Biomedical subjects
Publications and source records attributed to J C Kim.
We present a case of ovarian leiomyoma of a 46-year-old woman with a history of a palpable lower abdominal mass. A multiloculated multiseptated mainly cystic mass in the left adnexa on computed tomography (CT) was initially considered to be an ovarian mucinous cystadenoma. This mass, however, was proved to be a left ovarian vascular leiomyoma on the surgical pathology.
To compare how often the central lucency of pelvic phleboliths is seen on plain radiographs and noncontrast helical computed tomography (CT), both images in 70 patients with renal colic were analyzed. Both images revealed the same number of phleboliths in all cases except one in which one of two phleboliths demonstrated by CT was not seen on radiographs. Radiography revealed central lucency in 95 of 149 pelvic phleboliths (63%), but CT failed to depict a hypodense center in any of 150 phleboliths. The presence or absence of central lucency on CT images cannot, therefore, be used to differentiate phleboliths from distal ureteral calculi.
Ultrasonographic and computed tomographic findings of 21 cases of pathologically proven xanthogranulomatous pyelonephritis (XGP) in 20 patients were retrospectively evaluated. Seventeen (81%) were diffuse, and extrarenal extension occurred in 13 cases (62%). The kidney was enlarged diffusely in 12 cases (57%), and focally in 3 (14%). Urinary calculi were present in 16 cases (76%), with staghorn calculi in 4 of these, and hydronephrosis occurred in 17 (81%). In addition to typical features of XGP, the condition may also show variable imaging findings.
As a potent drug carrier for systemic fungal infections, amphotericin B(AmB)-phospholipid composite particles (APCPs) were prepared by the spray drying method. AmB and egg phosphatidylcholine, co-dissolved in methanol (0.0425-0.45 mg AmB/ml, 0.17-1.8 mg lipid/ml), was nebulized at 2 ml/min. The aerosol produced was carried by air at 1000 ml/min to the inner tubes of a serially connected distilling column system, of which the outer tubes were supplied with circulating water of 95 degrees C. The particles, by scanning electron microphotography, are spherical and submicronsized. Upon hydration of the particles in phosphate-buffered saline for 30 min at room temperature, liposome-like bilayer vesicles were formed along with AmB-phospholipid complexes, evidenced by the transmission electron microphotographs and the positive peak around 330 nm of the circular dichroism spectrum, respectively. The hemolytic abilities of the APCPs were lower than those of free drug, without loss of the antifungal activity. The suppressed hemolysis could be ascribed to the liposomes and to the complexes that are reconstituted by hydration of APCPs. The dry composite particles could circumvent the inherent instability of liposomal formulations.
PURPOSE: The purpose of this study was to evaluate the usefulness of the "bridging vascular sign" in the diagnosis of an exophytic uterine leiomyoma and differentiation of a uterine leiomyoma from some other mass arising in the adnexa on pelvic MRI. METHOD: Of 52 women with a pelvic mass in whom pelvic MRI was performed to determine its origin, 26 women with surgicopathologically proven leiomyomas were included in this study. The other 26 women were proved to have indeterminate adnexal masses such as tuboovarian abscess, endometrioma, fibroma, etc. To obtain axial/ sagittal T2-weighted and pre-/postcontrast T1-weighted images, a 1.5 T unit was used. Positive bridging vascular sign was defined as the presence of curvilinear tortuous signal void vascular structures crossing and/or between the uterus and the pelvic mass. For the presence or absence of this sign, the percentages of patients in each group were calculated and compared. RESULTS: Bridging vascular sign was present in 20 (76.9%) of 26 cases of leiomyomas but in no cases of other adnexal masses. Only exophytic uterine leiomyomas had this sign. CONCLUSION: Bridging vascular sign on MRI may be a useful radiologic sign in the diagnosis and differentiation of an exophytic uterine leiomyoma from some other mass arising in the adnexa.
PURPOSE: The purpose of this work was to evaluate the CT features of 15 patients with primary colorectal signet-ring cell carcinomas. METHOD: We retrospectively reviewed the CT scans of 15 patients (mean age 44 years) with pathologically proved colorectal signet-ring cell carcinoma. On CT, we evaluated the site and length of the tumor, bowel wall thickening patterns, perirectal or pericolic infiltration, the presence or absence of colonic obstruction, and metastasis to other organs. RESULTS: The tumors were located in the rectum in nine patients, the sigmoid colon in one, the hepatic flexure in one, the transverse colon in one, the ascending colon in two, and the cecum in one. The tumor length ranged from 4.0 to 10.0 cm (mean 6.1 cm) with mean thickness of 2.1 cm. CT showed concentric bowel wall thickening in all patients ("even" in 8 and "uneven" in 7), target appearance was noted in 4, perirectal or pericolic infiltrations were moderate to severe in 12, and colorectal obstruction was seen in 6. In the tumor spread patterns, lymphadenopathy was noted in 13, invasion to adjacent pelvic organs in 5, peritoneal carcinomatosis in 4, liver metastasis in 2, and periureteric metastasis in 1. CONCLUSION: Primary signet-ring cell colorectal carcinoma should be included for differential consideration when CT shows a long length of concentric bowel wall thickening and target sign, especially when such findings occur in the rectum and in young patients.
Radioimmunoguided surgery (RIGS) has been known as a sophisticated tool to detect micrometastasis intraoperatively. A preclinical model of RIGS was designed to test the possible clinical applicability of the biparatopic antibody in detecting colorectal cancer. The biparatopic antibody was constructed using two anti-carcinoembryonic antigen (CEA)-specific antibodies, T84.66 and PR1A3, reacting against two different epitopes. (125)I-labeled biparatopic antibody was introduced via the principal colonic arteries at the end of operation in 10 operable patients with colon cancer. After 24 h, the radioactivities of the tumors and lymph nodes were counted using the gamma-detecting probe. The radioactivity count was performed ex vivo. The accurate detection in the primary tumors and metastatic lymph nodes were 100 and 88.7% respectively. False-positive detections occurred in 24 of 256 lymph nodes (9.4%), whereas false-negative detections occurred in 5 of them (2%). The most frequent cause of false-positive detection was dissociated radionuclides trapped in the lymphatic tissues. False-negative detections occurred mainly from weak targeting by radiolabeled antibody, probably due to weak expression of tumor CEA. Conclusively, as most detection errors appear to be reduced within 3 days in vivo, the biparatopic antibody can efficiently be applied to the clinical RIGS, thereby facilitating accurate detection and removal of occult cancer foci in colorectal cancer.
OBJECTIVE: Multilocular cystic renal cell carcinoma (MCRCC) is a recently described variety of renal cell carcinoma with characteristic pathologic and clinical features. The purpose of this study was to analyze the imaging findings of MCRCCs. MATERIALS AND METHODS: Ten adult patients with pathologically proven unilateral MCRCC who underwent renal US and CT were included in this study. The radiologic findings were retrospectively evaluated for cystic content, wall, septum, nodularity, calcification and solid portion by three radiologists who established a consensus. Imaging and postnephrectomy pathologic findings were compared. RESULTS: All patients were adults (six males and four females) and their ages ranged from 33 to 68 years (mean, 46). On US and CT images, all tumors appeared as well-defined multilocular cystic masses composed of serous or complicated fluid. In all patients, unenhanced CT scans revealed hypodense cystic portions, and in four tumors, due to the presence of hemorrhage or gelatinous fluid, some hyperdense areas were also noted. In no tumor was an expansile solid nodule seen in the thin septa, and in only one was there dystrophic calcification in a septum. Small areas of solid portion constituting less than 10% of the entire lesion were found in six of the ten tumors, and these areas were slightly enhanced on enhanced CT scans. In all patients, imaging and pathologic findings correlated closely. CONCLUSION: On US and CT images, MCRCC appeared as a well-defined multilocular cystic mass with serous, proteinaceous or hemorrhagic fluid, with no expansile solid nodules in the thin septa, and sometimes with small slightly enhanced solid areas. Where radiologic examinations demonstrate a cystic renal mass of this kind in adult males, MCRCC should be included in the differential diagnosis.
BACKGROUND: From our preliminary study, we found corneal hypersensitivity after excimer laser. To study the effects of corneal epithelial wound healing on corneal sensitivity, we investigated the recovery of corneal sensitivity following excimer laser and manual epithelial debridement. METHODS: The corneal epithelium of the right eye of New Zealand white rabbits (n = 19) was manually debrided and the left eye was ablated with the excimer laser (5 Hz, 160 mJ/cm2, 47-micrometer depth). The wound-healing rate was measured up to 46 hours. Corneal sensitivity was measured for 10 weeks. RESULTS: There was no significant difference in the wound-healing rate, but at 36 hours there was a reduction in wound-healing rate of the excimer ablated corneas. In the laser-ablated cornea, sensitivity rapidly increased to a normal level by day 5, and then it continued to increase gradually and reached a maximum at day 42. Thereafter, it retained a higher level than normal up to 10 weeks. There were significant differences in the recovery of sensitivity following excimer ablation and manual debridement. CONCLUSIONS: These results show the development of a lasting enhanced sensitivity in the cornea after excimer laser ablation, suggesting the need to conduct further studies of neural plasticity and sensory thresholds following interventions on the corneal surface.
Most centers consider medically unresponsive pulmonary hypertension an absolute contraindication to orthotopic cardiac transplantation because the alternative surgical therapy, heterotopic graft placement, is associated with decreased survival, although most patients normalize their pulmonary hemodynamics postoperatively. Orthotopic transplantation in patients with elevated, but responsive pulmonary pressures, also is associated with an increased operative mortality rate and decreased long-term survival. The authors present the case of a patient with medically unresponsive pulmonary hypertension who was mechanically supported in an effort to improve his orthotopic transplant candidacy and decrease his risk. After informed consent, a HeartMate left ventricular assist device (LVAD) was inserted and the pulmonary hemodynamic response was monitored. Immediately before LVAD insertion, the pulmonary artery pressure (PA) was 74/28 mmHg with a transpulmonary gradient (TPG) of 28 mmHg, and a pulmonary vascular resistance (PVR) of 6.6 Wood units, despite prolonged dobutamine, milrinone, and prostaglandin E1 infusions. After 10 weeks of LVAD support, pressure and resistance improved; pulmonary artery pressure was 28/15 mmHg, transpulmonary gradient was 15 mmHg, and pulmonary vascular resistance was 2.8 Wood units. This patient subsequently underwent an uneventful orthotopic heart transplant. At 1 year after transplantation, pulmonary artery hemodynamics were normal (PA 34/14 mmHg, TPG at 8 mmHg, and PVR at 1.5 Wood units). The authors recommend the consideration of LVAD placement in patients with medically unresponsive pulmonary artery hypertension to assess PA responsiveness and improve the patient's orthotopic cardiac transplant candidacy and decrease the operative risk. However, several weeks may be needed for normalization of pressure and resistance.