surgical pathology. The meta-analytic pooled sensitivity and specificity of the viable category using each criterion were calculated using a bivariate random-effects model and compared using bivariate meta-regression. Results: For five eligible studies (430 patients with 631 treated observations), the pooled per-lesion sensitivities and specificities were 58% (95% confidence interval [CI], 45%–70%) and 93% (95% CI, 88%–96%) for the LR-TR viable category and 56% (95% CI, 42%–69%) and 86% (95% CI, 72%–94%) for the mRECIST viable category, respectively. The LR-TR viable category provided significantly higher pooled specificity (p < 0.01) than the mRECIST but comparable pooled sensitivity (p = 0.53). Conclusion The LR-TR algorithm demonstrated better specificity than mRECIST, without a significant difference in sensitivity for the diagnosis of pathologically viable HCC after LRT.

Malignant tumors of the appendix are rare and are histologically similar to those arising elsewhere in theintestines. The frequency of specific tumor types and the clinical presentation of symptomatic tumors are,however, significantly different. Before surgery, correct diagnosis of a malignant appendiceal tumor is rare; mosttumors are diagnosed by a pathologist while examining an appendectomy specimen. With the advent of high resolutionimaging modalities (ultrasound and helical CT), malignant tumors of the appendix may be more accurately diagnosed;this report describes the imaging findings of malignant appendiceal tumors.
Appendectomy ; Appendix* ; Diagnosis

Despite of various neurophysiologic monitoring methods under general anesthesia, functional mapping at awake state during brain surgery is helpful for conservation of speech and motor function. But, awake craniotomy in children or adolescents is worrisome considering their emotional friabilities. We present our experience on anesthetic management for awake craniotomy in an adolescent patient. The patient was 16 years old male who would undergo awake craniotomy for removal of brain tumor. Scalp nerve block was done with local anesthetics and we infused propofol and remifentanil with target controlled infusion. The patient endured well and was cooperative before scalp suture, but when surgeon sutured scalp, he complained of pain and was suddenly agitated. We decided change to general anesthesia. Neurosurgeon did full neurologic examinations and there was no neurologic deficit except facial palsy of right side. Facial palsy had improved with time.
Adolescent ; Anesthesia, General ; Anesthetics, Local ; Brain ; Brain Neoplasms ; Child ; Craniotomy ; Dihydroergotamine ; Facial Paralysis ; Humans ; Male ; Nerve Block ; Neurologic Examination ; Neurologic Manifestations ; Piperidines ; Propofol ; Scalp ; Sutures

BACKGROUND/AIMS: Transarterial chemoembolization (TACE) is the standard locoregional treatment in patients with unresectable hepatocellular carcinoma (HCC). Angiogenesis and inflammation play important roles in tumor growth in HCC. In this study, we evaluated the associations between the levels of growth factors and inflammatory markers and clinical prognosis in patients with unresectable HCC treated with TACE. METHODS: The clinical outcomes of 58 HCC patients treated with TACE at the Catholic Medical Centers from January, 2012 to February 2015 were evaluated. Baseline levels of the growth factors vascular endothelial growth factor, fibroblast growth factor, platelet-derived growth factor, and hepatocyte growth factor and the inflammatory cytokines interleukin (IL)-17 and high sensitivity C-reactive protein (hs-CRP) were compared with the treatment outcomes. The primary endpoint was time to progression (TTP); the secondary endpoint was overall survival (OS). RESULTS: During the 20.8 months of follow-up, TTP was significantly delayed in patients with low levels of hs-CRP (≤0.15) and IL-17 (≤0.94) and a maximal tumor diameter ≤5 cm (P=0.010, P=0.015, and 0.048, respectively). Patients with HCC with low hs-CRP and IL-17 levels had a longer survival than that of those with high hs-CRP levels and IL-17 (35.1 vs. 22.5 months, P=0.000; 41 vs. 21.8 months, P=0.000, respectively). However, any baseline growth factors were not significantly correlated with TTP and OS. CONCLUSIONS: Elevated IL-17 and hs-CRP may be predictive of a poor outcome in patients with HCC treated with TACE. A better understanding of this relationship will require further investigation of the immune mechanisms underlying tumor progression.
C-Reactive Protein* ; Carcinoma, Hepatocellular* ; Cytokines ; Fibroblast Growth Factors ; Follow-Up Studies ; Hepatocyte Growth Factor ; Humans ; Inflammation ; Intercellular Signaling Peptides and Proteins ; Interleukin-17* ; Interleukins ; Platelet-Derived Growth Factor ; Prognosis ; Vascular Endothelial Growth Factor A

PURPOSE: The purpose of this study was to evaluate the usefulness of contrast enhancement in assessing thedepth of stromal invasion in patients with uterine cervical tumors by comparing dynamic and late contrast-enhancedT1-weighted MR imaging with T2-weighted MR imaging. MATERIALS AND METHODS: Of 58 surgically proven uterinecervical cancer patients, 31 in whom tumors were seen on MRI were included in this study. Using a 1.5 T magnet,T2-weighted contrast-enhanced dynamic, and T1-weighted MR imaging were performed. In each MR imaging sequence,tumor visualization, margin delineation, enhancement pattern and depth of stromal invasion were evaluated onsagittal images and were correlated with pathological findings of resected uterus, focusing on the depth ofstromal invasion. RESULTS: Surgical FIGO stages were IB1 in 20 patients, IB2 in three, IIA in six, and IIB intwo. A tumor was detected in 29 (94%) patients on T2-weighted images, in 26 (84%) on dynamic contrast enhancedimages, and in 28 (90%) on contrast enhanced T1-weighted images. The tumor demonstrated a clear margin in 22 (71%)patients on late contrast-enhanced T1-weighted images, in 21 (68%) on dynamic images, and in 13 (42%) onT2-weighted images. Correlated with pathologic findings, the depth of stromal invasion was overestimated onT2-weighted images in eight (26%) patients, and on dynamic and late contrast-enhanced T1-weighted images in three(10%) and three (10%) respectively. CONCLUSION: Tumor margins are clearer and the extent of tumors may be moreaccurately evaluated on dynamic MR and late contrast-enhanced T1-weighted imaging. These sequences thas seem to beuseful, and superior to T2-weighted imaging, for assessing the depth of stromal invasion in patients with cervicalcarcinoma.
Cervix Uteri* ; Female ; Humans ; Magnetic Resonance Imaging* ; Uterus

OBJECTIVE: To compare the usefulness of unenhanced spiral CT (UCT) with that of excretory urography (EU) in patients with acute flank pain. MATERIALS AND METHODS: Thirty patients presenting with acute flank pain under-went both UCT and EU. Both techniques were used to determine the presence, size, and location of urinary stone, and the presence or absence of secondary signs was also evaluated. The existence of ureteral stone was confirmed by its removal or spontaneous passage during follow-up. The absence of a stone was determined on the basis of the clinical and radiological evidence. RESULTS: Twenty-one of the 30 patients had one or more ureteral stones and nine had no stone. CT depicted 22 of 23 calculi in the 21 patients with a stone, and no calculus in all nine without a stone. The sensitivity and specificity of UCT were 96% and 100%, respectively. EU disclosed 14 calculi in the 21 patients with a stone and no calculus in eight of the nine without a stone. UCT and EU demon-strated secondary signs of ureterolithiasis in 15 and 17 patients, respectively. CONCLUSION: For the evaluation of patients with acute flank pain, UCT is an excellent modality with high sensitivity and specificity. In near future it may replace EU.
Adult ; Colic/*radiography ; Female ; Human ; Male ; Middle Age ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods ; Ureteral Calculi/*radiography ; Ureteral Diseases/*radiography ; *Urography

A 54-year-old man who had metastasis of gastric cancer was referred to pain clinic to control his severe epigastric pain.After the confirmation of the effect of the diagnostic celiac plexus block, c-arm-guided neurolysis of celiac plexus using alcohol was performed without any sensory or motor change.Five days after the chemical neurolysis, elevated hemidiaphragm and basal atelectasis of right lung were noted at routine chest X-ray follow-up without any respiratory symptoms such as dyspnea.There was no evidence of diaphragmatic metastasis. Two months after the neurolysis, the radiographic finding did not show any change.
Celiac Plexus ; Follow-Up Studies ; Humans ; Lung ; Middle Aged ; Neoplasm Metastasis ; Nerve Block ; Pain Clinics ; Pulmonary Atelectasis ; Respiratory Paralysis ; Stomach Neoplasms ; Thorax

PURPOSE: This study evaluated the accuracy of helical CT angiography (HCTA) in a preoperative evaluation of living renal transplant donors (LRTDs) for visualizing the renal vascular anatomy with an emphasis on identifying the number of renal arteries and the presence of small branches and venous anomalies. MATERIALS AND METHODS: From Jan. 2000 to Feb. 2001, a total of 50 potential LRTDs were evaluated with conventional renal angiography (CRA) and HCTA. All candidates then underwent a donor nephrectomy. The HCTA was done according to a standard HCTA protocol. The intraoperative findings on the number of renal vessels were compared with those of the CRA and HCTA respectively. RESULTS: There was an overall agreement on the number of renal arteries and veins between the CRA findings and 3-D reconstruction of the HCTA (91%, 95%). The overall accuracies for predicting the number of renal arteries and veins relative to the intraoperetive findings were 84%, 94% for CRA and 80%, 94% for HCTA respectively. The CRA missed 8 accessory renal arteries while HCTA missed 10. In HCTA, cases with an accessory renal artery with a diameter < or =5 Fr. (1.65mm) and two cases of an early branching single vessel simulating dual arteries, were misdiagnosed. Despite the misdiagnosed cases, there was no significant intraoperative morbidity. The HCTA revealed another lesion of a renal parenchyme, the urinary collecting system and other viscera. There were no significant complications in the process of both techniques. The cost of HCTA was 48% less than the CRA plus the excretory urography (EU) for imaging the potential LRTDs. CONCLUSIONS: A HCTA appears to be as accurate as a CRA for visualizing the renal vascular anatomy in the preoperative assessment of potential LRTDs. A HCTA has the potential to be a good alternative to a CRA plus EU for assessing potential LRTDs.
Angiography* ; Arteries ; Humans ; Kidney Transplantation ; Nephrectomy ; Renal Artery ; Tissue Donors* ; Tomography, Spiral Computed* ; Urography ; Veins ; Viscera