Multiple congenital anomalies in a Korean native calf (Bos taurus coreanae) / 대한수의학회지

Supernumerary ectopic limb(s) (SEL) is a congenital anomaly defined as the presence of accessory limb(s) attached to various body regions. This paper describes a case of SEL with ectopic lung and ectopia cordis in a newborn calf, based on macroscopic, microscopic and radiographic findings. External features of multiple congenital anomalies included an ectopic lung growing over the middle of the backbone and covered with normal haired skin. Ectopia cordis was found in the abdominal cavity and attached to the liver. Two extra abnormal limbs originated separately from within the ectopic lung. Most of the abdominal organs were exposed to the outside through the opened abdominal cavity. Microscopically the ectopic lung tissue had edema in the connective tissue around the bronchus and artery. Changes in other organs included congestion of the renal medulla, infiltration of inflammatory cells (lymphocytes and eosinophils) around the hepatic portal tract, and edema surrounding blood vessels and neurons in the brain. The rudimentary humerus of the forelimb was attached to the thoracic spine, as viewed radiographically. The hindlimb was consisted of an irregularly shaped femur, short tibia and fibula, two tarsal bones, one metatarsal bone, and three phalanges. This is the first description of congenital anomalies involving the SEL, ectopic lung and ectopia cordis in a calf.

Radiologic and Clinical Features of Idiopathic Granulomatous Lobular Mastitis Mimicking Advanced Breast Cancer

Idiopathic granulomatous lobular mastitis (IGLM), also known as idiopathic granulomatous mastitis, is a rare chronic inflammatory lesion of the breast that can clinically and radiographically mimic breast carcinoma. The aim of this study was to describe the radiological imaging and clinical features of IGLM in order to better differentiate this disorder from breast cancer. We performed a retrospective analysis of the clinical and radiographic features of 11 women with a total of 12 IGLM lesions. The ages of these women ranged between 29 and 42 years, with a mean age of 34.8 years. Ten patients were examined by both mammography and sonography and one by sonography alone. The sites that were the most frequently involved were the peripheral (6/12), diffuse, (3/12), and subareolar (3/12) regions of the breast. The patient mammograms showed irregular ill-defined masses (7/11), diffuse increased densities (3/11), and one oval obscured mass. In addition, patient sonograms showed irregular tubular lesions (7/12) or lobulated masses with minimal parenchymal distortion (2/12), parenchymal distortion without definite mass lesions (2/12), and one oval mass. Subcutaneous fat obliteration (12/12) and skin thickening (11/12) were also observed in these patients. Contrary to previous reports, skin changes and subareolar involvement were not rare occurrences in IGLM. In conclusion, the sonographic features of IGLM show irregular or tubular hypoechoic masses with minimal parenchymal distortion. Both clinical information and the description of radiographic features of IGLM may aid in the differentiation between IGLM and breast cancer, however histological confirmation is still required for the proper diagnosis and treatment of the disorder.

Combination chemotherapy with vinorelbine and ifosfamide for advanced non-small cell lung cancer / 대한내과학회지

BACKGROUND: Although cisplatin (CDDP)-based chemotherapy is currently considered to be the most active treatment for advanced non-small cell lung cancer (NSCLC), ultimate prognosis still remains poor. More effective cytotoxic agents are needed to improve outcom of these patients. We evaluated the efficacy and safty of combination chemotherapy with vinorelbine and ifosfamide in patients with advanced NSCLC. METHODS: Thirty-three chemotherapy-nave patients with stage IIIB or IV NSCLC were treated with vinorelbine 25 mg/m2 on days 1 & 8 and ifosfamide 2 g/m2 on days 1, 2 & 3 with mesna every 3 weeks. RESULTS: Among thirty evaluable patients who received the vinorelbine/ifosfamide combination chemotherapy, nine (30%) partial responses were observed. With median follow-up duration of 80weeks, the median response duration and overall survival durations were 23 weeks and 38 weeks respectively. World Health Organization grade 3 to 4 neutropenia and anemia occured in 5% and 4.3% respectively. CONCLUSION: Combination chemotherapy with vinorelbine and ifosfamide is an effective treatment for patients with advanced NSCLC with a manageable toxicity.

A Case of Nonspecific Interstitial Pneumonia Associated with Systemic Lupus Erythematosus / 결핵

Systemic lupus erythematosus frequently has thoracic involvement among connective tissue diseases. One of the pleuropulmonary manifestations is diffuse interstitial lung disease including nonspecific interstitial pneumonia(NSIP). NSIP if a newly classified disease among interstitial lung diseases. Systemic lupus erythematosus has a better prognosis than usual interstitial peumonia(UIP) and responds well to steroids. In this report, a 34 year-old woman who complained of a dry cough, and exertional dyspnea for 2 months is described. The chest X-ray showed fine reticular opacities and a mild honeycomb appearance in both basal lungs. High resolution computed tomography(HRCT) showed bilateral patchy areas of ground-glass attenuation and a mild honeycomb appearance in the subpleural of both the lower and the middle portion of the lung fields. An open lung biopsy showed prominent lymphocytic interstitial inflammation and fibrosis with small are as with a honeycomb appearance. This case was diagnosed as NSIP associated with systemic lupus erythematosus and was managed with oral steroids. Here we report a case of nonspecific interstitial pneumonia associated with systemic lupus erythematosus confirmed by HRCT and an open lung biopsy with a review of the relevant literature.

The Effect of reconstituted basement membrane on the expression of the anterior pituitary hormones of the rat / 대한해부학회지

This study was performed to investigate the effect of Matrigel, a reconstituted basement membrane, on the expression of the anterior pituitary hormones in culture. Rat pituitary cells cultured for 6 days on Matrigel showed 3-dimensional, lobular structures with connecting cells while those on plastic showed flat, polygonal cells forming a monolayer. Western blot analysis showed that prolactin (PRL) content in the anterior pituitary cells was higher compared to those cultured on plastic. In comparison, TSH expression was not increased in cultures on Matrigel. The total cell number and the proportion of fibroblasts was decreased. These results suggested that Matrigel is a useful culture substrate for the enhanced expression of PRL but not for TSH. Further studies are needed in order to find a useful culture substrate for TSH cells.

A Case of benign metastasizing leiomyoma in the lung / 결핵

Benign metastasizing leiomyoma usually occurs in women and is associated with a past hysterectomy in 80% of the cases, which is a rare entity. The patient was a 39-year-old woman who complained of cough and sputum. She underwent hysterectomy beacuse of benign leiomyoma ten years age. Chest X-ray showed nodular lesion in the left lung field. Chest CT showed a 3cm sized round well defined mass at left hilum with mild indentation of segmental bronchi of left upper lobe and a small tiny nodule in right lower lung field. Nodular lesion of left upper lobe was resected by thoracotomy.Pathological evaluation showed benign spindle-like cells having nuclei without cytotic atypia similar to those of benign leiomyoma. Immunohistochemical stainings for desmin and smooth muscle actin were positive. Therefore these nodules are considered as benign metastasizing leiomyoma from a uterine leiomyoma. We report this case with the review of literature.

Comparison between Mammography, Ultrasonography and 99 mTc-MIBI Scintimammography in the Diagnosis of Breast Cancer

PURPOSE: To compare the feasibility of 9 9 mTc-MIBI scintimammography as a tumor localizing agent in breast lesions in comparison with that of mammography and ultrasonography, and to evaluate the efficacy of these three modalities. MATERIALS AND METHODS: Sixty-four breast lesions were classified as benign or malignant on the basis of sono-graphic and mammographic criteria and were further analyzed by means of 99mTc-MIBI scintimammography. The classifications thus obtained were compared with the biopsy findings, and in order to compare the three techniques, the sensitivity, specificity, accuracy, and negative and positive predictive values were calculated for each individual modality. RESULTS: Of 64 histologically proven lesions, 33 were malignant and 31 were benign. Sensitivities and specificities for malignancy were 86.2% and 64.5% for mammography, 87.9% and 76.7 % for sonography, and 78.8% and 74.2% for 99mTc-MIBI scintimammography. CONCLUSION: Mammography and ultrasonogrphy are reliable diagnostic modalities for the detection of breast cancer. 99mTc-MIBI scintimammography has a higher specificity than mammography and it may help to reduce unnecessary biopsies.

A case of primary diffuse nodular pulmonary amyloidosis localized in the lung / 결핵

Nodular pulmonary amyloidosis is one of the rare manifestation of amyloid disease. It is known to be caused by anyloid L fibrils in the majority of case. We experienced an unusual case of a forty-one year-old woman who was presented with multiple nodular lesion on the chest X-ray. CT-guided core needle bilpsy, performed on the lesion, showed apple green birefringes, when stained Congo red and examined under polarized light. Ultrastructurally, there are randomly oriented, forming densed networks, and consists of fine, 7.5 to 10nm diameter, rigid, non-branching filaments of various lengths in electron-microscopic finding. We report a case of primary diffuse nodular pulmonary amyloidosis only localized in the lung, which was confirmed by CT guided core needle biopsy.

Diagnostic Accuracy of Quantitative Scintimammography Using Tc-99m MIBI According to ROC Curve Analysis for Breast Cancer

BACKGROUND: Technetium-99m sestamibi scintimammography (SMM) has been shown to be a useful diagnostic test in the detection of breast cancer, and the receiver operating characteristic (ROC) curve analysis provides detailed information about the diagnostic test. A ROC curve analysis was performed to evaluate the feasibility of Tc-99m sestamibi quantitative scintimammography (qSMM) for differentiating malignant from benign breast lesions. METHODS: Prone anterior, lateral planar, and supine SPECT imagings were performed on 75 female patients (mean age=43.4 yr) with breast masses (size> or =0.8 cm) after intravenous injection of 30 mCi of Tc-99m sestamibi. 45 malignant and 30 benign lesions were histologically proven. Three regions of interest (ROIs) were drawn over designated areas: lesion (L), normal breast opposite to the lesion (NL), and right chest wall (CW). L/NL and the L/CW ratios on both the SPECT and the planar images were analyzed. RESULTS: ROC curve analysis revealed that planar L/NL ratio and the SPECT L/NL and L/CW ratios provide better diagnostic accuracies for detecting breast cancer than the planar L/CW ratio did (p<0.05). From the qSMM (mean), which was an arithmetic mean of the planar L/NL, ratio the SPECT L/NL ratio and the SPECT L/CW ratio, the sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy were 84%, 77%, 84%, 77%, and 81%, respectively. Presence of axillary lymph-node metastasis showed a higher qSMM (mean) value (4.09 {n=17} vs 3.09 {n=28}, p=0.06). CONCLUSIONS: qSMM (mean) is a useful objective method for differentiating malignant from benign breast lesions.

Imaging Findings of Adenomatous Hyperplasia of the Liver

PURPOSE: To determine the features of hepatic adenomatous hyperplasia using different imaging modalities. MATERIALS AND METHODS: Twenty-two patients with 29 adenomatous hyperplastic nodules of the liver (0.9-3.1 cm) underwent sonography (29 lesions), CT (24 lesions), angiography (11 lesions), MR (12 lesions), and Lipiodol CT(seven lesions). Each lesion was analyzed for echogenicity, attenuation, vascularity, signal intensity, and Lipiodol uptake. RESULTS: On sonograms, echogenicity was high in 16, low in 11, and iso- in 2 of 29 lesions. On contrast enhanced CT scans, attenuation was high in 4, low in 14, and iso- in 6 of 24 lesions. On hepatic angiograms, vascularity of lesions was avascular in 9 and slightly vascular in 2 of 11 lesions. On MR images, signal intensity was high in 11 and iso- in 1 of 12 lesions on T1-weighted MRI, and iso- in 7, and low in 5 of 12 lesions on T2-weighted MRI. On iodized-oil CT scans, retention of Lipiodol was present in 3 and absent in 4 of seven lesions. CONCLUSION: Common imaging findings of adenomatous hyperplasia of the liver are high echogenicity on sonography, low attenuation on CT, hypovascularity on angiography, high signal intensity on T1-weighted MRI, and iso- or low signal intensity on T2-weighted MRI.

Usefulness of US-Guided Automated Gun Biopsy of Nonpalpable Breast Lesions

PURPOSE: To evaluate the clinical usefulness of ultrasonography (US) - guided automated gun biopsy of nonpalpable breast lesions. MATERIALS AND METHODS: In 30 nonpalpable breast lesions over 0.6cm and detected on US, we performed US-guided biopsy using an 18-gauge automated biopsy gun. Two to four specimens were obtained from each lesion. We analyzed the site, size and depth of the lesions, and the length and histopathologic results of the specimens. In four lesions, surgical biopsy and gun biopsy results were compared. RESULTS: In 29 of 30 lesions (96.7%), specimens were adequate for histopathologic diagnosis, and this was as follows: one case of infiltrating ductal carcinoma, 13 of fibrocystic disease, 10 of fibrocystic disease versus fibroadenoma and one of fibroadenoma. There was also one reactive hyperplasia of LN, and one fatty one and two normal tissues, and inthese four lesions, agreement between gun and surgical biopsy results was 100%. The only complication was minor bleeding, which was controlled by compression. CONCLUSION: US-guided automated gun biopsy is a clinically useful and safe procedure for evaluating nonpalpable breast lesions detected on US.

The Investigation of Statistical Descriptions in the Original Articles of Journal of the Korean Radiological Society

PURPOSE: The purpose of this study was to identify errors in statistical descriptions in articles published in the journal of Korean Radiological Society and to suggest guidelines for the reduction of such errors. MATERIALS AND METHODS: In order to investigate statistical errors, 139 of the 514 original articles published between July 1994 were analysed. To assess the validity of statistical descriptions, five items were evaluated. The five items included descriptions of basic data, statistical tests and their results, tables, articles which had presented two or more statistical methods or results, and the Chi-square test. RESULTS: The percentages of correct descriptions of basic data, statistical tests and their results, tables, articles which had presented two or more statistical methods or results, and the Chi-square test were 86.3%, 74.8%, 24.4%, 76.7% and 79.4%, respectively. In 50 of 139 articles (36.0%), statistical descriptions were correct. CONCLUSION: More than half of the articles assessed contained statistical errors; inaccuracies of this kind might raise doubts about the objective validity of an article and the authors should there fore be careful when performing a study which needs statistical descriptions.

Spiral CT of Hepatocellular Carcinoma: Correlation of CT Scans during the Arterial Phase with Angiography

PURPOSE: To correlate the enhancement pattern of hepatocellular carcinoma during the arterial phase of spiral CT with vascularity on angiography. MATERIALS AND METHODS: Forty-Two patients with hepatocellular carcinoma underwent spiral CT and angioigraphy. spiral CT was performed with a section thickness of 10mm and a table speedof 10 or 13 mm/sec. 120mL of contrast medium was injected at 3 mL/sec. Spiral CT scans during the arterial phase were obtained 35 seconds after the injection of contrast medium. CT findings of 78 lesions less than 4cm indiameter were correlated with angiographic findings. RESULTS: The attenuation of lesions was high(n=69),iso(n=5), and low(n=4) compared with liver parenchyma during the arterial phase of spiral CT. in lesions with high-, iso-, and low-attenuation during the arterial phase of spiral CT, hypervascularity on angiograms was foundin 63 of 69(91.3%), three of five(60%), and three of four lesions(75%), respectively. Six lesions with high-attenuation on the arterial phase of spiral CT were not seen on angiography. Two iso-attenuated and onelow-attenuated lesion were hypovascular on angiograms. CONCLUSION: The results of this study suggest that with some exceptions there was good correlation between the arterial phase of spiral CT and angiography.

Effects of Magnetization Transfer in Gadolinium-Enhanced Brain MR Imaging

PURPOSE: To evaluate the effect of magnetization transfer(MT) in contrast-enhanced brain MR imaging of the various intracranial diseases. MATERIALS AND METHODS: We prospectively studied the effect of MT incontrast-enhanced brain MR imaging 101 patients with a variety of intracranial diseases. In all patients contrast-enhanced T1-weighted(TR/TE = 550/14) SE MR images with and without MT were obtained on a 1.5 Tsuper conducting unit(Magnetom, Siemens). The MT pulse used for MT images was an 8.1 msec(=250 Hz band width) syncpulse, 1000 Hz off-resonance. We randomly divided the patients into two groups : group I and group II. Group I consisted of 54 patients in whom contrast-enhanced images without MT and then images with MT were obtained just ofter the injection of Gd-DTPA(0.1 mmol/kg). In group II(47 patients), contrast-enhanced images with MT and then the images without MT were obtained, considering the delayed-enhancement effect. The effect of MT was assessed visually and quantitatively. For quantitative assessment, contrast to noise ratios(CNR) were calculated in 27 cases with enhancing intracranial tumors larger than 1 cm. We then compared CNRs of contrast-enhanced images with and without MT. The paired t-test was used for statistical analysis. RESULTS: On visual assessment, only11.9%(12/101) of normally enhancing structures and only 20.3%(14/69) of enhancing lesions showed improved enhancement in images with MT. There was however, no case in which the enhancing lesion was seen only in MR image with MT but not in that without MT. On quantitative analysis there was no statistically significant difference between overall images with MT and those without MT(p>0.05). The average CNR of images with MT was higher than that of images without MT in group I, but not in group II. CONCLUSION: MT in contrast-enhanced brain MR imaging resulted in contrast improvement in a limited number(less than approximately 20%) of patients. Routine application of MT images to contrast-enhanced brain MR imaging may be of limited value. Further studies on the clinical usefulness of MT technique with more refined MT pulse are thus needed.

MR Findings of Thoracic and Abdominal Aortic Aneurysms: Comparison with Anglographic and Surgical Findings

PURPOSE: To assess the utility of spin-echo magnetic resonance(MR) imaging in the evaluation of thoracic and abdominal aortic aneurysm. MATERIALS AND METHODS: The spin-echo MR images of 27 aortic aneurysms in 22 patients were analyzed and correlated with angiography and/or operative findings retrospectively. Evaluations included location, type, and maximum diameter of the aneuyusm, mural thrombus, major branch involvement, and relationship with adjacent organ. RESULTS: The location of aneurysms was ascending thoracic aorta in seven cases, ascending thoracic aorta and aortic arch in one, descending thoracic aorta in six, thoracoabdominal aorta in three, and abdominal aorta in eight. Nineteen were fusiform, and eight were saccular. The mean of maximum diameters of the aneurysms was 7.9cm (4-10cm) on MR and 7.3cm (3-10cm) on angiography. Mural thrombus were noted in 13 cases on MR imaging and seven cases on angiograhpy. Angiography also underestimated the amount of mural thrombus. Eight cases involved major aortic branches. Although MR imaging and angiography were equal in the assessment of major abdominal aortic branches, MR imaging could not clearly demonstrate arch vessels, especially left subclavian artery, in aortic arch aneurysms. Among seven ascending thoracic aneurysms, six had aortic regurgitation. MR imaging showed left ventricular enlargement in all six cases. There was pericardial effusion in four cases which were noted only on MR imaging. MR imaging demonstrated hydronephrosis and renal atrophy in two cases of abdominal aortic aneurysms respectively. CONCLUSION: In the assessment of size of the aneurysm, mural thrombus, and relation with adjacent organs, MR imaging was better than angiography. MR and anglographic findings were equal in the assessment of the location and type of the aneurysm. Angiography was better than MR imaging in the assessment of major branch involvement, especially left subclavian artery.