With conventional radiological approaches, diagnosis of perinephric abscess is difficult in many occasions. CTand ultrasound enable accurate detection of lesions and precise determination of their extent. We review our casesand discuss the usefulness of these new modalities for the diagnosis and follow up of the lesions.
Abscess ; Diagnosis ; Follow-Up Studies ; Ultrasonography

Opacification of the gallbladder after parenteral administration of contrast material usually indicates diminished renal function but can occur with normal renal function. The authors recently experienced 13 cases of such vicarious excretion of contrast media. Among 13 patients. 9 patients had renal disease unilateral ureteral stone(n=3), staghorn calculi(n=2), acute renal failure from sepsis(n=1), renal contusion(n=2) and unilateral renal artery involvement by dissecting aortic aneurysm(n=1). Of these 9 patients, 3 patients showed abnormal serum creatinine levels at the time of presentation or shortly thereafter. In 6 patients, injection of a large amount of contrast media was possibly the additional cause of vicarius excretion. There was no detectable cause in the remaining 4 patients. Heterotopic excretion of contrast media is clearly a complex phenomenon, the reason for which it is difficult to establish with certainty in each individual case. Anyhow, vicarius excretion of contrast media occurs more frequently than previously thought, and it can occur not only with abnormal renal function but with normal function also.
Acute Kidney Injury ; Contrast Media ; Creatinine ; Gallbladder* ; Humans ; Renal Artery ; Ureter

Recently, accumulation of knowledge on cerebrovascular microanatomy and its hemodynamics and advances in interventional equipments, especially microcatheters, could make superselective embolization as well as for an adjunctive preoperative procedures The authors performed superselective angiography and embolization with Tracker microcatheter in 25 procedures out of 15 patients with brain arteriovenous malformations (AVMs). Complete embolization was done in 7 prtients (46.7%), nearly complete embolization in 6 patients(40.4%), and partial embolization in 2 patients (13.3%). The overall curative success rate of embolization was 86.7%. Five patients showed no complication at all. Mild complications, however, were observed in 7 patients (46.8%). Severe complications such as AVM or Tracker rupture were observed in 3 patients (20%). In conclusion, superselective embolization is and effective method for the treatment of brain AVMs, and multiple session embolizations could reduce the complication rate and increase the success rate.
Angiography ; Arteriovenous Malformations* ; Brain* ; Hemodynamics ; Humans ; Methods ; Preoperative Care ; Rupture

No abstract available.
Contrast Media* ; Glass* ; Syringes*

No abstract available.
Arteries*

Many reports have been published on the tissue damage of a shock wave with respect to histopatological changes in light microscopy and various imaging modalities. However, the studies on the electron microscopic findings and cause of renal functional change such as parenchymal obstructive pattern following extracorporeal shock wave lithotripsy (ESWL) have not been elucidated. In order to evaluate the microstructural changes after shock wave exposure, gross, light microscopic and trasmission electron microscopic findings were analyzed with rabbit kidneys. Preliminary study (n=2) was performed to determine the dosage intensity of shock waves to inflict damage, using a EDAP LT 01 piezoelectric extracorporeal shock wave lithotriptor. A shoke wave of various intensities were given to the left kidneys of 3 different groups of rabbits. Storage value of 100, 50, 25 at rate of 20/sec under 87% power were given to group I (n=4), group II (n=4), and group III(n=3) respectively. The right kidneys were preserved as the control group. The rabbits were killed 6-12 hours later. In gross, there were a few subcapsular hemorrhagic foci and mild congestion of corticomedullary junction without a large hematoma formation. No significant differences were noted between each group. Light microscopic findings were mainly hydropic changes in the proximal convoluted tubules and congestion without significant necrotic changes. The observed pathologic changes in the transmission electron microscopy were vacuolization of cytoplasm with swelling of epithelial cells especially porximal convoluted tubules. There were also tubular obstruction due to swelling and desquamation of epithelial cells into tubular lumen. The structural changes of intracellular organelles were not found at storage values of 25 and 50. But dilatation and structural alterations of endoplasmic reticulums were noted of 100 with cell membrane rupture. The findings of this study suggest that tubular obstructions with or without structural change of intracellular organelles is one cause of renal functional change such as parenchymal obstructive pattern after ESWL.
Cell Membrane ; Cytoplasm ; Dilatation ; Endoplasmic Reticulum ; Epithelial Cells ; Estrogens, Conjugated (USP) ; Hematoma ; Kidney* ; Lithotripsy ; Microscopy ; Microscopy, Electron, Transmission ; Organelles ; Rabbits ; Rupture ; Shock*

PURPOSE: The purpose of this study is to assess the effect of Transcatheter Arterial Embolization(TAE) according to anglographic findings in hepatocellular carcinoma. MATERIALS AND METHOD: We retrospectively reviewed 50 cases who received TAE for unresectable hepatocellular carcinoma. We analyzed the anglographic findings which were correlated with the effect of TAE. The common anglographic findings of the hepatocellular carcinoma were tumor staining, neovascularity and enlargement of feeding artery. These anglographic findings were classified into grade 0, +1, +2. Effect of TAE were classified into five patterns;good response, partial response, minimal response, no response and more aggravation. RESULT:In grading of tumor staining, among 50 cases, the grade 0, +1, +2 were seen in 1 case(2%), 14 cases(28%), 35 cases(70%) each. In grading of enlargement of feeding artery, the grade 0, +1, +2 were seen in 7 cases(14%), 19 cases(38%), 24 cases(48%) each. In grading of neovascularity, the grade 0, +1, +2 were seen in 6 cases(12%), 15 cases(30%), 29 cases(58%) each. This study showed that the higher grade of anglographic finding, the better effect of TAE. A statistically significant differance was found (p<0.005). But the TAE was not effective in some cases (the maximum diameter of mass is over 10cm, portal vein thrombosis or ateriovenous shunt) in spite of high grade. CONCLUSION: We believe that these angiogr. aphic findings (tumor staining, enlargement of feeding artery, neovascularity) are one of important indices for anticipating the effect of TAE in patients with unresectable hepatocellular carcinoma.
Arteries ; Carcinoma, Hepatocellular* ; Humans ; Retrospective Studies ; Venous Thrombosis

No abstract available.
Gallbladder* ; Lithotripsy*

PURPOSE: All procedures for the removal of retained intrahepatic stones were performed on inpatient basis. We evaluated the advantage of the procedures performed on inpatient basis compared with outpatient basis in terms of the success rate, causes of failure and the complication. MATERIALS AND METHODS: Percutaneous removal of retained intrahepatic stones was performed in 58 patients through a T-tube tract on inpatient basis from April 1990 to December 4992. Stones were exclusively intrahepatic in 28 patients, whereas 30 patients had combined stones in common bile duct. Preshaped catheters, baskets, and balloon catheters were used to remove the stones and dilate the strictures of the ducts. Extracorporeal shock wave lithotripsy and choledochoscopy with electrohydraulic lithotripsy were used to crush the impacted stones. RESULTS: The stones were completely removed in 34 (58.6%) of 58 patients and most of the stones were removed in 17 patients (29.3%). The overall success rate was 87.9%. The complications (cholangitis in 13% and pancreatitis in 0.8% per session) were found and successfully managed by appropriate care. CONCLUSION: Better success rate could be achieved by more aggressive appraoch on inpatient basis when compared with previous reports on outpatient basis. We suggest that the procedures should be performed on inpatient basis especially in a case with severe strictures or impacted stones.
Catheters ; Common Bile Duct ; Constriction, Pathologic ; Humans ; Inpatients ; Lithotripsy ; Outpatients ; Pancreatitis ; Shock

PURPOSE: Bronchial artery embolization has been effective in the treatment of massive hemoptysis. The purpose of this study was to report the effectiveness of bronchial artery embolization in patients with chronic recurrent hemoptysis intractable to medical treatment. MATERIALS AND METHODS: This study included 25 patients who were admitted for treatment of chronic recurrent hemoptysis with bronchial artery embolization. Chronic recurrent hemoptysis was defined as condition intractable to medical treatment persistently and occuring over two times per two months. The target vessels for embolization were selected in consideration of the results of aortography as well as the finding of chest radiography and bronchoscopy. After selective arteriography for embolization by using 5-French Simmons catheter, embolic agents(mainly polyvinyl alcohol(PVA) and additionally gelfoam and coils) were released through the catheter. The results of the embolization were assessed with the review of medical records. RESULT: The causes of the hemoptysis were pulmonary tuberculosis(n=12,48%), bronchiectasis(n=6,24%), aspergilloma(n=3,12%), chronic obstructive pulmonary disease(n=2,8%), chronic bronchitis(n=I,4%) and lung abscess(n=1,4%). Selective embolization was carried out in 49 sites(42 in bronchial artery and 7 in nonbronchial systemic collaterals). Early success rate within 2 months was 96%. After long-term follow up study (6-30 months, average 15 months), complete remission was 72%, partial remission 12% and recurrence 12% respectively. During and after embolization, major complications such as spinal cord injury or bronchial wall necrosis was not found. Minor complications were chest pain, shoulder pain and chilling sense, which were relieved spontaneously within a few days. CONCLUSION: High success rate and relatively low recurrence with no significant complication were achieved with bronchial artery embolization in the patients complaining of chronic recurrent hemoptysis.
Angiography ; Aortography ; Bronchial Arteries* ; Bronchoscopy ; Catheters ; Chest Pain ; Follow-Up Studies ; Gelatin Sponge, Absorbable ; Hemoptysis* ; Humans ; Lung ; Medical Records ; Necrosis ; Polyvinyls ; Radiography ; Recurrence ; Shoulder Pain ; Spinal Cord Injuries ; Thorax