The authors devdeloped a computer program for automatic coding of ACR (American College of Radiology) code. The automatic coding of the ACR code is essential for computerization of the data in the department of radiology. This program was written in FoxBASE language and has been used for automatic coding of diagnosis in the Deparment of Radiology, Wallace Memorial Baptist Hospital since May 1992. The ACR dictionary files consisted of 11 files, one for the organ code and the others for the pathology code. The organ code was obtained by typing organ name or code number itself among the upper and lower level codes of the selected one that were simultaneously displayed on the screen. According to the first number of the selected organ code. the corresponding pathology code file was chosen augomatically. By the similar fashion of organ code selection, the proper pathologic dode was obtained. An example of obtained ACR code is "131.3661". This procedure was reproducible regardless of the number of fields of data. Bacause this program was written in "User's Defined Function" from, decoding of the stored ACR code was achieved by this same program and incoporation of this program into another data processing program was possible. This program had merits of simple operation, accurate and detail coding, and easy adjustment for another program. Therefore, this program can be used for automation of routine work in the department of radiology.
Automation ; Clinical Coding* ; Diagnosis ; Methods* ; Pathology ; Protestantism

Magnetic resonance images frequently demonstrate asymmetrical mucosal volume in the nasal area of asymptomatic patients. To further evaluate this phenomenon, sequential MR examinations of the nasal cavity and paranasal sinuses were performed three to four times during a 3 to 8 hours period in ten normal volunteers. The study demonstrated that the mucosal volume changes alternated from side to side during this period in eight volunteers. Changes were also observed within the ethmoid sinuses, nasal septum and nasolacrimal ducts. Awareness of MR findings of nasal cycle may reduce the likehood of inflammatory disease being confused with normal physiologic changes, and also may provide another method in the study of this physiologic phenomenon.
Ethmoid Sinus ; Healthy Volunteers ; Humans ; Methods ; Nasal Cavity ; Nasal Septum ; Nasolacrimal Duct ; Paranasal Sinuses ; Volunteers

PURPOSE: The aim of this study was to estimate the degree of difficulty in total mesorectal excisions (TMEs) for rectal cancer by using statistical methods after analysis of factors affecting the resection time and incomplete resection. METHODS: A total of 63 patients who underwent a total mesorectal excision for rectal cancer were evaluated. MRI pelvimetry data {(transverse diameter (TD), obstetric conjugate (OC), interspinous distance (ID), sacrum length (SL), sacrum depth (SD)}, tumor size (TS), T stage, and body mass index (BMI) were prospectively analyzed. A stepwise multiple regression analysis was performed to determine the operating time prediction equation by using these variables, and the differences in the mean operating time hased on gross evaluations of each specimen were analyzed. RESULTS: A stepwise multiple regression with the operating time as a dependent variable led to the following equation: Operation time (min)=35.726-2.162xTD (cm)-2.324 x OC (cm) + 2.671 x SL (cm) + 1.274 x TS (cm), with r2=0.533 and SEE=5.438. The mean operating time according to a gross evaluation of the TME specimen was 20.0 +/- 7.3 min in complete TME cases (n=42) and 27.9 +/- 7.2 min in incomplete TME cases (n=21) (P<0.001). CONCLUSIONS: MRI pelvimetry data (TD, OC, SL) and tumor size were factors affecting the operation time in TMEs for rectal cancer, and the operating time could be predicted by using the equation of the present study. Also, the mean operating time in incomplete TME cases was longer than that in complete TME cases. Thus, the degree of difficulty of an operation for rectal cancer can be predicted by using these factors.
Body Mass Index ; Humans ; Magnetic Resonance Imaging ; Pelvimetry ; Prospective Studies ; Rectal Neoplasms* ; Sacrum

Retrorectal cystic harmatoma; Tailgut cyst, is a rare congenital disease typically presented as presacral mass, and malignant change of this disease is extremely rare. Frequently, This disease is misdiagnosed or confused at initial time. So, we have a case of tailgut cyst and report the clinical symptom and the result. A 40-year-old woman has admitted at Severance hospital for the anal pain. About 6cm sized irregular cystic and solid mass in the retrorectal area involving coccygeal bone and right gluteal muscle tendon were detected in magnetic resonance image. Under the impression of malignant tailgut cyst, the patient underwent Hartmann's operation (abdomino-sacral approach) under the sacral resection (S4, 5). The pathology was adenocarcinoma (poorly differentiated) arising from a tailgut cyst involving rectal adventitia, gluteus muscle and sacral bone. For the following 4 months after the operation, The patient is doing well with no evidence of recurrence.
Adenocarcinoma* ; Adult ; Adventitia ; Female ; Humans ; Pathology ; Recurrence ; Tendons

PURPOSE: As the oncologic safety of coloanal anastomosis (CAA) has been proven by many other authors, the incidence of CAA following a ultra-low anterior resection has increased. The purpose of this study is to evaluate the functional outcomes and complications for patients who underwent an ultra-low anterior resection and CAA for distal rectal cancer. METHODS: 57 patients underwent CAA following an ultra-low anterior resection between July 1997 and November 2003. 44 patients, who were followed up for more than 6 month after diverting ileostomy repair were evaluated for recurrence pattern, complications, and functional outcomes. RESULTS: The median follow-up period was 32.0+/-22.8 (8~83) months. The mean age of the patients was 54.3+/-10.4 (23~74) years. The types of anastomosis were straight CAA (n=20) and J pouch CAA (n=37). The mean tumor size was 4.1+/-1.9 (2~8) cm, the mean distal resection margin was 1.3+/-0.9 (0.2~4) cm. Six months later, the anastomosis distance following diverting ileostomy repair was measured at 3.24+/-0.6 (2~4) cm from the anal verge. The complications were multiple fistulas (n=3), fistula with anal stenosis (n=1), local recurrence with anal stenosis (n=1), anal stenosis (n=7). Anal incontinence (Kirwan grade III) was noted in 14 patients, and bowel movements more than 6 times per day were observed in 16 patients. Overall recurrence occurred in 6 patients (13.6%). The 5-years survival rate was 84.4%, and the 5-year disease-free survival was 68.9%. CONCLUSIONS: Although CAA in patients with rectal cancer provides excellent long-term survival, a low risk of recurrence, in tolerable function, complications, and poor functional outcomes have been observed with CAA; therefore, the choice of this method should be considered carefully.
Colonic Pouches ; Constriction, Pathologic ; Disease-Free Survival ; Fistula ; Follow-Up Studies ; Hand* ; Humans ; Ileostomy ; Incidence ; Rectal Neoplasms* ; Recurrence ; Survival Rate

PURPOSE: The management of local recurrence after curative surgery of the rectal cancer remains difficult clinical problems to surgeons. This study was performed to analyze the outcomes of patients with local pelvic recurrence according to its recurrence type. METHODS: A total 109 patients with local recurrence were evaluated. Among the 109 patients 62 were local recurrence alone and 47 were both local and systemic recurrence. The recurrence type was classified as Central, Anterior, Posterior, Lateral and Perineal recurrence according to the relation of the tumor location and either intra pelvic organ and/or fixed pelvic structure. RESULTS: Only 26 (23.9%) of the 109 patients had curative resection and the remaining 83 (76.1%) patients had palliative exploration or nonsurgical procedure. The resectability according to the recurrence type showed that the Central and Anterior type was higher than other type of recurrences (P=0.001). When the primary operation was Abdominoperineal Resection (APR) the resectability was poorer than Low Anterior Resection (LAR) (P=0.0001). When comparing the patients with local recurrence alone, the 5 year survival rate was significantly higher patients treated by curative resection than palliative or non-resection group (P=0.002). Mean follow up period was 44.2+/-30.0 months and mean recurrence time between primary operation and recurrence was 26.0+/-22.7 months. CONCLUSIONS: Resection for central type of the recurrent is potentially curative, however treatment failure was common when the recurrence invaded fixed pelvic structure. Our data suggest that local pelvic recurrence should be treated with radical resection as can as possible.
Classification* ; Follow-Up Studies ; Humans ; Prognosis* ; Rectal Neoplasms* ; Recurrence* ; Survival Rate ; Treatment Failure

The case of a 23-year-old female treated with aggressive high-dose therapy for Burkitt's lymphoma is reported. A positron emission tomography and computed tomography scan after completion of chemotherapy revealed a residual hypermetabolic lesion in the right pelvic cavity. A pelvic magnetic resonance imaging scan showed circumferential wall thickening at the tip of the appendix. A laparoscopic exploration and appendectomy were performed, and a pathologic examination of the resected appendix revealed xanthogranulomatous appendicitis. This is a rare case of a xanthogranulomatous appendicitis mimicking remnant Burkitt's lymphoma after completion of chemotherapy.
Appendectomy ; Appendicitis* ; Appendix ; Burkitt Lymphoma* ; Drug Therapy* ; Female ; Humans ; Magnetic Resonance Imaging ; Positron-Emission Tomography ; Young Adult

PURPOSE: To determine the correlation between areas of decreased parenchymal attenuation seen in cases of bronchiectasis, and the severity and extent of the condition, as revealed by HRCT and the plmonary function test (PFT). MATERIALS AND METHODS: The findings of forty-five patients with bronchiectasis who had undergone PFT and HRCT were retrospectively analysed. CT scores were calculated according to the severity and extent of the condition, and areas of low attenuation, and the correlation coefficients between these were determined. Bronchiectasis was classified as either cylindrical or cystic, and using Student's t test, the statistical significance of the results of the PFT were determined. RESULT: The severity and extent of bronchiectasis correlated with the extent of areas of low attenuation (r > .45, p < .05), with especially significant correlation between the extent of these areas and the extent of the condition (r =.84, p=.0001). Correlation was greater in cases involving the cylinlrical variety than the cystic. The extent of low attenuation areas correlated with FEV1, FVC, MMEF, and DLCO (r > .44, p < .01). The functional parameters of the PFT which help differentiate between cylindrical and cystic bronchiectasis are FEV1, FVC, MMEF, DLCO (p < .01), RV, and TLC (p < .05). CONCLUSION: In patients with bronchiectasis, the extent of the condition correlated closely with the extent of low attenuation, and the latter, especially in cases of cylindrical bronchiectasis, showed significant correlation with the extent of abnormalities revealed by the pulmonary function test.
Bronchiectasis* ; Humans ; Respiratory Function Tests* ; Retrospective Studies

PURPOSE: Studies of the circumferential resection margin (CRM) in rectal cancer surgery have revealed that inadequate surgical excision correlates with a high risk of recurrence. This study was designed to evaluate the prognostic value of the CRM in rectal cancer. METHODS: All 504 patients who underwent a total mesorectal excision for rectal cancer between 1997 and 2001 were studied. The distance between the CRM and the tumor on pathology slides (HE stain, x 20 times) was measured. The CRM was stained by using the Davidson marking system(R) (Bradley Product, Inc. USA), and a micrometer was used for the measurement. We divided the patients into a negative CRM group (CRM >3 mm), an abutting CRM group (CRM < or =3 mm without involvement), and a positive CRM group (CRM was in the tumor), and compared the oncologic results among the groups. RESULTS: The numbers of patients in the negative CRM, the abutting CRM, and the positive CRM groups were 452, 18, and 34 respectively. The mean follow- up durations were 45.1 months (range, 1.1~88.7), 41.9 months (range, 10.7~75.2), and 33.0 months (range, 4.8~83.4), respectively. The Aslter-Coller stages of all patients were from B2 to C3. The local recurrence rate, the systemic recurrence rate, and the combined recurrence rate were, respectively, 5.5%, 17.3%, and 3.8% in the negative CRM group (>3 mm), 5.6%, 38.9%, and 5.6% in the abutting CRM group, and 8.8%, 44.1%, and 8.8% in the positive CRM group. The five-year survival rates for the negative CRM, the abutted CRM and the positive CRM groups were 73.3%, 48.4%, and 25.5% (P<0.001), respectively, and the disease-free 5-year survival rates were 63.1%, 30.6%, 24.0% (P<0.001). The CRM was shown to be an independent prognostic factor by multivariate analyses adjusted for known predictors of outcome (P<0.001). CONCLUSIONS: The prognosis for a member of the abutting or the positive CRM group was more unfavorable than it was for a member of the negative CRM group; therefore, measurement of the CRM should be reported in the pathologic report. For patients with an abutting or a positive CRM, neoadjuvant or adjuvant chemoradiotherapy should be considered for better oncologic outcomes.
Chemoradiotherapy, Adjuvant ; Humans ; Multivariate Analysis ; Pathology ; Prognosis ; Rectal Neoplasms* ; Recurrence ; Survival Rate

PURPOSE: Tumor response of patients with locally advanced rectal cancer after chemoradiation showed 60~70% of tumor volume reduction and T and N downstaging. Curative resection with total mesorectal excision should be followed for good oncologic outcomes. This study was designed to analyze the oncologic outcomes in patients who received preoperative chemoradiation followed by total mesorectal excision for locally advanced rectal cancer according to pathologic T and N stage. METHODS: Total 108 patients with locally advanced rectal cancer treated between 1989 and 2000. All patients were analyzed retrospectively and staged as T3, 4 N (+) by transrectal ultrasonography and pelvic MRI. All patients received a 5, 040 cGy of radiation over 5 weeks and systemic intravenous bolus chemotherapy 5 FU 450 mg/m2 and leucovorin 20 mg/m2 for 5 days was given during first and fifth weeks of radiation treatment, followed four to six weeks later by radical surgery. RESULTS: Among 108 patients there were 74 males and 34 females. Mean age was 54.4 years in male and 52.3 years in female. Mean follow up periods was 41.3 months. Complete follow up was in 96.4% of patients. Curative resection was done in 90 patients (83.3%). The most common type of surgery was low anterior resection in 40 (44.4%) and unresectable patients in 10 (9.3%). Postoperative morbidities were wound infection (n=10, 9.2%), anastomostic leakage (n=2, 1.9%), and anastomotic stricture (n=1, 0.9%). After chemoradiation, tumor stage were as follows: pathologic complete remission was in 7 (6.5%), pT1, T2 N0 (stage I) was in 21 (19.4%), T3N0 (stage II) was in 28 (25.9%) and T3 N (+) (stage III) was in 34 (31.5%). The rate of local recurrence was 10.7% in stage II and 20.6% in stage III. Systemic recurrence was 21.4% in stage II and 47.1% in stage III. 5 year survival rate according to T stage was T0 (100%), T1 (100%), T2 (79.5%), T3 (43.7%), T4 (33.3%) (p=0.0088). According to N stage, N (-)(72.0%) and N (+) (35.7%)(p=0.002). Among T3 patients, 5 year survival rate was N (-)(58.2%) vs. N (+)(32.0%)(P=0.0228). CONCLUSION: Preoperative chemoradiation followed by total mesorectal excision downstaged locally advanced rectal cancer and showed high resectability. Clinical outcomes correlated with pathologic T and N downstaging. Patients who did not show pathologic T and N downstaging showed high local and systemic failure and poor prognosis.
Constriction, Pathologic ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Leucovorin ; Magnetic Resonance Imaging ; Male ; Prognosis ; Rectal Neoplasms* ; Recurrence ; Retrospective Studies ; Survival Rate ; Tumor Burden ; Ultrasonography ; Wound Infection