PURPOSE: To evaluate CT findings of internal hernia. MATERIALS AND METHODS: Three patients with internal hernia had abdominal CT scans and two of them had small bowel follow through examinations. The CT features of two patients with retroanastomotic and one patient with left paraduodenal hernia were evaluated and correlated with small bowel follow through examinations, and surgical findings. Two patients with retroanastomotic hernia had a history of subtotal gastrectomy with antecolic gastrojejunostomy. The diagnosis of internal hernia was made on the basis of surgical find ings in two patients of retroanastomotic hernia, and characteristic barium study findings in one patient of left paraduodenal hernia. RESULTS: The small bowel follow through examination showed small bowel loops gathered in a circumscribed mass in the left mid abdomen, and delay in passage through these loops. In case of left paraduodenal hernia, abrupt narrowing of the distal duodenum could be identified. The characteristic CT findings of all three patients were whorling of the mesentery and mesenteric vessels in the left mid-abdomen. In the patient with left paraduodenal hernia, after resolution of the gastrointestinal symptoms, a follow-up CT scan showed spontaneous disappearance of whorling of the mesentery and mesenteric vessels suggesting spontaneous resolution of the hernia. In the other two cases, upon exploration of the abdomen, dilatation of afferent duodenum caused by adhesion between ligament of Treitz and adjacent bowel walls, and retro- anastomotic herniation of the efferent loops were found. CONCLUSION: The usual diagnosis of internal hernia is based on the appearance of the small bowel follow through examination. However, we consider that the whorling appearance(we call it whorling sign) of the mesentery and mesenteric vessels on CT scan is also suggestive of internal hernia in patients under clinical suspicion.
Abdomen ; Barium ; Diagnosis ; Dilatation ; Duodenum ; Follow-Up Studies ; Gastrectomy ; Gastric Bypass ; Hernia ; Humans ; Ligaments ; Mesentery* ; Tomography, X-Ray Computed

PURPOSE: To evaluate the radiologic findings of alimentary anthrax. MATERIALS AND METHODS: 19 patients with alimentary anthrax, which was caused by ingestion of contaminated beef, were included in this study. The diagnosis was made .b.y demonstration of Bacillus anthracis in smear and culture of the contaminated meat. We evaluated the clinical manifestations and the findings of thoracic, abdominal radiographs, cervical, abdominal ultrasonograms and abdominal CT scans. RESULTS: Out of the 19 patients with the alimentary infection, 9 had oropharyngeal form, 18 had abdominal form and 8 had combination of oropharyngeal and abdominal form. The patients had general symptoms and signs such as fever, chill, myalgia. Clinical symptoms and signs were sore throat, throat injection, throat ulcer and patch in oropharyngeal form, and nausea, vomiting, abdominal pain, diarrhea, and gross GI bleeding in abdominal form. Radiologic findings included enlarged cervical lymph nodes(36%) in oropharyngeal form, and paralytic ileus(26%), ascites(26%), hepatomegaly(21%), enlarged mesenteric lymph nodes(26%), small bowel wall thickening(5%) in abdominal form. In two patients, late complications occurred as intestinal obstruction due to ileal stricture with perforation, and inflammatory changes of pelvic cavity due to ileovesical fistula. CONCLUSION: Radiologic findings of alimentary anthrax are difficult in differentiation from those of other inflammatory bowel disease, but those radiologic findings with clinical manifestations may be helpful in diagnosis and evaluation of disease process in patients with alimentary anthrax.
Abdominal Pain ; Anthrax* ; Bacillus anthracis ; Constriction, Pathologic ; Diagnosis ; Diarrhea ; Eating ; Fever ; Fistula ; Hemorrhage ; Humans ; Inflammatory Bowel Diseases ; Intestinal Obstruction ; Meat ; Myalgia ; Nausea ; Pharyngitis ; Pharynx ; Tomography, X-Ray Computed ; Ulcer ; Ultrasonography ; Vomiting

PURPOSE: The purpose of this study was to evaluate the patency, procedure related complications and effectiveness of Wallstent application to the malignant biliary obstruction as a palliative treatment. MATERIALS AND METHODS: We retrospectively reviewed the clinical results, duration of survival, patency rate and complication of the Wallstent application on 33 patients who had had obstructive jaundice by the malignant lesion in recent 3 years. One or two step procedures. were mainly taken with 10mm diameter Wallstents. Grouping according to place the stent at the hilum or not, and grouping according to place the stent through the ampulla or not were done to evaluate the difference of the patency and survival rate between the groups. RESULTS: Biliary endoprosthesis with Wallstent were successfully placed in all patients without difficulty. Procedure related short-term complication rate was about 18.1% (n=6/33). Complications were fever(n=4), cholecystitis(n=1) and sepsis(n=l). Long-term complications were mainly obstruction(n=9/31) of the Wallstent during the follow-up period. Also cholecystitis occurred in one patient 3 months later. Mean survival duration was 139.72 (46-237)days ormong those who expired. Mean patency duration of stents was 139.67 (26-310) days. Survival rates were 93.5% at the second month, 68.8% at the third month, 61.2% at the 4th month, 53.5% at the 5th month, 49.1% at the 7th month and 35.7% at the 9th month. Patency rates were 93.7% at the second month, 84.2% at the 4th month, 66.9% at the 5th month, 59.5% at the 7th month and 39.6% at the 10th month. The application was repeated in the 6 patients with stent occlusion. Significant statistical difference could not be found between the groups according to placing the stent at the hilum and according to placing the stent through the ampulla. Patency rates were higher than survival rates in the follow-up period. CONCLUSION: Wallstent application provides good palliation with little discomfort and few complications in the patients with malignant obstructive jaundice.
Cholecystitis ; Follow-Up Studies ; Humans ; Jaundice, Obstructive ; Palliative Care ; Retrospective Studies ; Stents ; Survival Rate

The ultrasound-guided fine needle aspirations were performed in order to diagnose a suspected neoplastic orinfectious diseases in 52 patients with focal liver disease. Of these, neoplastic lesions were suspected in 31patients and infectious lesions in 21 patients ultrasonically and/or clinically. The overall accuracy for bothsuspected malignant and infectious disease was 79%(41/52). The primary indication for fine needle aspiration wasto document the presense of malignancy and to avoid a diagnostic laparotomy, and to drain hepatic abscesses.Consequently we were convinced that the ultasound
Aspirations (Psychology) ; Biopsy ; Biopsy, Fine-Needle ; Communicable Diseases ; Diagnosis ; Humans ; Laparotomy ; Liver Diseases ; Liver ; Methods ; Needles ; Ultrasonography

Anti-N-methyl-D aspartate receptor (NMDAR) encephalitis is often accompanied with ovarian teratomas. It has a variety of clinical manifestations including psychiatric symptoms, seizure, and motor dysfunctions. The diagnosis can be definite when clinical symptoms are present and anti-NMDAR antibodies in cerebrospinal fluid are detected. However, in patients with suspected anti-NMDAR encephalitis with teratomas, early surgery may help the clinical outcome even if the antibodies are initially negative. The authors report a patient whose clinical symptoms improved significantly after early removal of teratoma.

We developed the 166Ho-chitosan, the new radiation synovectomy agent. Holmium is the more practical isotope based on its longer half-life. And chitosan, is ideal and suitable particles based on its soluble and biodegradable characteristics. We investigated the biocompatibility of the 166Ho-chitosan complex to evaluate the suitability as a radiation synovectomy agent. In vitro stability test, the 166Ho-chitosan complex suspension in saline was stored at room temperture and 37degrees C for 25 days and decay rate was of determined by ITLC(Instant Thin Layer Chromatography). In vivo stability test, the 166Ho-chitosan complex was injected into rabbit joints and followed by gamma camera imaging to quantify extra-articular leakage. Biodistribution study, the 166Ho-chitosan complex was injected into rabbit joints. After 48 hours heart, liver, urinary bladder, spleen, lung, brain, kidney, blood were extracted and radioactivities were measured. In vitro stability test, there was no significant change of radioactivity and no leakage problem indicating the prepared 166Ho-chitosan complex is sufficiently stable. In vivo stability tests revealed that more than 98% of the 166Ho-chitosan remained in joint over a 2 days period. The mean retention percentage of 166Ho-chitosan in knee were 99.9%, 99.9%, 99.8%, 99.7% at 2 h, 6 h, 1 day and 2 days, respectively. A biodistribution study of the rabbits revealed that leakage to heart, liver, urinary bladder, spleen, lung, brain, kidney, blood is 0.71, 1.5, 0.50, 1.5, 0.25, 0.26, 0.81, 0.065(% Injected Dose x 10-3/gram), respectively. The 166Ho-chitosan complex shows less leakge than any other radiation synovectomy agents. Our results indicate that 166Ho-chitosan have the biocompatibility and the suitability as a radiation synovectomy agent.
Brain ; Chitosan* ; Half-Life ; Heart ; Holmium ; Joints ; Kidney ; Knee ; Liver ; Lung ; Rabbits* ; Radioactivity ; Radionuclide Imaging ; Spleen ; Urinary Bladder

PURPOSE: As general population survival has improved in the last few decades, the age of patients participating in renal transplantation also has increased. This study aimed to investigate the impact of donor and recipient age as predictor of long-term graft survival in renal transplantation. METHODS: We analyzed the transplantation outcome in 598 patients, who received renal transplantation from 1978 to 2003 at Hanyang Universitiy. Patients were divided into four groups according to the age at renal transplantation. Group A (donor age> or =50, recipient age> or =50, n=19/3.2%), group B (donor age> or =50, recipient age<50, n=153/25.5%), group C (donor age<50, recipient age> or =50, n=69/11.6%), group D (donor age<50, recipient age<50, n=357/59.8%). Univariate analysis was used to assess the effect of donor and recipient age as predictor factors of graft outcome. We used Kaplan Meier log-rank method for graft survival and P values less than 0.05 were considered significant. RESULTS: In elderly donor group, graft survival was 89.8% at 1 year, 76.4% at 3 years and younger donor group was 92.8 at 1year, 84.0% at 3 years and the differences showed statistic significance (P=0.009). Univariate analysis of age factor showed a significant reduction of graft survival in recipients transplanted with kidneys coming from donors older than 50 years, however recipient age greater than 50 years was not found as an independent risk factor. The incidence of rejection was 24.6% in elderly donor group and 23.5% in younger donor group (P=NS). Among the four groups, the most valuable result was group D and the 1 year and 3 years graft survival were 93.1%, 84.5% respectively but it was not significant statistically (P=0.50). CONCLUSION: This result is important for the design of allocation and transplantation strategies for kidneys procured in elderly donors and recipients.
Age Factors ; Aged ; Graft Survival ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Risk Factors ; Tissue Donors* ; Transplants

PURPOSE: Estimation of body fluid volume in hyponatremia is useful for diagnosis and therapeutic decision-making. Physical examination has been generally used to estimate body fluid volume, but it depends on the physician's abilities. Bioimpedance spectroscopy has been suggested to be a reliable method for the estimation of body fluid volume. Therefore, this study investigated whether bioimpedance spectroscopy could replace physical examination in hyponatremia. MATERIALS AND METHODS: The study included 30 patients with hyponatremia. At the time of the initial visit, body fluid volume was estimated simultaneously by both physical examination and bioimpedance spectroscopy. Estimation of body fluid status by clinical diagnosis was performed as well, which determined body fluid status corresponds with the most likely cause of hyponatremia (clinical body fluid estimation). RESULTS: The results of body fluid volume estimated by physical examination, bioimpedance spectroscopy, and clinical body fluid estimation showed that 9, 10, and 9 patients, respectively, were hypervolemic; 13, 15 and 16 patients, respectively, were euvolemic; and 8, 5, and 5 patients, respectively, were hypovolemic. Cohen's kappa analysis showed a significant agreement between physical examination and bioimpedance spectroscopy (kappa coefficient, 0.632, p<0.001). In addition, bioimpedance spectroscopy showed a higher level of agreement with clinical body fluid estimation than physical examination (kappa coefficient, 0.602 vs. 0.524). CONCLUSION: This study suggests that bioimpedance spectroscopy could replace physical examination for estimating body fluid status in hyponatremia. In addition, bioimpedance spectroscopy might correspond better with clinical diagnosis than physical examination in the estimation of body fluid status in hyponatremia.
Body Fluids* ; Diagnosis ; Humans ; Hyponatremia* ; Hypovolemia ; Methods ; Physical Examination ; Spectrum Analysis*

The medical records of six cases of nesidioblastosis were examined to determine the diagnostic approach, treatment, and neurologic sequelae. All six patients were male, and their ages at the onset of the disease ranged from one day to six months (mean 3.36 +/- 2.5 mo.). Initial clinical features were seizure, cyanosis, poor feeding, and apnea. Other subsequent symptoms were developmental delay, hyperactivity, and cold sweating. The Birth weight of the neonatal onset group was heavier than the postneonatal onset group (4.4 +/- 0.3 vs 3.26 +/- 0.04 kg). Before the diagnosis of hyperinsulinism, steroids of ACTH proved effective for seizure control. Initially, hyperinsulinemia (serum insulin greater than 10 microU/ml) was detected in four cases, but another two cases also showed hyperinsulinism by insulin/glucose(I/G) ratio greater than 0.3 during the fasting test. The glucagon response performed in 2 cases, showed normal and partial responses. Euglycemia was obtained by near total pancreatectomy (95% pancreatic resection)without malabsorption or persistent diabetes. In one case, nesidioblastoma coexisted with nesidioblastosis. Developmental delay was noted in three cases. In this group, the mean duration between symptom onset and operation was longer than the group without developmental delay (1.25 +/- 0.47 vs 0.38 +/- 0.19 yr).
Brain Damage, Chronic/*etiology ; Child, Preschool ; Developmental Disabilities/etiology ; Humans ; Hypoglycemia/blood/*etiology ; Infant ; Infant, Newborn ; Insulin/*blood ; Male ; Pancreatic Diseases/complications/*diagnosis/therapy ; Postoperative Complications/epidemiology

PURPOSE: This study was performed to identify the health and nutritional status of Korean adults according to food security by age group. METHODS: The subjects were 20~79 year old adults (n = 16,595) who participated in the fifth Korea National Health and Nutrition Examination Survey (2010~2012). Subjects were divided into three groups based on food security such as secure, mildly insecure, and moderately/severely insecure groups. Dietary intake was estimated by 24-hour dietary recall. As for mental health status, the data on mental stress, sleep hours, depression symptoms, and suicide ideation were used. RESULTS: Korean adults who were exposed to high food insecurity typically had low income levels, lived alone, and were recipients of basic welfare. In the 20~39y group, people with higher food insecurity had lower concentrations of hemoglobin and higher iron-binding capacity. In the 40~59y group, people with higher food insecurity had lower HDL-cholesterol. In the 60~79y group, people with higher food insecurity had higher total cholesterol levels, more stress, more experiences of depression symptoms, and were more suicidal. Mean intakes of energy, protein, calcium, phosphorus, potassium, vitamin A, carotene, vitamin B1, vitamin B2, niacin, and vitamin C were lower in the food insecure groups. Amounts of vegetables, fruits, and seasoning intakes tended to be lower in people with higher food insecurity. The effects of food security on nutrition intake were greater in the 40~59y and 60~79y groups than the 20–39y group. CONCLUSION: Food insecurity was related to certain health indicators such as anemia and cholesterol levels and affected mental health. The effects of food insecurity on health and nutritional status were different by age group.
Adult* ; Anemia ; Ascorbic Acid ; Calcium ; Carotenoids ; Cholesterol ; Depression ; Family Characteristics* ; Food Supply* ; Fruit ; Humans ; Korea* ; Mental Health ; Niacin ; Nutrition Surveys* ; Nutritional Status* ; Phosphorus ; Potassium ; Riboflavin ; Seasons ; Suicide ; Thiamine ; Vegetables ; Vitamin A