[en] To evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) and pul-sed-spray pharmaco-mechanical thrombolysis (PSPMT) using urokinase for the management of insufficient hemodialysis access. Between September 1996 and May 1998, 21 insufficient hemodialysis accesses were treated in 16 patients(3 artificial arteriovenous fistulae, AVF; and 13 arteriovenous graft, AVG). PTA and PSPMT were performed in 6 and 15 cases, respectively, and success and long-term patency rates were evaluated. The overall success rate of PTA and PSPMT for insufficient hemodialysis access was 76. 2%(16/21). The success rates of PTA and PSPMT were 83.3%(5/6) and 73.3%(11/15), respectively. The primary patency rates of PSPMT were 69±12.8% at 6 months and 38±18.6% at 12 months. One of the two initially successful PTAs had been patent for 7 months, and the second PTA was performed at that time due to venous stenosis. The other was patent for 15 months throughout the follow-up period. PTA and PSPMT are effective primary methods for the treatment of insufficient hemodialysis access;success and patency rates were high, and the procedures can be performed repeatedly.=20

[en] To evaluate prospectively the results of interventional radiologic placement of tunneled central venous catheters, and subsequent complications. Between April 1997 and April 1998, a total of 557 tunneled central venous catheters were percutaneously placed in 517 consecutive patients in an interventional radiology suite. The indications were chemotherapy in 533 cases, total parenteral nutrition in 23 and transfusion in one. Complications were evaluated prospectively by means of a chart review, chest radiography, central vein angiography and blood/catheter culture. The technical success rate for tunneled central venous catheter placement was 100% (557/557 cases). The duration of catheter placement ranged from 4 to 356 (mean, 112±4.6) days; Hickman catheters were removed in 252 cases during follow-up. Early complications included 3 cases of pneumothorax(0.5%), 4 cases of local bleeding/hematoma(0.7%), 2 cases of primary malposition(0.4%), and 1 case of catheter leakage(0.2%). Late complications included 42 cases of catheter-related infection(7.5%), 40 cases of venous thrombosis (7.2%), 18 cases of migration (3.2%), 5 cases of catheter / pericatheter of occlusion(0.8%), and 1 case of pseudoaneurysm(0.2%). The infection rate and thrombosis rate per 1000 days were 1.57 and 1.50, respectively. The technical success rate of interventional radiologic placement of tunneled central venous catheters was high. In comparison to conventional surgical placement, it is a more reliable method and leads to fewer complications

[en] We evaluated the effectiveness of balloon dilatation and bougienage of post-operative anastomotic stricture of upper G-I tract. We performed 22 balloon dilatation and 24 bougienage in 40 patients of post operative anastomotic stricture. The causes of operation were esophageal cancer(n=20), stomach cancer(n=16), laryngeal cancer(n=2), chemical(n=2)strictures. Successful dilatation of the anastomotic site stricture were achieved during the procedure in 38 patients(95%). There was one cases of esophageal perforation as a complication. Esophageal balloon dilatation and bougienage are safe and effective method for post operative anastomotic site stricture of upper G-I tract

[en] Six bare stents and six covered stents were inserted in the trachea of 12 dogs under general anesthesia. After 1-10 weeks of observation, the dogs were killed, and the trachea and lung were examined grossly and histologically. Pneumonia and stent migration were observed more frequently at covered stent group. Inflammatory change of the trachea was more severe at covered stent group. In conclusion, we believe that it is inadequate to insert silicone covered stent in the tracheobronchial tree. (Author)

[en] The primary biliary carcinoma is usually unresectable at presentation, because of early lymphatic spread. To determine the incidence and the spread pattern of lymph node metastases according to the location of the primary tumor, we analyzed the CT scans of the patients with primary biliary adenocarcinoma. We reviewed the CT scans of 92 patients with pathologically proven primary biliary adenocacinima, including 45 peripheral cholangiocarcinomas, 22 hilar cholangiocarcinomas, 18 gallbladder carcinomas, and 7 common bile duct carcinomas. Positive adenopathy was diagnosed when the node exceeded 10 mm in short axis. The overall incidence of nodal metastases was 59.8% (55/92); 66.7% in peripheral cholangiocarcinoma, 54.5% in hilar cholangiocarcinoma, 55.6% in gallbladder carcinoma, and 42.9% in common bile duct carcinoma. The most commonly involved nodal group was the lesser omentum, followed by the celiac, periaortic, and peripancreatic group. The phrenic node group was only involved in the cases with the peripheral or hilar cholangiocarcinoma. The primary biliary carcinoma has a high incidence of lymph node metastases at the time of diagnosis, and shows different nodal spread pattern according to the location of the primary tumor. Involvement of the phrenic node was limited to the peripheral and hilar cholangiocarcinoma

[en] In patients with inoperable malignant biliary obstruction, percutaneous transhepatic biliary drainage (PTBD) has been the method of choice for palliative treatment. All patients except three had undergone PTBD, and the stents were placed 5-7 days after the initial drainage procedure. Three patients underwent stent placement on the same day of PTBD. External drainage catheter is converted to various types of tube endoprostheses with associated physiologic and psychologic benefits. Tube stents, however, have some problems such as migration, occlusion, and traumatic implantation procedure. We report our experiences and clinical results of percutaneous placement of metallic stents in 40 patients with malignant biliary obstruction

[en] We evaluated the diagnostic accuracy and clinical usefulness of fluoroscopy-guided bone biopsy. A total of 31 patients with various skeletal lesions underwent fluoroscopy-guided bone biopsies. The targets were long bones in 16 cases, pelvic bones in 7 cases, spines in 6 cases, and ribs in the rest 2 cases. The overall accuracy was 71%(22/31). The accuracy was 100% in case of primary sarcoma and multiple myeloma. But it was low in malignant lymphoma(1/4), malignant fibrous histiocytoma(0/1), and nonossifying fibroma(0/1). Percutaneous fluoroscopy-guided bone biopsy is a simple, safe, not-expensive, and rather accurate diagnostic procedure in evaluation of bone tumors. In addition to that, it is useful in the management planning and follow-up of the patients

[en] We present a case with congenital absence of the infrarenal portion of inferior vena cava and iliac venous system, showing unusual venous collaterals including the left ovarian venous collateral via parametrial venous complex, and a mesenteric-periureteric venous connection. The venous collateral pathways were demonstrated by computed tomography and venography

[en] We performed this study to evaluate detectability and delineation of extent of helicopter carcinoma by comparison between nonenhenced and contrast-enhanced CT scan. During a three-year period, 174 patients with hepatocellular carcinomas were examined by CT at Seoul National University Hospital. Fifty-three patients had histological proof by operation of liver biopsy, while 121 patients were diagnosed by characteristic angiographic finding and elevated α fetoprotein level (>500ng/ml). All 174 patients were studied with a CT-9800 scanner. CT scans were obtained both before and after administration of contrast medium. Contrast material was given by bolus injection of 120ml of ioxitalamate meglumine. CT findings were divided into three categories; Good: tumor is noted, and extent of tumor is clearly defined; Fair: tumor is noted, but extent of tumor is not defined; Poor: tumor is noted. In 165 cases of the tumor on nonenhanced CT scans, 131 cases (79%) showed low-density, 29 cases (18%) iso-density, one case, high-density and 4 cases (2.4%) mixed density. In 174 cases of the tumor on contrast-enhanced CT scans, 170 cases (97%) showed low-density, 3 cases (1.8%) iso-density, and I cases mixed density (0.6%). In 165 cases of the tumor on nonenhanced CT scans, 64 cases (39%) were categorized as good in tumor localization, 53 cases (32%) as fair, and 48 cases (2.9%) as poor. However, 174 cases of the tumor on contrast-enhanced CT scans, Our results indicate that contrast-enhanced CT scans are better than nonehanced CT scans in detecting the tumor and defining them and reduce radiation exposure to the patients by omitting nonenhanced CT scans in clinically suspected hepatocellular carcinoma.

[en] The purpose of this study is to assess magnetic resonance (MR) imaging findings of malignant fibrous histiocytoma (MFH) of bone and to evaluate the role of contrast-enhanced MR imaging in the diagnosis of bone MFH. MR imagings of pathologically proven bone MFH in ten patients were reviewed. Enhanced study was also performed with Gd-DTPA. The MR images were evaluated for signal intensity, homogeneity, marginal definition, presence of internal septation, cortical destruction, soft tissue extension, joint involvement and contrast enhancement. Tumors showed iso- or slightly high signal intensity to muscle on T1-weighted images and heterogeneously high signal intensity on T2-weighted images. Four cases showed poor-marginated border on T2-weighted images and four cases had internal septa. Eight of nine patients with intravenous administration of Gd-DTPA showed contrast enhancement, five were heterogeneous and three were homogeneous. All cases showed cortical destruction and soft tissue extension. Five cases showed joint involvement. Bone MFH showed similar MR imaging findings of soft tissue MFH or other malignant bone tumors, but joint involvement was suggestive finding of bone MFH