PURPOSE: To identify the longterm hemodynamics of various hepatic masses and to determine any differential findings by using postangiographic CT performed with increased amount of contrast media and time than conventional contrast CT. MATERIALS AND METHODS: 50 confirmed masses consisted of 22 hepatocellular carcinoma, 10 cholangiocarcinoma, 9 metastasis, and 9 cavernous hemangioma were included. The changes of the density of internal viable tumor portion relative to surrounding normal liver parenchyma in postangiographic CT from that in conventional CT were classified as 3 patterns; no specific changes, increase, or decrease. RESULTS: in 22 cases of hepatoceilular carcinoma, six cases showed no relative density change, four cases increase, and twelve cases decrease. In ten cases of cholangiocarcinoma, one case showed no change, nine cases increase. In nine cases of metastasis, four cases showed no change, five cases increase. In nine cases of hemangioma, all cases showed increase. CONCLUSION: In postangiographic CT which emphasize the significance of postequilibrium and delayed phase, other hemodynamic changes undetected in angiography could more easily be comprehended. Considering the differing amount of consumed contrast media and time duration, and with reference of other imaging modalities, differential diagnosis of hepatic masses based on longterm hemodynamics could easily be made.
Angiography ; Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Contrast Media ; Diagnosis, Differential ; Hemangioma ; Hemangioma, Cavernous ; Hemodynamics ; Liver ; Neoplasm Metastasis ; Specific Gravity

Abnormalities of the posterior arch, including congenitally absent cervical pedicle and cervical spondylolysis, are rare entities that are usually found incidentally on neck radiographs. It is important to recognize these characteristic radiological features because their radiographic appearance may cause them to be confused with more serious entities such as fractures, locked facets, and tumor-induced bony erosions. Also, it is important to distinguish these abnormalities from similar pathologies to prevent the use of inappropriate treatment. We report the relevant clinical and radiological findings seen in three cases of posterior arch defect after trauma with review of pertinent literature.
Congenital Abnormalities ; Neck ; Spine ; Spondylolysis

OBJECTIVE: The petrosal meningiomas involving the middle cranial fossa through the Meckel's cave represent a difficult surgical challenge. We report our experience of removing these lesions through the suboccipital approach combined with a technique that expose the Meckel's cave by removing the bony prominence located above the porus of the internal acoustic meatus, called the suprameatal tubercle, and the surrounding bone. METHODS: Between the period of January 1999 and October 2001, a total of seven patients with petrosal meningiomas involving the Meckel's cave were operated upon using suboccipital suprameatal approach. In the supine position, suboccipital craniotomy was performed. The main mass located predominantly within the cerebellopontine angle(CPA) was removed using intradural approach. The suprameatal tubercle was drilled-out to expose the Meckel's cave. And then, the tumor extended into the middle cranial fossa through the Meckel's cave was removed. RESULTS: In every case, the tumor extending into the Meckel's cave was exposed well. The tumors were completely removed in all patients without serious complications. CONCLUSION: We believe that suboccipital suprameatal approach offers a safe and effective method to remove some selected lesions of the CPA area extended into the middle cranial fossa through the Meckel's cave without the need for complex procedures, if the main mass is located predominantly in the CPA area.
Acoustics ; Cranial Fossa, Middle ; Craniotomy ; Humans ; Meningioma* ; Supine Position

Surgical treatment for afferent loop syndrome (ALS) in patients with recurrent gastric cancer is usually not feasible because of the recurrent tumor mass at the anastomosis site and/or extensive carcinomatosis resulting in bowel loop fixation. Furthermore, ALS usually makes oral intake impossible, resulting in a rapid deterioration in general condition. In this situation, gastroscopic stenting at the anastomotic site and/or percutaneous external drainage may be a more feasible alternative for palliation. We herein report a recurrent gastric cancer whose ALS was successfully treated with internal and external drainage procedures.
Afferent Loop Syndrome* ; Carcinoma ; Drainage* ; Humans ; Stents* ; Stomach Neoplasms*

OBJECTIVES: Though gastric cancer is one of the most common cancer in Korea, there have been few studies to explore psychological distress in gastric cancer. The purpose of this study was to investigate the prevalence and associated risk factors of psychological distress among patients with gastric cancer. METHODS: With consecutive sampling, a total of 274 patients with gastric cancer who admitted to a cancer center in a general hospital were recruited and assessed on psychological distress using the Hospital Anxiety and Depression Scale(HADS). Sociodemographic and cancer-related clinical variables were also evaluated. RESULTS: One hundred fifty-three(55.8%) patients with gastric cancer showed psychological distress. Logistic regression models revealed that having alcohol drinking experience[odds ratio(OR)=2.10, p=0,034] and low performance status(OR=2.40 p=0.002) were significantly associated with psychological distress in patients with gastric cancer. CONCLUSIONS: These findings indicate that approximately half of patients with gastric cancer suffered from psychological distress and having alcohol drinking experience and low performance status would be associated risk factors, suggesting the need for distress screening and psychosocial supportive care in patients with gastric cancer.
Alcohol Drinking ; Anxiety ; Depression ; Hospitals, General ; Humans ; Korea ; Logistic Models ; Mass Screening ; Prevalence ; Risk Factors ; Stomach Neoplasms

PURPOSE: The evaluation of tumor recurrence or metastasis in postgastrectomy cancer patients usually depends on a serum tumor marker test or radiologic study, but in both cases, accuracy is difficult to determine. The purpose of this study was to evaluate the relationship between abdominal CT and serum tumor markers. MATERIALS AND METHODS: In 337 cases involving 226 patients who had undergone curative surgery for gastric cancer, we compared serum tumor markers and CT for the evaluation of metastasis. Among these 337 cases, CEA level was measured in 317, CA 19-9 level in 166, and both of these in 146. The cutoff level for serum carcinoembryonic antigen (CEA) and CA19-9 were 10 ng/ml and 33 U/ml, respectively. RESULTS: CEA level was elevated in 59 of 317 cases (18.6 %) and that of CA 19-9 in 58 of 166 (34.9 %). Slightly higher overall senstivity and specificity was observed for CEA than for CA 19-9 (72.9 % vs 67.2 %, 83.3 % vs 70.4 %, respectively). Among the total of 337 cases, liver or lymph node metastases were detected in 91 cases (27.0 %) on CT. Negative predictive value was significantly higher in CEA than in CA 19-9 (93.1 % vs 80 %, respectively) (p < 0.01), but positive predictive value was lower (50 % vs 54.9 %, respectively). On CT scan, there was a significant relationship between serum tumor marker level and hepatic and nodal metastasis ; specificity and positivity of serum tumor markers were both higher than sensitivity and negativity. CONCLUSION: Follow-up CT less useful when tumor markers levels are not elevated, but when these are elevated in postgastrectomy cancer patients, meticulous radiologic evaluation is necessary for the early detection of residual or recurrent tumors.
Carcinoembryonic Antigen ; Follow-Up Studies ; Humans ; Liver ; Lymph Nodes ; Neoplasm Metastasis* ; Recurrence ; Sensitivity and Specificity ; Stomach Neoplasms* ; Tomography, X-Ray Computed ; Biomarkers, Tumor*

Hydrops fetalis is diagnosed when abnormal fluid collections are manifest in two or more fetal compartments, including abdominal ascites, pleural effusions, pericardial effusions, skin edema, polyhydroamniosis and placental edema. Although fetal hydrops was hystorically most commonly associated with Rh blood group isoimmunization, the availability of Rh immunoglobulin has increased the proportion of fetuses affected due to nonimmune etiologies. We have experienced a case of nonimmune hydrops fetalis at 32 weeks of gestation in a 27-year-old woman and reported that with brief review of related literatures.
Adult ; Ascites ; Edema ; Female ; Fetus ; Humans ; Hydrops Fetalis* ; Immunoglobulins ; Pericardial Effusion ; Pleural Effusion ; Pregnancy ; Skin

Neurilemmomas are tumors arising from the myelin-producing Schwann cells of the peripheral nervous system. Neurilemmomas of the 12th cranial nerve are rare, with most originating intracranially. The rarity of such pathology in the submandibular space makes proper preoperative diagnosis difficult, and is often mistaken to be an inflammatory mass, a malignant lymph node or a salivary gland tumor. The preoperative diagnosis of hypoglossal nerve neurilemmoma in this region is very important in that the patient must be warned of the morbidity of sacrificing the nerve during surgical excision and that the surgeon might be prepared for nerve graft. Therefore, we report recent experience of 2 cases of hypoglossal nerve neurilemmomas occurring in the submandibular area with a review of literature focusing on radiological findings and preoperative differential diagnosis.
Cranial Nerves ; Diagnosis ; Diagnosis, Differential ; Humans ; Hypoglossal Nerve ; Lymph Nodes ; Neck ; Neurilemmoma* ; Pathology ; Peripheral Nervous System ; Salivary Glands ; Schwann Cells ; Transplants

Adrenocortical carcinoma is a rare malignant endocrine tumor which accounts for about 0.05% to 0.2% of all carcinomas. Three clinical patterns can be encountered. In 30% of the cases, a mass syndrome without any clinical evidence of hypersecretion is presented as abdominal pain, a palpable abdominal mass, abdominal distension, and weight loss. In 60% of the cases, an overt clinical syndrome of hypersecretion is of almost purely hypercortisolism in 30% of such cases, vilirization in 22%, feminization in 10%, hyperaldosteronism in 2.5%, and a mixed secretion in 35%. In the remaining 10% of the cases, an adrenal `incidentaloma' is found incidentally during evaluation of the other disease. About 70% to 80% of patients are diagnosed with an advanced stage (III or IV) and metastasis has occured in 20% to 40% of the patients at the time of presentation. Early surgery an with adrenalectomy is the only means of cure. The prognosis is poor with a 5-years survival rate of 16% to 34% due to initial diagnosis at an advanced stage. Recently, we experienced two cases of adrenocortical carcinomas. In case I, a 62-year-old female patient presented with a clinical syndrome of hypercortisolism and had an extensive local invasion of stage IV; in case II, a 49-year-old male patient complained of abdominal pain and distension without any clinical syndrome of hypersecretion and had stage IV liver metastasis.
Abdominal Pain ; Adrenalectomy ; Adrenocortical Carcinoma* ; Cushing Syndrome ; Diagnosis ; Female ; Feminization ; Humans ; Hyperaldosteronism ; Liver ; Male ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Survival Rate ; Weight Loss

PURPOSE: The aim of this study was to compare the short-term surgical and long-term functional outcomes of Billroth I, Billroth II, and Roux-en-Y reconstruction after laparoscopic distal gastrectomy. MATERIALS AND METHODS: We retrospectively collected data from 697 patients who underwent laparoscopic distal gastrectomy for operable gastric cancer between January 2009 and December 2012. The patients were classified into three groups according to the reconstruction methods: Billroth I, Billroth II, and Roux-en-Y. The parameters evaluated included patient and tumor characteristics, operative details, and postoperative complications classified according to the Clavien-Dindo classification. Endoscopic findings of the remnant stomach were evaluated according to the residue, gastritis, bile (RGB) classification and the Los Angeles classification 1 year postoperatively. RESULTS: Billroth I, Billroth II, and Roux-en-Y were performed in 165 (23.7%), 371 (53.2%), and 161 patients (23.1%), respectively. Operation time was significantly shorter (173.4+/-44.7 minute, P<0.001) as was time to first flatus (2.8+/-0.8 days, P=0.009), time to first soft diet was significantly faster (4.3+/-1.0 days, P<0.001), and postoperative hospital stay was significantly shorter (7.7+/-4.0 days, P=0.004) in Billroth I in comparison to the other methods. Postoperative complications higher than Clavien-Dindo grade III occurred in 61 patients (8.8%) with no statistically significant differences between groups (P=0.797). Endoscopic findings confirmed that gastric residue, gastritis, bile reflux, and reflux esophagitis were significantly lower in Roux-en-Y (P<0.001) patients. CONCLUSIONS: Roux-en-Y reconstruction after laparoscopic distal gastrectomy for middle-third gastric cancer is beneficial in terms of long-term functional outcome, whereas Billroth I reconstruction for distal-third gastric cancer has a superior short-term surgical outcome and postoperative weight change.
Anastomosis, Surgical ; Bile ; Bile Reflux ; Classification ; Diet ; Esophagitis, Peptic ; Flatulence ; Gastrectomy* ; Gastric Stump ; Gastritis ; Gastroenterostomy ; Humans ; Laparoscopy ; Length of Stay ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms