No abstract available.
Ultrasonography*

PURPOSE: We analysed the role of modified Gianturco self-expandable stents in the treatment of tracheobronchial stenosis in 13 patients. MATERIALS AND METHODS: We inserted modified Gianturco self-expandable stents under the fluoroscopic and bronchoscopic guidance. There were stenosis in the trachea(n--2), the right main bronchus(n=2), and the left main bronchus(n=9). The causes of the stenosis were endobronchial tuberculosis(n=10), intubation granuloma (n=l), restenosis after surgical reconstruction(n=2). RESULTS: Dyspnea or wheezing was improved within 1 or 2 days following the procedure. There were 32% and 22% respective increase in average FEV1 and FVC. Lung perfusion scan showed 9.6% increase of perfusion in the involved lung. No complications related to the procedure were encountered. During follow-up period of up to 31 months, 2 patients showed tracheal or bronchial restenosis, at 3 and 6 months, retrospectively. There was a distal migration of the stents in one case. CONCLUSION: During the follow up period after stent insertion, improvement of the obstructive changes and dyspnea persisted in 10 out of 13 patients. The modified Gianturco self-expandable metallic stents may be a good choice for the treatment of tracheobronchial stenosis, either as a primary treatment, or when the reconstruction failed.
Constriction, Pathologic* ; Dyspnea ; Follow-Up Studies ; Granuloma ; Humans ; Intubation ; Lung ; Perfusion ; Respiratory Sounds ; Retrospective Studies ; Stents*

PURPOSE: The purpose of this study was to determine the following:the safety of fine needle aspiration biopsy in immunocompromized children with radiographic features of Pneumocystis car/nil pneumonia, its diagnostic rate in those groups and the appropriate radiographic stage for fine needle aspiration biopsy to prove the etiologic agent. METHODS AND MATERIALS: We retrospectively reviewed the patient records of 16 children with immune compromizing diseases who had undergone fine needle aspiration biopsy of the lung. They showed the infectious sign of the lung along with the radiographic pattern of diffuse pulmonary disease, suggesting Pneumocystis carlnil pneumonia. All patients had underlying lymphoreticular malignancies including 14 acute lymphocytic leukemia and 2 non Hodgkin's lymphoma. According to the radiographic pattern of biopsy site, parenchymal disease was categorized as fine reticulonodular density(n=4), ground-glass opacity(n=9) and compact consolidation(n=3). We assessed the diagnostic rate of Pneumocystis carinii pneumonia and complications in each of the three groups. RESULTS: A diagnosis of Pneumocystis carinii pneumonia was established by fine needle aspiration biopsy in 9 patients(56%) including 2 of 4 patients with fine reticulonodular density, 4 of 9 patients with ground-glass opacity, and all 3 patients with compact consolidation. Four patients(25%) developed pneumothorax, and three of them required tube insertion. There was no patient who developed hemoptysis. CONCLUSION: Fine needle aspiration biopsy is a safe and easy method that can yield Pneumocystis carinii organism at a relatively high rate in immunocompromized children with diffuse pulmonary lesions suopicions of Pneumocystis carinii pneumonia. We recommend performing fine needle aspiration biopsy regardlesss of radiographic patterns when Pneumocystis carinii pneumonia is suggested.
Biopsy* ; Biopsy, Fine-Needle* ; Child* ; Diagnosis ; Hemoptysis ; Humans ; Lung Diseases ; Lung* ; Lymphoma, Non-Hodgkin ; Pneumocystis ; Pneumocystis carinii ; Pneumonia* ; Pneumonia, Pneumocystis ; Pneumothorax ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Retrospective Studies

Radiological analysis of chest lesions detected on chest radiographs or CT scans begins with their classification into parenchymal, pleural, or extrapleural lesions according to their presumed origin. The mediastinum is divided anatomically into the anterior, middle, and posterior mediastinal compartments, and localizing a mediastinal mass to one of these divisions can locationfacilitate their differential diagnosis. A differential diagnosis of a mediastinal mass is usually based on a number of findings, including its ; the structure from which it is arising; whether it is single, multifocal (involving several different areas or lymph node groups), or diffuse; its size and shape; its attenuation (fatty, fluid, soft-tissue, or a combination of these); the presence of calcification along with its characteristics and amount; and its opacification following the administration of contrast agents.
Classification ; Contrast Media ; Diagnosis, Differential ; Lymph Nodes ; Mediastinal Diseases* ; Mediastinal Neoplasms ; Mediastinum ; Pleural Diseases ; Radiography, Thoracic ; Thorax ; Tomography, X-Ray Computed

PURPOSE: To evaluate effectiveness of oblique approach under biplane fluoroscopic guidance in transthoracic fine needle aspiration biopsy. MATERIALS AND METHODS: Fourteen consecutive patients underwent transthoracic fine needle aspiration biopsy for subcarinal lesions. Subcarina was the only accessible biopsy site in 13 patients. Subcarinal biopsy was performed to determine the presence of metastasis in an enlarged subcarinal lymph node in the remaining one patient. Before biopsy, we evaluated the size and location of the lesion on preliminary plain chest X-ray film and CT scan. Under dual projection fluoroscopic guidence, biopsy was performed through right posterior intercostal space with the patient prone by using oblique approach. On 15 degree LAO projection the needle was directed to the area anterior to the spine and advanced to the line extending through the posterior wall of the main bronchus. RESULTS: Cytologic diagnosis was made in 12 out of 14 patients(accuracy 85.7%). The final diagnosis consisted of 5 squamous cell carcinoma, 5 small cell carcinoma, 1 adenocarcinoma and 1 adenosquamous carcinoma. Pneumothorax developed in 2 patients(14%) and was managed by chest tube drainage. Mild hemoptysis was observed in 2. CONCLUSION: Transthoracic fine needle aspiration biopsy using oblique approach under biplane fluoroscopic guidance is a relatively safe and sensitive method for the histologic diagnosis of subcarinal lesion.
Adenocarcinoma ; Biopsy* ; Biopsy, Fine-Needle* ; Bronchi ; Carcinoma, Adenosquamous ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Chest Tubes ; Diagnosis ; Drainage ; Hemoptysis ; Humans ; Lymph Nodes ; Needles ; Neoplasm Metastasis ; Pneumothorax ; Spine ; Thorax ; Tomography, X-Ray Computed ; X-Ray Film

CT scans of 21 patients(intrathoracic goiter=7. Castleman disease=6, pulmonary carcinoid tumor=3, parathyroid adenoma=1, thyroid carcinoma=1, paraganglioma=1, benign pleural mesothelioma=1, sclerosing hemangioma=1) with mediastinal tumors that are known to be enhanced with intravenous injection of contrast media, were studied retrospectively to investigate the enhancing capabilities f those tumors and to describe their CT findings. The degree of enhancement was estimated by visual inspection with a grading system. All but one case of cystic parathyroid adenoma showed enhancement on post-contrast scan. The degree of enhancement was not helpful in differentiating these tumors. Characteristic location and pattern of tumor extension were found in cases of intrathoracic goiter, parathyroid adenoma, thyroid carcinoma and paraganglioma. Calcifications were found in intrathoracic goiter(5/7). Castleman disease(2/6). Pulmonary carcinoid(1/3), thyroid carcinoma. Necrotic low-attenuation areas were in intrathoracic goiter(7/7), parathyroid adenoma, thyroid carcinoma and paraganglioma. In conclusion, mediastinal tumors that are known to be enhanced in the literature were enhanced with rare exception, and if we consider the predilection site of those tumors, the scope of differential diagnosis can reasonably be narrowed.
Carcinoid Tumor ; Contrast Media ; Diagnosis, Differential ; Goiter, Substernal ; Injections, Intravenous ; Paraganglioma ; Parathyroid Neoplasms ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Tomography, X-Ray Computed

Unilateral absence of a pulmonary artery is an uncommon anomaly, which presents as an isolated lesion or in combination with other congenital heart disease such as TOF or PD^. We encountered three cases of isolated unilateral absence of a pulmonary artery;one was left pulmonary artery agenesis with right sided aortic arch and the others were right pulmonary artery agenesis with left sided aortic arch. Plain chest radiograph showed considerable loss of unilateal lung volume and lack of ipsilateral hilar shadow. Pulmonary angiogram which was done in two cases, revealed proximal interruption of a pulmonary artery. Chest CT was done in only one case, on which right pulmonary artery was absent and was replaced by adipose tissue. CT with its clean demonstration pulmonary artery without any evidence of aquired obstruction of a pulmonary artery by pulmonary embolism or tumor invasion, maybe a valuable method for evaluaton of the unilateral absence of a pulmonary artery.
Adipose Tissue ; Aorta, Thoracic ; Heart Defects, Congenital ; Lung ; Pulmonary Artery* ; Pulmonary Embolism ; Radiography, Thoracic ; Tomography, X-Ray Computed

Based upon the concept that carcinogenesis is associated with apoptosis, specific therapies designed to enhance the susceptibility of cancer cells to undergo apoptosis could be developed. Thus, in this paper, it was designed to investigate whether, using rat animal model with chemical-induced hepatocellular carcinoma, TGF-1 in vivo could induce apoptosis in cancer. The chemical hepatocarcinogenic procedure of Solt-Farber method was used on Sprague-Dawley rats. Experimental groups were divided into group A treated with the standard Solt-Farber regimen of diethylnitrosamine (DEN) and 2-Acetaminofluorene (AAF), group B TGF-, group C TGF-1, and group D adriamycin after hepatocellular carcinoma developed. For detection of apoptotic cells, apoptotic indices were examined by the in situ end DNA labelling method. The expression of proliferating cell nuclear antigen was examined by immunohistochemical staining. Apoptosis of rat hepatocellular carcinoma cells increased significantly to 4.92+/-2.32/HPF in the group C compared with the control group (A) (2.54+/-1.13/HPF; P<0.05). Two distinctly different populations of proliferating hepatocellular carcinoma cells were identified. The cells at G1/S boundary (weak granular staining) increased to 15.75+/-6.19/HPF and 6.45+/-2.93/HPF in the groups C and D, respectively, but decreased to 2.42+/-2.06/HPF in the group B compared with the control group (A) (6.38+/-2.18/HPF; p<0.05). The cells at S phase (strong granular staining) increased to 3.37+/-2.69/HPF in the group B but decreased to 0.32+/-0.47/HPF in the group D (p<0.05). In conclusion, these results indicate that the TGF-1 may be used as an effective anticancer agent.
Animals ; Apoptosis ; Carcinogenesis ; Carcinoma, Hepatocellular* ; Diethylnitrosamine ; DNA ; Doxorubicin ; Models, Animal ; Proliferating Cell Nuclear Antigen ; Rats* ; Rats, Sprague-Dawley ; S Phase ; Transforming Growth Factor alpha ; Transforming Growth Factor beta1* ; Transforming Growth Factors*

Intrahepatic stones are frequently associated with recurrent pyogenic cholangiohepatitis and complete surgical removal of the stones is almost always difficult because of the large number of stones and associated bile duct strictures. One hundred and seventy-nine patients with retained intrahepatic stones underwent percuttaneous stone removal utilizing a preshaped angulated catheter and a Dormia basket under fluoroscopy with a combination of techniques including irrigation-suction. crushing of large stones. balloon dilatation of strictures and extracorporenal shock wave lithotripsy. The procedure was performed through a mature T-tube tract (177 patients) and a mature transhepatic tube tract (two patients). Stones were exclusively intrahepatic in 130 patients. whereas 49 patients also had stones in the common bile duct. In 91 (50.8%) of 179 patients. the stones were completely removed and in 36 (20.1%) patients most of the stones were removed. The overall success rate was 70.9% ngulation deformity. stricture of bile ducts and impacted stones were the factor most often responsible for failure, No significant complications were observed. Fluoroscopicalyy-guided percutaneous interventional procedures with a preshaped angulated catheter is an useful complementary procedure to surgery for patients with intrahepatic stones. the major benefits of an individually fitted angulated catheter are its safety and easy access to small peripheral bile ducts.
Bile Ducts ; Catheters* ; Common Bile Duct ; Congenital Abnormalities ; Constriction, Pathologic ; Dilatation ; Fluoroscopy ; Humans ; Lithotripsy ; Shock

PURPOSE: To describe CT findings and differential points of cystic thymic lesions. MATERIAL AND METHOD: We evaluated retrospectively total 19 masses with well marginated cystic lesions at thymic area on CT scans. They were 10 teratomas, 3 congenital thymic cysts, 2 multilocular thymic cysts(associated with thymoma and myasthenia gravis in each), 2 cysts Assciated with thymic Hodgkin's lymphomas an ectopic parathyroid cyst, and an infected thymic cyst. The radiological abnormalities evaluated were thickness of the wall, presence or abscene of septa, mural nodule, solid component, calcification and fat component. RESULTS: All three cases of congenital thymic cysts and an ectopic parathyroid cyst appeared as thin-walled unilocular cyst with homogeneous internal density and without identifiable solid component. In multilocular thymic cyst, there were thick wall and solid components(n=2), thick internal septa and calcifications(n=l). The cysts of teratomas manifested thick walls(n=9), internal septa(n=4), calcifications(n=6), fat components(n=4), and solid components(n=4). Cysts in Hodgkin's diseases appeared as multilocular or unilocular and had thick wall and septa without calcification. infected thymic cyst presented with multilocular cystic mass with identifiable wall and septa, calcification, and solid components. CONCLUSION: The thymic diseases with cystic lesion include teratomas, congenital thymic cysts, multilocular thymic cysts, parathyroid cyst, .and Hodgkin's disease. Congenital thymic cyst and ectopic parathyroid cyst are thin-walled unilocular cystic lesions. Cystic lesions associated with teratoma, Hodgkin's disease, and multilocular thymic cyst are thick-walled cystic lesions with or without solid component.
Hodgkin Disease ; Mediastinal Cyst ; Myasthenia Gravis ; Retrospective Studies ; Teratoma ; Thymoma ; Tomography, X-Ray Computed