Malignant mixed m llerian tumor (MMMT) of the ovary is very rare neoplasm consisting of both a sarcomatous and carcinomatous component and represent is fewer than 1% of all ovarian malignancies. Characteristically, ovarian MMMTs follow an aggressive clinical course, and long-term survival is unusual. Almost all MMMTs are found in postmenopausal women, often with low parity and usually in an advanced stage. Stage has been recognized as the single most important prognostic factors. However, a major improvement in prognosis for this rare malignancy has not yet been achieved. The authors have experienced one case of primary malignant mixed m llerian tumor of the ovary and report our experience with a brief review of literature.
Female ; Humans ; Ovary* ; Parity ; Prognosis

PURPOSE: To determine adequate timing of acquisition of contrast-enhanced fluid attenuated inversion recovery (FLAIR) by using multiphasic contrast-enhanced FLAIR magnetic resonance imaging (MRI) and to evaluate added value in detecting small intracerebral metastases 5 mm or less. MATERIALS AND METHODS: Twenty-nine patients, that underwent multiphasic contrast-enhanced FLAIR MRI and contrast-enhanced T1 weighted image (T1WI) were included and total number of small intracerebral metastases was 131. Sensitivity, specificity and accuracy of lesion detection were evaluated. Contrast ratio (CR) and enhancement ratio of each lesion were compared and analyzed among each imaging sequence. RESULTS: Sensitivity, specificity and accuracy of lesion detection were increased when contrast-enhanced FLAIR was added to contrast-enhanced T1WI. Area of under receiver operating characteristic curve significantly increased by addition of contrast-enhanced FLAIR than using contrast-enhanced T1WI alone (p < 0.05). CR was significantly higher in contrast-enhanced T1WI than FLAIR (p < 0.001). All of the above results were not different according to time of acquisition of contrastenhanced FLAIR. CONCLUSION There was advantage of conducting contrast-enhanced FLAIR MRI, but multiphasic contrast-enhanced FLAIR did not provide additional information for detection of small intracerebral metastases compared with single-phase FLAIR MRI.

Catamenial hemoptysis is a rare condition, characterized by recurrent hemoptysis associated with the presence of intrapulmonary or endobronchial endometrial tissue. Therapeutic strategies proposed for intrapulmonary endometriosis with catamenial hemoptysis consist of medical treatments and surgery. Bronchial artery embolization is a well-established modality in the management of massive or recurrent hemoptysis, but has seldom been used for the treatment of catamenial hemoptysis. We report a case of catamenial hemoptysis associated with pulmonary parenchymal endometriosis, which was successfully treated by a bronchial artery embolization.
Bronchial Arteries* ; Embolization, Therapeutic ; Endometriosis ; Female ; Hemoptysis*

Acute humoral rejection after renal transplantation is associated with a higher frequency of allograft dysfunction and graft loss. We report a case of acute humoral rejection which was treated successfully with plasmapheresis and intravenous immunoglobulin. A 31- year-old man developed azotemia after kidney transplantation. Kidney biopsy finding was compatible with antibody-mediated rejection, demonstrated by the infiltration of monocytes and neutrophils and the deposition of C4d on glomerulus and peritubular capillaries. We performed five plasmapheresis with concomitant treatment of intravenous immunoglobulin after each session. With aggressive treatment, there was improvement of oliguric acute renal failure, accompanied by decrease in the percentage of PRA and the titer of donor specific antibodies. Repeated kidney biopsy revealed persistent C4d staining on peritubular capillaries despite disappearance of donor specific antibodies. In conclusion, plasmapheresis and intravenous immunoglobulin are effective in treating acute humoral rejection.
Male ; Humans ; Biopsy

PURPOSE: We evaluated the technical aspect and efficacy of transcatheter arterial embolization (TAE) in cases of intractable postpartum bleeding by comparing the angiographic findings women patients according to their delivery pattern. MATERIALS AND METHODS: Between July of 2003 and March of 2008, 55 female patients were enrolled in this study. Of the 55 patients, 36 underwent a vaginal delivery (group 1), whereas 19 underwent a cesarean section delivery (group 2). We retrospectively evaluated the angiographic findings and the embolization technique between groups, using a Pearson Chi-Square test. Medical records and telephone interview findings were also reviewed to evaluate the efficacy of TAE and the outcome of fertility. RESULTS: Significantly greater positive angiographic findings were found in group 2 (63.2%) relative to group 1 (30.6%). For positive angiographic findings, except for AVM, the embolization was performed using coil or glue with gelfoam. For the negative angiographic findings or AVM, the gelfoam was the only embolic agent used. In all patients except for one, bleeding stopped after embolization. Major complications occurred in 2 patients only, and included uterine synechia and perforation. All patients except for one recovered after menstruation. In total, four patients became pregnant and one patient delivered a healthy infant. CONCLUSION: Positive angiographic findings requiring embolization with coil or glue, as well as gelfoam, were more commonly encountered in group 2 than in group 1. Based on the outcome of the study group, TAE is a safe and effective treatment for intractable postpartum bleeding and is also useful for preserving fertility.
Adhesives ; Angiography ; Cesarean Section ; Embolization, Therapeutic ; Female ; Fertility ; Gelatin Sponge, Absorbable ; Hemorrhage ; Humans ; Infant ; Interviews as Topic ; Medical Records ; Menstruation ; Obstetric Labor Complications ; Postpartum Hemorrhage ; Postpartum Period ; Pregnancy ; Retrospective Studies ; Uterus

BACKGROUND: Point-of-care (POC) testing is expanding because of the many advantages, such as faster turnaround time, immediate decision making and patient management. However, POC testing has problems; poor maintenance and quality control of devices and management of test results. We installed data management system (DMS) for POC blood gas analyzers using local area network for the resolution of those problems. METHODS: We connected nine POC blood gas analyzers Rapidpoint 400 (Bayer Diagnostics Ltd., Newbury, UK) to POC data manager Rapidlink (Bayer Diagnostics Ltd.) by device interface using local area network and developed in-house program for connecting POC data manager to laboratory information system (LIS)/hospital information system (HIS). We surveyed user acceptability and reliability of test results. We examined patterns of problems detected and solved in operating DMS based on quality records. We calculated the change of the yearly test numbers of arterial blood gas analysis (ABGA) after installation of DMS. RESULTS: Test results of POC blood gas analyzers were transferred to LIS and could be checked in HIS. By means of user survey, we judged that the users of POC blood gas analyzers operated the devices with ease and thought test results reliable. POC data manager server implemented in central laboratory enabled remote maintenance and quality control of devices with little workload. POC ABGA test number increased by 3.7 fold during the two years. CONCLUSIONS: We developed DMS for POC blood gas analyzers, enabling test result retrieval and remote maintenance and quality control of devices. This is very informative study for other hospitals installing DMS for POC testing in Korea.
Blood Gas Analysis ; Clinical Laboratory Information Systems ; Decision Making ; Humans ; Information Systems ; Korea ; Local Area Networks* ; Quality Control

PURPOSE: We describe our experience with the use of N-butyl cyanoacrylate (NBCA) embolization of abdominal wall bleeding and we evaluate the clinical effectiveness of the procedure. MATERIALS AND METHODS: Embolization was performed in nine patients with abdominal wall bleeding. The sites of embolization were the left first lumbar (n = 1), left second lumbar (n = 1), right inferior epigastric (n = 2), left inferior epigastric (n = 3), right circumflex iliac (n = 1), and left circumflex iliac artery (n = 1). A coil was used with NBCA in one patient due to difficulty in selecting only a bleeding focus and anticipated reflux. NBCA was mixed with Lipiodol at the ratio of 1:1 to 1:4. Blood pressure and heart rate were measured before and after the embolization procedure, and the serial hemoglobin and hematocrit levels and transfusion requirements were reviewed to evaluate hemostasis and rebleeding. RESULTS: Hemostasis was obtained in six out of the nine patients and technical success was achieved in all patients. There were no procedure-related complications. Four out of the nine patients died due to rebleeding of a subarachnoid hemorrhage (n = 1), multiorgan failure (n = 1), and hepatic failure (n = 2) that occurred two to nine days after the embolization procedure. One patient had rebleeding. The five surviving patients had no rebleeding, and the patients continue to visit the clinic on an outpatient basis. CONCLUSION: NBCA embolization is a clinically safe procedure and is effective for abdominal wall bleeding.
Abdominal Wall ; Arteries ; Blood Pressure ; Cyanoacrylates ; Embolization, Therapeutic ; Ethiodized Oil ; Heart Rate ; Hematocrit ; Hemoglobins ; Hemorrhage ; Hemostasis ; Humans ; Iliac Artery ; Liver Failure ; Outpatients ; Subarachnoid Hemorrhage

PURPOSE: Various embolic agents have been used for embolization of acute gastrointestinal (GI) arterial bleeding. N-butyl cyanoacrylate (NBCA) is not easy to handle, but it is a useful embolic agent. In this retrospective study, we describe our experience with NBCA embolization of acute gastroduodenal ulcer bleeding. MATERIALS AND METHODS: NBCA embolization was performed in seven patients with acute upper GI arterial bleeding; they had five gastric ulcers and two duodenal ulcers. NBCA embolization was done in the left gastric artery (n = 3), right gastric artery (n = 2), gastroduodenal artery (n = 1) and pancreaticoduodenal artery (n = 1). Coil was used along with NBCA in a gastric bleeding patient because of difficulty in selecting a feeding artery. NBCA was mixed with Lipiodol at the ratio of 1:1 to 1:2. The blood pressure and heart rate around the time of embolization, the serial hemoglobin and hematocrit levels and the transfusion requirements were reviewed to evaluate hemostasis and rebleeding. RESULTS: Technical success was achieved in all the cases. Two procedure-related complications happened; embolism of the NBCA mixture to the common hepatic artery occurred in a case with embolization of the left gastric artery, and reflux of the NBCA mixture occurred into the adjacent gastric tissue, but these did not cause any clinical problems. Four of seven patients did not present with rebleeding, but two had rebleeding 10 and 16 days, respectively, after embolization and they died of cardiac arrest at 2 months and 37 days, respectively. One other patient died of sepsis and respiratory failure within 24 hours without rebleeding. CONCLUSION: NBCA embolization with or without other embolic agents could be safe and effective for treating acute gastroduodenal ulcer bleeding.
Arteries ; Blood Pressure ; Cyanoacrylates* ; Duodenal Ulcer ; Embolism ; Embolization, Therapeutic* ; Ethiodized Oil ; Heart Arrest ; Heart Rate ; Hematocrit ; Hemorrhage* ; Hemostasis ; Hepatic Artery ; Humans ; Peptic Ulcer* ; Respiratory Insufficiency ; Retrospective Studies ; Sepsis ; Stomach Ulcer

PURPOSE: Various embolic agents have been used for embolization of acute gastrointestinal (GI) arterial bleeding. N-butyl cyanoacrylate (NBCA) is not easy to handle, but it is a useful embolic agent. In this retrospective study, we describe our experience with NBCA embolization of acute gastroduodenal ulcer bleeding. MATERIALS AND METHODS: NBCA embolization was performed in seven patients with acute upper GI arterial bleeding; they had five gastric ulcers and two duodenal ulcers. NBCA embolization was done in the left gastric artery (n = 3), right gastric artery (n = 2), gastroduodenal artery (n = 1) and pancreaticoduodenal artery (n = 1). Coil was used along with NBCA in a gastric bleeding patient because of difficulty in selecting a feeding artery. NBCA was mixed with Lipiodol at the ratio of 1:1 to 1:2. The blood pressure and heart rate around the time of embolization, the serial hemoglobin and hematocrit levels and the transfusion requirements were reviewed to evaluate hemostasis and rebleeding. RESULTS: Technical success was achieved in all the cases. Two procedure-related complications happened; embolism of the NBCA mixture to the common hepatic artery occurred in a case with embolization of the left gastric artery, and reflux of the NBCA mixture occurred into the adjacent gastric tissue, but these did not cause any clinical problems. Four of seven patients did not present with rebleeding, but two had rebleeding 10 and 16 days, respectively, after embolization and they died of cardiac arrest at 2 months and 37 days, respectively. One other patient died of sepsis and respiratory failure within 24 hours without rebleeding. CONCLUSION: NBCA embolization with or without other embolic agents could be safe and effective for treating acute gastroduodenal ulcer bleeding.
Arteries ; Blood Pressure ; Cyanoacrylates* ; Duodenal Ulcer ; Embolism ; Embolization, Therapeutic* ; Ethiodized Oil ; Heart Arrest ; Heart Rate ; Hematocrit ; Hemorrhage* ; Hemostasis ; Hepatic Artery ; Humans ; Peptic Ulcer* ; Respiratory Insufficiency ; Retrospective Studies ; Sepsis ; Stomach Ulcer

OBJECTIVE: The identification of cancer stem-like cells is a recent development in ovarian cancer. Compared to other cancer cells, cancer stem-like cells present more chemo-resistance and more aggressive characteristics. They play an important role in the recurrence and drug resistance of cancer. Therefore, the target therapy of cancer stem-like cell may become a promising and effective approach for ovarian cancer treatment. It may also help to provide novel diagnostic and therapeutic strategies. METHODS: The OVCAR3 cell line was cultured under serum-free conditions to produce floating spheres. The CD44⁺CD117⁺ cell line was isolated from the human ovarian cancer cell line OVCAR3 by using immune magnetic-activated cell sorting system. The expression of stemness genes such as OCT3/4, NANOG and SOX2 mRNA were determined by reverse transcription polymerase chain reaction. OVCAR3 parental and OVCAR3 CD44⁺CD117⁺ cells were grown in different doses of paclitaxel and salinomycin to evaluate the effect of salinomycin. And growth inhibition of OVCAR3 CD44+CD117+ cells by paclitaxel combined with salinomycin was determined by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. RESULTS: Tumor spheroids generated from the OVCAR3 cell line are shown to have highly enriched CD44 and CD117 expression. Treatment with a combination of paclitaxel and salinomycin demonstrated growth inhibition of OVCAR3 CD44+CD117+ cells. CONCLUSION: The present study is a detailed investigation on the expression of CD44 and CD117 in cancer stem cells and evaluates their specific tumorigenic characteristics in ovarian cancer. This study also demonstrates significant growth inhibition of cancer stem-like cells by paclitaxel combined with salinomycin. Identification of these cancer stem-like cell markers and growth inhibition effect of salinomycin may be the next step to the development of novel target therapy in ovarian cancer.
Cell Line ; Drug Resistance ; Humans ; Neoplastic Stem Cells ; Ovarian Neoplasms* ; Paclitaxel ; Parents ; Polymerase Chain Reaction ; Recurrence ; Reverse Transcription ; RNA, Messenger