1.Comparing efficacies of different treatment regimens in patients with hepatocellular carcinoma accompanied by portal vein tumor thrombus using network meta-analysis
Seungji LEE ; Sung Kyu SONG ; Byungje BAE ; Yongkeun PARK
Annals of Surgical Treatment and Research 2022;103(5):280-289
Purpose:
Although various treatment regimens have been introduced for hepatocellular carcinoma (HCC) accompanied by portal vein tumor thrombosis (PVTT), comprehensive and direct comparisons between them are limited. Thus, the purpose of this study was to perform a network meta-analysis (NMA) to compare the efficacies of different treatment regimens for HCC accompanied by PVTT.
Methods:
A systematic review was conducted to identify studies comparing 2 or more treatment regimens for HCC accompanied by PVTT without extrahepatic metastasis and reporting each overall survival (OS). Endpoints of this NMA were to hazard ratios with confidential intervals for OS and mean survival time difference of each treatment regimen comparison using a random-effects model. Each treatment regimen was then ranked using the P-score to assess the probability of the superiority of each one.
Results:
Eleven studies involving 1,623 patients that yielded 16 comparisons were identified and enrolled in this NMA. There were 12 different treatment regimens as comparators, including sorafenib therapy alone (reference treatment).The NMA suggested that the following 4 treatment regimens improved OS compared to sorafenib: surgical resection followed by portal vein chemotherapy (SR plus PVC), SR, radiofrequency ablation plus sorafenib, and transarterial chemoembolization combined with selective internal radiation therapy. SR plus PVC was ranked the best treatment regimen for OS (P-score, 93.9%).
Conclusion
Comparative efficacy based on this NMA may help clinicians select treatment for HCC accompanied by PVTT. If amenable, aggressive locoregional treatment regimens such as SR plus PVC should be considered for HCC accompanied by PVTT.
2.Arrhythmogenic Right Ventricular Cardiomyopathy as a Cause of Sudden Unexplained Death.
Tae In PARK ; Dong Ja KIM ; Yoon Kyung SOHN ; Jong Min CHAE ; Jung Sik KWAK ; Hun Sik PARK ; Yongkeun CHO ; Shung Chull CHAE ; Jae Eun CHUN ; Eu Hyun PARK
Korean Circulation Journal 2001;31(3):335-340
OBJECTIVE: Arrhythmogenic right ventricular cardiomyopathy(ARVC) is a progressive cardiac muscle disease characterized as progressive fibrofatty replacement of the right ventricle, severe ventricular arrhythmia, and sudden death. However, there is no report of ARVC as a cause of sudden death in Korea. METHODS and RESULTS: Postmortem studies were done to 115 cases of sudden unexplained death at department of legal medicine, school of medicine, Kyungpook national university in year 1999. We identified 7 cases(6%) of typical ARVC with no other identifiable cause of sudden death. The subjects included 5 males and 2 females, ranging in age from 19 to 41 years (mean 29.7 years). All were found dead at bed (5 cases) or workshop (2 cases). Five cases were fibrofatty types and two cases were fatty types. Right ventricular aneurysm, inflammatory infiltrates and left ventricular involvement were found in 4, 2 and 1 cases, repectively. Two cases had family history of sudden death before age 40. No one was suspected of having cardiovascular disease or ARVC before death. CONCLUSION: These findings indicate that ARVC in Taegu-Kyungpook area may be more frequent than previously thought. ARVC may be a major cause of sudden unexplained death.
Aneurysm
;
Arrhythmias, Cardiac
;
Arrhythmogenic Right Ventricular Dysplasia*
;
Cardiovascular Diseases
;
Death, Sudden
;
Education
;
Female
;
Forensic Medicine
;
Gyeongsangbuk-do
;
Heart Ventricles
;
Humans
;
Korea
;
Male
;
Myocardium
3.Unique Red Blood Cell Morphology Detected in a Patient with Myelodysplastic Syndrome by Three-dimensional Refractive Index Tomography
Se eun KOO ; Seongsoo JANG ; Chan Jeoung PARK ; Young Uk CHO ; YongKeun PARK
Laboratory Medicine Online 2019;9(3):185-188
The three-dimensional (3-D) shape of erythrocytes is strongly associated with various diseases. However, conventional optical imaging approaches with Wright's staining only provide information on two-dimensional morphology. Here, we employed optical diffraction tomography (ODT), a label-free 3-D quantitative phase imaging technique, and observed uniquely shaped red blood cells (RBCs) in the peripheral blood of a patient diagnosed with myelodysplastic syndrome. Peripheral blood samples were collected when the patient visited our hospital for his two out-patient follow-ups in May 2018. The 3-D tomograms of randomly chosen RBCs were reconstructed using a commercial ODT setup. From the reconstructed 3-D RBCs, 37.5% and 32.8% of RBCs demonstrated cup-like shapes at the first and the second out-patient follow-up, respectively. Even though this is a single case report, the finding is novel and can be a potential dyserythropoietic feature found in peripheral blood.
Erythrocytes
;
Follow-Up Studies
;
Humans
;
Myelodysplastic Syndromes
;
Optical Imaging
;
Outpatients
;
Refractometry
4.Reconstructed Three-Dimensional Images and Parameters of Individual Erythrocytes Using Optical Diffraction Tomography Microscopy
Se eun KOO ; Seongsoo JANG ; YongKeun PARK ; Chan Jeoung PARK
Annals of Laboratory Medicine 2019;39(2):223-226
No abstract available.
Erythrocytes
;
Imaging, Three-Dimensional
;
Microscopy
5.Post-stress Measurements of Left Ventricular Function With Gated Perfusion SPECT: Comparison with Resting Measurements by using Exercise and Adenosine Stress.
Yong Whi PARK ; Ju Yup HAN ; Byeong Cheol AHN ; Hun Sik PARK ; Yongkeun CHO ; Jaetae LEE ; Shung Chull CHAE ; Jae Eun JUN ; Eu Hyun PARK
Korean Circulation Journal 2001;31(10):1019-1026
BACKGROUND AND OBJECTIVES: This study was designed to investigate the relationship between myocardial perfusion defect in single photon emission tomography(SPECT) and the difference in left ventricular functional parameters obtained after stress and at rest. MATERIALS AND METHODS: Eighty five patients known to have coronary artery disease (CAD) or suspected to have CAD underwent gated Tc-99m sestamibi SPECT using one or separate day rest/stress protocol. We compared post-stress left ventricular ejection fraction (LVEF-s) with that at rest (LVEF-r) in gated myocardial SPECT. We considered myocardial stunning was developed when LVEF was >5% lower than that at rest. METHODS: Forty one (48%) patients demonstrated reversible or irreversible perfusion defects in gated perfusion SPECT (group 1). Forty four (52%) patients demonstrated normal perfusion status (group 2). In group 1, LVEF-s was significantly lower than that at rest([mean+/-SD] 46+/-15.5 vs 48+/-16.0 respectively, p<0.05). In group 2, There was no significant difference among LVEF-s and LVEF-r(60+/-7.6 vs 61+/-7.9, p=NS). In group 1, no difference was observed between LVEF-s and LVEF-r by stress modes. In 13 (32%) of 41 patients with perfusion defects, LVEF-s was >5% lower than LVEF-r. CONCLUSION: The LVEF obtained after stress with gated SPECT may not reflect true resting values. We recommend gated myocardial perfusion SPECT should be performed also at rest especially in patients with myocardial perfusion defects.
Adenosine*
;
Coronary Artery Disease
;
Humans
;
Myocardial Stunning
;
Perfusion*
;
Stroke Volume
;
Tomography, Emission-Computed, Single-Photon*
;
Ventricular Function, Left*
6.Optimal International Normalized Ratio for Warfarin Therapy in Elderly Korean Patients with Non-Valvular Atrial Fibrillation.
Won Suk CHOI ; Jae Hee KIM ; Se Yong JANG ; Sun Hee PARK ; Myung Hwan BAE ; Jang Hoon LEE ; Dong Heon YANG ; Hun Sik PARK ; Yongkeun CHO ; Shung Chull CHAE
International Journal of Arrhythmia 2016;17(4):167-173
BACKGROUND AND OBJECTIVES: Optimal international normalized ratio (INR) in elderly atrial fibrillation (AF) patients at higher risk of hemorrhagic events remains unclear. We investigated the efficacy and safety of low-intensity warfarin therapy (target international normalized ratio [INR], 1.6-2.6) in elderly Korean patients with nonvalvular AF (NVAF). SUBJECTS AND METHODS: We enrolled 528 NVAF patients (mean age, 67±9 years; 361 men) who were actively taking warfarin. Major events were defined based on the annual rates of ischemic stroke, systemic embolism, and major bleeding events requiring blood transfusion or hospitalization. Time in therapeutic range (TTR) was 45±19% for all patients. RESULTS: Ischemic stroke and systemic embolism occurred in 20 patients with INR between 1.00 and 2.44 (16 ischemic strokes and 4 systemic embolisms) and major bleeding in 37 patients with INR between 1.74 and no coagulation (exceed laboratory detection capability, more than 10 [7 intracranial hemorrhages, 21 gastrointestinal bleedings, and 9 others]). Incidence rates of ischemic or hemorrhagic events at INR<2.00, 2-3, and >3 were 3.0%, 1.4%, and 20.1% per year, respectively. In patients who were ≥70 years old, CHADS₂, CHA₂DS₂VASc, and HAS-BLED scores were significantly higher compared with those in patients who were <70 years old. When we applied the INR between 1.6 and 2.6, as recommended by the Japanese AF Guideline for patients≥70 years old, the TTR increased from 43.8% to 58.6%. In addition, ischemic or hemorrhagic event rates decreased from 1.9% to 1.2% within the optimal INR range. CONCLUSION: Low-intensity warfarin therapy (INR, 1.6-2.6) should be considered in elderly Korean patients with NVAF.
Aged*
;
Asian Continental Ancestry Group
;
Atrial Fibrillation*
;
Blood Transfusion
;
Embolism
;
Hemorrhage
;
Hospitalization
;
Humans
;
Incidence
;
International Normalized Ratio*
;
Intracranial Hemorrhages
;
Stroke
;
Warfarin*
7.Multiple Fistula Emptying into the Left Ventricle through the Entire Left Ventricular Wall.
Dong Yeub LEE ; Seon Hee PARK ; Myeong Hwan BAE ; Jang Hun LEE ; Dong Heon YANG ; Hun Sik PARK ; Yongkeun CHO ; Shung Chull CHAE ; Jae Eun JUN
Journal of Cardiovascular Ultrasound 2012;20(2):108-111
Coronary artery fistulae are usually identified during invasive coronary angiographies. However, in this case, we made the early detection of coronary artery fistulae during non-invasive transthoracic echocardiography, by demonstrating diastolic multiple abnormal color Doppler flows on the entire left ventricular walls including left ventricular free wall, interventricular septum and apex, which were mimicking firecracker on the whole left ventricle. Fistulous communication from the coronary artery to the left ventricle is rare. Moreover, a case of multiple coronary fistulae emptying into the left ventricle through the entire left ventricular walls including left ventricular free wall, interventricular septum and apex is uncommon. We report a case of a 31-year-old woman who was diagnosed with multiple fistula communicating with entire left ventricular wall.
Adult
;
Coronary Angiography
;
Coronary Vessels
;
Echocardiography
;
Female
;
Fistula
;
Heart Ventricles
;
Humans
8.A Case of Chronic Periaortitis with Retroperitoneal Fibrosis.
Sun Hee PARK ; Churl Hyun IM ; Dong Heon YANG ; Jong Wan KANG ; Jae Yong YOON ; Hyun Jun CHO ; Hun Sik PARK ; Yongkeun CHO ; Shung Chull CHAE ; Jae Eun JUN
Korean Circulation Journal 2012;42(12):857-860
A 73-year-old man with a history of hypertension and ascending aortic dissection was hospitalized for aggravated abdominal pain and general ache for 3 months. Follow-up CT showed aggravated abdominal aortic hematoma with aneurysm, atherosclerotic periaortitis and bilateral hydronephrosis. An initial laboratory finding showed elevated levels of inflammatory markers and renal dysfunction. Positron emission tomography-CT showed an increased standardized uptake values level in the aortic arch, descending thoracic aorta, major branch, abdominal aorta, and common iliac artery. For bilateral hydronephrosis, a double J catheter insertion was performed. Tissue specimens obtained from previous surgery on the aorta indicated the infiltration of lympho-plasma cells without granuloma formation in the aortic wall. After a combined therapy of high dose steroid therapy with azathioprine, the patient's initial complaints of abdominal pain, weakness and azotemia improved. This case was diagnosed as chronic periaortitis based on aortic inflammation at biopsy, which was complicated with retroperitoneal fibrosis and ureteric obstruction.
Abdominal Pain
;
Aneurysm
;
Aorta
;
Aorta, Abdominal
;
Aorta, Thoracic
;
Azathioprine
;
Azotemia
;
Biopsy
;
Catheters
;
Electrons
;
Follow-Up Studies
;
Granuloma
;
Hematoma
;
Hydronephrosis
;
Hypertension
;
Iliac Artery
;
Inflammation
;
Retroperitoneal Fibrosis
;
Ureter
9.Epinephrine-Induced Polymorphic Ventricular Tachycardia in a Patient With Congenital Long QT Syndrome.
Jae Hee KIM ; Sun Hee PARK ; Kyun Hee KIM ; Won Suk CHOI ; Jung Kyu KANG ; Na Young KIM ; Yongkeun CHO
Korean Circulation Journal 2009;39(9):386-388
A 24-year-old woman presented to the department of plastic surgery for surgical excision of a nevus on her nose. Although her history failed to reveal any cardiac disease, her pre-operative electrocardiogram (ECG) showed an extremely prolonged QT interval of up to 528 msec. Repeated history-taking after admission revealed three syncopal episodes associated with both physical and emotional stress, and because the two-dimensional echocardiography and exercise ECG test were normal except for the prolonged QT interval, an epinephrine test was done to assess QT interval changes after an epinephrine infusion. Immediately after a bolus injection of epinephrine (0.1 microgram/kg), marked prolongation of the QT interval developed, followed by polymorphic ventricular tachycardia which was immediately terminated with direct current shock, resulting in the diagnosis of a long QT syndrome (LQTS), probably type 1. Gene studies were recommended, but declined by the patient and her family. She was instructed to avoid competitive sports, and a beta-blocker was prescribed after which she remained symptom-free.
Echocardiography
;
Electrocardiography
;
Epinephrine
;
Female
;
Heart Diseases
;
Humans
;
Long QT Syndrome
;
Nevus
;
Nose
;
Shock
;
Sports
;
Stress, Psychological
;
Surgery, Plastic
;
Syncope
;
Tachycardia, Ventricular
;
Young Adult
10.Predictors of Weight Reduction and Smoking Cessation in Overweight and Obese Patients with Acute Myocardial infarctions.
Jung Kyu KANG ; Jang Hoon LEE ; Su Young HA ; Myung Hwan BAE ; Dong Heon YANG ; Hun Sik PARK ; Yongkeun CHO ; Shung Chull CHAE ; Jae Eun JUN
Yeungnam University Journal of Medicine 2011;28(1):20-30
BACKGROUND: Little is known about predictors of lifestyle modification in overweight or obese patients with acute myocardial infarctions. METHODS: Between October 2005 and May 2007, 311 overweight or obese patients with an AMI visited Kyungpook National University Hospital. Among them, 216 patients (63+/-11 years old, 144 males) with > or =1 year of follow-up were included. RESULTS: Body weight of all patients showed a significant decrease and 20% showed a >3% weight reduction at 1 year of follow-up. Ninety-six (44%) patients were smoking at baseline, and 52% of them had quit by 1 year of follow-up. Only six smokers were successful with both a >3% weight reduction and smoking cessation. In multivariate analysis, age (OR 1.084, 95% CI 1.028-1.144, p=0.003) and smoking cessation (OR 0.167, 95% CI 0.048-0.575, p=0.005) were independent predictors of weight reduction. Abdominal circumference was a negative predictor of smoking cessation (OR 0.903, 95% CI 0.820-0.994, p=0.037). CONCLUSIONS: Mean body weight of all patients showed a significant decrease at follow-up. Smoking cessation and age were independent predictors of weight reduction, and abdominal circumference was a negative predictor of smoking cessation.
Body Weight
;
Follow-Up Studies
;
Humans
;
Life Style
;
Multivariate Analysis
;
Myocardial Infarction
;
Overweight
;
Smoke
;
Smoking
;
Smoking Cessation
;
Weight Loss