Characteristics of Peripheral versus Central Lung Cancer Since 2000 / 고신대학교의과대학학술지

OBJECTIVES: The aim of this study was to explore the changes of bronchoscopic features according to epidemiologic change of lung cancer. METHODS: We performed a retrospective review of the clinical characteristics of 1,139 lung cancer patient who underwent bronchoscopy at Kosin University Hospital from January 2000 to December 2010. RESULTS: The age of patients increased significantly during the last decade (P < 0.001). The most common histological type was adenocarcinoma (38.1%), followed by squamous carcinoma (35.7%) and small cell carcinoma (15.3%). There was an increasing incidence of adenocarcinoma over the time (P < 0.001). Bronchoscopic feature were divided into two classes; central type, peripheral type. The peripheral type was predominant (62.3%). The proportion of peripheral type has been increased in process of time (49.7% vs. 63.7% vs. 73.7%; P < 0.01). Among the major histopathologic type of lung cancer, adenocarcinoma (81.3%) and unclassifiable non-small-cell lung cancer (73.4%), small cell carcinoma (56.9%) were associated with preferential occurrence of peripheral type. Squamous cell carcinoma of the lung more often arised in central type (59%). However, the proportion of peripheral squamous cell carcinoma has been increased. On the subgroup analysis, the median survival time of peripheral type with adenocarcinoma and small cell carcinoma were longer than central type (P < 0.05). CONCLUSIONS: The age of the lung cancer patients at diagnosis was getting older. The most frequent histopathologic type was adenocarcinoma. The proportion of peripheral type lung cancer gradually increased over the time. The survival time of peripheral type lung cancer was longer than central type.

Alterations of Regional Cerebral Blood Flow in Major Depressive Disorder / 핵의학분자영상

PURPOSE: The authors analyzed how the regional cerebral blood flow (rCBF) findings of patients with major depression differ from the normal control, and our results were compared to previous reports. MATERIALS AND METHODS: Twelve patients fulfilling DSM-IV criteria for major depression who were off all psychotropic medications for >4weeks (male: 7, female: 5, age range: 19~52 years, average age: 29.3+/-9.9 years) and 14 normal volunteers (male: 8, female: 6, age range: 19~53 years, average age: 31.4+/-9.2 years) were recruited. Images of brain perfusion SPECT were obtained using Tc-99m ECD and patterns of the rCBF were compared between patients with major depression and the healthy control subjects. RESULTS: The patients with major depression showed increase of the r-CBF in right lingual gyrus, right fusiform gyrus, left lingual gyrus, left precuneus, and left superior temporal gyrus, and showed decrease of r-CBF in right pons, left medial frontal gyrus, cingulate gyrus of left limbic lobe, cingulate gyrus of right frontal lobe, and cingulate gyrus of right limbic lobe compared to the normal control. CONCLUSION: The Tc-99m ECD brain perfusion SPECT findings in our study did not differ from the previously reported regional cerebral blood flow pattern of patients with major depression. Especially, decreased rCBF pattern typical to major depression patients in the right pons, left medial frontal gyrus, and cingulate regions was clearly demonstrated.

Role of 18F-fluorodeoxyglucose PET/CT in Recurrent Ovary Cancer / 핵의학분자영상

PURPOSE: To date, anatomical imaging modalities of the pelvis and tumor markers have been the mainstay of surveillance for recurrent ovary cancer. This study aimed to assess the role of 18F-FDG PET/CT in evaluation of ovary cancer recurrences, especially in comparison with enhanced CT and tumor marker CA 125. Materials and METHODS: 73 patients who had PET/CT scan for restaging of confirmed ovary cancer, and additional imaging with enhanced CT of the pelvis within one month were included. CA 125 level was available in all patients. From the PET/CT images, maximum standard uptake values (SUVmax) of suspected recurrence sites were recorded. Confirmation was available through re-operation or biopsy in 26 cases, and clinical assessment with series of follow-up images in 47. RESULTS: PET/CT had 93% sensitivity and 88% specificity for detecting recurrent ovary cancer. Enhanced CT of pelvis had sensitivity and specificity of 83% and 88%, and CA 125 50% and 95%. CONCLUSION: PET/CT has higher sensitivity for detecting recurrent ovary cancer compared to enhanced CT though the differences were not significant. PET/CT has significantly higher sensitivity than CA 125. However, the three tests all agreed in only 43% of the recurrence cases, and recurrence should be suspected when any of the tests, especially PET/CT, show positive findings.

The Role of fluorodeoxyglucose PET in the management of breast cancer / 한양의대학술지

In breast cancer, FDG PET is more accurate than conventional imaging methods for detecting distant metastases or local recurrences, and enables early ssessment of treatment response in patients undergoing primary chemotherapy. Though FDG PET has limited sensitivity in detecting tumor of small size, well differentiated tumor or lobar carcinoma, and regional lymph node metastasis, FDG PET is useful in cases with obscure MR images and axillary lymph node metastasis in locally advanced breast cancer. To minimize the side effects and cost of chemotherapy, imaging methods are required to monitor theresponse to chemotherapy, early and accurately. FDG PET is the appropriate method for this purpose. We reviewed the role of FDG-PET in diagnosis and initial staging of breast cancer, monitoring response to chemotherapy, and identifying metastatic and recurrent disease.

Brain Abscess Uptake at Tl-201 Brain SPECT / 핵의학분자영상

A 22-year-old woman with a history of acute lymphoblastic leukemia was hospitalized for headache and vomiting. CT scan showed a well-defined, ring like enhancing mass in the left frontal lobe with surrounding edema and midline shift. Magnetic resonance imaging demonstrated a round homogeneous mass with a ring of enhancement in the left frontal lobe. Tl-201 brain SPECT showed increased focal uptake coinciding with the CT and MRI abnormality. Aspiration of the lesion performed through a burr hole yielded many neutrophils, a few lymphocytes and histiocytes with some strands of filamentous microorganism-like material. Modified AFB stained negative for norcardia. Gram stain showed a few white blood cells and no microorganism. Antibiotics were started and produced a good clinical response. After one month, CT scan showed markedly reduction in size and extent was observed.

Epidural Blood Patch in Patient with Spontaneous Intracranial Hypotension: A case report / 대한마취과학회지

Spontaneous intracranial hypotension is a syndrome characterized by postural headache without trauma, spinal anesthesia or other medical history. The headache is usually resolved in a few days or weeks if the patient remains in bed with good hydration. Relief can usually be obtained by the application of a blood patch, by injecting 10-20 ml of the patient's own blood into the epidural space close to the leakage site. In the overwhelming majority of patients, the leak is at the level of the spine, particularly the thoracic spine and cervicothoracic junction. Spontaneous intracranial hypotension presenting with mental change has rarely been reported. We report a 39 years old male patient who was diagnosed with spontaneous intracranial hypotension. The patient experienced continuous headache followed by slight mental change. The patient was successfully managed by 3 episodes of epidural blood patch.

Epidural Blood Patch in Patient with Spontaneous Intracranial Hypotension: A case report / 대한마취과학회지

Spontaneous intracranial hypotension is a syndrome characterized by postural headache without trauma, spinal anesthesia or other medical history. The headache is usually resolved in a few days or weeks if the patient remains in bed with good hydration. Relief can usually be obtained by the application of a blood patch, by injecting 10-20 ml of the patient's own blood into the epidural space close to the leakage site. In the overwhelming majority of patients, the leak is at the level of the spine, particularly the thoracic spine and cervicothoracic junction. Spontaneous intracranial hypotension presenting with mental change has rarely been reported. We report a 39 years old male patient who was diagnosed with spontaneous intracranial hypotension. The patient experienced continuous headache followed by slight mental change. The patient was successfully managed by 3 episodes of epidural blood patch.

Repeated Ventricular Fibrillation during Emergence of General Anesthesia Caused by Variant Angina: A case report / 대한마취과학회지

Variant angina is characterized by recurrent attacks of chest pain occurring at rest and associated with ST segment elevation on EKG and its cause is now established to be spasm of a major coronary artery. In patient with variant angina coronary artery spasm can be provoked by a number of physiologic maneuver, hyperventilation and pharmacologic agents such as ergonovine, histamine, epinephrine, methacholine, and dopamine. This may be associated with acute myocardial infarction and severe cardiac arrhythmia including ventricular tachycardia and fibrillation as well as sudden death. We present a case of repeated ventricular fibrillation that occured in a 60 years old male patient at the emergence from anesthesia. The cause of venticullar fibrillation was strongly suspected of variant angina on the basis of EKG findings. The patient was successfully resucitated by intensive treatment and nitroglycerine infusion. The patient recovered uneventfully and diagnosed variant angina by ergonovine test performed after recovery.

Effects of Lidocaine and Airway Epithelium on Tension in the Rat Tracheal Smooth Muscle / 대한마취과학회지

BACKGROUND: Lidocaine is often administered intravenously to suppress airway reflexes associated with tracheal intubation or tracheal suction. In addition, lidocaine is known to have airway relaxant effects through a direct relaxant mechanism on the smooth muscle. The presence of airway epithelium has been reported to reduce the sensitivity and maximum contractile response to histamine or acetylcholine(ACh). The purpose of this study was to determine whether the cumulative application of lidocaine may cause a concentration-dependent relaxation of the rat tracheal smooth muscle strips with intact or rubbed epithelium. METHODS: Using the rat tracheal smooth muscle strips, the effects of 10 6~3 10 3M of lidocaine pretreatment on isometric tension induced by 40 mM of K+ or 10 5M of ACh in presence or absence of adherent epithelium, and the influences of 10 6M of propranolol, 10 4M of L-NAME and 10 6M of atropine on relaxing response of lidocaine were studied. RESULTS: The tracheal smooth muscle concentration induced by K+ and ACh was similar magnitude both in presence or absence of adherent epithelium. The removal of epithelium did not affect the relaxant effect of lidocaine on the K+ and ACh-induced tracheal smooth muscle contraction. Lidocaine pretreatment reduced Ca2+-dependent contraction of the rat tracheal smooth muscle. Following pretreatment of the tracheal smooth muscle preparations respectively with propranolol, L-NAME and atropine the relaxing responses to lidocaine of tracheal smooth muscle were not depressed. CONCLUSIONS: These results suggest that the effect of the epithelium on lidocaine-induced relaxation of the tracheal smooth muscle is not significant and lidocaine may directly relax tracheal smooth muscle by the influences on the Ca2+ mobilization.