1.Prevalence and Anatomy of Aberrant Right Subclavian Artery Evaluated by Computed Tomographic Angiography at a Single Institution in Korea
Yunsuk CHOI ; Sang Bong CHUNG ; Myoung Soo KIM
Journal of Korean Neurosurgical Society 2019;62(2):175-182
OBJECTIVE: Aberrant right subclavian artery (ARSA) is a rare anatomical variant of the origin of the right subclavian artery. ARSA is defined as the right subclavian artery originating as the final branch of the aortic arch. The purpose of this study is to determine the prevalence and the anatomy of ARSA evaluated with computed tomography (CT) angiography.METHODS: CT angiography was performed in 3460 patients between March 1, 2014 and November 30, 2015 and the results were analyzed. The origin of the ARSA, course of the vessel, possible inadvertent ARSA puncture site during subclavian vein catheterization, Kommerell diverticula, and associated vascular anomalies were evaluated. We used the literature to review the clinical importance of ARSA.RESULTS: Seventeen in 3460 patients had ARSA. All ARSAs in 17 patients originated from the posterior aspect of the aortic arch and traveled along a retroesophageal course to the right thoracic outlet. All 17 ARSAs were located in the anterior portion from first to fourth thoracic vertebral bodies and were located near the right subclavian vein at the medial third of the clavicle. Only one of 17 patients presented with dysphagia.CONCLUSION: It is important to be aware ARSA before surgical approaches to upper thoracic vertebrae in order to avoid complications and effect proper treatment. In patients with a known ARSA, a right transradial approach for aortography or cerebral angiography should be changed to a left radial artery or transfemoral approach.
Angiography
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Aorta, Thoracic
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Aortography
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Catheterization
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Catheters
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Cerebral Angiography
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Clavicle
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Deglutition Disorders
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Diverticulum
;
Humans
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Korea
;
Prevalence
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Punctures
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Radial Artery
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Subclavian Artery
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Subclavian Vein
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Thoracic Vertebrae
2.A Type 1 Persistent Proatlantal Artery Originating from the External Carotid Artery Detected by Computed Tomographic Angiography
Yunsuk CHOI ; Sang Bong CHUNG ; Myoung Soo KIM
Journal of Cerebrovascular and Endovascular Neurosurgery 2018;20(4):231-234
A persistent proatlantal artery (PA) is rare. We report a type 1 persistent PA originating from the right external carotid artery (ECA). A 78-year-old woman presented with dizziness. Computed tomographic (CT) angiography showed a persistent PA originating from the right ECA. This persistent PA did not pass through the atlas transverse foramen. The extracranial segment of this artery in the atlas transverse process level had a more lateral position than a normal left vertebral artery. CT angiography well demonstrated the relationship with bony structures and the course of this persistent PA. This anomalous artery in our patient presented as an incidental finding. Surgeon should recognize a persistent PA when performing carotid endarterectomy or ligation of the ECA for avoidance of complication.
Aged
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Angiography
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Arteries
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Carotid Artery, External
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Dizziness
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Embryonic Development
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Endarterectomy, Carotid
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Female
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Humans
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Incidental Findings
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Ligation
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Pregnancy
;
Vertebral Artery
4.Pancreatic Metastasis from Invasive Ductal Carcinoma of the Breast.
Jin Hee NOH ; Su Jin KOH ; Hye Jeong CHOI ; Hee Jeong JEON ; Jae Sung AHN ; Yunsuk CHOI ; Young Joo MIN
Korean Journal of Medicine 2017;92(3):308-311
Pancreatic metastases from primary breast cancer are very rare. We report a case of pancreatic metastasis from invasive ductal carcinoma 13 years after the initial diagnosis of breast cancer. When the pancreatic mass was discovered, it was believed to be a primary pancreatic cancer due to the long interval from the initial diagnosis of breast cancer to metastasis. However, it was confirmed as metastatic breast cancer based on the pathology after surgical removal. Follow-up imaging has shown no recurrence.
Breast Neoplasms
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Breast*
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Carcinoma, Ductal*
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Diagnosis
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Follow-Up Studies
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Neoplasm Metastasis*
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Pancreatic Neoplasms
;
Pathology
;
Recurrence
5.A Case Report of Rituximab Therapy for Recurrent Thrombotic Thrombocytopenia Purpura.
Seungbum LEE ; Je Hwan LEE ; Yunsuk CHOI ; Ji Hee YU ; Yoon Hee CHUN ; Won Jung CHOI ; Sang Su JUNG
Korean Journal of Hematology 2009;44(3):193-197
Thrombotic thrombocytopenic purpura (TTP) is a rare medical condition characterized by thrombocytopenia, microangiopathic hemolytic anemia, neurologic manifestations, and infrequently, renal involvement. In many cases, TTP is associated with deficiency of the von Willebrand factor-cleaving protease, ADAMTS13, and treatment with plasma exchange is effective in the majority of patients. We report a patient with acute TTP in whom remission was not achieved by initial treatment consisting of plasma exchange and corticosteroids. In view of the severe autoantibody-mediated ADAMTS-13 deficiency, treatment was initiated with rituximab, a chimeric monoclonal antibody directed against the CD 20 antigen present on B lymphocytes. The patient received 4 weekly infusions of rituximab (375 mg/m2). Four weeks after the last infusion of rituximab, a complete clinical and laboratory remission was documented. We conclude that rituximab should be considered in patients with TTP with acquired ADAMTS-13 deficiency, who fail to respond to standard treatment with plasma exchange and corticosteroids. Rituximab may result in a lowered requirement for plasmapheresis and avoid the complications of salvage immunosuppressive therapy.
Adrenal Cortex Hormones
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Anemia, Hemolytic
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Antibodies, Monoclonal, Murine-Derived
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B-Lymphocytes
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Humans
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Neurologic Manifestations
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Plasma Exchange
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Plasmapheresis
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Purpura
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Purpura, Thrombotic Thrombocytopenic
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Thrombocytopenia
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Thymine Nucleotides
;
Rituximab
6.Prognostic significance of BLK expression in R-CHOP treated diffuse large B-cell lymphoma
Soyeon CHOI ; Yoo Jin LEE ; Yunsuk CHOI ; Misung KIM ; Hyun-Jung KIM ; Ji Eun KIM ; Sukjoong OH ; Seoung Wan CHAE ; Hee Jeong CHA ; Jae-Cheol JO
Journal of Pathology and Translational Medicine 2022;56(5):281-288
Background:
The aim of the present study was to evaluate the prognostic significance of B-cell lymphocyte kinase (BLK) expression for survival outcomes in diffuse large B-cell lymphoma (DLBCL) patients treated with R-CHOP.
Methods:
We retrospectively analyzed the medical records of 89 patients from two tertiary referral hospitals. The expression of BLK, SYK, and CDK1 were evaluated in a semiquantitative method using an H-score, and the proportions of BCL2 and C-MYC were evaluated.
Results:
A total of 89 patients received R-CHOP chemotherapy as a first-line chemotherapy. The expression rates of BLK in tumor cells was 39.2% (n = 34). BLK expression status was not significantly associated with clinical variables; however, BLK expression in tumor cells was significantly associated with the expression of both C-MYC and BCL2 (p = .003). With a median follow-up of 60.4 months, patients with BLK expression had significantly lower 5-year progression-free survival (PFS) and overall survival rates (49.8% and 60.9%, respectively) than patients without BLK expression (77.3% and 86.7%, respectively). In multivariate analysis for PFS, BLK positivity was an independent poor prognostic factor (hazard ratio, 2.208; p = .040).
Conclusions
Here, we describe the clinicopathological features and survival outcome according to expression of BLK in DLBCL. Approximately 39% of DLBCL patients showed BLK positivity, which was associated as a predictive marker for poor prognosis in patients who received R-CHOP chemotherapy.
7.Expression and prognostic significance of microRNAs in Korean patients with myelodysplastic syndrome
Yunsuk CHOI ; Eun Hye HUR ; Ju Hyun MOON ; Bon Kwan GOO ; Dae Ro CHOI ; Je Hwan LEE
The Korean Journal of Internal Medicine 2019;34(2):390-400
BACKGROUND/AIMS:
Various alterations of microRNA (miRNA) expression have been reported in myelodysplastic syndrome (MDS). We aimed to investigate the unique patterns and prognostic significance of miRNA expression in Korean patients with MDS.
METHODS:
Bone marrow mononuclear cells were collected from eight healthy controls and 26 patients with MDS, and miRNAs were isolated and assessed via quantitative real-time polymerase chain reaction for selected miRNAs, including miR-21, miR-124a, miR-126, miR-146b-5p, miR-155, miR-182, miR-200c, miR-342-5p, miR-708, and Let-7a.
RESULTS:
MiR-124a, miR-155, miR-182, miR-200c, miR-342-5p, and Let-7a were significantly underexpressed in patients with MDS, compared to healthy controls. MiR-21, miR-126, 146b-5p, and miR-155 transcript levels were significantly lower in international prognostic scoring system lower (low and intermediate-1) risk MDS than in higher (intermediate-2 and high) risk MDS. Higher expression levels of miR-126 and miR-155 correlated with significantly shorter overall survival and leukemia-free survival. Higher miR-124a expression also tended to be related to shorter survivals.
CONCLUSIONS
Although our study was limited by the relatively small number of patients included, we identified several miRNAs associated with pathogenesis, leukemic transformation, and prognosis in MDS.
8.Healthcare-Associated Pneumonia among Hospitalized Patients: Is It Different from Community Acquired Pneumonia?.
Gil Myung SEONG ; Miok KIM ; Jaechun LEE ; Jong Hoo LEE ; Sun Young JEONG ; Yunsuk CHOI ; Woo Jeong KIM
Tuberculosis and Respiratory Diseases 2014;76(2):66-74
BACKGROUND: The increasing number of outpatients with multidrug-resistant (MDR) pathogens has led to a new category of pneumonia, termed healthcare-associated pneumonia (HCAP). We determined the differences in etiology and outcomes between patients with HCAP and those with community-acquired pneumonia (CAP) to clarify the risk factors for HCAP mortality. METHODS: A retrospective study comparing patients with HCAP and CAP at Jeju National University Hospital. The primary outcome was 30-day mortality. RESULTS: A total of 483 patients (208 patients HCAP, 275 patients with CAP) were evaluated. Patients with HCAP were older than those with CAP (median, 74 years; interquartile range [IQR], 65-81 vs. median, 69 years; IQR, 52-78; p<0.0001). Streptococcus pneumoniae was the major pathogen in both groups, and MDR pathogens were isolated more frequently from patients with HCAP than with CAP (18.8% vs. 4.9%, p<0.0001). Initial pneumonia severity was greater in patients with HCAP than with CAP. The total 30-day mortality rate was 9.9% and was higher in patients with HCAP based on univariate analysis (16.3% vs. 5.1%; odds ratio (OR), 3.64; 95% confidence interval (CI), 1.90-6.99; p<0.0001). After adjusting for age, sex, comorbidities, and initial severity, the association between HCAP and 30-day mortality became non-significant (OR, 1.98; 95% CI, 0.94-4.18; p=0.167). CONCLUSION: HCAP was a common cause of hospital admissions and was associated with a high mortality rate. This increased mortality was related primarily to age and initial clinical vital signs, rather than combination antibiotic therapy or type of pneumonia.
Anti-Bacterial Agents
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Comorbidity
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Drug Resistance
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Humans
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Mortality
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Odds Ratio
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Outpatients
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Pneumonia*
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Retrospective Studies
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Risk Factors
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Streptococcus pneumoniae
;
Vital Signs
9.Bone marrow metastasis of small cell lung carcinoma with spontaneous tumor lysis syndrome without hepatic metastasis at diagnosis: first case report in Korea and review of literature
Sang Hyuk PARK ; Ji Hun LIM ; Joseph JEONG ; Seon Ho LEE ; Hee Jeong CHA ; Yunsuk CHOI ; Jae Cheol JO
Blood Research 2019;54(3):231-233
No abstract available.
Bone Marrow
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Diagnosis
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Korea
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Neoplasm Metastasis
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Small Cell Lung Carcinoma
;
Tumor Lysis Syndrome
10.High-grade nodal marginal zone lymphoma with diffuse bone marrow involvement and IgM-type monoclonal paraproteinemia: a case report and review of the literature
Sang Hyuk PARK ; Jaewook KIM ; Joseph JEONG ; Seon Ho LEE ; Hee Jeong CHA ; Seol Hoon PARK ; Yunsuk CHOI ; Jae Cheol JO ; Ji Hun LIM
Blood Research 2019;54(3):229-231
No abstract available.
Bone Marrow
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Lymphoma
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Paraproteinemias