PURPOSE: To evaluate the rates of inter- and intraobserver agreement of the BI-RADS US lexicon. MATERIALS AND METHODS: Two radiologists reviewed 60 sonograms of solid breast masses to evaluate interobserver agreement. After four weeks, the radiologists reinterpreted the series to evaluate the intraobserver agreement. The radiologists described shape, orientation, margin, lesion boundary, echo pattern, posterior acoustic features and microcalcifications. Final assessment categories and management plans were suggested for each case. The rates of inter- and intraobserver agreements were measured by the use of kappa statistics. RESULTS: Interobserver agreement ranged from the highest for orientation (k=0.65) and shape (k=0.61) to the lowest for posterior acoustic features (k=0.42). For the final assessment categories (k=0.46) and management (k=0.49), interobserver agreements were moderate. Intraobserver agreement ranged from the highest for microcalcifications in mass (k=0.90, 0.82) and orientation (k=0.87, 0.83) and the lowest for echo patterns (k=0.62, 0.57) and posterior acoustic features (k=0.59, 0.65). In the final assessment category and management, intraobserver agreements were substantial or nearly complete (k=0.65-0.83). CONCLUSION: There were variable ranged inter- and intraobserver agreements in the description of the BI-RADS US lexicon of solid breast masses. Among them, margin and lesion boundary showed lower agreements. A modification of the BI-RADS US lexicon with more detailed guidelines, followed by continuous education, are suggested.
Acoustics ; Breast* ; Education ; Information Systems*

No abstract available.
Varicocele*

The Kaposi's sarcoma, which was found in an immunosuppressed patient of renal transplantation, may have been developed by long term use of immunosuppressant agent after the renal transplantation. The case was a 29-year-old woman who was diagnosed as chronic renal failure in 1988, and since then, she had been on CAPD until May, 1997. After the renal transplantation in May 1997, the patient has been prescribed cyclosporin and prednisone as immunosuppressant agent. In June 1997, she showed clinical symptom of Kaposi's sarcoma with multiple papules and nodules in the skin and viscera, such as ureter, urinary bladder, stomach, duodenum and subcutaneous tissue of the chest. Multiple excisional biopsies were carried out in the skin, ureter, urinary bladder, stomach and duodenum. All of excisional biopses indicated nodular stages with extensive proliferation of spindle shaped, somewhat pleomorphic cells which have slit-like vascular spaces, proliferation of small vessels, and extravasation of erythrocytes. These lesions nearly diminished after sytemic chemotherpy, excision and discontinuity of immunosuppressive agents.
Adult ; Biopsy ; Cyclosporine ; Duodenum ; Erythrocytes ; Female ; Humans ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Kidney Transplantation ; Peritoneal Dialysis, Continuous Ambulatory ; Prednisone ; Sarcoma, Kaposi* ; Skin ; Stomach ; Subcutaneous Tissue ; Thorax ; Ureter ; Urinary Bladder ; Viscera

The Kaposi's sarcoma, which was found in an immunosuppressed patient of renal transplantation, may have been developed by long term use of immunosuppressant agent after the renal transplantation. The case was a 29-year-old woman who was diagnosed as chronic renal failure in 1988, and since then, she had been on CAPD until May, 1997. After the renal transplantation in May 1997, the patient has been prescribed cyclosporin and prednisone as immunosuppressant agent. In June 1997, she showed clinical symptom of Kaposi's sarcoma with multiple papules and nodules in the skin and viscera, such as ureter, urinary bladder, stomach, duodenum and subcutaneous tissue of the chest. Multiple excisional biopsies were carried out in the skin, ureter, urinary bladder, stomach and duodenum. All of excisional biopses indicated nodular stages with extensive proliferation of spindle shaped, somewhat pleomorphic cells which have slit-like vascular spaces, proliferation of small vessels, and extravasation of erythrocytes. These lesions nearly diminished after sytemic chemotherpy, excision and discontinuity of immunosuppressive agents.
Adult ; Biopsy ; Cyclosporine ; Duodenum ; Erythrocytes ; Female ; Humans ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Kidney Transplantation ; Peritoneal Dialysis, Continuous Ambulatory ; Prednisone ; Sarcoma, Kaposi* ; Skin ; Stomach ; Subcutaneous Tissue ; Thorax ; Ureter ; Urinary Bladder ; Viscera

Total hip arthroplasty for ankylosed hip has a higher risk of failure due to the poor condition of the hip abductors and the altered configuration of the bone, which lead to poor positioning or fixation of the prosthesis. Fifty-one hips (42 patients) converted to total hip arthroplasty between March 1983 and March 1994 have been reviewed three to thirteen years six months after operation. The average period of follow-up was four years nine months. Twenty six of the patients were men and sixteen were women. The average age at the time of operation was 40 years old (range,19 to 70 years). Among the 51 hips, bony ankylosis were 27 hips and fibrous ankylosis were 24 hips, spontaneous ankylosis were 40 hips and surgical ankylosis were 11 hips. The duration of hip fusion was 13 years six months in the bony ankylosis and 16 years one month in the fibrous ankylosis. Preoperatively 33 cases had low back pain, ipsilateral or contralateral knee or hip pain. In asymptomatic 18 cases, conversion total hip arthroplasty was also performed for the management of functional disabilities due to severe malpositioned ankylosis. At the time of the last follow-up, 25 cases were free from pain and six patients had a mild degree pain on the hip, knee or thigh. In bony ankylosis, the postoperative average hip motion ranged from 1.1 degrees to 93.2 degrees (average arc of motion of 92.1 degrees). In fibrous ankylosis, the postoperative average hip motion ranged from 1.7 degrees to 96.6 degrees (average arc of motion of 94.9 degrees). The average Harris hip score was improved from 66 to 86.9 in bony ankylosis and from 49 to 89.5 in fibrous anklyosis. The postoperative leg length discrepancy was 1.1 cm in average. The postoperative complications included heterotropic ossification in 25 cases (49%), cup loosening in two cases (3.9%) and stem loosening in three cases (5.6%). As for the clinical results, 24 cases (89%) of bony ankylosis and 23 cases (96%) of fibrous ankylosis had satisfactory functional results at the last follow-up. In conclusion, the conversion total hip arthroplasty could provide functional improvement, pain relief and especially correction of leg length discrepancy in most cases of ankylosed hip.
Adult ; Ankylosis ; Arthroplasty, Replacement, Hip* ; Female ; Follow-Up Studies ; Hip* ; Humans ; Knee ; Leg ; Low Back Pain ; Male ; Postoperative Complications ; Prostheses and Implants ; Thigh

PURPOSE: The purpose of this study was to evaluate the effect of steroid injection according to the stage of Finkelstein's test and the severity of tenderness on radial styloid in de Quervain's disease. METHODS: Between January 2011 and December 2012, a total of 57 patients (57 wrists) treated with steroid injection in de Quervain's disease were enrolled on this study. The severity of tenderness, the stage of Finkelstein's test and pain score using visual analogue scale (VAS) were assessed before steroid injection. And the effect of steroid injection was assessed until one year after steroid injection. The relationship between the recurrence of de Quervain's disease after steroid injection and pre-injection findings including tenderness, Finkelstein's test and VAS was assessed. RESULTS: The success rate of steroid injection was 71.9% (41/57 patients). The outcome of steroid injection was not significantly related to the severity of tenderness (p=0.648), the stage of Finkelstein's test (p=0.530) and VAS score (p=0.607). CONCLUSION: The tenderness on radial styloid and the Finkelstein's test are important physical findings for the diagnosis of de Quervain's disease. However, the severity of tenderness and the stage of Finkelstein's test were not showed as predictive factors for the outcome.
De Quervain Disease* ; Diagnosis ; Humans ; Recurrence*

Herpes zoster myelitis is quite rare and it's MRI findings have not been reported. We report a patient who developed a progressive myelopathy after a characteristic herpes zoster skin lesions involving right C3 and C4 dermatomes. The lesions were recognizable in T1-weighted images of MRI as hypointense areas in the central portion of the long segment of the spinal cord, which became more prominent in T2-weighted image as increased signal intensities. In this patient computed tomographic metrizamide myelography (CTMM) showed no detectable intra or extramedullary lesion except a slight bulging of the cervical cord.
Herpes Zoster* ; Humans ; Magnetic Resonance Imaging ; Metrizamide ; Myelitis* ; Myelography ; Skin ; Spinal Cord ; Spinal Cord Diseases

Symmetrical Digital Gangrene (SDG) is characterized by the sudden onset of peripheral, symmetrical gangrene in the absence of any major vascular occlusive disease. Catecholamine inotropes are frequently used for the treatment of septic shock combined with an unstable hemodynamic state, and their usage can rarely induce SDG. There is no standard treatment for the SDG. Early recognition and prompt management of sepsis and expeditious process of weaning off of the inotropes are necessary to prevent progression of SDG. To the best of our knowledge, this is the first report in Korea regarding the treatment of SDG induced by catecholamine inotropes.

PURPOSE: To evaluate the efficacy of angiography in the diagnosis and treatment of pseudoaneurysm manifesting arterial hemorrhage as a significant complication following pancreatoduodenectomy. MATERIALS AND METHODS: For 51 months, of a total of 298 patients who had undergone pancreatoduodenectomy, 19 patients (6.4%) developed clinically significant hemorrhage and nine patients proved to have a pseudoaneurysm on angiography. These nine patients (3.0%) were managed by transcatheter arterial embolization. We analyzed clinical feature, angiographic findings and hemostatic effect of embolization retrospectively. RESULTS: In nine patients (3.0%), pseudoaneurysm was diagnosed on angiography (common hepatic artery in four, gastroduodenal artery in three, proper hepatic artery in one, and left gastroepoploic artery in one patient). The size ranged from 0.3 cm to 6.5 cm (mean 1.9 cm). And extravasation was noted in five patients (55.6%). The remained ten patients showed no evidence of bleeding on angiography. Those who manifested as early bleeding (within two weeks) or delayed bleeding (later than two weeks) were five and four patients respectively. Before the onset of major bleeding, among the nine pseudoaneurysm patients, seven patients (77.8%) had experienced percutaneous drainage due to intra-abdominal fluid collection with or without abscess resulting from anastomotic leak, and all nine patients had had preliminary minor bleeding. The angiogram demonstrated an exact site of bleeding as a pseudoaneurysm followed by transcatheter arterial embolization (microcoil in eight patients, gelfoam in one) and achieved complete hemostasis yielding a success rate of 100%. Overall, no patients experienced complications related directly to the transcatheter arterial embolization technique. During the follow-up period (72-1,336days, mean 640), no recurrence of bleeding was noted. CONCLUSION: Although pseudoaneurysm is a rare complication, it is important as a cause of hemorrhage after pancreatoduodenectomy. Angiography followed by transcatheter arterial embolization allows early diagnosis and hemostasis of pseudoaneurysm and minimizes the need for high-risk emergency surgery.
Abscess ; Anastomotic Leak ; Aneurysm, False* ; Angiography* ; Arteries ; Diagnosis* ; Drainage ; Early Diagnosis ; Emergencies ; Follow-Up Studies ; Gelatin Sponge, Absorbable ; Hemorrhage ; Hemostasis ; Hepatic Artery ; Humans ; Pancreaticoduodenectomy* ; Recurrence ; Retrospective Studies

Budd-Chiari syndrome is acute or subacute occlusion of the hepatic vein and IVC, The occlusion of hepatic veins often reveals dramatic illness characterized by abdominal pain, ascites, hepatomegaly and a poor prognosis. Several recent reports have suggested that balloon dilatation may be effective in Budd-Chiari syndrome. We experienced a case of Budd-Chiari syndrome with IVC web which was successfully treated with balloon dilatation. We report the case here with a brief review of literature,
Abdominal Pain ; Ascites ; Budd-Chiari Syndrome* ; Dilatation* ; Hepatic Veins ; Hepatomegaly ; Prognosis