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1.
J Clin Immunol ; 44(4): 84, 2024 Apr 05.
Artículo en Inglés | MEDLINE | ID: mdl-38578320

RESUMEN

PURPOSE: Patients with STAT1 gain-of-function (GOF) mutations often exhibit autoimmune features. The JAK1/2 inhibitor ruxolitinib can be administered to alleviate autoimmune symptoms; however, it is unclear how immune cells are molecularly changed by ruxolitinib treatment. Then, we aimed to investigate the trnscriptional and epigenetic status of immune cells before and after ruxolitinib treatment in a patient with STAT1 GOF. METHODS: A patient with a heterozygous STAT1 GOF variant (p.Ala267Val), exhibiting autoimmune features, was treated with ruxolitinib, and peripheral blood mononuclear cells (PBMCs) were longitudinally collected. PBMCs were transcriptionally analyzed by single-cell cellular indexing of the transcriptomes and epitopes by sequencing (CITE-seq), and epigenetically analyzed by assay of transposase-accessible chromatin sequencing (ATAC-seq). RESULTS: CITE-seq analysis revealed that before treatment, the patient's PBMCs exhibited aberrantly activated inflammatory features, especially IFN-related features. In particular, monocytes showed high expression levels of a subset of IFN-stimulated genes (ISGs). Ruxolitinib treatment substantially downregulated aberrantly overexpressed ISGs, and improved autoimmune features. However, epigenetic analysis demonstrated that genetic regions of ISGs-e.g., STAT1, IRF1, MX1, and OAS1-were highly accessible even after ruxolitinib treatment. When ruxolitinib was temporarily discontinued, the patient's autoimmune features were aggravated, which is in line with sustained epigenetic abnormality. CONCLUSIONS: In a patient with STAT1 GOF, ruxolitinib treatment improved autoimmune features and downregulated aberrantly overexpressed ISGs, but did not correct epigenetic abnormality of ISGs.


Asunto(s)
Mutación con Ganancia de Función , Pirazoles , Factor de Transcripción STAT1 , Humanos , Mutación con Ganancia de Función/genética , Leucocitos Mononucleares/metabolismo , Nitrilos/farmacología , Pirazoles/farmacología , Pirimidinas/farmacología , Factor de Transcripción STAT1/genética
2.
J Korean Med Sci ; 39(21): e172, 2024 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-38832477

RESUMEN

BACKGROUND: We aimed to analyze the effects of an antimicrobial stewardship program (ASP) on the proportion of antimicrobial-resistant pathogens in bacteremia, antimicrobial use, and mortality in pediatric patients. METHODS: A retrospective single-center study was performed on pediatric inpatients under 19 years old who received systemic antimicrobial treatment from 2001 to 2019. A pediatric infectious disease attending physician started ASP in January 2008. The study period was divided into the pre-intervention (2001-2008) and the post-intervention (2009-2019) periods. The amount of antimicrobial use was defined as days of therapy per 1,000 patient-days, and the differences were compared using delta slope (= changes in slopes) between the two study periods by an interrupted time-series analysis. The proportion of resistant pathogens and the 30-day overall mortality rate were analyzed by the χ². RESULTS: The proportion of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae bacteremia increased from 17% (39 of 235) in the pre-intervention period to 35% (189 of 533) in the post-intervention period (P < 0.001). The total amount of antimicrobial use significantly decreased after the introduction of ASP (delta slope value = -16.5; 95% confidence interval [CI], -30.6 to -2.3; P = 0.049). The 30-day overall mortality rate in patients with bacteremia did not increase, being 10% (55 of 564) in the pre-intervention and 10% (94 of 941) in the post-intervention period (P = 0.881). CONCLUSION: The introduction of ASP for pediatric patients reduced the delta slope of the total antimicrobial use without increasing the mortality rate despite an increased incidence of ESBL-producing gram-negative bacteremia.


Asunto(s)
Antibacterianos , Programas de Optimización del Uso de los Antimicrobianos , Bacteriemia , Análisis de Series de Tiempo Interrumpido , Klebsiella pneumoniae , Humanos , Estudios Retrospectivos , Niño , Bacteriemia/tratamiento farmacológico , Bacteriemia/mortalidad , Bacteriemia/microbiología , Femenino , Masculino , Preescolar , Antibacterianos/uso terapéutico , Lactante , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/aislamiento & purificación , Adolescente , Escherichia coli/efectos de los fármacos , Escherichia coli/aislamiento & purificación , Hospitales Pediátricos
3.
Appl Microbiol Biotechnol ; 107(22): 6789-6798, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-37725139

RESUMEN

Congenital cytomegalovirus (CMV) infection is a common cause of sensorineural hearing loss and neurodevelopmental impairment in newborns. However, congenital CMV infection cannot be diagnosed using samples collected more than 3 weeks after birth because testing after this time cannot distinguish between congenital infection and postnatal infection. Herein, we developed a robust loop-mediated isothermal amplification (LAMP) assay for the large-scale screening of newborns for congenital CMV infection. In contrast to conventional quantitative polymerase chain reaction (qPCR), which detects CMV within a dynamic range of 1.0 × 106 to 1.0 × 102 copies/µL, our quantitative LAMP assay (qLAMP) detects CMV within a dynamic range of 1.1 × 108 to 1.1 × 103 copies/µL. Moreover, the turnaround time for obtaining results following DNA extraction is 90 min in qPCR but only 15 min in qLamp. The colorimetric LAMP assay can also detect CMV down to 1.1 × 103 copies/µL within 30 min, irrespective of the type of heat source. Our LAMP assay can be utilized in central laboratories as an alternative to conventional qPCR for quantitative CMV detection, or for point-of-care testing in low-resource environments, such as developing countries, via colorimetric naked-eye detection. KEY POINTS: • LAMP assay enables large-scale screening of newborns for congenital CMV infection. • LAMP allows colorimetric or quantitative detection of congenital CMV infection. • LAMP assay can be used as a point-of-care testing tool in low-resource environments.

4.
J Korean Med Sci ; 38(32): e248, 2023 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-37582498

RESUMEN

The pediatric population with comorbidities is a high-risk group for severe coronavirus disease 2019 (COVID-19). As of January 2023, the COVID-19 vaccination rate for at least two doses among Korean children 5-11 years is low at 1.1%. We summarized the COVID-19 vaccination status for the pediatric population (5-17 years) with comorbidities through July 2022 using the National Health Insurance Service database. Pediatric patients with comorbidities had higher vaccination rates than the general pediatric population (2.4% vs. 1.1% in 5-11-year-olds [P < 0.001], 76.5% vs. 66.1% in 12-17-year-olds [P < 0.001]). However, there were substantial differences according to comorbidity category, and the 2-dose vaccination rate was lowest among children with immunodeficiency in all age groups (1.1% in 5-11-year-olds, 51.2% in 12-17-year-olds). The COVID-19 vaccination rate among Korean children has remained stagnant at a low proportion despite ongoing outreach. Thus, more proactive strategies are needed alongside continuous surveillance.


Asunto(s)
COVID-19 , Humanos , Niño , COVID-19/epidemiología , COVID-19/prevención & control , Vacunas contra la COVID-19 , Comorbilidad , Vacunación , República de Corea/epidemiología
5.
J Korean Med Sci ; 38(48): e361, 2023 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-38084025

RESUMEN

BACKGROUND: Pediatric urinary tract infection (UTI) caused by extended-spectrum ß-lactamase (ESBL)-positive gram-negative bacilli (GNB) has limited options for oral antibiotic treatment. The purpose of this study was to investigate the susceptibility of ESBL-positive Escherichia coli and Klebsiella pneumoniae isolates from pediatric urine samples to two oral antibiotics (fosfomycin and nitrofurantoin). METHODS: From November 2020 to April 2022, ESBL-positive E. coli and K. pneumoniae isolates from urine samples were collected at Samsung Medical Center, Seoul, Korea. Patients over 18 years of age or with malignancy were excluded. For repeated isolates from the same patient, only the first isolate was tested. Minimum inhibitory concentrations (MICs) were measured using agar (fosfomycin) or broth (nitrofurantoin) dilution methods. MIC50 and MIC90 were measured for fosfomycin and nitrofurantoin in both E. coli and K. pneumoniae. RESULTS: There were 117 isolates from 117 patients, with a median age of 7 months (range, 0.0-18.5 years). Among 117 isolates, 92.3% (108/117) were E. coli and 7.7% (9/117) were K. pneumoniae. Isolates from the pediatric intensive care unit (PICU) and general ward (GW) was 11.1% (13/117) and 88.9% (104/117), respectively. Among 108 E. coli isolates, MIC50 and MIC90 for fosfomycin were 0.5 µg/mL and 2 µg/mL, respectively. Fosfomycin susceptibility rate was 97.2% (105/108) with a breakpoint of 128 µg/mL. Fosfomycin susceptibility rate was significantly lower in PICU isolates than in GW isolates (81.8% vs. 99.0%, P = 0.027). For nitrofurantoin, both the MIC50 and MIC90 were 16 µg/mL. Nitrofurantoin susceptibility rate was 96.3% (104/108) with a breakpoint of 64 µg/mL based on Clinical and Laboratory Standards Institute guidelines. Among the nine K. pneumoniae isolates, the MIC50 and MIC90 for fosfomycin was 2 µg/mL and 32 µg/mL, respectively. MIC50 and MIC90 for nitrofurantoin were 64 µg/mL and 128 µg/mL, respectively. CONCLUSION: For uncomplicated UTI caused by ESBL-positive GNB in Korean children, treatment with fosfomycin and nitrofurantoin for E. coli infections can be considered as an effective oral therapy option.


Asunto(s)
Infecciones por Escherichia coli , Fosfomicina , Infecciones Urinarias , Humanos , Niño , Adolescente , Adulto , Recién Nacido , Lactante , Fosfomicina/farmacología , Fosfomicina/uso terapéutico , Nitrofurantoína/farmacología , Nitrofurantoína/uso terapéutico , Escherichia coli , Klebsiella pneumoniae , beta-Lactamasas , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones Urinarias/tratamiento farmacológico , Pruebas de Sensibilidad Microbiana
6.
J Korean Med Sci ; 38(32): e249, 2023 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-37582499

RESUMEN

BACKGROUND: The aim of this study was to capture multifaceted clinical characteristics of congenital cytomegalovirus (CMV) infection from diagnosis to treatment using a multidisciplinary approach including obstetrics, pediatrics, pathology, and otorhinolaryngology-head and neck surgery. METHODS: This is a retrospective study including 30 consecutive cases of congenital CMV infection that were diagnosed at a single tertiary hospital located in Seoul, Korea from January 2009 to December 2020. Congenital CMV infection was defined as a positive result by polymerase chain reaction from urine, saliva or cerebrospinal fluid or positive CMV IgM from neonatal blood sampled within 3 weeks after birth. All cases were analyzed with respect to whole clinical characteristics from diagnosis to treatment of congenital CMV by a multidisciplinary approach including prenatal sonographic findings, maternal immune status regarding CMV infection, detailed placental pathology, neonatal clinical manifestation, auditory brainstem response test, and antiviral treatment (ganciclovir or valganciclovir). Long-term outcomes including developmental delay and hearing loss were also investigated. RESULTS: The total number of births during the study period in our institution was 19,385, with the prevalence of congenital infection estimated to be 0.15%. Among 30 cases of congenital CMV, the median gestational age at delivery was 32.2 weeks [range, 22.6-40.0] and 66.7% of these infants were delivered preterm at less than 37 weeks. Suspected fetal growth restriction was the most common prenatal ultrasound finding (50%) followed by ventriculomegaly (17.9%) and abnormal placenta (17.9%), defined as thick placenta with calcification. No abnormal findings on ultrasound examination were observed in one-third of births. Maternal CMV serology tests were conducted in only 8 cases, and one case each of positive and equivocal IgM were found. The most common placental pathologic findings were chronic villitis (66.7%) and calcification (63.0%), whereas viral inclusions were identified in only 22.2%. The most common neonatal manifestations were jaundice (58.6%) followed by elevation of aspartate aminotransferase (55.2%) and thrombocytopenia (51.7%). After excluding cases for which long-term outcomes were unavailable due to death (n = 4) or subsequent follow up loss (n = 3), developmental delay was confirmed in 43.5% of infants (10/23), and hearing loss was confirmed in 42.9% (9/21) during the follow-up period. In our cohort, 56.7% (17/30) of neonates were treated for congenital CMV with ganciclovir or valganciclovir. CONCLUSION: Our data show that prenatal findings including maternal serologic tests and ultrasound have limited ability to detect congenital CMV in Korea. Given that CMV is associated with high rates of developmental delay and hearing loss in infants, there is an urgent need to develop specific strategies for the definite diagnosis of congenital CMV infection during the perinatal period by a multidisciplinary approach to decrease the risks of neurologic impairment and hearing loss through early antiviral treatment.


Asunto(s)
Infecciones por Citomegalovirus , Pérdida Auditiva , Lactante , Recién Nacido , Embarazo , Femenino , Humanos , Niño , Valganciclovir/uso terapéutico , Estudios Retrospectivos , Placenta , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por Citomegalovirus/complicaciones , Ganciclovir/uso terapéutico , Antivirales/uso terapéutico , Retardo del Crecimiento Fetal , Parto , Inmunoglobulina M
7.
Medicina (Kaunas) ; 59(11)2023 Nov 19.
Artículo en Inglés | MEDLINE | ID: mdl-38004087

RESUMEN

A pseudoaneurysm of the subclavian artery following central venous catheter placement is a rare but potentially fatal complication that often requires surgical intervention. However, surgical repair of the subclavian artery remains challenging. Herein, we report the case of a male patient undergoing hemodialysis who developed a pseudoaneurysm of the subclavian artery after a bedside central vein catheter placement. Hemostasis was successfully achieved by selecting the pseudoaneurysm using a microcatheter. At the 10-month follow-up, the pseudoaneurysm was completely excluded, and the patient was in a stable condition. The patient underwent native arteriovenous fistula creation and hemodialysis. Endovascular treatment could be an effective nonsurgical treatment for subclavian artery pseudoaneurysms and has been attempted as a first-line treatment option.


Asunto(s)
Aneurisma Falso , Cateterismo Venoso Central , Humanos , Masculino , Arteria Subclavia , Aneurisma Falso/etiología , Aneurisma Falso/terapia , Diálisis Renal/efectos adversos , Cateterismo Venoso Central/efectos adversos , Catéteres/efectos adversos
8.
Medicina (Kaunas) ; 59(6)2023 Jun 11.
Artículo en Inglés | MEDLINE | ID: mdl-37374325

RESUMEN

Background and Objectives: This study aimed to evaluate the added value of cone-beam computed tomography (CBCT) for detecting hepatocellular carcinomas (HCC) and feeding arteries during transcatheter arterial chemoembolization (TACE). Material and methods: Seventy-six patients underwent TACE and CBCT. We subcategorized patients into groups I (61 patients: possible superselection of tumor/feeding arteries) and II (15 patients: limited superselection of tumor/feeding arteries). We evaluated fluoroscopy time and radiation dose during TACE. Two blinded radiologists independently performed an interval reading based on digital subtraction angiography (DSA) imaging only and DSA combined with CBCT in group I. Result: The mean total fluoroscopy time was 1456.3 ± 605.6 s. The mean dose-area product (DAP), mean DAP of CBCT, and mean ratio of DAP of CBCT to total DAP was 137.1 ± 69.2 Gy cm2, 18.3 ± 7.1 Gy cm2, and 13.3%, respectively. The sensitivity for detecting HCC increased after the additional CBCT reading, from 69.6% to 97.3% and 69.6% to 96.4% for readers 1 and 2, respectively. The sensitivity for detecting feeding arteries increased from 60.3% to 96.6% and 63.8% to 97.4% for readers 1 and 2, respectively. Conclusions: CBCT can increase sensitivity for detecting HCCs and feeding arteries without significantly increasing the radiation exposure.


Asunto(s)
Carcinoma Hepatocelular , Quimioembolización Terapéutica , Neoplasias Hepáticas , Exposición a la Radiación , Humanos , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/terapia , Arterias/patología , Tomografía Computarizada de Haz Cónico/métodos , Estudios Retrospectivos
9.
J Korean Med Sci ; 36(32): e232, 2021 Aug 16.
Artículo en Inglés | MEDLINE | ID: mdl-34402230

RESUMEN

BACKGROUND: Korean health authority plans to vaccinate adolescents against coronavirus disease 2019 (COVID-19) starting high school seniors during the summer vacation of 2021. However, the myocarditis/pericarditis following COVID-19 vaccine has been reported recently in adolescents and young adults. This study was performed to answer the urgent questions about the basic epidemiology and clinical course of myocarditis/pericarditis in hospitalized patients prior to the introduction of COVID-19 vaccines in pediatric population. METHODS: A retrospective medical record analysis including frequency, clinical characteristics, etiology and outcome of myocarditis/pericarditis was conducted in 17 years and younger patients who were hospitalized in two referral hospitals in Korea between 2010 and 2019. RESULTS: Total 142 patients with myocarditis (n = 119) and/or pericarditis (n = 23) were identified. Median age was 5.4 years (interquartile range, 0.6-12.9 years; range, 11 days-17.8 years), and male was 61%. In adolescents aged 12-17 years, the male to female ratio was 3.2. Myocarditis/pericarditis occurred 0.70 per 1,000 in-patients during the study period: 0.96 (< 1 year), 0.50 (1-5 years), 0.67 (6-11 years) and 1.22 (12-17 years) per 1,000 in-patients, respectively. There was an increasing tendency for the annual frequency from 0.34 in 2010 to 1.25 per 1,000 in-patients in 2019 (P = 0.021). Among the 56 (40%) proven pathogens at admission, Mycoplasma pneumoniae (n = 11, 8%) and enterovirus (n = 10, 7%) were most common. Of the 142 patients, 99 (70%) required pediatric intensive care unit care and 10 (7%) received heart transplantation. In addition, 61 patients (61/131, 47%) without heart medication at admission needed heart medication when they were discharged. Eleven (7.7%) patients died, of which five patients were previously healthy. The median age of deceased patients was lower than the survival group (0.8 vs. 6.3 years, P = 0.014). CONCLUSION: The frequency of myocarditis/pericarditis was highest among male adolescent in-patients; however, the outcome was favorable in this group without any mortality.


Asunto(s)
Vacunas contra la COVID-19/efectos adversos , Miocarditis/epidemiología , Miocarditis/patología , Pericarditis/epidemiología , Pericarditis/patología , Adolescente , Vacuna BNT162 , COVID-19/prevención & control , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , República de Corea/epidemiología , Estudios Retrospectivos , Vacunación/efectos adversos
10.
AJR Am J Roentgenol ; 214(1): 213-217, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31613658

RESUMEN

OBJECTIVE. This study evaluated the technical feasibility and clinical effectiveness of fluoroscopic stent placement in malignant colorectal obstructions after failed endoscopic stent placement. MATERIALS AND METHODS. Between January 2004 and December 2017, 41 patients with malignant colorectal obstructions were referred for fluoroscopic stent placement after failed endoscopy. The procedures were performed for palliation (n = 35) or as a bridge to surgery (n = 6). The technical and clinical success, complications, stent patency duration, and patient survival were retrospectively analyzed. RESULTS. Fluoroscopic stent placement was technically successful in 38 patients (92.7%). The causes of technical failure were complete obstruction (n = 1), redundant sigmoid colon (n = 1), and colon perforation (n = 1). Clinical success was achieved in 37 patients with technical success (97.4%). Major complications occurred in three patients (7.9%) and included colon perforation (n = 2) and anal pain (n = 1). The six patients with stenting as a bridge to surgery underwent elective colectomy uneventfully (100%). In 32 patients with technically successful palliative stenting, the median primary stent patency duration and patient survival were 353 days (95% CI, 162-353 days) and 335 days (95% CI, 116-335 days), respectively. CONCLUSION. Fluoroscopic colorectal stent placement is technically feasible and clinically effective in most patients with failed endoscopic procedures.


Asunto(s)
Colonoscopía , Neoplasias Colorrectales/complicaciones , Fluoroscopía , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Implantación de Prótesis/métodos , Stents , Anciano , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Insuficiencia del Tratamiento , Resultado del Tratamiento
11.
J Comput Assist Tomogr ; 44(1): 145-152, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31939896

RESUMEN

OBJECTIVES: We investigated the computed tomographic characteristics of gastrointestinal air motion artifact (GIAMA), which can be misinterpreted as active gastrointestinal bleeding. METHODS: We simulated GIAMA using 3 types of air-ball phantoms (air-ball in water, air-ball in oil, air-water-ball in oil) and a bovine intestine in oil phantom. We also performed a retrospective clinical review of precontrast abdominal computed tomography images of 76 patients to investigate the frequency, location, shape, and maximum density of hyperdense GIAMA. RESULTS: In phantom studies, air motion artifacts appeared as dark and bright streak artifacts at the borders of a moving air-ball and water or oil. In the clinical study, hyperdense GIAMA was visualized in 60 (79.0%) of 76 patients. The small intestine was most commonly affected (46.4%), and the intramural type had the highest frequency (58.0%). CONCLUSION: Knowing the radiologic features of GIAMA can assists radiologists in identifying active gastrointestinal bleeding sites accurately.


Asunto(s)
Hemorragia Gastrointestinal/diagnóstico por imagen , Tomografía Computarizada Multidetector/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Adulto , Anciano , Anciano de 80 o más Años , Animales , Bovinos , Reacciones Falso Positivas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fantasmas de Imagen , Estudios Retrospectivos , Sensibilidad y Especificidad , Adulto Joven
12.
J Pediatr ; 193: 134-138.e1, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29198767

RESUMEN

OBJECTIVES: To evaluate pancreatic echogenicity on transabdominal ultrasonography and the correlation of fatty pancreas with metabolic syndrome (MetS), as well as insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR]). STUDY DESIGN: This retrospective study included 135 obese children and adolescents who underwent transabdominal ultrasonography from January 2015 to December 2015. Fatty pancreas was quantitatively analyzed using the pancreato-perihepatic fat index (PPHFI). The correlation between the PPHFI and HOMA-IR was analyzed, and multivariate logistic regression analysis was used to determine factors that were independently correlated with MetS. Receiver operating characteristic curve analysis was performed to determine the best cut-off value of the PPHFI for diagnosing MetS. RESULTS: The PPHFI and the HOMA-IR value were significantly higher in subjects with MetS than in those without MetS (P < .0001). The PPHFI also showed an association with the HOMA-IR value (r = 0.70; P <.0001). The PPHFI was an independent factor for diagnosing MetS (OR 4.36; P = .032). The best cut-off value for the PPHFI for a diagnosis of MetS was 2.34 with a sensitivity of 0.96 and specificity 0.70. CONCLUSIONS: These results suggest that an increased PPHFI is significantly correlated with MetS and insulin resistance, and that the PPHFI may be a useful indicator for diagnosing MetS in obese children and adolescents. The impact of the presence of fatty pancreas in obese children and adolescents must be evaluated.


Asunto(s)
Homeostasis/fisiología , Síndrome Metabólico/complicaciones , Enfermedades Pancreáticas/diagnóstico por imagen , Obesidad Infantil/complicaciones , Ultrasonografía/métodos , Adolescente , Niño , Hígado Graso/complicaciones , Hígado Graso/diagnóstico por imagen , Femenino , Humanos , Lípidos/sangre , Masculino , Páncreas/diagnóstico por imagen , Páncreas/patología , Enfermedades Pancreáticas/etiología , Curva ROC , Estudios Retrospectivos , Factores de Riesgo
13.
J Korean Soc Radiol ; 85(2): 463-467, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38617856

RESUMEN

Acupuncture is increasingly being used in Asian countries and is generally considered a relatively safe procedure. However, adverse events have been reported consistently. Therefore, clinicians should be aware of the possibility of acupuncture-related complications and should actively treat serious cases. We report a case of an acupuncture-induced large abscess in the retroperitoneal cavity and thigh muscles treated with percutaneous catheter drainage, surgical incision, and drainage.

14.
Sci Rep ; 14(1): 9406, 2024 04 24.
Artículo en Inglés | MEDLINE | ID: mdl-38658695

RESUMEN

This retrospective study evaluated the safety and efficacy of fluoroscopy-guided urethral catheterization in patients who failed blind or cystoscopy-assisted urethral catheterization. We utilized our institutional database between January 2011 and March 2023, and patients with failed blind or cystoscopy-assisted urethral catheterization and subsequent fluoroscopy-guided urethral catheterization were included. A 5-Fr catheter was inserted into the urethral orifice, and the retrograde urethrography (RGU) was acquired. Subsequently, the operator attempted to pass a hydrophilic guidewire to the urethra. If the guidewire and guiding catheter could be successfully passed into the bladder, but the urethral catheter failed pass due to urethral stricture, the operator determined either attempted again with a reduced catheter diameter or performed balloon dilation according to their preference. Finally, an appropriately sized urethral catheter was selected, and an endhole was created using an 18-gauge needle. The catheter was then inserted over the wire to position the tip in the bladder lumen and ballooned to secure it. We reviewed patients' medical histories, the presence of hematuria, and RGU to determine urethral abnormalities. Procedure-related data were assessed. Study enrolled a total of 179 fluoroscopy-guided urethral catheterizations from 149 patients (all males; mean age, 73.3 ± 13.3 years). A total of 225 urethral strictures were confirmed in 141 patients, while eight patients had no strictures. Urethral rupture was confirmed in 62 patients, and hematuria occurred in 34 patients after blind or cystoscopy-assisted urethral catheterization failed. Technical and clinical success rates were 100%, and procedure-related complications were observed in four patients (2.2%). The mean time from request to urethral catheter insertion was 129.7 ± 127.8 min. The mean total fluoroscopy time was 3.5 ± 2.5 min and the mean total DAP was 25.4 ± 25.1 Gy cm2. Balloon dilation was performed in 77 patients. Total procedure time was 9.2 ± 7.6 min, and the mean procedure time without balloon dilation was 7.1 ± 5.7 min. Fluoroscopy-guided urethral catheterization is a safe and efficient alternative in patients where blind or cystoscopy-assisted urethral catheterization has failed or when cystoscopy-urethral catheterization cannot be performed.


Asunto(s)
Cistoscopía , Estrechez Uretral , Cateterismo Urinario , Humanos , Fluoroscopía/métodos , Cistoscopía/métodos , Cistoscopía/efectos adversos , Masculino , Anciano , Estudios Retrospectivos , Persona de Mediana Edad , Estrechez Uretral/terapia , Estrechez Uretral/diagnóstico por imagen , Cateterismo Urinario/métodos , Cateterismo Urinario/efectos adversos , Anciano de 80 o más Años , Uretra/diagnóstico por imagen , Uretra/cirugía
15.
Microbiol Spectr ; 12(4): e0424923, 2024 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-38451228

RESUMEN

The aim of this study was to compare the performance of the newly developed SMG HHV-6 Q Real-Time PCR Kit (SMG assay) with the RealStar HHV-6 PCR Kit (RealStar assay). The analytical sensitivity and specificity, linearity, and precision of the SMG assay were evaluated. The clinical performance of the SMG assay was assessed and compared with that of the RealStar assay using 207 clinical specimens (HHV-6A positive, n = 51; HHV-6B positive, n = 64; HHV-6A/B negative, n = 92). The limit of detection of the SMG assay was 2.92 log10 copies/mL for HHV-6A DNA and 2.88 log10 copies/mL for HHV-6B DNA. The linear range was determined to be 3.40-9.00 log10 copies/mL for both viruses. Intra- and inter-assay variability were below 5% at concentrations ranging from 4 to 9 log10 copies/mL. No cross-reactivity was observed with the 25 microorganisms included in the specificity panel. The clinical sensitivity and specificity of the SMG and RealStar assays compared to in-house polymerase chain reaction and sequencing were as follows: SMG assay, 98.0% and 100% for HHV-6A DNA, respectively, and 96.9% and 100% for HHV-6B DNA, respectively; RealStar assay, 98.0% and 100% for HHV-6A DNA, respectively, and 90.6% and 100% for HHV-6B DNA, respectively. The correlation coefficients between viral loads measured by the two assays were 0.948 and 0.975, with mean differences of 0.62 and 0.32 log10 copies/mL for HHV-6A and HHV-6B DNA, respectively. These results demonstrate that the SMG assay is a sensitive and reliable tool for the quantitative detection and differentiation of HHV-6A and HHV-6B DNA.IMPORTANCEQuantitative real-time PCR (qPCR) that can distinguish between HHV-6A and HHV-6B DNA is recommended for diagnosis of active infection. The SMG HHV-6 Q Real-Time PCR Kit (SMG assay) is a newly developed qPCR assay that can differentiate between HHV-6A and HHV-6B DNA; however, little is known about its performance. In this study, we assessed the performance of the SMG assay and compared it with that of a commercially available qPCR assay, the RealStar HHV-6 PCR Kit (RealStar assay). The SMG assay demonstrated excellent analytical sensitivity and specificity, precision, and linearity. Furthermore, the viral loads measured by the SMG assay were highly correlated with those measured by the RealStar assay. Our results suggest that the SMG assay is a useful diagnostic tool for quantitative detection and differentiation of HHV-6A and HHV-6B DNA.


Asunto(s)
Herpesvirus Humano 6 , Infecciones por Roseolovirus , Humanos , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Herpesvirus Humano 6/genética , ADN Viral/genética , Sensibilidad y Especificidad , Carga Viral/métodos , Infecciones por Roseolovirus/diagnóstico
16.
Radiol Case Rep ; 18(3): 1277-1281, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-36691412

RESUMEN

Axillofemoral bypass graft stump syndrome is an uncommon complication of axillofemoral bypass graft surgery. The traditional treatment is open surgical repair; however, endovascular recanalization can be achieved. Interventional treatment by approaching the brachial artery contralateral to the lesion site has rarely been reported in acute upper extremity ischemia. We report a case of recanalization through the left brachial artery due to embolic occlusion of the right brachial and axillary arteries and suspected axillofemoral bypass graft stump syndrome in a 71-year-old man. Access through the common femoral artery was impossible because the patient underwent reoperation of the left axillofemoral bypass and femorofemoral bypass due to occlusion of the right axillofemoral bypass and femorofemoral bypass surgery. Furthermore, bilateral radial arteries were occluded, allowing access to the left brachial artery. Two self-expandable stents were inserted into the occlusion of the right brachial and axillary arteries, and the stump area was covered. Aspiration thrombectomy was performed for embolism in the ulnar artery. Axillofemoral bypass graft stump syndrome can also be treated with interventional management. If access to the bilateral common femoral and radial arteries is not possible, an upper extremity arterial procedure through the contralateral brachial artery may be considered in cases of steno-occlusion of the upper extremities.

17.
J Korean Soc Radiol ; 84(3): 705-712, 2023 May.
Artículo en Coreano | MEDLINE | ID: mdl-37324985

RESUMEN

Common femoral artery pseudoaneurysm is a potentially serious complication of peripheral angiography. There have been few prior reports of simultaneous pseudoaneurysm in both common femoral arteries after percutaneous access. Here we report the case of a 58-year-old male patient who presented with phlegmon or abscess a few days after bilateral femoral access, after which newly developed bilateral femoral pseudoaneurysm with wide neck was observed on CT angiography 2 months after infection treatment. Because the patient refused surgery for pseudoaneurysm, a stent-graft was inserted in the left side, and percutaneous thrombin injection under US guidance with balloon occlusion was performed for the right side. Most pseudoaneurysms occur immediately after the causative procedure. However, there have been some cases in which pseudoaneurysms may occur several weeks or months later; it is therefore necessary to check the risk factors and to carefully observe the hemostasis site.

18.
J Korean Soc Radiol ; 84(5): 1158-1162, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37869124

RESUMEN

Ortner's or cardiovocal syndrome is hoarseness attributable to left recurrent laryngeal nerve (RLN) palsy associated with mechanical compression of the nerve by pathologically enlarged cardiovascular structures. Ortner's syndrome is a rare condition, and to our knowledge, only a few cases have been reported in Korea. Furthermore, this condition is extremely uncommon in pediatric patients with thyrotoxicosis-related RLN paralysis. We report a case of reversible Ortner's syndrome in an adolescent who presented with secondary pulmonary hypertension related to thyrotoxicosis.

19.
J Korean Soc Radiol ; 84(1): 170-184, 2023 Jan.
Artículo en Coreano | MEDLINE | ID: mdl-36818703

RESUMEN

Purpose: To assess the magnitude of differences between attenuation values of the true non-contrast image (TNC) and virtual non-contrast image (VNC) derived from twin-beam dual-energy CT (tbDECT) and dual-source DECT (dsDECT). Materials and Methods: This retrospective study included 62 patients who underwent liver dynamic DECT with tbDECT (n = 32) or dsDECT (n = 30). Arterial VNC (AVNC), portal VNC (PVNC), and delayed VNC (DVNC) were reconstructed using multiphasic DECT. Attenuation values of multiple intra-abdominal organs (n = 11) on TNCs were subsequently compared to those on multiphasic VNCs. Further, we investigated the percentage of cases with an absolute difference between TNC and VNC of ≤ 10 Hounsfield units (HU). Results: For the mean attenuation values of TNC and VNC, 33 items for each DECT were compared according to the multiphasic VNCs and organs. More than half of the comparison items for each DECT showed significant differences (tbDECT 17/33; dsDECT 19/33; Bonferroni correction p < 0.0167). The percentage of cases with an absolute difference ≤ 10 HU was 56.7%, 69.2%, and 78.6% in AVNC, PVNC, and DVNC in tbDECT, respectively, and 70.5%, 78%, and 78% in dsDECT, respectively. Conclusion: VNCs derived from the two DECTs were insufficient to replace TNCs because of the considerable difference in attenuation values.

20.
Microbiol Spectr ; 11(6): e0167323, 2023 Dec 12.
Artículo en Inglés | MEDLINE | ID: mdl-37800931

RESUMEN

IMPORTANCE: This manuscript describes an occurrence of false-positive GM tests in patients receiving TPN products from a manufacturer who had recently changed the supplier of the glucose component. We describe the clinical presentation of nine false-positive cases and the results of serologic and microbiological investigations of the TPN products suspected of contamination with GM. Attempts to detect GM in parenteral nutrition products were made since the detection of GM in sodium gluconate-containing solutions in 2007, but none of them identified the source of elevated GM indexes in TPN products. However, the present study demonstrated that the glucose component of the TPN products contained a high level of GM antigen, which caused false-positive GM assay results. The source of GM was glucoamylase, which was derived from A. niger in the manufacturing process. Physicians and clinical microbiology laboratories should be aware of this issue to improve interpretation and patient care.


Asunto(s)
Aspergillus , Mananos , Humanos , Reacciones Falso Positivas , Inmunoensayo , Nutrición Parenteral Total , Antígenos Fúngicos
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