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.

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

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

No abstract available.
Erythrocytes ; Imaging, Three-Dimensional ; Microscopy

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*

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

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