Primary uterine leiomyosarcomas are very rare malignant tumors and the related MR findings have been the subject of only a few case reports. We describe the MR findings of two cases of histologically confirmed primary leiomyosarcoma, correlating these pathologic findings.
Leiomyosarcoma

PURPOSE: The objective of this study was to assess attenuation correction algorithms with the 137Cs point source for the brain positron emission tomography (PET) imaging process. MATERIALS AND METHODS: Four different types of phantoms were used in this study for testing various types of the attenuation correction techniques. Transmission data of a 137Cs point source were acquired after infusing the emission source into phantoms and then the emission data were subsequently acquired in 3D acquisition mode. Scatter corrections were performed with a background tail-fitting algorithm. Emission data were then reconstructed using iterative reconstruction method with a measured (MAC), elliptical (ELAC), segmented (SAC) and remapping (RAC) attenuation correction, respectively. Reconstructed images were then both qualitatively and quantitatively assessed. In addition, reconstructed images of a normal subject were assessed by nuclear medicine physicians. Subtracted images were also compared. RESULTS: ELAC, SAC, and RAC provided a uniform phantom image with less noise for a cylindrical phantom. In contrast, a decrease in intensity at the central portion of the attenuation map was noticed at the result of the MAC. Reconstructed images of Jaszack and Hoffan phantoms presented better quality with RAC and SAC. The attenuation of a skull on images of the normal subject was clearly noticed and the attenuation correction without considering the attenuation of the skull resulted in artificial defects on images of the brain. CONCLUSION: the complicated and improved attenuation correction methods were needed to obtain the better accuracy of the quantitative brain PET images.
Brain ; Noise ; Nuclear Medicine ; Positron-Emission Tomography ; Skull

An intrathoracic mass that manifested compression sign of large vessel and heart by mass was confirmed as huge sinoatrial nodal artery aneurysm and resection of aneurysm was performed. Preoperative precise diagnosis of coronary artery aneurysm is difficult because the most coronary artery aneurysm is incidentally confirmed during diagnostic coronary angiography or autopsy. So huge coronary artery aneurysm which manifests compression sign of large vessel and heart by the mass may be misdiagnosed as simple mediastinal mass. We reports huge coronary artery aneurysm that manifested compression sign of large vessel and heart by the mass with reviews of anesthetic management and diagnostic approach.
Aneurysm* ; Arteries* ; Autopsy ; Coronary Angiography ; Coronary Vessels ; Diagnosis ; Heart* ; Humans ; Thoracic Surgery*

Lymphangioleiomyomatosis result from the proliferation of immature smooth muscle cells in the peribronchial, perivascular and perilymphatic areas of the lung. The disease primarily affects women of childbearing age, which has dyspnea, recurrent episodes of pneumothorax, pulmonary edema, chylous effusion and hemoptysis as symptoms. Most patients die from respiratory failure within 10 years after diagnosis. Definite diagnosis depends on histologic findings. We report our experience of anesthetic management for a pregnant woman with lymphangioleiomyomatosis which was confirmed with biopsy of inguinal lymph nodes.
Anesthesia, Epidural* ; Biopsy ; Cesarean Section* ; Diagnosis ; Dyspnea ; Female ; Hemoptysis ; Humans ; Lung ; Lymph Nodes ; Lymphangioleiomyomatosis ; Myocytes, Smooth Muscle ; Pneumothorax ; Pregnancy ; Pregnant Women* ; Pulmonary Edema ; Respiratory Insufficiency

OBJECTIVE: to investigate the effect of high glucose and spent peritoneal dialysate on the TGF-beta1 synthesis of cultured human peritoneal MC(HPMC); to examine the effect of costimulation with high glucose or dialysate and cytokines, interleukin-1beta(IL-1beta) and tumor necrosis factor-alpha(TNF-alpha), on transforming growth factor(TGF-beta1) synthesis of HPMC. DISIGN: HPMCs were exposed to different concentrations of glucose(30, 60 & 90 mM/L) or spent peritoneal dialysate for 48 hours in the absence or presence of IL-1beta(1ng/ml) and TNF-alpha(1ng/ml). TGF-beta1 mRNA expression was assessed by Northern blot analysis and TGF-beta1 protein synthesis and release by Western blot analysis with immunoprecipitation. RESULTS: Exposure of MC to high glucose condition(30mM, 60mM & 90mM of D- glucose) induced 2.3-, 3.6- and 4.0-fold increases in TGF-beta1 mRNA expression of MC with enhanced TGF-beta1 protein synthesis and secretion into the media. Incubation with spent dialysate also significantly increased TGF-beta1 mRNA expression & protein secretion compared to control media(P<0.05) Stimulation with IL-1beta(1ng/ml) or TNF-alpha(1ng/ml) significantly increased TGF-beta1 mRNA expression after 48 hours above the control level by 2.7-fold and 2.1-fold, respectively. However, TNF-alpha-induced increase in TGF-beta1 mRNA expression was not translated into TGF-beta1 protein secretion whereas IL-1beta stimulation induced a significant increase in TGF-beta1 protein secretion as well as TGF-beta1 mRNA expression. Combined stimulation of high glucose or spent dialysate together with IL-1beta or TNF-alpha showed a greater increase in TGF-beta1 mRNA expression and protein secretion compared to stimulation with high glucose or spent dialysate alone. CONCLUSION: Our results clearly show that high glucose concentration of peritoneal dialysate and spent dialysate themselves might be sufficient to stimulate the production of TGF-beta1 by peritoneal mesothelial cell. This state of chronic induction of TGF-beta1 is further exaggerated in the presence of peritonitis because of stimulatory effect of proinflammatory cytokines, resulting in the augmented TGF-beta1 synthesis, thus promoting peritoneal fibrosis.
Blotting, Northern ; Blotting, Western ; Cytokines ; Glucose ; Humans* ; Immunoprecipitation ; Necrosis ; Peritoneal Fibrosis ; Peritonitis ; RNA, Messenger ; Transforming Growth Factor beta1 ; Tumor Necrosis Factor-alpha

During pregnancy profound immunologic, metabolic, endocrine, and vascular changes occur. Because of these changes, some diseases are affected by pregnancy. These diseases can aggravate or improve during pregnancy. Lymphomatoid papulosis is a continuing self-healing eruption whose lesions are clinically benign but histologically contain malignant-appearing cells. We report a case of lymphomatoid papulosis which developed in 30-year-old pregnant woman. And we discussed the possible association between lymphomatoid papulosis and pregnancy.
Pregnancy ; Female ; Humans

Kawasaki disease (KD) can cause acquired heart disease and systemic vasculitis in children. It is treated with intravenous immunoglobulin (IVIG). A significant complication is development of coronary artery lesions such as dilatations or aneurysms. However, uncommon complications can occur, like autoimmune hemolytic anemia when IVIG is used. We present a case of autoimmune hemolytic anemia associated with KD. Dilatation of right coronary artery was found at echocardiography and he was treated twice with IVIG (2 g/kg) with interval of 48 hours. Laboratory finding showed hemoglobin 7.1 g/dL, hematocrit 20.8%, corrected reticulocyte 5.86%, total bilirubin 0.29 mg/dL, lactate dehydrogenase 425 IU/L, and haptoglobin 5 mg/dL. Normocytic, normochromic anemia with anisopoikilocytosis was found on peripheral blood smear, and direct antiglobulin test was positive. The patient was started on oral prednisolone for 3 weeks, with which all symptoms resolved. We report this rare case, prompting consideration of IVIG associated complications when treating KD.
Anemia ; Anemia, Hemolytic, Autoimmune ; Aneurysm ; Bilirubin ; Child ; Coombs Test ; Coronary Vessels ; Dilatation ; Echocardiography ; Haptoglobins ; Heart Diseases ; Hematocrit ; Humans ; Immunization, Passive ; Immunoglobulins ; Immunoglobulins, Intravenous ; L-Lactate Dehydrogenase ; Mucocutaneous Lymph Node Syndrome ; Prednisolone ; Reticulocytes ; Systemic Vasculitis

BACKGROUND: Currently brain dead solid organ transplantations are performed in several institutions, and these are extended in Korea. Especially liver transplantation requires such a large amounts of blood components including filtered and irradiated cellular components that blood bank should give a great support to provide them. For effective management and reducing workload of blood bank in solid organ transplantation, we evaluated the blood component usage according to the type of organ transplantation and suggest a guideline for its optimal blood ordering schedule. METHODS: From February 1995 to October 1997, 143 solid organ transplantations (18 adults and 7 pediatric liver transplants, 115 renal transplants and 3 heart transplants) were performed in Samsung Medical Center. We investigated amount of blood components requested by surgeons or anesthesiologists, and evaluated their usage, discard rate and C/T ratio (crossmatch to transfusion ratio) during perioperative, intraoperative and postoperative period for solid organ transplantation. In liver and heart transplantation, the usage of blood component according to the operative phases was also evaluated. RESULTS: All of the patients who underwent liver and heart transplantation and 15% of the patients who underwent renal transplantation were transfused with blood components during operation. For adult liver transplantation, 31.1 units of leukocyte-depleted red blood cells (LDRBC), 43.6 units of fresh frozen plasma (FFP) and 16.3 units of leukocyte depleted platelets (LDPC) on an average were transfused. Intraoperative salvage using Cell Saver was performed in liver transplantation and the volume of salvaged was 7127.6 mL which was equivalent to 28.5 units of RBCs. The C/T ratio of RBCs was 1.4. In pediatric liver transplantation, 4.8 units of LDRBC and 4.3 units of FFP were transfused with C/T ratio of 1.9. Two of 5 pediatric liver transplantation donors were transfused with 3 units of RBCs, 1.5 units of FFP and 1.0 unit of whole blood by preoperative autologous blood donation. Only 18 out of 115 patients who underwent renal transplantation were transfused with 2 units of RBCs and 2 units of FFP. The discard rate revealed over 60% and C/T ratio was 4.6-5.1 in renal transplantation. For the heart transplantation 1.3 units of RBCs, 5.6 units of FFP, and 7.3 units of LDPC were transfused. The C/T ratio was 3.8. CONCLUSION: Compared with foreign reports, slightly larger amount of blood components were used for liver transplantation, however similar amount were used for renal and heart transplantation. As the results of present study, we propose a guideline for optimal blood ordering schedule for solid organ transplantation considering the marginal safety : 40 units of LDRBC, 50 units of FFP, 20 units of LDPC and 8 units of Cryoprecipitate for adult liver transplantation; 5 units of LDRBC and 6 units of FFP for pediatric liver transplantation; 2 units of LDRBC, 6 units of FFP and 10 units of LDPC for heart transplantation. Additional requests of blood components for liver and heart transplantation might be decided considering the clinical situations.
Adult ; Appointments and Schedules ; Blood Banks ; Blood Donors ; Brain Death ; Erythrocytes ; Heart ; Heart Transplantation ; Humans ; Kidney Transplantation ; Korea ; Leukocytes ; Liver ; Liver Transplantation ; Organ Transplantation* ; Plasma ; Postoperative Period ; Tissue Donors ; Transplants*

BACKGROUND: Maintenance of volume status and treatment of hypovolemia constitute an important component of anesthetic management. A Pulse oxymeter providing a continuous display of the pulse waveform offers a new method of estimating relative volume status during positive pressure ventilation. This study was undertaken to use the pulse wave variance of a plethysmographic signal measured from a pulse oximeter as a useful tool in the assessment of volume status. METHODS: Forty patients underwent general anesthesia with controlled positive pressure ventilation. After induction, the fluid infusion rate was 100 cc/hr until the dura was opened. During the operation, fluid losses were not replaced until hemodynamic variables were printed out. In addition to standard monitoring,the arterial pressure was monitored with a radial artery catheter. Systolic pressure variation (SPV) was defined as the maximum variation in peak systolic pressure during the respiratory cycle and measured in mmHg. Plethysmographic pulse wave variation (PWV) was defined as the maximum variation in the waveform peaks during the respiratory cycle and measured in millimeters from the printed output of the pulse oximeter. SPV and PWV were printed out right after induction and right before dura opening. In addition to SPV and PWV, other hemodynamic variables (HR, MAP, CVP) were obtained. RESULTS: Heart rate, SPV and PWV increased before the dura opening compared with those after induction. PWV correlated well with SPV after fluid losses CONCLUSIONS: A Pulse oximeter which is a standard monitor in anesthesia provides a useful, noninvasive and inexpensive adjunct to the more invasive estimators of volume status.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure* ; Catheters ; Heart Rate ; Hemodynamics ; Humans ; Hypovolemia ; Positive-Pressure Respiration ; Radial Artery

PURPOSE: In order to obtain better quantitation of kidney uptake, this study is to evaluate a conjugate view method (CVM) using a geometric mean attenuation correction for kidney uptake and to compare it to Gate's method. MATERIALS AND METHODS: We used a Monte Carlo code, SIMIND and a Zubal phantom, to simulate kidney uptake. SIMIND was both simulated with or without scatter for the Zubal phantom. Also, a real phantom test was carried out using a dual-head gamma camera. The activity of 0.5 mCi was infused into two small cylinder phantoms of 5 cm diameter, and then, they were inserted into a cylinder phantom of 20 cm diameter. The results by the CVM method were compared with ideal data without both of attenuation and scatter and with Gate's method. The CVM was performed with or without scatter correction. The Gate's method was performed without scatter correction and it was evaluated with regards to 0.12 cm (-1) and 0.15 cm (-1) attenuation coefficients. Data were analyzed with comparisons of mean counts in the regions of interest (ROI), profiles drawn over kidney images and linear regression. Correlation coefficients were calculated with ideal data, as well. RESULTS: In the case of the computer simulation, mean counts measured from ideal data, the CVM and the Gate's method were (right: 998 +/- 209, left: 896 +/- 249), (right: 911 +/- 207, left: 815 +/- 265), and (right: 1065 +/- 267, left: 1546 +/- 267), respectively. The ideal data showed good correlation with the CVM and the correlation coefficients of the CVM, Gate's method were (right: 0.91, left: 0.93) and (right: 0.85, left: 0.90), respectively. CONCLUSION: The conjugate view method using geometric mean attenuation correction resulted in better accuracy than the Gate's method. In conclusion, the conjugate view method independent of renal depths may provide more accurate kidney uptake.
Computer Simulation ; Gamma Cameras ; Kidney* ; Linear Models