Background: The risk of device thrombosis and device-oriented clinical outcomes with bioresorbable vascular scaffold (BVS) was reported to be significantly higher than with contemporary drug-eluting stents (DESs). However, optimal device implantation may improve clinical outcomes in patients receiving BVS. The current study evaluated mid-term safety and efficacy of Absorb BVS with meticulous device optimization under intravascular imaging guidance. Methods: The SMART-REWARD and PERSPECTIVE-PCI registries in Korea prospectively enrolled 390 patients with BVS and 675 patients with DES, respectively. The primary endpoint was target vessel failure (TVF) at 2 years and the secondary major endpoint was patientoriented composite outcome (POCO) at 2 years. Results: Patient-level pooled analysis evaluated 1,003 patients (377 patients with BVS and 626 patients with DES). Mean scaffold diameter per lesion was 3.24 ± 0.30 mm in BVS group.Most BVSs were implanted with pre-dilatation (90.9%), intravascular imaging guidance (74.9%), and post-dilatation (73.1%) at proximal to mid segment (81.9%) in target vessel.Patients treated with BVS showed comparable risks of 2-year TVF (2.9% vs. 3.7%, adjusted hazard ratio [HR], 1.283, 95% confidence interval [CI], 0.487–3.378, P = 0.615) and 2-year POCO (4.5% vs. 5.9%, adjusted HR, 1.413, 95% CI, 0.663–3.012,P = 0.370) than those with DES. The rate of 2-year definite or probable device thrombosis (0.3% vs. 0.5%, P = 0.424) was also similar. The sensitivity analyses consistently showed comparable risk of TVF and POCO between the 2 groups. Conclusion With meticulous device optimization under imaging guidance and avoidance of implantation in small vessels, BVS showed comparable risks of 2-year TVF and device thrombosis with DES.

The energy spectra for electron beam of medical linear accelerator were calculated using a GEANT4 Medical Linac 2 example code. The incident electron mean energy were 6, 9, 12, 16, 20 MeV. This code was designed to calculate electron beam energy spectra according to material, thickness and location of electron scattering foil affecting electron beam characteristic. Lead, Copper, Aluminum and Gold were used for scattering foil. The energy distribution for electron and photon were analyzed by changing position of scattering foil in the head of linear accelerator. The effect of electron scattering foil on energy spectra which is basic data of simulation for medical linear accelerator were presented. The calculated results would be used in design of medical accelerator head.
Aluminum ; Copper ; Electrons ; Head ; Particle Accelerators

OBJECTIVE: To evaluate the short-term clinical effects of intra-articular shoulder injection with botulinum toxin type A (BoNT-A) in acute hemiplegic stroke patients with complex regional pain syndrome type I (CRPS I). METHOD: Fifty patients were assigned at random to receive intra-articular shoulder injection. The treatment groups were divided into two groups: BoNT-A group, 200 IU of BoNT-A and 2 ml of normal saline; triamcinolone acetonide (TA) group, 20 mg of triamcinolone and 2 ml of 2% lidocaine. Uptake ratio of quantitative three phase bone scintigraphy (QTPBS) was calculated by dividing the radioactivity count on the affected side by that on the unaffected side. Shoulder pain was assessed by visual analogue scale (VAS) and neuropathic pain scale (NPS). Range of motion (ROM) of shoulder joint and functional independence measurement (FIM) of upper limb were evaluated. All of them were measured before injection, and 4 weeks after injection. RESULTS: After 4 weeks, the uptake ratio of blood pool phase was significantly decreased in hands of BoNT-A group than TA group. VAS, ROM and upper extremity FIM was similarly improved in both groups. Pain intensity and cold pain of NPS were similarly decreased in both groups. Hot pain and dull pain of NPS decreased more significantly in BoNT-A group than TA group. CONCLUSION: In the short-term, intra-articular BoNT-A shoulder injection maybe has the therapeutic effect on acute CRPS I related stroke. And the uptake ratio of blood pool phase of the hand of QTPBS may be useful to assess the therapeutic effect of CRPS after acute stroke.
Botulinum Toxins ; Botulinum Toxins, Type A ; Cold Temperature ; Hand ; Humans ; Lidocaine ; Neuralgia ; Radioactivity ; Range of Motion, Articular ; Shoulder ; Shoulder Joint ; Shoulder Pain ; Stroke ; Triamcinolone ; Triamcinolone Acetonide ; Upper Extremity

PURPOSE: Arteriovenous fistula (AV fistula) and immune suppressive drug have a different effect on wound healing. AV fistula supposed to have a positive role of wound healing by the increased blood flow around the wound. But immunosuppressive drug has a well known effect of delayed wound healing. METHODS: We experienced 55 years old female patient who suffered from 9% burn of TBSA, 2nd to 3rd degree burn of arm and chest wall with arteriovenous fistula in the burned arm. She also take immunosuppressive drugs for 13 years due to kidney transplantation. RESULTS: She takes two consecutive skin graft operations on post admission day 14 and 42. Bleeding from the surface of eschar excised arm was profuse so it makes us unable to finish in the first operation. But graft skins were well taken except partial take-off in chest wall area. Episode of shock make 2nd skin graft postponed for a month but the skin uptake of arm was very successful. CONCLUSION: The arteriovenous fistula has the positive effect in the case of burn wound healing including the skin graft, exceed the negative role of immunosuppressive drugs in the wound healing.
Arm ; Arteriovenous Fistula ; Burns ; Female ; Fistula ; Hemorrhage ; Humans ; Hydrogels ; Kidney ; Shock ; Skin ; Thoracic Wall ; Transplants ; Wound Healing

In the field of the forensic medicine, deciding the cause of the injury is very important. Forensic doctors usually use their naked eyes, two dimensional photos, the characteristics and the distribution of the wounds for evaluating the cause of the injuries. After body release, forensic doctors not infrequently met the questions from the law enforcement whether the injuries were matched with the new facts or statements given through the progression of the investigation. In the face of answering this question, the information or evidence about the injury is insufficient. New technologies and instruments are being developed and will be helpful for getting the evidence from the human skin injuries. In this preliminary study, authors try to find the usefulness of appraisal techniques(3D scanner, trace evidence, TMDT, alternative light) that are already used for other purposes in forensic field. These techniques have their own merits for preserving the evidences from the injured skin. But further studies and systemic approaches are essential for more scientifically verified evaluation of the cause of the skin injury.
Humans

BACKGROUND/AIMS: Recently, living donor liver transplantation (LDLT) has been frequently performed in Korea because of the limited availability of a cadaveric donor (CD). We evaluated the clinical features of patients with biliary complications after liver transplantation and we compared the incidence of biliary complications according to the type of donor and the anastomotic type of the biliary tract. METHODS: Between May 1996 and July 2004, 300 patients (CDLT 102/LDLT 198) underwent liver transplantation at Samsung Medical Center. The patients who experienced biliary complications during the follow-up period were enrolled to the study and we retrospectively reviewed their cases. RESULTS: Sixty-seven cases (23%) of biliary complications were noticed in 53 patients (18%). The complications consisted of 20 cases (7%) of bile leakage, 38 cases (13%) of biliary strictures, 7 cases (2%) of biliary stones, and 2 cases (1%) of biliary stenosis due to other cause. There was no significant difference on the incidence of complications between CDLT (15/102; 14.7%) and LDLT (38/198; 19.2%) (p=0.42). In addition, there was no significant difference between choledocho-choledochostomy (43/237; 18.1%) and hepatico-jejunostomy (10/ 63; 15.9%)(p=0.85) CONCLUSIONS: The incidence rate of biliary complication after liver transplantation was 23%, and there was no difference according to the type of donor and the anastomotic type of biliary tract.
Adult* ; Bile ; Biliary Tract ; Cadaver ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Liver Transplantation* ; Liver* ; Living Donors ; Retrospective Studies ; Tissue Donors

PURPOSE: By virtue of advances in scientific methods and technical systems, there has been a rapid growth in the number of end stage renal disease (ESRD) patients treated using continuous ambulatory peritoneal dialysis (CAPD) as their primary renal replacement therapy. However, there are various catheter related complications that are limiting factors in patient and catheter maintenance. This study was aimed at introducing of the techniques of CAPD catheter implantation designed for reducing the complication rate, as well as conducting an investigation of the incidence of CAPD catheter related complications and patient survival and catheter survival rates. METHODS: We performed 234 cases of CAPD catheter implantation using a conventional surgical method (n=162, between January 1993 and December 1997) or a modified surgical method (n=72, between January 1998 and December 1999), and retrospectively reviewed the patient's medical records to elucidate the incidence of early catheter related complications and the catheter removal rate in relation to the surgical methods. RESULTS: There were 21 cases (23.8%) of peritonitis in the modified group, which was less than that in the conventional group (79 cases, 48.8%) (P=0.036). There were 9 cases (12.5%) of exit site and tunnel infection in the modified group, which was less than that in the conventional group (36 cases, 22.2%) (P=0.019). We were able to reduce the peritonitis as well as exit site and tunnel infection by a long segment of tunneling and immobilization of the catheter to the skin. Nine cases of leakage (5.5%) have occurred in the conventional group and one case (1.3%) in the modified group; the difference was statistically significant (P=0.046). CONCLUSION: These results indicate that our modified surgical methods can reduce the rate of early catheter related complications.
Catheters* ; Humans ; Immobilization ; Incidence ; Kidney Failure, Chronic ; Medical Records ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Renal Replacement Therapy ; Retrospective Studies ; Skin ; Survival Rate ; Virtues

Paraganglioma of the cauda equina or filum terminale is rare tumor and was first described in 1970. The authors present a case of paraganglioma of the cauda equina in a 55 year-old-man with nonspecific back pain. To our knowledge, there has been only a few report of MRI of a paraganglioma of the cauda equina. Diagnosis can be made with immunohistochemical study and electron microscopy after surgical removal. Because of frequent recurrence, total excision is mandatory.
Back Pain ; Cauda Equina* ; Diagnosis ; Magnetic Resonance Imaging ; Microscopy, Electron ; Paraganglioma* ; Recurrence

We report a case of B-cell lymphoma primarily involving the skin in a 12-year-old boy. The histopathologic findings were compatible with those of small lymphocytic type of non-Hodgkin's lymphoma. A cutaneous lesion was the sole manifestation of his disease without any other organ involvement. Immunophenotypic studies and immunoglobulin gene rearrangement with Southern blot analysis determined its lineages and monoclonality with result of B-cell lineage neoplasm, i. d. CD20⁺, C1323⁺, CD35⁻ and rearranged band on JH probe. We treated him with surgical excision and CVP regimen of chemotherapy (cyclophosphamide, vincristine, prednisolone). There is no recurrence or metastasis during the last six months.
B-Lymphocytes ; Blotting, Southern ; Child ; Drug Therapy ; Genes, Immunoglobulin ; Humans ; Immunophenotyping ; Lymphoma, B-Cell* ; Lymphoma, Non-Hodgkin ; Male ; Neoplasm Metastasis ; Recurrence ; Skin ; Vincristine

A case of rare symptomatic cerebellopontine angle lipoma treated by surgical decompression is described. In this 28-year-old male with intermittent facial pain 17 years, a mass was noted in the right cerebellopontine angle on C-T and MRI. Partial removal of the mass was made for decompression of the lesion from the trigeminal nerve root entry zone. The surgical biopsy results was lipoma. This represents, to our knowledge, the first lipoma in the cerebellopontine angle reportes in the Korean literature.
Adult ; Biopsy ; Cerebellopontine Angle* ; Decompression ; Decompression, Surgical ; Facial Pain ; Humans ; Lipoma* ; Magnetic Resonance Imaging ; Male ; Neuroma, Acoustic ; Trigeminal Nerve ; Trigeminal Neuralgia*