Biomedical subjects

S H Kuo

Publications and source records attributed to S H Kuo.

At least 55 records · Page 3Linked to original sources

PubMed1995

Clinical spectrum of tuberculosis in older patients.

OBJECTIVE: To investigate the clinical differences between old and young patients infected with Mycobacterium tuberculosis in a developing country. DESIGN: Retrospective chart and chest radiograph review. SETTING: A university-affiliated teaching hospital. PATIENTS: The medical records of patients with documented tuberculosis (TB) from January 1990 through December 1991 were analyzed. Clinical assessment included sex, age, diagnosis at first visit, past history, symptoms and signs, laboratory data, X-ray findings, bacteriological examinations, outcome, time elapsed from first visit to initiation of anti-TB therapy and the major determinants for starting anti-TB therapy. Statistical significances were analyzed by Student's t test and chi 2 tests. RESULTS: Among 205 patients with culture-proven TB, 57 were 65 years of age and older (range, 65 to 91; mean, 73) and 148 under 65 years of age (range, 16 to 64; mean, 41). There was a higher incidence of previous TB (26.3% vs. 16.2%) and diabetes mellitus (24.5% vs. 14.3%) in the elderly patients. Initial diagnosis of TB at first visit was less frequent in the elderly than in the young group (38.6% vs. 47.3%), although symptoms and signs at first visit were similar in each of the age groups. Radiographic presentation with mass lesions was more frequently encountered in elderly patients (10.5% vs. 2.1%, P < .05). Elapsed time from the first visit to suspicion of TB and the initiation of anti-TB therapy was frequently delayed in elderly patients (22 +/- 23 vs. 13 +/- 20 days, P < .05). The incidence of drug-resistance (39% vs. 16%, P < .05) and unfavorable response to anti-TB therapy (17.5% vs. 3.4%, P < .05) were significantly higher in the older patients. CONCLUSIONS: Although clinical presentation of TB in the elderly did not differ significantly from that in younger patients, this study showed that diagnosis and treatment were more often delayed in the elderly, and there was a higher incidence of treatment failure.

Adolescent↗

PubMed1995

Direct determination of cryptococcal antigen in transthoracic needle aspirate for diagnosis of pulmonary cryptococcosis.

Pulmonary cryptococcosis causes significant morbidity and mortality in immunocompromised patients. Definitive diagnosis of pulmonary cryptococcosis is usually difficult. The use of direct determination of cryptococcal antigen in transthoracic needle aspirate to diagnose pulmonary cryptococcosis was investigated. Over a 2-year period, we studied a total of 41 patients with respiratory symptoms and pulmonary infiltrates of unknown etiology who were suspected of having pulmonary cryptococcosis. Twenty-two patients were immunocompetent patients and 19 patients were immunocompromised. A diagnosis of pulmonary cryptococcosis was based on cytological examination, culture for Cryptococcus neoformans, histopathologic examination, and clinical response to antifungal therapy. All patients underwent chest ultrasound and ultrasound-guided percutaneous transthoracic needle aspiration to obtain specimens for cryptococcal antigen determination. The presence of cryptococcal antigen was determined by the latex agglutination system (CALAS; Meridian Diagnostics, Cincinnati, Ohio). An antigen titer equal to or greater than 1:8 was considered positive. The specimens were also sent for cytological examination, fungal culture, and/or histopathologic examination. A final diagnosis of pulmonary cryptococcosis was made in eight patients. Direct determinations of cryptococcal antigen in lung aspirate were positive in all eight patients with pulmonary cryptococcosis (100% sensitivity, 97% specificity, a positive predictive value of 89%, and negative value of 100%), and there was only one false-positive in noncryptococcosis patients. The diagnostic accuracy was 97.5%. Serum cryptococcal antigen was positive in only three patients with pulmonary cryptococcosis (sensitivity, 37.5%). This study showed that direct measurement of cryptococcal antigen in lung aspirate can be a rapid and useful test for diagnosis of pulmonary cryptococcosis.

Adolescent↗

PubMed1995

Transthoracic needle biopsy of thoracic tumours by a colour Doppler ultrasound puncture guiding device.

BACKGROUND: Ultrasound guided transthoracic needle aspiration biopsy has recently been used to obtain specimens for histological diagnosis of pulmonary and mediastinal tumours. Conventional real time, grey scale puncture guiding devices cannot differentiate vascular structures, and clear visualisation of the needle shaft or tip within a desired target is not always possible. This study describes a new built-in colour Doppler ultrasound puncture guiding device and assesses the relative safety of transthoracic needle aspiration biopsy of thoracic tumours by grey scale or colour Doppler ultrasound guidance. METHODS: Thirty patients with radiographic evidence of pulmonary (22 patients) or mediastinal tumours (eight patients) underwent ultrasonographic evaluation and transthoracic needle aspiration biopsy by using the colour Doppler ultrasound puncture guiding device (Aloka UST 5045P-3.5). These tumours were initially examined by grey scale ultrasound, and colour Doppler imaging was then used to evaluate the number of blood vessels surrounding and within the target tumour and the possibility of visualisation of the needle shaft or needle tip during the aspiration biopsy procedure. RESULTS: The colour Doppler ultrasound guiding device was far superior to the grey scale device for identification of the number of vessels surrounding or within the target tumour (83% v 20%) and for visualisation of the needle shaft or needle tip (80% v 17%). CONCLUSIONS: By using the colour Doppler ultrasound puncture device, vascular structures surrounding or within the target tumour can be verified. Visualisation of the needle shaft or tip is also better. Biopsy routes can be selected to avoid puncturing vessels. This approach should be particularly helpful for guiding biopsies of mediastinal tumours, where puncturing the heart or great vessels is a potential complication.

Adult↗

PubMed1995

Tumor angiogenesis correlates with histologic type and metastasis in non-small-cell lung cancer.

This study investigated the clinico-pathologic correlation of tumor angiogenesis in non-small-cell lung cancers. Formalin-fixed, paraffin-embedded surgical specimens of 55 consecutive patients with primary non-small-cell lung cancers were examined. Included were 26 squamous cell carcinomas and 29 adenocarcinomas. Twenty-five patients had stage I disease, eight patients had stage II disease, and 22 patients had stage IIIA or IIIB disease. Among them, 28 had nodal metastasis and 27 did not. The microvessel was demonstrated by immunocytochemical staining for factor VIII and platelet endothelial cell adhesion molecules (PECAM-1). The microvessels in the areas of highest neovascularization were counted under light microscopy in 200x field by two independent observers without knowledge of clinical information. At least three separate fields were counted for each specimen. The Mann-Whitney U test was used for statistical analysis. The microvessel counts in adenocarcinoma were significantly higher than in the squamous cell carcinoma (54.4 +/- 35.65 versus 26.16 +/- 20.46 in factor VIII staining and 80.52 +/- 48.42 versus 40.04 +/- 32.33 in PECAM-1 staining; p < 0.001). The microvessel counts in patients with Stages I-II disease were significantly lower than that of stages IIIA-IIIB disease (23.63 +/- 16.21 versus 65.36 +/- 31.92 in factor VIII staining and 41.85 +/- 36.76 versus 93.00 +/- 43.08 in PECAM-1; p < 0.001). Patients with nodal metastasis had higher microvessel density than those without nodal metastasis (56.67 +/- 35.55 versus 23.44 +/- 15.77 in factor VIII staining and 86.89 +/- 46.46 versus 36.30 +/- 25.83 in PECAM-1 staining; p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗

PubMed1995

A pseudoepidemic of Mycobacterium chelonae infection caused by contamination of a fibreoptic bronchoscope suction channel.

An unusual increase in the frequency of isolation of Mycobacterium chelonae subspecies chelonae from specimens of bronchial washings was found between September and December 1992 in National Taiwan University Hospital. During this period, a total of 123 patients underwent fibreoptic bronchoscopy with an Olympus P20. Seventy six patients had bronchial washing for bacteriological study and cytological examination. Acid-fast bacilli were found in 21 patients, in 18 of whom Mycobacterium chelonae were isolated from bronchial washing cultures. Eight patients were treated as mycobacterial infected, because of the presence of unexplained pulmonary lesion, positive acid-fast stain and culture for Mycobacterium chelonae. Diagnosis of lung cancer was delayed in one patient because of the initial negative cytological study and positive bacterial culture. The fibreoptic bronchoscope was disinfected by automated washing machine (EW-20, Olympus) using 2.3% glutaraldehyde according to a standard protocol. From a survey to search for possible sources of contamination, they were identified at the suction channel of four different bronchoscopes. This episode proved to be a pseudoepidemic. The contamination was controlled by extensive suction and rinsing of the channel with 70% alcohol immediately after disinfection by the automated bronchoscope disinfection machine. This study shows that, despite using the disinfection machine, the suction channel could still be contaminated with Mycobacterium chelonae. This may cause diagnostic confusion and unnecessary antimycobacterial treatment.

Aged↗

PubMed1995

"Fluid color" sign: a useful indicator for discrimination between pleural thickening and pleural effusion.

Color Doppler imaging has been applied traditionally in the evaluation of cardiovascular diseases. Recently it was observed that color signal may appear within the fluid collection in the pleural space during respiratory and cardiac cycles ("fluid color sign"). We performed this applicability of fluid color sign to the detection of pleural fluid capable of being removed to assess needle aspiration. From July 1992 to February 1994, we prospectively analyzed 76 patients who were suspected of having minimal pleural effusion on the basis of their chest radiographs. All patients were examined by color Doppler ultrasonography for the presence of fluid color sign, which was followed by needle aspiration to verify the presence of pleural effusion. Among the 65 patients with aspiratable fluid, 58 demonstrated positive fluid color sign (sensitivity 89.2%). None of the patients with solid pleural thickening showed fluid color sign (specificity 100%). With its relatively high sensitivity and specificity, the fluid color sign may be a useful diagnostic aid to real-time, gray scale ultrasonography for minimal or loculated effusion.

Adolescent↗

PubMed1995

Nodular amyloidosis of the lung and the breast mimicking breast carcinoma with pulmonary metastasis.

Nodular amyloidosis of the breast and lung is a rare condition of unknown aetiology. The disease runs a benign course, but offers a diagnostic problem due to nonspecific histological features. We describe the case of a 56 year old woman with a 5 year history of multiple nodules of both lungs and left breast, clinically mimicking breast carcinoma with pulmonary metastasis. To our knowledge, this is the first case of cytologically proven amyloidosis diagnosed by ultrasound-guided percutaneous transthoracic fine-needle aspiration of pulmonary nodules.

Amyloidosis↗

PubMed1995

Systemic lupus erythematosus presenting as pleural effusion: report of a case.

Systemic lupus erythematosus (SLE) presenting as a pleural effusion in a young male is not common. This paper describes a 20-year-old man who was admitted to hospital with a spiking fever, chills and cough. A chest x-ray showed alveolar infiltration and a moderate right-sided pleural effusion. The patient was treated for parapneumonic effusion. Thoracentesis was performed and cytology of the aspirated fluid was initially interpreted as showing only numerous polymorphonuclear (PMN) leukocytes. However, in spite of antibiotic treatment the symptoms persisted. A careful review of the cytology specimen showed classic lupus erythematosus (LE) cells in addition to PMN cells. Subsequent investigation, including antinuclear antibodies titer, confirmed the diagnosis of LE pleurisy. Therapy with antibiotics was discontinued and treatment with prednisolone 20 mg daily was begun. There was a rapid clinical response including resolution of the fever and pleural effusion.

Adult↗

PubMed1994

Carcinoid tumours of the thymus.

BACKGROUND: Carcinoid tumours of the thymus are rare. The clinical manifestations, radiographic findings, and cytological features of eight histopathologically verified thymic carcinoid tumours have been assessed. METHODS: One hundred and sixty two patients of mean age 52 (range 31-68) years with malignant mediastinal tumours were reviewed retrospectively and eight cases of thymic carcinoid were identified. Four of the eight patients were diagnosed by percutaneous ultrasound guided fine needle aspiration biopsy via a parasternal approach. RESULTS: Two patients had Cushing's syndrome at presentation and four had symptoms and signs secondary to mediastinal compression. Two were asymptomatic. Local extension of the tumour to pleura, pericardium, great vessels, phrenic nerve or regional lymph nodes, or both, were found in seven patients. Only one had the tumour confined to the thymus at diagnosis. Distant metastases were found in two patients, one to both lungs and the other in the iliac bone. Local recurrence or distant metastases developed 15-60 months after surgery in four of the five patients who underwent radical resection of the thymic tumour. Three patients died at 17 months, 34 months, and 10 years after diagnosis. The other five patients are alive at 9-51 months. CONCLUSION: Thymic carcinoid is a slow growing tumour with a poor prognosis because of its tendency to local and distant spread. Cytological examination of samples obtained by ultrasound guided fine needle aspiration may provide a useful method for diagnosis in selected patients.

Adult↗

PubMed1994

Superior vena cava syndrome. Rapid histologic diagnosis by ultrasound-guided transthoracic needle aspiration biopsy.

We prospectively analyzed the diagnostic yield and safety of ultrasound (US)-guided transthoracic needle aspiration biopsy in the histologic diagnosis of 40 patients with superior vena cava (SVC) syndrome. During a 4-yr period, 40 patients with SVC obstruction were admitted to National Taiwan University Hospital. Of these patients 10 had histologic confirmation by sputum cytology (3 patients), fiberoptic bronchoscopy with biopsy (2 patients), or lymph node biopsy (5 patients) at admission. A total of 30 undiagnosed patients underwent real-time ultrasonographic (US) evaluation as well as color Doppler imaging. Patients with tumor detectable by US underwent US-guided transthoracic needle aspiration biopsy. Of the 30 patients who received US chest examination, 29 had widening of the upper mediastinal shadows in the chest radiographs. In 27 patients tumors were detected by chest US. After assessment of collateral vessels by color Doppler US, these 27 patients underwent US-guided transthoracic needle aspiration biopsies; histologic diagnoses were confirmed in 25. The diagnostic yield was 83.3%. The mean duration from admission to histologic diagnosis was 2.1 days. None of the patients developed complications. We conclude that chest US and color Doppler images are useful tools for evaluation of patients with SVC syndrome. US-guided transthoracic needle aspiration biopsy appears to be a safe, effective, and rapid approach for obtaining an accurate histologic diagnosis. Specific treatment can thus be initiated without delay.

Adult↗

PubMed1994

The bacteriology of obstructive pneumonitis. A prospective study using ultrasound-guided transthoracic needle aspiration.

Obstructive pneumonitis, the opacity that develops distal to an obstructing endobronchial lesion or external compression, is actually a combination of atelectasis, bronchiectasis with mucus plugging, and true parenchymal inflammation. In the majority of cases, it is usually not possible to determine whether infection is present or not from the radiographic findings alone. The aim of this study was to evaluate the bacteriology of obstructive pneumonitis and the influence of this result on the treatment of patients. From March 1992 to February 1993, 26 consecutive patients (20 men and six women) with obstructive pneumonitis were investigated. The obstructive pneumonitis had been caused by malignant tumors in 24 and benign lesions in two. Chest ultrasound (US) and US-guided percutaneous transthoracic aspirations were undergone to obtain specimens for microbiologic examination. Microorganisms were isolated from seven of nine febrile patients and two of 17 nonfebrile patients. A total of 16 bacterial strains are detected in obstructive pneumonitis (Pseudomonas aeruginosa, Klebsiella pneumoniae, viridant streptococci, Bacteroides fragilis, two Peptostreptococcus species, Mycobacterium tuberculosis, Pseudomonas maltophilia, Streptococcus sanguis, Staphylococcus aureus, Bacteroides thetaiotamomicrons, Bacteroides intermedius, Bacteroides species, Veillonella species, aerobic gram-positive bacilli, and Escherichia coli). In five cases the isolates were monobacteriae, and in the remaining four cases, cultures yielded more than one bacteria. The results of aspirate cultures led to changes in the initial antibiotic trial in seven of nine patients, and fever subsided thereafter. Pneumothorax occurred in one cases as the sole complication. The pathogen causing obstructive pneumonitis is very heterogeneous, and polymicrobial infection is common.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

Image comparison of real-time gray-scale ultrasound and color Doppler ultrasound for use in diagnosis of minimal pleural effusion.

To assess the value of color Doppler ultrasound in distinguishing minimal pleural effusion from pleural thickening, a prospective analysis was done on the ultrasonographic findings in 51 patients. Real-time, gray-scale, and color Doppler chest ultrasound examinations were carried out by different sonographers who had no clinical information concerning the patients. The sonographer evaluated the images for internal echogenicity of the effusion, pleural lesions that change shape with respiration, and movable septa and echo-densities in pleural space in conventional gray-scale as well as color signal in color Doppler ultrasound. Of the 35 patients with true effusion, 33 had positive color signal (sensitivity 94.3%, 95% confidence intervals [CI] 89 to 98.6%); in 16 patients without effusion, none had color signal (specificity 100%, 95% CI 83 to 100%). Although real-time, gray-scale ultrasound is also sensitive for detecting minimal effusion (sensitivity 100%, 95% CI 92 to 100%), it is less specific (specificity 68.7%, 95% CI 46 to 91.5%). Five of 16 examinations showing fluid-like lesions were found to be deceptive. With relatively high sensitivity and specificity, this method proved to be a useful diagnostic aid to real-time, gray-scale ultrasound for diagnosis of minimal or loculated effusion.

Adolescent↗

PubMed1994

Mucosa-associated lymphoid tissue lymphoma of the lung with cold-reacting autoantibody-mediated hemolytic anemia.

Mucosa-associated lymphoid tissue lymphoma (MALT-oma) of the lung is a rare low-grade B cell lymphoma arising from bronchus-associated lymphoid tissue. This report concerns a 39-year-old woman with bilateral diffuse alveolar consolidations and cold-reacting autoantibody-mediated hemolytic anemia. Open-lung biopsy showed angulated lymphoid cells with lymphoepithelial lesions. Immunocytochemistry revealed that the lymphoid cells were positive for CD19, CD20, and IgM (lambda), which was consistent with immunophenotype of MALToma. The serum immunoelectrophoresis demonstrated IgM (lambda) monoclonal gammopathy. The association of cold-reacting auto-antibody-mediated hemolytic anemia with MALToma, to our knowledge, has never been reported before in the English language.

Adult↗

PubMed1994

Panhypopituitarism caused by solitary parasellar metastasis from lung cancer.

Clinical panhypopituitarism caused by cancer with parasellar metastasis and hypothalamic invasion is very rare. This report concerns a lung cancer patient who had solitary parasellar metastasis with diabetes insipidus and panhypopituitarism as an initial manifestation, which was documented by contrast-enhanced computed tomographic scan, Gd-DTPA-enhanced magnetic resonance imaging, and endocrinologic studies.

Adenocarcinoma↗

PubMed1994

Differentiation of benign and malignant cervical lymph nodes with color Doppler sonography.

OBJECTIVE: This study proposed to evaluate the efficacy of color Doppler sonography in detecting possible differences in blood flow patterns between malignant and benign cervical lymph nodes. SUBJECTS AND METHODS: During a period of 12 months, the palpable cervical lymph nodes of 48 untreated patients were prospectively evaluated with color Doppler sonography and Doppler flow wave analysis. Histopathologic diagnoses were obtained by sonographically guided fine-needle aspiration biopsy and/or excisional biopsy. RESULTS: We found 16 benign lymph nodes (four were tuberculous lymphadenitis, four were reactive hyperplasia, and eight were unspecified) and 32 malignant lymph nodes (13 were squamous cell carcinomas, nine were adenocarcinomas, four were small-cell carcinomas, three were lymphomas, and three were miscellaneous). Color Doppler flow patterns were seen in six (38%) of the 16 benign lymph nodes and in 29 (91%) of the 32 malignant lymph nodes. Twenty-six (81%) of the 32 malignant lymph nodes had abnormal flow patterns, with resistance indexes less than 0.6. However, three (19%) of the 16 benign lymph nodes also had abnormal flow patterns, and only seven (54%) of 13 squamous cell carcinomas had abnormal flow patterns. CONCLUSION: Color Doppler sonography has limited clinical value in differentiating malignant from benign cervical lymph nodes and in obviating biopsy.

Adenocarcinoma↗

PubMed1994

Color Doppler sonography of benign and malignant pulmonary masses.

OBJECTIVE: The purpose of this study was to compare blood flow in benign and malignant pulmonary masses by assessing the spectral waveforms obtained during color Doppler sonography. SUBJECTS AND METHODS: Fifty lung cancers in 46 patients and 28 benign lung lesions in 28 patients were evaluated with color Doppler sonography. Spectral wave analysis of blood flow (specifically, the Doppler variables of pulsatility index, resistive index, peak systolic velocity, and end diastolic velocity) was used to determine the distal impedance of vessels in malignant and benign pulmonary lesions. RESULTS: The flow signal detection rates for lung cancers and benign pulmonary lesions were 64% and 79%, respectively. All lung cancers with detectable flow signals had either relatively low-impedance flows or arteriovenous shunting, unlike the benign lesions, which usually had relatively high-impedance flows. For lung cancers, the pulsatility index was 1.43 +/- 0.31, the resistive index was 0.52 +/- 0.13, peak systolic velocity was 0.17 +/- 0.07 m/sec, and end diastolic velocity was 0.07 +/- 0.03 m/sec. For benign lung lesions, the pulsatility index was 3.32 +/- 0.68, the resistive index was 0.90 +/- 0.06, peak systolic velocity was 0.28 +/- 0.09 m/sec, and end diastolic velocity was 0.03 +/- 0.01 m/sec. All four variables were significantly different (p < .001) between lung cancers and benign lung lesions. When a cutoff value of mean +/- 2 SD was used, the resistive index and pulsatility index were shown to be sensitive and specific for the diagnosis of lung cancer (sensitivity, specificity = 100%, 95% for resistive index; 97%, 95% for pulsatility index). Flow was detected less often in squamous cell carcinoma than in adenocarcinoma and small-cell carcinoma. CONCLUSION: We conclude that color Doppler sonography is useful for showing vascularity in pulmonary masses, and may be helpful in differentiating malignant from benign lung tumors.

Blood Flow Velocity↗

PubMed1994

Ultrasonography and needle aspiration cytology in the diagnosis and management of parathyroid lesions.

To elucidate the diagnostic value of fine needle aspiration (FNA) cytology of ultrasonically suspected parathyroid lesions, we reviewed a series of 17 cases seen over the past two years. Patients with biochemically proven primary or secondary hyperparathyroidism were examined by ultrasonography using a 7.5-MHz linear transducer. Ultrasound-guided FNA cytologic examinations with Riu's stain were performed on 13 patients who had questionable ultrasonographic patterns. The aspirates were considered adequate in nine out of 13 cases (69%). The cytologic patterns, characterized by tight cohesion of naked nuclei with indistinct cell border showing hypermonomorphism and overlapping of nuclei, were noted in adenomatous and hyperplastic lesions. There were several different findings noted in the case of parathyroid carcinoma, including loose cohesion of nuclei, larger nuclear size, and prominent anisokaryosis. One patient with secondary hyperparathyroidism who previously had a neck exploration, received an ultrasonically-guided percutaneous alcohol injection to the parathyroid lesion after cytologic verification. The result was remarkable both in volume reduction and in clinical improvement. The results suggest that ultrasound-guided FNA cytologic examination with Riu's stain is safe, simple and helpful in the localization of parathyroid lesions prior to surgery or percutaneous alcohol ablation therapy.

Adenoma↗

PubMed1994

Role of urinary cytology and urinary deoxyribonucleic acid flow cytometry in the diagnosis of bladder cancer.

In order to determine the diagnostic efficiencies of urinary cytology and urinary deoxyribonucleic acid (DNA) flow cytometry (FCM) in the detection of bladder cancer, 92 patients were studied from March 1991 to the end of July 1992. Thirty cases had previously undergone operation for bladder cancer and 62 cases were suspected as bladder cancer. One to three fresh voided urine samples from the same patient were sent for conventional urinary cytology and urinary DNA FCM analysis. Each patient underwent cystoscopic examination or surgical histopathologic examination to verify the presence of bladder tumor. From December 1991 to the end of July 1992, 52 cases were analyzed and reported separately due to improved FCM techniques. Urinary DNA FCM showed a higher sensitivity than cytology in both the total (p < 0.05) and the second half time period (p < 0.01). Cytology showed a statistically superior specificity against FCM in the total period (p < 0.05) but not in the second half time period (p > 0.1). Combining sensitivity and specificity, FCM's overall accuracy rate was better than cytology in the second half time period (p < 0.05). To clarify the specific features of bladder tumors in which FCM showed superior sensitivity than cytology, we analysed the detection rates for various features of bladder tumor in the second half time period. FCM was better than cytology in detecting multiple tumors, small tumors and papillary tumors. No statistical differences were obtained if tumors were single, larger than 3 cm or flat in outer surface. To our knowledge, no previous similar analysis has been reported in the literature.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗