Alternative Techniques for Cannulation of Biliary Strictures Resistant to the 0.035” System Following Living Donor Liver Transplantation

윤희망,김진형,고기영,송호영,권동일,성규보 대한영상의학회 2012 Korean Journal of Radiology Vol.13 No.2

Objective: To assess the clinical efficacy of alternative techniques for biliary stricture cannulation in patients undergoing living donor liver transplantation (LDLT), after cannulation failure with a conventional (0.035-inch guidewire) technique. Subjects and Methods: Of 293 patients with biliary strictures after LDLT, 19 (6%) patients, 11 men and 8 women of mean age 48.5 years, had the failed cannulation of the stricture by conventional techniques. Recannulation was attempted by using two alternative methods, namely a micro-catheter set via percutaneous access and a snare (rendezvous) technique using percutaneous and endoscopic approaches. Results: Strictures were successfully cannulated in 16 (84%) of the 19 patients. A microcatheter set was used in 12 and a snare technique in four patients. Stricture cannulation failed in the remaining three patients, who finally underwent surgical revision. Conclusion: Most technical failures using a conventional technique for biliary stricture cannulation after LDLT can be overcome by using a microcatheter set or a snare (rendezvous) technique. Objective: To assess the clinical efficacy of alternative techniques for biliary stricture cannulation in patients undergoing living donor liver transplantation (LDLT), after cannulation failure with a conventional (0.035-inch guidewire) technique. Subjects and Methods: Of 293 patients with biliary strictures after LDLT, 19 (6%) patients, 11 men and 8 women of mean age 48.5 years, had the failed cannulation of the stricture by conventional techniques. Recannulation was attempted by using two alternative methods, namely a micro-catheter set via percutaneous access and a snare (rendezvous) technique using percutaneous and endoscopic approaches. Results: Strictures were successfully cannulated in 16 (84%) of the 19 patients. A microcatheter set was used in 12 and a snare technique in four patients. Stricture cannulation failed in the remaining three patients, who finally underwent surgical revision. Conclusion: Most technical failures using a conventional technique for biliary stricture cannulation after LDLT can be overcome by using a microcatheter set or a snare (rendezvous) technique.

Re-Assessment of Applicability of Greulich and Pyle-Based Bone Age to Korean Children Using Manual and Deep Learning-Based Automated Method

황지선,윤희망,황재연,김평화,백보람,배병욱,성진경,김화정,정아영,조영아,이진성 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.7

Purpose: To evaluate the applicability of Greulich-Pyle (GP) standards to bone age (BA) assessment in healthy Korean childrenusing manual and deep learning-based methods. Materials and Methods: We collected 485 hand radiographs of healthy children aged 2–17 years (262 boys) between 2008 and2017. Based on GP method, BA was assessed manually by two radiologists and automatically by two deep learning-based BA as sessment (DLBAA), which estimated GP-assigned (original model) and optimal (modified model) BAs. Estimated BA was com pared to chronological age (CA) using intraclass correlation (ICC), Bland-Altman analysis, linear regression, mean absolute error,and root mean square error. The proportion of children showing a difference >12 months between the estimated BA and CA wascalculated. Results: CA and all estimated BA showed excellent agreement (ICC ≥0.978, p<0.001) and significant positive linear correlations (R2≥0.935, p<0.001). The estimated BA of all methods showed systematic bias and tended to be lower than CA in younger patients, andhigher than CA in older patients (regression slopes ≤-0.11, p<0.001). The mean absolute error of radiologist 1, radiologist 2, origi nal, and modified DLBAA models were 13.09, 13.12, 11.52, and 11.31 months, respectively. The difference between estimatedBA and CA was >12 months in 44.3%, 44.5%, 39.2%, and 36.1% for radiologist 1, radiologist 2, original, and modified DLBAAmodels, respectively. Conclusion: Contemporary healthy Korean children showed different rates of skeletal development than GP standard-BA, andsystemic bias should be considered when determining children’s skeletal maturation.

Adrenal Cortical Neoplasm with Uncertain Malignant Potential Arising in the Heterotopic Adrenal Cortex in the Liver of a Patient with Beckwith-Wiedemann Syndrome

김은나,송동은,윤희망,이범희,김종재 대한병리학회 2019 Journal of Pathology and Translational Medicine Vol.53 No.2

Patients with Beckwith-Wiedemann syndrome (BWS) are predisposed to developing embryonal tumors, with hepatoblastoma being the most common type. Our patient showed hemihypertrophy, macroglossia, and paternal uniparental disomy in chromosome 11 and was diagnosed with BWS. When the patient was 9 months old, a 2.5 × 1.5 cm oval hypoechoic exophytic mass was detected in the inferior tip of his right liver. Preoperative imaging identified it as hepatoblastoma; however, histologic, immunohistochemistry, and electron microscopic findings were compatible with adrenal cortical neoplasm with uncertain malignant potential. The origin of the adrenal tissue seemed to be heterotopic. Here, we describe for the first time an adrenal cortical neoplasm with uncertain malignant potential arising in the heterotopic adrenal cortex located in the liver of a patient with BWS.

Moyamoya disease in a 3-year-old boy presenting with a focal motor seizure provoked by hyperventilation

황수진,김중헌,윤희망,염미선 대한소아응급의학회 2018 대한소아응급의학회지 Vol.5 No.1

A previously healthy, 3-year-old boy presented to the emergency department with an afebrile focal motor seizure. He was found crying and having a seizure 30 minutes earlier. During this seizure, he was jerking his head and right extremities. Subsequent magnetic resonance imaging showed acute infarction in the bilateral frontal lobes, chiefly in the left. After hospitalization, conventional angiography demonstrated bilateral stenosis of the distal internal carotid arteries with development of lenticulostriate collaterals, which confirmed the diagnosis of moyamoya disease. It is vital to recognize focal motor seizures and situations related to hyperventilation in children with a seizure, which imply a structural lesion and a provoked cerebral ischemia in preexisting moyamoya disease, respectively.

Children’s Hepatic Tumors International Collaboration-Hepatoblastoma Stratification (CHIC-HS) System for Pediatric Patients with Hepatoblastoma: A Retrospective, Hospital-Based Cohort Study in South Korea

김평화,신현주,윤희망,최영훈,남궁정만,김대연,고경남,이미정,윤혜성,류철주,한정우,한승민,조영아 대한암학회 2022 Cancer Research and Treatment Vol.54 No.1

Purpose In 2017, the Children’s Hepatic Tumors International Collaboration-Hepatoblastoma Stratification (CHIC-HS) system was introduced. We aimed to evaluate the accuracy of CHIC-HS System for the prediction of event-free survival (EFS) in Korean pediatric patients with hepatoblastoma. Materials and Methods This two-center retrospective study included consecutive Korean pediatric patients with histopathologically confirmed hepatoblastoma from March 1988 through September 2019. We compared EFS among four risk groups according to the CHIC-HS system. Discriminatory ability of CHIC-HS system was also evaluated using optimism-corrected C-statistics. Factors associated with EFS were explored using multivariable Cox regression analysis. Results We included 129 patients (mean age, 2.6±3.3 years; female:male, 63:66). The 5-year EFS rates in the very low, low, intermediate, and high-risk groups, according to the CHIC-HS system were 90.0%, 82.8%, 73.5%, and 51.3%, respectively. The CHIC-HS system aligned significantly well with EFS outcomes (p=0.004). The optimism-corrected C index of CHIC-HS was 0.644 (95% confidence interval [CI], 0.561 to 0.727). Age ≥ 8 (vs. age ≤ 2; hazard ratio [HR], 2.781; 95% CI, 1.187 to 6.512; p=0.018), PRE-Treatment EXTent of tumor (PRETEXT) stage IV (vs. PRETEXT I or II; HR, 2.774; 95% CI, 1.228 to 5.974; p=0.009), and presence of metastasis (HR, 2.886; 95% CI, 1.457 to 5.719; p=0.002), which are incorporated as the first three nodes in the CHIC-HS system, were independently associated with EFS. Conclusion The CHIC-HS system aligned significantly well with EFS outcomes in Korean pediatric patients with hepatoblastoma. Age group, PRETEXT stage, and presence of metastasis were independently associated with EFS. Purpose In 2017, the Children’s Hepatic Tumors International Collaboration-Hepatoblastoma Stratification (CHIC-HS) system was introduced. We aimed to evaluate the accuracy of CHIC-HS System for the prediction of event-free survival (EFS) in Korean pediatric patients with hepatoblastoma.Materials and Methods This two-center retrospective study included consecutive Korean pediatric patients with histopathologically confirmed hepatoblastoma from March 1988 through September 2019. We compared EFS among four risk groups according to the CHIC-HS system. Discriminatory ability of CHIC-HS system was also evaluated using optimism-corrected C-statistics. Factors associated with EFS were explored using multivariable Cox regression analysis.Results We included 129 patients (mean age, 2.6±3.3 years; female:male, 63:66). The 5-year EFS rates in the very low, low, intermediate, and high-risk groups, according to the CHIC-HS system were 90.0%, 82.8%, 73.5%, and 51.3%, respectively. The CHIC-HS system aligned significantly well with EFS outcomes (p=0.004). The optimism-corrected C index of CHIC-HS was 0.644 (95% confidence interval [CI], 0.561 to 0.727). Age ≥ 8 (vs. age ≤ 2; hazard ratio [HR], 2.781; 95% CI, 1.187 to 6.512; p=0.018), PRE-Treatment EXTent of tumor (PRETEXT) stage IV (vs. PRETEXT I or II; HR, 2.774; 95% CI, 1.228 to 5.974; p=0.009), and presence of metastasis (HR, 2.886; 95% CI, 1.457 to 5.719; p=0.002), which are incorporated as the first three nodes in the CHIC-HS system, were independently associated with EFS.Conclusion The CHIC-HS system aligned significantly well with EFS outcomes in Korean pediatric patients with hepatoblastoma. Age group, PRETEXT stage, and presence of metastasis were independently associated with EFS.

Transcatheter Arterial Chemoembolization for Infiltrative Hepatocellular Carcinoma: Clinical Safety and Efficacy and Factors Influencing Patient Survival

한기창,김진형,윤희망,Eun-Joung Kim,권동일,고기영,윤현기,고흥규 대한영상의학회 2014 Korean Journal of Radiology Vol.15 No.4

Objective: To evaluate the safety and efficacy of transcatheter arterial chemoembolization (TACE) in patients with infiltrative hepatocellular carcinoma (HCC) and to identify the prognostic factors associated with patient survival. Materials and Methods: Fifty two patients who underwent TACE for infiltrative HCC were evaluated between 2007 and 2010. The maximum diameter of the tumors ranged from 7 cm to 22 cm (median 15 cm). Of 46 infiltrative HCC patients with portal vein tumor thrombosis, 32 patients received adjuvant radiation therapy for portal vein tumor thrombosis after TACE. Results: The tumor response by European Association for the Study of the Liver criteria was partial in 18%, stable in 47%, and progressive in 35% of the patients. The median survival time was 5.7 months (Kaplan-Meier analysis). The survival rates were 48% at six months, 25% at one year, and 12% at two years. In the multivariable Cox regression analysis, Child-Pugh class (p = 0.02), adjuvant radiotherapy (p = 0.003) and tumor response after TACE (p = 0.004) were significant factors associated with patient survival. Major complications occurred in nine patients. The major complication rate was significantly higher in patients with Child-Pugh B than in patients with Child-Pugh A (p = 0.049, χ2 test). Conclusion: Transcatheter arterial chemoembolization can be a safe treatment option in infiltrative HCC patients with Child Pugh class A. Child Pugh class A, radiotherapy for portal vein tumor thrombosis after TACE and tumor response are good prognostic factors for an increased survival after TACE in patients with infiltrative HCCs.

일개 지역사회에서 여성의 골 밀도와 체성분과의 관계

권근상,백송은,윤희망,진주련 대한임상건강증진학회 2005 Korean Journal of Health Promotion Vol.5 No.4

Background : The purpose of this study was to analyze the relationship between BMD(bone mineral density) and body composition in women in a community and find the protective factor of the osteoporosis.Methods : The study subjects were 36 premenopausal women and 111 postmenopausal women who did not take any drugs and have any diseases affecting BMD. We analyzed the relationship between BMD and body composition. So, BMD was measured at the os calcis with dual energy X-ray absorptiometry, and body composition was measured with bioelectrical impedance analysis. Results : The mean age of premenopausal women was 46.69 years andpostmenopausal women was 60.85 years. There were statistical differences in BMD of the two groups; 0.53±0.08, 0.39±0.10 respectively. In premenopausal women, only age was correlated with BMD(r=-0.366, p〈0.05). But in postmenopausal women, age(r=-0.471, p〈0.01), parity(r=-0.231, p〈0.05), and lactation period(r=-0.247, p〈0.05) were negatively correlated with BMD, whereasweight(r=0.481, p〈0.01), BMI(r=0.332, p〈0.01), fat mass(r=0.370, p〈0.01), fat free mass(r=0.536, p〈0.01) and muscle mass(r=0.538, p〈0.01) were positively correlated with BMD. In a multiple linear regression analysis adjusted by age, parity, lactation period and exercise, total and partial R were 0.422, 0.196 in weight, 0.365, 0.118 in BMI, 0.386, 0.148 in fat mass, 0.410, 0.236 in fat free mass and 0.409, 0.233 in muscle mass respectively.Conclusions : This study suggests that fat free mass and muscle mass, among body compositions, are the major determinants of BMD at the os calcis in postmenopausal women. Thus, we think that proper exercise and diet will be required for increasing fat free mass, especially muscle mass, to prevent the osteoporosis. -연구배경 본 연구의 목적은 일개 지역사회 여성의 골밀도와 체성분 간의 관련성을 알아보고 , 이를 통하여 골다공증의 예방요인을 규명하는데 있다.방 법 2005년 7월 10일부터 15일까지 전라북도 김제지역의 만 40세 이상 70세 이하의 여성 169명을 대상으로 설문조사 , 이중 골밀도 X-선 흡수법을 이용한 골밀도 , 생체전기저항 분석법을 이용한 체성분 등을 조사하였으며 , 이 중 당뇨병 , 갑상선 질환, 류마티스 관절염 등의 과거력이 없으며 칼슘제재 및 기타 약물을 복용하지 않는 성인여성 147명(폐경 전 여성 36명, 폐경 후 여성 111명)을 최종 연구대상으로 하였다 . 결 과 폐경 전 여성에서의 골밀도는 체성분과 연관성을 나타내지 않았으며 , 폐경 후 여성에서의 골밀도는 체성분 중 체지방률을 제외한 체중, 체질량지수, 체지방량, 제지방량, 근육량과 모두 양의 상관관계를 나타냈다 . 폐경 후 여성에서 연령 , 수유기간, 출산력, 운동여부가 포함된 회귀모형에 체중 , 체질량지수, 체지방량, 제지방량, 근육량 등을 추가한 5가지 모델에 대해 다중선형회귀분석을 실시한 결과 , 제지방량과 근육량을 포함한 두 모델의 설명력과 기여도가 가장 높게 나타나 이 두 지표가 골밀도와 보다 큰 관련성이 있는 것으로 조사되었다 . 결 론 폐경 이후 여성의 골 밀도는 체중, 체질량지수, 체지방량, 제지방량, 근육량 등의 체성분에 영향을 미치나, 이 중 특히 제지방량과 근육량이 골 밀도와 보다 큰 연관성이 있으며, 골다공증 예방을 위해서는 제지방량, 특히 근육량을 높이기 위한 적정량의 운동과 음식섭취가 필요할 것으로 생각된다.

Altered Structural Network in Newly Onset Childhood Absence Epilepsy

김은희,심우현,이진성,윤희망,고태성,염미선 대한신경과학회 2020 Journal of Clinical Neurology Vol.16 No.4

Background and Purpose Recent quantitative neuroimaging studies of childhood absence epilepsy (CAE) have identified various structural abnormalities that might be involved in the onset of absence seizure and associated cognitive and behavioral functions. However, the neuroanatomical alterations specific to CAE remain unclear, and so this study investigated the regional alterations of brain structures associated with newly diagnosed CAE. Methods Surface and volumetric magnetic resonance imaging data of patients with newly diagnosed CAE (n=18) and age-matched healthy controls (n=18) were analyzed using Free- Surfer software. A group comparison using analysis of covariance was performed with significance criteria of p<0.05 and p<0.01 in global and regional analyses, respectively. Results Compared with control subjects, the patients with CAE had smaller total and regional volumes of cortical gray-matter (GM) in the right rostral middle frontal, right lateral orbitofrontal, and left rostral middle frontal regions, as well as in the right precentral, right superior, middle, left middle, and inferior temporal gyri. The cortex in the right posterior cingulate gyrus and left medial occipital region was significantly thicker in patients with CAE than in controls. Conclusions Patients with CAE showed a reduced bilateral frontotemporal cortical GM volume and an increased posterior medial cortical thickness, which are associated with the default mode network. These structural changes can be suggested as the neural basis of the absence seizures and neuropsychiatric comorbidities in CAE.

Does the Reporting Quality of Diagnostic Test Accuracy Studies, as Defined by STARD 2015, Affect Citation?

최영준,정미선,구현정,박지은,윤희망,박성호 대한영상의학회 2016 Korean Journal of Radiology Vol.17 No.5

Objective: To determine the rate with which diagnostic test accuracy studies that are published in a general radiology journal adhere to the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015, and to explore the relationship between adherence rate and citation rate while avoiding confounding by journal factors. Materials and Methods: All eligible diagnostic test accuracy studies that were published in the Korean Journal of Radiology in 2011–2015 were identified. Five reviewers assessed each article for yes/no compliance with 27 of the 30 STARD 2015 checklist items (items 28, 29, and 30 were excluded). The total STARD score (number of fulfilled STARD items) was calculated. The score of the 15 STARD items that related directly to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 was also calculated. The number of times each article was cited (as indicated by the Web of Science) after publication until March 2016 and the article exposure time (time in months between publication and March 2016) were extracted. Results: Sixty-three articles were analyzed. The mean (range) total and QUADAS-2-related STARD scores were 20.0 (14.5–25) and 11.4 (7–15), respectively. The mean citation number was 4 (0–21). Citation number did not associate significantly with either STARD score after accounting for exposure time (total score: correlation coefficient = 0.154, p = 0.232; QUADAS-2-related score: correlation coefficient = 0.143, p = 0.266). Conclusion: The degree of adherence to STARD 2015 was moderate for this journal, indicating that there is room for improvement. When adjusted for exposure time, the degree of adherence did not affect the citation rate.

Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal

박지은,한경화,성유섭,정미선,구현정,윤희망,최영준,이승수,김경원,신영빈,안수아,조효민,박성호 대한영상의학회 2017 Korean Journal of Radiology Vol.18 No.6

Objective: To evaluate the frequency and adequacy of statistical analyses in a general radiology journal when reporting a reliability analysis for a diagnostic test. Materials and Methods: Sixty-three studies of diagnostic test accuracy (DTA) and 36 studies reporting reliability analyses published in the Korean Journal of Radiology between 2012 and 2016 were analyzed. Studies were judged using the methodological guidelines of the Radiological Society of North America-Quantitative Imaging Biomarkers Alliance (RSNA-QIBA), and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) initiative. DTA studies were evaluated by nine editorial board members of the journal. Reliability studies were evaluated by study reviewers experienced with reliability analysis. Results: Thirty-one (49.2%) of the 63 DTA studies did not include a reliability analysis when deemed necessary. Among the 36 reliability studies, proper statistical methods were used in all (5/5) studies dealing with dichotomous/nominal data, 46.7% (7/15) of studies dealing with ordinal data, and 95.2% (20/21) of studies dealing with continuous data. Statistical methods were described in sufficient detail regarding weighted kappa in 28.6% (2/7) of studies and regarding the model and assumptions of intraclass correlation coefficient in 35.3% (6/17) and 29.4% (5/17) of studies, respectively. Reliability parameters were used as if they were agreement parameters in 23.1% (3/13) of studies. Reproducibility and repeatability were used incorrectly in 20% (3/15) of studies. Conclusion: Greater attention to the importance of reporting reliability, thorough description of the related statistical methods, efforts not to neglect agreement parameters, and better use of relevant terminology is necessary.