PURPOSE: The purpose of this study is to compare the frequency with which pseudole-sions around the gallbladder (GB) fossa are revealed by multiphasic CT, by CT during arterial portography (CTAP), and by CT during hepatic arteriography (CTHA) and to determine their radiological characteristics. MATERIALS AND METHODS:Multiphasic CT, CTAP, and CTHA examinations of 81 patients without pathology of the GB and around the GB fossa were evaluated for pseudolesion around the GB fossa. The definition of pseudolesion was as follows: 1) hyperattenuation during the arterial phase and isoattenuation during the delayed phase of multipha-sic CT, or perfusion defect on CTAP and hyperattenuation on CTHA; 2) no Lipiodol tagging on Lipiodol CT; 3) all findings observed adjacent to the gallbladder fossa; and 4) no interval change on follow-up CTAP and CTHA. We compared the frequency of pseudolesions around the GB fossa, as seen on multiphasic CT, CTAP, and CTHA, and determined their size, location, and shape, as revealed by CTHA. RESULTS: The frequency of pseudolesion was 2.5% (2/81) on multiphasic CT, while on CTAP or CTHA, the frequency was 53.1% (43/81), and 58 pseudolesions were identi-fied. Of 58 pseudolesions, 56 were revealed by CTAP and 57 by CTHA. Forty-nine of 58 pseudolesions were larger and all pseudolesions showed more contrast to parenchyma on CTHA than on CTAP. The location of pseudolesions was segment V(32 of 58), IV (25 of 58), and VI (1 of 58), and their size ranged from 5 to 30 (mean, 17.5)mm. Pseudolesions were wedge-shaped (48 of 58), oval (6 of 58), bandlike (3 of 58), or round (1 of 58). CONCLUSION: CTAP and CTHA frequently revealed pseudolesion around the GB fossa. The radiological characteristics of these modalities help differentiate pseudolesions from true tumoral hepatic lesions.
Angiography ; Ethiodized Oil ; Follow-Up Studies ; Gallbladder* ; Humans ; Pathology ; Perfusion ; Portography

BACKGROUND: Continuous arterial blood pressure monitoring is a highly effective method in an operation and the intensive care unit. However, the accuracy of the monitoring system could be influenced by the radius and longitude of the catheter. This study was executed to examine the effects of the radius and longitude of a catheter. METHODS: Forty-two pediatric patients scheduled to undergo open heart surgery were selected. After induction of anesthesia, the radial artery pressure was measured by a 22-gauge (1 inch) catheter and the femoral artery pressure was measured by a 20-gauge (1.16 inch) catheter, 22-gauge catheter and 20-gauge (12 cm) catheter in succession. Influences of the radius and longitude were analysed respectively. All values are expressed as mean +/- SD and analysed using the paired t-test; P < 0.05 was considered significant. RESULTS: The systolic pressure of the 20-gauge (1.16 inch) catheter was higher than that of the 22- gauge (1 inch) catheter. The systolic pressure of the 20-gauge (1.16 inch) catheter was higher than that of the 20-gauge (12 cm) catheter. Mean and diastolic pressures were low in the 20-gauge (1.16 inch) catheter, compared with the 20-gauge (12 cm) catheter. CONCLUSIONS: Shorter and/or larger radius catheters could increase the pulse pressure in pediatric patients.
Anesthesia ; Arterial Pressure* ; Blood Pressure ; Catheters* ; Femoral Artery ; Humans ; Intensive Care Units ; Radial Artery ; Radius* ; Thoracic Surgery

PURPOSE: To evaluate the usefulness of transurethral exchange of double-J ureteral stent as an effective alternative to the cystoscopic approach. MATERIALS AND METHODS: There were 20 exchange cases involving seven patients (six women and one man) who initially underwent antegrade manipulation of a double-J ureteral stent. Indications for stent placement were ureteral stricture caused by malignancy in six patients [cervical carcinoma (n=5), stomach carcinoma (n=1) ], and renal tuberculosis in one. An 8-F Nelaton catheter was inserted in the bladder via the urethra and contrast material was injected until the bladder was fully distended. The distal end of a double-J ureteral stent was extracted to the urethral orifice using a goose-neck snare and a 0.035 "stiff guide wire was then advanced to the renal pelvis through the stent. After that, the stent was removed and a 4-F Cobra catheter was advanced to the renal pelvis along the guide wire. Contrast material was injected through the catheter, and the renal pelvis, calyx and ureter were opacified. The 0.035 "stiff guide wire was again inserted via the catheter, a new double-J ureteral stent was inserted, and the catheter removed. Finally, the new double-J stent was properly located within the renal pelvis and the bladder. RESULTS: Double-J ureteral stents were successfully exchanged in 19 of 20 exchange cases. After the procedure, all patients reported tolerable, minimal lower abdominal pain. CONCLUSION: Transurethral exchange of double-J ureteral stent is a useful alternative to cystoscopy.
Abdominal Pain ; Catheters ; Constriction, Pathologic ; Cystoscopy ; Elapidae ; Female ; Humans ; Kidney Pelvis ; SNARE Proteins* ; Stents* ; Stomach ; Tuberculosis, Renal ; Ureter* ; Urethra ; Urinary Bladder

Hypokalemia periodic paralysis, a clinical syndrome characterised by systemic weakness and low serum potassium, is a rare but treatable cause of acute weakness. Attacks of flaccid paralysis can be associated with hypokalemia triggered by insulin. Insulin reduce the conductance of the inward rectifier K+ channel for outward-flowing currents. Therefore, insulin potentiates depolarization of hypokalmeic periodic paralysis. We have experienced a case of hypokalemic periodic paralysis induced by hyperinsulinemia in 38-year old man, with complaint of intermittent paralysis of extremities. On admission, serum K+ was 2.1 mEq/L. He was no family history of muscle weakness. Thyroid function was normal. Serum levels of aldosterone, renin and cortisol were normal. Random plasma glucose level was 129 mg/dL and serum insulin was 131 uIU/mL. Shortly after intravenous supplementation of potassium, muscle weakness was improved. Oral glucose tolerance test revealed impaired glucose tolerance and hyperresponse of insulin and phosphate.
Adult ; Aldosterone ; Blood Glucose ; Extremities ; Glucose ; Glucose Tolerance Test ; Humans ; Hydrocortisone ; Hyperinsulinism* ; Hypokalemia ; Hypokalemic Periodic Paralysis ; Insulin ; Muscle Weakness ; Paralysis* ; Potassium ; Potassium Channels, Inwardly Rectifying ; Renin ; Thyroid Gland

PURPOSE: To evaluate the safety and efficacy of double puncture of a single common femoral artery for CThepatic arteriography(CTHA) and CT arterial portography(CTAP) in patients with hepatocellular carcinoma. MATERIAL AND METHODS: Between October and December 1995, 35 patients with hepatocellular carcinoma underwent doublepuncture of a single common femoral artery for combined CTHA and CTAP. Preangiographic laboratory data were asfollows : platelet count from 28,000 to 250,000/mm3 (average, 124,500/mm3) ; prothrombin time from 45.8% to100%(average, 85.3%). In the inguinal area, a pair of 21G puncture needles were used unilaterally for the firsttwo femoral punctures, at a distance of 5-7mm ; a 0.018" guidewire for the insertion of a 4-F sheath in a coaxialmicropuncure introducer set ; and a 0.035" guidewire and 4 F check-flo sheath for the insertion of 4-F catheters.After being moved to the CT room, patients then underwent spiral CTHA and CTAP for further detection ofhepatocellular carcinoma nodules. Transarterial chemoembolization followed, and the punctured site was thencompressed by the usual finger compression method. After initial compression and one day later, we observed thepuncture site for complications such as hematoma formation, thromboembolization or arteriovenous fistula ; ect. RESULTS: Except for the formation of two mild hematomas, no remarkable severe complications were noted. Fifteenpatients who had previously undergone combined spiral CTHA and CTAP using the bilateral femoral puncture method(with a 5-F check-flo sheath) felt more comfortable than when an earlier method was used. CONCLUSION: For combinedCTHA and CTAP, double puncture of a single common femoral artery is safer and more comfortable than the bilateralfemoral puncture method.
Angiography* ; Arteriovenous Fistula ; Carcinoma, Hepatocellular ; Femoral Artery* ; Fingers ; Hematoma ; Humans ; Needles ; Platelet Count ; Portography* ; Prothrombin Time ; Punctures