Phalangeal intraosseous well-differentiated osteosarcoma of the hand.

A case of intraosseous well-differentiated osteosarcoma in one phalanx of the hand is reported. A 78-year-old man noticed swelling in the little finger of his right hand approximately 7 years before referral. Imaging disclosed a tumour with a "ground glass" appearance and irregular mottled calcification occupying almost all of the phalanx marrow and suggested slight invasion into the soft tissue. Open biopsy suggested a diagnosis of well-differentiated fibroblastic osteosarcoma. The finger and its metacarpal bone were amputated and a tumour measuring 3.5 x 2.2 x 2.0 cm and with an indistinct soft tissue margin was found in the bone marrow. Histologically, the tumour was composed of fibroblastic cells with few mitoses, and neoplastic bone formation was apparent. Although the tumour appeared to be a fibrous dysplasia, the presence of nuclear atypia, hypercellularity, and the absence of a typical woven bone pattern in addition to the soft tissue invasion indicated otherwise. Ultrastructural examination showed focal myofibroblastic differentiation, and immunohistochemistry revealed smooth muscle actin, vimentin, osteocalcin, osteonectin and MIBI in the tumour cells. This ultrastructural and immunohistochemical study is believed to be the first detailed report of an intraosseous well-differentiated osteosarcoma of phalangeal bone.

A case of bilateral reversible thalamic lesions.

We describe a case of bilateral reversible thalamic lesions with no neurological deficits and a good prognosis. The lesions appeared as low-density areas on CT and high-intensity areas on T2-weighted MR imaging, and resolved within 1 month, suggesting that the cause was edema.

Dermatofibrosarcoma protuberans. CT findings with pathologic correlation in 6 cases.

PURPOSE: To characterize the CT findings of dermatofibrosarcoma protuberans. MATERIAL AND METHODS: CT and pathologic specimens of 6 patients with dermatofibrosarcoma protuberans (5 in the trunk and 1 in the leg) were retrospectively reviewed. RESULTS: CT clearly defined the tumors in the dermis and subcutaneous tissue with a characteristic, if not pathognomonic, protrusion. On postcontrast CT, 3 tumors showed marginal enhancement and central low density, while the others showed homogeneous enhancement. Pathologically, the marginal enhancement on CT corresponded to fibrosarcomatous changes, and the central low density to necrosis. The tumors with homogeneous enhancement had no sarcomatous changes. CONCLUSION: CT allows detection and precise anatomic localization of dermatofibrosarcoma protuberans. Marginal enhancement with central low density on CT may suggest a relatively poor prognosis.

Minnesota Multiphasic Personality Inventory correlates of panic disorder with agoraphobia: changes with treatment.

Forty-seven patients meeting DSM-III-R criteria for panic disorder with agoraphobia (PAG) were assessed by the Minnesota Multiphasic Personality Inventory (MMPI) at baseline and after 8 weeks of treatment with imipramine, clomipramine and placebo. At pre-treatment patients had higher MMPI scores than the local normative data, the highest scores being for depression, hypochondria and hysteria. At week 8 the scores of most MMPI scales were significantly reduced. In addition, patients who showed clinical improvement had pre- and post-treatment scores lower than the unimproved patients. The results suggest that the abnormal MMPI profile found in PAG patients reflects the clinical state and that personality pathology relates to treatment outcome. The reduction in MMPI scores was associated with response to active treatment. We conclude that therapeutic interventions that successfully reduce PAG symptoms also modify personality scores.

Minnesota multiphasic personality inventory correlates of panic disorder with agoraphobia: changes with treatment

Forty-seven patients meeting DSM-III-R criteria for panic disorder with agoraphobia (PAG) were assessed by the Minnesota Multiphasic Personality Inventory (MMPI) at baseline and after 8 weeks of treatment with imipramine, clomipramine and placebo. At pre-treatment patients had higher MMPI scores than the local normative data, the highest scores being for depression, hypochondria and hysteria. At week 8 the scores of most MMPI scales were significantly reduced. In addition, patients who showed clinical improvement had pre - and post-treatment scores lower than the unimproved patients. The results suggest that the abnormal MMPI profile found in PAG patients reflects the clinical state and that personality pathology relates to treatment outcome. The reduction in MMPI scores was associated with response to active treatment. We conclude that therapeutic interventions that successfully reduce PAG symptoms also modify personality scores

[The assessment of tumor blood flow factors using dynamic CT--a comparison with positron emission tomography].

The dynamic computed tomography (CT) was performed by using rapid-sequence scanning following an intravenous bolus injection of contrast material. Time-density curve was applied for Gamma variate curve fitting and CT attenuation values were applied for two compartment model. The value of 1/CM, k1 and k2 were defined as the blood flow factors in this study. The inhalation of C15O2 using positron emission tomography (PET) can be useful for determining regional tumor blood flow (rBF). CT and PET were performed in twelve patients. The diagnosis was malignant lymphoma in four, and others; two liver metastasis, one focal nodular hyperplasia of the liver, one dermatofibrosarcoma, one hepatocellular carcinoma, one malignant melanoma, one malignant meningioma, one bone metastasis. The correlations among rBF, 1/CM, and k1 were good, and better correlations were obtained among tumor blood flow factors and rBF in the case of the tumors which existed far from air way and/or had low blood flow. The distance from air way effected both the value of rBF and tumor blood flow factors. Both the distance from air way and pathology caused conflicting results between rBF and tumor blood flow factors. Dynamic CT was particularly useful for evaluated the blood flow of tumors that had contact with air way.

Clomipramine, a better reference drug for panic/agoraphobia. I. Effectiveness comparison with imipramine.

An 8-week, double-blind, flexible-dose trial comparing low doses of clomipramine (mean=50 mg) with moderate doses of imipramine (mean=113.8 mg and propanteline (active placebo), was carried out in 60 out-patients with panic disorder with or without agoraphobia. Efficacy evaluation included global, anxiety and depression rating scales, and the determination of rates of relapse over up to 10 weeks of single-blind placebo follow-up. Both tricyclics were significantly more effective than propanteline, but clomipramine tended to act faster and more consistently than imipramine on most measures. Given the degree of blindness achieved and the significantly lower doses of clomipramine, this seems a better reference drug than imipramine for clinical trials in panic/agoraphobia.

[CT of pulmonary dirofilariasis--differential diagnosis from lung cancer].

We present here four cases of pulmonary dirofilariasis in which histological examination of the surgical specimen showed occlusion of the peripheral pulmonary artery by filariae and formation of a necrotic mass surrounded by reactive inflammation and hemorrhage. Radiological examination showed a solitary pulmonary nodule in three cases and a wedge-shaped consolidation in one case. Although pulmonary nodules in dirofilariasis closely mimic bronchogenic carcinoma on radiographs , it is possible to distinguish them from bronchogenic carcinoma on the basis of the following findings: (1) coexistence of subtle satellite lesions, (2) absence of pleural involvement, (3) fine marginal speculations, and (4) lack of concentric marginal speculations (eccentric speculation). In each case of dirofilariasis, CT showed the peripheral pulmonary artery entering the mass. This finding differentiates this disease from metastatic lung tumor, because in tumor metastasis via the pulmonary arteries, visible vessels are not usually involved.