PURPOSE: An oblique interface in the right cardiophrenic angle, extending superomedially from rightretrocardiac or supradiaphragmatic region inferolaterally to peridiaphragmatic region, is occasionally observed onposteroanterior chest radiograph. The aim of this study was to evaluate the frequency of visualization of the interface on chest radiographs and to elucidate its nature on radiographic-CT correlation. MATERIALS AND METHODS: Posteroanterior chest radiographs from 300 consecutive subjects were analyzed to evaluate the frequency and demographic data about an oblique interface in the right cardiophrenic angle. Thin-section CT scans(1-mmcollimation and 5-mm intervals) were obtained from the subjects with positive interface on chest radiograph for assessment of the nature of the interface. The demographic data in the subjects with and without the interface were tested statistically to note any difference between two groups. RESULTS: Oblique interface in the right cardiophrenic angle was present in 29 subjects(9.7%) on chest radiograph. The age of the subjects with positive interface(13 men and 16 women) ranged from 19 to 70 years(mean +/-SD, 47+/- 12.7 years) whereas the age of thesubijects without the interface from 16 to 82 years (mean +/-SD, 50+/-9.1 years)(p>0.1). The body weight of thesubjects with the interface ranged from 41 to 72 Kg(mean +/-SD, 60 +/- 8.0Kg) whereas the body weight of thesubjects without the interface from 41 to 85 Kg(mean +/-SD, 63+/-10.1Kg)(p>0.1). On CT scan, it was formed due tocontact between the epipericardial fat and the right middle lobe of the lung in 27 subjects(93%) and between the inferior vena cava and the medial basal segment of the right lower lobe of the lung in two(7%). CONCLUSION: Oblique interface in the right cardiophrenic angle is occasionally visualized on chest radiograph. It is formed due to contact between the right middle lobe of the lung and pericardial fat in most cases. The frequency of visualization of the interface has no relationship to age and body weight of the subjects.
Body Weight ; Humans ; Lung ; Male ; Radiography, Thoracic ; Thorax* ; Tomography, X-Ray Computed

No abstract available.
Low Back Pain*

PURPOSE: In determining image quality of mammography,many factors are related. Selection of film and screen is one of them. Authors took phantom images of nine film-screen combinations under properly controlled conditions and compared them to evaluate their image qualities. In addition, KVp, mAs and surface dose were evaluated at each combination to deterrhine proper exposure conditions. MATERIALS AND METHODS: Using phantom,images of nine film-screen combinations composed of Fuji MI-NC, UM-MA, UM-MH films and Fuji Fine,Medium, Kodak Min-R screeens were taken. Phantom(Ackermann Mammochip Phantom) was composed of simulations for microcalcifications, fibers, nodules, lymph nodes, breast tissue and breast cancer masses. For phantom of 4.5 cm compressed breast equivalent, 28 KVp was used. For 1.5 and 3.0 cm equivalant phantoms, 24 KVp and 26 KVp was used. At each KVp, mammographic images were taken at various mAs. Among images taken by this process, best images were selected and then, according to scoring method, comparison of image quality for each combination was done. With dosimation strip, surface doses for various conditions were evaluated. RESULTS: Combination of Fuji UM-MA film and Fuji Fine screen showed best image quality regardless of KVp or phantom thickness. For the best image, 10 mAs with 26 KVp was most ideal while mAs with 24 KVp was optimal for equivalent phantom of 3.0 cm thickness breast. At this condition, surface dose was less than other combinations when combinations involving UM-MH films were used. On the other hand,when combinations involving MI-NC films were used, surface dose was higher than others. CONCLUSION: Using phantom, image quality of film-screen combinations could be evaluated and compared. Such process can contribute to best quality image with decreased exposure and can play a role in quality asurance program.
Breast ; Breast Neoplasms ; Lymph Nodes ; Research Design

Residual biliary stone can be effectively treated by nonoperative procedure using steerable catheter andbasket in the recent year. We analysed the 27 cases of residual biliary stone, which were refered to radiologydepartement of Yonsei University during last 2 years, from June 1982 to June 1984. The results as follows; 1. Thelocation of residual stones are extrahepatic in 14 cases (51.9%), intrahepatic in 5 cases(18.5%) and both intraand extrahepatic duct in 8 cases(29.6%). 2. In 13 of 27 cases(48.1%) were required multiple sessions. 3.Fragmentation of stone was done in 16(59.3%) in 27 cases. 4. Success rate in extrahepatic duct is 13 in 14casese(92.6%), intrahepatic duct 3 cases in 5(60%), and both intra and extrahepatic duct 7 in 8 cases(87.5%).Overal success rate in 27 cases is 85.2%
Catheters

In paediatric orthopaedic, it has been discovered that the fracture of the epiphyseal plate may cause not only growth disturbances but also progressive deformity upon appendicular skeleton of a growing child. Between 1972 May and 1983 April, 102 inward patients(106 cases) who were 18 years old or younger were treated in the department of orthopaedic surgery of Hanyang University Hospital because of epiphyseal plate fractures. The results were summerized as followings: 1. The peak age was from 5 years to 14 years(average, 10.2 years old). 2. The sex ratio was 4.3 for male to 1 for female. 3. The left side was involved more frequently than the right extremity. 4. The most common cause of fractures was injury on fall down(in 41.4% of all cases). 5. The incidence of epiphyseal fracture was 8.1% of fracture in children. 6. The most common fracture was developed at humeral epiphysis. 7. The most common type of epiphyseal fracture was Salter and Harris type IV. 8. The 50.5% of all cases was treated by closed reduction and cast immobilization, 48.1% by open reduction and internal fixation, and 1.9% by closed reduction and traction. 9. The average period of immobilization was 5.2 weeks. 10. The incidence of complication of all cases was 13.2%, but only 2 cases of them(1.9%) were needed for operation because of their complication.
Child ; Clinical Study ; Congenital Abnormalities ; Epiphyses ; Extremities ; Female ; Growth Plate ; Humans ; Immobilization ; Incidence ; Male ; Sex Ratio ; Skeleton ; Traction

PURPOSE: To assess the outcome of tunneled central venous catheter placement via the right internal jugular vein. MATERIALS AND METHODS: Between June 2001 and May 2002, 670 consecutive Hickman catheters were placed in 654 patients via the right internal jugular vein. The procedural complications arising and follow-up data obtained from May to July 2002 were evaluated. RESULTS: The technical success rate for catheter placement was 99.9% (669/670). Procedural complications were limited to eight cases (1.2%), including three pneumothoraces, one early migration of the catheter, one clinically unimportant air embolism, one catheter injury, one catheter kinking and one primary malpositioning in the azygos vein. Catheter dwelling time ranged from 1 to 407 (mean 107.1) days. During the follow-up period, 416 catheters were removed for various reasons: treatment had ended (n=334), patients declined treatment or their drug regimen was changed (n=16), late complications arose (n=53), or other circumstances intervened (n=13). Late complications included 44 cases of catheter-related infection (6.6%), five of catheter migration (0.7%), two of catheter occlusion (0.3%), one of thrombophlebitis (0.15%), and one of catheter-related right atrial thrombosis (0.15%). Only one instance of symptomatic venous thrombosis or stenosis was noted , namely the one case of thrombophlebitis. CONCLUSION: Because the incidence of subsequent symptomatic venous thrombosis or stenosis is lower, the preferred route for tunneled central venous catheter placement is the right internal jugular vein.
Azygos Vein ; Catheter-Related Infections ; Catheters* ; Central Venous Catheters ; Constriction, Pathologic ; Embolism, Air ; Follow-Up Studies ; Humans ; Incidence ; Jugular Veins* ; Thrombophlebitis ; Thrombosis ; Venous Thrombosis

PURPOSE: To evaluate the safety and efficacy of Hickman catheter placement via the subclavian vein under fluoroscopic guidance with intravenous contrast injection. MATERIALS AND METHODS: During an eleven-month period, 187 Hickman catheters were percutaneously placed in 167 consecutive patients in an interventional radiology suite. Subclavian venous puncture was made with injection of contrast medium into the peripheral venous line. After subclavian venous access had been obtained, a subcutaneous tunnel was created using a peel-away sheath or a tunneler. The Hickman catheters were inserted through a peel-away sheath, the distal tip of which was at the junction of the right atrium and the superior vena cava. RESULTS: One hundred and eighty-six Hickman catheters were successfully placed; the one failure was due to an atomical tortuosity of the vein(0.53%). Complications included one case of subclavian vein occlusion (0.53%); three of line occlusion by thrombus (1.6%); one of oozing at the suture site (0.53%); six of infection or inflammation (3.2%); eight of natural removal (4.2%); one case of air embolism (0.53%) and two of malposition (0.1%). Major complications such as pneumothorax or arterial puncture leading to mediastinal hemorrhage did not, however, occur. CONCLUSION: The authors concluded that radiologic Hickman catheter placement offers advantages over traditional approaches in terms of safety, convenience, and time and cost savings.
Catheters ; Cost Savings ; Embolism, Air ; Heart Atria ; Hemorrhage ; Humans ; Inflammation ; Pneumothorax ; Punctures ; Radiology, Interventional ; Subclavian Vein* ; Sutures ; Thrombosis ; Vena Cava, Superior

This study was done to determine the attenuating effect of fentanyl, esmolol and labetalol on the undesirable hemodynamic response to endotracheal intubation. Eighty patients, ASA physical status I-II, scheduled for elective surgery, were randomly divided to 4 groups(n=20, respectively), received a preintubation dose of either normal saline, 3 ug/kg fentanyl, 3 ug/kg fentanyl and 2.5 mg/kg esmolol, or 3 ug/kg fentanyl and 0.5 mg/kg labetalol. Controlled blood pressure and heart rate were recorded in the operating room at arrival of patients. Denitrogenation was done and 3 ug/kg fentanyl was administered at minute 0. Either sympathetic blocker was intravenously infused for 1 minute at minute 1. Induction was accomplished by administering 5 mg/kg thiopental sodium at minute 3, Larynogscopy and endotracheal intubation were performed by one investigator at minute 5. Data from patients in whom intubation required more than 15 seconds were excluded. Heart rate and blood pressure were recorded every minute for 10 minutes after administration of fentanyl. Highest value of heart rate and systolic blood pressure in all groups were recorded 1 minute after endotracheal intubation. Maximum percent increase in systolic blood pressure(meanSD) after intubation were significantly lower in fentanyl(4%+/-17%), esmolol and fentanyl(-5%+/-14%), and labetalol and fentanyl(-3%+/-20%) groups than in the normal saline(27%+/-15%) group(P<0.05). Maximal percent increase in heart rate was significantly lower only in esmolol and fentanyl(4%+/- 18%)group than in normal saline(27%+/-23%) group(P<0.05). The authors observed that combined pretreatment with esmolol and fentanyl provided more reliable protection against increases in both heart rate and systolic blood pressure accompanying laryngoscopy and intubation.
Blood Pressure ; Fentanyl* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Intubation, Intratracheal* ; Labetalol* ; Laryngoscopy ; Operating Rooms ; Research Personnel ; Thiopental

Eight patients with diffuse panbronchiolitis were evaluated with chest radiograph and high-resolution computed tomography(HRCT). Paients consisted of 5 med and 3 women, aged 27-75 years(average, 54 years). Chest radiographic findings were diffuse small nodular densities, linear shadows, and thickened bronchial wall predominantly in both lower lung fields. All 8 patients had pansinusitis. On HRCT, small nodules and branching linear structures, 1-3mm internal to the pleural surface, representing centrilobular bronchiolar lesion, were found along with thickening of medium and small sized bronchial wall. These nodules did not show coalescence. In conclusion, chest radiographs were usually suggestive and high-resolution CT was diagnostic of diffuse panbronchiolitis.
Female ; Humans ; Lung ; Radiography, Thoracic* ; Thorax*

BACKGROUND: Tourniquet pain is probably mediated by C-fiber. The ability of fentanyl to interrupt this nociceptive conduction was studied by administering either fentanyl or saline intrathecally along with hyperbaric bupivacaine for spinal anesthesia. METHOD: The incidence of tourniquet pain was evaluated in 60 patients having orthopedic surgery of the lower extremities during spinal anesthesia by administering either 30 mcg fentanyl (group 2) or saline (group 1) along with 0.5% hyperbaric bupivacaine 10 mg. We measured the maximal sensory spread of analgesia to pinprick, the incidence of tourniquet pain, and the sensory anesthesia to pinprick at the onset of tourniquet pain. RESULTS: The average maximal sensory spread of analgesia was the same in both groups (T9). The incidence of tourniquet pain was significantly greater in group 1 (33%) than in group 2 (10%). The sensory levels of anesthesia at the onset of tourniquet pain were not different in two groups. CONCLUSIONS: Intrathecal fentanyl was effective against tourniquet pain for 2 hours of the orthopedic surgery of the lower extremities.
Analgesia ; Anesthesia ; Anesthesia, Spinal* ; Bupivacaine* ; Fentanyl* ; Humans ; Incidence ; Lower Extremity ; Orthopedics ; Tourniquets*