Objectives: We reviewed the operational definitions of colorectal cancer (CRC) from studies using the Korean National Health Insurance Service (NHIS) and compared CRC incidence derived from the commonly used operational definitions in the literature with the statistics reported by the Korea Central Cancer Registry (KCCR). Methods: We searched the MEDLINE and KoreaMed databases to identify studies containing operational definitions of CRC, published until January 15, 2021. All pertinent data concerning the study period, the utilized database, and the outcome variable were extracted. Within the NHIS-National Sample Cohort, age-standardized incidence rates (ASRs) of CRC were calculated for each operational definition found in the literature between 2005 and 2019. These rates were then compared with ASRs from the KCCR. Results: From the 62 eligible studies, 9 operational definitions for CRC were identified. The most commonly used operational definition was “C18-C20” (n=20), followed by “C18-C20 with claim code for treatment” (n=3) and “C18-C20 with V193 (code for registered cancer patients’ payment deduction)” (n=3). The ASRs reported using these operational definitions were lower than the ASRs from KCCR, except for “C18-C20 used as the main diagnosis.” The smallest difference in ASRs was observed for “C18-C20,” followed by “C18- C20 with V193,” and “C18-C20 with claim code for hospitalization or code for treatment.” Conclusions In defining CRC patients utilizing the NHIS database, the ASR derived through the operational definition of “C18-C20 as the main diagnosis” was comparable to the ASR from the KCCR. Depending on the study hypothesis, operational definitions using treatment codes may be utilized.

A spinal arteriovenous fistula is a rare vascular disease that is characterized by abnormal connections between the vertebral artery or its branches and the neighboring veins. Bruit and back pain are common symptoms related to the fistula. Spinal cord dysfunction can also occur as a result of blood flow steal, venous hypertension, or mechanical compression of the nerve roots and spinal cord. We report a huge arteriovenous fistula in the spinal canal at the thoracic vertebra, which was characterized by a large azygous vein connected to the epidural vein causing osteolysis on the vertebral body and spinal cord compression symptoms. Staged embolization was performed using 80 coils.
Arteriovenous Fistula ; Back Pain ; Fistula ; Hypertension ; Osteolysis ; Spinal Canal ; Spinal Cord ; Spinal Cord Compression ; Spine ; Vascular Diseases ; Veins ; Vertebral Artery

BACKGROUND: Unlike 99mTc-Sestamibi, microbubbles used during myocardial contrast echocardiography (MCE) exist only in the vascular space. Therefore, there may be a difference in the pattern of myocardial perfusion between MCE and 99mTc-Sestamibi Single-Photon Emission Computed Tomography (SPECT) in acute myocardial infarction (AMI). OBJECTIVES: The purpose of this study was to assess myocardial perfusion using MCE with intravenous infusion of perfluorocarbon-exposed sonicated dextrose albumin microbubbles (IV MCE), and to compare it with SPECT and MCE with intracoronary injection of sonicated Hexabrix (IC MCE). METHODS: Seventeen patients with AMI (male 13, age 59.5+/-8.8 years, anterior MI 10) underwent IV MCE at 8.1+/-3.7 days after onset. SPECT and IC MCE were also performed at 1.2+/-1.0 days and 2.0+/-1.5 days from IV MCE respectively. Any revascularization procedures were not performed between three studies. Perfusion defect by three methods was scored semiquantitatively as 1 : normal perfusion, 0.5 : moderate defect, and 0 : severe defect at 16 segments of the left ventricle. RESULTS: 1) Perfusion defect in infarction territory was detected in 15 patients with SPECT, 12 patients with IV MCE and 11 patients with IC MCE. 2) Concordance of perfusion score at each segment was 93% between IV MCE and IC MCE, 65% between IV MCE and SPECT, and 64% between IC MCE and SPECT. 3) With IV MCE, perfusion defect was observed in all 32 segments which were considered as having defect (score 0 and 0.5) by IC MCE. However, defect by IV MCE was found only in 31 out of 108 segments considered as having defect by SPECT. CONCLUSION: In the assessment of myocardial perfusion in pts with AMI, IV MCE and IC MCE showed similar results. However, there was some discrepancy in the extent of perfusion defect between MCE studies and SPECT.
Echocardiography ; Glucose ; Heart Ventricles ; Humans ; Infarction ; Infusions, Intravenous ; Ioxaglic Acid ; Microbubbles ; Myocardial Infarction* ; Perfusion* ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: A well-developed collateral circulation (CC) is frequently observed in patients with total coronary occlusion. However, the fate of CC after successful coronary angioplasty (PTCA) is not clearly defined. The purpose of this study was to assess the temporal change of CC after successful PTCA of a totally occluded artery using coronary angiography (CA) and myocardial contrast echocardiography (MCE). METHODS: The study group comprised 20 consecutive patients (16 male, mean age 54 years) who underwent elective PTCA for total coronary occlusion. CA was performed before, immediately after and 24hrs after PTCA. MCE was performed before, immediately after and 24hrs after PTCA by intracoronary injection of sonicated radiographic contrast medium. According to the angiographic findings, CC was graded on a scale of 0 to 3 as follows. O=no visible filling ; 1 =collateral filling of side branches ; 2=partial collateral filling of the epicardial artery, 3=complete filling of the epicardial artery. On MCE, myocardial perfusion by CC was assessed by scoring the contrast pattern of collateral-dependent myocardial segments as follows . 0, none ; 0.5, patchy or epicardial; or 1, homogenous. RESULTS: Left anterior descending artery was occluded in 12 patients and right coronary artery in 8 patient. CA collateral grade before PTCA was grade 2 in 5 patients and grade 3 in 15. PTCA with stenting was successfully performed in all patients without significant residual stenosis. CA showed CC disappeared after PTCA in all patients. However, residual collateral perfusion was observed in 7 patients by MCE performed immediately after PTCA (score 1 in 3 patients ; score 0.5 in 4 patients). This residual collateral perfusion could be demonstrated even 24hrs after PTCA by MCE in 3 patients. CONCLUSION: Although angiographically not visible, coronary CC may persist even, after successful PTCA of a totally occluded artery. MCE is a useful clinical tool in the evaluation of temporal change of CC after PTCA.
Angioplasty* ; Arteries ; Collateral Circulation* ; Constriction, Pathologic ; Coronary Angiography* ; Coronary Occlusion ; Coronary Vessels ; Echocardiography* ; Humans ; Male ; Perfusion* ; Stents

OBJECTIVE: The object of this study was to assess the accuracy of dipyridamole stress intravenous (IV) myocardial contrast echocardiography (MCE) using pulse inversion harmonic imaging and PESDA in the detection of perfusion defect in the patients with coronary artery disease in comparison with dipyridamole stress Tc-99m sestamibi SPECT. METHODS: Total 46 patients (29 males, mean age 64 years old) were consecutively enrolled. Patients with prior myocardial infarction were excluded. MCE and Tc-99m sestamibi SPECT were performed at the same day during rest and after 0.56 or 0.84mg/Kg dipyridamole infusion. Continuous IV infusion of PESDA (2-5 mL/min) was administered while obtaining triggered (1:1) end-systolic apical 2, 4 chamber and long axis views. Tc-99m sestamibi was injected 3 minutes after dipyridamole. Tc-99m sestamibi SPECT images were obtained one hour later. Coronary angiography was followed within two days in all patients. Tc-99m sestamibi SPECT images were matched to the sixteen segments of left ventricle according to American Society of Echocardiography for segmental comparison. Both images were analyzed visually. Results Using coronary angiography as the standard, MCE showed overall sensitivity of 70.7%, specificity of 95.8%, positive predictive value (PPV) of 87.8% and negative predictive value (NPV) of 88.5% in the detection of coronary atherosclerosis (70% stenosis). Tc-99m sestamibi SPECT showed sensitivity of 75.6%, specificity of 98.9%, PPV of 96.8% and NPV of 90.6%. The overall concordance rate between MCE and Tc-99m sestamibi SPECT for the detection of perfusion defects was 86.9% (Cohen's kappa value 0.63) according to the coronary territory and 86.8% (Cohen's kappa value 0.55) according to segmental analysis. CONCLUSION: Dipyridamole stress IV MCE using pulse inversion harmonic imaging and PESDA is feasible and comparable to Tc-99m sestamibi SPECT in identifying significant coronary stenosis and inducible myocardial perfusion defects in the patients with coronary artery disease. MCE using pulse inversion harmonic imaging seems to be a promising modality for assessing myocardial perfusion in the patients with suspected coronary artery disease.
Axis, Cervical Vertebra ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Dipyridamole ; Echocardiography* ; Heart Ventricles ; Humans* ; Male ; Myocardial Infarction ; Perfusion* ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: Cardiac troponin T (cTnT), a useful marker for diagnosing acute myocardial infarction (AMI) in the general population, is significantly higher than the usual cut-off value in many end-stage renal disease (ESRD) patients without clinically apparent evidence of AMI. The aim of this study was to evaluate the clinical usefulness of cTnT in ESRD patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: Two hundred eighty-four ESRD patients with ACS were enrolled between March 2002 and February 2008. These patients were followed until death or June 2009. Medical records were reviewed retrospectively. The cut-off value of cTnT for AMI was evaluated using a receiver operating characteristic (ROC) curve. We calculated Kaplan-Meier survival curves, and potential outcome predictors were determined by Cox proportional hazard analysis. RESULTS: AMIs were diagnosed in 40 patients (14.1%). The area under the curve was 0.98 in the ROC curve (p<0.001; 95% CI, 0.95-1.00). The summation of sensitivity and specificity was highest at the initial cTnT value of 0.35 ng/mL (sensitivity, 0.95; specificity, 0.97). Survival analysis showed a statistically significant difference in all-cause and cardiovascular mortalities for the group with an initial cTnT > or =0.35 ng/mL compared to the other groups. Initial serum cTnT concentration was an independent predictor for mortality. CONCLUSION: Because ESRD patients with an initial cTnT concentration > or =0.35 ng/mL have a poor prognosis, it is suggested that urgent diagnosis and treatment be indicated in dialysis patients with ACS when the initial cTnT levels are > or =0.35 ng/mL.
Acute Coronary Syndrome/blood/complications/*diagnosis/mortality ; Aged ; Biological Markers/blood ; Female ; Humans ; Kidney Failure, Chronic/blood/complications/*diagnosis/mortality ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; Troponin T/*blood

alpha-Mangostin is a xanthon derivative contained in the fruit hull of mangosteen (Garcinia mangostana L.), and the administration of alpha-Mangostin inhibited the growth of transplanted colon cancer, Her/CT26 cells which expressed Her-2/neu as tumor antigen. Although alpha-Mangostin was reported to have inhibitory activity against sarco/endoplasmic reticulum Ca2+ ATPase like thapsigargin, it showed different activity for autophagy regulation. In the current study, we found that alpha-Mangostin induced autophagy activation in mouse intestinal epithelial cells, as GFP-LC3 transgenic mice were orally administered with 20 mg/kg of alpha-Mangostin daily for three days. However, the activation of autophagy by alpha-Mangostin did not significantly increase OVA-specific T cell proliferation. As we assessed ER stress by using XBP-1 reporter system and phosphorylation of eIF2alpha, thapsigargin-induced ER stress was significantly reduced by alpha-Mangostin. However, coadministration of thapsigargin with alpha-Mangostin completely blocked the antitumor activity of alpha-Mangostin, suggesting ER stress with autophagy blockade accelerated tumor growth in mouse colon cancer model. Thus the antitumor activity of alpha-Mangostin can be ascribable to the autophagy activation rather than ER stress induction.
Animals ; Autophagy ; Calcium-Transporting ATPases ; Cell Proliferation ; Colonic Neoplasms ; Epithelial Cells ; Fruit ; Garcinia mangostana ; Mice ; Mice, Transgenic ; Phosphorylation ; Reticulum ; Thapsigargin ; Transplants ; Xanthones