Project EPIC (Early Palliative Care In COPD): A Formative and Summative Evaluation of the EPIC Telehealth Intervention

CONTEXT

Early, concurrent palliative care interventions in chronic obstructive pulmonary disease (COPD) are limited. Project EPIC (Early Palliative Care In COPD) is a multiphase mixed methods study working to fill this gap.

OBJECTIVES

To conduct a formative and summative evaluation of EPIC, a telephonic nurse coach-led early palliative care intervention for COPD adapted from the ENABLE© intervention in cancer.

METHODS

Phase I Formative Evaluation: Patients with moderate-to-very-severe COPD, family caregivers, and pulmonary and palliative care clinicians rated the acceptability and feasibility of EPIC (≥4 out of five on a Likert-scale survey). Phase II Summative Evaluation: Patients and family caregivers in Phase I participated in a pilot of the three month EPIC prototype to evaluate intervention and data collection feasibility (≥70% completion) and to seek qualitative feedback.

RESULTS

Phase I Formative Evaluation: Patients (n=10), family caregivers (n=10), pulmonary clinicians (n=6), and palliative care clinicians (n=6) found EPIC acceptable and feasible to support adaptation, while priority early palliative care needs in COPD from our prior research mapped well to the EPIC prototype. Phase II Summative Evaluation: Patients (n=5; ages 49-72, 40% moderate COPD, 40% Black) and their family caregivers (n=5; ages 51-73, 40% Black) completed 100% of EPIC prototype components, including weekly telephone sessions, a one month follow-up call, Advance Directive, palliative care clinic attendance, and 95% of monthly phone data collection sessions. Feedback from participants about EPIC was all positive.

CONCLUSION

EPIC was acceptable and feasible in patients with COPD and their family caregivers. Larger feasibility and effectiveness trials are warranted.

Characteristics of silicon nitride deposited by very high frequency (162 MHz)-plasma enhanced atomic layer deposition using bis(diethylamino)silane

Silicon nitrides, deposited by capacitively coupled plasma (CCP)-type plasma enhanced atomic layer deposition (PEALD), are generally applied to today's nanoscale semiconductor devices, and are currently being investigated in terms of their potential applications in the context of flexible displays, etc. During the PEALD process, 13.56 MHz rf power is generally employed for the generation of reactive gas plasma. In this study, the effects of a higher plasma generation frequency of 162 MHz on both plasma and silicon nitride film characteristics are investigated for the purpose of silicon nitride PEALD, using bis(diethylamino)silane (BDEAS) as the silicon precursor, and N₂ plasma as the reactant gas. The PEALD silicon nitride film deposited using the 162 MHz CCP exhibited improved film characteristics, such as reduced surface roughness, a lower carbon percentage, a higher N/Si ratio, a lower wet etch rate in a diluted HF solution, lower leakage current, and higher electric breakdown field, and more uniform step coverage of the silicon nitride film deposited in a high aspect ratio trench, as compared to silicon nitride PEALD using 13.56 MHz CCP. These improved PEALD silicon nitride film characteristics are believed to be related to the higher ion density, higher reactive gas dissociation, and lower ion bombardment energy to the substrate observed in N₂ plasma with a 162 MHz CCP.

Association between recovery from Bell's palsy and body mass index

BACKGROUND

Although many factors have been found to be involved in recovery from Bell's palsy, no study has investigated the association between recovery from Bell's palsy and obesity. This study therefore evaluated the association between recovery from Bell's palsy and body mass index (BMI).

METHODS

Subjects were classified into five groups based on BMI (kg/m² ). Demographic and clinical characteristics were compared among these groups. Assessed factors included sex, age, time from paralysis to visiting a hospital, the presence of comorbidities such as diabetes mellitus and hypertension, degree of initial facial nerve paralysis by House-Brackmann (H-B) grade and neurophysiological testing, and final recovery rate.

RESULTS

Based on BMI, 37 subjects were classified as underweight, 169 as normal weight, 140 as overweight, 155 as obese and 42 as severely obese. Classification of the degree of initial facial nerve paralysis as moderate or severe, according to H-B grade and electroneurography, showed no difference in severity of initial facial paralysis among the five groups (P > 0.05). However, the final recovery rate was significantly higher in the normal weight than in the underweight or obese group (P < 0.05).

CONCLUSIONS

Obesity or underweight had no effect on the severity of initial facial paralysis, but the final recovery rate was lower in the obese and underweight groups than in the normal group.

Metal allergy in eyelid dermatitis and the evaluation of metal contents in eye shadows

BACKGROUND

Allergic contact dermatitis is a common diagnosis in eyelid dermatitis. Sensitization to metals is prevalent in eyelid dermatitis and colour cosmetic products are frequently suspected as the source of metal exposure.

OBJECTIVE

To investigate the contact allergens for eyelid dermatitis and to assess metal contents in eye shadow products.

METHODS

Data were collected in the department of dermatology of Ewha Womans University hospital from December 1998 to February 2014. A total of 983 patients were patch tested during the period and 67 patients had eyelid dermatitis among them. To examine metal elements in colour cosmetic products for eyes, randomly selected 10 eye shadows were analysed.

RESULTS

Frequent allergens were metals, thiomersal and phenylenediamine in patients with eyelid dermatitis. The sensitization rates of individual allergens were not significantly different between patients with eyelid dermatitis and without eyelid dermatitis. All 10 eye shadow products contained more than 5 ppm of at least one element, nickel, cobalt or chromium.

CONCLUSION

Metals were top-rank allergens in patients with eyelid dermatitis as in the remaining patients patch tested. The eye shadow products contained significant amount of nickel, cobalt or chromium to elicit allergic reactions.

Comparison of steroid administration methods in patients with idiopathic sudden sensorineural hearing loss: a retrospective observational study

OBJECTIVES

To compare the recovery rates of patients with idiopathic sudden sensorineural hearing loss (ISSHL) treated with oral systemic steroids (PO) or intratympanic steroid injection (IT) or both.

DESIGN

A retrospective observational study.

SETTING

Tertiary referral centre.

PARTICIPANTS

Eight hundred and forty-four patients diagnosed with ISSHL within 14 days of the onset of symptoms. The patients were divided into three groups by treatment modality.

MAIN OUTCOME MEASURES

Threshold of pure-tone tests, age, accompanying symptoms and underlying diseases were compared. The level of final hearing recovery was evaluated by the application of the results of the pure-tone test that was performed at least 3 months after the completion of each treatment.

RESULTS

Final hearing recovery rate differed significantly by the type of treatment (P = 0.031). Recovery rates in the PO and combined groups were significantly higher in patients with mild (85.1% and 88.6%, respectively) than with profound (52.8% and 69.0%, respectively) hearing loss (P < 0.05). In contrast, severity and recovery rate were not significantly correlated in the IT group (P > 0.05). Combined treatment yielded significantly higher recovery rates than other treatment modalities in patients without hypertension (HTN) and diabetes mellitus (DM) (P = 0.021).

CONCLUSION

In the group treated with combined therapy, better hearing improvement was obtained than in the groups treated with systemic steroid only or with intratympanic steroid injection only without complications. These findings suggest that the combination of systemic administration and intratympanic injection may improve patient prognosis.

Steroid plus antiviral treatment for Bell's palsy

OBJECTIVES

The effectiveness of antiviral agents for the treatment of Bell's palsy is uncertain. We evaluated whether a steroid with an antiviral agent (S + A group) provided better recovery outcomes than a steroid alone (S group) in patients with Bell's palsy.

SUBJECTS AND DESIGN

A total of 1342 patients diagnosed with Bell's palsy who visited the Kyung Hee Medical Center in Seoul, Korea, from 2002 to 2012 were included in this study. Patients in the S + A group were treated with prednisolone and antiviral agents (n = 569) and those in the S group with prednisolone alone (n = 773). Outcomes were measured using the House-Brackmann (HB) scale according to age, initial disease severity, electroneurography (ENoG) findings and underlying comorbidities.

RESULTS

The rate of recovery (HB grades I and II) with initially severe Bell's palsy (HB grades V and VI) was higher in the S + A than in the S group (P = 0.001). However, the rates of recovery were similar with initially moderate palsy (HB grades II-IV) (P = 0.502). In patients classified according to age and ENoG-determined severity of palsy, the overall recovery rate was higher in the S + A than in the S group, but the differences were not statistically significant (P > 0.05 for both). The recovery rate without diabetes mellitus (DM) and hypertension (HTN) was higher in the S + A group than in the S group (P = 0.031). But in the patients with HTN and DM, the difference in recovery rates between the S + A and S groups was not statistically significant (P = 0.805).

CONCLUSIONS

Treatment with a steroid plus antiviral agent resulted in significantly higher recovery rates than steroid therapy alone in patients with initially severe Bell's palsy and without either HTN or DM, and a nonsignificant trend towards higher recovery rates in all patients with Bell's palsy in this study. Antiviral agents may therefore help in the treatment of Bell's palsy.

Partial oxidation of dimethyl ether using the structured catalyst Rh/Al2O3/Al prepared through the anodic oxidation of aluminum

The partial oxidation of dimethyl ether (DME) was investigated using the structured catalyst Rh/Al2O3/Al. The porous Al2O3 layer was synthesized on the aluminum plate through anodic oxidation in an oxalic-acid solution. It was observed that about 20 nm nanopores were well developed in the Al2O3 layer. The thickness of Al2O3 layer can be adjusted by controlling the anodizing time and current density. After pore-widening and hot-water treatment, the Al2O3/Al plate was calcined at 500 degrees C for 3 h. The obtained delta-Al2O3 had a specific surface area of 160 m2/g, making it fit to be used as a catalyst support. A microchannel reactor was designed and fabricated to evaluate the catalytic activity of Rh/Al2O3/Al in the partial oxidation of DME. The structured catalyst showed an 86% maximum hydrogen yield at 450 degrees C. On the other hand, the maximum syngas yield by a pack-bed-type catalyst could be attained by using a more than fivefold Rh amount compared to that used in the structured Rh/Al2O3/Al catalyst.

Genome-wide methylation profile of nasal polyps: relation to aspirin hypersensitivity in asthmatics

BACKGROUND

In addition to the dysregulation of arachidonic acid metabolism in aspirin-intolerant asthma (AIA), aspirin acetylsalicylic acid (ASA) exerts effects on inflammation and immunity; however, many of these effects are unknown.

OBJECTIVE

The aim of the study was to evaluate the methylation status of whole genome in blood and polyp tissues with and without aspirin hypersensitivity.

METHODS

Genome-wide DNA methylation levels in nasal polyps and peripheral blood cells were examined by microarray analysis using five subjects with AIA and four subjects with aspirin-tolerant asthma (ATA).

RESULTS

In the nasal polyps of the patients with AIA, hypermethylation was detected at 332 loci in 296 genes, while hypomethylation was detected at 158 loci in 141 genes. Gene ontologic and pathway enrichment analyses revealed that genes involved in lymphocyte proliferation, cell proliferation, leukocyte activation, cytokine biosynthesis, cytokine secretion, immune responses, inflammation, and immunoglobulin binding were hypomethylated, while genes involved in ectoderm development, hemostasis, wound healing, calcium ion binding, and oxidoreductase activity were hypermethylated. In the arachidonate pathway, PGDS, ALOX5AP, and LTB4R were hypomethylated, whereas PTGES was hypermethylated.

CONCLUSION

The nasal polyps of patients with AIA have characteristic methylation patterns affecting 337 genes. The genes and pathways identified in this study may be associated with the presence of aspirin hypersensitivity in asthmatics and are therefore attractive targets for future research.

Case report. Lipomatous haemangiopericytoma (fat-forming solitary fibrous tumour) involving the perineum: CT and MRI findings and pathological correlation

Lipomatous haemangiopericytoma (a fat-forming solitary fibrous tumour) is a rare soft-tissue tumour histologically characterized by haemangiopericytomatous vasculature and the presence of mature adipocytes. We report the CT and MRI findings of a case of lipomatous haemangiopericytoma involving the perineum. CT showed a well-circumscribed soft-tissue density mass containing a small area of fat density and a punctuate calcification. On MR images, the mass was mostly isointense to the muscle on T(1) weighted images, with heterogeneous signal intensity on T(2) weighted images, and showed strong contrast enhancement except for the fatty and dense collagenous components. This is the first case report of imaging findings of a lipomatous haemangiopericytoma in the radiological literature. Although rare, lipomatous haemangiopericytoma should be considered as a differential diagnosis of fat-containing, hypervascular soft-tissue tumours with variable signal intensity on T(2) weighted images.

Case report: Ovarian cavernous haemangioma presenting as a heavily calcified adnexal mass

Haemangioma is an extremely rare tumour of the ovary. We describe the CT and MRI findings of a heavily calcified ovarian haemangioma in a 69-year-old woman presenting with adnexal torsion. CT showed a well-circumscribed mass with extensive punctate calcifications, located posterior to the uterus. MR images showed dark signal intensities of the mass on both T(1) and T(2) weighted images, with poor enhancement of the mass on contrast-enhanced T(1) weighted images. MR images also demonstrated a beak-like protrusion from the adnexal mass, representing the adnexal torsion. This is the first case report of a heavily calcified ovarian haemangioma in the English literature. Although rare, ovarian haemangioma should be included in the differential diagnosis of a heavily calcified adnexal mass.

Chilaiditi syndrome caused by Fitz-Hugh-Curtis syndrome: multidetector CT findings

Chilaiditi syndrome is a condition in which the colon or small intestine is interposed temporarily or permanently between the liver and the diaphragm. Usually, it is an asymptomatic and incidental radiographic finding, but it may be a potential source of abdominal problems, ranging from intermittent mild abdominal pain to acute intestinal obstruction. We report multidetector computed tomographic findings of a case of Chilaiditi syndrome presenting as small bowel obstruction due to hepatodiaphragmatic interposition of the ileal loop, which was entrapped by adhesive bands caused by Fitz-Hugh-Curtis syndrome.

Magnetic resonance imaging and diffusion-weighted imaging changes after hypoglycemic coma

The authors report a case of severe hypoglycemic encephalopathy in an elderly patient. The magnetic resonance images showed bilateral cortical signal changes and basal ganglia lesions, which spared the thalami. The lesions were bright on fluid-attenuated inversion recovery and diffusion-weighted images and dark on the apparent diffusion coefficient map, being more conspicuous on the diffusion-weighted images than on the fluid-attenuated inversion recovery images. A literature review of the imaging features and pathophysiological mechanism in comparison with those of hypoxic ischemic injury is discussed.

Proliferative actions of natriuretic peptides on neuroblastoma cells. Involvement of guanylyl cyclase and non-guanylyl cyclase pathways

To identify neural tumor cell lines that could be used as models to study growth-related natriuretic peptide actions, we determined the effects of these peptides on the proliferation of human and rodent neuroblastoma cell lines. Subnanomolar concentrations of atrial natriuretic peptide (ANP) and type C natriuretic peptide (CNP) stimulated proliferation in all four cell lines. These actions were associated with cGMP elevation and were blocked by a protein kinase G inhibitor. These data imply the involvement of guanylyl cyclase (GC)-coupled natriuretic receptors. However, higher concentrations of ANP and CNP, and low concentrations of des-[Gln(18),Ser(19),Gly(20),Leu(21),Gly(22)]-ANP(4-23)-NH(2) (desANP(4-23)) (analog for NPR-C receptor) exerted antiproliferative actions in three of the cell lines. These effects were insensitive to a protein kinase G inhibitor and to HS-142-1, suggesting that growth-inhibitory actions involved a non-GC receptor. They did not appear to involve cAMP, protein kinase A, protein kinase C, or calcium mobilization but were abolished when constitutive mitogen-activated protein kinase activity was inhibited. Radioligand binding experiments revealed the presence of a uniform class of binding sites in NG108 cells and multiple binding sites in Neuro2a cells. Northern and reverse transcriptase-polymerase chain reaction analyses revealed differential gene expression for NPR-A/B/C in NG108 and Neuro2a cells. The results indicate that natriuretic peptides stimulate neuroblastoma cell proliferation through type NPR-A/B (GC) receptors. Higher concentrations of ANP and CNP exerted a mitogen-activated protein kinase-dependent antiproliferative action mediated by a non-GC receptor that interacts with desANP(4-23) with relatively high affinity.

CT differentiation of mesenteric ischemia due to vasculitis and thromboembolic disease

PURPOSE

The purpose of this work was to differentiate CT findings of acute mesenteric ischemia due to vasculitis (MV) or thromboembolism (MTE).

METHOD

CT scans of 69 patients with mesenteric ischemia caused by MV (n = 37) or MTE (n = 32) were analyzed. After dividing the patients into groups with and without MV, we compared them with regard to gastrointestinal tract involvement patterns, mesenteric changes, and presence or absence of vascular thrombosis, atherosclerosis, other organ changes, and ascites.

RESULTS

Duodenum was involved only in the MV group (30%). The MV group had preferential involvement of the small intestine (89%) to large intestine (51%), whereas the MTE group showed even distribution. Multisegmental bowel involvement was more common in the MV group (86%) than in the MTE group (44%), especially in both jejunum and ileum and both small and large intestine. The MV group showed prominent involvement of the superior mesenteric vessel territory, although the MTE group showed even distribution. Splenomegaly and hydronephrosis were more frequently seen in the MV group and vascular thrombosis and atherosclerosis in the MTE group.

CONCLUSION

Although considerable overlap was noted, CT is useful in differentiating MV from MTE.

Characteristic MR findings of cervical pregnancy

The aim of this study was to define the characteristic MR findings of cervical pregnancy. Twelve patients with cervical pregnancy underwent MRI because of difficulty in the diagnosis by ultrasonography, human chorionic gonadotropin assessment, and other clinical evaluations. The assessment of MRI included size and location of the lesion, margin, MR signal intensity, rim of low-signal intensity, enhancement pattern, appearance of enhancing solid component, parametrial change, endometrial change, pelvic fluid collection, and ovarian change. All cases showed ill-marginated mass with very heterogeneous signal intensity on T2-weighted images, irregular internal high-signal intensities on T1-weighted images, a partial or circumferential rim of low-signal intensity, dense irregular peripheral enhancement and enhancing papillary solid components with accompanying tubular signal voids, and variably increased parametrial vascularities. This heterogeneous hemorrhagic mass with densely enhancing papillary solid components may be the typical MR finding for cervical pregnancy. J. Magn. Reson. Imaging 2001;13:918-922.

Pituitary adenylyl cyclase-activating polypeptide stimulates DNA synthesis but delays maturation of oligodendrocyte progenitors

The neuropeptide pituitary adenylyl cyclase-activating peptide (PACAP) and one of its receptors (PAC(1)) are expressed in embryonic neural tube, where they appear to regulate neurogenesis and patterning. We now show that PAC(1) gene expression is also present in neonatal rats in the ventricular and subventricular zones and in the optic chiasm, areas that are rich in oligodendrocyte (OL) progenitors (OLP). Because actions of PACAP on OLP have not been reported, we examined the effects of PACAP on the proliferation of purified OLP in culture and on myelinogenesis in cerebellar slices. Northern analyses on total RNA from purified glial cell subtypes revealed an abundant 7 kb hybridizing transcript in OLP, which was confirmed to correspond to the PAC(1) receptor by reverse transcription-PCR. The presence of this receptor was also corroborated by radioligand binding and cAMP assay. In cultured OL, receptor density decreased during maturation but was partially counterbalanced by the appearance of sites that bound both PACAP and the related peptide vasoactive intestinal peptide. PACAP increased DNA synthesis in OLP cultures almost twofold and increased the bromodeoxyuridine-labeling index in O4-positive OLP. PACAP treatment also resulted in decreased sulfate incorporation into sulfatide in cultures of differentiating OL. The PACAP effect on sulfatide synthesis was fully reproduced in a cerebellar explant model. These findings indicate that PACAP may act at two stages during OL development to (1) stimulate proliferation and (2) delay maturation and/or myelinogenesis.

The findings of ruptured hepatocellular carcinoma on helical CT

To evaluate the helical CT findings of ruptured hepatocellular carcinoma (HCC), 12 patients with ruptured HCC were reviewed with regard to the tumour's location, size and contour protrusion, the appearance of the mass, the enhancement pattern, multiplicity and secondary changes. All ruptured tumours were located at the periphery of the liver and had a protruding contour. The maximum diameter of tumours ranged from 2 cm to 16 cm. Discontinuity of the hepatic surface was seen in 11 cases. In eight cases, CT images during the arterial phase showed a non-enhancing low attenuating lesion with focal discontinuity and peripheral rim enhancement. Seven cases showed separation of tumour content from the peripheral enhancing rim and intraperitoneal rupture of tumour content into the perihepatic space. Because of the similar appearance to an enucleated orbital globe with remaining sclera, this was termed the "enucleation sign". As well as ruptured masses, 10 cases with non-ruptured masses also showed a non-enhancing low attenuating pattern. Seven cases showed a haematoma with high attenuation around the ruptured mass. The peripheral location, protruding contour, discontinuity of the hepatic surface and surrounding haematoma are helpful signs in the diagnosis of ruptured HCC. The "enucleation sign" may be a characteristic finding in ruptured HCC.

The vascular manifestations of Behçet's disease: angiographic and CT findings

The purpose was to evaluate angiographic and CT manifestations of vascular Behçet's disease. The medical records of 64 patients with Behçet's disease, treated in our hospital during the last 4 years, were reviewed. 37 patients underwent angiography or CT in the symptomatic regions because of symptoms or clinical signs of vascular involvement by Behçet's disease. 33 (male:female ratio 28:5; mean age 35 years) of the 37 patients demonstrated vascular involvement, which was surgically proven (18 patients) or diagnosed on angiography (15 patients). Angiograms and CT images of these 33 patients were retrospectively analysed for lesion type, location, extent and other characteristic findings of vascular involvement. 12 patients had only venous lesions, 11 had only arterial lesions and 10 had both arterial and venous lesions. The major angiographic findings of vascular Behçet's disease were acute or chronic thrombosis in deep veins of the lower extremities (19 patients), in the inferior vena cava (4 patients) and in the superior vena cava (2 patients), pseudoaneurysms of large or medium sized arteries (11 patients), and occlusions/ stenoses of distal run-off arteries (13 patients). Common CT findings were obliterated deep veins (8 patients) and non-calcified thickened aneurysmal walls (9 patients), with or without contrast enhancement. The combination of these angiographic and CT findings with clinical manifestations are helpful in distinguishing vascular Behçet's disease from other vasculitides.

Kaposi's sarcoma involving a transplanted kidney, ureter and urinary bladder: ultrasound and CT findings

We report the imaging findings in a case of Kaposi's sarcoma involving a transplanted kidney, ureter and urinary bladder. Ultrasound and CT demonstrated multiple nodular masses in the pelvis of the transplanted kidney, ureter and bladder. The masses enhanced well on CT following i.v. contrast medium.

Radiological features of leiomyomatous tumors of the colon and rectum

PURPOSE

The purpose of this study was to evaluate the radiological features of 12 pathologically proven cases of colorectal leiomyomatous tumors.

METHOD

A retrospective analysis of radiologic findings was performed in 12 patients with pathologically proven colorectal leiomyomatous tumors (2 leiomyomas and 10 leiomyosarcomas). Available radiologic studies included abdominal CT scans in 11 patients, double contrast barium studies in 4, and pelvic MRI in 1. On imaging, we evaluated the size, tumor margin (smooth or lobulated), morphologic appearance, growth patterns (endocolic, exocolic, or combined), contrast enhancement patterns, presence or absence of calcification within the tumors, and metastasis.

RESULTS

The involved tumor sites were the colon in 2 patients and the rectum in 10. The mean tumor size was 7.9 cm (range 2-15 cm): It was 3.5 cm in leiomyomas and 8.8 cm in leiomyosarcomas. On imaging studies, the tumor margin was smooth in three patients and lobulated in nine, with endocolic growth in one, exocolic in four, and combined in the remaining seven. Eight of the 12 tumors showed varying degrees of internal necrosis with heterogeneous contrast enhancement. Dystrophic calcification was noted in five patients. Metastasis was seen in the liver in three patients at the time of initial diagnosis, and lymphadenopathy was noted in two patients (paraaortic space in one and perirectal space in two).

CONCLUSION

Although rare, the diagnosis of leiomyomatous tumor may be suggested especially when the tumor occurring in the colorectum shows exocolic growth or calcification with varying degree of internal necrosis.

Radiologic features of vasculitis involving the gastrointestinal tract

Vasculitides can cause local or diffuse pathologic changes in the gastrointestinal tract, resulting in nonspecific paralytic ileus, mesenteric ischemia, submucosal edema and hemorrhage, or bowel perforation or stricture. The extent and clinical course of disease depend on the size and location of the affected vessel and the histologic characteristics of the lesion. Vasculitis may primarily involve large vessels (eg, giant cell arteritis, Takayasu arteritis), medium-sized vessels (eg, polyarteritis nodosa, Kawasaki disease, primary granulomatous central nervous system vasculitis), or small vessels (eg, Wegener granulomatosis, Churg-Strauss syndrome, microscopic polyangiitis, Henoch-Schönlein syndrome, systemic lupus erythematosus, rheumatoid vasculitis, Behçet syndrome). Radiologic findings in various types of vasculitis often overlap considerably and therefore have limited value in making a specific diagnosis. Nevertheless, the possibility of vasculitis should be considered whenever mesenteric ischemic changes occur in young patients, are noted at unusual sites (eg, stomach, duodenum, rectum), have a tendency to concomitantly involve the small and large intestine, and are associated with genitourinary involvement. Knowledge of systemic clinical manifestations in affected patients may suggest and even help establish the specific diagnosis.

Urinary bladder involvement in patients with systemic lupus erythematosus: with review of the literature

OBJECTIVES

To investigate the etiologies of urinary bladder involvement in patients with systemic lupus erythematosus (SLE), the clinicoradiologic features of gastrointestinal tract manifestations and clinical outcomes in patients with lupus cystitis accompanied by gastrointestinal manifestations.

METHODS

We conducted a retrospective chart review on 413 patients with SLE. Patients were selected for review on the basis of lower urinary tract symptoms including urinary frequency, urgency and urinary incontinence. Radiologic studies were analyzed in patients with lupus cystitis.

RESULTS

Ten consecutive patients, complicated with lower urinary tract symptoms, were identified. Underlying etiologies were as follows: lupus cystitis in five, neurogenic dysfunction secondary to transverse myelitis in three, cyclophosphamide-induced cystitis in one and tuberculous cystitis in one patient. All patients with lupus cystitis showed gastrointestinal manifestations, such as abdominal pain, nausea, vomiting and/or diarrhea during the periods of cystitis symptoms. In all patients with lupus cystitis, paralytic ileus was demonstrated on plain abdominal X-ray and ascites, bilateral hydroureteronephrosis and thickened bladder wall were identified on abdominal ultrasound or CT. Abdominal CT revealed bowel wall thickening in four of the five patients. The main sites of thickened bowel on abdominal CT were territory supplied by superior mesenteric artery. Two of five patients with lupus cystitis expired during the follow-up period.

CONCLUSION

Diverse etiologies may cause lower urinary tract symptoms in patients with SLE. Lupus cystitis is strongly associated with gastrointestinal involvement and abdominal CT can be a useful radiologic tool to investigate the gastrointestinal tract involvement in patients with lupus cystitis.

Brenner tumor of the ovary: CT and MR findings

PURPOSE

The purpose of this study was to determine the CT and MR characteristics of Brenner tumors, rare epithelial neoplasms of the ovary.

METHOD

CT and MR scans of eight pathologically proven Brenner tumors of the ovary (seven benign, one malignant, and one associated with mucinous cystadenoma) were retrospectively reviewed. The masses were analyzed for location, size, external configuration, internal architecture, enhancement pattern, presence of calcification, and metastatic spread.

RESULTS

The patients' median age was 63 years (range 39-79 years), and the mean size of the tumors was 11.4 cm (7.5-17 cm). All tumors were unilateral and had a well-defined margin. The mass was mostly solid in three, mostly cystic in one, and "mixed" solid and cystic in four cases. The tumors with cystic components (n = 5) were mostly multilocular in appearance (n = 4). All the solid components showed mild homogeneous enhancement on postcontrast CT and MRI. Extensive amorphous calcification within the solid component on CT was seen in five of six cases (83%). No characteristic findings discriminating malignancy from benign Brenner tumor could be found.

CONCLUSION

Extensive amorphous calcification in a solid mass or solid component in a multilocular cystic mass is a characteristic finding of Brenner tumor of the ovary on CT and MRI.

Collision tumors of the ovary associated with teratoma: clues to the correct preoperative diagnosis

PURPOSE

Collision tumors represent a coexistence of two adjacent but histologically distinct tumors without histologic admixture in an organ. The purpose of this study was to describe the imaging findings of collision tumors of the ovary associated with teratoma and to look for clues that might lead to the correct preoperative diagnosis.

METHOD

Seven pathologically proven cases of collision tumor of the ovary associated with teratoma were retrospectively reviewed. Ovarian teratomas were coexistent with mucinous cystadenoma (n = 4), borderline mucinous tumor (n = 1), mucinous cystadenocarcinoma (n = 1), and dysgerminoma (n = 1). US (n = 5), CT (n = 3), and/or MRI (n = 4) findings were evaluated.

RESULTS

In addition to the typical findings of teratoma, the mass contained a multiloculated cystic portion filled with nonfatty fluid, suggesting the coexistent epithelial tumor in five cases. In one case, the mass contained a large solid component, suggesting the possibility of collision tumor. In the remaining one case, coexistent small mucinous cystadenoma could not be identified.

CONCLUSION

Preoperative imaging for ovarian teratoma revealed a collision tumor in six of seven cases. The possibility of a collision tumor should be considered when an ovarian teratoma has imaging findings that cannot be explained solely by an ovarian teratoma.

CT features of torsion of benign cystic teratoma of the ovary

PURPOSE

The purpose of this work was to evaluate the usefulness of CT scans for distinguishing torsed from uncomplicated benign cystic teratoma (BCT).

METHOD

Retrospective analysis was performed in 14 torsed BCTs (14 patients) and in 23 uncomplicated BCTs (20 patients) for comparison. The features on CT scans were compared to the pathologic findings.

RESULTS

CT findings indicating torsed BCT were the presence of eccentric wall thickening of >1 cm, peritumoral infiltration, and presence of enlarged solid tubal mass adjacent to the uterus (p < 0.05).

CONCLUSION

The present study suggests that CT is useful in differentiating torsed from uncomplicated BCT. Although CT findings are not specific for some patients, detection of certain CT findings could increase the diagnostic accuracy.

Diffuse and focal adenomyosis: MR imaging findings

Adenomyosis is a common gynecologic disorder that affects women during their menstrual life. Preoperative magnetic resonance (MR) images obtained in 45 patients with pathologically proved adenomyosis who underwent hysterectomy were retrospectively reviewed. Diffuse adenomyosis was seen in 30 cases (66.7%) and focal adenomyosis in 15 cases (33.3%). On T2-weighted MR images, diffuse adenomyosis usually manifested as diffuse thickening of the endometrial-myometrial junctional zone (7-37 mm; mean, 16 mm) with homogeneous low signal intensity. T2-weighted MR images were superior to contrast material-enhanced T1-weighted images in the evaluation of junctional zone thickening. High-signal-intensity foci were observed on T2-weighted images only in nine cases and on both T1- and T2-weighted images in three cases. Focal adenomyosis manifested on both T2-weighted and contrast-enhanced T1-weighted MR images as a localized, low-signal-intensity round or oval mass with a diameter of 2-7 cm (mean, 3.8 cm). All but one of the focal lesions had ill-defined margins. High-signal-intensity foci were noted in all cases of focal adenomyosis, either on T2-weighted images only (four cases) or on both T1- and T2-weighted images (11 cases). MR imaging is useful in diagnosing adenomyosis, differentiating adenomyosis from uterine myoma, and planning appropriate treatment.

Primary mucinous cystadenocarcinoma of the appendix: CT findings

OBJECTIVE

The preoperative diagnosis of a primary appendiceal tumor can be difficult because of its rarity and the paucity of material in the radiology literature. The purpose of this study was to describe CT findings in six patients with primary mucinous cystadenocarcinoma of the appendix.

CONCLUSION

When CT reveals a cystic mass with enhancing wall nodularity in the expected area of the appendix, especially in older patients, the possibility of primary mucinous cystadenocarcinoma should be considered.

Staging of early endometrial carcinoma: assessment with T2-weighted and gadolinium-enhanced T1-weighted MR imaging

This study evaluated the usefulness of T2-weighted and gadolinium-enhanced T1-weighted magnetic resonance (MR) images correlated with patients' menopausal status in assessing the depth of myometrial invasion in stage I endometrial carcinoma. MR images of 46 patients with stage I endometrial carcinoma were retrospectively reviewed. Twenty-five patients were premenopausal, and 21 were postmenopausal. The staging accuracy without regard to menopausal status was 59% for T2-weighted images and 61% for gadolinium-enhanced T1-weighted images. However, when staging accuracy was evaluated separately in the premenopausal and postmenopausal patient groups, T2-weighted imaging had an accuracy of 80% in the premenopausal group and gadolinium-enhanced T1-weighted imaging had an accuracy of 81% in the postmenopausal group. Therefore, T2-weighted imaging was more accurate in premenopausal patients and gadolinium-enhanced T1-weighted imaging was more accurate in postmenopausal patients. The overall accuracy of staging with MR imaging improved to 80% when patients' menopausal status was considered. Therefore, menopausal status should be considered when T2-weighted and gadolinium-enhanced T1-weighted MR images are used to stage early endometrial carcinoma.

CT features of systemic lupus erythematosus in patients with acute abdominal pain: emphasis on ischemic bowel disease

PURPOSE

To evaluate the computed tomographic (CT) features of systemic lupus erythematosus (SLE) in patients with acute abdominal pain. Special emphasis was placed on the analysis of ischemic bowel disease.

MATERIALS AND METHODS

The authors retrospectively reviewed the images from 39 abdominal CT examinations performed in 33 patients with SLE and acute abdominal pain. Images were evaluated for bowel wall changes, mesenteric changes, fluid collection, retroperitoneal lymphadenopathy, peritoneal enhancement, and hepatomegaly as well as for changes in other abdominal organs. Ischemic bowel disease was diagnosed if at least three of the following signs were seen: bowel wall thickening, target sign, dilatation of intestinal segments, engorgement of mesenteric vessels, and increased attenuation of mesenteric fat.

RESULTS

Thirty-one (79%) of the 39 examinations had CT findings diagnostic of ischemic bowel disease, including symmetric bowel wall thickening (n = 29), target sign (n = 26), and mesenteric vascular engorgement and haziness (n = 31). In 24 cases, bowel wall thickening was multifocal, with variable length, and did not appear to be confined to a single vascular territory.

CONCLUSION

The most common CT finding in patients with SLE and acute abdominal pain is ischemic bowel disease. CT is useful for detecting the primary cause of gastrointestinal symptoms, planning treatment, and monitoring for infarction or perforation.

Two cases of common bile duct stone after liver transplantation

Biliary complications after orthotopic liver transplants are a continuing cause of morbidity and mortality. Biliary stones and sludge are less well known complications of hepatic transplantation, although they have long been recognized. Recently we experienced two cases of biliary stones developed after liver transplantation. One 32-year-old male, who frequently admitted due to recurrent cholangitis, was treated with percutaneous transhepatic biliary drainage and choledochojejunostomy with cholecystectomy. The other 58-year-old male, who had stones in commone bile duct, was treated by endoscopic manipulation. They are in good condition without recurrent bile duct stones or its accompanying complications. Although stones and sludge are relatively infrequent after liver transplantation, surgical or interventional radiologic treatments are usually performed for treatment.

Post-traumatic arterial priapism: colour Doppler examination and superselective arterial embolization

PURPOSE

To evaluate selective embolization for management of post-traumatic priapism and colour Doppler sonography for the diagnosis of the causative lesion and for planning embolization.

MATERIALS AND METHODS

Six male patients with post-traumatic priapism underwent selective angiography and embolization. Colour Doppler sonography with grey-scale was performed in all six patients before angiography.

RESULTS

Selective angiography showed intracavernosal arteriovenous fistulas in all patients and pseudoaneurysm of the cavernosal artery (or common penile artery) in three patients. After successful embolization, detumescence was achieved in all patients. Colour Doppler sonography enabled localization and characterization of the lesion causing priapism in four patients. Grey-scale ultrasonography showed the dilated cavernosal sinuses in all patients.

CONCLUSION

Angiography with selective embolization is safe and effective method to correct post-traumatic priapism. Colour Doppler sonography with grey scale is a useful preangiographic study, as it allows for characterization and localization of the causative lesion except lesions at the proximal cavernosal or distal penile artery near the symphysis pubis.

Benign solitary fibrous tumour of the pre-sacral space: MRI findings

Benign solitary fibrous tumour, a rare mesenchymal tumour of adults, usually arises from the pleura. Only a few cases have been reported in the retroperitoneum and, to our knowledge, there has been no report of its imaging features. We describe the MRI features of benign solitary fibrous tumour arising from the pre-sacral space.

Mucocele of the appendix: ultrasonographic and CT findings

BACKGROUND

Mucocele of the appendix is a rare disease entity, but preoperative diagnosis is very important. With the advent of ultrasonography (US) and computed tomography (CT), it has been possible to preoperatively diagnose mucocele of the appendix. We describe the spectrum of US and CT findings of mucocele of the appendix and the differential points from mimicking diseases.

METHODS

We evaluated 17 patients with pathologically proven mucocele of the appendix by using US and CT. Pathologic diagnoses of 17 patients were mucinous cystadenoma in 11 patients, mucinous cystadenocarcinoma in two, and mucosal hyperplasia in four. We analyzed morphologic characteristics of mucocele of the appendix at US and CT.

RESULTS

The typical US finding were a cystic mass with variable internal echogenicity, layered wall, and calcification in the wall. The CT finding was a well-encapsulated cystic mass with a wall of variable thickness. Both cases with focal nodular solid enhancing portion in the wall on CT were pathologically proven as mucinous cystadenocarcinoma.

CONCLUSION

US and CT were useful methods in diagnosing mucocele of the appendix and differentiating this condition from mimicking diseases. Nodular enhancing lesion in the wall of the mucocele may be a finding suggestive of malignant cause of mucocele.

Gastrointestinal leiomyoma and leiomyosarcoma: CT differentiation

PURPOSE

Our goal was to evaluate CT efficacy in differentiating gastrointestinal leiomyoma and leiomyosarcoma.

METHOD

We retrospectively reviewed CT scans of 45 patients (21 men, 24 women, mean age 55 years) with surgically proven gastrointestinal leiomyomas (n = 21) and leiomyosarcomas (n = 24) with respect to size, contour, enhancing pattern, mesenteric fat infiltration, calcification, ulceration, regional lymphadenopathy, direct invasion, distant metastasis, and growth pattern after visual inspection by two radiologists in agreement. On the basis of these CT features, subjective diagnosis was also categorized into three groups (Group I: probably benign, Group II: probably malignant, Group III: diagnostic malignant). The results were compared with the final histopathologic diagnosis.

RESULTS

In addition to the features of direct invasion and distant metastasis suggesting diagnostic malignancy, the CT features favoring malignancy with statistical significance included larger size (> 5 cm), lobulated contour, heterogeneous enhancement, mesenteric fat infiltration, ulceration, regional lymphadenopathy, and exophytic growth pattern (p < 0.005). However, calcification was not significant in differentiating the two entities (p = 0.25163). A subjective analysis revealed 89% sensitivity, 85% specificity, and 87% accuracy for diagnosis of leiomyosarcoma.

CONCLUSION

CT features are useful in differentiating leiomyoma and leiomyosarcoma in gastrointestinal tract.

Resistive index of the intrascrotal artery in scrotal inflammatory disease

PURPOSE

To investigate the utility of the resistive indices (RIs) of the epididymal and intratesticular arteries, and to establish diagnostic criteria for scrotal inflammatory disease on the basis of quantitative color Doppler sonography.

MATERIAL AND METHODS

We prospectively examined 29 consecutive patients with scrotal pain, and 15 normal control subjects. The RIs of the intratesticular and epididymal arteries were obtained from color Doppler sonographs.

RESULTS

The RIs of the testicular artery in epididymoorchitis were significantly lower than those in normal control subjects and in epididymitis (p < 0.01) while the RIs of the testicular artery in epididymitis and control subjects were similar (p > 0.5). With a cut-off value of RI = 0.5, sensitivity, specificity, accuracy, and positive and negative predictive values were 91%, 94%, 94%, 83%, and 77% respectively. The mean RI of the epididymal arteries in epididymitis and epididymoorchitis was 0.49 +/- 0.11. A high level of diagnostic accuracy in scrotal inflammatory disease was achieved when the RIs of the intratesticular and epididymal arteries were less than 0.5 and 0.7 respectively.

CONCLUSION

The RI of the intrascrotal artery would give a more objective evaluation than subjective assessment and could provide diagnostic criteria for scrotal inflammatory disease.

Blunt traumatic rupture of the diaphragm: sonographic diagnosis

Ultrasonographic features of seven patients with diaphragmatic rupture due to blunt trauma were analyzed. The ruptures occurred at the left hemidiaphragm in four patients and at the right in three. Direct ultrasonographic findings were as follows: disrupted diaphragm in four patients; nonvisualized diaphragm in three patients; floating diaphragm in two patients; and herniation of the liver or bowel loops through the diaphragmatic defect in three patients. Indirect sonographic findings included pleural effusion or subphrenic fluid collection in five patients and splenic laceration in one. Although the number of patients was limited, ultrasonography was very useful for the diagnosis of diaphragmatic rupture.

Eosinophilic cholangitis: US, CT, and cholangiography findings

We report a case of eosinophilic cholangitis, with US, CT, and cholangiographic findings. The lesion showed marked wall thickening of cystic and common bile ducts on US and CT together with mild diffuse narrowing of the common duct on cholangiography.

Intussusception: characteristic radiolucencies on the abdominal radiograph

Six hundred and twenty-five sets of supine and erect abdominal radiographs of 288 patients with the confirmed diagnosis of intussusception (315 episodes) and 310 patients without intussusception were reviewed retrospectively to determine the characteristic radiographic features of intussusception. Among the patients with intussusception, 155 episodes (49%) showed a soft tissue mass and nearly half of these (71) showed characteristic radiolucencies (target, crescentic, or amorphous) in the soft tissue mass. Thirty-five episodes showed the radiolucencies on both the supine and erect radiographs; in 16 cases the type of radiolucency differed on the two films. In patients without intussusception, abnormal radiolucencies were seen in only seven cases (2.3%). Computed tomography performed prospectively in five patients showed the radiolucencies in the soft tissue mass to be intussuscepted mesenteric fat. We conclude that abnormal radiolucencies in the soft tissue mass on plain radiographs are characteristic of intussusception.

CT of hypervascular hepatic tumors: are unenhanced scans necessary for diagnosis?

OBJECTIVE

In most institutions, a combination of unenhanced and contrast-enhanced CT is used to screen patients for suspected hypervascular hepatic neoplasms. Elimination of the unenhanced examination could save time and expense and reduce the patient's exposure to radiation. We compared unenhanced and incremental bolus dynamic contrast-enhanced CT for detection of hypervascular hepatic neoplasms and evaluated the need for preliminary unenhanced hepatic CT.

SUBJECTS AND METHODS

We prospectively examined 101 consecutive patients with hypervascular primary hepatic malignant tumors or suspected hypervascular metastases. Primary hepatic neoplasms included hepatocellular carcinoma (seven), sarcoma (two), and hemangioendothelioma (one); extrahepatic primary tumors included breast (37) and renal cell (24) carcinoma, melanoma (15), carcinoid (nine), and endocrine and other tumors (six). All patients had both unenhanced and bolus dynamic contrast-enhanced CT with 5-mm collimated sections at 8-mm intervals. For contrast-enhanced CT, 150-180 ml of IV contrast material, a mechanical power injector, and a scanning protocol that allowed completion of liver imaging within 2 min were used. Both unenhanced and contrast-enhanced CT scans were compared for detection and conspicuousness of hepatic lesions.

RESULTS

Hepatic lesions were found in 34 patients. In 21 patients, all hepatic lesions seen on unenhanced scans also were apparent on contrast-enhanced scans. However, in 12 (57%) of 21 patients, lesions were more conspicuous and better defined on contrast-enhanced scans. The absolute number of lesions detected with each method of scanning differed in 12 patients. In four patients, the contrast-enhanced scan showed more lesions; in five patients, the unenhanced scan showed more lesions; and in three patients, administration of contrast material obscured some lesions shown on unenhanced scans and made others more conspicuous. If only a contrast-enhanced CT scan had been obtained, the presence of malignant hepatic neoplasm would have been missed in only one case (a patient with a single 2.8-cm metastasis from renal cell carcinoma).

CONCLUSION

Bolus dynamic contrast-enhanced CT alone correctly showed the presence or absence of primary or metastatic hypervascular hepatic tumors in 100 of 101 cases. If the goal of CT examination is detection of hypervascular hepatic lesions, use of contrast-enhanced CT alone may be adequate and the addition of unenhanced scans is not cost-effective.

Intestinal infarction secondary to mesenteric venous thrombosis: CT-pathologic correlation

We reviewed CT of four patients with surgically proved bowel infarction secondary to superior mesenteric vein (SMV) thrombosis. Pathologic correlation was available in all patients. Three patients had thrombus in both portal vein and proximal SMV and the remaining patient had thrombus that was seen only in the peripheral branches of the SMV. Contrast-enhanced CT showed a segmental distribution of marked concentric bowel wall thickening in all four patients. Two patients also showed zones of different attenuation in the bowel wall, which were caused by varying degrees of edema and hemorrhage in the submucosa. Dense peripheral enhancement of the bowel wall was present in one patient. Other CT findings included ascites and mesenteric changes such as edema and vascular engorgement. The combination of thrombus in the SMV with bowel wall thickening strongly suggests bowel infarction and, therefore, warrants initiation of appropriate therapy.

Impact of clinical history on film interpretation

We performed a study to determine whether clinical history gives a positive or negative influence on X-ray film interpretation. One hundred and nine patient's radiograms, consisting of 55 normal and 54 abnormal cases (136 abnormalities), were interpreted twice by three pairs of residents in radiology and a pair of qualified radiologists, without clinical history first and with clinical history next. The interpreters recorded diagnosis and confidence level of normal or abnormal findings on a six-point scale. Analysis of receiver operating characteristic (ROC) curves showed that knowledge of clinical history improved diagnostic accuracy. Residents, especially beginners, should be advised to obtain clinical history whenever they read radiograms.