PURPOSE: Acute diverticulitis of the right colon is not rare in Korea and the clinical presentation is indistin guishable from acute appendicitis. Cecal diverticulitis has led to a controversy in the management of disease. METHODS: Thirty-one cases of acute cecal diverticulitis who underwent operation for suspected acute appendicitis were reviewed retrospectively from January 1995 to December 1998. RESULTS: There were 17 men & 14 women. Ages ranged from 9 to 69 (mean: 37.5) years. All patients presented with signs and symptoms as acute appendicitis. All patients were explored through a transverse incision in the right lower quadrant under the impression of acute appendicitis. An appendectomy and drainage was performed in 13 patients, and resection of the lesion was performed in 18 patients (12 ileocecal resection, one partial cecectomy including appendix, one partial cecectomy and an appendectomy, 4 diverticulectomy and appendectomy), depending on the location of diverticulitis, severity of inflammation, and surgeon. Staples (TA(R), GIA(R)) were used in all cecal resection cases except for diverticulectomy. Five complications were observed, 3 in cecal resection cases (one wound seroma, one wound infection and one bleeding), and 2 in appendectomy and drainage cases (two wound infections). There was no postoperative mortality. The average length of the postoperative stay was 10.2 days in the drainage group and 8.8 days in the cecal resection group. Two recurrences were observed. One was the patient who had diverticulectomy performed. The other was a patient who had had appendectomy and drainage. CONCLUSION: We concluded that the preferred surgical management of an acute cecal diverticulitis operated for a presumed acute appendicitis is cecectomy using staples depending on its location and severity of inflammation. It was safe, relatively easy to do through the same incision, and could be a definitive treatment.
Appendectomy* ; Appendicitis ; Appendix ; Colon ; Diverticulitis* ; Drainage ; Female ; Humans ; Inflammation ; Korea ; Male ; Mortality ; Recurrence ; Retrospective Studies ; Seroma ; Wound Infection ; Wounds and Injuries

Choriocarcinoma associated with a normal pregnancy is rare. Futhermore, choriocarcinoma coexistent with a viable pregnancy is even rarer and associated with a greater risk of hepatic and cerebral involvement. So timely diagnosis of the disease is important for successful treatment and aggressive diagnostic procedures may therefore warranted. The patient should be treated with primary intensive combination chemotherapy(EMA-CO) and the selective use of irradiation and surgical therapy. We experienced a case of metastatic choriocarcinoma of lung and kidney following preterm delivery at 34th week of pregnancy and so present it with brief review of literature.
Choriocarcinoma* ; Diagnosis ; Female ; Humans ; Kidney ; Lung ; Pregnancy ; Pregnancy*

No abstract available.
Chorionic Gonadotropin* ; Humans* ; Hypertension* ; Pregnancy*

BACKGROUND: The differential diagnosis of common pigmented skin lesions is important in cosmetic dermatology. The computer aided image analysis would be a potent ancillary diagnostic tool when patients are hesitant to undergo a skin biopsy. OBJECTIVE: We investigated the numerical parameters discriminating each pigmented skin lesion from another with statistical significance. METHODS: For each of the five magnified digital images containing clinically diagnosed nevus, lentigo and seborrheic keratosis, a total of 23 parameters describing the morphological, color, texture and topological features were calculated with the aid of a self-developed image analysis software. A novel concept of concentricity was proposed, which represents how closely the color segmentation resembles a concentric circle. RESULTS: Morphologically, seborrheic keratosis was bigger and spikier than nevus and lentigo. The color histogram revealed that nevus was the darkest and had the widest variation in tone. In the aspect of texture, the surface of the nevus showed the highest contrast and correlation. Finally, the color segmented pattern of the nevus and lentigo was far more concentric than that of seborrheic keratosis. CONCLUSION: We found that the subtle distinctions between nevus, lentigo and seborrheic keratosis, which are likely to be unrecognized by ocular inspection, are well emphasized and detected with the aid of software.
Bioengineering ; Cosmetics ; Dermatology ; Diagnosis, Differential ; Humans ; Image Processing, Computer-Assisted ; Keratosis, Seborrheic ; Lentigo ; Nevus ; Skin

BACKGROUND: The differential diagnosis of common pigmented skin lesions is important in cosmetic dermatology. The computer aided image analysis would be a potent ancillary diagnostic tool when patients are hesitant to undergo a skin biopsy. OBJECTIVE: We investigated the numerical parameters discriminating each pigmented skin lesion from another with statistical significance. METHODS: For each of the five magnified digital images containing clinically diagnosed nevus, lentigo and seborrheic keratosis, a total of 23 parameters describing the morphological, color, texture and topological features were calculated with the aid of a self-developed image analysis software. A novel concept of concentricity was proposed, which represents how closely the color segmentation resembles a concentric circle. RESULTS: Morphologically, seborrheic keratosis was bigger and spikier than nevus and lentigo. The color histogram revealed that nevus was the darkest and had the widest variation in tone. In the aspect of texture, the surface of the nevus showed the highest contrast and correlation. Finally, the color segmented pattern of the nevus and lentigo was far more concentric than that of seborrheic keratosis. CONCLUSION: We found that the subtle distinctions between nevus, lentigo and seborrheic keratosis, which are likely to be unrecognized by ocular inspection, are well emphasized and detected with the aid of software.
Bioengineering ; Cosmetics ; Dermatology ; Diagnosis, Differential ; Humans ; Image Processing, Computer-Assisted ; Keratosis, Seborrheic ; Lentigo ; Nevus ; Skin

Several studies report varing incidence of spinal cord injury without radiologic abnormality (SCIWORA) from 21% to 66% in children. Fifty-five percentage of SCIWORA involves the cervical cord. The mechanisms of neural damage of SCIWORA include flexion, hyperextension, longitudinal distraction and ischemia. But spinal cord infarction related to vertebral arterial injury is rare. The authors report a case of selective spinal cord infarction on gray matter with unilateral vertebral artery injury after a minor trauma, in a 4-year-old boy. Neurological signs and symptoms developed 12 hours after the trauma. Initial postcontrast magnetic resonance imaging (MRI) showed an enhancement in the left vertebral artery. Follow up postcontrast MRI showed a selective signal change on the central gray matter and unilateral vertebral artery. We present this case with the review of literatures.
Child* ; Child, Preschool ; Follow-Up Studies ; Humans ; Incidence ; Infarction* ; Ischemia ; Magnetic Resonance Imaging ; Male ; Spinal Cord Injuries ; Spinal Cord* ; Vertebral Artery*

OBJECTIVE: The purpose of this study was to evaluate and compare the natural course of morphologic changes and clinical outcomes between large central extruded disc herniation and sequestration. METHOD: The study population consisted of 22 patients with sequestration and large central extrusion by an magnetic resonance (MR) imaging study. Seventeen (11 patients with sequestration, 6 patients with large central extrusion) patients underwent a follow-up MR imaging study. The size of herniated disc was measured on serial MR imaging studies and the change in size was classified into four categories. Clinical evaluations were also done using visual analogue scale (VAS), Oswestry low back pain disability questionnaire scoring, straight leg raising test (SLRT) and so forth. RESULTS: Successful clinical improvement was achieved in both groups. The VAS and Oswestry disability scoring established a greater change in the group with sequestration than in the group with large central extrusion. Greater morphologic decrease in the herniated discs occurred more frequently in sequestered disc herniation than large central extruded disc herniation. CONCLUSION: Both sequestered disc and large central extruded disc herniation could be treated successfully by conservative treatment.
Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Leg ; Low Back Pain ; Magnetic Resonance Imaging ; Surveys and Questionnaires

PURPOSE: we often find variable degrees of FDG uptake and patterns in stomach, which can make difficult to distinguish physiologic uptake from pathologic uptake on FDG PET. The purpose of this study was to find out the significant findings of stomach on FDG PET. MATERIALS AND METHODS: Thirty-eight patients who underwent both FDG PET and endoscopy within one week from Jun. 2003, to Aug. 2004 were included in this study. We reviewed 38 patients (18 for medical check up, 15 for work up of other malignancies, and 5 for the evaluation of stomach lesion). Their mean age was 56 years old (range: 32~79), men and women were 28 and 10, respectively. Two nuclear physicians evaluated five parameters on FDG PET findings of stomach with a consensus: 1) visual grades 2) maximum SUV (max.SUV) 3) focal 4) diffuse and 5) asymmetric patterns. We correlated the lesions of FDG PET findings of stomach with those of endoscopy. We considered more than equivocal findings on FDG PET as positive. RESULTS: The six of 38 patients were proven as malignant lesions by endoscopic biopsy and others were inflammatory lesions (ulcer in 3, chronic atrophic gastritis in 12, uncommon forms of gastritis in 5), non-inflammatory lesions (n=3), and normal stomach (n=9). By the visual analysis, malignant lesions had higher FDG uptake than the others. The max.SUV of malignant lesions was 7.95 4.83 which was significantly higher than the other benign lesions (2.9 0.69 in ulcer, 3.08 1.2 in chronic atrophic gastritis, 3.2 1.49 in uncommon forms of gastritis (p=0.044) ). In the appearance of stomach on FDG PET, malignant lesions were shown focal (5 of 6) and benign inflammatory lesions were shown diffuse (9 of 20) and asymmetric (14 of 20). Benign lesions and normal stomach were shown variable degrees of uptake and patterns. Some cases of benign inflammatory lesions such as ulcer and gastritis were shown focal and mimicked cancerous lesion (4 of 15). CONCLUSION: Gastric malignant lesions had higher FDG uptake and focal pattern. However, benign inflammatory lesions had moderate degrees of uptake and diffuse and asymmetric patterns rather than focal. It is difficult to differentiate between benign lesions including normal.
Biopsy ; Consensus ; Electrons* ; Endoscopy ; Female ; Gastritis ; Gastritis, Atrophic ; Humans ; Male ; Middle Aged ; Positron-Emission Tomography* ; Stomach* ; Ulcer

BACKGROUND/AIMS: Infection of pancreatic necrosis is one of the leading cause of death in patients with severe necrotizing pancreatits. Because of high mortality rate up to 50%, immediate surgical debridement including pancreatectomy is recommended. However, early surgical treatment still showed high mortality rate and better treatment strategy is required. This study was conducted to evaluate the outcomes of early intensive non-surgical treatments in patients with infected necrotizing pancreatitis. METHODS: This study was based on retrospective analysis of 71 patients with acute severe necrotizing pancreatitis (APACHE II score>or=8, or Ranson's score>or=3, and pancreatic necrosis on CT scan), who were admitted to medical center during past 16 years. Infection of pancreatic necrosis was confirmed by fine needle aspiration, and early intensive medical treatments comprised of prophylactic antibiotics coverage, fluid resuscitation, organ preserving supportive measures, and percutaneous catheter drainage were carried out. RESULTS: Among the enrolled patients, infections were suspected in 46 patients, but fine needle aspirations were done only in 32 patients. In 21 patients, infections of necrotic tissue were confirmed by bacteriology, while other 11 patients showed no evidence of bacterial growth. Of 21 patients with infected necrosis, initial surgical interventions were performed in 2 patients, while initial medical treatments were performed in 19 patients. The success rate of medical treatment group in infected necrotizing pancreatitis was 79% (15/19). The mortality rate of medical treatment group and surgical treatment group was 5% (1/19) and 50% (1/2). CONCLUSIONS: Early intensive medical treatment seems to be a good therapeutic strategy, even if the infection has developed in pancreatic necrosis. Further prospective randomized studies are required to confirm this finding.
Bacterial Infections/diagnosis/*prevention & control ; Humans ; Pancreatitis, Acute Necrotizing/complications/diagnosis/*therapy ; Retrospective Studies ; Treatment Outcome

A prospective and longitudinal investigation concerning clinical outcomes and morphologic changes of large lumbar disc herniations by MR imaging. To compare the clinical outcomes and the natural morphologic changes of between sequestered and large central extruded disc herniations. The spontaneous disappearance or diminution of large herniated lumbar discs in the spinal canal is known. Poor clinical outcome and small changes of herniated discs have been shown for large central extruded disc herniations with conservative treatment. The study population consisted of 22 patients with sequestration and a large central as extrusion established by an MR imaging study. Seventeen (11 patients with sequestration, and 6 patients with a large central extrusion) patients underwent a follow-up MR imaging study. The size of the herniated disc was measured on serial MR imaging studies, and the changes in size were classified into four categories. Clinical evaluations were also performed using a visual analogue scale (VAS), the Oswestry lowback pain disability questionnaire, the straight leg raising test (SLRT) and so forth. Both the sequestered and large central extruded disc herniations showed a successful clinical outcome after conservative treatment in 17 of 22 patients (77%) in total: 11 of 13 patients (85%) with sequestered disc herniations, and 6 of 9 patients (67%) with large central extruded disc herniations. VAS and Oswestry disability scoring showed a greater change in the group with sequestration than in the group with large central extrusions. In the group with sequestration, seven patients reported the disappearance of herniated disc materials, and four patients showed a marked decrease in the size of their herniated discs in follow-up MR images. However, in the group with large central extrusions, only two patients showed a decrease in the size of their herniated discs. Large central extruded disc herniations can be treated successfully by conservative treatment. Outcomes seemed to be as good as or slightly inferior to those of sequestered disc herniations. However, a greater morphologic decrease in the herniated discs occurred more frequently for sequestered disc herniations than for large central extruded disc herniations.
Adult ; Aged ; Comparative Study ; Female ; Human ; Intervertebral Disk Displacement/*diagnosis/*therapy ; Longitudinal Studies ; *Magnetic Resonance Imaging ; Male ; Middle Age ; Prospective Studies ; Treatment Outcome