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1.
Yonsei Medical Journal ; : 66-71, 2022.
Article in English | WPRIM | ID: wpr-919612

ABSTRACT

Purpose@#Proteinuria is a clinical sign of adverse cardiovascular outcomes, including stroke. We aimed to assess the relationship between proteinuria and the occurrence of cerebral infarction. @*Materials and Methods@#In total, 208854 Koreans who participated in the 2009 medical examination were followed up until 2013 using the database of the National Health Insurance Service. The results of urine dipstick tests were utilized to assess proteinuria as absent, 1+, 2+, or ≥3+. The International Classification of Diseases code 163 was used to document cerebral infarction. @*Results@#Between 2009 and 2013, 2383 cases (1.14%) of cerebral infarction occurred during 912772.9 person-years of follow-up. Hazard ratios for incident cerebral infarction increased with inceasing amounts of urine protein from 1.53 (1.23–1.90) in group 2 (1+), 1.67 (1.22–2.28) in group 3 (2+), and 2.66 (1.79–3.96) in group 4 (≥3+), compared to the reference group with little to no detectable urine protein (p<0.001, respectively). @*Conclusion@#An increase in urine protein levels was significantly related to the risk of developing cerebral infarction. Our results suggest that proteinuria might be a potential risk factor for cerebral infarction and that urine dipstick test analysis may be clinically useful for predicting stroke.

2.
Article in English | WPRIM | ID: wpr-919471

ABSTRACT

Background@#Only a few studies directly compared the therapeutic efficacy and safety of two pressurized metered-dose inhalers (pMDIs) in asthma. We analyzed the asthma treatment outcomes, safety, and patient preferences using formoterol/beclomethasone (FORM/BDP), a pMDI with extra-fine particles, compared with formoterol/budesonide (FORM/BUD), another pMDI with non-extra-fine particles. @*Methods@#In this randomized, double-blind, double-dummy parallel group study, 40 adult asthmatics were randomized to FORM/BDP group (n=18; active FORM/BDP and placebo FORM/BUD) or FORM/BUD group (n=22; active FORM/BUD and placebo FORM/BDP). During the two visits (baseline and end of 8-week treatment), subjects were asked to answer questionnaires including asthma control test (ACT), asthma control questionnaires (ACQ), and Quality of Life Questionnaire for Adult Korean Asthmatics (QLQAKA). Lung function, compliance with inhaler, and inhaler-handling skills were also assessed. @*Results@#Ten subjects in the FORM/BDP group and 14 in the FORM/BUD group completed follow-up visits. ACT, ACQ, QLQAKA (a primary outcome), and adverse events did not differ between two groups. We found that the increase in forced expiratory volume in 1 second/forced vital capacity and forced expiratory flow at 25% to 75% of the pulmonary volume in the FORM/BDP group was higher than in the FORM/BUD group. Regarding preference, subjects responded that the flume velocity of FORM/BDP was higher, but more adequate than that of FORM/BUD. They also answered that FORM/BDP reached the trachea and bronchus and irritated them significantly more than FORM/BUD. @*Conclusion@#The use of pMDI with extra-fine particles may relieve small airway obstruction more than the one with non-extra-fine particles despite no significant differences in overall treatment outcomes. Some asthmatics have a misconception about the adequacy of high flume velocity of pMDIs.

3.
Article in English | WPRIM | ID: wpr-914116

ABSTRACT

Background@#The aim of this study was to determine if it was feasible and safe to perform total hip arthroplasty (THA) using the direct anterior approach (DAA) when compared with the conventional posterolateral approach (PA) in patients with femoral neck fractures. The time required to start walking was investigated to identify advantages of the muscle-sparing approach. Safety of the approach was judged based on the incidence and nature of all complications. @*Methods@#We retrospectively reviewed 67 THA cases due to femoral neck fractures from October 2015 to January 2019. The PA was used in 31 cases, and the DAA was used in 36 cases. The average operative time and amount of bleeding were evaluated. Cup inclination, anteversion, and leg length discrepancy (LLD) were also measured on radiographs. The time to start walking and complications (e.g., intraoperative fracture, infection, and dislocation) were recorded. @*Results@#The mean operative time was 84.35 ± 13.95 minutes in PA group and 99.22 ± 20.33 minutes in DAA group (p = 0.010). But after experiencing 20 cases using the DAA, there was no statistically significant difference in the operative time between the groups. The mean volume of bleeding was 428.73 ± 207.26 mL in the PA group and 482.47 ± 150.14 mL in the DAA group. There was no difference in the acetabular cup position between two groups. Ambulation was started at 3.94 days after surgery on average in the PA group and 3.14 days in the DAA group, showing a statistically significant difference. Intraoperative fracture and infection were not observed in either group. The incidence of LLD was 1 in each group. The dislocation rate was 3.2% (1 case) in the PA group and 5.5% (2 cases) in the DAA group. @*Conclusions@#Although the DAA for THA was similar to the PA in terms of operative time, volume of bleeding, and complications, the DAA showed a great advantage in early rehabilitation as a muscle-sparing procedure in the elderly with femoral neck fractures.

4.
Article in English | WPRIM | ID: wpr-927028

ABSTRACT

Background/Aims@#There are few studies describing contemporary status of mechanical ventilation in Korea. We investigated changes in management and outcome of mechanical ventilation in Korea. @*Methods@#International, prospective observational cohort studies have been conducted every 6 years since 1998. Korean intensive care units (ICUs) participated in 2010 and 2016 cohorts. We compared 2016 and 2010 Korean data. @*Results@#Two hundred and twenty-six patients from 18 ICUs and 275 patients from 12 ICUs enrolled in 2016 and 2010, respectively. In 2016 compared to 2010, use of non-invasive ventilation outside ICU increased (10.2% vs. 2.5%, p = 0.001). Pressure-control ventilation was the most common mode in both groups. Initial tidal volume (7.1 mL/kg vs. 7.4 mL/kg, p = 0.372) and positive end-expiratory pressure (6 cmH2O vs. 6 cmH2O, p = 0.141) were similar, but peak pressure (22 cmH2O vs. 24 cmH2O, p = 0.011) was lower in 2016. More patients received sedatives (70.7% vs. 57.0%, p = 0.002) and analgesics (86.5% vs. 51.1%, p < 0.001) in 2016. The awakening (48.4% vs. 31.0%, p = 0.002) was more frequently attempted in 2016. The accidental extubation rate decreased to one tenth of what it was in 2010 (1.1% vs. 10.2%, p < 0.001). The ICU mortality did not change (31.4% 35.6%, p = 0.343) but ICU length of stay showed a decreasing trend (9 days vs. 10 days, p = 0.054) in 2016. @*Conclusions@#There were temporal changes in care of patients on mechanical ventilation including better control of pain and agitation, and active attempt of awakening.

5.
Article in English | WPRIM | ID: wpr-927003

ABSTRACT

Background/Aims@#The prevalence and effects of airway diseases, including asthma, eosinophilic bronchitis (EB), chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap (ACO) have not been thoroughly studied in patients with idiopathic pulmonary fibrosis (IPF). This study aimed to evaluate the prevalence of airway diseases in patients with IPF and to identify the differences in symptoms based on the presence of airway diseases. @*Methods@#This single-institution prospective cohort study was conducted from June 2017 to September 2018, at the Seoul National University Hospital. Spirometry with bronchodilator, methacholine bronchial provocation test, induced sputum with eosinophil stain, and exhaled nitric oxide were performed to confirm the presence of airway disease. The modified Medical Research Council (mMRC) dyspnea scale, COPD assessment test (CAT), St. George’s Respiratory Questionnaire (SGRQ), EuroQol-5 dimension (EQ-5D) index, and cough-specific quality of life questionnaire (CQLQ) data were collected to assess symptom severity. @*Results@#Total 147 patients with IPF were screened, and 70 patients were analyzed. The prevalence of airway diseases in the participants was as follows: 5.0% had COPD, 1.7% had asthma, 3.3% had ACO, and 1.7% had EB. The mMRC, CAT, SGRQ, EQ-5D, and CQLQ scores did not differ regardless of combined airway disease. After 3 months, the SGRQ (p = 0.028) and CQLQ (p = 0.030) scores were significantly higher in patients with airway disease than in those without. @*Conclusions@#The prevalence of airway diseases in patients with IPF is low, but when airway diseases are accompanied by IPF, symptom severity and quality of life may worsen rapidly.

6.
Article in English | WPRIM | ID: wpr-926760

ABSTRACT

Objective@#To compare pneumonic-type invasive mucinous adenocarcinoma (pIMA) confined to a single lobe with clinical T2, T3, and T4 stage lung cancer without pathological node metastasis regarding survival after curative surgery and to identify prognostic factors for pIMA. @*Materials and Methods@#From January 2010 to December 2017, 41 patients (15 male; mean age ± standard deviation, 66.0 ± 9.9 years) who had pIMA confined to a single lobe on computed tomography (CT) and underwent curative surgery were identified in two tertiary hospitals. Three hundred and thirteen patients (222 male; 66.3 ± 9.4 years) who had non-small cell lung cancer (NSCLC) without pathological node metastasis and underwent curative surgery in one participating institution formed a reference group. Relapse-free survival (RFS) and overall survival (OS) were calculated using the Kaplan–Meier method.Cox proportional hazard regression analysis was performed to identify factors associated with the survival of patients with pIMA. @*Results@#The 5-year RFS and OS rates in patients with pIMA were 33.1% and 56.0%, respectively, compared with 74.3% and 91%, 64.3% and 71.8%, and 46.9% and 49.5% for patients with clinical stage T2, T3, and T4 NSCLC in the reference group, respectively. The RFS of patients with pIMA was comparable to that of patients with clinical stage T4 NSCLC and significantly worse than that of patients with clinical stage T3 NSCLC (p = 0.012). The differences in OS between patients with pIMA and those with clinical stage T3 or T4 NSCLC were not significant (p = 0.11 and p = 0.37, respectively). In patients with pIMA, the presence of separate nodules was a significant factor associated with poor RFS and OS {unadjusted hazard ratio (HR), 4.66 (95% confidence interval [CI], 1.95–11.11), p < 0.001 for RFS; adjusted HR, 4.53 (95% CI, 1.59–12.89), p = 0.005 for OS}. @*Conclusion@#The RFS of patients with pIMA was comparable to that of patients with clinical stage T4 lung cancer. Separate nodules on CT were associated with poor RFS and OS in patients with pIMA.

7.
Ultrasonography ; : 103-114, 2021.
Article in English | WPRIM | ID: wpr-919512

ABSTRACT

Purpose@#This study quantified the impact of respiratory motion on liver stiffness measurements according to different shear wave elastography (SWE) techniques and region of interest (ROI) methods, using liver fibrosis phantoms. @*Methods@#Three operators measured stiffness values in four phantoms with different stiffness on a moving platform with two SWE techniques (point-SWE [pSWE] and 2-dimensional SWE [2D-SWE]), three types of motion (static mode and moving mode at low and high speeds), and four ROI methods in 2D-SWE (circle, point, box, and multiple). The circular ROI method was used to compare the two SWE techniques. The occurrence of technical failure and unreliable measurements, stiffness values, and measurement time were evaluated. @*Results@#Technical failure was observed only in moving mode for pSWE and 2D-SWE (n=1 for both). Unreliable measurements were also only observed in moving mode and were significantly less common in 2D-SWE (n=1) than in pSWE (n=12) (P<0.001). No statistically significant differences in the technical failure rate or stiffness values were noted between the static and moving modes for both SWE techniques. The technical failure and unreliable measurement rates were not significantly different among the ROI methods for 2D-SWE. Stiffness values did not differ significantly according to the ROI method used in any moving mode. However, the multiple ROI method had significantly shorter measurement times than the circular ROI method for all moving modes. @*Conclusion@#2D-SWE may be preferable for evaluating liver fibrosis in patients with poor breath-hold. Furthermore, 2D-SWE with multiple ROIs enables rapid measurements, without affecting liver stiffness values.

8.
Psychiatry Investigation ; : 986-996, 2021.
Article in English | WPRIM | ID: wpr-918737

ABSTRACT

Objective@#As of 2019, suicide is serious problem in Korea, with the highest suicide rate among OECD countries. To reduce suicide rates Emergency Department Based Post-Suicide Attempt Case Management carried out with government funding in South Korea, but it is insufficient to address the issue. Aim of this study is to prevent suicide attempts through continuous provision of mental health services even after discharge from acute care. @*Methods@#We selected 15 mental health specialists who are multidisciplinary experts in Suicide Prevention. Two-round Delphi survey was conducted on them to reach an agreement for hospital-based case management. @*Results@#The first Delphi survey consisted of 8 areas and 39 questions. Among them, 30 questions draw agreement above the reference value. The second Delphi survey, consisted of 37 questions, resulted in 32 above-standard questions. @*Conclusion@#Consensus was reached in most category of the Hospital Based Case Management for Suicide High-Risk Group. Core of the developed plan was to provide services to patients who visited the hospital, pursue the stability and universalization of services through a medical insurance fee system. In the future, hospital-based case management service will be implemented as a new model contributing to the reduction of suicide rates in Korea.

9.
Article in English | WPRIM | ID: wpr-915491

ABSTRACT

Background@#It is essential to determine the distribution of the causative microorganisms in the region and the status of local antibiotic resistance for the proper treatment of hospitalacquired pneumonia/ventilator-associated pneumonia (HAP/VAP). This study aimed to investigate the occurrence and causative strains of HAP/VAP, distribution of resistant bacteria, use of antibiotics, and the ensuing outcomes of patients in Korea. @*Methods@#A multicenter prospective observational cohort study was conducted among patients with HAP/VAP admitted to the medical intensive care unit of 5 tertiary referral centers between August 2012 and June 2015. Patients' demographic and clinical data were collected. @*Results@#A total of 381 patients were diagnosed with HAP/VAP. Their median age was 69 (59–76) years and 71% were males. A majority of the patients (88%) had late-onset (> 5 days) HAP/VAP. One-quarter of the patients (n = 99) had at least one risk factor for multidrug-resistant (MDR) pathogens, such as prior intravenous antibiotic use within the last 90 days. Microbiological specimens were mostly obtained noninvasively (87%) using sputum or endotracheal aspirates. Pathogens were identified in 235 (62%) of the 381 patients. The most common bacterial pathogen was Acinetobacter baumannii (n = 89), followed by Staphylococcus aureus (n = 52), Klebsiella pneumoniae (n = 25) and Pseudomonas aeruginosa (n = 22). Most of isolated A. baumannii (97%) and S. aureus (88%) were multidrug resistant. The most commonly used empirical antibiotic regimens were carbapenem-based antibiotics (38%), followed by extended-spectrum penicillin/ β-lactamase inhibitor (34%). Glycopeptide or linezolid were also used in combination in 54% of patients. The 28-day mortality rate of the patients with HAP/VAP was 30% and the 60-day mortality was 46%. Patients who used empirical antibiotics appropriately had significantly lower mortality rates than those who did not (28-day mortality: 25% vs. 40%, P = 0.032; 60-day mortality: 41% vs. 55%, P = 0.032, respectively). Administration of appropriate empirical antibiotics (odds ratio [OR], 0.282; confidence interval [CI], 0.092–0.859; P = 0.026), Day 7 treatment failure (OR, 4.515; CI, 1.545–13.192; P= 0.006), and APACHE II score on day 1 (OR, 1.326; CI, 0.988–1.779; P = 0.012) were the factors that determined the 28-day mortality in patients with HAP who had identified bacteria as pathogens. @*Conclusion@#In HAP/VAP patients, there was a large burden of MDR pathogens, and their associated mortality rate was high. Proper selection of empirical antibiotics was significantly associated with the patient's prognosis; however, there was a discrepancy between major pathogens and empirical antibiotic therapy.

10.
Hip & Pelvis ; : 18-24, 2021.
Article in English | WPRIM | ID: wpr-914518

ABSTRACT

Purpose@#We classified the articles published in the journal Hip & Pelvis and analyzed the relationship between study characteristics and citation rates. @*Materials and Methods@#All articles published in Hip & Pelvis from 2009 to 2019 were included. We classified the articles according to the type, language, listing in PubMed Central (PMC), treatment modality, material, design, anatomical focus, number of authors, and number of cases. We analyzed the citation rate according to this classification, with yearly citation rate reflecting the exposure period until March 2020. @*Results@#The yearly citation rate increased significantly after the language of the journal was changed from Korean to English in June 2014 (mean=0.96 vs. 1.63, P<0.05), and again after the journal was listed in PMC in March 2016 (mean=1.05 vs. 1.92, P<0.05). The yearly citation rates of review articles was highest, followed by those of editorials, original articles, and case reports (in this order). Among original articles, trauma-related articles had higher yearly citation rates than non-trauma-related articles (mean=1.00 vs. 0.68, P=0.034). Among clinical articles, studies focusing on the pelvis had higher yearly citation rates than studies on the hip or femur (mean=1.85 vs. 0.71 vs. 0.91, P=0.003). @*Conclusion@#The yearly citation rate of articles increased significantly after the language of Hip & Pelvis was changed to English and after the journal was listed in PMC. The mean yearly citation rate of articles focusing on the pelvis was significantly higher than that of articles focusing on the hip or femur.

11.
Asian Spine Journal ; : 659-663, 2021.
Article in English | WPRIM | ID: wpr-913689

ABSTRACT

Study DesignA cross-sectional study.PurposeTo examine the influence of restrictive pulmonary dysfunction on osteoporotic thoracic vertebral fractures.Overview of LiteratureOsteoporotic thoracic vertebral fractures generally result in an increased kyphotic angle, which in turn may lead to pulmonary function impairment. Impaired pulmonary function could be associated with vertebral fractures. However, an association between osteoporotic thoracic vertebral fractures and pulmonary function remains controversial.MethodsA total of 96 patients were enrolled in this study, 30 of whom had osteoporotic thoracic vertebral fractures (group 1), 30 with chronic back pain (group 2), and 36 with chronic pulmonary diseases (group 3). Radiologic study of prevalent vertebral fractures, thoracic kyphotic angle, bone mineral density, relaxed expiratory vital capacity, forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) in spirometry was investigated.ResultsThe mean FVC and FEV1 were 75.66%±20.23% and 79.93%±22.48%, respectively, in group 1; 84.50%±16.25% and 91.87%±21.65%, respectively, in group 2; and 91.64%±17.53% and 91.03%±23.71%, respectively, in group 3. Group 1 (patients with osteoporotic thoracic vertebral fracture) had the lowest FVC among the three groups (p=0.01). Group 1 revealed worse result of pulmonary dysfunction than group 3 (patients with chronic pulmonary diseases) (p=0.01). The average kyphosis angle of the thoracic spine was 26.95°±15.17°, 36.47°±20.08°, and 28.58°±10.58° in groups 1, 2, and 3, respectively. There was a negative correlation between thoracic kyphosis and FEV1 (r=−0.309, p=0.01).ConclusionsThe results suggest that osteoporotic thoracic vertebral fracture burden could be affected by restrictive pulmonary dysfunction.

12.
Yonsei Medical Journal ; : 1052-1061, 2021.
Article in English | WPRIM | ID: wpr-904271

ABSTRACT

Purpose@#This study aimed to investigate whether a deep learning model for automated detection of unruptured intracranial aneurysms on time-of-flight (TOF) magnetic resonance angiography (MRA) can achieve a target diagnostic performance comparable to that of human radiologists for approval from the Korean Ministry of Food and Drug Safety as an artificial intelligence-applied software. @*Materials and Methods@#In this single-center, retrospective, confirmatory clinical trial, the diagnostic performance of the model was evaluated in a predetermined test set. After sample size estimation, the test set consisted of 135 aneurysm-containing examinations with 168 intracranial aneurysms and 197 aneurysm-free examinations. The target sensitivity and specificity were set as 87% and 92%, respectively. The patient-wise sensitivity and specificity of the model were analyzed. Moreover, the lesion-wise sensitivity and false-positive detection rate per case were also investigated. @*Results@#The sensitivity and specificity of the model were 91.11% [95% confidence interval (CI): 84.99, 95.32] and 93.91% (95% CI:89.60, 96.81), respectively, which met the target performance values. The lesion-wise sensitivity was 92.26%. The overall falsepositive detection rate per case was 0.123. Of the 168 aneurysms, 13 aneurysms from 12 examinations were missed by the model. @*Conclusion@#The present deep learning model for automated detection of unruptured intracranial aneurysms on TOF MRA achieved the target diagnostic performance comparable to that of human radiologists. With high standalone performance, this model may be useful for accurate and efficient diagnosis of intracranial aneurysm.

13.
Article in English | WPRIM | ID: wpr-904161

ABSTRACT

Background@#Fractional exhaled nitric oxide (FeNO) is a non-invasive marker for eosinophilic airway inflammation and a good predictor of response to corticosteroids. There is a need for a reliable and accurate measurement method, as FeNO measurements have been widely used in clinical practice. Our study aimed to compare two FeNO analyzers and derive a conversion equation for FeNO measurements in adults. @*Methods@#We included 99 participants who had chief complaints of chronic cough and difficulty in breathing. The participants underwent concurrent FeNO measurement using NIOX VERO (Circassia AB) and NObreath (Bedfont). We compared the values of the two devices and analyzed their correlation and agreement. We then formulated an equation to convert FeNO values measured by NObreath into those obtained by NIOX VERO. @*Results@#The mean age of the participants was 51.2±17.1 years, with a female predominance (58.6%). Approximately 60% of the participants had asthma. The FeNO level measured by NIOX VERO (median, 27; interquartile range [IQR], 15–45) was significantly lower than that measured by NObreath (median, 38; IQR, 22–58; p<0.001). There was a strong positive correlation between the two devices (r=0.779, p<0.001). Additionally, Bland-Altman plots and intraclass correlation coefficient demonstrated a good agreement. Using linear regression, we derived the following conversion equation: natural log (Ln) (NObreath)=0.728×Ln (NIOX VERO)+1.244. @*Conclusion@#The FeNO values of NIOX VERO and NObreath were in good agreement and had positive correlations. Our proposed conversion equation could help assess the accuracy of the two analyzers.

14.
The Korean Journal of Pain ; : 193-200, 2021.
Article in English | WPRIM | ID: wpr-903788

ABSTRACT

Background@#Local anesthetic infiltration at the site of a surgical wound is commonly used to control postoperative pain. In this study, we examined the effectiveness of continuous local infiltration at an abdominal surgical site in patients undergoing anterior lumbar interbody fusion (ALIF) surgery. @*Methods@#Sixty-one patients who underwent ALIF surgery were enrolled. For thirtyone of them, a continuous local anesthetics infiltration system was used at the abdominal site. We collected data regarding the patients’ sleep quality; satisfaction with pain control after surgery; abilities to perform physical tasks and the additional application of opioids in the postoperative 48 hours. @*Results@#The On-Q system group showed reduced visual analogue scale scores for pain at the surgical site during rest and movement at 0, 12, 24, and 48 hours; and more was satisfied with pain control management at the first postoperative day (7.0 ± 1.2 vs. 6.0 ± 1.4; P = 0.003) and week (8.1 ± 1.6 vs. 7.0 ± 1.8; Background: Local anesthetic infiltration at the site of a surgical wound is commonly used to control postoperative pain. In this study, we examined the effectiveness of continuous local infiltration at an abdominal surgical site in patients undergoing anterior lumbar interbody fusion (ALIF) surgery. @*Methods@#Sixty-one patients who underwent ALIF surgery were enrolled. For thirtyone of them, a continuous local anesthetics infiltration system was used at the abdominal site. We collected data regarding the patients’ sleep quality; satisfaction with pain control after surgery; abilities to perform physical tasks and the additional application of opioids in the postoperative 48 hours. @*Results@#The On-Q system group showed reduced visual analogue scale scores for pain at the surgical site during rest and movement at 0, 12, 24, and 48 hours; and more was satisfied with pain control management at the first postoperative day (7.0 ± 1.2 vs. 6.0 ± 1.4; P = 0.003) and week (8.1 ± 1.6 vs. 7.0 ± 1.8; P = 0.010) than the control group. The number of additional patient-controlled analgesia (PCA) bolus and pethidine injections was lower in the On-Q group (PCA: 3.67 ± 1.35 vs. 4.60 ± 1.88; P = 0.049 and pethidine: 2.09 ± 1.07 vs. 2.73 ± 1.38;P = 0.032). Patients who used the On-Q system performed more diverse activity and achieved earlier ambulation than those in the control group. @*Conclusions@#Continuous wound infiltration with ropivacaine using an On-Q system may be effective for controlling postoperative pain after ALIF surgery. 0.010) than the control group. The number of additional patient-controlled analgesia (PCA) bolus and pethidine injections was lower in the On-Q group (PCA: 3.67 ± 1.35 vs. 4.60 ± 1.88; P = 0.049 and pethidine: 2.09 ± 1.07 vs. 2.73 ± 1.38; P = 0.032). Patients who used the On-Q system performed more diverse activity and achieved earlier ambulation than those in the control group. @*Conclusions@#Continuous wound infiltration with ropivacaine using an On-Q system may be effective for controlling postoperative pain after ALIF surgery.

15.
Article in English | WPRIM | ID: wpr-903755

ABSTRACT

Objective@#The aim of this study was to compare the differences in mandibular posterior anatomic limit (MPAL) distances stratified by vertical patterns in patients with skeletal Class III malocclusion by using cone-beam computed tomography (CBCT). @*Methods@#CBCT images of 48 patients with skeletal Class III malocclusion (mean age, 22.8 ± 3.1 years) categorized according to the vertical patterns (hypodivergent, normodivergent, and hyperdivergent; n = 16 per group) were analyzed. While parallel to the posterior occlusal line, the shortest linear distances from the distal root of the mandibular second molar to the inner cortex of the mandibular body were measured at depths of 4, 6, and 8 mm from the cementoenamel junction. MPAL distances were compared between the three groups, and their correlations were analyzed. @*Results@#The mean ages, sex distribution, asymmetry, and crowding in the three groups showed no significant differences. MPAL distance was significantly longer in male (3.8 ± 2.6 mm) than in female (1.8 ± 1.2 mm) at the 8-mm root level. At all root levels, MPAL distances were significantly different in the hypodivergent and hyperdivergent groups (p < 0.001) and between the normodivergent and hyperdivergent groups (p < 0.01). MPAL distances were the shortest in the hyperdivergent group. The mandibular plane angle highly correlated with MPAL distances at all root levels (p < 0.01). @*Conclusions@#MPAL distances were the shortest in patients with hyperdivergent patterns and showed a decreasing tendency as the mandibular plane angle increased. MPAL distances were significantly shorter (~3.16 mm) at the 8-mm root level.

16.
Korean Journal of Radiology ; : 1555-1568, 2021.
Article in English | WPRIM | ID: wpr-902500

ABSTRACT

Pulmonary embolism (PE) is a potentially fatal disease if the diagnosis or treatment is delayed. Currently, multidetector computed tomography (MDCT) is considered the standard imaging method for diagnosing PE. Dual-energy CT (DECT) has the advantages of MDCT and can provide functional information for patients with PE. The aim of this review is to present the potential clinical applications of DECT in PE, focusing on the diagnosis and risk stratification of PE.

17.
Korean Journal of Radiology ; : 1719-1729, 2021.
Article in English | WPRIM | ID: wpr-902492

ABSTRACT

Objective@#Emphysema and small-airway disease are the two major components of chronic obstructive pulmonary disease (COPD). We propose a novel method of quantitative computed tomography (CT) emphysema air-trapping composite (EAtC) mapping to assess each COPD component. We analyzed the potential use of this method for assessing lung function in patients with COPD. @*Materials and Methods@#A total of 584 patients with COPD underwent inspiration and expiration CTs. Using pairwise analysis of inspiration and expiration CTs with non-rigid registration, EAtC mapping classified lung parenchyma into three areas: Normal, functional air trapping (fAT), and emphysema (Emph). We defined fAT as the area with a density change of less than 60 Hounsfield units (HU) between inspiration and expiration CTs among areas with a density less than -856 HU on inspiration CT. The volume fraction of each area was compared with clinical parameters and pulmonary function tests (PFTs). The results were compared with those of parametric response mapping (PRM) analysis. @*Results@#The relative volumes of the EAtC classes differed according to the Global Initiative for Chronic Obstructive Lung Disease stages (p < 0.001). Each class showed moderate correlations with forced expiratory volume in 1 second (FEV 1) and FEV 1/forced vital capacity (FVC) (r = -0.659–0.674, p < 0.001). Both fAT and Emph were significant predictors of FEV 1 and FEV 1/FVC (R2 = 0.352 and 0.488, respectively; p < 0.001). fAT was a significant predictor of mean forced expiratory flow between 25% and 75% and residual volume/total vital capacity (R2 = 0.264 and 0.233, respectively; p < 0.001), while Emph and age were significant predictors of carbon monoxide diffusing capacity (R2 = 0.303; p < 0.001). fAT showed better correlations with PFTs than with small-airway disease on PRM. @*Conclusion@#The proposed quantitative CT EAtC mapping provides comprehensive lung functional information on each disease component of COPD, which may serve as an imaging biomarker of lung function.

18.
Korean Journal of Radiology ; : 1066-1076, 2021.
Article in English | WPRIM | ID: wpr-902449

ABSTRACT

Objective@#To evaluate the performance of the 2018 Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) Practice Guidelines (hereafter, PG) for the diagnosis of hepatocellular carcinoma (HCC) using gadoxetic acid-enhanced MRI, compared to the Liver Imaging-Reporting and Data System (LI-RADS) version 2018 (hereafter, v2018). @*Materials and Methods@#From January 2013 to October 2015, treatment-naïve hepatic lesions (≥ 1 cm) on gadoxetic acidenhanced MRI in consecutive patients with chronic hepatitis B or cirrhosis were retrospectively evaluated. For each lesion, three radiologists independently analyzed the imaging features and classified the lesions into categories according to the 2018 KLCA-NCC PG and LI-RADS v2018. The imaging features and categories were determined by consensus. Generalized estimating equation (GEE) models were used to compare the per-lesion diagnostic performance of the 2018 KLCA-NCC PG and LI-RADS v2018 using the consensus data. @*Results@#In total, 422 lesions (234 HCCs, 45 non-HCC malignancies, and 143 benign lesions) from 387 patients (79% male; mean age, 59 years) were included. In all lesions, the definite HCC (2018 KLCA-NCC PG) had a higher sensitivity and lower specificity than LR-5 (LI-RADS v2018) (87.2% [204/234] vs. 80.8% [189/234], p < 0.001; 86.2% [162/188] vs. 91.0% [171/188], p = 0.002). However, in lesions of size ≥ 2 cm, the definite HCC had a higher sensitivity than the LR-5 (86.8% [164/189] vs. 82.0 (155/189), p = 0.002) without a reduction in the specificity (80.0% [48/60] vs. 83.3% [50/60], p = 0.15).In all lesions, the sensitivity and specificity of the definite/probable HCC (2018 KLCA-NCC PG) and LR-5/4 did not differ significantly (89.7% [210/234] vs. 91.5% [214/234], p = 0.204; 83.5% [157/188] vs. 79.3% [149/188], p = 0.071). @*Conclusion@#For the diagnosis of HCC of size ≥ 2 cm, the definite HCC (2018 KLCA-NCC PG) had a higher sensitivity than LR-5, without a reduction in specificity. The definite/probable HCC (2018 KLCA-NCC PG) had a similar sensitivity and specificity to that those of the LR-5/4.

19.
Article in English | WPRIM | ID: wpr-900735

ABSTRACT

Since the first report of a nasal septal abscess (NSA) from a dental origin (1920), six articles have been published in the English literature to date. The most common cause of NSA is an infection of the nasal septal hematoma after trauma. This is a report of an uncommon cause of NSA with a dental origin. A PubMed search performed regardless of year and country using the terms (“nasal septal abscess”) OR (“nasal septum abscess”) initially yielded 229 articles. After screening, seven articles (eight patients) were selected. Addition of two related articles produced a total of nine articles (10 patients) to be included. The age of the included patients ranged from 7 to 69 years (mean, 32.82 years; standard deviation, ±23.86 years). The sex composition was as followed: males (n=7; 63.6%), females (n=4; 36.4%). Dental histories were various: periapical lesions, caries, extraction, endodontic therapy, and cystic lesions. The maxillary incisor dominated as the tooth of origin. Early diagnosis and treatment of NSAs are important to avoid not only facial deformity, but also severe complications (e.g., intracranial infection). If NSA is suspected in patients without facial trauma, the possibility of a dental origin, especially from the maxillary incisor area, should be considered.

20.
Article in English | WPRIM | ID: wpr-897971

ABSTRACT

Background@#Although ultrasound-guided needle decompression (US-GND) can treat calcific tendinitis of the shoulder effectively, repeat procedures might be required for unresolved symptoms. We evaluated the overall clinical outcomes of US-GND with subacromial steroid injection and the final results and factors predisposing toward repeat procedures. @*Methods@#Ninety-eight patients who underwent US-GND for calcific tendinitis of the supraspinatus/infraspinatus were analyzed between March 2017 and December 2018. The clinical outcomes (pain visual analog scale, functional visual analog scale [FVAS], and American Shoulder and Elbow Surgeons [ASES] score) and final subjective satisfaction were compared between groups A (single US-GND) and B (repeat US-GND). The factors predisposing toward repeated US-GNDs were analyzed. @*Results@#We found that 59.3% (58/98) of patient ASES scores were ≥80, and 73.5% of patients (72/98) were satisfied with the outcome. Group B (n=14) demonstrated a significantly higher rate of dominant-arm involvement compared to group A (78.6% vs. 48.8%, P=0.046). However, initial calcification size, shape, number, density, subscapularis involvement, lavage, and procedure time did not differ significantly between the groups. Group B showed poorer final FVAS (7 [interquartile range, 6–8] vs. 8 [interquartile range, 7–9], p=0.036) and subjective satisfaction compared to group A (satisfied: 5 [35.7%] vs. 67 [79.8%], p<0.001]. @*Conclusions@#US-GND with subacromial steroid injection is a viable treatment option for calcific tendinitis of the shoulder. Dominant-arm involvement was the only independent factor for repeated US-GND. Final outcome of repeated US-GND for unimproved patients was promising; however, these outcomes were poor compared to those of the patients who improved after the first procedure.

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