PURPOSE: The purpose of this study was to evaluate the utility of two-phase dynamic CT, early and equilibrium pahse, in the preoperative staging of rectal cancers. MATERIALS AND METHODS: We performed incremental dynamic CT after rectal infusion of water in 34 patients with pathologically proved rectal cancers. Two-phase dynamic CT findings were prospectively analyzed and correlated with surgical and histopathologic findings. A total of 150ml of nonionic contrast medium was intravenously administered with a power injector at a flow rate of 5ml/sec for 30 sec, and two-phase images were obtained at 30 sec(early phase) and 2 min (equilibrium phase) after bolus injection. Local tumor staging and regional lymph node were classified by TNM staging. RESULTS: All 34 rectal cancers showed a moderate to marked enhancement in the early phase and a homogeneous and prolonged enhancement of the entire lesion in the equilibrium phase. T-staging of primary tumors were 85.3%(29/34) in early phase and 70.6%(24/34) in equilibrium phase. The accuracy in determining the perirectal fat invasion of rectal cancer was 92%(23/25) in early phase, and 72%(18/25) in equilibrium phase. The sensitivity & specificity of the regional lymph node metastasis were 63.6% and 79.1% in early phase, and 54.5% and 65.2% in equilibrium phase, respectively. CONCLUSION: Early phase dynamic CT was more accurate for the preoperative staging of rectal cancer than that at equilibrium phase.
Humans ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm Staging ; Prospective Studies ; Rectal Neoplasms* ; Sensitivity and Specificity ; Water

PURPOSE: To evaluate MRI(Magnetic Resonance Imaging) findings of miliary tuberculosis of the brain. MATERIALS AND METHODS: Six patients with miliary tuberculosis of the brain diagnosed by characteristic clinical or laboratory findings were studied with spin echo MRI before and after contrast enhancement. We retrospectively evaluated MRI findings acording to the appearance, distribution, location, and enhancement pattern of the granulomas as well as associated other abnormalities. RESULTS: In six patients, contrast-enhanced MRI of thebrain showed numerous punctate, contrast enhancing lesions scattered throughout the brain. Unenhanced MRI failed to demonstrate small granulomas except a few small foci of high signal intensity on T2-weighted images. The shapes of enhancing granulomas were homogeneous nodular enhancement in 86% of cases and small ring enhancement in 14%.98% of granulomas were smaller than 3-mm and 2% were larger. Although several lesions were located in the basalganglia, thalamus, and brain stem, the majority were located in the subpial and subarachnoid space. There was no significant difference in distribution of granulomas between the supratentorial and the infratentorial areas. Other associated abnormalities were focal meningitis in five cases and focal cerebritis in one. On chest radiograph, all patients had miliary tuberculosis in the lungs. CONCLUSION: Contrast-enhanced T1-weighted MRimaging showed numerous round, very small enhancing lesions scattered throughout the brain. The majority of lesions were located in the subpial and subarachnoid space. Contrast-enhanced T1-weighted images are helpful inthe detection and diagnosis of miliary disseminated tuberculous granulomas and meningitis.
Brain Stem ; Brain* ; Diagnosis ; Granuloma ; Humans ; Lung ; Magnetic Resonance Imaging* ; Meningitis ; Subarachnoid Space ; Thalamus ; Tuberculosis, Central Nervous System ; Tuberculosis, Miliary*

PURPOSE: To assess the value of dynamic fast infusion of contrast material in the detection and diagnosis of hepatocellular carcinoma(HCC) with spiral CT. MATERIALS AND METHODS: Two-phase dynamic spiral CT was performed in 59 patients with 104 HCCs. 150ml of nonionic contrast material was injected with an automatic injector at the rateof 5 ml/sec. Two-phase images were obtained at 20-45 sec(arterial dominant phase) and 2-5 min(equilibrium phase)after the initiation of bolus injection of contrast material. The tumors were divided into three groups(<3cm,3-5cm, and >5cm) according to the size and the enhancement patterns on two-phase images were compared. RESULTS: Inthe arterial phase, HCCs showed total or partial hyperattenuation in 79% of cases(82/104), isoattenuation in 12%,and hypoattenuation in 9%. In the equilibrium phase, HCCs showed hypoattenuation in 86%(89/104) and isoattenuationin 14%. The most common and characteristic enhancement patterns of HCCs were hyperattenuation in the arterialphase and hypoattenuataion in the equilibrium phase ; in the latter, capsules were demonstrated in 45% of cases. Invasions of the portal and/or hepatic vein were demonstrated in 34% of cases. CONCLUSION: Dynamic fastinfusion(5ml/sec) of contrast material(150ml) is useful in the detection and diagnosis of HCCs with spiral CT.
Capsules ; Carcinoma, Hepatocellular* ; Diagnosis ; Hepatic Veins ; Humans ; Tomography, Spiral Computed*

PURPOSE: To evaluate the usefulness of dynamic spiral computed tomography(CT) during the portal phase with ahigher IV injection rate of contrast material in detecting hepatic metastases. MATERIALS AND METHODS: We reviewed two-phase dynamic spiral CT in 44 patients with hepatic metastases of pathologically proven primary malignancy. One hundred and fifty ml. of non-ionic contrast material was administered with a power injector at a rate of 5ml/sec., and two-phase images at 55-80 sec.(portal phase) and 2-5 min.(equilibrium phase) were obtained after thestart of bolus injection. Two phase images were compared for detectability of hepatic metastases according tosize, number and enhancement pattern. RESULTS: In cases of metastases less than 1cm, 113 lesions(100%) that showed clearly defined hypodense lesions were detected in the portal phase of dynamic CT. However, the equilibriumphase images showed hypodense lesions in 58 cases(51%) and isodense lesions in 55cases(49%). In cases of metastases 1-2cm in size, the portal phase images detected 70 hypodense lesions(92%) and six hyperdense lesions(8%). In the equilibrium phase, however, the lesions were hypodense in 54 cases(71%), hyperdense infour(5%), and isodense in 18(24%). In cases of metastases larger than 2 cm, portal phase images showed 29 hypodense lesions(97%) and one hyperdense lesion(3%). In the equilibrium phase, however, the lesions were hypodense in 25 cases(83%), hyperdense in two(7%), and mixed in three(10%). As compared with the portal phase, most metastatic lesions were detected as poorly defined hypodense or isodense lesions in the equilibrium phase and decrease in size due to peripheral enhancement. CONCLUSION: Dynamic spiral CT during the portal phase with a higher IV injection rate(5 ml/sec) of contrast material is a useful method for detecting hepatic metastases, especially small lesions less than 1cm.
Humans ; Liver* ; Neoplasm Metastasis* ; Tomography, Spiral Computed*

PURPOSE: To determine the CT findings which distinguish consolidation-type bronchioloalveolar carcinoma fromnecrotizing pneumonia. MATERIALS AND METHOD: This study involved ten patients with pathologically-provenconsolidation-type bronchioloalveolar carcinoma and 34 with necrotizing pneumonia proven pathologically either inthe laboratory or clinically. We retrospectively analyzed CT features including the enhancement pattern ofconsolidated lung, the presence and internal density of cavity within consolidated lung, CT angiogram sign,air-bronchogram, pleural enhancement, pleural effusion, and change in extrapleural tissue and its density. RESULT: CT findings in patients with necrotizing pneumonia showed higher attenuation in marginal (94.1%) and inner(85.3%) portions in consolidated lung than in muscles (p<0.005); the presence of cavity (91.2%, p<0.05) ; cavitywith fluid or air-fluid level (77.4%, p<0.005); pleural enhancement (88.2%, p<0.00003) ; pleural effusion (33.3%,p<0.05); and change in extrapleural tissue (64.7%, p<0.05). CT findings in patients with consolidation-typebronchioloalveolar carcinoma showed lower attenuation in marginal (90.0%) and inner (60.0%) portions ofconsolidated lung than muscles (p<0.005) and of cavity containing air (100%; p<0.005). However, air-bronchogramand CT angiogram signs were not helpful in differentiating the two groups. CONCLUSION: CT can help differentiateconsolidation-type bronchioloalveolar carcinoma and necrotizing pneumonia.
Adenocarcinoma, Bronchiolo-Alveolar* ; Diagnosis, Differential* ; Humans ; Lung ; Muscles ; Pleural Effusion ; Pneumonia* ; Retrospective Studies

Anal cancer is a relatively rare disease to supply consistent therapeutic modality. We analysed 18 anal cancer patients treated from 1989 to 1996 at the Department of Surgery, Asan Medical Center, to evaluate two categories of the treatment e.g. initial surgery followed by radiochemotherapy and radiochemotherapy Preceding surgery. The aim of this study is to evaluate the advantage and pitfall of both therapeutic options. Among 18 patients presenting with carcinoma of the anus, the dominant histologic type was squamous followed by cloacogenic and verrucous carcinoma, 72%, 17%, 11% respectively According to the staging system of AJCC/UICC, T1 and T2 were 12 patients, NO were 7 patients. According to the treatment options, abdominoperineal resection preceding radiochemotherapy were performed in 8 patients, Whereas surgery after radiochemo-therapy were in 10 patients. Among the 8 patient with prior surgery, two patients developed recurrent disease and one patient was dead. Among the 10 patient with prior radiochemotherapy, two patients developed recurrent disease and two patients were dead. Histological differentiation of squamous cell carcinoma was significantly related with survival. The metachronous lymph nodes metastasis showed poorer prognosis than the synchronous metastasis. Radiochemotherapy shoud be considered as primary therapy of anal cancer that obviated wide excision sacrificing anorectal function.
Anal Canal ; Anus Neoplasms* ; Carcinoma, Squamous Cell ; Carcinoma, Verrucous ; Chemoradiotherapy ; Chungcheongnam-do ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Rare Diseases

PURPOSE: The growth, progression, and metastasis of malignant neoplasms are influenced by the environment of the tumor and by proliferation of the tumor itself. Angiogenesis of a malignant neoplasm is a very important environmental factor of tumor growth and metastasis. Also, it is a prognostic factor for malignant neoplasms. The mechanism of angiogenesis, such as the effects of cytokines and angiogenesis-promoting factors, is incompletely understood. METHODS: This study was designed to define the role of tumor necrosis factor-alpha (TNF-alpha) and the vascular endothelial growth factor (VEGF) in angiogenesis induced by lipopolysaccharide (LPS) and thalidomide (anticytokine drug) in CT26 murine colon cancer transplanted to BALB/c mice. RESULTS: The tumor size in the LPS-treated group (n=3, 2.1+/-0.26 cm) was larger than it was in the LPS thalidomide-treated group (n=4, 1.95+/-0.19 cm) and in the control group (n=3, 1.6+/-0.20 cm) (P<0.05). The microvessel density determined by CD31 immunostaining was lowest for the control group and highest for the LPS- treated group, but the differences were not statistically significant. An immunohistochemical study showed that the expressions of TNF-alpha (P<0.01) and VEGF (P<0.05) were higher in the experimental groups than they were in the control group. Also, the LPS thalidomide-treated group had lower expressions of TNF-alpha (P<0.01) and VEGF (P<0.05) than the LPS-treated group. Western blots revealed that the TNF-alpha and the VEGF levels semiquantitatively increased from the control group to the LPS thalidomide-treated group to the LPS-treated group. CONCLUSIONS: Our study revealed that low doses of LPS stimulated angiogenesis through increased expression of TNF-alpha and VEGF. Thalidomide decreased angiogenesis, probably through suppression of TNF-alpha with a decreased expression of VEGF. We conclude that TNF-alpha, suppressed by thalidomide, in the model of transplanted colon cancer may inhibit angiogenesis through coincident decrease in the expression of VEGF.
Animals ; Blotting, Western ; Colon* ; Colonic Neoplasms* ; Colorectal Neoplasms ; Cytokines ; Mice* ; Microvessels ; Neoplasm Metastasis ; Thalidomide* ; Tumor Necrosis Factor-alpha* ; Vascular Endothelial Growth Factor A*

PURPOSE: To evaluate the usefulness and diagnostic accuracy of turbo spin-echo(TSE) proton-density andT2-weighted images of meniscal tears of the knee. MATERIALS AND METHODS: We retrospectively evaluated thesensitivity, specificity, and accuracy of TSE proton density and T2-weighted images of meniscal tears confirmedarthroscopically or surgically in 47 patients(98 menisci). The routine TSE parameters used in all patients werethe dual echo sequence with sagittal proton density and T2-weighed images(4000/16, 90/5/2 [TR/effectiveTE/ETL/NEX]), and fat-suppressed coronal proton density and T2-weighted images. The chi-square test was used forstatistical analysis. RESULTS: The sensitivity, specificity, and accuracy of TSE proton density images for thedetection of meniscal tears were 93.9%, 93.8%, and 93.9%, respectively, in the medial meniscus, and 92.9%, 91.4%,and 91.8% in the lateral. On T2-weighted images the corresponding figures were 87.9%, 93.8%, and 89.8%,respectively, in the medial meniscus, and 64.3%, 91.4%, and 83.7 % in the lateral. CONCLUSION: With regard tosensitivity and accuracy, TSE proton density images of meniscal tears were superior to TSE T2-weighted images.
Humans ; Knee* ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Protons ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND/AIMS: Our previous studies of ionization and solubility of unconjugated bilirubin (UCB) yielded inappropriately large differences between the two carboxylic pK'a values of UCB. These data, however, were not ideal due to crystal effects, matastability, impurities of the bilirubin, and imprecision of analyses at low UCB. METHODS: The sodium salt of taurocholate (TC) was purified and dissolved in water to 100 mM. Chloroform (CHCl3) was purified by vacuum distillation. Buffers used were: citrate from pH 4 to 6, phosphate from pH 6 to 8, and borate above pH 8. All had an ionic strength of 0.10. The problems were minimized by rapid solvent partition of UCB from CHCl3 into buffered aqueous NaCl, and a new, accurate assay of low UCB in the aqueous phase which was achieved by concentrating the UCB through back extraction into small volumes of CHCl3. RESULTS: In contrast with the crystal dissolution studies, the two pK'a value were similar. H2B0, not HB-, was the dominant UCB species in the pH range of bile (6.0 to 8.0). The aqueous solubilities of UCB were 90 to 98% less. Less than 0.01% of the bile salt partitioned into the CHCl3 phase and self-association of B= was negligible. UCB solubilities in 50 mM TC were 2 to 10% of those obtained by crystal dissolution, and, up to pH 7.9, were below the maximum UCB concentration in normal human bile. CONCLUSIONS: We suggest that the markedly increased binding of UCB with each ionization step is due to the disruption of the internal hydrogen bonds of the ionized carboxyl groups on interaction with the bile salt. We propose to extend the study of partition to determine the activity and the degradation products of calcium salts of unbound bilirubin fractions.
Bilirubin/*chemistry ; Chloroform ; English Abstract ; Hydrogen-Ion Concentration ; In Vitro ; Solubility ; Solvents ; Taurocholic Acid/*chemistry

Acute pancreatitis is a serious disease with fatality rate up to 15%. We recently experienced a case of acute pancreatitis induced by multiple drugs in a patient with ulcerative colitis. A 20-year-old female visited with abdominal pain and hematochezia and diagnosed of ulcerative colitis. Sulfasalazine and prednisolone were used. However, acute pancreatitis occurred after 4 weeks of treatment with additional azathioprine treatment. Drug-induced pancreatitis was suspected, and she was recovered with conventional therapy for acute pancreatitis. Therefore, it was proposed that acute pancreatitis was induced by azathioprine. However, after the administration of sulfasalazine, pancreatitis relapsed. Furthermore, even the re-administration of 5-ASA and azathioprine induced relapse of acute pancreatitis. We concluded that acute pancreatitis was induced by multiple drugs in this patient with ulcerative colitis.
Acute Disease ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Antimetabolites/adverse effects ; Azathioprine/adverse effects ; Colitis, Ulcerative/diagnosis/*drug therapy ; Colonoscopy ; Female ; Humans ; Mesalamine/adverse effects ; Pancreatitis/*chemically induced/*diagnosis ; Sulfasalazine/adverse effects ; Tomography, X-Ray Computed ; Young Adult