We report a case of old gravel aspiration in a 57-year-old man who had been accidentally buried in a field of construction for ten hours, three years prior. A chest radiograph showed peribronchial pneumonic infiltrates in the right lower lobe, with a proximal ovoid radiopaque endobronchial density at the trunchus basalis. These findings were more clearly visualized on the 64-channel multidetector CT (MDCT). Moreover, the patient recovered from his condition, following a bronchoscopic retrieval. However, the patient had persistent bronchiectasis of the right lower lobe on a subsequent follow-up chest radiograph, one month later.
Adult ; Bronchiectasis ; Follow-Up Studies ; Foreign Bodies ; Humans ; Middle Aged ; Thorax ; Tomography, X-Ray Computed

PURPOSE: The 2005 resuscitation guidelines stipulate the need for monitoring CPR (cardiopulmonary resuscitation) quality. Recently, several clinical investigations have shown that a real time monitoring and feedback system is effective for improving the quality of chest compressions during resuscitation. However little data exists regarding the accuracy of the monitoring system using an accelerometer sensor and a pressure sensor for the measuring of compression rate and depth. Our goal for this study was to investigate how well chest compression rate and depth can be estimated using the monitoring system. METHODS: Thirty seconds of continuous chest compressions were delivered on a standard skillmeter manikin lying on the floor with the monitoring system. The chest compressions were delivered with variations in compression rate (67~142 /min) and with variations in compression depth (22~61 mm). A total of 120 sets of compressions were delivered for validation of rate and depth. RESULTS: The correlation coefficient for compression rate between the monitoring system and the standard method was 0.999 (p<0.001), and Bland-Altman analysis showed a mean bias of -0.10+/-0.77/min, with limits of agreement ranging from -1.60 to 1.40 /min. The correlation coefficient for compression depth between two methods was 0.983 (p<0.001), and Bland-Altman analysis showed a mean bias of 4.2+/-2.0 mm, with limits of agreement ranging from 0.24 to 8.10 mm. CONCLUSION: Compared with a skillmeter manikin, a monitoring system for the quality of CPR estimates chest compression rate precisely, but overestimates chest compression depth by an average of 10.3%.
Bias (Epidemiology) ; Cardiopulmonary Resuscitation ; Deception ; Delivery of Health Care ; Floors and Floorcoverings ; Manikins ; Monitoring, Physiologic ; Resuscitation ; Thorax

PURPOSE: To compare the usefulness of test bolus examination in three-dimensional contrast enhanced MR angiography of the carotid artery with that of the fixed delay time method. MATERIALS AND METHODS: Sixty consecutive patients (mean age, 60.1 years) in whom carotid arterial disease was suspected and who were examined during a 17-month period were divided into two equal groups. For group A, a fixed delay time of 5 secs was used, while for group B, the delay time of the test bolus examination was calculated from the signal intensity versus time curve of the carotid artery, obtained after the test injection of 1 ml contrast material into the right brachal vein. Overall image quality, discrimination between the arterial and the venous phase, and the contrast-to-noise ratio(CNR) of the carotid artery were compared between the two groups. Overall image quality was classified as excellent, good, moderate or poor, and discrimination between the two phases was graded IV-I according to the degree of jugular venous enhancement. RESULTS: In group A, overall image quality of the carotid artery was classified as excellent or good in 13 (43.3%)and 9 (30.0%) cases, respectively, while in group B the corresponding figures were 23 (76.7%) and 5 (16.7%). The differences between the two groups were statistically significant (p<0.05). In terms of discrimination between the arterial and venous phase, 20 (66.7%) of the 30 cases in group A were assigned grade IV or III, while 28 (93.3%) of the 30 in group B were assigned these same grades (p<0.05). The CNR of the carotid artery was higher in group B(67.1 +/-16.1) than in group A(27.3 +/-17.8), with statistical significance(p<0.05). CONCLUSION: For examination of the carotid artery, contrast enhanced MR angiography using a test bolus is su-perior to the fixed delay time method.
Angiography* ; Carotid Arteries* ; Carotid Artery Diseases ; Discrimination (Psychology) ; Humans ; Veins

Cardiac contusion is an increasingly recognized entity in patients with nonpenetrating chest injury. Unifortunately, the diagnosis of cardiac trauma, particularly cardiac contusion, is imprecise and may be confounded by the presence of associated injuries, hypoxia, shock, and metabolic abnormalities. Symptomatic cardiac injury follwing blunt chest trauma is relatively rare, and valvular injury is even rarer. The valves most commonly affected are mitral and tricuspid. Although tricuspid regurgitations are usually asymptomatic and can resolve spontaneously, recent developments in echocardiography made possible the precise diagnosis of valvular injuries noninvasively, The authors report the case of tricuspid regurgitation incidentally detected by echocardiography in a construction worker who had suffered multiple fractures.
Anoxia ; Contusions ; Diagnosis ; Echocardiography* ; Humans ; Shock ; Thoracic Injuries ; Thorax ; Tricuspid Valve Insufficiency ; Tricuspid Valve*

PURPOSE: To evaluate the differences in MR findings of metastatic adenocarcinoma and non-adenocarcinoma of thebrain. MATERIALS AND METHODS: We retrospectively analyzed MR findigns of metastatic brain tumors in 32 patients;in all cases, pathologic diagnosis was estabilished by biopsy or surgical resection. The signal intensities ofbrain lesions on multiple pulse sequences were compared. The enhancement patterns, degree of peritumoral edema,and number and size of brain lesions were also compared. RESULTS: The study group consisted of 19 patients withmetastatic adenocarcinoma and 13 with metastatic non-adenocarcinoma ; there were 64 adenocarcinomas and 45non-adenocarcinomas. On T1WI, the signal intensity of the lesions was hypointense, isointense, and hyperintense in57.8%, 39.0%, and 3.2% of adenocarcinomas; and 84.5%, 13.3%, and 2.2% of non-adenocarcinomas, respectively. OnT2WI, signals were hyperintense, isointense, hypointense, and heterogeneous in 67.2%, 10.9%, 17.2%, and 4.7% ofadenocarcinomas ; and 80%, 0%, 8.9%, and 11.1% of non-adenocarcinomas, respectively. On T2WI, seven of 19 patientswith adenocarcinoma and two of 13 with non-adenocarcinoma were either hypo- or isointense relative to the whitematter. In the adenocarcinoma group, hypo- or isointensity was seen in four cases of gastrointestinal cancer, twoof lung cancer, and one of endometrial cancer ; in the non-adenocarcinoma group, this was seen in retroperitonealembryonal carcinoma and small cell carcinoma of the lung. Two cases of adenocarcinoma showed hypointensity on T2WIand hyperintensity on TIWI, and this was probably related to the presence of blood products. On histopathology,one case of adenocarcinoma showing hypointensity on T2WI was shown to contain mucin. CONCLUSION: When brainmetastasis shows hypo- or isointensity on T2WI, adenocarcinoma is more likely than non-adenocarcinoma.
Adenocarcinoma* ; Biopsy ; Brain Neoplasms ; Brain* ; Carcinoma, Small Cell ; Diagnosis ; Endometrial Neoplasms ; Female ; Gastrointestinal Neoplasms ; Humans ; Lung ; Lung Neoplasms ; Mucins ; Retrospective Studies

PURPOSE: To assess the effect of a rectal enema on interfraction prostate movement in bone alignment (BA) for prostate radiotherapy (RT), we analyzed the spatial difference in prostates in a bone-matched setup. MATERIALS AND METHODS: We performed BA retrospectively with data from prostate cancer patients who underwent image-guided RT (IGRT). The prostate was identified with implanted fiducial markers. The setup for the IGRT was conducted with the matching of three fiducial markers on RT planning computed tomography images and those on two oblique kV x-ray images. Offline BA was performed at the same position. The coordinates of a virtual prostate in BA and a real prostate were obtained by use of the ExaxTrac/NovalisBody system, and the distance between them was calculated as the spatial difference. Interfraction prostate displacement was drawn from the comparison of the spatial differences. RESULTS: A total of 15 patients with localized prostate cancer treated with curative hypofractionated IGRT were enrolled. A total of 420 fractions were analyzed. The mean of the interfraction prostate displacements after BA was 3.12+/-2.00 mm (range, 0.20-10.53 mm). The directional difference was profound in the anterior-posterior and supero-inferior directions (2.14+/-1.73 mm and 1.97+/-1.44 mm, respectively) compared with the right-left direction (0.26+/-0.22 mm, p<0.05). The required margin around the clinical target volume was 4.97 mm with the formula of van Herk et al. CONCLUSIONS: The interfraction prostate displacement was less frequent when a rectal enema was performed before the procedure. A rectal enema can be used to reduce interfraction prostate displacement and resulting clinical target volume-to-planning target volume margin.
Enema* ; Fiducial Markers ; Humans ; Prostate* ; Prostatic Neoplasms ; Radiotherapy* ; Retrospective Studies

PURPOSE: To evaluate the prevalence of capsular retraction in malignant hepatic tumors and the factorsinvolved. MATERIALS AND METHODS: Between January 1994 and December 1996, we retrospectively reviewed the CT scansof 152 patients with pathologically-proven, peripherally-located, malignant hepatic tumors. We evaluated size,site, portal and hepatic venous obstruction, bile duct dilatation, and liver atrophy in 18 cases involvingcapsular retraction. RESULTS: The overall prevalence of capsular retraction among malignant hepatic tumors was18/152(12%) ; the prevalence was 9/129(7%) in hepatocellular carcinoma, 6/14(43%) in cholangiocarcinoma and3/9(33%) in metastatic cancer ; among cases of cholangiocarcinoma and metastatic cancer, the prevalence washigh(p <0.05). Portal venous obstruction was seen in six patients with hepatocellular carcinoma (a high incidence ;p=0.041) and one with cholangiocarcinoma. Hepatic venous obstruction was demonstrated in one patient withhepatocellular carcinoma and one with cholangiocarcinoma. Among cholangiocarcinoma patients, bile duct obstructionwas seen in four and liver atrophy in three, but among metastatic cancer cases there were no similar findings. CONCLUSION: The main factors causing capsular retraction were portal venous obstruction in hepatocellularcarcinoma and bile duct obstruction and liver atrophy in cholangiocarcinoma.
Atrophy ; Bile Ducts ; Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Cholestasis ; Dilatation ; Humans ; Incidence ; Liver ; Prevalence ; Retrospective Studies

STUDY DESIGN: This was a retrospective cohort study. PURPOSE: We evaluated the predictive value of the Spinal Instability Neoplastic Score (SINS) system for spinal adverse events (SAEs) in patients with single spinal metastatic tumor. OVERVIEW OF LITERATURE: The SINS system was developed to assess spinal instability in patients with single metastatic spinal tumor. However, the system’s potential predictive value for SAEs has been partially studied. METHODS: This system was applied to a retrospective cohort of 78 patients with single spinal metastatic tumors. The patients underwent surgical treatment and were postoperatively followed up for at least 2 years or until death. The attribution of each score and total SINS to SAE (vertebral compression fracture [VCF] and spinal cord compression [SCC]) occurrence was assessed using the Cox proportional hazards model. RESULTS: SAEs occurred on average 7 months after diagnosis of spinal metastasis. The mean survival rate post diagnosis was 43 months. Multivariate analysis using the Cox proportional hazards model revealed that the pain (p=0.029) and spinal alignment (p=0.001) scores were significantly related to VCF occurrence, whereas the pain (p=0.008) and posterolateral involvement (p=0.009) scores were related to SCC occurrence. CONCLUSIONS: Among the components of the SINS system, while pain and spinal alignment showed a significant association with VCF occurrence, pain and posterolateral involvement showed association with SCC occurrence.
Cohort Studies ; Diagnosis ; Fractures, Compression ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Spinal Cord Compression ; Survival Rate

BACKGROUNDS: The purpose of this study was to examine the incidence of new fractures after treatment with alendronate or raloxifene in patients with compression fractures treated with cement augmentation. METHODS: 140 patients with compression fracture treated with vertebroplasty or kyphoplasty between January 2007 and January 2013 were divided into 3 groups, an unmedicated group (n=31), an alendronate group (n=49), and a raloxifene group (n=60). The incidence of new fractures in 3 groups were investigated. RESULTS: The incidence of new fractures was 29% (9 cases) in unmedicated group, 20% (10 case) in alendronate group, and 26% (16 case) in raloxifene group. Average period to new fracture was 16.2 months in alendronate group and 21.5 months in raloxifene group. CONCLUSIONS: After treatment with alendronate or raloxifene, BMD increased and incidence of new fractures decreased in patients with osteoporotic compression fracture treated with vertebroplasty or kyphoplasty. Patients with alendronate showed numerical improvement in BMD and incidence of new fractures than raloxifene. But, incidence of new fractures in spine and other site showed no statisically significant.
Alendronate ; Fractures, Compression ; Humans ; Incidence ; Kyphoplasty ; Osteoporosis ; Raloxifene Hydrochloride ; Spine ; Vertebroplasty

Background: This study aimed to determine the magnitude of volume reduction of the latissimus dorsi (LD) muscle after treatment using only postoperative radiotherapy (PORTx) in patients who underwent immediate breast reconstruction using an extended LD musculocutaneous (eLDMC) flap after partial mastectomy. Methods: We retrospectively reviewed 28 patients who underwent partial mastectomy and an eLDMC flap, received only PORTx, and underwent chest computed tomography (CT) 7 to 10 days after surgery and 18±4 months after the end of radiotherapy, from March 2011 to June 2016. The motor nerve to the LD was resected in all patients. One plastic surgeon performed the procedures, and the follow-up period was at least 36 months (mean, 46.6 months). The author obtained LD measurements from axial CT views, and the measurements were verified by an experienced radiologist. The threshold for statistical significance was set at P<0.05. Results: A statistically significant decrease in the LD volume was found after the end of PORTx (range, 61.19%–80.82%; mean, 69.04%) in comparison to the measurements obtained 7 to 10 days postoperatively (P<0.05). All cases were observed clinically for over 3 years. Conclusions The size of an eLDMC flap should be determined considering an average LD reduction of 69% after PORTx. Particular care should be taken in determining the size of an eLDMC flap if the LD is thick or if it occupies a large portion of the flap.