, Jeong Hyun Yoo, Jeong Soo Suh, Chung Sik Rhee Ultrasound has been found to be accurate, reliable and noninvasive method in the measurement of spleen. The study was undertaken to obtain standard values of size in three dimensions and normal range of splenic volume by the use of splenic volumetric index(SVI) in normal korean adults.
We experienced 100 cases of abdominal ultrasonography of normal korean adults from May 1995 to August 1995.
1) The average size of spleen in adult male was 6.85±1.31cm in breadth, 4.93±1.27cm in thickness, 6.33±1.46cm in height ; in adult females, 6.61±1.23cm, 5.17±1.26cm, 6.33. 42cm, respectively ; total average, 6.73±1,27cm, 5.05±1.27cm, 6.33±1.39cm,respectively.
2) The average splenic volumetric index in adult male was 8.20±3.95; in adult females, 8.41±4.08 ; total average,8.31±4.00. There were no statistical differences of SVI and size between sex and age.
Although ultrasonography is less accurate than computed tomography, it is rapid and simple method for splenic measurement.
We retrospectively analyzed the clinical and radiologic findings of broncho-pulmonary dysplasia.
We retrospectively studied the chest radiographs of 10 infants, who were clinically diagnosed as bronchopulmonary dysplasia from January, 1994 to December, 1995.
The underlying disease of the cases that has BPD were, there were hyaline membrane disease in 4 cases, repeating apnea in 4 cases, septicemia, peneumonia in 2 cases.
The most common radiological findings were coarse nodular & streaky densities in perihilar region(7/10),emphysematous overdistention(6/10), and other findings such as bubbly pattern (3/10), lace-like pattern with strands of density(2/10) appeared.
Premature and infants with thigh oxygen and intermittent positive pressure ventilation therapy, the chronic persistent pulmonary abnormality in chest X-ray films highly suggests the possibility of bronchopulmonar dysplasia.
, Chung Sik Rhee This experimental study was performed for evaluate the effects of cis-di-amminedichloroplatinum(II) (cis-DDP) on the radiation injury of rat bowel by histopathologic changes.
Rats were exposed to entire abdomen by a single doses of X-ray(6-10 Gy) without or witn cis-DDP(2.5mg/kg). Rats were divided into 3 groups such as radiation alone, cis-DDP alone and combined group. In combined group, cis-DDP was given 30minutes before or immediately after irradiation.
Cis-DDP induced the inflammatory cell infiltrations with focal necrosis of the mucosa in the small bowel and no abnormal change in the large bowel. In radiation alone group, mucosal necrosis, subrnucosal fibrosis and muscular necrosis were prominent changes in small bowel and submucosal fibrosis in the large bowel. The submucosal fibrosis in the small bowel was appealed in 10 Gy of radiation alone group and 8 Gy of cis-DDP infusion after radiation and 6 Gy of cis-DDP infusion before radiation of combined group. In the large bowel, submucosal fibrosis was noted in 8 Gy of radiation alone group and 8 Gy of cis-DDP infusion after radiation and 6 Gy of cis-DDP infusion before radiation of combined group. In the small bowel, the enhancement ratio was 1.67 in a group of cis-DDP infusion before radiation and 125 in a group of cis-DDP infusion after radiation as the end point was the submucosal fibrosis,In the large bowel, the enhancement ratio was 1.33 in a group of cis-DDP infusion before radiation and 1.0 in a cup of cis-DDP infusion after radiation as e end point was e submucosal fibrosis.
This study suggested that cis-DDP enhance the radiation effect in the small and large bowel especially when cis-DDP was infused before radiation.
, Eun Cheol Chung, Jeong Soo Suh, Chung Sik Rhee Abdominal ultrasound for the health screen was performed in 4610 adults from the Jan. 1993 to Mar. 1995 at Ewha University Hospital Health Clinic. Gross abnormalities were noted in the 33.3% of examined persons. The most common finding was fatty liver(21.6%). And other abnormalities were renal cyst, gallbladder stone, hepatic cyst, and hepatic calcification in the order of frequency. It is concluded that abdominal ultrasound is an important screening modality in the adults.
Accidental traums is the third most common cause of death in the Korea. Computed Tomography(CT) has been the champion diagnosis and management planning of abdominal injuries its use has decreased the number of negative exploratory laparotomies significantly, A CT-based injury severity of four grades was vised and applied in 24 patients with blond splenic injury as the sole or predominant intraperitoneal injury detedted with Preoperative CT. While patients with high grades of splenic injury generally required early surgery, eight(33%) of 24 patients with initial grade 3 or 2 injury were treated successfully without surgery. Thirteen(54%) or 24 patients with initial all grades ten injury wereted successfully wihtout surgery. Results show that while CT remains an accurate method of indeutifying and quantifying initial splenic injury, as well as documenting progression or healing of critical injury, all of went on to manifest splenic injury documented by repeat CT examination after onset of clinical symptom.
, Chung Sik Rhee There are variable radiological method for breast disease including mammography, breast ultrasound, thermography, CT-mammography and MRI. Among these, mammography is the oldest and the gold standard for diagnosis of breast disease. In mammography, the primary consideration is the demonstration of the absence or presence of the breast lesion and if present, the benignity of malignancy of the lesion.
The authors analyzed the mammographic findings in 145 cases pathologically proven cases of various breast disease.
The results were as follows:
1) The most prevalent age group of benign lesion was 3rd-4th decade with frequency of 65.3% and that of malignant lesion was 4th-5th decade with frequency of 66.6%.
2) The most frequent site of breast lesion was upper outer quadrant in benignity and malignancy.
3) Pathologic type of breast malignancy was all of ductal carinoma with various type, and the most common benignity is breast tumor(57.8%) and followed fibrocystic disease(27.3%).
4) The detection of abnormal findings of malignant lesion was 87.5% including mass lesion(75%) and benign lesion was 80.1% including mass lesion(54.5%).
Conclusively, the authours suggest that mammography is very useful method for the detection & diagnosis of breast disease.
, Kyung Ja Lee, Chung Sik Rhee Cis-DDP has been used as a radiosensitizer in combination treatment modality far malignanttumors, of which mechanism is uncertain. The efects of combined Cis-DDP and irradiationon number of tumors have been studied in vitro and in vivo. The effects of combined Cis-DDP and irradiation on the liver are important because the liver is a radiosensitive organand frequently exposed to irradiation during treatment for intra-abdominal malignancies. Butthe studies of combined Cis-DDP and irradiation on the liver have not been reported.
So, this study was peformed to see the effect of Cis-DDP in combination with radiationon the liver. Total 66 Sprague-Dawley rats were divided into 5 groups; control, Cis-DDP(2.5mg/kg) administration, radiation(6, 8, lOGy, respectively), and combined Cis-DDP and radia-tion. which consisted of pre- and post-administration of Cis-DDP. Light and electron microscopic examination was performed 30 days after each experiments.
Cis-DDP administration induced mild congestion and focal hemorrhage in hepatic lobuleswith focal necrosis and degeneration of hepatocytes. Electron microscopic examination showedirregular cytoplasmic organelles and chromatin clumping in hepatocytes. In radiation treatmentgroup. hemorrhage of hepatic lobules, necrosis and degeneration of hepatocytes, edema andinflammation in portal tracts were aggravated with increased dosage of radiation. Hepatic lobulardisarray and inflammatory cell infiltration in portal tracts were noted from 8 Gy radiation.Vacuoles and electron dense bodies as well as swollen mitochondria in hepatocytes were frequently noted on electron microscopic examination. With combined treatment all He light andelectron microscopic changes were more severe than radiation alone regardless of sequenceof Cis-DDP administration and lobular disarray and inflammation in portal tracts were startedto note with 6 Gy radiation. When the hepatic lobular disarray and inflammation in portaltracts were used as end-points. the enhancement ratio of Cis-DDP was 1.3 in normal rat livers.
, Ho In Chung, Chung Sik Rhee We retrospectively reviewed chest radiographs of 101 patients with primary pneumonia treatedat department of pediatrics between January 1990 and June 1992 to understand pnelimoniaradiologic patterns in ages of children and to attain helpful information in diagnosing pediaoicpneumonia hereafter.
Results were as follows :
1) The cases of infantile pneumonia (under 1 year of age) were 42. The most frequent Hadingwas peribronchial infiltration with overaeration(24 cases, 57.1% ), followed by multiple patchyatelectasis associated with peribronchial infiltration and overaeration(8 cases, 19.0%). parahilarperibronchial infiltration (5 cases. 11.9%), peribronchial infiltration and air space consolidation(2 cases,4.8%), air space consolidation(2 cases,4.8%) and bronchopneumonia pattern(1 case,2.4%).
2) The cases of 1~6 years of age were 52. The most common finding was parahilar peribron-chial infiltration(29 cases, 55.8%), followed by air space consolidation(13 cases. 25.0%), andbronchopneumonia pattern(10 cases, 19,2%).
3) The rases of 7~13 years of age were 7. All cases showed air space consolidation.Under 6 years of age, the radiographic findings of pneumonia differed from that of adult.
Over 7 years of age, the pattern of pneumonia was similar to that of adult.
, Chung Sik Rhee The effect of radiation and Cis-dichlorodiammineplatinum(II)(Cis-DDP) in combination was studied in the renal histopathologic changes of the rat. The histologic evaluation was performed 30 days after the single dose of Cis-DDP(2.5mg/kg) and X-ray irradiation(6,8,10 Gy. single dose) and combination of Cis-DDP and X-ray. For the combined treatment a single dose of Cis-DDP was given 30 min before or immediately after radiation(pre-and post-radiation group).
Cis-DDP alone, showed mild necrosis, degeneration, hemorrhage and focal inflammatory cell infiltrations in the renal tubule and mild congestion of the glomerulus. In radiation alone. edema of the glomerulus and tubular degeneration was seen with 10 Gy and 8 Gy, respectively. With combined chemotherapy and radiation, edema of glomeruli and tubular degeneration was seen with 8 and 6 Gy irradiation, respectively in both pre-and post-radiation group. Tubular necrosis and degeneration and interstitial inflammatory cell infiltrations were more marked in pre-radiation group. When the edema of glomerulus was used as an endpoint, the enhancement ratio was 1.25 in normal rat kidney.
Computed Tomography(CT) was used in the evaluation of 180 patients suffering abdominal trauma.
There were 15 patients with CT and surgically proved pancreatic injuries, which include 13 cases of blunt trauma and 2 cases of penetrating trauma and 165 cases had normal CT scans.
A wide variety of injuries was detected. including 9 pancreatic lacerations or contusinos. 4 pancreatic fractures, and 2 post traumatic pseudocyst, were retrospectively reviewed to determine the role and accuracy of the CT scan in evaluating pancreatic injury.
A CT is of pancreatic trauma could be difficult to diagnosis in patients who are scanned within 24 hrs after an injury or to distinguish a motion or streak artifact caused by nasogastric tube or air oral contrast fluid level in the stomach.
The diagnosis of pancreatic injury requires a high index of suspicion with close scurtiny of the CT images.
The imaging results and medical records of 48 patients with CT appearance suggestive of fatty liver were reviewed, fatty liver often has a distinctive appearance with CT, usually with a nonspherical shape. absence of mass effect, and a density close to water or fat. Significant correlation was found between changes in CT value of the liver and fat accumulation in the liver cells.
The fat infiltrated area of hepatic parenchyma had CT value ranging from -25(HU) to 42(HU) on unenhanced scan. The CT diagnosis of fatty metamorphosis is usually suggested when the CT density of the liver is less than the spleen, because the normal hepatic parenchyma has an attenuation value approximately 9(HU) greater than the spleen.
The sensitivity of CT in demonstrating fat may prove valuable in the detection and monitoring of fatty infiltration on the liver.
, Kyung Ja Lee, Chung Sik Rhee Radiobiological and clinical evidences indicate that irradiation combined with hyperthermia produce a significant improvement in therapeutic effect of cancer.
Hyperthermia can enhance the radiation effect as a synergistic reaction in irradiation combined with hyperthermia. Hyperthermia sensitize radioresistant S-phase and inhibit cellular recovery from the sublethal damage.
Ninety guinea pigs were divided into 4 groups for the experiment of application of irradiation combined with hyperthermia on their heart; (1) normal control group. (2) group receiving only hperthermia. (3) group receiving a single dose of irradiation of 10, 20 and 30 Gy resepectively. (4) group receiving varying single dose of irradiation like group (3) irradiation combined hyperthermia. Heating by 100 watt. 2450 MHz microwave hyperthermia on the heart was applied for 30 minutes maintaining 42~45℃ immediately following irradiation.
Microscopic examination and calculation of thermal enhancement ratio were carried out and results were as follows:
1) Hyperthermia alone did not evoke much changes. compared to normal control group.
2) In the group of irradiation alone. myocrdial muscle degeneration was noted in l0Gy irradiation and its severity was increased along with radiation dose.
3) In the group of irradiation alone. myocardial muscle necrosis was noted at 15 days after 20Gy irradiation. In the group of irradiation cmbined with hyperthermia. myocardial muscle necrosis was noted in l0Gy irradiation.
4) In the group of irradiation alone, interstitial fibrosis was noted at 15 days after 30Gy irradiation. In the group of irradiation combined with hyperthermia. interstitial fibrosis was noted at 15 days after 20Gy irradiation and its severity was increased along with radiation dose.
5) The thermal enhancement ratio(TER) was 1.5 on the end point of interstitial fibrosis of the guinea pig heart.
, Eun Joo Ahn, Chung Sik Rhee Gastric carcinoma is the most common malignancy in Korea. The peak incidence of gastric carcinoma is over 50 years of age and male predominance, about 2:1. Computed tomography scan is the one of the most useful diagnostic tool for evaluation of extension, staging and operability of gastric carcinoma. For evaluation of the utility of the preoperative computed tomography scan in gastric carcinoma, surgically proved 72 cases of gastric carcinoma were analyzed by modified Moss classification1) based on computed tomography scan and pathological classification.
The results were as follows ;
1) The accuracy of computed tomography scan in each stage of gastric carcinoma was 100% in stage I. 67% in stage II. 69% in stage III. and 85% in stage IV.
2) The overall accuracy of computed tomography scan for staging of gastric carinoma was 72%.
3) The accuracy of computed tomography scan for detection of regional lymph node metastasis was 78%. and 90% for retroperitineal lymph node metastasis.
4) The accuracy of computed tomography scan for detection of distant metastasis was 90%.
5) Computed tomography scan was the most useful diagnostic method for evaluation of extension and metastasis of gastric carcinoma and it is necessary for treatment planning and prognostic evaluation before surgery.
, Chung Sik Rhee The maximum ionization point of supervoltage X-ray radiation modality is moved to subcutaneous tissue by the build up effect, as the result, the surface dose of the skin is decreased. It is necessary to measure the accurate dose distribution of supervoltage X-ray radiation modality and determine its biological effect on the skin in order to increase the effect of radiation therapy. By using 6MV Linear accelerator, the absorbed dose of the skin and subcutaneous tissue was determined by physical aspect in relationship of 6 MV X-ray and tissue and a uniform formula was developed. For the experiment, guinea pigs were divided into 3 groups. A single irradiation group was irradiated with 10-60Gy, and a single irradiation group with 0.5cm, 1.0cm and 1.5cm bolus was irradiated with 10-40Gy, and fractionation group was irradiated with 20Gy by 3 fractionation for 1 week and with 30Gy, 2, 3, 5 fractionation for 1week and 2weeks respectively. The results were as follows: 1) The absorbed dose of 6MV X-ray was increased depending on the depth of skin and its maximum point was 1.5cm from skin surface. 2) The skin score by a single dose irradiation was proportionally increased by the dose and D1-5, dose at the point of skin score 1.5 was 25Gy. 3) The maximum skin reaction by a single dose irradiation was developed about 24th day after irradiation and generally the skin reaction was developed earlier in higher dose. 4) By using the bolus, the skin score was increased by the ratio of 53%, 78%, and 100% of dose increment depending on the thickness of the bolus 0.5cm, 1.0cm and 1.5cm respectively. 5) The light microscopic finding of a single dose irradiation without bolus showed more prominent changes in the dermis than epidermis, whereas a single dose irradiation with bolus showed prominent epidermal change. 6) Electron microscopic findings of a single dose irradiation with bolus were severe edema and degeneative change of collagen and dermal appendages in dermis. 7) The skin score of fractionation group was decreased by incresing number of fractionation and duration of overall time in the same total dose. 8) The skin reaction in epidermis was correspond to depth dose of 0.4cm from the surface in biological effect. 9) The biological isodose effect by fractionation irradiation of 6MV X-ray was correspond to number of fractionation of Ellis formula, but the change by overall time is slightly decreased in longer time(T0.08).
, Ok Soon Yim, Chung Sik Rhee Most juvenile polyps develop as isolated colonic lesions in children less than 12 years of age and average age is 4-year-old.
Rectal bleeding is the most common symptom and family history is generally negative and malignant potentiality is absent.
On barium enema, the polyps are identified roundish filling defect, often pedunculated, which are located most commonly in the rectum or sigmoid.
Juvenile polyps are retention or inflammatory polyps and predominant histological feature is an abundant connective tissue stroma which contains cystic structures lining by simple epithelium and numerous inflammatory cells may be present.
A 12-year-old boy has been complained of rectal bleeding and rectal prolapse during defecation for 6 months and Juvenile polyposis has been confirmed by radiological (complete double contrast barium enema) and pathological findings.
, Soo Mee Lim, Chung Sik Rhee To determine the computed tomographic findings of cervical lymphadenopathy which distinguish tuberculous lymphadenitis from metastatic lymphadenopathy.
We retrospectively analyzed the CT findings of 21 patients with tuberculous lymphadenitis and 19 with metastatic lymphadenopathy in terms of location, size, shape, presence and shape of necrosis, and presence of extranodal extension.
The tuberculous lymphadenopathy was predominantly located in spinal accessory chain(level V)(42%), but metastatic lymphadinopathy was predominantly located in internal jugular chain(level II)(37%). Of the 21 patients with tuberculous lymphadenitis, the shape was conglomerated lesion with irregular margin in 13 cases. Of the 19 patients with metastatic lymphadenopathy, conglomerated lesion in 4 cases, which were statistically significant(p<0.05). The presence of central necrosis was more frequent in tuberculous lymphadenitis(n=20) than metastatic lymphadenopathy(n=11)(p<0.05). The presence of extranodal extension was significantly different between tuberculous(n=19) and metastatic lymphadenopathy(n=1)(p<0.05).
Cervical tuberculous lymphadenitis frequently involves the spinal accessory chain in young woman. The irregular conglomerated lesion with irregular central necrosis and extranodal extension on CT scan is suggestive of cervical tuberculous lymphadenitis, which is useful in differentiating from metastatic lymphadenopathy.
, Hye-Young Choi, Chung Sik Rhee, Sun Hee Sung To evaluate pathologic findings of fibrocystic disease correlated with sonographic findings in the patients with solid lesion on ultrasonography.
Total 63 pathologically proven fibrocystic disease in 57 patients are retrospectively evaluated. On ultrasonography, the lesions were divided into solid and non-solid mass-like lesions. We analyzed the margin and echogenicity of solid mass-like lesions that were correlated with pathologic findings and also statistically analyzed Chi-square and Fisher's exact test.
Ultrasonogram of fibrocystic disease showed solid mass-like lesion in 73% and non solid mass-like lesion in 27%. Among the solid lesions, well-defined margin revealed in 72%, ill-defined margin in 28% and hypoechoic in 59%, isoechoic 41%. On the pathologic analysis, the solid and the non-solid mass-like lesion showed respectively : fibrous stroma in 56.5% and 53%, fibroadenomatous change in 50% and 12%, mixed stroma in 41% and 35.3%, cystic change in 37% and 70.6%, ductectasia in 28% and 58.8%, lobular hyperplasia in 26% and 12%, ductal hyperplasia 13% and 5.9%, and adenosis in 8.7% and 0%. The solid lesions showed more fibroadenomatous change and the difference between there was statistically significant(p=0.008).
The solid mass-like lesion, which represented as a well-defined isoechoic benign mass on ultrasonogram was more common than as expected, and this was due to the fibroadenomaous change on histopathology.
, Jeong Soo Suh, Chung Sik Rhee To investigate whether measurements of hepatic metastases before contrast administration are different from measuments after contrast administration. And to gain more effective follow up method by analyzing the difference of contrast between pre- and postcontrast scans.
Thirty patients with herpatic metastases were underwent conventional CT. Continuous 10mm thick slices were obtained from liver dome to pelvic inlet, then the patients received IV injection of contrast material, and same method as precontrast CT scan was performed. Additional 5mm thin slice scan was obtained in case of need. Three radiologists performed independent bidimensional measurements of the randomly selected lesion on both pre- and postcontrast images at the same level and analyzed the difference of the size and contrast.
The size of hepatic metastases were measured as smaller on postcontrast images ; average 41.4±43.5cm2 on precontrast scan & 35.2±37.5cm2 on postcontrast scan. There was significant difference by paired t-test(p<0.02). 24 of 30 cases(80%) showed better conspicuity on postcontrast images, 5(16.7%), on precontrast images and 1(3.3%) showed similiar conspicuity on both pre- and postcontrast images. The contrast of hepatic metastases was significantly higher on postcontrast scan by chi-square test(p<0.01).
Hepatic metastases are significantly smaller on postcontrast images. The contrast between metastatic lesion & liver parenchyme was better on postcontrast scan. Therefore, serial assessment of hepatic metastases size by CT should not be compared mixed pre- and postcontrast image. And postcontrast scan is more effective method than precontrast for follow up of hepatic metastasis.
, Ku Yong Chung, Jeong Soo Suh, Chung Sik Rhee Our purpose was to discuss the current results of renal transplantation at our institute and to document the usefulness of the ultrasonography in the follow-up of renal allograft.
Thirty five renal allografts who operated and followed-up at our hospital were included. All patients underwent renal duplex and Doppler sonography. According the clinical course of allograft, the sonographic findings were classified into successful renal transplantation(SRT), acute rejection(AR), chronic rejection(CR), and graft failure(GF). We retrogradely analyzed the sonographic findings as follows : renal size(length, width, thickness), cortex echogenicity, corticomedullary differentiation, renal sinus and pyramid, renal pelvis, resistive index(RI).
Results of allografts were as follows : SRT, 24 case(68.6%) ; AR, 6(17.1%) : CR, 3(8.6%) ; and GF, 2(5.7%). The changes of length of allografts were shown no statistically significant changes between the groups, but there is significant increase of thickness of allograft in AC and GF with significance. The mean RI was statistically increased in AR(RI=0.87), and the mean RI's of other groups were 0.65, 0.70, and 0.67 in order to SRT, CR, GF. Parenchymal echogenicities are changed in 66.7% of AC and CR, 25% of SRT, and 50% of GF without clinical significance. There are changes of CMJ, pyramid, sinus echo, renal pelvis of allografts, however, which were shown no statistical significance.
Even though we have small cases and short experiences of renal transplantation at our institute, we considered we have relatively good results and it was guessed there were many efforts for the renal transplantation. The duplex and Doppler sonography were useful tools in the follow-up of allograft, especially deciding acute rejection and graft failure, although it is difficult to decide chronic rejection and can not used to differentiate between the main parenchymal causes of graft failure.
, Jeong Hyun Yoo, Chung Sik Rhee Although the usefulness of mammography as screening test for breast cancer is still in dispute,its use to patients over 50 years of age is valid.
Since Wolfe fisrt classified breast parenchymal pattern of mammography into 4 patterns, N1, Pl, P2, DY, many authors have adopted the clitoris in studing the changes of the parenchymal patterns for certain ages and the risk for breast cancer of certain parenchymal patterns.
Authors reviewed 50 cases of breast cancer which diagnosed by radiologic studies including mammography, galactography, and computed tomography, and confirmed by pathologically.
The results were as follows :
1) Incidence of breast cancer according to parenchymal pattern was : 9 cases(18%) in N1 type breast 5 cases(10%) in Pl type breast 32 cases(64%) in P2 type breast, 4 cases(8%)in DY type breast.
2) Detection rate of cancer lesion according to parenchymal pattern was : 89% in N1 typebreast, 80% in Pl type breast 63% in P2 type breast 25% in DY type breast.
Most frequent age distribution was 5th and 6th decade.
In conclusion, mammographic parenchymal pattern is valid indicator for breast cancer.
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