PURPOSE:The primary biliary carcinoma is usually unresectable at presentation, because of early lymphatic spread. To determine the incidence and the spread pattern of lymph node metastases according to the location of the primary tumor, we analyzed the CT scans of the patients with primary biliary adenocarcinome. MATERIALS AND METHODS: We reviewed the CT scans of 92 patients with pathologically proven primary biliary adenocarcinoma, including 45 peripheral cholangiocarcinomas, 22 hilar cholangiocarcinomas, 18 gallbladder carcinomas, and 7 common bile duct carcinomas. Positive adenopathy was diagnosed when the node exceeded 10 mm in short axis. RESULTS:The overall incidence of nodal metastases was 59.8 % (55/92); 66.7 % in peripheral cholangiocarcinoma, 54.5 % in hilar cholangiocarcinoma, 55.6 % in gallbladder carcinoma, and 42.9 % in common bile duct carcinoma. The most commonly involved nodal group was the lesser omentum, followed by the celiac, periaortic, and peripancreatic group. The phrenic node group was only involved in the cases with the peripheral or hilar cholangiocarci nome. CONCLUSION:The primary biliary carcinoma has a high incidence of lymph node metastases at the time of diagnosis, and shows different nodal spread pattern according to the location of the primary tumor. Involvement of the phrenic node was limited to the peripheral and hilar cholangiocarcinoma.
Adenocarcinoma ; Axis, Cervical Vertebra ; Biliary Tract* ; Cholangiocarcinoma ; Common Bile Duct ; Diagnosis ; Gallbladder ; Humans ; Incidence ; Lymph Nodes* ; Neoplasm Metastasis* ; Omentum ; Tomography, X-Ray Computed

In consecutive 56 patients with cervical carcinoma, we retrospectively analyzed the accuracy of magnetic resonance imaging (MRI) in regard of determining the depth of stromal invasion and reviewed the pitfalls in MRI interpretation. All patients underwent hysterectomy and were categorized into 3 groups: (1) no stromal invasion, (2) invasion to inner 2/3 of stromal thickness, (3) invasion to outer 1/3 of stromal thickness. In each group, MR image was analyzed for the size of the tumor mass and the ratio of spared stromal thickness to normal stromal full thickness (invasion ratio). Most tumor masses were not detected in the group of no stromal invasion. The degree of the depth of stromal invasion increased with the tumor size, and invasion ratio decreased as stromal invasion deepened. Overall accuracy for stromal invasion on MRI was 69.6%,and positive predictive value (PPV) for no stromal invasion was relatively lower than those of the other two groups. MRI is a promising modality to evaluate stromal invasion of cervical carcinoma by measuring the tumor size and invasion ratio, if MRI is performed prior to biopsy in axial scan perpendicular to the endocervical long axis.
Biopsy ; Humans ; Hysterectomy ; Magnetic Resonance Imaging* ; Pathology, Surgical* ; Retrospective Studies

We retrospectively analyzed the clinical and CT manifestation of 12 patients with nonlymphomatous renal metastases from eight different sites. Primary sites were lung(2), liver (2), stomach(2), uterine cervix (2), pancreas(1), rectum(1), penis (1), and unknown primary site(1). In all patients, clinical symptoms and laboratory findings were nonspecific. Major CT findings of renal metastases were multiple, small, hypodense lesions concomitant with multiple organ involvement. Although there are few differential points between renal cell carcinoma and metastasis, the single most important differential point was the presence of mass lesion on location other than kidney and in such case, the lesion on kidney proved to be metastasis usually. In cases with remission of primary malignancy, biopsy of new renal lesion seemed to be indispensable.
Biopsy ; Carcinoma, Renal Cell ; Cervix Uteri ; Female ; Humans ; Kidney ; Liver ; Male ; Neoplasm Metastasis* ; Penis ; Retrospective Studies

OBJECTIVES: It has been constantly reported that mismatch negativity (MMN) is impaired in patients with schizophrenia. However, the mechanism which relates impaired MMN and schizophrenia is not clear yet. The aim of this study is to investigate the association between MMN and clinical variables including functional status in patients with schizophrenia. METHODS: The present study assessed MMN using passive auditory oddball task in 26 patients with schizophrenia and 48 healthy controls. Repeated measures Analysis of Variance with age as a covariate was carried out for comparing peak amplitude and latency of MMN at 8 central line electrodes (FPz, Fz, FCz, Cz, CPz, Pz, POz, Oz) across groups. Pearson's correlation was performed to reveal the relationship between MMN and clinical variables including neurocognitive test results and the Global Assessment of Functioning score. RESULTS: MMN amplitude was significantly reduced in patients with schizophrenia compared with healthy controls. Pearson's correlation showed that subsets of short form of Korean Wechsler Adult Intelligence Scale scores and GAF scores were associated with MMN amplitude in patients with schizophrenia. CONCLUSION: These findings suggest that MMN amplitude is associated with current functional status including cognitive function in patients with schizophrenia.
Adult ; Analysis of Variance ; Electrodes ; Humans ; Intelligence ; Schizophrenia*

We report a case of necrotizing arteritis involving the gallbladder. This case was clinically diagnosed as cholelithiasis with cholecystitis, and necrotizing arteritis was found in the surgically resected specimen. Vascular changes were similar to those seen in classic polyarteritis nodosa, involving medium-sized muscular arteries and characterized by fibrinoid necrosis and panarterial and periarterial inflammation varying from active to resolving stages. Acute cholecystitis is a rare initial clinical manifestation of the systemic vasculitis. If acute cholecystitis is found in the absence of obvious cause, careful examination is essential. Since steroid therapy improves the prognosis in the systemic vasculitis, clinicians and pathologists should be aware of this unusual lesion.
Arteries ; Cholecystitis ; Cholecystitis, Acute ; Cholelithiasis ; Gallbladder* ; Inflammation ; Necrosis ; Polyarteritis Nodosa ; Prognosis ; Systemic Vasculitis ; Vasculitis*

No abstract available.
Dilatation* ; Urethra*

PURPOSE: The purpose of this study was to evaluate the usefulness of CT-guided percutaneous needle aspiration(PCNA) of paraaortic and pelvic lymph nodes in patients with uterine cervical carcinoma. MATERIALS AND METHODS: CT-guided PCNA was performed in 18 patients with treated cervical carcinoma. initial clinical stages were CIS in one, lb in three, lib in ten, and IIIb in four cases. We used 20 gauge Westcott needles for aspiration. Mean depth from skin to lymph nodes was 10.0cm in paraaortic group (n=13) and was 7.9cm in pelvic group (n=5). The size of lymph nodes ranged 1.0-3.0cm (mean :1.8) and 1.5-5.0cm (mean :2.6cm), respectively. RESULTS: All cases with paraaortic lymph node enlargement were proved to be metastatic lymphadenopathy. In five cases with pelvic lymph node enlargement, three were proved to be malignancy and two were negative. Among 16 cases with metastatic lymphadenopathy, eight patients were treated with chemotherapy, five with radiation therapy, and three with chemotherapy and radiotherapy. In two cases with negative results lymph nodes were disappeared or unchanged on follow up CT scans. No complications were encountered during CT-guided PCNA procedure. CONCLUSION: CT-guided PCNA of paraaortic and pelvic lymph nodes is a useful method in determining metastasis from cervical carcinoma and in planning further treatment.
Biopsy, Fine-Needle* ; Drug Therapy ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Lymphatic Diseases ; Needles ; Neoplasm Metastasis ; Proliferating Cell Nuclear Antigen ; Radiotherapy ; Skin ; Tomography, X-Ray Computed

BACKGROUND: One of the main disadvantages of caudal block is the long latent period before a satisfactory blockade is obtained. Many investigators have used various preparations of local anesthetic solutions to improve the speed of onset. This study was performed to evaluate the effectiveness of prewarming of lidocaine HCl for caudal block. METHODS: Fifty healthy young patients (ASA I) were allocated into two groups, A and B. In group A, the local anesthetic solution were injected at room temperature (25 degrees C), while in group B, they were injected at 37oC. All the caudal block were performed using 2% lidocaine HCl 20 ml with fentanyl 100ug and epinephrine 1:200,000. The onset time was defined as the period from completion of injection until the patient first noticed loss of sensation to pin-prick on perianal region. Assessment of sensory loss was made at 15 seconds interval. We have compared the onset of sensory blockade between groups. The duration of analgesia and any significant side effects were also recorded. RESULTS: The onset of sensory blockade was significantly faster in group B (3.5 +/- 0.5 minutes) than group A (6.2 +/- 0.9 minutes). The duration of analgesia were not significantly changed between groups. Side effects of urinary retention, pruritus and nausea were noted between both groups but the difference was not significant. CONCLUSIONS: We have found that the onset time was 44% faster with warm lidocaine-fentanyl mixture (37 degrees C) than with the room temperature (25 degrees C). The improved clinical usefulness was achieved with no increase in side effects. The technique is a safe and effective method to reduce the latency of onset.
Analgesia ; Epinephrine ; Fentanyl ; Humans ; Lidocaine ; Nausea ; Pruritus ; Research Personnel ; Sensation ; Urinary Retention

No abstract available.

In air leak syndrome, a significant portion of the volume delivered during a positive pressure breath can be lost through the leak. HFOV can achieve adequate ventilation at lower peak and/or mean intrapulmonary pressure than conventional mechanical ventilation (CMV) and has been an effective treatment of already established air leak syndrome. We report a 1-day-old male infant with severe respiratory failure from pneumothorax and pneumomediastinum, who was refractory to CMV with chest tube drainage. HFOV was applied to this patient for 114 hours, and improvement of oxygenation and ventilation as well as significant reduction of pneumothorax followed.
Chest Tubes ; Drainage ; Humans ; Infant ; Male ; Mediastinal Emphysema ; Oxygen ; Pneumothorax ; Respiration, Artificial ; Respiratory Insufficiency ; Ventilation*