PURPOSE: Diverticular disease of the colon is relatively common in western population and rare in oriental population but in recent years the incidence is steadily increasing in oriental population including Korean, so more concerns and appropriate management are required. METHODS: We reviewed 111cases who had diverticular disease in the colon from January 1988 to May 1998 in the Soonchunhyang University Chunan Hospital. Of 111 cases, 87 cases were treated conservatively and 24 cases received a surgical treatment. RESULTS: The annual incidence increased progressively for the last 10 years. The mean age of the patients at the time of diagnosis was 49.6 years and the most common age-group was forth decades (25%). The diverticula were located in the right colon 89%, left colon 7% and both side 4%. Among 24 surgically treated cases, the most common preoperative diagnosis was acute appendicitis (75%) and the correct preoperative diagnosis was made only 3 cases (13%) who had previous appendectomy history, previous diagnosed history or received barium enema due to recurrent pain attack. The surgical procedures of the colonic diverticulosis were right hemicolectomy (6 cases), ileo-ascending colectomy (6 cases), diverticulectomy (2 cases), segmental resection of transverse colon (1 case), left hemicolectomy (1 case), appendectomy (2 cases), appendectomy with drainage (3 cases), appendectomy with drainage and diverticulectomy (3 cases). The postoperative complication was wound infection in all complicated cases. There was no postoperative mortality. CONCLUSIONS: The outcome of patients in our series is satisfactory despite of diagnostic inaccuracies. Preoperative barium study is recommended in those above the 40 years of age suspected the appendicitis. We recommend surgery for patients after two or three episodes of acute diverticulitis that resolves after medical treatment with antibiotics.
Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Barium ; Chungcheongnam-do ; Colectomy ; Colon* ; Colon, Transverse ; Diagnosis ; Diverticulitis ; Diverticulosis, Colonic ; Diverticulum ; Drainage ; Enema ; Humans ; Incidence ; Mortality ; Postoperative Complications ; Wound Infection

PURPOSE: The purpose of this study is to assess the clinical utility of multiplanar reformation images of helical CT in the evaluation of pancreatic diseases. MATERIALS AND METHODS: Helical CT scans of the pancreas were obtained in 30 patients with pancreatic diseases. Helical CT was performed with 5mm collimation at 5mm/sec table speed during rapid injection of intravenous contrast agent using power injector. After scanning, helical volume data were reconstructed at 2mm interval and then multiplanar reformation of the pancreas and adjacent structures was done. In both prospective reconstructed axial images and multiplanar reformation images, detection of pancreatic lesion, extent of lesion, and vascular and bile ductal changes were analyzed with a grading system of 1,2, 3. RESULTS: The mean grade of detection of pancreatic lesions was 2.37 in the prospective axial image and 2.83 in multiplanar reformation image, extent of diseases was 2.40 in prospective axial image and 2.97 in multiplanar reformation image, and vascular and bile ductal changes was 2.00 in the prospective axial image and 2.97 in multiplanar reformation image. All the differences were statistically significant (P<0.0001). CONCLUSION: Multiplanar reformation images of helical CT are useful in the evaluation of pancreatic diseases and especially in the demonstratibn of complex anatomic relationships between the pancreas and surrounding structures.
Bile Ducts ; Humans ; Pancreas ; Pancreatic Diseases* ; Prospective Studies ; Tomography, Spiral Computed*

A case-control study was conducted to investigate the association between the risk of cancer and selenium concentration in blood and toenails. Seventy three patients and two hundreds eighty three controls were selected at the Yeungnam University Hospital between May and September in 1991. The selected cases were patients who had been hospitalized for stomach or colon cancer at the Department of General Surgery. The controls were people who visited to check physical examination at the Automated Mediscreening Center. The selenium concentration in whole blood and toenails were measured by atomic absorption spectrophotometer equipped with graphite furnace atomizer. The following information was ascertained for all cancer patients and controls: sex, age, body mass index, blood pressure, total serum cholesterol, and history of smoking and drinking. The mean selenium concentration in blood and toenail for all cancer patients were 143.6±10.8 µg/l and 1.04±0.62 µg/g and for the controls. 167.0±14.5 µg/l and 1.15±0.55 µg/g, respectively. The difference in blood and toenail selenium concentrations of the two cancer sites was not statistically significant. Metastasis did not influence the concentration of selenium in blood and toenails. In the multiple logistic regression analysis, the blood selenium concentration (aOR: 0.888, 95% CI: 0.860-0.918), age, BMI and total serum cholesterol were significant variables for risk of cancer, but the selenium concentration in toenail was not shown to be a significant variable in this regression analysis. The coefficient for blood selenium concentration adjusted for age, sex, diastolic blood pressure, total serum cholesterol, body mass index and smoking was -0.1184 (p<0.01). These findings suggest that low selenium concentration is associated with gastrointestinal cancers. Further epidemiologic studies including important variables such as other antioxidant micronutrients will be necessary.
Absorption ; Blood Pressure ; Body Mass Index ; Case-Control Studies ; Cholesterol ; Colonic Neoplasms ; Drinking ; Epidemiologic Studies ; Gastrointestinal Neoplasms ; Graphite ; Humans ; Logistic Models ; Micronutrients ; Nails* ; Nebulizers and Vaporizers ; Neoplasm Metastasis ; Physical Examination ; Selenium* ; Smoke ; Smoking ; Stomach

No abstract available.
Mesenteric Artery, Superior

Acute mesenteric infarction is a catastrophic illness representing a diverse spectrum of pathologic conditions which ultimately lead to necrosis of the intestine and which is uniformly fatal if left untreated. Despite better understanding of the disease process, acute mesenteric infarction continues to be a lethal disorder with high mortality rate. We experienced two cases of acute mesenteric infarction due to superior mesenteric arterial and venous branch occlusion, respectively, in recent years: One case was focal segmental ischemia with normal radiologic finding including angiography, successfully treated with segmental resection of the necrotized ileum, another case was mesenteric venous thrombosis, also treated with resection of necrotized small intestine followed by second look operation.
Angiography ; Catastrophic Illness ; Ileum ; Infarction* ; Intestine, Small ; Intestines ; Ischemia ; Mortality ; Necrosis ; Venous Thrombosis

PURPOSE: To compare the CT findings of peritoneal tuberculosis (PT) and peritoneal carcinomatosis (PC) based on the morphologic features of the peritoneum and assess the relationship between the degree of peritoneal thickness and the severity of omental infiltration in PT and PC. MATERIALS AND METHODS: We retrospectively reviewed the CT findings of 15 patients with PT and 14 with PC. We checked the morphologic changes of the peritoneum as seen on CT, for the following points: 1) the presence of peritoneal change: 2) the pattern of any change-diffuse thickening, plaque or nodularity, combined thickening (diffuse and plaque, or nodularity); 3) the degree of thickness on the whole peritoneum - mild (grossly definite, but not more than 3 mm), moderate (more than 3mm); 4) the presence of irregularity on the peritoneal surface. We also evaluated the significance of the relationship between peritoneal thickness and omental infiltration in both disease entities. The degree of omental infiltration was described as follows : grade I (no change or focal smudge pattern); grade II ( diffuse smudge), grade III (omental cake regardless extent). RESULTS: Peritoneal change was seen in 12 of 15 PT patients and in 7 of 14 PC patients. In all 12 PT patients, the pattern of change was diffuse thickening, and among the seven PC patients, there was diffuse thickening in one, plaque or nodular thickening in four, and combined thickening in two. In PT patients, the degree of thickness on the whole peritoneum was mild in six and moderate in six, and in PC patients it was mild in two and moderate in one. An irregular peritoneum surface was seen in one patient with PT and in two with PC. The degree of omental infiltration in PT was grade I in four patients, grade II in six andgrade III in five. In PC, it was grade I in six patients, grade II in two and grade III in six. Smooth diffuse thickening of the peritoneum was seen in 11 of 15 PT cases and in one of 14 PC (P<0.01). Accompanying plaque or nodularity was seen only in PC, in six of 14 patients (P<0.001). The relationship between the degree of peritoneal thickness and severity of omental infiltration was significantly proportional in PT (r=0.900, P<0.001), but not in PC (r=0.068, P>0.5). CONCLUSION: In PT and PC different CT findings based on peritoneal morphologic changes might be useful in differentiating these two entities. In addition, careful observation of relationship between the peritoneal change and the severity of omental infiltration is necessary.
Carcinoma* ; Humans ; Peritoneum ; Peritonitis, Tuberculous* ; Retrospective Studies ; Tuberculosis

The clinical and pathological features of five patients with intraventricular neurocytoma are reported. Distribution among men and women is equal. The patients' age at diagnosis ranged from 20 to 57 years. The lesions were located in the lateral and third ventricles. Raised intracranial pressure was the main cause of the clinical manifestations. An isodense mass with multiple intratumoral cysts and homogeneous contrast enhancement was the characteristic computerized tomographic finding. Cerebral angiography showed homogeneous vascular staining in four patients. Magnetic resonance images revealed a mass isointense with the cerebral cortex on both T1- and T2-weighted images. Gadolinium-diethylenetnaminepenta-acetic acid-enhanced images showed homogeneous enhancement. Total removal of the tumor was performed in five patients. Histologically, all tumors were composed of small uniform cells with perinuclear halo and regular round nuclei. Immunohistochemical studies demonstrated strong positivity for neuron-specif ic enolase in all five cases and for synaptophysin in two cases.
Cerebral Angiography ; Cerebral Cortex ; Diagnosis ; Female ; Humans ; Intracranial Pressure ; Male ; Neurocytoma* ; Phosphopyruvate Hydratase ; Synaptophysin ; Third Ventricle

The clinical and pathological features of five patients with intraventricular neurocytoma are reported. Distribution among men and women is equal. The patients' age at diagnosis ranged from 20 to 57 years. The lesions were located in the lateral and third ventricles. Raised intracranial pressure was the main cause of the clinical manifestations. An isodense mass with multiple intratumoral cysts and homogeneous contrast enhancement was the characteristic computerized tomographic finding. Cerebral angiography showed homogeneous vascular staining in four patients. Magnetic resonance images revealed a mass isointense with the cerebral cortex on both T1- and T2-weighted images. Gadolinium-diethylenetnaminepenta-acetic acid-enhanced images showed homogeneous enhancement. Total removal of the tumor was performed in five patients. Histologically, all tumors were composed of small uniform cells with perinuclear halo and regular round nuclei. Immunohistochemical studies demonstrated strong positivity for neuron-specif ic enolase in all five cases and for synaptophysin in two cases.
Cerebral Angiography ; Cerebral Cortex ; Diagnosis ; Female ; Humans ; Intracranial Pressure ; Male ; Neurocytoma* ; Phosphopyruvate Hydratase ; Synaptophysin ; Third Ventricle

PURPOSE: We compared CT findings of thickened wall-type gallbladder cancer with those of complicated cholecystitis. MATERIALS AND METHODS: We retrospectively reviewed abdominal CT scans of ten patients with thickened wall-type gallbladder cancer and eight patients with complicated cholecystitis, from March 1991 to November 1995. RESULTS: CT findings of thickened wall-type gallbladder cancer showed diffuse or focal wallthickening. Wall thickness was 5.3-18.0 mm(mean value, 12.2mm ; n=10). Gallbladder wall thickness of complicatedcholecystitis was 3.0-14.0mm (mean value, 6.6mm ; n=8). Statistical significance was noted between thickened wall-type gallbladder cancer and complicated cholecytitis(p<0.0029). Irregular wall thickening was noted in 7/10cases of thickened wall-type gallbladder cancer(70%). Regular wall thickening was noted in 6/8 cases of complicated cholecystitis(75%). The luminal diameter of thickened wall-type gallbladder cancer was 3.3-5.4cm (meanvalue, 4.2cm ; n=10). The luminal diameter of complicated cholecystitis was 5.2-8.0cm (mean value, 6.5cm ; n=8).Statistical significance was noted between thickened wall-type gallbladder cancer and complicated cholecystitis(p<0.0003). The halo sign was noted in only 3/8 cases of complicated cholecystitis(38%). Secondary findings of thickened wall-type gallbladder caner was lymphadenopathy in 3/10 cases(30%), and liver invasion in 2/10 cases(20%). Secondary findings of complicated cholecystitis were liver abscess in 2/8 cases(25%), and RLQ abdominal fluid collection and pleural effusion in 4/8 cases(50%). CONCLUSION: Differential factors of thickened wall-type gallbladder cancer from complicated cholecystits are gallbladder wall thickness, regularity of wall thickness, halo sign, secondary findings and luminal distention.
Cholecystitis* ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Liver ; Liver Abscess ; Lymphatic Diseases ; Phenobarbital ; Pleural Effusion ; Retrospective Studies ; Tomography, X-Ray Computed

We have experienced 3 cases of recurrent urinary tract infection with ureterovesical reflux under age of 10 years. Two of these patients have completely recovered after surgical reimplantantation which were confirmed by follow-up VCUG 6 to 8 month after surgery. One showed hydronephrotic change of right kidney by intravenous pyelogram taken 7 months after surgical reimplantation. A brief review of the related literature wag also presented and discussed the importance of radiological investigation in recurrent urinary tract infection.
Follow-Up Studies ; Humans ; Kidney ; Replantation ; Urinary Tract Infections* ; Urinary Tract*