No abstract available.

Magnetic resonance image of INFH were correlated with histologic sections. Seventeen patients withe eighteen hips were included in this study. reoperative radiographs and MRI were taken for the patients. Three hips were in stage II, nine hips were in stage III, and remaining six were in stage IV respectively(Ficat and Alert). These hips were replaced with artificial joint and resected heads were examined. The specimens were bisected along the imaging plane, and studied histologically and matched with respective MR images of T1 and T2. Specimen MRI was performed on three femoral head immediately after femoral head removal. Necrotic portion of the femoral head in earlier stage showed higher signal intensity in T1-weighted image. Subchondral void, necrotic bone and saponified fat were responsible for low signal intensity in necrotic portion. Low signal band adjacent to the necrotic foci represented inner fibrous tissue and outer reactive sclerotic bone. Outside the fibrous band, the signal intensity diminished compared with normal fatty marrow. these findings were attributed by cellular infiltration and trabecular bony proliferation. MRI patterns were variable in various stages, but corresponded well with histologic findings.
Bone Marrow ; Head ; Hip ; Humans ; Joints ; Magnetic Resonance Imaging ; Necrosis

Malignant fibrous histiocytoma (MFH) occurs primarily in the extremities and trunk, however primary malignant fibrous histiocytoma of the alimentary tract, particularly of the jejunum, is uncommon. This case report presents a case of malignant fibrous histiocytoma as the primary lesion of the jejunum in a 42-year-old male patient with a 10-day history of melena. A small bowel tumor was resected without complication. The final diagnosis was based on the pathological report of the surgical specimen.
Adult ; Diagnosis ; Extremities ; Histiocytoma, Malignant Fibrous* ; Humans ; Jejunum* ; Male ; Melena

Gastritis cystica profunda (GCP) is a rare disease which shows multiple cystic gastric glands within the submucosa of the stomach. GCP lesions mainly develop at the site of gastroenterostomy and exhibit benign behavior. However, there have been a number of debates over its malignant potential. Several reports have documented GCP accompanied by gastric carcinomas, but the relationship between the two conditions remains uncertain. Here we report two cases of GCP with dysplasia accompanied by synchronous multiple early gastric cancers without previous gastric surgery.
Aged ; Cysts/*diagnosis/pathology ; Early Detection of Cancer ; Gastric Mucosa/pathology ; Gastritis/complications/*diagnosis/pathology ; Humans ; Male ; Neoplasms, Multiple Primary/*diagnosis/pathology ; Stomach Neoplasms/complications/*diagnosis/pathology

Gastritis cystica profunda (GCP) is a rare disease which shows multiple cystic gastric glands within the submucosa of the stomach. GCP lesions mainly develop at the site of gastroenterostomy and exhibit benign behavior. However, there have been a number of debates over its malignant potential. Several reports have documented GCP accompanied by gastric carcinomas, but the relationship between the two conditions remains uncertain. Here we report two cases of GCP with dysplasia accompanied by synchronous multiple early gastric cancers without previous gastric surgery.
Aged ; Cysts/*diagnosis/pathology ; Early Detection of Cancer ; Gastric Mucosa/pathology ; Gastritis/complications/*diagnosis/pathology ; Humans ; Male ; Neoplasms, Multiple Primary/*diagnosis/pathology ; Stomach Neoplasms/complications/*diagnosis/pathology

BACKGROUND: A sustained outbreak of multi-resistant Acinetobacter baumannii has been noticed in intensive care unit (ICU) of a newly opened hospital. METHODS: We retrospectively studied 72 patients in the ICU whose specimen grew A. baumannii from March to December 1995. To identify risk factors for infection, a case control study was conducted. Comparing clinical characteristics of 19 infected patients with those of 53 colonized cases. Environmental culture was performed in January 1996 to identify the source of infection. We analyzed antibiotic susceptibility of the isolates, and ribotyping was performed with 52 isolates. RESULTS: Nineteen out of 72 patients developed disease: primary sepsis 2, catheter related infection 2, catheter related infection and pneumonia 2, wound infection 5, wound infection and sepsis 2, pneumonia 6. On comparison of clinical characteristics between the infected and colonized groups, central venous catheterization was a significant risk factor for development of disease by A. baumannii (P<0.05) and duration of lCU stay was a factor independently associated with A. baumannii infection by logistic regression analysis. An epidemiologic investigation failed to identify the source of infection, but we found 2 of 3 sinks in lCU were heavily contaminated by the organism. Antibiogram of the isolates showed a multi-drug resistance including amikacin, which was found to increase gradually during the course of the outbreak. Ribotyping showed 3 major subtypes: 2A (18 isolates) 2B (16) 2B'(13) and other types (5). CONCLUSION: The findings from this study support the reports from many parts of the world that A. baumannii plays an increasingly important role as one of the major nosocomial pathogens.
Acinetobacter baumannii ; Amikacin ; Case-Control Studies ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Colon ; Drug Resistance, Multiple ; Humans ; Intensive Care Units* ; Critical Care* ; Logistic Models ; Microbial Sensitivity Tests ; Pneumonia ; Retrospective Studies ; Ribotyping ; Risk Factors ; Sepsis ; Wound Infection

BACKGROUND: A sustained outbreak of multi-resistant Acinetobacter baumannii has been noticed in intensive care unit (ICU) of a newly opened hospital. METHODS: We retrospectively studied 72 patients in the ICU whose specimen grew A. baumannii from March to December 1995. To identify risk factors for infection, a case control study was conducted. Comparing clinical characteristics of 19 infected patients with those of 53 colonized cases. Environmental culture was performed in January 1996 to identify the source of infection. We analyzed antibiotic susceptibility of the isolates, and ribotyping was performed with 52 isolates. RESULTS: Nineteen out of 72 patients developed disease: primary sepsis 2, catheter related infection 2, catheter related infection and pneumonia 2, wound infection 5, wound infection and sepsis 2, pneumonia 6. On comparison of clinical characteristics between the infected and colonized groups, central venous catheterization was a significant risk factor for development of disease by A. baumannii (P<0.05) and duration of lCU stay was a factor independently associated with A. baumannii infection by logistic regression analysis. An epidemiologic investigation failed to identify the source of infection, but we found 2 of 3 sinks in lCU were heavily contaminated by the organism. Antibiogram of the isolates showed a multi-drug resistance including amikacin, which was found to increase gradually during the course of the outbreak. Ribotyping showed 3 major subtypes: 2A (18 isolates) 2B (16) 2B'(13) and other types (5). CONCLUSION: The findings from this study support the reports from many parts of the world that A. baumannii plays an increasingly important role as one of the major nosocomial pathogens.
Acinetobacter baumannii ; Amikacin ; Case-Control Studies ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Colon ; Drug Resistance, Multiple ; Humans ; Intensive Care Units* ; Critical Care* ; Logistic Models ; Microbial Sensitivity Tests ; Pneumonia ; Retrospective Studies ; Ribotyping ; Risk Factors ; Sepsis ; Wound Infection

Early post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) prediction may allow safe same-day outpatients discharge after ERCP and earlier proper management. This study aimed to assess the usefulness of the 4-hour post-ERCP serum amylase and lipase levels for PEP early prediction and to investigate predictive cut-off values for 4-hour post-ERCP serum amylase and lipase levels for safe discharge and urgent initiation of resuscitation. The data of 516 consecutive patients with native papilla who underwent ERCP between January 2013 and August 2014 were retrospectively reviewed. Serum amylase and lipase levels were measured before, and 4 and 24 hours after ERCP. PEP occurred in 16 (3.1%) patients. The receiver-operator characteristic curve for 4-hour post-ERCP serum amylase and lipase levels showed that the areas under the curve were 0.919 and 0.933, respectively, demonstrating good test performances as predictors for PEP (both P values < 0.001). The amylase level > 1.5 × the upper limit of reference (ULR) was found useful for PEP exclusion with a sensitivity of 93.8%, while 4 × ULR was found useful to guide preventive therapy with the best specificity of 93.2%. Similarly, the lipase level 2 × ULR showed best sensitivity, while 8 × ULR had the best specificity. Logistic regression analysis showed that 4-hour post-ERCP amylase level > 4 × ULR, lipase level > 8 × ULR, precut sphincterotomy, and pancreatic sphincterotomy were significant predictors for PEP. In conclusion, 4-hour post-ERCP amylase and lipase levels are useful early predictors of PEP that can ensure safe discharge or prompt resuscitation after ERCP.
Amylases* ; Cholangiopancreatography, Endoscopic Retrograde ; Humans ; Lipase* ; Logistic Models ; Outpatients ; Pancreatitis* ; Resuscitation ; Retrospective Studies ; Sensitivity and Specificity

Successful management of patients with persistent or recurring pain after lumbar disc surgery requires comprehensive evaluation to accurately localize the anatomic sources of pain. The results of reoperation for recurrent disc herniation are uniformly good, whereas those of reoperation for scar tissue are poor. There have been few studies comparing the ability of enhanced MRI and CT/discography to distinguish between scar tissue and recurrent disc herniation. We evaluated 23 patients with recurring pain after lumbar disc surgery. Two neurosurgeons independently reviewed CT/discography and MRI of each patient before and after gadolinium enhancement. To determine the accuracy, sensitivity, and specificity of each test, responses were compared with surgical findings and CT/discography was found to be more sensitive and specific in distinguishing between scar and recurrent disc herniation. Characteristics associated with recurrent disc herniation include nonenhanced or rim-enhanced abnormality surrounding a low signal on enhanced MRI. and extension of contrast into the epidural space on CT/discography. For determining the need to repeat open disc surgery, combined MRI and CT/discography is more accurate and sensitive than either test alone.
Cicatrix ; Epidural Space ; Gadolinium ; Humans ; Magnetic Resonance Imaging ; Reoperation ; Sensitivity and Specificity

OBJECTIVES: The cold provocation test for diagnosing the vascular component in hand-arm vibration syndrome (HAVS) is likely to be accepted as an objective test, and a few studies have been performed. However, controversy has continued regarding the diagnostic performance of this method. Although objective methods such as plethysmography and laser doppler flowmetry have been studied, they have not received as much attention as other diagnostic methods. Therefore, our study aim was to spread the awareness of HAVS by reporting the results of the cold provocation test in a hand-transmitted vibration exposure group. METHODS: The study subjects were 549 workers who had been exposed to hand-transmitted vibrations and reported symptoms in their hands. While the subject immersed both their hands in 10degrees C water for 10 minutes, the skin temperature of 10 fingers was recorded from pre-immersion time to 20 minute postimmersion including 10 minutes immersion time. The recovery rates were calculated from the recorded skin temperatures. The 'decreased recovery rate' criteria were less than 30% at 5 minutes post-immersion and 60% at 10 minute post-immersion. RESULTS: Of the subjects, 69.1% and 30.9% had more severe symptoms in the right and left hands, respectively. The mean finger skin temperature of the right hand after cold-water immersion for 10 minutes was approximately 10degrees C, which increased gradually with time, but they did not reach the baseline temperature at 20 minutes post-immersion. The deviations of the skin temperature in the subjects were higher in the recovery phase than in the baseline and cold immersion phase. The 3rd finger of both hands showed the lowest 5-minute recovery rate among the fingers examined, and the left 4th finger and right 3rd finger showed the lowest 10-minute recovery rate. Of the subjects, 37.6% and 10.4% of subjects showed a lower recovery rate at 5 and 10 minutes in at least one finger, respectively, while 10.2% showed a lower recovery rate at both 5 and 10 minutes simultaneously in at least one finger. CONCLUSIONS: The larger deviations in the recovery phase than in the other phases indicated that interindividual differences are more prominent in the recovery phase. There might be no benefit in observing the finger skin temperature for an additional 10 minutes after 10 minutes post-immersion. Overall, approximately 10% of the subjects in the HAVS risk group had HAVS.
Cold Temperature ; Fingers ; Hand ; Hand-Arm Vibration Syndrome ; Immersion ; Laser-Doppler Flowmetry ; Plethysmography ; Skin Temperature ; Vibration ; Water