Low density lipoprotein (LDL) was removed by repeated extracorporeal adsorption with a dextran sulphate cellulose column in 5 patients with clinical signs of poor peripheral circulation. The LDL apheresis was continued for 2 to 10 months, and symptoms such as cold or "heavy" legs, or intermittent claudication rapidly improved early in the treatment course in all 5 patients. Clearing of mentation occurred in 3, and recovery of kidney function was seen in 1 patient. These improvements occurred concomitant with a reduction in LDL level.

Aged↗

PubMedDate not supplied

MRI of primary spleen angiosarcoma with iron accumulation.

A case of splenic angiosarcoma with siderotic nodules is reported. The tumor was hyperechoic on ultrasound and had high density on CT and very low intensity on MR. Gandy-Gamna nodules (siderotic nodules) were demonstrated histopathogically.

Hemangiosarcoma↗

PubMedDate not supplied

MRI of bronchogenic cysts.

The MR appearance of eight bronchogenic cysts is reported. All the cysts appeared homogeneous and were of very high signal intensity, approximating that of CSF on spin-echo T2-weighted imaging, and of relatively high intensity, between that of muscle and subcutaneous fat on T1-weighted imaging. The cysts were round or ovoid and were well demarcated. These findings are consistent with the fluid-containing properties of cysts.

Adipose Tissue↗

PubMedDate not supplied

"CT angiogram sign" in obstructive pneumonitis and pneumonia.

OBJECTIVE: The "CT angiogram sign" in dynamic pulmonary CT consists of enhanced branching pulmonary vessels in a homogeneous hypoattenuating consolidation of lung parenchyma and is reportedly useful for diagnosing lobar bronchioloalveolar cell carcinomas. MATERIALS AND METHODS: To identify cases exhibiting the CT angiogram sign, we retrospectively reviewed the reports of 5,500 dynamic incremental CT examinations of the chest. RESULTS: We identified the CT angiogram sign in five patients with obstructive pneumonitis due to lung tumors and four patients with pneumonias. CONCLUSION: The CT angiogram sign can be observed in pulmonary consolidation of varying etiologies.

Adenocarcinoma, Bronchiolo-Alveolar↗

PubMedDate not supplied

MR evaluation of intrapulmonary hematoma.

We report a case of circumscribed intrapulmonary hematoma, in which MR findings were useful in establishing the diagnosis. It is usually easy to make a diagnosis of intrapulmonary hematoma using conventional methods, when clinical history of trauma and regression of the mass can be observed on serial radiography. However, in this case the mass remained almost unchanged 4 months after trauma on chest radiography and CT. Magnetic resonance revealed a hyperintense mass with an even higher signal rim on T1-weighted imaging and an irregular hyperintense mass on T2*-weighted imaging. We made a diagnosis of pulmonary hematoma based on these MR findings. Follow-up chest radiography and CT taken 1 year after the injury, revealed a substantial decrease in the size of the mass, which confirmed the diagnosis. As in this case, some intrapulmonary hematomas regress very slowly or may even increase in size, and diagnosis can be difficult with conventional methods. In such cases, MRI can be helpful.

Adult↗

PubMedDate not supplied

Signal intensity characteristics of mediastinal cystic masses on T1-weighted MRI.

OBJECTIVE: We evaluated the intracystic MR signal intensity of mediastinal cystic masses to identify characteristic intensity patterns according to histologic type. MATERIALS AND METHODS: Magnetic resonance imaging was performed on 26 cystic mediastinal masses consisting of 8 thymic cysts, 5 bronchogenic cysts, 4 pericardial cysts, 5 cystic teratomas, and 4 cystic neurogenic tumors. Signal intensity ratios of each cyst to muscle were calculated on T1-weighted imaging. Surgical records were reviewed to document the presence of intracystic hemorrhage. Chemical analysis of intracystic fluid was performed in three cases. RESULTS: Bronchogenic cysts, cystic teratomas, and cystic neurogenic tumors had relatively high levels of signal intensities. Each pericardial cyst had a lower signal intensity than muscle. The signal intensities of thymic cysts were variable. Intracystic hemorrhage was present in 1 bronchogenic cyst, 2 cystic neurogenic tumors, 4 cystic teratomas, and 3 thymic cysts. No hemorrhage was found in any of the pericardial cysts. Sebaceous fluid was present in 1 cystic teratoma. CONCLUSION: The varying intensities of different cysts were considered to reflect the nature of the intracystic fluid. Since the nature of the fluid can reflect the histology to some extent, T1-weighted MRI will help to differentiate cystic mediastinal masses.

Bronchogenic Cyst↗

PubMedDate not supplied

Helical CT imaging of bronchial arteries with curved reformation technique in comparison with selective bronchial arteriography: preliminary report.

PURPOSE: Our goal was to evaluate the ability of helical CT to identify and demonstrate the origins and courses of bronchial arteries, using the curved reformation technique, in patients undergoing bronchial arterial interventional procedures. METHODS: Thin section helical CT was performed on seven patients before bronchial arterial interventional procedures. The curved reformation technique was used to demonstrate the origins and continuous vessel tracing of bronchial arteries and compared with bronchial arteriographic findings. RESULTS: In all, 16 bronchial arteries were evaluated, 8 on the right and 8 on the left. The origins of 12 bronchial arteries were identified. In the demonstration of tracing vessels, seven right bronchial arteries and three left were classified as excellent or fair. CONCLUSION: Helical CT imaging with the curved reformation technique is helpful in identifying bronchial arteries, especially on the right, in patients with indications for bronchial arterial interventional procedures.

Adult↗

PubMedDate not supplied

Patterns of peripheral enhancement in breast masses: correlation of findings on contrast medium enhanced MRI with histologic features and tumor angiogenesis.

PURPOSE: Our goal was to review patterns of peripheral enhancement on contrast-enhanced MRI of the breast and to correlate radiologic findings with pathologic features. METHOD: We reviewed the MR images of 124 consecutive women with breast lesions. Peripheral enhancement was identified in 35 (32 malignant, 3 benign) lesions. MRI findings were correlated with pathologic features including microvessel density and distribution determined histologically. RESULTS: Early peripheral enhancement with centripetal progression was seen in invasive carcinomas with a high peripheral and a low central microvessel density, associated with fibrosis and/or necrosis (n = 18; 15 with central fibrosis, 2 with fibrosis and necrosis, and 1 with necrosis alone). Early peripheral enhancement with minimal or no change in enhancement was seen in both malignant (n = 10) and benign (n = 3) lesions. Delayed peripheral enhancement with centrifugal progression was seen in carcinomas that had an expansive growth pattern and a high marginal vessel density with or without a vascularized rim of connective tissue (n = 4). CONCLUSION: Early peripheral enhancement with centripetal progression appears to be fairly specific for carcinomas, whereas early enhancement with minimal or no centripetal progression, although more common in malignant tumors, may be seen in some benign lesions as well.

Adult↗

PubMedDate not supplied

Bronchogenic carcinoma invasion of the chest wall: evaluation with dynamic cine MRI during breathing.

PURPOSE: Our goal was to assess the utility of breathing dynamic cine MR (BDCMR) in the evaluation of tumor invasion to the chest wall in bronchogenic carcinomas. METHOD: BDCMR imaging was performed preoperatively in 25 patients with bronchogenic carcinomas adjacent to the chest wall. Twelve sequential images were obtained in the same coronal and/or sagittal planes during one respiratory cycle with fast spoiled GRASS sequence, and analysis with cine-loop display was performed. RESULTS: In all 14 cases in which free movement of tumor along the parietal pleura on BDCMR was demonstrated, no chest wall invasion was evident at thoracotomy. However, of 11 patients with fixation of the tumor on BDCMR, 5 had benign pleural adhesions, 5 had chest wall invasion at thoracotomy, and 1 with an apical tumor had no benign pleural adhesion or chest wall invasion. CONCLUSION: Although BDCMR cannot distinguish benign pleural adhesions from chest wall invasion by tumor, this method accurately estimated the free movement of lung tumors with no invasion of chest wall from bronchogenic carcinomas prior to surgery.

Aged↗

PubMedDate not supplied

"Crazy paving appearance" on high resolution CT in various diseases.

PURPOSE: The purpose of this work was to demonstrate the variety of causes of crazy-paving appearance (CPA) on high resolution CT (HRCT). METHOD: To identify cases exhibiting CPA (ground-glass opacity with superimposed interlobular septal thickening and intralobular interstitial thickening) on HRCT, we prospectively searched for them over a period of 29 months. RESULTS: We identified 10 cases of CPA on HRCT, including 4 Pneumocystis carinii pneumonia, 1 alveolar proteinosis, 1 usual interstitial pneumonia, 1 pulmonary hemorrhage, 1 acute radiation pneumonitis, 1 adult respiratory distress syndrome, and 1 drug-induced pneumonitis. CONCLUSION: CPA can result from a variety of diseases. When we encounter CPA on HRCT, clinical information is necessary for differentiation of these entities.

Adolescent↗

PubMedDate not supplied

Diagnostic reasoning of high- and low-domain-knowledge clinicians: a reanalysis.

Thinking-aloud protocols provided by Joseph and Patel were reanalyzed to determine the extent to which their conclusions could be replicated by independently developed coding schemes. The data set consisted of protocols from four cardiologists (low domain knowledge = LDK) and four endocrinologists (high domain knowledge = HDK), individually working on a diagnostic problem in endocrinology. The two analyses agree that the HDK physicians related data to potential diagnoses more than did the LDK group and were more focused on the correct diagnostic components. However, the reanalysis found no meaningful difference between the groups in diagnostic accuracy, speed of diagnosis, or the breadth of the search space used to seek a solution. In the reanalysis, the HDK physicians employed more single-cue inference and less multiple-cue inference. The generalizability of results of protocol-analysis studies can be assessed by using several complementary coding schemes.

Aged↗

PubMedDate not supplied

Telomerase activity in body cavity fluid and peritoneal washings in uterine and ovarian cancer.

The telomeric repeat amplification protocol (TRAP) assay was used to measure telomerase activity in body cavity fluid from 10 ovarian cancer patients (ascites 9; pleural fluid, 1), ascites and peritoneal washings from eight uterine corpus cancer patients, and ascites from one with cancer of the uterine cervix. Telomerase activity was observed in five of six (83.3%) samples with positive cytology, one of four (25%) samples with suspicious cytology and one of nine (11.1%) samples with negative cytology. A high level of activity was observed in samples containing large numbers of blood-cell components, which could be removed without inactivating the telomerase by treating the samples with Nycodenz (N,N1-Bis (2,3-dihydroxypropyl)-5-[N-(2,3-dihydroxypropyl) acetamide] 2,4,6-triiodo-isophtalamide). In two patients with ovarian cancer treated with anticancer drugs, 5 and 7 days after treatment, intracellular vacuoles and multinucleation were observed in ascites tumour cells, and telomerase activity decreased. At 14 to 21 days after treatment, the ascites tumour cell morphology was the same as before treatment, and telomerase activity rose once again. The TRAP assay is a sensitive method of detecting telomerase in cytological material and may provide a useful adjunct to cytological diagnosis.

Adult↗

PubMedDate not supplied

Radiotherapy combined with transcatheter arterial infusion of cisplatin versus oral fluoropyrimidine anticancer agent for locally advanced carcinoma of the uterine cervix: a prospective follow-up study.

We randomized patients with locally advanced cervical cancer to receive radiotherapy combined with transcatheter arterial infusion (TAI) of cisplatin or oral fluoropyrimidine anticancer agents, and compared the prognosis by a prospective follow-up study. Sixty patients were studied who completed their planned radiation therapy with chemotherapy at the Department of Obstetrics and Gynecology of Hiroshima University Hospital between January 1991 and December 1998. Patients were randomly assigned to receive (A) radiotherapy with TAI of 120 mg/body cisplatin twice a month at the interval of 4 weeks or (B) radiotherapy with 200 mg/day oral 5-FU or UFT every day. In both groups, radiotherapy is routinely 50 Gy of external beam irradiation to the whole pelvis and 18-20 Gy (point A dose) of intracavitary irradiation using a remote after loading system (RALS). Serious adverse reactions interfering with treatment did not appear in either group. The effective histologic response was 28/32 (87.5%) in group A and 25/28 (89.3%) in group B. The median follow-up period were 28.3 months and 25.4 months in group A and B, respectively. There was no significant difference in the overall survival and disease-free survival rates for all patients, clinical stage III and squamous cell carcinoma. We could not conclude that radiotherapy with TAI of cisplatin achieved superior therapeutic efficacy in locally advanced cervical cancer. To improve the therapeutic effects, it is important to establish a new cisplatin-containing chemoradiotherapy regimen.

Adenocarcinoma↗