PURPOSE: To evaluate CT findings of internal hernia. MATERIALS AND METHODS: Three patients with internal hernia had abdominal CT scans and two of them had small bowel follow through examinations. The CT features of two patients with retroanastomotic and one patient with left paraduodenal hernia were evaluated and correlated with small bowel follow through examinations, and surgical findings. Two patients with retroanastomotic hernia had a history of subtotal gastrectomy with antecolic gastrojejunostomy. The diagnosis of internal hernia was made on the basis of surgical find ings in two patients of retroanastomotic hernia, and characteristic barium study findings in one patient of left paraduodenal hernia. RESULTS: The small bowel follow through examination showed small bowel loops gathered in a circumscribed mass in the left mid abdomen, and delay in passage through these loops. In case of left paraduodenal hernia, abrupt narrowing of the distal duodenum could be identified. The characteristic CT findings of all three patients were whorling of the mesentery and mesenteric vessels in the left mid-abdomen. In the patient with left paraduodenal hernia, after resolution of the gastrointestinal symptoms, a follow-up CT scan showed spontaneous disappearance of whorling of the mesentery and mesenteric vessels suggesting spontaneous resolution of the hernia. In the other two cases, upon exploration of the abdomen, dilatation of afferent duodenum caused by adhesion between ligament of Treitz and adjacent bowel walls, and retro- anastomotic herniation of the efferent loops were found. CONCLUSION: The usual diagnosis of internal hernia is based on the appearance of the small bowel follow through examination. However, we consider that the whorling appearance(we call it whorling sign) of the mesentery and mesenteric vessels on CT scan is also suggestive of internal hernia in patients under clinical suspicion.
Abdomen ; Barium ; Diagnosis ; Dilatation ; Duodenum ; Follow-Up Studies ; Gastrectomy ; Gastric Bypass ; Hernia ; Humans ; Ligaments ; Mesentery* ; Tomography, X-Ray Computed

PURPOSE: To evaluate the radiologic findings of alimentary anthrax. MATERIALS AND METHODS: 19 patients with alimentary anthrax, which was caused by ingestion of contaminated beef, were included in this study. The diagnosis was made .b.y demonstration of Bacillus anthracis in smear and culture of the contaminated meat. We evaluated the clinical manifestations and the findings of thoracic, abdominal radiographs, cervical, abdominal ultrasonograms and abdominal CT scans. RESULTS: Out of the 19 patients with the alimentary infection, 9 had oropharyngeal form, 18 had abdominal form and 8 had combination of oropharyngeal and abdominal form. The patients had general symptoms and signs such as fever, chill, myalgia. Clinical symptoms and signs were sore throat, throat injection, throat ulcer and patch in oropharyngeal form, and nausea, vomiting, abdominal pain, diarrhea, and gross GI bleeding in abdominal form. Radiologic findings included enlarged cervical lymph nodes(36%) in oropharyngeal form, and paralytic ileus(26%), ascites(26%), hepatomegaly(21%), enlarged mesenteric lymph nodes(26%), small bowel wall thickening(5%) in abdominal form. In two patients, late complications occurred as intestinal obstruction due to ileal stricture with perforation, and inflammatory changes of pelvic cavity due to ileovesical fistula. CONCLUSION: Radiologic findings of alimentary anthrax are difficult in differentiation from those of other inflammatory bowel disease, but those radiologic findings with clinical manifestations may be helpful in diagnosis and evaluation of disease process in patients with alimentary anthrax.
Abdominal Pain ; Anthrax* ; Bacillus anthracis ; Constriction, Pathologic ; Diagnosis ; Diarrhea ; Eating ; Fever ; Fistula ; Hemorrhage ; Humans ; Inflammatory Bowel Diseases ; Intestinal Obstruction ; Meat ; Myalgia ; Nausea ; Pharyngitis ; Pharynx ; Tomography, X-Ray Computed ; Ulcer ; Ultrasonography ; Vomiting

A 27-year-old male presented with an anterior myocardial infarction following blunt chest trauma sustained in motorcycle accident. On examination, there was no visible wound on the chest wall. Echocardiogram showed dyskinesia over anterior left ventricular wall. Subsequent coronary angiogram demonstrated dissection at the proximal portion of the left anterior descending coronary artery and left ventriculogram showed apical anerysm and thrombus. He was treated by coronary artery bypass graft.
Adult ; Coronary Artery Bypass ; Coronary Vessels* ; Dyskinesias ; Humans ; Male ; Motorcycles ; Myocardial Infarction ; Thoracic Wall ; Thorax* ; Thrombosis ; Transplants ; Wounds and Injuries

We experienced a case of brainstem encephalitis that is possibly caused by herpes simplex virus infection in a 3 year-old girl. The diagnosis was made by clinical symptoms, neurologic exam, serologic test, brain CT, brain MRI and brainstem biopsy. Herpes simplex virus specific antibody was detected from cerebrospinal fluid and the titer was 11.78 by enzyme immunoassay. Stereotaxic brainstem biopsy was done for differenciate from brainstem glioma at 24th hospital day. Patient was treated with acyclovir and improved in association with neurologic sequallae at 3 months later. Brief review of literatures was made.
Acyclovir ; Biopsy ; Brain ; Brain Stem* ; Cerebrospinal Fluid ; Child, Preschool ; Diagnosis ; Encephalitis* ; Female ; Glioma ; Humans ; Immunoenzyme Techniques ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Serologic Tests ; Simplexvirus

PURPOSE: To report a case of a patient with posterior ischemic optic neuropathy and abducens nerve palsy who responded to steroid therapy. CASE SUMMARY: A 47-year-old man visited our clinic with decreasing visual acuity and abduction limitation in his right eye, which suddenly started 4 days earlier. The best corrected visual acuity (BCVA) was 20/250 in the right eye and 20/20 in the left eye. Fundus examination showed normal in both eyes, and relative afferent pupillary defect was positive in the right eye. The visual field test showed a right central scotoma with inferior altitudinal field defect. In addition, the brain magnetic resonance imaging (MRI) was done. Orbit MRI, fluorescein angiography (FAG), and carotid ultrasonography results were normal. Therefore, the patient was diagnosed with non-arteritic posterior ischemic optic neuropathy. The systemic steroid therapy was started and tapered over a period of 5 weeks. At one month after treatment, the BCVA was 20/20 and abduction limitation in the right eye improved.
Abducens Nerve ; Abducens Nerve Diseases ; Brain ; Eye ; Fluorescein Angiography ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Optic Neuropathy, Ischemic ; Orbit ; Pupil Disorders ; Scotoma ; Visual Acuity ; Visual Field Tests

Rhabdomyosarcoma is the most common soft tissue sarcoma in childhood and young adult. Rhabdomyosarcoma can be classified into one of four type; embryonal, alveolar, pleomorphic, undifferentiated. Embryonal rhabdomyosarcomas of the female genital tract are rare, malignant tumors derived from primitive myogenic precursor and generally occur during infancy and childhood. About twenty percent of rhabdomyosarcoma arise in the genitourinary tract, with slightly more than half being embryonal rhabdomyosarcoma. Vaginal primaries are 5-times more common than cervical primaries. Overall, cervical tumor may predominate in adolescent. In perimenopausal women, the uterus is the most common site of rhabdomyosarcoma. The management of rhabdomyosarcoma of genitourinary tract has changed slowly from pelvic exenteration without adjuvant therapy to neoadjuvant chemotherapy followed by less radical surgery and postoperative radiation. Embryonal rhabdomyosarcomas originates in the uterine cervix are extremely rare especially in the thirties. So, little information is available regarding its prognosis and therapy. We present a case of a woman 31 years old with embryonal rhabdomyosarcoma of the uterine cervix with a review of a literature.
Adolescent ; Adult* ; Cervix Uteri* ; Drug Therapy ; Female ; Humans ; Pelvic Exenteration ; Prognosis ; Rhabdomyosarcoma ; Rhabdomyosarcoma, Embryonal* ; Sarcoma ; Uterus ; Young Adult

OBJECTIVE: The purpose of our study evaluate to assess the feasibility and safety of performing vaginal hysterectomy on our experience. METHODS: Between 1990 year and 1997 year, 3408 women underwent vaginal hysterectomy without laparoscopic assistance at Hallym University Hospital in Korea. All hysterectomies(abdominal & vaginal) were reviewed and these were compared with all hysterectomy cases from most recent year available for complete analysis. RESULT: 1. In 1990 yrs~1997 yrs, vaginal hysterectomies compromised 51%(vaginal hysterectomy [below VH]: 268 / total abdominal hysterectomy [below TAH]: 258; 1990), 55%(VH: 254/TAH: 212; 1991), 60%(VH: 346/TAH: 227; 1992), 64%(VH: 341/TAH: 190; 1993), 72%(VH: 434/TAH: 168; 1994), 75%(VH: 489/TAH: 156; 1995), 76.%(VH: 632/TAH: 196; 1996), 78%(VH: 657/TAH: 190;1997), a high increased rate of vaginal hysterectomy significantly. 2. The average age of patients was 41.9+/- 8.18(26~84) years old and 25 nullipara and 274 primiparas and 3109 multiparas. The mean parity was 2.74+/-0.36. 3. The common surgical indications were uterine myoma(53.9%), prolapse of uteri(23.3%), CIN II-III or microinvasive cervical cancer(6.5%), others(16.3%) 4. The average time of operation(hysterectomy and colporrhaphy) was 78.3+/- 14.2 min(40~230). 5. The average weight of uterus was 166.5+/- 111.4 gm(60~1130 gm), 34.0% was done morcellation. 6. 5.7% of operated women had previous abdominal operaton (without tubal ligation). 7. The common associated procedures were posterior colporrhaphy(47.4%), anteroposterior colporrhaphy(45.6%), adnexectomy(4.9%), other(2.1%). 8. The mean blood loss was 280+/- 104.4 ml and 12.4% of operated women were need of transfusion. 9. The minor complication rate was 10.6% e.g. urinary retention(5.3%-179cases), abdominal bleeding (including conversion TAH) (0.3%-9cases), pelvic hematoma(0.3%-11cases), post operation fever(2.8%-94cases), mortality cases none. 10. The mean hospital days were 7 days(4~20) CONCLUSION: In our experience the following conclusions have been reached that vaginal hysterectomy is usually well tolerated by most women, a safe operation with few complications and without notable blood loss and without the need of expensive laparoscopic equipment. The incidence of vaginal hysterectomy is characterized by pronounced fluctuations suggested that no valid general guidelines have yet been established for the indication via vagina of surgical treatment. The incidence of vaginal hysterectomy correlates with the experience of individual surgeon strongly. Vaginal hysterectomy remains the method of choice for removal of the uterus in the absence of absolute contraindication.
Female ; Hemorrhage ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal ; Incidence ; Korea* ; Mortality ; Parity ; Prolapse ; Uterus ; Vagina

No abstract available.
Ascitic Fluid* ; Endometriosis* ; Female ; Humans ; Interleukins*

BACKGROUND/AIMS: It has been recently reported that celiac ganglia can be identified by linear-array endoscopic ultrasonography (EUS). Still, there has been no report on the detection rate of celiac ganglia with radial scanning EUS. The aim of this study was to evaluate the detection rate of celiac ganglia by radial scanning echoendoscopy during a routine examination. METHODS: We prospectively enrolled 57 consecutive patients (23 men, 34 women; mean age 54 years, range 21-78 years) who were referred for EUS examination from September 2006 to December 2006. EUS was performed using a radial scanning echoendoscope. The size, location and EUS appearance of the celiac ganglia were recorded for each patient. RESULTS: Celiac ganglia were identified in 51 out of 57 patients (89.4%). They were identified at the left side of the celiac trunk and aorta and between the celiac artery and the left adrenal gland. They appeared as hypoechoic, oblong or lobulated structures, often with an irregular edge, and they often contained a hyperechoic focus or strand. The mean size was 18 mm by 4 mm. Structures corresponding to the visualized celiac ganglia were retrospectively identified on CT scans in 33 among the 37 patients (89.2%). CONCLUSIONS: The results of this study showed that celiac ganglia could be identified, with radial scanning EUS, in the majority of subjects.
Adult ; Aged ; Endosonography/*methods ; Female ; Ganglia, Sympathetic/radiography/*ultrasonography ; Humans ; Male ; Middle Aged ; Prospective Studies ; Reproducibility of Results ; Tomography, X-Ray Computed