Pattern Analysis of Left Ventricular Remodeling Using Cardiac Computed Tomography in Children with Congenital Heart Disease: Preliminary Results

Objective@#To assess left ventricular remodeling patterns using cardiac computed tomography (CT) in children with congenital heart disease and correlate these patterns with their clinical course. @*Materials and Methods@#Left ventricular volume and myocardial mass were quantified in 17 children with congenital heart disease who underwent initial and follow-up end-systolic cardiac CT studies with a mean follow-up duration of 8.4 ± 9.7 months. Based on changes in the indexed left ventricular myocardial mass (LVMi) and left ventricular mass-volume ratio (LVMVR), left ventricular remodeling between the two serial cardiac CT examinations was categorized into one of four patterns: pattern 1, increased LVMi and increased LVMVR; pattern 2, decreased LVMi and decreased LVMVR; pattern 3, increased LVMi and decreased LVMVR; and pattern 4, decreased LVMi and increased LVMVR. Left ventricular remodeling patterns were correlated with unfavorable clinical courses. @*Results@#Baseline LVMi and LVMVR were 65.1 ± 37.9 g/m2 and 4.0 ± 3.2 g/mL, respectively. LVMi increased in 10 patients and decreased in seven patients. LVMVR increased in seven patients and decreased in 10 patients. Pattern 1 was observed in seven patients, pattern 2 in seven, and pattern 3 in three patients. Unfavorable events were observed in 29% (2/7) of patients with pattern 1 and 67% (2/3) of patients with pattern 3, but no such events occurred in pattern 2 during the follow-up period (4.4 ± 2.7 years). @*Conclusion@#Left ventricular remodeling patterns can be characterized using cardiac CT in children with congenital heart disease and may be used to predict their clinical course.

Computed Tomography-Based Ventricular Volumes and Morphometric Parameters for Deciding the Treatment Strategy in Children with a Hypoplastic Left Ventricle: Preliminary Results

OBJECTIVE: To determine the utility of computed tomography (CT) ventricular volumes and morphometric parameters for deciding the treatment strategy in children with a hypoplastic left ventricle (LV). MATERIALS AND METHODS: Ninety-four consecutive children were included in this study and divided into small LV single ventricle repair (SVR) (n = 28), small LV biventricular repair (BVR) (n = 6), disease-matched control (n = 19), and control (n = 41) groups. The CT-based indexed LV volumes, LV-to-right-ventricular (LV/RV) volume ratio, left-to-right atrioventricular valve (AVV) area ratio, left-to-right AVV diameter ratio, and LV/RV long dimension ratio were compared between groups. Proportions of preferred SVR in the small LV SVR group suggested by the parameters were evaluated. RESULTS: Indexed LV end-systolic (ES) and end-diastolic (ED) volumes in the small LV SVR group (6.3 ± 4.0 mL/m² and 14.4 ± 10.2 mL/m², respectively) were significantly smaller than those in the disease-matched control group (16.0 ± 4.7 mL/m² and 37.7 ± 12.0 mL/m², respectively; p < 0.001) and the control group (16.0 ± 5.5 mL/m² and 46.3 ± 10.8 mL/m², respectively; p < 0.001). These volumes were 8.3 ± 2.4 mL/m² and 21.4 ± 5.3 mL/m², respectively, in the small LV BVR group. ES and ED indexed LV volumes of < 7 mL/m² and < 17 mL/m², LV/RV volume ratios of < 0.22 and < 0.25, AVV area ratios of < 0.33 and < 0.24, and AVV diameter ratios of < 0.52 and < 0.46, respectively, enabled the differentiation of a subset of patients in the small LV SVR group from those in the two control groups. One patient in the small LV biventricular group died after BVR, indicating that this patient might not have been a good candidate based on the suggested cut-off values. CONCLUSION: CT-based ventricular volumes and morphometric parameters can suggest cut-off values for SVR in children with a hypoplastic LV.

The Relationship of the Facial Injury Location and the Traumatic Brain Hemorrhage

PURPOSE: Several studies have reported that facial fractures were associated with traumatic brain injuries or cervical injuries. The purpose of this study was to analyze the relationship between the location of facial injury and traumatic brain hemorrhage in order to support future decisions for image evaluation in facial injury patients. METHODS: In this retrospective cohort study, we evaluated facial injury patients without external head trauma who visited the emergency department at our hospital between January 1, 2014 and October 31, 2014. We divided the cohort into 2 groups: Facial injury patients with associated traumatic brain hemorrhage and those without traumatic brain hemorrhage. We compared the factors related to traumatic brain hemorrhage, such as facial injury locations, mechanism of accident, types of wounds, altered mentality, headache, and loss of consciousness between the two groups. RESULTS: In 873 patients, 73 (8.36%) presented traumatic brain hemorrhage and the other 800 had no traumatic brain hemorrhage on a brain computed tomography (CT) scan. The rate of headache, loss of consciousness, altered mentality, traffic accident, fall down, fracture, temporal injury, frontal injury, multiple facial area injury, and upper facial area (frontal and upper orbital area) injury were higher in the traumatic brain hemorrhage group than in the non-traumatic brain hemorrhage group (p<0.05). The risk factors of traumatic brain hemorrhage were headache, loss of consciousness, altered mentality, facial bone fracture, and temporal area injury of the face. CONCLUSION: If a facial injury patient has any of the following factors temporal area injury, facial bone fracture, altered mentality, headache, and loss of consciousness, we have to evaluate the brain CT scan even if the patient had no external head injury.

The Breast Adenomyoepithelioma

Adenomyoepithelioma occurs often in the salivary gland. But adenomyoepithelioma of the breast is very rare, and diagnostic tools are not found. The biological characters of disease are not fully understood. These days, a few case was reported in Korea with development of pathologic diagnostic tools. At first, we diagnosed this case as breast cancer and did MRM operation. But this case was diagnosed as adenomyoepithelioma at the special immunohistochemistry stain. Most of the adenomyoepithelioma is benign disease, but this case was malignant change. We experienced one case of malignant adenomyoepithelioma of the breast and report the case with review of literatures.

Risk of the Gastric Cancer Associated with the Interleukin 1beta Gene Polymorphism and Helicobacter pylori

PURPOSE: According to the recent studies, it is shown that the polymorphism of Interleukin 1beta gene is associated with the incidence of gastric cancer caused by the Helicobacter pylori infection. Interleukin 1beta is a cytokine markedly inhibiting gastric acid secretion. Interleukin 1beta production associated with Helicobacter pylori gastric infection may exacerbate mucosal damage including chronic gastritis and atrophic gastritis, may induce eventual neoplasia. Among these Interleukin 1beta gene polymorphisms, polymorphisms at -31 portion and -511 portion may associated with these processes, eventually increase the risk of gastric cancer. We investigated the risk of gastric cancer according to the Helicobacter pylori infection and genetic polymorphism of Interleukin 1beta in gastric cancer patients. MATERIALS AND METHODS: 176 individuals with gastric cancer and 40 healthy controls were analyzed. Each group was divided into two groups whether they infected with Helicobacter pylori or not. DNA was extracted from the peripheral blood in all groups. The PCR-RFLP method was used for investigating the distribution of genotype of C/C, C/T, T/T at -31 portion and -511 portion. RESULTS: T/T genotype at -511 portion was 19.3% in gastric cancer cases and 10% in controls, which was statistically significant. (P=0.0432) The risk of gastric cancer was increased 4.86 (1.26~18.77) in group which had T/T genotype. In gastric cancer cases, C/C genotype at 31 portion was 27.6% in group with Helicobacter pylori infection and 12.8% in group without infection, which was statistically significant. (P=0.0047) The risk of gastric cancer was increased 4.82 (1.81~12.81) in group which had C/C genotype. CONCLUSION: T genotype at -511 portion among the Interleukin 1beta genetic polymorphisms may be the risk factor of gastric cancer. And, with Helicobacter pylori infection, C genotype at -31 portion may be the risk factor of gastric cancer.

Clinical Effects of Chemotherapy Combined with Interferon-alpha in Colorectal Cancer

PURPOSE: In advanced colorectal cancer, 5-Fluorouracil (5-FU) and Leucovorin (LV) have been used as a standard chemotherapy regimen. 5-FU is a popular chemotherapeutic drug for colorectal cancers and LV is the most effective modulator of 5-FU. Recently, some studies using Interferon (INF) combination therapy with 5-FU to enhance the anti-tumor effect of 5-FU have been performed. The outcomes were reportet to be better than those of studies using single agent therapy. However, the clinical effect of a combination therapy with INF is still controversial. So that, we performed this study to understand the advantages of INF combination therapy in advanced colorectal cancers in the Korean population. METHODS: We recruited patients who had been diagnosed with for colorectal cancers and received operations and postoperative adjuvant chemotherapy in Uijongbu St. Mary's hospital, from July, 1995, to June, 1999. The patients were divided into two groups; control group treated with the Mayo clinic chemotherapy regimen of 5-FU plus LV, and study group treated with additional INF-alpha to 5-FU-LV combination treatment. We evaluated the clinical outcomes such as the overall survival rate, the recurrence rate, and the chemotoxicity between two groups. RESULTS: In comparison of 5 year survival rates of two groups for each stage of the colorectal cancer, those of stage B2 were 90.9% in the control group and 80.0% in the study group. For stage C patients, the values were 80.2% in control group and 52.5% in the study group. The overall 5-year survival rates of the control group and the study group regardless of stages were 77.1%, and 63.4%, respectively. The 5-year disease-free survival rates for stage B2 were 82.8% in the control group and 72.9% in the study group. For stage C patients, those were 42.6% in the control group and 34.4% in the study group. The recurrence and metastatic rates were 19.2% (local recurrence; 2, metastasis; 12) in the control group and 36.1% (local recurrence; 3 metastasis; 27) in the study group. The overall incidences of chemotoxicity were 24.7% in the control group and 31.3% in the study group. CONCLUSIONS: There was no evidence that chemotherapy using 5-FU and LV combined with INF-alpha in advanced colorectal cancer patients was more effective than the Mayo regimen of 5-FU and LV. More large scale clinical studies are warranted to evaluate the efficacy of additional INF therapy in colorectal cancer patients.