Revascularizations of 14 occlusive arterial diseases in the lower extremities with the Transluminal Endarterectomy Catheter was done successfully. The causes of occlusions were atherosclerosis in 9 cases and cardiogenic thromboembolism in 5 cases. The site of lesions were at the common femoral artery in 1 case, the superficial femoral artery in 6 cases and the popliteal artery in 7 cases. The length of the lesion were below 5cm(n=3), 5-10cm(n=2), 11-20cm(n=6) and 21-30cm(n=3). Complications were distal embolism(n=1) and hematoma at the puncture site(n=1). No symptoms recurred in any cases during 2 months -15 months followup. Endarterectomy with Transluminal Endarterectomy Catheter was found to be an effective method for revasculizations of occlusive arterial disease in the lower extremity, especially in long segmental occlusion.
Atherosclerosis ; Catheters ; Endarterectomy* ; Femoral Artery ; Follow-Up Studies ; Hematoma ; Lower Extremity* ; Methods ; Popliteal Artery ; Punctures ; Thromboembolism

The presence of A-V shunting in hepatocellular carcinoma is an important factor for deciding the prognosis and in the management with transarterial chemoembolization. Twenty-four patients with hepatocellular carcinoma performed with CO2-DSA and iodinated-DSA were reviewed for the evaluation of visibility of A-V shunting. It was classified by the visibility into clearly visible, faintly visible and invisible. Also the authors evaluated neovascularity and tumor staining. And we checked side effects after the injection of CO2 gas during CO2-DSA. A-V shunting was noted in 19 cases(63%), which were clearly visible in 15 of 19 cases(79%) on CO2-DSA and in 7 of 19 cases(37%) on iodinated-DSA. In 3 cases, A-V shunting was noted only on CO2-DSA. CO2-DSA(17%)was inferior to iodinated-DSA in detection of neovasculaity and tumor staining. Side effects from CO2-DSA were abdominal pain(1 case) and chest discomfort(1 case) but improved within several minutes. In conclusion, CO2-DSA is a sensitive and effective method for the detection of A-V shunting in hepatoma.
Carcinoma, Hepatocellular* ; Humans ; Methods ; Prognosis ; Thorax

Chronic hepatitis C (CHC) treatment has dramatically improved since direct-acting antiviral (DAA) therapy was introduced. However, the use of DAA therapy in CHC patients with hepatocellular carcinoma (HCC) remains controversial. We investigated the DAA treatment response in CHC patients with HCC. Methods: We retrospectively analyzed CHC patients treated with DAA from 2016 to 2018. Patients were divided into two groups based on their HCC-history before DAA therapy. Baseline characteristics, sustained virologic response at 12 weeks (SVR 12), and HCC recurrence after DAA therapy were evaluated. We also used propensity score matching (PSM) in a 2:1 ratio to reduce confounding variables. Results: A total of 192 patients were enrolled; 78.1% were treatment-naïve, and 34.9% had liver cirrhosis (LC). Among these patients, 168 did not have HCC, and 24 had HCC. The HCC group was older (57.0 years vs. 72.0 years, p < 0.001), had a higher incidence of LC (26.2% vs. 95.8%, p < 0.001), fibrosis-4 index (2.6 vs. 9.2, p < 0.001), liver stiffness measurement (7.0 kPa vs. 17.4 kPa, p = 0.012), and α-fetoprotein (4.4 ng/mL vs. 8.2 ng/mL, p ≤ 0.001). The SVR 12 rate was 97.0% in the non- HCC group and 91.7% in the HCC group (p = 0.213). HCC recurrence was observed in 14 patients (58.3%) in the HCC group. Conclusions: DAA treatment efficacy in CHC patients with or those without HCC were not significantly different, and HCC recurrence was relatively common.

BACKGROUND: BRAF mutation has been recognized as an important biomarker of colorectal cancer (CRC) for targeted therapy and prognosis prediction. However, sequencing for every CRC case is not cost-effective. An antibody specific for BRAF V600E mutant protein has been introduced, and we thus examined the utility of BRAF VE1 immunohistochemistry for evaluating BRAF mutations in CRC. METHODS: Fifty-one BRAF-mutated CRCs and 100 age and sexmatched BRAF wild-type CRCs between 2005 and 2015 were selected from the archives of Asan Medical Center. Tissue microarrays were constructed and stained with BRAF VE1 antibody. RESULTS: Forty-nine of the 51 BRAF-mutant CRCs (96.1%) showed more than moderate cytoplasmic staining, except for two weakly stained cases. Six of 100 BRAF wild-type cases also stained positive with BRAF VE1 antibody; four stained weakly and two stained moderately. Normal colonic crypts showed nonspecific weak staining, and a few CRC cases exhibited moderate nuclear reactivity (3 BRAF-mutant and 10 BRAF wild-type cases). BRAF-mutated CRC patients had higher pathologic stages and worse survival than BRAF wild-type patients. CONCLUSIONS: BRAF VE1 immunohistochemistry showed high sensitivity and specificity, but occasional nonspecific staining in tumor cell nuclei and normal colonic crypts may limit their routine clinical use. Thus, BRAF VE1 immunohistochemistry may be a useful screening tool for BRAF V600E mutation in CRCs, provided that additional sequencing studies can be done to confirm the mutation in BRAF VE1 antibody-positive cases.
Cell Nucleus ; Chungcheongnam-do ; Colon ; Colorectal Neoplasms ; Cytoplasm ; Humans ; Immunohistochemistry ; Mass Screening ; Mutant Proteins ; Prognosis ; Sensitivity and Specificity ; Sequence Analysis, DNA

BACKGROUND/AIMS: Although endoscopic band ligation or injection sclerotherapy are the current standard therapies for bleeding esophageal varices, the best method for initial control is unclear. The aim of this prospective study was to compare the efficacy and toxicity of somatostatin and vasopressin in the management of esophageal variceal hemorrhage. METHODS: From March, 1997 to September, 1998, 28 consecutive cirrhotic patients admitted to the Yonsei Medical Center because of active variceal bleeding were included in this trial. The patients were randomized to receive either somatostatin (15 patients) or vasopressin (13 patients) for 48 hours. RESULTS: There were no significant differences between the two treatment groups in relation to Child's classification, amount of bleeding before randomization and units of blood transfused during therapy. Initial control of bleeding was achieved in 13 (86.7%) patients receiving somatostatin and in 10 (76.9%) of those treated with vasopressin. However, two patients in the somatostatin group and two in the vasopressin group bled again during treatment. Therefore complete control of bleeding during the 48 hours of therapy was achieved in 11 (73.4%) patients treated with somatostatin and in eight (61.5%) of those receiving vasopressin. Differences were observed in complications associated with each therapy. Vasopressin produced complications in four patients (chest pain in two, hypertension in one and hyponatremia-induced seizure in one) while somatostatin produced minor complication in one patient. CONCLUSIONS: This study suggests that somatostatin is efficacious in controlling acute hemorrhage from esophageal varices and has a lower risk of adverse effects than vasopressin.
Classification ; Esophageal and Gastric Varices ; Hemorrhage* ; Humans ; Hypertension ; Ligation ; Prospective Studies* ; Random Allocation ; Sclerotherapy ; Seizures ; Somatostatin* ; Vasopressins*

The upper thoracic vertebrae through anterior approach depends upon several variables; The diameter of the thoracic inlet, the height of the clavicles and manubrium anteriorly, and the extent of the cervicothoracic kyphosis. Preoperatively, the upper margin of the manubrium should be compaired with the vertebral body level on a standard lateral roentegenogam or mid-sagittal MRI of the upper thoracic spine. We measured the distance and the level of the corresponding vertebra of line A(horizontal line from the suprasternal notch to the corresponding vertebra) and line B(perpendicular line from the suprasternal notch to the corresponding vertebra ; thoracic inlet) on mid-sagittal MRI of normal subjects. The results were as follows: 1) In 95 cases(94 cumulative %), the line A fell to the T2 lower one third through T4 lower one third and the mean distance was 49.8+/-4.2mm(means standard deviation). 2) In 92 cases(91 cumulative %), the line B fell to the T1 lower one third to T3 middle one third and the mean distance was 45.5+/-4.9mm(means standard deviation). 3) The relation of the height and the distance with age, sex, weight, height, and body mass index were not statistically significant. We concluded that anatomical analysis of the mid-sagittal MRI of the cervicothoracic vertebrae will be helpful in selecting the access route to the cervicothoracic lesion.
Adult* ; Bays ; Body Mass Index ; Clavicle ; Humans ; Kyphosis ; Magnetic Resonance Imaging ; Manubrium ; Spine* ; Thoracic Vertebrae

PURPOSE: To establish the proper approach and management of an urachal anomaly in children. MATERIALS AND METHODS: We retrospectively reviewed the medical records and imaging studies of 33 children (21 boys, 12 girls) treated for an urachal anomaly over a ten-year period. RESULTS: Twenty-four patients were equally diagnosed with either an urachal sinus or urachal cyst; the other nine patients were confirmed to have a patent urachus. Umbilical discharge (14 patients) and umbilical granuloma (9 patients) were the most common presentations. The 12 patients with an urachal sinus underwent ultrasonography (USG) (10; diagnostic), 2 fistulography (all; diagnostic). Those with an urachal cyst underwent either USG (6/12; diagnostic), computed tomography (CT) (3; diagnostic), fistulography (2; diagnostic), or magnetic resonance imaging (MRI) (1; diagnostic). One subject was affected by acute appendicitis, which was confirmed by CT. Of the 9 children with patent urachus, 7 underwent USG (all; diagnostic); exploration without further imaging studies was performed on the remaining 2 subjects. Surgical excision was performed in 30 patients. Omphalomesenteric duct or Meckel's diverticulum were incidental findings, which were simultaneously repaired. Conservative treatment was successful in only 3 patients. CONCLUSIONS: Urachal anomalies in children mainly manifest as umbilical discharges and umbilical granuloma, but may present non-specific symptoms in some cases. USG is a useful method for diagnosis, but other imaging modalities can be useful to establish the differential diagnosis. A limited number of children with urachal anomalies, mainly presenting with an umbilical discharge, can be managed conservatively. However, complete surgical excision of the lesion, with the possible associated anomalies, should be the basic scheme for children with urachal anomalies.
Appendicitis ; Child* ; Diagnosis ; Diagnosis, Differential ; Granuloma ; Humans ; Incidental Findings ; Magnetic Resonance Imaging ; Meckel Diverticulum ; Medical Records ; Retrospective Studies ; Ultrasonography ; Urachal Cyst ; Urachus ; Vitelline Duct

urpose: Misonidazole is a radiosensitizer that binds in hypoxic cells. The purpose of this study was to find out the feasibility of I-131-Iodomisonidazole (IMISO) for imaging of tumor hypoxia. MATERIALS AND METHODS: Tosyl precursor was dissolved in acetonitrile and I-131-NaI was added to synthesize IMISO. Balb/c mice inoculated with CT-26 adenocarcinoma were injected with IMISO. Mice were sacrificed at 1,2,4,24 hr and % of injected dose per gram of tissue (%ID/g) was determined. For scintigraphy and MRI, mouse bearing CT-26 adenocarcinoma was administered with IMISO and imaging was performed 4 hr after. Then, mouse body was fixed and microtomized slice was placed on radiographic film for autoradiography. RESULTS: %ID/g of tumor was 1.64 (1h), 0.98 (2h), 0.85 (4h) and 0.20 (24h), respectively. At 24h, %ID/g of tumor was higher than that of all other tissues except thyroid. Tumor to muscle ratio increased with time and tumor to blood ratio also increased with time and reached 1.53 at 24 hr. On autoradiogram, tumor was well visualized as an increased activity in central hypoxic area of the tumor which corresponds to the area of high signal intensity on T2-weighted MR image. On scintigraphy, tumor uptake was visualized. CONCLUSION:: This RESULTS suggest that IMISO may have a potential for tumor hypoxia imaging in mouse model. However, further study is needed to improve it's localization in tumor tissue and to achieve acceptable images of tumor hypoxia.
Adenocarcinoma* ; Animals ; Anoxia* ; Autoradiography ; Magnetic Resonance Imaging ; Mice* ; Misonidazole ; Radionuclide Imaging ; Thyroid Gland ; X-Ray Film

BACKGROUND: Irbersatan, an orally active antihypertensive agent, effectively reduce blood pressure by directly blocking angiotensin II receptors without any significant adverse effects. The purpose of this study is to evaluate the efficacy and safety of irbesartan in patients with mild to moderate hypertension. METHODS: This study enrolled 83 patients who had diastolic pressure above 95 mmHg and below 110 mmHg on two measurements. Sixty eight patients were administered 150mg of irbesartan, an angiotensin II receptor blocker, daily for four weeks as an initial dosage. If the sitting diastolic pressure was equal to or greater than 90 mmHg after a 4 week treatment period, the dosage was doubled until the end of 8 weeks. Baseline pressures, antihypertensive effect, side effects, laboratory findings were compared before and after treatment. RESULTS: Fourty two patients out of 53 patients having completed this study showed decreased blood pressure equal to or more than 5 mmHg of the sitting diastolic pressure (response rate=79%). Twenty one patients out of 53 patients showed normalized blood pressure below 90 mmHg of the sitting diastolic pressure (normalization rate=40%). The extent of decrease in diastolic and systolic blood pressure after eight week treatment was an average 11.7+/-10.1 mmHg and 16.3+/-18.9 mmHg, respectively (p<0.05). Nineteen ontoward side effects was observed in 17 patients out of 68 patients with medication (frequency of ontoward effects=25%). Only one case with headache was considered to be related to the medication. Abnormal laboratory findings were observed in eight patients, and only one case with elevation of bilirubin and ALT levels was considered to be related to the medication. CONCLUSION: In conclusion, irbesartan is a safe and effective antihypertensive drug in patients with mild to moderate hypertension with tolerable side effects.
Bilirubin ; Blood Pressure ; Headache ; Humans ; Hypertension* ; Receptors, Angiotensin

Intermittent exotropia occurs commonly in Korea and its clinical characteristics are relatively well known. We analyzed the clinical characteristics of intermittent exotropia and studied the relationship among them. We examined 229 patients(92 males and 137 females( who first visited three strabismic clinics. The age of onset, frequency, family history and symptoms of intermittent exotropia were examined. The angle and type of deviation were studied and sensory tests were done. The mean age of onset was 32.4 months and frequency ws 39.1% and family history was 8.7%. Photophobia was the most common symptom of intermittent exotropia. The distant angle of deviation was 26.7 prism diopters in average and the near angle was 25.3 prism diopters in average. The most common type of intermittent exotropia was basic type. followed by simulated divergence excess type, convergence insufficiency type, and divergence excess type. In statistical study, there was no significant relationship among clinical characteristics of intermittent exotroia.
Age of Onset ; Exotropia* ; Humans ; Korea ; Male ; Ocular Motility Disorders ; Photophobia ; Statistics as Topic ; Strabismus