The recent cases of anthrax due to bioterrorism in the United States have reminded us that our society is also vulnerable to biological attacks. Illnesses due to bioterrorism are not naturally occurring diseases, and therefore may show presentations not familiar to many doctors. The last case of smallpox was reported in 1960, and doctors aged less than 60 years have no experience of smallpox. Anthrax is a rare zoonosis, and no case of inhalation anthrax has been reported in Korea. American doctors might be on high alert to bioterrorism after September 11, 2001. However, it took more than 2 weeks from the symptom onset of the index case to the recognition that anthrax outbreak had occurred due to bioterrorism. This delay shows how difficult it is to recognize bioterrorism. This article describes clinical recognition and management of patients exposed to biological warfare agents, especially agents causing anthrax, smallpox, plague, and botulism.
Anthrax ; Biological Warfare Agents* ; Biological Warfare* ; Bioterrorism ; Botulism* ; Humans ; Inhalation ; Korea ; Plague* ; Smallpox ; United States

Since the introduction of percutaneous balloon angioplasty by Gruentzig in 1979, percutaneous coronary intervention (PCI) has become the main treatment modality for the management of coronary heart disease. More than 1,000,000 PCI procedures are performed annually worldwide. With the advent of new therapeutic technologies, the indications for PCI have markedly expanded. Nowadays, improvements in balloon technology, popular use of coronary stent, and the proper administration of antiplatelet agents including GPIIbIIIa inhibitors have influenced the acute procedural outcomes. This technological and procedural advance in PCI has resulted in angiographic success rates of 96 to 99%, with Q-wave MI rates of 1 to 3%, emergency coronary bypass surgery rates of 0.2 to 3%, and unadjusted in-hospital mortality rates of 0.5~1.4%. However, despite the marked improvements in the acute outcome of PCI, long-term results including the restenosis rate are less impressive. The restenosis rate following balloon angioplasty reaches 30~40%, and is higher in certain clinical and angiographic subsets. The recent introduction of intracoronary stent and brachytherapy (intracoronary lesional ionizing radiation therapy) has a favorable impact on the restenosis precess including elastic recoil and intimal hyperplasia. Intracoronary stents decreased elastic recoil and remodeling and intracoronary radiation reduced intimal hyperplasia. Several randomized clinical trials to assess the efficacy of stents and intracoronary brachytherapy are ongoing with impressive results. In 2001, a breakthrough has been made in the prevention and the treatment of restenosis with the advent of a drug-eluting stent. Balloon-expandable stents coated with rapamycin or paclitaxol showed nearly 0% restenosis rate at 6-month follow-up. We might expect to solve restenosis completely in a very near future.
Angioplasty, Balloon ; Brachytherapy ; Coronary Disease ; Drug-Eluting Stents ; Emergencies ; Follow-Up Studies ; Hospital Mortality ; Hyperplasia ; Percutaneous Coronary Intervention* ; Platelet Aggregation Inhibitors ; Radiation, Ionizing ; Sirolimus ; Stents

Several procedures in the interventional radiology for the urogenital system are reviewed herein. Interventional radiology has advanced rapidly in recent years as new technologies have become available. Arterial embolization of uterine fibroids is an example. Pelvic varices are frequently encountered in the general population and can be directly associated with a significant morbidity. The affected venous axes can be easily catheterized in a selective, retrograde manner and then can be occluded through this minimally invasive route, avoiding major surgical complications while giving comparable results. Interventional uroradiologic techniques have had a major impact on the care of the urologic patients by allowing non-operative treatment in many diseases. This article also reviews percutaneous nephrostomy with an emphasis on urologic calculi, interventional therapy for neoplasms and trauma to the urinary tract, treatment of renovascular hypertension, and the management of renal cysts.
Calculi ; Catheters ; Humans ; Hypertension, Renovascular ; Leiomyoma ; Nephrostomy, Percutaneous ; Radiology, Interventional* ; Urinary Tract ; Urogenital System* ; Varicose Veins

Percutaneous gastrostomy, ballon dilatation, and metallic stent placement are the most common interventional procedures in radiology for the GI tract. Percutaneous gastrostomy provides nutritional support for patients with a debilitating disease or major swallowing difficulty. The most common candidates are patients with cerebral vascular accidents. Percutaneous gastrostomy is associated with a lower morbidity than surgically or endoscopically placed gastrostomy catheters and is also less expensive. Benign strictures of the GI tract are generally treated by balloon dilatation. Very tight strictures usually require stepwise dilation, beginning with a small balloon and gradually increasing the balloon diameter. Balloon dilatation is technically successful in more than 90% of patients, and functional success is achieved in 86∼90%. Metallic stents are used to manage strictures or obstructions in the esophagus and GI tract. For the esophagus, stent placement has been used effectively in the treatment of malignant dysphagia and is now a well-established procedure. The technical success rate approaches 100% and improvements in the dysphagia score ranges from 83% to 100%. From the successful use in the esophagus, stents have been employed in the stomach, duodenum, and colon. Metallic stents are currently an estalished component of the nonsurgical management of gastroduodenal and colorectal obstructions. Metallic stents within the stomach, duodenum, or colon are used for nonsurgical palliation of the symptoms of gastric or colonic obstruction rather than as a curative procedure. This palliation is intended to improve the quality of life in patients with an unresectable disease or used as an interin procedure prior to a definitive surgical management.
Catheters ; Colon ; Constriction, Pathologic ; Deglutition ; Deglutition Disorders ; Dilatation ; Duodenum ; Esophagus ; Gastrointestinal Tract* ; Gastrostomy ; Humans ; Nutritional Support ; Quality of Life ; Stents ; Stomach

Hepatobiliary interventional procedures are most important and commonly practiced procedures in Korea. These procedures comprise about 60~80% of procedures in interventional radiology. We can do percutaneous transhepatic biliary drainage(PTBD), percutaneous cholecystostomy in patients with bile duct and cystic duct obstruction. These procedures prevent high-risk operation and are performed on an emergency basis in some patients with bile infection. A residual biliary stone after operation can be removed with basket and shock wave without reoperation and multiple intrahepatic stones also can be removed through the PTBD tract without operation. Transarterial chemoembolization is a very effective method and has the widest range of indications in treatment of hepatocellular carcinoma(HCC). Also we can treat HCC percutaneously with local injection of absolute ethanol and radiofrequency ablation. Transjugular intrahepatic portosystemic shunt(TIPS) has replaced surgical shunt operation in variceal bleeding in liver cirrhosis. Resection of a large volume of liver is a very safe method after portal vein embolization of a lobe to be resected due to hypertrophy of the remaining lobes of the liver. Metallic stenting of kinking vessels always shows excellent results and we can employ this technique for hepatic vein and portal vein kinking after living-donor liver transplantation.
Bile ; Bile Ducts ; Catheter Ablation ; Cholecystostomy ; Cystic Duct ; Emergencies ; Esophageal and Gastric Varices ; Ethanol ; Hepatic Veins ; Humans ; Hypertrophy ; Korea ; Liver ; Liver Cirrhosis ; Liver Transplantation ; Methods ; Portal Vein ; Radiology, Interventional ; Reoperation ; Shock ; Stents

Recently interventional radiologic procedures for vascular occlusive diseases have become an alternative to the surgical method. Percutaneous transluminal angioplasty(PTA) is an effective treatment for a short, concentric, segmental, stenotic lesion. The patency rate of PTA depends on the nature of the lesion. The long-term patency rate is high in iliac artery lesions. Percutaneous stent placement is an effective long-term treatment for patients with iliac insufficiency. New stents, such as a drug-coated, radioactive stent, are under investigation to overcome the re-stenosis after PTA or stent insertion. Percutaneously placed endoluminal stent-grafts for treatment of abdominal aortic aneurysm were developed to avoid major intraabdominal surgery and related morbidity and mortality.
Aortic Aneurysm, Abdominal ; Humans ; Iliac Artery ; Methods ; Mortality ; Radiology, Interventional* ; Stents ; Vascular Diseases*

After the percutaneous transarterial technique was introduced by Seldinger in 1953, the percutaneous transcatheter embolization technique was developed. Autologous clot, first used by Doppman in 1968 to occlude a spinal arteriovenous malformation, was quickly adopted for management of gastrointestinal hemorrhage, genitourinary hemorrhage, traumatic hemorrhage, and hemoptysis. The notable improvement of the angiographic techniques rendered the interventional treatment the mainstay in the management of bleeding. Interventional treatment can be a life-saving procedure for massive bleeding or an important adjunct in reducing blood loss during operation and occasionally radical treatment of bleeding diseases. The goal of embolotherapy is to reduce the pulse pressure in the bleeding artery while maintaining an enough collateral flow to preserve the tissue viability. A variety of embolic materials have been proved safe and effective. Gelfoam pledget, polyvinyl alcohol, and coil are most commonly used. Gelfoam powder, extremely small polyvinyl alcohol, and absolute alcohol should be used carefully because of the risk of mucosal ischemia and necrosis.
Arteries ; Arteriovenous Malformations ; Blood Pressure ; Embolization, Therapeutic ; Ethanol ; Gastrointestinal Hemorrhage ; Gelatin Sponge, Absorbable ; Hemoptysis ; Hemorrhage* ; Ischemia ; Necrosis ; Polyvinyl Alcohol ; Tissue Survival

Interventional neuroradiology is the catheter-based therapy for vascular lesions of the brain and spine. During the past decade, the field has expanded rapidly, and ongoing technical developments are improving the application, safety, and efficacy of this therapy. A growing number of intracranial disorders are amenable to endovascular interventions, which include aneurysms, vasospasm from aneurismal subarachnoid hemorrhage, arteriovenous malformations, dural arteriovenous fistulas, intracranial tumors, thromboembolic occlusion of intracranial arteries and atherosclerosis. Interventional procedure alone is able to treat patients with diseases that cannot be treated with neurosurgery and radiation ; however, in many cases a combination of these methods provides the best outcome for the patients. Treatment strategies must be developed in collaboration with other neurological sciences and experienced multidisciplinary teams must be responsible for handling of patients with CNS lesions. Both education in practical skill and ethics must be part of structured training programs in especially assigned neurointerventional centers.
Aneurysm ; Arteries ; Arteriovenous Malformations ; Atherosclerosis ; Brain ; Catheters ; Central Nervous System Vascular Malformations ; Cooperative Behavior ; Education ; Ethics ; Humans ; Neurosurgery ; Radiology, Interventional* ; Spine ; Subarachnoid Hemorrhage

Among various vascular interventional procedures, there are some procedures of vascular recanalization often encountered by primary physicians in clinical practice. These are percutaneous transluminal angioplasty (PTA) and stent application in the lower extremity ishemia, catheter-directed thrombolysis with PTA, stenting for iliofemoral deep vein thrombosis, and interventional management of arteriovenous fistula and graft for hemodialysis access. PTA and stent are safe and effective treatment for iliac arterial stenosis and occlusion with a good long-term patency rate. Long-term effectiveness of femoropopliteal stent is yet to be determined. Catheter-directed thrombolysis is a new emerging vascular intervention for acute iliofemoral deep vein thrombosis. May-Thurner syndrome can be effectively treated with thrombolysis in the iliofemoral vein followed by PTA ad stenting for the left iliac vein stenosis or occlusion. For the failing arteriovenous fistula or grafts in patients with hemodialysis, interventional radiologists can play an important role for the maintenance of the patency by percutaneous thrombolysis and balloon dilatation. It will be very helpful for the primary physicians to understand the role of the interventional radiologists and the indications, techniques, and results of those vascular interventional procedures often encountered in daily practice.
Angioplasty ; Arteriovenous Fistula ; Constriction, Pathologic ; Dilatation ; Humans ; Iliac Vein ; Lower Extremity ; May-Thurner Syndrome ; Renal Dialysis ; Stents ; Transplants ; Veins ; Venous Thrombosis

No abstract available.