PURPOSE: To analize the correlation between dynamic vascular pattern and structural histologic type of HCC. MATERIALS AND METHODS: The materials consisted of 35 cases of HCC, which could be classified by structural histologic type and had available preoperative arterial dominant images. Excluding one case of pseudoglandular type, we compared structural histologic type of the tumors(trabecular group;13 cases, mixed group;10 cases, and nontrabecular group ;11 cases) with dynamic vascular pattern such as degrees of tumor staining, severity of tumor vessels on hepatic angiography, and with enhancing degrees of early phase relative to late phase on two-phase incremental bolus dynamic CT. RESULTS: In hepatic anglogram, trabecular group showed stronger tumor staining and more prominant dilatation and irregularity of tumor vessels than those of nontrabecular group, and In two-phase incremental bolus dynamic CT, and trabecular group showed more prominant tumor enhancement in early phase than those in late phase. CONCLUSION: The trabecular type(typical) and non-ti'abecular type of HCC showed radiologically different vascular patterns and therefore we believe that this maybe the basis with which diagnosis and treatment policy of radiologically atypical HCC could be made.
Angiography ; Diagnosis ; Dilatation

PURPOSE: To assess the value of the bolus-tagging method for improving the image quality of contrast-enhanced MR abdominal angiography, and to evaluate the relationship between peak arterial enhancement time and patients' age, weight and heart rate. MATERIALS AND METHODS: Contrast-enhanced 3D FISP abdominal MR angiography was performed in 81 patients during a four-month period. The bolus-tagging method was used in a study group comprising 33 patients, and to this end, 1 ml of Gd-DTPA (gadolinium-diethylenetriamine penta-acetic acid) was administered. thirty sequential images (1 image/sec) were then obtained using turbo-FLASH sequencing. After determining peak arterial enhancement time from the time-to-signal intensity curve, optimal scan delay time can be calculated according to the formula used in our patient series. The 48 patients in whom the bolus-tagging method was not used comprised the control group ; in the study group scanning commenced at the optimal scan delay time (and at 10 seconds in the control group) after the administration of 0.2 mM/kg Gd-DTPA using an automatic power injector. Using a three-point scale we evaluated and compared between the two groups the success with which arterial images were obtained. In addition, vascular visibility -an indication of the quality of arteries and veins-was determined using a four-point scale. In the study group, the relationship between peak arterial enhancement time and patients' age, weight heart rate was also assessed. RESULTS: Pure arterial images were successfully obtained in 32 patients (97%) in the study group and in 40 (83%) in the control group. This difference was not statistically significant (p>.05). With regard to vascular visibility, diagnostic arterial images were seen in 30 patients (91%) in the study group and in 33 patients (69%) in the control group; arterial visibility was significantly better in the study group (p=.0197). On the other hand, the diagnostic venous images were seen in 31 patients (94%) in the study group and in 36 (75%) in the control group; there was no significant difference between the two groups (p=.2367). Peak arterial enhancement time increased significantly with age (r=.443, p=.0098); no correlation,however was seen between peak arterial enhancement time and weight (p>.05) or heart rate (p>.05). CONCLUSION: Used with contrast-enhanced 3-D FISP MR abdominal angiography, the bolus-tagging method provides better arterial visibility. Peak arterial enhancement time increased significantly with age.
Angiography* ; Arteries ; Gadolinium ; Gadolinium DTPA ; Hand ; Heart Rate ; Humans

PURPOSE: To assess the value of the bolus-tagging method for improving the image quality of contrast-enhanced MR abdominal angiography, and to evaluate the relationship between peak arterial enhancement time and patients' age, weight and heart rate. MATERIALS AND METHODS: Contrast-enhanced 3D FISP abdominal MR angiography was performed in 81 patients during a four-month period. The bolus-tagging method was used in a study group comprising 33 patients, and to this end, 1 ml of Gd-DTPA (gadolinium-diethylenetriamine penta-acetic acid) was administered. thirty sequential images (1 image/sec) were then obtained using turbo-FLASH sequencing. After determining peak arterial enhancement time from the time-to-signal intensity curve, optimal scan delay time can be calculated according to the formula used in our patient series. The 48 patients in whom the bolus-tagging method was not used comprised the control group ; in the study group scanning commenced at the optimal scan delay time (and at 10 seconds in the control group) after the administration of 0.2 mM/kg Gd-DTPA using an automatic power injector. Using a three-point scale we evaluated and compared between the two groups the success with which arterial images were obtained. In addition, vascular visibility -an indication of the quality of arteries and veins-was determined using a four-point scale. In the study group, the relationship between peak arterial enhancement time and patients' age, weight heart rate was also assessed. RESULTS: Pure arterial images were successfully obtained in 32 patients (97%) in the study group and in 40 (83%) in the control group. This difference was not statistically significant (p>.05). With regard to vascular visibility, diagnostic arterial images were seen in 30 patients (91%) in the study group and in 33 patients (69%) in the control group; arterial visibility was significantly better in the study group (p=.0197). On the other hand, the diagnostic venous images were seen in 31 patients (94%) in the study group and in 36 (75%) in the control group; there was no significant difference between the two groups (p=.2367). Peak arterial enhancement time increased significantly with age (r=.443, p=.0098); no correlation,however was seen between peak arterial enhancement time and weight (p>.05) or heart rate (p>.05). CONCLUSION: Used with contrast-enhanced 3-D FISP MR abdominal angiography, the bolus-tagging method provides better arterial visibility. Peak arterial enhancement time increased significantly with age.
Angiography* ; Arteries ; Gadolinium ; Gadolinium DTPA ; Hand ; Heart Rate ; Humans

The frequency of invasive fungal infections has increased during the period of chemotherapy. Fungal infections are an increasing cause of morbidity and mortality in patients with hematological malignancies. The most common organism are Candida albicans. This report describes our experience in a 28-year-old woman who developed symptoms of hepatic candidiasis which were confirmed with liver biopsy after remission induction chemotherapy for acute myeloid leukemia. In our case, the patient did not improve clinically despite administration of 610 mg amphotericin B. Severe leukocytosis, increasing alkaline phosphatase and clinical deterioration developed rapidly, and then we switched to fluconazole, taking into consideration successful fluconazole treatment of patients with chronic disseminated candidiasis and acute hepatic candidiasis. She remains in clinically and radiological improving at the time of this report.
Adult ; Alkaline Phosphatase ; Amphotericin B ; Biopsy ; Candida albicans ; Candidiasis* ; Drug Therapy ; Female ; Fluconazole* ; Hematologic Neoplasms ; Humans ; Leukemia, Myeloid, Acute ; Leukocytosis ; Liver ; Mortality ; Remission Induction

Diffuse infiltrative lymphocytosis syndrome is an autoimmune syndrome that is characterized by the oligoclonal expansion of CD8+ T-lymphocytes in response to human immunodeficiency virus (HIV) antigens. The clinical manifestations include bilateral enlargement of the parotid glands, lymphocytic interstitial pneumonitis, lymphocytic hepatitis, neurological involvement and systemic lymphadenopathies. In addition to a positive HIV test, the diagnostic histopathological findings are CD8+ T-lymphocytic infiltrations in the lymphnodes, liver, lung, muscle and the salivary or lacrimal glands without granulomatous or neoplastic involvement. We report a case of pulmonary involvement of diffuse infiltrative lymphocytosis syndrome that was associated with a human immunodeficiency virus infection.
Hepatitis ; HIV* ; Humans* ; Lacrimal Apparatus ; Liver ; Lung ; Lung Diseases, Interstitial ; Lymphocytosis* ; Parotid Gland ; T-Lymphocytes

Autoimmune hepatitis (AIH) is an undissolved inflammatory process of the liver characterized by the periportal hepatitis on histological examination and serum autoantibody. AIH seems to be partly responsible for chronic liver disease of unknown etiology in Korea. Perinuclear-Antineutrophil nuclear antibody (p-ANNA) are detected in up to 88% of patient with primary sclerosing cholangitis (PSC) and presence of p-ANNA in PSC makes them a reasonable diagnostic maker in conjuction with standard diagnostic test. But p-ANNA in AIH is rare and it's role remain unclear. We report the first case of 39 year-old-female patient with AIH type-1 with p-ANNA strong positivity.
Cholangitis, Sclerosing ; Diagnostic Tests, Routine ; Hepatitis ; Hepatitis, Autoimmune* ; Humans ; Korea ; Liver ; Liver Diseases

Actinomycosis is caused by filamentous Gram positive anaerobic bacteria from the Actinomycetaceae family, and known as a rare cause of the infection at the eyeball. We report magnetic resonance findings of a 60-year-old Korean man with cervicofacial actinomycosis, including cellulitis in the eye and central nervous system actinomycosis. On orbital magnetic resonance imaging, gadolinium-enhanced T1-weight images showed multiple abnormal enhancing lesions in head and neck including right eye, and some include low signal intensities which considered as abscesses. The lesions was diagnosed as actinomycosis by incisional biopsy, and since then was cured by using antibiotics of penicillin family.
Abscess ; Actinomycetaceae ; Actinomycosis ; Actinomycosis, Cervicofacial* ; Anti-Bacterial Agents ; Bacteria, Anaerobic ; Biopsy ; Cellulitis ; Central Nervous System ; Head ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neck ; Orbit* ; Penicillins

Background: The aim of this study was to evaluate clinical experience with arthroscopic debridement for septic arthritis of the shoulder joint and to report on our patient outcomes. Methods: The retrospective analysis included 36 shoulders (male:female, 15:21), contributed by 35 patients (mean age, 63.8 years) treated by arthroscopy for septic arthritis of the shoulder between November 2003 and February 2016. The mean follow-up period was 14.3 months (range, 12–33 months). An additional posterolateral portal and a 70º arthroscope was used to access the posteroinferior glenohumeral (GH) joint and posteroinferior subacromial (SA) space, respectively. Irrigation was performed with a large volume of fluid (25.1±8.1 L). Multiple suction drains (average, 3.3 drains) were inserted into the GH joint and SA space and removed 8.9±4.3 days after surgery. Intravenous antibiotics were administered for 3.9±1.8 weeks after surgery, followed by oral antibiotic treatment for another 3.6±1.9 weeks. Results: Among the 36 shoulders, reoperation was required in two cases (5.6%). The average range of motion achieved was 150.0º for forward flexion and T9 for internal rotation. The mean simple shoulder test score was 7.9±3.6 points. Nineteen shoulders (52.8%) had acupuncture or injection history prior to the infection. Pathogens were identified in 15 shoulders, with Staphylococcus aureus being the most commonly identified pathogen (10/15). Both the GH joint and the SA space were involved in 21 shoulders, while 14 cases involved only the GH joint and one case involved only the SA space. Conclusions Complete debridement using an additional posterolateral portal and 70º arthroscope, a large volume of irrigation with >20 L of saline, and multiple suction drains may reduce the reoperation rate.

BACKGROUND AND OBJECTIVES: This study was performed to identify echocardiographic parameters related to postoperative clinical outcome (PCO) in patients undergoing surgery for severe tricuspid regurgitation (TR) following mitral valve surgery. The indications for surgery due to severe TR following mitral valve surgery are not well defined largely because of a lack of knowledge of the prognostic factors of PCO in these patients. SUBJECTS AND METHODS: Eighteen patients (male/female; 2/16, mean age 58 years) with severe TR associated with prior mitral valve surgery were prospectively enrolled. Comprehensive echocardiographic examinations were performed before and 15+/-7 months after surgery. Favorable PCO was defined as an improvement of > or =1 in New York Heart Association (NYHA) functional class or a >25% increase in respiratory variation of IVC diameter. Non-survivors and survivors without a favorable PCO were defined as having an unfavorable PCO. RESULTS: The operative mortality was 11% (2/18). Of the 16 survivors, nine (9/16, 56%) achieved a favorable PCO. NYHA functional class, age, left ventricular ejection fraction, right ventricular fractional area change, severity of TR and pulmonary artery pressure were not related to PCO. Only systolic tricuspid annulus velocity (ST') was found to be associated with PCO (favorable vs unfavorable PCO; 12.9+/-2.1cm/s vs 9.7+/-1.7cm/s, p<0.05). For ST' value (9.5 cm/s, the sensitivity, specificity, positive and negative predictive values for predicting an unfavorable PCO were 67%, 100%, 100% and 75%, respectively. CONCLUSION: This study shows that ST' can predict PCO in patients undergoing surgery for severe TR following mitral valve surgery.
Echocardiography* ; Heart ; Humans ; Mitral Valve ; Mortality ; Prospective Studies ; Pulmonary Artery ; Sensitivity and Specificity ; Stroke Volume ; Survivors ; Tricuspid Valve Insufficiency*

Atrial aneurysms involving the free wall or atrial appendage are very rare intracardiac anomalies, less than 100 case reported worldwide. It is usually detected by chance and also could be associated with atrial arrhythmias or systemic embolism. Transthoracic echocardiography and cardiac MRI is the standard diagnostic modality. Aneurysmectomy is usually recommended especially in symptomatic cases. We review the literature and report a case of atrial appendiceal aneurysm, a 23 year-old young man whose diagnosis was established with transthoracic echocardiography and cardiac CT angiography.
Aneurysm* ; Angiography ; Arrhythmias, Cardiac ; Atrial Appendage* ; Diagnosis ; Echocardiography ; Embolism ; Heart Aneurysm ; Humans ; Magnetic Resonance Imaging ; Young Adult