• Journal of the Korean Society of Radiology
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• v.83 no.3
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• pp.705-711
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• 2022

A 46-year-old male with alcoholic liver cirrhosis underwent a transjugular intrahepatic portosystemic shunt (TIPS) for refractory ascites. On the 9th day after the procedure, he presented with melena and decreasing hemoglobin levels. Hemobilia due to fistula formation between the right intrahepatic bile duct and right hepatic artery was suspected on computed tomography. Angiography revealed a fistula of the small branches of the hepatic segmental arteries, and right intrahepatic bile duct was confirmed; embolization was successfully performed with a coil for the eighth segmental hepatic artery, a glue-lipiodol mixture for the fifth segmental hepatic artery, and gelfoam slurry for the right anterior hepatic artery. However, 2 days after embolization, the patient died owing to aggravated disseminated intravascular coagulopathy. When gastrointestinal bleeding occurs after TIPS, careful evaluation is immediately required, and hemobilia should be considered.

• Biomedical Science Letters
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• v.8 no.3
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• pp.115-125
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• 2002

Gram-negative septicemia, which continues to be a serious clinical problem, is one of the major causes of morbidity and mortality in hospitalized patients. Endotoxin of gram-negative bacteria is a pivotal pathogen of sepsis. To understand the effect of endotoxin on hematological aspect and the time course in early childhood, this study was designed with experimental septic model of young rabbits (8 week-old). Rabbits were divided into control (n=7) and endotoxin group (0.50 mg/kg of endotoxin). The endotoxin group was subdivided into six groups by the sampling times: 3, 6, 12, 24, 48 and 72 hr-group (E-G$_{3}$, E-G$_{6}$, E-G$_{12}$, E-G$_{24}$, E-G$_{48}$ and E-G$_{72hrs}$, each n=7). The evaluation of CBC, activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen concentration, coagulation factors and D-dimer were taken from the bloods. The number of leukocytes was lower in E-G$_{3}$ and E-G$_{6hrs}$ (due to pantocytopenia), whereas it was higher in E-G$_{24}$ and E-G$_{48}$ (due to neutrophilia and/or lymphophilia) than in control group (P<0.05). Platelet counts in E-G$_{3}$, E-G$_{6}$, E-G$_{12}$, E-G$_{24}$ and E-G$_{48hrs}$ were lower than those of control group (P<0.05). Normoblast counts in E-G$_{3}$, E-G$_{6}$, E-G$_{12}$, E-G$_{24}$ and E-G$_{48hrs}$ were higher than those of control group (p<0.01). APTT in E-G$_{3}$, E-G$_{6}$, E-G$_{12}$, E-G$_{24}$ and E-G$_{72hrs}$ were longer while PT in E-G$_{3}$, E-G$_{6}$, E-G$_{48}$ and E-G$_{72hrs}$ were higher than those of control group (p<0.05). Fibrinogen concentrations were lower in E-G$_{3}$, E-G$_{6}$ and E-G$_{12}$ but higher in E-G$_{48}$ and E-G$_{72hrs}$ than those of control (p<0.05). Intrinsic coagulation factors (XII, XI, IX, VIII) in all endotoxin groups were significantly lower than those of control group (p<0.05). Extrinsic coagulation factor (X, VII, V, II) were lower in E-G$_{3}$, E-G$_{6}$, E-G$_{12}$ and E-G$_{24hrs}$ whereas they were higher in E-G$_{48}$ and E-G$_{72hrs}$ than in control group (p<0.05). D-dimer concentrations in E-G$_{48}$ and E-G$_{72hrs}$ were higher than those of control group (P<0.001). We concluded that endotoxin led to extensive hematological disturbances including disseminated intravascular coagulation in the young rabbits and that this pathologic condition in the infant and childhood groups will cause the grave results.

• Journal of Chest Surgery
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• v.31 no.8
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• pp.739-748
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• 1998

Background: It has been well documented that transient occlusion of the coronary artery causes myocardial ischemia and finally cell death when ischemia is sustained for more than 20 minutes. Extensive studies have revealed that ischemic myocardium cannot recover without reperfusion by adequate restoration of blood flow, however, reperfusion can cause long-lasting cardiac dysfunction and aggravation of structural damage. The author therefore attempted to examine the effect of postischemic reperfusion on myocardial ultrastructure and to determine the rationales for recanalization therapy to salvage ischemic myocardium. Materials and methods: Young Holstein-Friesian cows(130∼140 Kg body weight; n=40) of both sexes, maintained with nutritionally balanced diet and under constant conditions, were used. The left anterior descending coronary artery(LAD) was occluded by ligation with 4-0 silk snare for 20 minutes and recanalized by release of the ligation under continuous intravenous drip anesthesia with sodium pentobarbital(0.15 mg/Kg/min). Drill biopsies of the risk area (antero-lateral wall) were performed at just on reperfusion(5 minutes), 1-, 2-, 3-, 6-, 12-hours after recanalization, and at 1-hour assist(only with mechanical respiration and fluid replacement) after 12-hour recanalization. The materials were subdivided into subepicardial and subendocardial tissues. Tissue samples were examined with a transmission electron microscope (Philips EM 300) at the accelerating voltage of 60 KeV. Results: After a 20-minute ligation of the LAD, myocytes showed slight to moderate degree of ultrastructural changes including subsarcolemmal bleb formation, loss of nuclear matrix, clumping of chromatin and margination, mitochondrial destruction, and contracture of sarcomeres. However, microvascular structures were relatively well preserved. After 1-hour reperfusion, nuclear and mitochondrial matrices reappeared and intravascular plugging by polymorphonuclear leukocytes or platelets was observed. However, nucleoli and intramitochondrial granules reappeared within 3 hours of reperfusion and a large number of myocytes were recovered progressively within 6 hours of reperfusion. Recovery was apparent in the subepicardial myocytes and there were no distinct changes in the ultrastructure except narrowed lumen of the microvessels in the later period of reperfusion. Conclusions: It is likely that the ischemic myocardium could not be salvaged without adequate restoration of coronary flow and that the microvasculature is more resistant to reversible period of ischemia than subendocardium and subepicardium. Therefore, thrombolysis and/or angioplasty may be a rational method of therapy for coronarogenic myocardial ischemia. However, it may take a relatively longer period of time to recover from ischemic insult and reperfusion injury should be considered.

• Tuberculosis and Respiratory Diseases
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• v.59 no.6
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• pp.651-655
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• 2005

Background : Diagnosing a pulmonary embolism is difficult because its presenting symptoms are nonspecific and there are limitations with all of the objective tests. The D-dimer is known to be a marker of the lysis of intravascular cross-linked fibrin as a result of the activation of the endogenous fibrinolytic pathways, and the D-dimer assay is these an objective method for diagnosing a pulmonary embolism. This study assessed the benefits of the D-dimer test for diagnosing a pulmonary embolism using semiquantitative latex agglutination. Methods : The latex agglutination results of 185 patients were retrospectively reviewed. The D-dimer test was performed at the time a pulmonary embolism was suspected. Ninety patients(group I) were diagnosis with PE through spiral chest CT or a chest CT angiogram, perfusion/ventilation scans, and/or pulmonary angiogram. Ninety-five patients (group II) were found not to have a pulmonary embolism through the above tests. Results : The male to female ratio and mean age in groups I and II was 37:55, and 57 years old to 50:45 and 52 years old, respectively. When the cut off value for a positive D-dimer assay was set to $500{\mu}g$, the sensitivity, positive predictive value, negative predictive value and specificity was 86.7%, 61.4%, 79.3%, and 48.4%, respectively. Conclusion : The semiquantitative latex agglutination method in the D-dimer test has a lower sensitivity and negative predictive value than the well known ELISA test particularly for small emboli. Therefore, this test is not a suitable screening test for excluding a pulmonary embolism.

• Clinical and Experimental Pediatrics
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• v.45 no.8
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• pp.961-966
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• 2002

Purpose : We compared the underlying or associated diseases according to the frequency of platelet transfusions in neonates with thrombocytopenia to know the factors predicting which patients will require multiple platelet transfusions. We also compared mortality. Methods : A retrospective study was performed in 72 neonates who received the platelet transfusions in neonatal intensive care unit(NICU) between August 1996 and July 2001. Group I received one platelet transfusion and group II received two or more. We compared the frequency of underlying or assodiated diseases such as sepsis/disseminated intravascular coagulopathy(DIC), respiratory distress syndrome(RDS), intraventricular hemorrhage(IVH), patent ductus arteriosus (PDA), necrotizing enterocolitis(NEC), liver or renal disease, and mortality between two groups. Results : Of the 72 patients, 29(40.2%) received one and 43(59.7%) received two or more transfusions; 16(22.2%) received four or more. There were no statistically significant differences in gestational age, birth weight, sex, and maternal history between two groups. C-section rate was higher in group II(20.7% vs. 55.8%, P<0.05) and the incidence of PDA was higher in group I (55.2% vs. 30.2%, P<0.05). Otherwise, there were no statistically significant differences in the incidence of sepsis/DIC, RDS, IVH, RDS, CLD, NEC, liver or renal disease, pulmonary hemorrhage and hypoxic ischemic encephalopathy, and mortality between group I and group II. Conclusion : There was no significant difference in clinical morbidity and mortality according to the frequency of platelet transfusion in neonates with thrombocytopenia. Further study is needed to know the predicting factor for multiple platelet transfusions in neonates with thrombocytopenia.

• Clinical and Experimental Pediatrics
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• v.51 no.5
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• pp.474-480
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• 2008

Purpose : Stress hyperglycemia is common in critically ill adult patients. It is known as a predictor of increased mortality, and intensive insulin therapy has been shown to improve the prognosis in such patients. We have investigated the relationship between early stress hyperglycemia and clinical outcomes in preterm infants. Methods : In this study, 141 preterm infants with a gestational age of less than 30 weeks were enrolled. The hyperglycemic group was defined as that having maximum glucose of more than 150 mg/dL (n=61) during the first 48 h of life, and the non-hyperglycemic group was defined as that having maximum glucose of less than 150 mg/dL (n=80). Perinatal history, severity of illness using the Clinical Risk Index for Babies (CRIB) score, clinical outcomes, and mortality of the two groups were compared. Results : There was no significant difference in the gestational age between the two groups, but the birth weight (P<0.001) was significantly lower, and the CRIB score (P<0.001) was significantly higher in the hyperglycemic group. Disseminated intravascular coagulation (P<0.001) and clinically suspected sepsis (P=0.046) were more common in the hyperglycemic group. Mortality was markedly higher in the hyperglycemic group (11.3% vs. 41.0%, P<0.001). On performing a stepwise multiple logistic regression analysis, hyperglycemia (OR 3.787; 95% CI 1.324 to 10.829), the CRIB score (OR 1.252; 95% CI 1.047 to 1.496) and birth weight (OR 0.997; 95% CI 0.994 to 1.000) was independently associated with higher mortality. Conclusion : Stress hyperglycemia within the first 48 h of life is independently related to increased morbidity and mortality in preterm infants.

• Journal of the Korean Society of Radiology
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• v.14 no.5
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• pp.619-626
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• 2020

This study aimed to identify the error rates in Catheter Calibration Mode, Auto Calibration Mode, and Segment Calibration Mode among many calibration modes as a quantitative evaluation tool used for predicting the diameter and length of balloon or stent in percutaneous intravascular balloon dilatation or stent insertion. Our experiment was conducted with Copper Wire of 2 mm × 80 mm (diameter × length) manufactured elaborately for quantitative evaluation in calibration and Metal Ball of 5, 10, 15, 30, and 40 mm and Acryl Phantom of 25 mm, 50 mm, 75mm, 100 mm, 125 mm, 150mm, 175 mm, and 200 mm. At each height, subtraction images were acquired with a cineangiograph and Stenosis Analysis Tool as a software provided by the equipment company was used for measurement. To evaluate the error rates in Catheter Calibration Mode, Copper Wire was put on each acryl phantom before shooting. Copper Wire of 2 mm in diameter was set as a diameter for catheter, and Copper Wire of 8 mm in length was measured with Multi-segments. As a result, the error rates appeared at 1.13 ~ 5.63%. To evaluate the error rates in Auto Calibration Mode, the height of acryl was entered at each height of acryl phantom and the length of 8 mm Copper Wire was measured with Multi-segments and as a result, the error rates appeared at 0 ~ 0.26%. To evaluate the error rates in Segment Calibration Mode, each metal ball on the floor of table was calibrated and the length of 8 mm Copper Wire on each acryl phantom was measured and the length of 8 mm Copper Wire depending on the changes of acryl phantom height was measured with Mutli-segments and as a result, the error rates appeared at 1.05 ~ 19.04%. And in the experiment on OID changes in Auto Calibration Mode, the height of acryl phantom was fixed at 100mm and OID only changed within the range of 450 mm ~ 600 mm and as a result, the error rates appeared at 0.13 ~ 0.38%. In conclusion, it was found that entering the height values in Auto Calibration Mode, among these Calibration Modes for evaluating quantitative vascular dimensions provided by the software was the calibration method with the least error rates and it is thus considered that for calibration using a metal ball or other objects, putting them in the same height as that of treatment sites before calibrating is the method that can reduce the error rates the most.

• Pediatric Infection and Vaccine
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• v.5 no.2
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• pp.258-266
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• 1998

Purpose : Cases of adenoviral penumonia with rapidly progressive clinical course were experienced. We reviewed these patients in viewpoint of clinical manifestation and adenoviral serotypes. Methods : Culture and indirect immunofluorescence for respiratory viruses including respiratory syncytial virus, influenza virus, parainfluenza virus, adenovirus was done with nasopharyngeal aspirates from patients who admitted due to respiratory infections in Fatima Hospital, Masan from Nov. 1996 to Jul. 1997. Cultured adenovirus was serotyped by both neutralization and hemagglutination inhibition test. Medical records were reviewed for 5 patients with respiratory failure from adenovirus was isolated and serotyped. Results : The total number of examined patients was 460 patients. We isolated respiratory viruses in 143(30.9%) patients. Adenovirus was isolated from 66 out of 143(46.2%) patients. During Jan 1997 to May 1997, five patients with ages of 18 days to 11 months who were infected by adenovirus and had high fever with dyspnea and required assisted mechanical ventilation. One patients discharged against doctor's advice then died. Two of four patients had complications of disseminated intravascular coagulation; two had bronchiolitis obliterans. Two isolates were serotype 7, and one was serotype 5, and two were untyped. Conclusion : Severe pneumonia caused by serotype 7 continued to occur in 1997 following the epidemic in 1996, and severe pneumonia may also be caused by serotype 5 and other serotypes.

• Pediatric Infection and Vaccine
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• v.10 no.2
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• pp.186-192
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• 2003

Purposes : Recently, acute gastroenteritis broke out among the neonates transferred from postpartum care centers located in Seoul, and Gyeounggi area. Thus, we researched the cause, progress and characters of the disease by analyzing the cases from 9 hospitals in Seoul and Gyeounggi area. Methods : We conducted retrospective study of 33 neonates transferred from postpartum care centers from October 2001 to July 2002 : we divided the neonates into 2 groups. The severe group had any of following 5 conditions : blood pH <7.20, respiratory difficulty, mechanical ventilation, shock, and disseminated intravascular coagulation. And the rest were classified into the moderate group. Results : The severe group was significantly more aged than the moderate group(P= 0.005). Weight loss was significantly severe in the severe group(P=0.0512). In blood gas analysis, bicarbonate was less in the severe group than the moderate group(P=0.032). In the virus examination, rotavirus was detected in 7 cases, and astrovirus was detected in 1 case. In the severe group, 4 neonates were dead. Conclusion : In acute gastroenteritis of neonates, early diagnosis and treatment are important. Thus, the legislation of postpartum care center is needed, and the medical specialists should be stationed in postpartum care center. We assume that the severe group had severe conditions because they were treated comparatively late. However, to find out the cause of the disease and to cope with it, the nationwide epidemiologic study on acute gastrenteritis of neonates is needed.

• Clinical and Experimental Pediatrics
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• v.46 no.1
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• pp.67-75
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• 2003

Purpose : Intravascular stent implantation for the treatment of postoperative branch pulmonary artery(PA) stenosis has been used successfully. However, the cross sectional area of contralateral branch PA does not regress in spite of the successful dilation of the stenotic branch PA after stent implantation. We analyzed the morphologic and hemodynamic factors on the size of branch PA after successful stent implantation. Methods : The subjects in our study were 23 children who had undergone stent implantaion from Jan. 1995 to Jul. 2002 in the Division of Yonsei Pediatric Cardiology. We evaluated the cross sectional area index(CSAI) of branch PA before and after stent implantation at follow-up catheterization. We also investigated factors such as residual pulmonary stenosis, pulmonary regurgitation(PR), systolic pressure of right ventricle, and lung perfusion scan. Results : The CSAI of the RPA without stenosis changed from mean $238{\pm}17mm^2/BSA$ to mean $249{\pm}20mm^2/BSA$(P=0.47), but didn't regress. The CSAI of the LPA with stenosis was increased effectively by stent implantation from the mean $102{\pm}12mm^2/BSA$ to mean $125{\pm}11mm^2/BSA$(P< 0.05). At follow up after stent implantation, the CSAI of PA is correlated with the residual PR fraction after stent implantation. Conclusion : In a group with increased residual PR, CSAI of RPA was found to be significantly increased between the pre- and post-stages of stent implantation. So, we suspect that the pulmonary regurgitation remaining after right ventricle outlet tract(RVOT) dilatation surgery is correlated with the increase in CSAI of RPA.