Forty five patients with inferior vena cava (IVC) thrombosis were studied with the use of ultrasonography (US) and computed tomography (CT). Thirty seven cases were cased by tumor extension and the primary neoplasms were hepatocellular Ca. (26cases), renal cell Ca. (6 cases), Wilms' tumor (1 case), IVC leiomyosarcoma (1 case) and retroperitoneal metastatic tumor (3 cases). Non-tumor thrombus were 8 cases which included 5 cases of Budd-Chiari syndrome and 3 cases of thrombophlebitis. US and CT both were good for the diagnosis of IVC thrombosis. Cranial extension was better demonstrated by US whereas CT yielded better delineation of the lower extension. Even though, differentiation of tumor non-tumor thrombi by the echogenecity and density of the thrombus was not possible, the finkdings of adjacent tumor mass, complete obstructive thrombus within dilated lumen with bulging wall, and nontapered acute margin of thrombus made the possibility of tumor thrombus more likely.
Budd-Chiari Syndrome ; Diagnosis ; Humans ; Leiomyosarcoma ; Thrombophlebitis ; Thrombosis* ; Ultrasonography ; Vena Cava, Inferior* ; Wilms Tumor

Vesiculobullous eruptions are a rare cutaneous manifestation of systemic lupus erythematosus (SLE). They are related to intense inflammation within the cutaneous lesions and subsequent blister formation. We report a case of vesiculobullous eruption of SLE in a 23-year-old male. The bullous eruptions were present ori the lip, forehead, both feet and hands. He met ARA(American Rheumatism Association) is criteria for a diagnosis of SLE and the eruptions developed during a systemic attack of the disease. Routine histology of the lesion showed subepidermal blisters with intact epidermis and dense neutrophilic infiltration in the upper dermis. Direct immunofluorescence of lesional skin showed a linear-granular pattern of immune deposits at the dermoepidermal junction. Electronmicroscopy of the lesional skin showing subepidermal bullae are located beneath the lamina densa. Combination therapy of prednisolone and hydrochloroquine showed complete clearing of the lesions within several weeks. We observed a good response without evidence of recurrence.
Blister ; Dermis ; Diagnosis ; Epidermis ; Fluorescent Antibody Technique, Direct ; Foot ; Forehead ; Hand ; Humans ; Inflammation ; Lip ; Lupus Erythematosus, Systemic* ; Male ; Neutrophils ; Prednisolone ; Recurrence ; Rheumatic Diseases ; Skin ; Young Adult

The incidence of pancreatic trauma is increasing and still remains a major source of morbidity and mortality. We have graded the pancreatic trauma on CT according to its pattern into four grades. We also determine the accuracy of CT in the evaluation of pancreatic trauma and the role of CT for delineation of pancretic ductal injury which is critical factor in outcome of pancreatic trauma. CT correctly diagnosed the pancreatic trauma and its traumatic pattern and severity in 22 of 25 cases. Pancreatic enlargement was the most common findings observed in 19 cases. Other findings were 15 cases of intrapancreatic low density hematoma, 12 cases of parenchymal fracture which were predilected in pancreatic neck area. CT grade III and IV could predict the pancreatic ductal injury, and was well correlated with severity of posttraumatic pancreatitis, duration of admission days and incidence of complications. So we concluded that CT can play a definite role for diagnosing and determining the prognosis of pancreatic trauma.
Diagnosis* ; Hematoma ; Incidence ; Mortality ; Neck ; Pancreatic Ducts ; Pancreatitis ; Prognosis

There has not been any report on massive air-containing liver abscess in diabetic patients, although emphysematous cholecystitis or pyelonephritis is a well-known complication in them. Authors report two cases of emphysematous liver abscess in diabetic patient, which showed typical findings of massive air-containing hepatic abscess on ultrasonography and computed tomography, but very poor progrosis in spite of immediate and successful percutanoeus drainage procedure.
Drainage ; Emphysematous Cholecystitis ; Humans ; Liver Abscess* ; Liver* ; Pyelonephritis ; Ultrasonography

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

A 29 year old woman with unresectable leiomyosarcoma of the inferior vena cave extending into the right atrium of the heart was presented. The upper and middle inferior vena cava involved and there were both intrinsic and extrinsic tumor growth components. The diagnosis was made by a combination of radiological studies including ultrasound, CT, inferior vena cavography and arteriography and the diagnosis was confirmed by ultrasound guided rumor biopsy. The clinical and radiological presenting features were reviewed.
Angiography ; Biopsy ; Diagnosis ; Female ; Heart ; Heart Atria ; Humans ; Leiomyosarcoma* ; Ultrasonography ; Vena Cava, Inferior*

A 29 year old woman with unresectable leiomyosarcoma of the inferior vena cave extending into the right atrium of the heart was presented. The upper and middle inferior vena cava involved and there were both intrinsic and extrinsic tumor growth components. The diagnosis was made by a combination of radiological studies including ultrasound, CT, inferior vena cavography and arteriography and the diagnosis was confirmed by ultrasound guided rumor biopsy. The clinical and radiological presenting features were reviewed.
Angiography ; Biopsy ; Diagnosis ; Female ; Heart ; Heart Atria ; Humans ; Leiomyosarcoma* ; Ultrasonography ; Vena Cava, Inferior*

BACKGROUND AND OBJECTIVES: Some patients who have undergone tonsillectomy complain of voice change, but few studies for the mechanism of voice change were found. To solve this problem, study of voice change after tonsillectomy and adenotonsillectomy was done. MATERIALS AND METHODS: We analyzed voice change of 22 patients who underwent tonsillectomy and 15 patients who underwent adenotonsillectomy at CSL (computerized speech laboratory), St. Benedict Hospital. With the measured cross sectional area of vocal tract and its length from the glottis on MR images, we presented the change of cross sectional area schematically after tonsillectomy. RESULTS: Acoustically, the frequencies of the second formant of /e/ and /i/ increased and that of the first formant of /u/ decreased significantly after tonsillectomy and the frequency of the second formant of /o/ and those of the second and third formants of /i/ and /u/ increased significantly after adenotonsillectomy. It was also showed acoustically that the formant bandwidths of /a/ and /hana/ after tonsillectomy and those of /e/ and /hana/ after adenotonsillectomy increased due to nasalization. Anatomically, it was showed that the cross sectional area of oropharyngeal cavity increased and coupling effect of vocal tract happened after tonsillectomy. CONCLUSION: This study showed that acoustic characteristics and vocal tract shapes of the patients did change following tonsillectomy and adenotonsillectomy. It is imperative that we explain to patients about the postoperative voice change. Research should also be done to find ways to induce better voice changes following the operations.
Acoustics* ; Glottis ; Humans ; Magnetic Resonance Imaging ; Tonsillectomy* ; Voice*

Intrahepatic stones are frequently associated with recurrent pyogenic cholangiohepatitis and complete surgical removal of the stones is almost always difficult because of the large number of stones and associated bile duct strictures. One hundred and seventy-nine patients with retained intrahepatic stones underwent percuttaneous stone removal utilizing a preshaped angulated catheter and a Dormia basket under fluoroscopy with a combination of techniques including irrigation-suction. crushing of large stones. balloon dilatation of strictures and extracorporenal shock wave lithotripsy. The procedure was performed through a mature T-tube tract (177 patients) and a mature transhepatic tube tract (two patients). Stones were exclusively intrahepatic in 130 patients. whereas 49 patients also had stones in the common bile duct. In 91 (50.8%) of 179 patients. the stones were completely removed and in 36 (20.1%) patients most of the stones were removed. The overall success rate was 70.9% ngulation deformity. stricture of bile ducts and impacted stones were the factor most often responsible for failure, No significant complications were observed. Fluoroscopicalyy-guided percutaneous interventional procedures with a preshaped angulated catheter is an useful complementary procedure to surgery for patients with intrahepatic stones. the major benefits of an individually fitted angulated catheter are its safety and easy access to small peripheral bile ducts.
Bile Ducts ; Catheters* ; Common Bile Duct ; Congenital Abnormalities ; Constriction, Pathologic ; Dilatation ; Fluoroscopy ; Humans ; Lithotripsy ; Shock