ABSTRACT
PURPOSE: There have been recent studies of the 18F-fluorodeoxyglucose positron emission tomography and computed tomography (18F-FDG PET/CT) in the staging, detection, and follow-up of the breast cancer occurrence and recurrence. There was controversy concerning the use of 18F-FDG PET/CT for staging primary breast cancer. In this study, we investigated the potential effects of 18F-FDG PET/CT in the initial assessment of patients with primary breast cancer. METHODS: From January 2008 to December 2009, 154 consecutive biopsy-proven invasive breast cancer patients were enrolled in this study. Patients underwent conventional imaging studies including mammography, breast ultrasonography (USG), and magnetic resonance imaging for local assessment, and plain chest X-ray, liver USG, and bone scan to rule out distant metastasis. All 154 patients underwent 18F-FDG PET/CT in the initial assessment. RESULTS: 18F-FDG PET/CT did not detect primary breast lesions in 16 patients with a sensitivity of 89.6% and detected only 5 multiple lesions (12.5%) out of 40 cases. Histologically confirmed axillary lymph node (LN) metastases were in 51 patients, and the sensitivity and specificity of 18F-FDG PET/CT to detect metastatic axilla were 37.3% and 95.8%, respectively; whereas the corresponding estimates of USG were 41.2% and 93.7%, respectively. Eleven extra-axillary LN metastases were found in eight patients, and seven lesions were detected by 18F-FDG PET/CT only. The sensitivity and specificity of 18F-FDG PET/CT in detecting distant metastasis were 100% and 96.4%, respectively; whereas the sensitivity and specificity of the conventional imaging were 61.5% and 99.2%, respectively. CONCLUSION: 18F-FDG PET/CT cannot be recommended as a primary diagnostic procedure in breast cancer, but it has the potential to be used as an additional imaging tool for the detection of axillary metastasis, distant metastasis, and extra-axillary LN metastasis. 18F-FDG PET/CT cannot solely replace the conventional diagnostic procedure in primary breast cancer. The best approach may be the combination of different imaging modalities.
Subject(s)
Humans , Axilla , Breast , Breast Neoplasms , Diagnostic Imaging , Fluorodeoxyglucose F18 , Follow-Up Studies , Liver , Lymph Nodes , Magnetic Resonance Imaging , Mammography , Neoplasm Metastasis , Positron-Emission Tomography , Positron Emission Tomography Computed Tomography , Recurrence , Sensitivity and Specificity , Thorax , Ultrasonography, MammaryABSTRACT
PURPOSE: Hemodialysis remains the most important support for patients with end stage renal disease, and vascular access is an essential component for their life. Since 1966, internal arteriovenous fistula (AVF) has been used widely today. If vessels were not available for AVF, the alternative would be used such as prosthetic graft. But in 1997, the National Kidney Foundation-Dialysis Outcome and Quality Initiative (DOQI) recommended increased use of native arteriovenous fistula to improve overall patency and curtail angioaccess costs. This retrospective study is to review our experience and to evaluate the overall patency rate and the influencing factors on the patency of the AVF. METHOD: From March 1995 through October 2000, 111 fistulas were created of 111 patients in Eulji university hospital. Among them, 106 cases were able to follow up survey. The statistical analysis used by SPSS package. RESULT: The male versus female ratio was 1.22:1 and the age distribution was occurred on from 3rd decade to 9th decade. the common causes of renal failure was hypertension, glomerulonephritis and diabetes (62.1%). the autogenous graft fistulas were performed in 101 cases (wrist/antecubital fossa. 101/3), Goretex graft fistula were 7 cases. The early graft failures were 12 cases (11.4%) and the causes was thrombosis or stricture, and immaturation, psudoaneurysm, venous hypertension in order of frequency. At 12, 24, 36 months, the assisted patency rates of AVF were 80.4, 76.5, 71.3%, respectively. CONCLUSION: We could get higher patency rate of AVF due to liberal use of native veins and aggressive intervention of the failing AVF as recommendation of DOQI.
Subject(s)
Female , Humans , Male , Age Distribution , Arteriovenous Fistula , Constriction, Pathologic , Fistula , Follow-Up Studies , Glomerulonephritis , Hypertension , Kidney , Kidney Failure, Chronic , Polytetrafluoroethylene , Renal Dialysis , Renal Insufficiency , Retrospective Studies , Thrombosis , Transplants , VeinsABSTRACT
BACKGROUND: A laparoscopic cholecystectomy has many clinical advantages and is now recognize as the choice for treatment for gallstones. However a laparoscopic cholecystectomy is often not feasible or is converted to the conventional open method in patients with acute cholecystitis because of surrounding adhesion, tissue edema, and high postoperative complications. Lately, good clinical results have been reported by many authors for a percutaneous cholecystostomy followed by a laparoscopic cholecystectomy in the management of acute cholecystitis. METHODS: Between January 1996 and March 1997, 56 acute cholecystitis patients were surgically treated in our institution. Thirteen patients underwent percutaneous drainage followed by a laparoscopic cholecystectomy (Group I). Also a laparoscopic cholecystectomy without a prior percutaneous cholecystostomy was attempted in 43 patients (Group II). RESULTS: There were no differences in the age and the sex distributions, the chief complaints on admission, and the severity of inflammation between the two groups. The only significant difference was the wall thickness of the gallbladder on postoperative pathologic examinations, 4.7 mm for Group I and 6.2 mm Group II (p=0.038). For the patients in Group I, percutaneous drainage of the gallbladder continued for 5.4 days on average, and the cholecystectomy was usually performed about 15 days later. A laparoscopic cholecystectomy was possible in 10 patients (76%) in Group I, but had to be converted to the open method in 3 patients. In Group II, only 17 patients (39.5%) out of 43 underwent a successful laparoscopic cholecystectomy. In other words, the open conversion rate was 24% in Group I and 60.5% in Group II. The wall thicknesses of the gallbladder excised laparoscopically were 3.98 mm and those of the conventionally removed gallbladder were 6.96 mm on average. This difference in the wall thickness was statistically significant (p=0.013) and was the only factor related with the open conversion rate. CONCLUSIONS: We think that a laparoscopic cholecystectomy performed several days after percutaneous drainage of the gallbladder to eliminate acute inflammation may be recommended for management of acute cholecystitis patients with severe clinical symptoms and ultrasonographic findings of marked gallbladder dilatation or pericholecystic fluid collection.