PURPOSE: To assess the accuracy of preoperative CT staging of RCC and to compare the relationship between T stage and the incidence of metastasis on the basis of the old (1992) and the new (1997) UICC & AJCC tumor classification system. MATERIALS AND METHODS: In 112 cases of surgically resected RCC, the stagings of preoperative CT scans were de-termined retrospectively by two radiologists and were compared with the results of pathologic examinations. In 70 cases which had been followed up over three years after surgery, the incidence of metastasis at initial diagnosis and during the follow-up period was assessed. All cases were reconsidered, and using the old and the new TNM classification, the incidence of metastasis was compared. RESULTS: According to the old TNM classification, 5 cases (4%) were staged at T1, 73(65%) at T2, 21(19%) at T3a, 9(8%) at T3b, 0 at T3c, and 4(4%) at T4. Using the new TNM classification, we also staged 54 cases (48%) at T1 and 24(21%) at T2. Overall, using this new classification, CT correctly staged 79% of patients (88/112) overstaged 15%(17/112) and understaged 6%(7/112) . CT had a sensitivity of 84% and specificity of 91% in new T1 tumors, 71% and 95%, respectively, in new T2 tumors, 69% and 88% in T3a tumors, 78% and 98% in T3b tumors, and 75% and 99% in T4 tumors. CT had a sensitivity of 44% and a specificity of 99% in old T1 tumors, and 82% and 71%, respectively, in old T2 tumors. The incidence of metastasis in CT-staged (cT) tumors was 0% (0/4) in old cT1, 8% (3/39) in new cT1, 29% (4/14) in new cT2, 67% (6/9) in cT3a, and 75% (6/8) in cT3b. CONCLUSION: In the staging of T1 tumors, CT is more sensitive when the new TNM classification is used. Even though the cut off point between T1 and T2 tumors had been in creased from 2.5 to 7.0 cm, T1 tumors staged according to the new system did not show a significantly higher incidence of metastasis than those staged according to the old.
Carcinoma, Renal Cell* ; Classification ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Neoplasm Metastasis ; Neoplasm Staging* ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed

Spontaneous extrahepatic rupture of hepatocellular carcinoma (HCC) is a rare but serious complication that occurs with an incidence of between 5 and 15% of patients with HCC. It is thought to be preceded by rapid expansion due to intratumoral bleed-ing. Extrahepatic rupture of HCC has been reported as a rare complication of tran-scatheter arterial embolization (TAE). Although there have been reports of extrahepatic rupture of HCC after TAE, but there is no report regarding intratumoral hemor-rhage into HCC during TAE. We report a unique case of intratumoral hemorrhage into HCC during TAE presumably triggered by TAE. Although a rare complication, intratumoral hemorrhage into HCC after TAE should be considered in any patient with TAE due to HCC.
Carcinoma, Hepatocellular/*blood supply ; Catheterization/*adverse effects ; Embolization, Therapeutic/*adverse effects ; Hemorrhage/*diagnosis/*etiology ; Humans ; Liver Neoplasms/*blood supply ; Male ; Middle Aged ; Rupture, Spontaneous/diagnosis/etiology

PURPOSE: To evaluate the vascular pattern of lymph nodes, and the usefulness of color Doppler sonogaphy indifferentiating benign from malignant superficial lymphadenopathy. MATERIALS AND METHODS: Twenty-six patientswere pathologically and clinically confirmed to be suffering from benign reactive lymphadenitis and tuberculosis(n=16) or lymphoma and malignant lymphadenitis (n=10). Lymph node shape was assessed by the ratio of longitudinaldiameter to transverse diameter(L/T), and patients were thus assigned to one of two groups : L/T >or =2, or L/T<2.The hilar vascular pattern of lymph node was assessed by color Doppler sonography and classified as central,eccentric, or absent. On the basis of peripheral vascularity, patients were divided into three groups according tocircumferental linear vascularity. An absence of peripheral vascularity was classified as grade 0. If less thanhalf the periphery was covered by linear vascularity, a patient was assigned to as grade I, and if more than halfwas covered by a vessel, the classification was grade II. RESULTS: Statistically significant differences in L/Tratio were noted between malignant and benign node (p<.001). Of the 16 benign reactive nodes, 13 showed L/T >or =2,and 3 L/T<2. while in nine of the ten malignant nodes, L/T<2 was noted. Among 16 benign reactive nodes, hilarvascularity was central in 13, eccentric in one, and absent in two. Among the ten malignant nodes, thecorresponding totals were nil, four, and Six. The hilar vascular pattern showed statistically significantdifferentiation between malignant and benign node (p<.05). Among 16 benign reactive nodes, 13 were grade 0, twowere grade I, and one was grade II, while among ten malignant nodes, two were grade 0 and eight were grade I. Onthe basis of vascular pattern, the difference between benign and malignant nodes was statistically significant(p<.05). CONCLUSION: L/T ratio<2, absent or eccentric hilar vascularity, and the presence of peripheralvascularity are suggestive of malignant lymph node. The shape of LN and pattern revealed by an analysis of nodalvascularity using color Doppler sonography are useful in differential diagnosis of benign and malignantlymphadenopathy.
Classification ; Diagnosis, Differential ; Humans ; Lymph Nodes ; Lymphadenitis ; Lymphatic Diseases* ; Lymphoma

No abstract available.
Airports* ; Disasters*

The prognostic impact of body mass index (BMI) in patients with upper tract urothelial carcinoma (UTUC) is an ongoing debate. Our study aimed to investigate the prognostic role of BMI in patients treated with radical nephroureterectomy (RNU) for UTUC from a multi-institutional Korean collaboration. We retrospectively reviewed data from 440 patients who underwent RNU for UTUC at four institutions in Korea. To avoid biasing the survival estimates, patients who had previous or concomitant muscle-invasive bladder tumors were excluded. BMI was categorized into approximate quartiles with the lowest quartile assigned to the reference group. Kaplan-Meier and multivariate Cox regression analyses were performed to assess the influence of BMI on survival. The lower quartile BMI group showed significantly increased overall mortality (OM) and cancer specific mortality (CSM) compared to the 25%-50% quartiles and upper quartile BMI groups. Kaplan-Meier estimates showed similar results. Based on multivariate Cox regression analysis, preoperative BMI as a continuous variable was an independent predictor for OM and CSM. In conclusion, preoperative underweight patients with UTUC in Korea survive less after RNU. Preoperative BMI may provide additional prognostic information to establish risk factors.
Aged ; Asian Continental Ancestry Group ; Body Mass Index ; Carcinoma, Transitional Cell/*mortality ; Cystectomy/*mortality ; Female ; Humans ; Kidney Pelvis/surgery ; Male ; Nephrectomy/*mortality ; Republic of Korea ; Retrospective Studies ; Thinness/*mortality ; Ureter/surgery ; Urinary Bladder/surgery ; Urologic Neoplasms/*mortality/pathology/*surgery ; Urothelium/pathology/*surgery

PURPOSE: To analyze the factors associated with the zebra pattern in CT during arterial portography(CTAP). MATERIALS AND METHODS: In 275 CTAP procedures, the factors associated with the zebra pattern, such as laminar flow in the portal vein, the presence of liver cirrhosis, the artery selected for CTAP, location of the catheter tip in the superior mesenteric artery(SMA), splenic volume, and the existence of an aberrant right hepatic artery(RHA) emerging from the SMA were analyzed. RESULTS: In 106 of 275 procedures (38.5%), a zebra pattern was apparent. Portal venous laminal flow was seen in 92 % of procedures in the group with this pattern and in 63 % in the group without it. Eighty-three of 235 procedures (35.3 %) in which the SMA was injected and 23 of 40(57.5 %) involving splenic artery injection showed the zebra pattern. In 22 of 35(62.8 %) in which the catheter tip was located in the distal SMA and 61 of 200 ( 30.5 %) in which this was at a proximal site, the zebra pattern was evident. Mean splenic volume was less in the group with the zebra pattern. The effect on the zebra pattern of liver cirrhosis and an aberrant RHA emerging from the SMA was not statistically significant. CONCLUSION: In CTAP, the incidence of the zebra pattern was 38.6%, and was related to laminal flow in the portal vein. The pattern is frequently seen in CTAP involving contrast injection via the splenic artery, distal location of a catheter tip in the SMA, and small splenic volume.
Arteries ; Catheters ; Equidae* ; Incidence ; Liver Cirrhosis ; Portal Vein ; Portography* ; Splenic Artery

PURPOSE: We report herein 119 patients with pheochromocytoma at our institute over the last 23 years. MATERIALS AND METHODS: Between 1986 and 2009, 119 patients were diagnosed with pheochromocytoma at our institute. We reviewed the medical records of these patients. RESULTS: Of 119 patients, 45 were male and 74 were female, and mean age was 43.83 +/- 13.49 years. Forty-three patients (36.1%) were diagnosed incidentally, and 8 patients (6.7%) were found to have familial pheochromocytoma. The mean dimension of the tumors was 5.89 +/- 3.18 cm. 4 patients had bilateral tumors; three of these patients were found to have familial pheochromocytoma and 1 patient was diagnosed with malignant pheochromocytoma. A total of eight patients (6.7%) were found to have malignant pheochromocytoma. In 1 patient, metastasis to a lymph node was found at the time of diagnosis. Metastases were found at a mean of 49 +/- 25.83 (6-75) months after surgery in the other seven patients. 6 patients died of malignant pheochromocytoma at a mean of 31 +/- 28.71 months (1-81) after diagnosis, and the other 2 patients survived for 15 and 24 months, respectively. CONCLUSION: Approximately 35% of patients with pheochromocytoma are diagnosed incidentally, and the number of detected cases is increasing. Although familial pheochromocytoma was found only in 6.7% of the patients, genetic testing should be considered in all patients, especially in patients with a family history, young age, or multifocal, bilateral, extra-adrenal, or malignant tumors. Given that malignant pheochromocytomas are frequently diagnosed during the follow-up period, long-term follow-up is necessary to confirm the absence of recurrence or metastasis.
Adolescent ; Adrenal Gland Neoplasms/diagnosis/pathology ; Adult ; Aged ; Child ; Female ; Humans ; Male ; Middle Aged ; Pheochromocytoma/*diagnosis/pathology ; Young Adult

No abstract available.
Disasters*

We evaluated the correlations between BMI, fasting glucose, insulin, testosterone level, insulin resistance, and prostate size in non-diabetic benign prostatic hyperplasia (BPH) patients with normal testosterone levels. Data from 212 non-diabetic BPH patients with normal testosterone levels, who underwent transurethral resection of the prostate (TURP) due to medical treatment failure, were evaluated retrospectively. Patients with prostate specific antigen (PSA) levels of > or = 3 ng/mL underwent multicore transrectal prostate biopsy before TURP to rule out prostate cancer. Patients with diabetes mellitus (DM) or serum testosterone levels of < 3.50 ng/mL were excluded from analysis. Correlations between clinical and laboratory parameters were determined. Prostate size correlated positively with age (r = 0.227, P < 0.001), PSA (r = 0.510, P < 0.001), and fasting glucose level (r = 0.186, P = 0.007), but not with BMI, testosterone, insulin level, or insulin resistance (each P > 0.05). Testosterone level inversely correlated with BMI (r = -0.327, P < 0.001), insulin level (r = -0.207, P = 0.003), and insulin resistance (r = -0.221, P = 0.001), but not with age, prostate size, PSA, or fasting glucose level (each P > 0.05). Upon multiple adjusted linear regression analysis, prostate size correlated with elevated PSA (P < 0.001) and increased fasting glucose levels (P = 0.023). In non-DM BPH patients with normal testosterone levels, fasting glucose level is an independent risk factor for prostate hyperplasia.
Age Factors ; Aged ; Blood Glucose/*analysis ; Body Mass Index ; Humans ; Insulin/blood ; Insulin Resistance ; Linear Models ; Male ; Middle Aged ; Organ Size ; Prostate/*anatomy & histology ; Prostate-Specific Antigen/blood ; Prostatic Hyperplasia/metabolism/*pathology ; Retrospective Studies ; Risk Factors ; Testosterone/*blood

OBJECTIVE: The purpose of this study was to evaluate the fistulographic features of malfunctioning axillary loop-configured arteriovenous grafts and the efficacy of percutaneous interventions in failed axillary loop-configured arteriovenous grafts. MATERIALS AND METHODS: Ten patients with axillary loop-configured arteriovenous grafts were referred for evaluation of graft patency or upper arm swelling. Fistulography and percutaneous intervention, including thrombolysis, percutaneous transluminal angioplasty and stent placement, were performed. Statistical analysis of the procedure success rate and the primary and secondary patency rates was done. RESULTS: Four patients had graft related and subclavian venous stenosis, two patients had graft related stenosis and another four patients had subclavian venous stenosis only. Sixteen sessions of interventional procedures were performed in eight patients (average: 2 sessions / patient) until the end of follow-up. An interventional procedure was not done in two patients with central venous stenosis. The overall procedure success rate was 69% (11 of 16 sessions). The post-intervention primary and secondary patency rates were 50% and 63% at three months, 38% and 63% at six months and 25% and 63% at one year, respectively. CONCLUSION: Dysfunctional axillary loop-configured arteriovenous grafts almost always had subclavian venous and graft-related stenosis. Interventional treatments are helpful to overcome this and these treatments are expected to play a major role in restoring and maintaining the axillary loop-configured arteriovenous loop grafts.
Adult ; Aged ; Angioplasty, Balloon/*methods ; Arteriovenous Shunt, Surgical/*methods ; Blood Vessel Prosthesis Implantation/*methods ; Chronic Disease ; Constriction, Pathologic/therapy/ultrasonography ; Female ; Follow-Up Studies ; Graft Occlusion, Vascular/*therapy/ultrasonography ; Humans ; Kidney Failure, Chronic/*complications/therapy ; Male ; Middle Aged ; *Renal Dialysis ; Subclavian Vein/ultrasonography ; Survival Analysis ; Treatment Outcome ; Vascular Patency