Duodenal varices can result from portal hypertension regardless of the etiologies of liver cirrhosis. Bleeding from duodenal varices is rare but often severe and life threatening. Treatment modalities of duodenal varices include endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt, and surgery. As an initial treatment, endoscopic sclerotherapy is recommended due to easy accessibility but has limited success in controlling active duodenal variceal bleeding. In this case, we report a spurting duodenal varix treated with Histoacryl(R) injection in a 48-year-old woman with secondary biliary cirrhosis. Endoscopic sclerotherapy with Histoacryl(R) is a useful therapeutic measure in the treatment of bleeding duodenal varix.
Esophageal and Gastric Varices* ; Female ; Hemorrhage ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Liver Cirrhosis, Biliary* ; Middle Aged ; Portasystemic Shunt, Surgical ; Sclerotherapy* ; Varicose Veins

PURPOSE: To demonstrate the usefulness of MR imaging and MR angiography in the evaluation of patients whohave undergone surgery for DeBakey type1 or 2 aortic dissection. MATERIALS AND METHODS: Nineteen patients who hadundergone surgery for DeBakey type I(n=13) or type II(n=6) aortic dissection were included in our study. Graftinterposition had been performed in 11 patients, ascending aorta replacement in five, and hemi-arch or total archreplacement in three. MRI was performed 3-40 months(mean:12.5) months after surgery. Twenty(turbo) spin-echo MRimages and 12 contrast-enhanced MR angiographs(3-D FISP) of 19 patients were retrospectively analyzed with regardto perigraft site(perigraft thickness or thrombus), graft site(anastomotic site, deformity of graft), status ofremnant false lumen(remnant intimal flap, flow in false lumen, size, and shape), and involvement of arch vessels. RESULTS: Perigraft sites were demonstrated on spin-echo axial images (9/11), and in no case was theredemonstrable hematoma or perigraft flow. Distal anastomotic sites were identifiable in 17 of 20 cases, and graftredundancy was noted in eight. Remnant false lumen distal to the graft vessel was present in all patients who hadundergone DeBakey type 1 aortic dissection(n=14). Flow in the false lumen was also demonstrated in all DeBakeytype 1 cases on spin-echo images and MR angiography. Remnant false lumen increased in size in six of 14 cases, andtended to show a concave margin to true lumen compared with preoperative imaging. In 8 of 9 patients whose archvessels had been preoperatively involved, intimal flaps in arch vessels remained. CONCLUSION: MR imaging is auseful tool for the postoperative assessment of patients who have undergone aortic dissection. In addition,remnant intimal flap, flow dynamics in false lumen, and involvement of arch vessels can be easily identified by MRangiography.
Angiography* ; Aorta ; Congenital Abnormalities ; Hematoma ; Humans ; Magnetic Resonance Imaging* ; Retrospective Studies ; Transplants

PURPOSE: To compare the usefulness of Gadolinium-enhanced MR angiography(Gd-MRA) with spin-echo(SE) MRI forthe evalvation of acute aortic dissection. MATERIALS AND METHODS: During a recent one-year period weretrospectively reviewed the results of SE MRI and Gd-MRA in 14 patients (10 males, 4 females; mean age 57 years)with acute aortic dissection. DeBakey type I was found in six patients, DeBakey type II in one, and DeBakey typeIII in seven. MR techniques were as follows. First, multislice multiphase images were obtained in axial, coronaland oblique sagittal planes using SE T1WI(TR/TE/flip angle=600/14/90; acquisition time=25min), and images ofselected slices were obtained using breath-hold turbo SE T2WI(TR/TE/flip angle=800/76/160). Second, breath-holdGd-MRA imaging (3D-FISP; TR/TE/Flip angle=4.2/1.7/25; acquisition time=1min) was performed, with oblique sagittal(arch view) orientation. We compared 14 SE MRI images with nine thoracic and five abdominal Gd-MRA images,evalvating the presence and extent of intimal flap, entry and reentry tear, thrombus in false lumen (andcomparison to true lumen), the involvement of major branching vessels of the aortic arch, the origin of majorabdominal branching vessels, the presence of hemothorax and hemopericardium. RESULTS: Both SE MRI and Gd-MRA veryaccurately detected the extent of intimal flap, and false lumen status. For detecting the site of entry tear, andthe involvement of major branching vessels at the aortic arch, Gd-MRA(n=12) was more accurate than SE MRI(n=7).When used to image 20 vessels in five patients, Gd-MRA identified with perfect accuracy the origin of majorabdominal branching vessels; SE MRI, however, demonstrated only six of 20 vessels. SE MRI, however, was muchsuperior for the identification of complications such as hemothorax(n=9) and hemopericardium(n=2); in thisrespect, Gd-MRA failed completely. CONCLUSION: For the evaluation of patients with acute aortic dissection, Gd-MRAprovides information regarding site of entry tear and the involvement of major branching vessels very much fasterthan SE-MRI. In such cases, Gd-MRA can therefore be used for initial investigatory imaging.
Aorta, Thoracic ; Female ; Gadolinium* ; Hemothorax ; Humans ; Magnetic Resonance Imaging ; Male ; Pericardial Effusion ; Thrombosis

The aim of our study was to describe the radiologic findings of extensive acute lung injury associated with limited thoracic irradiation. Limited thoracic irradiation occasionally results in acute lung injury. In this condition, chest radiograph shows diffuse ground-glass appearance in both lungs and thin-section CT scans show diffuse bilateral ground-glass attenuation with traction bronchiectasis, interlobular septal thickening and intralobular smooth linear opacities.
Acute Disease ; Adenocarcinoma/radiotherapy ; Adenocarcinoma/pathology ; Adenocarcinoma/drug therapy ; Adenocarcinoma/complications* ; Carcinoma, Squamous Cell/radiotherapy ; Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/drug therapy ; Carcinoma, Squamous Cell/complications* ; Journal Article ; Human ; Lung/radiation effects* ; Lung/pathology ; Lung Neoplasms/radiotherapy ; Lung Neoplasms/pathology ; Lung Neoplasms/drug therapy ; Lung Neoplasms/complications* ; Male ; Middle Age ; Radiation Injuries/radiography ; Radiation Injuries/pathology ; Radiation Injuries/etiology* ; Thorax/radiation effects

OBJECTIVES: Plasma lipid profiles and Apolipoprotein E (ApoE) are established risk factors for cardiovascular disease (CVD). The knowledge of lipid profile may estimate the potential victims of cardiovascular disease before its initiation and progression and offers the opportunity for primary prevention. The most common ApoE polymorphism has been found to influence plasma lipid concentrations and its correlation with CVD has been extensively investigated in the last decade. METHODS: The ApoE polymorphism and its influence on plasma lipid were investigated in healthy woman workers. The information on confounding factors was obtained through a self-administered questionnaire and ApoE polymorphism was investigated using PCR. RESULTS: The relative frequencies of alleles E2, E3 and E4 for the study population (n=305) were 0.127, 0.750 and 0.121, respectively. ApoE polymorphism was associated with variations in plasma HDL-cholesterol lipid profile. In order to estimate the independent effects of alleles E2 and E4, as compared with E3, on lipid profile, multiple regression was performed after adjustment for confounding variables such as age, BMI, blood pressure, education status, insulin, fasting glucose, HOMA-IR, menopause. ApoE2 had a negative association with HDL cholesterol and ApoE4 had a positive association with LDL cholesterol. CONCLUSIONS: This study identified that the ApoE and CVD risk factors contribute to the lipid profiles, similar to other studies. The analysis including dietary intake and other gene in further studies may help to identify clear effects on lipid profiles as risk factor for CVD.
Adult ; Apolipoproteins E/blood/*genetics/metabolism ; Cardiovascular Diseases/epidemiology/prevention & control ; Cholesterol, HDL/genetics ; Female ; *Genotype ; Humans ; Lipid Metabolism/*genetics ; Polymerase Chain Reaction ; Primary Prevention

A 72-year-old woman was admitted due to a solitary pulmonary nodule incidentally found after routine chestradiography. Chest CT showed a solitary pulmonary nodule without calcification in the right upper lobe. Threeyears earlier, she had spent 3 months in Arizona. Surgical resection was performed after percutaneoustransthoracic fine needle aspiration had suggested malignaney. The lesion was caseous and necrotic, andhisto-logic examination indicated the presence of endosporulating spherules. We report a case ofcoccidioidomyco-sis which was resected in order to rule out lung cancer.
Aged ; Arizona ; Biopsy, Fine-Needle ; Coccidioidomycosis* ; Female ; Humans ; Lung Neoplasms ; Solitary Pulmonary Nodule ; Tomography, X-Ray Computed

PURPOSE: To determine the specific high-resolution CT features of sarcoidosis in which the observed pattern is predominantly pseudoalveolar. MATERIALS AND METHODS: We retrospectively reviewed the HRCT findings in 15 cases in which chest radiography demonstrated pseudoalveolar consolidation. In all 15, sarcoidosis was pathologically proven. The distribution and characterization of the following CT features was meticulously scrutinized: distribution and characterization of pseudoalveolar lesions, air-bronchograms, micronodules, thickening of bronchovascular bundles and interlobular septa, lung distortion, ground-glass opacities and combined hilar and mediastinal lymphadenopathy. Follow-up CT scans were available in three cases after corticosteroid administration. RESULTS: Between one and 12 (mean, 5.6) pseudoalveolar lesions appeared as dense homogeneous or inhomogeneous opacities 1-4.5 cm in diameter and with an irregular margin located either at the lung periphery adjacent to the pleural surface or along the bronchovascular bundles, with mainly bilateral distribution (n=14, 93%). An air-bronchogram was observed in ten cases. Micronodules were observed at the periphery of the lesion or surrounding lung, which along with a thickened bronchovascular bundle was a consistent feature in all cases. Additional CT features included hilar and mediastinal lymphadenopathy (n=14, 93%), thickened interlobular septa (n=12, 80%), and ground-glass opacity (n=10, 67%). Lung distortion was noted in only one case (7%). After steroid administration pseudoalveolar lesions decreased in number and size in all three cases in which follow-up CT was available. CONCLUSION: The consistent HRCT features of pseudoalveolar sarcoidosis are bilateral multifocal dense homogenous or inhomogenous opacity and an irregular margin located either at the lung periphery adjacent to the pleural surface or along the bronchovascular bundles. Micronodules are present at the periphery of the lesion or surrounding lung. The features are reversible at steroid administration.
Follow-Up Studies ; Lung ; Lymphatic Diseases ; Radiography ; Retrospective Studies ; Sarcoidosis* ; Thorax ; Tomography, X-Ray Computed

OBJECTIVE: To investigate the efficacy of systemic pulmonary rehabilitation (PR) after lung resection in patients with lung cancer. METHODS: Forty-one patients undergoing lung resection were enrolled and classified into the experimental (n=31) and control groups (n=10). The experimental group underwent post-operative systemic PR which was conducted 30 min/day on every hospitalization day by an expert physical therapist. The control group received the same education about the PR exercises and were encouraged to self-exercise without supervision of the physical therapist. The PR group was taught a self-PR program and feedback was provided regularly until 6 months after surgery. We conducted pulmonary function testing (PFT) and used a visual analog scale (VAS) to evaluate pain, and the modified Borg Dyspnea Scale (mBS) to measure perceived respiratory exertion shortly before and 2 weeks, 1, 3, and 6 months after surgery. RESULTS: A significant improvement on the VAS was observed in patients who received systemic PR >3 months. Significant improvements in forced vital capacity (FVC) and mBS score were observed in patients who received systemic PR >6 months (p<0.05). Other PFT results were not different compared with those in the control group. CONCLUSION: Patients who received lung resection suffered a significant decline in functional reserve and increases in pain and subjective dyspnea deteriorating quality of life (QoL). Systemic PR supervised by a therapist helped improve reduced pulmonary FVC and QoL and minimized discomfort during the postoperative periods in patients who underwent lung resection.
Dyspnea ; Education ; Exercise ; Hospitalization ; Humans ; Lung Neoplasms ; Lung* ; Organization and Administration ; Physical Therapists ; Postoperative Period ; Quality of Life ; Rehabilitation* ; Respiratory Function Tests ; Visual Analog Scale ; Vital Capacity