Coronary artery bypass graft surgery (CABG) is the standard of care in the treatment of advanced coronary artery disease. Invasive coronary angiography has been used to assess the status of graft. Recently, multidetector computed tomography (MDCT) has emerged as an important diagnostic tool for the evaluation of graft patency. Many studies have shown that MDCT has a high sensitivity and specificity in detecting graft occlusion or high-grade stenosis. However, there are several diagnostic pitfalls in evaluating CABG graft patency due to several factors, including technical factors, patient factors, and flow competition. Acknowledgment of these pitfalls and remedies to avoid wrong interpretation is essential to improve diagnostic accuracy. In addition, MDCT yields additional information such as plural effusion, pericardial effusion, sternal infection, pneumonia, pulmonary embolism, and so on. The continuing advance in the MDCT technology suggests that MDCT will be a rapid, convenient, and noninvasive tool in evaluating CABG patients in the near future.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Humans ; Multidetector Computed Tomography* ; Pericardial Effusion ; Pneumonia ; Pulmonary Embolism ; Sensitivity and Specificity ; Standard of Care ; Transplants

Recent advances in new technologies such as artificial intelligence, big data, and virtual reality have led to significant innovations in various industries. Artificial intelligence, particularly in applications using deep learning algorithms, has shown performance superior to that of humans in several contexts. Accordingly, many researchers and companies have tried to apply artificial intelligence to the healthcare system, with applications including image interpretation, voice recognition, clinical decision support, risk prediction, drug discovery, medical robotics, and workflow improvement. However, several important technical, ethical, and social barriers must be overcome, such as overfitting, lack of interpretability, privacy, security, and safety. Doctors should be prepared to play a key role in applying artificial intelligence through the full course of development, validation, clinical performance, and monitoring.

Recent advances in new technologies such as artificial intelligence, big data, and virtual reality have led to significant innovations in various industries. Artificial intelligence, particularly in applications using deep learning algorithms, has shown performance superior to that of humans in several contexts. Accordingly, many researchers and companies have tried to apply artificial intelligence to the healthcare system, with applications including image interpretation, voice recognition, clinical decision support, risk prediction, drug discovery, medical robotics, and workflow improvement. However, several important technical, ethical, and social barriers must be overcome, such as overfitting, lack of interpretability, privacy, security, and safety. Doctors should be prepared to play a key role in applying artificial intelligence through the full course of development, validation, clinical performance, and monitoring.
Artificial Intelligence ; Decision Support Systems, Clinical ; Delivery of Health Care ; Drug Discovery ; Humans ; Learning ; Machine Learning ; Privacy ; Robotics ; Voice

Fulminant hepatic failure (FHF) is a rare but fatal disease with a 40%-80% mortality, often requiring liver transplantation, which is hard to perform in children. A therapeutic intervention alternative to liver transplantation is an extracorporeal artificial liver support system. Molecular Adsorbent Recirculation Systems® (MARS) has emerged as a bridge therapy for adult FHF, whereas in pediatric FHF, there have been a small number of cases of implementing MARS. Recently, we witnessed the recovery of 2 teenagers with FHFs caused by acetaminophen and a diet aid. Both patients were treated uneventfully, with early use of MARS. These cases suggest that early use of MARS may be a promising therapeutic intervention in pediatric drug-induced FHF.

Pilomatricoma, known as calcifying epithelioma of Malherbe, is a deep dermal or subcutaneous tumor showing slow growth. There are some reports showing rapid enlargement of the tumors as a result of variable amounts of bleeding into the intratumoral cystic space and into the superficial dermis. We report an uncommon case of a rapidly enlarged pilomatricoma due to simultaneous in tratumoral and intradermal hemorrhage.
Dermis ; Hemorrhage* ; Pilomatrixoma*

PURPOSE: To describe MR findings of recurred giant cell tumor of bone. MATERIALS AND METHODS: MR imagings of ten cases of pathologically proven recurrence of giant cell tumor were retrospectively analyzed. Location of recurrence, multiplicity of recurred tumor, signal intensity and homogeneity, pattern of gadolinium enhancement, soft tissue and articular surface involvement were evaluated. RESULTS: Tumors were located in peripheral portion of previous operation site(80%). Six cases recurred as multiple lesions. Tumor showed low signal intensity on T1 weighted images(100%), high signal intensity on T2 weighted images(100%) and inhomogeneous peripheral rim enhancing pattern(75%). Soft tissue and articular surface involvement were also demonstrated. CONCLUSION: We concluded that characteristic MR findings of recurred giant cell tumor could be helpful in early detection and precise evaluation of tumor recurrence.
Gadolinium ; Giant Cell Tumor of Bone ; Giant Cell Tumors* ; Giant Cells* ; Recurrence ; Retrospective Studies

We report the CT findings of diffuse esophageal spasm (DES) in a patient with dysphagia. Although an uncommon condition, DES should be included in the differential diagnosis if relatively long and symmetric segmental esophageal wall thickening and an epiphrenic esophageal diverticulum are noted at CT.
Deglutition Disorders ; Diagnosis, Differential ; Diverticulum, Esophageal ; Esophageal Spasm, Diffuse* ; Humans

The most common cause of obstructive sleep apnea syndrome (OSAS) in childhood is adenotonsillar hypertrophy. Adenotonsillectomy improves the symptoms quite well in most cases. However, some patients could experience the OSAS again after adenotonsillectomy, who might have several risk factors such as incomplete operation, misdiagnosis, combined anatomical malformation, sinusitis or chronic allergic rhinitis, obesity, initial severe OSAS, and early onset OSAS. We report a case of 11-year-old obese boy who presented with snoring for several years. He was obese with body mass index (BMI) of 26.3 kg/m2 and also found to have fatty liver by ultrasonogram. Initial polysomnography (PSG) showed that he met the criteria of severe OSAS with the apnea-hypopnea index (AHI) of 70.5. He underwent adenotonsillectomy and symptoms improved immediately. Four months later symptoms were relieved with AHI of 0, but 1 year after the adenotonsillectomy he started to complain snoring again and the subsequent PSG results showed that OSAS has relapsed with AHI of 43. Paranasal sinus X-ray and physical examination showed sinusitis and re-growth of adenoid. Obesity was proved not to be a contributing factor because his BMI decreased to normal range (23.1 kg/m2) after diet control and regular exercise. Also, liver transaminase was normalized and fatty liver was disappeared on follow-up abdominal ultrasonogram. After treatment of sinusitis, symptoms were relieved with decreased AHI (8.5). This case suggests that simple adenotonsillectomy might not be the end of OSAS treatment in childhood. Patients who had adenotonsillectomy should be followed by subsequent PSG if symptoms recur. It is also important to be aware of risk factors in the recurrent OSAS for the proper intervention according to the cause.
Adenoids ; Body Mass Index ; Child ; Diagnostic Errors ; Diet ; Fatty Liver ; Follow-Up Studies ; Humans ; Hypertrophy ; Liver ; Obesity ; Physical Examination ; Polysomnography ; Reference Values ; Rhinitis ; Rhinitis, Allergic, Perennial ; Risk Factors ; Sinusitis ; Sleep Apnea, Obstructive ; Snoring

BACKGROUND: Vitiligo has been associated with various disorders including pernicious anemia, diabetes, hyperthyroidism, hypothyroidism, alopecia areata, Addison's disease, and so on. Autoantibodies against specific organs are also frequently found. However, the positive rates of these autoantibodies' detection by various reporters showed too much diversity to extrapolate a definitive conclusion. OBJECTIVE: The purpose of this study was to investigate the autoimmune aspects of vitiligo by evaluating the detection rates of various organ-specific autoantibodies. METHODS: We classified vitiligo patients into 2 groups(autoantibody positive group and autoantibody negative group) and 3 types(localized, generalized, and universalis). The overall detection rates of various autoimmune and endocrine diseases were also assessed in patients and the control, which was composed of 40 young healthy volunteers. RESULTS: There were 106 males(33.0%) and 215 females(67.0%) in total 321 vitiligo patients. 115 patients(35.8%) were determined to be autoanitibody positive, and 206 patients(64.2%) were negative. The most frequent type of vitiligo was generalized type in both autoantibody positive and negative group. Mean age of onset was 30.8 years. And there was a statistically significant difference between autoantibody positive(37.6 years) and negative(29.3 years) group(p < 0.05). Average disease duration was 6.5 years in autoantibody positive group and 4.3 years in autoantibody negative group. The positive rates of anti-nuclear, anti-microsomal. anti-smooth muscle antibody, and rheumatoid factor showed no significant differences between vitiligo patients and normal control group(p > 0.05). But the positive rate of antithyroid antibody was significantly higher in vitiligo patients than in normal control(kappa2 = 4.234, p = 0.040). The prevalence rates of autoimmune & endocrine disorders showed no significant differences between vitiligo patients and normal control(p>0.05). The prevalence rates of autoimmune and endocrine disorders were higher in autoantibody positive vitiligo group(33.0%) than in negative group(29.6%), although it was not statistically significant(p>0.05). However, the prevalence rate of thyroid disease itself was significantly higher in autoantibody positive group than in negative group(p = 0.004). Treatment response to PUVA therapy was better in autoantibody positive group than in negative group(p = 0.0003). CONCLUSION: With these results, we were able to conclude that anti-thyroglobulin antibody is more frequently found in vitiligo patients than in normal control. And autoantibody positive vitiligo patients showed higher prevalence rate of thyroid disease and better treatment response to PUVA therapy than in autoantibody negative vitiligo patients. Therefore, the presence of autoantibody in vitiligo patients seems to be related with a better treatment response for PUVA therapy.
Addison Disease ; Age of Onset ; Alopecia Areata ; Anemia, Pernicious ; Autoantibodies* ; Endocrine System Diseases ; Healthy Volunteers ; Humans ; Hyperthyroidism ; Hypothyroidism ; Prevalence ; PUVA Therapy ; Rheumatoid Factor ; Thyroid Diseases ; Vitiligo*

PURPOSE: To evaluate the usefulness and limitations of power Doppler sonography in determining the tumor vascularity. MATERIALS AND METHODS: Power Doppler sonography was performed on VX2 carcinomas present in rabbit thighs, and the findings were compared with those of microangiography in an almost identical plane. Tumor vascularity was qualitatively analysed on the basis of tumor vessel distribution and density, and the presence of thick and thin vesels ; for a comparison of tumor vascularity as seen on microangiography, tumor blood flow signals shown by power Doppler sonography were graded 3, 2, 1, 0. For quantitative analysis, a comparison was made of the percentage of tumor area occupied by vessels, as shown in each study. Data analysis utilized the Wilcoxon signed-rank test and Spearman correlation test. RESULTS: Mean tumor vascularity scores, as seen on power Doppler sonography and relating to tumor vessel distribution and density, and the presence of thick and thin vessels, were 2.87, 2.73, 2.93 and 2.73, respectively. The means and medians of the percentages of tumor area occupied by vessels were 22.7% & 23.5% and 36.4% & 34.7% on microangiography and power Doppler sonography, respectively. Thus, there was good correlation between these two modes. CONCLUSION: Power doppler sonography could demonstrate the tumor vascularity on microangiography relatively well but tend to overestimate it.
Neoplasms, Experimental ; Statistics as Topic ; Thigh