No abstract available.
Dislocations*

PURPOSE: Carcinosarcomas are rare neoplasms in which both malignant epithelial and mesenchymal elements are identified. We have found only twenty one cases of primary cutaneous carcinosarcoma in the English language literature. Therefore it has been difficult to diagnosis because its unclear etiology and low frequency. METHODS: A 31-year-old young man with a protruding mass on his ankle dorsum was examined. The tumor was 7 x 6 x 3 cm sized and arose from a burn scar. The mass was wide excised and applied split thickness skin graft. Characteristic pathologic finding was a mixture of squamous cell carcinoma and malignant fibrous histiocytoma. RESULTS: Three months after the operation, the patient died of multiple metastasis to the liver, lung and finally of sepsis despite adjuvant chemotherapy and adjuvant radiotherapy. CONCLUSION: If a metastatic cutaneous carcinosarcoma is diagnosed, wide excision is required. There should be more aggressive management to minimize the risk of recurrence. Further research into the etiology and pathophysiology of the disease and a more careful differential diagnosis may allow improvement in treatment.
Adult ; Animals ; Ankle ; Burns ; Carcinoma, Squamous Cell ; Carcinosarcoma ; Chemotherapy, Adjuvant ; Cicatrix ; Diagnosis, Differential ; Histiocytoma, Malignant Fibrous ; Humans ; Liver ; Lung ; Neoplasm Metastasis ; Recurrence ; Sepsis ; Skin ; Transplants ; Ulcer

Peripheral arterial occlusive disease caused by atherosclerosis can present with intermittent claudication or critical limb ischemia. Proper diagnosis and management is warranted to improve symptoms and salvage limbs. With the introduction of new techniques and dedicated materials, endovascular recanalization is widely performed for the treatment of peripheral arterial occlusive disease because it is less invasive than surgery. However, there are various opinions regarding the appropriate indications and procedure methods for interventional recanalization according to operator and institution in Korea. Therefore, we intend to provide evidence based guidelines for interventional recanalization by multidisciplinary consensus. These guidelines are the result of a close collaboration between physicians from many different areas of expertise including interventional radiology, interventional cardiology, and vascular surgery. The goal of these guidelines is to ensure better treatment, to serve as a guide to the clinician, and consequently, to contribute to public health care.
Arterial Occlusive Diseases/radiography/*therapy ; Arteries/pathology ; Endovascular Procedures/*standards ; Humans ; Intermittent Claudication/radiography/therapy ; Limb Salvage/methods ; Lower Extremity/*blood supply ; Peripheral Arterial Disease/radiography/*therapy ; *Practice Guidelines as Topic ; Republic of Korea

BACKGROUND: Recently, many institutions have acquired multi-detector computed tomography (MDCT) systems. This made it easier and more convenient to use MDCT as a initial diagnostic modality for hemoptysis. The purpose of this study was to evaluate the usefulness of MDCT before bronchoscopy and/or bronchial arterial embolization (BAE) for hemoptysis. METHODS: We studied a total of 125 patients with hemoptysis who underwent, between 2006 and 2008, MDCT in a routine protocol before bronchoscopy and/or BAE. One hundred two patients underwent bronchoscopy and 29 patients underwent BAE. We compared the usefulness of MDCT and bronchoscopy for detecting the bleeding site and identifying the cause. We also evaluated our ability, using MDCT, to detect instances where the bronchial artery caused hemoptysis. RESULTS: The rate of detection of a bleeding site was 75.5% on MDCT and 50.9% on bronchoscopy. MDCT and bronchoscopy detected the bleeding site in agreement in 62.7% of patients. MDCT alone found the bleeding site in 27.5% of cases. MDCT identified the cause of hemoptysis in 77.5% and bronchoscopy in 11.8%. In 29 patients who underwent BAE, we detected a total of 37 hypertrophied bronchial arteries that were causing hemoptysis. Of 37 bronchial arteries, 23 (62.2%) were depicted on MDCT. CONCLUSION: MDCT is superior to bronchoscopy for detecting the bleeding site and identifying the cause of hemoptysis. MDCT can also predict the side of affected bronchial artery with depiction of hypertrophied bronchial artery and localizing the bleeding site. Doing MDCT before bronchoscopy and BAE can provide a guideline for the next step.
Bronchial Arteries ; Bronchoscopy ; Hemoptysis ; Hemorrhage ; Humans ; Tomography, X-Ray Computed

PURPOSE: The aim of this study was to determine the potential usefulness of uterine artery embolization (UAE) for the management of uterine leiomyoma. MATERIALS AND METHODS: Sixty nine patients (mean age; 40.3 years, age range; 31-52 years) who underwent UAE for symptomatic fibroids (with menorrhagia, dysmenorrhea and bulk-related symptoms) from January 2000 to December 2000 were retrospectively analyzed. The mean follow-up period was 3.5 months (range: 1-8 months). The fibroids ranged in size from 2.0 cm to 13.2 cm with a mean size of 5.8 cm. We performed embolization using polyvinyl alcohol particles (250-710microgram). The improvement of the clinical symptoms was analyzed. Reduction of the uterine and predominant fibroid volumes was assessed using MRI. RESULTS: Symptom improvement for the menorrhagia (87.5%), dysmenorrhea (83.3%) and the bulk-related symptoms (79.2%) was reported. Complications included ovarian failure in four patients (5.8% of the total patients, mean age: 43.3 yrs) and infection in three patients (4.3% of the total patients) who underwent conservative management with intravenous antibiotics and analgesics. The volume reduction rate of the uterus and the predominant fibroids after uterine artery embolization were 36.3% and 56.6%, respectively. CONCLUSION: UAE is a promising new treatment for symptomatic fibroids and may be a valuable alternative to hysterectomy.
Analgesics ; Anti-Bacterial Agents ; Dysmenorrhea ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Leiomyoma* ; Magnetic Resonance Imaging ; Menorrhagia ; Polyvinyl Alcohol ; Retrospective Studies ; Uterine Artery Embolization* ; Uterine Artery* ; Uterus

No abstract available.
Fusariosis* ; Hand* ; Snake Bites* ; Wounds and Injuries*

PURPOSE: To evaluate the utility of quantification of coronary artery calcification using spiral CT. MATERIALS AND METHODS: Spiral CT scans of the heart were obtained in 25 patients with coronary artery disease diagnosed by coronary angiography and in six controls without coronary artery disease. Spiral CT was performedwith 3 mm collimation at 3 mm/sec table speed and the obtained volume data of the heart was reconstructed at 2 mm intervals. Total calcium scores of the 30 contiguous slices of the proximal coronary artery were calculated basedon the areas and peak density. Two groups were compared for total scores and sensitivity, and specificity and positive predictive values were calculated. RESULTS: The number of subjects with coronary calcification(totalcalcium score>0) detected by spiral CT were 20(80%) of 25 with coronary artery disease and 2(33%) of 6 without coronary artery disease. The sensitivity, specificity, and positive predictive values were 80%, 67% and 91% respectively. Sensitivity was 64%, specificity was 80% in patients aged < or =60. Sensitivity was 76% and specificity was 83%(total calcium score 10). CONCLUSION: Quantification of coronary artery calcification using spiral CT haslow specificity in the older group and low sensitivity in the younger group ; the procedure is therefore may notbe useful as a non invase screening test to predict the prescence of coronary artery disease. In the younger group, however, a cardiac workup is strongly indicated if calcification is present.
Arteries ; Calcium ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Heart ; Humans ; Mass Screening ; Sensitivity and Specificity ; Tomography, Spiral Computed*

PURPOSE: To determine the value of CT(Computerized Tomography) in the diagnosis of laryngeal tuberculosis and to assess to what extent its characteristic findings different from those of aryngeal carcinoma. Materials and Methods : CT scans of twelve patients with laryngeal tuberculosis were reviewed and compared with those of fifteen patients with laryngeal cancer, retrospectively. Clinical symptoms, laryngoscopic examinations and the presence of pulmonary tuberculosis on chest radiographs were also reviewed. RESULTS: In laryngeal tuberculosis, bilater alsymmetric or asymmetric involvement was noted in nine(75%) patients, while unilateral involvement was seen in three(25%). This was significantly different from laryngeal cancer in which unilateral involvement was noted in twelve patients(80%). Diffuse thickening of the free margin of the epiglottis was a characteristic and frquent finding in tuberculosis(n=6, 50%). No deep submucosal infiltration of preepiglottic and paralaryngeal fat spacesis seen in tuberculosis in spite of large areas of involvement of laryngeal mucosa, while twelve patients(80%) with laryngeal cancer showed thickened deep infiltration which resulted in a submucosal mass. CONCLUSION: CT was useful in the diagnosis of laryngeal tuberculosis and its CT findings wee characterized by bilateral involvement, thickening of the free margin of the epiglottis and good preservation of preepiglottic and paralaryngeal fatspaces in spite of large areas of involvement.
Diagnosis ; Epiglottis ; Humans ; Laryngeal Mucosa ; Laryngeal Neoplasms ; Radiography, Thoracic ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculosis ; Tuberculosis, Laryngeal*

BACKGROUND/AIMS: There are few data supporting the diagnostic yield of brush cytology depending on the order of cytologic preparation method or the location or shape of tumors in biliary strictures. We investigated diagnostic yields and variations in brush cytology with direct smear and cell-block preparations according to sampling preparation sequence and tumor location and shape in biliary strictures. METHODS: Patients who had undergone ERCP with tissue sampling between August 2009 and April 2013 were analyzed retrospectively. Group A was examined using brush cytology with direct smear followed by cell-block with or without biopsy, while the reverse order was performed for group B. RESULTS: Among 138 enrolled patients, 92 patients (A: 36, B: 56) underwent both brush cytology with direct smear and cell-block preparations. No differences in sensitivity, specificity, or accuracy were observed according to the sampling preparation method and the location or shape of tumors in biliary strictures. The cellularity observed from brush cytology with direct smear was better than that from cell-block according to the location of the tumor (p<0.01). The diagnostic yield was increased in both groups with addition of an endobiliary biopsy. CONCLUSIONS: No difference in diagnostic accuracy was observed between the sequences of preparation for brush cytology with direct smear and cell-block techniques. Brush cytology showed better cellularity for diagnosis.
Aged ; Aged, 80 and over ; Bile Duct Neoplasms/*pathology ; Cholangiocarcinoma/pathology ; Cholangiopancreatography, Endoscopic Retrograde ; *Cytodiagnosis ; Female ; Gallbladder Neoplasms/pathology ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Pancreatic Neoplasms/pathology ; Retrospective Studies ; Sensitivity and Specificity

PURPOSE: We retrospectively investigated how patients age and prostate volume influence on the cancer detection rate in Korean men with prostate-specific antigen (PSA) levels of 4.0 to 10.0ng/ml. MATERIALS AND METHODS: 791 Korean men who underwent transrectal ultrasound guided prostate biopsies (TRBx) at 12 medical centers were analyzed retrospectively during the previous 10 years. TRBx were performed in cases with PSA levels of 4.0 to 10.0ng/ml. The biopsy-proven cancer patient group was compared to the non-cancer patient group according to age, PSA, prostate volume and PSAD. RESULTS: Among the 791 patients who underwent TRBx, prostate cancer was detected in 123 patients (15.5%). The mean age (cancer group vs non-cancer group=69.1 vs 63.8 year-old), prostate volume (38.0 vs 42.5ml, respectively) and PSAD (0.21 vs 0.18ng/ml/ml, respectively) were found in statistically significant between the two groups. The cancer detection rate (20.1%) in the small prostate (less than 40ml) was significantly higher than that (10.3%) of the large prostate. The cancer detection rate was significantly increased with age: from 14.4% for the 50 to 59 year-old patients to 31.6% for the 80 or more year-old patients. CONCLUSIONS: The cancer detection rate in Korean men with a gray zone PSA level is lower than that of Caucasians. However, regarding the detection of prostate cancer in Korean men, the older age group and the patients with less than 40ml of prostate volume among the patients with gray zone PSA levels are considered as the important factors to decide whether biopsy of prostate is needed.
Biopsy ; Humans ; Male ; Middle Aged ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Retrospective Studies* ; Ultrasonography