BACKGROUND AND OBJECTIVE: Fractional flow reserve (FFR) has emerged as an easily obtainable, and accurate, lesion-specific parameters for the physiological evaluation of coronary artery stenosis. However, the effects of the lesion length and eccentricity on the FFR remain unclear. Therefore, the relationship between the lesion length and eccentricity to the FFR, and the lesion length to the degree of stenosis were studied to see if there was any significant influence on the trans-stenotic pressure gradients and the FFR. SUBJECTS AND METHODS: Intravascular ultrasound (IVUS) was performed and the FFR measured in 19 lesions, ranging from 80 to 90% in area stenosis (AST), using a pressure wire. The eccentric index at the most stenotic site, and the length of the coronary stenosis lesion, above 50 and 70% of the AST, at the most stenotic site were obtained using IVUS. The FFR was defined by the ratio of distal mean coronary pressure (Pd) to that of the aortic mean pressure (Pa) under hyperemia. RESULTS: The FFR showed no correlation with the eccentricity or the length of the stenosis lesions when they were more than 50% of the AST (p>0.05). However, the FFR showed a significant correlation with the length of the most stenotic lesions (r=-0.79, p<0.001) and the lesions with an AST of more than 70% (r=-0.47, p<0.05). The hyperemic pressure gradient across the lesion showed a significant correlation with the length of the lesion, but only to those with the most severe portion of stenosis (r=0.64, p=0.003). CONCLUSION: In the functional evaluation of coronary stenosis, the length of the most stenotic lesions, as well as the cross sectional area and minimal lumen area at the most stenotic lesion, should be considered, as this study has shown that the length of the most severe stenotic lesion could influence the FFR and trans-stenotic pressure gradients.
Constriction, Pathologic ; Coronary Stenosis ; Hyperemia ; Ultrasonography ; Ultrasonography, Interventional

In the past, most hepatolithiasis had been brown pigment stones in Korea. However, stones with high cholesterol content are found with increasing frequency. Abdominal ultrasonography is superior to CT for detection of cholesterol hepatolithiasis. The characteristic gross morphology of pure cholesterol hepatolithiasis shown by cholangioscopy is diagnostic. An effective medical management consists of stone removal by percutaneous transhepatic cholangioscopy and ursodeoxycholic acid for the prevention of recurrence. We here report a case of primary pure cholesterol hepatolithiasis with a review of the literature. A 29-year-old woman presented with right upper quadrant pain. Abdominal ultrasonography showed right intrahepatic duct stones. A cholangioscopy revealed typical cholesterol stones, mucosal hyperemia, and mild narrowing in stone-bearing intrahepatic duct. Cholangioscopic stone removal via the percutaneous transhepatic route was successfully performed. To prevent recurrence, ursodeoxycholic acid was administered.
Adult ; Cholesterol* ; Female ; Humans ; Hyperemia ; Korea ; Recurrence ; Ultrasonography ; Ursodeoxycholic Acid

PURPOSE: The purpose of this study was to evaluate the ultrasonographic findings of secondary appendicitis (SA) and to discuss the differential findings compared with primary appendicitis. METHODS: In this study, we analyzed the ultrasonographic findings of 94 patients under 15 years old of age treated at our institution from May 2005 to May 2014 who had bowel inflammation and an inflamed appendix with a maximal outer diameter >6 mm that improved with nonsurgical treatment (the SA group). Ninety-nine patients with pathologically proven acute appendicitis (the primary appendicitis [PA] group) from June 2013 to May 2014 and 44 patients with pathologically negative appendectomy results from May 2005 to May 2014 were also included to compare the ultrasonographic features of these conditions. A retrospective review of the ultrasonographic findings was performed by two radiologists. The clinical and laboratory findings were also reviewed. The results were statically analyzed using analysis of variance, the Pearson chi-square test, and the two-tailed Fisher exact test. RESULTS: Compared with PA, cases of SA had a smaller diameter (9.8 mm vs. 6.6 mm, P < 0.001), and were less likely to show periappendiceal fat inflammation (98% vs. 6%, P < 0.001) or an appendicolith (34% vs. 11%, P < 0.001). SA showed mural hyperemia on color Doppler ultrasonography as frequently as PA (P=0.887). CONCLUSION: The ultrasonographic features of SA included an increased diameter compared to a healthy appendix and the same level of hyperemia as in PA. However, the diameter was commonly in the equivocal range (mean diameter, 6.6 mm), and periappendiceal fat inflammation was rarely present in SA.
Appendectomy ; Appendicitis* ; Appendix ; Humans ; Hyperemia ; Inflammation ; Pediatrics ; Retrospective Studies ; Ultrasonography* ; Ultrasonography, Doppler, Color

BACKGROUND: Intravascular ultrasound (IVUS) is one of the golden standards for the assessment of optimal angioplasty. Pressure-derived myocardial fractional flow reserve (FFRmyo) is a lesion-specific functional index of epicardial conduit and may be particularly useful for the assessment of optimal coronary angioplasty. The purpose of this study was to assess IVUS parameters and FFRmyo after successful angioplasty on coronary angiogram and compare them between balloon and stent group. METHODS: The study population consisted of 28 patients who underwent revascularization (14 cases of balloon angioplasty only, 14 cases of angioplasty with stent) from Jan. 1999 to Aug. 2000 at Inha University Hospital. After successful angioplasty on coronary angiogram, we measured minimal luminal diameter (MLD), minimal luminal area (MLA), lesion area stenosis (l-AST) and reference area stenosis (r-AST) with IVUS imaging. And we calculated FFRmyo from the ratio of mean coronary pressure distal to the stenosis (Pd) to the aortic mean pressure (Pa) during maximum coronary hyperemia (Pd/Pa). RESULTS: There was significant difference of MLD (2.2+/-0.4 vs 2.6+/-0.3), MLA (4.4+/-1.1 vs 6.4+/-1.7), r-AST (43.7+/-9.2 vs 29.8+/-9.4) and FFRmyo (0.89+/-0.07 vs 0.93+/-0.03) between balloon and stent group. All IVUS parameters (MLD, MLA, r-AST) are well correlated with FFRmyo after angioplasty (r=0.52, p<0.05, r=0.48, p<0.05 and r=-0.72, p<0.05 respectively). By multiple regression analysis, r-AST showed the best correlation with FFRmyo among IVUS parameters. CONCLUSION: Coronary angioplasty with stent showed more favorable MLD, MLA, r-AST and FFRmyo than balloon angioplasty. FFRmyo may be seemed to be alternative to IVUS for estimating the result of coronary angioplasty.
Angioplasty* ; Angioplasty, Balloon ; Constriction, Pathologic ; Fractional Flow Reserve, Myocardial ; Humans ; Hyperemia ; Phenobarbital ; Stents ; Ultrasonography*

PURPOSE: To reconstruct the midface, local flaps such as nasolabial flaps have been frequently used. These local flaps, however, have the shortcomings of requiring a secondary operation or limitations in the movement of the flap. Thus, new methods have been developed. This paper reports a case wherein the basal cell carcinoma on the cheek was resected and the skin and soft tissue defect was successfully treated using a facial artery perforator flap. METHODS: A 68-year-old female consulted the authors on the basal cell carcinoma that developed on her cheek. The mass was fully resected and revealed a 2.3 x 2.3 cm defective region. Using a Doppler ultrasonography, the facial artery path was traced, and using a loupe magnification, the facial artery perforator flap was elevated and the defective region was covered with the flap. RESULTS: The flap developed early venous congestion, but it disappeared without any treatment. Six months after the surgery, the patient was satisfied with the postoperative result. CONCLUSION: The facial artery perforator flap has a thin pedicle. It offers a big arc of the rotation that allows free movement and one-stage operation. These strengths make the method useful for the reconstruction of the midface among other procedures.
Aged ; Arteries ; Carcinoma, Basal Cell ; Cheek ; Female ; Humans ; Hyperemia ; Perforator Flap ; Skin ; Ultrasonography, Doppler

PURPOSE: To assess the feasibility and effectiveness of transperineal ultrasonography (TPUS) for the evaluation of perianal Crohn disease (PCD) in pediatric patients. METHODS: Between September 2010 and August 2013, 64 TPUS examinations were performed in 43 patients (34 males and 9 females; mean age+/-standard deviation, 13.3+/-2.4 years; age range, 6 to 17 years) to evaluate PCD. The pain severity, location, and activity of perianal fistula, the presence of an abscess, and anal canal hyperemia were retrospectively evaluated. Spearman rank correlation analysis was performed to assess the relationship between the severity of the pain and the fistula activity, the presence of an abscess, and anal canal hyperemia. RESULTS: All examinations were successfully performed. Thirty-nine examinations (60.9%) were performed without any pain experienced by the patient, 19 examinations (29.7%) with mild pain, five examinations (7.8%) with moderate pain, and one examination (1.6%) with severe pain. The pain severity was correlated with the fistula activity (P<0.01). An anterior fistula location was more common than a posterior location. Active fistulas and abscesses were identified during 30 examinations (46.9%) and 12 examinations (18.8%), respectively. Anal canal hyperemia was identified in 31 examinations (48.4%). CONCLUSION: TPUS with a color Doppler study is useful for visualizing a perianal fistula or abscess and for assessing its inflammatory activity in pediatric Crohn patients.
Abscess* ; Anal Canal ; Crohn Disease* ; Female ; Fistula* ; Humans ; Hyperemia ; Male ; Pediatrics ; Perineum ; Retrospective Studies ; Ultrasonography*

BACKGROUND AND OBJECTIVES: Although estrogen replacement therapy has been associated with reduction of cardiovascular events in postmeno-pausal women (PMW), the underlying mechanisms are pooly understood. Because the beneficial effect of estrogen on vasomotor function and production of vasoconstrictive endothelin-1 may be a mechanism by which cardiovascular disease events are reduced, we accessed the acute effect of estrogen on endothelial dependent, independent vasodilaton and plasma endothelin-1 level and investigated whether the acute effect of estrogen on vascular response is related to reduced circulating plasma endothelin-1 level. MATERIALS AND METHOD: The diameter of the brachial artery at rest, during reactive hyperemia (FMV) and to response to nitroglycerine (NMV) were measured using high resolution ultrasound. Twenty-one PMW, 523 years old, 8 of whom had hypercholesterolemia were included and randomized to receive placebo, conjugated estrogen 2.5 mg and 5.0 mg with one week between each investigation. FMV and plasma endothelin-1 were assessed before and 30 minutes after iv administration of each substance. Sublingual nitroglycerine (NG) was given at the end of each investigation and NMV was measured. RESULTS: FMV and plasma endothelin-1 were not changed after placebo administration. FMV increased sinigicantly only after administration of CE 5.0 mg in healhy PMW and both after administration of CE 2.5 and 5.0 mg in PMW with hypercholesterolemia. NG induced more significant vasodilation after administration of estrogen than placebo in only PMW with hypercholesterolemia. Plasma endothelin-1 level decreased significantly after administration of CE 5.0 mg in PMW with hypercholesterolemia. We could not find direct correlation between increase of FMV and decrease of plasma endothelin-1 level. CONCLUSION: IV administration of conjugated estrogen improves endothelium-dependent vasodilation in PMW and may improve endothelium-independent vasodilation in PMW with hypercholesterolemia. These finding may be partly originated by reduced plasma endothelin-1 level after estrogen administration.
Brachial Artery ; Cardiovascular Diseases ; Endothelin-1* ; Endothelium ; Estrogen Replacement Therapy ; Estrogens* ; Female ; Humans ; Hypercholesterolemia ; Hyperemia ; Menopause ; Nitroglycerin ; Plasma* ; Ultrasonography ; Vasodilation

BACKGROUND/AIMS: Consistently defining disease activity remains a critical challenge in the follow-up of patients with Crohn's disease (CD). We investigated the potential applicability of abdominal ultrasonography with color Doppler (USCD) analysis for the detection of morphological alterations and inflammatory activity in CD. METHODS: Forty-three patients with CD ileitis/ileocolitis were evaluated using USCD analysis with measurements obtained on the terminal ileum and right colon. Sonographic parameters included wall thickening, stricture, hyperemia, presence of intra-abdominal mass, and fistulas. Patients were evaluated for the clinical activity (Harvey-Bradshaw Index [HBI]), fecal calprotectin (FC) and C-reactive protein (CRP). The USCD performance was assessed using magnetic resonance enterography (MRE) as a criterion standard. RESULTS: Most measurements obtained with USCD matched the data generated with MRE; however, the agreement improved in clinically active patients where sensitivity, positive predictive value, and accuracy were >80%, considering wall thickening and hyperemia. Complications such as intestinal wall thickening, stricture formation, and hyperemia, were detected in the USCD analysis with moderate agreement with MRE. The best agreement with the USCD analysis was obtained in regard to FC, where the sensitivity, positive predictive value, and accuracy were >70%. The overall performance of USCD was superior to that of HBI, FC and CRP levels, particularly when considering thickening, stricture, and hyperemia parameters. CONCLUSIONS: USCD represents a practical noninvasive and low-cost tool for evaluating patients with ileal or ileocolonic disease, particularly in clinically active CD. Therefore, USCD might become a useful asset in the follow-up of patients with CD.
C-Reactive Protein ; Colon ; Constriction, Pathologic ; Crohn Disease ; Fistula ; Follow-Up Studies ; Humans ; Hyperemia ; Ileitis ; Ileum ; Leukocyte L1 Antigen Complex ; Magnetic Resonance Imaging ; Ultrasonography ; Ultrasonography, Doppler, Color

BACKGROUND AND OBJECTIVES: Flow-mediated brachial artery vasoactivity has been recently proposed as a noninvasive means for assessing endotheial function. This endothelial function is impaired in certain cardiovascular conditions, including essential hypertension. METHODS: The study population included 50 healthy subjects aged 22 to 62 years (mean+/-SD, 42+/-12 years), all normotensive, nondiabetic with cholesterol level <220 mg/dL and no family history of premature vascular disease. Normal subjects were classified according to age into those younger than and those older than 40 years. Using high-resolution ultrasound, brachial artery diameter and flow were measured at rest, during reactive hyperemia (with flow increase causing flow-mediated dilation [FMD], which depends on normal endothelial function), and after sublingual nitroglycerin, an endothelium-independent vasodilation. To better characterize this technique, this study was an attempt to assess the flow-mediated vasodilation in two separate protocols (as follows); (1) the stimulus response to various duration of occlusion (using 1 and 5 min), and (2) the stimulus response to various pressure of occlusion (using low and high pressure). In 28 patients (mean+/-SD, 52+/-7 years) with essential hypertension, this study was additionally evaluated endothelial function. The measurements have been compared with those of 14 healthy control subjects. In all subjects, the intima-media thickness (IMT) of the common carotid artery was also measured. This study sought to 1) determine whether endothelial dysfunction was presented in patients with essential hypertension, and 2) examine IMT in these patients. RESULTS: 1) Both in the younger and the older groups, the basal diameter and flow of the brachial artery were significantly increased in men than women. The values were 4.4+/-0.1 mm and 186+/-16 ml/min in men and 3.6+/-0.09 mm and 125+/-13 ml/min in women (p<0.001; p<0.01). In subjects younger than 40 years, flow-mediated dilation (FMD) and the difference in flow response were similar between men and women. But, in subjects older than 40 years, FMD was decreased in men than women (6.6+/-1.6 vs. 14.7+/-1.6%. p<0.01) and the difference in flow response was also decreased in men than women (217+/-24.3 vs. 314+/-40.5%, p<0.05). In younger and older groups, there were no significant change in the nitroglyserin response in either gender. 2) Fifteen normal subjects underwent sequential evaluation following 1 and 5 min of upper arm blood pressure cuff occlusion. There were substantial increase in brachial artery diameter and flow immediately after release of 1 and 5 min of occlusion. The FMD and the difference in flow response following release of occlusion between 5 min duration (11.5+/-1.9%, 253+/-36%) and 1 min duration (6.6+/-1.2%, 53+/-11%) were statistically significant (p<0.05; p<0.001). But, the percent change of diameter following release of occlusion between 5 and 1 min was not statistically significant (p<0.05). 3) Fourteen normal subjects was evaluated the effects of various pressure on endothelial cell function. Inflation pressure was maintained at 30 mm Hg higher than systolic pressure for 5 min and 200 mm Hg (70-90 mm Hg higher than systolic pressure) for 5 min in a random fashion, and then the cuff was suddenly deflated. The diameter and flow response following release of occlusion between high and low pressure were not statistical significance (p>0.05). 4) Flow-mediated dilatation was significantly lower in patients with essential hypertension than in normotensive control subjects (4.2+/-0.8 vs. 7.3+/-1.3 %, p<0.05). Intima-media thickness was significantly higher in patients with hypertension than in normotensive control subjects (0.82+/-0.04 vs. 0.64+/-0.04 mm, p<0.05). Nitroglycerin-mediated vasodilation (9.5+/-1.4 %) in patients with essential hypertension did not differ significantly from those in normotensive control subjects (10.0+/-2.6%, p>0.05). CONCLUSIONS: The study demonstrated that 1) in men older than 40 years, flow-mediated, endothelium-dependent vasodilation of the brachial artery was declined, 2) longer brachial artery occlusion resulted in more vasodilation despite similar hyperemic responses, 3) using low (30 mm Hg higher than systolic pressure) and high (70-90 mm Hg higher than systolic pressure) pressure, each pressure of occlusion was similar hyperemic response, and 4) in patients with essential hypertension, flow-medeiated vasodilation was significantly impaired and IMT was increased than in normotensive control subjects.
Adult* ; Arm ; Blood Pressure ; Brachial Artery ; Carotid Arteries ; Carotid Artery, Common ; Cholesterol ; Dilatation ; Endothelial Cells ; Female ; Humans ; Hyperemia ; Hypertension* ; Inflation, Economic ; Male ; Nitroglycerin ; Ultrasonography ; Vascular Diseases ; Vasodilation

Although there have been several reported cases of enterocolitis caused by Yersinia enterocolitica, its colonoscopic findings have not been reported in Korea. We recently experienced two cases of Y. enterocolitica enterocolitis, where the colonoscopic examinations were performed. Two patients visited our hospital due to right lower quadrant pain. The thickened terminal ileum and right side colon with enlarged mesenteric nodes were observed on ultrasonography using graded compression method. Y. enterocolitica was isolated from stool in both cases, The colonascopy revealed nodular elevations, erosion., hyperemia, and edema on the terminal ileum and small hyperemic erosions or aphthoid ulcers on the colon, especially on the right side of the colon. In one of the cases, the aphthoid ulcers could be also seen on the sigmoid colon. Their clinical symptoms and signs improved 3-5 days after their visit without using antibiotics. We report these cases with a review of the relevant literature.
Anti-Bacterial Agents ; Colon ; Colon, Sigmoid ; Colonoscopy ; Edema ; Enterocolitis* ; Esophagus* ; Humans ; Hyperemia ; Ileum ; Intestines* ; Korea ; Lymphadenitis* ; Stomach* ; Ulcer ; Ultrasonography ; Yemen* ; Yersinia enterocolitica* ; Yersinia*