Bronchiolitis obliterans is a distinct pathologic entity, characterized by the accumulation of pigmented macrophages within respiratory bronchioles and adjacent to air spaces, and thickening of the peribronchial interstitium. It has been reported to be associated with viral infection, drug, toxic fume, bone marrow transplantation, and connective tissue disorders such as rheumatoid arthritis. The etiology of bronchiolitis obliterans in the post-renal transplantation state is not yet clear, although several possibilities such as drug toxicity, graft-versus-host disease or postinfectious condition have been postulated. We presented three patient who had bronchiolitis obliterans, as a complication following renal transplantation. Chest radiograph showed bilateral perihilar reticular infiltration or ground glass appearances that progressed to either diffuse alveolar consolidations or solitary nodule. The main finding in each lung biopsy was the presence of macrophages within respiratory bronchioles as well as in the neighboring alveolar ducts and alveoli. Alveolar septa in these areas often showed nonspecific thickening by fibrosis, mild chronic inflammatory cell infiltrate, and hyperplasia of alveolar lining cells and type II pneumocytes.
Arthritis, Rheumatoid ; Biopsy ; Bone Marrow Transplantation ; Bronchioles ; Bronchiolitis Obliterans* ; Bronchiolitis* ; Connective Tissue ; Drug-Related Side Effects and Adverse Reactions ; Fibrosis ; Glass ; Graft vs Host Disease ; Humans ; Hyperplasia ; Kidney Transplantation ; Lung ; Macrophages ; Pneumocytes ; Radiography, Thoracic

Stasis dermatitis is one of the important skin manifestations of venous stasis. Therefore, the searching for the cause of venous stasis is importrnt. Two cases of stasis dermatitis with inferior vena caval obstruction are reported and possible etiologic factor is discussed. Case I The patient, 38-year-old carpenter, was admitted at Choong Buk Medical Center in April, 1974 with superficial venous engorgement of the lower extremities which had begun to appear two years after severe blunt trauma to both legs in 1962. 5 years prior to admission, abdomial venous engorgement and abdominal fullness developed and was exaggerated gradually. Since 2 years prior to admission, he has been suffered from the recurrent exudative ulcer on the right lower leg The physical examination revealed mild icteric sclera, hepatomegaly, abdominal distension, tortuous venous engorgement on the abdomen, the lateral chest wall and the lower extremities, and edematous scaly brawny pigmentation of the lower legs. Esphagogram showed no esphageal varices. Inferior vena cavogram showed complete obstruction at the level of upper border of 2nd lumbar vertebra and well developed collateral circulation, Findings of skin biopsy on the right lower leg showed moderate acanthosis, increased pigmentation of bosal cell layer in the epidermis, capillary proliferation, diffuse inflammatory cell infiltration with increased fibrosis and hemosiderin granules in the dermis. Case II The patient. 36-year-old farmer, was admitted at Dept. of Dermatology, St. Mary's Hospital, Catholic Medical College in Sept., 1973.The physical examination revealed hepatomegaly, abdominal distension, superficial venous engorgement on the abdomen, the neck and the lower extrcmities, severe edema and pigmentation of the lower legs, and the multiplc. Exudative ulcers on the left lower leg. Liver scanning showed somewhat general enlargement with some mottlings along the margin and relative prominance of the left lobe. Liver biopsy revealed findings of non specific chrcnic hepatitis. Inferior vena cavogram through the left femoral vein showed complete obstruction at the level between 11th and 12th thoracic vertebrae.His peripheral edema and ascites was much subsided after adequate bed rest and the skin lesion improved with scar formation.
Abdomen ; Adult ; Ascites ; Bed Rest ; Biopsy ; Capillaries ; Cicatrix ; Collateral Circulation ; Dermatitis* ; Dermatology ; Dermis ; Edema ; Epidermis ; Femoral Vein ; Fibrinogen ; Fibrosis ; Hemosiderin ; Hepatitis ; Hepatomegaly ; Humans ; Hyperemia ; Leg ; Liver ; Lower Extremity ; Neck ; Physical Examination ; Pigmentation ; Sclera ; Skin ; Skin Manifestations ; Spine ; Thoracic Wall ; Ulcer ; Varicose Veins

The trachea is a cartilagenous and membranous tubular midline structure with parallel walls. Tracheal deviation may be caused either by traction toward the diseased hemithorax or by compression toward the normal side. Unless an obvious mass is observed radiographically, occasionally it can be difficult to decide whether the trachea has been pushed or pulled from its normal position in the mediastinum. We studied the differences between tracheal deviation patterns in 23 patients with fibroatelectatic pulmonary tuberculosis and 35 patients with elongated and dilated aortas. In cases of retraction of the trachea by fibroatelectatic pulmonary tuberculosis, the diameter of the deviated segment was greater than that of the normal segment and deviation of the wall adjacent to the fibroatelectasis from its normal position was greater than that of the opposite wall. In cases of compression of the trachea by the elongated and dilated aorta, the diameter of the diviated segment was smaller than that of the normal segment and deviation of the wall adjacent to the aortic arch from its normal position was greater than that of the opposite wall. We conclude that these differences between tracheal deviation patterns are useful signs for discriminating retraction from compression. Thus when the trachea is retracted, the deviation of the juxtalesional wall is greater than that of the lesion-free wall, and vice versa.
Aorta ; Aorta, Thoracic ; Diagnosis, Differential* ; Humans ; Mediastinum ; Trachea* ; Traction* ; Tuberculosis, Pulmonary

Follow-up sonographic studies of three infants, whose initial sonograms showed findings suggestive of choledochal cyst, demonstrated disappearance of cystic dilatation of the common bile ducts. The phenomena could be accounted for by acute common bile duct obstruction secondary to bile sludge. Bile plug syndrome should also be included in the differencial diagnosis. When a cystic or fusiform dilatation of the common bile duct is seen on sonogram. Conservative management must be the choice of approach unless the finding is proven to unchanged over a period of time and irreversible.
Bile ; Choledochal Cyst ; Common Bile Duct* ; Diagnosis ; Dilatation* ; Follow-Up Studies ; Humans ; Infant* ; Sewage ; Ultrasonography

In vivo 1H MR spectroscopic studies were performed on the human brain in six normal volunteers. Some distinct proton metabolites, such as N-acetylaspartate (NAA), creatine/phosphoccreatine (Cr), choline/phosphocholine (Cho), myo-inostitol (Ins) and lipid (fat) were clearly identified in normal brain tissues. The signal intensity of NAA resonance is strongest. The standard ratios of metabolites from the normal brain tissues in specific regions were obtained for the references of further in vivo 1H MR spectroscopic studies. Our initial results suggest the in vivo 1H MR spectroscopy may provide more precise diagnosis on the basis of the metabolic informations on brain tissues. The unique ability of in vivo 1H MR spectroscopy to offer noninvasive information about tissue biochemistry in patients will stimulate its impact on clinical research and disease diagnosis.
Biochemistry ; Brain* ; Diagnosis ; Healthy Volunteers* ; Humans* ; Magnetic Resonance Spectroscopy* ; Protons

PURPOSE: To evaluate the spatial distribution of various proton metabolites in the human brain with use of water-suppressed in vivo 1H MR spectroscopic imaging (MRSI) technique MATERIALS AND METHODS: All of water-suppressed in vivo 1H MRSI were performed on 1.5 T whole-body MRI/MRS system using Stimulated Echo Acquisition Method (STEAM) Chemical shift Imaging (CSI) pulse sequence. T1 -weighted MR images were used for CSl Field Of View (FOV; 24 cm). Voxel size of 1.S cm3 was designated from the periphery of the brain which was divided by 1024 x 16 x 16data points. RESULTS: Metabolite images of N-acetylaspartate (NAA), creatine/phosphocreatine (Cr) + choline/phosphocholine (Cho), and complex of gamma-aminobutyric acid (GABA) -I- glutamate (Glu) were obtained on the human brain. CONCLUSION: Our preliminary study suggests that in vivo 1H MRSl could provide the metabolite imaging to compensate for hypermetabolism on Positron Emission Tomography (PET) scans on the basis of the metabolic informations on brain tissues. The unique ability of in vivo 1H MRSI to offer noninvasive informations about tissue biochemistry in disease states will stimulate on clinical research and disease diagnosis.
Biochemistry ; Brain* ; Diagnosis ; gamma-Aminobutyric Acid ; Glutamic Acid ; Humans* ; Magnetic Resonance Imaging ; Positron-Emission Tomography ; Protons

Disparity among cholangiograms is rarely observed. The causes of disparity include spontaneous disappearance of gall stone, incomplete filling of smaller branch, technical problems, interpretative errors, and overriding of evidence. 5pontaneous disappearance of gall stone is rare but has been well documented in both radioligic and clinical literatures. Recently we have experienced spontaneous disappearance of a large stone in the common bile duct and this formsthe basis of the present case report. The patient, 53-year-old female, was admitted on January 18, 1982 to 5t. Mary's Hospital, Catholic Medical College because of repeated episodes of pain in the epigastrium and the right upper quadrant for the past 2 months. On admission, physical examination revealed tenderness in the epigastrium and the right μpper quadrant. Laboratory tests revealed bilirubin 2.2 mgfdl and alkaline phosphatase 76 .5 KA/dl. A percutaneous transhepatic cholagiogram(PTC} performed 2 days later revealed a large stone measuring 16 × 26mm in size in the distal CBD. The CBD and CHD proximal to the stone were moderately dilated. Most of the intrahepatic ducts were well delineated without fi lJ ing defect or evidence of stone. However, the in ferior segment of the posterior branch of the right intrahepatic duct (IPRH) was not delineated. The ending of the nonvisualized segment was rather abrupt. The patient suffered severe abdominal pain 2 days after PTC, and was treated with Buscopanø compositum. The attack ceased 20 hours after the onset of colicky abdominal pain. An operation was performed 4 days after PTC. To our surprise there was no stone in the distal CBD. The gallbladder was resected and a T-tube has been placed. A table cholangiogram confirmed disappearance of the stone, but IPRH was agin not opacified except for a short ditance just after bifurcation from the main branch. Eight days after surgery a follow-up T-tube cholangiogram was performed. No residual stone was found in the extrahepatic bile duct. However, IPRH which was not opacifled until then became distinctly visualized demonstrating multiple intra-ductal radiolucent stones, There was a diaphragm-like structure obstructing the lumen and confining the stones located proximally to the site obstructed in the precedent cholangiograms, The radiologic and clinical importances of our observation in this case are four fold: 1. Gall stone up to the diameter of 14 × 23mm can pass through the papilla spontaneously, 2. Repeat diagnostic imaging is imperative when patient became asymptomatic after severe colicky abdominal pain before the intended operation, 3. Without optimal delineation of intrahepatic biliaη radicles, residual stone or stones cannot be exciuded in the cholangiograms, 4. And finally, to avoid misdiagnosis a comprehensive knowledge of normal anatomy of cholangiogram is required.
Abdominal Pain ; Alkaline Phosphatase ; Bile Ducts, Extrahepatic ; Bilirubin ; Common Bile Duct ; Diagnostic Errors ; Diagnostic Imaging ; Diaphragm ; Female ; Follow-Up Studies ; Gallbladder ; Gallstones ; Humans ; Middle Aged ; Physical Examination

After a lobectomy the apearance of the chest roentgenogram may return so nearly to normal that it isfrequently very difficult to tell which lobe has been moved without refering to the thoracic surgeon's record. Thereriew of literature failed to disclose previous articles concerning the differential diagnosis between upper andlower lobectomy. Clues of a lobectomy may be found in the rib cage, hilar shadows, pleura and disphragms, but they do not specifically incidate which lobe has been removed. In the present study we anlaysed anatomico-spatialchanges of the pulmonary basal arteries, hilar point, vascular redistribution, diaphragm and rib cage on the plainchest films taken before and after a lobectomy in 33 cases seen at the Dept. of Radiology, St. Mary's Hospoital, Catholic Medical College. Firstly we observed the pulmonary basal artery after a lobectomy on plain chest film. In 12 cases of upper lobectomy the pulmonary basal artery was easily identified in every case. However in all of 21cases of lower lobectomy, the pulmonary basal artery was not identified. Next, a shift of the hilar point waschecked after a lobectomy. Regarding to vascular redistribution, the blood vessels was counted at upper and lowerlung fields by simon's method before and after a lobectomy, respectively. Finally, the level of the diaphragm wascompared in the pre. and post-opeative films and resected rib was scrutinized. The present study revealed that themost reliable sign to indicate specifically which lobe has been resected is persistence or disappearance of thepulmonary basal artery. Then i.e. in upper lobectomy the pulmonary basal artery was easily identified, but inlower lobectomy the pulmoanry basal artery was not dectable. Other findings such as vascular redistribution,elevated diaphragm and resected rib were not specific.
Arteries ; Blood Vessels ; Diagnosis, Differential ; Diaphragm ; Methods ; Pleura ; Ribs ; Thorax

The technic of selective transbronchial brush biopsy has been described by authors in a number of medialcenters. The procedure was popularized by Fennessy. This procedure should be considered for any hospital that isprovided with an image intensifier and adequate laboratory facilities. Between May and Aug. 1982, 13 patientsunderwent transbronchial brush biopsy at the Department of Radiology, St. Mary's Catholic Medical College. In mostcases, biopsy was performed was perforemd because of the presence of a pulmonary lesion or lesions suspicious ofmalignancy or infection in which cytologic and bacteriologic tests had failed to establish a diagnosis. Our recentclinical experience forms the basis of this communication. 1. As a reulst of bronchial brush biopsy, 4 cases ofpulmonary tuberculosis, 1 case each of alveolar cell ca, small cell ca, undifferentiated ca, and 3 cases ofbacterial pneumonia could be positively diagnosed. 2. The complications are transient hemoptysis and fever in 1case. 3. Bronchial brush biopsy has been proven to be a safe procefure with a high yield in the cytologic andbacteriologic diagnosis of diseases of the respiratory tract.
Biopsy ; Diagnosis ; Fever ; Hemoptysis ; Lung Diseases ; Lung ; Pneumonia ; Respiratory System ; Tuberculosis

It is well established that the CT is an essential part not only in screening primary brain tumors, but alsoin staging known malignancy. This paper reports various CT findings demonstrated in 12 cases of choriocarciomawith brain metastasis. The CT findings such as the number, location and density of the metastatic lesions, thedegree of brain edema, mass effect and effect of contrast enhancement are reviewed as well as the episode ofstroke syndrome and survival duration after neurologic symptoms attacks. The results were as follows; 1. Ten ofthese cases showed solitary metastatic lesion and remaining 2 cases were multiple lesions. 2. One was isodensedensity and the others were hemorrhagic increased denstiy by CT. 3. All of these showed mass effect to thesurrounding structures along with moderate to marked brain edema. 4. The position of the metastatic lesion werelocated at the supratentorially in all cases. Most of them were at the unilateral frontal or parietal area of bothof them. One which noted multiple metastatic foci showed at the bilateral occipital regions. 5. Nine cases showedring enhancement after contrast infusion. One which noted isodense density on the noninfusion scan showed alsoring enhancement after contrast infusion. 6. Nine cases showed positive stroke syndrom. One of them was perforemdemergency craniotomy. The remainging 3 cases noted progressive neurologic symptoms. 7. Two cases were noted onlybrain metastasis but the others also had various degree of pulmonary metastasis and 2 of latter had hepaticmetastasis, too. 8. Most of the cases were treated with CHAMOCA regimen, and one of them was taken whole brainirradiation (3000 rads/2 weeks). Another one case revealed marked regression of not only metastatic brain lesionbut the pulmonary lesion after the 8th course of CHAMOCA regimen and still alive for over 460 days.
Brain Edema ; Brain Neoplasms ; Brain ; Choriocarcinoma ; Craniotomy ; Female ; Mass Screening ; Neoplasm Metastasis ; Neurologic Manifestations ; Occipital Lobe ; Pregnancy ; Rabeprazole ; Stroke