PURPOSE: Traumatic rupture of the diaphragm is not easy to diagnose and often delayed. Delayed diagnosis of diaphragmatic rupture accompanied by higher chances of strangulation of herniated viscera which may result in higher morbility and mortality. The purpose of this study was to evaluate diagnostic accuracy of spiral CT, MRI and US for the diagnosis of diaphragmatic rupture in an animal model. MATERIALS AND METHODS: Small, medium, and large sized transabdominal diaphragmatic ruptures were surgically made in experimental rabbits and then followed up with spiral CT, MRI, and US at 1 day, 3 day, and 1 week after operation. RESULTS: US was superior to MRI or spiral CT in diagnosis of diaphragmatic rupture(P<0.05). The sensitivity and specificity were 94.4% and 92.9% for US, 54.0% and 85.7% for MRI, and 46.0% and 78.6% for spiral CT, respectively. The size of laceration was not related to diagnostic sensitivity in US. Sensitively of MRI and spiral CT increased as the size of laceration were larger, but no statistical significant was present(P>0.05). All experimental animals developed pleural effusion or hemothorax one day after operation. In acute phase. US and MRI were more sensitive than spiral CT in detecting diaphragmatic rupture. Spinal CT was more sensitive than US and MRI in delayed phase but without statistical significance(P>0.05) In the experimental rabbits with accompanying visceral hernia through the diaphragmatic defect, diagnostic accuracy was found equally high among three image modalities(P>0.05). CONCLUSION: This study indicates that US is the most accurate diagnostic method in detecting injury to the diaphragm in a rabbit model. The findings obtained in this experimental study can be applied to the diaphragmatic rupture of human being.
Animals ; Delayed Diagnosis ; Diagnosis* ; Diaphragm ; Hemothorax ; Hernia ; Humans ; Lacerations ; Magnetic Resonance Imaging ; Models, Animal ; Mortality ; Pleural Effusion ; Rabbits ; Rupture* ; Sensitivity and Specificity ; Tomography, Spiral Computed* ; Ultrasonography* ; Viscera

PURPOSE: Granulomatous mastitis is a rare benign inflammatory breast disease of an unknown etiology. Clinically and radiologically, it can mimic a breast carcinoma. Therefore, surgeons, pathologists, radiologists need to be aware of this condition in order to avoid unnecessary mastectomies. This study examined the modalities that are important for diagnosing and treating of the granulomatous mastitis. METHODS: The data regarding 14 patients with histologically confirmed granulomatous mastitis and treated at our hospital were analyzed. Age, associated disease, parity, past history of breast feeding and oral contraceptives, radiology findings were retrospectively evaluated. RESULTS: Among the 14 patients, the mean age was 41 years with 5 being in their thirties. Breast pain was the most common presentation. Of the 14 patients, 11 patients had breast-fed and none had previously used oral contraceptives. No patient suffered from pulmonary tuberculosis. Preoperative mammography and ultrasonography was not helpful in identifying granulomatous mastitis. After ultrasonography, 7 patients were found to have mastitis with an abscess and a benign or malignant tumor was found in 3 patients. Two of the 14 patients were diagnosed using pre-operative fine-needle aspiration, which that showed an epithelial histiocyte or multinucleated giant cell. Three cases completely recovered after an excision. In 11 cases, incision and drainage were performed but there was a recurrence in 4 of these, which needed to be treated more than twice by an incision and drainage and steroid. The average treatment period was 5 months and a recurrence was encountered in 4 patients within a 30-month follow-up period. CONCLUSION: Granulomatous mastitis is rare, but it is important to make a histological diagnosis at the early stages. It is believed that a complete excision of the lesion will help prevent a recurrence, and patients with a frequent recurrence can be treated with steroid after stopping unnecessary antibiotic treatment.
Abscess ; Biopsy, Fine-Needle ; Breast Diseases ; Breast Feeding ; Breast Neoplasms ; Contraceptives, Oral ; Diagnosis ; Drainage ; Female ; Follow-Up Studies ; Giant Cells ; Granulomatous Mastitis* ; Histiocytes ; Humans ; Mammography ; Mastectomy ; Mastitis ; Mastodynia ; Parity ; Recurrence ; Retrospective Studies ; Tuberculosis, Pulmonary ; Ultrasonography

No abstract available.
Amniocentesis* ; Cytogenetics* ; Female ; Humans ; Pregnancy ; Pregnancy Trimester, Second*

The authors report clinical results of fifty-two traumatic thoracolumbar bburstfractures treated by internal fixation with Kaneda device after anterior decompression during recent six years. The burst fractures occurred most frequently at the age of twenties and thirties. The main causes of injury were vehicle accident and fall.In all cases, spinal decompression, internal instrumet fixation and bone fusion(rib, iliac bone) were performed. No patient showed neurological deterioration after surgery and almost all patients improved post operatively by on grade of Frankel's(classification). Thirty-three patients(85%) with Denis type I and II showed the correction of the fracture deformities with good bony fusion and 9 of 13 patients(70%) with Denis type IV showed bony fusion in serial follow-up. It if thus concluded that anterolateral internal fixation combined with bony fusion provide good mechanical stability and decompression of protruding ventral bone fragments above conus medullaris level.
Congenital Abnormalities ; Conus Snail ; Decompression ; Decompression, Surgical* ; Follow-Up Studies ; Humans

Ventricular tachycardia is an important tachyarrhythmia which is encountered commonly in clinical field. The accompanying manifestations could be variable just from palpitation to sudden cardiac death. The classification of this arrhythmia has not completly settled yet, but in a broad way this arrhythmia is classified according to the prescence or abscence or underlying heart disease, especially coronary artery disease. Recently, therapeutic modalities for this arrhythmia have been changed a lot from classical antiarrhythmic drugs to radiofrequency ablation or ICD implantation although there are still some problems to overcome. We experienced a case of 34-year-old female having an incessant ventricular tacycardia which was abolished after endomyocardial biopsy performed to differentiate underlying myocardial pathology.
Adult ; Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Biopsy* ; Catheter Ablation ; Classification ; Coronary Artery Disease ; Death, Sudden, Cardiac ; Female ; Heart Diseases ; Humans ; Pathology ; Tachycardia ; Tachycardia, Ventricular*

Dermoid cysts of the spinal canal are rare benign congenital tumors, accounting for 1~2% of all intraspinal tumors. We report a case of lumbar extramedullary cyst, combined with congenital sacral meningocele. The clinical features, characteristics on MRI, pathologic findings, and surgical treatment of such a rare extramedullary benign tumor is discussed with the relevant literature.
Dermoid Cyst* ; Magnetic Resonance Imaging ; Meningocele* ; Spinal Canal

Occasionally it is difficult to preoperatively confirm the bleeding focus in acute lower gastrointestinal bleeding patients. Therefore, many diagnostic evaluations are needed - for example, colonoscopy, selective mesenteric angiography and Tc-99m RBC scintigraphy. However, if the bleeding focus remains unconfirmed preoperatively when the patient's state is unstable hemodynamically, the surgeon must inevitably perform exploratory laparotomy, followed by intraoperative endoscopy. We herein propose a new method of intraoperative endoscopy using Trocar(R) (Ethicon). Trocar(R) (Ethicon) was used in laparoscopic operation. This method has the merits of no air leakage, no contamination, fewer complicatons and ease of evaluation. We recommend that the use of Trocar(R) (Ethicon) in intraoperative endoscopy is essential in emergency operations for acute lower gastrointestinal bleeding.
Angiography ; Colonoscopy ; Emergencies ; Endoscopy* ; Hemorrhage* ; Humans ; Laparotomy ; Radionuclide Imaging

Advanced hepatocellular carcinoma (HCC) has a poor prognosis and few effective therapies. Recently, low-dose antiangiogenic (also called metronomic) chemotherapy has been tested in patients with advanced HCC. Here, we report two patients with advanced HCC who showed a good response after metronomic chemotherapy. The first was a 54-year-old man who was diagnosed with advanced HCC with lung metastasis. After three cycles of metronomic chemotherapy, the size of tumor and pulmonary metastatic lesions had decreased markedly on follow-up computed tomography. The second was a 54-year-old woman who was diagnosed with HCC with portal vein thrombosis. Metronomic therapy was performed. After 9 months, tumor enhancement in the arterial phase had disappeared completely, and the portal vein thrombus was decreased slightly. Metronomic therapy is an interesting treatment option for patients with advanced HCC. More clinical data and studies are needed to confirm this result.
Carcinoma, Hepatocellular ; Female ; Follow-Up Studies ; Hepatic Artery ; Humans ; Lung ; Middle Aged ; Neoplasm Metastasis ; Portal Vein ; Prognosis ; Thrombosis

Multifocal atrial tachycardia (MAT) is a rare arrhythmia in the newborn. MAT can be difficult to diagnose; it is frequently confused with atrial fibrillation. MAT is difficult to treat but often resolves spontaneously within the first year of life. A newborn with a rapid and irregular pulse rate was diagnosed with multifocal atrial tachycardia by eletrocardiography (ECG) using a hand-made transesophageal electrode. Treatment with propranolol was attempted but ineffective. Treatment with digoxin and sotalol was attempted. The heart rhythm gradually reverted to a sinus rhythm with this treatment. We report our experience managing a neonate with MAT diagnosed by ECG using a hand-made transesophageal electrode.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Digoxin ; Electrocardiography ; Electrodes ; Heart ; Heart Rate ; Humans ; Infant, Newborn ; Propranolol ; Sotalol ; Tachycardia

BACKGROUND/AIMS: Matrix metalloproteinases (MMP)-2 and -9 can degrade essential components of vascular integrity. The aim of this study was to investigate the association between those MMPs and variceal bleeding (VB). METHODS: Fifteen controls, 12 patients with acute ulcer bleeding (UB) group, 37 patients with varix (V group), and 35 patients with acute VB group were enrolled. Serum was obtained to measure MMP-2 and -9 activity by zymogram protease assays. RESULTS: The activity levels of these compounds were compared with the controls' median value. The median MMP-9 activity was 1.0 in controls, 1.05 in the UB group, 0.43 in the V group, and 0.96 in the VB group. The level of MMP-9 activity was higher in the VB group than in the V group (p<0.001). In the VB group, there was a signifi cant decrease in MMP-9 activity over time after bleeding (p<0.001). The median MMP-2 activity level was 1.0 in controls, 1.01 in the UB group, 1.50 in the V group, and 1.55 in the VB group. The level of MMP-2 activity was similar in the VB and V groups. CONCLUSIONS: The level of MMP-9 activity increased in association with VB. The role of MMP-9 in the pathogenesis of VB should be verified.
Esophageal and Gastric Varices ; Hemorrhage ; Humans ; Matrix Metalloproteinase 2 ; Matrix Metalloproteinase 9 ; Matrix Metalloproteinases ; Ulcer ; Varicose Veins