BACKGROUND: Conventional echocardiography provides fundamental information about mitral valve morphology and function but is often subjective and has a relatively low specificity in evaluating valve calcific deposit, which is critical information for the preoperative decision. We hypothesized that mitral valvular calcification could be detected in standard two-dimensional echocardiograms of mitral valve in vivo by evaluating regional gray level(echo amplitude) using computerized image analysis so that we could overcome the subjectivity and low specificity of conventional echocardiography. METHODS: We tested this hypothesis by performing standard 2.5MHz two-dimensional echoes on mitral valve and myocardium in 30 patients with mitral stenosis, scheduled to undergo mitral valve replacement. We compared gray level of each region of interest in mitral valve and myocardium in stop-frame images with the degree of calcifications identified by pathologic and radiographic examinations. RESULTS: Ratio of mean gray level of mitral valve to mean gray level of myocardium was the most reliable value in evaluating degree of calcification. Quantitatively, region of calcification displayed the ratio of significantly higher value than that of no calcification. In case of anterior mitral valve, the ratio of the evident calcified region was greater than 3.11, that of the region without calcification was less than 2.42 and that of microcalcification was betwwn 2.42 and 3.11. For posterior mitral valve, the ratio of the evident calcified region was greater than 3.50, that of the region without calcification was less than 2.19 and that of microcalcification was between 2.19 and 3.50. The sensitivity and specificity of this method for assessment of degree of calcification was 75% and 100% for anterior mitral valve and 9% and 87.5% for posterior mitral valve. CONCLUSION: Mitral valvular calcification could be detected quantitatively in standard two dimensional echocardiograms of mitral valve in vivo by evaluating regional gray level(echo amplitude) using computerized image analysis.
Echocardiography ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Myocardium ; Sensitivity and Specificity

PURPOSE: The purpose of this study was to measure the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of normal adult brain tissue and tumors, and to compare the differences. MATERIALS AND METHODS: Eight normal adults and ten patients in whom intracranial tumors had been diagnosed were included. Imaging was performed using a 1.5 T MR unit and a single-shot spin-echo EPI pulse sequence (TR/TE=4024/94 msec, 128 acquisition/256 reconstruction, 23 cm FOV, 5 mm thickness, 2 mm interslice gap, 4 NSA), six different direction gradients (x, y, z, xy, yz, xz), and 2 b-values (0, 1000). Isotropic ADC (D) was obtained from seven images per slice, and fractional anisotropy (FA) was calculated from the isotropic ADC and eigenvalues of three directions. A region of interest was drawn at frontal gray and white matter, periventricular white matter, the corpus callosum, internal capsule, caudate nucleus and center of the tumor mass, and for each region, fractional anisotropy readings were obtained. RESULTS: In normal adults, the findings were as follows: frontal gray matter: D=0.81+/-0.06, FA=0.32+/-0.03; frontal white matter: D=0.79+/-0.04, FA=0.56+/-0.09, periventricular white matter: D=0.77+/-0.02, FA=0.51 +/-0.04; corpus callosum: D=0.79+/-0.07, FA=0.82+/-0.07; internal capsule: D=0.73+/-0.04, FA=0.77+/-0.05; caudate nucleus: D=0.76+/-0.05, FA=0.35+/-0.05. High anisotropy was demonstrated in white matter, especially in the corpus callosum and internal capsule, and the degree of anisotropy was similar in gray and deep gray matter. For most brain tumors, isotropic ADC was similar to that of white matter, but fractional anisotropy was lower. A low-grade astrocytoma showed higher isotropic ADC and lower fractional anisotropy than normal white matter, and at the center of a meningioma, fractional anisotropy was high. CONCLUSION: For the classification of brain tumors and determination of the extent of disease, comparison between the apparent diffusion coefficient and fractional anisotropy is useful.
Adult ; Anisotropy* ; Astrocytoma ; Brain Neoplasms* ; Brain* ; Caudate Nucleus ; Classification ; Corpus Callosum ; Diffusion Tensor Imaging* ; Diffusion* ; Humans ; Internal Capsule ; Meningioma ; Reading

A 49-year-old woman visited the clinic because of acute hepatitis and acute kidney injury with decreased urine output presenting microscopic hematuria and proteinuria. An abdominal computed tomography revealed a localized, hypoattenuated lesion in a hepatic lateral segment, and kidney biopsy showed oxalate crystal deposition with tubular necrosis. In addition, the patient's 24-hour urinary excretion of oxalate was increased. Her kidney and liver injury improved after sessions of hemodialysis, and urinary oxalate excretion was normalized. Major mutations in primary hyperoxaluria have not been proven. A full sequencing of target genes may be helpful to diagnose a rare form of primary hyperoxaluria.
Acute Kidney Injury ; Biopsy ; Female ; Hematuria ; Hepatitis ; Humans ; Hyperoxaluria* ; Hyperoxaluria, Primary ; Kidney* ; Liver* ; Middle Aged ; Necrosis ; Proteinuria ; Renal Dialysis

OBJECTIVE: To determine the effect of prolotherapy on lateral epicondylitis, and the difference of treatment effect according to the findings of ultrasonography. METHOD: The subjects were 84 patients who were diagnosed as lateral epicondylitis. The pain score was evaluated by using VAS (Visual Analogue Scale) before treatment and 1 month and 6 months after the 3rd injection. Ultrasonography was done to 49 patients who were suspicious of tendinous tear. RESULTS: In the comparison of the VAS before treatment and after the 3rd injection, it was 6.79+/-0.88, 2.95+/-1.90, respectively, which demonstrated statistical significant decrease (p<0.01). We found more significant reduction of VAS in the subjects without tendinous tear (7.08+/-0.91 to 2.16+/-1.57) than those with partial tendinous tear (6.90+/-0.93 to 3.67+/-1.76) (p<0.01). Among 71 patients whose symptom was improved after the treatment, 57 patients (80.2%) demonstrated sustained improvement at 9 months and 14 patients (19.7%) relapsed at 9 months. CONCLUSION: Prolotherapy is an effective treatment method in the lateral epicondylitis of elbow. Ultrasonography could be a useful diagnostic method which could predict the effect of prolotherapy.
Elbow* ; Humans ; Tears ; Ultrasonography

Iatrogenic calcinosis cutis is due to the intravenous administration of calcium gluconate or calcium chloride to treat hypocalcemia. The arthors report three cases of calcinosis cutis with calcifications involving the upper or lower extremities in neonates following the extravasation of calcium gluconate. Three neonates, a 2-week-old girl, 4-week-old boy, and a 4-week-old girl, were consulted for indurated nodules after the intravenous administration of calcium gluconate at the intensive care unit. Complete remission of palpable nodule and calcification was observed on the radiograph at three weeks, four weeks and six months after the initial presentation in each. All three neonates with iatrogenic calcinosis curtis were resolved spontaneously without functional and cosmetic complications. According to enhancement of the patient's cognition about benign disease, a suitable explanation of the disease and avoiding unnecessary treatment through an early diagnosis of iatrogenic calcinosis cutis will reduce a number of potential medical malpractice disputes.
Administration, Intravenous ; Calcinosis ; Calcium Chloride ; Calcium Gluconate ; Calcium ; Cognition ; Dissent and Disputes ; Early Diagnosis ; Female ; Humans ; Hypocalcemia ; Infant, Newborn ; Intensive Care Units ; Lower Extremity ; Male ; Malpractice

OBJECTIVE: To know the accuracy of caudal epidural steroid injection procedure without fluoroscopy guidance, and determine ascending level of injected solution according to injection volume. METHOD: The subjects were 35 patients with low back pain. Needle insertion was performed without fluoroscopy, then we confirm the position of needle with fluoroscopy. The level of injected solution was measured with fluoroscopy and x-ray after injecting every 5 ml of solution, which is mixture of triamcinolone, 2% lidocaine, contrast medium, and normal saline. The effect of treatment was measured by Visual Analogue Scale (VAS). RESULTS: Successful needle placement occurred in 27 cases without fluoroscopy. After injecting 20 ml of solution, the ascending level of solution were S1 in 8 cases, L5 in 12 cases, L4 in 8 cases, L3 in 1 case, L2 in 4 cases, L1 in 2 cases. In the comparison of the VAS before and after treatment, it was 6.3+/-1.2 and 2.9+/-1.3 respectively, which demonstrated statistically significant decrease (p+/-0.05). CONCLUSION: Caudal epidural injection could be performed more accurately under the fluoroscopic guidance. After injecting 20 ml of solution, the ascending level of the solution were restricted at lower lumbosacral area in most of cases.
Fluoroscopy ; Humans ; Injections, Epidural* ; Lidocaine ; Low Back Pain ; Needles* ; Triamcinolone

OBJECTIVE: To compare the ultrasonographic findings of chronic lateral epicondylitis of elbow with partial tear of common extensor tendon before and after prolotherapy. METHOD: The subjects were 12 cases of chronic lateral epicondylitis with partial tear of common extensor tendon, which were confirmed by ultrasonography. We examined the common extensor tendon with ultrasonography at initial visit. After injecting 15% dextrose solution monthly for five times, follow up ultrasonography was performed one month after last injection. RESULTS: Before prolotherapy, every case had anechoic focus without normal fibrillar pattern, which represented partial tear of tendon. Seven cases showed focal or diffuse hypoechoic foci with loss of normal fibrillar pattern of tendon, which represented tendinosis. After prolotherapy, initial anechoic foci were changed to smaller size with diffuse fibrillar pattern inside in 6 cases, to the same the sized hypoechoic foci with diffuse fibrillar pattern inside in 2 cases. And a few fibrillar pattern were seen within the initial anechoic focus in 1 case and most of anechoic foci were filled with fibrillar pattern except small anechoic foci in 3 cases. CONCLUSION: Prolotherapy can help the recovery process of chronic lateral epicondylitis. And ultrasonography can be a useful method to evaluate the therapentic effect of lateral epicondylitis.
Elbow ; Follow-Up Studies ; Glucose ; Tears* ; Tendinopathy ; Tendons ; Ultrasonography

Background: To evaluate the degree of deformation in patients with ankle osteoarthritis (OA), it is essential to measure the threedimensional (3D), in other words, stereoscopic alignment of the ankle, subtalar, and foot arches. Generally, measurement of radiological parameters use two-dimensional (2D) anteroposterior and lateral radiographs in a weight-bearing state; however, computeraided 3D analysis (Disior) using weight-bearing cone-beam computed tomography (CBCT) has recently been introduced. Methods: In this study, we compared the 2D human radiographic method with a stereoscopic image in patients with ankle arthritis. We enrolled 57 patients diagnosed with OA (28 left and 29 right) and obtained both standing radiographs and weight-bearing CBCT. Patients were divided by the Takakura stage. The interclass correlation coefficient (ICC) for each result was confirmed. Results: On the ICC between 2D radiographs and 3D analysis, the tibiotalar surface angle and lateral talo-1st metatarsal angle showed a good ICC grade (> 0.6), while other parameters did not have significant ICC results. Three-dimension was superior to radiographs in terms of statistical significance. Conclusions We demonstrated that 2D and stereoscopic images are useful for the diagnosis of OA. Our study also confirmed that the radiographic features affected by ankle OA varied. However, according to the results, the typical radiography is not sufficient to diagnose and determine a treatment plan for ankle OA. Therefore, the method of using 3D images should be considered.

PURPOSE: To determine the prevalence and degree of CAC (coronary artery calcification) in appearently healthy middle-aged Koreans, and the relation of CAC to risk factors for atherosclerosis. MATERIALS AND METHODS: A total of 289 apparently healthy personnel at Yonsei University (male: 170, female: 119, age: mean(SD=54.9 +/-7.1 years) underwent EBT (electron bean tomography). The risk factors for atherosclerosis, which included diabetes mellitus, hypertension, smoking, a family history of precocious onset, obesity, hyperlipidemia, and high intraperitoneal fat, were scrutinized. One hundred and sixty-eight subjects (58 % ) had at least one risk factor. The CAC score was calculated for all subjects and for each coronary artery separately and was then analyzed by age and sex and in relation to the risk factors. RESULTS: The prevalence of CAC was 40% in men and 18.5% in women (mean score: 29.7 vs. 9.9). The number of individuals who had one, two, or more than two risk factors was 141, 41, and 19, respectively. The number of risk factors and the prevalence and score of CAC were significantly correlated (p=0.01, 0.02 respectively). The number of individuals with no risk factor, with without CAC, was 58(20.1%) and 103(35.6% ) , respectively, while the number with some risk factor, with or without CAC, was 38(13.1%) and 90(31.1%), respectively. The CAC score was significantly higher in the presence of hypertension, low HDL, or obesity (p=0.001, 0.049, and 0.068, respectively). Smoking appeared to have a borderline effect on the calcium score (p=0.118). CONCLUSION: This study should provide useful information for interpreting CAC scores and establishing a treatment strategy for Koreans. The comparison of our results with other studies will enable a better understanding of the process and risk factors of atherosclerosis in Koreans.
Arteries ; Atherosclerosis ; Calcium* ; Coronary Vessels ; Diabetes Mellitus ; Female ; Humans ; Hyperlipidemias ; Hypertension ; Male ; Obesity ; Prevalence ; Risk Factors ; Smoke ; Smoking

BACKGROUND: Recently, endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR), have been used for treatment of thoracic and abdominal aortic aneurysms. The purpose of this study was to analyze the outcome and predictors for 30-day mortality and complications, in patients that underwent EVAR and/or TEVAR under general anesthesia. METHODS: In this study, 151 cases of EVAR and/or TEVAR under general anesthesia in 140 patients during 2009–2017 were studied. The primary outcome was 30-day mortality after surgery. Multivariate logistic regression analysis was used, to clarify risk for postoperative 30-day mortality. RESULTS: Postoperative 30-day mortality rate was 9.9% in the study population (10.3% in EVAR, and 9.3% in TEVAR, respectively). Seventy-two cases (47.7%) experienced postoperative complications within 30 days. Elderly older than age 76.5 (odds ratio [ORs] = 48.89, 95% confidential interval [95% CI] 1.40–1,710.25, P = 0.032), technically expertness (OR = 0.01, 95% CI 0.00–0.40, P = 0.013), severity of systemic complications (OR = 23.24, 95% CI, 2.27–238.24, P = 0.008), and severity of local-vascular complications (OR = 31.87, 95% CI, 1.29–784.66, P = 0.034) were significantly associated with 30-day mortality. CONCLUSIONS: This study revealed that elderly, technically expertness, and severity of systemic and local-vascular complications were associated with 30-day mortality of EVAR and TEVAR in aortic aneurysm.
Aged ; Anesthesia, General ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Humans ; Length of Stay ; Logistic Models ; Mortality ; Postoperative Complications ; Risk Factors ; Treatment Outcome