PURPOSE: To determine the CT findings of immediately postoperative complications including anastomoticleakage, and to evaluate the usefulness of CT scan in the assessment of early postoperative complications ofpylorus preserving Whipple pancreaticoduodenectomy (PPPD) MATERIALS AND METHODS: During the early postoperativeperiod, fluid accomulated in the abdominal cavity of ten of 23 patients who had undergone PPPD. In all cases, thetime interval between the first follow up CT scan and surgery was no more than two weeks. At each leakage site, wecompared CT findings with those of conventional fluoroscopic studies: upper gastrointestinal studies with oralwater-soluble contrast materials, a contrast injection study via drainage catheters in place in the stomach, thesite of choledochojejunostomy during surgery and pancreaticojejunostomy, and nine cases of sinogram viapercutaneous drainage catheters. We also evaluated CT findings of the locations, amounts, and margin of the fluidcollections. If conventional fluoroscopic studies showed no evidence of anastomotic leakage, as was the case withsix patients, the leakage site was determined on the basis of clinical and laboratory data. In four of the six,this was found to be the site of pancreaticojejunostomy, and in the other two, an abscess without anastomoticleakage. RESULTS: Eight patients showed intra-abdominal fluid collections due to leakage at anastomotic sites: infive, this was the site of pancreaticojejunostomy, and in three, that of choledochojejunostomy. One patient showeda right subphrenic abscess, and another, a loculated fluid collection between the jejunal loops, without leakageat the anastomotic site. CT scans in all three cases with leakage at the site of choledochojejunostomy showed thesmall collection of fluid to be relatively well demarcated and confined to the areas of lesser sac or gallbladderbed. In four of five cases of leakage at the site of pancreaticojejunostomy, the large collection of fluid waswidespread; it occupied areas which included the perihepatic and peripancreatic space, as well as the paracolicgutters and pelvic cavity. CONCLUSION: In some cases of suspected complications arising after PPPD, and includinganastomotic leakage and abdominal abscess, leakage is not revealed by conventional fluoroscopic studies; in suchcases, CT scanning may help detect the complications and determine the site of anastomotic leakage.
Abdominal Abscess ; Abdominal Cavity ; Abscess ; Anastomotic Leak ; Catheters ; Choledochostomy ; Contrast Media ; Drainage ; Follow-Up Studies ; Humans ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy ; Peritoneal Cavity ; Postoperative Complications* ; Stomach ; Subphrenic Abscess ; Tomography, X-Ray Computed

PURPOSE: To compare the efficacy and safety of CT-guided automated gun biopsy with those of fine needleaspiration biopsy of pulmonary lesions. MATERIALS AND METHODS: Under CT guidance, we performed automated gunbiopsies in 115 cases of 109 patients and fine needle aspiration biopsies in 119 cases of 108 patients withpulmonary lesions. Between the two methods, we compared the diagnostic rate, diagnostic accuracy and frequency ofcomplications according to the depth and diameter of pulmonary lesions. RESULTS: The overall diagnostic rates ofautomated gun biopsy and fine needle aspiration biopsy were 76.5% (88/115) and 64.7% (77/119) respectively. Therewas a significant statistical difference (p=0.048), especially in the case of malignant lesions less than 3 cm(p=0.027) and more than 6 cm (p=0.008) in maximal diameter. The diagnostic accuracy of automated gun biopsy andfine needle aspiration biopsy showed significant statistical difference only in malignant lesions more than 6cm inmaximal diameter (p=0.008), and in the lesions located from 1 cm to less than 3cm from the pleura (p=0.030), asseen on CT. There was no significant statistical difference in the frequency of complications. CONCLUSION:Automated gun biopsy of pulmonary lesions under CT guidance is safe, with complications rate comparable to thoseof fine needle aspiration biopsy. A higher overall diagnostic rate can be achieved by automated gun biopsy than byfine needle aspiration biopsy. For the diagnosis of pulmonary lesions under CT guidance, automated gun biopsy istherefore a more useful procedure than fine needle aspiration biopsy.
Biopsy* ; Biopsy, Fine-Needle* ; Biopsy, Needle ; Diagnosis ; Humans ; Needles ; Pleura

The internal morphology of the right and left atria of rabbit, cat, pig, and human, particularly on the luminal structures of the auricle, were observed by stereomicroscope improving corrosion casting method using latex. Structures of the right auricular casts markedly differ from those of the left side, consisting of defined surface sturctures with distinct folds and branching patterns. The main atrial region consists of smooth surfaced single mass of the latex, and the auricular region is characterized by well developed branching patte and delicate small folds. The results of this study indicate that auricula have well organized duct-like luminal structures and many small pouches (out-pocketings) expanding the internal wall of the duct-like structures and small pouches. The endocardial nuclear imprints on the surface of the folds in the auricular region appeared larger and deeper than those on the atrium proper region of the atrial cast. These morphological observation will be aid in understanding structures of auricular lumen, regional differences of the endocardium and their function to the secretory process of atrial natriuretic peptide (ANP) release.
Animals* ; Cats ; Corrosion Casting* ; Corrosion* ; Endocardium ; Humans ; Latex ; Methods* ; Phenobarbital* ; Secretory Pathway

Seven fibrovascular diabetic preretinal membranes were examined with lightmicroscophic immunohistochemical stain and electron-microscopy to evaluate the possibility of pericytes to be involved in membrane contraction. Pericytes were positively stained with anti-actin antibody together with some stromal cells thought to be myofibroblasts presumedly. On transmission electron microscopic study, pericytes were highly active with numerous cytoplasmic processes and contained abundant microfilaments considered as actin in their cytoplasm. Pericyte/endothelial cell ratio of vascular channels were increased in some actively proliferative portion of the membranes. Myofibroblasts that contain abundant cytoplasmic microfilaments were also demonstrated in the extravascular stroma of the membranes and were very similar to the pericytes morphologically. Although the evidence that the pericytes are related to the origin of the myofibroblasts could not be demonstrated, this study suggested that the pericytes may play important roles in development and contraction mechanism of fibrovascular diabetic preretinal membranes.
Actin Cytoskeleton ; Actins ; Cytoplasm ; Membranes* ; Myofibroblasts ; Pericytes* ; Stromal Cells

Most distal radius fractures are currently being treated with anterior plating using anatomical precontoured locking compression plates via the anterior approach. However, it is difficult to fix the volar articular marginal fragment because these anatomical plates should be placed proximally to the watershed line. There were just a few methods of fixation for this fragment on medical literature. Herein, we introduced a tension band wiring technique for fixation of a volar articular marginal fragment in the distal radius.
Radius Fractures ; Radius

PURPOSE: To evaluate the usefulness of contrast-enhanced T1-weighted MR imaging in the diagnosis and stagingof uterine cervical carcinoma. MATERIALS AND METHODS: MR images (T1WI, T2WI and CE-T1WI) of 40 patients withhistologically proven uterine cervical carcinoma were reviewed by three radiologists. Tumor visualization, signalintensity, degree of enhancement, delineation of tumor margin, assessment of parametrial involvement, andevaluation of pelvic lymph node metastasis were analynized on each sequence, retrospectively. We compared theaccuracy of CE-T1WI with that of T2WI in the diagnosis and staging of uterine cervical carcinoma. RESULTS: Tumorswere detected in 35/40 cases (87.5%) on T2WI, and in 34/40 (85.0%) on CE-T1WI. On T2WI, signal intensities of allvisualized tumors were more hyperintense than those of normal cervical stroma. The signal intensities of enhancedtumors were lower(79.4%), similar to (5.9%), or higher than (14.7%) those of well-enhanced normal myometrium. Inthe assessment of parametrial involvement and the evaluation of pelvic lymph node metastasis, accuracy during eachsequence was 85.7% (12/14) and 100% (28/28), respectively. With regard to delineation of tumor margin, nostatistical difference was found between CE-T1WI and T2WI, though in cases of lesions greater than 3 cm in maximalsize, the margin was clearer in 14 cases, and less clear in 4 cases, on CE-T1WI than on T2WI, with a significantstatistical difference. The accuracy of tumor staging was 78.6% (11/14) on T2WI, and 71.4% (10/14) on CE-T1WI. CONCLUSION: There was no significant statistical difference in tumor visualization, accuracy of staging, andevaluation of pelvic lymph node metastasis between T2W1 and CE-T1WI. CE-T1WI was superior to T2WI in delineatingthe margin of tumors more than 3 cm in maximal size. Contrast-enhanced T1WI appears to be useful for evaluatingthe extent of large cervical carcinomas.
Animals ; Diagnosis ; Female ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging* ; Mice ; Myometrium ; Neoplasm Metastasis ; Neoplasm Staging ; Retrospective Studies

No abstract available.
Diagnosis* ; Osteomyelitis*

The management of nonunion with severe bone loss is a challenging task to both surgeons and patients. It often requires prolonged and potentially painful treatments. Moreover, it also represents serious socioeconomic issues for patients. Inadequate fracture stability, disrupted biology, such as blood supply and soft tissue, as well as severe bone loss or presence of infection are possible reasons for nonunion. Several different treatment modalities are available, including nail dynamization, plate osteosynthesis, exchange nailing, and adjuvant alternatives, such as electrical or ultrasound stimulation. Autogenous bone graft remains the standard method to reconstruct small defects. Distraction osteogenesis and induced membrane techniques are contemporary strategies of choice for the reconstruction of larger bony defects. Herein, we attempt to describe the key techniques that may be employed in treating nonunion with severe bone loss.
Biology ; Humans ; Membranes ; Methods ; Osteogenesis, Distraction ; Surgeons ; Transplants ; Ultrasonography

No abstract available.
Lymphoma, Non-Hodgkin*

No abstract available.
Fractures, Bone*