Midterm Outcomes of Open Surgical Repair Compared with Thoracic Endovascular Repair for Isolated Descending Thoracic Aortic Disease

OBJECTIVE: This study aimed to assess the surgical morbidity and mortality of thoracic endovascular repair (TEVAR) as compared with open surgical repair (OSR) for isolated descending thoracic aortic disease. MATERIALS AND METHODS: From January 1, 2006 through May 31, 2010, a total of 68 patients with isolated descending thoracic aortic disease were retrospectively reviewed for the presence of perioperative complication, 30-day mortality, and clinical success. The patients were divided into two groups (group 1, OSR, n = 40 vs. group 2, TEVAR, n = 28) and these groups were compared for major variables and late outcomes. RESULTS: The mean age was 58 years (group I = 54 vs. group II = 63 years, p = 0.011). Significant perioperative complications occurred in 12 patients: 8 (20%) in group I and 4 (13%) in group II (p = 0.3). There were five 30 day mortalities of which 4 occurred in group I and 1 in group II (p = 0.23). Clinical success (effective aortic remodeling and complete false lumen obliteration or thrombosis) was achieved in 20 patients (71%). Mean Kaplan-Meier survival rate at 1 year was similar for both groups (group 1 = 87% vs. group 2 = 80%, p = 0.65). CONCLUSION: Thoracic endovascular repair for isolated thoracic aortic disease shows comparable results to OSR. However, the potential for endoleak or rupture remains a challenge that needs to be addressed in the future. Therefore, close follow-up study is needed for the evaluation of satisfactory long-term outcomes.

A case report of functional treatment in severe condyle resorption female adult patient

Hepatocellular Carcinoma with Extensive Hepatic Artery Injury: Transcatheter Arterial Chemoembolization through Collaterals after Coil Embolization of Gastric Arteries

PURPOSE: To evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE) after coil embolization of the gastroduodenal artery in hepatocellular carcinoma cases with multiple collateral arteries caused by proper hepatic artery injury. MATERIALS AND METHODS: Between March 1997 and November 1998, a prospective trial of transcatheter arterial chemoembolization (TACE) was performed through collaterals from the gastroduodenal artery of 31 hepato-cellular carcinoma patients with extensive proper hepatic artery injury due to repeated TACE. Among this number, 16 (group A) underwent TACE after coil embolization of the right gastric and gastroduodenal artery. The other 15 patients (group B) underwent TACE without coil embolization. The two groups had the same T-NM stage and Child-Pugh status. During the follow-up period, group A underwent additional TACE 3.3 times, and group B 2.8 times. The therapeutic effect of TACE was evaluated with computed tomography and by measuring alpha-fetoprotein levels. Complications were evaluated by means of gastrofibroscopy, laboratory data, and evalvation of the patients clinical symptoms. The results obtained after six months and one year were compared within and between each group. RESULTS: At six months follow-up, CT findings had improved or were unchanged in 11 patients(69 %) in group A, and four patients(27 %) in group B(p=0.032). In ten patients in each group, the level of alpha-fetoprotein was above 200 ng/ml. Its level was decreased in five patients(50%) and three patients(30%), respectively. The six-month survival rate was 81 %(13/16) in group A and 67 %(10/15) in group B (p=0.43), while the one-year survival figures for these two groups were 50 %(8/16) and 20%(3/15), respectively(p=0.135). In group A, the CT findings were steady in five out of eight patients(63%), while in group B, CT findings showed that tumors with increased alpha-fetoprotein levels had increased in size and/or number. In group A, it was found that in two (33 %) of six patients whose initial alpha-fetoprotein level was over 200ng/nl, this level had decreased. Acute gastric ulcer was found in two patients in group A, and mild acute pancreatitis in one. One patient in group B was also found to have an acute gastric ulcer. CONCLUSION: In view of the advanced disease stage of patients for whom a long period has elapsed since initial diagnosis, TACE after coil embolization of gastric arteries may be a safe and acceptable method for use in the treatment of hepatocellular carcinoma with extensive hepatic artery injury.

The Imaging Findings of Small(< or =15mm) Portal Defects in the Liver on CT Arterial Portography: Evaluationwith CT Hepatic Arteriography and Lipiodol CT

PURPOSE: To assess the malignant potential of small(< or =15mm) portal defects seen on CT arterial portography,the findings of CT hepatic arteriography and lipiodol CT CT were reviewed. MATERIALS AND METHODS: In 91 patientswho underwent both CTAP and CTHA, small portal defects were re-viewed for frequency, multiplicity and location. Weprospectively evauluated changes in the size and enhance-ment pattern of malignant lesions on follow up CTaccording to density on CTHA, location, lipiodol deposits on lipiodol CT, and multiplicity. RESULTS: Among the 91patients, 102 small defects were defected in 42 patients(46%). Small portal defects were benign, malignant, and ofundetermined malignant potential in 77%, 20% and 3% of cases, respectively. Small portal defects that werehyperattenuated on CTHA, and lipiodol deposits on lipiodol CT, were malignant in 42% and 70% of cases,respectively. Location and multiplicity did not show statistically significant variation between benign andmalignant defects. CONCLUSION: Small portal defects are common and there is a high probability that portaldefects smaller than 15mm are benign, even in patients with a known hepatic mass and defect that washyperattenuated on CTHA. If a small defect showed lipiodol deposit on lipiodol CT, malignancy must be suspected.

A photoelastic study on the stress distribution in bone by the transpalatal lingual arch / 대한치과교정학회지

The purpose of this study was to investigate the stress distribution and intensity derived from the transpalatal lingual arch in the investing bone composed of photoelastic material(PL-3). The transpalatal lingual arch wire was deflected in the horizontal and vertical direction to give the various conditions. The two-dimensional photoelastic stress analysis was performed, and the stress distrebution was recored by photofraphy. The results were as follows: 1. In bilateral expansion, as horizontal deflection was singly applied, the stress was more concentrated on the root apex in square free end than round. In square free end, as vertical deflection was increased gradually, the black line meaning center of rotation moced inferiorly togerher with the increment of whole fringes. 2. In application of vertical deflection on anchorage side for unilateral expansion, the stress distribution that expansive force leaned to expansion side was observed. As vertical deflection increased, the extruding stress was obesrved on molar of expansion side. And as horisontal deflection increased, the tipping stress on the molar of anchorage side was observed. 3. In unilateral rotation with the asymmetric toe-in, the fringe appeared on the distal aspect of root apex.

A Study Using Diffusion-Weighted MR Image in the Experimental Models with Diffusion Difference

PURPOSE: To see the stability and error in the diffusion-weighted magnetic resonance (MR) imaging technique in the experimental models and to observe the signal intensities in the early cerebral lesions of the animal models. MATERIALS AND METHODS: Diffusion coefficients of acetone and distilled water were measured by diffusion-weighted MR image and were compared with actual values. Differentiation of diffusion from perfusion were done at the resin flow phantom. The signal intensities caused by early parenchymal changes were measured in normal, hypovolemic, and embolic, and dead animal models by using diffusion-weighted image and compared with pathoIogic finding and vital staining. RESULTS: Diffusion coefficients of acetone and distilled water were 4.48 x 10-3 and 2.72 x 10-3 which were very close to the actual values. Diffusion-weighted MR image obtained at flow phantom was not affected by flow (perfusion) at the 100-400 of b-factor range. Animal study done at that b-factor range revealed a significant signal difference between the left and right sides only at the embolic model induced by polyvinyl alchol particles (p<0.05). These changes were not detected in microscopic finding but could be identified in vital staining. CONCLUSION: Diffusion-weighted MR image can be used to detect early parenchymal change when the appropriate b-factor range was applied.

MR Findings of ADEIVI in Children

PURPOSE: To evaluate MR characteristics of acute disseminated encephalomyelitis (ADEM) in children, which was confirmed by clinical findings. MATERIALS AND METHODS: The subjects were six patients, who were diagnosed by clinical findings. One subject had recurrence one year after clinical improvement leading to one additional care with the total of seven. The modes of viral infections were as follows;four cases of non-specific upper respiratory tract infection, one of E-B virus, one of Japanese-B-encephalitis vaccination, and one of upper respiratory infection in Bruton's disease. The Gd-DTPA enhanced scan was performed in all cases. MR findings were evaluated in anatomic location of the lesions, presence or absence of contrast enhancement, and the temporal changes were also evaluated on follow-up MRI. RESULT: There were multifocal high signal intensity lesions on T2WI in all cases. The location of lesions were basal ganglia in five, thalamus and brain stem in four, and cerebral gray and white matter and cerebellar white matter in three. Bilaterality was 77%. There were contrast enhancement in two of three cerebral cortical lesions and one of three white matter lesions. The size of lesions decreased on the first follow-up MRI which were done after 1 month in 4 cases, but new lesions were developed in two cases. On the second follow-up MRI which were done 2 months after, all lesions were decreased in size and there was no newly developed lesion. However, in one case who had recurrent similar symptom after 1 year, several new lesions developed on follow-up MRI, and it was comidened as a recurrence. CONCLUSION: The characteristic MR findings of ADEM were multifocal bilateral white and gray matter lesions which were high signal intensities on T2WI. The majority of lesions improved on follow-up MRI, but occasionally showed multiphasic pattern.

CT Evaluation of Solitary Pulmonary Nodule

PURPOSE: To evaluate criteria for differentiating benign versus malignant solitary pulmonary nodules (SPNs) by analyzing their morphology and perinodular parenchymal changes on CT/HRCT. MATERIALS AND METHODS: We retrospectively reviewed the CT/HRCT in 99 patients with SPN. Sixty two cases were proved by surgery, PCNA, clinical follow up and etc. Thirty seven cases were diagnosed by typical benign calcification. We defined SPN as a discrete, single lesion in the lung with margins that are sharp enough to permit measurement of diameter. We excluded lesions more than 4cm in diameter and lesions with cavity from our study protocol. The study included 41 malignant nodules and 58 benign nodules. RESULTS: Mean diameter of malignant nodule was 2.9cm, benign nodule was 2.2cm. Peripheral location of nodule was 28 in malignant nodules, 50 in benign nodules. Typical benign calcification was observed in 37 tuberculoma and three hamartoma. Lobulated margin was noted in 32 malignant nodules and 14 benign nodules. Spiculated margin was observed in 17 malignant nodules and 20 benign nodules. Low attenuation within the nodule was observed in 14 malignant nodules and 12 benign nodules. Pleural tail was observed in 14 malignant nodules and 31 benign nodules. Air bronchogram was noted in 18 malignant nodules and 4 benign nodules. Juxta nodular tuberculosis was observed in 6 malignant nodules and 29 benign nodules. CONCLUSION: Malignant nodules were larger than benign nodules and more commonly demonstrated a Iobulated contour and air bronchogram (p<0.05). Benign nodules more commonly demonstrated low density in the nodule and associated with juxta nodular tuberculosis and peripheral location (p<0.05). Spiculated margin and pleural tail were not helpful to differentiate benign from malignant nodule.

CT Evaluation of Solitary Pulmonary Nodule

PURPOSE: To evaluate criteria for differentiating benign versus malignant solitary pulmonary nodules (SPNs) by analyzing their morphology and perinodular parenchymal changes on CT/HRCT. MATERIALS AND METHODS: We retrospectively reviewed the CT/HRCT in 99 patients with SPN. Sixty two cases were proved by surgery, PCNA, clinical follow up and etc. Thirty seven cases were diagnosed by typical benign calcification. We defined SPN as a discrete, single lesion in the lung with margins that are sharp enough to permit measurement of diameter. We excluded lesions more than 4cm in diameter and lesions with cavity from our study protocol. The study included 41 malignant nodules and 58 benign nodules. RESULTS: Mean diameter of malignant nodule was 2.9cm, benign nodule was 2.2cm. Peripheral location of nodule was 28 in malignant nodules, 50 in benign nodules. Typical benign calcification was observed in 37 tuberculoma and three hamartoma. Lobulated margin was noted in 32 malignant nodules and 14 benign nodules. Spiculated margin was observed in 17 malignant nodules and 20 benign nodules. Low attenuation within the nodule was observed in 14 malignant nodules and 12 benign nodules. Pleural tail was observed in 14 malignant nodules and 31 benign nodules. Air bronchogram was noted in 18 malignant nodules and 4 benign nodules. Juxta nodular tuberculosis was observed in 6 malignant nodules and 29 benign nodules. CONCLUSION: Malignant nodules were larger than benign nodules and more commonly demonstrated a Iobulated contour and air bronchogram (p<0.05). Benign nodules more commonly demonstrated low density in the nodule and associated with juxta nodular tuberculosis and peripheral location (p<0.05). Spiculated margin and pleural tail were not helpful to differentiate benign from malignant nodule.