Epithelioid smooth muscle tumor is relatively rare and potentially malignant, especially in retroperitoneum. Distinct criteria for malignancy still have not been clarified in this epithelioid variant arising in retroperitoneum. We report a deceptively benign-appearing epithelioid leiomyosarcoma in a 50-year-old female. She was admitted with abdominal discomfort and dysuria. Abdominal CT showed a well-demarcated, 10 10 cm sized, solid mass in retroperitoneum. Concomitant metastatic lesions were noted in right lung field. Surgical excision of retroperitoneal mass and right lung lobectomy were performed. The retroperitoneal mass showed yellowish-tan, well-delineated and lobulated appearance. Histologically, this tumor was composed of predominantly epithelioid, round to oval cells with distinct clear cytoplasm and slightly atypical nuclei. Mitosis was rare (0~1/50 HPF). Lung lesions were morphologically similar to that of retroperitoneum.
Cytoplasm ; Dysuria ; Female ; Humans ; Leiomyosarcoma* ; Lung ; Middle Aged ; Mitosis ; Smooth Muscle Tumor ; Tomography, X-Ray Computed

Although spontaneous bacterial peritonitis is a frequent complication in the childhood nephrotic syndrome, it is very rare in adults with nephrotic syndrome. It frequently develops when the patients are either in relapse or receiving steroid therapy at the time peritonitis is diagnosed. We report an unusual case of a spontaneous bacterial peritonitis as the presenting feature in a 15-year-old male patient with nephrotic syndrome. He presented with diffuse abdominal pain and distension for 15 days. Abdominal paracentesis revealed the diagnostic laboratory findings of peritonitis, and the bacterial culture of the ascites showed a mixed growth of Escherichia coli and Pseudomonas aeruzinosa. His serum albu- min level was 1.6gldL and the amount of 24 hours proteinuria was 21.0g/day. Although he was treated with adequate antibiotics for 3 weeks, the peritonitis was more aggravated. We decided to insert a catheter into the peritoneal cavity for continuous drainage of the intractable ascites. Two weeks after drainage, the peritonitis improved as the peritonitis subsided, the proteinuria disappeared completely without a steroid therapy. Six months after spontaneous remission, the proteinuria have recurred, and the kidney biopsy then showed focal segmental glomerulorsclerosis.
Abdominal Pain ; Adolescent ; Adult ; Anti-Bacterial Agents ; Ascites ; Biopsy ; Catheters ; Drainage ; Escherichia coli ; Humans ; Kidney ; Male ; Nephrotic Syndrome* ; Paracentesis ; Peritoneal Cavity ; Peritonitis* ; Proteinuria ; Pseudomonas ; Recurrence ; Remission, Spontaneous

Iodinated contrast-induced acute renal failure is estimated to occur in 0.15 to 2% of all patients undergoing contrast imaging studies. Incidence is higher in patients with renal insufficiency, diabetes mellitus, dehydration, multiple myeloma, congestive heart failure, advanced age. We here report successful vascular interventional procedure by using gadopentetate dimeglumine(Gd-DTPA) as a contrast agent in a patient with chronic renal insufficiency and right superficial femoral artery stenosis. The patient had a history of iodinated contrast-induced acute renal failure. Gd-DTPA(0.17mmoVkg) diluted 1: 1 with 0.9% norrnal saline was used as contrast agent for the interventional procedure. Percutaneous transluminal angioplasty was successfully performed and there was no evidence of contrast material- induced acute renal failure after the procedure. Gd- DTPA is an alternative contrast agent for patients with chronic renal insufficiency.
Acute Kidney Injury ; Angioplasty* ; Constriction, Pathologic ; Dehydration ; Diabetes Mellitus ; Femoral Artery ; Gadolinium DTPA* ; Heart Failure ; Humans ; Incidence ; Multiple Myeloma ; Pentetic Acid ; Renal Insufficiency ; Renal Insufficiency, Chronic*

BACKGROUNDS/AIMS: To investigate survival rates and prognostic factors of patients with gallbladder cancer who were treated with surgery and postoperative radiation therapy. METHODS: Seventeen gallbladder cancer patients who received surgery and postoperative radiotherapy from October 1989 to April 1998 were included in this retrospective study. Five patients had stage II, 8 patients had stage III, and 4 patients had stage IV disease according to the 1997 American Joint Committee on Cancer (AJCC) staging. All patients received > or =40 Gy of postoperative radiotherapy with a daily dose of 2.0 Gy/fraction and 15 patients received concurrent chemotherapy. An analysis was performed for the endpoints of overall and disease-free survival. RESULTS: Of the 17 patients, 13 had no residual disease (R0), 1 had microscopic residual disease (R1), and 3 had macroscopic residual disease (R2) after surgery. Among patients with no residual disease, 4 had locoregional recurrences during the follow-up period. One patient with microscopic residual disease had local recurrence. The 5-year overall survival rate was 38.2%. The median overall survival time was 21 months and the median disease-free survival time was 12 months. Old age (> or =60 years old), female gender, a high pathological stage (> or =IVA), and the presence of residual disease after surgery were significant prognostic factors for disease-free survival. CONCLUSIONS: Despite a high proportion of patients with advanced disease and macroscopic residual disease, the prognosis of gallbladder patients who had postoperative radiotherapy is encouraging. Additional investigation to improve the loco-regional control of gallbladder cancer patients with adverse prognostic factors is warranted.
Disease-Free Survival ; Female ; Follow-Up Studies ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Joints ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

No abstract available.
Brain Neoplasms* ; Brain* ; Child* ; Humans

With the increasing number of interventional angiographic procedures, iodinated contrast induced nephropathy has become an important cause of iatrogenic acute renal failure. Gadopentetate dimeglumine, gadolinium chelated by DTPA, are widely used in magnetic resonance imaging without adverse effect on renal function in patients with renal insufficiency. It also has sufficient radiographic density to allow visualization and has been described as an alternative contrast agent for angiography. Here we report a case of successful angioplasty using gadopentetate dimeglumine as a contrast agent in a patient with both renal artery stenosis and renal insufficiency. The patient had a history of iodinated contrast induced acute renal failure. Using this contrast agent, angioplasty was successfully performed and contrast induced acute renal failure did not occur after this procedure.
Acute Kidney Injury ; Angiography ; Angioplasty* ; Gadolinium ; Gadolinium DTPA* ; Humans ; Magnetic Resonance Imaging ; Pentetic Acid ; Renal Artery Obstruction* ; Renal Artery* ; Renal Insufficiency*

Providing satisfactory vascular access for hemodialysis remains one of the most challenging problems confronting nephrologists. We evaluated the effect of percutaneous angioplasty on the treatment of stenosis and obstruction of arteriovenous fistula (AVF) in the chronic hemodialysis patients. Twenty-six dilatations of stenotic or occluded lesions in hemodialysis access fistulas were performed. The type of AVF was an native AVF in 19 cases and a graft in 7 cases. The lesions involved fore arm vein in 16 cases and an upper arm veins in 10 cases. Indications for angioplasty included acute obstruction of blood flow(9 patients), increased venous dialysis(VDP) or urea recirculation ratio(URR)(8 patients), arm edema or difficulty in needle placement(6 patients), poor maturation before first needling(3 patients). The PTA initially succeeded in 23 of 26 cases(88.5%) and 3 month patency rate was 80.5%. In 8 patients with increased VDP or URR, both VDP and URR significantly decreased after PTA (VDP;118.1+/-20.7mmHg vs 89.5+/-23.8 mmHg, P= 0.04, URR;23.9+/-18.4% vs 7.5+/-6.1%, P=0.02). The complications of PTA were vessel rupture(1 patient) and hematoma(2 patients). In conclusion, PTA seems to be effective therapy in the treatment of stenosis and obstruction of arteriovenous fistula(AVF) without serious complications in the chronic hemodialysis patients.
Angioplasty* ; Arm ; Arteriovenous Fistula* ; Constriction, Pathologic* ; Dilatation ; Edema ; Fistula ; Humans ; Needles ; Renal Dialysis* ; Transplants ; Urea ; Veins

BACKGROUND: The radiocephalic arteriovenous fistula (AVF), which provides the best vascular access for hemodialysis, continues to have a high incidence of early failure. This was studied to determine primary and secondary patency rate of percutaneous transluminal angioplasty (PTA) in hemodialysis patients who had early dysfunction of this AVF within 1 year after the operation. METHODS: This retrospective study enrolled 39 hemodialysis patients with early dysfunction of radiocephalic AVF who received PTA between January, 1997 and December, 2002 at Uijongbu St. Mary's Hospital. The lesions occurred at proximal vein of upper arm and central vein were excluded. The primary and secondary patency rate of PTA was evaluated using Kaplan-Meier method. According to diabetes, age, sex, onset of AVF dysfunction after the operation, thrombosis, patency rate was compared with log-rank test. RESULTS: The mean age of the patients was 54+/-13 years and the number of male was 16 (41.2%). Twenty-four patients (61.5%) had diabetes and Among 39 lesions observed at venography, there were 33 cases of stenosis and 6 cases of complete occlusion due to thrombosis. The onset of AVF dysfunction after the operation was 5.3+/-3.6 months and 11 cases developed before the first needling. Total PTAs were performed and initial success rate was 94.2% (n=49). Primary patency rate at 6, 12, 24, and 48 months was 74.8%, 55.8%, 55.8%, and 55.8%, respectively. Secondary patency rate at 6, 12, 24, 48 months was 89.7%, 86.1%, 81.8%, 81.8%. Diabetes, age, sex, onset of AVF dysfunction after the operation, thrombosis did not influenced primary patency rate of PTA. There was no PTA-related complication. CONCLUSION: Percutaneous transluminal angioplasty is considered to be effective and safe treatment for early dysfunction of radiocephalic arteriovenous fistula in hemodialysis patients.
Angioplasty* ; Arm ; Arteriovenous Fistula* ; Constriction, Pathologic ; Humans ; Incidence ; Male ; Phlebography ; Renal Dialysis ; Retrospective Studies ; Thrombosis ; Veins

OBJECTIVES: The authors present a retrospective analysis of 100 consecutive adult patients harboring craniopharyngiomas who underwent microsurgical resection between 1981 and 1999 to assess the long-term outcome of surgical treatment and to determine the most optimal management strategy. METHODS: The extent of surgical removal was divided into four categories; GTR(gross total removal), RSTR(radical subtotal removal), STR(subtotal removal),and PR(partial removal). The median follow-up period was 50 months(4-198). CT scan and/or MR imaging and hormonal status were evaluated to the last follow-up. RESULTS: Visual disturbance was the most common presentation, which was improved in 42 cases and aggravated in 19 cases following the operation. Hypopituitarism was detected in 56 patients preoperatively, 82 during the immediate postoperative period, and 76 at the last follow-up. Improvement of pituitary function was not observed in any of these patients. Twenty of 100 patients showed recurrence at the mean of 27 months(3 to 196). The median progression-free survival(PFS) time of all patients was 145 months and 5-year PFS rate was 74%. Five-year PFS rate of GTR or RSTR group(71%) was significantly higher than that of STR or PR group(30%)(p=0.01). Postoperative radiation therapy significantly prolonged the PFS from 94 months in non-radiation group to 182 months(p=0.002). However, there was no statistical difference in number of patients who required hormonal replacement therapy between radiation and non-radiation group. CONCLUSION: Visual disturbance can be improved by early diagnosis and surgical decompression. GTR or RSTR in selected patients is considered a proper surgical strategy. Post-operative radiation therapy for residual tumors must be considered, although the ideal timing of radiation therapy is to be determined.
Adult* ; Craniopharyngioma* ; Decompression, Surgical ; Early Diagnosis ; Follow-Up Studies ; Humans ; Hypopituitarism ; Magnetic Resonance Imaging ; Neoplasm, Residual ; Postoperative Period ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: This study was attempted to evaluate the effect of adjuvant radiotherapy and chemotherapy after curative resection of extrahepatic bile duct cancer. MATERIALS AND METHODS: The authors performed a retrospective analysis of 57 patients with extrahepatic bile duct cancer not involving the hepatic duct confluence and curatively resected at Seoul National University Hospital between 1990 and 1995. Resection margins of all cases were confirmed pathologically as free of cancer cells. Among 57 patients, 29 received adjuvant therapy. Total 4000 cGy of external beam radiation was delivered to each. 5-fluorouracil (5-FU) was administered as a radiosensitizer. After 4 weeks of radiation therapy, 5-FU maintenance chemotherapy was started and given every 4 weeks up to 12 cycles or until evidence of relapse. RESULTS: The overall median survival of 57 patients was 24 months. I- and 2-year overall survival rate was 73.7 and 52.6%. There was no difference in overall survival rate between adjuvant therapy group (n=29) and operation-only group (n 28). We tried to evaluate the effect on survival of adjuvant therapy according to lymph node status. Patients of Tl stage were excluded from analysis. Adjuvant therapy had no survival benefit in the lymph node positive group. But in the lymph node negative group, 1- and 2-year survival rate of patients who underwent adjuvant therapy were 89.5% and 68.4% whereas 1 and 2-year survival rate of patients in operation-only group were 57.9% and 36.8%, which was statistically significant (p=0.0278, 0.0472). And by multivariate analysis, the survival improvement of 1- and 2-year survival rate in adjuvant therapy group was due to adjuvant therapy itself. CONCLUSION: Our trial of external beam radiotherapy combined with 5-FU chemotherapy after curative resection of extrahepatic bile duct cancer did not show improved overall survival. However the 1- and 2-year survival rate of patients with negative lymph node and advanced T stage ( > T 1) were improved in adjuvant therapy group, so adjuvant therapy may give survival benefit to a certain patient group with negative lymph node.
Bile Ducts, Extrahepatic* ; Drug Therapy ; Fluorouracil ; Hepatic Duct, Common ; Humans ; Lymph Nodes ; Maintenance Chemotherapy ; Multivariate Analysis ; Radiotherapy ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Seoul ; Survival Rate