Electrodeless conductivity tensor imaging (CTI) using MRI: basic theory and animal experiments

The electrical conductivity is a passive material property primarily determined by concentrations of charge carriers and their mobility. The macroscopic conductivity of a biological tissue at low frequency may exhibit anisotropy related with its structural directionality. When expressed as a tensor and properly quantified, the conductivity tensor can provide diagnostic information of numerous diseases. Imaging conductivity distributions inside the human body requires probing it by externally injecting conduction currents or inducing eddy currents. At low frequency, the Faraday induction is negligible and it has been necessary in most practical cases to inject currents through surface electrodes. Here we report a novel method to reconstruct conductivity tensor images using an MRI scanner without current injection. This electrodeless method of conductivity tensor imaging (CTI) utilizes B1 mapping to recover a high-frequency isotropic conductivity image which is influenced by contents in both extracellular and intracellular spaces. Multi-b diffusion weighted imaging is then utilized to extract the effects of the extracellular space and incorporate its directional structural property. Implementing the novel CTI method in a clinical MRI scanner, we reconstructed in vivo conductivity tensor images of canine brains. Depending on the details of the implementation, it may produce conductivity contrast images for conductivity weighted imaging (CWI). Clinical applications of CTI and CWI may include imaging of tumor, ischemia, inflammation, cirrhosis, and other diseases. CTI can provide patient-specific models for source imaging, transcranial dc stimulation, deep brain stimulation, and electroporation.

A Pathophysiological Validation of Collagenase II-Induced Biochemical Osteoarthritis Animal Model in Rabbit

BACKGROUND: Current dilemma working with surgically-induced OA (osteoarthritis) model include inconsistent pathological state due to various influence from surrounding tissues. On the contrary, biochemical induction of OA using collagenase II has several advantageous points in a sense that it does not involve surgery to induce model and the extent of induced cartilage degeneration is almost uniform. However, concerns still exists because biochemical OA model induce abrupt destruction of cartilage tissues through enzymatic digestion in a short period of time, and this might accompany systemic inflammatory response, which is rather a trait of RA (rheumatoid arthritis) than being a trait of OA. METHODS: To clear the concern about the systemic inflammatory response that might be caused by abrupt destruction of cartilage tissue, OA was induced to only one leg of an animal and the other leg was examined to confirm the presence of systemic degenerative effect. RESULTS: Although the cartilage tissues were rapidly degenerated during short period of time upon biochemical induction of OA, they did not accompanied with RA-like process based on the histology data showing degeneration of articular cartilage occurred only in the collagenase-injected knee joint. Scoring evaluation data indicated that the cartilage tissues in non-induced joint remained intact. Neutrophil count transiently increase between day 8 and day 16, and there were no significant change in other complete blood count profile showing a characteristics of OA disease. CONCLUSION: These study shows that biochemically induced cartilage degeneration truly represented uniform and reliable OA state.

Realistic Electric Field Mapping of Anisotropic Muscle During Electrical Stimulation Using a Combination of Water Diffusion Tensor and Electrical Conductivity / 대한배뇨장애요실금학회지

PURPOSE: To realistically map the electric fields of biological tissues using a diffusion tensor magnetic resonance electrical impedance tomography (DT-MREIT) method to estimate tissue response during electrical stimulation. METHODS: Imaging experiments were performed using chunks of bovine muscle. Two silver wire electrodes were positioned inside the muscle tissue for electrical stimulation. Electric pulses were applied with a 100-V amplitude and 100-μs width using a voltage stimulator. During electrical stimulation, we collected DT-MREIT data from a 3T magnetic resonance imaging scanner. We adopted the projected current density method to calculate the electric field. Based on the relation between the water diffusion tensor and the conductivity tensor, we computed the position-dependent scale factor using the measured magnetic flux density data. Then, a final conductivity tensor map was reconstructed using the multiplication of the water diffusion tensor and the scale factor. RESULTS: The current density images from DT-MREIT data represent the internal current flows that exist not only in the electrodes but also in surrounding regions. The reconstructed electric filed map from our anisotropic conductivity tensor with the projected current density shows coverage that is more than 2 times as wide, and higher signals in both the electrodes and surrounding tissues, than the previous isotropic method owing to the consideration of tissue anisotropy. CONCLUSIONS: An electric field map obtained by an anisotropic reconstruction method showed different patterns from the results of the previous isotropic reconstruction method. Since accurate electric field mapping is important to correctly estimate the coverage of the electrical treatment, future studies should include more rigorous validations of the new method through in vivo and in situ experiments.

Capsanthin Inhibits both Adipogenesis in 3T3-L1 Preadipocytes and Weight Gain in High-Fat Diet-Induced Obese Mice

Adipogenesis in murine preadipocyte 3T3L-1 has been used as a model system to study anti-obese bioactive molecules. During adipogenesis in 3T3-L1 preadipocytes, we found that capsanthin inhibited adipogenesis (IC₅₀; 2.5 μM) and also showed lipolytic activity in differentiated adipocytes from the preadipocytes (ED₅₀ ; 872 nM). We identified that the pharmacological activity of capsanthin on adipogenesis in 3T3-L1 was mainly due to its adrenoceptor-β2-agonistic activity. In high-fat diet animal model study, capsanthin significantly enhanced spontaneous locomotive activities together with progressive weight-loss. The capsanthin-induced activation of kinetic behavior in mice was associated with the excessive production of ATP initiated by both the enhanced lipolytic activity together with accelerated oxidation of fatty acids due to the adrenoceptor β2-agonistic activity of capsanthin. Capsanthin also dose-dependently increased adiponectin and p-AMPK activity in high fat diet animals, suggesting that capsanthin has both anti-obesity and insulin sensitizing activities.

Application of 3D Surface Scanners in Forensic Science and Medicine ( I ): Digital Storage of Human Skeletons and Development of Appraisal Methods for Incident Scenes / 대한법의학회지

The aim of this project was to use 3D scanning data collected at incident scenes and various evidence to 1) develop surveying methods based on 3D data consisting of overall and detailed scene evidence, captured by long-range and micros-canner, which can be shared by personnel working in different fields such as forensic medicine, video analysis, physical analysis, traffic engineering, and fire investigation; 2) create digital storage for human skeletons and set the foundation for virtual anthropology; and 3) improve the credibility of 3D evidence by virtual remodeling and simulation of incident scenes and evidence to provide a basis for advanced and high-tech scientific investigation. Two complete skeletons of male and female were scanned using 3D micro-scanner. Each bone was successfully reproduced and assembled in virtual space. In addition, recreating evidence scheduled for invasive examination by creating RP (rapid prototype) was possible. These outcomes could play an important role in setting up the new field of virtual anthropology. Case-specific surveying methods were developed through analysis of 3D scanning data collected by long-range surface scanners at the scenes of vehicular accidents, falls, shootings, and violent crimes. A technique and recording method was also developed for detecting forged seals by micro-scanning the pressure exerted on the seal. Appraisal methods developed in this project could be utilized to secure 3D data of human skeletal remains and incident scenes, create a standard for application, and increase objectivity, reproducibility, and accuracy of scanning methods. We plan to develop case-specific 3D data analysis techniques to improve the credibility of analysis at the NFS and to establish a 3D data collection and analysis team.

Growth Status and Body Composition in Children with Central Precocious Puberty and Early Puberty

PURPOSE: The aim of this study was to analyze the growth status and body composition in children with central precocious puberty (CPP ) and early puberty (EP). METHODS: One hundred and five girls (mean age, 7.7 +/- 0.8 years) with early thelarche were included, and a gonadotropin-releasing hormone (GnRH) stimulation test was performed. We divided the subjects into two groups based on peak leuteinizing hormone (LH) levels; peak LH level > or = 5 mIU/L was diagnosed as CPP (n = 49), and peak LH level < 5 mIU/L was diagnosed as EP (n = 56). Patients' height, weight, and body composition were measured, and their body mass index (BMI) and Z-score were calculated. Fat mass (FF), fat-free mass (FFM), fat mass index (FMI), fat-free mass index (FFMI), and percent of body fat (PBF) were compared. RESULTS: Height, weight, and height Z-score were not significantly different between the CPP and EP groups. Weight Z-score (P = 0.045), BMI (P = 0.015), BMI Z-score (P = 0.006), PBF (P = 0.018), FM (P = 0.047), and FMI (P = 0.017) in the EP group were significantly greater than in the CPP group. CONCLUSION: In EP girls, increased BMI was attributed to increased FMI. Body-composition analysis might be a useful tool in monitoring life style modification during pubertal growth.

Growth Status and Body Composition in Children with Central Precocious Puberty and Early Puberty

PURPOSE: The aim of this study was to analyze the growth status and body composition in children with central precocious puberty (CPP ) and early puberty (EP). METHODS: One hundred and five girls (mean age, 7.7 +/- 0.8 years) with early thelarche were included, and a gonadotropin-releasing hormone (GnRH) stimulation test was performed. We divided the subjects into two groups based on peak leuteinizing hormone (LH) levels; peak LH level > or = 5 mIU/L was diagnosed as CPP (n = 49), and peak LH level < 5 mIU/L was diagnosed as EP (n = 56). Patients' height, weight, and body composition were measured, and their body mass index (BMI) and Z-score were calculated. Fat mass (FF), fat-free mass (FFM), fat mass index (FMI), fat-free mass index (FFMI), and percent of body fat (PBF) were compared. RESULTS: Height, weight, and height Z-score were not significantly different between the CPP and EP groups. Weight Z-score (P = 0.045), BMI (P = 0.015), BMI Z-score (P = 0.006), PBF (P = 0.018), FM (P = 0.047), and FMI (P = 0.017) in the EP group were significantly greater than in the CPP group. CONCLUSION: In EP girls, increased BMI was attributed to increased FMI. Body-composition analysis might be a useful tool in monitoring life style modification during pubertal growth.

A Case of Type II Membranoproliferative Glomerulonephritis Detected by School Urinary Screening Tests

Type II membranoproliferative glomerulonephritis (MPGN) is characterized by thickening of the glomerular basement membrane owing to electron-dense deposits on electron microscopy. We experienced a case of type II MPGN in a child presenting with proteinuria, hematuria on school urinary screening tests. He had been treated with losartan and enalapril. This is the first case report of type II MPGN detected by school urinary screening tests in Korea. Thus we report a case of 10-years-old male with type II MPGN with a review of brief literature.

Da Vinci Robot-Assisted Pulmonary Lobectomy in Early Stage Lung Cancer: 3 cases report / 대한흉부외과학회지

Video-assisted pulmonary lobectomy was introduced in the early 1990's by several authors, and the frequency of video-assisted thoracic surgery (VATS) lobectomy for lung cancer has been slowly increasing because of its safety and oncologic acceptability in patients with early stage lung cancer. However, VATS is limited by 2D imaging, an unsteady camera platform, and limited maneuverability of its instruments. The da Vinci Surgical System was recently introduced to overcome these limitations. It has a 3D endoscopic system with high resolution and magnified binocular views and EndoWrist instruments. We report three cases of da Vinci robot system-assisted pulmonary lobectomy in patients with early stage lung cancer.

F-18 FDG PET Scan findings in Patients with Pulmonary Involvement in the Hypereosinophilic Syndrome / 대한핵의학회잡지

PURPOSE: Hypereosinophilic syndrome (HES) is an infiltrative disease of eosinophils affecting multiple organs including the lung. F-18 2-fluoro-2-deoxyglucose (F-18 FDG) may accumulate at sites of inflammation or infection, making interpretation of whole body PET scan difficult in patients with cancer. This study was to evaluate the PET findings of HES with lung involvement and to find out differential PET features between lung malignancy and HES with lung involvement. MATERIAL AND METHODS: F-18 FDG PET and low dose chest CT scan was performed for screening of lung cancer. Eight patients who showed ground-glass attenuation (GGA) and consolidation on chest CT scan with peripheral blood eosinophilia were included in this study. The patients with history of parasite infection, allergy and collagen vascular disease were excluded. CT features and FDG PET findings were meticulously evaluated for the distribution of GGA and consolidation and nodules on CT scan and mean and maximal SUV of abnormalities depicted on F-18 FDG PET scan. In eight patients, follow-up chest CT scan and FDG PET scan were done one or two weeks after initial study. RESULTS: F-18 FDG PET scan identified metabolically active lesions in seven out of eight patients. Maximal SUV was ranged from 2.8 to 10.6 and mean SUV was ranged from 2.2 to 7.2. Remaining one patient had maximal SUV of 1.3. On follow-up FDG PET scan taken on from one to four weeks later showed decreased degree of initially noted FDG uptakes or migration of previously noted abnormal FDG uptakes. CONCLUSIONS: Lung involvement in the HES might be identified as abnormal uptake foci on FDG PET scan mimicking lung cancer. Follow-up FDG PET and CT scan for the identification of migration or resolution of abnormalities and decrement of SUV would be of help for the differentiation between lung cancer and HES with lung involvement.

A Case of Verrucous Carcinoma of the Hard Palate and the Nasal Floor / 대한이비인후과학회지

Verrucous carcinoma is a distinct morphologic variant of well differentiated squamous cell carcinoma that is most often seen in the oral cavity & larynx but extremely rare in the nasal cavity. This neoplasm has been characterized as a slow growing lesion in elderly smokers with poor oral hygiene. It is histologically and locally invasive but metastasis is rare. We report a case of verrucous carcinoma found in the hard palate & the nasal floor and treated by surgical excision with a review of the literature.

Cerebral Activation Associated with Visually Evoked Sexual Arousal in the Limbic System: Functional MR Imaging

PURPOSE: To identify the brain centers associated with visually evoked sexual arousal in the human brain, and to investigate the neural mechanism for sexual arousal using functional MRI (fMRI). MATERIALS AND METHODS: A total of 20 sexually potent volunteers consisting of 10 males (mean age: 24) and 10 females (mean age: 23) underwent fMRI on a 1.5 T MR scanner (GE Signa Horizon). The fMRI data were obtained from 7 slices (10 mm slice thickness) parallel to the AC-PC (anterior commissure and posterior commissure) line, giving a total of 511 MR images. The sexual stimulation consisted of a 1-minute rest with black screen, followed by a 4-minute stimulation by an erotic video film, and concluded with a 2-minute rest. The brain activation maps and their quantification were analyzed by the statistical parametric mapping (SPM 99) program. RESULTS: The brain activation regions associated with visual sexual arousal in the limbic system are the posterior cingulate gyrus, parahippocampal gyrus, hypothalamus, medial cingulate gyrus, thalamus, amygdala, anterior cingulate gyrus, insula, hippocampus, caudate nucleus, globus pallidus and putamen. Especially, the parahippocampal gyrus, cingulate gyrus, thalamus and hypothalamus were highly activated in comparison with other areas. The overall activities of the limbic lobe, diencephalon, and basal ganglia were 11.8%, 10.5%, and 3.4%, respectively. In the correlation test between brain activity and sexual arousal, the hypothalamus and thalamus showed positive correlation, but the other brain areas showed no correlation. CONCLUSION: The fMRI is useful to quantitatively evaluate the cerebral activation associated with visually evoked, sexual arousal in the human brain. This result may be helpful by providing clinically valuable information on sexual disorder in humans as well as by increasing the understanding of the neuroanatomical correlates of sexual arousal.

Qualitative and Quantitative Measurement of Human Brain Activity Using Pixel Subtraction Algorithm

PURPOSE: To develop an automated quantification program, which is called FALBA (Functional & Anatomical Labeling of Brain Activation), and to provide information on the brain centers, brain activity (%) and hemispheric lateralization index on the basis of a brain activation map obtained from functional MR imaging. MATERIALS AND METHODS: The 3-dimensional activation MR images were processed by a statistical parametric mapping program (SPM99, The Wellcome Department of Cognitive Neurology, University College London, UK) and MRIcro software (www.mricro.com). The 3-dimensional images were first converted into 2-dimensional sectional images, and then overlapped with the corresponding T1-weighted images. Then, the image dataset was extended to -59 mm to 83 mm with a 2 mm slice-gap, giving 73 axial images. By using a pixel subtraction method, the differences in the R, G, B values between the T1-weighted images and the activation images were extracted, in order to produce black & white (B/W) differentiation images, in which each pixel is represented by 24-bit R, G, B true colors. Subsequently, another pixel differentiation method was applied to two template images, namely one functional and one anatomical index image, in order to generate functional and anatomical differentiation images containing regional brain activation information based on the Brodmann's and anatomical areas, respectively. In addition, the regional brain lateralization indices were automatically determined, in order to evaluate the hemispheric predominance, with the positive (+) and negative (-) indices showing left and right predominance, respectively. RESULTS: The manual counting method currently used is time consuming and has limited accuracy and reliability in the case of the activated cerebrocortical regions. The FALBA program we developed was 240 times faster than the manual counting method: -10 hours for manual accounting and -2.5 minutes for the FALBA program using a Pentium IV processor. Compared with the FALBA program, the manual quantification method showed an average error of 0.334+/-0.007 (%). Thus, the manual counting method gave less accurate quantitative information on brain activation than the FALBA program. CONCLUSION: The FALBA program is capable of providing accurate quantitative results, including the identification of the brain activation region and lateralization index with respect to the functional and anatomical areas. Also, the processing time was dramatically shortened in comparison with the manual counting method.

Qualitative and Quantitative Measurement of Brain Activity Associated with Visual Sexual Arousal in Males and Females: 3.0 Tesla Functional MR Imaging

PURPOSE: The present study utilized 3.0 Tesla functional MR imaging to identify and quantify the activated brain regions associated with visually evoked sexual arousal, and also to discriminate the gender differences between the cortical activation patterns in response to sexual stimuli. MATERIALS AND METHODS: A total of 24 healthy, right-handed volunteers, 14 males (mean age: 24) and 10 females (mean age: 23), with normal heterosexual function underwent functional MRI on a 3.0T MR scanner (Forte, Isole technique, Korea). The sexual stimulation consisted of a 1-minute rest with black screen, followed by a 3-minute stimulation by an erotic video film, and concluded with a 1-minute rest. The fMRI data was obtained from 20 slices (5 mm slice thickness, no gap) parallel to the AC-PC (anterior commissure and posterior commissure) line on the sagittal plane, giving a total of 2,100 images. The brain activation maps and the resulting quantification were analyzed by the statistical parametric mapping program, SPM 99. The mean-activated images were obtained from each individual activation map using one sampled t-test. The FALBA program, which is a new algorithm based on the pixel differentiation method, was used to identify and quantify the brain activation and lateralization indices with respect to the functional and anatomical terms. RESULTS: In both male and female volunteers, significant brain activation showed in the limbic areas of the parahippocampal gyrus, septal area, cingulate gyrus and thalamus. It is interesting to note that the septal areas gave a relatively lower activation ratio with high brain activities. On the contrary, the putamen, insula cortex, and corpus callosum gave a higher activation ratio with low brain activities. In particular, brain activation in the septal area, which was not reported in the previous fMRI studies under 1.5 Tesla, represents a distinct finding of this study using 3.0 T MR scanner. The overall lateralization index of activation shows left predominance (LI=35.3%) in the limbic system during sexual stimulation. The gender differences of brain activation in response to sexual arousal were characterized as follows. The activation area observed in males was the hypothalamus in the limbic system, whereas in females it was the cingulate gyrus, head of caudate nucleus, insula and corpus callosum. These findings reveal dissimilarities between males and females in neuronal responses to sexual arousal. As for the overall lateralization of activation in the limbic system, male volunteers gave a lateralization index that was greater than that of females by 300%. CONCLUSION: Our findings confirmed that neuroanatomical regions are associated with visually evoked sexual arousal and also with gender differences in response to sexual stimulation. Given that data from time-course traces of activation pattern and findings are observed by different stimuli, such as tactile and olfactory sense, it might be helpful to evaluate the neurophysiological mechanism for sexual arousal, and furthermore, to develop new diagnostic tools for sexual dysfunction and disorder.

Diagnosis and Treatment of Primary Mediastinal Tumors and Cysts: Forty-two years report in a University Hospital / 결핵

BACKGROUND: The diagnostic and therapeutic approaches to mediastinal tumors and cysts have changed over the past three decades. This report summarizes our forty-two years of experience with these tumors. METHODS: This study retrospectively reviewed 479 patients with primary mediastinal tumors and cysts that were diagnosed and managed over the past 17-year period (1985~2002) and compared them to the report of the previous 25-year result (1960~1985) in Yonsei University College of Medicine, Severance Hospital in Seoul, Korea. RESULTS: During the 17 years, there were 479 cases of pathologically proven mediastinal tumors and cysts. Thymoma (38.2%) was the most common mediastinal tumor and has increased noticeably during recent years. The gender ratio showed a male predominance (1.3:1) and the age distributions were even over all the age groups. The most common sites of the tumor and the proportion(28.6%) of malignant tumors were the same as that previously reported. A diagnosis of a tumor in asymptomatic patients was possible in 174 cases (36.3%), which was higher that reported previously. The diagnostic yield of a fine needle aspiration biopsy was 68.6% in the total tumors and 80.9% in the malignant tumors. A surgical resection was the most frequently chosen treatment modality and was performed in 405 cases (84.6%). The complete resection rate was 91.1%, which is higher than the previous result of 78.8%. CONCLUSION: These results showed that the prevalence of mediastinal tumors and cysts, particularly thymoma, increased. A fine needle aspiration biopsy was a valuable preoperative differential diagnostic method for malignant tumors. The surgical and complete resection rate increased remarkably possibly due to the better applicable chest CT scans, the more frequent health check-up provided by the regular health promotion program for all people as a health insurance policy, and the improved diagnostic techniques in the pathologic, radiological, and clinical fields.

Radiographic Manifestations of Reperfusion Edema after Transplantation

PURPOSE: To elucidate the sequential radiologic manifestations of reperfusion edema after lung transplantation. MATERIALS AND METHODS: The study group comprised five consecutive lung transplant recipients (M:F=3:2; mean age; 47.5 years) who between July 1996 and April 2002 underwent lung transplantation procedures (four, unilateral; one, bilateral) at our institution. We retrospectively reviewed the serial postoperative radiographs obtained and characterized the lung infiltrates. RESULTS: Lung infiltrates compatible with reperfusion edema were present in all patients (5/5). Reperfusion edema appeared on day 1 in four, and by day 2 in the other. In all transplanted lungs, infiltrates were found in the perihilar and basilar regions, and were scored as maximal on day 1 in one, day 3 in two, day 4 in one and day 5 in the other. CONCLUSION: The recognition of sequential radiological manifestations helps identify recognition of reperfusion edema after lung transplantation.

A Case of Non-Hodgkin's Lymphoma of the Oral Cavity Presenting as a Buccal Mass / 대한이비인후과학회지

Non-Hodgkin's lymphoma is a heterogenous group of neoplasm affecting the lymphoid system. About 10% of Non-Hodgkin's lymphoma occur in the extra-nodal region in the head and neck area and more than half of extra-nodal lymphoma in the head and neck area involves the Waldeyer's ring. Localization in the oral cavity is rare. We experienced one rare case of Non-Hodgkin's lymphoma in the oral cavity, with trismus and persistent ulcerated swelling in the right-side cheek as the chief complaint.

Contemporary Augmentation Rhinoplasty with Autogenous Cartilage Grafts after Removal of Nasal Paraffinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasal paraffinoma originating from the liquid paraffin injected for the purpose of augmentation rhinoplasty has many complications such as itching sensation, pain and tenderness, hardness, erythema and telangiectasia, protrusion of lump and even psychologic problems. The only method of improvement is surgical removal of paraffinoma and reconstructive rhinoplasty. The aim of this study is to investigate patients' satisfaction about symptoms and signs in aesthetic aspects through analyzing survey papers following surgery. MATERIALS AND METHOD: We have treated 11 cases of nasal paraffinoma by contemporary augmentation rhinoplasty with autogenous cartilage grafts after removal of nasal paraffinoma from October, 1996 to May, 2000. The patients' ages ranged from 36 to 62 years and all were women. Patients' satisfaction about symptoms and signs in aesthetic aspects was investigated through analyzing survey papers at 6 months after surgery. We also have observed changes after surgery by conducting serial photographic documentation. RESULTS: All patients were satisfied with the results about symptoms and signs in aesthetic aspects. Serial photographic documentation showed the subsided skin lesion and nasal dorsum narrowing. CONCLUSION: Our results indicated that contemporary augmentation rhinoplasty with autogenous cartilage grafts after removal of nasal paraffinoma is one of the effective treatment for nasal paraffinoma.

Heart-Lung Transplantation in a Patient with VSD, PDA and Eisenmenger's Syndrome / 대한흉부외과학회지

Heart-lung transplantation is a widely accepted treatment for Eisenmenger's syndrome. The patient is a 41-years-old male diagnosed with Eisenmenger's syndrome due to patent ductus arteriosus. The pressures were checked as follows: aorta 130/80 mean 100 mmHg, pulmonary artery 130/80 mean 109 mmHg, and right ventricle 130/20 mmHg, right atrium mean 20 mmHg. The patient needed heart-lung transplantation due to enlarged right pulmonary artery (diameter 7.5 cm). The donor was a 24 years-old male diagnosed as brain death due to subdural hematoma. Ligation of patent ductus arteriosus was performed under the cardiopulmonary bypass followed by heart-lung transplantation. Patient was extubated on postoperative day one, transferred to the general ward on day 3, and was discharged on postoperative day 33. Cardiac and lung biopsy was performed on postoperative day 41 with no signs of rejection.

Clinical Features of Pulmonary Large Cell Neuroendocrine Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was performed to investigate the clinical features of large cell neuroendocrine carcinomas (LCNEC). MATERIALS AND METHODS: We retrospectively reviewed the histopathology and clinical information of 37 patients with LCNEC, diagnosed between June 1992 and May 2002 at the Severance Hospital, and performed immunohistochemical (IHC) staining. RESULTS: The prevalence of LCNEC among primary lung cancers was 0.3%, 37 out of 13, 012 cases over a 10 year period. The mean age was 61+/-12 years old, with 34 (92%) males and 3 (8%) females. 30 patients smoked, with an average of 42 packs per year. A cough was the most frequent symptom. The tumor was located at the periphery of the lung in 24 cases (65%). Among the 30 cases that underwent surgery, 4 were diagnosed pathological stage IA, 11 IB, 1 IIB, 13 IIIA and 1 IIIB. The 7 clinically non-operable cases were IIIB in 3, and IV in 4. The positive rates of CD56, thyroid transcription factor-1 (TTF-1), chromogranin A, synaptophysin and 34betaE12 for tumor cells were 88.9, 55.6, 42.1, 31.6 and 21.1%, respectively, from the IHC staining. The median survival time and 5 year-survival rate were 24 months and 27%, respectively. The group that underwent surgery had a better prognosis than those that did not. CONCLUSION: The positive rates for the tumor markers varied, but those of the CD56 and TFT-1 were the highest. The possibility of LCNEC needs to be evaluated for the following situations: small cell carcinomas located at the periphery and not responding chemotherapy, small cell carcinomas diagnosed by percutaneous needle aspiration, poorly differentiated non-mall cell carcinomas, with uncertain histologic type, and unclassified neuroendocrine tumor, etc.