Alzheimer’s Disease Prediction Using Attention Mechanism with Dual‑Phase 18 F‑Florbetaben Images / 대한핵의학회잡지

Materials and Methods@#A total of 264 patients (74 CN and 190 AD), who underwent FBB imaging test and neuropsychological tests, were retrospectively analyzed. Early- and delay-phase FBB images were spatially normalized with an in-house FBB template. The regional standard uptake value ratios were calculated with the cerebellar region as a reference region and used as independent variables that predict the diagnostic label assigned to the raw image. @*Results@#AD positivity scores estimated from dual-phase FBB showed better accuracy (ACC) and area under the receiver operating characteristic curve (AUROC) for AD detection (ACC: 0.858, AUROC: 0.831) than those from delay phase FBB imaging (ACC: 0.821, AUROC: 0.794). AD positivity score estimated by dual-phase FBB (R: −0.5412) shows a higher correlation with psychological test compared to only dFBB (R: −0.2975). In the relevance analysis, we observed that LSTM uses different time and regions of early-phase FBB for each disease group for AD detection. @*Conclusions@#These results show that the aggregated model with dual-phase FBB with long short-term memory and attention mechanism can be used to provide a more accurate AD positivity score, which shows a closer association with AD, than the prediction with only a single phase FBB.

The predictive value of serum myeloma protein in solitary plasmacytoma

Purpose@#To identify the clinical usefulness of serum M protein and to establish a rationale for regular follow-up with serum protein electrophoresis in solitary plasmacytoma. @*Materials and Methods@#Sixty-nine patients with solitary plasmacytoma and solitary plasmacytoma with minimal marrow involvement according to the International Myeloma Working Group criteria were retrospectively reviewed. @*Results@#At a median follow-up of 6.2 years, 5-year local control (LC), 5-year multiple myeloma-free survival (MMFS), 5-year failure-free survival (FFS), and 5-year overall survival (OS) were 82.6%, 44.1%, 41.8%, and 85.1%, respectively. Among the patients whose initial serum M protein was present or not evaluated, 37.3% of patients showed disappearance of serum M protein after various treatment. MMFS of these patients were comparable to non-secretory plasmacytoma with undetectable levels of M protein, and significantly better than patients with persistent M protein. Increase of serum M protein ≥0.1 g/dL was most predictive of treatment failure with area under the curve of 0.731. @*Conclusion@#Patients who eventually showed persistence of serum M protein after treatment showed worse MMFS and FFS compared to those whose serum M protein disappeared or who had initially non-secretory disease. The increase of serum M protein level ≥0.1 g/dL from current nadir was predictive of treatment failure. Therefore, regular follow-up with serum M protein is highly recommended especially unless the patient had initially non-secretory disease.

Enzyme-treated date plum leave extract ameliorates atopic dermatitis-like skin lesion in hairless mice

Objective: To evaluate the effect of different extracts of Diospyros lotus leaves in atopic dermatitis Methods: Diospyros lotus leaves were extracted in ethanol and treated with or without hydrochloric acid or α-rhamnosidase to obtain three different extracts-ethanol, acid-hydrolyzed, and enzyme-hydrolyzed leaf extracts of date plum. The myricitrin content in all samples was measured using HPLC analysis. In vitro antioxidant and anti-inflammatory activities of the extracts were determined by measuring DPPH radical scavenging activities and nitric oxide production in RAW264.7 cells, respectively. Seven-week-old male hairless mice were used to evaluate the anti-atopic dermatitis effects of three extracts in vivo. Splenocytes and mast cells were used to further determine the anti-atopic dermatitis effects of the major compound in the ethanol leaf extract. Results: Enzyme-hydrolyzed leaf extract showed significant in vitro antioxidant and anti-inflammatory activities, and attenuated atopic dermatitis-like skin symptoms and clinical signs more significantly than ethanol and acid-hydrolyzed leaf extracts in 1-fluoro-2,4-dinitrobenzene and house dust mite antigen-treated hairless mice. Enzyme-hydrolyzed leaf extract also suppressed the serum level of immunoglobulin E, interleukin (IL)-4, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, thymic stromal lymphopoietin, and thymus and activation-regulated chemokine in mice with atopic dermatitis. Furthermore, histological analysis revealed that enzyme-hydrolyzed leaf extract suppressed the increased epidermal thickness, dermal infiltration of inflammatory cells, and infiltration and degranulation of mast cells more markedly than the other two extracts in atopic dermatitis-like skin lesions. In addition, this extract effectively inhibited the production of IFN-γ, IL-4,and thymus and activation-regulated chemokine compared with the other two extracts in concanavalin A-stimulated splenocytes. Myricitrin, a major compound of enzyme-hydrolyzed leaf extract, suppressed atopic dermatitis biomarkers in stimulated mouse splenocytes and HMC-1 human mast cells. Conclusions: These results suggest that enzyme-hydrolyzed leaf extract might be a potential candidate to treat atopic dermatitis.

Transduced Tat-aldose Reductase Protects Hippocampal Neuronal Cells against Oxidative Stress-induced Damage

Aldose reductase (AR) protein, a member of the NADPH-dependent aldo-keto reductase family, reduces a wide range of aldehydes and enhances cell survival by inhibition of oxidative stress. Oxidative stress is known as one of the major pathological factor in ischemia. Since the precise function of AR protein in ischemic injury is fully unclear, we examined the function of AR protein in hippocampal neuronal (HT-22) cells and in an animal model of ischemia in this study. Cell permeable Tat-AR protein was produced by fusion of protein transduction domain in Tat for delivery into the cells. Tat-AR protein transduced into HT-22 cells and significantly inhibited cell death and regulated the mitogen-activate protein kinases (MAPKs), Bcl-2, Bax, and Caspase-3 under oxidative stress condition. In an ischemic animal model, Tat-AR protein transduced into the brain tissues through the blood-brain barrier (BBB) and drastically decreased neuronal cell death in hippocampal CA1 region. These results indicate that transduced Tat-AR protein has protective effects against oxidative stress-induced neuronal cell death in vitro and in vivo, suggesting that Tat-AR protein could be used as potential therapeutic agent in ischemic injury.

Disulfiram, a Re-positioned Aldehyde Dehydrogenase Inhibitor, Enhances Radiosensitivity of Human Glioblastoma Cells In Vitro / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Glioblastoma, the most common brain tumor in adults, has poor prognosis. The purpose of this study was to determine the effect of disulfiram (DSF), an aldehyde dehydrogenase inhibitor, on in vitro radiosensitivity of glioblastoma cells with different methylation status of O⁶-methylguanine-DNA methyltransferase (MGMT) promoter and the underlying mechanism of such effect. MATERIALS AND METHODS: Five human glioblastoma cells (U138MG, T98G, U251MG, U87MG, and U373MG) and one normal human astrocyte (NHA) cell were cultured and treated with DSF or 6MV X-rays (0, 2, 4, 6, and 8 Gy). For combined treatment, cells were treated with DSF before irradiation. Surviving fractions fit from cell survival based on colony forming ability. Apoptosis, DNA damage repair, and cell cycle distributionwere assayed bywestern blot for cleaved caspase-3, γH2AX staining, and flow cytometry, respectively. RESULTS: DSF induced radiosensitization in most of the glioblastoma cells, especially, in the cells with radioresistance as wildtype unmethylated promoter (MGMT-wt), but did not in normal NHA cell. DSF augmented or induced cleavage of caspase-3 in all cells after irradiation. DSF inhibited repair of radiation-induced DNA damage in MGMT-wt cells, but not in cells with methylated MGMT promoter. DSF abrogated radiation-induced G2/M arrest in T98G and U251MG cells. CONCLUSION: Radiosensitivity of glioblastoma cells were preferentially enhanced by pre-irradiation DSF treatment compared to normal cell, especially radioresistant cells such as MGMT-wt cells. Induction of apoptosis or inhibition of DNA damage repair may underlie DSF-induced radiosensitization. Clinical benefit of combining DSF with radiotherapy should be investigated in the future.

Fabrication of additive manufacturing interim denture and comparison with conventional interim denture: A case report / 대한치과보철학회지

With development of digital dentistry, the 3-dimensional (3D) manufacturing industry using computer-aided design and computer-aided manufacturing (CAD/CAM) has grown dramatically in recent years. Denture fabrication using digital method is also increasing due to the recent development of digital technology in dentistry. The 3D manufacturing process can be categorized into 2 types: subtractive manufacturing (SM) and additive manufacturing (AM). SM, such as milling is based on cutting away from a solid block of materal. AM, such as 3D printing, is based on adding the material layer by layer. AM enables the fabrication of complex structures that are difficult to mill. In this case, additive manufacturing method was applied to the fabrication of the resin-based complete denture to a 80 year-old patient. During the follow-up periods, the denture using digital method has provided satisfactory results esthetically and functionally.

Neutral zone approach and external impression for rehabilitation of macroglossia: a case report

Macroglossia is an obstacle in regard to general prosthodontic restoration. Not only is it difficult to obtain support and stability from dentures manufactured from normal protocol, obtaining efficacy from basic mastication is also difficult. In such cases, realizing harmony between the occlusion and surrounding muscle structures may be important with regard to manufacture of stable full dentures, and it is necessary to form the appropriate polished surface for this case. The neutral zone is defined as the potential area resulting from the neuromuscular function that results in equilibrium between the outward force exerted by the tongue and the inward force exerted by the lips and cheeks. The artificial teeth of the full denture lies in this area, and if the polished zone follows the anatomic form of the dynamic muscles, the movement of the muscles simply acts as an element of stabilizing the dentures improving the esthetics through facial support.

Single implant restoration with esthetic prosthodontic treatment in maxillary anterior tooth: A case report / 대한치과보철학회지

In a single implant restoration of maxillary anterior teeth, it is difficult to accomplish an aesthetic restoration of the implant prosthesis in the case of gingival recession and bone defect problems. To maintain aesthetic stability in the long term, it is important to place the implant in the ideal position as well as the recovery of the soft tissue and harmony with the prosthesis. Not only ideal implant position but also the harmony with surrounding soft tissues are important to fabricate aesthetic implant prosthesis for these cases. for these cases, a 47- years -old male with lowered level of osseous crest and gingival recession on maxillary anterior tooth was treated with guided bone regeneration and gingival recontouring.

Effect of Time Interval between Breast-Conserving Surgery and Radiation Therapy on Outcomes of Node-Positive Breast Cancer Patients Treated with Adjuvant Doxorubicin/Cyclophosphamide Followed by Taxane / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study evaluated the effect of surgery-radiotherapy interval (SRI) on outcomes in patients treated with adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) and adjuvant four cycles of doxorubicin/cyclophosphamide (AC) followed by four cycles of taxane. MATERIALS AND METHODS: From 1999 to 2007, 397 eligible patients were diagnosed. The effect of SRI on outcomes was analyzed using a Cox proportional hazards model, and a maximal chi-square method was used to identify optimal cut-off value of SRI for each outcome. RESULTS: The median SRI was 6.7 months (range, 5.6 to 10.3 months). A SRI of 7 months was the significant cut-off value for distant metastasis-free survival (DMFS) and disease-free survival (DFS) using a maximal chi-square method. For overall survival, a significant cut-off value was not found. The patients with SRI > 7 months had worse 6-year DMFS and DFS than those with SRI ≤ 7 months on univariate analysis (DMFS, 81% vs. 91%, p=0.003; DFS, 78% vs. 89%, p=0.002). On multivariate analysis, SRI > 7 months did not affect DMFS and DFS. CONCLUSION: RT delayed for more than 7 months after BCS and adjuvant four cycles of AC followed by four cycles of taxane did not compromise clinical outcomes.

A Case of Secondary Primary Malignancy after Lenalidomide Therapy for Multiple Myeloma / 대한내과학회지

Lenalidomide, an orally administered immune-modulating drug, has several mechanisms of action against multiple myeloma (MM). However, the mechanisms of action of immune-modulating drugs are not understood completely. Lenalidomide maintenance therapy prolongs the time to progression and increases the overall survival in patients with MM. However, secondary primary malignancy (SPM) has been noted as a serious adverse event in patients with MM treated with lenalidomide. Lenalidomide treatment is not covered by insurance. Consequently, physicians have little experience with the adverse events of lenalidomide treatment in patients with MM. Here, we describe a case of breast cancer after lenalidomide treatment for MM. To our knowledge, this is the first report of a lenalidomide-associated SPM in Korea. The risk factors associated with lenalidomide-associated SPM should be considered carefully when implementing chemotherapy regimens in patients with MM.

Acute Myocardial Infarction in a Patient with an Anomalous Origin of the Right Coronary Artery from the Left Anterior Descending Coronary Artery / 대한내과학회지

A 55-year-old male underwent coronary artery intervention for an acute myocardial infarction of the inferior or lateral wall. The initial left coronary angiogram showed total occlusion of the proximal left circumflex artery (LCX). There was an abnormal coronary artery originating from the mid-portion of the left anterior descending artery (LAD) and running to the right ventricular side. However, we could not identify the anomalous right coronary artery (RCA). We tried to find the RCA in the right coronary cusp to confirm the infarction-related artery, but failed. A focused left coronary angiogram in the posteroanterior projection revealed the entire anatomy of the anomalous RCA. An anomalous origin of the RCA from the LAD is a rare coronary artery anomaly that might affect the physician's decision during coronary intervention. We report an anomalous origin of the RCA from the mid-LAD and discuss the anatomy and clinical significance.

A Case of von Hippel-Lindau Disease with Aortic Valve Insufficiency / 영남의대학술지

Von Hippel-Lindau (VHL) disease is an autosomal dominant hereditary disorder caused by a germline mutation of the VHL gene. It is a multi-systemic disorder that is predisposed to benign or malignant tumors of visceral organs such as hemangioblastoma of the central nervous system, renal cell carcinoma, retinal angioma and pheochromocytoma. We report herein a case of VHL disease that initially manifested with aortic valve insufficiency.

Proton Beam Radiotherapy for Pediatric Gliomas: Early Outcomes and Dose Comparison / 임상소아혈액종양

BACKGROUND: Proton beam radiotherapy (PBT) has shown to provide high radiation dose to tumors and to save surrounding normal tissues because of its physical characteristics, Bragg peak. In the current study, we report the early outcomes for pediatric patients with intracranial gliomas treated with PBT and compared PBT plan (pencil beam scanning and double scattering) with intensity modulated radiotherapy (IMRT) plan and three dimensional-conformal radiotherapy (3D-CRT) plan. METHODS: Clinical data from 18 consecutive children with intracranial gliomas who underwent PBT from May 2007 to April 2012 was collected. The median follow-up duration was 16 months (range 6-69). RESULTS: There were 9 patients with brain stem glioma, 2 patients with optic pathway glioma, 2 patients with low grade glioma (LGG), 2 patients with anaplastic astrocytoma (AA) and 3 patients with glioblastoma multiforme (GBM). The median overall survival for patients with brain stem glioma was 11 months. Patients with optic pathway glioma, LGG or AA were all alive without progression except one patient. Among patients with GBM, one patient had no evidence of disease 25 months after PBT. When PBT plan was compared to those of IMRT and 3D-CRT for patients with LGG or AA and one patient with brain stem glioma by DVH analysis, PBT showed better sparing effect on normal tissue compared to IMRT and 3D-CRT, especially in low dose area. CONCLUSION: PBT could be delivered safely and effectively to pediatric patients with gliomas. For confirming the clinical benefits of PBT, further follow-up is necessary.

Proton Beam Radiotherapy for Pediatric Gliomas: Early Outcomes and Dose Comparison / 임상소아혈액종양

BACKGROUND: Proton beam radiotherapy (PBT) has shown to provide high radiation dose to tumors and to save surrounding normal tissues because of its physical characteristics, Bragg peak. In the current study, we report the early outcomes for pediatric patients with intracranial gliomas treated with PBT and compared PBT plan (pencil beam scanning and double scattering) with intensity modulated radiotherapy (IMRT) plan and three dimensional-conformal radiotherapy (3D-CRT) plan.METHODS: Clinical data from 18 consecutive children with intracranial gliomas who underwent PBT from May 2007 to April 2012 was collected. The median follow-up duration was 16 months (range 6-69).RESULTS: There were 9 patients with brain stem glioma, 2 patients with optic pathway glioma, 2 patients with low grade glioma (LGG), 2 patients with anaplastic astrocytoma (AA) and 3 patients with glioblastoma multiforme (GBM). The median overall survival for patients with brain stem glioma was 11 months. Patients with optic pathway glioma, LGG or AA were all alive without progression except one patient. Among patients with GBM, one patient had no evidence of disease 25 months after PBT. When PBT plan was compared to those of IMRT and 3D-CRT for patients with LGG or AA and one patient with brain stem glioma by DVH analysis, PBT showed better sparing effect on normal tissue compared to IMRT and 3D-CRT, especially in low dose area.CONCLUSION: PBT could be delivered safely and effectively to pediatric patients with gliomas. For confirming the clinical benefits of PBT, further follow-up is necessary.

Salvage radiotherapy for lymph node recurrence after radical surgery in cervical cancer / 부인종양

OBJECTIVE: This study was to evaluate the treatment outcomes and prognostic factors of patients treated with salvage radiotherapy for the treatment of isolated lymph node recurrence of cervical cancer. METHODS: Between 1990 and 2009, 22 cervical cancer patients with lymph node recurrence who had previously undergone radical hysterectomy and pelvic lymph node dissection were treated with salvage radiotherapy with (n=18) or without (n=4) chemotherapy. Of the 22 patients, 10 had supraclavicular lymph node recurrence, 9 had para-aortic lymph node, and 3 had inguinal lymph node. The median total radiotherapy dose was 60 Gy (range, 40 to 70 Gy). Initial pathologic findings, latent period to lymph node recurrence and other clinical parameters such as squamous cell carcinoma antigen (SCC-Ag) level and concurrent chemotherapy were identified as prognostic factors for survival. RESULTS: The median follow-up period after salvage radiotherapy was 31.2 months (range, 12.1 to 148.9 months). The 5-year progression-free and overall survival rates of all patients were 32.7% and 30.7%, respectively. Concurrent chemoradiotherapy (p=0.009) and longer latent period to lymph node recurrence (>18 months vs. 8 ng/dL vs. < or =8 ng/dL, p=0.008) and longer latent period to lymph node recurrence (p=0.040) for overall survival. Treatment failure after salvage radiotherapy occurred in 14 (63.6%) for the 22 patients (in field, 2; out of field, 10; both in and out field, 2). Grade 3 acute skin (n=2) and hematologic toxicity (n=1) developed in 3 patients. CONCLUSION: For isolated lymph node recurrence of cervical cancer, salvage radiotherapy with concurrent chemotherapy should be considered, especially in patients with a long-term progression-free period.

Molecular biomarkers in extrahepatic bile duct cancer patients undergoing chemoradiotherapy for gross residual disease after surgery

PURPOSE: To analyze the outcomes of chemoradiotherapy for extrahepatic bile duct (EHBD) cancer patients who underwent R2 resection or bypass surgery and to identify prognostic factors affecting clinical outcomes, especially in terms of molecular biomarkers. MATERIALS AND METHODS: Medical records of 21 patients with EHBD cancer who underwent R2 resection or bypass surgery followed by chemoradiotherapy from May 2001 to June 2010 were retrospectively reviewed. All surgical specimens were re-evaluated by immunohistochemical staining using phosphorylated protein kinase B (pAKT), CD24, matrix metalloproteinase 9 (MMP9), survivin, and beta-catenin antibodies. The relationship between clinical outcomes and immunohistochemical results was investigated. RESULTS: At a median follow-up of 20 months, the actuarial 2-year locoregional progression-free, distant metastasis-free and overall survival were 37%, 56%, and 54%, respectively. On univariate analysis using clinicopathologic factors, there was no significant prognostic factor. In the immunohistochemical staining, cytoplasmic staining, and nuclear staining of pAKT was positive in 10 and 6 patients, respectively. There were positive CD24 in 7 patients, MMP9 in 16 patients, survivin in 8 patients, and beta-catenin in 3 patients. On univariate analysis, there was no significant value of immunohistochemical results for clinical outcomes. CONCLUSION: There was no significant association between clinical outcomes of patients with EHBD cancer who received chemoradiotherapy after R2 resection or bypass surgery and pAKT, CD24, MMP9, survivin, and beta-catenin. Future research is needed on a larger data set or with other molecular biomarkers.

Acoustic characteristics of patients undergoing short-term endotracheal intubation with or without thyroidectomy who had no nerve injury / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We carried out an acoustic analysis to investigate the phonatory characteristics of patients undergoing short-term endotracheal intubation with or without thyroidectomy, and who had no nerve injury. MATERIALS AND METHODS: The patients were divided into two groups, one undergoing thyroidectomy (39 cases) and the other not undergoing thyroidectomy (25 cases). All patients of the thyroidectomy group had undergone thyroidectomy using general anesthesia with endotracheal intubation. All patients of the other group had undergone chronic ear surgery with the same anesthetic method and duration. For the evaluation of voice, preoperative and postoperative acoustic analyses were done. RESULTS: On the acoustic analysis of thyroidectomy group, jitter, shimmer and the vocal range were significantly increased at one day after thyroidectomy. But one month after thyroidectomy, these changes return to statistically insignificant increments, except for shimmer and the vocal range. These acoustical changes were not related to the extent of surgery between total thyroidectomy and hemithyroidectomy. In comparison with acoustical changes after short-term endotracheal intubation, the change of jitter and shimmer of thyroidectomy group did differ significantly. CONCLUSION: Voice alteration after thyroidectomy without nerve injury may be associated with the disturbance of the prelaryngeal musculature. This voice changes emphasize the importance of the extralaryngeal skeleton for pitch control and early intensive speech therapy, especially in patients who need their voice professionally.

Clinical Characteristics of Chronic Paranasal Sinusitis in the Patients with End Stage Renal Disease

BACKGROUND AND OBJECTIVES: Infections account for much of the morbidity and nearly half of the mortality in renal transplant recipient. Recently there has been a marked increase in the number of renal transplantation and preoperative screening test for chronic paranasal sinusitis. Authors analyzed the clinical manifestations and postoperative courses after the endoscopic sinus surgery in the patients with end stage renal disease. MATERIALS AND METHODS: 1,175 patients had been consulted to the otolaryngology department for routine evaluations about the presence of acute and chronic paranasal sinusitis prior to kidney transplantation between Jun. 1989 to Aug. 1998. Among them, 30 patients were diagnosed as significant chronic paranasal sinusitis and 5 patients were treated with endoscopic sinus surgery. Medical records and radiographs of the 30 patients were reviewed retrospectively. RESULTS: The prevalence of chronic paranasal sinusitis in patients with end stage renal disease was 2.5%. Twelve patients were asymptomatic and chief complaints of symptomatic patients were nasal obstruction (55.6%), rhinorrhea (27.8%), and postnasal drip (16.7%). Eleven patients had nasal polyps and twelve patients showed purulent discharge. All the patients who were surgically treated experienced postopertive bleeding and 2 of them required transfusion. CONCLUSION: The presence of asymptomatic sinusitis among the patients with end stage renal disease necessitates diagnositc screening tests for chronic paranasal sinusitis. The incidence of postoperative bleeding after endoscopic sinus surgery in patients with end stage renal disease is much higher than that of otherwise healthy sinusitis patients.

Clinical Characteristics of Chronic Paranasal Sinusitis in the Patients with End Stage Renal Disease

BACKGROUND AND OBJECTIVES: Infections account for much of the morbidity and nearly half of the mortality in renal transplant recipient. Recently there has been a marked increase in the number of renal transplantation and preoperative screening test for chronic paranasal sinusitis. Authors analyzed the clinical manifestations and postoperative courses after the endoscopic sinus surgery in the patients with end stage renal disease. MATERIALS AND METHODS: 1,175 patients had been consulted to the otolaryngology department for routine evaluations about the presence of acute and chronic paranasal sinusitis prior to kidney transplantation between Jun. 1989 to Aug. 1998. Among them, 30 patients were diagnosed as significant chronic paranasal sinusitis and 5 patients were treated with endoscopic sinus surgery. Medical records and radiographs of the 30 patients were reviewed retrospectively. RESULTS: The prevalence of chronic paranasal sinusitis in patients with end stage renal disease was 2.5%. Twelve patients were asymptomatic and chief complaints of symptomatic patients were nasal obstruction (55.6%), rhinorrhea (27.8%), and postnasal drip (16.7%). Eleven patients had nasal polyps and twelve patients showed purulent discharge. All the patients who were surgically treated experienced postopertive bleeding and 2 of them required transfusion. CONCLUSION: The presence of asymptomatic sinusitis among the patients with end stage renal disease necessitates diagnositc screening tests for chronic paranasal sinusitis. The incidence of postoperative bleeding after endoscopic sinus surgery in patients with end stage renal disease is much higher than that of otherwise healthy sinusitis patients.

Morphologic Differences of Vessel Wall at Sites of Focal and Diffuse Coronary Vasospasm by Intravascular Ultrasound(IVUS)

BACKGROUND AND OBJECTIVES: The coronary vasospasm has been shown to play an important role in the pathogenesis of not only variant angina but also ischemic heart disease in general, including other forms of angina pectoris, acute myocardial infarct, and sudden death. The angiographic features of coronary vasospasm are focal and diffuse patterns in clinical setting. We attempted to clarify the differences in vessel wall morphologic appearance between the sites of focal and diffuse vasospasm by intravascular ultrasound(IVUS). MATERIAL AND METHODS: We studied 23 patients(32 segments) with variant angina in whom coronary angiograms were normal and coronary spasm was documented by intracoronary injection of acetylcholine. Coronary spasm was defined as luminal diameter reduction > or = 90% compared with baseline coronary artery diameter. Focal spasm was defined if the length of spastic narrowing was less than 10mm. By IVUS, we observed atheromatous plaques in 32 spasm segments with either focal or diffuse vasospasm. We measured maximal intimal thickness, luminal cross-sectional area(CSA), and external elastic membrane-CSA in spasm sites. RESULT: When comparing maximal intimal thickness between focal (n=15) and diffuse vasospasm segments(n=17), there was significantly greater thickness at focal spasm segments(1.21+/-0.36mm vs. 0.70+/-0.23mm, P<0.001). The maximal plaque area was similar between two groups but tended to be greater in focal spasm segments(6.03+/-2.06mm2 vs. 4.92+/-2.59mm2, P=NS). When circular shaped factor(CSF : standardized index of eccentricity) was compared, focal spasm segments were greater than diffuse spasm segments(0.89+/-0.06 vs. 0.97+/-0.02, P<0.001). At the segments of focal spasm, remodeling index was greater compared to the segments of diffuse spasm(1.02+/-0.16 vs. 0.86+/-0.13, P<0.001). CONCLUSION: Focal spasm segments were more eccentric and had greater atheromatous plaque than diffuse spasm segments. Positive remodeling pattern was observed at the segments of focal spasm and negative remodeling pattern at the segments of diffuse spasm. There were morphologic differences of vessel wall appearance between focal and diffuse spasm sites.