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Biomedical subjects

Jin Wook Chung

Publications and source records attributed to Jin Wook Chung.

At least 19 recordsLinked to original sources

Internal mammary arteries supplying hepatocellular carcinoma: vascular anatomy at digital subtraction angiography in 97 patients.

PURPOSE: To retrospectively evaluate the vascular anatomy of the internal mammary arteries that supply hepatocellular carcinomas (HCCs), with an emphasis on number of tumor feeders. MATERIALS AND METHODS: This retrospective study was approved by the institutional review board; informed consent was waived. Between August 1996 and July 2005, internal mammary arteries that supply HCCs were found in 97 (2.2%) of 4438 patients (76 men, 21 women; mean age, 55 years +/- 10.5 [standard deviation]; range, 19-79 years). Computed tomographic scans and digital subtraction angiograms in these 97 patients were retrospectively reviewed in consensus by two interventional radiologists. Tumor size, number of tumor feeders, and tumor location were recorded. The t test and analysis of variance were used to correlate tumor size with number of tumor feeders, tumor feeder laterality, and transcatheter arterial chemoembolization (TACE) time. RESULTS: The following 125 tumor feeders were identified in 97 patients: phrenic branch (n = 59), musculophrenic artery (n = 40), superior epigastric artery (n = 15), anterior intercostal artery (n = 6), ensiform artery (n = 4), and pericardiacophrenic artery (n = 1). In two patients, tumors were in dorsal hepatic areas directly beneath the diaphragm. Half of the tumors located in liver segments II or III were supplied by the right internal mammary artery. In three patients, the tumor feeders from the left internal mammary artery crossed the midline. Tumor size was not statistically associated with number of tumor feeders (P = .076), tumor feeder laterality (P = .141), and TACE time (P = .729). CONCLUSION: The common tumor feeders of the internal mammary artery are the phrenic branch and the musculophrenic artery. Moreover, the internal mammary artery can supply a tumor even in the dorsal hepatic area.

Adult↗

Local toxicity of hepatic arterial infusion of hexokinase II inhibitor, 3-bromopyruvate: In vivo investigation in normal rabbit model.

RATIONALE AND OBJECTIVES: 3-Bromopyruvate (3-BrPA), an hexokinase II inhibitor, is known to have high necrotic rate in hyperglycolytic liver tumor models without apparent damage to the normal liver parenchyma. The toxicity of intra-arterial delivery of 3-BrPA in various concentrations has not been specifically investigated using a normal rabbit model. MATERIALS AND METHODS: Twenty rabbits treated with intra-arterial 3-BrPA were divided into four groups according to its dose and infusion level: 1 mM at the left hepatic artery (group I), 5 mM at the left hepatic artery (group II), 25 mM at the left hepatic artery (group III), and 25 mM at the common hepatic artery (group IV). After selective catheterization, 30 ml of 3-BrPA was infused for 2 minutes. As a control group, five rabbits were treated with normal saline. During 1-week follow-up, toxicities were evaluated with blood laboratory results, mortality, and histopathologic examination. RESULTS: All 10 rabbits treated with 25 mM 3-BrPA and 2 rabbits treated with 5 mM 3-BrPA died within 3 days after treatment. In 10 of the 12 deaths, hemorrhagic pyloric or duodenal necrosis was noted. Hepatotoxicities on blood laboratory results were dose dependent but transient in the surviving rabbits. CONCLUSION: Selective intra-arterial administration of 25 mM 3-BrPA can cause considerable toxicities not only in the liver but also in the gastrointestinal system and are dose dependent and can cause death in high doses.

Animals↗

Intraarterial gene delivery in rabbit hepatic tumors: transfection with nonviral vector by using iodized oil emulsion.

PURPOSE: To evaluate the feasibility of an iodized oil emulsion that is used for the chemoembolization of hepatocellular carcinoma as a modifier of a nonviral gene transfer system for intraarterial gene delivery in experimentally induced hepatic tumors. MATERIALS AND METHODS: Experiments were performed in accordance with National Institutes of Health guidelines for the care and use of laboratory animals and were approved by the animal research committee at Seoul National University Hospital. VX2 carcinoma was implanted into the liver of 26 rabbits. Four nonviral gene transfer systems were prepared by using pCMV-luc+ as a reporter gene. The first system consisted of a DNA and polyethylenimine (PEI) complex (n = 7); the second, of a DNA and PEI complex mixed with iopamidol and iodized oil (n = 7); the third, of a DNA and PEI complex mixed with iopamidol (n = 7); and the fourth, of a DNA and PEI complex mixed with iodized oil (n = 5). For the DNA and PEI complex that was mixed with iopamidol and iodized oil, iopamidol was used to stabilize the emulsion. Twenty days after tumor implantation, intraarterial gene delivery was performed by selective catheterization of the hepatic artery. Rabbits were euthanized 24 hours after gene delivery. Luciferase activity was assayed in the tumor, left hepatic lobe, right hepatic lobe, and other organs and was statistically analyzed for comparison between complexes by using the Kruskal-Wallis test. RESULTS: Luciferase activity in the tumor was significantly higher for the group that received DNA, PEI, iopamidol, and iodized oil than for any other group (Kruskal-Wallis test, P < .05). Luciferase activity in the left hepatic lobe, right hepatic lobe, and other organs was not significantly different between complexes. Selective gene expression in tumor cells was confirmed by means of immunohistochemical analysis for luciferase. CONCLUSION: It is feasible to use an iodized oil emulsion system for the intratumoral transfection of nonviral vectors in experimentally induced hypervascular hepatic tumors.

Animals↗

Nonhepatic arteries originating from the hepatic arteries: angiographic analysis in 250 patients.

PURPOSE: To investigate the prevalence and patterns of origin of nonhepatic arteries originating from the proper hepatic artery (PHA) or its distal branches and to assess their relation to anatomic variations. MATERIALS AND METHODS: Digital subtraction celiac arteriography and selective left hepatic arteriography was performed in 250 patients with hepatocellular carcinoma. Three interventional radiologists interpreted the angiograms on the monitor by consensus. If necessary, further superselective arteriography was performed. The prevalence of nonhepatic arteries, their sites of origin, and the influence of underlying anatomic variants were analyzed. RESULTS: Nonhepatic arteries were found in 205 patients. The most common nonhepatic artery was the right gastric artery (RGA; n = 196), followed by the hepatic falciform artery (HFA; n = 129), accessory left gastric artery (LGA; n = 43), posterior superior pancreaticoduodenal artery (PSPDA; n = 18), and left inferior phrenic artery (LIPA; n = 5). The left hepatic artery (LHA) was the most frequent origin of nonhepatic arteries (170 of 250). Regardless of anatomic variation, the most common origins of the RGA and HFA were the PHA and the segment IV hepatic artery, respectively. In patients with an aberrant LHA from the LGA, no accessory LGAs or LIPAs were found. PSPDAs preferentially arose from variant hepatic arteries arising from the gastroduodenal artery. CONCLUSIONS: Nonhepatic arteries commonly arise from the hepatic arteries, especially the LHA and PHA. Moreover, variants of the celiac and hepatic arteries influence the prevalence and sites of origin of nonhepatic arteries.

Adult↗

Hepatocellular carcinoma: transcatheter arterial chemoembolization of the gonadal artery.

Over the past 9 years, the authors have identified gonadal arteries supplying hepatocellular carcinoma in seven of 4,438 patients (0.16%) whom they attempted to treat by transcatheter arterial chemoembolization. All seven patients had tumors in the Couinaud segment 6 (S6) of the liver (mean size, 6.8 cm). The gonadal arteries in all seven patients showed anatomic variations, including a high origin (n = 3) and a common trunk with the adrenal artery (n = 4). The gonadal artery with anatomic variation may supply hepatocellular carcinomas located in liver S6.

Adult↗

Urine attenuation ratio: A new CT indicator of renal artery stenosis.

OBJECTIVE: The purpose of our study was to evaluate the value of a ratio of the attenuation measurements of urine in each kidney (hereafter referred to as the urine CT attenuation ratio) in the detection and lateralization of significant renal artery stenosis (RAS). SUBJECTS AND METHODS: In 33 patients with suspected renovascular hypertension and 43 normotensive patients, 5-mm-thick transverse CT scans of the kidney area were obtained 4 min after helical CT angiography (CTA). The attenuation of urine in each kidney was measured, and its ratio was calculated. All 76 patients underwent intraarterial digital subtraction angiography within 2 days after the CT examination. The results of angiography were correlated with the urine attenuation ratio of both kidneys. RESULTS: Twenty-six patients showed significant RAS: unilaterally in 20 and bilaterally in six patients. Two patients showed moderate stenosis of renal arteries. The other patients with essential hypertension (n = 5) or normal blood pressure (n = 43) showed normal renal arteries. The CT attenuation of urine in each kidney was measured and its ratio calculated in all patients except four patients with unilateral RAS. The urine CT attenuation ratio in 22 patients with significant RAS ranged from 1.11 to 4.76 (mean, 2.07). The two patients with moderate RAS showed ratios of 1.83 and 1.23. The others (n = 48) had a urine CT attenuation ratio that ranged from 1.00 to 1.54 (mean, 1.07). The difference of the ratio between the RAS group and the normal group was statistically significant (p < 0.01). The mean urine CT attenuation ratio was 2.18 in patients with unilateral RAS (n = 16) and 1.75 in patients with bilateral RAS (n = 6). The difference of the ratio between the two groups was not statistically significant (p = 0.16). At a cutoff value of 1.22, the sensitivity, specificity, positive predictive value, and negative predictive value of the urine CT attenuation ratio in the diagnosis of significant RAS were 95%, 96%, 91%, and 98%, respectively. CONCLUSION: The urine CT attenuation ratio is a simple and reliable indicator with which to detect and lateralize significant RAS and is a useful adjunct to helical CTA.

Adult↗

Technical feasibility and biocompatibility of a newly designed separating stent-graft in the normal canine aorta.

OBJECTIVE: The objectives of this study were to assess the performance of a newly designed separating stent-graft system with respect to the technical feasibility of transfemoral deployment, the maintenance of vessel patency, and stent deformity due to mechanical defects; and to evaluate its in vivo healing characteristics, including thrombus formation, and endothelial covering of the stent-graft when placed in the normal aorta of a canine model. CONCLUSION: The newly designed separating stent-graft allowed accurate deployment without migration. This animal study also provided an opportunity to examine the healing process associated with an ultrathin polyester fabric nitinol stent and showed predictable healing characteristics in the normal thoracic aorta in this canine model.

Animals↗

Superficial venous aneurysm: reports of 3 cases and literature review.

OBJECTIVE: The purpose of this series is to describe the ultrasonographic and computed tomographic (CT) findings of superficial venous aneurysms sometimes misdiagnosed as subcutaneous soft tissue tumors. METHODS: Two of the patients had an asymptomatic subcutaneous mass that gradually increased in size; the third patient had a superficial mass in the right antecubital fossa associated with pain and occasional edema. All of the patients were examined with ultrasonography, and 2 had CT scans. RESULTS: In all cases, ultrasound examinations showed a well-defined heterogeneous echoic lesion that was contiguous with the adjacent superficial vein and easily compressed by the probe, whereas a Doppler study indicated a venous spectral wave without pulsation. Dynamic enhanced CT showed homogeneous enhancement in the late phase, with contiguity with the adjacent vein. Only the third patient had an internal, floating, heterogeneous, echoic mass-like lesion, suggesting a chronic thrombus in the lesion on ultrasonography. This patient underwent aneurysmectomy with end-to-end anastomosis. CONCLUSIONS: Venous aneurysm should be included in the differential diagnosis of a subcutaneous mass, and an accurate understanding of the differences between superficial and deep venous aneurysms may help in diagnosis and treatment.

Aneurysm↗

[A case of infiltrative hepatocellular carcinoma with main portal vein tumor thrombosis successfully treated by transarterial chemoembolization].

A 63-year-old HBsAg-positive male patient was admitted for the evaluation of a liver mass that was detected on ultrasonography. Spiral computed tomography (CT) revealed infiltrative hepatocellular carcinoma (HCC) in the right hepatic lobe with main portal vein tumor thrombosis. His liver function was Child-Pugh class A and the serum alpha fetoprotein level was 7,400 ng/mL. Transarterial chemoembolization (TACE) via the right hepatic artery was performed. Following 3 sessions of TACE every 2 months, spiral CT revealed no evidence of viable tumor. The thrombi within the main portal vein disappeared with performing localized hepatic infarction at the site of the previous tumor. He is still alive 15 months after the third TACE without evidence of recurred tumor and his liver function remains well preserved. This case suggests that TACE might be effective and safe even in the patients with infiltrative HCC with main portal vein tumor thrombosis, if the extent of the tumor is limited and the liver function and portal flow via the collaterals are preserved.

Carcinoma, Hepatocellular↗

Hypoxia stimulates proliferation of human hepatoma cells through the induction of hexokinase II expression.

BACKGROUND/AIMS: In a hypoxic state, a glycolytic system is operating as a salvage pathway of generating ATP, and hexokinase II, the first enzyme in this system, might be over-expressed in hepatocellular carcinomas (HCCs). This study was to evaluate if hexokinase II is participating in HCC cell survival in a hypoxic state, and to analyze the mechanism of cell death caused by hexokinase II-specific inhibition. METHODS: Human hepatoma cell lines were grown either in a normoxic or hypoxic condition. Hexokinase II and hypoxia-inducible factor-1alpha (HIF-1alpha) expression were evaluated using immunoblot techniques. Cell growth was assessed using the MTS assay. Apoptotic signaling cascades were explored by immunoblot analysis. RESULTS: Hypoxia stimulated HCC cellular growth through HIF-1alpha-dependent induction of hexokinase II expression. The hexokinase II-specific inhibitor, 3-bromopyruvate, significantly suppressed cellular growth in a hypoxic state compared to cells in a normoxic condition. This suppression was due to the induction of apoptosis through activating mitochondrial apoptotic signaling cascades. CONCLUSIONS: This study demonstrates that hypoxia stimulates HCC cellular growth through hexokinase II induction, and its inhibition induces apoptotic cell death. Therefore, hexokinase II induction may participate in HCC progression and the blockage of this enzyme may therapeutically be efficacious in human HCCs.

Carcinoma, Hepatocellular↗

Role of computed tomographic angiography in the detection and comprehensive evaluation of persistent sciatic artery.

PURPOSE: To define the role of computed tomographic (CT) angiography in the evaluation of persistent sciatic artery and to identify its potential advantages as a diagnostic modality. METHODS: Between July 2002 and August 2004, 307 consecutive patients underwent CT angiography for suspected lower-extremity arterial insufficiency. All CT angiograms were retrospectively reviewed to determine the presence and laterality of persistent sciatic artery and its associated vascular abnormalities, such as aneurysm, thrombus, distal thromboembolism, and atherosclerotic change. The relationship of persistent sciatic artery with adjacent structures, such as sciatic nerve, muscle, accompanying vein, and femoral artery, as well as the presence of other anomalies, was analyzed. Clinical data regarding the presenting symptoms and hospital course were obtained from patient charts. RESULTS: Six persistent sciatic arteries, with or without occlusion, were identified in five female patients (age range, 54 to 80 years). CT angiography revealed unilateral persistent sciatic artery in four patients (left, 3; right, 1) and bilateral persistent sciatic artery in one patient. Aneurysm was present in two (mean size, 26 mm x 20 mm), thrombosis in three, and distal thromboembolism in all six persistent sciatic arteries. All persistent sciatic arteries coursed along the sciatic nerve and continued as popliteal artery. Characteristically, in all these instances, the superficial femoral arteries were hypoplastic and tapered smoothly. Anomalous popliteal venous drainage was noted in all ipsilateral limbs with persistent sciatic artery and even in contralateral limbs with normal superficial femoral artery in all but one. CONCLUSION: CT angiography enables the detection of persistent sciatic artery even in the presence of complete occlusion and is useful in the comprehensive evaluation of various complications and associated venous anomalies. It can potentially be used as the sole imaging modality for persistent sciatic artery.

Aged↗

Recognizing extrahepatic collateral vessels that supply hepatocellular carcinoma to avoid complications of transcatheter arterial chemoembolization.

Extrahepatic collateral arteries commonly supply hepatocellular carcinomas if the tumors are large or peripherally located. Because development of these vessels interferes with effective control of the tumor with transcatheter arterial chemoembolization (TACE), radiologists should become familiar with the imaging findings of extrahepatic collateral vessels to detect them at an early stage. The authors observed 2104 such vessels in 860 patients over 5.5 years. The extrahepatic collateral vessels observed originated from the inferior phrenic artery, omental branch, adrenal artery, intercostal artery, cystic artery, internal mammary artery, renal or renal capsular artery, branch of the superior mesenteric artery, gastric artery, and lumbar artery. The authors suspected extrahepatic collateral vessels when (a) a tumor grew exophytically or invaded adjacent organs, (b) a tumor was in contact with the ligaments and bare area of the liver, (c) a hypertrophied extrahepatic collateral vessel was observed on a computed tomographic (CT) scan, (d) a peripheral defect of iodized oil retention within a tumor was seen during chemoembolization or on a follow-up CT scan, (e) a local recurrence developed at the peripheral portion of the treated tumor during follow-up, or (f) a sustained elevation in serum alpha-fetoprotein level was noted despite adequate embolization of the hepatic artery. When both the hepatic artery and extrahepatic collateral vessels supply a tumor, additional extrahepatic collateral vessel chemoembolization should be attempted to increase the therapeutic efficacy of TACE for hepatocellular carcinoma.

Adult↗

Transjugular intrahepatic portosystemic shunt for acute variceal bleeding in patients with viral liver cirrhosis: predictors of early mortality.

OBJECTIVE: The purpose of our study was to assess the predictors of early mortality after the creation of transjugular intrahepatic portosystemic shunts (TIPS) for acute variceal bleeding in patients with viral liver cirrhosis. MATERIALS AND METHODS: Seventy-three patients (56 men and 17 women; mean age, 51.3 years) with viral liver cirrhosis who underwent TIPS placement for acute variceal bleeding were studied. Multiple covariates, including demographic, clinical, and biochemical parameters, were included in univariate and multivariate analyses to determine their association with early (30-day) mortality. RESULTS: During the follow-up period (mean, 35 months 3 days), shunt dysfunction occurred in 33 patients (45.2%). Forty-three patients (58.9%) died, and 23 patients (31.5%) died within 30 days of TIPS. Early death was predicted independently by hyperbilirubinemia (> 3 mg/dL; p = 0.004; odds ratio, 10.6) and elevated serum creatinine level (> 1.7 mg/dL; p =0.018; odds ratio, 12.0). CONCLUSION: Hyperbilirubinemia and elevated serum creatinine level are predictive of early mortality after TIPS creation for acute variceal bleeding in patients with viral liver cirrhosis.

Acute Disease↗

[Radiological intervention of hepatocellular carcinoma].

In spite of the nice screening program using the state-of-the-art imaging modalities, most patients with hepatocellular carcinoma (HCC) are not eligible for curative resection due to poor hepatic functional reserve and multiplicity of the tumors. Therefore they greatly rely on percutaneous interventional procedures. Among these, transcatheter arterial chemoembolization and local ablation therapies including ethanol injection therapy or radiofrequency (RF) thermal ablation have gained wider acceptance for the local treatment of unresectable HCC with growing evidence of survival gain. Although we need more prospective randomized trials to determine the definite role of these interventional therapies, the current consensus is that they are safe and effective for the local control of small HCC and have a potential to replace definitive surgical options. In this review, the basic principles and published clinical results including long-term survival rates and complications are reviewed. The benefits and limitations of each therapy are also discussed.

Carcinoma, Hepatocellular↗

Phacoemulsification and foldable intraocular lens implantation combined with vitrectomy and silicone oil tamponade for severe proliferative diabetic retinopathy.

PURPOSE: To determine the clinical outcomes of phacoemulsification and foldable intraocular lens (IOL) implantation combined with primary vitrectomy and silicone oil tamponade to treat severe proliferative diabetic retinopathy (PDR). SETTING: Department of Ophthalmology, Seoul National University College of Medicine, and Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea. METHODS: The results of combined cataract surgery and silicone oil injection in 20 eyes (20 patients) were retrospectively analyzed. All patients had tractional or tractional-rhegmatogenous retinal detachment and clinically significant lens opacities; none had previous intraocular surgery. An acrylic foldable IOL was implanted in the capsular bag or ciliary sulcus. RESULTS: Primary anatomic success was achieved in 90% of eyes. Functional success was attained in 60% of eyes after a mean follow-up of 7.6 months. The postoperative visual acuity improved in 60% of patients, was unchanged in 20%, and was worse in 20%. Silicone oil was removed in 80% of patients without complications after a mean of 3.4 months. The mean absolute value of the difference between the predicted refraction and postoperative refraction was 0.74 diopter (D) (range 0.03 to 1.74 D). CONCLUSION: Phacoemulsification and foldable IOL implantation combined with primary vitrectomy and silicone oil tamponade was performed safely with favorable anatomic and visual outcomes in eyes with severe PDR.

Adult↗

Acute iliofemoral deep vein thrombosis: evaluation of underlying anatomic abnormalities by spiral CT venography.

PURPOSE: To evaluate the spectrum of underlying anatomic abnormalities in iliofemoral deep vein thrombosis (DVT) by spiral computed tomographic (CT) venography. MATERIALS AND METHODS: During the past 4 years, 56 patients with acute iliofemoral DVT have been evaluated by CT venography at our institution. Forty-four patients had left-sided DVT, nine had right-sided DVT, and the remaining three had DVT in both extremities. CT venography was performed with use of 2.5-3.2-mm x-ray beam collimation and a 1.25-2.0-mm reconstruction interval. Spiral scans were initiated 5 minutes after intravenous contrast medium injection. The CT venograms were correlated with catheter venograms. In addition, with use of axial sections and their three-dimensional reconstructions, including multiplanar reformation and volume rendering, the presence or absence of central obstructing lesions and their causes were evaluated. RESULTS: Among 44 patients with left-sided DVT, 37 had significant anatomic abnormalities in their iliofemoral veins or inferior vena cava (IVC). The most common lesion was left common iliac vein compression by the right common iliac artery (n = 27; exaggerated by a bony spur in nine and associated with extrinsic compression by the left internal iliac artery in two). Of the nine patients with right-sided DVT, six had significant anatomic abnormalities including encasement or extrinsic compression of their iliac veins by various causes (n = 3) and venous stricture without extrinsic lesions (n = 3). Among three patients with DVT in both extremities, two had anatomic abnormalities in the IVC. Therefore, 45 of 56 patients had anatomic abnormalities central to the thrombosed deep veins. CONCLUSION: The majority of patients with acute iliofemoral DVT had underlying anatomic abnormalities. The presence of central stenosis or obstruction and their causes can be evaluated by spiral CT venography.

Adolescent↗

Transcatheter arterial embolization with 188Rhenium-HDD-labeled iodized oil in rabbit VX2 liver tumor.

PURPOSE: To evaluate the antitumor effect of transcatheter arterial embolization (TAE) with use of rhenium 188 HDD (4-hexadecyl 2,2,9,9-tetramethyl-4,7-diaza-1,10-decanethiol)-labeled iodized oil and to compare it with that of transcatheter arterial chemoembolization (TACE) with use of an established chemotherapeutic agent and iodized oil in experimentally induced liver tumor. MATERIALS AND METHODS: VX2 carcinoma was grown in the livers of 57 rabbits. TAE was performed with (188)Re-HDD-labeled iodized oil (Re-Lp group; n = 21), doxorubicin/iodized oil emulsion (Dx-Lp group; n = 21), and iodized oil alone (n = 15). Sequential conjugated planar imaging was performed for dosimetry of the radioisotope in the Re-Lp group (n = 15). Growth ratio and percentage of viable tumor were estimated by computed tomography and histopathologic examination. Hepatic and hematologic toxicities were evaluated by biochemical analysis. RESULTS: On conjugated planar imaging, radioactivity was concentrated on the tumor (effective half-life, 16.2 hours), and mean radiation dose to the tumor was 147.7 Gy. The mean growth ratios 1, 2, and 3 weeks after TAE and the percentage of viable tumor in the Re-Lp group (-3.4, -7.6, -11.1, and 0.3%) and the Dx-Lp group (-3.2, -5.3, 29.0, and 2.6%) were significantly lower than the respective values in the iodized oil group (45.5, 145.4, 283.0, and 30.1%; P < .001). However, the differences between the values in the Re-Lp group and those in the Dx-Lp group were not significant (P values of .165-0.497 for growth ratios; P = .134 for percentage of viable tumor). There was similar transient hepatotoxicity in all three groups. CONCLUSIONS: TAE with (188)Re-HDD-labeled iodized oil has potent antitumor effect in VX2 liver tumor that is comparable with that of TACE with an established chemotherapeutic agent.

Animals↗