[en] To assess the efficacy and safety of a 'mini-perc' technique of percutaneous nephrolithotomy using a 14-Fr peel-away sheath for the removal of pyelocaliceal stones, and to determine appropriate inclusion criteria. Form July 1999 to June 2002, the medical records and radiographic images of 72 patients who underwent the 'mini-perc' technique of percutaneous nephrolithotomy with a 14-Fr peel-away sheath, were reviewed to determine clinical history, stone characteristics, immediate stone free rate, final stone free rate after additional procedures, complications, and hospital stay. We also analyzed the effect of the longest stone diameter, the cumulative longest diameter of stones, the cumulative stone burden, and the stone density on the immediate stone free rate using a Fisher exact test. The only major complication, arterial bleeding, occurred in a patient with Child A liver cirrhosis and was successfully treated by embolization with coils and a gelatin sponge. The immediate stone free rate was 80.6%, which was significantly influenced by stone diameter but not stone density. The mean hospital stay after the procedure was 3.97 days. The 'mini-perc' technique of percutaneous nephrolithotomy, which uses the 14-Fr peel-away sheath, is a safe and effective modality for treating renal calculi

[en] We wanted to valuate the mid-term therapeutic results of percutaneous transhepatic balloon angioplasty for portal vein stenosis after liver transplantation. From May 1996 to Feb 2005, 420 patients underwent liver transplantation. Percutaneous transhepatic angioplasty of the portal vein was attempted in six patients. The patients presented with the clinical signs and symptoms of portal venous hypertension or they were identified by surveillance doppler ultrasonography. The preangioplasty and postangioplasty pressure gradients were recorded. The therapeutic results were monitored by the follow up of the clinical symptoms, the laboratory values, CT and ultrasonography. The overall technical success rate was 100%. The clinical success rate was 83% (5/6). A total of eight sessions of balloon angioplasty were performed in six patients. The mean pressure gradient decreased from 14.5 mmHg to 2.8 mmHg before and after treatment, respectively. The follow up periods ranged from three months to 64 months (mean period; 32 months). Portal venous patency was maintained in all six patients until the final follow up. Combined hepatic venous stenosis was seen in one patient who was treated with stent placement. One patient showed puncture tract bleeding, and this patient was treated with coil embolization of the right portal puncture tract via the left transhepatic portal venous approach. Percutaneous transhepatic balloon angioplasty is an effective treatment for the portal vein stenosis that occurs after liver transplantation, and our results showed good mid-term patency with using this technique

[en] We wanted to evaluate the diverse distribution and relation of the hepatic segments, as divided by the portal venous territories, on the isotropic multi-planar reformatted (MPR) CT images and we wanted to find their correlation to the intrahepatic venous structures. Fifty adult patients who underwent portal phase CT images and who had the normal liver contours at CT were included in our study. The portal phase images were obtained with a slice collimation and reconstruction interval of 1.25 mm, and they were reformatted in the coronal and sagittal planes with a slab thickness of 3 mm. For analysis of these MPR images, various terms were newly defined according to the portal venous territories (e.g., three vertical planes [right, middle and left] and one transverse plane and their plane angles, the transverse and longitudinal angles). Also, the dominant segments of the right lobe were newly divided into the S7-and S8-dominant types by comparing the transverse angles. The imaging analysis was then conducted for the following: (1) the diversity of the three vertical planes and the one transverse plane and their plane angles, (2) the proportion of the dominant segments of the right lobe and their relation with the plane angles, and (3) the correlation between the dominant segments and the intrahepatic venous structures. The number of the S7-and the S8-dominant types was 21 and 29, respectively. The vertical and transverse planes were undulating and diverse according to the dominant segments as follows: the plane angles of the right vertical and middle vertical planes were more vertical in the S7-dominant type than in the S8-dominant type (ρ < 0.001). The right transverse plane angle was more horizontal in the S8-dominant type (ρ < 0.05). The left transverse plane angle seemed to be rather vertical than horizontal. For the intrahepatic venous structures, despite of our limited data, the anomalous intrahepatic venous structures might have some correlation with the dominant segments. According to our results, we suggest that the isotropic MPR images could successfully depict the vertical and transverse planes of the real hepatic segments, as divided by the portal venous territories, which were diverse according to their dominant types

[en] To assess CT findings of pulmonary sarcoidosis and correlate these with sACE level and PFT Between 1989 and 1995, 14 patients (4 men and 10 women, aged between 28 and 55 years) with histologically confirmed pulmonary sarcoidosis were consecutively selected. HRCT scans were performed in 12 patients and conventional CT scans in two. CT findings were reviewed by three radiologists, and were correlated with the index of disease activity based on sACE level and pulmonary function test. Pulmonary parenchymal abnormalities were seen in all patients;small nodules of less than 3mm in diameter were seen in eight. Other abnormalities were nodules of more than 3mm in diameter (n=7), confluent nodules (n=5), ground glass opacity (n=5), patchy areas of consolidation with air bronchogram (n=5), and architectural distortion (n=3). The upper lung zone was more frequently involved than the middle or lower zone. In ten patients, the paripheral interstitum was predominantly involved, while only three patients showed predominant peribronchovascular involvement. Lymphadenopathy was noted in 13. There was no correlation between sACE level, the results of a pulmonary function test and the extent of parenchymal involvement. HRCT is valuable for the identification, characterization, and determination of the extent to which parenchymal lung is involved in sarcoidosis. The extent of this involvement does not correlate with sACE level and pulmonary function test results

[en] To investigate the regional changes in gray matter volume by using optimized voxel based morphometry in the whole brain of patients with Alzheimer's disease (AD) and to determine its correlation with cognitive function. Nineteen patients with AD (mean mini mental state examination (MMSE) score = 20.4) and 19 age-matched control subjects (mean MMSE score 29) participated in this prospective study. T1-weighted 3D-SPGR scans were obtained for each subject. These T1-weighted images were spatially normalized into study-specific T1 template and segmented into gray matter, white matter and CSF. After the images were modulated and smoothed, all of the gray matter images were compared with control images by using voxel-wise statistical parametric test (two-sample-test). In patients with AD, total gray matter volume was significantly smaller than normal control (552 ± 39 mL vs. 632 ± 51 mL, ρ 0.001). Significant gray matter loss was seen in both the hippocampus and amygdala complexs, and the parahippocampi and frontoparietal cortices (ρ < 0.01, family wise error corrected). Left cerebral atrophy was more prominent than the right. Loss of gray matter volume in both the superior frontal gyri and left inferior temporal gyrus had a strong correlation with lower MMSE score. Optimized VBM was able to visualize pathologic changes of AD in vivo. In AD there was widespread gray matter volume loss in the frontoparietal lobes as well as the medial temporal lobes and had a strong correlation between volume loss of specific cortical areas and MMSE score

[en] We wanted to evaluate usefulness of uncovered stent in comparison with covered stent for the palliative treatment of malignant colorectal obstruction. Covered (n = 52, type 1 and type 2) and uncovered (n = 22, type 3) stents were placed in 74 patients with malignant colorectal obstruction. Stent insertion was performed for palliative treatment in 37 patients (covered stent: n = 23 and uncovered stent: n = 14). In the palliative group, the data on the success of the procedure, the stent patency and the complications between the two groups (covered versus uncovered stents) were compared. The technical success rate was 89% (33/37). Symptomatic improvement was achieved in 86% (18/21) of the covered stent group and in 92% (11/12) of the uncovered stent group patients. The period of follow-up ranged from three to 319 days (mean period: 116±85 days). The mean period of stent patency was 157±33 days in the covered stent group and 165±25 days in the uncovered stent group. In the covered stent group, stent migration (n = 11), stent fracture (n = 2) and poor expansion of the stent (n = 2) were noted. In the uncovered stent group, tumor ingrowth into the stents (n = 3) was noted. Self-expanding metallic stents are effective for relieving malignant colorectal obstruction. The rate of complications is lower in the uncovered stent group than in the covered stent group

[en] We analyzed image factors to determine the characteristic factors that need for intelligent replenishment system of the auto film processor. We processed the serial 300 sheets of radiographic films of chest phantom without replenishment of developing and fixation replenisher. We took the digital data by using film digitizer which scanned the films and automatically summed up the pixel values of the films. We analyzed characteristic curves, average gradients and relative speeds of individual film using densitometer and step densitometry. We also evaluated the pH of developer, fixer, and washer fluid with digital pH meter. Fixer residual rate and washing effect were measured by densitometer using the reagent methods. There was no significant reduction of the digital density numbers of the serial films without replenishment of developer and fixer. The average gradients were gradually decreased by 0.02 and relative speeds were also gradually decreased by 6.96% relative to initial standard step-densitometric measurement. The pHs of developer and fixer were reflected the inactivation of each fluid. The fixer residual rates and washing effects after processing each 25 sheets of films were in the normal range. We suggest that the digital data are not reliable due to limitation of the hardware and software of the film digitizer. We conclude that average gradient and relative speed which mean the film's contrast and sensitivity respectively are reliable factors for determining the need for the replenishment of the auto film processor. We need more study of simpler equations and programming for more intelligent replenishment system of the auto film processor

[en] To determine the optimal parameters of abdominal HASTE imaging by means of a comparison of intermediate and long TE (echo time). We evaluated 30 consecutive patients who had undergone liver MR during a three-month period. Twelve patients were diagnosed as normal, four as having liver cirrhosis, and 14 were found to be suffering form hepatic hemangioma. On the basis of measured signal intensity of the liver, spleen, pancreas and gallbladder, and of fat, muscle, hemangioma, and background, we calculated the ratios of signal to noise (S/N), signal difference to noise (SD/N), and signal intensity (SI). Image quality was compared using these three ratios, and using two HASTE sequences with TEs of 90 msec and 134 msec, images were qualitatively evaluated. S/N ratio of the liver was higher when TE was 90 msec(p<.05), though S/N, SD/N and SI rations of the spleen, gallbladder, and pancreas-and of hemangiom-were higher when TE was 134 msec (p<.05). However, in muscle, all these three ratios were higher at a TE of 90 msec. SD/N ratio and SI of fat were higher at a TE of 134 msec. Overall image quality was better at a TE of 134 msec than at one of 90msec. A HASTE sequence with a TE of 134msec showed greater tissue contrast and stronger T2-weighted images than one with a TE of 90msec

[en] Rapid and effective hemostasis at femoral puncture sites minimizes both the hospital stay and patient discomfort. Therefore, a variety of arterial closure devices have been developed to facilitate the closure of femoral arteriotomy. The objective of this prospective study was to compare the efficacy of two different closure devices; a collagen plug device (Angio-Seal) and a suture-mediated closure device (the Closer S). From March 28, 2003 to August 31, 2004, we conducted a prospective study in which 1,676 cases of 1,180 patients were treated with two different types of closure device. Angio-Seal was used in 961 cases and the Closer S in 715 cases. The efficacy of the closure devices was assessed, as well as complications occurring at the puncture sites. Successful immediate hemostasis was achieved in 95.2% of the cases treated with Angio-Seal, and in 89.5% of the cases treated with the Closer S (ρ < 0.05). The rates of minor and major complications occurring between the two groups were not significantly different. In the Closer S group, we observed four major complications (0.6%), that consisted of one massive retroperitoneal hemorrhage (surgically explored) and three pseudoaneurysms. In the Angio-Seal group, we observed three major complications (0.3%) that consisted of one femoral artery occlusion, one case of infection treated with intravenous antibiotics and one pseudoaneurysm. The use of Angio-Seal was found to be more effective than that of the Closer S with regard to the immediate hemostasis of the femoral puncture sites. However, we detected no significant differences in the rate at which complications occurred

[en] To evaluate the usefulness of CT in patients with gastrointestinal fistula. We retrospectively reviewed the CT scans of 17 patients with various type of gastrointestinal fistula. The presence of these fistulae was confirmed by laparotomy in seven patients and by barium studies in fifteen. We evaluated the diagnostic accuracy of CT in these cases, and in correlation with barium studies and surgical findings, subsequently analyzed the CT findings. We determined the presence or absence of fistula tract, flow diversion of oral contrast media, bowel wall changes adjacent to the fistula tract, and extraluminal manifestations such as soft tissue mass, free air, leakage of oral contrast media, and peritoneal changes. The diagnosis of gastrointestinal fistula was possible on CT in nine (53%) of the 17 patients by using the CT criteria of direct visualization of the fistula tract (n=6) or flow diversion of oral contrast media(n=4). Other ancillary findings included bowel wall thickening adjacent to fistula tract in 15 patients, extraluminal soft-tissue mass in five, extraluminal free air in ten, extraluminal contrast leakage in four, and varying degrees of mesenteric and/or omental infiltration in 15. CT scanning is useful for the diagnosis of gastrointestinal fistula, which may be possible if the fistula tract and flow diversion of oral contrast materials are seen. It is also useful for evaluation of the extent of the etiologic disease