Hyuk Jae Jung

Image quality and radiation dose of CT venography with double dose reduction using model based iterative reconstruction: comparison with conventional CT venography using filtered back projection:

Background Computed tomography venography (CTV) at low kVp using model-based iterative reconstruction (MBIR) can enhance vascular enhancement with noise reduction. Purpose To evaluate image qualities and radiation doses of CTV at 80 kVp using MBIR and a small iodine contrast media (CM) dose and to compare these with those of CTV performed using a conventional protocol. Material and Methods Sixty-five patients (mean age = 58.1 ± 7.2 years) that underwent CTV for the evaluation of deep vein thrombosis (DVT) and varicose veins were enrolled in this study. Patients were divided into two groups: Group A (35 patients, 80 kVp, MBIR, automatic tube current modulation, CM = 270 mg/mL, 100 mL) and Group B (30 patients, 100 kVp, filtered back projection [FBP], 120 fixed mA, CM = 370 mg/mL, 120 mL). Objective and subjective image qualities of inferior vena cava (IVC), femoral vein (FV), and popliteal vein (PV) were assessed and radiation doses were recorded. Results Mean vascular enhancement in group A was significantly lower than in group B (P < 0.01). Noise in group A was significantly lower than in group B except for PV and contrast-to-noise ratio were not significantly different in the two groups (P > 0.05). In addition, radiation dose in group A was significantly lower than in group B (P < 0.001). Subjective image quality comparison revealed group A was statistically inferior to group B except for subjective image noise. Conclusion CTV at 80 kVp using MBIR with small iodine contrast dose provided acceptable image quality at a lower radiation dose than conventional CTV using FBP.

Infected Groin (Graft/Patch): Managed with Sartorious Muscle Flap

Purpose: The purpose of this study was to review the natural history, clinical outcome and safety in patients undergoing sartorius muscle flap (SMF) for groin infection, including lymphocele. Materials and Methods: We retrospectively reviewed the records of patients who underwent SMF in a single center between 2000 and 2009. Results: Thirty patients (17 male, 13 female) underwent SMF for groin infection, which included infections of 22 artificial femoral bypass grafts (including 2 cryoveins) and 5 common femoral patch grafts, and 3 lymphocele infections (2 cardiac catheterizations and 1 penile cancer lymph node dissection). Wound isolates were most commonly Gram-positive organisms (n=22) with Gram-negative isolates and mixed infections accounting for 4 and 3 cases, respectively. In 9 patients there was no growth of organisms. Adjunctive wound vacuum-asssisted wound closure therapy was performed in 18 patients. Follow-up duration ranged from 8 days to 56 months (mean 14.1 months) after SMF. Reoperation was performed in 3 patients due to wound bleeding (n=1) and reinfection (n=1). One patient underwent graft excision with external bypass operation. There was 1 mortality case due to sepsis during the study period. Conclusion: We found that muscle flap surgery provides successful single-intervention therapy for groin infections including lymphocele. Graft ligation or aggressive excision with bypass surgery should be reserved for patients requiring rapid control of sepsis for lifesaving.

Hybrid Treatment of Coexisting Renal Artery Aneurysm and Abdominal Aortic Aneurysm in a Gallbladder Cancer Patient

Renal artery aneurysm (RAA) is uncommon, and the coexistence of an abdominal aortic aneurysm (AAA) is an extremely rare condition with potentially high life-threatening mortality in case of rupture. Aneurysms can be treated by endovascular intervention or open surgery. Although most of aneurysms are treated by endovascular intervention, open surgery is often necessary for RAAs associated with the proximal renal bifurcation or the branches in the distal renal arteries. We report a rare case of coexisting RAA with AAA treated by hybrid method, consisting of endovascular aneurysm repair for AAA and open surgery for RAA located adjacent to the distal branches of the renal artery.

Combination of Surgical Thrombectomy and Direct Thrombolysis in Acute Abdomen with Portal and Superior Mesenteric Vein Thrombosis

Portal vein (PV) thrombosis (PVT) is a rare condition with development of thrombosis in the PV and its branches. Further extension to the splenic and superior mesenteric vein (SMV) causes intestinal infarction, with a reported mortality of up to 50%. A variety of treatments for PVT exist including anticoagulation, thrombolysis, surgical thrombectomy, insertion of shunts, bypass surgery, and liver transplantation. We experienced a case of successfully treated by surgical thrombectomy with direct thrombolysis into the thrombosed-PV and SMV. A 31-year-old male presented worsening abdominal pain for one week. Preoperative contrast enhanced computed tomography scan revealed complete PVT extending to splenic vein and SMV. The PV was accessed surgically and opened by thrombectomy; visual inspection confirmed proximal and distal flow. Urokinase was administered directly into the inferior mesenteric vein with successful decrease in thrombus burden. The complete angiography showed complete dissolution of thrombosis in PV and SMV.

Ruptured Mycotic Aneurysm of the Common Carotid Artery: A Case Report

Mycotic aneurysms of the common carotid artery (CCA) are very rare and warrant surgical treatment to prevent rupture and death. A 89-year-old man who complained of a sore throat and swelling of the right side of neck. He had no history of trauma or neck infection. Physical examination revealed hard and pulsatile mass. Computed tomography showed initially pseudoaneurysm rupture on the right CCA with surrounding inflammation. The emergency operation revealed mycotic aneurysm rupture with CCA necrosis and was successfully done by wide debridement and carotid artery resection with interposition bypass. The resected tissue and blood culture grew growth of Staphylococcus aureus group. We report a rare case of mycotic aneurysm of right CCA that treated by bypass interposition.

Hybrid treatment of multilevel revascularization in patients with peripheral arterial disease – a multi-centre study in Korea

BACKGROUND Endovascular treatment is an alternative first-line management for peripheral artery disease (PAD). Hybrid treatment (HT) is defined as a combined treatment for patients with PAD using endovascular and open surgery, simultaneously performed in an operating room. The results of HT are reportedly good for multilevel revascularization (MR) in patients with chronic limb ischaemia, and even in older high-risk patients. The goal of this study was to examine the clinical and haemodynamic outcomes of HT in patients who need MR. PATIENTS AND METHODS Nine university hospitals in Korea participated in this multicentre study. A total of 134 patients with multilevel PAD underwent HT and MR. Patients were enrolled from July 2014 to June 2015 and were followed for 18 months. RESULTS The mean age of the patients was 68.8 ± 9.93 years and 88.1 % were men. Patients with Rutherford category 2 to 3 and 4 to 6 comprised 59.0 % and 42.0 % of the group, respectively. The technical success rate was 100 %. The primary patency rates at 12 and 18 months were 77.6 % and 63.9 %, respectively. The primary-assisted patency rates at 12 and 18 months were both 90.0 %. The pre-operative mean ankle brachial index (0.43 ± 0.23) increased to 0.87 ± 0.23 at six months post-operatively (t-test, p < 0.05). The amputation free survival rate was 97.1 %. CONCLUSIONS Although outcomes of multilevel PAD are reportedly poor when endovascular treatment alone is used, we have shown that HT is a feasible alternative modality for patients with multilevel PAD, with satisfactory amputation-free survival and freedom from re-intervention rates.

Rescue Technique for Malposition Caused by Mislabeled Stent Graft in Thoracic Aneurysm

The aim of this paper is to report a salvage treatment for malpositioned stent graft due to mislabeled product during thoracic endovascular aortic repair (TEVAR) in descending thoracic aneurysm (DTA). A 78-year-old male presented with 6.7×4.1 cm sized saccular DTA and 7.1×7.3 cm sized abdominal aortic aneurysm (AAA). DTA was initially treated by TEVAR and 2 months later AAA was treated by open aortic repair. Unfortunately, although the stent graft was correctly labeled for DTA, the actual size of product wrapped in a box was different contrary to our expectations. On completion angiography, proximal sealing zone showed no endoleak, however, celiac trunk and superior mesenteric artery (SMA) was found to be accidentally occluded. Through an emergent thoracotomy, distal part of stent graft was removed by cutting distal segment of stent graft and pulling out maneuver to restore blood flow. The completion angiography presented no endoleak, and celiac trunk and SMA were secured. Cutting distal segment of stent graft and pulling out maneuver is one of feasible rescue technique to maintain blood flow of occluded celiac trunk during TEVAR.

Is Beta-Blocker Use Beneficial in Breast Cancer? A Meta-Analysis

Objective: Preclinical studies have proved that beta-blocking agents inhibit several pathways for breast cancer progression and metastasis. We aimed to evaluate the association between beta-blocker use and prognosis of breast cancer. Methods: A systematic search for studies from MEDLINE and EMBASE (inception to March 2014) was performed using the keywords “breast cancer” and “beta-blocker.” In 2 groups of breast cancer patients (beta-blocker users and non-beta-blocker users), overall deaths (ODs), cancer-specific deaths (CSDs), and recurrences were compared. Results: Six studies including 18,118 patients were eligible for this analysis. Two studies with 3,139 patients were included in the analysis of ODs. The random-effects model showed no significant difference in ODs between beta-blocker users and non-beta-blocker users (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.50-1.52, p = 0.49). Four studies with 13,782 patients were included in the measurement of CSDs. The difference in CSDs between beta-blocker users and non-beta-blocker users was not significant using the fixed-effect model (OR 0.93, 95% CI 0.82-1.06, p = 0.29). Three studies with 3,923 patients were included in the calculation of recurrences. Overall, beta-blockers did not affect the incidence of recurrence (OR 0.70, 95% CI 0.25-1.95, p = 0.49). Conclusion: Beta-blockers were not beneficial regarding ODs, CSDs, or recurrences. Further studies are needed to evaluate the associations between the effects of beta-blockers and subtypes of breast cancer.

Stereotactic vacuum-assisted breast biopsy under lateral decubitus position

Purpose Stereotactic vacuum-assisted breast biopsy (VAB) has been established as a standard method for histological diagnosis of microcalcification or nonpalpable breast lesions on mammography. Generally, the procedure has been done under the prone position or upright sitting position. We herein attempt to evaluate clinical utility of Stereotactic VAB under lateral decubitus position. Methods One hundred six women (mean age, 51.2 years) with mammographically detected microcalcification underwent lateral decubitus positioning VAB using the 8G probe. In all cases, we obtained mammography specimens for identification of microcalcification and postprocedure mammography. We reviewed mean procedure time, pieces of specimen, pathology and follow-up mammography. Results The procedure took approximately 20 minutes (range, 15-24 minutes). Average number of obtained specimens was 8.5 pieces (range, 6-12 pieces). Microcalcifications were confirmed in both specimen mammography and microscopic slides. Of 106 cases, 10 cases were diagnosed as ductal carcinoma in situ. Additional surgical management was performed. Atypical ductal hyperplasias were found in 8 cases, and fibrocystic changes in 88 cases. Conclusion Stereotactic VAB using the 8G probe under lateral decubitus position does not need a dedicated table, and is easier to maintain the position. Also, this procedure is accurate and safe. Thus, stereotactic VAB using the 8G probe under lateral decubitus position will be a useful method for diagnosis of microcalcification or nonpalpable breast lesions on mammography.