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

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

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

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

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: After the final report of Clinical Outcomes of Surgical Therapy (COST) study group, the application of laparoscopic surgery in colon cancer a spread widely. However, laparoscopic surgery in the rectum is still regarded as a complicated procedure to start due to technical difficulties and a steep learning curve. The aim of this study was to show the safety and technical feasibility of a laparoscopic low anterior resection at an early time on the learning curve in comparison with open low anterior resection. METHODS: The learning curves of one colorectal surgeon in open and laparoscopic low anterior resections were retrospectively compared. The compared factors were clinicopathologic characteristics, operation time, and the factors associated with postoperative recovery, morbidity and mortality. RESULTS: There were no significant differences in age or sex between two groups. The operation time was significantly longer in the laparoscopy group (P<0.001) In the view point of postoperative recovery, the laparoscopy group showed significant advantages in hospital stay (P<0.001), the passage of flatus (P<0.001), the number of analgesics used (P=0.03), and the removal of foley catheter (P=0.001). There were no conversions in the laparoscopy group, and the complication rate was lower in the laparoscopy group (10.7% vs. 17.6%). There was no postoperative mortality in either group. CONCLUSIONS: Even though the operation time was significantly longer in the laparoscopy group, a laparoscopic low anterior resection appears to have some benefits in postoperative recovery and morbidity. In terms of surgical outcomes, a laparoscopic low anterior resection can be performed safely even in early times on the learning curve.
Analgesics ; Catheters ; Colonic Neoplasms ; Flatulence ; Laparoscopy ; Learning Curve* ; Learning* ; Length of Stay ; Mortality ; Rectum ; Retrospective Studies

PURPOSE: About 10 percent of patients with colorectal cancer develop pulmonary metastases, but selection of patients for resection of lung metastases is difficult problem. This study was performed to identify prognostic factors after resection of pulmonary metastases from colorectal cancer. METHODS: We reviewed retrospectively the clinical course of 64 patients who underwent surgical resection of primary colorectal cancer and metastatic lung disease at the Yonsei University College of Medicine between November 1994 and January 2005. We analyzed the prognostic factors with special reference of the clinicopathologic factors of primary tumors. Univariate and multivariate analyses of survival were used to identify significant prognostic factors. RESULTS: Overall five-year survival rate after resection of lung metastases was 38.4 %. The mean size of the largest metastatic nodules is 2.73 cm. The median interval between colorectal resection and lung resection (disease free interval) was 28.7 months. The disease free interval, number and size of the pulmonary metastases were not significant prognostic factor. The negative hilar lymph node metastasis, colon cancer rather than rectal cancer, normal serum CEA were significant prognostic factors in multivariate analysis. CONCLUSION: Pulmonary resection for metastases from colorectal cancer may help prolong survival in selected patients. In this study, we found that if patients had negative pulmonary hilar lymph node metastases, normal range of serum CEA, and colon cancer rather than rectal cancer, the prognosis preferable than others.
Colonic Neoplasms ; Colorectal Neoplasms* ; Humans ; Lung ; Lung Diseases ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis* ; Prognosis ; Rectal Neoplasms ; Reference Values ; Retrospective Studies ; Survival Rate