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1.
Article | WPRIM | ID: wpr-835296

ABSTRACT

Background@#Lung adenocarcinoma (LUAD) with ground-glass opacity (GGO) can become aggravated, but the reasons for this aggravation are not fully understood. The goal of this study was to analyze the genetic features and causes of progression of GGO LUAD. @*Methods@#LUAD tumor samples and normal tissues were analyzed using an Illumina HiSeq 4000 system. After the tumor mutational burden (TMB) was calculated, the identified mutations were classified as those found only in GGO LUAD, those present only in nonGGO LUAD, and those common to both tissue types. Ten high-frequency genes were selected from each domain, after which protein interaction network analysis was conducted. @*Results@#Overall, 227 mutations in GGO LUAD, 212 in non-GGO LUAD, and 48 that were common to both tumor types were found. The TMB was 8.8 in GGO and 7.8 in non-GGO samples. In GGO LUAD, mutations of FCGBP and SFTPA1 were identified. FOXQ1, IRF5, and MAGEC1 mutations were common to both types, and CDC27 and NOTCH4 mutations were identified in the non-GGO LUAD. Protein interaction network analysis indicated that IRF5 (common to both tissue types) and CDC27 (found in the non-GGO LUAD) had significant biological functions related to the cell cycle and proliferation. @*Conclusion@#In conclusion, GGO LUAD exhibited a higher TMB than non-GGO LUAD. No clinically meaningful mutations were found to be specific to GGO LUAD, but mutations involved in the epithelial-mesenchymal transition or cell cycle were found in both tumor types and in non-GGO tissue alone. These findings could explain the non-invasiveness of GGO-type LUAD.

2.
Article | WPRIM | ID: wpr-833420

ABSTRACT

Objective@#: Despite widespread use of flow diverters (FDs) to treat aneurysms, the exact healing mechanism associated with FDs remains poorly understood. We aim to describe the healing process of aneurysms treated using FDs by demonstrating the histopathologic progression in a canine aneurysm model. @*Methods@#: Twenty-one side wall aneurysms were created in common carotid artery of eight dogs and treated with two different FDs. Angiographic follow-ups were done immediately after placement of the device, 4 weeks and 12 weeks. At last follow-up, the aneurysm and the device-implanted parent artery were harvested. @*Results@#: Histopathologic findings of aneurysms at 4 weeks follow-up showed intra-aneurysm thrombus formation in laminating fashion, and neointimal thickening at the mid-segment of aneurysm. However, there are inhomogenous findings in aneurysms treated with the same type of FD showing same angiographic outcomes. At 12 weeks, aneurysms of complete and near-complete occlusion revealed markedly shrunken aneurysm filled with organized connective tissues with thin neointima. Aneurysms of incomplete occlusion at 12 weeks showed small amount of organized thrombus around fringe neck and large empty space with thick neointmal formation. Neointimal thickness and diameter stenosis was not significantly different between the groups of FD specification and follow-up period. @*Conclusion@#: Intra-aneurysmal thrombus formation and organization seem to be an important factor for the complete occlusion of aneurysms treated using the FD. Neointimal formation could occur along the struts of the FD independently of intra-aneurysmal thrombus formation. However, neointimal formation could not solely lead to complete aneurysm healing.

3.
Article in English | WPRIM | ID: wpr-788751

ABSTRACT

OBJECTIVE: To describe our experiences with a fully equipped high-end digital subtraction angiography (DSA) system within a hybrid operating room (OR).METHODS: A single-plane DSA system with 3-dimensional rotational angiography, cone-beam computed tomography (CBCT), and real-time navigation software was used in our hybrid OR. Between April 2014 and January 2018, 191 sessions of cerebrovascular procedures were performed in our hybrid OR. After the retrospective review of all cases, the procedures were categorized into three subcategorical procedures : combined endovascular and surgical procedure, complementary rescue procedure during intervention and surgery, and frameless stereotaxic operation.RESULTS: Forty-nine of 191 procedures were performed using hybrid techniques. Four cases of blood blister aneurysms and a ruptured posterior inferior cerebellar artery aneurysm were treated using bypass surgery and endovascular trapping. Eight cases of ruptured aneurysm with intracranial hemorrhage (ICH) were treated by partial embolization and surgical clipping. Six cases of ruptured arteriovenous malformation with ICH were treated by Onyx embolization of nidus and subsequent surgical removal of nidus and ICH. Two (5.4%) of the 37 cases of pre-mature rupture during clipping were secured by endovascular coil embolization. In one (0.8%) complicated case of 103 intra-arterial thrombectomy procedures, emergency surgical embolectomy with bypass surgery was performed. In 27 cases of ICH, frameless stereotaxic hematoma aspiration was performed using XperGuide® system (Philips Medical Systems, Best, the Netherlands). All procedures were performed in single sessions without any procedural complications.CONCLUSION: Hybrid OR with a fully equipped DSA system could provide precise and safe treatment strategies for cerebrovascular diseases. Especially, we could suggest a strategy to cope flexibly in complex lesions or unexpected situations in hybrid OR. CBCT with real-time navigation software could augment the usefulness of hybrid OR.


Subject(s)
Aneurysm , Aneurysm, Ruptured , Angiography , Angiography, Digital Subtraction , Arteries , Arteriovenous Malformations , Blister , Cerebrovascular Disorders , Cone-Beam Computed Tomography , Embolectomy , Embolization, Therapeutic , Emergencies , Hematoma , Intracranial Hemorrhages , Operating Rooms , Retrospective Studies , Rupture , Surgical Instruments , Thrombectomy
4.
Korean Circulation Journal ; : 1066-1111, 2019.
Article in English | WPRIM | ID: wpr-759405

ABSTRACT

Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular (CV) disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of thirty-three authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers CV mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.


Subject(s)
Acute Coronary Syndrome , Cause of Death , Consultants , Coronary Disease , Delivery of Health Care , Heart , Hospitals, General , Hospitals, University , Humans , Insurance Benefits , Korea , Life Style , Methods , Mortality , Myocardial Infarction , Nutritionists , Physical Therapists , Preventive Medicine , Recurrence , Rehabilitation , Secondary Prevention , Specialization , Sports Medicine , Surgeons
5.
Article in English | WPRIM | ID: wpr-762635

ABSTRACT

OBJECTIVE: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and three additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and two general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, three rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. PRINCIPAL CONCLUSIONS: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.


Subject(s)
Acute Coronary Syndrome , Cardiovascular Diseases , Cause of Death , Consultants , Coronary Disease , Delivery of Health Care , Heart , Hospitals, General , Hospitals, University , Humans , Insurance Benefits , Korea , Life Style , Methods , Mortality , Myocardial Infarction , Nutritionists , Physical Therapists , Preventive Medicine , Recurrence , Rehabilitation , Secondary Prevention , Specialization , Sports Medicine , Surgeons
6.
Article in English | WPRIM | ID: wpr-765322

ABSTRACT

OBJECTIVE: To describe our experiences with a fully equipped high-end digital subtraction angiography (DSA) system within a hybrid operating room (OR). METHODS: A single-plane DSA system with 3-dimensional rotational angiography, cone-beam computed tomography (CBCT), and real-time navigation software was used in our hybrid OR. Between April 2014 and January 2018, 191 sessions of cerebrovascular procedures were performed in our hybrid OR. After the retrospective review of all cases, the procedures were categorized into three subcategorical procedures : combined endovascular and surgical procedure, complementary rescue procedure during intervention and surgery, and frameless stereotaxic operation. RESULTS: Forty-nine of 191 procedures were performed using hybrid techniques. Four cases of blood blister aneurysms and a ruptured posterior inferior cerebellar artery aneurysm were treated using bypass surgery and endovascular trapping. Eight cases of ruptured aneurysm with intracranial hemorrhage (ICH) were treated by partial embolization and surgical clipping. Six cases of ruptured arteriovenous malformation with ICH were treated by Onyx embolization of nidus and subsequent surgical removal of nidus and ICH. Two (5.4%) of the 37 cases of pre-mature rupture during clipping were secured by endovascular coil embolization. In one (0.8%) complicated case of 103 intra-arterial thrombectomy procedures, emergency surgical embolectomy with bypass surgery was performed. In 27 cases of ICH, frameless stereotaxic hematoma aspiration was performed using XperGuide® system (Philips Medical Systems, Best, the Netherlands). All procedures were performed in single sessions without any procedural complications. CONCLUSION: Hybrid OR with a fully equipped DSA system could provide precise and safe treatment strategies for cerebrovascular diseases. Especially, we could suggest a strategy to cope flexibly in complex lesions or unexpected situations in hybrid OR. CBCT with real-time navigation software could augment the usefulness of hybrid OR.


Subject(s)
Aneurysm , Aneurysm, Ruptured , Angiography , Angiography, Digital Subtraction , Arteries , Arteriovenous Malformations , Blister , Cerebrovascular Disorders , Cone-Beam Computed Tomography , Embolectomy , Embolization, Therapeutic , Emergencies , Hematoma , Intracranial Hemorrhages , Operating Rooms , Retrospective Studies , Rupture , Surgical Instruments , Thrombectomy
7.
Article in English | WPRIM | ID: wpr-761858

ABSTRACT

BACKGROUND: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. RESULTS: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. CONCLUSION: Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.


Subject(s)
Acute Coronary Syndrome , Cardiovascular Diseases , Cause of Death , Consultants , Coronary Disease , Delivery of Health Care , Heart , Hospitals, General , Hospitals, University , Humans , Insurance Benefits , Korea , Life Style , Methods , Mortality , Myocardial Infarction , Nutritionists , Physical Therapists , Preventive Medicine , Recurrence , Rehabilitation , Secondary Prevention , Specialization , Sports Medicine , Surgeons
8.
Article in Korean | WPRIM | ID: wpr-738618

ABSTRACT

PURPOSE: To report a case of chemical injury of the cornea caused by high-dose ethanol during orbital wall fracture repair. CASE SUMMARY: A 56-year-old male presented with pain after blowout fracture repair surgery. During the surgery, 2% hexethanol solution (2% chlorhexidine and 72% ethanol mixture), which was used for disinfection of the face, flowed into the left eye. Conjunctival injection in the left limbus, a large corneal epithelial defect, and severe stromal edema were subsequently observed. The patient was treated with topical antibiotics, steroids, and autologous serum eye drops. After 1 week, the corneal epithelial defect was improved, but at the second month of therapy, recurrent corneal erosion with deterioration of the endothelial cell function occurred. Anterior stromal puncture and laser keratectomy were performed. The corneal epithelial defect and erosion improved, but the endothelial cell density was severely decreased. CONCLUSIONS: The 2% hexethanol solution is usually used for preoperative skin disinfection, but it contains a high concentration of ethanol. The surgeon should be aware that high concentrations of ethanol may result in severe corneal damage, including corneal endothelial dysfunction and limbal cell deficiency.


Subject(s)
Anti-Bacterial Agents , Chlorhexidine , Cornea , Corneal Injuries , Corneal Surgery, Laser , Disinfection , Edema , Endothelial Cells , Ethanol , Humans , Male , Middle Aged , Ophthalmic Solutions , Orbit , Punctures , Skin , Steroids
9.
Article in Korean | WPRIM | ID: wpr-738596

ABSTRACT

PURPOSE: We report a case of toxic keratoconjunctivitis resulting from the self-application of human breast milk as a traditional folk remedy for allergic conjunctivitis. CASE SUMMARY: An 82-year-old woman presented with pain and conjunctival hyperemia in the right eye that had been worsening for three days. Two months previously, she was treated with antiallergic eye drops for allergic conjunctivitis at another eye clinic. However, the symptoms did not improve. She applied her daughter-in-law's breast milk into her right eye as a folk remedy for three days. The pain and conjunctival hyperemia worsened. At the initial visit, her corrected visual acuity was 0.3 in the right eye. Slit lamp examination demonstrated conjunctival hyperemia, punctate epithelial erosion at the central cornea, corneal keratic precipitates and white-colored deposits in the peripheral cornea combined with irregularly shaped small nodules. There was no anterior chamber inflammation. There was no medical history of rheumatoid arthritis or tuberculosis. Blood tests for serum and other infectious and inflammatory levels for infection and inflammatory markers were performed followed by application of topical steroids and antibiotics with artificial tears. After 3 weeks of treatment, conjunctival hyperemia and corneal deposits had almost resolved and best-corrected visual acuity improved to 1.0. CONCLUSIONS: The self-application of human breast milk may cause toxic keratoconjunctivitis. Therefore, efforts should be made, actively, to inform and educate the elderly in rural areas not to use human breast milk as a folk remedy.


Subject(s)
Aged , Aged, 80 and over , Anterior Chamber , Anti-Bacterial Agents , Arthritis, Rheumatoid , Breast , Conjunctivitis, Allergic , Cornea , Female , Hematologic Tests , Humans , Hyperemia , Inflammation , Keratoconjunctivitis , Lubricant Eye Drops , Medicine, Traditional , Milk, Human , Ophthalmic Solutions , Slit Lamp , Steroids , Tuberculosis , Visual Acuity
11.
Article in English | WPRIM | ID: wpr-717042

ABSTRACT

Technical advances with devices such as catheters, balloons, and stents have widened the indications for endovascular coiling for unfavorable aneurysms. The authors report two cases of coil embolization for a wide-neck bifurcated aneurysm with anterograde horizontal stenting via microcatheter looping. Two women, aged 56 and 38 years, respectively, had an undertall- and overwide-neck aneurysm with bifurcated branches at the basilar bifurcation and middle cerebral bifurcation, respectively. The delivery microcatheter was steamed so that it could be looped deliberately to the opposite vessel. The enterprise stent was first anchored to the vessel of the posterior cerebral artery on one side. The remaining portion was spanned into a looped microcatheter to the opposite branch while pushing the stent. The Neuroform Atlas stent was passed directly through the looped segment of the microcatheter at the M2 branch and spanned horizontally by unsheathing. Under horizontal stenting, complete coil embolization was achieved without immediate or delayed complications in both cases. This novel technique presents a viable option for stent-assisted coiling within an optimal anatomy.


Subject(s)
Aneurysm , Catheters , Embolization, Therapeutic , Female , Humans , Intracranial Aneurysm , Posterior Cerebral Artery , Steam , Stents
12.
Article in Korean | WPRIM | ID: wpr-193502

ABSTRACT

PURPOSE: To investigate the clinical features and treatment outcomes of ocular toxocariasis in Jeju Island using ultra-wide-field fundus photography. METHODS: We retrospectively reviewed the medical records of 40 eyes of 37 patients who were diagnosed with ocular toxocariasis based on clinical aspects and serologic tests. The quality of history-taking was assessed and peripheral blood samples were analyzed. Ocular characteristics were evaluated using ultra-wide-field fundus photography and optical coherence tomography. Changes in visual acuity and funduscopic findings after treatment were also analyzed. RESULTS: The average age of the patients was 57.9 years and the mean Toxocara canis IgG titer was 1.979 ± 0.486. The most common fundus findings were vitreous opacity (63.6%) and granuloma (60%). Granulomas that were not initially observed within the field of view of conventional fundus photography were found using ultra-wide-field imaging in 15 eyes (62.5%). Ultra-wide-field fluorescein angiography showed peripheral vascular leakage in 16 eyes (69.6%). Treatment with oral prednisolone and albendazole resulted in average vision improvements of 0.19 ± 0.07 logMAR (p = 0.031) as well as significant improvements in anterior chamber inflammation and vitreous opacity. Combination therapy led to a significantly lower recurrence rate than prednisolone monotherapy (p = 0.049). CONCLUSIONS: In Jeju Island, the mean Toxocara canis IgG titer of ocular toxocariasis was high. The incidences of vitreous opacity and granulomas were also high. Ultra-wide-field fundus imaging was useful for finding peripheral retinal lesions and peripheral vascular leakage that were not observed within the field of view of conventional fundus photography. Ultra-wide-field fundus imaging was valuable not only during clinical diagnosis, but also on follow-up evaluations of ocular toxocariasis. Treatment with oral prednisolone and albendazole effectively improved ocular inflammation and visual acuity and helped reduce the recurrence rate.


Subject(s)
Albendazole , Anterior Chamber , Diagnosis , Fluorescein Angiography , Follow-Up Studies , Granuloma , Humans , Immunoglobulin G , Incidence , Inflammation , Medical Records , Photography , Prednisolone , Recurrence , Retinaldehyde , Retrospective Studies , Serologic Tests , Tomography, Optical Coherence , Toxocara canis , Toxocariasis , Uveitis , Visual Acuity
13.
Article in English | WPRIM | ID: wpr-163483

ABSTRACT

OBJECTIVE: To evaluate the radiographic and clinical outcomes of percutaneous vertebroplasty (PVP) in patients with Kümmell's disease. METHODS: A retrospective review was conducted for 19 vertebrae in 18 patients, between January 2012 and June 2016. A visual analogue scale (VAS) score was used to determine each patient's subjective level of pain (0=no pain to 10=severe pain) preoperative, immediately postoperative and at the last follow-up (at least 12 months after PVP). Radiographic parameters such as regional and global kyphotic angle, lumbar lordosis (LL), thoracolumbar junction (TLJ) angle, vertebral height, cement leakage, refracture, and adjacent level fracture were evaluated by the clinician preoperative, immediate postoperative and at the last follow-up. RESULTS: The mean VAS score significantly decreased after PVP and the decrease was maintained through to the final follow-up (p<0.05). However, the regional and global kyphotic angle, LL, and TLJ angle were not improved. Cement leakage was observed in 5 cases (26.3%): however, there were no cases of cement leakage into the spinal canal. No neurological deterioration was observed, even among patients with cement leakage. Adjacent level fractures were detected in 3 cases (15.8%). CONCLUSION: PVP can be considered as an effective treatment option for pain relief and maintenance of sagittal balance in patients with Kümmell's disease.


Subject(s)
Animals , Follow-Up Studies , Humans , Lordosis , Retrospective Studies , Spinal Canal , Spine , Vertebroplasty
14.
Article in English | WPRIM | ID: wpr-163474

ABSTRACT

Traumatic pseudoaneurysms of middle meningeal artery (MMA) and medial sphenoid wing dural arteriovenous fistula (dAVF) are rare. These lesions usually result from traumatic brain injury, and associated with skull fracture. In this paper, the authors report a case of a patient with a ruptured traumatic pseudoaneurysm of MMA and medial sphenoid wing dAVF presented with an intracerebral hemorrhage in the left temporal region and subarachnoid hemorrhage. These lesions were completely obliterated by endovascular treatment, and the patient was recovered without any neurologic deficit. However, 18-day after the procedure, delayed neurologic deficits were developed due to cerebral vasospasm.


Subject(s)
Aneurysm, False , Arteriovenous Fistula , Brain Injuries , Central Nervous System Vascular Malformations , Cerebral Hemorrhage , Humans , Meningeal Arteries , Neurologic Manifestations , Skull Fractures , Subarachnoid Hemorrhage , Subarachnoid Hemorrhage, Traumatic , Temporal Lobe , Vasospasm, Intracranial
15.
Article in English | WPRIM | ID: wpr-34231

ABSTRACT

Current guidelines recommend that coronary artery calcium (CAC) screening should only be used for intermediate risk groups (Framingham risk score [FRS] of 10%-20%). The CAC distributions and coronary artery disease (CAD) prevalence in various FRS strata were determined. The benefit to lower risk populations of CAC score-based screening was also assessed. In total, 1,854 participants (aged 40-79 years) without history of CAD, stroke, or diabetes were enrolled. CAC scores of > 0, ≥ 100, and ≥ 300 were present in 33.8%, 8.2%, and 2.9% of the participants, respectively. The CAC scores rose significantly as the FRS grew more severe (P 20% strata were 3.4%, 6.7%, 9.0%, and 11.6% (P 20%; P < 0.05). In conclusion, the yield of screening for significant CAC and occult CAD is low in the very low risk population but it rises in low and intermediate risk populations.


Subject(s)
Aged , Calcium/analysis , Coronary Artery Disease/diagnosis , Coronary Vessels/chemistry , Female , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Prevalence , Risk Factors , Severity of Illness Index , Tomography, X-Ray Computed
16.
Article in English | WPRIM | ID: wpr-89901

ABSTRACT

Stress-induced cardiomyopathy has become a more recognized and reported entity. It can be caused by emotional or physical stress, which causes excessive catecholamine release. Typically, the clinical course is benign with conservative treatment being effective. However, stress-induced cardiomyopathy can be fatal. A 41-year-old female presented with cardiogenic shock followed by sudden back pain. Initial echocardiographic finding showed severely decreased ejection fraction with akinesia at all mid-to-apical walls with relatively preserved basal wall contractility. The coronary artery was intact on coronary angiography. Cardiac resuscitation and extra-corporeal membrane oxygenation was needed to manage the cardiogenic shock. Recovery was complete after 2 weeks.


Subject(s)
Adult , Back Pain , Cardiomyopathies , Coronary Angiography , Coronary Vessels , Echocardiography , Extracorporeal Membrane Oxygenation , Female , Humans , Membranes , Oxygen , Resuscitation , Shock , Shock, Cardiogenic , Takotsubo Cardiomyopathy
17.
Korean Journal of Medicine ; : 398-403, 2015.
Article in Korean | WPRIM | ID: wpr-205906

ABSTRACT

An abdominal aorta with a maximal diameter of > 3.0 cm is considered aneurysmal. Abdominal aortic aneurysm (AAA) most often affects the segment of aorta between the renal arteries. Patients with aneurysms under observation should undergo periodic imaging to assess for aortic expansion, but the optimal surveillance schedule has not been defined clearly. Generally, surveillance is every 6 to 12 months by ultrasound or computed tomography for medium-sized aneurysms (4.0 to 5.4 cm in diameter), but less frequent intervals (every 2 to 3 years) are recommended for smaller aneurysms. The primary goals of aneurysm repair are to prevent rupture while minimizing morbidity and mortality associated with repair. Two methods of aneurysm repair are currently available: traditional open surgery and endovascular aneurysm repair (EVAR). In randomized trials, EVAR is associated with lower perioperative morbidity and mortality compared with open AAA repair but does not completely eliminate the future risk of AAA rupture, whereas open repair is associated with higher perioperative morbidity and mortality than EVAR but provides a more definitive repair. Physicians must choose an individualized approach for AAA repair, taking into account the patient's age, aortic anatomy, life expectancy, and risk factors for perioperative morbidity and mortality.


Subject(s)
Aneurysm , Aorta , Aorta, Abdominal , Aortic Aneurysm , Aortic Aneurysm, Abdominal , Appointments and Schedules , Humans , Life Expectancy , Mortality , Renal Artery , Risk Factors , Rupture , Ultrasonography
18.
Article in English | WPRIM | ID: wpr-205811

ABSTRACT

A 21-year-old female presented with acute epidural hemorrhage (EDH) on the left temporal region associated with skull fracture after traffic accident. She was neurologically deteriorated at four-hour after an admission, and follow-up computed tomography revealed increased amount of EDH. Under the general anesthesia, emergency craniotomy was performed. During the surgery, massive bleeding from the base of middle cranial fossa was observed. However, we could not identify an origin of bleeding and foramen spinosum due to brain swelling and obscured surgical field. Consequently, her systolic blood pressure was dropped to 60 mm Hg with >110 beat/min of heart rate. Therefore, we decided to perform an intraoperative angiography after gauze packing into the middle cranial fossa. Intraoperative angiography showed a large pseudoaneurysm with massive contrast leakage of the middle meningeal artery (MMA). Intraoperative endovascular embolization of the pseudoaneurysm and MMA by using n-butyl-2-cyanoacrylate was done. After that, her vital sign became stable, and we could complete the operation after the achievement of adequate hemostasis. Intraoperative angiography and endovascular embolization of MMA was effective in achieving adequate hemostasis in case with brisk bleeding from the middle cranial fossa could not be controlled in an open surgical field.


Subject(s)
Accidents, Traffic , Anesthesia, General , Aneurysm, False , Angiography , Blood Pressure , Brain Edema , Cranial Fossa, Middle , Craniotomy , Emergencies , Enbucrilate , Female , Follow-Up Studies , Heart Rate , Hematoma, Epidural, Cranial , Hemorrhage , Hemostasis , Humans , Meningeal Arteries , Skull Fractures , Vital Signs , Young Adult
19.
Article in English | WPRIM | ID: wpr-204043

ABSTRACT

OBJECTIVE: We reviewed the feasibility, safety and efficacy as well as the clinical outcome and long-term angiographic results of endovascular treatment (EVT) of the anterior communicating artery (ACoA) aneurysms. METHODS: A total of 429 ACoA aneurysms in 426 patients were treated using coil embolization between March 1996 and October 2010 in a single institution. Pretreatment aneurysmal features were checked using angiogram. We had usually used tailored steam shaped microcatheter according to individual angiographic architectures. Immediate postembolization outcomes were evaluated using an angiographic outcome scale and clinical evaluation was performed using the Glasgow Outcome Scale (GOS). RESULTS: Postembolization angiograms demonstrated total occlusion of aneurysm in 290 of 429 (67.6%) aneurysms, neck remnant in 80 (18.6%) and body filling in 59 (13.8%). Dome direction and aneurysm angle was not associated with initial angiographic outcomes. The procedure-related morbidity rate was 0.9% (4 of 429). Clinical and imaging follow-up more than 6 months were available in 382 (89.0%) patients with a mean of 26.2 months. Overall rate of major recanalization was 7.9% (30 of 382) and all of them were retreated without complications. At the last follow-up, 233 (99.2%) of 235 patients had GOS of 5 in unruptured group, and 152 (79.5%) of 191 patients showed good clinical outcomes (GOS of 4 or 5) in ruptured group. CONCLUSION: Tailored steam shaping of the microcatheter is vital to achieve good angiographic outcomes regardless of aneurysmal direction. EVT is feasible and safe for most ACoA aneurysms with acceptable immediate and long-term outcomes.


Subject(s)
Aneurysm , Arteries , Embolization, Therapeutic , Follow-Up Studies , Glasgow Outcome Scale , Humans , Intracranial Aneurysm , Neck , Steam
20.
Yonsei Medical Journal ; : 510-518, 2015.
Article in English | WPRIM | ID: wpr-141611

ABSTRACT

PURPOSE: The validity of tomotherapy-based simultaneous integrated boost (TOMOSIB) was assessed in terms of acute intestinal/urinary toxicity by comparing with 3-dimensional conformal radiotherapy (3DCRT) in cases of whole-pelvis radiation therapy (WPRT) for prostate cancer. MATERIALS AND METHODS: Thirty-eight consecutive patients who underwent curative WPRT were retrospectively reviewed. Twenty six (68.4%) received 3DCRT and the others (31.6%) were treated with TOMOSIB. A local boost to the prostate circumferential area was added to WPRT sequentially for 3DCRT and concomitantly for TOMOSIB. The total median prostate or prostatic bed dose was 64.8 Gy including median 45.0 Gy of WPRT. Acute toxicities were assessed according to RTOG criteria. RESULTS: Overall intestinal toxicity was lower in TOMOSIB group than 3DCRT group (p=0.008). When it was divided into rectum and non-rectum intestine (NRI), TOMOSIB showed borderline superiority only in NRI toxicity (p=0.047). For the urinary toxicity, there was no significant difference between two groups (p=0.796). On dosimetric analysis for the rectum and bladder, dose delivered to 80% (p<0.001) and volume receiving 25-40 Gy (p<0.001) were remarkably higher in 3DCRT. For the NRI, only maximum dose showed significant results between two groups (p<0.001). CONCLUSION: Intestinal toxicity should be verified with more detailed anatomic categorization such as rectum and NRI. TOMOSIB could not reduce urinary toxicity because of inevitably high dose exposure to the prostatic urethra. Current dosimetry system did not properly reflect intestinal/urinary toxicity, and suitable dosimetric guidelines are needed in TOMOSIB.


Subject(s)
Adenocarcinoma/pathology , Aged , Humans , Intestine, Small/radiation effects , Male , Middle Aged , Pelvis/radiation effects , Prostatic Neoplasms/pathology , Radiation Injuries , Radiotherapy Dosage , Radiotherapy, Intensity-Modulated/adverse effects , Rectum/radiation effects , Retrospective Studies , Urinary Bladder/radiation effects
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