PURPOSE: The residual intrahepatic stones with biliary strictures are difficult to remove percutaneously via T-tube tract after surgery in patients with recurrent pyogenic cholangitis. We evaluated the effectiveness of percutaneous balloon dilatation of benign biliary strictures. MATERIALS AND METHODS: The balloon dilatations with 6-12mm angioplasty balloon catheter and stone extractions were performed via a T-tube tract after surgical treatment in 15 patients with recurrent pyogenic cholangitis. The balloons were inflated for 3-4minutes under 5 atm. until disappearance of waist of the stricture site, from one to seven session. After balloon dilatation, residual stones were extracted with saline irrigation or stone basket. RESULTS: Among total 42 strictures, the balloon dilatation was succesful in 27 strictures(64.3%), partially successful in 12 strictures(28.6%), and failed in three strictures(7.1%). Single or central biliary strictures were dilated easily rather than multiple ductal strictures. Of 26 sites with residual intrahepatic stones, stone extraction was complete in 17 sites(65.4%), incomplete in seven sites(26.9%) due to impacted or large stone and acute ductal angulation, and failed in two sites(7.7%). CONCLUSION: Percutaneous balloon dilatation of benign biliary strictures is an effective procedure for extraction of residual intrahepatic stones associated with recurrent pyogenic cholangitis.
Angioplasty ; Catheters ; Cholangitis ; Constriction, Pathologic* ; Dilatation* ; Humans

PURPOSE: To evaluate changes of pancreatic size with aging in control subjects and in non-insulin-dependent diabetic patients. MATERIALS AND METHODS: Two groups of non-insulin-dependent diabetic patients were examined; one had been treated with an oral hypoglycemic agent(n=59), and the other with insulin(n=56). The CT findings of 175 patients without clinical evidence of pancreatic disease were included as a normal control. RESULTS: In control subjects, pancreatic size and age correlated. The pancreas was smaller in non-insulin-dependent diabetics than incontrol subjects and smaller in insulin- treated non-insulin-dependent diabetics than in non-insulin treated patients. CONCLUSION: The pancreas was smaller in non-insulin-dependent diabetic patients than in control subjects within the same age range.
Aging ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Humans ; Pancreas* ; Pancreatic Diseases

PURPOSE: To evaluate the usefulness of US-guided percutaneous gun biopsy through the left lobe of the liverwith compression for the diagnosis of diffuse hepatic diseases and prevention of post-biopsy complications. MATERIALS AND METHODS: In 35 patients with diffuse hepatic diseases, we performed US-guided percutaneous biopsy via the left lobe of the liver. After biopsy, we immediately applied an extrinsic hands-on compression maneuver at the biopsy site. The integrity of tissue architecture and numbers of portal triad visible in each specimen were histologically examined and post-biopsy complications were documented. RESULTS: A histopathologic diagnosis could be made in all patients except one(97.1%). Microscopically, no significant crush artifact or fragmentation was demonstrated in these 34 patients. The average number of portal triad per specimen was about 4.1. Although two patients complained of severe pain at the biopsy site, no serious post-biopsy complication was noted. CONCLUSION: US-guided percutaneous gun biopsy through the left lobe of the liver with compression appears to be an effective and safe procedure for the evaluation of diffuse hepatic diseases.
Artifacts ; Biopsy* ; Diagnosis ; Hemostasis* ; Humans ; Liver*

STUDY DESIGN: A retrospective study OBJECTIVES: To study the socio-psychological adaptation through the psychoanalysis in the patients with spinal cord injury. MATERIALS AND METHODS: From May 1998 to Aug. 2003 we chose the 15 patients who have been undergone surgery for spinal cord injury after spinal fracture. Psycological analysis were based on the Korean version of Beck Depression Index(K-BDI), Hamilton Anxiety Scale, and the Minnesota Multiphasic Personality Inventory(MMPI), and valuation of quality of life. RESULTS: K-BDI applied results showed an average of 33.5+/-10.3, having a higher average than normal. Hamilton Anxiety Scale resulted with an average of 32.4+/-9.4. 4 patients were taken intensive care psychologically beause of depression. The Lie score out of the MMPI`s suitability scale showed 43.3+/-9.7, Validity score as 75.4+/-23.6, and Defensiveness score with 47.7+/-10.6 as average and standard deviation, resulting a higher as to normal. Further more, clinical scales of Hypochondriasis scale was 69.9+/-12.6, Depression as 65.5+/-15.3, Hysteria scale as 67.9+/-11.5, Psychopathic deviate as 65.6+/-12.1, Paranonia as 71.9+/-17.6, Psychasthenia scale as 67.9+/-12.3, Schizophrenia as 70.4+/-17.8, Hypomania scale as 54.0+/-11.3, and social introversion scale as much as 60.1+/-15.0 higher than normal. In evaluation the quality of life, there was a prominent issue in the occupation(0.1) and economic independence(0.5) out of the total 6 items, difference was 0.6, social adaptation was 0.8, physical independence was 0.7 and orientation(1.6) was similar to normal person. CONCLUSION: As the physical and the psychological changes abrupt at the same time with the spinal cord injury, it is important to encourage the patients to have a strong ego to have an optimistic confidence of recuperation.
Anxiety ; Depression ; Ego ; Humans ; Hypochondriasis ; Hysteria ; Critical Care ; Introversion (Psychology) ; Minnesota ; Psychoanalysis ; Quality of Life* ; Retrospective Studies ; Schizophrenia ; Spinal Cord Injuries* ; Spinal Cord* ; Spinal Fractures* ; Weights and Measures

STUDY DESIGN: A retrospective study OBJECTIVES: To study the socio-psychological adaptation through the psychoanalysis in the patients with spinal cord injury. MATERIALS AND METHODS: From May 1998 to Aug. 2003 we chose the 15 patients who have been undergone surgery for spinal cord injury after spinal fracture. Psycological analysis were based on the Korean version of Beck Depression Index(K-BDI), Hamilton Anxiety Scale, and the Minnesota Multiphasic Personality Inventory(MMPI), and valuation of quality of life. RESULTS: K-BDI applied results showed an average of 33.5+/-10.3, having a higher average than normal. Hamilton Anxiety Scale resulted with an average of 32.4+/-9.4. 4 patients were taken intensive care psychologically beause of depression. The Lie score out of the MMPI`s suitability scale showed 43.3+/-9.7, Validity score as 75.4+/-23.6, and Defensiveness score with 47.7+/-10.6 as average and standard deviation, resulting a higher as to normal. Further more, clinical scales of Hypochondriasis scale was 69.9+/-12.6, Depression as 65.5+/-15.3, Hysteria scale as 67.9+/-11.5, Psychopathic deviate as 65.6+/-12.1, Paranonia as 71.9+/-17.6, Psychasthenia scale as 67.9+/-12.3, Schizophrenia as 70.4+/-17.8, Hypomania scale as 54.0+/-11.3, and social introversion scale as much as 60.1+/-15.0 higher than normal. In evaluation the quality of life, there was a prominent issue in the occupation(0.1) and economic independence(0.5) out of the total 6 items, difference was 0.6, social adaptation was 0.8, physical independence was 0.7 and orientation(1.6) was similar to normal person. CONCLUSION: As the physical and the psychological changes abrupt at the same time with the spinal cord injury, it is important to encourage the patients to have a strong ego to have an optimistic confidence of recuperation.
Anxiety ; Depression ; Ego ; Humans ; Hypochondriasis ; Hysteria ; Critical Care ; Introversion (Psychology) ; Minnesota ; Psychoanalysis ; Quality of Life* ; Retrospective Studies ; Schizophrenia ; Spinal Cord Injuries* ; Spinal Cord* ; Spinal Fractures* ; Weights and Measures

Alveolar Bone Grafting ; Alveolar Process ; Bone Marrow ; Bone Transplantation ; Busan ; Female ; Humans ; Male ; Maxilla ; Surgery, Oral ; Transplants

PURPOSE: To evaluate two-phase dynamic CT with water as oral contrast agents in the CT diagnosis of gastric stromal tumors. MATERIALS AND METHODS: We retrospectively reviewed the CT findings in 21 patients with pathologically proven gastric stromal tumors. Six were found to be benign, twelve were malignant, and there were three cases of STUMP (stromal tumor uncertain malignant potential). Two-phase dynamic CT scans with water as oral contrast agents were obtained 60-70secs (portal phase) and 3 mins (equilibrium phase) after the start of IV contrast administration. We determined the size, growth pattern, and enhancement pattern of the tumors and overlying mucosa, the presence or absence of ulceration and necrosis, tumor extent, and lymph node and distant metastasis. The CT and pathologic findings were correlated. RESULTS: All six benign tumors and three STUMP were less than 5.5 cm in size, and during the portal phase showed round endogastric masses with highly enhanced, intact overlying mucosa. Twelve malignant tumors were 4.5-15.5 cm in size (mean, 11.5cm); an endogastric mass was seen in three cases, an exogastric mass in one, and a mixed pattern in eight. On portal phase images the tumors were not significantly enhanced, but highly enhanced feeding vessels were noted in five larger tumors (> 10 cm). All 12 malignant tumors showed ulceration and necrosis, and interruption of overlying mucosa was clearly seen during the portal phase. We were readily able to evaluate tumor extent during this phase, and in ten malignant tumors there was no invasion of adjacent organs. Seven malignant tumors showed air density within their necrotic portion (p<0.05). On equilibrium phase images, all malignant tumors showed heterogeneous enhancement due to necrosis, and poorly enhanced overlying mucosa. CONCLUSION: Dynamic CT during the portal phase with water as oral contrast agents was useful for depicting the submucosal origin of gastric stromal tumors and for evaluating the extent of malignant stromal tumors. Our results suggest that these CT findings may be helpful for differentiating between benign and malignant stromal tumors, and in distinguishing them from other gastric tumors.
Contrast Media* ; Diagnosis ; Humans ; Lymph Nodes ; Mucous Membrane ; Necrosis ; Neoplasm Metastasis ; Retrospective Studies ; Tomography, X-Ray Computed ; Ulcer ; Water*

PURPOSE: To evaluate the usefulness of two-phase helical CT in patients with recurrent pyogenic cholangitis (RPC) for the detection of acute inflammation and assessment of the degree of portal vein (PV) stenosis as a cause of hepatic parenchymal atrophy. MATERIALS AND METHODS: We retrospectively reviewed two-phase CT findings in 30 patients with RPC diagnosed by CT, ERCP (endoscopic retrograde cholangiopancreatography), and surgery. Two-phase helical CT scans were obtained 30 sec (arterial phase, AP) and 70 sec (portal phase, PP) after the start of IV administration of contrast material. Without prior information, we analyzed periductal parenchymal and ductal wall enhancement during the AP and PP, and the degree of PV stenosis during the PP. Acute inflammation was diagnosed on the basis of symptoms and laboratory findings. To evaluate the relationship between parenchymal atrophy and PV stenosis, the degree of PV stenosis in affected parenchyma was classified as one of three types (mild,<25%; moderate, 25-75%; severe, >75%), as compared with the diameter of normal PV in unaffected parenchyma. RESULTS: Ten of the 30 patients underwent CT during the acute inflammatory stage and 20 during the remission stage. Of the ten patients with acute inflammation, eight (80%) showed transient periductal parenchymal enhancement during the AP (p<0.05), which correlated closely with acute inflammation. Only three (15%) of the 20 patients with remission, however, showed transient parenchymal enhancement during this phase, at which time ductal wall enhancement was seen in three (30%) of the ten patients with acute inflammation and in seven (35%) of the 20 who showed remission (p>0.05). There was no significant difference in parenchymal and ductal wall enhancement during the PP between patients with acute inflammation and those who showed remission (p>0.05). Hepatic parenchymal atrophy of the lesion was seen in 24 patients. Among these, PV stenosis was mild in five (21%), moderate in 14 (58%), and severe in five (21%). Degree of PV stenosis correlated closely with severity of parenchymal atrophy during the PP. In six patients without parenchymal atrophy, PV caliber was normal. CONCLUSION: Our results suggest that in patients with RPC, two-phase helical CT is useful for the detection of transient periductal parenchymal enhancement accompanying acute inflammation during the AP, and for assessment of the degree of PV stenosis as a cause of hepatic parenchymal atrophy during the PP.
Atrophy ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis* ; Constriction, Pathologic ; Humans ; Inflammation ; Portal Vein ; Retrospective Studies ; Tomography, Spiral Computed*

PURPOSE: To assess the usefulness of a CT severity index(CTSI) for the evaluation of acute pancreatitis and to correlate it with clinical findings. MATERIALS AND METHODS: We retrospectively evaluated contrast enhanced CT in 34 patients with acute pancreatitis. They were categorized into low-score(0-2), middle-score(3-6), and high-score(7-10) groups according to CTSI points, and those groups were correlated with duration of fasting period, days in hospital morbidity and mortality. We attempted to determine the differences in CTSI between pancreatitis caused by alcohol and by biliary tract disease. RESULTS: Of 34 patients, 11 were placed in the low-score group, 19 in the middle-score group, and 4 in the high-score group. The patients in the middle-score group experienced longer fasting period and stayed longer in hospital than those in the low-score group(p<.05 and p=.08, respectively). Morbidity was 0% in the low-score group, 37% in the middle-score group and 50% in the high-score group. Mortality occurred in two patients in high-score group, only. Alcohol-induced pancreatitis generally showed a higher CTSI and more severe clinical course than pancreatitis caused by biliary tract disease. CONCLUSION: In the evaluation of acute pancreatitis, CTSI can be a useful predictor of its prognosis.
Biliary Tract Diseases ; Fasting ; Humans ; Mortality ; Pancreatitis* ; Prognosis ; Retrospective Studies

PURPOSE: A number of researchers have suggested the use of sodium hyaluronate carboxymethyl cellulose (HA-CMC) membrane for preventing postoperative adhesion. This study evaluated the antiadhesive effect and safety of HA-CMC membrane in thyroidectomy for papillary thyroid cancer. METHODS: One hundred sixty-two patients who underwent thyroidectomy were prospectively randomized. In the study group of 80 patients, the 7.5 cm x 13 cm HA-CMC membrane was applied to the operative field after thyroidectomy. The subjects were asked about complications including adhesive symptoms using an 8-item questionnaire at 2 weeks, 3 months, and 6 months after surgery. In addition, items on the appearance of neck wrinkles and scars were evaluated by a physician who had no information about the patient's allocation. RESULTS: There were no significant differences in complications such as swallowing difficulty, and wrinkles between study and control groups. Both groups presented significantly decreased scores over time in swallowing difficulty, and wrinkles. There were no complications regarding the HA-CMC membrane. CONCLUSION: The antiadhesive effect of HA-CMC membrane in thyroid surgery is still uncertain, although it is biologically safe. Further investigation is needed to confirm the antiadhesive effect of HA-CMC membrane in thyroid surgery.
Adhesives ; Carboxymethylcellulose Sodium ; Cellulose* ; Cicatrix ; Deglutition ; Humans ; Hyaluronic Acid ; Membranes* ; Neck ; Prospective Studies ; Surveys and Questionnaires ; Sodium* ; Thyroid Gland* ; Thyroidectomy