PURPOSE: The purpose of this study is to compare CO2 DSA and nonionic contrast media angiography in respect to the quality of the opacification of collaterals and incidence of side-effects in peripheral occlusive arterial disease. MATERIALS AND METHODS: Sixteen patients who were suspected to have peripheral occlusive arterial disease were performed angiography with nonionic contrast media and CO2 at the same location with the same catheter. The causes of the lesions were atherosclerosis(n=7) and Buerger's disease(n:9). CO2 DSA was compared with nonionic contrast media angiography in respect to the quality of image in the diagnosis of the lesions, opacifications of collaterals and side-effects. RESULTS: In atherosclerosis;quality of the images of CO2 DSA was same as that of nonionic contrast media angiography in 6 patients and was poor in 1 patient;opacifications of collaterals of CO2 DSA were same as that of nonionic contrast media angiography in 5 patients and was poor in 2 patients. In Buerger's disease;quality of the images of CO2 DSA was same as that of nonionic contrast media angiography in 2 patients and was poor in 7 patients;opacifications of collaterals of CO2 DSA were same as that of nonionic contrast media angiography in 1 patient and was poor in 8 patients. Leg pain was the only side-effect after CO2 injection occuring in 4 out of 16 patients. CONCLUSION: CO2 could be used as safe contrast media in patient with risk factors for nonionic contrast media and for diagnosis of the atherosclerosis in lower extremity. For the procedures such as vascular intervention reguiring large amount of contrast media CO2 could effectively replace nonionic contrast media.
Angiography* ; Atherosclerosis ; Catheters ; Contrast Media ; Diagnosis ; Humans ; Incidence ; Leg ; Lower Extremity* ; Risk Factors

OBJECTIVE: To evaluate and compare the rate and etiologies of second trimester pregnancy loss in monochorionic (MC) or dichorionic (DC) twins, and natural or assisted reproductive technology (ART) twins. METHODS: Between January 1997 and December 2008, there were 146 cases of second trimester twin pregnancy losses (between 12 and 24 weeks gestation) from 2,467 twin pregnancies. They were divided into four groups according to chorionicity and fertilization. Chorionicity was established by ultrasound at early gestation and confirmed by histologic examination after delivery. From a total of 2,467 twin deliveries, 392 MC, 2058 DC, and 17 unknown chorionicity were observed. Fertilization methods were classified as 736 natural, 1,590 ART, and 141 unknown conceptions. The pregnancy loss rate and possible mechanisms were compared in each group. RESULTS: During the study period, there were 43 MC, 86 DC, and 17 unknown chorionicities and 45 natural, 78 ART, and 23 unknown fertilizations. Total twin pregnancy loss rate was 5.9% (146/2,467), with 11.0% (43/392) and 4.2% (86/2,058) for MC twin group and DC twin group, respectively. Likewise, it was 6.1% (45/736) and 4.9% (78/1,590) for natural twin group and ART twin group. The most common cause was intrauterine fetal death (IUFD) in 22 (51.2%) in MC twin group and preterm premature rupture of membranes (PPROM) in 40 (46.5%) in DC twin group, followed by preterm labor (PTL) in 37 (43%). In natural pregnancy, IUFD was the most common etiology in 20 (44.5%) and for ART twin group, it was PTL in 35 (44.9%). CONCLUSION: Twin pregnancy loss rate was higher in MC twin group compared with DC twin group in the second trimester. MC twin group had a higher incidence of IUFD as a cause of second trimester pregnancy loss. The etiologies in DC twin group were PPROM and PTL. It is suggested that antenatal care in twin pregnancy should be explored for preventing fetal loss and promoting neonatal well-being.
Chorion ; Female ; Fertilization ; Fetal Death ; Humans ; Incidence ; Membranes ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy, Twin ; Reproductive Techniques, Assisted ; Rupture ; Twins

PURPOSE: This study aims to evaluate the loosening torque on the implant fixture, and to assess the accuracy of difference electronic torque drivers.MATERIALS AND METHODS: Three electronic torque drivers were used to measure the loosening torque on the implant system (AnyOne; MegaGen). The implant fixtures were divided among the 3 electronic torque driver types (W&H, SAESHIN, and NSK group) and 9 for each group. The screws were fastened at the implant fixture by three electronic torque drivers using the tightening torques recommended by the manufacturers of the drivers. After 10 minutes, the screws were again fastened at the implant fixture with equal torque. Then, the loosening torques were measured with an MGT12 torque gauge (MARK-10, Inc.). This measurement procedure was repeated 10 times under loosening torques of 15 Ncm, 25 Ncm, and 35 Ncm. In the statistical analysis, all values of loosening torque were analyzed with the one-way ANOVA and Kruskal-Wallis test (α=.05) for comparative evaluation.RESULTS: There were significant inter-group differences at loosening torques of 15 Ncm and 25 Ncm (P<.05). The accuracy of the NSK driver was the highest, followed by SAESHIN and W&H. There was no significant difference between NSK and W&H at 35 Ncm (P>.05). The SAESHIN driver showed the closest loosening torque at 35 Ncm.CONCLUSION: The most accurate loosening torques were SAESHIN at 35 Ncm, and NSK at 15 Ncm and 25 Ncm. Since the loosening torque may vary depending on the tightening torques and electronic torque drivers, periodic calibration of the electronic torque driver is recommended.
Calibration ; Torque

Adenomyosis is a nonneoplastic hyperplastic lesion, characterized by invagination of proliferating endometrial glands into myometrium. In dogs, uterine adenomyosis is relatively rare and it is important in Toxicologic Pathology to differentiate other non-neoplastic and neoplastic lesions in uterus. In the present study, we report two cases of adenomyosis in the female beagle dogs used for a chemical toxicity test. Clinically, one out of the two female beagle dogs, 15 months of age, had vaginal bleeding for 2 weeks and the other one, 11 months of age, showed swelling of vulva for a week. At necropsy, the weight of uterus was markedly increased to 27.9 g and 15.8 g, compared with the mean value (4.01+/-2.37, n=6) of that of other normal dogs, respectively. The parameters of hematology and serum chemistry were ranged normal in both of the dogs with enlarged uterus. For differentiation of connective tissue with muscle fibers, Van Gieson stain was also performed in the serial tissue sections. Histopathologically, the lesions of the enlarged uteruses were characterized by proliferating endometrial glands into myometrium, surrounded by connective tissue. The endometrial glands were proliferating downward to myometrium or embedded in multiple clustered glands in deeper myometrium without compressing the adjacent muscle fibers. The gland epithelial cells are uniformly cuboidal shape with a dense and bottom-located nucleus. These gross and histological findings were consistent with adenomyosis.
Adenomyosis ; Animals ; Connective Tissue ; Dogs ; Endometrial Hyperplasia ; Epithelial Cells ; Female ; Hematology ; Humans ; Mice ; Muscles ; Myometrium ; Toxicity Tests ; Uterine Hemorrhage ; Uterus ; Vulva

Background/Aims: Recent evidence has identified the significance of type 2 iodothyronine deiodinase (DIO2) in various diseases. However, the role of DIO2 polymorphism in metabolic parameters in patients with hypothyroidism is not fully understood. Methods: We assessed the polymorphism of the DIO2 gene and various clinical parameters in 118 patients who were diagnosed with hypothyroidism from the Ansan-Anseong cohort of the Korean Genome and Epidemiology Study. Furthermore, we systematically analyzed Genotype-Tissue Expression (GTEx) data. Results: A total of 118 participants with hypothyroidism were recruited; 32 (27.1%) were homozygous for the Thr allele, 86 (73.9%) were homozygous for the Ala allele or heterozygous. Patients with hypothyroidism with DIO2 polymorphism without hypertension at baseline had higher incidence of hypertension compared to patients without DIO2 polymorphism. Analysis of the GTEx database revealed that elevation of DIO2 expression is associated with enhancement of genes involved in blood vessel regulation and angiogenesis. Conclusions Commonly inherited variation in the DIO2 gene is associated with high blood pressure and prevalence of hypertension in patients with hypothyroidism. Our results suggest that genetic variation in the hypothalamic-pituitary-thyroid pathway in influencing susceptibility to hypertension.

One-lung ventilation with a double-lumen endotracheal tube or a Univent(R) tube may be difficult or dangerous in small patients, children, and patients with anatomic abnormalities of the airway. The use of a bronchial blocker through a single-lumen endotracheal tube has been used successfully in such situations. A 69-year-old woman was scheduled for Ivor-Lewis operation and right upper lobectomy. She could not be intubated with a internal diameter 6.0 mm Univent(R) tube owing to narrow diameter of the vocal cord. We report a successful one-lung ventilation using a Uniblocker(R) through an adult-size single-lumen endotracheal tube in a small woman, who needed postoperative ventilator care.
Aged ; Child ; Female ; Humans ; One-Lung Ventilation ; Ventilators, Mechanical ; Vocal Cords

The surgical closure of VSD in patient with severe pulmonary hypertension has been considered a difficult problem for surgeons, because sudden hemodynamic change after closure of the defect could bring on high perioperative mortality. Recently, it was reported that UVP (unidirectional valve patch), which allows some blood to flow from right to left in case of acute right heart failure, is effective in improving the postoperative hemodynamics after closing septal defects. This 42-year old woman had suffered from VSD for 20 years and recently complained of worsening exertional dyspnea for three months, and was diagnosed of a large VSD (2.0 cm in diameter) with severe pulmonary hypertension (116/38 mm Hg), equal to systemic arterial pressure. We could successfully close VSD with severe pulmonary hypertension using one UVP and the other UVP for the creative ASD to be prepared against possible acute right heart failure. She was discharged on the fourteenth postoperative day and has been well for twelve months with spontanenous closure of UVP patch at the ninth postopeative month.
Adult ; Arterial Pressure ; Dyspnea ; Female ; Heart Failure ; Heart Septal Defects ; Heart Septal Defects, Ventricular* ; Hemodynamics ; Humans ; Hypertension, Pulmonary* ; Mortality

Standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) have been considered prognostic factors for survival in many cancers. However, their prognostic value for radiotherapy-treated squamous esophageal cancer has not been evaluated. In this study, SUV, MTV, and TLG were measured to predict their prognostic role in overall survival (OS) in 38 esophageal cancer patients who had undergone 18F-FDG PET/CT before radiotherapy. TLG demonstrated higher sensitivity and specificity for predicting OS than MTV and SUV; and a better OS was observed in patients with low TLG compared to those with high TLG in locally advanced disease (OS, 46.9 months; 95% confidence interval [CI], 33.50-60.26 vs. 25.3 months; 95% CI, 8.37-42.28; P=0.003). Multivariate analyses in these patients determined that TLG and the use of combination chemotherapy were the independent prognostic factors for OS (hazard ratio [HR], 7.12; 95% CI, 2.038-24.857; P=0.002 and HR, 6.76; 95% CI, 2.149-21.248; P=0.001, respectively). These results suggest that TLG is an independent prognostic factor for OS and a better predictor of survival than MTV and SUV in patients with locally advanced esophageal cancer treated with radiotherapy.
Adult ; Aged ; Aged, 80 and over ; Area Under Curve ; Esophageal Neoplasms/mortality/pathology/*radiography ; Female ; Fluorodeoxyglucose F18/chemistry ; Glycolysis/*physiology ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; *Positron-Emission Tomography ; Prognosis ; Proportional Hazards Models ; ROC Curve ; Radiopharmaceuticals/*chemistry ; Retrospective Studies ; Survival Rate ; *Tomography, X-Ray Computed

Many researchers have focused on the role of adipocytes in increasing efficient bone tissue engineering and osteogenic differentiation of stem cells. Previous reports have not reached a definite consensus on whether adipocytes positively influence in vitro osteogenic differentiation and in vivo bone formation. We investigated the adipocyte influence on osteogenic differentiation from adipose-derived stromal cells (ADSCs) and bone formation through histological analysis in vitro and in vivo. Using the direct co-culture system, we analyzed the influence of adipocytes to promote the differentiation fate of ADSCs. Using co-transplantation of ADSC-derived adipocytes and osteoblasts into the dorsal region of mice, the osteogenesis and bone quality were determined by histological morphology, radiography, and the measurement of the Ca²⁺ concentration. The adipocyte negatively affected the osteoblast differentiation of ADSCs in the in vitro system and induced osteogenesis of osteoblasts in the in vivo system through co-transplantation. Interestingly, in the co-transplanted adipocytes and osteoblasts, the bone formation areas decreased in the osteoblast only group compared with the mixed adipocytes and osteoblast group 6 weeks after transplantation. Conversely, co-transplantation and osteoblast transplantation had similar degrees of calcification as observed from radiography analysis and the measurement of the Ca²⁺ concentrations. Our results revealed that adipocytes inhibited osteoblast differentiation in vitro but enhanced the efficacy of osteogenesis in vivo. In addition, the adipocytes controlled the activity of osteoclasts in the newly formed bone tissue. Our approach can be used to reconstruct bone using stem cell-based tissue engineering and to enhance the understanding of the role adipocytes play.
Adipocytes* ; Animals ; Bone and Bones ; Coculture Techniques* ; Consensus ; In Vitro Techniques* ; Mice* ; Osteoblasts* ; Osteoclasts ; Osteogenesis ; Radiography ; Stem Cells ; Stromal Cells ; Tissue Engineering

BACKGROUND: Tissue engineering approaches to treat damaged bone include various tissue transplants such as autologous, allogeneic, and xenografts. Artificial materials have been widely introduced to meet the demand for graft materials, but insufficiency in supply is still not resolved. In this study, human adipose tissue, easily obtained from the human body, was harvested, and the tissue was decellularized to fabricate a decellularized human adipose tissue matrix (DM) as an alternative graft material. METHODS: Human adipose tissue was obtained via liposuction. The obtained fresh adipose tissue sample was cut into pieces then put into decellularization solution (1% antibiotic–antimycotic solution and 1% phenylmethanesulphonyl fluoride). Lipids were further removed via treatment in isopropanol. The sample was then subjected to another enzymatic digestion and lipid removal processes. The obtained decellularized adipose tissue matrix was lyophilized to form a graft material in disc shape. RESULTS: Decellularization was confirmed by nuclear staining methods and detection of RNA and DNA via PCR. Bone morphogenetic protein 2 (BMP2)-loaded DM showed the ability to form new bone tissue when implanted in subcutaneous tissue. In recovery of a mouse calvarial defect model, BMP2-loaded DM exhibited similar levels of bone tissue regeneration efficiency compared with a well-defined commercial product, BMP2-loaded CollaCoteⓇ. CONCLUSION The DM developed in this study is expected to address the problem of insufficient supply of graft materials and contribute to the treatment of bone defects of critical size as an alternative bone graft material with preserved extracellular matrix components.