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2.
Diagn Interv Radiol ; 2024 May 13.
Artículo en Inglés | MEDLINE | ID: mdl-38738746

RESUMEN

PURPOSE: To evaluate the efficacy of staged full-length balloon-assisted maturation (BAM) for the maturation of arteriovenous fistulas (AVFs) on entire segmental veins, including stenosis, causing primary AVF failure. METHODS: This study included patients who underwent AVF surgery using an autogenous vein between February 2020 and June 2021 and received staged angioplasty with a full-length balloon catheter. To minimize balloon overlap and the risk of barotrauma to the immature vein, serial-staged upsizing balloon angioplasty with a long balloon catheter covering the entire vein segment was employed approximately 2 weeks apart. RESULTS: Twenty-three patients (mean age, 69.50 years; mean follow-up, 620.62 days) with average diameters of the radial artery and cephalic vein at 2.14 ± 0.5 mm and 2.43 ± 0.5 mm, respectively, were enrolled. In the first procedure, the average AVF diameter and flow were 4.03 ± 0.57 mm and 438.08 ± 220.95 mL/min, respectively, with juxta-anastomotic stenosis (JAS) present in 61.5% of cases. After staged full-length BAM, the average fistula diameter and flow improved to 5.95 ± 0.86 mm and 717.52 ± 305.95 mL/min, respectively. Maturation was achieved in 87% of the cases. No hematomas or ruptures occurred around the arterialized veins. Despite successful maturation and cannulation, 65.2% of the patients required additional percutaneous transluminal angioplasty (PTA) during the follow-up period. The necessity for PTA was determined by the presence of JAS prior to the first staged full-length BAM, with an odds ratio of 11.74 (95% confidence interval: 1.31-104.96, P = 0.03). CONCLUSION: Staged full-length BAM can be safely used in patients with small veins requiring further maturation. Most patients achieved successful cannulation following maturation without post-procedural complications. CLINICAL SIGNIFICANCE: Staged full-length BAM is a safe and effective method for enhancing maturation in patients with underdeveloped small veins.

3.
Cancers (Basel) ; 15(17)2023 Aug 24.
Artículo en Inglés | MEDLINE | ID: mdl-37686509

RESUMEN

This study aimed to compare the prognosis and characteristics of patients with advanced hepatocellular carcinoma treated with first-line atezolizumab plus bevacizumab (AB) combination therapy and hepatic artery infusion chemotherapy (HAIC). We retrospectively assessed 193 and 114 patients treated with HAIC and AB combination therapy, respectively, between January 2018 and May 2023. The progression-free survival (PFS) of patients treated with AB combination therapy was significantly superior to that of patients treated with HAIC (p < 0.05), but there was no significant difference in overall survival (OS). After propensity score matching, our data revealed no significant differences in OS and PFS between patients who received AB combination therapy and those who received HAIC therapy (p = 0.5617 and 0.3522, respectively). In conclusion, our propensity score study reveals no significant differences in OS and PFS between patients treated with AB combination therapy and those treated with HAIC.

4.
J Korean Soc Radiol ; 84(4): 824-834, 2023 Jul.
Artículo en Coreano | MEDLINE | ID: mdl-37559810

RESUMEN

Interventional management is commonly used for traumatic injuries to the abdominal solid organs. The American Association for the Surgery of Trauma (AAST) and the World Society of Emergency Surgery (WSES) recently published guidelines for the management and treatment of liver, spleen, and kidney injuries, emphasizing the importance of interventions. Here, we discuss the characteristics of each organ and the procedure method for each organ that interventional radiologists need to know when treating trauma patients.

5.
Ulus Travma Acil Cerrahi Derg ; 29(6): 669-676, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-37278075

RESUMEN

BACKGROUND: Splenic arterial embolization (SAE) is an effective intervention for the management of arterial hemorrhage asso-ciated with blunt splenic injury. However, its role and clinical outcomes in pediatric and adolescent patients are unclear. The aim of this study is to assess the role and the clinical outcomes of SAE for blunt splenic injuries in pediatric and adolescent trauma patients. METHODS: A retrospective cohort study was performed in patients aged ≤17 years with blunt splenic injury transferred to a re-gional trauma center in a tertiary referral hospital between November 01, 2015, and September 30, 2020. The final study population consisted of 40 pediatric and adolescent patients with blunt splenic injuries. The patient demographics, mechanisms of injury, details of injuries, angiographic findings, embolization techniques, and technical and clinical outcomes, including spleen salvage rates and pro-cedure-related complications, were examined. RESULTS: Of the 40 pediatric and adolescent patients with blunt splenic injury, 17 underwent SAE (42.53%). The clinical success rate was 88.2% (15/17). No cases of embolization-related complications or clinical failure were observed. Spleen salvage after SAE was achieved in all patients. In addition, no statistically significant differences were observed in clinical outcomes (clinical success and spleen salvage rates) between low-grade (World Society of Emergency Surgery [WSES] spleen trauma classification I or II) and high-grade (WSES classification III or IV) splenic injury groups. CONCLUSION: SAE is a safe and feasible procedure, and is effective for successful spleen salvage of blunt splenic injuries in pediatric and adolescent patients.


Asunto(s)
Traumatismos Abdominales , Embolización Terapéutica , Heridas no Penetrantes , Humanos , Adolescente , Niño , Bazo/lesiones , Estudios Retrospectivos , Resultado del Tratamiento , Arteria Esplénica/lesiones , Puntaje de Gravedad del Traumatismo , Embolización Terapéutica/métodos , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/terapia , Traumatismos Abdominales/terapia
6.
J Vasc Access ; 24(1): 158-161, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34148399

RESUMEN

An arteriovenous fistula was required for permanent vascular access in a patient undergoing hemodialysis due to progressive chronic kidney disease associated with short bowel syndrome. In the present report, we discuss the case of a patient who underwent arteriovenous grafting because there was no proper native vein as a route, following which a seroma developed near the arterial anastomosis. Despite several surgical treatments, seroma not only recurred but also affected dialysis by compressing the graft. A stent was inserted into the graft to withstand the pressure from the seroma, and because one stent could not withstand the pressure, the stent overlapped where it received the most compression. Since then, the patency of graft has been well maintained for more than 2 years. Increasing the radial force of overlapping stents would be an alternative plan to help solve the problematic repeated compressible seroma despite multiple surgical treatments.


Asunto(s)
Derivación Arteriovenosa Quirúrgica , Implantación de Prótesis Vascular , Humanos , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/cirugía , Grado de Desobstrucción Vascular , Resultado del Tratamiento , Seroma/diagnóstico por imagen , Seroma/etiología , Implantación de Prótesis Vascular/efectos adversos , Derivación Arteriovenosa Quirúrgica/efectos adversos , Estudios Retrospectivos , Diálisis Renal/efectos adversos , Stents/efectos adversos
7.
Sci Prog ; 105(4): 368504221146066, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36540044

RESUMEN

BACKGROUND: We assessed the outcomes of a push-pull monorail technique to overcome a difficult anatomical course through the left internal jugular vein in implantable port insertions. METHODS: From December 2018 to May 2021, a total of 5326 patients were referred for implantable port insertion in our interventional unit, among which 472 cases were requested for insertion on the left side. Our monorail technique was applied only when the catheter tip entered the azygos vein instead of the superior vena cava (n = 8). The technique consists of a puncture at the distal tip of the port catheter with a 21-gauge micropuncture needle, advancing a 0.018-inch hair-wire to the guide, providing support for the pre-assembled port, and advancing the microsheath over the hair-wire to prevent extrusion of the catheter. RESULTS: The push-pull monorail technique was performed in eight patients, and all cases were technically successful, exhibiting a technical success rate of 100%. There were no immediate or delayed complications. CONCLUSIONS: The push-pull monorail technique is helpful in overcoming the difficult anatomical course through the left internal jugular vein during implantable port insertion.


Asunto(s)
Cateterismo Venoso Central , Humanos , Cateterismo Venoso Central/métodos , Vena Cava Superior , Venas Yugulares , Punciones/métodos
8.
J Endovasc Ther ; : 15266028221134894, 2022 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-36342200

RESUMEN

PURPOSE: To evaluate the optimal sizing of an aortic stent graft in patients with blunt thoracic aortic injury (BTAI), considering the decrease in diameter in hypovolemic status. MATERIALS AND METHODS: From 2014 to 2020, 25 patients who underwent thoracic endovascular aortic repair (TEVAR) for BTAI were included. Hemodynamic parameters in the emergency room (ER) and just before the main procedure (MP) were collected. The aortic sizes were measured during initial computed tomography (CT) on arrival in the ER, aortography (AG) during TEVAR, and final CT in the outpatient clinic. The appropriateness of the inserted stent graft size was investigated. RESULTS: The mean values of the final CT/initial CT and final CT/initial AG (proximal descending thoracic aorta [pDTA]) were 113% and 105%, respectively. The final CT/initial CT (pDTA; 122.2% vs 108.8%, p=0.01) and final CT/initial AG (pDTA; 113.4% vs 102.1%, p<0.01) were significantly higher in patients with systolic blood pressure (SBP; MP) ≤90 mm Hg. The final CT/initial CT (pDTA; 120.4% vs 109.0%, p=0.03) and final CT/initial AG (pDTA; 111.4% vs 102.6%, p=0.01) were significantly higher in patients with mean blood pressure (MBP; MP) ≤70 mm Hg. On an average, the inserted stent grafts were oversized by 130% on initial AG. Based on the final CT scan, the inserted stent graft was as large as 122%. CONCLUSION: In the case of hemodynamic instability with SBP (MP) ≤90 mm Hg or MBP (MP) ≤70 mm Hg, despite adequate resuscitation, an oversized TEVAR stent graft of 130% can reduce the occurrence of endoleak and is sufficiently safe. CLINICAL IMPACT: Despite sufficient resuscitation, the aorta size measured during TEVAR in patients with hemodynamic instability with systolic BP <90 mmHg and mean BP <70 mmHg may be reduced by more than 15% compared to that in the normal state. In this study, the mean size of the stent grafts were oversized by 130% on initial aortography, but were oversized by 122% based on final CT. When the stent graft was oversized by 130% in TEVAR for hemodynamic unstable patient with BTAI, the patient reached the proper oversizing subsequent to hemodynamic recovery.

9.
J Vasc Access ; : 11297298221130895, 2022 Oct 19.
Artículo en Inglés | MEDLINE | ID: mdl-36262020

RESUMEN

Although iatrogenic pseudoaneurysm is an infrequent complication, it can be life threatening if ruptured. There are several treatment methods for managing this complication. This case report demonstrates a technique using ultrasonography-guided suture-mediated vascular closure devices without angiography to successfully treat iatrogenic superficial femoral pseudoaneurysm following an unintended hemodialysis catheter insertion. In particular, when it is difficult to use a contrast due to a patient's condition as in this case, suture-mediated vascular closure device with ultrasonography guidance can be used as a therapeutic method.

10.
J Clin Lab Anal ; 36(11): e24707, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-36164743

RESUMEN

BACKGROUND: Urinary crystals are the most diverse forms of urine sediments. Reference images for typical urinary crystals are common, however, but images for interpreting atypical urinary crystals are very rare. The authors reviewed various forms and solubility tests of urine crystals to interpret atypical crystals found in clinical specimens. METHODS: We reviewed textbooks on urinary crystals and articles published in PubMed. Some atypical crystals were confirmed using a solubility test. RESULTS: The classification, shape, chemical structure, and solubility of the crystals were summarized. In the solubility test, some crystals showed different results; therefore, a new solubility test was proposed based on the literature review. We presented various types of calcium oxalates. CONCLUSIONS: These review articles will be helpful in the examination of atypical crystals found in clinical specimens. The solubility test requires additional studies to discriminate the inconsistent results between the authors.


Asunto(s)
Oxalato de Calcio , Cálculos Urinarios , Humanos , Solubilidad , Cristalización , Oxalato de Calcio/análisis , Orina/química , Cálculos Urinarios/química
11.
Diagn Interv Radiol ; 28(1): 72-78, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35142614

RESUMEN

PURPOSE We examined whether superselective embolization of the renal artery could be effectively employed to preserve traumatic kidneys and assessed its clinical outcomes. METHODS Between December 2015 and November 2019, 26 patients who had American Association for the Surgery of Trauma grade V traumatic shattered kidneys were identified. Among them, a retrospective review was conducted of 16 patients who underwent superselective renal artery embolization for shattered kidney. The mean age was 41.2 ± 15.7 years, and the mean follow-up duration was 138.2 ± 140.1 days. Patient data including procedure details and clinical outcomes were reviewed, and the preserved volume of kidney parenchyma was calculated. RESULTS Bleeding control was achieved in 13 (81%) patients and kidney preservation was achieved in 11 (79%). There was no mortality, and the median intensive care unit stay was 1.5 days. The mean volume of remnant kidney was 122.3 ± 66.0 cm3 (70%) on the last follow-up computed tomography. The estimated glomerular filtration rate was not significantly changed after superselective renal artery embolization. CONCLUSION Superselective renal artery embolization using a microcatheter for the shattered kidney effectively controlled hemorrhage in acute stage trauma and enabled kidney preservation.


Asunto(s)
Embolización Terapéutica , Heridas no Penetrantes , Adulto , Humanos , Riñón/diagnóstico por imagen , Riñón/cirugía , Persona de Mediana Edad , Arteria Renal/diagnóstico por imagen , Estudios Retrospectivos , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/terapia
12.
J Liver Cancer ; 22(1): 75-83, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37383536

RESUMEN

Hepatocellular carcinoma (HCC) is a cytotoxic chemotherapy-resistant tumor and most HCCs arise in a background of liver cirrhosis of various causes. Although the IMBrave150 trial showed remarkable advancements in the treatment of unresectable HCC with atezolizumab plus bevacizumab (AteBeva), therapeutic outcomes were unsatisfactory in more than half of the patients. Accordingly, many ongoing trials combine conventional modalities with new drugs such as immune checkpoint inhibitors for better treatment outcomes, and they are expected to benefit patients with limited responses to conventional treatment. Here, two patients with advanced stage HCC with preserved liver function and good performance status showed partial response after treatment with combination or sequential therapy of AteBeva, hepatic arterial infusion chemotherapy, radiation therapy, and transarterial chemoembolization. These findings indicate the efficacy of multidisciplinary treatment against advanced HCC. Additional studies are required to establish optimal treatment strategies.

13.
J Vasc Access ; 23(3): 383-389, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-33586510

RESUMEN

BACKGROUND: Access-related hand ischemia (ARHI) is a major complication of arteriovenous fistula (AVF). This study aimed to assess the predictive efficacy of skin perfusion pressure (SPP) measurement for ARHI by examining the relationship between SPP and ARHI development and progression after AVF surgery. METHODS: Twenty-five patients (16 men and 9 women) who underwent AVF surgery based on the brachial artery between January 2018 and December 2018 were included. The pre- and postoperative SPP values were measured on the day of surgery. ARHI occurrence and severity were measured within 3 days and at 6 months after surgery. Receiver operating characteristic curve analysis was used to evaluate the prediction model of ARHI, and the cutoff points for the calculated coefficients were determined. RESULTS: There was a significant correlation between the occurrence of immediate ARHI and the SPP gradient (p = 0.024). An SPP gradient value >50 mmHg had sensitivity and specificity values of 53.85% and 91.67%, respectively, in predicting the occurrence of immediate ARHI. A postoperative SPP <48 mmHg was significantly correlated with the occurrence of 6-month ARHI (p = 0.005), with sensitivity and specificity values of 71.43% and 83.33%, respectively. CONCLUSION: The SPP gradient and postoperative SPP values may be effective clinical predictors of ARHI occurring immediately and 6 months after surgery, respectively, with high specificity. These findings could allow clinicians to diagnose and begin early interventions to help prevent ischemic tissue damage in hemodialysis patients following AVF surgery.


Asunto(s)
Fístula Arteriovenosa , Derivación Arteriovenosa Quirúrgica , Derivación Arteriovenosa Quirúrgica/efectos adversos , Arteria Braquial/diagnóstico por imagen , Arteria Braquial/cirugía , Femenino , Humanos , Isquemia/diagnóstico , Isquemia/etiología , Isquemia/cirugía , Masculino , Perfusión/efectos adversos , Flujo Sanguíneo Regional , Diálisis Renal/efectos adversos , Resultado del Tratamiento
14.
Eur J Trauma Emerg Surg ; 48(3): 1929-1938, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33523237

RESUMEN

BACKGROUND: While transarterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, the clinical outcomes according to door-to-embolization (DTE) time are unclear. This study investigated how DTE time affects outcomes in patients with severe pelvic fracture. METHODS: Using a trauma database between November 1, 2015 and December 31, 2019, trauma patients undergoing TAE were retrospectively reviewed. The final study population included 192 patients treated with TAE. The relationships between DTE time and patients' outcomes were evaluated. Multiple binomial logistic regression analyses, multiple linear regression analyses, and Cox hazard proportional regression analyses were performed to estimate the impacts of DTE time on clinical outcomes. RESULTS: The median DTE time was 150 min (interquartile range, 121-184). The mortality rates in the first 24 h and overall were 3.7% and 14.6%, respectively. DTE time served as an independent risk factor for mortality in the first 24 h (adjusted odds ratio = 2.00, 95% confidence interval [CI] = 1.20-3.34, p = 0.008). In Cox proportional hazards regression analyses, the adjusted hazard ratio of DTE time for mortality at 28 days was 1.24 (95% CI = 1.04-1.47, p = 0.014). In addition, there was a positive relationship between DTE time and requirement for packed red blood cell transfusion during the initial 24 h and a negative relationship between DTE time and ICU-free days to day 28. CONCLUSION: Shorter DTE time was associated with better survival in the first 24 h, as well as other clinical outcomes, in patients with complex pelvic fracture who underwent TAE. Efforts to minimize DTE time are recommended to improve the clinical outcomes in patients with pelvic fracture treated with TAE.


Asunto(s)
Embolización Terapéutica , Fracturas Óseas , Huesos Pélvicos , Fracturas Óseas/complicaciones , Hemorragia/complicaciones , Hemorragia/terapia , Humanos , Huesos Pélvicos/lesiones , Estudios Retrospectivos , Resultado del Tratamiento
15.
J Vasc Access ; 23(2): 286-294, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33530823

RESUMEN

BACKGROUND: This study aimed to evaluate the correlation between duplex ultrasonography (DUS) and ultrasound dilution (UD) measurement's results and determine the factors affecting the correlation of the measured values among other clinical factors in patients. METHODS: This cross-sectional study was conducted from April 2020 to May 2020 and included 60 patients who visited our dialysis centre. The flow of the fistula was measured in the proximal brachial artery using DUS. While dialysis was performed on the same day, the access flow was measured using the UD method. The correlation and agreement between the access flows acquired by each measurement method were analysed. Similarly, the correlation was analysed by classifying the groups based on the predisposing factor, and statistically significant factors were observed through comparison. RESULTS: Both measurements showed a moderate positive correlation (r = 0.60, p < 0.01). The bias (mean of UD-DUS) between the two measurements was about 230 mL/min. When the measurement site of DUS was near the inflow artery and in the same anatomical section, a strong correlation with the measurement value of UD was observed (brachial based fistula: r = 0.85, radial based fistula: r = 0.87). Similarly, for patients without diabetes and those who regularly underwent access surveillance for the dialysis route, strong correlations were observed between the two measurements (r = 0.79 and r = 0.88). CONCLUSIONS: Several factors can influence the correlation between UD and DUS. The findings showed a high correlation for DUS measurement sites within the same anatomical section as the inflow artery, patients without diabetes, and patients undergoing periodic surveillance.


Asunto(s)
Derivación Arteriovenosa Quirúrgica , Derivación Arteriovenosa Quirúrgica/efectos adversos , Velocidad del Flujo Sanguíneo , Estudios Transversales , Humanos , Flujo Sanguíneo Regional , Diálisis Renal/métodos , Ultrasonografía , Ultrasonografía Doppler Dúplex/métodos
16.
Ann Lab Med ; 42(1): 24-35, 2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-34374346

RESUMEN

BACKGROUND: Laboratory parameter abnormalities are commonly observed in COVID-19 patients; however, their clinical significance remains controversial. We assessed the prevalence, characteristics, and clinical impact of laboratory parameters in COVID-19 patients hospitalized in Daegu, Korea. METHODS: We investigated the clinical and laboratory parameters of 1,952 COVID-19 patients on admission in nine hospitals in Daegu, Korea. The average patient age was 58.1 years, and 700 (35.9%) patients were men. The patients were classified into mild (N=1,612), moderate (N=294), and severe (N=46) disease groups based on clinical severity scores. We used chi-square test, multiple comparison analysis, and multinomial logistic regression to evaluate the correlation between laboratory parameters and disease severity. RESULTS: Laboratory parameters on admission in the three disease groups were significantly different in terms of hematologic (Hb, Hct, white blood cell count, lymphocyte%, and platelet count), coagulation (prothrombin time and activated partial thromboplastin time), biochemical (albumin, aspartate aminotransferase, alanine aminotransferase, lactate, blood urea nitrogen, creatinine, and electrolytes), inflammatory (C-reactive protein and procalcitonin), cardiac (creatinine kinase MB isoenzyme and troponin I), and molecular virologic (Ct value of SARS-CoV-2 RdRP gene) parameters. Relative lymphopenia, prothrombin time prolongation, and hypoalbuminemia were significant indicators of COVID-19 severity. Patients with both hypoalbuminemia and lymphopenia had a higher risk of severe COVID-19. CONCLUSIONS: Laboratory parameter abnormalities on admission are common, are significantly associated with clinical severity, and can serve as independent predictors of COVID-19 severity. Monitoring the laboratory parameters, including albumin and lymphocyte count, is crucial for timely treatment of COVID-19.


Asunto(s)
COVID-19 , Análisis de Datos , Humanos , Laboratorios , Masculino , Persona de Mediana Edad , República de Corea/epidemiología , Estudios Retrospectivos , SARS-CoV-2
17.
Asian J Surg ; 45(1): 239-245, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34078580

RESUMEN

OBJECTIVE: The purpose of this study was to determine whether TAE negatively impacted perioperative outcomes in patients who underwent open surgery for pelvic trauma. METHODS: We retrospectively reviewed the medical records and radiographs of patients who had open surgery for an acute pelvic trauma between February 2014 and May 2017. The patients were classified into two groups: those who underwent TAE and those who did not. We evaluated preoperative demographics and perioperative outcomes between the two groups. Injury type-specific comparisons were also performed. RESULTS: A total of 136 patients (50 TAE and 86 non-TAE) were included in this study. There were significant differences in preoperative demographics including the type of injury, injury severity score, revised trauma score, surgical approach, initial blood pressure, and the amount of transfusion within 24 h between the two groups. However, no differences in perioperative outcomes were identified except for the amount of total transfusion. There were significant differences between the two groups in the injury type-specific comparisons, specifically in the amount of transfusion within 24 h in patients with pelvic ring injury and in the injury severity score in patients with acetabular fracture. However, there was no difference in perioperative outcomes between the groups for either injury type. CONCLUSION: In the present study, we were unable to identify negative effects of TAE on perioperative outcomes. Therefore, when considering open surgery subsequent to TAE, there is no evidence of increased risk for negative perioperative outcomes, especially with respect to bone healing and deep infection.


Asunto(s)
Embolización Terapéutica , Fracturas de Cadera , Huesos Pélvicos , Humanos , Pelvis , Estudios Retrospectivos
18.
Asian J Surg ; 45(11): 2224-2230, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34836763

RESUMEN

BACKGROUND/OBJECTIVE: Blunt traumatic aortic injury (BTAI) is rare and fatal. Treatment has evolved with advances in imaging and the emergence of thoracic endovascular aortic repair (TEVAR). This study reports a single-center, 5-year experience of TEVAR and open repair for BTAI. METHODS: Patients with BTAI treated at a level I trauma center from 2014 to 2019 were retrospectively reviewed with patient charts and successive computed tomography angiography images. Patients were grouped according to treatment modality: open repair, TEVAR, or medical management, chosen based on patients' characteristics and injury severity. Groups were compared in terms of preoperative demographics, injury characteristics, operative variables, short-term, and long-term outcomes. RESULTS: Forty-two patients were included in the study: 16 (38%) underwent open repair, 17 (40.4%) underwent TEVAR, seven (16.6%) were managed medically, and two (4.7%) died during triage. The median age was 49 years (interquartile range [IQR], 38-57.5 years), and 92.5% were male; the median Injury Severity Score was 33 (IQR, 29-41). Overall mortality was 7.5%. The median hospital stay was 33 days (IQR, 19.5-58.5). Patients undergoing open repair were significantly younger (43 vs. 55 years; p = 0.002) and had a smaller aortic diameter (22.3 vs. 24.0 mm; p=<0.001) than those undergoing TEVAR. No BTAI-related late mortality or reintervention was observed during follow-ups. CONCLUSION: This study demonstrated excellent outcomes with multidisciplinary team efforts and appropriate application of treatment modality. TEVAR is ideal for older or severely injured patients; open repair is an important alternative for young patients or patients with unsuitable aortic anatomy.


Asunto(s)
Implantación de Prótesis Vascular , Procedimientos Endovasculares , Lesiones del Sistema Vascular , Heridas no Penetrantes , Adulto , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Procedimientos Endovasculares/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/cirugía , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/cirugía
19.
Clin Lab ; 67(11)2021 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-34758229

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) started to spread in Daegu beginning at the end of February 2020. IgG and IgM antibodies against SARS-CoV-2 were measured in hospitalized patients with COVID-19 with moderate to severe symptoms to improve the understanding of antibody responses. METHODS: We enrolled 312 patients with COVID-19 admitted to seven hospitals located in Daegu. Using serum (or plasma) samples from patients with polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infections, both IgG and IgM antibodies were measured using commercial enzyme-linked immunosorbent assay (R-FIND CO¬VID-19 ELISA, SG medical, Seoul, Korea). RESULTS: The median value from the initial diagnosis, confirmed by SARS-CoV-2 PCR, to the sampling date was 24 days (day 1 to 88). The total positive rate of IgG was 93.9% and the positive IgM rate was 39.4%, without considering the elapsed period after diagnosis. Positive IgG and IgM rates were highest at 100.0% and 59.0%, respectively, at 3 weeks (15 - 21 days). IgG showed a high positive rate of 79.3% even within 7 days after the initial diag-nosis of the disease and maintained a positive rate of 97.8% until after 8 weeks. CONCLUSIONS: Among hospitalized patients with COVID-19, IgG was detected from the beginning of the diagnosis and persisted for an extended time period.


Asunto(s)
COVID-19 , Anticuerpos Antivirales , Formación de Anticuerpos , Ensayo de Inmunoadsorción Enzimática , Humanos , Inmunoglobulina G , Inmunoglobulina M , República de Corea , SARS-CoV-2 , Sensibilidad y Especificidad
20.
J Korean Med Sci ; 36(43): e294, 2021 Nov 08.
Artículo en Inglés | MEDLINE | ID: mdl-34751011

RESUMEN

BACKGROUND: In Korea, the first community outbreak of coronavirus disease 2019 (COVID-19) occurred in Daegu on February 18, 2020. This study was performed to investigate the prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antibodies in healthcare workers (HCWs) at 6 major hospitals in Daegu. METHODS: Blood specimens of 2,935 HCWs at 6 major hospitals in Daegu from January 2021 to February 2021 were collected. Every specimen was tested for antibody against SARS-CoV-2 using both Elecsys Anti-SARS-CoV-2 electrochemiluminescence immunoassay (Roche Diagnostics, Rotkreuz, Switzerland) and R-FIND COVID-19 IgG/M/A enzyme-linked immunosorbent assay kit (SG medical Inc., Seoul, Korea) as screening tests. If 1 or more of these screening test results was positive, 2 additional antibody tests were performed using Abbott Anti-SARS-CoV-2 IgG assay (Abbott, Abbott Park, IL, USA) and cPass SARS-CoV-2 Neutralization Antibody Detection Kit (GenScript USA Inc., Piscataway, NJ, USA). If 2 or more of the total 4 test results were positive, it was determined as positive for the antibody against SARS-CoV-2. RESULTS: According to the criteria of SARS-CoV-2 antibody positivity determination, 12 subjects were determined as positive. The overall positive rate of the SARS-CoV-2 antibody was 0.41% (12/2,935). Of the 12 subjects determined as positive, 7 were diagnosed with COVID-19, and the remaining 5 were nondiagnosed cases of COVID-19. CONCLUSION: In early 2021, the overall seroprevalence of SARS-CoV-2 antibody among HCW located in Daegu was 0.41%, and 0.17% excluding COVID-19 confirmed subjects. These results were not particularly high compared with the general public and were much lower than HCWs in other countries.


Asunto(s)
Anticuerpos Antivirales/sangre , COVID-19/diagnóstico , COVID-19/inmunología , Personal de Salud/estadística & datos numéricos , Inmunoglobulina G/sangre , Adulto , Anciano , Anticuerpos Neutralizantes , Especificidad de Anticuerpos , COVID-19/epidemiología , Ensayo de Inmunoadsorción Enzimática , Femenino , Hospitales , Humanos , Inmunoglobulina A/sangre , Inmunoglobulina M/sangre , Masculino , Persona de Mediana Edad , Prevalencia , República de Corea/epidemiología , SARS-CoV-2
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