• Nuclear Medicine and Molecular Imaging
• /
• v.40 no.6
• /
• pp.316-321
• /
• 2006

Purpose: Differential diagnosis between arteriovenous (AVMs) aud non-arteriovenous malformations (nAVMs) is important in patients with congenital vascular malformations, because AVMs can cause hemodynamic alteration and require immediate treatment. We investigated whether transarterial lung perfusion scintigraphy (TLPS) was useful for the diagnosis and post-therapeutic evaluation of AVMs in extremities. Materials and Methods: Fifty-seven patients (M:F=26:31, $21{\pm}13$ yr, 9 upper and 48 lower extremities) suspected of congenital vascular malformations in extremities underwent TLPS using $^{99m}Tc-MAA$ before embolization/sclerotherapy. Dose-corrected shunt fraction (SF) was calculated from time-activity curve of the lung. Final diagnosis of AVMs was determined by angiography. in patients with AVMs, follow-up TLPS was done for post-therapeutic evaluation. Results: Sixteen patients (8 upper and 8 lower extremities) had AVMs, while the remaining 41 had nAVMs (1 upper and 40 lower extremities). The mean SF of AVMs on TLPS was significantly higher than that of nAVMs ($66.4{\pm}25.8%\;vs.\;2.8{\pm}4.3%$), p=0.003). The sensitivity, specificity, and accuracy of TLPS (cut-off of SF = 20.0%) in diagnosis of AVMs before treatment were 93.8% (15/16), 100% (41/41) and 98.2% (56/57), respectively. The follow-up TLPS and angiography for post-therapeutic evaluation showed concordant results in 13 of 16 patients (81.3%) with AVMs. The mean SF of TLPS was significantly decreased after embolization/sclerotherapy ($69.5{\pm}24.0%\;vs.\;41.0{\pm}34.7%$, p=0.01). Conclusion: TLPS provides hemodynamic information of AVMs in extremities semiquantitatively. Furthermore, the results of TLPS showed a high concordance rate with angiographic findings. Therefore, TLPS is useful for the diagnosis and post-therapeutic evaluation of AVMs in extremities.

• Radiation Oncology Journal
• /
• v.20 no.2
• /
• pp.123-129
• /
• 2002

Purpose : The purpose of this study 띤as to determine the potential role of three-dimensional conformal radiotherapy (3D-CRT) in the treatment of primary unresectable hepatocellular carcinoma. The preliminary results on the efficacy and the toxicity of 3D-CRT are reported. Materials and Methods : Seventeen patients were enrolled in this study, which was conducted prospectively from January 1995 to June 1997. The exclusion criteria included the presence of extrahepatic metastasis, liver cirrhosis of Child-Pugh classification C, tumors occupying more than two thirds of the entire liver, and a performance status of more than 3 on the ECOG scale. Two patients were treated with radiotherapy only while the remaining 15 were treated with combined transcatheter arterial chemoembolization. Radiotherapy was given to the field including the tumor plus a 1.5 cm margin using a 3D-CRT technique. The radiation dose ranged from $36\~60\;Gy$ (median; 59.4 Gy). Tumor response was based on a radiological examination such as the CT scan, MR imaging, and hepatic artery angiography at $4\~8$ weeks following the completion of treatment. The acute and subacute toxicities were monitored. Results : An objective response was observed in 11 out of 17 patients, giving a response rate of $64.7\%$. The actuarial survival rate at 2 years was $21.2\%$ from the start of radiotherapy (median survival; 19 months). Six patients developed a distant metastasis consisting of a lung metastasis in 5 patients and bone metastasis in one. The complications related to 30-CRT were gastro-duodenitis $(\geq\;grade\;2)$ in 2 patients. There were no treatment related deaths and radiation induced hepatitis. Conclusion : The preliminary results show that 3D-CRT is a reliable and effective treatment modality for primary unresectable hepatocellular carcinoma compared to other conventional modalities. Further studies to evaluate the definitive role of the 3D-CRT technique in the treatment of primary unresectable hepatocellular carcinoma are needed.

• Journal of the Korean Society of Radiology
• /
• v.81 no.3
• /
• pp.620-631
• /
• 2020

Purpose We aimed to assess local tumor progression (LTP) rate and associated prognostic factors in 92 patients who underwent radiofrequency ablation (RFA) using saline-perfused electrodes to treat hepatocellular carcinoma (HCC) (≤ 5 cm). Materials and Methods Total 92 patients with 148 HCCs were treated with RFA using saline-perfused electrodes, from 2009 to 2015. We retrospectively evaluated technical success, technique efficacy, and LTP rates. Potential prognostic factors for LTP were perivascular tumor, subphrenic tumor, artificial ascites, tumor size (≥ 2 cm), and previous treatment of transarterial chemoembolization. Analysis was performed by lesion, rather than by person. Results During follow-up period from 1 to 97.4 months, total cumulative LTP rates were 7.9%, 11.4%, and 14.6% at 1, 3, and 5 years, respectively. These values were significantly higher in the perivascular (35.1%; p = 0.009) and subphrenic group (38.9%; p = 0.002) at 5-year. We did not observe any significant difference in LTP according to other prognostic factors (p > 0.05). Conclusion RFA with saline-perfused electrode is a safe and effective treatment modality for HCC (≤ 5 cm), with lower LTP rates. Nevertheless, perivascular and subphrenic HCCs demonstrated higher LTP rate than other sites. It is imperative to note that perivascular and subphrenic location of HCC are associated with a high risk of local recurrence, despite the use of saline-perfused electrodes.

• Journal of Hospice and Palliative Care
• /
• v.13 no.3
• /
• pp.153-160
• /
• 2010

Purpose: The purpose of the present study was to investigate needs and satisfaction on the medical services of cancer patients in Jeju Special Self-Governing Province. Methods: Total 174 cancer patients, who visited at the clinic of Jeju National University Hospital, submitted informed consent and participated in this study from July 13 to July 30, 2009. Self questionnaire was used and data were analyzed with Kolmogorov-Smirnov test, Mann-Whitney U test, ANOVA, and Kruskal-Wallis test. Results: Participants expressed the needs of most economical support (3.38 out of 4), followed by counseling of treatment plan (3.22), information of disease (3.07), and disease management except cancer (2.97). Participants were satisfied most with religious counseling (3.41), followed by nursing service support (3.39), employment counseling (3.26), and counseling for family or interpersonal relationships (3.26). The satisfaction of economical support was the lowest (1.98). Satisfaction of men was higher than women, and needs in patients who were living with children was the highest. Patients who were living alone or with children showed the lowest satisfaction about the medical services. There were no significant differences in the general characteristics, however, participants who were older than 60 years of age or had higher income showed lower needs and higher satisfaction. There were no significant differences in the medical characteristics, however, thyroid cancer patients and patients who were treated with radiation therapy or transarterial embolization showed low satisfaction. Conclusion: Cancer patients seemed to need more economical support, information of treatment or disease, and symptom management. Furthermore, there were various needs about the services, depending on family formation or economical support of patients. Therefore, it is certain that patients who were suffering from other cancers, except the 5 major cancers, needed more services. In conclusion, continuous and systemic policy to consider patient's characteristics and needs are needed in community as well as health care system.

• Journal of the Korean Society of Radiology
• /
• v.82 no.5
• /
• pp.1258-1273
• /
• 2021

Purpose The balloon-stent technique (BST) has certain strengths as an assisted technique for the treatment of complex aneurysms. After Atlas release, the BST can be executed without an exchange maneuver of the balloon to the stent-delivery catheter. The purpose of this article is to share our experience with the BST using the Scepter-Atlas combination. Materials and Methods Device inspection led us to a simple method to avoid failure in loading Atlas to the Scepter. From March 2018 to December 2019, 57 unruptured distal internal carotid artery (dICA) aneurysms were treated with coil embolization; among which, 25 aneurysms in 23 patients were treated with BST. Clinical and angiographic data were retrospectively collected and reviewed. Results The technical success rate of the Scepter-Atlas combination increased from 50% to 100% after careful inspection. BST angiographic results were comparable to the stent-assisted coil (SAC) group treated during the immediately post-embolization same period (modified Raymond-Roy classification [MRRC] 1 & 2 84% in BST, 96.3% in SAC) and during short-term follow-up (MRRC 1 & 2 95.8% in BST, 88.4% in SAC). A small number of patients showed periprocedural complications, but none had clinical consequences. Conclusion BST using the Scepter-Atlas combination can provide an effective and safe method for the treatment of dICA aneurysms. Scepters can be used as delivery catheters for Atlas.

• Neonatal Medicine
• /
• v.18 no.1
• /
• pp.117-123
• /
• 2011

Purpose: Congenital intrahepatic portosystemic shunts are rare disease and clinically asymptomatic shunts may be detected by chance on ultrasonogram before and after birth. We studied clinical course, treatment and prognosis of congenital intrahepatic portosystemic shunt at prenatal or neonatal period. Methods: Medical records of 8 patients which were diagnosed in intrahepatic portosystemic shunt in Cheil General Hospital from 2006 through 2010 were reviewed retrospectively. Results: Eight patients with congenital intrahepatic portosystemic shunts were identified. Six patients were diagnosed at prenatal radiological screening, including three cases of intrauterine growth restriction and two cases of preterm baby. One case with increased serum ammonia underwent coil embolization. In four cases including one case that presented elevated direct bilirubin, shunts were closed spontaneously within 11th month after birth. Two patients were diagnosed on abdominal sonogram after birth because of elevated direct hyperbilirubinemia, all of whom presented intrauterine growth restriction. Closure of shunts was confirmed during 4th month to 6th month. Conclusion: Congenital intrahepatic portosystemic shunts are clinically asymptomatic mostly and spontaneous closure is expected within 2 years age. But occasionally they have severe complication, so clinical and radiological observation is needed. Specially in cases of intrauterine growth retardation without evident cause, the possible diagnosis of congenital intrahepatic portosystemic shunts should be considered and prenatal and postnatal examination should be performed. When prenatal diagnosis is made, fetal wellbeing should be monitored periodically until spontaneous closure of shunts.

• The Korean Journal of Nuclear Medicine
• /
• v.28 no.1
• /
• pp.85-88
• /
• 1994

근래 골조직에 있어서 자율신경의 기능에 대하여 많은 연구가 이루어지고 있으며, 골내의 자율신경의 해부학적 분포는 많이 알려져 있다. 그러나 임상적으로 반사적 교감신경 이상이나 레이노드 현상등과 같은 교감신경의 기능이상증에서나, 버거씨병 등의 치료 목적으로 시행되고 있는 교감신경 절제술 후, 자율신경기능의 변화가 사지골의 혈류나 골대사에 미치는 영향에 대하여는 아직도 논란의 여지가 있다. 저자들은 교감신경절제술 후 시간 경과에 따른 골에 미치는 영향을 알아보기 위하여 흰쥐에서 골대사와 혈류상태를 비교적 충실히 반영하는 정량적 골스캔을 시행하였다. 체중 $300{\sim}400g$의 수컷 흰쥐 10마리에서 복강을 통한 편측 요추부 교감신경절제술을 시행하였고, 수술 전과 후 1일, 3일, 1주, 2주, 3주, 4주에 양측 하지에서 각각 골스캔을 시행하고 교감신경 절제측 하지와 정상 하지에 대칭적으로 관심구역을 정하여 양측의 골스캔상 섭취계수를 비교하였다. 측정부위는 각 하지의 대퇴골간, 경골간 및 중족골로 하였다. 교감신경 절제술을 시행한 하지에서는 골스캔 소견상 수술 후 1일 또는 3일부터 동위원소 집적이 유의하게 증가되었으며 원위부로 갈수록 더욱 증가되었다. 그러나 3주 이후에는 정상측 수준으로 환원되었다. 교감신경절제술 후 골스캔상 동위원소집적이 증가되는 것은 골자체의 혈류가 증가되기 때문이며 이차적으로 골의 흡수를 유발하여 골밀도가 감소하는 것으로 생각되는데 이러한 변화는 시술 후 1일 째부터 관찰되어 사지골이 교감신경 절제에 매우 민감하게 반응하는 것을 알 수 있었다.9m}Tc$-MAA를 이용한 간 동맥 혈류 검사는 간암에서 색전술의 효과를 정확히 평가할 수 있는 유용한 검사법으로 이용될 수 있으리라 생각한다. 활성화 과정을 알아볼 수 있었으며 위상영상히스토그램을 통하여 이를 정량화하여 심실내 전기적 활성의 비동시성 여부를 추적관찰 할 수 있는 비관혈적검사임을 확인하였다.며, 3. $^{99m}Tc$으로 표지된 avidin과 streptavidin은 먼저 간으로 흡수된 후 대사된 다음 신장으로 배설된다는 사실을 알았다.damole에 의한 부작용은 흉통, 두통, 복통 등의 순이었고 전예에서 호전되었으며 생명에 위험을 초래할 수 있는 정도의 심장마비나 심부정맥은 한 예에서도 없었다. 결론적으로 dipyridamole은 약물부하 심근 SPECT 검사에 안전하게 사용할 수 있는 약물로 사료된다. 미소핵 빈도수가 증가하는 경향을 보였으나, 각 군간에 통계학적으로 유의한 차이는 없었다(p>0.05). 결론 : 임상적으로 치료를 중단하게 되는 1000mCi/60 Kg(16.67 mCi/Kg)를 투여한 군에서도 생쥐 골수내 미소핵이 발현되지 않는 것으로 보아, 방사성옥소는 비교적 안심하고 치료에 사용할 수 있는 제제로 사료되었다.반드시 비례하지만은 않아서 시간경과에 따른 추후 검사가 필요하리라 생각된다. 또한 방광요관역류가 있는 환아에서 DMSA 섭취율로 신기능을 평가할 때, 특히 영유아에서 연령에 따른 고려가 있어야 할 것으로 보인다.었다. 4) $^{99m}Tc-DISIDA$ hepatobiliary scintigram 음성율을

• Journal of Chest Surgery
• /
• v.32 no.3
• /
• pp.281-286
• /
• 1999

Background: The purpose of this study is to analyze the types of complications, the incidences of complications, and preoperative and postoperative risk factors affecting the incidence of the complication. Material and Method: Between August 1990 and August 1997 in Asan Medical Center, 42 patients(24 men and 18 women) underwent surgical resection for pulmonary aspergilloma. The mean age was 46.6${\pm}$11.5 years(range 29 to 69 years). Hemoptysis(90%) was the most common presentation. Pulmonary tuberculosis was the most common predisposing cause(81%). The associated diseases were bronchiectasis(n=11), active puolmonary tuberculosis(n=9), diabetes mellitus(n=8), lung carcinoid(n=1), and acute myeloblastic leukemia(n=1). Lobectomy was done in 32 cases(76%), segmentectomy or wedge resection in 4, pneumonectomy in 2, and lobectomy combined with segmentectomy in 4. Result: Operative mortality was 2%. The most common postoperative complication was persistent air leakage(n=6). The variables such as age, sex, pulmonary function test, amount and duration of hemoptysis, associated diseases(diabetes mellitus, active pulmonary tuberculosis), mode of preoperative management(steroid, antifungal agent, bronchial arterial embolization), and modes of operative procedures were statistically insignificant. The radiologic extent of infiltration to normal lung parenchyme was statistically significant(p=0.04). Conclusion: We conclude that the extent of the infiltration to normal lung parenchyme in preoperative radiologic studies should be carefully evaluated to reduce the postoperative complications in surgery for pulmonary aspergilloma.