The authors defined precaval retropancreatic space as the space between pancreatic head with portal vein and IVC analyzed the CT findings of this space to know the normal structures and size in this space, We evaluated 100 cases of normal anbdominal CT scan to find out normal anatomic structures of precaval retropancreatic space retrospectively. We also measured the distance between these structures and calculated the minimum, maximum and mean values. At the splenoportal confluence level, normal structures between portal vein and IVC were vessel (21%), lymph node (19%), and caudate lobe of liver (2%) in order of frequency. The maximum AP diameter of portocaval lymph node was 4mm. Common bile duct(CBD) was seen in 44% and the diameter was mean 3mm and maximum 11mm. CBD was located in extrapancreatic (75%) and lateral (60.6%0 to pancreatic head. At IVC-left renal vein level, the maximum distance between CBD and IVC was 5mm and the structure between posterior pancreatic surface and IVC was only fat tissue. Knowledge of these normal structures and measurement will be helpful in differentiating pancreatic mass with retropancreatic mass such as lymphadenopathy.
Bile ; Head ; Liver ; Lymph Nodes ; Lymphatic Diseases ; Portal Vein ; Renal Veins ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: In a diabetic foot ulcer, superficial fungal infection of the foot may disrupt the skin integrity and provide an avenue for bacterial infection. The prevalence of fungal infection in diabetic foot ulcer has been reported as 12-30% in Caucasian patients. However, no data are available for Korean patients. The purpose of the study was to examine the prevalence of fungal infection in diabetic foot patients admitted in our clinic. METHODS: This study included consecutive 30 diabetic foot ulcer patients(24 males and 6 females) admitted from May 2007 to July 2007. The mean age was 60.5 years. All patients underwent mycological examination including direct microscopic examination in KOH and culturing on slants and tubes with Sabouraud's glucose agar. RESULTS: Clinical signs of presumed fungal infection, which were examined by dermatologists, were found in all patients included in this study. Direct microscopic examination was positive for the specimens of the skin and the toenails in 28(93.3%) and 25(83.3%) patients, respectively. In addition, culture result was positive for the specimens of the skin and the toenails in 5(16.73%) and 7(23.3%) patients, respectively. CONCLUSION: The prevalence of fungal infection in diabetic foot ulcer patients admitted in our clinic is much higher than that in Caucasian patients(83.3-93.3% vs 12-30%).
Agar ; Bacterial Infections ; Diabetic Foot ; Foot ; Glucose ; Humans ; Male ; Nails ; Prevalence ; Skin ; Ulcer

PURPOSE: Recent advances in the methods of treating cancer in young patients have led to both an increased frequency of CNS complications as well as prolonged life expectancy. We intend to analyze the clinical aspects and laboratory findings of patients with CNS complications during and after treatment. METHODS: We reviewed the medical records of 174 childhood cancer patients treated with chemotherapy admitted to the Dept. of Pediatrics, Keimyung University Dongsan Hospital, from January 1995 to November 2002. Among them, 15 cases with CNS complications were investigated in this study. RESULTS: CNS abnormalities were found in 13 patients by CT or MRI during treatment such as leukoencephalopathy(n=7), mineralizing microangiopathy(n=4), brain infarction(n=3), intracranial hemorrhage(n=1), and hypoxic ischemic encephalopathy(n=1). It was found that two patients had two or more CNS abnormalities. Two patients who had no imaging abnormalities had convulsions, possibly after the addition of intrathecal methotrexate. The patients with intracranial hemorrhage and brain infarction had rapid and fatal clinical courses. The hypoxic ischemic encephalopathy following electrolyte imbalance completely recovered after correction of electrolyte. CONCLUSION: The CNS complications that occur during and after chemotherapy influence prognoses significantly, and remain neurologic sequelae. Therefore early diagnosis and prophylaxis for CNS complications and regular physical examination of patients who have recieved cancer therapy are strongly recommended.
Brain ; Brain Infarction ; Drug Therapy ; Early Diagnosis ; Humans ; Hypoxia-Ischemia, Brain ; Intracranial Hemorrhages ; Leukoencephalopathies ; Life Expectancy ; Magnetic Resonance Imaging ; Medical Records ; Methotrexate ; Pediatrics ; Physical Examination ; Prognosis ; Seizures

PURPOSE: To evaluate the dynamic enhancement patterns of focal hepatic lesions using breath-hold dynamic MR imaging for differential diagnosis. MATERIALS AND METHOD: Thirty three patients (24 men and 12 women, mean age of 55 years) with 56 known liver masses on CT scan and US underwent MR imaging with 1.5T. After Tl-weighted fast multiplanar spoiled gradient recalled (FMPSPGR) imaging, breath-hold FMPSPGR images were obtained at 0, 1, 3, 5, and 10 minutes after bolus injection of Gd-DTPA. The cases consisted of 16 hepatocellular carcinomas, 24 hemangiomas, 6 metastases, 3 cholangiocellular carcinomas, and 7 hepatic cysts. The dynamic enhancement patterns were evaluated on the basis of initial enhancement study and, the degree of enhancement was also levaluaied. RESULTS: Of 24 hemangiomas, most cases showed centripetal filling-in pattern of enhancement except 3 cases which showed homogeneous enhancement pattern on the early dynamic phase. All hemangiomas showed very high signal intensity which persisted to the delayed phase. The eccentric enhancement pattern was the most common type in hemangiomas (63%). Hepatocellular carcinomas had heterogeneous enhancement pattern on early and delayed phase (81, 88%) and showed diminished signal intensity on the delayed images. 14 of 16 hepatocellular carcinomas (88%) had peritumoral halo. Variable enhancement pattern was observed in metastases including progressive centripetal filling-in pattern (67%). All metastases showed prominent peritumoral halos and low signal intensity. Cholangiocellular carcinomas showed early centripetal filling-in and heterogeneous enhancement pattern on delayed phase. None of hepatic cysts showed enhancement. CONCLUSIONS: Dynamic breath-hold MR imaging with Gd enhancement allows accurate assessment of hemodynamic status of hepatic lesions and is useful in differential diagnosis of focal hepatic lerions.
Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Diagnosis, Differential ; Female ; Gadolinium DTPA ; Hemangioma ; Hemodynamics ; Humans ; Liver ; Magnetic Resonance Imaging* ; Male ; Neoplasm Metastasis ; Tomography, X-Ray Computed

PURPOSE: To evaluate the dynamic enhancement patterns of focal hepatic lesions using breath-hold dynamic MR imaging for differential diagnosis. MATERIALS AND METHOD: Thirty three patients (24 men and 12 women, mean age of 55 years) with 56 known liver masses on CT scan and US underwent MR imaging with 1.5T. After Tl-weighted fast multiplanar spoiled gradient recalled (FMPSPGR) imaging, breath-hold FMPSPGR images were obtained at 0, 1, 3, 5, and 10 minutes after bolus injection of Gd-DTPA. The cases consisted of 16 hepatocellular carcinomas, 24 hemangiomas, 6 metastases, 3 cholangiocellular carcinomas, and 7 hepatic cysts. The dynamic enhancement patterns were evaluated on the basis of initial enhancement study and, the degree of enhancement was also levaluaied. RESULTS: Of 24 hemangiomas, most cases showed centripetal filling-in pattern of enhancement except 3 cases which showed homogeneous enhancement pattern on the early dynamic phase. All hemangiomas showed very high signal intensity which persisted to the delayed phase. The eccentric enhancement pattern was the most common type in hemangiomas (63%). Hepatocellular carcinomas had heterogeneous enhancement pattern on early and delayed phase (81, 88%) and showed diminished signal intensity on the delayed images. 14 of 16 hepatocellular carcinomas (88%) had peritumoral halo. Variable enhancement pattern was observed in metastases including progressive centripetal filling-in pattern (67%). All metastases showed prominent peritumoral halos and low signal intensity. Cholangiocellular carcinomas showed early centripetal filling-in and heterogeneous enhancement pattern on delayed phase. None of hepatic cysts showed enhancement. CONCLUSIONS: Dynamic breath-hold MR imaging with Gd enhancement allows accurate assessment of hemodynamic status of hepatic lesions and is useful in differential diagnosis of focal hepatic lerions.
Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Diagnosis, Differential ; Female ; Gadolinium DTPA ; Hemangioma ; Hemodynamics ; Humans ; Liver ; Magnetic Resonance Imaging* ; Male ; Neoplasm Metastasis ; Tomography, X-Ray Computed

PURPOSE: To compare the ability of tumor detection and the lesion conspicuity between T1- and T2-weighted fast scanning sequences and T1- and T2-weighted conventional spin echo techniques in MR imaging of hepatic tumors. MATERIALS AND METHOD: Hepatic tumors were induced on 13 male Sprague-Dawley rats by feeding 3'-methyl-dimethylethylaminoazobenzene mixed with Miller's III formula for 12 weeks. MR images were obtained with 1.5T magnet with dual TMJ coil(Signa, GE Medical Systems, Milwaukee, USA). Animals were anesthesized with 150mg/kg of ketamine hydrochloride. T2 weighted fast spin echo(FSE), conventional spin echo(CSE) T2- and T1WI, fast multiplanar spoiled gradient recalled(FMPSPGR) imaging were obtained. Number of detected, tumors and contrast-to-noise ratio of the tumors were compared for each sequence. RESULTS: Overall 110 tumors were developed. 75% of the tumors were detected on FSE, 65% on FMPSPGR, 41% on conventional T2WI, and 41% on T1WI images. For tumors more than 5mm in diameter, sensitivity was 88% on FMPSPGR, 65% on conventional T2WI, and 81% on TIWI images respectively. CNR of the tumor was 28.94 +/- 21.6 on FSE, 13.57 +/- 8.64 on FMPSPGR, 12.62 +/- 10.65 on CSE T2WI, and 9.47 +/- 8.05 on CSE TIWI images, which was significantly high on FSE (p<0.05). CONCLUSION: Fast spin echo T2 WI shows highest sensitivity and tumor-to-liver contrast. FMPSPGR imaging is also favorably comparable with conventional T1WI. Therfore, these two pulse sequences can be useful in clinical condition for hepatic MR imaging.
Animals ; Humans ; Ketamine ; Magnetic Resonance Imaging ; Male ; Rats* ; Rats, Sprague-Dawley ; Temporomandibular Joint

PURPOSE: Although considered uncommon, periprosthetic fracture of the femur after hip arthroplasty is a serious complication that can be difficult to treat. Authors analyzed the types of fracture and modality of treatment. MATERIALS AND METHODS: Between Jan. 1983 and Dec. 1997, 17 cases of postoperative periprosthetic fractures had been treated at our hospital. These cases were followed up for an average of 58 (13-123) months. The fractures were classified according to Duncan and Masri classification. Three cases of type A, and 6 cases of type B1, 3 cases of type B2, 3 cases of type B3 and 2 cases of type C. The 3 cases of type A and 2 cases oftype B1 were conservative treatments. The 4 cases of type B1 were treated with open reduction and internal fixation with bone graft. The 3 cases of type B2 and 3 cases in type B3 were treated with long stem revision. The 2 cases of type C were treated with open reduction and internal fixation with bone graft. RESULTS: Bony union happened in all cases. The results according to Beals and Tower criteria were excellent in 12 cases, good in 3 cases and poor in 2 cases. CONCLUSIONS: The most frequent cause of periprostic fracture was trauma and other causes were loosening and osteolysis. Proper treatment method of periprosthetic fracture were important for stability of femoral stem
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Classification ; Femur* ; Hip ; Osteolysis ; Periprosthetic Fractures ; Transplants

BACKGROUND: The current various case-finding instruments for detecting depression in Korea are too cucumbersome and time-consuming for routine use in primary care or student and soldier groups because of too many questions. We carried out this study in order to investigate the validity of the two-question case-finding instrument for detecting depression easily in the primary care or the mentioned groups. METHODS: We selected one boy high school in Seoul and 155 sophomer students answered the questionnaire by self-report. The questionnaire included two questions about depressed mood and anhedonia: (1) "During the past month, have you often been bothered by feeling down, depressed or hopeless?" (2) "During the past month, have you often been bothered by little interest or pleasure in doing things(e.g., studying, playing or talking with friends) ?". And then a resident of family medicine interviewed them and made a diagnosis for depression using the diagnostic criteria of DSM-IV. Simultaneously we compared the test characteristics of a two-question case-finding instrument with those of a previously validated Beck Depression Inventory as a currently world-wide used screening instrument for depression. RESULTS: The prevalence of major depression as determined by the interview was 6.6%(10 of 151). The two-question case finding instrument had a Cronbach's alpha of 0.663-internal consistency, a sensitivity of 100%, a specificity of 54.6%, a positive likelihood ratio of 2.20 and a negative predictive value of 1.00.(A "yes" answer to either of the two questions was considered a positive test.) And the BDI had a sensitivity of 90%, a specificity of 68.1%, a positive likelihood ratio of 3.63 and a negative predictive value of 0.99(cut-off point=15). Area under the ROC curves of the two-question case-finding instrument was 0.882, greater than that of the BDI, 0.834. CONCLUSIONS: The test characteristics of a two-question case-finding instrument were higher compared to those of BDI for major depression. Therefore, the two-question case-finding instrument is a useful measure for detecting depression and less time-consuming in primary care and certain groups.
Adolescent ; Anhedonia ; Depression* ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Korea ; Male ; Mass Screening* ; Military Personnel ; Pleasure ; Prevalence ; Primary Health Care ; ROC Curve ; Sensitivity and Specificity ; Seoul ; Surveys and Questionnaires

Retinoic acid has been used successfully as a differentiating agent in acute promyelocytic leukemia and neuroblastoma. However, some adverse effects have been recognized, such as headaches, dry skin and retinoic acid syndrome, a life threatening acute cardiorespiratory disorder. Acute pancreatitis with hyperlipidemia has rarely been reported. We experienced a case of acute pancreatitis with hyperlipidemia in a neuroblastoma patient after retinoic acid therapy for 21 months. Although the patient was ordered nothing by mouth and total parenteral nutrition was administrated, she died of disseminated intravascular coagulopathy and pulmonary hemorrhage, possibly because of oral intake during her recovery period.
Headache ; Hemorrhage ; Humans ; Hyperlipidemias ; Leukemia, Promyelocytic, Acute ; Mouth ; Neuroblastoma* ; Pancreatitis* ; Parenteral Nutrition, Total ; Skin ; Tretinoin*

PURPOSE: To determine the efficacy of Gd-ethoxybenzyl-DTPA(Gd-EOB-DTPA) in MR imaging of primary hepatictumors in rats. MATERIALS AND METHODS: Primary hepatic tumors had been induced on 12 male Sprague-Dawley rats byoral administration of an experimental diet containing 3'-methyl-4'-dimethylaminobenzene for 12 weeks. T1-weighted spin echo images were obtained with 1.5 T system before and after injection of 25 micro mol/kg ofGd-EOB-DTPA. The detection rate of tumors in each image was compared to that in resected specimens. Signal intensity of the liver and the largest tumor were measured in each rat on pre- and postcontrast images. Signal tonoise ratio(SNR) of the liver and liver-to-tumor contrast to noise ratio(CNR) were calculated. RESULTS: One hundred and twenty-five liver tumors were identified on gross examination. Fifty one lesions(41%) on precontrast images, and 80(64%) on postcontrast images were demonstrated (p<0.01). Of the 33 tumors larger than 5mm, 28lesions(85%) were demonstrated on precontrast image, and 31(94%) on postcontrast image (p>0.05). Of the 92 lesions smaller than 5mm in diameter, 23(25%) were seen on precontrast image and 49 the (53%) on postcontrast image(p<0.01). After contrast enhancement, the signal intensity of both liver and tumor increased(p<0.05), though background noise also increased (p>0.05). Consequently, SNR increased significantly in the liver from 10.89 +/-1.96(mean standard error) to 15.59 +/- 2.34(p<0.05), but not in tumors(from 8.21 +/- 3.71 to 8.85 +/- 5.42). Liver-to-tumor CNR increased from 5.55 +/- 0.94 to 13.25 +/- 2.50 (p<0.01). CONCLUSION: The use of Gd-EOB-DTPA canincrease the detection rate of primary hepatic tumors in rats, especially of small lesions.
Animals ; Diet ; Gadolinium ; Humans ; Liver ; Magnetic Resonance Imaging* ; Male ; Noise ; Rats* ; Rats, Sprague-Dawley