Clinical Significance of Combining Preoperative and Postoperative Albumin-Bilirubin Score in Colorectal Cancer / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Albumin-bilirubin (ALBI) score is a well-known prognostic factor for various diseases, including colorectal cancer (CRC). However, little is known about the significance of postoperative ALBI score changes in patients with CRC. @*Materials and Methods@#A total of 723 patients who underwent surgery were enrolled. Preoperative ALBI (ALBI-pre) and postoperative ALBI (ALBI-post) scores were divided into low and high score groups. ALBI-trend was defined as a combination of four groups comprising the low and high ALBI-pre and ALBI-post score groups. Kaplan-Meier survival curves were used to compare the overall survival (OS) between the different ALBI groups. The Cox proportional hazards model was used to examine the independent relevant factors of OS. Stratification performance was compared between the different ALBI groupings using Harrell’s concordance index (C-index). @*Results@#ALBI-pre, ALBI-post, and ALBI-trend score groups were significant prognostic factors of OS in the univariable analysis. However, multivariable analysis showed that ALBI-trend was an independent prognostic factor while ALBI-pre and ALBI-post were not. The C-index of ALBI-trend (0.622; 95% confidence interval [CI], 0.587 to 0.655) was higher than that of ALBI-pre (0.589; 95% CI, 0.557 to 0.621; bootstrap mean difference, 0.033; 95% CI, 0.013 to 0.057) and ALBI-post (0.575; 95% CI, 0.545 to 0.605; bootstrap mean difference, 0.047; 95% CI, 0.024 to 0.074). @*Conclusion@#Combining ALBI-pre and ALBI-post scores is an independent prognostic factor of OS and shows superior predictive power compared to ALBI-pre or ALBI-post alone in patients with CRC.

Pseudoglandular Formation in Hepatocellular Carcinoma Determines Apparent Diffusion Coefficient in Diffusion-Weighted MRI

PURPOSE: To determine the impact of pseudoglandular formation on apparent diffusion coefficient (ADC) values of hepatocellular carcinoma (HCC) in diffusion-weighted imaging (DWI), and to validate the results using histopathological grades. MATERIALS AND METHODS: We assessed 182 HCCs surgically resected from 169 consecutive patients. Each type of tumor pseudoglandular formation was categorized into “non-,” “mixed-,” or “pure-,” based on official histopathology reports. The ADC for each tumor was independently measured, using the largest region of interest on the ADC map. Data were assessed using the analysis of variance test, with Bonferroni correction for post hoc analysis to stratify the relationship of ADCs with pseudoglandular formation, followed by subgroup analysis according to the histopathological tumor grades. RESULTS: The mean ADC was significantly higher in pure pseudoglandular lesions (n = 5, 1.29 ± 0.08 × 10−3 mm2/s) than in non-pseudoglandular lesions (n = 132, 1.08 ± 0.17 × 10−3 mm2/s; P = 0.003) or mixed-pseudoglandular lesions (n = 45, 1.16 ± 0.24 × 10−3 mm2/s; P = 0.034). The ADC values and pseudoglandular formation were significantly correlated in moderately differentiated HCCs (n = 103; r = 0.307, P = 0.007), while well- (n = 19) and poorly-differentiated HCCs (n = 60) did not show significant correlation (r = 0.105 and 0.068, respectively; P = 0.600 and 0.685, respectively). CONCLUSION: The degree of pseudoglandular formation could be one of the determinants of ADC in DWI of HCCs-especially moderately differentiated HCCs-while its influence does not appear to be significant in well- or poorly differentiated HCCs.

Attenuation-Based Automatic Tube Potential Selection in Cerebral Computed Tomography Angiography: Effects on Radiation Exposure and Image Quality

OBJECTIVE@#To investigate the feasibility of using the attenuation-based automatic tube potential selection (ATPS) algorithm for cerebral computed tomography angiography (CTA) and to assess radiation dose, vascular attenuation, and image quality compared to a conventional fixed 120-kVp protocol.@*MATERIALS AND METHODS@#Among 36 volunteers for cerebral CTA, a total of 18 were scanned with fixed 120 kVp and 140 effective mAs using automatic tube current modulation. The other 18 were scanned with an ATPS algorithm. Radiation doses, attenuation, contrast-to-noise ratio (CNR) of the cerebral arteries, subjective scores for arterial attenuation, edge sharpness of the artery, visibility of small arteries, venous contamination, image noise, and overall image quality were compared between the groups.@*RESULTS@#The volume CT dose index and effective dose of the ATPS group were lower than those of the fixed 120-kVp group. The ATPS group had significantly higher arterial attenuation and no significant difference in CNR, compared with the fixed 120-kVp. The ATPS group had higher subjective scores for arterial attenuation, edge sharpness of the artery, visibility of small arteries, and overall image quality.@*CONCLUSION@#The ATPS algorithm for the cerebral CTA reduced radiation dose by 43% while maintaining image quality and improved the attenuation of cerebral arteries by selecting lower tube potential.

Diffusion-Weighted MRI of Malignant versus Benign Portal Vein Thrombosis

OBJECTIVE: To validate the diffusion-weighted MRI (DWI) for differentiation of benign from malignant portal vein thrombosis. MATERIALS AND METHODS: The Institutional Review Board approved this retrospective study and waived informed consent. A total of 59 consecutive patients (52 men and 7 women, aged 40-85 years) with grossly defined portal vein thrombus (PVT) on hepatic MRI were retrospectively analyzed. Among them, liver cirrhosis was found in 45 patients, and hepatocellular carcinoma in 47 patients. DWI was performed using b values of 50 and 800 sec/mm2 at 1.5-T unit. A thrombus was considered malignant if it enhanced on dynamic CT or MRI; otherwise, it was considered bland. There were 18 bland thrombi and 49 malignant thrombi in 59 patients, including 8 patients with simultaneous benign and malignant PVT. Mean apparent diffusion coefficients (ADCs) of benign and malignant PVTs were compared by using Mann-Whitney U test. Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: The mean ADC ± standard deviation of bland and malignant PVT were 1.00 ± 0.39 × 10(-3) mm2/sec and 0.92 ± 0.25 × 10(-3) mm2/sec, respectively; without significant difference (p = 0.799). The area under ROC curve for ADC was 0.520. An ADC value of > 1.35 × 10(-3) mm2/sec predicted bland PVT with a specificity of 94.6% (95% confidence interval [CI]: 84.9-98.9%) and a sensitivity of 22.2% (95% CI: 6.4-47.6%), respectively. CONCLUSION: Due to the wide range and considerable overlap of the ADCs, DWI cannot differentiate the benign from malignant thrombi efficiently.

Prognostic value of gallbladder wall thickening in patients with acute hepatitis A

PURPOSE: To investigate the clinical significance of gallbladder (GB) wall thickening frequently observed in patients with acute hepatitis A. METHODS: A total of 328 consecutive patients who were diagnosed with acute hepatitis A and underwent abdominal ultrasonography were enrolled retrospectively. Patients were divided into two groups: GB wall thickening (> or =3 mm, group A) and no thickening (group B). Group A was subdivided into two subgroups (GB wall thickening of > or =10 mm, group A-1 and > or =3 mm to <10 mm, group A-2). The laboratory results related to liver function, hospitalization duration, and time to normalization of liver function were compared between the groups. RESULTS: A total of 230 patients showed GB wall thickening (group A). Besides gamma-glutamyl transpeptidase and alkaline phosphatase, all laboratory results of group A were significantly higher than those of group B (P<0.05). Compared with group B, the hospitalization duration and the time to normalization of liver function were significantly longer in group A (P<0.05). Group A-1 included 146 patients and group A-2 included 84 patients. No significant differences in laboratory results, hospitalization duration, and time to normalization of liver function were found between the two subgroups. In the multivariate logistic regression analysis, serum alanine transaminase, total bilirubin and albumin levels, and hospitalization duration were significantly associated with GB wall thickening in patients with hepatitis A. CONCLUSION: The presence of GB wall thickening in patients with acute hepatitis A suggests a poorer prognosis irrespective of the degree of GB wall thickening or the degree of liver enzyme elevation.

MRI Features of Hepatocellular Carcinoma Related to Biologic Behavior

Imaging studies including magnetic resonance imaging (MRI) play a crucial role in the diagnosis and staging of hepatocellular carcinoma (HCC). Several recent studies reveal a large number of MRI features related to the prognosis of HCC. In this review, we discuss various MRI features of HCC and their implications for the diagnosis and prognosis as imaging biomarkers. As a whole, the favorable MRI findings of HCC are small size, encapsulation, intralesional fat, high apparent diffusion coefficient (ADC) value, and smooth margins or hyperintensity on the hepatobiliary phase of gadoxetic acid-enhanced MRI. Unfavorable findings include large size, multifocality, low ADC value, non-smooth margins or hypointensity on hepatobiliary phase images. MRI findings are potential imaging biomarkers in patients with HCC.

A Case of Adenocarcinomatous Transformation of a Sacrococcygeal Teratoma in an Adult / 대한내과학회지

Sacrococcygeal teratoma (SCT) is an unusual tumor in adults. The incidence of malignant transformation of this tumor increases when its excision is delayed beyond 1 month of age. We report an uncommon case of adenocarcinoma arising within the colonic mucosa of a mature teratoma of the sacrococcyx in a 44-year-old male. The patient received surgical resection for a sacrococcygeal mass in a local hospital and was diagnosed with adenocarcinoma arising from SCT. He was referred to our hospital for further treatment and received chemotherapy as adjuvant treatment. After 4.5 years, the coccygeal mass recurred on follow-up imaging workup, and surgical resection was performed. On pathologic work-up, residual disease at the resection margin was identified microscopically. Pathologic diagnosis was a primary adenocarcinoma arising from the colonic mucosa within a mature teratoma. The patient received adjuvant-chemotherapy and radiotherapy and has been followed up.

CT Venography for Deep Vein Thrombosis Using a Low Tube Voltage (100 kVp) Setting Could Increase Venous Enhancement and Reduce the Amount of Administered Iodine

OBJECTIVE: To investigate the validity of the 100 kVp setting in CT venography (CTV) in the diagnosis of deep vein thrombosis (DVT), and to evaluate the feasibility of reducing the amount of administered iodine in this setting. MATERIALS AND METHODS: After receiving the contrast medium (CM) of 2.0 mL/kg, 88 patients underwent CTV of the pelvis and lower extremities by using one of four protocols: Group A, 120 kVp setting and 370 mgI/mL CM; group B, 120 kVp and 300 mgI/mL; group C, 100 kVp and 370 mgI/mL; group D, 100 kVp and 300 mgI/mL. The groups were evaluated for venous attenuation, vein-to-muscle contrast-to-noise ratio (CNRVEIN), DVT-to-vein contrast-to-noise ratio (CNRDVT), and subjective degree of venous enhancement and image quality. RESULTS: Venous attenuation and CNRVEIN were significantly higher in group C (144.3 Hounsfield unit [HU] and 11.9), but there was no significant difference between group A (118.0 HU and 8.2) and D (122.4 HU and 7.9). The attenuation value of DVT was not significantly different among the four groups, and group C had a higher absolute CNRDVT than the other groups. The overall diagnostic image quality and venous enhancement were significantly higher in group C, but there was no difference between groups A and D. CONCLUSION: The 100 kVp setting in CTV substantially help improve venous enhancement and CNRVEIN. Furthermore, it enables to reduce the amount of administered iodine while maintaining venous attenuation, as compared with the 120 kVp setting.

A Case of Adrenocortical Carcinoma Secreting Cortisol and Aldosterone / 영남의대학술지

Adrenocortical carcinomas are rare and frequently aggressive tumors that may be functional (hormone-secreting) and may cause Cushing's syndrome or virilization, or non-functional and manifest as an abdominal mass. This paper reports the case of a 77-year-old woman with cortisol- and aldosterone-secreting adrenal carcinoma. The patient complained of general weakness, a moon face, and weight gain. She also had hypokalemia and hypertension. Her endocrinological data showed excessive aldosterone production and non-suppressible cortisol production in a low-dose dexamethasone suppresion test. Her abdominal CT showed a right adrenal mass. She underwent right adrenalectomy, and her histology revealed the presence of adrenocortical carcinoma. After adrenalectomy, her hypokalemia returned to normal and she is being treated with hydrocortisone.

Factors Influencing Children's Mental Health State / 정신간호학회지

PURPOSE: The purpose of this study was to investigate the factors that influence children's mental health state. METHODS: The subjects were 127 boys and 132 girls in the 5th and 6th grades of elementary school. Data were collected through Child Problem-Behavior Screening Questionnaire, Parental Behavior Rating Scale, Conflict Tactics Scales, Self-Esteem Scales, and Index of Peer Relations. Subjects were divided into the risk group and normal group of the mental health state by the scores of CPSQ and were analyzed by chi2 test, t-test, and logistic regression using SPSS/WIN 14.0. RESULTS: The risk group was 70.3% and normal group was 29.7% of the subjects. Self-esteem, peer relationship, and academic achievement were important factors influencing children's mental health state. CONCLUSION: Results of this study suggest interventions to improve self-esteem, peer relationship, and academic achievement for promoting children's mental health state.

Factors Influencing Children's Mental Health State / 정신간호학회지

PURPOSE: The purpose of this study was to investigate the factors that influence children's mental health state. METHODS: The subjects were 127 boys and 132 girls in the 5th and 6th grades of elementary school. Data were collected through Child Problem-Behavior Screening Questionnaire, Parental Behavior Rating Scale, Conflict Tactics Scales, Self-Esteem Scales, and Index of Peer Relations. Subjects were divided into the risk group and normal group of the mental health state by the scores of CPSQ and were analyzed by chi2 test, t-test, and logistic regression using SPSS/WIN 14.0. RESULTS: The risk group was 70.3% and normal group was 29.7% of the subjects. Self-esteem, peer relationship, and academic achievement were important factors influencing children's mental health state. CONCLUSION: Results of this study suggest interventions to improve self-esteem, peer relationship, and academic achievement for promoting children's mental health state.

Comparative Study of Lumbar Magnetic Resonance Imaging and Myelography in Young Soldiers with Herniated Lumbar Disc

OBJECTIVE: This study was undertaken to compare the diagnostic performances of magnetic resonance imaging (MRI), MR myelography (MRM) and myelography in young soldiers with a herniated lumbar disc (HLD). METHODS: Sixty-five male soldiers with HLD comprised the study cohort. A visual analogue scale for low back pain (VAS-LBP), VAS for leg radiating pain (VAS-LP), and Oswestry disability index (ODI) were applied. Lumbar MR, MRM, and myelographic findings were checked and evaluated by four independent radiologists, respectively. Each radiologist was asked to score (1 to 5) the degree of disc protrusion and nerve root compression using modified grading systems devised by the North American Spine Society and Pfirrmann and the physical examination rules for conscription in the Republic of Korea. Correlated coefficients between clinical and radiological factors were calculated. Interpretational reproducibility between MRI and myelography by four bases were calculated and compared. RESULTS: Mean patient age was 20.5 +/- 1.1. Mean VAS-LBP and VAS-LP were 6.7 +/- 1.6 and 7.4 +/- 1.7, respectively. Mean ODI was 48.0 +/- 16.2%. Mean MRI, MRM, and myelography scores were 3.3 +/- 0.9, 3.5 +/- 1.0, and 3.9 +/- 1.1, respectively. All scores of diagnostic performances were significantly correlated (p < 0.05). However, none of these scores reflected the severity of patients' symptoms. There was no statistical difference of interpretational reproducibility between MRI and myelography. CONCLUSION: Although MRI and myelography are based on different principles, they produce similar interpretational reproducibility in young soldiers with a HLD. However, these modalities do not reflect the severity of symptoms.

Effects of Oral Care Using Chlorhexidine Gluconate on Ventilator-Associated Pneumonia in the Intensive Care Unit / 병원감염관리

BACKGROUND: This study was aimed to identify the effect of oral care using 0.1% chlorhexidine gluconate (CHG) on ventilator-associated pneumonia (VAP) in the intensive care unit (lCU). METHODS: A total of 82 ventilated patient were enrolled in this prospective clinical trial performed during the 6-month period from October, 2005 through March, 2006. oral care was performed on the patients three times a day with 0.1% CHG for the study group and with 0.9% saline for the control group. To evaluate the colonization of potential pathogens, sputum cultures were taken on the first day of ventilation and followed on days 3, 5, 7, and 14. RESULTS: The overall incidence rate of YAP was 0.359 in the CHG-treated group compared to 0.116 in the NaCI-treated group (P=0.017). Likewise, 1000 device-day incidence rate of YAP was significantly lower in the CHG-treated group than in the NaCI-treated group (P=0.0396). However, among the patients whose initial sputrm cultures were positive , both the incidence rate (P=0.114) and 1000 device-day incidence rate (P=0.361) were not statistically significant. The average time from the day of ventilation to the onset of VAP among the patients whose initial sputrm cutures were positive was 14 days in the CHG-treated group and 9 days in the NaCI-treated group, but the difference was not statistically significant (P=0.169). CONCLUSION: An oral care with 0.1% CHG was helpful in controlling VAP in the ICU patients, but the effectiveness of CHG could not be confirmed in the patients whose initial sputrm cultures were positive.

Efficacy of 1:1000 Diluted Heparin versus 0.9% Normal Saline for Maintenance of Intermittent Intravenous Locks / 기본간호학회지

The objective of this research was to compare the flushing effects using 1:1,000 diluted heparin or 0.9% normal saline in relation to needle gauge and frequency of IV medications. The comparative categories were clotting, duration of patency, and incidence of phlebitis. The design of research was a Nonequivalent Control group, Post test, Nonsynchrorized Design. The independent variable was 0.9% normal saline flushing the IV locks and the dependent variables were clotting, duration of patency, and incidence of phlebitis. Subjects were medical-surgical inpatients over 15 years old and with peripherally placed IVs who were hospitalized in a university medical center. Exclusion criteria included foreigners and those who were rejected for this research. The final sample for data analysis included 295 IV sites in 194 patients; 154 were in the saline group and 141 were in the heparin group. Subjects were assigned to have IV locks is flushed with 0.9% normal saline in the experimental group and to have IV lock flushed with 1:1,000 diluted heparin(100 units) in the control group. In order to increase reliability, the nurses who were assigned to the units involved in the study received an explanation on the standard method for locking an IV, recording method for observational data and criteria for the detection of phelbitis. Data were collected for a period of 2 weeks, from March 16, 2000 to March 29, 2000. Total duration of IV was defined the time of IV insertion to the time of discontinuation. Phlebitis was defined as the presence of the following : pain, swelling, erythema at the insertion site. Chi-square was used to determine the association between the degree of clotting, duration of patency, and incidence of phlebitis for the diluted heparine or the normal saline and needle gauge and frequency of IV medications. The results are summarized as follows : (a) There was difference in the degree of clotting between two groups(x2=5.882, p=.015). (b) There was no difference in the degree of duration of patency between two groups(x2=2.439, p=.295). (c) There was no difference in the incidence of phlebits between two groups(x2=0.190, p=.663). (d) There was difference in the degree of clotting(x2=6.209, p=.013) and in the degree of duration of patency(x2=6.978, p=.031) according the needle guage between the two groups. (e) There was difference in the incidence of phlebitis(x2=5.008, p=.025) according to the frequencies of IV injection between two groups.