영양막질환의 초음파소견

조준식 충남대학교 의과대학 지역사회의학연구소 1987 충남의대잡지 Vol.14 No.2

Ultrasongraphic findings of Trophoblastic disease were analysed in 28 cases which were confirmed by D&E or hysterectomy during the period from March 1984 to Sep. 1987 at Chungnam University Hospital. The results were follows: 1. There were 18 cases of complete mole, 5 cases of partial mole, 2 cases of invasive mole and 3 cases of choriocarcinoma. 2. The size of uterus in cases of known dates was large for dates in 9(64%) of 14 cases of complete mole and small for dates in 4(100%) of 4 cases of partial mole. 3. The uterine wall was well defined from intrauterine content in 19(83%) of 23 cases of H mole and ill defined in 4(80%) of 5 cases of invasive mole and choriocarcinoma. 4. Typical homogeneous small vesicular echo pattern was in 8(44%) of 18 cases of complete mole and associated with variable degree of internal degeneration in 10 cases (56%). 5. Sonographic pattern of partial mole was variable and indistinguishable from complete mole and missed abortion. 6. Invasive mole and choriocarcinoma showed heterogeneous vesicular echo pattern with focal echogenic area or irregular sonolucent area and ill defined uterine wall. 7. Theca lutein cysts were combined in 6 cases(21%). 8. The accuracy of sonongraphic diagnosis was 89%.

진행위암의 수술전 병기결정에서 문맥기 나선식 CT의 유용성 : Usefulness of Helical CT during the Portal Venous Phase

조준식,신경숙 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2

The purpose of this study was to evaluate the effect of helical CT during the portal venous phase after oral ingestion of water in the preoperative staging of advanced gastric carcinomas. Of the patients underwent helical CT scanning for preoperative staging of gastric carcinoma, 70 patients with pathologically proved advanced gastric carcinomas were selected in this study. The patients ingested 600-800m1 of water as a oral contrast agent before CT scanning. A total 130150ml of nonionic contrast material was administered at the rate of 4ml/s. We obtained portal venous phase images at 60 s and equilibrium phase images at 3 min after the start of bolus administration of intravenous contrast material. Two-phase CT findings were prospectively evaluated and correlated with histopathologic findings according to TNM classification. The primary tumors were detected on CT scans in 69 (98.5%) of 70 cases. The accuracy of CT for T staging was 74.3% (52 of 70 cases). T staging was understaged in 13 cases (18.6%) and overstaged in five (7.1%). The accuracy for N staging was 67.1% (47 of 70 cases). N staging was understaged in 16 cases (22.9%) and overstaged in seven (10%). Our results suggest that helical CT during the portal venous phase can improve the accuracy of CT in the preoperative staging of advanced gastric carcinomas.

급성 폐쇄성 담관염의 치료에서 경피적 담배액술의 역할

조준식,김충현 충남대학교 의과대학 지역사회의학연구소 1990 충남의대잡지 Vol.17 No.2

Acute obstructive cholangitis may manifest clinically from mild to severe suppurative form. Percutaneous biliary drainage (PBD) provide alternative for nonoperative biliary decompression in acute obstructive cholangitis. We analyzed our experience of PBD in 35 patients with acute obstructive cholangitis. The underlying diseases were 26 maliganant tumors and 9 benign diseases. Acute suppurative cholangitis occurred in 11 of 35 patients and the causes were 6 benign disases due to bile duct stone and 5 maliganant tumors. PBD was performed succssfully in 32 of 35 patients, 29 patients were managed effectively, partial success in 3 patients, and failed in 3 patients as a result of septic shock and biliary-portal venous fistula. Palliative PBD for advanced malignant tumor underwent in 19 patients and preoperative PBD underwent in 13 patients. Successful surgery after effective biliary decompression was performed in 12 of 13 patients who underwent preoperative PBD. This analysis suggest that PBD is initial treatment of choice for acute suppurative cholangitis and can be performed safely in acute obstructive cholangitis for palliative or preoperative management.

위에 생긴 이소성 췌장의 진단에 있어 경구 조영제로 물을 사용한 후 조영증강 역동적 CT의 가치

조준식,신경숙 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

To describe the usual and unusual CT findings of heterotopic pancreatic of the stomach and to evaluate the usefulness of dynamic contrast-enhanced CT with water as an oral contrast agent in diagnosing heterotopic pancreas We retrospectively reviewed CT findings in 10 patients with pathologically proved gastric heterotopic pancreas by operation (n=9) or endoscopic resection (n=1). In three patients, conventional CT with diluted Gastrografin solution as an oral contrast agent was performed. In seven patients, two-phase dynamic CT scans after ingestion of 600-800 ml of water were obtained in the early phase and equilibrium phase. Dynamic CT findings of heterotopic pancreas were correlated with histopathologic findings. All 10 heterotopic pancreatic rests were detected with conventional CT or dynamic CT. In seven cases who underwent dynamic CT after ingestion of water, highly enhanced mucosal layers overlying the lesions were identified and all lesions were well delineated in the submucosal layer In four of these seven cases, heterotopic pancreas showed high enhancement similar to that of adjacent normal pancreatic enhancement in the early phase of dynamic CT. The usual CT findings of gastric heterotopic pancreas were oval-shaped submucosal masses (<3cm) in the gastric antrum. The unusual CT findings were infiltrating heterotopic pancreas into the muscle layer in one, cystic dilatation of heterotopic pancreatic ducts in two, and malignant change with mucin secreting cystadencoarcinoma in one. Gastric heterotopic pancreas usually showed oval-shaped submucosal masses (<3cm) in the gastric antrum with high enhancement similar the that of pancreatic enhancment in the early phase of dynamic CT. Our results suggest that contrast-enhanced dynamic CT after ingestion of water may be helpful in diagnosing gastric heterotopic pancreas.

위암에 의한 간 전이의 CT 진단에 있어 조영제의 급속 정맥주사방법을 이용한 문맥기 역동적 CT의 유용성 : Usefulness of Bolus Dynamic CT During Portal Phase

조준식,송창준,김종철,이병철 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

Purpose : We evaluated the usefulness of dynamic CT during portal phase with faster injection rate of contrast material in detecting hepatic metastases from gastric cancers. Subjects and Methods : We retrospectively analyzed two-phase dynamic CT findings (portal phase and equilibrium phase) in 17 patients with pathologically proven gastric cancers and hepatic metastases. In 13 patients, a total of 150ml of nonionic contrast material was administered with a power injector at a flow rate of 5ml/sec for 30 sec, and two-phase images were obtained at 45-70 sec (portal phase) and 2-4 min (equilibrium phase) after the start of bolus injection. In four patients, two-phase dynamic CT with spiral technique was performed with the same method. Results : In cases of metastases less than 1 cm in diameter, 65 lesions were detected in the portal phase that showed clearly defined hypodense lesions in highly enhanced hepatic parenchyma. Whereas, only nine (14%) lesions were detected in the equilibrium phase and the remaining 56(86%) lesions showed isoattenuation. In cases of metastases more than 1 cm in diameter, 37 lesions were detected in the portal phase that showed clearly defined hypoattenuations. whereas, the images of equilibrium phase showed isoattenuation in five (14%), mixed attenuation in three (8%), and hypoattenuation in 29 (78%). The lesions detected in the equilibrium phase showed poorly defined hypodense lesions and tended to decrease in size due to peripheral enhancement of lesions. Conclusion : Dynamic CT during portal phase with faster injection rate of IV contrast material is an useful technique in detecting hepatic metastases from gastric cancers, particularly small lesions less than 1 cm in diameter.

복부농양 및 액체저류의 경피적 카테타 배액술

조준식 충남대학교 의과대학 지역사회의학연구소 1988 충남의대잡지 Vol.15 No.2

Percutaneous catheter drainage using a combination of US, CT and fluoroscopic guidance has become the treatment of choice for various abdominal abscesses and fluid collections. It is an important alternative to surgical treatment because of its high success rate, low mortality rate and low complication. The Author analyzed the results of percutaneous catheter drainage in 30 patients with abdominal abscesses and fluid collections at Chungnam National University Hospital from May 1986 to Aug. 1988. The results were as follows: 1. Successful drainage of the collection with avoidance of operation was achieved in 24/30 (80%) patients and partial success in 3 patients among 6 failures and recurrences 2. There were 2 failures and 4 recurrence and these were due to phlegmon, organized tissue, multiplicity, fistulae, or underlying tumor. 3. Comlication was minor in most cases 4. The overall, complete and partial success rate was 90%, failure rate was 6.7% and recurrent rate was 13.3%.

담관침습을 일으킨 간세포암과 간내 담관암의 감별 진단에 있어 조영제의 급속 정맥 주입방법을 이용한 동맥기 역동적 CT의 유용성 : Value of Arterial Phase Dynamic CT with a Higher Intravenous Injection Rate of Contrast Material

조준식,김대홍 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.2

PURPOSE : To evaluate the value of arterial phase dynamic computed tomography (CT) with a highs intravenous (IV) injection rate of contrast material in diagnosing hepatocellular carcinoma (HCC) with bile duct invasion mimicking intrahepatic cholangiocarcinoma (CAC). MATERIALS AND METHODS : Two-phase dynamic CT was performed in 19 patients with pa thologically proven HCCs (n=9) and CACs (n=10). Two-phase images were obtained at 20-50 sec (arterial phase) and 2-4 min (equilibrium phase) after the start of IV injection of contrast material (5 ml/sec, 150 ml). Two-phase images were compared and correlated with pathologic findings. RESULTS : On the arterial phase images, HCCs showed total heterogeneous hyperattenuation in all nine and CACs showed hvpoattenuation in seven and hypoattenuation with peripheral rim enhancement in three. On the equilibrium phase images, all HCCs showed hypoattenuation and capsular enhancement in four. However, all CACs showed hypoattenuation with peripheral or inhomogeneous isodense enhancement. Enhancement patterns of HCCs with bile duct invasion in the arterial phase were significantly different from that of intrahepatic CACs. CONCLUSION : Arterial phase dynamic CT with a higher IV injection rate of contrast material enables HCC with bile duct invasion to differentiate from intrahepatic CAC.

간농양의 초음파 소견

조준식 충남대학교 의과대학 지역사회의학연구소 1985 충남의대잡지 Vol.12 No.2

Author had analysed the ultrasonographic findings in 24 cases of liver abscess which were confirmed by needle aspiration and operation during the period from June 1982 to July 1985. The result were as follows: 1. Among total 24 cases, male was 16 cases and female was 8 cases. The majority of patients were in older individuals between the age of 40-69 years. 2. Right lobe was the most common involed site of liver abscess. Multiple lesions were 3 cases and all pyogenic. All the 5 cases of amebic abscess were single lesion and situated in right lobe. 3. Sonographic appearance of pygenic abscess was variable from anechoic to highly echogenic and usually well defined. The majority of amebic abscess were well defined and in all cases, round or oval anechoic and hypoechoic lesions which shown homogeneously weak internal echo and variable through transmission. 4. Poorly defined hypoechoic or slightly echogenic lesion with peripheral echo-free halo were proved to be early abscess in follow up study. 5. Analysis of sonogaphic findings of liver abscess with corresponding pathologic change enabled to make differentiation from other intrahepatic lesion. Early diagnosis of liver abscess by using ultrasound considered to be treated effectively without significant mortality.

硬化性 物質(Sotradecol^ⓡ과 Tetracycline)을 利用한 腎動脈塞栓에 關한 實驗的 硏究

趙俊植,李秉喆 충남대학교 의과대학 지역사회의학연구소 1987 충남의대잡지 Vol.14 No.1

Transcatheter embolization. of renal artery using Gelfoam^ⓡ soaked in Sotradecol^ⓡ sodium tetradecyl sulfate) and Tetracycline solution in rabbits was performed to evaluate the effect of intra-arterial injection. Selective renal arteriography was done at 15 minutes, 1 week and 4 weeks after embolization. The rabbits were subsequently sacrificed and histopathologic examination performed. The result were as follows: 1. Initial segmental occlusion was sustained in 11 of 16 cases that performed follow-up angiography. Recanalized vessels showed irregular narrowing and marked decrease in number in 2 of 5 cases and progressive occlusion of segmental and proximal renal artery in 3 of 5 cases. 2. The infarcted kidneys were swollen and enlarged at 1 week. There were resulted in shrinkage of infarcted kidney and compansatory hypertrophy of opposite kidney depending on intitial extent of infarcted area at 4 weeks. 3. After embolization, minute collateral vessels were developed in 10 of 16 cases without remarkable nephrogram in infarcted area. 4. The effect of, Tetracycline seemed, to be similar to that of Sotradecol in producing arterial occlusion. 5% Tetracycline was :more injurious than 2.5% concentration in occlusion of renal artery. 5. Abscess formation within infarcted kidney was occurred in two cases using Sotradecol but not occurred in cases using Tetracycline. 6. Sotradecol and Tetracycline were the effective agents of producing persistent renal infarction with peripheral as well as central occlusion. It was consirdered that intra-arterial injection of Tetracycline was the available mean of producing persistent renal artery embolization.

단순 두부 촬영상에 있어서 두부 손상에 관한 방사선학적 연구

조준식 충남대학교 의과대학 지역사회의학연구소 1978 충남의대잡지 Vol.5 No.2

Along with the development of material civilization, various kinds of accidents including traffic accidents are on the steady increase. Of these cases, the head trauma is very serious in condition and requires accurate diagnosis and treasment. Out of the 300 cases of head trauma patients, we observed how simple skull X-ray exmination had influenced on the clinical diagnosis and treatment in Chungnam National University Hospital from April 1977 to March 1978. 1. Skull fracture detected in the 90 patients of 300 patients which were injured head, trauma. 2. The sex and age incidence of head trauma were 229 men(76.3%) and 71womon (23.7%) ant commonly noted in the second, third decade. 3. The commonest cause of head trauma was the traffic accident(42.7%) and the next were local trauma by object, falls. 4. The fracture of skull valult was most frequent and the linear fracture had a majors 5. There was no specific relationship between the incidence of skull fracture, clingy symptoms, and physical findings. 6. The admission of patients were increased in the case of the detection of skull fracture but was not influenced the afterward treatment. 7. The mortality rate of head trauma was 11. 7% and in 19 patients (54. 3%) were associated with fracture and in 16 patients (45. 7%) were no fracture. There was no specific relationship between the mortality rate and skull fracture.