Oral cholecystography is one of the most relible and widely used x-ray examination which enables us to observe not only morphological features of the gallbladder (GB) but also its functioning state. It was disclosed that functional evaluation of the GB is mandatory to recognize such kinetic disorders of the viscus as acalculous cholecystitis or dyskinesia. For the purpose of functional evaluation, fat meal has been used traditionally. Recently, cholecystokinin(CCK) and ceruletide were introduced into clinical diagnosis of the GB, the usefulness of which we have confirmed. In the present study we have made an attempt at improving cholecystagogic effect of conventional fat meals(FM) such as whole mild and egg yolk by changing the posture of the examined from sitting up to right decubitus position after the ingestion of fat meal. The hypothesis involved in this study is that the presence of quantitatively more fat meal in the duodenum per unit time may result in more effective cholecystagogic action and such a setting would be created by enhancement of pyloric passage of fat meal by decubitus posturing. Clinical materials consisted of 280 normal oral GB series (136 males and 144 females) andthey were divided into 4 equally numbered groups of mild sitting and mild decubitus and egg sitting and eggdecubitus. Upon confirming satisfactory opacification of the GB 11 hours after the ingestion of 3g of sodiumipodate or iopanoci acid either 2 pieces of medium sized hen's egg yolk were given. The xaminess were then allowed either sitting up comfortably on a bench or lying down on the right flank on a couch. After the ingestion of fat mean, x ray was taken at the end of 30 minutes in all but the mild decubitus group in which x rays were taken serially at the end of 5, 15, 30 and 60 minutes. The frontal area of each opacified GB was measured by using aplanimeter and the contraction rate before and after fat meal stimulation was calculated by the following equation and delineation of the biliary tree was analyzed in each group. Contraction rate (%) = (1
Acalculous Cholecystitis ; Biliary Tract ; Ceruletide ; Cholecystography ; Deception ; Diagnosis ; Duodenum ; Dyskinesias ; Eating ; Egg Yolk ; Gallbladder ; Humans ; Male ; Meals ; Ovum ; Posture

PURPOSE: To describe the radiographic and MR characteristics of subacute diaphyseal osteomyelitis of the long bone. MATERIALS AND METHODS: We retrospectively analyzed plain radiographs and MR images in nine children and two young adults with surgically-proven diaphyseal osteomyelitis of the long bones. MR imaging was carried out before and after Gd-DPTA administration. Patients charts were reviewed for clinical and laboratory data and histologic correlation was available in all cases. RESULTS: All patients had a history of a minimum of 2 weeks' duration. All presented with an insidious onset of mild pain; they showed apyrexia and normal erythrocyte sedimentation rate. In all patients, plain radiographs showed single or multiple linear periosteal reaction with cortical irregularity. Medullary abnormality was not found except in one case which showed an abscess cavity. MR images revealed thickening or irregularity of the cortex, periosteal reaction, bone marrow signal alteration, and perilesional edema. CONCLUSION: Subacute diaphyseal osteomyelitis of the long bone is broadly based on the cortex, and elicits more sclerosis and periosteal reaction. Familarity with plain radiographs and MR features may be useful in the diagnosis of subacute diaphyseal osteomyelitis.
Abscess ; Blood Sedimentation ; Bone Marrow ; Child ; Diagnosis ; Edema ; Humans ; Magnetic Resonance Imaging* ; Osteomyelitis* ; Periostitis ; Retrospective Studies ; Sclerosis ; Young Adult

No abstract available.
Stroke Volume*

The sparsity of publication concerning CT findings of tuberculous arthritis prompted authors to retrospectively evaluate 12 patients with tuberculous arthritis for characteristic CT findings. In each patient, the diagnosis of tuberculous arthritis was confirmed by surgery or biopsy. The CT examinations were evaluated by two radiologists retrospectively. Involved joints were the hip joint in seven patients, the sacroiliac joint in three parients, and the shoulder and ankle joint in one patients each. CT features included subchondral bony erosion(12 patients), soft tissue mass in the joint space(nine), widenining of the joint space(eight), ipsilateral muscle atrophy(eight), thickening of the joint capsule(seven), intra-articular effusion(six), soft tissue abscess(five),and bony sclerosis(four). In seven patients with the duration of symptoms less than 1 year, thickening of joint capsule and intra-articular effusion were the predominent findings, while bony sclerosis, gross bone destruction, and soft tissue mass in joint space were seen in five patients with the duration of symptoms longer than 1 year. Our results indicate that CT is useful in the diagnosis of tuberculous arthritis by demonstrating characteristic pathologic changes of the joint space, soft tissue abnormality and bony involvement.
Ankle Joint ; Arthritis* ; Biopsy ; Diagnosis ; Hip Joint ; Humans ; Joint Capsule ; Joints ; Publications ; Retrospective Studies ; Sacroiliac Joint ; Sclerosis ; Shoulder

The present experimental study was designed to address two issues. The first was to investigate whether oxidation voltage of titanium implants influenced bone tissue responses after an in vivo implantation. The second aim was to investigate secondary stability change after 1 to 3months period. Screw-shaped implants with a wide range of oxide properties were prepared by electrochemical oxidation methods, where the oxide thickness varied in the range of 3-15micrometer. The micro structure revealed pore sizes of 1-3micrometer, the crystal structures of the titanium oxide were amorphous, anatase and a mixture of anatase and rutile type. Bone tissue responses were evaluated by resonance frequency measurements that were undertaken 1 to 3months after insertion in the rabbit tibia. It was concluded that no statistical difference of RFA values was found between the groups, RFA gains after 1month and 3months were calculated.
Bone and Bones ; Oxides* ; Tibia ; Titanium

Portal vein invasion is a grave prognostic indicator in the setting of hepatocellular carcinoma (HCC). There is currently no effective method for preventing the invasion of HCC into the main portal vein. We report here a case of advanced HCC with portal vein tumor thrombosis that was effectively treated with percutaneous ethanol injection (PEI), having previously enabled subsequent successive transarterial chemoembolization (TACE). A 60-year-old male patient was diagnosed with a huge HCC, based on computed tomography and angiographic findings. Despite two sessions of TACE, the tumor invaded the right portal vein. PEI was performed on the malignant portal vein thrombosis, and three sessions thereof reduced the extent of tumor thrombi in the portal vein. Successive TACEs were performed to treat the HCC in the hepatic parenchyma. The patient was still living 19 months after the first PEI with no evidence of tumor recurrence, and his liver function remained well preserved.
Carcinoma, Hepatocellular/complications/*diagnosis/pathology ; Chemoembolization, Therapeutic ; Ethanol/*administration & dosage ; Humans ; Injections, Intralesional ; Liver Neoplasms/complications/*diagnosis/pathology ; Male ; Middle Aged ; Neoplasm Invasiveness ; *Portal Vein/pathology ; Tomography, X-Ray Computed ; Venous Thrombosis/complications/diagnosis/*therapy

BACKGROUND: Endotracheal intubation with direct laryngoscope requires movement of the head, neck, and cervical spine. Spine movement may be limited for anatomical reasons or because of cervical spine injury. The lightwand requires less neck flexion and head extension than the conventional laryngoscope. The purpose of this study was to compare the extension of cervical spine obtained with lightwand and Macintosh laryngoscope. METHODS: Twenty patients requiring general anesthesia with endotracheal intubation were studied. Patients were placed on the operating table and anesthesia was induced. Intubation were performed on two occasions: with lightwands and Macintosh #3 laryngoscopes. Cricoid pressure was not applied. To determine cervical spine extension, five radiographs were taken in each patient (before induction, during mask ventilation, during intubation with lightwand, during laryngoscopy with the Macintosh blade: in the best glottic view or during intubation). RESULTS: Of 20 cases, we excluded 2 cases due to the technical error. Significant reduction of radiographic cervical spine extension were found in the lightwand compared to Macintosh blade at all cervical level. Mean atlantooccipital extension angles were 6.2o and 11.7o for the lightwand and Macintosh, respectively. There were no significant differences between mask ventilation and intubation with lightwand. CONCLUSIONS: Lightwand may be better than the conventional intubation in patients whose cervical spine movement is limited or undesirable, especially in the patients in whom awake intubation is not available.
Anesthesia ; Anesthesia, General ; Head ; Humans ; Intubation ; Intubation, Intratracheal* ; Laryngoscopes* ; Laryngoscopy ; Masks ; Neck ; Operating Tables ; Spine* ; Ventilation

BACKGROUND/AIMS: Recent experience with endoscopic transmural drainage of pancreatic pseudocysts prompted the use of a similar technique for the primary treatment of infected pancreatic fluid collection (PFC) such as pancreatic abscess and infected pancreatic necrosis (IPN). The aim of this study was to determine the safety and effectiveness of endoscopic transmural drainage for the primary treatment of infected PFC complicating acute pancreatitis. METHODS: In 11 patients, a total of 13 infected PFC (11 pancreatic abscesses and 2 IPNs) compressing the stomach, duodenum, or both were drained endoscopically by means of an endoscopic fistulization followed by stent (s) placement alone or additional nasopancreatic catheter insertion. Complete resolution of PFC was defined as the absence of symptoms and no residual collection on the follow-up computed tomography. RESULTS: Complete resolution was achieved in 12 infected PFC (92%) (10 pancreatic abscesses and 2 IPNs) after stent placement for a mean duration of 31 days. For IPN and 2 pancreatic abscess, insertion of a nasopancreatic catheter was required to irrigate thick pus or necrotic debris. There was 1 case of bleeding (8%) but no mortality. CONCULSIONS: Endoscopic transmural drainage is an effective therapy with minimal morbidity for infected pancreatic fluid collection compressing the gut lumen and is a valuable alternative to surgical drainage.
Abscess ; Catheters ; Drainage* ; Duodenum ; Follow-Up Studies ; Hemorrhage ; Humans ; Mortality ; Necrosis ; Pancreatic Pseudocyst ; Pancreatitis ; Stents ; Stomach ; Suppuration

BACKGROUND/AIMS: Although early recognition and treatment with effective antibiotics have lead to improvements in the prognosis of patients with spontaneous bacterial peritonitis (SBP), it remains to be a serious complication in cirrhotic patients. This study was designed to evaluate the clinical manifestations and prognosis of patients with liver cirrhosis and SBP in Korea. METHODS: This was a multicenter retrospective study examining 157 episodes of SBP in 145 patients with cirrhosis. SBP was diagnosed based on a polymorphonuclear cell count in ascitic fluid of >250 cells/mm3 in the absence of data compatible with secondary peritonitis. RESULTS: The mean age of the cohort was 56 years, and 121 (77%) of the 157 episodes of SBP occurred in men. Microorganisms were isolated in 66 episodes (42%): Gram-negative bacteria in 54 (81.8%), Gram-positive in 11 (16.7%), and Candida in 1. Isolated Gram-negative organisms were resistant to third-generation cephalosporin in 6 cases (17%), to ciprofloxacin in 11 (20.8%), and to penicillin in 33 (62.3%). The treatment failure and in-hospital mortality rates were 12.1% and 21%, respectively. A high Model of End-Stage Liver Disease (MELD) score, SBP caused by extended-spectrum beta-lactamase-producing organisms, and hepatocellular carcinoma were independent prognostic factors of high in-hospital mortality. CONCLUSIONS: SBP remains to be a serious complication with high in-hospital mortality, especially in patients with a high MELD score.
Anti-Bacterial Agents ; Ascitic Fluid ; Candida ; Carcinoma, Hepatocellular ; Cell Count ; Ciprofloxacin ; Cohort Studies ; Fibrosis ; Gram-Negative Bacteria ; Hospital Mortality ; Humans ; Liver ; Liver Cirrhosis ; Liver Diseases ; Male ; Penicillins ; Peritonitis ; Prognosis ; Retrospective Studies ; Treatment Failure

Herbal remedies and health foods are widely used, and their side effects have been reported. We describe two cases of symptomatic toxic hepatitis that developed in middle-aged women after ingesting arrowroot juice. The clinical manifestations were nausea, vomiting, and jaundice. The diagnosis of toxic hepatitis was made using the Roussel Uclaf Causality Assessment Method score on the basis of the patient's history and laboratory data. After supportive care, the patients showed rapid improvements of clinical symptoms, laboratory findings, and liver stiffness. Clinicians should be aware that the consumption of arrowroot juice can cause toxic hepatitis.
Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; Drug-Induced Liver Injury/complications/*diagnosis/ultrasonography ; Elasticity Imaging Techniques ; Exanthema/complications ; Female ; Humans ; Marantaceae/*chemistry ; Middle Aged ; Plant Extracts/*toxicity