A case report of a 60 year-old man with lichen aureus of leg is presented. Clinically the solitary golden to purple colored patch consists of lichenoid papules, plsque, and mild petechiae around the lesion, and the histology reveals a dense and bandlike infiltrate hugging thepidermis. It consists of lymphocytes, histiocytes, eosinophils, and many extravasated erythrocytes and hemosiderin in dermis, but a few red cells and increased melanin pigment can also be seen in the epidermis. The eruption is mildly itchy and has been present 6 months.
Dermis ; Eosinophils ; Epidermis ; Erythrocytes ; Hemosiderin ; Histiocytes ; Humans ; Leg ; Lichens* ; Lymphocytes ; Melanins ; Middle Aged ; Purpura

A wide variety of cancers metastasize to the ovaries. In a majority of instances the primary site is the gastrointestinal tract, breast, or other gynecologic organs. The best known tumor of this type is signet-ring cell adenocarcinoma. The gallbladder and bile duct are rare sources of these metastases. The authors have had an experience of a case that was presented of Krukenberg tumor metastatic from the gallbladder and report the case with brief review of literature.
Adenocarcinoma ; Bile Ducts ; Breast ; Female ; Gallbladder* ; Gastrointestinal Tract ; Krukenberg Tumor* ; Neoplasm Metastasis* ; Ovary

No abstract available.
Ultrasonography*

PURPOSE: To evaluate the accuracy of T2-weighted imaging and MR cholangiopancreatography using the single shot fast spin-echo technique for evaluating pancreaticobiliary disease. MATERIALS AND METHODS: B e t ween March and July 1997, axial and coronal T2-weighted images ( T E : 8 0 -2 00 msec) and MR cholangiopancreatograms(TE:800 -1 2 00 msec) were obtained in two ways [single slab (thickness:30 -50 mm) and multislice acquisition under chemical fat saturation] using SSFSE pulse sequencing in 131 cases of suspected pancreati-cobiliary disease. The accuracy of SSFSE MR imaging was assessed in 89 lesions of 74 patients [male,48; female,26; age range, 3 0 -86 (mean,59)years] confirmed surgicopathologically(50 lesions in 39 patients) and clinically (39 lesions in 35 patients). Two radiologists reviewed the MR images and diagnosis was determined by consensus. RESULTS: Correct diagnosis was confirmed in 84 of 89 lesions (94 %). Seven lesions were falsely interpreted, false positive and false negative results accounting for two and five cases, respective l y. Two pancreatic cancers were misdiagnosed as pancreatitis and a cancer of the proximal common bile duct(CBD) was interpreted as a distal CBD cancer. The sensitivity of SSFSE MR imaging for malignancy was 93 %. One CBD stone revealed by endoscopic retrograde cholangiopancreatography (ERCP) was not detected on MR images. In contrast, a stone in the CBD seen on MR images was not apparent on subsequent ERC P. Sensitivity and specificity for calculous disease were 96 % and 99.7 %, respective l y. A benign stricture of the ampulla of Vater was falsely interpreted as normal, and correct diagnosis was possible in two falsely diagnosed cases when MR images were rev i ewed retrospectively. CONCLUSION: The combination of T2-weighted and cholangiographic images using SSFSE is an accurate method for diagnosing pancreaticobiliary diseases.
Ampulla of Vater ; Bile ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance* ; Consensus ; Constriction, Pathologic ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Pancreatic Neoplasms ; Pancreatitis ; Retrospective Studies ; Sensitivity and Specificity

OBJECTIVES: Quality of life (QoL) was a important factor of treatment outcome in alcoholics. This study was to examine the relationship between family support and quality of life among alcoholics, to explore the moderating effect of abstinence self-efficacy on those relationship and to suggest practical implications for intervention services. METHODS: Data for this study were collected through the use of a survey instrument completed by 771 alcohol dependent admitted to inpatient treatment from 20 psychiatric hospital. Subjects were screened using the Family support, Drug Taking Confidence Questionnaire-8, World Health Organization Quality of Life Assessment Instrument. Collected data were analysed by moderated multiple regression and simple slope analysis. RESULTS: Family support was directly associated with QoL. Also the abstinence self-efficacy had moderating effects on relationship between family support and QoL. Simple slope analysis showed that the effects of family support on QoL were significant at low and high levels of abstinence self-efficacy and especially the effects of family support on QoL were more higher at the high levels of abstinence self-efficacy. CONCLUSION: This findings suggest that abstinence self-efficacy is an important factor to QoL among alcohol dependents. Increasing self-efficacy, family support will be improve the QoL and recovering process. Based on these findings suggest practical intervention.
Alcoholics ; Alcoholism ; Hospitals, Psychiatric ; Humans ; Inpatients ; Quality of Life ; Treatment Outcome ; World Health Organization

PURPOSE: To determine relative image qualities and to evaluate their ability to visualize biliary trees and pancreatic ducts, we compared the breath-hold fast spin echo (FSE) and respiratory triggered FSE technique in magnetic resonance cholangiopancreatography (MRCP). MATERIALS AND METHODS: Forty-seven patients with suspected of hepatic disease but no pancreatic or biliary ductal dilatation, as determined by other imaging techniques('group of pathologic pancreatobiliary tree') underwent MRCP. Heavily T2-weighted FSE coronal images were obtained by both breath-hold and respiratory triggered techniques. These two images were 3D-reconstructed using a maximal intensity projection algorithm. Three radiologists scored the image qualities of anatomic structures in each set of image, then directly compared the image quality of the images obtained by the two techniques. RESULTS: For the visualization of common hepatic ducts and common bile dvcts, FSE MRCP images obtained using the respiratory-triggered technique were triggered technique were significantly better than those obtained using the breath-hold technique (P<0.05). Fifty-nine to 88% of breath-hold images of the biliary tree and 63-95% of respiratory triggered images were optimal. For the pancreatic duct, however, 24% of breath-hold images and 15% of respiratory-triggered images provided optimal image quality. In direct comparison, respiratory triggered images were better in 25 cases (52.1%), both images were comparable in 12 cases (25.0%), and in 11 cases (22.9%), breath-hold images were better. These differences were statistically significant (p<0.05). CONCLUSION: For the vizualization of extrahepatic bile ducts, the respiratory triggered FSE sequence was better than the breath-hold sequence; for the evaluation of both a non-dilated and dilated pancreatobiliary system, however, both techniques need further development.
Bile ; Bile Ducts, Extrahepatic ; Biliary Tract ; Cholangiopancreatography, Magnetic Resonance ; Dilatation ; Hepatic Duct, Common ; Humans ; Pancreatic Ducts

Syphilitic aortitis, passing out of our mind, is the most common systemic manifestation of late syphilis and is more typically manifestated 10 to 30 years afterward. This diagnosis has been made less frequently in recent decades than in the past, because of public awareness of syphilis and screening program. Treponema pallidum lodge within vasa vasorum, especially ascending aorta cause the histologic changes, which are responsible for the three major forms of symptomatic cardiovascular syphilis, including aortic insufficiency, coronary ostial stenosis, and aortic aneurysm. We experienced a case of syphilitic aortitis with aortic insufficiency and aortic aneurysm in a 48-year-old man presented with progressive dyspnea. Echocardiography, chest CT, and later surgical correction were performed and surgical specimen revealed the histologic finding consistent with syphilitic aortitis. We report this case with a review of the literature.
Aorta ; Aortic Aneurysm* ; Aortitis ; Constriction, Pathologic ; Diagnosis ; Dyspnea ; Echocardiography ; Humans ; Mass Screening ; Middle Aged ; Syphilis ; Syphilis, Cardiovascular* ; Tomography, X-Ray Computed ; Treponema pallidum ; Vasa Vasorum

PURPOSE: To evaluate the usefulness of multidetector-row CT (MDCT) with gastric luminal distention using effervescent granules in patients with previous subtotal gastrectomy for the evaluation of the stomach, anastomotic site and jejunum, and to compare its findings with those of spiral CT using oral contrast media in the same patients. MATERIALS AND METHODS: Thirty-one patients (M:F=25:6, mean age; 58 years) with previous subtotal gastrectomy, who underwent both spiral CT using oral contrast media and MDCT using effervescent granules, were studied. The distensibility of the gastric lumen, anastomotic site and jejunal lumen was graded as either poor, fair or good. The thickening or mass of the gastric and small bowel wall was also evaluated. RESULTS: The distensibility of the gastric lumen, anastomotic site and jejunal lumen were better demonstrated by MDCT using effervescent granules than by spiral CT using an oral contrast agent (p<0.05). The distensibility of the stomach and jejunum was similar in 14 cases (45.2%) on spiral CT and 16 cases (51.6%) on MDCT. The anastomotic site was better demonstrated when effervescent granules were used than when oral contrast media was used in 21 cases (67.7%). No cases of poor distention of the stomach or anastomotic site were detected when using effervescent granules. CONCLUSION: Follow-up MDCT using effervescent granules showed better distensibility of the gastric lumen, anastomotic site and jejunal lumen than spiral CT using oral contrast media in all of the patients having undergone subtotal gastrectomy.
Contrast Media ; Follow-Up Studies ; Gastrectomy ; Humans ; Jejunum ; Phenobarbital ; Stomach ; Stomach Neoplasms* ; Tomography, Spiral Computed

PURPOSE: To compare the effectiveness of the in-phase(IP) sequence and the opposed-phase(OP) sequence in the detection of focal hepatic lesions in the single breath-hold hepatic MR imaging with fast gradient T1-weighted pulse sequences. MATERIALS AND METHODS: If and OP T1-weighted breath-hold imaging was performed using fast gradient echo sequences in 45 patients referred for known focal hepatic lesions, in which 78 lesions were detected. There blind readers independently reviewed the images for lesion detectability. The signal-to-noise ratio(SNR) of the liver, the lesion-to-liver contrast-to-noise ratio(CNR) and the liver-to-spleen CNR were also compared. A consensus was reached by three readers to determine which sequence is better in image quality. RESULTS: On OP images, 61(78%), 61(78%), and 63(89%) lesions were correctly identified for reader 1, 2 and 3, respectively. On IP images, 66(85%), 65(83%), and 65(93%) lesions were detected for each reader, respectively. When two image sets were combined, 71(91%), 69(88%), and 76(97%) lesions respectively were detected for each reader. In cases of hepatocellular carcinoma, liver-to-lesion CNR was greater on the OP images(p<0.05), but in other lesions significant differences was not demonstrated. Liver-to-spleen CNR was higher in OP images(p<0.1), but the SNR of the liver was higher on the If images. CONCLUSION: Use of both If and OP imaging can be helpful to avoid erroneous missing of some focal hepatic lesions.
Carcinoma, Hepatocellular ; Consensus ; Humans ; Liver* ; Magnetic Resonance Imaging*

Coronavirus disease 2019 (COVID-19) in patients with underlying diseases, is associated with high infection and mortality rates, which may result in acute respiratory distress syndrome and death. Mucopolysaccharidosis (MPS) type II is a progressive metabolic disorder that stems from cellular accumulation of the glycosaminoglycans, heparan, and dermatan sulfate. Upper and lower airway obstruction and restrictive pulmonary diseases are common complaints of patients with MPS, and respiratory infections of bacterial or viral origin could result in fatal outcomes. We report a case of COVID-19 in a 16-year-old adolescent with MPS type II, who had been treated with idursulfase since 5 years of age. Prior to infection, the patient’s clinical history included developmental delays, abdominal distension, snoring, and facial dysmorphism. His primary complaints at the time of admission included rhinorrhea, cough, and sputum without fever or increased oxygen demand. His heart rate, respiratory rate, and oxygen saturation were within the normal biological reference intervals, and chest radiography revealed no signs of pneumonia. Consequently, supportive therapy and quarantine were recommended. The patient experienced an uneventful course of COVID-19 despite underlying MPS type II, which may be the result of an unfavorable host cell environment and changes in expression patterns of proteins involved in interactions with viral proteins. Moreover, elevated serum heparan sulfate in patients with MPS may compete with cell surface heparan sulfate, which is essential for successful interaction between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein and the host cell surface, thereby protecting against intracellular penetration by SARS-CoV-2.