Publications by authors named "Heon Han"

33 Publications

The Importance of Early Recognition, Timely Management, and the Role of Healthcare Providers in Multisystem Inflammatory Syndrome in Children.

J Korean Med Sci 2021 Jan 11;36(2):e17. Epub 2021 Jan 11.

Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Korea.

In April 2020, a pediatric report of an unusual inflammatory illness associated with coronavirus disease 2019 (COVID-19) led to similar cases in Europe and North America, which was referred to as multisystem inflammatory syndrome in children (MIS-C). Herein, we describe the case of a 12-year-old boy who had a history of polymerase chain reaction-confirmed COVID-19 and developed MIS-C approximately three weeks after an initial diagnosis of COVID-19. High fever with abdominal pain mimicking appendicitis was the initial manifestation of MIS-C, which could have been easily missed if the patient's history of COVID-19 was ignored. Intravenous immunoglobulin was administered twice, 24 hours apart, five days after the onset of MIS-C, and the patient fully recovered without any obvious sequelae. Early recognition by disease awareness and prompt management are the keys to saving the lives of children affected by MIS-C.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3346/jkms.2021.36.e17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801153PMC
January 2021

Effectiveness of negative pressure isolation stretcher and rooms for SARS-CoV-2 nosocomial infection control and maintenance of South Korean emergency department capacity.

Am J Emerg Med 2020 Oct 1. Epub 2020 Oct 1.

Department of Paediatrics, Chungbuk National University Hospital, 776, 1st Sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28646, South Korea. Electronic address:

Objective: There are growing concerns regarding the lack of COVID-19 pandemic response capacity in already overwhelmed emergency departments (EDs), and lack of proper isolation facilities. This study evaluated the effectiveness of the negative pressure isolation stretcher (NPIS) and additional negative pressure isolation rooms (NPIRs) on the maintenance of emergency care capacity during the COVID-19 outbreak.

Methods: A before and after intervention study was performed between February 27, 2020 and March 31, 2020 at the ED of Chungbuk National University Hospital, Cheongju, South Korea. A total of 2455 patients who visited the ED during the study period were included. Interventions included the introduction of the NPIS and additional NPIRs in the ED. The main outcome of the study was frequency of medical cessation. Secondary outcomes were the average number of ED visits and lengths of stay.

Results: After the intervention, average frequency of medical cessation was significantly decreased from 1.6 times per day (range 0-4) in the pre-intervention period to 0.6 times per day (range 0-3) in the post-intervention period (p-value <0.01). On the other hand, the number of patients visiting the ED increased significantly from 67.2 persons per day (range 58-79) pre-intervention to 76.3 persons per day (range 61-88) post-intervention (p value <0.01). However, there were no statistically significant differences in the average ED length of stay across the study phases (p value = 0.50).

Conclusions: This intervention may provide an effective way to prepare and meet the ED response needs of the COVID-19 pandemic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2020.09.081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528735PMC
October 2020

Bilateral Obstructive Uropathy Caused by Congenital Bladder Diverticulum Presenting as Hypertensive Retinopathy.

J Korean Med Sci 2018 Feb 19;33(8):e54. Epub 2018 Feb 19.

Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.

A congenital bladder diverticulum (CBD) is caused by inherent muscular weakness instead of obstruction of the bladder outlet. The major clinical conditions are recurrent urinary tract infection (UTI) and voiding dysfunction. This report describes a 15-year-old male adolescent who developed sudden visual disturbance resulting from hypertensive retinopathy. The cause of hypertension was bilateral obstructive uropathy caused by enlarged paraureteral bladder diverticula. After the non-functioning right kidney and ureter and the bilateral diverticula were removed, the left ureter was reimplanted in the bladder. Pathologic findings showed chronic pyelonephritis and partial loss of the bladder musculature in the diverticular wall. This observation indicates that dilated CBD can cause latent UTI, ureteral obstruction, hydronephrosis, and secondary hypertension.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3346/jkms.2018.33.e54DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5809749PMC
February 2018

Diagnosis of bronchial artery aneurysm by computed tomography: a case report.

Radiol Case Rep 2017 Sep 3;12(3):455-459. Epub 2017 Jun 3.

Department of Radiology, Kangwon National University Hospital, 156 Baengnyeong-ro, Chuncheon, Gangwon-do 24289, Republic of Korea.

Bronchial artery aneurysm is a rare vascular abnormality, with an incidence of <1% based on diagnosis by selective bronchial angiography. It is manifested in various forms, ranging from an incidental finding on radiologic examination to life-threatening hemorrhage resulting from aneurysm rupture. We report a case of a 60-year-old man with a mediastinal bronchial artery aneurysm which was incidentally detected on chest computed tomography.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.radcr.2017.04.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5551994PMC
September 2017

Clinical Value of Real-Time Ultrasonography-MRI Fusion Imaging for Second-Look Examination in Preoperative Breast Cancer Patients: Additional Lesion Detection and Treatment Planning.

Clin Breast Cancer 2018 08 14;18(4):261-269. Epub 2017 Jul 14.

Medical Science Research Center, Korea University Ansan Hospital, Gyeonggi-do, Republic of Korea.

Background: This study was conducted to evaluate the clinical effect of real-time magnetic resonance imaging (MRI)-navigated ultrasonography (US) for preoperative second-look examination in patients with breast cancer.

Patients And Methods: Between October 2013 and February 2015, 232 patients with breast cancer underwent MRI for staging; second-look US was performed in 70 patients to evaluate additional lesions suspected to be disease detected using MRI. We retrospectively included 67 lesions in 55 patients. Lesions were classified as detected on conventional US (group 1), and not visible on conventional US, but detected on MRI-navigated US (group 2). The imaging features between groups 1 and 2 were compared using Student t, χ, or Fisher exact tests. We compared the detection rate and histopathology of additional lesions using a McNemar test.

Results: Heterogeneous background echotexture (69.6% [16 of 23] vs. 34.1% [14 of 41]) and lesion isoechogenicity (65.2% [15 of 23] vs. 7.3% [3 of 41]) on US and middle or posterior lesion depth on MRI (78.3% [18 of 23] vs. 46.3% [19 of 41]) were more common in group 2 (P < .05). More lesions were detected using MRI-navigated US (64 of 67; 95.5%) than conventional US (41 of 67; 61.2%; P < .01). Using MRI-navigated US we found more high-risk or malignant lesions than conventional US (21 vs. 11; P < .01). The optimal treatment plan was determined for 9 of 16 (56.3%) patients by virtue of MRI-navigated US.

Conclusion: Real-time MRI-navigated US significantly improved the detection of additional high-risk or malignant lesions during second-look US in preoperative evaluation of patients with breast cancer and ultimately determined the optimal treatment plan.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clbc.2017.07.007DOI Listing
August 2018

Outcomes of Esophageal Arterial Embolization for Treatment of Hemoptysis.

J Vasc Interv Radiol 2017 Feb 7;28(2):284-290. Epub 2016 Dec 7.

Department of Radiology, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates.

Purpose: To investigate safety and efficacy of esophageal arterial embolization (EAE) in addition to bronchial arterial embolization (BAE) for treatment of hemoptysis as well as the importance and characteristics of esophageal arteries in patients with hemoptysis.

Materials And Methods: Between January 2013 and December 2014, 20 patients (13 men and 7 women, mean age 58.4 y) underwent EAE in addition to BAE for hemoptysis. Retrospective review of patient records was performed to evaluate major causes of hemoptysis, treatment indications based on CT findings, esophageal angiography findings, and outcomes after embolization including clinical success rate and complications.

Results: Hemoptysis was caused by bronchiectasis (12 patients), tuberculosis (7 patients), and lobectomy (1 patient). CT showed lower lobe lung lesions in all (100%) patients. The esophageal arteries originated from the aorta between the carina and diaphragm (18 patients) or from the inferior phrenic arteries (2 patients) and were tortuous with longitudinal off-midline courses. Communications between the esophageal and the bronchial or inferior phrenic arteries were present in 12 patients. One patient who was treated using N-butyl cyanoacrylate developed dysphagia that resolved with medical treatment. Repeat BAE was performed in 2 patients 5 days and 20 days later, and the clinical success rate was 90% (18/20).

Conclusions: EAE in addition to BAE is safe in the treatment of hemoptysis and should be considered for lower lobe lesions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvir.2016.09.026DOI Listing
February 2017

Prognostic Significance of a Complete Response on Breast MRI in Patients Who Received Neoadjuvant Chemotherapy According to the Molecular Subtype.

Korean J Radiol 2015 Sep-Oct;16(5):986-95. Epub 2015 Aug 21.

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.

Objective: To evaluate the relationship between response categories assessed by magnetic resonance imaging (MRI) or pathology and survival outcomes, and to determine whether there are prognostic differences among molecular subtypes.

Materials And Methods: We evaluated 174 patients with biopsy-confirmed invasive breast cancer who had undergone MRI before and after neoadjuvant chemotherapy, but before surgery. Pathology findings were classified as a pathologic complete response (pCR) or a non-pCR, and MRI findings were designated as a radiologic CR (rCR) or a non-rCR. We evaluated overall and subtype-specific associations between clinicopathological factors including the assessment categories and recurrence, using the Cox proportional hazards model.

Results: There were 41 recurrences (9 locoregional and 32 distant recurrences). There were statistically significant differences in recurrence outcomes between patients who achieved a radiologic or a pCR and patients who did not achieve a radiologic or a pCR (recurrence hazard ratio, 11.02; p = 0.018 and recurrence hazard ratio, 3.93; p = 0.022, respectively). Kaplan-Meier curves for recurrence-free survival showed that triple-negative breast cancer was the only subtype that showed significantly better outcomes in patients who achieved a CR compared to patients who did not achieve a CR by both radiologic and pathologic assessments (p = 0.004 and 0.001, respectively). A multivariate analysis found that patients who achieved a rCR and a pCR did not display significantly different recurrence outcomes (recurrence hazard ratio, 2.02; p = 0.505 and recurrence hazard ratio, 1.12; p = 0.869, respectively).

Conclusion: Outcomes of patients who achieved a rCR were similar to those of patients who achieved a pCR. To evaluate survival difference according to molecular subtypes, a larger study is needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3348/kjr.2015.16.5.986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559795PMC
March 2016

Clinical characteristics and outcome of incidental atrial septal openings in very low birth weight infants.

Neonatology 2014 28;105(2):85-90. Epub 2013 Nov 28.

Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea.

Background: Atrial septal openings (ASOs) are very common in premature infants.

Objective: The study aimed to evaluate the prevalence and natural course of ASOs in very low birth weight (VLBW) infants diagnosed in the first week of life and the association of ASOs with various clinical factors.

Methods: We retrospectively reviewed the medical records of 217 infants born with a weight of <1,500 g between January 2007 and December 2011. Echocardiography was conducted within the first week of life in all infants. Clinical factors were compared between infants with ASO and those with an intact atrial septum. ASO closure was confirmed by echocardiography at the 3-month follow-up and subsequently every 6 months.

Results: The incidence of ASOs was 40.3% in VLBW infants. Patent ductus arteriosus (PDA) was associated with a higher incidence of ASO in a multivariate analysis (OR 4.005, 95% CI 2.015-7.960, p < 0.001), and PDA was a predictor of early ASO closure. The rate of oxygen requirement for at least 28 days was higher in infants with ASO, whereas oxygen dependency at 36 weeks' postmenstrual age did not differ between the infant groups. The mean time of closure was 5.8 ± 7.1 months of age (range 0-36). All followed infants showed spontaneous closure within 3 years.

Conclusions: ASOs occur at a relatively high incidence in VLBW infants, but most of these close spontaneously within 3 years. PDA was predictive of ASO at the first echocardiography but did not delay ASO closure. The ASOs in VLBW infants were not a significant cause of concern.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000356164DOI Listing
October 2014

A comparison of logistic regression analysis and an artificial neural network using the BI-RADS lexicon for ultrasonography in conjunction with introbserver variability.

J Digit Imaging 2012 Oct;25(5):599-606

Department of Radiology, Kangwon National University College of Medicine, 192-1 Hyoja 2-dong, Chuncheon, Kangwon-do, 200-701, Republic of Korea.

To determine which Breast Imaging Reporting and Data System (BI-RADS) descriptors for ultrasound are predictors for breast cancer using logistic regression (LR) analysis in conjunction with interobserver variability between breast radiologists, and to compare the performance of artificial neural network (ANN) and LR models in differentiation of benign and malignant breast masses. Five breast radiologists retrospectively reviewed 140 breast masses and described each lesion using BI-RADS lexicon and categorized final assessments. Interobserver agreements between the observers were measured by kappa statistics. The radiologists' responses for BI-RADS were pooled. The data were divided randomly into train (n = 70) and test sets (n = 70). Using train set, optimal independent variables were determined by using LR analysis with forward stepwise selection. The LR and ANN models were constructed with the optimal independent variables and the biopsy results as dependent variable. Performances of the models and radiologists were evaluated on the test set using receiver-operating characteristic (ROC) analysis. Among BI-RADS descriptors, margin and boundary were determined as the predictors according to stepwise LR showing moderate interobserver agreement. Area under the ROC curves (AUC) for both of LR and ANN were 0.87 (95% CI, 0.77-0.94). AUCs for the five radiologists ranged 0.79-0.91. There was no significant difference in AUC values among the LR, ANN, and radiologists (p > 0.05). Margin and boundary were found as statistically significant predictors with good interobserver agreement. Use of the LR and ANN showed similar performance to that of the radiologists for differentiation of benign and malignant breast masses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10278-012-9457-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447099PMC
October 2012

Reference values for serum levels of insulin-like growth factor-I and insulin-like growth factor binding protein-3 in Korean children and adolescents.

Clin Biochem 2012 Jan 12;45(1-2):16-21. Epub 2011 Oct 12.

Department of Pediatrics, Institute of Endocrinology, College of Medicine, Yonsei University, Republic of Korea.

Objective: Measurements of serum insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) are utilized in the diagnostic work-up and clinical management of children with growth disorders. We designed this study to establish the reference values of serum IGF-I and IGFBP-3 levels according to age, sex and pubertal stage in Korean children and adolescents.

Methods: For the study, 1378 healthy Korean children and adolescents aged 0 to 17 years (722 boys, 656 girls) were randomly selected. Blood samples were collected, and the stored sera were assayed for IGF-I and IGFBP-3 using immunoradiometric assay (IRMA, Immunotech). The R 2.8.1 program (Bell Laboratories) was used to generate reference percentile curves for IGF-I and IGFBP-3 according to age, sex, and pubertal stage

Results: Serum IGFBP-3 level was higher in girls compared to that in boys of the same ages throughout the pubertal period, whereas IGF-I was only higher for girls younger than 13 years of age. Serum levels of IGF-I and IGFBP-3 increased steadily with age in the prepubertal stage, followed by a progressive decline thereafter. Peak levels of serum IGF-I and IGFBP-3 were observed two years earlier in girls compared to those in boys (13 vs. 15 years of age, respectively). Serum IGF-I and IGFBP-3 concentrations were highest at Tanner stage IV in boys and girls, with a subsequent decline.

Conclusions: Our reference value model based on age, sex, and pubertal stage can improve the diagnostic utility of IGF-1 and IGFBP-3 levels in the evaluation and management of Korean children and adolescents with growth disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clinbiochem.2011.10.003DOI Listing
January 2012

Small atypical cervical nodes detected on sonography in patients with squamous cell carcinoma of the head and neck: probability of metastasis.

J Ultrasound Med 2010 Apr;29(4):531-7

Department of Radiology, Kangwon National University College of Medicine, Chuncheon, Korea.

Objective: The purpose of this study was to assess the probability of metastasis of small atypical cervical lymph nodes detected on sonography in patients with squamous cell carcinoma (SCC) of the head and neck.

Methods: We reviewed, retrospectively and blindly, sonographic findings of 148 patients (118 men and 30 women; mean age, 58.2 years) who underwent curative neck dissection. Each lymph node was classified by using a 4-point scale: 1, definitely benign; 2, indeterminate (small [short-axis diameter <10 mm for levels I and II and <7 mm for levels III-VI] atypical node); 3, definitely metastatic; and 4, large (>3-cm) metastatic. Lymph nodes were considered atypical if they met at least 1 of the following criteria: a long- to short-axis diameter ratio of less than 2.0, absence of a normal echogenic hilum, and heterogeneous echogenicity of the cortex. These results were verified, on a level-by-level basis, with histopathologic findings.

Results: Small atypical nodes were found on sonography in 63 cervical levels of 48 patients, of which 18 (28.6%) were proved to have metastatic nodes. The probability of metastasis was significantly higher with than without a large (>3-cm) ipsilateral metastatic node (0.50 versus 0.20; P = .038) and marginally higher with than without an ipsilateral metastatic node (0.41 versus 0.16; P = .061) but not significantly associated with the T stage of the primary tumor (P = .238) or the presence of an ipsilateral tumor (P = .904).

Conclusions: Metastasis was encountered in about 30% of small atypical cervical nodes on sonography in patients with SCC of the head and neck. Our results indicate that small atypical nodes must be interpreted with consideration of metastatic nodes in the ipsilateral neck.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7863/jum.2010.29.4.531DOI Listing
April 2010

Pericardial fat is more abundant in patients with coronary atherosclerosis and even in the non-obese patients: evaluation with cardiac CT angiography.

Int J Cardiovasc Imaging 2010 Feb;26 Suppl 1:53-62

Department of Radiology, Korea University Guro Hospital, Seoul, Korea.

Epicardial adipose tissue (EAT) may play an important role for developing an unfavorable cardiovascular risk profile. However, it has not been investigated if EAT is associated with coronary atherosclerosis in non-obese patients. We aimed to evaluate whether EAT is related to coronary atherosclerosis in non-obese patients. Among the consecutive patients who underwent coronary CT angiography(CCTA) with an intermediate pretest likelihood for having coronary artery disease, we excluded the patients whose body mass index (BMI) was over 30 kg/m(2) or whose CCTA image quality was not sufficient for the detection of coronary plaque. The remaining patients were divided into the normal and abnormal groups based on the presence of atherosclerotic plaques as seen on the CCTA images. The cardiovascular risk factors were matched between the two groups. Ultimately, 100 patients were included in the normal group and 100 patients were included in the abnormal group. The pericardial fat area was measured at the subaortic level of the heart on the axial CT images. The pericardial fat area was significantly larger in the abnormal group as compared to the normal group (18.1 +/- 10.2 vs. 14.6 +/- 8.7 cm(2),P = 0.019). Even though the overweight patients(25
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10554-009-9542-2DOI Listing
February 2010

Sonographic changes after removing all benign breast masses with sonographically guided vacuum-assisted biopsy.

Acta Radiol 2009 Nov;50(9):968-74

Department of Radiology, Korea Cancer Center Hospital, Seoul, Korea.

Background: Total removal of benign breast masses by vacuum-assisted biopsy (VAB) is now increasingly accepted as a treatment option. However, little is known about whether this procedure produces early changes on follow-up sonography and, if so, how often and what factors might influence them.

Purpose: To evaluate sonographic changes after total removal of benign breast masses using sonographically guided VAB and to determine the influencing factors.

Material And Methods: We evaluated sonographic changes prospectively 1 week, 1 month, and 6 months after biopsying 32 benign masses from which all sonographic evidence had been removed during sonographically guided directional VAB performed with 8- or 11-gauge needles. Procedural factors were documented and compared with sonographic findings.

Results: At 1-week follow-up, hematomas were observed in 84% (27/32) of the lesions. After 1 month, while the hematomas had resolved in all but five lesions, focal new architectural distortion had developed in 26 (90%) lesions; 11 lesions were graded as severe, mimicking malignancy. After 6 months, 23 lesions with various degrees of architectural distortion were observed. Six of the 32 lesions (19%) contained a residual lesion. No statistically significant association between sonographic findings and procedural variables was identified, except between the degree of hematoma and lesion size.

Conclusion: The total removal of benign breast masses using sonographically guided VAB frequently produces changes on follow-up sonography after 6 months. Although these changes failed to show statistical significance with procedural factors, a larger dedicated study is needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/02841850903130836DOI Listing
November 2009

Phase contrast microradiography of mouse lung using synchrotron X-ray: correlation with optical microscopy.

Yonsei Med J 2009 Jun 23;50(3):422-6. Epub 2009 Jun 23.

Department of Radiology, Korea University Guro Hospital, 97 Guro-dong, Guro-gu, Seoul, Korea.

Purpose: The purpose of this study is to evaluate the feasibility of phase contrast X-ray microtomography and microradiography, using a polychromatic synchrotron X-ray, for analysis of the mouse lung microstructure.

Materials And Methods: Normal mice were used for experiments. Some of the mouse lungs were prepared by the lung fixation-inflation method. The resulting sponge-like inflated lung samples were used for microtomography. The remaining mouse lungs were cut into 10 microm sections and were used for microradiography and optical microscopic correlation. The experiments on mouse lung samples were performed at the 7B2 beamline of the Pohang Light Source in Korea.

Results: Phase contrast X-ray microtomography of inflated lung samples showed individual alveolar structure on 3-D reconstruction. Phase contrast microradiographs of thin lung samples showed microstructure of lung, such as alveoli and bronchioles, and were well correlated with optical microscopic images.

Conclusions: The results indicate that the phase contrast X-ray microtomography and microradiography using polychromatic synchrotron X-ray is feasible for evaluation of microstructure of the lung.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3349/ymj.2009.50.3.422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2703767PMC
June 2009

Noncalcified ductal carcinoma in situ: imaging and histologic findings in 36 tumors.

J Ultrasound Med 2009 Jul;28(7):903-10

Department of Radiology, Korea Cancer Center Hospital, Seoul, Korea.

Objective: The purpose of this study was to evaluate imaging findings in noncalcified ductal carcinoma in situ (DCIS) and to compare histologic findings between noncalcified and calcified DCIS.

Methods: From January 2005 to May 2008, 195 patients with pathologically confirmed DCIS were recruited. Among these, 36 patients (18%) had noncalcified DCIS. We retrospectively reviewed their imaging findings according to the American College of Radiology Breast Imaging Reporting and Data System. We also reviewed pathologic reports for all patients with DCIS to obtain information on the histologic type, nuclear grade, and biological markers.

Results: Among the 36 patients with noncalcified DCIS, 21 (58%) were symptomatic. On mammography, 25 patients (69%) showed abnormal findings, and 11 patients showed false-negative findings. On sonography, 29 of 36 patients (81%) showed a mass, whereas the remaining 7 patients (19%) showed nonmass lesions. The sonographic findings for the masses were variable: 25 of 29 masses (86%) were irregular in shape; 14 of 29 (48%) showed indistinct margins; and 9 (31%) were angular or spiculated. The orientation of the mass was not parallel in 6 of 29 cases (21%). Two of 29 masses (7%) showed an echogenic halo at the lesion boundary. Noncalcified DCIS tended to have a nonhigh nuclear grade and was frequently the noncomedo type. In addition, c-erb-B2 was more commonly expressed in calcified DCIS.

Conclusions: Imaging findings for noncalcified DCIS are relatively nonspecific and are frequently similar to those of invasive malignancy. This knowledge may be useful for detecting noncalcified DCIS, planning treatment, and predicting the prognosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7863/jum.2009.28.7.903DOI Listing
July 2009

Radiological findings of spinal schwannomas and meningiomas: focus on discrimination of two disease entities.

Eur Radiol 2009 Nov 6;19(11):2707-15. Epub 2009 Jun 6.

Department of Radiology, Wooridul Spine Hospital, Seoul, South Korea.

This study evaluates the effectiveness of CT and MR imaging in differentiating intradural extramedullary spinal schwannomas and meningiomas in a large group of patients. In addition, the study correlates tumour location, morphologic characteristics and enhancement pattern. From January 2000 to June 2007, we retrospectively reviewed 128 consecutive patients (51 male, 77 female; mean age at admission 53.8 years; range 17-83 years) with spinal intradural extramedullary tumours (92 schwannomas, 36 meningiomas) at our institution. Fifty-one of ninety-two schwannomas (55.4%) showed fluid signal intensity on T2-weighted MR images. Twenty-two of thirty-six meningiomas (61.1%) showed hyperintense signal intensity and thirteen of thirty-six meningiomas (36.1%) showed isointense signal on T2-weighted MR images. Fifty-four schwannomas (58.7%) showed rim enhancement and thirty-three meningiomas (91.7%) showed diffuse enhancement on contrast-enhanced T1-weighted MR imaging. Twenty-one meningiomas (58.3%) showed dural tail sign in contrast-enhanced T1-weighted MR imaging. Twenty-one meningiomas (58.3%) showed calcification on CT images. MR and CT imaging results are therefore useful for the differentiation of schwannomas from meningiomas of the spine.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00330-009-1466-7DOI Listing
November 2009

Incidental extracardiac findings at cardiac CT angiography: comparison of prevalence and clinical significance between precontrast low-dose whole thoracic scan and postcontrast retrospective ECG-gated cardiac scan.

Int J Cardiovasc Imaging 2009 Apr 9;25 Suppl 1:75-81. Epub 2009 Jan 9.

Department of Radiology, Guro Hospital, Korea University, 97 Guro-dong, Guro-gu, Seoul, 152-703, South Korea.

Purpose: To compare the prevalence and clinical significance of incidental extracardiac findings at cardiac CT angiography (CCTA) with precontrast low-dose whole thoracic scan (LDCT) and ECG-gated CCTA.

Materials And Methods: We reviewed 254 patients who underwent CCTA. All participants first underwent LDCT to determine a range for CCTA and to screen unrecognized extracardiac lesions. CCTA was reconstructed with a small field of view of the heart. Clinically significant extracardiac findings were defined as abnormalities requiring further diagnostic work up, therapeutic intervention, or follow-up.

Results: On LDCT, 285 extracardiac findings were detected in 62.6% patients; on CCTA, 18 findings in 7% patients. Among these, 66 findings in 20.4% patients were considered clinically significant on LDCT, and 4 findings in 1.6% patients on CCTA.

Conclusion: Clinically significant extracardiac findings are common in patients undergoing CCTA with a considerable number of extracardiac findings being detected only on LDCT. We advise performing whole thorax LDCT prior to CCTA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10554-008-9417-yDOI Listing
April 2009

Computer-aided diagnosis for the differentiation of malignant from benign thyroid nodules on ultrasonography.

Acad Radiol 2008 Jul;15(7):853-8

Department of Radiology, College of Medicine, Hallym University, Kangdong Sacred Heart Hospital, Kil-1 dong, Kangdong-gu, Seoul 134-701, Korea.

Rationale And Objectives: We sought to evaluate the diagnostic performance of an artificial neural network (ANN) and binary logistic regression (BLR) in differentiating malignant from benign thyroid nodules on ultrasonography.

Materials And Methods: Two experienced radiologists, who were unaware of the histopathological diagnosis, analyzed ultrasonographic (US) features of 109 pathologically proven thyroid lesions (49 malignant and 60 benign) in 96 patients. Each radiologist was asked to evaluate US findings and categorize nodules into one of the two groups (malignant vs. benign) in each case. The following 8 US parameters were assessed for each nodule: size, shape, margin, echogenicity, cystic change, microcalcification, macrocalcification, and halo sign. Statistically significant US findings were obtained with backward stepwise logistic regression and were used for training and testing of the ANN and the BLR. The performance of the ANN and BLR was compared to that of the radiologists using receiver-operating characteristic (ROC) analysis.

Results: Statistically significant US findings were size, margin, echogenicity, cystic change, and macrocalcification of the nodules. The area under the ROC curve (Az) values of ANN and BLR were 0.9492 +/- 0.0195 and 0.9046 +/- 0.0289, respectively. The Az value was 0.8300 +/- 0.0359 for reader 1 and 0.7600 +/- 0.0409 for reader 2. The Az values for ANN and BLR were significantly higher than those for both radiologists (all p < .05).

Conclusion: The performance of the ANN and the BLR was better than that of the radiologists in the distinction of benign and malignant thyroid nodules.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.acra.2007.12.022DOI Listing
July 2008

Image-guided transvaginal drainage of pelvic abscesses and fluid collection using a modified Seldinger technique.

Acta Radiol 2008 Jul;49(6):718-23

Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.

Background: Transvaginal drainage using the trocar method is advantageous as a single-step procedure; however, the procedure may occasionally be difficult to perform, due to buckling of the catheter in the elastic vaginal tissues, despite the presence of a stiff stylet.

Purpose: To evaluate the efficacy and the safety of image-guided transvaginal drainage of pelvic abscesses and fluid collection using a modified Seldinger technique.

Material And Methods: Fifteen patients (mean age 43 years, range 24-82 years) who underwent transvaginal aspiration (n=1) or catheter drainage (n=14) guided by ultrasound and fluoroscopy were enrolled in this retrospective study. A small coronal incision was performed to facilitate puncture using an 18G needle, tract dilatation, and the insertion of a drainage catheter by the Seldinger technique. Outcome was analyzed with respect to clinical success, technical success, and procedure-related complications.

Results: The overall clinical success rate was 87% (13/15 cases). The success rate of catheter drainage was 86% (12/14 cases), and the use of aspiration alone was successful in one patient. Technical success was achieved in all patients, without procedure-related complications.

Conclusion: Image-guided transvaginal drainage with a modified Seldinger technique can be a safe and effective alternative treatment for pelvic abscesses and fluid collection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02841850802065026DOI Listing
July 2008

The short-term effects of balloon-occluded retrograde transvenous obliteration, for treating gastric variceal bleeding, on portal hypertensive changes: a CT evaluation.

Korean J Radiol 2007 Nov-Dec;8(6):520-30

Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Objective: We wanted to evaluate the short-term effects of balloon-occluded retrograde transvenous obliteration (BRTO) for treating gastric variceal bleeding, in terms of the portal hypertensive changes, by comparing CT scans.

Materials And Methods: We enrolled 27 patients who underwent BRTO for gastric variceal bleeding and they had CT scans performed just before and after BRTO. The pre- and post-procedural CT scans were retrospectively compared by two radiologists working in consensus to evaluate the short-term effects of BRTO on the subsequent portal hypertensive changes, including ascites, splenomegaly, portosystemic collaterals (other than gastrorenal shunt), the gall bladder (GB) edema and the intestinal wall edema. Statistical differences were analyzed using the Wilcoxon signed rank test and the paired t-test.

Results: Following BRTO, ascites developed or was aggravated in 22 (82%) of 27 patients and it was improved in two patients; the median spleen volumes increased from 438.2 cm(3) to 580.8 cm(3), and based on a 15% volume change cut-off value, splenic enlargement occurred in 15 (56%) of the 27 patients. The development of new collaterals or worsening of existing collaterals was not observed in any patient. GB wall edema developed or was aggravated in four of 23 patients and this disappeared or improved in five; intestinal wall edema developed or was aggravated in nine of 27 patients, and this disappeared or improved in five. Statistically, we found significant differences for ascites and the splenic volumes before and after BRTO (p = 0.001 and p < 0.001, respectively)

Conclusion: Some portal hypertensive changes, including ascites and splenomegaly, can be aggravated shortly after BRTO.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627455PMC
http://dx.doi.org/10.3348/kjr.2007.8.6.520DOI Listing
March 2008

Detection of recurrent ovarian cancer at MRI: comparison with integrated PET/CT.

J Comput Assist Tomogr 2007 Nov-Dec;31(6):868-75

Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.

Objective: To compare the diagnostic performances of magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) for the detection of recurrent ovarian tumor.

Methods: Thirty-six patients who underwent primary cytoreductive surgery for ovarian carcinoma received both MRI and PET/CT for the evaluation of ovarian tumor recurrence. Recurrent ovarian tumors in abdomen and pelvis were classified based on site as follows: (1) local pelvic recurrence, (2) peritoneal lesion, (3) lymph nodal metastasis, and (4) distant metastasis. Patient-based and lesion-based analyses were retrospectively performed with the aim of detecting tumor recurrence. For the detection of recurrent ovarian tumors, we compared patient-based and lesion-based diagnostic accuracies of these 2 modalities using the McNemar test.

Results: Histopathologic, clinical, and radiological follow-up findings revealed recurrent ovarian tumors in 35 sites of 22 patients. These 35 sites consisted of local pelvic recurrence (n = 15), peritoneal lesions (n = 14), lymph nodal metastasis (n = 4), and abdominal wall metastasis (n = 2). In detecting recurrent ovarian tumor, patient-based sensitivity and the accuracy of PET/CT and MRI were 73% and 91% (P < 0.05), and 81% and 89% (P > 0.05), respectively. In addition, overall lesion-based sensitivity of PET/CT and MRI were 66% and 86%, respectively (P < 0.05). In detecting peritoneal lesions, overall lesion-based sensitivity and accuracy of PET/CT and MRI for peritoneal lesions were 43% and 86%, and 75% and 94%, respectively (P < 0.05).

Conclusions: Magnetic resonance imaging is more sensitive than PET/CT for detecting local pelvic recurrence and peritoneal lesions of recurrent ovarian tumors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/rct.0b013e31803e8c45DOI Listing
January 2008

Endovascular treatment of posterior cerebral artery aneurysms using detachable coils.

Neuroradiology 2008 Mar 13;50(3):237-42. Epub 2007 Nov 13.

Department of Radiology, Kangwon National University Hospital, 17-1 Hyoja 3-dong, Chuncheon, Kangwon-do 200-947, South Korea.

Introduction: Aneurysms of the posterior cerebral artery (PCA) are rare, and most of the studies reported in the literature in which the endovascular approach was applied were carried out on a limited number of patients with PCA aneurysms. We retrospectively reviewed our cases of PCA aneurysms--at various locations and of differing shapes--that received endovascular treatment and evaluated the treatment outcome.

Methods: From January 1996 to December 2006, 13 patients (eight females and five males) with 17 PCA aneurysms (nine fusiform and eight saccular) were treated using the endovascular approach. The age of the patients ranged from 20 to 67 years, with a mean age of 44 years. Of the 13 patients, ten presented with intracranial hemorrhage, and one patient, with a large P2 aneurysm, presented with trigeminal neuralgia; the aneurysms were asymptomatic in the remaining two patients.

Results: All 13 patients were successfully treated, with only one procedure-related symptomatic complication. Seven patients were treated by occlusion of the aneurysm and parent artery together; five patients, by selective embolization of the aneurysm; one patient, by partial coiling. Although infarctions were found in two patients treated with selective embolization and in three patients treated with parent artery occlusion, only one patient with a ruptured P2 aneurysm treated with parent artery occlusion developed transient amnesia as an ischemic symptom.

Conclusion: Posterior cerebral artery aneurysms can be treated safely with either occlusion of the aneurysm together with the PCA or with a selective coil embolization. Infarctions may occur after endovascular treatment, but they are rarely the cause of a disabling symptom.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00234-007-0321-2DOI Listing
March 2008

Acute and chronic complications of aortic intramural hematoma on follow-up computed tomography: incidence and predictor analysis.

J Comput Assist Tomogr 2007 May-Jun;31(3):435-40

Division of Cardiothoracic Radiology, Department of Radiology Bundang CHA Hospital, University of Pocheon Jungmoon College of Medicine, Kyonggi-do, Korea.

Objective: To ascertain the incidence of acute and chronic complications of aortic intramural hematoma (IMH) and to analyze the predictors of the development of each complication.

Materials And Methods: This retrospective study includes 107 consecutive patients diagnosed with aortic IMH by means of computed tomography (CT) during the period from January 1998 to December 2003 and followed up with serial CT examinations (median follow-up period, 320 days). There were 36 patients with type A and 71 with type B IMH. Initial and follow-up CT scans were reviewed, with special attention given to the development of complications, such as increase in the thickness of IMH, clinical and hemodynamic evolution requiring urgent surgery, and development of aortic dissection and/or aneurysm. If each complication developed within 30 days after the initial episode, we classified it as an acute complication; the others were classified as chronic complications. The time interval between the initial and the subsequent CT examination showing each complication was recorded. To identify the predictors of each complication, we analyzed the demographic and CT findings with regard to the following factors: age, sex, maximum thickness of the hematoma, maximum aortic diameter on initial CT examination, ulcerlike projection (ULP) on initial and follow-up CT examinations, and the degree of atherosclerosis. The Cox proportional hazards regression model with stepwise multivariate analyses was used to determine the significant predictors of each complication.

Results: Sixteen patients had acute complications consisting of aortic dissection (n = 7), aortic aneurysm (n = 6), and acute clinical and hemodynamic evolution requiring operation (n = 3). Three additional patients with aortic dissection (n = 1) and aneurysm (n = 2) underwent emergency surgery. Twenty-three patients with chronic complications had aortic dissection (n = 3), and aortic aneurysm (n = 20). Cox proportional hazards regression model revealed that the maximal diameter of involved aorta is the only significant predictor of the development of acute complications (P = 0.006), whereas the age (P = 0.040), type A IMH (P = 0.015), presence of ULP (P = 0.015), and newly developed ULP as revealed on follow-up CT examination (P = 0.032) were significant predictors of the development of chronic complications. With regard to the aortic dissection in 10 patients (9.3%; type A/B ratio, 5:5; median time interval, 34 days), Cox proportional hazards regression model revealed that the maximal thickness of the hematoma is the only significant predictor (P = 0.018). Twenty-one saccular and 5 fusiform aneurysms (24.3%) developed, as revealed on follow-up CT examinations (median time interval, 180 days). The presence of ULP (P = 0.030), type A (P = 0.038) and the maximal thickness of the hematoma (P = 0.017) were significant predictors for the development of an aneurysm.

Conclusions: The maximum thickness of a hematoma on the initial CT is the significant factor predicting the development of aortic dissection and aortic aneurysm. Patients with type A IMH and ULP, as revealed by initial and short-term follow-up CT examinations, should be carefully followed up with subsequent CT examination to monitor the development of an aortic aneurysm, which is a relatively common chronic complication of IMH.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/01.rct.0000250112.87585.8eDOI Listing
July 2007

Percutaneous treatment of failed native dialysis fistulas: use of pulse-spray pharmacomechanical thrombolysis as the primary mode of therapy.

Korean J Radiol 2006 Jul-Sep;7(3):180-6

Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Objective: To determine the efficacy and outcome of percutaneous treatment in restoring the function of failed native arteriovenous fistulas (AVFs) where pulse-spray pharmacomechanical thrombolysis was used as the primary mode of therapy.

Materials And Methods: From June 2001 to July 2005, 14 patients who had thrombosis of native AVFs underwent percutaneous restoration following 20 episodes of thrombosis. These included 6 repeated episodes in one forearm AVF and two episodes in another forearm AVF. All patients except one were treated with urokinase injection utilizing the pulse-spray technique and had subsequent balloon angioplasty. One patient was treated by percutaneous angioplasty alone. We retrospectively evaluated the feasibility of percutaneous treatment in restoring the function of the failed AVFs. The primary and secondary patencies were calculated by using a Kaplan-Meier analysis.

Results: Both technical and clinical success were achieved in 15 (75%) of 20 AVFs. Four of the five technical failures resulted from a failure to cross the occluded segment. One patient refused further participation in the trial through a brachial artery access following failure to cross the occluded segment via an initial retrograde venous puncture. There were no major procedure related complications observed. Including the initial technical failures, primary patency rates at six and 12 months were 64% and 55%, respectively. Secondary patency rates at six and 12 months were 71% and 63%, respectively.

Conclusion: Pulse-spray pharmacomechanical thrombolysis for treatment of the thrombosed AVFs is safe, effective and durable. This procedure should be considered as an option for the management of failed AVFs prior to surgical intervention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2667599PMC
http://dx.doi.org/10.3348/kjr.2006.7.3.180DOI Listing
December 2006

Mechanical thrombectomy of acute iliofemoral deep vein thrombosis with use of an Arrow-Trerotola percutaneous thrombectomy device.

J Vasc Interv Radiol 2006 Mar;17(3):487-95

Department of Radiology, Kwandong University College of Medicine, Seoul, Korea.

Purpose: To evaluate the immediate and 1-year clinical outcomes of mechanical thrombectomy with use of the Arrow-Trerotola percutaneous thrombectomy device (PTD) with or without low-dose urokinase in the treatment of acute iliofemoral deep vein thrombosis (DVT).

Materials And Methods: Mechanical thrombectomy with the PTD was performed in 25 patients with acute iliofemoral DVT. Thrombolytic therapy with low-dose urokinase was used in all patients without contraindications (n = 20). Other therapies used in combination included inferior vena cava filter insertion (n = 5), sheath aspiration thrombectomy (n = 25), and angioplasty and stent placement (n = 20).

Results: Initial technical and clinical success was achieved in all cases. In the 20 patients who had no contraindications to the use of urokinase, the dosage of urokinase did not exceed 1 million IU (range, 360,000-1,000,000 IU; mean, 640,000 IU). The mean time of urokinase infusion was 16 hours (range, 12-20). In five patients who had a contraindication to the use of urokinase, mechanical thrombectomy with the PTD was successful without the use of urokinase. There were no major complications. Primary patency of the stent-implanted common iliac vein segment was achieved at 1 year in 17 of 20 patients (85%). The overall 1-year clinical success rate was 92% (23 of 25 patients). Valvular insufficiency occurred in two patients (8%).

Conclusion: The PTD is an effective mechanical thrombectomy device in the treatment of acute iliofemoral DVT with or without adjunctive urokinase thrombolysis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/01.RVI.0000202611.93784.76DOI Listing
March 2006

Inflammation, mineral metabolism and progressive coronary artery calcification in patients on haemodialysis.

Nephrol Dial Transplant 2006 Jul 22;21(7):1915-20. Epub 2006 Mar 22.

Department of Internal Medicine, Kangwon National University Hospital, Hyoja-3-dong 17-1, Chunchon, Kangwon-do 200-947, Republic of Korea.

Background: Coronary artery calcification (CAC) is an extensive and common complication in patients with end-stage renal disease (ESRD). The aim of this study was to assess prospectively the change in CAC over a 2-year period and to identify the factors that may be associated with CAC progression in ESRD patients.

Methods: The final analysis was performed on 40 of 43 stable haemodialysis patients who initially entered into the study. The study population underwent multirow spiral computed tomography to derive CAC scores at baseline and after a minimum of 12 months (24 months in 30 patients, 18 months in four, and 12 months in the remaining six patients). To provide a stable estimate that was unbiased with respect to the baseline CAC, square root-transformed CAC scores were used for the analyses of the changes in CAC.

Results: The median CAC score was 191 (range, 0-2403) mm3 at baseline and increased to 253 (range, 0-2745) mm3 at follow-up (P < 0.001) and the median annualized change in square root-transformed CAC score was 1.48 (range, -0.95-8.64) mm3/year. The annualized change of the square root-transformed CAC score positively correlated with the time-integrated levels of C-reactive protein (R = 0.521, P = 0.001), phosphorus (R = 0.433, P = 0.005) and calcium x phosphorus product (R = 0.394, P = 0.012), but did not correlate with the levels of fetuin-A or lipid parameters. Even after adjusting for age, gender and baseline CAC score, C-reactive protein levels were independently associated with CAC progression.

Conclusion: These data suggest that chronic inflammation as well as altered mineral metabolism contributes to a rapid progression of CAC in ESRD patients. Additional, larger scale studies are required to confirm our findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ndt/gfl118DOI Listing
July 2006

Efficacy of femoral vascular closure devices in patients treated with anticoagulant, abciximab or thrombolytics during percutaneous endovascular procedures.

Korean J Radiol 2006 Jan-Mar;7(1):35-40

Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Objective: This study assessed the outcomes of using vascular closure devices following percutaneous transfemoral endovascular procedures in the patients who were treated with heparin, abciximab or thrombolytics (urokinase or t-PA) during the procedures.

Materials And Methods: From March 28, 2003 to August 31, 2004, we conducted a prospective and randomized study in which 1,676 cases of 1,180 patients were treated with one of the two different closure devices (the collagen plug device was Angio-Seal; the suture-mediated closure device was The Closer S) at the femoral access site after instituting percutaneous endovascular procedures. Among the 1,676 cases, 108 cases (the drug group) were treated with heparin only (n = 94), thrombolytics only (n = 10), heparin and thrombolytics (n = 3), or abciximab and thrombolytics (n = 1) during the procedures; 1,568 cases (the no-drug group) were treated without any medication. We compared the efficacy and complications between the two groups. Of the drug group, 42 cases underwent arterial closures with the collagen plug devices and 66 cases underwent arterial closures with the suture-mediated closure devices. We also compared the efficacy and complications between these two groups.

Results: The immediate hemostasis rates were 92.9% (1,456/1,568) in the no-drug group and 91.7% (99/108) in the drug group. Early complications occurred in four cases of the drug group. These included two episodes of rebleeding with using the Closer S, which required manual compression for at least 10 minutes, and two episodes of minor oozing with using one Angio-Seal and one Closer S, which required two hours of additional bed rest. There was no late complication. So, the total success rates were 90.8% (1,423/1,568) in the no-drug group and 88.0% (95/108) in the drug group. These results were not significantly different between the two groups (p = 0.34). In the drug group, the difference of the successful hemostasis rate between the collagen plug devices and the suture-mediated devices was also not statistically significant (92.9% vs. 84.8%, respectively; p = 0.21).

Conclusion: Arterial closure of the femoral access site with using vascular closure devices is both safe and effective, even in the patients who received heparin, abciximab or thrombolytics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2667575PMC
http://dx.doi.org/10.3348/kjr.2006.7.1.35DOI Listing
July 2006

Sleep apnea, coronary artery disease, and antioxidant status in hemodialysis patients.

Am J Kidney Dis 2005 May;45(5):875-82

Department of Internal Medicine, Kangwon National University Hospital, College of Medicine, Kangwon National University, Chuncheon, Kangwon-do, Republic of Korea.

Background: It recently was suggested that sleep apnea syndrome (SAS) is associated with the cardiovascular complications and outcomes seen in patients with end-stage renal disease (ESRD). This study investigates the association of SAS with coronary artery disease and antioxidant status in patients with ESRD.

Methods: Twenty-six hemodialysis patients underwent overnight polysomnography to evaluate sleep parameters. We performed multirow spiral computed tomography to derive coronary artery calcification (CAC) scores as an indicator of the severity of coronary artery disease and measured predialysis serum total antioxidant status (TAS) as a marker of antioxidant defenses.

Results: Nine of 26 patients had normal to mild SAS with an apnea-hypopnea index (AHI) less than 15, 9 patients had moderate SAS with an AHI of 15 to 30, and the remaining 8 patients had severe SAS with an AHI greater than 30. AHI and oxygen desaturation index (ODI) were strongly interrelated (r = 0.754; P < 0.001). CAC severity was associated with SAS severity: median CAC scores increased (P = 0.009) with increasing AHI category. However, values for TAS were not significantly different among the 3 AHI categories. CAC score also correlated positively (r = 0.564; P = 0.003) with ODI, and TAS correlated negatively (r = -0.539; P = 0.005) with ODI.

Conclusion: These results suggest that frequent oxygen desaturation triggered by SAS is associated with severe coronary artery disease and decreased antioxidant status in patients with ESRD. However, conclusions from this study should be drawn with caution because of its methodological limitations (cross-sectional design, heterogeneity of study population, and small number of patients).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.ajkd.2005.01.006DOI Listing
May 2005

Elevated concentrations of cardiac troponins are associated with severe coronary artery calcification in asymptomatic haemodialysis patients.

Nephrol Dial Transplant 2004 Dec 16;19(12):3117-23. Epub 2004 Nov 16.

Department of Internal Medicine, Kangwon National University Hospital, Hyoja-3-dong 17-1, Chunchon 200-093, Republic of Korea.

Background: Elevated concentrations of cardiac biomarkers, such as troponins and natriuretic peptides, have been shown to be predictive of poorer long-term cardiovascular outcomes in stable patients with end-stage renal disease (ESRD). However, little is known about the relationship between elevated concentrations of these cardiac markers and underlying coronary artery pathology in these patients. The aim of the present study was to investigate associations between coronary artery calcification (CAC) and the concentrations of cardiac biomarkers in ESRD patients.

Methods: We conducted a cross-sectional study of 38 asymptomatic patients (median age, 54 years; 26 males, 12 females; diabetic, 39%) who were undergoing chronic haemodialysis. In these patients, pre-dialysis circulating concentrations of cardiac troponin T (cTnT), cardiac troponin I (cTnI), creatine kinase-MB (CK-MB) and B-type natriuretic peptide (BNP) were measured. We quantified the level of CAC by multirow spiral computed tomography to obtain a CAC score. CAC scores > or = 400 were defined as being indicative of severe CAC.

Results: Severe CAC was detected in 17 patients (45%). The degree of CAC severity was positively associated (P < 0.05) with cTnT concentrations. Thus, 15% of patients had severe CAC in the lowest tertile of cTnT, 50% had severe CAC in the middle third, and 69% in the highest third. Similarly, the degree of severity of CAC was positively associated (P < 0.01) with cTnI concentrations across concentration categories. In contrast, there was no association between the degree of CAC severity and the concentrations of either BNP or CK-MB. A logistic regression analysis revealed that elevated concentrations of cTnT (> or = median vs or = 0.1 ng/ml vs
Conclusions: Elevated concentrations of cTnT and cTnI, but not BNP or CK-MB, were independently associated with the degree of severity of CAC in asymptomatic haemodialysis patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ndt/gfh488DOI Listing
December 2004

Cystic changes in intraabdominal extrahepatic metastases from gastrointestinal stromal tumors treated with imatinib.

Korean J Radiol 2004 Jul-Sep;5(3):157-63

Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, SNUMRC, Chongno-gu, Korea.

Objective: This study was undertaken for the purpose of describing the CT features of intra-abdominal extra-hepatic metastases from gastrointestinal stromal tumors in patients who were treated with imatinib.

Materials And Methods: Eleven patients with intra-abdominal extra-hepatic metastases from gastrointestinal stromal tumors, who were treated with imatinib between May 2001 and December 2003, were included in this study. The clinical findings and CT scans were retrospectively reviewed. The metastatic lesions were assessed according to the location, size (greatest diameter), attenuation, and the enhancing pattern before and after imatinib treatment.

Results: Prior to the treatment, the sizes and attenuation values of the metastatic lesions ranged from 5 to 20 cm and from 63 to 131 H, respectively. The metastatic lesions showed a heterogeneous enhancement pattern on the contrast-enhanced CT scans. After the treatment, the metastatic lesions became smaller in all 11 patients, and the corresponding attenuation value ranged from 15 to 51 H. The metastatic lesions became homogeneous and cystic in appearance on the follow-up CT scans, mimicking ascites.

Conclusion: Intra-abdominal extra-hepatic metastases of patients with gastrointestinal stromal tumors treated with imatinib may appear as well-circumscribed cystic lesions on contrast-enhanced CT. These metastases are likely to become smaller and resemble ascites, but may persist indefinitely on the followup CT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2698157PMC
http://dx.doi.org/10.3348/kjr.2004.5.3.157DOI Listing
February 2005