PURPOSE: To evaluate the contrast enhancement patterns and mass detection rate of metastatic adenocarcinoma of the liver in the early and late phase of spiral bolus dynamic CT. MATERIALS AND METHODS: Two-phase spiral bolus dynamic CT of the liver was performed on 34 patients with clinically or pathologically proved metastatic adenocarcinoma of the liver after bolus administration of 120 mL of contrast material intravenously. CT scanning was started at 45 seconds and 6 minutes after I~eginning of injection in 23 patients, and at 35 seconds and 3 minutes in another 11 patients. The enhancement patterns of the tumors were classified into 6 types compared with attenuation of surrounding normal liver parenchyma, as diffusely high, peripherally high, centrally high, mixed, iso, diffusely low. The enhancement patterns of 76 tumors in 34 patients were analysed. RESULTS: In the early phase, peripherally high attenuation was seen in 34(45%) and diffusely low attenuation in 23(30%). In the late phase, diffusely low attenuation was seen in 27(36%) followed by iso and mixed in 14 (18%), in each, and peripherally high in 13(17%). The appearances of enhancement pattern from the early to the late phase were variable. 12(16%) were diffusely low in both phases, 11(14%) were peripherally high in the early phase and diffusely low in the late phase, and 10(13%) were peripherally high in both phases. Number of tumor lesions detected were more in the early phase in 12(35%)patients, and in the late phase in 3(9%) patients. CONCLUSION: Metastatic adenocarcinoma of the liver showed variable enhancement patterns in the early and late phases of spiral bolus dynamic CT, although the most common pattern was peripherally high in early phase, and diffusely low in the late phase. The detection rate of masses was higher in early phase than late. The two-phase spiral bolus dynamic CT should be good method in detection and differential diagnosis of metastatic adenocarcinoma of the liver.
Adenocarcinoma* ; Diagnosis, Differential ; Humans ; Liver* ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed

PURPOSE: To evaluate the contrast enhancement patterns and mass detection rate of metastatic adenocarcinoma of the liver in the early and late phase of spiral bolus dynamic CT. MATERIALS AND METHODS: Two-phase spiral bolus dynamic CT of the liver was performed on 34 patients with clinically or pathologically proved metastatic adenocarcinoma of the liver after bolus administration of 120 mL of contrast material intravenously. CT scanning was started at 45 seconds and 6 minutes after I~eginning of injection in 23 patients, and at 35 seconds and 3 minutes in another 11 patients. The enhancement patterns of the tumors were classified into 6 types compared with attenuation of surrounding normal liver parenchyma, as diffusely high, peripherally high, centrally high, mixed, iso, diffusely low. The enhancement patterns of 76 tumors in 34 patients were analysed. RESULTS: In the early phase, peripherally high attenuation was seen in 34(45%) and diffusely low attenuation in 23(30%). In the late phase, diffusely low attenuation was seen in 27(36%) followed by iso and mixed in 14 (18%), in each, and peripherally high in 13(17%). The appearances of enhancement pattern from the early to the late phase were variable. 12(16%) were diffusely low in both phases, 11(14%) were peripherally high in the early phase and diffusely low in the late phase, and 10(13%) were peripherally high in both phases. Number of tumor lesions detected were more in the early phase in 12(35%)patients, and in the late phase in 3(9%) patients. CONCLUSION: Metastatic adenocarcinoma of the liver showed variable enhancement patterns in the early and late phases of spiral bolus dynamic CT, although the most common pattern was peripherally high in early phase, and diffusely low in the late phase. The detection rate of masses was higher in early phase than late. The two-phase spiral bolus dynamic CT should be good method in detection and differential diagnosis of metastatic adenocarcinoma of the liver.
Adenocarcinoma* ; Diagnosis, Differential ; Humans ; Liver* ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed

BACKGROUND: It is well-known that migraineurs frequently have abnormal findings on transcranial Doppler ultra-sound (TCD), but their clinical implications are not clear. We investigated the clinical significance of TCD findings in migraineurs. METHODS: One hundred thirty-seven consecutive migraineurs were prospectively gathered. The following clinical parameters were investigated : 1) age and sex, 2) time from onset of headache to visiting hospital, 3) frequency, duration, laterality, pulsating quality, and severity of headache, 4) presence of nausea, vomiting, photophobia, and phonophobia, 5) aura, and 6) aggravation of headache by routine physical activity. TCD was performed during a headache-free period to measure the mean flow velocities (MFVs) and other parameters of 13 intracranial and 2 extracranial vessels. If MFV of any artery or its side-to-side difference in each migraineur was beyond 2 standard deviations of corresponding age and sex-matched reference subgroups, the TCD result was regarded as abnormal. Correlations between abnormal TCD and clinical parameters were examined by univariate and multivariate analyses. RESULTS: Results of TCD were abnormal in 84 patients (61.3%). Pulsatility of headache and absence of aura were significantly correlated with abnormal TCD on univariate analyses (p=0.003 and 0.049 respectively). On multivariate analysis, pulsatility of headache was the only statistically significant predictor of abnormal TCD (p=0.015). Headache attacks tended to be less frequent in patients with abnormal TCD with marginal significance (p=0.050). CONCLUSIONS: Our study shows that abnormal results on TCD are more frequent in migraineurs with pulsatile headache. An association between abnormal TCD and frequency of headache attacks is suggested.
Arteries ; Epilepsy ; Headache ; Humans ; Hyperacusis ; Migraine Disorders ; Motor Activity ; Multivariate Analysis ; Nausea ; Photophobia ; Prospective Studies ; Vomiting

Ophthalmoplegia, ataxia, and areflexia are a classical triad of Miller Fisher syndrome (MFS). The experience of dizziness secondary to ophthalmoplegia is also not uncommon. However, nystagmus is rare and vertigo, a symptom of vestibulocerebellar dysfunction, has not been reported yet. A 56-year-old woman visited our hospital due to sudden vertigo. Initial examination revealed nystagmus evoked by a bilateral horizontal gaze with left side dysmetria. The next day, her symptoms rapidly aggravated to ophthalmoplegia, severe ataxia, areflexia, and quadriplegia. She was diag-nosed with MFS and was treated with intravenous immunoglobulin. On the fourth day, she developed respiratory fail-ure and a ventilator was applied. Twenty-eight days after her admission, she recovered to the point of walking without any aid and was discharged with minimal disability. There are still controversies surrounding the nosology of MFS and many investigators have reported evidence for brainstem involvement. Vertigo can be additional evidence for the involvement of the central nervous system in MFS.
Ataxia ; Brain Stem ; Central Nervous System ; Cerebellar Ataxia ; Dizziness ; Female ; Humans ; Immunoglobulins ; Middle Aged ; Miller Fisher Syndrome* ; Ophthalmoplegia ; Quadriplegia ; Research Personnel ; Ventilators, Mechanical ; Vertigo* ; Walking

PURPOSE: To evaluate the usefulness of the arterial dominant phase images of spiral CT in the detection and localization of pancreatic islet cell tumor. MATERIALS AND METHODS: Six patients with pathologically proven isletcell tumors of the pancreas were studied with two-phase spiral CT. Images of the arterial dominant phase and delayed phase were obtained at 30 and 180 seconds after the initiation of injection of 100 ml of contrast materialat a rate of 3ml/sec. The parameters of scanning were 3-mm thickness, table speed of 4mm/sec, and reconstruction at 2-mm intervals. Images were prospectively analyzed and the operative findings were used as the reference standard for tumor detection and localization. RESULTS: On arterial dominant phase images, lesions were definitely depicted in five patients(83%) and were suspicious in one (17%). In the delayed phase, only two tumors(33%) were demonstrated. CONCLUSION: The arterial dominant phase of spiral CT is useful in the preoperative detection and localization of islet cell tumor of the pancreas.
Adenoma, Islet Cell* ; Humans ; Islets of Langerhans* ; Pancreas* ; Prospective Studies ; Tomography, Spiral Computed*

No abstract available.
Ovarian Neoplasms* ; Transfection*

Familial adenomatous polyposis (FAP) includes early development of up to thousands of colorectal adenoma and of colonic adenocarcinoma in all untreated cases. Moreover, a variety of extracolonic manifestation are seen. Several reports have demontrated a high incidence of papillry carcinoma of thyroid. We experienced a case of familial adenomatous polyposis, presenting with thyoid papillry carcinoma, and reported with a brief review of literatures.
Adenocarcinoma ; Adenoma ; Adenomatous Polyposis Coli* ; Carcinoma, Papillary* ; Colon ; Incidence ; Thyroid Gland* ; Thyroid Neoplasms

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

PURPOSE: To compare the proliferation potential of the epithelial cells between unicystic ameloblastoma (UA), dentigerous cyst (DC), and odontogenic keratocyst (OKC) and to correlate this proliferation potential with the radiographic features of these three pathoses. MATERIALS AND METHODS: Immunohistochemical expression of PCNA, Ki-67, and cytokeratin as a proliferation marker were assessed for 15 cases of UA, 15 cases of DC, and 15 cases of OKC. The degree of immunochemical expression of three proliferation markers were correlated with the radiographic features, especially cortical expansion (negative and positive) and shape of border (scalloped and round). RESULTS: Using PCNA and Ki-67, OKC showed the highest proliferation potential and UA the lowest. Statistically significant differences were found between the OKC and the UA (p< 0.05). However, no statistically significant difference was present according to the radiographic features in all pathoses. Using cytokeratin, there was no significant differences of proliferation potential among three pathoses. CONCLUSIONS: OKC epithelium has the most intense proliferation potential, followed by the dentigeous cyst and then unicystic ameloblastoma. There is no significant relation between the radiographic features and the proliferation potential of epithelium of these three pathoses.
Ameloblastoma* ; Dentigerous Cyst* ; Epithelial Cells ; Epithelium ; Keratins* ; Ki-67 Antigen ; Odontogenic Cysts* ; Odontogenic Tumors ; Proliferating Cell Nuclear Antigen*

The explanation of isolated-organ tuberculosis rests on the assumption that in the course of the lymphatic or hematogenous dissemination of bacilli, organisms may be rapidly destroyed in all other sites save for the particular tissue involved in the isolated tuberculous process. Tuberculosis can arise in all tissues having lymphatics or blood supply, but the disease causing biliary tract obstruction has been known to be rare. Recently, we experi-enced a case of isolated-organ tuberculosis causing common bile duct obstruction and periductal lymph node enlargement in a 46-year-old Korean male. An ultrasonography-guided percutaneous needle biopsy revealed a granulomatous inflammation of the lymph node. After 7 months of anti-tuberculous medication, the common bile duct obstruction and periductal lymph node enlargement disappeared completely in a follow up abdominal CT and ERCP.
Biliary Tract ; Biopsy, Needle ; Cholangiopancreatography, Endoscopic Retrograde ; Cholestasis ; Common Bile Duct* ; Follow-Up Studies ; Humans ; Inflammation ; Lymph Nodes ; Lymphadenitis* ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Tuberculosis*