1.An Iliac Arteriovenous Fistula and Pseudoaneurysm after Lumbar Disc Surgery.
Chul An JEONG ; Kwan Ho PARK ; Yun Gu JO
Journal of Korean Neurosurgical Society 2004;36(5):415-418
Lumbar disc surgery is a common operation with rare vascular complications. The authors report a case of iliac arteriovenous(AV) fistula and pseudoaneurysm as a complication of lumbar disc surgery. A 52-year-old man underwent lumbar disc surgery 14 months prior to the admission. His chief complaints were progressive pain and swelling on the left lower limb. Contrast medium enhanced computed tomography(CT) scan showed dilatation in both iliac veins, right iliac AV fistula, and an pseudoaneurysm. Angiogram demonstrated a pseudoaneurysm originated from the right common iliac artery, associated left iliac vein compression, and dilatation in both iliac veins. The patient was treated with an endovascular stent placement. Angiogram obtained after stent grafting demonstrated elimination of the pseudoaneurysm, occlusion of the AV fistula, and right iliac artery patency. One month after the stent placement, his leg pain and swelling were improved markedly. A high suspicion based on clinical signs, CT scan, and angiography are important in the early detection of AV fistula. An endovascular stent placement is considered a promising treatment in select patients with iliac AV fistulae and pseudoaneurysms.
Aneurysm, False*
;
Angiography
;
Arteriovenous Fistula*
;
Blood Vessel Prosthesis
;
Dilatation
;
Fistula
;
Humans
;
Iliac Artery
;
Iliac Vein
;
Leg
;
Lower Extremity
;
Middle Aged
;
Stents
;
Tomography, X-Ray Computed
2.Real-world Treatment Pattern and Outcomes of Hypercalcemia among Solid Tumor Patients
Da Eun SHIN ; Seol Hee PARK ; Sung Hwan KIM ; Sung Yun SUH ; Yun Hee JO ; Yoon Sook CHO ; Seock Ah IM ; Ju Yeun LEE
Korean Journal of Clinical Pharmacy 2019;29(3):166-172
BACKGROUND: Hypercalcemia is an important metabolic emergency condition in cancer patients. Bisphosphonate is the treatment of choice for hypercalcemia, whereas calcitonin and hydration with furosemide are recommended for acute supportive therapy. However, data regarding real-world treatment patterns and outcomes of pharmacological treatments are limited. Therefore, we aimed to investigate the treatment patterns and clinical outcomes of hypercalcemia treatment in solid tumor patients. METHODS: Electronic medical records of 123 adults with solid cancers and albumin-corrected calcium levels >10.5 mg/dL or ionized calcium levels >1.35 mmol/L were reviewed. We retrospectively analyzed the pharmacological treatment and recovery rate according to the severity of hypercalcemia. RESULTS: A total of 177 cases were identified, of which 49 were not treated and 30 were treated with hydration only. In moderate-to-severe cases, 86.5% received pharmacological treatment. Thirty-four cases (19.2%) were treated with bisphosphonate alone and 58 cases (32.8%) were treated with bisphosphonate and calcitonin. In mild hypercalcemia cases, the recovery rate was higher for those receiving hydration only or pharmacological treatment (79.7%) than for those receiving no treatment (61.4%, p = 0.041). Most moderate-to-severe cases were treated with medication and of those treated, 56.3% recovered. The recovery rate was lower in those treated with bisphosphonate alone (38.2%) than in those who underwent calcitonin combination treatment (73.7%, p = 0.001). CONCLUSIONS: Bisphosphonate combined with calcitonin was found to be more effective than bisphosphonate alone for the treatment of moderate-to-severe hypercalcemia. Considering the current shortage of calcitonin, further efforts are required to ensure its stable supply.
Adult
;
Calcitonin
;
Calcium
;
Electronic Health Records
;
Emergencies
;
Furosemide
;
Humans
;
Hypercalcemia
;
Retrospective Studies
3.A case of protruded subserosal myoma through pelvic floor in pregnancy.
Yun Sung JO ; Ji Young KWON ; Hee Sun LIM ; Young Joo MUN ; Sang Hyoung LEE ; Dong Sung JAE ; Gu Taek HAN ; Ki Sung RYU
Korean Journal of Obstetrics and Gynecology 2006;49(12):2641-2645
Myoma is the most common tumor in gynecologic field. As ultrasonography because popular in antenatal care, the more cases of myoma and those adverse effects during pregnancy are more frequently detected. The management of myoma during pregnancy is conservative, but in rare circumstances, surgical intervention including myomectomy may be required. We have experienced a case of protruded subserosal myoma with the uterine cervix in midtrimester of pregnancy. The patient was managed surgically by transvaginal myomectomy and had successfully maintained pregnancy. We report a case of protruded subserosal myoma through pelvic floor in pregnancy with brief review of literatures.
Cervix Uteri
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Female
;
Humans
;
Myoma*
;
Pelvic Floor*
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Pregnancy Trimester, Second
;
Pregnancy*
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Ultrasonography
4.A Case of Locally Recurrent Gastric Cancer at Kim's Tie Site of the Jejunum after a Total Gastrectomy.
Byung Gu BAE ; Byoung Jo SUH ; Hang Jong YU ; Yun Kyung KANG ; Jin Pok KIM
Journal of the Korean Gastric Cancer Association 2005;5(1):52-56
Despite improvements in the surgical treatment of gastric adenocarcinomas, the recurrence rates remain high in patients with advanced-stage disease. Most of the recurrence occurs within 3 years of the surgical resection, and nearly 90% of the patients with recurrence die within 2 years of the diagnosis of recurrence. A recent study analyzed recurrence patterns for patients who had undergone a potentially curative gastrectomy. For those patients, 33% of the recurrences involved locoregional sites, 44% the peritoneum, and 38% distant sites. A 51-year-old female patient was diagnosed with stomach cancer and underwent a total gastrectomy with D2 lymph node dissection during Oct. 1999. The pathologic report indicated a T3N1M0 tumor. We performed immunochemotherapy for 2 years with regular follow up. A gastrofiberscopic examination done during Sep. 2004, cancer recurrence was found at the *Kim's tie site of the jejunual loop. We did an abdominal exploration and a segmental resection of cancer site with pathologically negative resection margins. After the operation, we started secondary chemotherapy with TS-1.
Adenocarcinoma
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Diagnosis
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Drug Therapy
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Female
;
Follow-Up Studies
;
Gastrectomy*
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Humans
;
Jejunum*
;
Lymph Node Excision
;
Middle Aged
;
Peritoneum
;
Recurrence
;
Stomach Neoplasms*
5.Survey study of powered toothbrush with guiding device for oral hygiene improvement.
Yun Soo PARK ; Chul Woo LEE ; Byoung Do HAHM ; Ki Tae KOO ; Tae Il KIM ; Yang Jo SEOL ; Yong Moo LEE ; In Chul RHYU ; Young GU ; Chong Pyoung CHUNG
The Journal of the Korean Academy of Periodontology 2009;39(4):407-412
PURPOSE: This study was performed to evaluate the effect of powered toothbrush with a wireless remote display on the subjective and objective oral hygiene improvement. METHODS: One hundred and fifteen subjects in healthy or mild gingivitis status between the ages of 20 and 90 were recruited and reviewed for study inclusion criteria. At first visit, 115 pre-screened subjects filled in the questionnaire form which consisted of demographic factors, behavioral factors (smoking, alcohol consumption), toothbrushing habits (brushing time and frequency), self-reported oral health status, and self-satisfaction. Baseline clinical indices (Plaque index, Gingival index) were also recorded by a periodontist. Subjects were instructed how to use powered toothbrush with a wireless remote display, and were provided with it. Thirty days after first visit, 90 subjects returned for the second assessment by self-reported questionnaire form and professional clinical checkup. Statistical analysis was performed using paired t-test for the difference between baseline and second visit data. The relationship among variables was examined with chi-square test and Fisher's exact test. RESULTS: Significant differences were not found on self-reported satisfaction related with sex, smoking, alcohol consumption (P<0.05). Self-reported tooth brushing habit was improved in the aspect of brushing time and frequency. Significant differences were found on the self-reported oral health status, self-satisfaction, and clinical indices between the baseline and second visit data (P<0.01). Clinical indices were significantly reduced after using powered toothbrush with a wireless remote display (P<0.01). No adverse reactions were reported during the study period. CONCLUSIONS: Powered toothbrush with a wireless remote display successfully promoted oral hygiene from the subjective and objective viewpoint after 30 days of home usage.
Alcohol Drinking
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Demography
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Gingivitis
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Oral Health
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Oral Hygiene
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Periodontal Index
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Personal Satisfaction
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Surveys and Questionnaires
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Smoke
;
Smoking
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Tooth
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Toothbrushing
6.Treatment of velopharyngeal insufficiency in a patient with a submucous cleft palate using a speech aid: the more treatment options, the better the treatment results
Yun Ha PARK ; Hyun Jun JO ; In Seok HONG ; Dae Ho LEEM ; Jin A BAEK ; Seung O KO
Maxillofacial Plastic and Reconstructive Surgery 2019;41(1):19-
BACKGROUND:
The submucous cleft palate (SMCP) is a type of cleft palate that may result in velopharyngeal insufficiency (VPI). Palate muscles completely separate oral and nasal cavities by closing off the velopharynx during functional processes such as speech or swallow. Also, hypernasality may arise from anatomical or neurological abnormalities in these functions. Treatments of this issue involve a combination of surgical intervention, speech aid, and speech therapy. This case report demonstrates successfully treated VPI resulted from SMCP without any surgical intervention but solely with speech aid appliance and speech therapy.CASE PRESENTATION: A 13-year-old female patient with a speech disorder from velopharyngeal insufficiency that was caused by a submucous cleft palate visited to our OMFS clinic. In the intraoral examination, the patient had a short soft palate and bifid uvula. And the muscles in the palate did not contract properly during oral speech. She had no surgical history such as primary palatoplasty or pharyngoplasty except for tonsillectomy. And there were no other medical histories. Objective speech assessment using nasometer was performed. We diagnosed that the patient had a SMCP. The patient has shown a decrease in speech intelligibility, which resulted from hypernasality. We decided to treat the patient with speech aid (palatal lift) along with speech therapy. During the 7-month treatment, hypernasality measured by a nasometer decreased and speech intelligibility became normal.
CONCLUSIONS
Surgery remains the first treatment option for patients with velopharyngeal insufficiencies from submucous cleft palates. However, there were few reports about objective speech evaluation pre- or post-operation. Moreover, there has been no report of non-surgical treatment in the recent studies. From this perspective, this report of objective improvement of speech intelligibility of VPI patient with SMCP by non-surgical treatment has a significant meaning. Speech aid can be considered as one of treatment options for management of SMCP.
7.Choroid Plexus as the Best Reference Region for Standardized Uptake Value Analysis on C11-Acetate PET/CT for Grading and Predicting Prognosis in Patients with Cerebral Gliomas
Dongwoo KIM ; Arthur CHO ; Sang Hyun HWANG ; KwanHyeong JO ; Jong Hee CHANG ; Mijin YUN
Nuclear Medicine and Molecular Imaging 2020;54(6):274-280
Purpose:
We aimed to compare different reference regions and select one with the most clinical relevance on C11-acetate (ACE) positron emission tomography/computed tomography (PET/CT) in patients with cerebral glioma.
Methods:
We retrospectively reviewed 51 patients with cerebral glioma who underwent baseline ACE PET/CT at diagnosis.Other than the standardized uptake value (SUV) of the primary tumor, SUVs of the reference regions including the normal gray matter, white matter, choroid plexus, and cerebellum were measured. Then, the SUV ratio (SUVR = tumor SUV max /reference region SUV mean ) was calculated. The effect of patient age on the SUV mean of each reference was examined and the SUVRs of each reference region were compared between grades. age, sex, tumor size, histological grades, SUVR , and the presence of isocitrate dehydrogenase (IDH) mutation were included for survival analyses.
Results:
Except for the cerebellum showing a mild negative correlation, we found no correlations between age and SUV mean using the gray matter, white matter, and choroid plexus (r = − 0.280, P < = 0.047). Only the SUVR -choroid plexus was able to differentiate between the WHO grades (Grade II vs. III, P < = 0.035; grade III vs. IV, P < < 0.001; grade II vs. IV, P < 0.001). Multivariate Cox proportional hazards models found that the SUVR-choroid plexus and IDH mutation were statistically significant for predicting OS.
Conclusion
Of the different reference regions used for grading cerebral gliomas, the choroid plexus was found to be the most optimal.In addition, the SUV ratio is useful to predict the overall survival in the model with the choroid plexus as a reference region.
8.Clinical and Genetic Characteristics Associated With Survival Outcome in Late-Onset Huntington’s Disease in South Korea
Yun Su HWANG ; Sungyang JO ; Gu-Hwan KIM ; Jee-Young LEE ; Ho-Sung RYU ; Eungseok OH ; Seung-Hwan LEE ; Young Seo KIM ; Sun Ju CHUNG
Journal of Clinical Neurology 2024;20(4):394-401
Background:
and Purpose The onset of Huntington’s disease (HD) usually occurs before the age of 50 years, and the median survival time from onset is 15 years. We investigated survival in patients with late-onset HD (LoHD) (age at onset ≥60 years) and the associations of the number of mutant CAG repeats and age at onset (AAO) with survival in patients with HD.
Methods:
Patients with genetically confirmed HD at six referral centers in South Korea between 2000 and 2020 were analyzed retrospectively. Baseline demographic, clinical, and genetic characteristics and the survival status as at December 2020 were collected.
Results:
Eighty-seven patients were included, comprising 26 with LoHD (AAO=68.77±5.91 years, mean±standard deviation; 40.54±1.53 mutant CAG repeats) and 61 with common-onset HD (CoHD) (AAO=44.12±8.61 years, 44.72±4.27 mutant CAG repeats). The ages at death were 77.78±7.46 and 53.72±10.86 years in patients with LoHD and CoHD, respectively (p< 0.001). The estimated survival time was 15.21±2.49 years for all HD patients, and 10.74±1.95 and 16.15±2.82 years in patients with LoHD and CoHD, respectively. More mutant CAG repeats and higher AAO were associated with shorter survival (hazard ratio [HR]=1.05, 95% confidence interval [CI]=1.01–1.09, p=0.019; and HR=1.17, 95% CI=1.03–1.31, p=0.013; respectively) for all HD patients. The LoHD group showed no significant factors associated with survival after disease onset, whereas the number of mutant CAG repeats had a significant effect (HR=1.12, 95% CI=1.01–1.23, pp=0.034) in the CoHD group.
Conclusions
Survival after disease onset was shorter in patients with LoHD than in those with CoHD. More mutant CAG repeats and higher AAO were associated with shorter survival in patients with HD.
9.Four cases of gastric submucosal mass suspected as anisakiasis.
Seoung Gu KIM ; Yun Ju JO ; Young Sook PARK ; Sung Hwan KIM ; Moon Hee SONG ; Han Hyo LEE ; Jeong Seon KIM ; Ji Won RYOU ; Jong Eun JOO ; Dong Hoon KIM
The Korean Journal of Parasitology 2006;44(1):81-86
Anisakiasis is a parasitic disease caused by ingestion of raw fish infected with anisakid larvae. Endoscopic changing patterns of submucosal lesions in chronic gastric anisakiasis have not been known yet. Here we report 4 cases of suspected gastric anisakiasis which were improved during follow-up periods without surgical treatment. The patients presented with abdominal pain, nausea and vomiting after consuming raw marine fish, and visited our gastroenterology outpatient department. Their endoscopic findings showed firm and yellowish submucosal masses accompanied with eccentric erosions. Histologic findings showed severe eosinophilic infiltrations. In blood tests, peripheral eosinophil counts and total IgE levels were elevated. We believed that all cases were caused by larval anisakid infections. The submucosal mass lesions disappeared during the follow-up periods of 2 to 4 mo.
Time Factors
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Stomach Neoplasms/diagnosis/pathology
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Seafood/parasitology
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Middle Aged
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Male
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Larva
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Immunoglobulin E/blood
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Humans
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Follow-Up Studies
;
Female
;
Eosinophils/cytology
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Endoscopy, Gastrointestinal/methods
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Diagnosis, Differential
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Chronic Disease
;
Anisakiasis/*diagnosis/parasitology
;
Animals
10.Detection of Clopidogrel Hyporesponsiveness Using a Point-of-Care Assay and the Impact of Additional Cilostazol Administration after Coronary Stent Implantation in Diabetic Patients.
Tae Hyun YANG ; Doo Il KIM ; Dong Kie KIM ; Jae Sik JANG ; Ung KIM ; Sang Hoon SEOL ; Dae Kyeong KIM ; Geu Ru HONG ; Jong Seon PARK ; Dong Gu SHIN ; Young Jo KIM ; Yun Kyeong CHO ; Chang Wook NAM ; Seung Ho HUR ; Kwon Bae KIM ; Dong Soo KIM
The Korean Journal of Internal Medicine 2011;26(2):145-152
BACKGROUND/AIMS: Impaired responsiveness to clopidogrel is common in patients with type 2 diabetes mellitus (DM). The aim of this study was to evaluate the clinical application of a point-of-care assay to detect impaired responsiveness to clopidogrel after coronary stent implantation in patients with type 2 DM. METHODS: We measured P2Y12 reaction units (PRU) with the VerifyNow point-of-care assay in 544 consecutive patients undergoing dual or triple (i.e., dual plus cilostazol) anti-platelet therapy after coronary stent implantation. High platelet reactivity (HPR) was defined as a PRU value > or = 240. RESULTS: The mean PRU values were 233.5 +/- 83.2 and 190.3 +/- 85.5 in patients undergoing dual or triple anti-platelet therapy, respectively (p < 0.001). Patients with DM manifested higher post treatment PRU values (238.3 +/- 82.4 vs. 210.8 +/- 86.8, p = 0.001) and a higher frequency of HPR (44.8% vs. 31.0%, p = 0.003) as compared to patients without DM. We also found that higher PRU values and a higher frequency of HPR were present in patients with DM who were undergoing both triple and dual anti-platelet therapy. However, the higher post-treatment PRU values observed in patients with DM decreased with triple anti-platelet therapy (219.4 +/- 82.5 vs. 247.9 +/- 81.1, p = 0.044). CONCLUSIONS: A point-of-care assay can detect elevated platelet reactivity and impaired responsiveness to clopidogrel in patients with type 2 DM. The addition of cilostazol to dual anti-platelet therapy may decrease post-treatment PRU values in patients with type 2 DM.
Aged
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Angioplasty, Balloon, Coronary/adverse effects/*instrumentation
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Aspirin/administration & dosage
;
Chi-Square Distribution
;
Coronary Disease/blood/*therapy
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Diabetes Mellitus, Type 2/*blood
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Drug Therapy, Combination
;
Female
;
Humans
;
Logistic Models
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Male
;
Middle Aged
;
Platelet Activation/*drug effects
;
Platelet Aggregation Inhibitors/*administration & dosage/adverse effects
;
*Platelet Function Tests
;
*Point-of-Care Systems
;
Predictive Value of Tests
;
Purinergic P2Y Receptor Antagonists/*administration & dosage/adverse effects
;
Registries
;
Republic of Korea
;
Risk Assessment
;
Risk Factors
;
*Stents
;
Tetrazoles/*administration & dosage/adverse effects
;
Ticlopidine/administration & dosage/adverse effects/*analogs & derivatives
;
Treatment Outcome