The differentiation between Malignancy-Related Ascites(MRA) and Non-Malignant Ascites (NMA) is important for further diagnostic and therapeutic procedures. Althought many parameters were investigated, none has provided a complete distinction between MRA and NMA. We investigated several ascitic fluid parameters to determine the differential power, and to ifferentiate malignant-related from nonmalignant-related ascites with a sequence of sensitive parameters followed by specific parameters. For the present sturdy, 80 patients with ascites were divided into two groups: MRA and NMA. The MRA group was consisted of 27 patients with proven malignancy by image study, biopsy, and follow up; 21 of these patients had peritoneal carcinomatosis, but the remaining 6 showed no evidence of peritoneal carcinomatosis. The NMA group was consisted of 53 patients with no evidence of malignancy; among these patients, one had SLE, and others had liver cirrhosis. The samples of blood and ascites were obtained simultaneously, and then the levels of ascites cholesterol, CEA, protein, LDH, cytology, albumin gradient, ascites/serum concentration ratios of LDH(LDH A/S), and ascites/serum concentration ratios of protein(protein A/S) were measured. Applying cut-off limits for determined parameters, we estimated the diagnostic efficacy of each parameter. Among the eight parameters investigated, ascites fluid cholesterol yielded the best sensitive value of 93%(cut-off value 30mg/dl), and cytologic examination and the protein A/S(cut-off value 0.5) showed the most specific value of 100% and 96%, respectively. Based on the above result, the diagnostic sequence with cholesterol as a sensitive parameter, followed by the combination of cytologic examination and protein A/S as specific parameters, was tested in 80 patients. This diagnostic sequence identified 81.5% of patients with malignancy, and all patients with peritoneal carcinomatosis were classified as malignancy-related ascites. In spite of many limitations, this proposed diagnostic sequence may permit a cost-effective and simple differentiation of malignacy-related ascites from nonmalignant ascites
Ascites* ; Ascitic Fluid* ; Biopsy ; Carcinoma ; Cholesterol ; Follow-Up Studies ; Humans ; Liver Cirrhosis

We report a case of Churg-Strauss syndrome with cardiac involvement presenting without cardiomegaly or cardiopulmonary symptoms. A 47-year-old woman was referred to our institution for myalgia, peripheral numbness, and eosinophilia. She had been diagnosed with bronchial asthma and allergic rhinitis four years ago. The patient exhibited eosinophilia (71%) and elevated cardiac enzymes (cTnI, 2.977 ng/mL). Cardiomegaly was not observed on chest radiography, but nonspecific ST segment changes were observed on electrocardiography. A transthoracic echocardiography revealed a dilated left ventricular cavity, a decreased left ventricle (42%), and diastolic dysfunction. Contrast-enhanced cardiac magnetic resonance imaging revealed delayed hyperenhancement 10 minutes after injecting gadolinium. An endomyocardial biopsy showed eosinophilic myocarditis associated with vasculitis. The patient was diagnosed with Churg-Strauss syndrome and received combination therapy with steroid and cyclophosphamide. After the second treatment cycle, the blood eosinophilia disappeared and the vasculitis and infiltration of eosinophils into the endomyocardial tissue had completely resolved.
Asthma ; Biopsy ; Cardiomegaly ; Churg-Strauss Syndrome ; Cyclophosphamide ; Echocardiography ; Electrocardiography ; Eosinophilia ; Eosinophils ; Female ; Gadolinium ; Heart Ventricles ; Humans ; Hypesthesia ; Magnetic Resonance Imaging ; Middle Aged ; Myocarditis ; Rhinitis ; Rhinitis, Allergic, Perennial ; Thorax ; Vasculitis

PURPOSE: To investigate the effects of radiation dose-escalation on the treatment outcome, complications and the other prognostic variables for glioblastoma patients treated with 3D-conformal radiotherapy (3D-CRT). MATERIALS AND METHODS: Between Jan 1997 and July 2002, a total of 75 patients with histologically proven diagnosis of glioblastoma were analyzed. The patients who had a Karnofsky Performance Score (KPS) of 60 or higher, and received at least 50 Gy of radiation to the tumor bed were eligible. All the patients were divided into two arms; Arm 1, the high-dose group was enrolled prospectively, and Arm 2, the low-dose group served as a retrospective control. Arm 1 patients received 63~70 Gy (Median 66 Gy, fraction size 1.8~2 Gy) with 3D-conformal radiotherapy, and Arm 2 received 59.4 Gy or less (Median 59.4 Gy, fraction size 1.8 Gy) with 2D-conventional radiotherapy. The Gross Tumor Volume (GTV) was defined by the surgical margin and the residual gross tumor on a contrast enhanced MRI. Surrounding edema was not included in the Clinical Target Volume (CTV) in Arm 1, so as to reduce the risk of late radiation associated complications; whereas as in Arm 2 it was included. The overall survival and progression free survival times were calculated from the date of surgery using the Kaplan-Meier method. The time to progression was measured with serial neurologic examinations and MRI or CT scans after RT completion. Acute and late toxicities were evaluated using the Radiation Therapy Oncology Group neurotoxicity scores. RESULTS: During the relatively short follow up period of 14 months, the median overall survival and progression free survival times were 15+/-1.65 and 11+/-0.95 months, respectively. There was a significantly longer survival time for the Arm 1 patients compared to those in Arm 2 (p=0.028). For Arm 1 patients, the median survival and progression free survival times were 21+/-5.03 and 12+/-1.59 months, respectively, while for Arm 2 patients they were 14+/-0.94 and 10+/-1.63 months, respectively. Especially in terms of the 2-year survival rate, the high-dose group showed a much better survival time than the low-dose group; 44.7% versus 19.2%. Upon univariate analyses, age, performance status, location of tumor, extent of surgery, tumor volume and radiation dose group were significant factors for survival. Multivariate analyses confirmed that the impact of radiation dose on survival was independent of age, performance status, extent of surgery and target volume. During the follow-up period, complications related directly with radiation, such as radionecrosis, has not been identified. CONCLUSION: Using 3D-conformal radiotherapy, which is able to reduce the radiation dose to normal tissues compared to 2D-conventional treatment, up to 70 Gy of radiation could be delivered to the GTV without significant toxicity. As an approach to intensify local treatment, the radiation dose escalation through 3D-CRT can be expected to increase the overall and progression free survival times for patients with glioblastomas.
Arm ; Diagnosis ; Disease-Free Survival ; Edema ; Follow-Up Studies ; Glioblastoma* ; Humans ; Magnetic Resonance Imaging ; Multivariate Analysis ; Neurologic Examination ; Prospective Studies ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Tomography, X-Ray Computed ; Treatment Outcome ; Tumor Burden