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Prevalence of Patent Foramen Ovale and Diagnostic Efficacy of Transcranial Doppler Sonography in Cryptogenic Ischemic Stroke Patients

  • Kim, Dae-Sik;Kim, Byung-Weon;Cho, Sung-Jun
    • Biomedical Science Letters
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    • v.15 no.1
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    • pp.17-23
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    • 2009
  • The prevalence of patent foramen ovale (PFO) in healthy persons was estimated as about $10{\sim}25%$ and was up to 40% in patients with stroke. Transesophageal echocardiography (TEE) was considered to be the most sensitive method to detect PFO and was used as the gold standard. Transcranial doppler sonography (TCD) of the middle cerebral artery (MCA) during a contrast (saline bubble) injection has recently been proposed as an alternative detecting method for PFO. In this study, we would like to know the difference between TCD value and TEE value in subjects with cryptogenic ischemic stroke. We performed TCD and TEE tests to detect PFO on 64 patients (30 women and 34 men, mean age was 59.4 years) with cryptogenic ischemic stroke. PFO prevalence through TCD was 45.3% (29 of 64 patients) and the prevalence through TEE was 34.4% (22 of 64 patients). There was no statistical significance between PFO test and TCD test (P=0.206). But TCD had a sensitivity of 90.9% (20 of 22 patients), specificity of 78.6% (33 of 42 patients), positive predictive value of 69.0% (20 of 29 patients), and negative predictive value of 94.3% (33 of 35 patients). We concluded that TCD was a highly sensitive method for detecting a right-left shunt. Therefore, the non-invasive TCD test is a method more effective than the anti-invasive TEE test in the cost and evaluation of the existence or nonexistence of right to left shunt in addition to the screening method of the cerebrovascular disorder. Considering these points, TCD test could be recommended for patients with cryptogenic ischemic stroke as a useful and convenient method for screening of the existence or nonexistence of a right to left shunt caused by PFO.

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Expression Profiles of Loneliness-associated Genes for Survival Prediction in Cancer Patients

  • You, Liang-Fu;Yeh, Jia-Rong;Su, Mu-Chun
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.1
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    • pp.185-190
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    • 2014
  • Influence of loneliness on human survival has been established epidemiologically, but genomic research remains undeveloped. We identified 34 loneliness-associated genes which were statistically significant for high-lonely and low-lonely individuals. With the univariate Cox proportional hazards regression model, we obtained corresponding regression coefficients for loneliness-associated genes fo individual cancer patients. Furthermore, risk scores could be generated with the combination of gene expression level multiplied by corresponding regression coefficients of loneliness-associated genes. We verified that high-risk score cancer patients had shorter mean survival time than their low-risk score counterparts. Then we validated the loneliness-associated gene signature in three independent brain cancer cohorts with Kaplan-Meier survival curves (n=77, 85 and 191), significantly separable by log-rank test with hazard ratios (HR) >1 and p-values <0.0001 (HR=2.94, 3.82, and 1.78). Moreover, we validated the loneliness-associated gene signature in bone cancer (HR=5.10, p-value=4.69e-3), lung cancer (HR=2.86, p-value=4.71e-5), ovarian cancer (HR=1.97, p-value=3.11e-5), and leukemia (HR=2.06, p-value=1.79e-4) cohorts. The last lymphoma cohort proved to have an HR=3.50, p-value=1.15e-7. Loneliness-associated genes had good survival prediction for cancer patients, especially bone cancer patients. Our study provided the first indication that expression of loneliness-associated genes are related to survival time of cancer patients.

Surgical Treatment of Thymoma (흉선종의 외과적 치료)

  • Jo, Gyu-Cheol;Jo, Gyu-Seok;Park, Ju-Cheol
    • Journal of Chest Surgery
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    • v.28 no.3
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    • pp.303-307
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    • 1995
  • We experenced 18 patients with surgically treated thymoma from January 1986 to December 1993. There were 13 male and 5 female ranged from 23 to 69 years of age. Among them Myasthenia gravis was present in 8 patients (44%) The predominant cell type was lymphocytic(11 patients), followed by epithelial (3) and mixed (4), and had no value in predicting prognosis. Treatment consisted of complete resection in 15 patients, partial resection in 2 patients and 1 patient was performed biopsy. Only, and then adjuvant radiation therapy was done in 7 patients and 3 patients needed adjuvant chemotherapy. Invasion of the adjacent tissue in thymoma was the most improtant prognostic value. There were 6 non-invasive tumors and 12 invasive tumors. Two patients with invasive thymomas resulted in death and one of 6 patients with non-invasive thymomas died during follow up ranged from 25 day to 60 months. The causes of death were myasthenic crisis in 1 patient, C. N. S. problem in 1 patient and pulmonary & mediastinal metastasis in 1 patient.

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A New D-dimer Cutoff Value to Improve the Exclusion of Deep Vein Thrombosis in Cancer Patients

  • Chen, Chong;Li, Gang;Liu, Yun-De;Gu, Ya-Jun
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.4
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    • pp.1655-1658
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    • 2014
  • Objective: To find a more appropriate alternative to D-dimer cutoff value for the diagnosis of deep vein thrombosis (DVT) in cancer patients. Methods: A total of 711 cancer patients with symptoms suspicious of DVT were included in the study. D-dimer levels were assessed using ELISA. All patients were subjected to imaging procedures. Results: Among 711 patients with cancer, 466 (65.5%) were females and 245 (34.5%) were males, with an average age of $57.3{\pm}13.23$ years. The mean age in the DVT group was significantly higher than in the non-DVT group (P<0.05). The D-dimer levels of the DVT group were significantly higher than those of the non-DVT group (P<0.05). The incidence rate of DVT varied significantly according to cancer type (P<0.05). Increasing age and lung cancer were significantly correlated with D-dimer levels (P<0.05), and a one-year increase in age was associated with a 14.28 ng/ml increase in the D-dimer value. The optimal cutoff point for D-dimer was found to be 981 ng/ml, with a sensitivity of 86.4%, specificity of 79.4%, and accuracy of 82.6%. If the D-dimer cutoff point was set to 981ng/ml, the specificity would increase from 61.8% to 85.5% without loss of sensitivity in patients aged 40 years or younger. In patients aged more than 40 years, the new cutoff almost doubled the specificity with slightly reduced sensitivity. Conclusion: In cancer patients, a new cutoff value of 981 ng/ml effectively improved the exclusion of DVT, especially for patients aged more than 40 years.

A Study on the Correlation between Anterior Tooth Contacts and Cephalometric Profile in Patients with Craniomandibular Disorders (두개하악장애환자의 전치부접촉과 측모두부형태간의 관계에 관한 연구)

  • Byung-Wook Kim;Kyung-Soo Han;Min Shin
    • Journal of Oral Medicine and Pain
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    • v.17 no.2
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    • pp.37-49
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    • 1992
  • 80 patients who presented at Wonkwang University Dental Hospital with craniomandibular disorders were collected for this study. To observe the occlusal contact pattern such as contact numbers, contact force and presence or absence of anterior occlusal contact, the author used T-Scan system (Tekscan, Inc, U.S.A.) with are computerized occlusal analysing system. And to study the correlation between craniofacial profile and occlusal contact pattern, cephalogram were also taken, The cephalometric items related to growth pattern, jaw bone relation and denture pattern were measured and analysed according to routine method by computerized program. The obtained data were statistically processed with SPSS/PC+ package about anterior contact pattern and its craniofacial relationship. The obtained results were as follows : 1. In terms of growth pattern, patients without anterior tooth contacts showed a tendency to downward growth of craniofacial profile. The value in this subjects were significantly different from the value of patients with anterior tooth contacts in items of low gonial angle, Jarabak ratio, SN to GoMe angle, FMA, occlusal plane to mandibular plane angle and ramus height. 2. In terms of jaw bone relationship, patients without anterior tooth contacts showed a tendency to backward growth of craniofacial profile. The value of this patients were significantly different from the value of patients with anterior tooth contacts in items of SNB, ANB, mandibular plane to anterior cranial base ratio, SNPo, NAPo and APDI items. 3. But in denture pattern, no statistically significant difference by the presence or absence of anterior tooth contacts were showed between this patients groups. 4. From this study, it could be proposed that anterior open bite in the patients with craniomandibular disorders would be originated from not dental discrepancy but skeletal discrepancy.

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A Study on the Velocity of the Mandibular Movement in Patients with Temporomandibular Disorders (측두하악장애환자에서 하악의 운동속도에 관한 연구)

  • Jung, Chan;Han, Kyung-Soo
    • Journal of Oral Medicine and Pain
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    • v.22 no.1
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    • pp.167-181
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    • 1997
  • The aim of this study was to investigate the relationship between velocity and factors which could affect the velocity of mandibular movement. For this study, 30 dental students without any masticatory signs and symptoms and 90 patients with temporomandibular disorders(TMD) were selected as the control group and the patients group, respectively. After determining Angle's classification and lateral guidance pattern of occlusion, clinical examination for TMD was perfomed. Velocity and distance of mandibular movements were recorded with BioEGN, reproducibility index of lateral excursions was evaluated by Pantronic(PRI) and BioEGN (BERI) activity in masticatory and cervical muscles were measured with BioEMG, and occlusal contact time and cross-arch unbalance(Total left-right statistics, TLR) on clenching were recorded with T-scan, respectively. The results of this study were as follows : 1. Velocity in the patients was faster than that in the controls in most mandibular movements, but on wide opening and closing movement, result was reverse. 2. Velocity on closing movements were faster than that on opening movements in the control group and a similar tendency was also shown in the patients group. 3. Patients with muscle disorders showed a tendency to have the highest value of velocity of all diagnostic subgroups, while patients with degenerative joint diseases showed a tendency to have the lowest value. 4. Patients with canine guidance showed a tendency to have the highest value of velocity in three subgroups by lateral guidance pattern, while patients with group function showed a tendency to have the lowest value. 5. BERI had a positive correlation with opening velocity on lateral excursion, while TLR had a negative correlation with opening velocity on swallowing. 6. EMG activity on clenching in masticatory muscles had negative correlation with opening velocity on border movements, and on swollowing, while the activity in rest correlated positively with opening velocity on border movements. 7. There were positive correlation between the velocity and the distance in long components of mandibular trajectory.

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An Assessment of Factors Affecting Plate Waste and Its Effects in Normal & Soft Diets Provided from Hospital Foodservice (병원 환자급식 중 일반식과 연식에서 발생되는 잔반의 원인과 손실 분석)

  • 양일선;김정려;이해영
    • Korean Journal of Community Nutrition
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    • v.6 no.5
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    • pp.830-836
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    • 2001
  • The purposes of this study were to : (a) analyze the portion size & plate waste of normal & soft diets provided by dietetic departments in hospital, (b) investigate the factors affecting plate waste, and (c) determine the nutritional & monetary value of plate waste. A questionnaire for food preference and sensory evaluation was developed and a survey was carried out for the 46 normal diet and 56 soft diet patients in Sanggye Paik hospital in Seoul. Serving size and plate waste were weighed by the electric scale, and CAN-Pro program was used to evaluate the nutrition value. The data were analyzed using the SAS package program for descriptive analysis, t-test, ANOVA, and Pearson correlation. The average plate waste rate for normal diet and soft diet were 30.3% and 49.6%. More plate waste amount occurred on female patients'diet than male patients'diets regardless of the kind of diet. The plate waste percentage of male patients were higher than those of female on normal diet. On soft diet, patients who hospitalized in surgery or pediatrics department were higher than in other wards. Plate waste of normal diet and amount were correlated positively, but wastage and preference were correlated negatively Negative correlation was between taste and plate waste, and between temperature and plate waste, too. On the other hand, plate waste caused the deficiency of some nutrients such as Ca, Fe, Vit. B$_2$and a great monetary loss.

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Early and Mid-Term Results after Operations for Pulmonary Atresia with Intact Ventricular Septum (온전한 심실중격을 갖고 있는 폐동맥폐쇄증의 수술 후 조기 및 중기 성적)

  • 성시찬;전희재;조광조;우종수;이형두
    • Journal of Chest Surgery
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    • v.33 no.6
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    • pp.476-486
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    • 2000
  • Background: Pulmonary atresia with intact ventricular septum(PA/IVS) is an anatomically heterogenous anomaly with a variety of surgical strategies possible. The purpose of the study is to evaluate the influence of right ventricular size on the early and midterm results of surgical repair of PA/IVS. Material and method: Medical records of 20 consecutive patients with PA/IVS operated on between January 1993 and August 1999 were retrospectively reviewed. There were 12 boys and 8 girls whose ages ranged from 2 days to 14.5 months (median 6 days). Their body weight ranged from 2.52kg to 9.35 kg(median 3.18kg). The preoperative Z-value of the diameter of the tricuspid valve(T-valve) was less than or -4 in 5 patients, between -4 and -2 in 1, between -2 and 0 in 7, between 0 and 2 in 6, and greater than or 2 in 1. All patients who had z-value of tricuspid valve greater than -2.05 were attempted biventricular repair(n=15) and all patients who had it smaller than -4.4 underwent systemic-pulmonary shunt operation only(n=3) or bidirectinal cavopulmonary shunt with right ventricular reconstruction(n=2). Result: Two early deaths(2/20, 10%) occurred. Both were infants who underwent transannular patch with shunt. One of these two had huge right ventricle(Z-value of tricuspid valve = 5). There were 2 late non-cardiac deaths 3 and 7 months after operations respectively. Follow-up was completed in all children at a mean of 35.3 months(range, 5 to 54 months). 10 of 11 survivors who underwent transannular patch or valvotomy with or without shunt procedure were in NYHA functional class I even though some of them had small interatrial communication or patent shunt. All three patients who had shunt procedure only at initial palliation completed Fontan procedures with no death. Two patients who underwent right ventricular outflow reconstruction with bidirectional cavopulmonary shunt were also in good condition. Conclusion: The transanular RVOT patch or valvotomy with or without systemic-pumonary shunt as an initial palliative procedure to achieve biventricular repair for the patients who had neither too small nor too large right ventricle(-2.05$\leq$Z-value of T-value of T-valve$\leq$2) could be performed at low operative risk(1/14 7.1%). Systemic-pulmonary shunt procedure and bidirectional cavopulmonary shunt procedure for the patients who had small right ventricle(Z-value of T-valve$\leq$4.4) could be also performed with low risk. But a patient with huge right atrium and ventricle(Z-value of t-valve=5) had poor operative result.

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Acidic Pelvic Drainage as a Predictive Factor For Anastomotic Leakage after Surgery for Patients with Rectal Cancer

  • Yang, Liu;Huang, Xin-En;Xu, Lin;Zhou, Xin;Zhou, Jian-Nong;Yu, Dong-Sheng;Li, Dong-Zheng;Guan, Xin
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.9
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    • pp.5441-5447
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    • 2013
  • Purpose: To demonstrate the value of sequential determinations of pelvic drainage in the identification of increased risk of anastomotic leakage (AL) after anterior resection for rectal cancer with a double stapling technique. Patients and Methods: Between January 2004 and December 2011, data for the daily postoperative pH of pelvic drainage fluid in 753 consecutive patients with rectal cancer who initially underwent anterior resection with a double stapling technique were reviewed. All patients experienced a total mesorectal excision. Patients with anastomotic leakage (Group AL, n=57) were compared to patients without leakage (Group nAL, n=696). Patients with perioperatively abdominopelvic implants that were likely to affect pH value (determined at $25^{\circ}C$) other than leakage were excluded. Mean postoperative values were compared. Results: Anastomotic leakage was noted in 57 (7.6%) of 753 patients with rectal cancer. The diagnosis of AL was made between the $6^{th}$ and $12^{th}$ postoperative day (POD; mean $8^{th}$ POD). There was no significance of the daily average values of pH on POD1 & 2 in group AL while a significantly sharp declining mean pH value reached its diagnostic point of AL (p<0.001) on POD3. A cut-off value of 6.978 on the $3^{rd}$ POD maximized the sensitivity (98.7.0%) and specificity (94.7%) in assessing the risk of leakage. Conclusion: According to these results, an early and persistent declining of pH value of pelvic drainage fluid after rectal surgery with anastomosis, is a marker of AL. A cut-off value of 6.798 determined at $25^{\circ}C$ on POD3 maximizes sensitivity and specificity.

Prophylactic Level VII Nodal Dissection as a Prognostic Factor in Papillary Thyroid Carcinoma: a Pilot Study of 27 Patients

  • Fayek, Ihab Samy
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.10
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    • pp.4211-4214
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    • 2015
  • Background: Prognostic value of prophylactic level VII nodal dissection in papillary thyroid carcinoma has been highlighted. Materials and Methods: A total of 27 patients with papillary thyroid carcinoma with N0 neck underwent total thyroidectomy with level VI and VII nodal dissection through same collar neck incision. Multicentricity, bilaterality, extrathyroidal extension, level VI and VII lymph nodes were studied as separate and independent prognostic factors for DFS at 24 months. Results: 21 females and 6 males with a mean age of 34.6 years old, tumor size was 5-24 mm. (mean 12.4 mm.), multicentricity in 11 patients 2-4 foci (mean 2.7), bilaterality in 8 patients and extrathyroidal extension in 8 patients. Dissected level VI LNs 2-8 (mean 5 LNs) and level VII LNs 1-4 (mean 1.9). Metastatic level VI LNs 0-3 (mean 1) and level VII LNs 0-2 (mean 0.5). Follow-up from 6-51 months (mean 25.6) with 7 patients showed recurrence (3 local and 4 distant). Cumulative DFS at 24 months was 87.8% and was significantly affected in relation to bilaterality (p-value <0.001), extrathyroidal extension (p-value <0.001), level VI positive ((p-value <0.001) and level VII positive ((p-value <0.001) LNs. No recurrences were detected during the follow-up period in the absence of level VI and level VII nodal involvement. Conclusions: Level VII prophylactic nodal dissection is an important and integral prognostic factor in papillary thyroid carcinoma. A larger multicenter study is crucial to reach a satisfactory conclusion about the necessity and safety of this approach.