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Byun, Byung Hyun,Kong, Chang-Bae,Lim, Ilhan,Choi, Chang Woon,Song, Won Seok,Cho, Wan Hyeong,Jeon, Dae-Geun,Koh, Jae-Soo,Lee, Soo-Yong,Lim, Sang Moo Society of Nuclear Medicine 2013 The Journal of nuclear medicine Vol.54 No.7
<P>We evaluated the potential of <SUP>18</SUP>F-FDG PET/CT and diffusion-weighted imaging (DWI) to monitor the histologic response in patients with extremity osteosarcoma receiving neoadjuvant chemotherapy, using sequential PET/CT and MR imaging. <B>Methods:</B> We prospectively registered 28 patients with high-grade osteosarcoma treated with 2 cycles of neoadjuvant chemotherapy and surgery. All patients underwent sequential <SUP>18</SUP>F-FDG PET/CT and MR imaging before (PET/MR1) and after neoadjuvant chemotherapy (PET/MR2). Maximum standardized uptake value (SUV), tumor volume based on MR imaging (MRV), and the mean apparent diffusion coefficient (ADC) values were measured on PET/MR1 (SUV1, MRV1, and ADC1) and PET/MR2 (SUV2, MRV2, and ADC2). The percentage changes in maximum SUV (ΔSUV), MRV (ΔMRV), and ADC (ΔADC) were calculated, and the correlations among these parameters were evaluated. After surgery, the effects of neoadjuvant chemotherapy were graded histopathologically: grades III and IV (necrosis of ≥ 90%) indicated a good response, and grades I and II (necrosis of < 90%) indicated a poor response. The optimum cutoff values of ΔSUV, ΔMRV, ΔADC, and their combination for predicting histologic response were assessed by single- and multi-receiver-operating-characteristic curve analysis. <B>Results:</B> Twenty-seven patients were enrolled in the present study after 1 patient with inadequate acquisition of MR imaging was excluded. ΔSUV and ΔADC negatively correlated with each other (ρ = −0.593, <I>P</I> = 0.001), and ΔMRV did not correlate with ΔSUV or ΔADC. The cutoff value, sensitivity, specificity, and accuracy for predicting good histologic response were ≤ −52%, 67%, 87%, and 78%, respectively, for ΔSUV and > 13%, 83%, 73%, and 78%, respectively, for ΔADC. However, ΔMRV did not predict histologic response. Sensitivity, specificity, and accuracy were 83%, 87%, and 85%, respectively, using the combined criterion of ΔSUV ≤ −31% and ΔADC > 13%. <B>Conclusion:</B> In the current preliminary study, both PET/CT and DWI are useful for predicting histologic response after neoadjuvant chemotherapy in osteosarcoma. Combining PET/CT and DWI may be an effective method to predict the histologic response of patients to neoadjuvant chemotherapy.</P>
Anemia in Chronic Liver Disease
( Sang Jun Suh ),( Han Ah Lee ),( Tae Hyung Kim ),( Young Sun Lee ),( Jong Jin Hyun ),( Young Kul Jung ),( Ji Hoon Kim ),( Yeon Seok Seo ),( Hyung Joon Yim ),( Jong Eun Yeon ),( Kwan Soo Byun ),( Soon 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: The anemia in chronic liver disease is common. The causes can be bleeding, malnutrition, erythrocyte sequestration and underproduction, and medicine’s side effects. Many patients are just regarded as iron deficiency anemia (IDA) and described iron supplements. We investigated the patterns of anemia in chronic liver disease and triage the causes. Methods: The patients invited to Korea university ansan hospital from 2012 to 2016 were investigated retrospectively. 1632 patients were test for anemia lab. The definition of anemia is <13.0g/dl(men) or 8.1g/dl(women) according to WHO’s threshold. Reticulocyte production index (RPI) is calculated by [reticulocyte count (%)*hematocrit/ 45]/reticulocyte maturation time. If RPI ≥2.5, it is classified as hemolysis or hemorrhage. If RPI < 2.5, it was checked red cell morphology. Normocytic (MCV 80-100) is classified as hypo-proliferative disorder, and macrocytic (MCV >100) or microcytic (MCV <80) is classified as maturation disorder. In hypo-proliferative disorder, eGFR (using MDRD fomula) < 30ml/min/1.73 m2 is classified as renal disease. If CRP >3mg/dl, it is classified as inflammatory disorder. In maturation disorder, if transferrin saturation (Fe/TIBC) <15% or ferritin <18 ng/ml, it classified as IDA. In macrocytic morphology, if the patients diagnosed as alcoholic disease, it is classified as folate and/or vitamin B12 deficiency. Others are classified as undetermined. This classification is modified from ‘algorithm of the physiologic classification of anemia’ of Harrison’s Internal Medicine. Results: Total 441 patients were available for analysis. 11 patients were classified as hemolysis/hemorrhage according to RPI ≥2.5. 430 patients were divided as hypo-proliferative (n=275) and maturation disorder (n=155) according to RBC morphology. IDA 72, renal disease 9, inflammatory disease 30, and thiamine folate deficiency 61 patients were classified. 258 patients were undermined. In IDA 72 patients, 38 patients were treated with iron supplement. In other causes 111 patients, 16 patients were described iron. In undermined 258 patients, 75 patients described iron. The proportion who diagnosed and appropriately treated with iron supplement was 8.8%, and 3.7% were miss treated, and 17.5% needed further evaluation. Conclusions: A lot of patients with anemia in chronic liver disease are treated with undetermined diagnosis. Using algorithm, many patients could be classified and treated appropriately.
( Sang Jun Suh ),( Jong Eun Yeon ),( Sun Jae Lee ),( Hyun Jung Lee ),( Eileen L. Yoon ),( Ji Hoon Kim ),( Yeon Seok Seo ),( Hyung Joon Yim ),( Kwan Soo Byun ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1
Background: Current guidelines suggest the criteria for discontinuation of nucleos(t)ide analogues (NA) in selected patients. However treatment induced virological response is not permanent. Aim of our study is to evaluate the clinical significance of HBsAg titer in predicting sustained virologic response after NA therapy discontinuation. Methods: From Jun 1998 to Dec 2010, medical record of 81 chronic hepatitis B patients who discontinued NA was analyzed retrospectively. Sustained virologic response (SVR) was arbitrarily defined as undetectable HBV DNA by real-time PCR(with lower limit of detection of 116 copies/mL, 20 IU/mL) persisted more than 12 months after treatment discontinuation. Results: Median age was 51 years, 54 (67%) patients were male, and 50 (62%)patients were HBeAg positive. Median baseline ALT, HBV DNA and HBsAg were 292 IU/mL, 7.1log10 IU/mL and 3.3log10 IU/mL. NA were lamivudine (n=53), adefovir (n=15), lamivudine combined with adefovir (n=4), and entecavir (n=9). Median treatment duration and follow-up period were 26 and 27 months. 11/81 (14%) patients had SVR. The cumulative relapse rates were 37/81 (46%) at 6 months and 42/81 (52%) 12 months after treatment discontinuation. The baseline ALT, HBV DNA and presence of HBeAg were not different between patients with or without SVR. In univariate analysis, age, treatment duration and HBsAg level at treatment discontinuation were different in patients with or without SVR; 51 vs. 43 years, p=0.033; 53 vs. 25 months, p=0.011; 2.1 vs. 3.3log10 IU/mL, p=0.003. In multivariate analysis, only HBsAg level at treatment discontinuation remained as an independent factor associated with SVR (p=0.019). The cutoff value of HBsAg level <2log10 IU/mL was predictive of SVR [(AUROC, 0.991; 95% confidence interval[CI], 0.000-1.000; p<0.05); sensitivity, 100%; specificity, 93%; positive predictive value, 69%; negative predictive value, 100%]. Conclusions: Large proportion of patients treated with oral antivirals relapsed after the treatment discontinuation. In the decision of the treatment discontinuation, HBsAg level <2log10 IU/mL at treatment discontinuation can predict sustained viral suppression in selected patients.
( Hyun Seok Cho ),( Dong Soo Han ),( Sang Bong Ahn ),( Tae Jun Byun ),( Tae Yeob Kim ),( Chang Soo Eun ),( Yong Cheol Jeon ),( Joo Hyun Sohn ) 대한소화기기능성질환·운동학회 2009 Gut and Liver Vol.3 No.4
Background/Aims: The optimal timing for interventional endoscopy in bleeding peptic ulcer disease is controversial. This study compared the outcomes between early endoscopy and delayed endoscopy in patients with bleeding peptic ulcer disease. Methods: We conducted a prospective analysis of data from 90 patients with bleeding peptic ulcer disease who visited the emergency room between May 2006 and September 2007. Patients were categorized into two groups: the early-endoscopy group (admitted during the daytime or at night with prompt endoscopic management) and the delayed-endoscopy group (admitted at night or during weekends, with endoscopic management delayed until the next day). We compared the clinical outcomes of endoscopy between the two groups. Results: There were 49 patients in the early-endoscopy group and 41 patients in the delayed-endoscopy group. Patient demographics, clinical characteristics, bleeding control modality, and Rockall score did not differ between the two groups. There were also no significant differences between the early- and delayed-endoscopy groups in the re-bleeding rate (3/49 vs 5/41, p=0.313), the duration of hospital stay (10.7 vs 9.3 days, p=0.437), and the total amount of blood transfused (3.4 vs 2.7 units, p=0.240). Conclusions: The effectiveness of interventional endoscopy for patients with bleeding peptic ulcer disease is not significantly affected by the timing of endoscopy. (Gut and Liver 2009;3:266-270)
Byun, Byung Hyun,Kong, Chang-Bae,Park, Jihyun,Seo, Youngseok,Lim, Ilhan,Choi, Chang Woon,Cho, Wan Hyeong,Jeon, Dae-Geun,Koh, Jae-Soo,Lee, Soo-Yong,Lim, Sang Moo Society of Nuclear Medicine 2013 The Journal of nuclear medicine Vol.54 No.10
<P>We evaluated the ability of metabolic and volumetric parameters measured by pretreatment <SUP>18</SUP>F-FDG PET/CT to predict the survival of patients with osteosarcoma of the extremities. <B>Methods:</B> The records of 83 patients with American Joint Committee on Cancer stage II extremity osteosarcoma treated with surgery and chemotherapy were retrospectively reviewed. Imaging parameters (maximum standardized uptake value, metabolic tumor volume [MTV], total lesion glycolysis, and tumor volume based on MR images) were measured before treatment, and histologic responses to neoadjuvant chemotherapy were assessed by examination of postsurgical specimens. Receiver-operating-characteristic curve analyses and the Cox proportional hazards model were used to analyze whether imaging and clinicopathologic parameters could predict metastasis-free survival. <B>Results:</B> Of the imaging parameters, MTV at the fixed standardized uptake value threshold of 2.0 (MTV(2.0)) most accurately predicted metastasis by receiver-operating-characteristic curve analysis (area under the curve = 0.679, <I>P</I> = 0.011). By multivariate analysis, MTV(2.0) > 105 mL (relative risk, 3.93; 95% confidence interval, 1.55–9.92) and poor response to neoadjuvant chemotherapy (relative risk, 4.83; 95% confidence interval, 1.64–14.21) independently shortened metastasis-free survival (<I>P</I> = 0.004 for both parameters). The stratification of patients by the combined criteria of MTV(2.0) and histologic response predicted outcome in more detail. <B>Conclusion:</B> MTV is an independent predictor of metastasis in patients with osteosarcoma of the extremities. The combination of MTV and histologic response predicts survival more accurately than the chemotherapeutic response alone.</P>
Byun, Sung-Hoon,Lee, Ji-Hyun,Kim, Hyo-Jung,Cho, Yeong-Cheol,Son, Jang-Ho Korean Academy of Dental Science 2016 Journal of korean dental science Vol.9 No.2
Clinicians must be able to recognize post-extraction complications and treat them in a timely manner; complications that may potentially be life-threatening require special attention. Although arteriovenous malformation (AVM) is a very rare disorder, it may induce life-threatening hemorrhage during surgical intervention in the pertinent site. The present article examines the diagnosis and treatment modalities of AVM based on the case of a patient who was diagnosed with AVM with continuous bleeding after tooth extraction and who was successfully treated.