Korea University Ansan Hospital Research Articles

Carotid Intima-Media Thickness Is Increased Not Only in Non-Alcoholic Fatty Liver Disease Patients but Also in Alcoholic Fatty Liver Patients

Background/Aims: There are many reports of non-alcoholic fatty liver disease (NAFLD) patients with increased carotid intima-media thickness (IMT). However, there is little information about carotid IMT in alcoholic fatty liver disease (AFLD) patients. We aimed to compare the carotid IMT of NAFLD patients and AFLD patients. Methods: The medical records of individuals who underwent carotid IMT measurement and abdominal ultrasonography between January 2006 and December 2008 at Korea University Ansan Hospital were retrospectively reviewed. The patients were divided into group A (no fatty liver without alcohol history), group B (NAFLD), group C (AFLD) and group D (no fatty liver with alcohol history). The carotid IMT results were compared across all groups. Results: The mean carotid IMT was 0.55 ± 0.1 mm for group A, 0.6 ± 0.1 mm for group B, 0.59 ± 0.1 mm for group C, and 0.54 ± 0.1 mm for group D. There were significant differences between groups A and B, groups A and C, and groups C and D (p < 0.05), but there were no differences between groups B and C (p = 0.736). Conclusions: We determined that patients with fatty livers have an increased carotid IMT both in NAFLD and AFLD patients.

The Usefulness of Dynamic Cine-Arthrography for Wrist Instability as Correlated with Arthroscopic Palmer Classification

Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea Department of Orthopedic Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea Received November 6, 2010 ; Accepted January 8, 2011 Address reprint requests to : Guen Young Lee, M.D., Department of Radiology, Korea University Ansan Hospital, 516, Gojan-dong, Danwon-gu, Ansan-si, Gyeonggi-do 425-707, Korea. Tel. 82-31-412-5227 Fax. 82-31-412-5224 E-mail: netty0523@hanmail.net Purpose: To introduce dynamic cine-arthrography and compare it with MR arthrography in the diagnosis of intrinsic ligament and triangular fibrocartilage complex tears, based on arthroscopic findings. Materials and Methods: A total of thirty-eight wrists of 38 patients who had undergone both dynamic cine-arthrography and MR arthrography were enrolled. Dynamic cinearthrography was performed after puncture of the radiocarpal joint by slow injection of contrast under continuous fluoroscopic guidance during passive wrist exercise. We obtained 1.5or 3-T MR arthrography with fat-suppressed T1-weighted coronal and axial images. We evaluated scapholunate and lunotriquetral ligaments and triangular fibrocartilage complex tears according to the Palmer classification system. Based on the arthroscopic findings, we compared the diagnostic values between the two examinations using Kappa values. Results: The overall sensitivity and specificity of diagnosis of intrinsic ligament tears was similar between dynamic cine-arthrography and MR arthrography (scapholunate ligament: sensitivity 66.7% vs. 80%, specificity 100% vs. 95.7%, lunotriquetral ligament: sensitivity 75.0% vs. 75.0%, specificity 94.1% vs. 91.2%). For triangular fibrocartilage complex tears, all diagnostic values were the same (sensitivity 96.4%, specificity 100%). The inter-examination agreement was substantial to perfect (kappa value 1.000). Conclusion: Dynamic cine-arthrography is valuable in the diagnosis of intrinsic ligament and triangular fibrocartilage complex tears compared to MR arthrography.

Quantitative Evaluation of the Hepatic Parenchymal Change in Patients with Chronic Liver Disease Using Gd-EOB-DTPA-enhanced MRI: Comparison with Normal Liver

Department of Diagnostic Radiology, Korea University Ansan Hospital Received July 6, 2010; Accepted October 14, 2010 Address reprint requests to : Sang Hoon Cha, M.D., Department of Diagnostic Radiology, Korea University Ansan Hospital, 516, Gojan-dong, Ansan-city, Gyeonggi-do 425-707, Korea. Tel. 82-31-412-5227 Fax. 82-31-412-5224 E-mail: sahcha@kumc.or.kr Purpose: We wanted to evaluate the capability of Gd-EOB-DTPA-enhanced MRI for diagnosing chronic liver disease by comparing the signal intensity change (SIC) of the hepatic parenchyma of patients with chronic liver disease with that of patients with a normal liver. Materials and Methods: This retrospective study included 50 patients who were pathologically confirmed as having liver cirrhosis (n=41) or chronic hepatitis (n=9) by surgery (n=9) or biopsy (n=41), and they all underwent Gd-EOB-DTPA-enhanced MRI between June 2008 and May 2010 (i.e., the patient group). We also analyzed 30 patients with normal livers as the control group. Quantitative image analysis was performed by measuring the signal-to-noise ratios for the pre-contrast images and the post-contrast 2-, 3-, 10-, 20-min delay images and then calculating the SIC of the precontrast and post-contrast images. We performed a detailed analysis of the collected data, which was transformed into a logarithmic form. The SICs of the two groups were compared by Greenhouse-Geisser sphericity correction. Results: Comparison of the SIC between the two groups showed a significant difference on the hepatocyte-phase 20-min image (p<0.0001). The mean SICs with log transformation for the patient and normal groups were 1.90 ± 0.10 and 2.23 ± 0.13, respectively, and the optimal cut-off value of the SIC with log transformation on the 20-min delay hepatocyte-phase image was 2.17 (sensitivity: 66.7%, specificity: 84.0%, positive predictive value: 71.4%, negative predictive value: 80.8%). Conclusion: Quantitative measurement of the SIC on the hepatocyte-phase image by Gd-EOB-DTPA-enhanced MRI could provide a convenient method to noninvasively diagnose chronic liver disease.

Subclinical infiltration of Basal cell carcinoma in asian patients: assessment after mohs micrographic surgery.

BackgroundSeveral differences in basal cell carcinomas (BCCs) were found, according to the ethnic group; for example, pigmented BCCs was more common in Asian or Hispanic patients. However, there are few reports on the subclinical extension of the BCC in Asian patients.ObjectiveThe aim of this study was to evaluate the subclinical infiltration of the basal cell carcinoma in Asian patients.MethodsAll patients with BCC who visited the department of dermatology at Korea University Ansan Hospital were treated with Mohs micrographic surgery. In 81 patients, 83 tumors of BCC were completely eradicated by Mohs micrographic surgery (MMS) from April 2001 to August 2008, and were reviewed in this study. Information recorded included the total margin and the number of stages of Mohs micrographic surgery, anatomic location, tumor size, presence of pigmentation, clinical type, and pathological subtype. We divided the clinical types into nodular, ulcerated, and pigmented, and the pathological types into nodular, micronodular, morpheaform, and adenoid. The BCC was of pigmented type if pigmentation covered more than 25% of the tumor, regardless of whether pigmentation was distinct, or if there was apparent pigmentation that covered more than 10% of the tumor.ResultsThe nose and cheek were the most common sites requiring more than one stage of surgery. In tumors smaller than 1 cm, 91.7% required only one stage of excision, compared with 60.6% in tumors larger than 1 cm. More than two Mohs stages were required in 25% of non-ulcerated BCCs and in 46.2% of ulcerated BCCs. Sixty eight percent of pigmented BCCs required only one stage of Mohs micrographic surgery. In cases of non-pigmented BCCs, only 45% required one Mohs stage. More than one Mohs stage was required in 19.2% of non-aggressive BCCs and in 42.9% of aggressive BCCs.ConclusionSubclinical infiltration differed between the two groups according to the size of the BCC (1 cm threshold) and most of the BCCs were located in the head and neck area. Considering this result, indication for MMS can be extended for BCCs larger than 1 cm in Asian patients. Ulcerated BCCs required more Mohs stages than non-ulcerated BCCs. Pigmented BCCs might show lesser subclinical infiltration than non-pigmented BCCs. Aggressive pathological subtypes showed more subclinical infiltration than the non-aggressive types; however, after evaluation of the border that was excised with MMS, mixed histologic types were found to be more frequent than generally accepted. Therefore, we consider that, when planning surgery, dermatologists should not place too much confidence in the pathologic subtypes identified by biopsy.

Evaluation of the LG Advansure™ Malaria P.f./P.v. real-time QPCR for the Diagnosis of Malaria

This article is available from http://www.labmedonline.org 2011, Laboratory Medicine Online This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background: Malaria is a problematic disease in Korea, and microscopic examination of Giemsa-stained blood smear has been used as the gold standard for its diagnosis. However, this technique is time-consuming and has low sensitivity in samples with low numbers of malarial parasites (<20 parasites/μL). Here, we evaluated the performance characteristics of the LG Advansure Malaria P.f./P.v. real-time QPCR (LG life sciences, Korea). Methods: Blood samples from 173 persons who visited Korea University Ansan Hospital were evaluated. QPCR was performed in 73 malaria patients and 100 healthy subjects by using the LG Advansure Malaria P.f./P.v. real-time QPCR kit, and the results were compared with those of microscopy. The detection limit of this kit was determined by serial dilution of Plasmodium-infected blood with normal blood (blood not infected with Plasmodium). Results: Among the 73 patients that were microscopically confirmed to have malaria (Plasmodium vivax infection, N=70, P. falciparum infection, N=3), 69 patients were diagnosed with P. vivax infection and 3 were diagnosed with P. falciparum infection by LG Advansure Malaria P.f./P.v. realtime QPCR. Both the tests indicated absence of infection in the 100 healthy subjects. The detection limit of LG Advansure Malaria P.f./P.v. real-time QPCR was 0.1 parasite/μL. Conclusions: LG Advansure Malaria P.f./P.v. real-time QPCR is a very sensitive and specific technique and can be used as a confirmatory test for malaria.

Evaluation of Plasmodium vivax ELISA for the blood screen

Plasmodium vivax malaria is the indigenous strain in the Republic of Korea (ROK). Plasmodium vivax can be transmitted through the transfusions of various blood components, which became a severe problem with the safety of blood transfusions and blood-related products in ROK. We evaluated a P.vivax-specific enzyme-linked immunosorbent assay (Genedia Malaria Ab ELISA 2.0, Green Cross, ROK) with blood samples from four groups: 251 samples from P.vivax-infected patients, 39 samples from post-treatment patients upon follow-up, 200 samples from healthy volunteers and 421 samples from domestic travellers to and from high endemic areas of ROK. The positive cases from the ELISA test were confirmed by both Giemsa microscopic and polymerase chain reaction methods. The clinical sensitivity and specificity of detecting P.vivax with ELISA test were 94.4% and 99.0%, respectively. Thirteen of 421 domestic travellers (3.0%) to endemic areas tested positive. The results indicate the effectiveness of detecting antibodies against P.vivax in blood with Genedia Malaria Ab ELISA 2.0 test in a large blood screen setting.

Left ventricular function and high-voltage electrical injury

Department of Cardiology and Critical Care Medicine, Korea University Ansan Hospital, Ansan, South Korea (Kim, Shin) Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, South Korea (Cho)

Effectiveness of canalicular laceration repair using monocanalicular intubation with Monoka tubes

This study aimed to evaluate the clinical efficacy of canalicular laceration repair using monocanalicular intubation with Monoka tubes. A total of 36 single lacerated canaliculi were repaired using monocanalicular intubation with Monoka tubes, without mucosal anastomosis of the canaliculi, and were retrospectively reviewed. Demographic information, injury locations, associated ocular injuries, complications and outcomes were analysed. Mean patient age was 34 years (range 1-64 years). Tubes were removed at a mean of 4.2 months (range 3-6 months). There were 26 lower canalicular lacerations (72%) and 10 upper canalicular lacerations (28%). Overall, 34 of 36 cases (92%) showed improvement in symptoms and exhibited positivity on the dye disappearance test at 4-12 months after the procedure (mean 7.8 months). In total, 21 patients (58%) achieved complete success, 13 patients (36%) achieved partial success and two patients (6%) suffered surgical failure. Complications were seen in five cases and included two early tube protrusions, two punctal slits and one punctal granuloma. Monocanalicular intubation with Monoka tubes leads to successful outcomes without significant complications and offers an alternative to bicanalicular intubation in the treatment of monocanalicular lacerations.

Changes in Liver Stiffness after Acute or Chronic Liver Injury due to Viral Hepatitis - Does Fibrosis Exist after Recovery from Acute Viral Hepatitis?

Liver stiffness (LS) measurement by transient elastography can estimate the degrees of liver fibrosis in patients with chronic liver disease. However, longitudinal data of LS after recovery of acute viral hepatitis are still lacking. In the present study, we aimed to evaluate among LS of patients at various stages of viral hepatitis and normal control. Patients who had admitted at Korea University Ansan Hospital between January 2006 and January 2007 due to acute viral hepatitis and recovered were recruited (group A, n=22). We compared the liver biochemistry and LS of group A with those of healthy control group (group B, n=23), current acute viral hepatitis group (group C, n=49), and chronic viral hepatitis group (group D, n=66). Mean ALT, total bilirubin, and LS level of group A were not different from group B (p=0.318, p=0.116, p=0.125, respectively). However, group A had lower ALT, total bilirubin, and LS values compared to group C (all p<0.001), and lower ALT and LS values compared to group D (p=0.007, p<0.001). The mean total bilirubin was not significantly different from group D (p=0.117). Our data suggest that liver fibrosis is a long-term sequela of chronic hepatitis, and not developed in patients who recovered from acute viral hepatitis.

TPH2 -703G/T SNP may have important effect on susceptibility to suicidal behavior in major depression

Background Serotonergic system-related genes can be good candidate genes for both major depressive disorder (MDD) and suicidal behavior. In this study, we aimed to investigate the association of serotonin 2A receptor gene -1438A/G SNP (HTR2A -1438A/G), tryptophan hydroxylase 2 gene -703G/T SNP (TPH2 -703G/T) and serotonin 1A receptor C-1019G (HTR1A C-1019G) with suicidal behavior. Methods One hundred and eighty one suicidal depressed patients and 143 non-suicidal depressed patients who met DSM-IV criteria for major depressive disorder were recruited from patients who were admitted to Korea University Ansan Hospital. One hundred seventy six normal controls were healthy volunteers who were recruited by local advertisement. Patients and normal controls were genotyped for HTR2A -1438A/G, TPH2 -703G/T and 5-HT1A C-1019G. The suicidal depressed patients were evaluated by the lethality of individual suicide attempts using Weisman and Worden's risk-rescue rating (RRR) and the Lethality Suicide Attempt Rating Scale-updated (LSARS-II). In order to assess the severity of depressive symptoms of patients, Hamilton's Depression Rating Scale (HDRS) was administered. Genotype and allele frequencies were compared between groups by χ 2 statistics. Association of genotype of the candidate genes with the lethality of suicidal behavior was examined with ANOVA by comparing the mean scores of LSARS and RRR according to the genotype. Results There were statistically significant differences in the genotype distributions and allele frequencies of TPH2 -703G/T between the suicidal depressive group and the normal control group. The homozygous allele G (G/G genotype) frequency was significantly higher in suicidal depressed patients than in controls. However, no differences in either genotype distribution or in allele frequencies of HTR2A -1438A/G and HTR1A C-1019G were observed between the suicidal depressed patients, the non-suicidal depressed patients, and the normal controls. There were no differences in the lethality of suicidal behavior in suicidal depressed patients according to the genotypes of three polymorphisms. Conclusion Our results suggest that TPH2 -703G/T SNP may have an important effect on susceptibility to suicidal behavior. Furthermore, an increased frequency of G allele of TPH2 SNP may be associated with elevated suicidal behavior itself rather than with the diagnosis of major depression and may increase risk of suicidality, independent of diagnosis.

GASTROINTESTINAL BLEEDING WITH ANTIPLATELET MEDICATION IN SEVERE PORTAL HYPERTENSIVE PATIENT AFTER LIVING DONOR LIVER TRANSPLANTATION: A CASE REPORT

1Department of Surgery, Korea University Guro Hospital, 2Department of Internal Medicine, Korea University Guro Hospital, 3Department of Surgery, Korea University Guro Hospital, 4Department of Surgery, Korea University Ansan Hospital, 5Department of Surgery, Korea University Guro Hospital

Risk Factor of Erosive Esophagitis for Adults with Normal Z-Line in Korea

Backgrounds: About one-third to one-half of GERD patients has erosive esophagitis. Prevalence of erosive esophagitis is gradually rising in Korea. There have been many cross-sectional studies on risk factors of erosive esophagitis. However, the risk factor of erosive esophagitis occurred in adults with normal Z-line is not well known. Aims: In this study, we investigated the incidence and risk factor of erosive esophagitis in adults with normal Z-line. Patients and Methods: We did a study on a consecutive series of subjects who underwent gastrofiberscopy for stomach cancer screening at the Center for Health Promotion, Korea university Ansan hospital in Korea, from January 2002 to December 2004. A total of 11,288 patients were screened. Of these, 1221 subjects who had normal Z-line with follow up period of more than two years were eligible for this study. Subjects were asked to answer a questionnaire on their education level, alcohol intake, smoking habit, amount of exercise, stress score and comorbidity. Waist circumference and body mass index was checked along with serum laboratory tests. Abdominal sonogram was performed to assess the presence of fatty liver. Gastrofiberscopy was performed during the follow up. Erosive esophagitis was subgrouped according to endoscopic findings of grade M (minimal change) and Los Angeles Classification. Grade M included blurred Z-line and whitish discoloration or hyperemia of distal esophagus. Results: Mean follow up time was 34.4 months (24∼58). Erosive esophagitis occurred in 133 patients (10.9%). From those who had erosive esophagitis, 86 cases were grade M (7.0%), 41 were LA-A (3.4%) and 6 were LA-B (0.5%). However, none was found to have more than LA-C. In univariate analysis, gender, education level, amount of alcohol intake and smoking, waist circumference, serum triglyceride and uric acid level proved to be a risk factor of erosive esophagitis. In Multivariate analysis, only waist circumference proved to be a significant risk factor. Conclusions: Incidence of erosive esophagitis in adults with normal Z-line was 10.9%. Waist circumference can be a predicting factor for erosive esophagitis.

Association of Snoring With Chronic Bronchitis

Snoring is more prevalent in patients with chronic bronchitis than in persons without it. Few studies have examined the effect of snoring on chronic bronchitis. We prospectively investigated the association between snoring and the incidence of chronic bronchitis. The baseline study was conducted from June 25, 2001, to January 29, 2003. Members of the study cohort consisted of 5015 male and female Korean citizens aged 40 to 69 years at baseline who participated in a comprehensive health examination and on-site interviews at Korea University Ansan Hospital. Of these, 4270 participants (52% men and 48% women) entered the analysis for the first 2-year follow-up from April 17, 2003, to February 20, 2005, and those who met the same inclusion criteria remained in the analysis for a second 2-year follow-up period from February 21, 2005, to November 17, 2006. We collected information on snoring at baseline and identified incident cases of chronic bronchitis during a 4-year follow-up period. On the baseline questionnaire, we excluded participants who reported the presence of cough and sputum production on most days for at least 3 months a year. During 4 years of follow-up, we documented 314 cases of new-onset chronic bronchitis (27.1 cases per 1000 person-years). After taking into account age, smoking, and other risk factors for chronic bronchitis, the multivariate relative risks of chronic bronchitis were 1.25 (95% confidence interval [CI], 0.95-1.64) for persons snoring 5 times per week or less and 1.68 (95% CI, 1.17-2.42) for those snoring 6 to 7 times per week compared with never snorers (P for trend = .049). The analyses stratified by risk factors, including smoking, occupation, and body mass index, showed a stronger association among never smokers, house workers, and overweight persons. In analysis for the joint effect of smoking and snoring, the relative risks of chronic bronchitis were 1.39 (95% CI, 1.01-1.90) for nonsmoking and snoring, 2.31 (95% CI, 1.38-3.87) for smoking and never snoring, and 2.86 (95% CI, 1.91-4.27) for smoking and snoring compared with nonsmoking and never snoring. This prospective study observed that snoring is associated with chronic bronchitis. Our findings provide support for the hypothesis that snoring influences the development of chronic bronchitis.

3602: Carotid atherosclerosis, intracranial artery stenosis and cerebral white matter lesions

Objectives: Intima-media thickness (IMT) of the carotid artery serves as a marker of general atherosclerosis and the association of IMT with ischemic stroke has been documented. The purpose of this study is to evaluate the association of IMT, intracranial artery stenosis and cerebral white matter lesions (WMLs).Methods: We collected data of B-mode ultrasound graphic measurements of carotid IMT and brain MRI and MRA from 712 acute ischemic stroke patients admitted to Korea University Ansan Hospital between January 2003 and December 2004. The mean age was 64.3 ± 15.2 years and 60.1% were male. Based on MRI/MRA finding, intracranial artery stenosis was defined and WMLs were rated.Results: Sixty-one percent of patients had intracranial artery stenosis on brain MRA. We found significant difference in age and carotid IMT between intracranial artery stenosis group and nonstenosis group. With increasing number of plaques in the carotid artery the severity of WMLs increased (p < 0.005). The carotid IMT was 0.54 ± 0.21 mm for nonstenosis group and 0.88 ± 0.24 mm for stenosis group (p < 0.001). The age and carotid IMT were associated with intracranial stenosis independently on multivariate logistic regression test.Conclusions: This study suggest that certain pathogenetic mechanisms are involved in the association with carotid IMT, intracranial artery stenosis and WMLs. Objectives: Intima-media thickness (IMT) of the carotid artery serves as a marker of general atherosclerosis and the association of IMT with ischemic stroke has been documented. The purpose of this study is to evaluate the association of IMT, intracranial artery stenosis and cerebral white matter lesions (WMLs). Methods: We collected data of B-mode ultrasound graphic measurements of carotid IMT and brain MRI and MRA from 712 acute ischemic stroke patients admitted to Korea University Ansan Hospital between January 2003 and December 2004. The mean age was 64.3 ± 15.2 years and 60.1% were male. Based on MRI/MRA finding, intracranial artery stenosis was defined and WMLs were rated. Results: Sixty-one percent of patients had intracranial artery stenosis on brain MRA. We found significant difference in age and carotid IMT between intracranial artery stenosis group and nonstenosis group. With increasing number of plaques in the carotid artery the severity of WMLs increased (p < 0.005). The carotid IMT was 0.54 ± 0.21 mm for nonstenosis group and 0.88 ± 0.24 mm for stenosis group (p < 0.001). The age and carotid IMT were associated with intracranial stenosis independently on multivariate logistic regression test. Conclusions: This study suggest that certain pathogenetic mechanisms are involved in the association with carotid IMT, intracranial artery stenosis and WMLs.

Efficacy of Loop Electrosurgical Excision Procedure in the Diagnosis and Treatment of Uterine Cervical Dysplasia

Objective: The purpose of this study was to evaluate the efficacy of loop electrosurgical excision procedure which can be done safely and efficiently in the out-patient setting for the diagnosis and treatment of uterine cervical dysplasia. Materials and methods: Retrospective review of 42 patients with the uterine cervical dysplasia who underwent LEEP at the Department of Ob & Gyn in Korea University Ansan Hospital from Jan. 1998 to Dec. 2000. The diagnostic accuracy among cytology, punch biopsy, and LEEP was investigated. Also, we interpreted margin status relation to residual tumor after conization and hysterectomy. We used the hybrid capture Ⅱ test, with the Digene Cervical Sampler(Digene Corporation, Gaithersburg, MD, USA), for high risk HPV DNA(HPV 16, 18 subtype) detection. Results: Cervical cytologic results were underestimated 52.4% in LSIL, but there was no case overestimated. HSIL group revealed 42.9%, 57.1% in severe dysplasia and CIS respectively. Punch biopsy was revealed accuracy with LEEP in 76.2%, but underestimated in 16.7% and overestimated in 7.1%. HPV DNA were positive in 15.4% of mild dysplasia, 25% in moderate dysplasia and 75%, 88.9% in severe dysplasia and CIS respectively. 11.9% of participants showed positive resection margins after LEEP. All subjects included low abdominal discomfort among their complications. But there was no serious complication. Conclusion: LEEP seems to be an effective method of diagnosis and treatment of cervical dysplasia based on cytology and colposcopically directed biopsy.