PURPOSE: To evaluate the usefulness of the CT-guided percutaneous lung biopsy for the solitary pulmonary nodules smaller than 15 mm in diameter. MATERIALS AND METHODS: Between April 2002 and May 2003, we evaluated twenty-five patients (11 men, 14 women, mean ages: 52.5 years) who had solitary pulmonary nodules, which we could not discriminate as being benign or malignant on the CT findings. All the subjects had CT-guided percutaenous cutting needle biopsy (PCNB) performed on them at our institution. A definitive diagnosis of benignity or malignancy was established to retrospectively analyze the patient's records. We evaluated the accuracy, sensitivity, specificity and complications of PCNB for the definitive diagnosis of benignity or malignancy. The sensitivity and specificity of PCNB were determined using the Chi-square test, and the correlations with pneumothorax and emphysema after biopsy were analyzed using Spearman's rank correlation coefficient. RESULTS: In two nodules of the twenty-five nodules, no definitive diagnosis could be established. Of the remaining twenty-three nodules, 7 (30.4%) were malignant and 16 (69.6%) were benign. Twenty (87%) of the twenty-three definitively diagnosed nodules were correctly diagnosed with PCNB. Of the twenty nodules, 6 (30%) were malignant and 14 (70%) were benign. The sensitivity and specificity of the malignant nodules were 85.7% (6/7) and 100% (16/16), respectively. The sensitivity and specificity of the benign nodules were 87.5% (14/16) and 85.7% (6/7), respectively. Post-biopsy complication occurred in nine patients (36%): Hemoptysis (n=4, 16%) and pneumothorax (n=5, 20%). However, there was not a statistical significance between pneumothorax and emphysema after biopsy (r=0.3, p=0.15). CONCLUSION: When CT-guided percutaneous lung biopsy of the solitary pulmonary nodules smaller than 15 mm in diameter was performed without an on-site cytopathologist, we know that PCNB can yield high diagnostic accuracy and very few complications.
Biopsy ; Biopsy, Needle* ; Diagnosis ; Emphysema ; Female ; Hemoptysis ; Humans ; Lung ; Male ; Needles* ; Pneumothorax ; Retrospective Studies ; Sensitivity and Specificity ; Solitary Pulmonary Nodule*

PURPOSE: To evaluate functional MR imaging of the motor speech area with and without motor stimulation duringthe rest period. MATERIALS AND METHODS: Nine healthy, right-handed volunteers(M:F=7:2, age:21-40years) wereincluded in this study. Brain activity was mapped using a multislice, gradient echo single shot EPI on a 1.5T MRscanner. The paradigm consisted on a series of alternating rest and activation tasks, performed six times. Each volunteer in the first study(group A) was given examples of motor stimulation during the rest period, while eachin the second study(group B) was not given examples of a rest period. Motor stimulation in group A was achieved bycontinuously flexing five fingers of the right hand. In both groups, maximum internal word generation was achievedduring the activation period. Using fMRI analysis software(Stimulate 5.0) and a cross-correlationmethod(background threshold, 200; correlation threshold, 0.3; ceiling, 1.0; floor, 0.3; minimal count, 3),functional images were analysed. After correlating the activated foci and a time-signal intensity curve, theactivated brain cortex and number of pixels were analysed and compared between the two tasks. The t-test was usedfor statistical analysis. RESULT: In all nine subjects in group A and B, activation was observed in and adjacentto the left Broca's area. The mean number of activated pixels was 31.6 in group A and 27.8 in group B, adifference which was not statistically significant(P>0.1). Activities in and adjacent to the right Broca 's areawere seen in seven of group A and four of group B. The mean number of activated pixels was 14.9 in group A and 18in group B. Eight of nine volunteers in group A showed activity in the left primary motor area with negativecorrelation to the time-signal intensity curve. The mean number of activated pixels for this group was 17.5. Inthree volonteers, activation in the right primary motor area was also observed, the mean number of activatedpixels in these cases was 10.0. CONCLUSION: During the rest period, functional MR imaging of the motor speechcenter combined with motor stimulation was more effective than that without stimulation, and simultaneouslyprovided mapping of the primary motor area.
Brain ; Fingers ; Hand ; Magnetic Resonance Imaging* ; Volunteers

A 47-year-old patient with diabetes mellitus was admitted with the complaints of sore throat and dysphagia. We performed an esophagogastroduodenoscopy and found esophageal ulcers. Histological examination of the esophageal biopsy revealed sulphur granules, and immunological findings ruled out viral infection. Thus, we diagnosed an isolated actinomycotic infection of the esophagus and treated the infection with oral amoxicillin. This case illustrates that actinomycotic infection of the esophagus can occur in immunocompetent patients. Therefore, when evaluating dysphagia, the probability of actinomycotic infection must be considered not only in immunocompromised patients, but in immunocompetent individualswith diabetes mellitus.
Actinomycosis ; Amoxicillin ; Biopsy ; Deglutition Disorders ; Diabetes Mellitus ; Endoscopy, Digestive System ; Esophagitis ; Esophagus ; Humans ; Immunocompromised Host ; Middle Aged ; Pharyngitis ; Ulcer

PURPOSE: The study was designed to verify effects of aromatherapy on depression, anxiety and the autonomic nervous system in breast cancer patients who are undergoing adjuvant radiotherapy. METHODS: Data were collected from November 2006 through March 2007 at the C university hospital in Seoul. The study included 33 patients and they were assigned to three groups. Group I had aroma oil inhalation for 2 minutes per time, three times a day for six weeks whereas Group II and a control group inhaled aroma oil for 2 minutes per time, once a day for six weeks. For Groups I and II, a mixture of lemon, lavender, rosewood and rose essential oils were used while control group inhaled tea tree oil. RESULTS: Depression was significantly decreased in patients in the experimental groups only. In Groups I and II patients, anxiety level was lower than that in control patients. Patients in Groups I and II also showed stronger physical resistance to stress than control group patients. CONCLUSION: Aromatherapy should be considered as a method that can significantly decrease depression in breast cancer patients who are undergoing adjuvant radiotherapy.
Anxiety ; Aromatherapy ; Autonomic Nervous System ; Breast ; Breast Neoplasms ; Depression ; Humans ; Inhalation ; Lavandula ; Oils, Volatile ; Radiotherapy, Adjuvant ; Tea

PURPOSE: Phosphatidylinositol 3-kinases/AKT pathway plays a pivotal role in hepatocellular carcinoma (HCC). Mutant PIK3CA, encoding the p110a catalytic subunit, stimulates the AKT pathway and promotes cell growth in various cancers. PIK3CA mutation rate has been usually reported as low frequency (<5%) in HCC except one report from Korea with 35.6%. Therefore, we investigated the frequency of PIK3CA mutations in Korean HCC patients. MATERIALS AND METHODS: We sequenced exons1, 3, 4, 6, 7, 8, 9, 19 and 20 of PIK3CA in 268 HCC tumor tissue samples by Sanger method and pyrosequencing assay. RESULTS: In this study, the mutations were not detected in exons3, 6, 8, and 19, and detected 1 at unknown SNP in exon1 and exon4, 2 at unknown SNP in exon7, 2 at unknown SNP in exon20. However, 1 at unknown SNP, 1 at G1635T and surprisingly all samples at A1634Cin exon9 were detected by Sanger method. Additional experiments with normal tissue, cloning experiments and a pyrosequencing assay revealed that the double peak at A1634C of exon9 is a pseudogene, not true mutation. The mutations found in this study were all different and small numbers, therefore, we cannot conclude specific relationship between clinical characteristics of HCC and mutation of PIK3CA. CONCLUSION: Our study suggests that the rate of PIK3CA mutation in the Korea population is in fact similar to the rates seen elsewhere in the world.
Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group/genetics ; Carcinoma, Hepatocellular/*genetics ; Exons ; Female ; Humans ; Liver Neoplasms/*genetics ; Male ; Middle Aged ; *Mutation ; Mutation Rate ; Phosphatidylinositol 3-Kinases/*genetics ; Polymorphism, Single Nucleotide ; Republic of Korea ; Young Adult

BACKGROUND: We evaluated the optimal concentrations of eye opening and orientation after propofol- fentanyl TCI by CSDT of the pharmacokinetic model using DiprifusorTM in adults retrospectively. Furthermore, we tried to compare those data with the cases of using propofol TCI alone that had been reported. METHODS: After obtaining informed consent and IRB approval, 124 patients of ASA class I or II scheduled for elective surgery were allocated into 3 groups according to age. Three groups were group 1 (n = 40): 18 - 29 years, group 2 (n = 42): 30 - 39 years, group 3 (n = 42): 40 - 54 years. Propofol infusion was started at a propofol target concentration (CT) of 6 microgram/ml by using DiprifusorTM. Anesthesia was mostly maintained with propofol CT 3.5 microgram/ml and fentanyl CT 1.5 ng/ml using a Stelpump and 67% nitrous oxide in oxygen. We estimated the average concentrations of propofol at eye opening and orientation in each group with DiprifusorTM, and we also evaluated the correlation coefficient. RESULTS: Total requirements of propofol in cases of propofol-fentanyl TCI were decreased by 18-26% than in propofol TCI alone. The average concentrations of propofol at eye opening and orientation after surgery were 1.2 - 1.4 microgram/ml. The times to show eye opening and orientation after surgery from stopping of nitrous oxide and infusion were 10.4 - 14.5 min in the propofol-fentanyl group compared with 7.5 - 11 min using propofol TCI alone. CONCLUSIONS: We concluded that the optimal concentrations of propofol at eye opening and orientation after surgery in cases of combination with fentanyl were 1.2 - 1.4 microgram/ml instead of 1.4 - 1.6 microgram/ml with using propofol alone.
Adult ; Anesthesia ; Ethics Committees, Research ; Fentanyl ; Humans ; Informed Consent ; Nitrous Oxide ; Oxygen ; Propofol* ; Retrospective Studies

PURPOSE: The purpose of this study was to compare prognostic differentiation performances of the 7th and the 8th edition of American Joint Committee on Cancer (AJCC) staging system for gastric cancer (GC) patients. MATERIALS AND METHODS: A total of 1,633 GC patients who underwent curative D2 resection followed by adjuvant chemotherapy alone (CA) or concurrent chemo-radiotherapy (CCRT) from 2004 to 2013 were included. Concordance index (c-index) was applied to compare the discriminatory ability. RESULTS: In the 8th edition, migration of stage was detected in 248 patients (15.2%). Among them, 121 patients were up-staged while 127 patients were down-staged. Overall, there was no statistically significant difference in the discriminatory ability between the 7th and 8th editions. The new edition of staging system, however, showed a trend of better prognostic performance not only in recurrence-free survival (c-index=0.734; 95% confidence interval [CI], 0.706 to 0.762 in the 7th edition vs. c-index=0.740; 95% CI, 0.712 to 0.768 in the 8th edition; p=0.14), but also in overall survival (c-index=0.717; 95% CI, 0.688 to 0.745 in the 7th edition vs. c-index=0.722; 95% CI, 0.694 to 0.751 in the 8th edition; p=0.19), especially in stage III. This finding was repeated in the subgroup analysis regardless of adjuvant CA or CCRT. CONCLUSION: Generally, the 8th edition of AJCC staging system had failed to show a superior discriminatory ability for curatively D2 resected GC patients than the 7th edition, although there was a trend of better prognostic performance of the new edition, regardless of adjuvant treatment method.
Chemotherapy, Adjuvant ; Humans ; Joints ; Methods ; Neoplasm Staging ; Prognosis ; Radiotherapy ; Recurrence ; Stomach Neoplasms

PURPOSE: To evaluate the radiologic findings for complete and partial ablation after percutaneous CT-guided transthoracic radiofrequency ablation (RFA) of lung VX2 tumor implanted in rabbits. MATERIALS AND METHODS: Thirteen rabbits with successfully implanted lung VX2 were used. Three rabbits as controls did not receive RFA while the other ten rabbits underwent RFA; 5 complete and 5 partial. RFA was performed using an internally cooled, 17-gauge electrode (Radionics, Burlington, MA) with a 1-cm active tip under CT guidance. Postprocedural CT was performed within 3 days, and we analyzed the ablated size, enhancement pattern, shape, margin, and complications of the complete and partial ablation groups. Rabbits were sacrificed after postprocedural CT with an overdose of ketamine, and pathologic findings of the ablated groups were compared with those of the control group. RESULTS: The size of the ablated lesions and the enhancement pattern differed between the completely and partially ablated groups on chest CT. The size of the ablated lesions was increased by 47.1% in the completely ablated group and by 2.1% in the partially ablated group. In the completely ablated group, VX2 tumor showed absolutely no enhancement, whereas only ablated pulmonary parenchyma outside VX2 showed mild enhancement on enhanced CT. In the partial ablated group, a part of VX2 became strongly enhanced on enhanced CT. On microscopic examination, the completely ablated group demonstrated that a viable tumor cell was not visible. In the partially ablated group, however, a viable tumor cell within the surrounding fibrous capsule on the peripheral area of the VX2 was observed. CONCLUSION: The important CT findings for evaluation of complete and partial RFA are the ablated size and enhancement pattern of the ablated lesion.
Animals ; Catheter Ablation ; Electrodes ; Ketamine ; Lung* ; Rabbits ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed

PURPOSE: To determine the effective embolic material and appropriate embolic site by comparing bowel changesafter arterial embolization in dogs in which the proximal or distal level of the superior mesenteric artery hadbeen occluded with gelfoam particles or a coil. MATERIAL AND METHODS: Using the coaxial catheter system,superselective arterial embolization was performed at sixteen sites in four dogs. In groups A and B, each site wasoccluded at the proximal or distal marginal artery, respectively, with gelfoam particles and in groups C and D, atthe proximal or distal artery, respectively, with a coi. All dogs were sacrifed one day after the procedure, andgross and microscopic histologic findings were evaluated. RESULT: In all dogs, the procedure was successful. Ingroup B, significant mucosal destruction, lymphocyte proliferation in submucosa and mucosa, and diffuse swellingin all layers of the intestine were found at all sites. The vessel in the submucosal layer was completelyobstructed by red blood cells and gelfoam.At three sites, the intestine showed diffuse ischemic change, and at oneother site, focal ischemic change was observed. In group D, exudation with destruction of mucosa and submucosalhemorrhage occurred at one site, but in groups A and C, intestinal layers were found to be normal. CONCLUSION: Using a coil, superselective arterial embolization was successful, even up to the distal level of the intestinalartery, and the intestine showed no ischemic change. Embolization with gelfoam must be performed carefully at theproximal level, and since it can cause severe intestinal necrosis, must be avoided at the distal level.
Animals ; Arteries ; Catheters ; Dogs ; Erythrocytes ; Gelatin Sponge, Absorbable* ; Intestines ; Lymphocytes ; Mesenteric Arteries ; Mesenteric Artery, Superior* ; Mucous Membrane ; Necrosis

BACKGROUND: Osteopontin (Opn) is recognized as an important adhesive bone matrix protein and a key cytokine involved in immune cell recruitment and tissue repair and remolding. However, serum levels of osteopontin have not been evaluated in patients with chronic obstructive pulmonary disease (COPD). Thus, the aim of this study was to evaluate and compare the serum levels of osteopontin in patients experiencing COPD exacerbations and in patients with stable COPD. METHODS: Serum samples were obtained from 22 healthy control subjects, 18 stable COPD patients, and 15 COPD with exacerbation patients. Serum concentrations of osteopontin were measured by the ELISA method. RESULTS: Serum levels of osteopontin were higher in patients with acute exacerbation than with stable COPD and in healthy control subjects (62.4+/-51.9 ng/mL, 36.9+/-11.1 ng/mL, 30+/-11 ng/mL, test for trend p=0.003). In the patients with COPD exacerbation, the osteopontin levels when the patient was discharged from the hospital tended to decrease compared to those at admission (45+/-52.1 ng/mL, 62.4+/-51.9 ng/mL, p=0.160). Osteopontin levels significantly increased according to patient factors, including never-smoker, ex-smoker and current smoker (23+/-5.7 ng/mL, 35.5+/-17.6 ng/mL, 58.6+/-47.8 ng/mL, test for trend p=0.006). Also, osteopontin levels showed a significantly negative correlation with forced expiratory volume in one second (FEV1%) predicted in healthy controls and stable COPD patients (r=-0.389; p=0.013). C-reactive protein (CRP) was positively correlated with osteopontin levels in patients with COPD exacerbation (r=0.775; p=0.002). CONCLUSION: The serum levels of osteopontin increased in patients with COPD exacerbation and tended to decrease after clinical improvement. These results suggest the possible role of osteopontin as a biomarker of acute exacerbation of COPD.
Adhesives ; Biomarkers ; Bone Matrix ; C-Reactive Protein ; Disease Progression ; Enzyme-Linked Immunosorbent Assay ; Forced Expiratory Volume ; Humans ; Osteopontin ; Pulmonary Disease, Chronic Obstructive