No abstract available.
Respiratory Insufficiency* ; Ventilators, Mechanical* ; Weaning*

PURPOSE: To compare the usefulness of double-dose contrast-enhanced CT (DDCE-CT) and conventional contrast-enhanced CT (CCE-CT) in the detection of metastatic brain lesions. MATERIALS AND METHODS: Sixteen patients with brain metastases were evaluated with both CCE-CT and thinslice DDCE-CT. For CCE-CT, an initial injection of 100 ml contrast medium was given, and DDCE-CT with both 10-mm and 5-mm thickness was performed after the addition of an extra 100 ml of contrast medium. The numbers of metastatic lesions detected by CCE-CT and by DDCE-CT were compared, as were the findings of contrast-enhanced MRI (CE-MRI) and thin-slice DDCE-CT in seven patients who underwent both these procedures. RESULTS: Fourteen metastatic brain lesions were detected by CCE-CT, 22 by 10-mm-thickness DDCE-CT, and 36 by 5-mm thickness DDCE-CT. Thus, almost 2.6 times more lesions were detected by thin-slice DDCE-CT than by CCE-CT. Metastatic lesions were detected by 10-mm-thickness DDCE-CT in 16 patients and by CCECT in seven; in five, edema only was detected, while in four there were no detectable metastases. CCE-CT detected four lesions of less than 5 mm in diameter, while 10-mm-thickness DDCE-CT and 5-mm-thickness DDCE-CT detected seven and 18 lesions, respectively. Eleven lesions were detected by thin-slice DDCE-CT and 17 by CE-MRI in the seven patients who underwent both CE-MRI and DDCE-CT. The lesions detected only by CE-MRI were less than 5 mm in diameter and were discovered in the cerebellum or inferior temporal lobe. CONCLUSION: Thin-slice DDCE-CT was superior to CCE-CT in detecting metastatic brain lesions.
Brain* ; Cerebellum ; Edema ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Temporal Lobe ; Tomography, X-Ray Computed*

Sacrococcygeal teratoma is the most common solid tumor to occur in neonates, in whom it mostly takes the form of an obvious exophytic mass. They are, however, rarely found in adults. We report the CT and histopathologic findings of an adult cystic teratoma arising from the lower sacrococcygeal region that was discovered incidentally. Unenhanced CT scans showed an oval-shaped, cystic lesion with hyperattenuating content and no contrast enhancement. After surgery, the gross specimen was seen to be a cystic lesion filled with mucin. Microscopy revealed three germ cell layers in the cystic wall and the lesion was confirmed as cystic teratoma.
Adult* ; Germ Cells ; Humans ; Infant, Newborn ; Microscopy ; Mucins ; Sacrococcygeal Region* ; Teratoma* ; Tomography, X-Ray Computed

PURPOSE: A delta-shaped anastomosis (DA) is a widely accepted technique used for a totally laparoscopic distal gastrectomy (TLDG). Several studies have suggested various modifications to overcome the drawbacks of an original DA. We present our novel technique―a T-shaped modified delta anastomosis (TDA), and we report the early outcomes with its use in a case series. METHODS: We retrospectively reviewed the medical records of 40 patients who underwent a TLDG with TDA for early gastric cancer at OOO between February 2016 and May 2017. Perioperative outcomes, postoperative complications, and operating time were analyzed, and all data were expressed as means±standard deviation. RESULTS: We observed no major complications that required immediate postoperative intervention. Other minor and non-surgical complications were delayed gastric emptying (n=1), pneumonia (n=2), atelectasis (n=3), dumping symptom (n=1), and symptomatic bile reflux (n=1). No wound infection was reported in any patient. The total operative time was 206.5±25.4 min and the estimated blood loss was 27.8±33.5 ml. The mean time required to perform the anastomosis was 20.9±6.7 min, and the mean number of cartridges used during the operation was 4.78±0.66. CONCLUSION: We conclude that a TDA following a laparoscopic distal gastrectomy was successfully developed and showed acceptable clinical outcome.
Bile Reflux ; Gastrectomy ; Gastric Emptying ; Humans ; Laparoscopy ; Medical Records ; Operative Time ; Pneumonia ; Postoperative Complications ; Pulmonary Atelectasis ; Retrospective Studies ; Stomach Neoplasms ; Wound Infection

Inflammatory myofibroblastic tumor is a rare benign condition of unknown etiology, and it may simulate malignancy. It is composed of myofibroblast, plasma cells and histiocytes and is found in lung, the liver, orbit, skin, mesentery, retroperitoneum and maxillary sinus. We report a case of inflammatory myofibroblastic tumor of perineal subcutaneous fat in a 35-year-old woman who complained of a palpable mass. Ultrasonography revealed a well-marginated lobulated hypoechoic lesion with peripheral poorly-defined hyperechoic strands in the subcutaneous fat of the right perineum. The lesion demonstrated low signal intensity on T1-weighted images and of heterogenous high signal intensity on T2-weighted images, compared with surrounding muscle. After intravenous injection of gadolinium, it showed clear homogeneous enhancement but poorlydefined adjacent strands. The final histologic diagnosis was inflammatory myofibroblastic tumor.
Adult ; Diagnosis ; Female ; Gadolinium ; Histiocytes ; Humans ; Injections, Intravenous ; Liver ; Lung ; Maxillary Sinus ; Mesentery ; Myofibroblasts* ; Orbit ; Perineum ; Plasma Cells ; Skin ; Subcutaneous Fat ; Ultrasonography

It has been reported that cavernous hemangiomas in the spine are generally located in vertebral bodies. Wereport a case of epidural cavernous hemangioma, a very rare condition, at the C7-T2 level. MR images showed adumbbell-shaped mass, with iso and high signal intensity on T1- and T2-weighted images, respectively. The mass wasintensely enhanced following Gd-DTPA injection.
Gadolinium DTPA ; Hemangioma, Cavernous* ; Spine

Inflammatory pseudotumors are tumor-like benign lesions of uncertain pathogenesis and have most commonly been reported in the lungs. In the pancreas they are rare. We describe a case of inflammatory pseudotumor of the pancreas which was seen to be isoattenuating at non-contrast CT, and as a well-defined nodule with homogeneous enhancement in the pancreatic tail at contrast-enhanced CT. After a preoperative diagnosis of islet cell tumor, partial pancreatectomy of the pancreatic tail, with splenectomy, was performed. The gross specimen was a yellowish-white, solid mass and the lesion was histopathologically confirmed as inflammatory pseudotumor with an extensive area of sparse cellular fibrosis and collagen deposition.
Adenoma, Islet Cell ; Collagen ; Diagnosis ; Fibrosis ; Granuloma, Plasma Cell* ; Lung ; Pancreas* ; Pancreatectomy ; Splenectomy ; Tomography, X-Ray Computed

PURPOSE: To compare the effectiveness of the in-phase(IP) sequence and the opposed-phase(OP) sequence in the detection of focal hepatic lesions in the single breath-hold hepatic MR imaging with fast gradient T1-weighted pulse sequences. MATERIALS AND METHODS: If and OP T1-weighted breath-hold imaging was performed using fast gradient echo sequences in 45 patients referred for known focal hepatic lesions, in which 78 lesions were detected. There blind readers independently reviewed the images for lesion detectability. The signal-to-noise ratio(SNR) of the liver, the lesion-to-liver contrast-to-noise ratio(CNR) and the liver-to-spleen CNR were also compared. A consensus was reached by three readers to determine which sequence is better in image quality. RESULTS: On OP images, 61(78%), 61(78%), and 63(89%) lesions were correctly identified for reader 1, 2 and 3, respectively. On IP images, 66(85%), 65(83%), and 65(93%) lesions were detected for each reader, respectively. When two image sets were combined, 71(91%), 69(88%), and 76(97%) lesions respectively were detected for each reader. In cases of hepatocellular carcinoma, liver-to-lesion CNR was greater on the OP images(p<0.05), but in other lesions significant differences was not demonstrated. Liver-to-spleen CNR was higher in OP images(p<0.1), but the SNR of the liver was higher on the If images. CONCLUSION: Use of both If and OP imaging can be helpful to avoid erroneous missing of some focal hepatic lesions.
Carcinoma, Hepatocellular ; Consensus ; Humans ; Liver* ; Magnetic Resonance Imaging*

PURPOSE: To assess the utility of multiphasic spiral CT for characterizing renal masses. MATERIALS AND METHODS: The study included 36 patients (53 lesions) referred for the evaluation of renal masses suspected on the basis of the results of sonography or radiography. Spiral CT of the kidneys was performed prior to and following power injection of intravenous contrast material (Optiray-320). Postcontrast imaging data were obtained and analyzed during early and late corticomedullary (20-30-second delay), nephrographic (60-70-second delay), and excretory (5-minute delay) phases. During each phase, the ability to detect renal masses was evaluated, and the ability to diagnose these masses on routine and multiphasic CT was assessed. Routine precontrast and excretory phase CT studies were performed and the usefulness of each phase for the diagnosis of renal cell carcinoma (RCC) and transitional cell carcinoma (TCC) was evaluated. RESULTS: The rates for the detection of renal masses were as follows: 94.3% on precontrast scan, 93.8% during the early corticomedulolary phase (ECMP), 98.1% during the late corticomedullary phase (LCMP), 100% during the nephrographic phase (NP), and 98.1% during the excretory phase (EP). During both routine and multiphasic CT, diagnostic accuracy was 96.2%, though for differential diagnosis, multiphasic CT was more helpful than routine CT in 4/16 cases of RCC and 2/8 cases of TCC. The highest for lesion characterization, during the LCMP in RCC, and the LCMP and NP in TCC ; for evaluation of tumor margin during the EP in both RCC and TCC ; for delineation of the renal artery, during the LCMP in both RCC and TCC ; for delineating the renal vein, during the NP in RCC, and the LCMP in TCC. CONCLUSION: For the detection and correct diagnosis oflesions, multiphasic CT was not superior to routine CT, but for the characterization of RCC and TCC, the former was helpful. The most useful phase can differ according to the kind of renal mass, and so for characterization of the mass, the most appropriate phase must be selected.
Carcinoma, Renal Cell ; Carcinoma, Transitional Cell ; Diagnosis ; Diagnosis, Differential ; Humans ; Kidney ; Radiography ; Renal Artery ; Renal Veins ; Tomography, Spiral Computed*

Dentatorubropallidoluysian atrophy (DRPLA) is a rare neurodegenerative disorder usually inherited with autosomal dominant pattern, which has been mostly described in reports from Japan. Recently, DRPLA proved to be associated with an expanded CAG nucleotide report in a gene on chromosome 12p. We report the first Korean family with this mutation, which was confirmed by genetic analysis. Case History : A 34 year-old man present ad with a 5 year history of clumsiness, seizures, and gait ataxia. He had dysarthria, clumsiness of hands, gait ataxia and intermittent choreic movements in both arms. There was mild cognitive impairment. EEG showed intermittent generalized slowing, and brain MRI revealed diffuse cerebral and cerebellar atrophy with enlarged 4th ventricle. There were three other affected family members; his 37-year old sister presented with choreiform movements developed at the age of 31. His father and uncle were reported to have been ataxic during the late period of their life, who died at age of 65 and 40 respectively. DNA studies of the prebend and his sister confirmed CAG repeat expansiom in the DRPLA gene, the size of which was 64 and 66, respectively. CONCLUSION: This is the first Korean family with DRPLA, and it should be considered in any patients with inherited neurodegenerative disorder with the above-mentioned clinical features
Adult ; Arm ; Atrophy* ; Brain ; Chorea ; DNA ; Dysarthria ; Electroencephalography ; Fathers ; Gait Ataxia ; Genes, vif ; Hand ; Humans ; Japan ; Magnetic Resonance Imaging ; Mild Cognitive Impairment ; Neurodegenerative Diseases ; Seizures ; Siblings