PURPOSE: To verify the usefulness of left portal vein angle (LPVA) on CT scan in the diagnosis of liver cirrhosis and to compare its diagnostic value with that of caudate to right lobe ratio (C/RL ratio). MATERIALS AND METHODS: LPVA, an angle formed by a vertical line and a line connecting the center of the vertebral body to the umbilical point of the left portal vein, and C/RL ratio were measured on CT scans of 100 cirrhotic and 100 normal livers. Diagnostic values of LPVA and C/RL ratio were compared statistically. RESULTS: The mean of LPVA was 18.9 degrees(SD; 7.6) for normal livers and 25.8 degreesSD; 8.4) for cirrhotic livers (P<0.001). The mean of C/RL ratio was 0.47(SD; 1.10) for normal livers and 0.58(SD;0.14) for cirrhotic livers (P<0.001). When LPVA was greater than 30 degreesliver cirrhosis was diagnosed with 36% sensitivity and 92% specificity. When C/RL ratio was greater than 0.60, the diagnose of liver cirrhosis was with 41% sensitivity and 90% specificity. There was no significant difference of the diagnostic accuracy between LPVA and C/R L ratio in ROC analysis. CONCLUSION: Both LPVA and C/RL ratio are useful diagnostic indices of liver cirrhosis on CTscan. LPVA is more convenient to measure than C/RL ratio.
Diagnosis* ; Fibrosis ; Liver Cirrhosis* ; Liver* ; Portal Vein* ; ROC Curve ; Sensitivity and Specificity ; Tomography, X-Ray Computed

The purpose of this study is to evaluate the efficacy of the balloon bronchoplasty in the treatment of the tuberculous bronchostenosis. Balloon bronchoplasty was performed in thirteen patients with stenosis of the left main bronchus (two with combined left upper and lower lobar bronchostenosis) using a inflatable balloon catheter under a fluoroscopic guide. We analysed the changes in the changes in the severity of dyspnea and wheezing, serial FEV1/FVC as a parameter of the airflow obstruction, and bronchial diameter and lung volume on chest radiographs. The extent of pulmonary tuberculosis was correlated with the improvement of FEV1/FVC. There was an improvement of dyspnea in 69%(9/13), decrease of wheezing in 69%(9/13), significant increase of FEV1/FVC in 18% (2/11). The increase of the bronchial diameter and lung volume were seen in 84%(11/13) and 53% (7/13), respectively. The significant increase of FEVI/FVC was seen in 28% (2/7) of the patients with lung involvement of tuberculosis less than one third of left upper lobe, whereas there was no increase in those of more than one third. There was no complication except transient leukocytosis, fever and blood-tinged sputum. In conclusion, balloon bronchoplasty is effective in the treatment of medically intractable tuberculous bronchostenosis, and can be considered as an initial method of treatment.
Bronchi ; Catheters ; Constriction, Pathologic ; Dyspnea ; Fever ; Humans ; Leukocytosis ; Lung ; Methods ; Radiography, Thoracic ; Respiratory Sounds ; Sputum ; Tuberculosis ; Tuberculosis, Pulmonary

The purpose of this study is to evaluate the efficacy of the balloon bronchoplasty in the treatment of the tuberculous bronchostenosis. Balloon bronchoplasty was performed in thirteen patients with stenosis of the left main bronchus (two with combined left upper and lower lobar bronchostenosis) using a inflatable balloon catheter under a fluoroscopic guide. We analysed the changes in the changes in the severity of dyspnea and wheezing, serial FEV1/FVC as a parameter of the airflow obstruction, and bronchial diameter and lung volume on chest radiographs. The extent of pulmonary tuberculosis was correlated with the improvement of FEV1/FVC. There was an improvement of dyspnea in 69%(9/13), decrease of wheezing in 69%(9/13), significant increase of FEV1/FVC in 18% (2/11). The increase of the bronchial diameter and lung volume were seen in 84%(11/13) and 53% (7/13), respectively. The significant increase of FEVI/FVC was seen in 28% (2/7) of the patients with lung involvement of tuberculosis less than one third of left upper lobe, whereas there was no increase in those of more than one third. There was no complication except transient leukocytosis, fever and blood-tinged sputum. In conclusion, balloon bronchoplasty is effective in the treatment of medically intractable tuberculous bronchostenosis, and can be considered as an initial method of treatment.
Bronchi ; Catheters ; Constriction, Pathologic ; Dyspnea ; Fever ; Humans ; Leukocytosis ; Lung ; Methods ; Radiography, Thoracic ; Respiratory Sounds ; Sputum ; Tuberculosis ; Tuberculosis, Pulmonary

Efficient management of human tissue samples is a critical issue; the supply of samples is unable to satisfy the current demands for research. Lack of informed consent is also an ethical problem. One of the goals of the 2012 revision of Korea's Bioethics and Safety Act was to implement regulations that govern the management of human tissue samples. To remain competitive, medical institutions must prepare for these future changes. In this report, we review two tissue management models that are currently in use; model 1 is the most common system utilized by hospitals in Korea and model 2 is implemented by some of the larger institutions. We also propose three alternative models that offer advantages over the systems currently in use. Model 3 is a multi-bank model that protects the independence of physicians and pathologists. Model 4 utilizes a comprehensive single bioresource bank; although in this case, the pathologists gain control of the samples, which may make it difficult to implement. Model 5, which employs a bioresource utilization steering committee (BUSC), is viable to implement and still maintains the advantages of Model 4. To comply with the upcoming law, we suggest that physicians and pathologists in an institution should collaborate to choose one of the improved models of tissue management system that best fits for their situation.
*Bioethics ; Biomedical Research/*legislation & jurisprudence ; Humans ; Models, Biological ; Republic of Korea

Objectives: ：The purpose of this study is to compare bleeding tendency of selective serotonin reuptake inhibitor (SSRI) and serotonin norepinephrine reuptake inhibitors (SNRI) using platelet function analyzer (PFA-100) in patients with major depressive disorder. Methods: ：This study is a prospective open-label study conducted by a single institution. A total of 41 subjects diagnosed with major depressive disorder under the DSM-5 diagnostic criteria participated in this study.The subjects were classified into SSRI (escitalopram) groups and SNRI (duloxetine) groups, respectively, according to random assignments. The closure time (CT) was measured using a platelet function analyzer (PFA-100) before each antidepressant was administered and after 6 weeks. Paired-sample t-test was conducted within each group to determine whether a specific antidepressant had an effect on closure time. In order to confirm the rela-tive change in platelet function between the two groups, an independent sample t-test was conducted to compare and analyze the change in closure time between the two groups. Results: ：There was no significant changes in closure time (CEPI-CT, CADP-CT) before and 6 weeks after drug administration in the SSRI and SNRI groups, and there was no difference in the amount of changes in closure time between the two groups. Conclusions ：Our results showed no difference in bleeding tendency between SSRI and SNRI. This study suggests that further large-scale studies on bleeding tendency for various antidepressants are needed in the future.

PURPOSE: To evaluate the differences in sonographic appearance and hemodynamics between hypoechoic andhyperechoic hemangioma. MATERIAL AND METHOD: We retrospectively reviewed the sonographic appearance and MRIfindings of 23 hypoechoic hepatic hemangiomas in 16 consecutive patients. Nine were men and seven were women, witha mean age of 50 years(range, 40-72). We analyzed the sonographic appearance such as size, shape, border,echogenecity, posterior acoustic enhancement and the presence of fatty liver, and MRI findings such as signalintensity, enhancement pattern. For comparison, we also reviewed the sonographic appearance and MRI findings of 23hyperechoic hemangiomas in 16 randomly selected patients. RESULTS: There were no differences in size, shape,incidence of posterior acoustic enhancement, MR signal intensity or enhancement pattern between hypoechoic andhyperechoic hemangiomas(p>0.05, Chi-square). However, fatty infiltration of the liver and echogenic rim of themasses were more commonly seen in hypoechoic hemangiomas(9:1, 5:0, respectively, p<0.05). CONCLUSIONS: There wereno differences in MR enhomcement pattern or incidence of posterior acoustic enhancement between hypoechoichyperechoic hemangioma. The vascularity of a mass therefore seems to contribute little to its echogenecity.
Acoustics ; Fatty Liver ; Female ; Hemangioma ; Hemodynamics ; Humans ; Incidence ; Liver* ; Magnetic Resonance Imaging* ; Male ; Retrospective Studies ; Ultrasonography

PURPOSE: To evaluate the usefulness of the arterial dominant phase images of spiral CT in the detection and localization of pancreatic islet cell tumor. MATERIALS AND METHODS: Six patients with pathologically proven isletcell tumors of the pancreas were studied with two-phase spiral CT. Images of the arterial dominant phase and delayed phase were obtained at 30 and 180 seconds after the initiation of injection of 100 ml of contrast materialat a rate of 3ml/sec. The parameters of scanning were 3-mm thickness, table speed of 4mm/sec, and reconstruction at 2-mm intervals. Images were prospectively analyzed and the operative findings were used as the reference standard for tumor detection and localization. RESULTS: On arterial dominant phase images, lesions were definitely depicted in five patients(83%) and were suspicious in one (17%). In the delayed phase, only two tumors(33%) were demonstrated. CONCLUSION: The arterial dominant phase of spiral CT is useful in the preoperative detection and localization of islet cell tumor of the pancreas.
Adenoma, Islet Cell* ; Humans ; Islets of Langerhans* ; Pancreas* ; Prospective Studies ; Tomography, Spiral Computed*

PURPOSE: To demonstrate CT findings of malignancies occurring in choledochal cysts focusing on the differential points with benign inflammation. MATERIALS AND METHODS: The CT findings of seven patients with malignancies occurring in choledochal cysts(six cholangiocarcinomas and one cholangiohepatoma) and three with benign inflammatory wall thickening were reviewed. Six were studied with two-phase(arterial and portal) CT(threethe malignancies and all benign inflammations) and the remainder with conventional CT in the late portal or equilibrium phase. Spiral dynamic CT scans were performed in all two phase CT, except in the case of onemalignancy. The study was focused on the shape and enhancement pattern of the lesions and the presence of localinvasion or distant metastasis. RESULTS: Three of seven associated malignancies showed concentric wall thickening(mean wall thickness=11.3mm), two eccentric, wall thickening and two polypoid masses. Two of three arterial phase CT scans showed tumor enhancement and one showed low attenuating concentric wall thickening, well delineated from a strongly enhanced pancreas. In portal or delayed phase CT scans, all masses were isodense orslightly hypodense compared with the liver or pancreas. Extensive regional lymphadenopathy or distant metastasis was present in six patients at the time of diagnosis. Three cases of benign inflammatory wall thickening showed athinner wall(mean thickness=5mm), and two showed arterial enhancement of the inner wall with only, a diffuse and even pattern. On preoperative CT diagnosis, two cases of benign inflammatory wall thickening were misdiagnosed as malignancies. CONCLUSION: Concentric wall thickening type was the most difficult to differentiate from benign wall thickening. Irregular wall thickening of more than 10mm and enhancement of the whole thickeness of the wall is a reliable sign of malignancy. Dynamic spiral CT is essential for this evaluation.
Cholangiocarcinoma ; Choledochal Cyst* ; Diagnosis ; Humans ; Inflammation* ; Liver ; Lymphatic Diseases ; Neoplasm Metastasis ; Pancreas ; Tomography, Spiral Computed ; Tomography, X-Ray Computed

PURPOSE: We evaluated the effectiveness of embolization in the management of congenital vascular malformations(CVMs). METHODS AND MATERIALS: A retrospective analysis was performed in 10 patients who underwent embolotherapy for their soft tissue CVMs(eight arteriovenous malformations, one hemangioma, one venous malformation) involving the extremity or back. In nine patients, intraarterial embolization was performed with multiple embolic agents including Gelfoam, Ivalon, IBCA, ethanol mixed with Lipiodol, and micro-coils. In one patient with venous malformation, direct puncture and embolization of the lesion were performed with absolute ethanol mixed with Lipiodol. RESULTS: In four patients, who subsequently underwent surgery, preoperative embolization decreased operative morbidity and facilitated a thorough extirpation. Five of six patients with inoperable CVMs experienced dramatic reduction of symptoms by single or repeated embolization, with a mean follow-up period of four months. CONCLUSION: We believe that preoperative embolization may decrease operative morbidity and facilitate a thorough extirpation in the patients with extensive but resectable CVMs and repeated embolizations are effective for symptom control in the patients with inoperable CVMs.
Arteriovenous Malformations ; Embolization, Therapeutic ; Ethanol ; Ethiodized Oil ; Extremities* ; Follow-Up Studies ; Gelatin Sponge, Absorbable ; Hemangioma ; Humans ; Punctures ; Retrospective Studies ; Vascular Malformations*

BACKGROUND/AIMS: The diagnostic value of PET-CT, in gastric cancer is well known, but the prognostic value of pretreatment PET-CT has not been adequately evaluated. This study aimed to investigate the preoperative prognostic value of PET-CT in gastric cancer patients. METHODS: A total of 107 patients underwent surgical treatment for gastric cancer from April 2007 to December 2010 at Dong-A University Medical Center after confirming the presence of F-18 fluorodeoxyglucose (FDG) uptake on preoperative PET-CT. Among these patients, the following subjects were excluded: follow-up loss (13), palliative resection (5), neoadjuvant chemotherapy (1), and unrelated death (1). The remaining 87 patients were included in this study and data were collected by retrospectively reviewing the medical records. The median follow-up duration, defined as the period from operation to last imaging study date, was 34.2+/-14.8 months. FDG uptake values were represented by maximal standardized uptake value (SUVmax). In order to assess the correlation between SUVmax and recurrence, Kaplan-Meier's survival analysis with log-rank test and cox proportional hazard model were performed. Receiver operating characteristic (ROC) curve was employed to determine the optimal cutoff value of SUVmax. RESULTS: The result of Kaplan-Meier's survival analysis with log-rank test were significantly different between high SUVmax group and low SUVmax group (p=0.035), the cutoff value of which was 5.6. However, in multivariate analysis with cox proportional hazard model, T-staging, N-staging and SUVmax did not show statistical significance (p=0.190, p=0.307, and p=0.436, respectively). CONCLUSIONS: High SUVmax on PET-CT in gastric cancer can be a useful prognostic factor.
Adult ; Aged ; Area Under Curve ; Female ; Fluorodeoxyglucose F18 ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Grading ; Neoplasm Staging ; Positron-Emission Tomography ; Prognosis ; Proportional Hazards Models ; ROC Curve ; Radiopharmaceuticals ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms/*diagnosis/mortality/surgery ; Tomography, X-Ray Computed