PURPOSE: Authors studied the injection method of contrast medium in routine chest spiral CT scan to obtain the best image in the mediastinum. MATERIALS AND METHODS: Dynamic static scan had been performed in 5 normal volunteers as a pilot study. In consideration of the result of pilot study, Chest spiral CT was performed in 217 patients by three different methods. We used 100cc nonionic contrast medium. Average attenuation of great vessels in the mediastinum were assessed in various injection methods. Image quality was graded with three levels of score by two radiologists. RESULTS: Peak enhancement time of the great vessels on pilot at dynamic static scan were as follows :52 sec at ascending aorta, 45 sec at pulmonary artery, and 40 sec at SVC. In the study of spiral CT, the highest attenMarion in the great vessels was obtained after injection of 100cc of contrast medium(2cc/sec, with 35-40 second scan delay), althrough artifact from highly enhancing SVC was most common in this method. Image quality were highest in the scans obtained with other methods(3-2-1cc/sec for 10-15-40 seconds, with 40 second scan delay). CONCLUSION: For chest spiral CT, authors recommend that scans should be obtained after infusion of 70--80cc of contrast medium during 35--40sec to obtain maximal vascular enhacement of mediastinum.
Aorta ; Artifacts ; Healthy Volunteers ; Humans ; Mediastinum ; Pilot Projects ; Pulmonary Artery ; Thorax* ; Tomography, Spiral Computed*

Paranasal sinus mucocele is a slowly expanding benign lesion which can occur as a result of obstruction in the sinus ostium or ostial tract. Frontal sinus mucocele differ from mucoceles of other sinuses in that the frontal outflow tract is usually narrower and less accessible. Since the introduction of endoscopic sinus surgical instrument and techniques, there has been an increasing trend towards the use of endoscopic transnasal technique for managing the paranasal sinus mucoceles. Some studies also recommend the use of intrafrontal stent to reduce the rate of restenosis of frontal sinus outflow tract. We experienced a case of recurrent frontal sinus mucocele complicated by visual disturbance and periorbital swelling. To treat this condition, an intranasal marsupialization was performed and an intrafrontal stent was applied. This paper reports the particulars of this case with a review of related literature.
Frontal Sinus* ; Mucocele* ; Stents* ; Surgical Instruments

BACKGROUND AND OBJECTIVES: During the index procedure of catheter ablation (CA) for atrial fibrillation (AF), it is important to assess whether other atrial or ventricular tachyarrhythmia coexist. Their symptoms are often attributed to residual tachycardia after successful elimination of AF by CA. This tachycardia could also be non-pulmonary vein (PV) foci initiated AF. This study examined the coexistence of other sustained tachyarrhythmia of patients who underwent radiofrequency CA (RFCA) for AF. SUBJECTS AND METHODS: Four hundred fifty-nine consecutive patients (375 males, aged 53.4+/-11.4 years) who underwent RFCA for AF were investigated. Atrial and ventricular programmed stimulation (PS) with or without isoproterenol infusion were performed, and spontaneously developed tachycardias were analyzed. RESULTS: Fifteen patients (3.3% of total) were diagnosed to have other sustained arrhythmias that included slow-fast type atrioventricular nodal reentrant tachycardia (AVNRT, n=6), atrioventricular reentrant tachycardia (AVRT, n=5) that utilized left posteroseptal (n=4) and parahisian bypass tract (n=1), atrial tachycardia (AT, n=2) originating from the foramen ovale (n=1) and the ostium of coronary sinus (n=1), sustained ventricular tachycardia (VT, n=2) involving one from the apical posterolateral wall of left ventricule in a normal heart and one from an anterolateral wall in an underlying myocardial infarction (MI). These sustained tachycardias were neither clinically documented nor had structural heart diseases, with the exception of one patient with MI associated VT. Two patients had the triple tachycardia; one involved AVNRT, AVRT, and AF, and the other involved VT, AT, and AF. All associated tachycardias were successfully eliminated by RFCA. CONCLUSION: Fifteen (3.3%) patients with AF had coexisting sustained tachycardia. RFCA was successful in these patients. Identification of tachycardia by PS before RFCA for AF should be done to maximize the efficacy of the first ablation session.
Aged ; Arrhythmias, Cardiac ; Atrial Fibrillation ; Catheter Ablation ; Catheters ; Coronary Sinus ; Foramen Ovale ; Heart ; Heart Diseases ; Humans ; Isoproterenol ; Male ; Myocardial Infarction ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Ventricular ; Veins

A lymphatic cyst of the stomach is rare benign tumor which is composed of thin-walled lymphatic space lined by benign-appearing endothelial cells. It rarely manifests clinical symptoms, so it is found incidentally in most cases. Recently, a case of submucosal lymphatic cyst associated with early gastric cancer was experienced. An endoscopy revealed a slightly elevated, edematous lesion adjacent to the malignant ulcer. This case is herein reported with a brief review of related literature.
Endoscopy ; Endothelial Cells ; Lymphocele* ; Stomach ; Stomach Neoplasms* ; Ulcer

BACKGROUND: The optimal treatment for mitral regurgitation from leaflet prolapse or multiple leaflet pathology is not yet established. Recently, new chordae formation(NC) with olytetra-fluoroethylene(PTFE) has become increasingly popular. The aims of the current study was to see the effects of new chordae formation on mitral alvuloplasty. MATERIAL AND METHOD: From January 1994 to december 1999 322 patients receiving itral valvuloplasty were divided into two groups in which 144 patients(Group I) received NC and 178 patients(group II) received mitral valvuloplasty without NC. Echocardiograms were performed in the immediate postoperative period, at 6 months and 1 year after surgery and annually thereafter. RESULT: Mitral valvuloplasty was performed for mitral regurgitation in 95%(322/ 337) of the patients and the mean followup period was 27+/-20.6 months of which follow-up was complete for 95.4%(306/ 322). The degree of mitral regurgitation in both groups I and II improved from 3.8+/-0.4 to 1.3+/-0.9 and 3.6+/-0.3 to 1.1+/-0.7, respectively. There was also no significant difference in the mean mitral area or transvavular pressure gradient across the mitral valve. The overall early and late mortality rates were 0.9%(3) and 1.2%(4), also showing no significant difference between the two groups. The late survival rate(97.8+/-1.6 vs 97.7+/-1.6%), freedom from structural degeneration 93.7+/-3.6 vs 90.7+/-3.4%) freedom from reoperation(99.3+/-0.7 vs 96.6+/-1.8%), freedom from thromboembolism, freedom infective endocarditis, and valve related complications showed no significant difference between the two groups. CONCLUSION: Mitral valvuloplasty with NC not only resulted in an increase in the volume of mitral reconstruction(r=0.98, p<0.01) but enhanced urability and stability comparable to currently established methods. Mitral valvuloplasty with NC was especially effective in the treatment of pan valvular pathology, commissural lesions and multiple leaflet pathology which would otherwise have been difficult to treat with current methods.
Endocarditis ; Follow-Up Studies ; Freedom ; Humans ; Mitral Valve Insufficiency ; Mitral Valve Prolapse ; Mitral Valve* ; Mortality ; Pathology ; Postoperative Period ; Prolapse ; Thromboembolism

BACKGROUND/AIMS: This study evaluated the relationship between thyroid nodules and metabolic syndrome (MS) and its components in apparently healthy Koreans. METHODS: We reviewed the records of 3,298 subjects with no noticeable symptoms who underwent thyroid ultrasound imaging as part of a routine check-up between July 2009 and June 2010; of these, 1,308 were excluded based upon predefined criteria. Among the remaining 1,990 patients, we examined the association between MS and its components and the incidence of thyroid nodules. RESULTS: Of the 1,990 subjects included in this study, 38.4% (n = 764) had thyroid nodules and 12.7% (n = 253) had MS. Female sex, older age, higher body mass index, larger waist circumference, higher glycated hemoglobin level, lower thyroid stimulating hormone level, and presence of MS were all closely related with the presence of thyroid nodules (all p < 0.05). Furthermore, the relevant number of MS components showed a positive linear correlation with the occurrence of thyroid nodules (p < 0.001). Evidence of MS alone was not independently associated with thyroid nodules after adjusting for sex and age in a multivariate binary logistic regression analysis; however, glycated hemoglobin for females and waist circumference for males, as well as both age and thyroid stimulating hormone for all patients, were identified as independent predictors for the existence of thyroid nodules (all p < 0.05). CONCLUSIONS: This study suggests a positive relationship between the components of MS and thyroid nodules in an ostensibly healthy Korean population. Our data support the idea that the recent increase in thyroid nodules is partly due to increases in both MS and obesity.
Adult ; Biomarkers/blood ; Body Mass Index ; Chi-Square Distribution ; Cross-Sectional Studies ; Diabetes Mellitus/diagnosis/epidemiology ; Female ; Hemoglobin A, Glycosylated/analysis ; Humans ; Incidence ; Linear Models ; Logistic Models ; Male ; Metabolic Syndrome X/blood/diagnosis/*epidemiology ; Middle Aged ; Multivariate Analysis ; Obesity/diagnosis/epidemiology ; Odds Ratio ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Thyroid Nodule/blood/diagnostic imaging/*epidemiology ; Thyrotropin/blood ; Waist Circumference

PURPOSE: We report the results of an external audit on the absorbed dose of radiotherapy beams independently performed by third parties. For this effort, we developed a method to measure the absorbed dose to water in an easy and convenient setup of solid water phantom. MATERIALS AND METHODS: In 2008, 12 radiotherapy centers voluntarily participated in the external auditing program and 47 beams of X-ray and electron were independently calibrated by the third party's American Association of Physicists in Medicine (AAPM) task group (TG)-51 protocol. Even though the AAPM TG-51 protocol recommended the use of water, water as a phantom has a few disadvantages, especially in a busy clinic. Instead, we used solid water phantom due to its reproducibility and convenience in terms of setup and transport. Dose conversion factors between solid water and water were determined for photon and electron beams of various energies by using a scaling method and experimental measurements. RESULTS: Most of the beams (74%) were within +/-2% of the deviation from the third party's protocol. However, two of 20 X-ray beams and three of 27 electron beams were out of the tolerance (+/-3%), including two beams with a >10% deviation. X-ray beams of higher than 6 MV had no conversion factors, while a 6 MV absorbed dose to a solid water phantom was 0.4% less than the dose to water. The electron dose conversion factors between the solid water phantom and water were determined: The higher the electron energy, the less is the conversion factor. The total uncertainty of the TG-51 protocol measurement using a solid water phantom was determined to be +/-1.5%. CONCLUSION: The developed method was successfully applied for the external auditing program, which could be evolved into a credential program of multi-institutional clinical trials. This dosimetry saved time for measuring doses as well as decreased the uncertainty of measurement possibly resulting from the reference setup in water.
Electrons ; Phenylpropionates ; Uncertainty ; Water

Hemobilia is a hemorrhage into the biliary tract that may follow trauma (including surgical and percutaneous techniques in hepatobiliary system), aneurysms of the hepatic artery (and its branch), tumors of the biliary tract, hepatoma, inflammation, liver abscess, and gallstone disease. But, a case has not been reported involving of hemobilia associated with gallbladder hemorrhage without obvious predisposing factors or causes. A 62-year-old woman was admitted to Kyunghee Medical Center due to intermittent nausea, and right upper quadrant pain for 2 days before admission. She had no history of abdominal trauma. On the second and third day of her stay, she experienced melena of which the amount was about 300 ml. Abdominal ultrasonography revealed a gallbladder with a 8 mm sized cystic lesion attached to the fundus. Computed tomographic (CT) evaluation of the abdomen demonstrated a highly enhanced 7~8 mm sized nodular mass in the lumen of the gallbladder. The gallbladder, cystic duct, and CBD were dilated due to the filling of blood clots or sludge material. An ERCP was performed and bleeding from the papilla of Vater was confirmed. Subsequently, emergent laparoscopic cholecystectomy was conducted. Pathologic evaluation revealed a grayish-red gallbladder that had a ruptured vessel. The ruptured vessel showed a severe hypertrophic state but there was no evidence of vasculitis, aneurysm, arterio-venous malformation, or malignancy. The case is here in reported of hemobilia associated with spontaneous gallbladder hemorrhage.
Abdomen ; Aneurysm ; Biliary Tract ; Carcinoma, Hepatocellular ; Causality ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Cystic Duct ; Female ; Gallbladder* ; Gallstones ; Hemobilia* ; Hemorrhage* ; Hepatic Artery ; Humans ; Inflammation ; Liver Abscess ; Melena ; Middle Aged ; Nausea ; Sewage ; Ultrasonography ; Vasculitis

BACKGROUND: Although a significant number of studies were done on focal segmental glomerulosclerosis(FSGS), its pathogenesis has not been sufficiently established yet. Recent studies suggested certain types of circulating factor(s) played an important role in development and recurrence after renal transplantation of FSGS by modifying the glomerular permeability of albumin. The purpose of this study performed on animals and through molecular-biological experiments is to certify the role of circulating factor (s), which cause proteinuria, by manipulating plasma of a FSGS patient who showed massive of proteinuria and wide effacement of glomerular epithelial foot processes in histologic examination after renal transplantation. also, whose massive proteinuria decreased significantly after plasma exchange. METHODS: The patient's plasma prior to(plasma A) or post to(plasma B) plasma exchange were injected into tail veins of two groups of male Sprague-Dawley rats, six in each. The ratio of 24 hour urine protein and urine creatinine(Uprt/Ucr) was calculated for each case. The 2D gel electrophoresis was performed in plasma A and plasma B. The pattern of 2D gel electrophoresis of plasma A was compared to those of plasma B and healthy human serum. RESULTS: Compared to control group, there was no significant differences in 24-hour Uprt/Ucr afer injecting 1, 2, 3, 5 mL of plasma A(p>0.05). There was no significant difference in 24-hour Uprt/Ucr between the injecting groups of plasma A and plasma B(p>0.05). We were not able to observe any new protein which did not appear in plasma B or healthy human serum in 2D gel electrophoresis. CONCLUSION: These results suggest that the proteinuria developed in a few hours after renal transplantation and is related to wide effacement of glomerular epithelial foot processes, and that it may be induced by a certain factor which is eliminated by the plasma exchange or restrained by the immunosuppressive agents. However, we were not able to find certain circulating factor(s) which rapidly changes albumin permeability in the patient's plasma with FSGS.
Animals ; Electrophoresis, Gel, Two-Dimensional ; Foot ; Glomerulosclerosis, Focal Segmental* ; Humans ; Immunosuppressive Agents ; Kidney Transplantation ; Male ; Permeability ; Plasma ; Plasma Exchange ; Proteinuria ; Rats, Sprague-Dawley ; Recurrence ; Veins

PURPOSE: To determine the clinical utility of coronary CT angiography (CCTA) with low-dose chest CT in the evaluation of patients with atypical chest pain. MATERIALS AND METHODS: Ninety-six patients (mean age 60.2 years; age range, 41-68 years; 70 males) were referred for CCTA with low-dose chest CT (16-slice MDCT, Siemens) for an evaluation of atypical chest pain. When significant stenoses (lumen diameter reduction > 50%) were detected on CCTA, invasive coronary angiography (CA) was performed as the standard of reference. In all patients, medical chart review or telephone contact with patients was used to evaluate the contribution of CCTA with low-dose chest CT to the final clinical diagnosis, at least 6 months after performing CCTA. RESULTS: Among 96 patients, seven patients (7%) had significant stenoses as detected on CCTA, whereas two patients (2%) had significant stenoses and five patients had insignificant stenoses or no stenosis, as detected on conventional catheter angiography. In 18 (19%) of the 89 patients without significant stenosis detected on CCTA, this protocol provided additional information that suggested or confirmed an alternate clinical diagnosis. CONCLUSION: In patients with atypical chest pain, CCTA with low-dose chest CT could help to exclude ischemic heart disease and could provide important ancillary information for the final diagnosis.
Angiography ; Catheters ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Humans ; Myocardial Ischemia ; Telephone ; Thorax ; Tomography, X-Ray Computed