PURPOSE: To investigate the levels of radiation exposure of an operator which may be influenced by the wearing an apron, type of procedure, duration of fluoroscopy and operator's skill during various interventional procedures MATERIALS AND METHODS: Radiation doses were measured both inside and outside the apron(0.5mm lead equivalent) of the operator by a film badge monitoring method and the duration of fluoroscopy was measured in 96 procedures prospectively. The procedures were 30 transcatheter arterial embolizations (TAE), 25 percutaneous transhepatic biliary drainages (PTBD), 16 stone removals (SR), 15 percutaneous needle aspirations (PCNA) and 10 percutaneous nephrostomies(PCN). To assess the difference of exposure by the operator's skill, the procedures of TAE and PTBD were done separately by groups of staffs and residents. RESULTS: Average protective effect of the apron was 72.8%. Average radiation exposure(unit:micro Sv/procedure) was 23.3 in PTBD by residents, 10.0 in PTBD by staffs, 10.0 in SR, 8.7 in TAE by residents, 7.3 in TAE by staffs, 9.0 in PCN and 6.0 in PCNA. Average radiation exposure of residents were 1.9 times greater than those of staffs. CONCLUSION: Radiation exposure was not proportionally related to the duration of fiuoroscopy, but influenced by wearing an apron, various types o[procedure and operator's skills.
Aspirations (Psychology) ; Film Dosimetry ; Fluoroscopy ; Needles ; Pregnenolone Carbonitrile ; Proliferating Cell Nuclear Antigen ; Prospective Studies

This study aimed to investigate the existence of GABA receptor and the mechanisms of action of GABA and diazepam of the trachealis muscle isolated from dog. Horizontal muscle strips of 2mm×15mm were prepared from canine trachea, and isometric myography in isolated muscle chamber bubbled with 95/5%-O₂/CO₂ at 36℃, at the pH of 7.4 was performed. Muscle strips contracted responding to the electrical field stimulation (ESP) by 2~20 Hz, 20 msec, monophasic square wave of 60 VDC. GABA and diazepam suppressed the EFS-induced contractions to the similar extent, significantly. (p<0.05). Bicuculline, a GABA(A) receptor antagonist blocked both GABA- and diazepam-inhibitions; but DAVA, a GABA(B) receptor antagoinst did not affect either of them. These results suggest than in the canine trachealis muscle, there may be only GABA(A) receptor, and GABA and diazepam inhibit the contractility via GABA(A) receptor.
Animals ; Bicuculline ; Diazepam ; Dogs ; gamma-Aminobutyric Acid* ; Hydrogen-Ion Concentration ; Myography ; Receptors, GABA ; Receptors, GABA-A ; Trachea

The villous adenoma of the duodenum is a rare disease and a considerable portion of the cases are known to be associated with malignancy. Although the diagnosis can be made with duodenoscopy, some cases showed false negative rate for malignancy detection with endoscopic biopsy only. So Whipple's operation is preferred than local excision. We experienced a case of tubulovillous adenoma involving ampulla of Vater, which recurred after local excision. So we report a case of tubulovillous adenoma involving ampulla of Vater with relevant literature.
Adenoma* ; Adenoma, Villous ; Ampulla of Vater* ; Biopsy ; Diagnosis ; Duodenoscopy ; Duodenum ; Rare Diseases

No abstract available.
Hemarthrosis* ; Knee*

No abstract available.
Neurosurgery*

No abstract available.
Neurosurgery*

No abstract available.
Atrial Fibrillation* ; Heart* ; Thoracic Surgery*

Objective: To investigate the diagnostic performance of contrast-enhanced ultrasound (CEUS) and its role as a second-line imaging modality after gadoxetate-enhanced MRI (Gd-EOB-MRI) in the diagnosis of hepatocellular carcinoma (HCC) among at risk observations. Materials and Methods: We prospectively enrolled participants at risk of HCC with treatment-naïve solid hepatic observations (≥ 1 cm) of Liver Imaging Reporting and Data System (LR)-3/4/5/M during surveillance and performed Gd-EOB-MRI. A total of one hundred and three participants with 103 hepatic observations (mean size, 28.2 ± 24.5 mm; HCCs [n = 79], non-HCC malignancies [n = 15], benign [n = 9]; diagnosed by pathology [n = 57], or noninvasive method [n = 46]) were included in this study. The participants underwent CEUS with sulfur hexafluoride. Arterial phase hyperenhancement (APHE) and washout on Gd-EOB-MRI and CEUS were evaluated. The distinctive washout in CEUS was defined as mild washout 60 seconds after contrast injection. The diagnostic ability of Gd-EOB-MRI and of CEUS as a second-line modality for HCC were determined according to the European Association for the Study of the Liver (EASL) and the Korean Liver Cancer Association and National Cancer Center (KLCA-NCC) guidelines. The diagnostic abilities of both imaging modalities were compared using the McNemar’s test. Results: The sensitivity of CEUS (60.8%) was lower than that of Gd-EOB-MRI (72.2%, p = 0.06 by EASL; 86.1%, p < 0.01 by KLCA-NCC); however, the specificity was 100%. By performing CEUS on the inconclusive observations in Gd-EOB-MRI, HCCs without APHE (n = 10) or washout (n = 12) on Gd-EOB-MRI further presented APHE (80.0%, 8/10) or distinctive washout (66.7%, 8/12) on CEUS, and more HCCs were diagnosed than with Gd-EOB-MRI alone (sensitivity: 72.2% vs. 83.5% by EASL, p < 0.01; 86.1% vs. 91.1% by KCLA-NCC, p = 0.04). There were no false-positive cases for HCC on CEUS. Conclusion The addition of CEUS to Gd-EOB-MRI as a second-line diagnostic modality increases the frequency of HCC diagnosis without changing the specificities.

Purpose: The aim of this study was to investigate the optimal washout criteria of perfluorobutane-enhanced ultrasonography (PFB-US) for the diagnosis of hepatocellular carcinoma (HCC) in high-risk individuals. Methods: Participants at risk of HCC with treatment-naïve solid hepatic observations (≥1 cm) who underwent PFB-US from March 2019 to September 2020 were prospectively recruited. Arterial phase hyperenhancement (APHE), washout time, and washout degree were evaluated. The diagnosis of HCC was made by non-rim APHE with late and mild washout. The per-lesion diagnostic performance for diagnosing HCC using different cutoffs for late washout (50, 55, 60, 65, and 70 seconds postcontrast) and the different time windows for determining washout (until 2, 3, 4, 5, 6, 7, 8, 9, and 10 minutes postcontrast) were compared using the McNemar test. Results: In total, 101 participants with 113 observations (mean size, 33.5±2.8 mm; HCCs [n=82], non-HCC malignancies [n=16], benign [n=15]) were evaluated. Non-rim APHE was observed in 86.6% (71/82) of HCCs. As the cutoff time for late washout increased, the specificity increased to 100% (95% confidence interval [CI], 88.8% to 100%) at the 60-second cutoff with 62.2% sensitivity (95% CI, 50.8% to 72.7%). When the time window for determining washout became wider, the sensitivity and accuracy increased until 6 minutes, with 100% specificity at all times. Conclusion Determining washout within 6 minutes after contrast injection with a 60-second cutoff for late washout showed the highest sensitivity without losing specificity for diagnosing HCC using PFB-US in individuals at high risk.

Seven days after starting carbamazepine therapy because of a central pain, a 67-year old man with the occlusion of left middle cerebral artery developed acute interstitial lung disease with severe dyspnea and decreased consciousness. Initial therapy included mechanical ventilation, discontinuation of carbamazepine, and injection with epinephrine and steroid. Five days after developing the acute interstitial lung disease, his clinical status and the finding of simple chest X-ray were markedly improved. Several days later, there was the removal of the ventilator and resolution of pulmonary symptoms. Acute interstitial lung disease is a rare fatal adverse reaction to carbamazepine therapy. However, awareness of carbamazepine-induced lung disease may reduce delays in both diagnosis and withdrawal of the drug.
Aged ; Carbamazepine ; Consciousness ; Diagnosis ; Dyspnea ; Epinephrine ; Humans ; Lung Diseases ; Lung Diseases, Interstitial* ; Middle Cerebral Artery ; Respiration, Artificial ; Thorax ; Ventilators, Mechanical