PURPOSE: Intravenous infusion of crystalloid solution is very important in the treatment of severe burn patients. But variable blood acid-base differences can be induced due to crystalloids. The aim of this study was to compare, in severe burn patients, the effects of two balanced fluids (Hartmann solution and plasma solution-A) on blood chemical differences. METHODS: A retrospective review was performed on 21 patients from January 2010 to December 2012 who admitted as severe burn patients to KEPCO Medical Center burn care unit. One group was resuscitated with Hartmann solution according to Parkland formula. The other one was resuscitated with plasma solution-A. RESULTS: 21 patients were enrolled. 14 patients belonged to plasma solution-A group and 7 patients belonged to Hartmann solution group. Bicarbonate, pH, serum lactate and serum electrolytes showed no statistic differences between plasma solution-A and Hartmann solution group (P>0.05). As time went by, pH and bicarbonate increased and serum lactate level decreased in both group. CONCLUSION: In this study, plasma solution-A had equally alkalinizing effect as Hartmann solution in severe burn patient resuscitation.
Acidosis ; Burns* ; Electrolytes ; Humans ; Hydrogen-Ion Concentration ; Infusions, Intravenous ; Lactic Acid ; Plasma* ; Resuscitation* ; Retrospective Studies

Ultrasound-guided percutaneous radiofrequency (RF) ablation has become one of the most promising local cancer therapies for both resectable and nonresectable hepatic tumors. Although RF ablation is a safe and effective technique for the treatment of liver tumors, the outcome of treatment can be closely related to the location and shape of the tumors. There may be difficulties with RF ablation of tumors that are adjacent to large vessels or extrahepatic heat-vulnerable organs and tumors in the caudate lobe, possibly resulting in major complications or treatment failure. Thus, a number of strategies have been developed to overcome these challenges, which include artificial ascites, needle track ablation, fusion imaging guidance, parallel targeting, bypass targeting, etc. Operators need to use the right strategy in the right situation to avoid the possibility of complications and incomplete thermal tissue destruction; with the right strategy, RF ablation can be performed successfully, even for hepatic tumors in high-risk locations. This article offers technical strategies that can be used to effectively perform RF ablation as well as to minimize possible complications related to the procedure with representative cases and schematic illustrations.
Ascites ; Bile Duct Diseases/etiology ; Carcinoma, Hepatocellular/*surgery/ultrasonography ; Catheter Ablation/adverse effects ; Humans ; Liver Neoplasms/*surgery/ultrasonography ; Neoplasm, Residual/etiology

Multidetector CT (MDCT) gastrography has been regarded as a promising technique for the preoperative imaging of gastric cancer. It has the ability to produce various three-dimensional (3D) images. Because 3D reconstruction images are more effective and intuitive for recognizing abnormal changes in the gastric folds and subtle mucosal nodularity than two-dimensional images, 3D MDCT gastrography can enhance the detection rate of early gastric cancer, which, in turn, contributes to the improvement of the accuracy of preoperative tumor (T) staging. In addition, shaded surface display and tissue transition projection images provide a global view of the stomach, with the exact location of gastric cancer, which may replace the need for barium studies. In this article, we discuss technical factors in producing high-quality MDCT gastrographic images and present cases demonstrating the usefulness of MDCT gastrography for the detection and T staging of gastric cancer while emphasizing the significance of preoperative localization of gastric cancer in terms of surgical margin.
Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Neoplasm Staging ; Stomach Neoplasms/pathology/*radiography/surgery ; Tomography, X-Ray Computed

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare subtype of cutaneous lymphoma. There have been a few case reports describing the radiologic imaging findings of SPTCL. We report a case of SPTCL, rarely presented with a breast mass. Here, we review her clinical history and radiologic (mammography and ultrasound) findings.
Adult ; Breast Neoplasms/*pathology/radiography/ultrasonography ; Female ; Humans ; Lymphoma, T-Cell/*pathology/radiography/ultrasonography ; Mammography ; Panniculitis/*pathology/radiography/ultrasonography ; Rare Diseases/*pathology/radiography/ultrasonography ; Skin Neoplasms/*pathology/radiography/ultrastructure

PURPOSE: The purpose of this study was to determine the underestimation rate of ductal carcinoma in situ (DCIS) on sonographically guided 14-gauge core needle biopsy of the breast and to investigate the factors associated with this underestimation. MATERIALS AND METHODS: We retrospectively reviewed 2990 consecutive lesions that underwent sonographically guided 14-gauge core needle biopsy between January 2005 and December 2008. Among them, 61 lesions were pathologically proven to be DCIS (2.04%). A total of 50 DCIS lesions (mean patient age: 50.7 years old, age range: 36-79 years old) that underwent surgical resection were included in this study. After surgery, the lesion proven to be invasive was defined as being in the underestimated group and the lesion proven to DCIS was defined as being in the correctly diagnosed group. We determined the underestimation rate of DCIS and we retrospectively reviewed and compared the clinical, pathologic and radiologic features of the two groups. RESULTS: The underestimation rate of DCIS was found to be 28% (14 of 50 lesions). The underestimation of DCIS was significantly frequent for a clinically palpable lesion (78.6% (11/14) vs. 30.5% (11/36), respectively, p = 0.002). The sonographically maximal diameter of a lesion was significantly larger in the underestimated group than that in the accurately diagnosed group (28.4 +/- 14.0 mm vs. 17.6 +/- 10.3 mm, respectively, p = 0.017) and underestimation was significantly frequent when the sonographic lesion size was > 20 mm (p = 0.012). There was no significant difference in terms of age, the lesion type, the Breast Imaging-Reporting and Data System (BI-RADS) category or the pathologic features between the two groups. CONCLUSION: The underestimation rate of DCIS was 28% for sonographically guided 14-gauge core needle biopsy of the breast. Clinical symptoms such as a palpable lesion and a sonographic lesion size > 20 mm were the factors related with the underestimation of DCIS.
Biopsy, Large-Core Needle ; Breast ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Humans ; Information Systems ; Retrospective Studies

PURPOSE: We wanted to evaluate the diagnostic benefits and safety of performing CT-guided transthoracic needle biopsy (TTNB) with using an18-gauge automated cutting needle. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 332 patients who underwent CT-guided transthoracic biopsy with an automated 18-gauge cutting needle for 341 thoracic lesions. The histopathologic results, diagnostic accuracy and complication rate were determined. RESULTS: 316 (92.7%) of 34l lesions were histopathologically diagnosed by CT-guided TTNB. The lesions were malignant in 172 patients and benign in 144 patients. The diagnostic accuracy was 92.9%. The sensitivity and specificity for malignant lesions were 93% and 92.3%, respectively. The sensitivity and specificity for benign lesions were 92.3% and 93%, respectively. TTNB induced complications developed for 54 of 341 (15.8%) procedures. The most frequent complication was pneumothorax (41/341, 12%). Nine patients with pneumothorax (9/41, 22%) required chest tube placement. CONCLUSION: CT-guided TTNB with an 18-gauge automated cutting needle could be useful for making the histopathologic diagnosis of malignant and benign pulmonary lesions as the technique provides a big enough tissue sample for histopathologic examination. The procedure-related complication rate was acceptably low.
Biopsy ; Biopsy, Needle* ; Chest Tubes ; Diagnosis ; Humans ; Medical Records ; Needles* ; Pneumothorax ; Retrospective Studies ; Sensitivity and Specificity

PURPOSE: We wanted to evaluate the safety and effectiveness of superselective transarterial embolization for the management of gastrointestinal bleeding. MATERIALS AND METHODS: We evaluated 97 of 115 patients who had undergone diagnostic angiography and transarterial embolization for gastrointestinal bleeding from February 2001 to July 2004, and they subsequently underwent superselective transarterial embolization. Their ages ranged from 17 to 88 years (mean age: 58.5 years), and 73 were men and 24 were women. The etiologies were a postoperative condition (n=31), ulcer (n=23), Mallory-Weiss syndrome (n=3), trauma (n=3), pseudoaneurysm from pancreatitis (n=3), diverticula (n=2), inflammatory bowel disease (n=2), tumor (n=2), Behcet's disease (n=2), hemobilia (n=1), and unknown origin (n=25). The regions of bleeding were the esophagus (n=3), stomach and duodenum (n=41), small bowel (n=38) and colon (n=15). All the patients underwent superselective transarterial embolization using microcoils, gelfoam or a combination of microcoils and gelfoam. Technical success was defined as devascularization of targeted vascular lesion or the disappearance of extravasation of the contrast media, as noted on the angiography after embolization. Clinical success was defined as the disappearance of clinical symptoms and the reestablishment of normal cardiovascular hemodynamics after transarterial embolization without any operation or endoscopic management. RESULTS: The technical success rate was 100%. The primary clinical success rate was 67% (65 of 97 patients). Of the 32 primary failures, fourteen patients underwent repeat embolization; of these, clinical success was achieved in all the patients and so the secondary clinical success rate was 81% (79 of 97 patients). Of the 18 patients with primary failures, five patients underwent operation, one patient underwent endoscopic management and the others died during the observation period due to disseminated coagulopathy or complications of their underlying diseases. During the follow up period, six patients of the 79 clinically successful patients died due to disseminated coagulopathy or complications of their underlying diseases, and so the total mortality rate was 19% (18 of 97 patients). Postembolization complications such as bowel ischemia or infarction did not occur during the observation period. CONCLUSION: Superselective transarterial embolization is an effective therapy for treating acute gastrointestinal hemorrhage, and it has a high technical rate and clinical success rate, and a low complication rate.
Aneurysm, False ; Angiography ; Colon ; Contrast Media ; Diverticulum ; Duodenum ; Esophagus ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Gelatin Sponge, Absorbable ; Hemobilia ; Hemodynamics ; Hemorrhage* ; Humans ; Infarction ; Inflammatory Bowel Diseases ; Ischemia ; Male ; Mallory-Weiss Syndrome ; Mortality ; Pancreatitis ; Stomach ; Ulcer

PURPOSE: We wanted to evaluate the potential role of dynamic incremental computed tomography (CT) for making the diagnosis of malignant solitary pulmonary nodule (SPN) by investigating the dynamic enhancement patterns. MATERIALS AND METHODS: Forty patients with presumed malignant SPN (diameter < 30 mm) were selected for dynamic incremental chest CT scanning. Histopathologic diagnoses of the malignant SPNs were obtained by surgical excision (n=8) and transthoracic needle biopsy (n=32), and they were squamous cell carcinoma (n=16), adenocarcinoma (n=14), small cell carcinoma (n=5), bronchioloalveolar carcinoma (n=3), and large cell carcinoma (n=2). CT scans were performed at the region of interest (ROI) of the lung nodule before and after contrast enhancement. The dynamic incremental CT scans after contrast enhancement were performed at 15 seconds, 30 seconds, 45 seconds, 60 seconds, 90 seconds, 2 minutes, 3 minutes and 4 minutes. The degree of contrast enhancement according to the time course and the time of maximum enhancement of the malignant nodules were recorded by measuring the Hounsfield Unit (HU) of the nodules at the ROI. We assessed the differences of the contrast enhancement patterns among the histopathologic subtypes of malignant SPN. RESULTS: In malignant SPN, the average time of maximum contrast enhancement was 62.2+/-16.2 seconds, and the average degree of maximum contrast enhancement was 66.4+/-22.17 HU. Most primary lung cancer showed rapid contrast enhancement with slow washout. The differences of the enhancement patterns among the histopathologic subtypes were not statistically significant (p > 0.05). CONCLUSION: Dynamic incremental chest CT was useful for making the diagnosis of malignant SPN that showed an established dynamic contrast enhancement pattern regardless of the histopatholgic subtypes.
Adenocarcinoma ; Adenocarcinoma, Bronchiolo-Alveolar ; Biopsy, Needle ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Humans ; Lung ; Lung Neoplasms ; Solitary Pulmonary Nodule* ; Tomography, X-Ray Computed

PURPOSE: The aim of this study was to determine a safe gastrointestinal contrast agent that could be used in various clinical situations where there is a risk of aspiration using a rabbit model. MATERIALS AND METHODS: 30 healthy white rabbits were used. The rabbits were divided into 5 groups containing six animals each, one control group (anesthesia only) and 4 groups receiving various contrast agents [Solotop (Barium sulphate suspension), Gastrografin (Sodium and meglumine amidotrizoate), and Telebrix (Meglumine ioxitalamate), Visipaque (Iodixanol)]. The contrast agents were injected selectively into a main bronchus via a catheter inserted under fluoroscopy guidance. The rabbits were sacrificed either 1 day or 7 days after injecting the contrast agents, and the tissue reaction of the bronchi and lungs were examined both macro- and microscopically. The level of alveolar septal thickening, peribronchiolar lymphocytic infiltration, pulmonary congestion and edema, inflammatory exudate in the alveoli or bronchiolar lumina, microabscess formation, necrosis, pigmentation of materials injected, and fibropurulent pleurisy were evaluated and graded according to the severity as follows: no change, mild, moderate, marked in degree. RESULTS: The common microscopic findings were alveolar septal thickening and peribronchiolar lymphocytic infiltration. Pulmonary congestion and edema, inflammatory exudate in the alveoli or bronchiolar lumina were observed in 21 out of 24 rabbits receiving the contrast agents. Pigmentation of the materials injected was observed only in the group receiving Solotop. An inflammatory exudate in the alveoli and bronchiolar/bronchial lumina, microabscess formation, and necrosis were noted in most groups, but was more frequent and severe in the group receiving Gastrografin. CONCLUSION: The histopathological reactions of the rabbit lungs after the intrabronchial application of a contrast agent showed variable degrees of inflammatory reactions. Gastrografin produced most severe and extensive reaction, Solotop and Telebrix a moderate reaction, and Visipaque a minimal reaction. Therefore, a non-ionic dimeric contrast agent such as Visipaque may be the safest contrast agent in the lung when a GI tract examination is performed in clinical situations where there is a risk of aspiration.
Animals ; Bronchi ; Catheters ; Contrast Media* ; Diatrizoate Meglumine ; Edema ; Estrogens, Conjugated (USP) ; Exudates and Transudates ; Fluoroscopy ; Gastrointestinal Tract ; Lung* ; Meglumine ; Necrosis ; Pigmentation ; Pleurisy ; Rabbits

PURPOSE: To evaluate the usefulness of apparent diffusion coefficient (ADC) values using diffusion-weighted magnetic resonance imaging (DWI) in patients with ovarian cystic tumors. MATERIALS AND METHODS: During past 12 months, we studied 30 patients who were clinically suspected of having ovarian cystic tumors and who underwent DWI using a 1.5 T MR unit. Eight patients with small cystic ovarian lesions of less than 3 cm in diameter and insufficient DWI were excluded from the calculation of the ADC values. The remaining twenty-six cystic ovarian lesions in 22 patients were classified into four groups; ovarian cysts, cystadenomas, other benign tumors, and malignant tumors. DWI was obtained using single-shot spin echo planar imaging and two gradient steps (b values of 0, 800 sec/mm2). The ADC values were measured using regions-of-interest (ROI) in the cystic components of the DWI located in the same section as the T2-weighted image and away from the septation and solid components. RESULTS: The mean ADC values were 0.196+/-0.105x10(-3) mm2/sec in the ovarian cysts, 1.312+/-1.064x10(-3) mm2/sec in the cystadenomas, 0.274+/-0.124x10(-3) mm2/sec in the other benign tumors, and 1.011+/-0.080x10(-3) mm2/sec in the malignant tumors. The differences in the ADC values between the ovarian cysts and cystadenomas, the ovarian cysts and malignant tumors, the cystadenomas and other benign tumors, and the other benign tumors and malignant tumors were statistically significant (p < 0.01). There was no statistically significant difference in the ADC values between the ovarian cysts and other benign tumors, or between the cystadenomas and malignant tumors (p > 0.05). CONCLUSION: The calculated ADC values using DWI should be helpful in the differential diagnosis of cystic ovarian tumors.
Cystadenoma ; Diagnosis, Differential ; Diffusion* ; Echo-Planar Imaging ; Female ; Humans ; Magnetic Resonance Imaging* ; Ovarian Cysts* ; Ovary