• Journal of the Korean Society of Radiology
• /
• v.83 no.5
• /
• pp.991-1002
• /
• 2022

Biliary atresia is a rare but significant cause of neonatal cholestasis. An early and accurate diagnosis is important for proper management and prognosis. To diagnose biliary atresia, various imaging studies using ultrasonography, MRI, hepatobiliary scans, and cholangiography can be performed, although ultrasonography is more important for initial imaging studies. In this article, we review the findings of biliary atresia from various imaging modalities, including ultrasonography, MRI, hepatobiliary scans, and cholangiography. The known key imaging features include abnormal gallbladder size and shape, periportal thickening visible as a 'triangular cord' sign, invisible common bile duct, increased hepatic arterial flow, and combined anomalies. Aside from the imaging findings of biliary atresia, we also reviewed the diagnostic difficulty in the early neonatal period and the role of imaging in predicting hepatic fibrosis. We hope that this review will aid in the diagnosis of biliary atresia.

• Journal of the Korean Society of Radiology
• /
• v.85 no.1
• /
• pp.109-123
• /
• 2024

Xanthogranulomatous (XG) inflammatory disease is a rare benign disease involving various organs, including the gallbladder, bile duct, pancreas, spleen, stomach, small bowel, colon, appendix, kidney, adrenal gland, urachus, urinary bladder, retroperitoneum, and female genital organs. The imaging features of XG inflammatory disease are nonspecific, usually presenting as a heterogeneous solid or cystic mass. The disease may also extend to adjacent structures. Due to its aggressive nature, it is occasionally misdiagnosed as a malignant neoplasm. Herein, we review the radiological features and clinical manifestations of XG inflammatory diseases in various organs of the abdomen and pelvis.

• Annals of Hepato-Biliary-Pancreatic Surgery
• /
• v.27 no.4
• /
• pp.380-387
• /
• 2023

Backgrounds/Aims: In 2019, the grading and staging system for neuroendocrine neoplasms (NENs) was significantly changed. In this study, we report the clinicopathological characteristics and surgical outcomes of patients with extrahepatic biliary NENs who underwent curative resection with or without adjuvant treatment. Methods: We retrospectively reviewed a database of 16 patients who developed NENs, neuroendocrine carcinoma (NEC), and mixed endocrine non-endocrine neoplasms (MiNENs) after curative resection. Among them, eight patients had ampulla of Vater (AoV) tumors, and eight patients had non-AoV tumors. Results: G1 and G2 were more frequently observed in the AoV group than in the non-AoV group (12.5% and 62.5%, respectively). In contrast, NEC and MiNEN were more common in the non-AoV group (50.0%). High Ki-67 index (> 20%) and perineural invasion (PNI) were more frequently observed in the non-AoV group. Advanced age (> 65 years), mitotic count > 20 per 2 mm², and Ki-67 index > 20% were strongly correlated with patient survival (p = 0.018, 0.009, and 0.044, respectively). Advanced age (> 65 years) and mitotic count > 20 per 2 mm² were significantly correlated with disease recurrence (p = 0.033 and 0.010, respectively). Conclusions: AoV and non-AoV tumors had significant differences in the histologic grade, Ki67, and PNI. Patients with non-AoV tumors had an increased risk for survival and recurrence than those in the AoV group. For extrahepatic biliary NENs, early detection of tumors, adequate surgery, and aggressive adjuvant treatment for high-risk patients are important to achieve long-term survival and prevent disease recurrence.

• Journal of radiological science and technology
• /
• v.31 no.4
• /
• pp.389-399
• /
• 2008

Corrections of attenuation, scatter and resolution are important in order to improve the accuracy of single photon emission computed tomography (SPECT) image reconstruction. Especially, the heart movement by respiration and beating cause the errors in the corrections. Myocardial phantom is used to verify the correction methods, but there are many different parts in the current phantoms in actual human body. Therefore the results using a phantom are often considered apart from the clinical data. We developed a new phantom that implements the human body structure around the thorax more faithfully. The new phantom has the small mediastinum which can simulate the structure in which the lung adjoins anterior, lateral and apex of myocardium. The container was made of acrylic and water-equivalent material was used for mediastinum. In addition, solidified polyurethane foam in epoxy resin was used for lung. Five different sizes of myocardium were developed for the quantitative gated SPECT (QGS). The septa of all different cardiac phantoms were designed so that they can be located at the same position. The proposed phantom was attached with liver and gallbladder, the adjustment was respectively possible for the height of them. The volumes of five cardiac ventricles were 150.0, 137.3, 83.1, 42.7 and 38.6ml respectively. The SPECT were performed for the new phantom, and the differences between the images were examined after the correction methods were applied. The three-dimensional tomography of myocardium was well reconstructed, and the subjective evaluations were done to show the difference among the various corrections. We developed the new cardiac and torso phantom, and the difference of various corrections was shown on SPECT images and QGS results.

• Journal of Korean Medical classics
• /
• v.5
• /
• pp.200-251
• /
• 1992

As concerned the life and the medical idea of Choo, Tan-Kye(朱丹溪), which it can be summarized as follows by studying. 1. Tan-Kye(丹溪) lived in the end of the won dynasty(元代末期), When the people starved and suffered from a flood-disaster and drought. etc, also the social conditions were in disorder on account of the corrupt ion of politics. And Cheol Kang seong(浙江省), located in the south region of China, has sterile soil and the climate condition humid and heatful. So the south district peoples have very weak constitution. So We can found that his medical idea reflected the phases of the periods and the regional enviornmental situations. 2. For that reason, Tan-Kye(丹溪) rejected the prescription of the "WHa Che Gook Bang(和劑局方)" which was prevalent at that time, in which the the pungent-dried herbs were widly used ; So he persisted in the "Sang Wha Lon(相火論)" and the "Positivity is usually excedeed while the negativity deficient(陽有餘陰不足論)". Then he treated with the drugs to nourish the negativity for the prime object to be applied in the clinic. 3. Tan-Kye(丹溪) refined the follows from the natural law; Heaven is to the positivity(陽) and the Earth is defined the negativity(陰), so the heaven is to the Macro(大) and the earth, micro(小):So the Sun is to the Positivity(陽), the Moon, the Negativity(陰): as to the Sun is always full while the moon always defected too. Therefore the "positivity is always excedeed for that the negativity is deficientalways(陽有餘陰不足)". In Human body, "the negativity energy (陰精) "is hard formed-easily defected(難成易虧)". And the heat(相火) in the body can be moved easily and let the negative energy to leak out. Therefore the more the positivity excedeed, the more the negativity deficient"(陽當有餘陰常不足). 4. He made it expanded the contents of the "Heat(相火)" in the Chapter Woon Chi of the Nae Kyeong(內徑) and discribed, the Life-string of the human body is originated from the movement of the "Heat with unique energy(相火一氣)". And more in human body, it is specifically regulated by the two visceras, Liver and Kidney, and is distributed in the 'Pericardium(心包絡)' 'Tripie Warmer(三焦)' 'Gallbladder(膽)' etc. In the point of his assertion of heat(相火), it is concluded both the physiological and the pathological heat of all. 5. Tan-Kye(丹溪) grew up in the family or the Confucianism. He was instructed the Confucianism(性理學) from Heo-Kyeom(許謙), the fourth diciple of Chu-Ja(朱子), and was received the Yoo Chang Ri(劉 張 李)'s triple doctrine from the La Tae Moo(羅太無), the second disciple of Yoo Wan So(劉完素). So there are much of content of Confucianism(性理學) in his medical thedry, and his theory has succeeded the achievements of the triple study. 6. About the theory of the "positivity is usually excedeed while the negativity deficient"(陽常有餘陰常不足論) of Tan-Kye, it was asserted that the positivity is never sufficient for the vital mainspring, by Chang, Kye-Pin(張介賓) and Lee, Kyoo-Zoon(李奎晙) etc. And for the Heat theory(相火論), eventhough the scholars of postorior generations criicized all of that, there are defect of the content and unification between them. 7. The father of the "Cha Eum Pa(滋陰派), Tan-Kye(丹溪) contributed considerably to the development of the oriental medicine and to the general therapy for the various diseases(一般雜病施治). 8. there are handed down and remained twenty or more of volumes of list of his writings. Among them, except "Kyeok Chi Yeo Ron"(格致餘論), "Kuk Pang Pal Hyeu"(局方發揮), they are reorganized by posteriority. There are Cho, Do-Chin(趙道震). Cho, Ee-Teok(趙以德), Tae, Sa-Gong(戴思恭), Wang Ri(王履) and Yoo, Suk-Yeon(劉淑淵) etc as disciples of his. And Wang Ryoon(王論) and Woo Pak(虞搏) as the admirer of him.

• Journal of Acupuncture Research
• /
• v.19 no.3
• /
• pp.107-114
• /
• 2002

Objective : This study was designed to find the most effective and safest way to overcome Lumbago due to blood stasis and sprain involved in a few Meridian Tendino-musculatures by evaluating the effect of two kinds of Dong-gi(Dong-qi) Acupuncture(DGA) and by reporting their side effects. Material : 97 patients of out and admission patients were selected, who were diagnosed with lumbar sprain caused by repetitive bending, heavy weight lifting, unsuitable posture, concussion and falling down and whose Lumbago due to blood stasis and sprain in the concept of oriental medicine. Methods : 97 patients were divided into three groups. One is exclusive DGA group to which DGA and the method retaining needles on the acupoints for about 20 minutes were applied, the other is DGA combined active exercise group in which patients stretched their Meridian Tendino-muscuIatures with their hips moving up and downward repeatedly during DGA, the third is DGA combined passive exercise group in which patients were made to flex or extend their bodies on the auto flexion-distraction table in a prone position, from 10 to 20 degree, during DGA. In each group, bed rest, physical therapy and herbal medicine were used according to symptoms, in addition to DGA. In DGA method, "Su(Shu)" points of the meridian related to the involved Meridian Tendino-musculature were mainly chosen, that is, Sokkol(Shugu, B65), Hugye(Houxi, SI3), ChungJo(Zhongzhu, TE3) were used, for most LBP belonged to Bladder and Gallbladder Meridian Tendino-musculature disorders. Pyong-Bo-Pyong-Sa(Ping-Bu-Ping-Xie) such as Dong-Gi and Yeom-Jeon(Nian-Zhuan) was applied as Bo-Sa method. For evaluation of effectiveness, new score system was devised by severity of pain and range of movement. the score was given twice at patients' first and last visit and the difference between first and last score was regarded as a evaluation scale, the effectiveness was classified into four grade by evaluation scale.(scale : 12-15; excellent, 8-11; good, 4-7; fair, 0-3; bad) Results : 1. Exclusive DGA, DGA combined active exercise and DGA combined passive exercise group showed 97, 87 and 89% in effectiveness. 2. Exclusive DGA, DGA combined active exercise and DGA combined passive exercise group showed no aggravation of pain, range of movement. 3. In blood test of 34 patients, only one patient showed abnormal rise of sGOT, sGPT and $\gamma$-GTP at his first visit and the others didn't show any detrimental change. DGA had no bad influence upon BUN and creatinine of patients. Conclusion : For complex theraphy combining DGA, exercise, physical therapy and Herbal medicine proved to be highly effective on treating lumbago due to blood stasis and sprain, this is expected to be available for clinical use.

• The Journal of Korean Society for Radiation Therapy
• /
• v.24 no.2
• /
• pp.85-93
• /
• 2012

Purpose: It is essential to minimize the respiratory-induced motion of involved organs in the Tomotherapy for tumor located in the chest and abdominal region. However, the application of breathing control system to Tomotherapy is limited. This study was aimed to investigate the possible application of the ABCHES system and its efficacy as a means of breathing control in the tomotherapy treatment. Materials and Methods: Five subjects who were treated with a Hi-Art Tomotherapy system for lung, liver, gallbladder and pancreatic tumors. All patients undertook trained on two breathing methodes using an ABCHES, free breathing methode and shallow breathing methode. When the patients could carry out the breathing control, 4D-CT scan was a total of 10 4D tomographic images were acquired. A radiologist resident manually drew the tumor region, including surrounding nomal organs, on each of CT images at the inhalation phase, the exhalation phase and the 40% phase (mid-inhalation) and average CT image. Those CT images were then exported to the Tomotherapy planning station. Data exported from the Tomotherapy planning station was analyzed to quantify characteristics of dose-volume histograms and motion of tumors. Organ motions under free breathing and shallow breathing were examined six directions, respectively. Radiation exposure to the surrounding organs were also measured and compared. Results: Organ motion is in the six directions with more than a 5 mm displacement. A total of 12 Organ motions occurred during free breathing while organ motions decreased to 2 times during shallow breathing under the use of Abches. Based on the quantitative analysis of the dose-volume histograms shallow breathing showed lower resulting values, compared to free breathing, in every measure. That is, treatment volume, the dose of radiation to the tumor and two surrounding normal organs (mean doses), the volume of healthy tissue exposed to radiation were lower at the shallow breathing state. Conclusion: This study proposes that the use of ABCHES is effective for the Tomotherapy treatment as it makes shortness of breathing easy for patients. Respiratory-induced tumor motion is minimized, and radiation exposure to surrounding normal tissues is also reduced as a result.

• The Journal of Korean Society for Radiation Therapy
• /
• v.31 no.2
• /
• pp.33-41
• /
• 2019

Purpose: The purpose of this study is to improve the reduction of coverage of PTVs adjacent to organ at risk (OAR) by setting up overlapping Planning Target Volume (PTV) during Volumetric Modulated Arc Therapy(VMAT). Materials and Methods: In patients who received Whole Brain, Gall Bladder and Rectum radiation therapy, We compared the cover change, maximum dose, Homogenicity Index and Conformity Index of PTV and also compared the maximum dose and average dose change of Organ At Risk by organizing treatment plans that are not applied overlaped PTV and treatment plans that are applied overlaped PTV in areas where coverage is insufficient. Results: overage of treatment plans with overlapping PTVs was increased in all patients, and overall coverage was also increased in each of the four patients. The maximum dose for PTV was increased in five patients, and the Homogenicity Index and Conformity Index for all patients did not differ much. The maximum dose of the lens was increased by 1.12 times, and the maximum dose was decreased in two patients for brain stem. The mean dose of the eyeball was increased by a maximum of 1.15 times, and there was no significant difference between both parotid gland. In case of gallbladder cancer patients, the mean dose in the liver and colon was decreased, and the mean dose in the duodenum was increased. In the case of rectal cancer patients, the mean dose was reduced for both femur and bladder set as OARs. The overall MU was shown to be similar in four patients, excluding one. Conclusion: If the critical dose of OAR is considered and used properly, I think it is a useful way to improve coverage of PTV.

• Radiation Oncology Journal
• /
• v.21 no.1
• /
• pp.35-43
• /
• 2003

Purpose :To analyze the survival period, prognostic factors and complications of patients having undergone high-dose-rate intraluminal brachytherapy (HDR-ILB) as a salvage radiation therapy, while having a catheter, for percutaneous transhepatic billary drainage (PTBD), inserted due to biliary obstruction caused by a secondary malignant biliary tumor Methods and Materials : A retrospective study was performed on 24 patients having undergone HDR-ILB, with PTBD catheter Insertion, be)ween December 1992 and August 2001. Their median age was 58.5, ranging from 35 to 82 years. The primary cancer site were the stomach, gallbladder, liver, pancreas and the colon, with 12, 6, 3, 2 and 1 cases, respectively. Eighteen patients were treated with external beam radiation therapy and HDR-lLB, while slx were treated with HDR-lLB only. The 4otal external beam, and brachytherapy radiations dose were 30$\~$61.2 and 9$\~$30 Gy, with median doses of 50 and 15 Gy, respectively. Results : Of the 24 patients analyzed, 22 died during the follow-up period, with a median survival of 7.3 months. The 6 and 12 months survival rates were 54.2 (13 patients) and 20.8$\%$ (5 patients), respectively. The median survivals for stomach and gailbladder cancers were 7.8 and 10.2 months, respectively, According to the unlvariate analysis, a significant factor affecting survival of over one year was the total radiation dose (over 50 Gy) (o=0.0200), with all )he patients surviving more than one year had been Irradiated with more than 50 Gy. The acute side effects during the radiation therapy were managed with conservative treatment. During the follow-up period, 5 patients showed symptoms of cholangltis due to the radiation therapy Conclusion :An extension to the survival of those patients treated with HDR-ILB is suggested compared to the median historical survival of 4hose patients treated with external biliary drainage. A boost radiation dose could be effectively given, by performing HDR-lLB, which is a prognostic factor In addition, the acute complications of radiation therapy were effectively controlled by conservative management, and It could be regarded as a safe treatment.

• Journal of Physiology & Pathology in Korean Medicine
• /
• v.17 no.5
• /
• pp.1157-1176
• /
• 2003

The following conclusions are induced from a study on the acupuncture therapy depending on hyungsang of the persons. The study is made on the basis of 'Internal classic (內經)& and &Clinical Lectures by Dr. Jeesan&. The acupuncture originated from the treatment of spasm with numbness in the southern area. The acupuncture is basically a remedy for the exterior disease of meridian but also it can be a cure for the interior disease of Jang and obstinate disease with accurate method. Three mechanisms of acupuncture are described in 'Internal classic'. The first is to make meridian circulate smoothly. The second is to regulate Ki and Hyul. The third is to regulate points through which the meridian-Ki goes in and out smoothly or adversely. There are two ways of acupuncture in 'Internal classic'. One is based on pulse and symptom and the other on the Hyungsang. The former is more generally used therapy, to which depletion method, Asi point method(阿是穴 療法), Inyoung-kigu pulse comparison method (人迎氣口脈法) and method depending on jang-bu disease belong. Acupuncture is done on Su points(輸穴) and back-su point(背兪穴) in case of jang-disease. In case of bu-disease, the treatment is done on Hap points(合穴) and Mo-points(募穴). The latter includes two methods; one according to invariable Hyungsang. And the other to variable Hyungsang. The method of acupuncture according to invariable Hyungsang usually selects Won-points(原穴). Different Hyungsang requires different method of acupuncture; In case of Dam type, the acupuncture is mainly practiced on four-Kwan points with reinforcing and reducing methods achieved by the direction of the needle tip pointing to. In case of Bangkwang type, the acupuncture is usually done on Jungwan(中脘) and Poongyung(豊隆) with reinforcing and reducing methods by means of respiration. In case of female, more effective are the acupoints on the right and lateral parts of the body selected on the basis of five su-points of the twelve meridians matching the heavenly stems and earthly branches. In case of male, more effective are the acupoints on the left, front and rear parts of the eight extra meridians. In case of acupuncture to the person with Hyungsang of five jang and six bu, each person's intrinsic Hyung, color, pulse, must be observed. Because symptoms of jang-bu disease also must be checked up. Acupuncture is done on the Won-points of the meridians related to the jang and bu where the disease starts. The disease of five jang is so obstinate that it requires both of medication and acupuncture for a long time. In case of acupuncture to the person with Hyungsang of animal types, diagnosis is made on the basis of shape, temper, function and color. And the treatment is given on the Won-points of corresponding exterior and interior meridians. For the fish type, the acupuncture is done on the kidney meridian of foot-soyin and the urinary bladder of foot-taiyang. For the bird type, on the heart meridian of hand-soyin, the pericardium meridian of hand-gualyin, and the small intestine meridian of hand-taiyang For the deer type, on the liver meridian of foot-gualyin and the gallbladder meridian of foot-soyang. For the turtle type, on the lung meridian of hand-taiyin and the large intestine meridian of hand-yangmyung.