• Korean Journal of Radiology
• /
• v.24 no.10
• /
• pp.983-995
• /
• 2023

Objective: To compare the diagnostic performance and interobserver agreement between contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CE-MRI) with magnetic resonance cholangiopancreatography (MRCP) for evaluating the resectability in patients with extrahepatic cholangiocarcinoma (eCCA). Materials and Methods: This retrospective study included treatment-naïve patients with pathologically confirmed eCCA, who underwent both CECT and CE-MRI with MRCP using extracellular contrast media between January 2015 and December 2020. Among the 214 patients (146 males; mean age ± standard deviation, 68 ± 9 years) included, 121 (56.5%) had perihilar cholangiocarcinoma. R0 resection was achieved in 108 of the 153 (70.6%) patients who underwent curative-intent surgery. Four fellowship-trained radiologists independently reviewed the findings of both CECT and CE-MRI with MRCP to assess the local tumor extent and distant metastasis for determining resectability. The pooled area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of CECT and CE-MRI with MRCP were compared using clinical, surgical, and pathological findings as reference standards. The interobserver agreement of resectability was evaluated using Fleiss kappa (κ). Results: No significant differences were observed between CECT and CE-MRI with MRCP in the pooled AUC (0.753 vs. 0.767), sensitivity (84.7% [366/432] vs. 90.3% [390/432]), and specificity (52.6% [223/424] vs. 51.4% [218/424]) (P > 0.05 for all). The AUC for determining resectability was higher when CECT and CE-MRI with MRCP were reviewed together than when CECT was reviewed alone in patients with discrepancies between the imaging modalities or with indeterminate resectability (0.798 [0.754-0.841] vs. 0.753 [0.697-0.808], P = 0.014). The interobserver agreement for overall resectability was fair for both CECT (κ = 0.323) and CE-MRI with MRCP (κ = 0.320), without a significant difference (P = 0.884). Conclusion: CECT and CE-MRI with MRCP showed no significant differences in the diagnostic performance and interobserver agreement in determining the resectability in patients with eCCA.

• Journal of the Korean Society of Radiology
• /
• v.84 no.6
• /
• pp.1367-1372
• /
• 2023

Primary angiitis of the central nervous system (PACNS) is a rare vasculitis in the central nervous system. Herein, we report a case of diagnosis and treatment of necrotic pattern PACNS, which was difficult to differentiate from a brain abscess. A 19-year-old male presented with blurred vision and a headache. Brain MRI revealed irregular rim-enhancing necrotic masses with central diffusion-high signal intensity in the corpus callosum and peripheral diffusion-high signal intensity in the left parietotemporal periventricular area. Susceptibility-weighted imaging revealed multiple punctate hemorrhages in the lesions. The patient was diagnosed with unusual abscess or tumefactive PACNS. Therefore, we initially treated the patient with antibiotics to rule out brain abscess. However, the brain lesions did not improve on follow-up MRI after the antibiotic treatment. Surgical biopsy was performed, and the histopathological diagnosis was PACNS with a necrotic pattern. The necrotic lesions became smaller on follow-up MRI after high-dose corticosteroid treatment.

• Journal of the Korean Society of Radiology
• /
• v.85 no.2
• /
• pp.421-427
• /
• 2024

Ectopic breast tissue can develop along the mammary ridge from the axilla to the groin, and the most common site is the axillae. Primary carcinoma of ectopic breast tissue is extremely rare. We report a rare case of a 61-year-old woman with a palpable mass in her left axilla who had a history of surgical excision of accessory breast tissue in the same area. Mammography (MMG), including axillary tail view, ultrasound (US), and breast MRI were performed. We evaluated the extent and characteristics of the microcalcifications in the axillary tail view. A US-guided biopsy was done, and histopathology revealed an invasive ductal carcinoma. Enhanced abdominal CT revealed multiple hepatic masses consistent with metastases, and the patient received palliative chemotherapy. Herein, we present a rare case of breast cancer arising from accessory breast tissue in the axilla, best appreciated on the axillary tail view of the patient's MMG.

• Korean Circulation Journal
• /
• v.53 no.11
• /
• pp.744-755
• /
• 2023

Background and Objectives: Aortic valve replacement (AVR) is considered a class I indication for symptomatic severe aortic stenosis (AS). However, there is little evidence regarding the potential benefits of early AVR in symptomatic patients diagnosed with normal-flow, low-gradient (NFLG) severe AS. Methods: Two-hundred eighty-one patients diagnosed with symptomatic NFLG severe AS (stroke volume index ≥35 mL/m², mean transaortic pressure gradient <40 mmHg, peak transaortic velocity <4 m/s, and aortic valve area <1.0 cm²) between January 2010 and December 2020 were included in this retrospective study. After performing 1:1 propensity score matching, 121 patients aged 75.1±9.8 years (including 63 women) who underwent early AVR within 3 months after index echocardiography, were compared with 121 patients who received conservative care. The primary outcome was a composite of all-cause death and heart failure (HF) hospitalization. Results: During a median follow-up of 21.9 months, 48 primary outcomes (18 in the early AVR group and 30 in the conservative care group) occurred. The early AVR group demonstrated a significantly lower incidence of primary outcomes (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.29-0.93; p=0.028); specifically, there was no significant difference in all-cause death (HR, 0.51; 95% CI, 0.23-1.16; p=0.110), although the early AVR group showed a significantly lower incidence of hospitalization for HF (HR, 0.43; 95% CI, 0.19-0.95, p=0.037). Subgroup analyses supported the main findings. Conclusions: An early AVR strategy may be beneficial in reducing the risk of a composite outcome of death or hospitalization for HF in symptomatic patients with NFLG severe AS. Future randomized studies are required to validate and confirm our findings.

• Journal of the Korean Institute of Landscape Architecture
• /
• v.48 no.5
• /
• pp.1-15
• /
• 2020

This study was designed to come up with a way of managing a cultural landscape forest by conducting research on the vegetation structure and growth characteristics. This study's target site, which was 45,201㎡ in size, was Pinus densiflora forest for Sugumagi placed at the entrance of Unmun Temple, Sinwon-ri, Unmun-myeon, and Cheongdo-gun in the southernmost part of Gyeongsangbuk-do, Korea. Sugumagi means the water of the valley flows far away, and where no downstream is visible according to feng shui. The historical sources of the Sugumagi Pinus densiflora forest at the entrance of Unmun Temple isn't clear. It waw only found at that location. The Pinus densiflora forest at the entrance of Unmun Temple is located in the waterway in terms of Feng Shui. The present condition of growth was investigated through a grid surveys of 98 trees and Pinus densiflora growth. As a result of the analysis of growth status, Pinus densiflora, Larix leptolepis, Zelkova serrata, Celtis sinensis, and Rhus javanica were distributed in the conopy layer, and 28 species including Ailanthus altissima were grown in the understroy layer, and 92 species, including Ampelopsis brevipedunculata, in the shrub layer. The plant community structure was divided into low, medium and high-density Pinus densiflora forests in the study area, based on the number in the conopy layer and the grade of and the trees analyzed. As a result of the analysis, the Pinus densiflora dominated the low, medium and high-density Pinus densiflora forests, and there were no competitive species. The relative dominance of the low-density Pinus densiflora forests was 46.9% on average, medium-density was 62.6% and 50.2% was found in high-density. The mean species diversity of Shannon in the low-density study was 0.7055, medium-density study was 0.8966 and the average species diversity of Shannon in the high-density study was 0.8317. The analysis of the age and growth of 25 sample trees in the Sugumagi Pinus densiflora forest shows that the distribution of the chest diameter (DBH) of the sample Pinus densiflora is 38 to 77cm with the average chest diameter being 61.1cm. The age was 84-161 years and the average was 114 years. In the Pinus densiflora forest, most(670,659, or 98.3%) of the tree trunk wound was collected for rosins during the Japanese colonia Era, Of the total 670, 659 were Pinus densiflora, 98.3% of the total. 394 were surgically repaired in 2005. For the preservation of the Sugumagi Pinus densiflora forest, dead trees should be replaced with substitute trees appropriate to the middle and south topography. It is demanded that foreign species such as Larix leptolepis in the research area should be removed and Pinus densiflora that underwent surgical operations should be regularly sterilized. It is also emphasized that the management of insecticide is important.

• Journal of Hospice and Palliative Care
• /
• v.12 no.1
• /
• pp.27-31
• /
• 2009

Purpose: Lymphedemas are tissue fluid swellings, usually on the arms or legs, and occur as a result of impaired lymphatic drainage. Presently, the most effective treatment available is complete decongestive physiotherapy (CDP). However, this therapy is ineffective in some patients and surgery may be indicated. Herein, we examined the efficacy of minimally invasive needle aspiration of the most enlarged areas in hypodermic adipose tissues, of patients who had failed CDP. Methods: We included 21 patients who were diagnosed with lymphedema stage II-III in the upper or lower extremities and visited the lymphedema clinic at a university hospital from September 1, 2003 to February 28, 2004. All patients had been treated with CDP at least once, but had failed to respond to the therapy for more than one year. Nine patients had breast cancer and 12 had cervical cancer. We identified the area with the most severe edema by using MRI and performed a 16-gauge angio-needle aspiration on the area. The patients were followed up for 3 months. Effectiveness of the treatment was evaluated by comparing the volume of edema before and after the treatment using Wilcoxon signed rank-test. Results: The mean reduction ratio of the volume of edema comparison normal volume was 41.1${\pm}$35.3% (P=0.001). There were no major or minor operative complications except localized hemorrhage. Conclusion: We conclude that a needle aspiration prior to other surgical treatments is relatively safe and effective for those patients who are unresponsive to CDP.

• The Journal of the Korean bone and joint tumor society
• /
• v.7 no.1
• /
• pp.20-27
• /
• 2001

Purpose : The giant cell tumor of tendon sheath is the second most common tumor of the hand, but recurred frequently although excision was performed. Authors analyzed and would report clinical findings and postoperative results of it. Materials and Methods : Between January 1991 and December 1998, 38 patients, 41 cases which the authors had performed excisional biopsy to the mass in the hand and diagnosed with the giant cell tumor of tendon sheath, was analyzed with age, sex, chief complaint, symptom duration, involved finger, involved tendon, frequently developed site in fingers, size, multiplicity, radiologic findings and recurrence. The mean duration of follow-up was 13.1 months (5~40 months). Results : Of 38 patients, twenty-nine were female. It is frequent in the fourth decade and mean age was 40.1 years old. The neurological compression symptom was found in 5 cases. The mean duration of symptom was 23.4 months. Flexor tendon was involved in 24 cases. The distal interphalangeal joint area in digit was involved most frequently in 20 cases. Index finger was the most common involved finger (14 cases), and long finger was the second most common (9 cases). All tumors were unilateral. The majority of patients had solitary lesion but one case had multiple lesion. In the radiologic findings, erosion or pressure indentation of bone was seen in 3 cases. All patients were operated by marginal excision. Recurrence rate was 5.1%. Conclusion : The risk factors in giant cell tumor of tendon sheath were female, forth decade, index finger, flexor tendon, and distal interphalangeal joint area. The recurrence was increased in marginal excision of recurred cases, in cases with multiple developed lesions or in multilobular lesion, so wide surgical excision is necessary to prevent recurrence.

• Childhood Kidney Diseases
• /
• v.17 no.1
• /
• pp.19-24
• /
• 2013

Purpose: Recently, enterococcus spp. have become one of the most common nosocomial pathogens with increasing rates of multi-drug resistance. However, study on enterococcal urinary tract infections (UTIs) in children is very limited, especially community acquired UTIs. We studied the clinical characteristics of enterococcus spp. in community acquired UTIs and antibiotic resistance within our urban area. Methods: All children with first episode of community acquired UTIs due to enterococcus spp. and Echerichia coli who were admitted in Pusan National University Children's Hospital between January 2010 and January 2013 were included in our study. We retrospectively reviewed their medical records. Results: During the study period, 201 patients were identified to have first episode of community acquired UTIs. 154 cases were E.coli UTIs (76.6%) and 11 cases were enterococcal UTIs (5.5%) and all enterococcus spp. were Enterococcus feacalis. In enterococcal UTI group, voiding cystourethrogram(VCUG) was performed in 7/11 patients and demonstrated 4 vesicoureteral refluxes (VURs) with renal scar and 3 patients underwent corrective surgery. In E.coli UTI group, VCUG was performed in 121/154 patients and demonstrated 23 VURs and 11 patients underwent corrective surgery. Enterococcal group had significant high rate of underlying urinary abnormalities and surgical corrections compared with E. coli group. All enterococcus spp. were susceptible to ampicillin, vancomycin and linezolid, but all were resistant to tetracycline. They also showed 71.4% resistance to trimethoprim-sulfamethoxazole and 20% resistance to ciprofloxacin. Conclusion: Community acquired enterococcal UTIs in children were rare within our urban area. However, they could be indicative of severe underlying urinary tract abnormalities.

• Journal of Chest Surgery
• /
• v.40 no.3 s.272
• /
• pp.200-208
• /
• 2007

Background: The effect of patient-prosthesis mismatch (PPM) on the clinical outcome following aortic valve replacement (AVR) remains controversial. This study compared the surgical outcomes of AVR between patients with a patient-prosthesis mismatch and those having undergone an aortic annular enlargement. Material and Method: Six hundred and twenty seven adult patients, who underwent AVR with stented bioprosthetic or mechanical valves, between January 1996 and February 2006, were evaluated. PPM was defined as an indexed effective orifice area (iEOA) ${\leq}0.85cm^2/m^2$, and Severe if the iEOA${\leq}0.65cm^2/m^2$ PPM was present in 103 (16.4%, PPM group) patients, and severe in 11 (1.8%, SPPM group). During the period of the study, 21 patients underwent an AVR with annular enlargement (AE group). Result: The mean iEOA of the AE group was larger than that of the PPM group ($0.95\;vs.\;0.76cm^2/m^2,\;p=0.00$). The AE group had longer CPB, ACC and operation times than the PPM group, and showed a tendency toward higher operative mortality (14.3% vs. 2.9%, p=0.06). The SPPM group had higher AV pressure gradients (peak/mean) than the AE group (72/45 mmHg vs. 38/25 mmHg, p=0.02/0.06) and suffered more AV related events (AV reoperation or severe aortic stenosis)(45.5% vs. 9.5%, p=0.03). LV masses were not regressed in the patients who experienced an AV related event. Conclusion: During AVR in patients with a small aortic annulus, annular enlargement should be carefully applied taking into account the high risk of operative mortality due to annular enlargement and co-morbidities of patients. Aortic annular enlargement; however, should be considered as an alternative method in patients expected to have a severe PPM after an AVR.

• Journal of agriculture & life science
• /
• v.45 no.2
• /
• pp.69-83
• /
• 2011

The aim of the research was to provide basic information for a suitable management and utilization of protected trees by law. To achieve this aim, this study investigated the current state, management status and utilization of protected trees by law in Gyeongsan city. The result of the current state of protected trees indicated that there were 55 protected trees designated since 1982. These trees consisted of 8 species which were located at 41 places. Major species was Sophora japonica (30.9%), followed by Zelkova serrata (23.6%). The protected trees have been used as sacred trees (45.5%) in the villages, followed by scenic trees (36.7%). 38.2% of the protected trees were 200 to 300 years old and 54.6% of the trees were 15 to 30 m in height. 34% of the protected trees were located in the villages, followed by beside road (19.5%). Single trees (78%) were mostly planted. The result of the management status indicated that 58.5% of the root area in protected trees were covered with bare ground, followed by gravel mulch (19.5%). The average of soil hardness was 9.64 mm. The safety fence of tree was installed at 9 places (22%) and a stone wall was built at 22 places (53.7%). 70.9% of the protected trees had a surgical operation to prevent cavities and to cure decay. Granite stone signs were installed at 33 places. The result of the utilization of protected trees indicated that 13 places were used as a rest area in the villages. It consisted of shelters, benches, athletic facilities and outdoor tables. The research suggested potential places for a mini park(pocket park) to recover a local community by using surrounding available land and improving current rest areas of protected trees. The research presented here is a first step towards a more comprehensive analysis of protected trees in Gyeongsan and further research is needed.