PURPOSE: We compared CT findings of thickened wall-type gallbladder cancer with those of complicated cholecystitis. MATERIALS AND METHODS: We retrospectively reviewed abdominal CT scans of ten patients with thickened wall-type gallbladder cancer and eight patients with complicated cholecystitis, from March 1991 to November 1995. RESULTS: CT findings of thickened wall-type gallbladder cancer showed diffuse or focal wallthickening. Wall thickness was 5.3-18.0 mm(mean value, 12.2mm ; n=10). Gallbladder wall thickness of complicatedcholecystitis was 3.0-14.0mm (mean value, 6.6mm ; n=8). Statistical significance was noted between thickened wall-type gallbladder cancer and complicated cholecytitis(p<0.0029). Irregular wall thickening was noted in 7/10cases of thickened wall-type gallbladder cancer(70%). Regular wall thickening was noted in 6/8 cases of complicated cholecystitis(75%). The luminal diameter of thickened wall-type gallbladder cancer was 3.3-5.4cm (meanvalue, 4.2cm ; n=10). The luminal diameter of complicated cholecystitis was 5.2-8.0cm (mean value, 6.5cm ; n=8).Statistical significance was noted between thickened wall-type gallbladder cancer and complicated cholecystitis(p<0.0003). The halo sign was noted in only 3/8 cases of complicated cholecystitis(38%). Secondary findings of thickened wall-type gallbladder caner was lymphadenopathy in 3/10 cases(30%), and liver invasion in 2/10 cases(20%). Secondary findings of complicated cholecystitis were liver abscess in 2/8 cases(25%), and RLQ abdominal fluid collection and pleural effusion in 4/8 cases(50%). CONCLUSION: Differential factors of thickened wall-type gallbladder cancer from complicated cholecystits are gallbladder wall thickness, regularity of wall thickness, halo sign, secondary findings and luminal distention.
Cholecystitis* ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Liver ; Liver Abscess ; Lymphatic Diseases ; Phenobarbital ; Pleural Effusion ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: To compare the CT findings of peritoneal tuberculosis (PT) and peritoneal carcinomatosis (PC) based on the morphologic features of the peritoneum and assess the relationship between the degree of peritoneal thickness and the severity of omental infiltration in PT and PC. MATERIALS AND METHODS: We retrospectively reviewed the CT findings of 15 patients with PT and 14 with PC. We checked the morphologic changes of the peritoneum as seen on CT, for the following points: 1) the presence of peritoneal change: 2) the pattern of any change-diffuse thickening, plaque or nodularity, combined thickening (diffuse and plaque, or nodularity); 3) the degree of thickness on the whole peritoneum - mild (grossly definite, but not more than 3 mm), moderate (more than 3mm); 4) the presence of irregularity on the peritoneal surface. We also evaluated the significance of the relationship between peritoneal thickness and omental infiltration in both disease entities. The degree of omental infiltration was described as follows : grade I (no change or focal smudge pattern); grade II ( diffuse smudge), grade III (omental cake regardless extent). RESULTS: Peritoneal change was seen in 12 of 15 PT patients and in 7 of 14 PC patients. In all 12 PT patients, the pattern of change was diffuse thickening, and among the seven PC patients, there was diffuse thickening in one, plaque or nodular thickening in four, and combined thickening in two. In PT patients, the degree of thickness on the whole peritoneum was mild in six and moderate in six, and in PC patients it was mild in two and moderate in one. An irregular peritoneum surface was seen in one patient with PT and in two with PC. The degree of omental infiltration in PT was grade I in four patients, grade II in six andgrade III in five. In PC, it was grade I in six patients, grade II in two and grade III in six. Smooth diffuse thickening of the peritoneum was seen in 11 of 15 PT cases and in one of 14 PC (P<0.01). Accompanying plaque or nodularity was seen only in PC, in six of 14 patients (P<0.001). The relationship between the degree of peritoneal thickness and severity of omental infiltration was significantly proportional in PT (r=0.900, P<0.001), but not in PC (r=0.068, P>0.5). CONCLUSION: In PT and PC different CT findings based on peritoneal morphologic changes might be useful in differentiating these two entities. In addition, careful observation of relationship between the peritoneal change and the severity of omental infiltration is necessary.
Carcinoma* ; Humans ; Peritoneum ; Peritonitis, Tuberculous* ; Retrospective Studies ; Tuberculosis

Adolescent ; Dentistry ; Dentofacial Deformities ; Humans ; Osteotomy ; Root Resorption ; Tooth

OBJECTIVE: It has been recognized that cold knife conization has higher incidence of postoperative hemorrhage and many techniques have been developed in an attempt to control hemorrhage. The aim of this study was to evaluate complications of Sturmdorf's suture in cold knife conization and to investigate various measures employed to reduce blood loss. METHODS: The results of 85 patients who had cold knife conization for diagnosis or treatment of cervical intraepithelial neoplasia (CIN) from August, 1997 to July, 2003 were reviewed. RESULTS: Among 85 patients, 83 patients (97.7%) had negative cut margins on conization specimen while 2 patients (2.3%) positive cut margins. 54 patients received no further treatment after cold knife conization and complications occurred in 9 patients (16.7%). Postoperative hemorrhage requiring additional hemostatic procedures occurred in 7 patients (13%), of which 6 patients were rehospitalized and 1 patient was managed at outpatient clinic with gauze packing only. Among 6 rehospitalized patients, hysterectomy was done in 2 patients and electrocoagulation in 1 patient. Packed red cell was transfused in 1 patient and 2 patients were managed with gauze packing only. Postoperative infection was found in 2 patients (3.7%). No other significant complications were noted. CONCLUSION: Cold knife conization using Sturmdorf's suture could be done to get much more accurate results of biopsy with relatively mild complication in magement of CIN, although several days? admission is needed and the other alternative methods seem to be more convenient.
Ambulatory Care Facilities ; Biopsy ; Cervical Intraepithelial Neoplasia ; Conization* ; Diagnosis ; Electrocoagulation ; Hemorrhage ; Humans ; Hysterectomy ; Incidence ; Postoperative Hemorrhage ; Sutures*

OBJECTIVE: To evaluate the association of level of CA-125 and severity of dysmenorrhea with lesion depth in adenomyosis. METHODS: Sixty-eight women who had undergone hysterectomy and were found to have pure adenomyosis on histopathologic examination were reviewed retrospectively. Specimens were stratified according to the degree of adenomyosis penetration into 4 groups: group A consisted of specimens with adenomyosis penetration into myometrium of up to 25%; group B, 26-50%; group C, 51-75%, and group D, >75%. All women were submitted to serum determination of CA-125. Severity of dysmenorrhea was assessed by means of a modification of 10-point verbal rating scale. RESULTS: Each group was not correlated with severity of dysmenorrhea (p=0.7394 Fisher's exact test). The means of serum CA-125 levels was increased corresponding to depth of adenomyosis (p=0.0441 ANOVA test). CONCLUSION: In this study, serum CA-125 level is associated with the depth lesion and severity of dysmenorrhea is not. Therefore, the level of serum CA-125 might be useful indicator in management of adenomyosis before surgery.
Adenomyosis* ; Animals ; Dysmenorrhea* ; Female ; Humans ; Hysterectomy ; Mice ; Myometrium ; Retrospective Studies

In 1861 Rokitanski laid down the law that the pyloric ring served as a barrier to the duodenal spread of gastric cancer. Although this theory was generally accepted, direct spread of gastric carcinoma into the duodenum has been reported. We report a case of gastric cancer spreading into the duodenum that was diagnosed by endoscopic duodenal biopsy and review the literature.
Biopsy ; Duodenum* ; Endoscopy ; Jurisprudence ; Stomach Neoplasms

BACKGROUND: Malignant pleural effusion is a common condition in neoplastic patients and palliative therapy is the usual treatment. Talc has been generally accepted to be the most effective sclerosant for chemical pleurodesis, but the optimal route of administration remains controversy. We compared the results of video-assisted thoracoscopic talc poudrage (VTP) with administering a bedside talc slurry through a chest tube (BTS) for the treatment of malignant pleural effusion. MATERIAL AND METHOD: From December 2004 to May 2006, 20 patients with malignant pleural effusion underwent chemical pleurodesis via VTP (group A, n=10), and BTS (group B, n=10). RESULT:The durations of chest tube placement after the procedure were 7.0+/-4.0 days (group A) and 6.7+/-3.6 days (group B). The hospital stays were 24.3+/-9.4 days (group A) and 30.7+/-21.5 days (group B), respectively. The symptoms of dyspnea were much more improved in group A (p-value=0.014) after discharge (mean f/u group A=8.5+/-2.2 months, group B 8.0+/-7.4 months). The collapsed portions of lung were better expanded in group A than in group B (p-value= 0.011). CONCLUSION: We recommend VTP for the selected patients with malignant pleural effusion because of the advantages of dissecting the fibrous peel to relieve the atelectasis and dyspnea, and excising the pleura for diagnosis with direct viewing of the lesion.
Chest Tubes ; Diagnosis ; Dyspnea ; Humans ; Length of Stay ; Lung ; Palliative Care ; Pleura ; Pleural Effusion ; Pleural Effusion, Malignant* ; Pleurodesis ; Pulmonary Atelectasis ; Talc* ; Thoracoscopy

To determine the recovery time from noise-induced temporary threshold shift (TTS), a prospective field study was conducted at three worksites where workers are known to be exposed high level of noise. Subjects were selected according to answers on a questionnaire which inquired about otological history and previous noise exposure, including avocational, military and occupational exposures. After excluding employees with past otologic problems, recent exposure to high level noise, and under medications, total 92 employees participated in the study. Among 92 participants, complete consecutive audiometric examinations were carried out at 0~2 hours, 5~7 hours, 14~16 hours after worktime noise exposure on 26 participants wearing hearing protectors and 22 participants wearing no protective devices. The difference between the hearing level 0~2 hours after noise exposure and 5~7 hours is statistically significant by paired t-test(p<0.01). The median recovery times calculated from the data of 22 participants wearing no protective hearing devices are 15.6 hours at 4000 Hz, and 7.7 hours, 10.3 hours, 8.4 hours at 1000 Hz, 2000 Hz and 8000 Hz respectively. These data suggest that when measuring the pure tone audiometry for noise exposed workers, at least 16 hours noise-free interval is required.
Audiometry ; Hearing ; Hearing Loss, Noise-Induced ; Humans ; Military Personnel ; Noise ; Occupational Exposure ; Prospective Studies ; Protective Devices ; Questionnaires ; Workplace

To determine the recovery time from noise-induced temporary threshold shift (TTS), a prospective field study was conducted at three worksites where workers are known to be exposed high level of noise. Subjects were selected according to answers on a questionnaire which inquired about otological history and previous noise exposure, including avocational, military and occupational exposures. After excluding employees with past otologic problems, recent exposure to high level noise, and under medications, total 92 employees participated in the study. Among 92 participants, complete consecutive audiometric examinations were carried out at 0~2 hours, 5~7 hours, 14~16 hours after worktime noise exposure on 26 participants wearing hearing protectors and 22 participants wearing no protective devices. The difference between the hearing level 0~2 hours after noise exposure and 5~7 hours is statistically significant by paired t-test(p<0.01). The median recovery times calculated from the data of 22 participants wearing no protective hearing devices are 15.6 hours at 4000 Hz, and 7.7 hours, 10.3 hours, 8.4 hours at 1000 Hz, 2000 Hz and 8000 Hz respectively. These data suggest that when measuring the pure tone audiometry for noise exposed workers, at least 16 hours noise-free interval is required.
Audiometry ; Hearing ; Hearing Loss, Noise-Induced ; Humans ; Military Personnel ; Noise ; Occupational Exposure ; Prospective Studies ; Protective Devices ; Questionnaires ; Workplace

Separation of symphysis pubis during vaginal delivery is rare condition with incidence ranging from 1/500 to 1/30000 deliveries. The injury is caused by fetal head exerting pressure on pelvic ligaments that have been relaxed by progesterone and relaxin. The separation might be associated with considerable pain, swelling and tenderness over the pubic area. Diagnosis is based on clinical findings and X-ray findings. The condition is treated conservatively with bed rest, analgesics and physical therapy. Prognosis is exellent. We experienced 3cases of separation of symphysis pubis during vaginal delivery and report these cases with a brief review of literature.
Analgesics ; Bed Rest ; Diagnosis ; Head ; Incidence ; Ligaments ; Progesterone ; Prognosis ; Relaxin