Sentinel Lymph Node Biopsy Using Technetium- 99m Antimony Sulfide Colloid and Isosulfan Blue Dye in Breast Cancer Patients / 한국유방암학회지

PURPOSE: Sentinel lymph node (SLN) biopsy is a useful method for assessing axillary nodal status and selecting axillary dissection in breast cancer patients. The goals of our study were to evaluate the detection rate of SLN and determine the accuracy of SLN biopsy in predicting axillary nodal status using technetium radiolabeled sulfur colloid and isosulfan blue dye. METHODS: Between January and August 2001, 55 breast cancer patients with clinically node negative results underwent SLN biopsy from the Department of Surgery at Ajou University Hospital. Both technetium radiolabeled sulfur colloid and isosulfan blue dye were used to guide SLN biopsy. SLN biopsy was always followed by a complete axillary dissection. The histopathology of SLNs determined from frozen sectioning and serial sectioning was compared with that of the nonsentinel nodes evaluated with routine Hematoxylin and Eosin stain. RESULTS: The overall SLN detection rate was 85.4% (47 of 55 patients). The staging accuracy of SLN biopsy was 97.9% (46 of 47 patients), the sensitivity 92.3% (12/13), the false negative rate 7.7% (1/13), and the negative predictive value 97.1% (34 of 35). CONCLUSION: Our study was a pilot study for SLN biopsy. SLN biopsy was more effective when a combination of technetium radiolabeled sulfur colloid and isosulfan blue dye were used. The results of our study support the hypothesis that SLN biopsy is an accurate predictor of axillary nodal status. SLN biopsy may be applicable to early breast cancer patients and thereby allow the omission of routine axillary dissection in selected cases.

Sentinel Lymph Node Biopsy Using Technetium- 99m Antimony Sulfide Colloid and Isosulfan Blue Dye in Breast Cancer Patients

PURPOSE: Sentinel lymph node (SLN) biopsy is a useful method for assessing axillary nodal status and selecting axillary dissection in breast cancer patients. The goals of our study were to evaluate the detection rate of SLN and determine the accuracy of SLN biopsy in predicting axillary nodal status using technetium radiolabeled sulfur colloid and isosulfan blue dye. METHODS: Between January and August 2001, 55 breast cancer patients with clinically node negative results underwent SLN biopsy from the Department of Surgery at Ajou University Hospital. Both technetium radiolabeled sulfur colloid and isosulfan blue dye were used to guide SLN biopsy. SLN biopsy was always followed by a complete axillary dissection. The histopathology of SLNs determined from frozen sectioning and serial sectioning was compared with that of the nonsentinel nodes evaluated with routine Hematoxylin and Eosin stain. RESULTS: The overall SLN detection rate was 85.4% (47 of 55 patients). The staging accuracy of SLN biopsy was 97.9% (46 of 47 patients), the sensitivity 92.3% (12/13), the false negative rate 7.7% (1/13), and the negative predictive value 97.1% (34 of 35). CONCLUSION: Our study was a pilot study for SLN biopsy. SLN biopsy was more effective when a combination of technetium radiolabeled sulfur colloid and isosulfan blue dye were used. The results of our study support the hypothesis that SLN biopsy is an accurate predictor of axillary nodal status. SLN biopsy may be applicable to early breast cancer patients and thereby allow the omission of routine axillary dissection in selected cases.

Nonbronchial Systemic Feeding Arteries in Patients with Hemoptysis: Predictive Factors at Radiography

PURPOSE: To determine the radiographic findings which predict the presence of nonbronchial systemic feeding arteries (NBFAs) in patients undergoing embolotherapy to control hemoptysis. MATERIALS AND METHODS: In 48 patients (39 men and 9 women; mean age, 51 years) who underwent embolotherapeutic procedures for controlling hemoptysis, selective angiography was performed at the intercostal, subclavian and bronchial arteries in 65 hemithoraces (right 11, left 20, bilateral 17). Underlying diseases were tuberculosis (n=34, including three patients with aspergilloma), bronchiectasis (n=11), paragonimiasis(n=2) and metastatic cancer (n=1). The presence of NBFA at angiography was correlated with radiographic findings including pleural thickening, parenchymal distortion, and the location of lung lesions. RESULTS: NBFAs were found in 34 (77%) of 44 hemithoraces with pleural thickening, and in six (29%) of 21 without pleural thickening; the sensitivity and specificity of prediction were 85% and 60%, respectively. NBFAs were observed with greater frequency as the thickness of the pleura increased, and the extent of pleural thickening correlated less with the presence of NBFA than did thickness. NBFAs were found in 35 (78%) of 45 hemithoraces with parenchymal distortion, and in five (25%) of 20 without distortion (p<0.001). In addition, the distribution of the underlying disease in the upper lung zone showed close correlation with the presence of NBFAs (p<0.05). CONCLUSION: In patients with hemoptysis, the pleural thickening revealed by radiography has a high sensitivity and a relatively low specificity for predicting the presence of NBFA, and patients with parenchymal distortion and upper lung lesions have a high incidence of NBFA.

Viable myocardium in reperfused acute myocardial infarction: rest and stress first-pass mr imaging

Feasibility of identifying viable myocardium in rest and stress magnetic resonance imaging (MRI) was evaluated using 3 hr occlusion and 30 min reperfusion model of left anterior descending (LAD) coronary artery in 12 felines. At rest MRI, viable myocardium confirmed by 2,3,5-triphenyl tetrazolium chloride (TTC)- staining showed rapid signal intensity (SI) rise followed by gradual decline not significantly different from normal myocardium that the two hyperperfused regions were distinguishable only from the hypoperfused nonviable myocardium. At stress MRI, hyperemia induced perfusion change was most pronounced in normal myocardium with earlier and greater peak enhancement followed by brisk 'washout' phase while minimally augmented enhancement in viable myocardium was still in 'washin' phase. From these findings, it was concluded that viable myocardium is identified in rest and stress MRI as redistributing hypo- perfusion compared to persistent hyper-perfusion of the normal myocardium and the persistent hypo-perfusion of the nonviable myocardium.

Multifocal Acute Osteomyelitis in a Mole Adolescent: A Case Report / 대한정형외과학회잡지

A 13-year-old boy developed fever and right leg pain, and multiple acupunctures were done on legs, then visited our ER for high fever, chill and painful swellings in both legs. Bone scan showed multiple hot spots on both distal femur, both proximal tibia, and left distal tibia. MRI revealed subperiosteal abscess in right proximal and left distal tibia and signal changes without abscess in other hot spot sites on bone scan. Surgical drainage of subperiosteal abscess and curettage were performed in the right proximal and the left distal tibia. Percutaneous drillings were done to other hot spot sites. All the lesions were cured after combined antibiotic chemotherapy. Multifocal osteomyelitis in a rapidly growing adolescent has been reported not rarely. It seemed that more attentions should be paid to the possibility of multifocal acute osteomyelitis in an adolescent

Popliteal Artery Occlusion after Total Hip Arthroplasty: A Case Report / 대한정형외과학회잡지

Vascular injury is a serious but rare complication of hip procedures. Most of vascular complications reported in articles occured in vessels around hip joint and femoral artery. To date, report of popliteal artery occlusion during or after total hip arthroplasty was absent. The authors have experienced one case of popliteal artery occlusion after total hip arthroplasty. It was suspected that the cause of occlusion of this particular case was a excessive maneuvering of limb during operation and then, artheromatous plaque fracture or thrombosis made occulusion in popliteal artery. Angiographic embolectomy using a catheter was performed and circulation of limb was recovered. To reduce the risk of vascular complications after total hip arthroplasty procedure, we recommend a thorough evaluation of lower extremity circulation in risky patient. And if a vascular insult is suspected either during or soon after the procedure, then a vascular consultation with arteriography including popliteal artery should be obtained urgently. Delay in treatment could result in a deleterious outcome.

Technetium-99m-methoxyisobutylisonitrile Scintigraphic Diagnosis ( Tc-99m MIBI SCAN ) of Breast Cancer

Patients with breast lesion suggestive of malignancy underwent Tc-99m MIBI scan in order to assess the value of this technique in the detection of breast carcinoma and axillary lymph node metastasis. One hundred five patients with breast lesion underwent 99m-MIBI scan before biopsy. 20mCi of Tc-99m MIBI was given intravenously in contralateral arm of the breast lesion and planar prone lateral and supine anterior views for 10 minutes each were taken. Pathological diagnoses were carcinoma in 77 breasts of 76 patients and benign in 29 patients. Pathologic types were DCIS in 4, IDC in 62, mucinous carcinoma in 3, medullary carcinoma in 2 and others in 6. The pathologic tumor status was DCIS in 4, T1 in 27 ,T2 in 30, T3 in 6, T4 in 4 and Tx is 6 cases. All patients with multiple lesions were positive. The sensitivity of Tc-99m-MIBI scan was 95%(73/77) and specificity was 69%(20/29). Sensitivity of mammography and ultrasonography were 85% and 82%. Axillary metastasis study showed 68% sensitivity and 92% specificity. The Tc-99m MIBI scan is a highly effective method in the diagnosis of breast cancer.

First-pass Perfusion Disturbance of Coronary Artery Stenosis: An Experimental Study Using MR Imaging with Gd-DTPA Enhancement

PURPOSE: In order to determine the value of first-pass MR imaging in the diagnosis of myocardial ischemia, first-pass perfusion abnormality of coronary artery stenosis was observed in MRI after gadopentate dimeglumine (Gd-DTPA) enhancement. MATERIALS AND METHODS: The left anterior descending (LAD) coronary arteries of six dogs were subjected to approximately 70% stenosis confirmed by coronary angiography. Half an hour after adenosine and 99mTc-sestamibi infusion, Gd-DTPA (0.2 mmol/kg) and methylene blue were administered and termination was induced with potassium chloride. SE T1-weighted and single-photon emission computed tomography (SPECT) images were subsequently obtained and the findings of perfusion defect compared with specimen stain. Three dimensionally reconstructed MR images were used to measure signal intensity (SI) of normal myocardium and perfusion defect from their sectional and total volume. RESULTS: Five of six dogs with LAD artey stenosis ranging from 66% to 73% displayed perfusion defect on MRI, SPECT, and specimen stain, but the remaining dog with stenosis of 58% showed no such defect. MRI showed the perfusion defect as distinct low SI, enabling the measurement of percentage perfusion defect (24.4+/-5.4%), which increased inferiorly. SI of normal myocardium and perfusion defect decreased inferiorly; their difference indicated stenosis-induced perfusion loss according to section location. Volumetric SI of normal myocardium and perfusion defect were 3.42+/-0.52 and 2.16+/-0.45, respectively (p < 0.05). CONCLUSION: Gd-DTPA enhanced MRI displayed first-pass perfusion abnormality of coronary artery stenosis as perfusion defect with distinct low SI ; this enabled the measurement of its volume and SI changes according to section location, and thus indicated the value of first-pass MR imaging in the diagnosis of myocardial ischemia.

Measurement of Total Lung Capacity: A Comparison of Spiral CT and Spirometry

PURPOSE: To determine the potential of spiral CT as a functional imaging modality of the lung asid from its proven value in morphological depiction. MATERIALS AND METHODS: Spiral CT scan was performed in ten normal female and nine normal male adults (mean age: 39, height: 163cm, weight: 62kg) after single full breath-holding. Three dimensional lung images were reconstructed (minimal threshold value: -1,000HU, maximal threshold values: -150,-250, -350, -450HU) to obtain total lung volume(TLV) on a histogram. Total lung volume measured by spiral CT was compared with TLV obtained by spirometry. RESULTS: Mean TLV measured by spirometry was 5.62 Land TLV measured by CT at maximal threshold values of -150, -250, -350, and -450HU was 6.63, 5.33, 5.15, and 4.98 L, respectively. Mean absolute differences between the modalities of 0.17L(3%), 0.32L(5.6%), 0.48L(8.5%), 0.65L(11.5) were statistically significant(p<0.001). Linear regression coefficients between the modalities were 0.99, 0.97, 0.95,and 0.94 and no statistically significant differences in accuracy of threshold levels in the estimation of lung volume(r=0.99, standard error=0.034L in all) were seen. CONCLUSION: TLV measured by spiral CT closely approximated that measured by spirometry. Spiral CT may be useful as a means of evaluating lung function.

Surface Image of Herniated Disc on Three-Dimensional CT

PURPOSE: To evaluate surface configuration of herniated disc on three-dimensional CT. MATERIALS AND METHODS: Three dimensional surface images reconstructed from CT scans(1mm thick) of 24 surgically confirmed herniated discs in 23 patients were revieved. Disc surface was classified into peripheral and central zones in contact with consecutive peripheral ring and central endplate. Surface irregularity was categorized into two types(local andgeneral). The incidence, size, and extent of local irregularity were observed. General irregularity incidence and severity ranges in 4 grades, and peripheral width were evaluated. The findings were correlated with discography. RESULTS: Local irregularity compatible with anulus tear in discography was shown in all. It was large(13/24) andmainly peripheral tract extending to disc margin in protrusion(3/5) and sequestration(5/7), and cleft encompassing central zone to disc margin in extrusion(9/12). General irregularity was predominantly grade 3(15/22) and was shown in all except in 2 puotrusions. peripheral width was 0.56 of central radius. CONCLUSION: Extrusion inherniated disc shows characteristic cleft encompassing central zone to disc margin whereas sequestration or protrusion displays tract extending from peripheral zone to disc margin. Thus, three dimensional surface imagingmay aid the diagnosis, follow-up, prediction, and treatment of herniated disc.

Storage Phosphor Digital Radiography in Portable Chest Imaging: Comparison of Image Quality with Conventional Film-Screen System with Variation of mAs

PURPOSE: To compare image quality of storage phosphor digital radiography(DR) with film-screen radiography in portable chest imaging, and to assess the minimum X-ray dose that can be applied to DR in adults without image degradation, and also to compare image qualities of low dose and standard dose DR. Materials and Methalos: A geometrical phantom similar to the human thorax was imaged by a portable radiographic unit with fixed kVp and variable m

Storage Phosphor Digital Radiography in Portable Chest Imaging: Comparison of Image Quality with Conventional Film-Screen System with Variation of mAs

PURPOSE: To compare image quality of storage phosphor digital radiography(DR) with film-screen radiography in portable chest imaging, and to assess the minimum X-ray dose that can be applied to DR in adults without image degradation, and also to compare image qualities of low dose and standard dose DR. Materials and Methalos: A geometrical phantom similar to the human thorax was imaged by a portable radiographic unit with fixed kVp and variable m

Surface Image of Normal Intervertebral Disc on 3 Dimensional CT

PURPOSE: To evaluate surface configuration of intervertebral disc on three dimensional CT. MATERIALS AND METHODS: Three dimensional surface images reconstructed from CTscans(1 mm thick) of 20discs in 14 healthy adults were reviewed. Disc surface was classified into peripheral and central zones in contact with consecutive peripheral ring and central endplate. Local irregularity incidence, pattern in radial, concentric, or mixed form, size, location, and extension were observed. Incidence and severity ranges in 4 grades of general irregularity, and peripheral width relative to central radius were evaluated. RESULTS: Normal disc mostly showed smooth surface with few display of small local irregularity(6/20) which was mainly radial in pattern(4/5), posterolaterally located(4/6), and confined within peripheral zone(5/6). General irregularity displayed(5/20) was all grade I and peripheral width was 0.82 of central radius. CONCLUSION: Normal disc shows smooth surface but few may display small local irregularity maybe due to very early degenerative change.

MR Findings of Multiple Sclerosis in Spinal Cord

PURPOSE: To analyze the MR imaging features of multiple sclerosis (MS) in spinal cord. MATERIALS AND METHODS: Nine MR (magnetic resonance) images of six patients with suspected MS were retrospectively evaluated in active phase (n=6) and inactive phase (n=3) before and after Gadolinium-DTPA administration. RESULTS: In all patients with clinically active phase, plaques of spinal cord appeared as high signal intensity on T2-weighted image with isointense cord swelling on Tl-weighted images. All lesions were enhanced on Gd-DTPA enhanced Tl-weighted images. The patterns of enhancement were nodular, circumferential rim-like, and segmental. On follow-up images in 3 patients who became clinically stable, all enhancing lesions disappeared. CONCLUSION: MR is a good modality in detection of spinal MS, and Gd-DTPA-enhanced MR is valuable in differentiating active MS from stable MS.

Diffuse Panbronchiolitis: High-Resolution CT Findings and Correla:don with Pulmonary Function Test

PURPOSE: Diffuse panbronchiolitis(DPB) is a chronic inflammatory airway disease of unknown causes mainly affecting the respiratory bronchioles and the more proximal bronchi. Findings on chest radiographs and high-resolution CT(HRCT) are well known and Akira classified HRCT findings of DPB into four types. Purpose of this study is to evaluate the relationship between findings of HRCT and PFT. METHODS AND MATERIALS: We retrospectively analyzed the chest radiographs and HRCT images of eleven patients with DPB and compared CT classification with pulmonary function test. RESULTS: Chest radiographs usually showed small nodular opacities throughout the both middle and lower lungs. The HRCT findings of DPB were centrilobularly distributed small nodular densities, branching linear densities contiguous with small round densities, dilated and thickened peripheral and central airways including bronchioles. More than one CT type by Akira's classification, usually two or three types, were found in nine patients. There was good correlation between CT types and FEV1%(p<0.05), CT types and FEV1/FVC (p<0.05) respectively. CONCLUSION: HRCT seems to be more useful for diagnosis and disease progression of DPB as compared with the chest radiographs or clinical stage such as pulmonary function test.

Anatomy of Pulmonary Lobes and Fissure: A Study Utilizing HRCT

PURPOSE: This study was performed to evaluate the features of pulmonary lobes and fissure in Korean and to compare with the previous results. MATERIALS AND METHODS: HRCT scans of 82 healthy Korean adults, performed with scan interval of 1.5/2.0 cm, were reviewed. RESULTS: Located mostly on inner aspect, incidences of incomplete oblique and horizontal fissure were 60% (Rt 48%, Lt 39%) and 51% respectively, lower than 70--80% and 60--75% of western studies. Superolateral oblique fissure, inferior accessory fissure, left horizontal fissure and other accessory fissure were shown in 1%, 13%, 7%, and 8% respectively. Lower lobe upper part faced laterally (Rt 91%, Lt 82%) while lower part faced medially (Rt 61%, Lt 79%). Right middle lobe ws highest posteromedially (49%) and was convex (97%). CONCLUSION: Features of pulmonary lobes and fissure in Korean were similar to the results of previous reports but with lower incidence of variation.

Experimental Embolization Using Histoacryl Blue (N-butyl 2-cyanoacrylate) in Pig Rete Mirabile

PURPOSE: This study was performed to evaluate any difference in the penetration of the acrylic glue into the pig rete mirabile according to the difference of the concentration of the glue mixture. MATERIALS AND METHODS: Three domestic pigs (12-15kg) were used. After obtaining a normal angiography, two different concentrations of 1:1 and 0.5:1 of Histoacryl Blue mixture with Lipiodol were administrated into pig rete mirabile and then anglographic and pathologic findings were analyzed after taking a postembolization angiography. RESULTS: The degree of the penetration of the glue mixture into the pig rete was different in the anglographic and pathologic findings according to the glue mixture ratio. In case of using 0.5:1 mixture of glue and Lipiodol, glue penetrated into the smaller vessels with size of about 80 micro rn than in case of using 1:1 mixture of glue and Lipiodol. CONCLUSION: Because the polymerization time of glue mixture will be different according to the concentration of glue mixture, a mixture with thin glue concentration seemed to penetrate deeply into the pig rete.

CT evaluation of colon carcinoma: Emphasis on distant lymph node invasion and liver metastases

Even though the value of computed tomography (CT) used to detect the colon carcinoma with minimal invasion is limited, its usefulnes sin the evaluation of the extent of disease such as hepatic metastasis or distant lymph node invasion has been emphasized. To examine the role of CT in the evaluation of colon carcinoma, CT scans obtained during the past 2 years in 56 patients with surgically proven colon carcinoma were reviewed and the findings correlated with pathologic results. The sensitivity and accuracy of CT for pericolic fat infiltration were 86, 58 and 80% respectively. Those of regional node were 60, 83 and 75% and distant node 67, 100 and 95%. Liver metastases showed sensitivity, specificity and accuracy of 83, 98, 96% and peritoneal metastases 67, 94 and 89% respectively. CT detected local invasion with fair degree of accuracy but the true value of CT lie in the detection of distant invasions such as liver and distant lymph node metastases thereby leading to preclusion of unnecessary procedures and implementation of appropriate precedures.

Nosocomial pneumonia in medico-surgical intensive care unit

Cases of hospital acquired pneumonia occurring during the 1st 12 months of Medico-Surgical ICU (Intensive care unit, MSICU) in operation were evaluated retrospectively to determine its incidence, common causative pathogens, outcome and radiological patterns with the new hospital setting providing a unique relatively aseptic environment. Among the 920 admitted patients, 73 episodes of nosocomial pneumonia on 63 patients were identified and the incidence rate was 7%. The most common pathogens were Pseudomonas. Staphylococcus, Serratia, and Enterobacter in the order of frequency of occurrence, and the gram-negative pathogens comprised 70%. Nosocomial pneumonia was more common after use of antibiotics due to such pathogens as Enterobacter, Acinetobacter, and Candida which caused poor outcome. Enterobacter had the greatest tendency to be related with poor outcome and Serratia the least. Overall mortality was 25%. Bronchopneumonia was the most common type of pneumonia caused by any pathogen except Acinetobacter which caused a mixed type of nosocomial pneumonia.