Jeong Mi Park

Pulmonary Cement Embolism after Percutaneous Vertebroplasty in Osteoporotic Vertebral Compression Fractures: Incidence, Characteristics, and Risk Factors

PURPOSEnTo prospectively evaluate the incidence of, characteristics of, and risk factors for pulmonary cement embolism after percutaneous vertebroplasty (PVP) in osteoporotic vertebral compression fractures (VCFs).nnnMATERIALS AND METHODSnInstitutional review board approval and written informed consent were obtained. From June 2006 to September 2007, 75 patients (57 women, 18 men; mean age, 74.78 years; range, 48-93 years) who underwent 78 PVP sessions at 119 levels for osteoporotic VCFs were prospectively enrolled in this study. Computed tomographic (CT) scans of the chest and treated vertebrae were obtained after PVP. The presence, location, involved pulmonary arteries, number, and size of each pulmonary cement embolus were analyzed at CT. Possible risk factors were analyzed as follows: Age, injected cement volumes, and numbers of treated vertebrae were analyzed by using the Mann-Whitney U test; operators (radiologist or nonradiologist), level of treated vertebrae, guidance equipment, approach (uni- or bipedicular), presence of intravertebral vacuum clefts, and presence of paravertebral venous leakage were analyzed by using Pearson chi(2) and Fisher exact tests.nnnRESULTSnPulmonary cement emboli developed in 18 (23%) of 78 PVP sessions and were detected in the distal to third-order pulmonary arteries. Only cement leakage into the inferior vena cava showed a statistically significant relationship to pulmonary cement embolism (P = .03). A higher frequency of pulmonary cement embolism was noted for the absence of intravertebral vacuum clefts, for the bipedicular approach, and for a nonradiologist operator with C-arm fluoroscopy (P > .05).nnnCONCLUSIONnIn osteoporotic VCFs, pulmonary cement embolism was detected in 23% of PVP sessions, developed in the distal to third-order pulmonary arteries, and was related to leakage into the inferior vena cava.

Serotonin transporter gene polymorphism and irritable bowel syndrome

Abstractu2002 Polymorphisms in the promoter region of the serotonin reuptake transporter (SERT) gene may underlie the disturbance in gut function in patients with irritable bowel syndrome (IBS). Association studies of SERT polymorphisms and IBS have shown diverse results among different countries, which might be due to racial and subject composition differences. The aim of this study was to assess the potential association between SERT polymorphisms and IBS in Koreans. A total of 190 IBS patients, who met the Rome II criteria, and 437 healthy controls were subjected to genotyping. SERT polymorphisms differed in the IBS and control groups (Pu2003=u20030.014). The SERT deletion/deletion genotype occurred with greater frequency in the diarrhoea‐predominant IBS group than in the controls. A strong genotypic association was observed between the SERT deletion/deletion genotype and diarrhoea‐predominant IBS (Pu2003=u20030.012). None of the clinical symptoms analysed was significantly associated with the SERT genotypes. The frequency of the SERT insertion/insertion genotype was much lower than that of the other two genotypes. A significant association was observed between the SERT polymorphism and IBS, especially diarrhoea‐predominant IBS, suggesting that the SERT gene is a potential candidate gene involved in IBS in Korea.

The role of small intestinal bacterial overgrowth in postgastrectomy patients.

Backgroundu2002 Small intestinal bacterial overgrowth (SIBO) is expected in postgastrectomy patients; however, its role has not been clarified. This study was to estimate the prevalence of SIBO and investigate the clinical role of SIBO in postgastrectomy patients.

Elevated levels of preoperative CA 15-3 and CEA serum levels have independently poor prognostic significance in breast cancer

BACKGROUNDnTo evaluate the prognostic value of preoperative tumor markers, cancer antigen 15-3 (CA 15-3) and carcinoembryonic antigen (CEA), in breast cancers.nnnPATIENTS AND METHODSnPreoperative CA 15-3 and CEA levels of 1681 patients were measured. The association of both tumor markers levels with clinicopathological parameters and outcomes was investigated by univariate and multivariate analyses.nnnRESULTSnAmong 1681 patients, elevated preoperative CA15-3 and CEA levels were identified in 176 and 131 patients, respectively. Higher preoperative CA 15-3 and CEA levels were significantly associated with a larger tumor size, axillary node metastases, and advanced stage. Patients with elevated CA 15-3 and CEA levels showed worse survival, even in stage-matched analysis. Patients with normal levels of both CA15-3 and CEA showed better survival than those with one or both markers levels elevated. In multivariate analysis, elevated preoperative CA 15-3 and CEA levels were independent prognostic factors. The statistical significance of elevated preoperative tumor markers levels on survival was solidified with longer follow-up and larger study population.nnnCONCLUSIONSnElevated preoperative CA 15-3 and CEA levels are associated with tumor burden and showed independent prognostic significance. Therefore, new treatment strategies are necessary for patients with elevated preoperative CA 15-3 and CEA levels in clinical practice.

Atypical benign lipomatous tumors in the soft tissue: radiographic and pathologic correlation.

This article describes the characteristic imaging findings and correlates them with the pathology in the nonfatty regions of benign atypical lipomatous tumors, which have different findings compared with typical lipomas and well-differentiated liposarcomas. For differentiating these tumors from typical lipomas and well-differentiated liposarcomas, it may be helpful to analyze nonfatty regions in benign atypical lipomatous tumors.

Various image findings of skeletal muscle metastases with clinical correlation.

ObjectiveThe purpose of this article is to describe the image findings of distant metastases to skeletal muscle with clinical correlation.Design and patientsThe records of nine consecutive patients with biopsy-proven metastases to skeletal muscle from primary malignancies were retrospectively reviewed for clinical history and findings from magnetic resonance imaging (MRI) (eight cases) or computed tomography (CT) (one case). Clinical history, interval between detection of primary tumor and metastases, multiplicity, primary cell type of malignancy, site of metastases, and nature of masses on MRI or CT were evaluated by two musculoskeletal radiologists.ResultsThe most common symptom was a painful mass (78%), and the most common site was the thigh (78%). Four patients showed a single mass (44%). There was previous malignancy in five patients (56%), but four patients had no prior malignancy (44%). The time interval between the detection of primary malignancy and metastases was 8xa0months to 15xa0years. Mean size of metastases was 5.1u2009±u20092.2xa0cm. The most common primary tumor was of the lung (two patients) and kidney (two patients), and the most common cell type was adenocarcinoma. On images, necrosis and peritumoral edema were relatively frequent. All cases showed good enhancement. of contrast medium.ConclusionSkeletal muscle metastases show good enhancement of contrast medium and frequent edema and necrosis. The possibility of skeletal muscle metastases should be borne in mind for patients with painful and multiple muscle masses.

Polyvinyl alcohol embolization adjuvant to oily chemoembolization in advanced hepatocellular carcinoma with arterioportal shunts.

Objective To assess the feasibility and safety of polyvinyl alcohol (PVA) embolization adjuvant to transarterial oily chemoembolization (P-TACE) in advanced hepatocellular carcinoma (HCC) with arterioportal shunts (APS). Materials and Methods Nineteen patients who underwent PVA embolization for APS before a routine chemoembolization (TACE) procedure were retrospectively reviewed. 10 of these 19 patients underwent follow-up TACE or P-TACE after P-TACE (Group A), but nine patients underwent only initial P-TACE because of progression of HCC and/or underlying liver cirrhosis (Group B). Hepatic function tests, APS grades, and portal flow directions were evaluated before and after P-TACE sessions. Complications after procedures and survival days were also evaluated. Results In group A, APS grade was improved in eight patients and five of six patients with hepatofugal flow showed restored hepatopetal flow postoperatively. No immediate complication was developed in either group. Transient hepatic insufficiency developed in eight (42.1%) of 19 patients after P-TACE, and seven (87.5%) of these eight recovered within two weeks under conservative care. The mean and median survival time all study subjects was 280 days and 162 days. Conclusion P-TACE is feasible and safe in advanced HCC patients with APS.

Percutaneous vertebroplasty for intravertebral cleft: analysis of therapeutic effects and outcome predictors

ObjectiveTo investigate the short-term therapeutic effect of percutaneous vertebroplasty (PVP) for intravertebral cleft (IVC) and to analyze possible outcome predictors.Materials and MethodsAfter retrospective review of spot radiographs during PVP, 23 patients were included in this study. Age, sex, symptom duration, functional status, injected cement volume, and type of approach were evaluated using patients’ medical and operative records. The following factors were analyzed on radiographs, MRI, dual bone densitometry, spot radiographs during PVP, and CT: anatomical location of the fracture, bone mineral density, morphology of the fracture, IVC morphology, presence of surrounding non-enhanced area and bone marrow edema, degeneration of adjacent discs, co-existing old compression fractures, patterns of cement opacification, pre-procedural kyphosis, and post-procedural kyphosis correction. Effectiveness was defined as a much-improved state or no pain after 1xa0week, 1xa0month, and 2xa0months. Statistical analyses were conducted to evaluate the relationship between those factors and therapeutic outcome using Fisher’s exact test, Chi-squared test, and the Mann–Whitney U test.ResultsPercutaneous vertebroplasty of IVC was effective in 16 out of 23 (69.6%) patients after 1xa0week and 1xa0month and 15 out of 23 (65.2%) patients after 2xa0months. Post-procedural kyphosis correction ≥5˚ and poor functional status (full dependency) were more common in the ineffective group after 1xa0week and 2xa0months respectively (Pu2009=u20090.047, Pu2009=u20090.02). Kyphotic correction ≥5˚ was related to pre-procedural kyphosis xa0≥15˚ (Pu2009=u20090.018). Functional status was related to subsequent fracture (Pu2009=u20090.005). Other factors were not statistically significant (Pu2009>u20090.05).ConclusionsPercutaneous vertebroplasty on osteoporotic vertebral compression fractures (VCF) with IVC was effective in only about 69.6% of patients after the first week and month and in 65.2% of patients after 2xa0months. Post-procedural kyphosis correction ≥5˚ was associated with poor outcomes after the first week. Twoxa0months after PVP, the functional status was more important because of the development of subsequent fractures.

Effect of Noise on the Detection of Rib Fractures by Residents

RATIONALE AND OBJECTIVESThe authors assessed the effect of noise on the detectability of rib fractures by residents. METHODSEight radiology residents read chest posterior-anterior radiographs of 92 subjects with rib fracture(s) and 28 normal subjects to detect rib fracture(s) according to a five-point scale of confidence, under quiet and “noisy” conditions. Each individuals attitude toward noise was measured by a multiple-choice questionnaire. RESULTSThe readers were divided into two groups depending on the questionnaire result: group A readers were accustomed to a quiet environment, and group B readers were accustomed to noisy environments or were unaffected by noise. Group As performance, measured by the area (Az) under the receiver operating characteristic (ROC) curve, was better in quiet conditions when compared with their performance in noisy conditions; however, the opposite tendency was observed for group B. There was a significant individual difference of performance in response to noise. CONCLUSIONEffect of noise on the detection of rib fractures depends on an individuals attitude toward sound and noise.

Oncogenic osteomalacia associated with soft tissue chondromyxoid fibroma

Oncogenic osteomalacia is a rarely described clinical entity characterized by hypophosphatemia, phosphaturia, and a low concentration of 1,25-dihydroxyvitamin D(3). It is most often associated with benign mesenchymal tumor and can be cured with surgical removal of the tumor. In this paper, we present a case of oncogenic osteomalacia caused by chondromyxoid fibroma in the soft tissue of the sole of the foot in a 56-year-old woman.