The purpose of this study is to evaluate the diagnostic accuracy of various quantitative indices for the differentiation of benign from malignant primary soft tissue tumors by FDG-PET. A series of 32 patients with a variety of histologically or clinically confirmed benign (20) or malignant (12) soft tissue lesions were evaluated with emission whole body (5min/bed position) PET after injection of [18F]FDG. Regional 20min transmission scan for the attenuation correction and calculation of SUV was performed in 16 patients (10 benign, 6malignant) followed by dynamic acquisition for 56min. Postinjection transmission scan for the attenuation correction and calculation of SUV was executed in the other 16 patients (10 benign, 6 malignant). The following indices were obtained : the peak and average SUV (pSUV, aSUV) of lesions, tumor-to-background ratio acquired at images of 51 min p.i. (TBR51), tumor-to-background ratio of areas under time-activity curves (TBRarea) and the ratio between the activities of tumor ROI at 51 min p.i. and at the time which background ROI reaches maximum activity on the time-activity curves (T51/Tmax). The pSUV, aSUV, TBR51, and TBRarea, in malignant lesions were significantly higher than those in benign lesions. We set the cut-off values of pSUV, aSUV, TBR51, TBRarea and T51/Tmax for the differentiation of benign and malignant lesions at 3.5, 2.8, 5.1, 4.3 and 1.55, respectively. The sensitivity, specificity and accuracy were 91.7%, 80.0%, 84.4% by pSUV and aSUV, 83.3%, 85.0%, 84.4% by TBR51, 83.3%, 100%, 93.8% by TBRarea and 66.7%, 70.0%, 68.8% by Tsl/Tmax. The time-activity curves did not give additional information compared to SUV or TBR. The one false negative was a case with low-grade fibrosarcoma and all four false positives were cases with inflammatory change on histology. The visual analysis of FDG-PET also detected the metastatic lesions in malignant cases with comparable accuracy. In conclusion, all pSUV, aSUV, TBR51, and TBRarea are useful metabolic semi-quantitative indices with good accuracy for the differentiation of benign from malignant soft-tissue lesions.
Fibrosarcoma ; Humans ; Positron-Emission Tomography ; Sensitivity and Specificity

PURPOSE: This study was conducted to report our single center experience with performing directional atherectomy in patients with infra-inguinal arterial disease by using the Silverhawk plaque excision device. This procedure was performed at Washington University Hospital in St. Louis, USA (WASH). METHODS: Fifty-six patients with 102 lesions and who were classified into the Rutherford categories 2 to 6 underwent 66 procedures using the Silverhawk device from November 2004 to July 2007 in WASH. The patients' medical records were retrospectively reviewed. RESULTS: The initial technical success rate was 86.4%. The primary patency rate and limb salvage rate at 1 year was 48.5% and 80.3%, respectively. After 2 year' s follow-up, there was no occlusion or limb loss, and the overall primary patency rate and limb salvage was 45.5% and 75.8%, respectively. The mean preoperative ABI was 0.52+/-0.24 and the postoperative ABI was 0.73+/-0.22 (P=0.001). The one-year primary patency rate in the TASC II A and B group was 56.4% and that in the C and D group was 29.6% (P=0.003, P=0.007), respectively. There was a significantly different between both groups. However, the location, nature and length of the lesion, the Rutherford category and the adjunctive procedures did not statistically affect the primary patency rate. CONCLUSION: In this study, the Silverhawk plaque excision device was a feasible treatment modality for infra-inguinal peripheral arterial disease because of its high technical success rate, the primary patency rate and the limb salvage rate. However, it had an obstacle for being accepted for widespread use because secondary endovascular techniques are frequently required for restenosis after plaque excision. The practical use of the Silverhawk is controversial and further studies will be needed.
Atherectomy ; Endovascular Procedures ; Extremities ; Follow-Up Studies ; Humans ; Limb Salvage ; Medical Records ; Peripheral Arterial Disease ; Retrospective Studies ; Washington

No abstract available.
Incontinentia Pigmenti*

Despite paramount clinical significance of white matter stroke, there is a paucity of researches on the pathomechanism of ischemic white matter damage and accompanying oligodendrocyte (OL) death. Therefore, a large gap exists between clinical needs and laboratory researches in this disease entity. Recent works have started to elucidate cellular and molecular basis of white matter injury under ischemic stress. In this paper, we briefly introduce white matter stroke from a clinical point of view and review pathophysiology of ischemic white matter injury characterized by OL death and demyelination. We present a series of evidence that Toll-like receptor 2 (TLR2), one of the membranous pattern recognition receptors, plays a cell-autonomous protective role in ischemic OL death and ensuing demyelination. Moreover, we also discuss our recent findings that its endogenous ligand, high-mobility group box 1 (HMGB1), is released from dying OLs and exerts autocrine trophic effects on OLs and myelin sheath under ischemic condition. We propose that modulation of TLR2 and its endogenous ligand HMGB1 can be a novel therapeutic target for ischemic white matter disease.
Demyelinating Diseases ; HMGB1 Protein ; Ischemia ; Leukoencephalopathies ; Myelin Sheath ; Oligodendroglia* ; Receptors, Pattern Recognition ; Stroke ; Toll-Like Receptor 2* ; Toll-Like Receptors* ; White Matter*

Cushing's syndrome associated with nodular adrenal glands will be divided into four main categories: adrenal adenoma, adrenal carcinoma, primary pigmented nodular adrenal dysplasia (PPNAD) and macronodular adrenal hyperplasia(MAH). The term macronodular adrenal hyperplasia is restricted to the presence of multiple nodules visible to the naked eye, ranging in size from 0.5 to 7.0 cm. We report a case of Cushings syndrome caused by bilateral macronodular adrenal hyperplasia (MAH). A 45-year-old man presented with Cushingoid features, hypertension and diabetes mellitus. Urine free cortisol was 449.9 mmol/day(27-276) and were not suppressed after administration of low-dose and high-dose dexamethasone. Plasma ACTH was very low(1.87 pmol/L(18)) and was not stimulated by administration of ovine CRH. In abdominal CT, both adrenal glands were markedly enlarged and nodular in appearance. Pituitary MRI showed no abnormal finding. Bilateral adrenalectomy was done. Histologic examination revealed multiple nodules and internodular hyperplasia. This case and other reports suggested that because of variable biochemical, radiologic and pathologic findings, macronodular adrenal hyperplasia represents a heterogeneous group of patients with varying degrees of adrenal autonomy.
Adenoma ; Adrenal Glands ; Adrenalectomy ; Adrenocorticotropic Hormone ; Cushing Syndrome ; Dexamethasone ; Diabetes Mellitus ; Humans ; Hydrocortisone ; Hyperplasia ; Hypertension ; Magnetic Resonance Imaging ; Middle Aged ; Plasma ; Tomography, X-Ray Computed

Background: Whole body scan using 131-iodine is performed to detect local recurrence or metastasis after thyroidectorny in differenciated thyroid cancer patients. The sensitivity of this procedure is related to the dose of radiopharmaceutical administered. It was reported that 131I posttreatment whole body scan demonstrate foci of tracer uptake not previously observed in diagnostic scan in 10~30% of cases. Posttreatment scans were most likely to reveal new foci in young patients(<45) and patients who had previously received radioactive iodine therapy. Method: We observed the frequency of discordant posttreatment scans and analysed the clicnical significance in 33 differenciated thyroid cancer patients who were admitted for radioiodine ablation from June, 1995 to April, 1996. Results: In 7 cases(21.2%), post treatment scan demonstrated cme or more foci of uptake and revealed less sites of uptake than diagnostic scan in 3 cases(9.1%). In one case with elevated thyroglobulin level and negative diagnostic scan, post treatment scan revealed new uptake sites with thyroid bed and cervical 1ymph node. The sites of discordant uptake were cervical lymph nodes in 4 cases and rnediastinal lymph node in one case, lung in one case, thyroid bed and cervical lymph nodes in one case, 3 cases of 7 pts(43%), demonstrated ane or more foci of uptake in post treatment scan, had history of previous radioiodine treatent. Conclusion: Post treatment scan confirmed uptake into remnant and metaststic tissues identified on the corresponding low dose diagnostic scans. Scanning after high dose radioiodine treatment frequently demonstrated one or more foci of uptake, especially in patients with previous radioiodine treatment, which were not visualized on the diagnostic low dose scan. Treatment scan may be useful for detection of remnant tissue or metastatic lesion in patients with elevated thyroglobulin and negative diagnostic scan.
Humans ; Iodine ; Lung ; Lymph Nodes ; Methods ; Neoplasm Metastasis ; Recurrence ; Thyroglobulin ; Thyroid Gland ; Thyroid Neoplasms ; Whole Body Imaging

This study evaluated the influence of application time of self-etching primers on microtensile bond strength (microTBS) to dentin using three self-etching primer adhesive systems. Dentin surfaces were exposed from forty-eight human molars. They were conditioned with three self-etching primers (Clearfil SE Bond [SE], Unifil Bond [UF], Tyrian SPE + One Step Plus [TY]) and different primining times (10s, 20s, 30s and 40s). Composite resins were bonded to dentin surfaces and specimens were made. microTBS was tested and statistically compared using by one-way ANOVA and Tukey's Test The results of this study presented that priming time for 10s in SE and UF groups and for 30s and 40s in TY group was highly decreased microTBS to dentin.
Adhesives ; Composite Resins ; Dentin* ; Humans ; Molar

Carcinoma of the parathyroid gland is rare, comprising only 0.1% to 5% of all patients with primary hyperparathyroidism. It presents with severe hypercalcemia, bone disease, palpable neck mass, renal involvement and etc. Since the initial operation offers the best chance for cure, preoperative localization and intraoperative recognition of parathyroid cancer are essential. Recently parathyroid imaging has been described with 99mTc-sestamibi as an alternative to 201Tl. This newer agent has many physical and dosirnetric advantages and represents higher detection sensitivity than 201Tl-99mTc subtraction scan. We experienced a 41-year-old man presenting with recurrent hyperparathyroidism in spite of 2 previous operations. In preoperative localization, there was no abnormal uptake in 201Tl-99mTc subtraction scan but 99mTc-sestamibi scan revealed metastatic foci on right cervical area. He was successfully treated with modified radical neck dissection.
Adult ; Bone Diseases ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Neck ; Neck Dissection ; Parathyroid Glands ; Parathyroid Neoplasms* ; Technetium Tc 99m Sestamibi*

Rhabdomyosarcoma originating from the chest wall is a rare malignant tumor in children and was considered to be guarded in prognosis previously. However, recent advances in multidisciplinary treatment of rhabdomyosarcoma in children have improved the disease free survival rate. Authors report a case of alveolar rhabdomyosarcoma, stage III, originating from the chest wall who is surviving free of disease for 15 months with aggressive chemotherapy and radiotherapy.
Child ; Disease-Free Survival ; Drug Therapy ; Humans ; Prognosis ; Radiotherapy ; Rhabdomyosarcoma ; Rhabdomyosarcoma, Alveolar* ; Thoracic Wall* ; Thorax*

Myxofibrosarcoma is also known as a myxoid variant of malignant fibrous histiocytoma, and this is one of the most common sarcomas in the extremities of elderly people; it is characterized by a high frequency of local recurrence. We herein report on a case of myxofibrosarcoma of the bladder. A 58-year-old man was referred to our hospital because of microscopic hematuria. Computed tomography(CT) and intravenous pyelography(IVP) showed a 12x7cm sized bladder mass in the pelvic cavity. The cystoscopic finding shows a protruding mass at the dome and posterior wall of the bladder. After exploratory laparotomy and tissue frozen biopsy were done, radical cystectomy and uretero-ileo-cutaneous anastomosis were then carried out. The diagnosis of the tumor was confirmed by histopathological examination. The myxofibrosarcoma of the bladder was completely excised, and there was no evidence of recurrence after 10 months of follow-up.
Male ; Humans ; Biopsy