1
|
Kim DH, Kang UR, Kim YH, Cha JG. Folded-Loop Guidewire Remodeling Technique: Catheterizing Markedly Angulated Branches during Intravascular Embolization. J Korean Soc Radiol 2023; 84:418-426. [PMID: 37051382 PMCID: PMC10083636 DOI: 10.3348/jksr.2022.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/06/2022] [Accepted: 07/20/2022] [Indexed: 02/21/2023]
Abstract
Purpose Practical challenges are encountered in percutaneous intravascular procedures when applied to markedly angulated branching vessels. Herein, we introduced a folded-loop guidewire remodeling technique-the guidewire-shaping technique-to overcome difficult catheterization. Materials and Methods First, the tip of a 0.014-inch micro-guidewire was manually shaped like a pigtail loop. Second, the shaped guidewire was introduced into the microcatheter and was preloaded into the hollow metal introducer for suitability with the microcatheter hub. Gentle rotation of the guidewire after release from the microcatheter can create the preshaped pigtail loop configuration. On pulling back, the loop loosened, the configuration was changed to a small U-shaped tip, and the guidewire tip was easily introduced into the target artery. Results Between December 2019 and January 2022, the described technique was used in 64 patients (male/female, 49/15; mean age, 66.8 ± 9.5 years) for selective arterial embolization, after failed attempts with the conventional selection technique. The technique was successful in 63/64 patients (98%). The indications of embolization include transcatheter arterial chemoembolization, gastrointestinal bleeding, hemoptysis, trauma-induced bleeding, and tumor bleeding. Conclusion The folded-loop guidewire remodeling technique facilitates the catheterization of markedly angulated branching arteries; when usual catheterization method fails.
Collapse
Affiliation(s)
- Dong Hyun Kim
- Department of Radiology, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Ung Rae Kang
- Department of Radiology, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Young Hwan Kim
- Department of Radiology, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jung Guen Cha
- Department of Radiology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| |
Collapse
|
2
|
Vu HD, Huynh PT, Ryu J, Kang UR, Youn SW, Kim H, Ahn HJ, Park K, Hwang SK, Chang YC, Lee YJ, Lee HJ, Lee J. Melittin-loaded Iron Oxide Nanoparticles Prevent Intracranial Arterial Dolichoectasia Development through Inhibition of Macrophage-mediated Inflammation. Int J Biol Sci 2021; 17:3818-3836. [PMID: 34671201 PMCID: PMC8495379 DOI: 10.7150/ijbs.60588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/22/2021] [Indexed: 12/24/2022] Open
Abstract
Rationale: In intracranial arterial dolichoectasia (IADE) development, the feedback loop between inflammatory cytokines and macrophages involves TNF-α and NF-κB signaling pathways and leads to subsequent MMP-9 activation and extracellular matrix (ECM) degeneration. In this proof-of-concept study, melittin-loaded L-arginine-coated iron oxide nanoparticle (MeLioN) was proposed as the protective measure of IADE formation for this macrophage-mediated inflammation and ECM degeneration. Methods: IADE was created in 8-week-old C57BL/6J male mice by inducing hypertension and elastase injection into a basal cistern. Melittin was loaded on the surface of ION as a core-shell structure (hydrodynamic size, 202.4 nm; polydispersity index, 0.158). Treatment of MeLioN (2.5 mg/kg, five doses) started after the IADE induction, and the brain was harvested in the third week. In the healthy control, disease control, and MeLioN-treated group, the morphologic changes of the cerebral arterial wall were measured by diameter, thickness, and ECM composition. The expression level of MMP-9, CD68, MCP-1, TNF-α, and NF-κB was assessed from immunohistochemistry, polymerase chain reaction, and Western blot assay. Results: MeLioN prevented morphologic changes of cerebral arterial wall related to IADE formation by restoring ECM alterations and suppressing MMP-9 expression. MeLioN inhibited MCP-1 expression and reduced CD68-positive macrophage recruitments into cerebral arterial walls. MeLioN blocked TNF-α activation and NF-κB signaling pathway. In the Sylvian cistern, co-localization was found between the CD68-positive macrophage infiltrations and the MeLioN distributions detected on Prussian Blue and T2* gradient-echo MRI, suggesting the role of macrophage harboring MeLioN. Conclusions: The macrophage infiltration into the arterial wall plays a critical role in the MMP-9 secretion. MeLioN, designed for ION-mediated melittin delivery, effectively prevents IADE formation by suppressing macrophage-mediated inflammations and MMP activity. MeLioN can be a promising strategy preventing IADE development in high-risk populations.
Collapse
Affiliation(s)
- Huy Duc Vu
- Department of Radiology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Phuong Tu Huynh
- Department of Radiology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Junghwa Ryu
- Department of Radiology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Ung Rae Kang
- Department of Radiology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Sung Won Youn
- Department of Radiology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hongtae Kim
- Department of Anatomy, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hyun Jin Ahn
- Department of Pathology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Kwankyu Park
- Department of Pathology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Soon-Kyung Hwang
- Department of Molecular Biology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Young-Chae Chang
- Department of Molecular Biology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Yong Jig Lee
- Department of Plastic Surgery, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hui Joong Lee
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jongmin Lee
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
| |
Collapse
|
3
|
Kim YS, Kang UR, Kim YH. The Spectrum of CT Findings of COVID-19 Pneumonia: Acute Alveolar Insult and Organizing Pneumonia as Different Phases of Lung Injury and Repair. Taehan Yongsang Uihakhoe Chi 2021; 82:359-370. [PMID: 36238728 PMCID: PMC9431937 DOI: 10.3348/jksr.2020.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/31/2020] [Accepted: 12/09/2020] [Indexed: 12/05/2022]
Abstract
Purpose To analyze the findings and serial changes in chest CT lesions in 123 symptomatic patients with coronavirus disease 2019 (COVID-19). Materials and Methods From February 19 to April 7, 2020, a total of 123 confirmed COVID-19 patients (male, 44; female, 79; mean age, 59.2 ± 18.6) were enrolled in this retrospective study. A total of 234 CT scans were reviewed for the following patterns: acute alveolar insult (AAI) patterns: ground-glass opacity (GGO), crazy-paving appearance, mixed pattern, and consolidation; organizing pneumonia (OP) patterns: perilobular patterns, band opacity, curvilinear opacity, reversed halo opacity, and small nodular consolidation; resolving patterns: pure GGO, remnant curvilinear, small nodular consolidation, and serial changes of lung abnormalities. We compared the proportions of AAI pattern, OP pattern, or resolving pattern with time progression and analyzed the association between the patterns and disease severity using Pearson chi-square and Fisher's exact test. Results Predominant CT patterns were AAI pattern (87%) in the early hospital period group (0-10 days, after the onset of symptoms), OP pattern (45.7%) in the later hospital period group (after 10 days), and resolving pattern in discharge and follow-up group (47.2% and 84.8%, respectively). The difference in the proportions of predominant CT patterns with time progression was statistically significant (p < 0.001, Pearson's chi-square test). No statistically significant association was observed between the patterns and disease severity (p = 0.055, Fisher's exact test). No fibrous changes in the lesions were observed on follow-up CT scans. Conclusion The serial CT scans of COVID-19 patients showed the spectrum of COVID pneumonia CT manifestations as different phases of lung injury and repair.
Collapse
|
4
|
Park SJ, Kim YH, Kang UR, Ji SW. Successful Treatment of Duodenal Variceal Bleeding with Coil-Assisted Retrograde Transvenous Obliteration: A Case Report. J Korean Soc Radiol 2020; 81:231-236. [PMID: 36238109 PMCID: PMC9432092 DOI: 10.3348/jksr.2020.81.1.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/22/2019] [Accepted: 06/03/2019] [Indexed: 11/17/2022]
Abstract
십이지장 정맥류는 간경화증에 의한 문맥압 고혈압 환자에서 발생할 수 있으며, 치명적인 심한 상부 위장관 출혈을 일으킬 수 있으나 아직까지 명확한 치료 지침이 정립되어 있지는 않다. 일차적으로 내시경으로 치료를 시도하고 지혈 실패 시 목정맥경유간속문맥전신순환연결술, 풍선 혹은 혈관 마개를 이용한 역행성 경정맥 폐색술, 피부간경유 폐색술 등과 같은 중재적 치료를 고려할 수 있다. 저자들은 내시경적 치료에 실패한 십이지장 정맥류 출혈 환자에게 저하된 간 기능과 해부학적인 구조의 제한으로 인해 코일을 이용한 역행성 경정맥 폐색술을 시행하여 성공적으로 치료한 1예를 경험하였기에 이를 보고하고자 한다.
Collapse
Affiliation(s)
- Se Jin Park
- Department of Radiology, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Young Hwan Kim
- Department of Radiology, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Ung Rae Kang
- Department of Radiology, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Seung Woo Ji
- Department of Radiology, CHA Gumi Medical Center, CHA University, Gumi, Korea
| |
Collapse
|
5
|
Park SJ, Kim YH, Kang UR, Ji SW. Transcatheter Arterial Embolization of a Ruptured Superior Rectal Artery Aneurysm in Type 1 Neurofibromatosis: A Case Report. J Korean Soc Radiol 2020; 81:726-732. [PMID: 36238611 PMCID: PMC9431908 DOI: 10.3348/jksr.2020.81.3.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/13/2019] [Accepted: 08/15/2019] [Indexed: 11/25/2022]
Abstract
신경섬유종증 1형은 상염색체우성질환으로 가장 흔한 유전 질환 중 하나이다. 혈관병증은 드물게 발생할 수 있으며, 신경섬유종증 1형 혈관병증은 동맥류, 협착, 동정맥기형의 형태로 나타난다. 동맥류의 경우 자연파열과 같은 치명적인 합병증을 유발할 수 있다. 신경섬유종증 1형과 연관된 하장간막동맥류의 파열로 인한 장간막출혈은 매우 드물게 보고되고 있다. 이에 저자들은 신경섬유종증 1형에 의한 방추형 상직장동맥류의 자발적 파열로 내원한 56세 여성환자에서 코일을 이용한 경도관 동맥 색전술을 시행하여 성공적으로 치료한 1예를 경험하였기에 이를 보고하고자 한다.
Collapse
Affiliation(s)
- Se Jin Park
- Department of Radiology, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Young Hwan Kim
- Department of Radiology, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Ung Rae Kang
- Department of Radiology, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Seung Woo Ji
- Department of Radiology, CHA Gumi Medical Center, CHA University, Gumi, Korea
| |
Collapse
|
6
|
Kim DW, Kim YH, Kang UR. Interventional Treatment of Chemical Pleuritis and Hemothorax Caused by Iatrogenic Internal Jugular Vein Perforation after Central Venous Port System Implantation: A Case Report. J Korean Soc Radiol 2020; 81:1459-1465. [PMID: 36237726 PMCID: PMC9431838 DOI: 10.3348/jksr.2020.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 11/15/2022]
Abstract
항암치료를 위해 흉강 내 속목정맥의 천자를 통한 피하매몰 중심정맥 케모포트(implantable central venous chemoport) 도관의 설치 중 발생할 수 있는 의인성 속목정맥 천공은 매운 드문 합병증 중의 하나로 혈흉이나 출혈성 쇼크를 일으킬 수 있으며, 부적절한 항암제 주입으로 인한 늑막삼출이 발생할 수 있다. 따라서 항암제 주입 전 조기에 진단하여 응급 개흉술을 통해 천공된 속목정맥을 봉합하는 것이 치료 원칙이다. 저자들은 우측 속목정맥을 통한 피하매몰 중심정맥 케모포트의 설치 후 발생한 속목정맥 천공 환자에서 부적절한 항암제 주입으로 인해 발생한 늑막삼출과 혈흉을 개흉술을 시행하지 않고 경피적 배액술 후 코일과 N-butyl cyanoacrylate를 이용한 색전술을 통해 성공적으로 치료한 1예를 경험하였기에 이를 보고하고자 한다.
Collapse
Affiliation(s)
- Do Woo Kim
- Department of Radiology, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Young Hwan Kim
- Department of Radiology, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Ung Rae Kang
- Department of Radiology, Daegu Catholic University College of Medicine, Daegu, Korea
| |
Collapse
|
7
|
Gu MJ, Yi JH, Kim YH, Lee HJ, Kang UR, Ji SW. Comparative Analysis of Image Quality and Adverse Events between Iopamidol 250 and Ioversol 320 in Hepatic Angiography for Transcatheter Arterial Chemoembolization. J Korean Soc Radiol 2020; 81:166-175. [PMID: 36238118 PMCID: PMC9432096 DOI: 10.3348/jksr.2020.81.1.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 12/02/2022]
Abstract
목적 간세포암의 화학색전술에 사용되는 조영제인 Ioversol 320과 Iopamidol 250을 영상 화질과 유해반응에서 차이가 있는지 비교 분석하고자 하였다. 대상과 방법 경동맥 화학색전술을 시행 받은 113명의 간세포암 환자를 대상으로 후향적으로 분석하였고, Iopamidol 250은 44명, Ioversol 320은 69명에게 주입하였다. 영상 화질은 혈관 인지도 및 일치도로 평가하였다. 혈관인지도는 두 명의 영상의학과 전문의가 간동맥 혈관조영술에서 간세분엽동맥, 췌십이지장동맥, 우위동맥, 우위대망동맥이 보이는 인지도와 명확도에 따라 3단계로 점수화하였다. 일치도는 혈관조영술과 전산화단층촬영에서 발견된 간세포암 수를 비교하였다. 시술 전후 임상증상을 조사하여 조영제 유해반응을 평가하였다. 결과 혈관인지도의 평균 점수는 Iopamidol 250은 2.92점, Ioversol 320은 2.94점이었다. 일치도는 Iopamidol 250은 31명(70.5%), Ioversol 320은 46명(66.7%)이 일치했으며, 혈관인지도와 일치도는 통계적 유의한 차이가 없었다(p > 0.05). Iopamidol 250은 1명, Ioversol 320은 6명의 환자가 오심을 호소하였으며, 유해반응 빈도의 유의한 차이는 없었다(p = 0.24). 결론 간세포암 화학색전술에서 Iopamidol 250은 Ioversol 320과 영상의 화질 및 유해반응에 유의한 차이가 없이 사용될 수 있을 것으로 생각된다.
Collapse
Affiliation(s)
- Min Jae Gu
- Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jae Hyuck Yi
- Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Young Hwan Kim
- Department of Radiology, Daegu Catholic University Medical Center, Catholic University of Daegu College of Medicine, Daegu, Korea
| | - Hee Jung Lee
- Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Ung Rae Kang
- Department of Radiology, Daegu Catholic University Medical Center, Catholic University of Daegu College of Medicine, Daegu, Korea
| | - Seung Woo Ji
- Department of Radiology, Daegu Catholic University Medical Center, Catholic University of Daegu College of Medicine, Daegu, Korea
- Department of Radiology, CHA Gumi Medical Center, CHA University, Gumi, Korea
| |
Collapse
|
8
|
Kim DW, Kim YH, Kang UR, Cho JW, Jang JS. Undifferentiated Pleomorphic Sarcoma of the Thoracic Aorta Presenting with Ruptured Saccular Aneurysm: A Case Report. J Korean Soc Radiol 2020; 81:1204-1209. [PMID: 36238047 PMCID: PMC9431878 DOI: 10.3348/jksr.2019.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/25/2019] [Accepted: 01/16/2020] [Indexed: 11/21/2022]
Abstract
흉부 대동맥 미분화성 다형성 육종은 매우 드문 질환으로 색전 사례, 신혈관성 고혈압, 등 통증 등의 증상을 보일 수 있다. 특히 대동맥 벽에서 기원하여 소낭 동맥류 파열로 보고된 경우는 극히 드물며 진균성 동맥류나 관통성 죽상경화 궤양과 감별이 어렵다. 이에 저자들은 소낭성 동맥류 파열로 혈관 내 흉부 대동맥 치료를 시행한 후 종괴가 발생하여 수술적 생검으로 확진된 미분화성 다형성 육종의 전산화단층촬영과 양전자방출단층촬영 소견을 보고하고자 하며 이를 통해 정확한 진단과 적절한 치료에 도움을 주고자 한다.
Collapse
Affiliation(s)
- Do Woo Kim
- Department of Radiology, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Young Hwan Kim
- Department of Radiology, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Ung Rae Kang
- Department of Radiology, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Jun Woo Cho
- Department of Thoracic Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Jae Seok Jang
- Department of Thoracic Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
| |
Collapse
|
9
|
Lee SY, Lee J, Kim YH, Kang UR, Cha JG, Lee J, Cha SI, Kim CH. Efficacy and Safety of AMPLATZER Vascular Plug Type IV for Embolization of Pulmonary Arteriovenous Malformations. J Vasc Interv Radiol 2019; 30:1082-1088. [PMID: 30824308 DOI: 10.1016/j.jvir.2018.07.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/26/2018] [Accepted: 07/28/2018] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To assess the efficacy and safety of the AMPLATZER Vascular Plug type IV for pulmonary arteriovenous malformation (PAVM) treatment. MATERIALS AND METHODS Between June 2013 and January 2018, 13 patients with 26 PAVMs were treated with the type IV AVP. Patients without follow-up computed tomography (CT) were excluded. Technical success was defined as flow occlusion on angiography. Plug-to-sac distance was measured on angiographic images. Feeding artery and venous sac diameter changes were measured on preprocedural and follow-up CT. Successful embolization was defined as > 70% sac size regression. Procedure time, device migration, and complications were evaluated. RESULTS Nine female patients (mean age, 49 y; range, 40-71 y) with 19 PAVMs were enrolled. Four patients with 7 PAVMs were lost to follow-up. Nineteen PAVMs were treated in 11 sessions, and the mean procedure time was 29 min. The technical success rate was 100%. Mean feeding artery diameter was 3.1 mm ± 0.7 (range, 2.1-4.9 mm). Mean plug-to-sac distance was 5.4 mm ± 4.9 (range, 0-13.3 mm). The mean CT follow-up period was 14 months ± 7 (range, 6-30 mo). Sixteen of 19 PAVMs (84%) were successfully embolized. Minor complications (tachycardia and chest discomfort) arose in 2 of 11 sessions. No device migrations or major complications occurred. CONCLUSIONS The type IV AVP showed an 84% treatment success rate based on 70% sac size regression criteria in small PAVMs. There were no device migrations or major complications.
Collapse
Affiliation(s)
- Sang Yub Lee
- Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea
| | - Jongmin Lee
- Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea.
| | - Young Hwan Kim
- Department of Radiology, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Ung Rae Kang
- Department of Radiology, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Jung Guen Cha
- Department of Radiology, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea
| | - Seung-Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea
| | - Chang-Ho Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea
| |
Collapse
|
10
|
Shin S, Kim D, Kang UR, Yang CS. Impact of CT imaging on predicting the surgical management of acute diverticulitis. Ann Surg Treat Res 2018; 94:322-329. [PMID: 29854710 PMCID: PMC5976573 DOI: 10.4174/astr.2018.94.6.322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/15/2018] [Accepted: 02/06/2018] [Indexed: 01/26/2023] Open
Abstract
Purpose The incidence of colonic diverticular disease is increasing, and several grading systems based on CT findings have been developed. The objective of this study was to define the impact of various CT findings of colonic diverticulitis and to demonstrate which factors affect the need for operative treatment. Methods Three hundred fifty-seven patients diagnosed with colonic diverticulitis from January 2010 to July 2016 were retrospectively evaluated. Patients were excluded if pure diverticulosis, diverticular bleeding, colon cancer, or relevant data deficiencies, and the remaining patients (n = 178) were reviewed. Patients were categorized into a successful nonoperation group and an operation group. The operation group was then matched 1:2 with the nonoperative group based on age, gender, American Society of Anesthesiologists physical status classification, and body mass index. Results After propensity score matching, there were no significant differences regarding patients' demographic characteristics between the 2 groups. Left location was more associated with need for operation than the right side (79.2% vs. 31.3%, P < 0.001). CT findings such as distant intraperitoneal air, pericolic air, and free fluid were significantly more apparent in the operation group. When these factors were evaluated in a multivariate analysis, distant intraperitoneal air showed statistical significance (P = 0.046) and pericolic air and left location a significant trend (P = 0.071 and P = 0.067, respectively). Conclusion This study suggests that distant intraperitoneal air is the most important factor in the need for surgery in patients with colonic diverticulitis. Further study will be able to identify more detailed CT findings and verify their significance, and will be helpful in designing practical scoring and classification systems.
Collapse
Affiliation(s)
- Seonhui Shin
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Daedong Kim
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ung Rae Kang
- Department of Radiology, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Chun-Seok Yang
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| |
Collapse
|
11
|
Jo HH, Kang SM, Kim SH, Ra M, Park BK, Kwon JG, Kim EY, Jung JT, Kim HG, Ryoo HM, Kang UR. [A Case of Gastro-Gastric Intussusception Secondary to Primary Gastric Lymphoma]. Korean J Gastroenterol 2017; 68:40-4. [PMID: 27443623 DOI: 10.4166/kjg.2016.68.1.40] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In adults, most intussusceptions develop from a lesion, usually a benign or malignant neoplasm, and can occur at any site in the gastrointestinal tract. Intussusception in the proximal gastrointestinal tract is uncommon, and gastro-gastric intussusception is extremely rare. We present a case of gastro-gastric intussusception secondary to a primary gastric lymphoma. An 82-year-old female patient presented with acute onset chest pain and vomiting. Abdominal CT revealed a gastro-gastric intussusception. We performed upper gastrointestinal endoscopy, revealing a large gastric mass invaginated into the gastric lumen and distorting the distal stomach. Uncomplicated gastric reposition was achieved with endoscopy of the distal stomach. Histological evaluation of the gastric mass revealed a diffuse large B cell lymphoma that was treated with chemotherapy.
Collapse
Affiliation(s)
- Hyeong Ho Jo
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sun Mi Kang
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Si Hye Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Moni Ra
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Byeong Kyu Park
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Joong Goo Kwon
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Eun Young Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jin Tae Jung
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ho Gak Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hun Mo Ryoo
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ung Rae Kang
- Department of Radiology, Catholic University of Daegu School of Medicine, Daegu, Korea
| |
Collapse
|
12
|
Jung SY, Chae HD, Kang UR, Kwak MA, Kim IH. Effect of Acupuncture on Postoperative Ileus after Distal Gastrectomy for Gastric Cancer. J Gastric Cancer 2017; 17:11-20. [PMID: 28337359 PMCID: PMC5362830 DOI: 10.5230/jgc.2017.17.e2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 09/27/2016] [Accepted: 10/05/2016] [Indexed: 12/20/2022] Open
Abstract
Purpose Acupuncture has recently been accepted as a treatment option for managing postoperative ileus (POI) and various functional gastrointestinal disorders. Therefore, we conducted a prospective randomized study to evaluate the effect of acupuncture on POI and other surgical outcomes in patients who underwent gastric surgery. Materials and Methods Thirty-six patients who underwent distal gastrectomy for gastric cancer from March to December 2015 were randomly assigned to acupuncture or non-acupuncture (NA) groups at 1:1 ratio. The acupuncture treatment was administered treatment once daily for 5 consecutive days starting at postoperative day 1. The primary outcome measure was the number of remnant sitz markers in the small intestine on abdominal radiograph. The secondary outcome measure was the surgical outcome, including the times to first flatus, first defecation, start of water intake, and start of soft diet, as well as length of hospital stay and laboratory findings. Results The acupuncture group had significantly fewer remnant sitz markers in the small intestine on postoperative days 3 and 5 compared to those in the NA group. A significant difference was observed in the numbers of remnant sitz markers in the small intestine with respect to group differences by time (P<0.0001). The acupuncture group showed relatively better surgical outcomes than those in the NA group, but the differences were not statistically significant. Conclusions In this clinical trial, acupuncture promoted the passage of sitz markers, which may reflect the possibility of reducing POI after distal gastrectomy.
Collapse
Affiliation(s)
- Se Yun Jung
- Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hyun Dong Chae
- Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ung Rae Kang
- Department of Radiology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Min Ah Kwak
- Department of Internal Medicine, College of Korean Medicine, Daegu Haany University, Daegu, Korea
| | - In Hwan Kim
- Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| |
Collapse
|
13
|
Kim YH, Kim YH, Kim CS, Kang UR, Kim SH, Kim JH. Comparison of Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) Using Ethanolamine Oleate (EO), BRTO Using Sodium Tetradecyl Sulfate (STS) Foam and Vascular Plug-Assisted Retrograde Transvenous Obliteration (PARTO). Cardiovasc Intervent Radiol 2016; 39:840-6. [PMID: 26757912 DOI: 10.1007/s00270-015-1288-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/22/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare the clinical outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) using ethanolamine oleate (EO), BRTO using sodium tetradecyl sulfate (STS) foam, and vascular plug-assisted retrograde transvenous obliteration (PARTO). MATERIALS AND METHODS From April 2004 to February 2015, ninety-five patients underwent retrograde transvenous obliteration for gastric varices were analyzed retrospectively. BRTO with EO was performed in 49 patients, BRTO with STS foam in 25, and PARTO in 21. Among them, we obtained follow-up data in 70 patients. Recurrence of gastric varices was evaluated by follow-up endoscopy or CT. Medical records were reviewed for the clinical efficacy. Statistical analyses were performed by Kaplan-Meier method, Chi-square, Fisher's, and Kruskal-Wallis tests. RESULTS Technical and clinical success was 94.7 %. As major complications, a hemoglobinuria and a death due to disseminated intravascular coagulation (DIC) were occurred in two patients with BRTO using EO. Recurrence occurred more frequently in PARTO group (P < 0.05). Recurrence occurred in three patients in BRTO using EO group and four patients in PARTO group with 3.2 and 32.8 % of each expected 1-year recurrence rates. There was no recurrence in BRTO using STS group. Abdominal pain occurred more frequently in BRTO using EO than BRTO using STS foam and PARTO (P < 0.05). Procedure time of PARTO was shorter than two conventional BRTOs (P < 0.05). CONCLUSIONS BRTO using STS foam or PARTO is better than BRTO using EO for treatment of gastric varices in terms of complication or procedure time. However, PARTO showed frequent recurrence of gastric varices during the long-term follow-up rather than BRTO.
Collapse
Affiliation(s)
- Young Hwan Kim
- Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, 56 Dalseong-Ro, Jun-Gu, Daegu, 700-712, Korea
| | - Young Hwan Kim
- Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, 56 Dalseong-Ro, Jun-Gu, Daegu, 700-712, Korea.
| | - Chan Sun Kim
- Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, 56 Dalseong-Ro, Jun-Gu, Daegu, 700-712, Korea
| | - Ung Rae Kang
- Department of Radiology, Daegu Catholic University Medical Center, Daegu, Korea
| | - See Hyung Kim
- Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, 56 Dalseong-Ro, Jun-Gu, Daegu, 700-712, Korea
| | - Joo Hwan Kim
- Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, 56 Dalseong-Ro, Jun-Gu, Daegu, 700-712, Korea
| |
Collapse
|
14
|
Kang UR, Kim YH, Lee YH. Endovascular stent graft for treatment of complicated spontaneous dissection of celiac artery: report of two cases. Korean J Radiol 2013; 14:460-4. [PMID: 23690714 PMCID: PMC3655301 DOI: 10.3348/kjr.2013.14.3.460] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 06/18/2012] [Indexed: 11/15/2022] Open
Abstract
We report 2 cases of complicated spontaneous dissection of the celiac artery, which were successfully treated by a stent graft. The first patient was a 47-year-old man who presented with acute abdominal pain. CT scan showed ruptured saccular aneurysm with surrounding retroperitoneal hematoma. The second patient was a 57-year-old man with progressive dissecting aneurysm. Endovascular stent graft was placed in the celiac trunk to control bleeding, and to prevent rupture in each patient. Follow-up CT scans showed complete obliteration of a dissecting aneurysm.
Collapse
Affiliation(s)
- Ung Rae Kang
- Department of Diagnostic Radiology, Catholic University of Daegu School of Medicine, Daegu 705-718, Korea
| | | | | |
Collapse
|
15
|
Affiliation(s)
- Hyung Ook Lee
- Department of Radiology, School of Medicine, Catholic University of Daegu, Korea
| | - Young Hwan Lee
- Department of Radiology, School of Medicine, Catholic University of Daegu, Korea
| | - Sung Hee Mun
- Department of Radiology, School of Medicine, Catholic University of Daegu, Korea
| | - Ung Rae Kang
- Department of Radiology, School of Medicine, Catholic University of Daegu, Korea
| | - Chae Kyung Lee
- Department of Radiology, Pohang St. Mary's Hospital, Korea
| | - Kyung Jin Suh
- Department of Radiology, School of Medicine, Dongguk University Gyeongju Hospital, Korea
| |
Collapse
|