Ossification of the Triradiate Cartilage and Posterior Acetabulum

PURPOSE@#This study attempts to evaluate the skeletal maturation patterns of the triradiate cartilage (TRC) and the posterior acetabular wall (PA), which can be easily assessed on body computerized tomography (CT). It also examines the effect of gender and age on ossification of both TRC and PA.@*MATERIALS AND METHODS@#This retrospective study included a total of 1324 CT scans for children between the ages of 6 and 16 years. Depending on the extent of ossification in each right or left aspect, determined by the consensus of two observers, the TRC and PA scans were categorized into Grades 4 and 3, respectively.@*RESULTS@#The TRC for boys began to ossify at age 10 and closed completely at 14, while the PA for boys started ossification at age 11 and entirely fused at 13. The ages of ossification center appearance and complete fusion in both TRC and PA for girls were exactly two years earlier than boys. The TRC fused within one year after the closure of the PA.@*CONCLUSION@#The appearance and closure of the TRC and PA ossification centers show predictable patterns of development, appearance and merger earlier in females than in males. The suggestion is that development and morphogenesis of both TRC and PA ossification centers can be adequately assessed by using 3-dimensional body CT.

Nobiletin attenuates neurotoxic mitochondrial calcium overload through K⁺ influx and ΔΨ(m) across mitochondrial inner membrane

Mitochondrial calcium overload is a crucial event in determining the fate of neuronal cell survival and death, implicated in pathogenesis of neurodegenerative diseases. One of the driving forces of calcium influx into mitochondria is mitochondria membrane potential (ΔΨ(m)). Therefore, pharmacological manipulation of ΔΨ(m) can be a promising strategy to prevent neuronal cell death against brain insults. Based on these issues, we investigated here whether nobiletin, a Citrus polymethoxylated flavone, prevents neurotoxic neuronal calcium overload and cell death via regulating basal ΔΨ(m) against neuronal insult in primary cortical neurons and pure brain mitochondria isolated from rat cortices. Results demonstrated that nobiletin treatment significantly increased cell viability against glutamate toxicity (100 µM, 20 min) in primary cortical neurons. Real-time imaging-based fluorometry data reveal that nobiletin evokes partial mitochondrial depolarization in these neurons. Nobiletin markedly attenuated mitochondrial calcium overload and reactive oxygen species (ROS) generation in glutamate (100 µM)-stimulated cortical neurons and isolated pure mitochondria exposed to high concentration of Ca²⁺ (5 µM). Nobiletin-induced partial mitochondrial depolarization in intact neurons was confirmed in isolated brain mitochondria using a fluorescence microplate reader. Nobiletin effects on basal ΔΨ(m) were completely abolished in K⁺-free medium on pure isolated mitochondria. Taken together, results demonstrate that K⁺ influx into mitochondria is critically involved in partial mitochondrial depolarization-related neuroprotective effect of nobiletin. Nobiletin-induced mitochondrial K⁺ influx is probably mediated, at least in part, by activation of mitochondrial K⁺ channels. However, further detailed studies should be conducted to determine exact molecular targets of nobiletin in mitochondria.

Comparison of CT Findings of Non-Tuberculous Mycobacterial Pulmonary Infection: Disease Stable versus Progressed Group

PURPOSE@#To compare initial CT findings of non-tuberculous mycobacteria (NTM) pulmonary infection between stable and progressed groups and determine whether they could be used to predict disease prognosis and treatment response.@*MATERIALS AND METHODS@#From July 2006 to October 2013, 71 patients with NTM infection were retrospectively reviewed. Lung lesion pattern of CT finding, specific species, disease duration, and follow-up period were analyzed. These patients were classified into NTM stable (n = 46) and progressed (n = 25) groups.@*RESULTS@#The most common CT findings of NTM infection were small nodules (n = 71, 100%) and bronchiectasis (n = 67, 94%). Large consolidation (> 2 cm, n = 34, 48%) and involvement of more than four lobes (n = 49, 69%) were also commonly observed. According to disease prognosis, large consolidation (n = 18, 72%, p = 0.003), cavitary lesion (n = 17, p = 0.002), and involvement of four or more lobes (n = 21, p = 0.044) on CT were significantly more frequent in disease progressed group than that in the stable group.@*CONCLUSION@#Among common CT findings of NTM disease, some CT findings such as large consolidation, cavitary lesion, and disease extent are good predictors of response to treatment in NTM pulmonary disease.

New start / 대한구강보건학회지

No abstract available.

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

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.

The Minimal Postoperative Follow-Up Period to Determine Secondary Surgery in Patients with Intermittent Exotropia

PURPOSE: We investigated the recommended minimum postoperative follow-up period for the determination of secondary corrective surgery for the consecutive esotropia (ET) and recurrent exotropia (XT) after the first intermittent XT surgery. METHODS: The medical records of 728 patients who underwent surgical treatment for intermittent XT between 2004 and 2009 with a minimum postoperative follow-up of 1 year were retrospectively reviewed. Each patient underwent a detailed sensory and motor examination, including measurements of near and distance stereoacuity, alternating-cover test, and extraocular muscle function testing. Consecutive ET was defined as esodeviation over 15 prism diopter (PD) at distance persisting for more than 6 months after surgery despite medical treatment. Recurrent XT was defined as exodeviation over 15 PD at distance after surgery despite medical treatment. RESULTS: The mean age of the 728 patients at first surgery was 7.5 years (range, 22 months - 30 years). When only the motor outcome was considered, 663 patients (91.1%) had an orthrotropia at the final follow-up and 44 patients (6.0%) among consecutive ET patients and 21 patients (2.9%) who had a recurrent XT underwent secondary surgical correction. Binocularity decreased postoperatively in patients with consecutive ET (p < 0.001), whereas the other patients demonstrated improved stereopsis postoperatively (p = 0.041, 0.021). Patients with consecutive ET showed esodeviation over 10 PD when compared with orthotropia after 2 months postoperatively (p = 0.005). At 6 months postoperatively, 17 (81.0%) of 21 patients with recurrent XT showed orthotropia with an exodeviation over 11 PD after 18 months postoperatively. CONCLUSIONS: The success rate of surgical correction for intermittent XT showed a favorable outcome. However, careful concern for consecutive ET and recurrent XT are required in postoperative follow-up periods. Over-corrected or consecutive ETs need early surgical correction because no further improvement of ocular alignment will occur after 2 months postoperatively and delayed correction can result in poor sensory binocularity. Under-corrected or recurrent XT should be observed for an extended period because of the exotropic drift after surgery, thus requiring periodic long term follow-up for secondary surgery at least for 18 months postoperatively.

The Minimal Postoperative Follow-Up Period to Determine Secondary Surgery in Patients with Intermittent Exotropia

PURPOSE: We investigated the recommended minimum postoperative follow-up period for the determination of secondary corrective surgery for the consecutive esotropia (ET) and recurrent exotropia (XT) after the first intermittent XT surgery. METHODS: The medical records of 728 patients who underwent surgical treatment for intermittent XT between 2004 and 2009 with a minimum postoperative follow-up of 1 year were retrospectively reviewed. Each patient underwent a detailed sensory and motor examination, including measurements of near and distance stereoacuity, alternating-cover test, and extraocular muscle function testing. Consecutive ET was defined as esodeviation over 15 prism diopter (PD) at distance persisting for more than 6 months after surgery despite medical treatment. Recurrent XT was defined as exodeviation over 15 PD at distance after surgery despite medical treatment. RESULTS: The mean age of the 728 patients at first surgery was 7.5 years (range, 22 months - 30 years). When only the motor outcome was considered, 663 patients (91.1%) had an orthrotropia at the final follow-up and 44 patients (6.0%) among consecutive ET patients and 21 patients (2.9%) who had a recurrent XT underwent secondary surgical correction. Binocularity decreased postoperatively in patients with consecutive ET (p < 0.001), whereas the other patients demonstrated improved stereopsis postoperatively (p = 0.041, 0.021). Patients with consecutive ET showed esodeviation over 10 PD when compared with orthotropia after 2 months postoperatively (p = 0.005). At 6 months postoperatively, 17 (81.0%) of 21 patients with recurrent XT showed orthotropia with an exodeviation over 11 PD after 18 months postoperatively. CONCLUSIONS: The success rate of surgical correction for intermittent XT showed a favorable outcome. However, careful concern for consecutive ET and recurrent XT are required in postoperative follow-up periods. Over-corrected or consecutive ETs need early surgical correction because no further improvement of ocular alignment will occur after 2 months postoperatively and delayed correction can result in poor sensory binocularity. Under-corrected or recurrent XT should be observed for an extended period because of the exotropic drift after surgery, thus requiring periodic long term follow-up for secondary surgery at least for 18 months postoperatively.

Refractive Errors and Strabismus in Down's Syndrome in Korea

PURPOSE: The aims of this study were to examine the distribution of refractive errors and clinical characteristics of strabismus in Korean patients with Down's syndrome. METHODS: A total of 41 Korean patients with Down's syndrome were screened for strabismus and refractive errors in 2009. RESULTS: A total of 41 patients with an average age of 11.9 years (range, 2 to 36 years) were screened. Eighteen patients (43.9%) had strabismus. Ten (23.4%) of 18 patients exhibited esotropia and the others had intermittent exotropia. The most frequently detected type of esotropia was acquired non-accommodative esotropia, and that of exotropia was the basic type. Fifteen patients (36.6%) had hypermetropia and 20 (48.8%) had myopia. The patients with esotropia had refractive errors of +4.89 diopters (D, +/-3.73) and the patients with exotropia had refractive errors of -0.31 D (+/-1.78). Six of ten patients with esotropia had an accommodation weakness. Twenty one patients (63.4%) had astigmatism. Eleven (28.6%) of 21 patients had anisometropia and six (14.6%) of those had clinically significant anisometropia. CONCLUSIONS: In Korean patients with Down's syndrome, esotropia was more common than exotropia and hypermetropia more common than myopia. Especially, Down's syndrome patients with esotropia generally exhibit clinically significant hyperopic errors (>+3.00 D) and evidence of under-accommodation. Thus, hypermetropia and accommodation weakness could be possible factors in esotropia when it occurs in Down's syndrome patients. Based on the results of this study, eye examinations of Down's syndrome patients should routinely include a measure of accommodation at near distances, and bifocals should be considered for those with evidence of under-accommodation.

A Case of Isolated Squamous Cell Carcinoma of the Orbit

PURPOSE: To report a case of isolated squamous cell carcinoma of the orbit. CASE SUMMARY: A 75-year-old man with over a 50 pack-year history of smoking presented discomfort and visual disturbance of the left eye for several months. His best-corrected visual acuity was 0.3, intraocular pressure was 9 mm Hg, and extraocular movements were normal. Slit-lamp examinations revealed no specific findings in the anterior segment in the left eye. However, retinal exams showed an oval-shaped, juxtapapillary mass-like lesion associated with retinal folding in the left eye. A huge, distorted echoic mass with an initial prominent spike and low-to-medium internal reflectivity with diminishing amplitude was observed on ocular ultrasonography. Enhanced CT revealed a highly-intense, irregular-circumscribed heterogeneous mass (2.0 x 2.0 x 1.5) in the superomedial quadrant of the left eye. Metastatic workups, including bone scan and CT of the head, neck, chest, and abdomen, were unremarkable. One week after the initial visit, the patient experienced pain and reduced visual acuity (light perception) in the left eye. Following the diagnosis, enucleation with tumor resection and hydroxyapatite implantation was performed. Histopathologic examination revealed a moderated-differentiated squamous cell carcinoma invading the sclera. The patient subsequently underwent radiation treatment and no evidence of recurrence was reported 6 months after surgery.

Effect of 23-gauge Sutureless Vitrectomy & Preoperative Bevacizumab on Results of Diabetic Vitrectomy

PURPOSE: To investigate the results of 23-gauge sutureless vitrectomy and preoperative bevacizumab in diabetic retinopathy cases. METHODS: A total of 212 eyes received pars plana vitrectomy by a single surgeon for proliferative diabetic retinopathy and were followed up for at least 6 months. The change of visual acuity and operative complications among the 20-gauge vitrectomy (group I, 86 eyes), 23-gauge vitrectomy (group II, 30 eyes), and 23-gauge vitrectomy with preoperative intravitreal bevacizumab (IVB) injection (group III, 96 eyes) were retrospectively analyzed. RESULTS: One month postoperatively, visual improvement was better in groups II and III than in group I. Three months postoperatively, visual improvement was better in group III than in groups I and II. Six months postoperatively, visual improvement in group III was better than in group I, but there was no significant difference between group II and III. Intraoperative retinal breaks and postoperative vitreous hemorrhage were less common in group III than in groups I and II. CONCLUSIONS: In patients with proliferative diabetic retinopathy, 23-gauge sutureless vitrectomy showed faster visual recovery compared with 20-gauge vitrectomy, and vitrectomy with preoperative bevacizumab had less intraoperative and postoperative complications than vitrectomy without preoperative bevacizumab.

Leber's Idiopathic Stellate Neuroretinitis with Peripapillary Serous Retinal Detachment

PURPOSE: To report a patient with Leber's idiopathic stellate neuroretinitis accompanying peripapillary sensory retinal detachment detected with optical coherence tomography. CASE SUMMARY: A 26-year-old woman complained of visual disturbance in her right eye for several months. Her best corrected visual acuity was 0.5 in the right eye and 0.9 in the left eye. A relative afferent papillary defect was present in the right eye. Severe disc swelling with retinal hemorrhage and stellate macular exudates were observed in the right eye. Fluorescein angiography revealed optic disc leakage. There appeared to be no leakage from the other retinal vessels or from the retinal pigment epithelium. OCT revealed outer nuclear-plexiform layer fluid accumulation in the papillomacular region. Eight weeks after steroid treatment, the best corrected visual acuity in the right eye had improved to 0.7, and the optic disc edema had improved. The OCT showed that the fluid in the outer nuclear-plexiform layer space had largely been absorbed.

Functional MRI of Language: Difference of its Activated Areas and Lateralization according to the Input Modality

PURPOSE: To compare fMRIs of visual and auditory word generation tasks, and to evaluate the difference of its activated areas and lateralization according to the mode of stimuli. MATERIALS AND METHODS: Eight male normal volunteers were included and all were right handed. Functional maps were obtained during auditory and visual word generation tasks in all. Normalized group analysis were performed in each task and the threshold for significance was set at p<0.05. Activated areas in each task were compared visually and statistically. RESULTS: In both tasks, left dominant activations were demonstrated and were more lateralized in visual task. Both frontal lobes (Broca's area, premotor area, and SMA) and left posterior middle temporal gyrus were activated in both tasks. Extensive bilateral temporal activations were noted in auditory task. Both occipital and parietal activations were demonstrated in visual task. CONCLUSION: Modality independent areas could be interpreted as a core area of language function. Modality specific areas may be associated with processing of stimuli. Visual task induced more lateralized activation and could be a more useful in language study than auditory task.

Percutaneous Excision of a Benign Breast Mass Using Ultrasound-guided, Vacuum-assisted Core Biopsy: A Review of 197 Cases with Long Term Follow-up

PURPOSE: To assess long term results of excising benign masses using ultrasound (US)-guided, vacuum-assisted core biopsy (Mammotome). MATERIALS AND METHODS: We enrolled 163 patients (197 masses) receiving USguided excision using vacuum-assisted core biopsy and follow-up sonography in this retrospective study. The masses were category 3 as determined by ultrasound imaging according to the Breast Imaging Reporting and Data System (BI-RADS) (n=145) or pathologically confirmed as benign masses by a previous core-needle biopsy although category 4a and 4b (n = 52). Pathology, the presence of hematoma and residual tissue, as well as scar formation were assessed. RESULTS: We diagnosed 190 (96.5%) benign masses, 4 (2.0%) malignant masses, and 3 (1.5%) high-risk lesions. Most (176 masses, 91.2%) were excised completely as demonstrated by the follow-up ultrasound examination. Scar changes were minimal (68.7%) or moderate (31.3%), with regression in 53%. CONCLUSION: US-guided excision using vacuum-assisted core biopsy is effective for the removal of benign breast masses. The majority of scars are minimal, with good cosmetic effect. However, subsequent excision should be done for malignant masses or phyllodes tumor because radiologic absence does not guarantee complete removal.

Phase Contrast Microradiography of Mouse Lung Using Synchrotron X-ray: Correlation with Optical Microscopy

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 um 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.

Differentiation between Small Bowel Intussusception in Children and Adults and the Radiological Findings which Require an Operation

PURPOSE: To assess the differences in small bowel intussusceptions between children and adults, and to interpret the radiological findings requiring a surgical procedure. MATERIALS AND METHODS: A total of 62 study subjects (35 children, 27 adults) with small bowel intussusception diagnosed by US or CT and seen between January 2005 and December 2007 were included in this study. Two radiologists retrospectively reviewed both the medical records and radiological findings of each study subject. We contrasted the range of features found to be typical of small bowel intussusception for both children and adults based on cause, abdominal symptoms, diagnostic tools, and treatments. Also, we evaluated the radiological findings requiring a surgical procedure. RESULTS: The causes of small bowel intussusception were not identified in children; however, 4 adults were found to have tumors (a lipoma, a hemangioma, 2 metastases) (p=0.031). All of the children (100%) and 8 adults (29.6%) had abdominal symptoms (p < 0.001). The primary diagnostic tool in children was the US (31 cases, 88.6%), as opposed to the CT in adults (27 cases, 100%) (p < 0.001). A spontaneous reduction was confirmed in all children (100%) and supposed in 23 adults (85.2%) (p=0.031). The noteworthy radiological findings of 4 study subjects having undergone a surgical procedure are masses at the lead point and small bowel obstruction (p < 0.0001). CONCLUSION: Cases of small bowel intussusception in children are different from cases observed in adults, based on cause, symptoms, and diagnostic tools. However, most cases are spontaneously reduced. Important radiological findings requiring a surgical procedure were found to be caused by masses at the lead point and at the small bowel obstruction.

Diagnostic Value of Dynamic Perfusion MR Imaging in Benign and Malignant Musculoskeletal Lesions

PURPOSE: To assess the diagnostic value of dynamic perfusion MR imaging for differentiation between benign and malignant musculoskeletal lesions. MATERIALS AND METHODS: Dynamic perfusion MR imaging was performed using a 3.0 T system in 32 female and 30 male patients (aged 10-90 years, mean age, 43 years). Following the assessment of the precontrast imaging, a dynamic study was performed. This dynamic technique allowed for 638 images to be obtained at 11 levels throughout the lesion. Twenty-eight lesions originated within bone (8 benign, 20 malignant), whereas 34 lesions were of soft tissue origin (22 benign, 12 malignant). The final diagnosis was histopathologically confirmed in all patients. To differentiate between benign and malignant lesions, we analyzed the four parameters: (maximal relative enhancement (MRE), time to peak (TTP), wash in rate (WI), steepest slope (SS) and the distribution of time intensity curve (TIC) patterns. RESULTS: The TTP, WI, and SS values of malignant lesions were statistically significant from those of benign lesions (p < 0.05). However, the difference for the MRE values was not statistically significant. The distribution of TIC patterns was a helpful indicator of benign or malignant state, however the difference between the two states was not significant. CONCLUSION: Dynamic perfusion MR imaging is a helpful tool in differentiating benign and malignant musculoskeletal lesions.

A Comparison between Dual-Exposure Dual-Energy Radiography and Standard Chest Radiography for the Diagnosis of Small Pulmonary Nodules

PURPOSE: To evaluate the utility of dual-exposure dual-energy radiography against the standard chest radiography in the discrimination of lung nodules and the presence of nodule calcification. MATERIALS AND METHODS: Twenty-nine patients with a total of 43 peripheral lung nodules were examined by dual-exposure dual-energy radiography (DER) and confirmed by a chest CT were included in the study. Of the identified peripheral lung nodules, 24 showed calcification and 19 did not. Further, 28 lesion-free regions from the same patient population were selected as negative controls. Two radiologists evaluated 71 marked locations using both standard chest radiographs (SR) and DER to determine whether the marked locations represented a true nodule, and whether nodule calcification was present. A continuous rating scale of 0-10 was used to represent each observer's confidence level. We calculated the areas under ROC curves (AUC) for SR alone and for DER, and performed a statistical analysis to compare the results. RESULTS: The ability to discriminate nodules was higher for DER than for SR. However, the was not statistically significant (p = 0.202). Inter-observer agreement was moderate regardless of if DER was used. The predictability of nodule calcification was significantly higher for DER compared to SR (p < .001). Moreover, inter-observer agreement was slight with SR alone but moderate with DER. CONCLUSION: DER, in conjunction with SR, has no additional benefit in small lung nodule discrimination but does provide a significant benefit in the characterization of nodule calcification.

Comparison of Ferucarbotran-Enhanced MRI and Triple-Phase MDCT for the Detection of Hepatocellular Carcinoma in Advanced Liver Cirrhosis

PURPOSE: To compare the diagnostic performance of ferucarbotran-enhanced MRI at 1.5-T with triple-phase multidetector-row helical CT (MDCT) to detect hepatocellular carcinoma in patients with advanced liver cirrhosis. MATERIALS AND METHODS: Twenty patients with advanced liver cirrhosis (Child's class B:C = 8:12) underwent ferucarbotran-enhanced MRI and triple-phase MDCT prior to liver transplantation. The mean time interval between the two imaging techniques was 18 days (range, 1-35 days). Three radiologists independently reviewed both images on a lesion-by-lesion basis and interpreted them for comparison with the pathologic findings of the explanted livers. As well, the sensitivity and an alternative-free response receiver operating characteristics (ROC) analysis was used to evaluate the diagnostic performance of each technique. RESULTS: The mean area under the ROC curve (Az) was significantly higher for the triple-phase MDCT (0.766) compared to the ferucarbotran-enhanced MRI (0.675) (p < 0.001). Similarly, the mean sensitivity of the triple-phase MDCT (60.3%) exceeded the ferucarbotran-enhanced MRI (43.1%). The results indicate that the triple-phase MDCT provides significantly greater mean sensitivity than the ferucarbotran-enhanced MRI (p < 0.001). CONCLUSION: The triple-phase MDCT provided a better diagnostic performance and higher sensitivity than the ferucarbotran-enhanced MRI for the detection of hepatocellular carcinomas in patients with advanced liver cirrhosis.

The Short-Term Effects of Balloon-Occluded Retrograde Transvenous Obliteration, for Treating Gastric Variceal Bleeding, on Portal Hypertensive Changes: a CT Evaluation

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 cm3 to 580.8 cm3, 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.

Usefulness of Fluoroscopy-Guided Intra-articular Injection of the Knee

PURPOSE: To determine the accuracy of the intra-articular location of hyaluroinc acid injection using a blind approach and to establish the usefulness of fluoroscopy-guided intra-articular injection. MATERIALS AND METHODS: A fluoroscopy unit was used for 368 intra-articular injections of hyaluronic acid to 93 knees in 65 patients. Initially, blind needle positioning was conducted on the fluoroscopy table. The failure rate of the blind approach among the 368 injections was evaluated, and a relationship between the Kellgren-Lawrence grade (K-L grade) and the incidence of repeated failures using the blind approach was determined for injections to 52 knees in 37 patients who received a complete cycle of injections (five consecutive injections with a one-week interval between injections). RESULTS: Using a blind approach, 298 of 368 trials (81.2%) resulted in a needle tip being placed in an intra-articular location, while 70 of 368 trials resulted in an extra-articular placement of the needle tip. Among 52 knees to which a complete cycle of injections (five consecutive injections with a one-week interval between injections) was administered, repeated failure of intra-articular placement using the blind approach was seen for 18 knees (34.6%); a more severe K-L grade assigned was associated with a higher rate of repeated failure. However, the trend was not statistically significant based on the Chi-squared test (p value = 0.14). CONCLUSION: Fluoroscopy-guided needle placement may be helpful to ensure therapeutic intra-articular injection of the knee.