PURPOSE: This study was aimed to review findings of gray-scale ultrasonography and to assess the diagnostic value of the resistive index (RI) in patients with acute epididymitis by comparing with that in normal volunteers. MATERIALS & METHODS: Gray-scale ultrasonogram was reviewed in nine patients with acute epididymitis for echogenicity, size and reactive hydrocele. Normal values of resistive index (RI) were obtained in 20 epididymides from 10 volunteers (aged 20-28, mean 23.7). Nine patients of epididymitis (aged 18-67, mean 37.2) were examinated with color Doppler sonography and RI was measured at 11 sites on epididymal arteries. For the prediction of acute epididymitis, accuracy, sensitivity and specificity were calculated at the cut-off value of RI in 0.65 and 0.70. RESULTS: Gray-scale ultrasonography showed echogenicity that was variable among the 9 cases (hype- rechoic 2 cases, isoechoic 2, hypoechoic 5), enlargement of epididymis in 8, and reactive hydrocele in 8 cases. Normal volunteers displayed color Doppler signals in 14 out of 20. The range of RI in normal volunteers were between 0.64 and 1.00 (mean, 0.79 +/- SD 0.10). In patients with acute epididymitis, color Doppler signals were detected in all patients. The range of RI in epididymitis were 0.40-0.68 (mean, 0.56 +/- SD 0.10). At cut-off RI value of 0.65, accuracy was 88%, sensitivity 81.8%, and specificity 92.7%. At cut-off value of 0.70, accuracy was 92%, sensitivity 100%, and specificity 85.7%. CONCLUSION: In addition to the findings of gray-scale ultrasonography, resistive index and color flow changes are valuable in diagnosing acute epididymitis.
Arteries ; Epididymis ; Epididymitis* ; Healthy Volunteers ; Humans ; Male ; Reference Values ; Sensitivity and Specificity ; Ultrasonography ; Volunteers

PURPOSE: It may be difficult to differentiate renal cell carcinoma involving collecting system from renal urothelial tumor invading into renal parenchyma. The purpose of this study was to assess the differences of CT findings between two conditions. MATERIALS AND METHODS: CT findings of 5 cases of renal cell carcinoma involving the renal collecting systems and 10 cases of renal urothelial tumors invading the renal parenchyma were compared, and analyzed about the presence or absence of hydronephrosis, normal or abnormal CT nephrogram, renal contour changes due to mass and tentative diagnosis. The diagnoses were confirmed at surgery. RESULTS: Renal cell carcinoma showed hydronephrosis in only 20% and normal CT nephrogram and outward contour bulging in all cases. In contrast, renal urothelial tumor showed hydronephrosis(70%), abnormal CT nephrogram(60%), and preservation of reniform shape(100%). CONCLUSION: Renal contour changes and CT nephrogram may be useful in distinguishing both disease entities.
Carcinoma, Renal Cell* ; Diagnosis ; Hydronephrosis

The MHC class II transactivator (CIITA) is the master transcriptional regulator of genes involved in MHC class II restricted antigen presentation. Previously we suggested another role of CIITA in Th1/Th2 balance by demonstrating that forced expression of CIITA in murine T cells repressed Th1 immunity both in vitro and in vivo. However, the results were contradictory to the report that CIITA functioned to suppress the production of Th2 cytokine by CD4+T cells in CIITA deficient mice. In this study, we investigated the influence of constitutive expression of CIITA in T cells on Th2 immune response in vivo using murine experimental colitis model. In the dextran sodium sulfate-induced acute colitis, a disease involving innate immunity, CIITA transgenic mice and wild type control mice showed similar progression of the disease. However, the development of oxazolone-induced colitis, a colitis mediated by predominantly Th2 immune response, was aggravated in CIITA-transgenic mice. And, CD4+T cells from the mesenteric lymph node of CIITA-transgenic mice treated with oxazolone exhibited a high level of IL-4 secretion. Together, these data demonstrate that constitutive expression of CIITA in T cells skews immune response to Th2, resulting in aggravation of Th2-mediated colitis in vivo.
Trans-Activators/*physiology ; Th2 Cells/*immunology ; T-Lymphocytes/*metabolism ; Oxazolone/pharmacology ; Nuclear Proteins/*physiology ; Mice, Transgenic ; Mice, Inbred C57BL ; Mice ; Interleukin-4/biosynthesis ; Colitis/*etiology ; Animals

PURPOSE: To evaluate MR characteristics of acute disseminated encephalomyelitis (ADEM) in children, which was confirmed by clinical findings. MATERIALS AND METHODS: The subjects were six patients, who were diagnosed by clinical findings. One subject had recurrence one year after clinical improvement leading to one additional care with the total of seven. The modes of viral infections were as follows;four cases of non-specific upper respiratory tract infection, one of E-B virus, one of Japanese-B-encephalitis vaccination, and one of upper respiratory infection in Bruton's disease. The Gd-DTPA enhanced scan was performed in all cases. MR findings were evaluated in anatomic location of the lesions, presence or absence of contrast enhancement, and the temporal changes were also evaluated on follow-up MRI. RESULT: There were multifocal high signal intensity lesions on T2WI in all cases. The location of lesions were basal ganglia in five, thalamus and brain stem in four, and cerebral gray and white matter and cerebellar white matter in three. Bilaterality was 77%. There were contrast enhancement in two of three cerebral cortical lesions and one of three white matter lesions. The size of lesions decreased on the first follow-up MRI which were done after 1 month in 4 cases, but new lesions were developed in two cases. On the second follow-up MRI which were done 2 months after, all lesions were decreased in size and there was no newly developed lesion. However, in one case who had recurrent similar symptom after 1 year, several new lesions developed on follow-up MRI, and it was comidened as a recurrence. CONCLUSION: The characteristic MR findings of ADEM were multifocal bilateral white and gray matter lesions which were high signal intensities on T2WI. The majority of lesions improved on follow-up MRI, but occasionally showed multiphasic pattern.
Basal Ganglia ; Brain Stem ; Child* ; Encephalomyelitis, Acute Disseminated ; Follow-Up Studies ; Gadolinium DTPA ; Herpesvirus 4, Human ; Humans ; Magnetic Resonance Imaging ; Recurrence ; Respiratory Tract Infections ; Thalamus ; Vaccination

PURPOSE: To perform a medical audit of screening mammography for breast cancer and to determine the benefit of this procedure for the early detection of this condition. MATERIALS AND METHODS:We reviewed the results of 43,329 instances of mammography in 36,802 women [18-86 (mean, 46) years old] who underwent the procedure at our health promotion center between January 1995 and December 1998. After reviewing the mammographic reports, we selected ACR BI-RADS assessment cate-gories 0, 4, 5, and then reviewed the follow-up studies and the pathologic results thus obtained. By comparison with the total number of patients diagnosed with breast cancer during the same period, false negative cases were confirmed, and from these data a medical audit was performed. RESULTS: The percentage of women undergoing mammographic examination has increased in recent years (from 64.5% in 1995 to 97.4% in 1998), and cases of breast cancer among those aged 30 to 69 has tended to increase. A total of 1,879 cases were assessed as BI-RADS categories 0, 4, 5, and of these, 155 were recommended for biopsy or surgery. A confirmatory pathologic diagnosis was obtained in 106 cases, and in 43 of these, breast cancer was pathologically proven. The recall rate was 5.1%, and the cancer detection rate was 1.2/1000 population. Positive predictive value 1(PPV1) was found in 2.3% of cases, PPV2 in 27.7%, and PPV3 in 40.6%. The most common mammographic finding was microcalcification (40.5%), and a pathological finding of invasive ductal carcinoma was found in 66.7% of cases. Patients diagnosed with breast cancer totalled 47 (four cases were false negative); the estimated sensitivity was 91.5%, with a specificity of 95.0%. The percentage of minimal cancers found was 48.8, while that of axillary node-positive invasive cancers was 33.3. The total rate of axillary nodal metastasis was 22.0%, and the rate of stages 0 and I was 73.2%. CONCLUSION: When appropriate interpretation and follow-up monitoring of screening mammography is per-formed, the procedure is effective for the early detection of breast cancer.
Biopsy ; Breast Neoplasms ; Carcinoma, Ductal ; Diagnosis ; Early Detection of Cancer ; Female ; Follow-Up Studies ; Health Promotion ; Humans ; Mammography* ; Mass Screening* ; Medical Audit ; Neoplasm Metastasis ; Sensitivity and Specificity

PURPOSE: Recently, incidental small renal tumors detected by computerized tomography(CT) or ultrasonography(US) have been increasing. Differentiation between the small renal cell carcinoma and benign tumorous lesions is often difficult. To reduce the unnecessary surgical interventions for these small renal tumors, we anayzed the radiologic findings of surgically removed small renal tumors(less than 3cm in diameter) and evaluated whether radiologic studies would predict their histologic findings. MATERIALS AND METHODS: Radiologic findings of 28 renal cell carcinomas(RCC), 7 angiomyolipomas(AML), 4 cysts including 2 multilocular cysts and 1 oncocytoma were analyzed, retrospectively. Density, contour, and heterogenity of the tumors on CT were evaluated, while echogenecity, posttumoral enhancement, peritumoral hypoechoic rim, and intratumoral cystic change on US were evaluated. RESULTS: Tiny fat density on CT was found in 4 of 7 AMLs and 1 of 28 RCCs. On US, 3 of 6 AMLs and 1 of 24 RCCs showed marked hyperechogenecity identical to the renal sinus fat. AMLs showed fat density in 4 of 7(57.1%) on CT and marked hyperechogenecity in 5 of 7(71.4%) on US, respectively. Two AMLs which showed hypoechogenecity and no fat density had less than 5% of fat on histologic examination while others had more than 30% of fat. All AMLs, oncocytoma and most RCCs(73%) showed exophytically out-bulging growth pattern while all benign cysts showed endophytic growth. Posttumoral sonic enhancement was found in 3 of 4 cysts and 1 of 24 RCCs. Peritumoral hypoechoic rim and intratumoral cystic changes were identified in 8 of 24(33%) and 7 of 24(29%) RCCs, respectively, while no such findings were detected in other tumors and cysts. CONCLUSIONS: Fat density on CT or marked hyperechogenecity identical to renal sinus fat on US strongly suggest angiomyolipoma, whereas endophytic growth pattern and posttumoral enhancement on US favor benign cyst. In the meantime, absence of above findings combined with peritumoral halo and/or intratumoral cystic change indicate renal cell carcinoma which should be explored.
Adenoma, Oxyphilic ; Angiomyolipoma ; Carcinoma, Renal Cell ; Retrospective Studies* ; Ultrasonography

PURPOSE: Recently, incidental small renal tumors detected by computerized tomography(CT) or ultrasonography(US) have been increasing. Differentiation between the small renal cell carcinoma and benign tumorous lesions is often difficult. To reduce the unnecessary surgical interventions for these small renal tumors, we anayzed the radiologic findings of surgically removed small renal tumors(less than 3cm in diameter) and evaluated whether radiologic studies would predict their histologic findings. MATERIALS AND METHODS: Radiologic findings of 28 renal cell carcinomas(RCC), 7 angiomyolipomas(AML), 4 cysts including 2 multilocular cysts and 1 oncocytoma were analyzed, retrospectively. Density, contour, and heterogenity of the tumors on CT were evaluated, while echogenecity, posttumoral enhancement, peritumoral hypoechoic rim, and intratumoral cystic change on US were evaluated. RESULTS: Tiny fat density on CT was found in 4 of 7 AMLs and 1 of 28 RCCs. On US, 3 of 6 AMLs and 1 of 24 RCCs showed marked hyperechogenecity identical to the renal sinus fat. AMLs showed fat density in 4 of 7(57.1%) on CT and marked hyperechogenecity in 5 of 7(71.4%) on US, respectively. Two AMLs which showed hypoechogenecity and no fat density had less than 5% of fat on histologic examination while others had more than 30% of fat. All AMLs, oncocytoma and most RCCs(73%) showed exophytically out-bulging growth pattern while all benign cysts showed endophytic growth. Posttumoral sonic enhancement was found in 3 of 4 cysts and 1 of 24 RCCs. Peritumoral hypoechoic rim and intratumoral cystic changes were identified in 8 of 24(33%) and 7 of 24(29%) RCCs, respectively, while no such findings were detected in other tumors and cysts. CONCLUSIONS: Fat density on CT or marked hyperechogenecity identical to renal sinus fat on US strongly suggest angiomyolipoma, whereas endophytic growth pattern and posttumoral enhancement on US favor benign cyst. In the meantime, absence of above findings combined with peritumoral halo and/or intratumoral cystic change indicate renal cell carcinoma which should be explored.
Adenoma, Oxyphilic ; Angiomyolipoma ; Carcinoma, Renal Cell ; Retrospective Studies* ; Ultrasonography

BACKGROUND: Gabapentin decreases acute nociceptive pain in animal and human studies when given before surgical incision. Various doses of gabapentin have been used (300-1,200 mg) to measure this preemptive effect. Here, we evaluated the optimal dose of gabapentin for reducing fentanyl consumption and the adverse effects of gabapentin following gynecologic surgery. METHODS: We recruited 100 patients who underwent laparotomy for gynecologic surgery. Patients were randomly divided into 4 groups and received a placebo (control), gabapentin 300 mg (G 300), gabapentin 600 mg (G 600), or gabapentin 1,200 mg (G 1200) 2 h before surgery. Postoperatively, patients received fentanyl via an intravenous patient controlled analgesia device. The cumulative fentanyl doses were recorded 2, 6, 12, 24 h, and 48 h postoperatively, and the sedation scale was recorded in the post anesthetic care unit (PACU). RESULTS: The postoperative fentanyl requirement was lower with gabapentin treatment, but there was no significant differences for the different doses. PACU sedation scores were not different in any group. CONCLUSIONS: Gabapentin has a preemptive effect in gynecologic surgery, but there were no additional fentanyl-sparing benefits at doses above 300 mg. Thus, 300 mg is an optimal dose for decreasing fentanyl consumption following gynecologic surgery.
Amines ; Analgesia, Patient-Controlled ; Animals ; Cyclohexanecarboxylic Acids ; Female ; Fentanyl ; gamma-Aminobutyric Acid ; Gynecologic Surgical Procedures ; Humans ; Laparotomy ; Nociceptive Pain

Objective: Dysphagia has been reported to occur in patients with inflammatory myopathy (IM). Although high-resolution impedance manometry (HRIM) provides precise information regarding the pharyngeal pressure, it has not yet been used for assessing dysphagia in routine clinical practice. This study determined whether the results of HRIM for evaluating deglutition disorders in patients with IM could reflect an abnormality that can’t be identified by a video fluoroscopic swallowing study (VFSS). Methods: We reviewed both VFSS and HRIM results of nine patients with IM, four of whom presented with globus sensation. Results: Cricopharyngeal muscle dysfunction was noted in all four patients with globus sensation, and the upper esophageal sphincter residual pressure (UESRP) was higher (≥8 mmHg) in the patients with pharyngeal residue.Using VFSS and HRIM, we demonstrated that dysphagia in patients with IM may arise owing to failed relaxation of UES or decreased hyolaryngeal excursion. Conclusion In conclusion, UES-RP values of ≥8 mmHg indicate the presence of pharyngeal residue and globus sensation in patients with IM. HRIM provided a comprehensive assessment of the mechanisms of dysphagia, and HRIM facilitated recognizing subtle abnormalities in pharyngeal contraction and UES function. HRIM can overcome the limitations of VFSS by allowing clinicians to perform objective measurements in patients with IM.

PURPOSE: To evaluate the effect of reduced volume of contrast media on vascular opacification and image quality in spiral CT of the chest. MATERIALS AND METHODS: Sixty patients referred for chest CT were examined withspiral CT with 60ml(n=30) or 90ml(n=30) of 30% ionic contrast media(Rayvist 300 , Schering, Germany) alternately.Injection rate of each group was as follows : 2.0 ml/sec for 20 seconds followed by 1.0 ml/sec for 20 seconds in 60ml group and 2.0ml/sec for 45 seconds in 90ml group. Twenty-five seconds scanning delay was employed. For the objective comparison of vascular opacification, CT numbers were measured at superior vena cava, ascending and descending aorta, right and left pulmonary artery, left atrium, and inferior vena cava. For the subjective comparison three radiologists scored the grade of vascular opacification and image quality blindly and independently. All data were analyzed statistically. RESULTS: The mean values of measured CT numbers in 90ml group were higher than those in 60ml group(p <.05) at the same level. The overall mean score of vascular opacification in 90ml group was 2.86, and 2.31 in 60ml group(p <.0001). In the overall mean score of imagequality, there was no statistically significant difference between 90ml group(2.46) and 60ml group(2.40). CONCLUSION: Althought there is some degradation of vascular opacification in 60ml group, overall image quality is not degraded. Therefore, 60 ml of contrast media can be used in spiral CT of the chest without degradation ofoverall image quality except in spiral CT angiography.
Angiography ; Aorta ; Contrast Media* ; Heart Atria ; Humans ; Pulmonary Artery ; Thorax* ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed ; Vena Cava, Inferior ; Vena Cava, Superior