Ciliated hepatic foregut cyst (CHFC) is a rare benign lesion consisting of ciliated pseudostratified columnar epithelium, loose subepithelial connective tissue, a smooth muscle layer, and an outer fibrous capsule. We encountered a patient with retroperitoneal and posterior mediastinal neurilemmoma and additional CHFC mimicking metastasis. Abdominal CT examination demonstrated that the posterior mediastinal and retroperitoneal lesions were lobulated, well-defined tumors with a neural foraminal extension that were pathologically confirmed as neurilemmomas. Unenhanced CT indicated that the additional lesion was a slightly hypodense mass relative to surrounding parenchyma at the medial segment of the left lobe of the liver, and after the IV ad-ministration of contrast material, the lesion did not show enhancement.
Connective Tissue ; Epithelium ; Humans ; Liver ; Muscle, Smooth ; Neoplasm Metastasis* ; Neurilemmoma ; Tomography, X-Ray Computed

No abstract available.
Lung Neoplasms* ; Lung* ; Neoplasm Metastasis* ; Toes*

OBJECTIVE: To compare the performance of superparamagnetic iron oxide (SPIO) -enhanced magnetic resonance (MR) imaging at 1.5T and dual-phase spiral computed tomography (CT) for the depiction of small hypervascular hepatocellular carcinomas (HCCs). MATERIALS AND METHODS: Forty-three patients with 70 small nodular HCCs (5-20 mm; mean, 13.7 mm) were examined. Diagnosis was based on the results of surgical biopsy in 22 patients and by the combined assessment of MR imaging, lipiodol CT, alpha feto-protein levels, and angiographic findings in 21. MR imaging consisted of respiratory-triggered turbo spin-echo T2-weighted imaging, T1-weighted fast low-angle shot, and T2* -weighted fast imaging with steady-state precession imaging before and after SPIO enhancement. CT imaging was performed with 5-mm collimation and 1: 1.4 pitch, and began 30 and 65 secs after the injection of 150 mL of contrast medium at a rate of 3 mL/sec. Two blinded observers reviewed all images independently on a segment-by-segment basis. Diagnostic accuracy was evaluated using receiver operating characteristics (ROC) analysis. RESULT: The mean areas (Az) under the ROC curves were 0.85 for SPIOenhanced MR imaging and 0.79 for dual-phase spiral CT (p < .05). The mean sensitivity of SPIO-enhanced MR imaging was significantly higher than that of CT (p < .05), i.e. 70.6% for MR imaging and 58.1% for CT. MR imaging had higher false-positive rates than dual-phase spiral CT, but the difference was not statistically significant (3.7% vs 3.3%) (p > .05). CONCLUSION: SPIO-enhanced MR imaging is more sensitive than dual-phase spiral CT for the depiction of small hypervascular hepatocellular carcinomas.

No abstract available.
Lasers, Solid-State* ; Papilloma*

PURPOSE: To compare liver hemangioma with hepatocellular carcinoma (HCC), as seen on superparamagneticiron oxide (SPIO)-enhanced MR images. MATERIALS AND METHODS: The study involved 30 patients with 51 focal hepatic mass lesions (31 hemangiomas, 20 HCCs). Breath-hold T1-weighted fast low angle shot (FLASH) and respiratory-triggered T2-weighted turbo-spin echo (TSE) images were obtained at 1.5 T before and after intravenous administration of SPIO particles. For quantitative analysis, percentage signal intensity change (PSIC) and contrast-to-noise ratio (CNR) of the lesions were calculated for T1-weighted FLASH and T2-weighted TSE before and after intravenous administration of SPIO particles. In addition, lesion conspicuity and imaging artifacts were analyzed qualitatively. RESULTS: After SPIO administration, percentage signal intensity increase on T1-weighted FLASH images was 73.0 +/-22.1% for hemangiomas and 21.8 +/-12.6% for HCCs, the difference being significant (p < 0.05). Taking a signal increase of 40% on postcontrast T1-weighted FLASH as the cut-off value, sensitivity and specificity for hemangiomas were 96.8% and 100%, respectively. In addition, the percentages of signal intensity loss on T2-weighted TSE images for hemangiomas and HCCs were 35.5 +/-17.2% and 0.2 +/-10.5%, respectively (p < 0.05). A comparison of lesion to liver CNR before and after SPIO infusion showed readings-for hemangiomas and HCCs, respectively - of 15.4 +/-6.0 and 4.7 +/-4.4 on T1-weighted FLASH images, and -2.6 +/-0.7 and 2.7 +/-4.4 on T2-weighted TSE images (p < 0.05). Qualitative analysis indicated that the conspicuity of HCCs was noticeably greater on postcontrast T2-weighted TSE images than on precontrast images (p < 0.05). CONCLUSION: The positive enhancement seen on T1-weighted FLASH images and the negative enhancement on T2 weighted TSE observed in liver hemangiomas after the administration of SPIO particles are valuable diagnostic features that can help characterize hemangiomas and differentiate them from HCCs.
Administration, Intravenous ; Artifacts ; Carcinoma, Hepatocellular* ; Hemangioma* ; Humans ; Iron* ; Liver ; Magnetic Resonance Imaging* ; Sensitivity and Specificity

PURPOSE: Urinary red blood cell morphology has been used to localize the site of hematuria in the urinary tract. But the pathologic mechanism for dysmorphic urinary red blood cells remains undefned. Our study was undertaken to investigate the mechanism of dysmorphic urinary RBCs in glomerular hematuria. We have attempted to reproduce in vitro the changes that occur in red cell morphology during passage through the renal tubule and to elucidate the role of urinary composition in determining morphology. METHODS: We examined a number of urinary samples under bright f eld microscopes with Wright's stain. 1) One drop of fresh venous blood was added to 1 ml experimental fluid, allowed to stand for 5 min and then assessed. The experimental fluids used were NaCl solutions in which the sodium concentration varied among 40 and 400mmol/L and similar saline solutions to which KCl(10, 50mmol/L), CaCl2(0.5, 2mmol/L), Urea(100, 400mmol/L) and pH(4, 8) had been added. We examined the RBC morphology in these solution. 2) In order to simulate passage of RBCs through the renal tubule, RBCs were initially suspended for 5 min in hypertonic solutions(NaCl 200mmol/L+Urea 70mmol/L+Urea 1000mmol/L). The RBCs were separated by centrifuging at 500rpm for 2 min in conical tubes, the supernatant was discarded and the RBCs washed and resuspended in a hypotonic solution(NaCl 60mmol/L) for 5 min. We added two urines(610mOsm/Kg H2O) to these solutions and then examined the RBCs morphology. RESULTS: The results were as follows; 1) Anisocytosis and hypochromia were found in NaCl 60mmol/L and 75mmol/L solutions and crenated RBC was found in Nacl 400mmol/L solution. But addition of potassium, calcium or urea and variation of the pH had no effect on red cell morphology. 2) when exposed to hypotonic solution, which simulated tubular condition(NaCl 60mmol/L), the RBCs became anisocytotic and hypochromic. These two features were particularly marked if cells were transferred to concentrated urine(610mOsm/kg H2O). CONCLUSIONS: It is evident that a hypotonic tubular condition is hostile for red cells and may be primarily responsible for hy0pochromia and anisocytosis of RBCs. Although two characteristic features of dysmorphism can be reproduced in vitro, a the bizarre deformity cannot be observed. Therefore passage of red cells through the hypotonic tubular segment alone does not account for the typical deformity. Because dilute urine specimens give a false impression by selective lysis of dysmorphic cells, concentrated urine is suitable for analysis of red cell morphology.
Calcium ; Congenital Abnormalities ; Erythrocytes ; Hematuria* ; Hydrogen-Ion Concentration ; Potassium ; Sodium ; Urea ; Urinary Tract

PURPOSE: To analysis the efficacy of MRI in assessing fracture configuration and frequency of associated soft tissue injuries in tibial plateau fractures. MATERIALS AND METHODS: In the plain films and MRI of 47 cases with tibial plateau fractures,every fracture was classified by findings on plain film and MRI respectively according to the Schatzker system and they were compared with each other. The degree of displacement and depression of the fracture fragments were measured on plain film and MRI. RESULTS: MRI was more accurate in determining the classification of the fracture and measuring the displacement and depression of fragments. Fracture classifications were changed in 12 cases. Especially in Schatzker VI cases, articular step off over 2 mm and articular fragments over 2X2 cm were revealed in detail by MRI. Evidence of internal derangement of the knee was found in 38 (80.8%) cases. CONCLUSION: Most of the cases with acute tibial plateau fracture were commonly associated with ligamentous and meniscal injuries. MRI can aid in accurate evaluation of tibial plateau fracture patterns and decision of treatment plan.
Classification ; Depression ; Knee ; Ligaments ; Magnetic Resonance Imaging* ; Soft Tissue Injuries

OBJECTIVE: To determine if a combination of ferucarbotran-enhanced T2*weighted-gradient echo (T2*W-GRE) and T2-weighted turbo spin echo (T2W-TSE) images in gadolinium- and ferucarbotran-enhanced MRI has additive efficacy compared to each image alone for detecting small (< or = 2.0 cm) hepatocellular carcinoma (HCC) lesions in a group of cirrhotic patients and metastases in a group of non-cirrhotic patients. MATERIALS AND METHODS: Two readers retrospectively analyzed gadolinium- and ferucarbotran-enhanced T2*W-GRE, T2W-TSE, and combined T2*W-GRE/T2W-TSE images of 119 patients with 157 HCCs and 32 patients with 98 metastases. The diagnostic accuracy and sensitivity for each image set and the combined set were evaluated using the alternative-free response receiver operating characteristic method. RESULTS: The mean area under the curve value of the combined set (0.966) tended to be better than that for each individual image set (T2W-TSE [0.910], T2*W-GRE [0.892]). Sensitivities in the combined set were higher than those in each individual image set for detecting HCC (mean, 93.0% versus 81.6% and 86.7%, respectively, p < 0.01). Sensitivities in the combined set and the T2W-TSE set were the same for detecting metastases, and both were higher than the sensitivity seen in the T2*W-GRE set (mean, 97.5% versus 85.2 %, p < 0.01). CONCLUSION: Combining ferucarbotran-enhanced T2*W-GRE and T2W-TSE has additive efficacy for detecting HCC in cirrhotic patients, but T2W-TSE is preferred for detecting metastases in non-cirrhotic patients.
Adult ; Aged ; Carcinoma, Hepatocellular/*diagnosis ; Contrast Media/*administration & dosage ; Female ; Gadolinium DTPA/*diagnostic use ; Humans ; Iron/*diagnostic use ; Liver Neoplasms/*diagnosis/secondary ; *Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Observer Variation ; Oxides/*diagnostic use ; Predictive Value of Tests ; Sensitivity and Specificity

Acute or chronic otitis media can cause intracranial complications, one of the most serious being brain abscess. Empirical antibiotic treatment and proper surgical management should be considered to avoid fatal consequences. However, proper extent and optimal timing of surgical intervention are still matters of debate. We present a case of a 31-year-old man who presented with acutely altered mental status, caused by otogenic brain abscess who we treated successfully with antibiotics and otologic surgery and no neurosurgical treatment.
Adult ; Anti-Bacterial Agents ; Brain Abscess* ; Humans ; Otitis Media ; Unconsciousness*

OBJECTIVES: To investigate whether smoking and the smoking status are predictors of the incident impaired fasting glucose (IFG) or type 2 diabetes in Korean men. METHODS: A cohort of 1,717 Korean men without IFG or diabetes, who underwent annual periodic health examinations for 4 years (2002-2006), were retrospectively investigated. IFG and diabetes were defined as a serum fasting glucose concentration of 100-125 mg/dL and more than 126 mg/dL, respectively. Cox's proportional hazards model was used to evaluate the association between smoking and development of IFG or type 2 diabetes. RESULTS: A total of 558 cases (32.5%) of incident IFG and 50 cases (2.9%) of diabetes occurred. After controlling for the potential predictors of diabetes, the relative risk for IFG, compared with the never smokers, was 1.02 (95% CI=0.88 to 1.19) for the ever-smokers, 0.96 (95% CI=0.79-1.16) for those who smoked 1-9 cigarettes/d, 1.15 (95% CI=1.01 to 1.30) for those who smoked 10-19 cigarettes/d, and 1.31 (95% CI=1.10 to 1.57) for those who smoked 20 or more cigarettes/d (the P value for the current smokers was only p<0.002). The respective multivariate adjusted relative risks for type 2 diabetes, compared with the neversmokers, were 1.07 (95% CI=0.64 to 1.92), 1.47 (95% CI=0.71 to 3.04), 1.84 (95% CI=0.92-3.04), and 1.87 (95% CI=1.13-3.67), respectively (the P value for the current smokers was only p=0.004). CONCLUSIONS: The smoking status and the number of cigarettes smoked daily are associated with an increased risk for developing IFG or type 2 diabetes in Korean men.
Adult ; Blood Glucose/*analysis ; Body Mass Index ; Diabetes Mellitus, Type 2/*metabolism ; Health Behavior ; Health Status ; Humans ; Korea/epidemiology ; Male ; Retrospective Studies ; Risk Factors ; Smoking/*adverse effects