Objective: Endovascular coil embolization is the primary treatment modality for intracranial aneurysms. However, its long-term durability remains of concern, with a considerable proportion of cases requiring aneurysm reopening and retreatment. Therefore, establishing optimal follow-up imaging protocols is necessary to ensure a durable occlusion. This study aimed to develop guidelines for follow-up imaging strategies after endovascular treatment of intracranial aneurysms. Methods: A committee comprising members of the Korean Neuroendovascular Society and other relevant societies was formed. A literature review and analyses of the major published guidelines were conducted to gather evidence. A panel of 40 experts convened to achieve a consensus on the recommendations using the modified Delphi method. Results: The panel members reached the following consensus: 1. Schedule the initial follow-up imaging within 3-6 months of treatment. 2. Noninvasive imaging modalities, such as three-dimensional time-of-flight magnetic resonance angiography (MRA) or contrast-enhanced MRA, are alternatives to digital subtraction angiography (DSA) during the first follow-up. 3. Schedule mid-term follow-up imaging at 1, 2, 4, and 6 years after the initial treatment. 4. If noninvasive imaging reveals unstable changes in the treated aneurysms, DSA should be considered. 5. Consider late-term follow-up imaging every 3–5 years for lifelong monitoring of patients with unstable changes or at high risk of recurrence. Conclusions The guidelines aim to provide physicians with the information to make informed decisions and provide patients with high-quality care. However, owing to a lack of specific recommendations and scientific data, these guidelines are based on expert consensus and should be considered in conjunction with individual patient characteristics and circumstances.

Helicobacter pylori (H. pylori), a causative agent of chronic gastritis and gastric cancer, has several virulent factors for own survival and progression toward gastric diseases in human stomach. Of those, H. pylori produces mainly urease (10~15% total protein weight) that neutralize the gastric acid for survival. Here, we identified the antigenic epitope of urease and then developed an ELISA using the antigen including the epitope of urease. We identified the antigenic epitope of urease that induces IgA antibodies in human using truncated mutants. Eight kinds of serially-truncated mutant of UreA and UreB were prepared and subjected to immunoblot using pooled sera of patients with gastric disorders. UreBEnd protein containing UreB epitope was produced and investigated its diagnostic value via ELISA in children. As a result, mutants having last 24 amino acid residues of UreB carboxyl terminus deleted did not show IgA-reactive band. The clones that contained the downstream of 448(th) amino acid in UreB showed IgA-reactive band. The serodiagnostic value of the UreBEnd recombinant protein including identified epitope was confirmed via IgA ELISA and shown to have 97% sensitivity and 100% specificity. These results demonstrated that carboxyl terminal region of UreB carries an antigenic epitope for IgA response in human. It may be useful for detecting H. pylori infection with improved test accuracy and minimum use of endoscopy.
Antibodies ; Child* ; Clone Cells ; Endoscopy ; Enzyme-Linked Immunosorbent Assay ; Epitopes* ; Gastric Acid ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunoglobulin A* ; Sensitivity and Specificity ; Stomach ; Stomach Diseases ; Stomach Neoplasms ; Urea* ; Urease*

OBJECTIVE: Traumatic pseudoaneurysms are rare but life-threatening lesions. We investigated the patients with these lesions to clarify their clinical characteristics and therapeutic strategies and we also reviewed the literatures on the treatment principles, possible options, and outcomes. METHODS: There were a total of 8 patients who were treated with traumatic intracranial pseudoaneurysms between April 1980 and January 2009. Medical charts and the imaging studies were reviewed for analysis. The outcome was measured with modified Rankin Scale (mRS) score at 6 months after treatment. RESULTS: All 8 patients were male and the mean age was 25 years old. Six of those were located at the cavernous segment of the internal carotid artery (ICA) and the other 2 was located at the M2 segment of middle cerebral artery. The causes of trauma were car accidents in 6, penetrating injury through the orbit in 1, and slip down injury in 1 patient. Massive epistaxis or hematemesis occurred in all patients with a pseudoaneurysm at the cavernous and ophthalmic segment of the ICA. All 6 patients of the cavernous and ophthalmic ICA group showed favorable outcome of mRS 0 to 1. The outcome of patients with middle cerebral artery pseudoaneurysm was mRS 2 to 3. CONCLUSION: Upon prompt diagnosis and proper treatment planning, it is possible to achieve favorable outcome in these patients. Lesions located at the cavernous segment of the ICA favored endovascular treatment while those at the middle cerebral artery favored surgical treatment.
Aneurysm, False* ; Carotid Artery, Internal ; Craniocerebral Trauma ; Diagnosis ; Epistaxis ; Hematemesis ; Humans ; Intracranial Aneurysm ; Male ; Middle Cerebral Artery ; Orbit ; Subarachnoid Hemorrhage

BACKGROUND/AIMS: Our study aimed to evaluate the efficacy of MMF as compared with intravenous cyclophosphamide as induction therapy for proliferative lupus nephritis in Koreans. METHODS: Forty-three patients who were diagnosed with proliferative lupus nephritis (WHO Class III and IV) between Jan 2000 and Dec 2006 were included in this study. Nineteen patients were treated with oral MMF (initial dose: 1.0 g/day and then it was increased to 2.0 g/day) and 24 patients were treated with 0.75-1.0 g/m2 of monthly intravenous cyclophosphamide (CP) followed by subsequent treatment with oral corticosteroid (initial dose 1 mg/kg/day and then it was slowly tapered down) for 6 months. The demographic and laboratory findings, the response rate and the adverse events were reviewed retrospectively and these were compared between the two groups. RESULTS: A complete response occurred in 7 out of the 19 patients (36.8%) treated with MMF and in 8 out of the 24 patients (33.3%) treated with CP, and the difference was not significantly different between the two groups (p=0.66). A partial response was achieved in 52.6% and 45.8%, respectively. There were no significant differences of the laboratory findings such as serum albumin, C3, C4, the urine protein/creatinine ratio and serum creatinine after treatment for 6 months. In addition, both groups had similar rates of adverse events. CONCLUSIONS: Our study showed that for the treatment of lupus nephritis, MMF was as effective as IV cyclophosphamide with similar adverse events. This finding suggests that MMF could be an alternative treatment for active lupus nephritis as induction therapy.
Creatinine ; Cyclophosphamide ; Humans ; Lupus Nephritis ; Mycophenolic Acid ; Retrospective Studies ; Serum Albumin

PURPOSE: To compare the efficacy of contrast-enhanced and T2-weighted magnetic resonance urography (MRU) for the depiction of obstruction and evaluation of the causes of obstructive uropathy with that of antegrade pyelography. MATERIALS AND METHODS: Twenty-five patients with obstructive uropathy who underwent percutaneous nephrostomy (PCN) and antegrade pyelography (AGP) were included in the study. We performed MR urography, comprising half-Fourier acquisition single-shot turbo spin-echo (HASTE) T2-weighted imaging and 3-D fast imaging with steady state precession (3-D FISP) T1-weighted imaging after gadolinium enhancement and compared the quality of the images of both the HASTE and 3-D FISP MRU techniques in terms of their depiction of the dilated pelvocalyceal system, and the level, type, and causes of obstruction. RESULTS: In terms of anatomical depiction of the pelvocalyceal system (p=0.002) and the causes of obstruction (p=0.003), T1-weighted MRU using 3D-FISP was significantly better than T2-weighted MRU using the HASTE sequence. Regarding level of obstruction, T2-weighted MRU using the HASTE sequence and contrastenhanced T1-weighted MRU using 3D-FISP showed an accuracy of 76% (19/25) and 84% (21/25), respectively. In terms of type of obstruction, the accuracy of T2-weighted MRU and T1-weighted CEMRU was 72%(18/25) and 88% (22/25), respectively. CONCLUSION: T2-weighted MRU and T1-weighted CEMRU provided both anatomical information and that relating to impaired renal function. The two modelities played a complementary role and their use could decrease the unnecessary use of invasive diagnostic examination for the evaluation of obstructive uropathy.
Gadolinium ; Humans ; Nephrostomy, Percutaneous ; Urography*

BACKGROUND AND OBJECTIVES: A rescue percutaneous coronary intervention (PCI) has been used to treat the patients after failed thrombolysis in acute myocardial infarction. However, short- and long-term benefits of rescue PCI has not been known exactly. The goal of this study was to examine the clinical and angiographic outcomes, success rate of the procedure, and long-term survival rate after rescue PCI. MATERIALS AND METHODS: Clinical and angiographic outcomes of 31 patients (Group I; 59.7+/-11.4 years, 80.6% male), who underwent rescue PCI were compared with those of 177 patients (Group II; 59.7+/-9.7 years, 79.7% male), primary PCI at Chonnam National University Hospital between January 1997 and December 1999. RESULTS: There were no significant differences in the risk factors for coronary artery diseases except for smoking (Group I; 24/31, 77.4% vs. Group II; 76/177, 42.9%, P<0.05). The incidence of cardiogenic shock was higher in Group I than in Group II (Group I; 7/31, 22.6% vs. Group II; 11/177, 6.2%, P<0.05). The coronary angiographic findings were not different between two groups. Thrombolysis in Myocardial Infarction flow of Group I was lower than in Group II (Group I; 1.14+/-0.93 vs. Group II; 1.61+/-1.14, P<0.05). Primary success rate was 93.6% (29/31) in Group I and 94.9% (168/177) in Group II (P<0.05). Baseline ejection fraction was lower in Group I than in Group II (Group I; 44.2+/-8.9% vs. Group II; 50.8+/-11.7, P<0.05), which improved in both groups (Group I; 51.7+/-7.9% vs. Group II; 60.7+/-13.4%, P<0.05) at six months after the procedures. The survival rate of Group I was 93.5%, 93.5% and 90.3% and that of Group II was 94.5%, 93.7% and 91% at 1 month, 6 and 12 months, respectively. CONCLUSION: Rescue PCI was associated with the risk factor of smoking and the high incidence of cardiogenic shock. The success rate of rescue PCI was comparable with primary PCI and left ventricular function was improved after rescue PCI on long-term clinical follow-up with relatively high survival rate.
Coronary Artery Disease ; Follow-Up Studies ; Humans ; Incidence ; Jeollanam-do ; Myocardial Infarction* ; Percutaneous Coronary Intervention* ; Risk Factors ; Shock, Cardiogenic ; Smoke ; Smoking ; Survival Rate ; Ventricular Function, Left

BACKGROUND: Coronary stenting is one of the most effective methods of percutaneous coronary interventions (PCI) in the treatment of intimal dissection and prevention of restenosis after balloon angioplasty. However, coronary stent restenosis still remains a major clinical limitation. METHODS: Three hundreds seventy three patients who underwent coronary stent implantations and follow-up coronary aniograms at Chonnam National University Hospital between June 1996 and December 1999, were divided into two groups: 123 patients with restenosis (Group A: 98 male, 25 female, 58.5+/-9.4 year-old) and 240 patients without restenosis (Group B: 193 male, 47 female). RESULTS: The prevalence of clinical diagnosis and risk factors for the atherosclerosis were not different between two groups. The indications for stenting and stent types, reference vessel diameter and minimal luminal diameter before stenting were not different. However, stent length was 23.4+/-7.57 mm in Group A and 20.8+/-6.58 mm in Group B, which were longer in Group A than in Group B (p=001). By multiple logistic regression analysis for the independent predictive factors for stent restenosis, the long stent more than 25mm in length was the only significant predictive factor after correction according to age, sex, risk factor, lipid profiles (OR=2.590, 95% C.I.=1.40-4.78). CONCLUSION: The long coronary stent more than 25 mm in length is a predictive factor of restenosis after coronary stenting.
Angioplasty, Balloon ; Atherosclerosis ; Coronary Vessels ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Jeollanam-do ; Logistic Models ; Male ; Percutaneous Coronary Intervention ; Phenobarbital ; Prevalence ; Risk Factors ; Stents*