-
Ji Hoon Jung,
Kee Don Choi, Seungbong Han,
Hwoon-Yong Jung,
Mi Young Do,
Hye-Sook Chang,
Jae-Won Choe,
Gin Hyug Lee,
Ho June Song,
Do Hoon Kim,
Kwi-Sook Choi,
Jeong Hoon Lee,
Ji Yong Ahn,
Mi-Young Kim,
Suh Eun Bae,
Jin-Ho Kim
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Studies on seroconversion and its reversion rate in Korean adults with Helicobacter pylori infection are very rare. The purpose of this study was to evaluate the overall seroprevalence, seroconversion rate, and seroreversion rate of H. pylori infection in an adult population. MATERIALS AND METHODS: We performed this retrospective cohort study on healthy adults who had visited our health screening center at Asan Medical Center more than twice between January 2000 and December 2010. We reviewed the anti- H. pylori Ab IgG profiles of the enrolled people and their family members and the results of esophagogastroduodenoscopies and a self-reported questionnaire. RESULTS: A total of 67,212 people were enrolled in this study. The mean follow-up duration was 4.6 years, and each participant visited the center for a mean of 3.8 visits. The overall proportions of participants demonstrating persistent seropositivity, persistent seronegativity, seroconversion, and seroreversion were 53.1%, 32.5%, 4.3%, and 10.1%, respectively. The annual seroconversion rate was 2.79%. The annual crude and spontaneous seroreversion rates of the entire study population were 3.64% and 2.42%, respectively. According to multivariate logistic regression, old age (HR = 1.015), smoking (HR = 1.216), alcohol consumption more than four times per week (HR = 1.263), marriage (HR = 2.735), and living with H. pylori-infected family members (HR = 1.525) were identified as statistically significant risk factors associated with seroconversion. CONCLUSION: The annual seroconversion rate was 2.79% in our study population. Marriage and living with H. pylori-infected family members were important risk factors affecting seroconversion in our adult population.
Helicobacter 03/2013; · 3.15 Impact Factor
-
Ji Yong Ahn,
Kee Don Choi,
Hee Kyong Na,
Ji Young Choi,
Mi-Young Kim,
Kwi-Sook Choi,
Jeong Hoon Lee,
Do Hoon Kim,
Ho June Song,
Gin Hyug Lee,
Hwoon-Yong Jung,
Jin-Ho Kim, Seungbong Han
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: There are insufficient reports on the outcomes and local recurrence rates for gastric neoplasms treated using argon plasma coagulation (APC). The purpose of this study was to analyze the clinical outcomes in early gastric cancer or gastric adenoma patients following APC treatment. METHODS: Seventy-one patients were enrolled and all underwent APC at the Asan Medical Center between July 2007 and August 2011. Clinical and oncological outcomes were analyzed. RESULTS: The median follow-up period was 20 months (interquartile range 13-29 months). Among the 71 patients we evaluated, nonlifting after submucosal saline injection was found in 35 patients and 15 patients (21.2 %) experienced local recurrence with a median period of 10 months (IQR 5-13 months). The rate of local recurrence was higher in the nonlifting group and the 40-W group than in the lifting group and the 60- or 80-W groups (31.4 vs. 11.1 %, p = 0.045 and 31.7 vs. 6.7 %, p = 0.017, respectively). Multivariate analysis showed that the power setting with the 40-W and nonlifting groups after submucosal injection was associated with local recurrence. CONCLUSIONS: APC therapy after submucosal saline injection using high power (60 or 80 W) appears to be an effective alternative in the management of gastric neoplasm.
Surgical Endoscopy 02/2013; · 4.01 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Aim: At present, limited in vivo information is available on the prevalence and severity of coronary atherosclerosis in asymptomatic healthy subjects. The aim of this study was to examine the prevalence, extent and severity of coronary atherosclerosis in healthy individuals.Methods: We performed an intravascular ultrasound (IVUS) examination on 198 heart transplant recipients 4 weeks after transplantation. The donor population consisted of 147 men and 51 women (31.4±11.0 years). The left anterior descending coronary artery was imaged in all patients, and 3 vessel images were obtained for 99 patients.Results: Angiographic appearance was completely normal in 177 of the 198 subjects (89.4%), while atherosclerotic luminal irregularities were observed in the remaining individuals. IVUS revealed that atherosclerotic lesions (defined as intimal thickness ≥0.5 mm at any site) were present in 96 patients (48.5%). The prevalence of coronary atherosclerosis rapidly increased with age (10-19 years, 5.9%; 20-29 years, 31.1%; 30-39 years, 59.0%; 40-49 years, 78.4%). In the diseased subgroup, atherosclerotic lesions were mostly eccentric (92.7%), with maximal intimal thickness of 0.99±0.42 mm (area stenosis, 32.2±11.7%). All coronary arteries were predominantly located in the proximal third of each vessel. Donor age, male sex, and hypertension were the determinants of coronary atherosclerosis measured by IVUS examination. As more risk factors were present, the risk of atherosclerosis increased.Conclusion: Coronary atherosclerosis is common in asymptomatic young healthy adults, supporting the need for preventive cardiology in the early stages of life.
Journal of atherosclerosis and thrombosis 02/2013; · 2.69 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: PURPOSE: To determine the usefulness of enhancement by iodized oil deposits on computed tomography (CT) following transarterial chemoembolization for hepatocellular carcinoma (HCC), and to compare the reliability of such CT imaging with that of magnetic resonance (MR) imaging. MATERIALS AND METHODS: Fifty-one patients for whom resected or explanted livers containing chemoembolized HCC lesions of at least 1 cm were available. Imaging responses were determined based on modified Response Evaluation Criteria In Solid Tumors (mRECIST) and European Association for the Study of the Liver (EASL) criteria for 59 target tumors on CT and MR scans before surgery. CT-based evaluation was performed per mRECIST and EASL criteria, considering iodized oil retention as indicating necrosis and, alternatively, as enhancing viable tissue ("mRECIST-Lipiodol" and "EASL-Lipiodol"). Pathologic necrosis was graded as 100%, 50%-99%, or less than 50%. RESULTS: Goodman-Kruskal γ-values for radiologic-pathologic correlation were greater than 0.95 for mRECIST and EASL criteria on CT or MR imaging. However, mRECIST-Lipiodol and EASL-Lipiodol measurements showed weaker correlation with pathologic findings, with γ-values of 0.797 and 0.846, respectively. With respect to intermethod agreement, weighted γ-values for mRECIST by CT and MR, and for EASL criteria by CT and MR, both exceeded 0.80, whereas mRECIST-Lipiodol and EASL-Lipiodol showed only moderate levels of agreement with mRECIST/EASL criteria by CT or MR imaging, with γ-values of 0.522-0.631. CONCLUSIONS: Response estimation based on measurement of iodized oil deposits as necrosis on CT when applying enhancement criteria after chemoembolization for HCC correlated well with actual pathologic class, and agreed with MR-based evaluation.
Journal of vascular and interventional radiology: JVIR 01/2013; · 1.81 Impact Factor
-
Jung-Min Ahn, Seungbong Han,
Yong Kyu Park,
Woo Seok Lee,
Jeong Yoon Jang,
Chang Hee Kwon,
Gyung-Min Park,
Young-Rak Cho,
Jong-Young Lee,
Won-Jang Kim,
Duk-Woo Park,
Soo-Jin Kang,
Seung-Whan Lee,
Young-Hak Kim,
Cheol Whan Lee,
Jae-Joong Kim,
Seong-Wook Park,
Seung-Jung Park
[show abstract]
[hide abstract]
ABSTRACT: It is unknown whether the use of intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention can attenuate the stent length effect on clinical outcomes. The aim of the present study was to determine the differential prognostic effect of IVUS according to the implanted stent length. We enrolled 3,244 consecutive patients from the Interventional Cardiology Research In-cooperation Society-Drug-Eluting Stents (IRIS-DES) registry who had undergone single or overlapping stent implantation. The primary end point was major adverse cardiac events (MACE; a composite of death, myocardial infarction, and target vessel revascularization). The study population was divided by the tertiles of implanted stent length and IVUS usage. IVUS use was at the discretion of the operator. After adjusting for significant covariates, the stent length was significantly associated with the risk of MACE in the no-IVUS group (hazard ratio 1.13, 95% confidence interval 1.01 to 1.28, p = 0.042) but not in the IVUS group (hazard ratio 1.08, 95% confidence interval 0.97 to 1.20, p = 0.16). In addition, in patients with an implanted stent length of ≤22 mm (n = 998), the risk of MACE was not significantly different between the IVUS group and the no-IVUS group (hazard ratio 1.06, 95% confidence interval 0.50 to 2.28, p = 0.88). In contrast, in patients with a longer implanted stent length, the risk of MACE was significantly lower in the IVUS group than in the no-IVUS group (hazard ratio 0.47, 95% confidence interval 0.24 to 0.92, p = 0.027 for 23 to 32 mm, n = 1,109; hazard ratio 0.57, 95% confidence interval 0.33 to 0.98, p = 0.042 for ≥33 mm, n = 1,137). In conclusion, IVUS usage can attenuate the detrimental effect of the increase in the implanted stent length, supporting IVUS usage, particularly during percutaneous coronary intervention with long stent implantation.
The American journal of cardiology 12/2012; · 3.58 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVES: We retrospectively investigated the prognostic value of hepatocyte nuclear factor-1 (HNF1) proteins in 159 liver transplant patients with hepatocellular carcinomas (HCC), including 36 (22.6%) exceeding the Milan criteria. METHODS: Expression of alpha-fetoprotein (AFP), HNF1α, and HNF1β was examined by immunohistochemistry on duplicate tissue microarray slides containing the HCC tumor explants. Times to recurrence and cancer death were analyzed based on the Cox regression model and compared according to expression of markers of interest. We compared risk predictions using area under the receiver operator curves (AU-ROCs) and c statistics. RESULTS: AFP, HNF1α, and HNF1β were positive in 22.6%, 46.5%, and 61%, respectively, of the tumor immunoprofiles. Although several variables were associated with times to recurrence and cancer death in univariate Cox analyses, only AFP expression for time to recurrence, and the Milan criteria and HNF1β expression for times to recurrence and cancer death, remained significant after multivariate adjustment. Expression of HNF1β, but not of HNF1α, was related to serum AFP ≥200 ng/mL, microvascular invasion, and AFP expression (p<0.05). A subgroup analysis showed that in the within-Milan group, recurrence and cancer death rates at 10 years in the HNF1β-negative patients were approximately one-tenth of those in the HNF1β-positive patients, but the difference was not significant in the non-Milan group. Addition of HNF1β expression to the Milan criteria increased the c statistics and AU-ROCs for both recurrence and mortality (p<0.05). CONCLUSIONS: Immunohistological detection of HNF1β predicts recurrence and death specific for HCC post-transplant, and provides an additive benefit over the Milan selection criteria on their own. © 2012 American Association for the Study of Liver Diseases.
Liver Transplantation 12/2012; · 3.39 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate factors associated with aortic enlargement in patients with a bicuspid aortic valve (BAV) and the impact of isolated aortic valve replacement (AVR).
A retrospective analysis of clinical data in a tertiary referral hospital.
We performed a cross-sectional analysis of 595 patients with BAV to assess variables determining maximal ascending aortic dimension. To measure annual dilatation rates, baseline and follow-up echocardiograms were analysed in 70 patients with BAV (BAV-AVR group) and 48 with a tricuspid aortic valve (TVA-AVR group) who underwent isolated AVR, and compared with 65 patients with BAV who did not undergo AVR (BAV-NAVR group).
Aortic regurgitation (AR) severity was associated with aortic sinus diameter (p<0.001), whereas aortic stenosis severity with the tubular diameter (p<0.001). Multivariate analysis showed that age was an independent factor for both sinus and tubular diameter with AR severity being for aortic sinus diameter and moderate to severe aortic stenosis or AR being for aortic tubular diameter. Despite younger age and lower prevalence of moderate to severe valvular dysfunction at baseline, the annual dilatation rates at sinus and tubular part were significantly higher in the BAV-NAVR than in the BAV-AVR and TAV-AVR groups (p<0.05 each), which did not differ in the BAV-AVR and TAV-AVR groups (p=0.402 for sinus and p=0.394 for tubular part).
Age-dependent aortic enlargement associated with significant valvular dysfunction and the protective effects of isolated AVR in patients with BAV indicate that valvular dysfunction is a major determinant to the development of aortopathy.
Heart (British Cardiac Society) 12/2012; 98(24):1822-7. · 4.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE:: To explore the prognostic value of the postsurgical half-life (HL) of serum alpha-fetoprotein (AFP). BACKGROUND:: There is still a paucity of early surrogate indicators of clinical endpoints after liver resection of hepatocellular carcinoma (HCC). METHODS:: The analysis was based on cohorts of 225 (exploration set) and 117 (validation set) treatment-naïve HCC patients undergoing curative liver resection. We defined 3 categories of AFP HL: early complete resolution of AFP, normal HL, and prolonged HL if the HL exceeded 7 days. Overall, probabilities of recurrence and survival were estimated and compared across the AFP HL categories. RESULTS:: In the exploration cohort, 48 patients (21.3%) achieved early AFP complete resolution, 116 (51.6%) had normal HL, and 61 (27.1%) had prolonged HL. Long AFP HL was significantly associated with early postoperative recurrence (P < 0.001), as was microvascular invasion. Early recurrence within 2 years of resection was observed in 59% of the patients with prolonged AFP HL compared with only 29.3% of those with normal AFP HL (P < 0.001). A log-rank test followed by multivariate Cox analysis identified an independent function of prolonged AFP HL in predicting shorter recurrence-free survival and overall survival time after HCC resection (hazard ratios, 2.81 and 3.58; P < 0.001). When AFP HL analysis was applied to the validation cohort, the association between prolonged AFP HL and survival endpoints (hazard ratio, 11.63 and 16.39; P < 0.001) was confirmed.
Annals of surgery 10/2012; · 7.90 Impact Factor
-
Jung-Min Ahn,
Duk-Woo Park,
Young-Hak Kim,
Haegeun Song,
Young-Rak Cho,
Won-Jang Kim,
Jong-Young Lee,
Soo-Jin Kang,
Seung-Whan Lee,
Cheol Whan Lee, [......],
Tae-Hyun Yang,
Nae-Hee Lee,
Joo-Young Yang,
Jong-Seon Park,
Won-Yong Shin,
Moo Hyun Kim,
Jang Ho Bae,
Myeong-Kon Kim,
Junghan Yoon,
Seung-Jung Park
[show abstract]
[hide abstract]
ABSTRACT: Procedural and clinical outcomes still remain unfavorable for patients with long coronary lesions who undergo stent-based coronary interventions. Therefore, we compared the relative efficacy and safety of resolute zotarolimus-eluting stents (R-ZES) and sirolimus-eluting stents (SES) for patients with de novo long coronary lesions.
This randomized, multicenter, prospective trial, called the Percutaneous Treatment of LONG Native Coronary Lesions With Drug-Eluting Stent-IV (LONG-DES IV) trial, compared long R-ZES and SES in 500 patients with long (≥25 mm) native coronary lesions. The primary end point of the trial was in-segment late luminal loss at 9-month angiographic follow-up. The baseline characteristics were not different between R-ZES and SES groups, including lesion lengths (32.4±13.5 mm versus 31.0±13.5 mm, P=0.27). At 9-month angiographic follow-up, the R-ZES was noninferior to the SES with respect to in-segment late luminal loss, the primary study end point (0.14±0.38 mm versus 0.12±0.43 mm, P for noninferiority=0.03, P for superiority=0.68). In addition, in-stent late luminal loss (0.26±0.36 mm versus 0.24±0.42 mm, P=0.78) and the rates of in-segment (5.2% versus 7.2%, P=0.44) and in-stent (4.0% versus 6.0%, P=0.41) binary restenosis were not significantly different between the 2 groups. There were no significant between-group differences in the rate of adverse clinical events (death, myocardial infarction, stent thrombosis, target-lesion revascularization, and composite outcomes).
For patients with de novo long coronary artery disease, R-ZES implantation showed noninferior angiographic outcomes as compared with SES implantation.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01186094.
Circulation Cardiovascular Interventions 10/2012; 5(5):633-40. · 6.06 Impact Factor
-
Ji Yong Ahn,
Hwoon-Yong Jung,
Sue Eun Bae,
Ji Hoon Jung,
Ji Young Choi,
Mi-Young Kim,
Jeong Hoon Lee,
Kwi-Sook Choi,
Do Hoon Kim,
Kee Don Choi,
Ho June Song,
Gin Hyug Lee,
Jin-Ho Kim, Seungbong Han
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Reducing food residue by proper preparation methods before endoscopy after distal gastrectomy can increase the quality of examination and decrease patient discomfort. We evaluated the risk factors for food residue and proper methods of preparation for endoscopy after distal gastrectomy. METHODS: Follow-up endoscopy with questionnaires was performed on 1,001 patients who underwent distal gastrectomy at Asan Medical Center between December 2010 and July 2011. RESULTS: Endoscopic examination failed in 94 patients (9.4 %) as a result of large amounts of food residue. Rates of failure were significantly higher in patients who ate a regular diet rather than a soft diet at last dinner before examination (13.9 vs. 6.1 %, p = 0.050), and in those who ate lunch rather than not eating lunch on the day before examination (14.6 vs. 7.7 %, p = 0.020). Multivariate analysis showed that the rate of failed examination was lower in patients who had a history of abdominal surgery (p = 0.011), those who ate a soft (p < 0.001) or liquid (p = 0.003) diet as a last meal rather than a regular diet, those who underwent Billroth I rather than Billroth II reconstruction (p = 0.035), patients with longer fasting time (p = 0.009), and those with a longer gastrectomy-to-endoscopy time interval (p < 0.001). CONCLUSIONS: Patients who undergo follow-up endoscopy after surgery should fast more than 18 h and ingest a soft or liquid diet on the day before examination.
Surgical Endoscopy 10/2012; · 4.01 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVES: The purpose of this study is to examine the risk of stroke in patients with heart failure with normal ejection fraction (HFNEF) and atrial fibrillation (AF). DESIGN: Clinical and echocardiographic data in patients with non-valvular AF who were not on anticoagulation were retrospectively investigated. A total of 304 patients had AF without heart failure, and 102 patients were diagnosed as AF with HFNEF. MAIN OUTCOME MEASURES: We compared the rate of ischaemic stroke, death and composite of these in the two groups. RESULTS: Patients with AF and HFNEF were older than those with AF only (71.6 vs 64.0 years, p<0.001). Female sex, diabetes mellitus, hypertension, chronic kidney disease, angina, myocardial infarction, use of β blocker or digoxin were more common in patients with AF and HFNEF. The rates of ischaemic stroke, death and composite of ischaemic stroke and death were higher in patients with AF and HFNEF than in those with AF only (20.6% vs 6.7%, p<0.001; 27.2% vs 2.0%, p<0.001; 41.2% vs 8.1%, p<0.001 at 3 years for AF with HFNEF vs AF only, respectively). After adjustment with propensity score method using the inverse probability of treatment weighting, the 3-year risks of for ischaemic stroke (HR 3.29; 95% CI 1.58 to 6.86; p=0.001), death (HR 5.52; 95% CI 2.24 to 13.63; p<0.001), and composite of ischaemic stroke and death (HR 4.08; 95% CI 2.30 to 7.26; p<0.001) were significantly higher in patients with AF and HFNEF. CONCLUSIONS: HFNEF is associated with an increased risk of stroke and death in patients with AF.
Heart (British Cardiac Society) 09/2012; · 4.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Aim and background. We reviewed the long-term clinical outcomes of patients treated with cisplatin-based concurrent chemoradiotherapy (CCRT) incorporating high-dose-rate (HDR) intracavitary brachytherapy (ICBT) in terms of toxicity, local control and survival rates. In addition, we identified prognostic factors for overall and disease-free survival. Methods and study design. Two hundred and nine patients with stage IB2-IVA cervical cancer underwent curative cisplatin-based CCRT plus HDR ICBT. Women with stage IB2-IIB disease were given 41.4 Gy of external radiotherapy followed by 35 Gy (in 7 fractions) of ICBT. Women with stage IIIA-IVA were given 50.4 Gy followed by 30 Gy (in 6 fractions) of ICBT. Patients with parametrial disease or pelvic lymphadenopathy were given parametrial boosts via external beam radiation at a dose of up to 65 Gy to thickened and 60 Gy to unthickened parametrial regions. Results. One hundred and thirty (62%) patients experienced acute grade 3-4 hematological toxicities and 11 (5%) patients had late grade 3 gastrointestinal or genitourinary complications. Complete responses occurred in 168 (80%) women as determined by clinical and imaging studies. The median follow-up period was 52 months for surviving patients and the 5-year overall and disease-free survival rates were 74% and 67%, respectively. Multivariate analysis indicated that tumor size and paraaortic lymph node involvement were prognostically significant in terms of overall survival, and that tumor diameter was a significant prognostic factor and pelvic lymph node status a marginally significant prognostic factor for disease-free survival. Conclusions. Patients treated with our current HDR ICBT protocol have acceptably low late complication rates and local control and survival rates comparable to those reported in other studies. Tumor diameter was an important prognostic factor in terms of both overall and disease-free survival, emphasizing the need for modern ICBT methodologies.
Tumori. 09/2012; 98(5):615-21.
-
[show abstract]
[hide abstract]
ABSTRACT: Only 30% to 40% of patients with advanced proximal neoplasms (APN) have distal colon neoplasms.
To develop a risk score model for APN and propose an individualized screening protocol for colorectal cancer.
Retrospective cohort study.
Tertiary-care center.
Derivation cohort (6200 adults) and validation cohort (1389 adults).
Screening colonoscopy.
An APN risk score model was developed from the derivation cohort (6200 adults) and was tested in the validation cohort (1389 adults), who underwent screening colonoscopy.
Age, male sex, and smoking were clinical risk factors for APN. The presence of a distal neoplasm was a sigmoidoscopic risk factor for APN. We calculated APN risk scores (0-8) based on these variables and classified patients as low risk (0-2) or high risk (3-8). In the validation cohort, the relative risk of APN was 3.5-fold higher in the high-risk group than in the low-risk group. Our model suggests that colonoscopy should be performed as an initial screening test in patients with a high clinical risk for APN. Sigmoidoscopy should be performed initially in patients with low clinical risk for APN followed by supplementary colonoscopy in those with high APN risk scores based on both clinical and sigmoidoscopic risk factors. This protocol detected APN in 22 of 34 APN+ patients (64.7%) with little increase in the endoscopy burden, whereas only 16 of 34 APN+ patients (47.1%) would be identified by initial sigmoidoscopy followed by colonoscopy only in cases with distal neoplasms.
Retrospective design.
Our APN risk score model provides an algorithm for efficient screening of colorectal cancer by sigmoidoscopy and colonoscopy.
Gastrointestinal endoscopy 08/2012; 76(4):818-28. · 6.71 Impact Factor
-
Ji Yong Ahn,
Hwoon-Yong Jung,
Ji Young Choi,
Mi-Young Kim,
Jeong Hoon Lee,
Kwi-Sook Choi,
Do Hoon Kim,
Kee Don Choi,
Ho June Song,
Gin Hyug Lee,
Jin-Ho Kim, Seungbong Han
[show abstract]
[hide abstract]
ABSTRACT: Background/Aims: We reviewed the clinical outcome of metachronous gastric adenocarcinoma according to the endoscopic interval after curative treatment of squamous esophageal carcinoma by endoscopic resection or surgical resection. Methodology: Eighteen cases with gastric adenocarcinoma after treatment of esophageal carcinoma at Asan Medical Center between March 1994 and March 2010 were analyzed retrospectively. Results: Median interval between treatment of esophageal cancer and detection of metachronous gastric cancer was 44 months (interquartile range [IQR]=25.5-77.8 months), and median endoscopic interval before finding gastric cancer was 15 months (IQR=12.0-44.8 months). In cases with 12 resectable gastric cancers, the median interval of previous endoscopy before gastric cancer was shorter than that for 6 unresectable cancers (12.0 months, IQR=12-16 months vs. 59.5 months, IQR=37.5-68.5 months, p<0.001) and the rate of death was lower (16.7% [2/12] vs. 83.3% [5/6], p=0.006). Logistic regression showed that a shorter duration of endoscopic interval increased the rate of resectability of gastric cancer (p<0.001) and a higher rate of unresectable gastric cancer and longer duration of endoscopic interval increased death (p=0.029 and p=0.004, respectively). Conclusions: After treatment of esophageal cancer, endoscopic examination at 12-month intervals is important to lower the rate of death due to metachronous gastric cancer.
Hepato-gastroenterology 07/2012; 60(121). · 0.66 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Serum alpha-fetoprotein (AFP) is frequently used to predict posthepatectomy outcomes in patients with hepatocellular carcinoma (HCC), but its predictive value is still not established. Therefore, we assessed the prognostic significance of AFP status.
Of 525 patients undergoing curative hepatectomy for HCC, 290 had preoperative AFP levels of ≥20 ng/mL (AFP-positive group) and 235 had AFP levels of <20 ng/mL (AFP-negative group). We compared the 2 groups with respect to time-to-recurrence, using the inverse probability of treatment weighted (IPTW) for the entire cohort and propensity score matching, and the cumulative incidence of HCC-specific mortality using competing risks regression.
During follow-up (median duration 64 months, range 2-137 months), HCC recurred in 54.9 % of the AFP-negative group and 52.4 % of the AFP-positive group; there was no death without recurrence. After IPTW adjustment, time-to-recurrence did not differ in the 2 groups (hazard ratio [HR] 0.86, 95 % confidence interval [95 % CI] 0.66-1.12; P = 0.28). In a propensity-score matched cohort (152 pairs), time-to-recurrence data were similar to those obtained by IPTW adjustment (HR 0.91, 95 % CI 0.65-1.25; P = 0.55). There was no difference in recurrence pattern (site and stage) or treatment between the 2 groups even after propensity-score matching. The adjusted HR evaluating the impact of AFP positivity on the risk of HCC-specific mortality was 0.77 (95 % CI 0.54-1.08; P = 0.13) A multivariable competing risks analysis also failed to reveal a significant correlation between baseline AFP level and HCC-specific mortality in the AFP-positive group.
Preoperative AFP levels are not useful for predicting recurrence or survival endpoints following curative hepatectomy for HCC.
Annals of Surgical Oncology 05/2012; 19(12):3687-96. · 4.17 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the analgesic efficacy of transversus abdominis plane (TAP) blocks in patients undergoing ileostomy reversal.
Retrospective chart review.
University-affiliated hospital.
The charts of 104 consecutive patients who underwent ileostomy reversal between November 1, 2008 and December 31, 2009 were reviewed. The charts of 69 patients were included in the study. Of these, 31 received a preoperative TAP block.
Patients' opioid requirements intraoperatively, in the Postanesthesia Care Unit (PACU), and during the 24-hour period after discharge from the PACU were recorded and converted to intravenous (IV) morphine equivalents. Patient-reported numerical pain scores (0-10) from the PACU and from the 24-hour postoperative period also were recorded. Additional nonopioid means of perioperative analgesia were noted, as were duration of stay in the PACU and the hospital.
Patients receiving TAP blocks required statistically significantly fewer opioids intraoperatively (P = 0.002), in the PACU (P = 0.003), and over the 24-hour period postoperatively (P = 0.01) than did patients who did not receive a TAP block. Mean numerical pain scores while in the PACU and for 24 hours postoperatively also were significantly lower (P = 0.015 and P = 0.019, respectively) in patients receiving a TAP block, as were numerical pain scores immediately on arrival at the PACU (P = 0.013).
TAP blocks are an effective means of reducing perioperative pain in patients undergoing ileostomy reversal.
Journal of clinical anesthesia 05/2012; 24(5):373-7. · 1.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Post-transplant outcomes for acute liver failure (ALF) are unsatisfactory, and there are debates about the most suitable type of graft. Given the critical shortage of donor organs, accurate assessment of post-transplant outcome in ALF patients is crucial to avoid a futile liver transplantation (LT).
A database of 160 consecutive adult ALF patients who underwent primary LT between 2000 and 2009 in a tertiary LT center was analyzed.
The most common causes of ALF were hepatitis B virus infection (30%) and herbal/folk medicine use (30%). Thirty-six (22.5%) and 124 (77.5%) patients underwent deceased-donor LT (DDLT) and adult-to-adult living-donor LT (LDLT), respectively. During a median follow-up period of 38 (range 1-132) months, the DDLT and LDLT groups showed similar patient (P = 0.99) and graft (P = 0.97) survival rates. The overall 1- and 3-year patient survival rates were 78.8 and 74.6%, respectively. Five predictors of patient survival were identified by bootstrapping and multivariate analysis: vasopressor requirement, estimated glomerular filtration rate, serum sodium concentration, recipient age, and donor age, at the time of transplant. By summing scores weighted in each of these predictor categories, we designed a prognostic scoring system (scores from -2 to 20) that estimated 1-year post-transplant mortality from 0 to 100% (c statistic 0.79).
Long-term outcomes after LDLT and DDLT were comparable in adult patients with ALF. A simple prognostic scoring system that includes 5 predictive variables at the time of LT may help estimate post-transplant survival in ALF patients, regardless of the type of transplant.
Journal of Gastroenterology 04/2012; 47(10):1115-24. · 4.16 Impact Factor
-
Hae-Geun Song,
Duk-Woo Park,
Young-Hak Kim,
Jung-Min Ahn,
Won-Jang Kim,
Jong-Young Lee,
Soo-Jin Kang,
Seung-Whan Lee,
Cheol Whan Lee,
Seong-Wook Park, Seungbong Han,
In-Whan Seong,
Nae-Hee Lee,
Bong-Ki Lee,
Keun Lee,
Seung-Wook Lee,
Deuk-Young Nah,
Seung-Jung Park
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study is to compare the efficacy of the treatment strategies for in-stent restenosis (ISR) of drug-eluting stents (DES) according to the morphologic pattern of restenosis.
Optimal treatment strategies for ISR within DES have not been adequately addressed yet.
Patients with ISR of DES were randomized according to the lesion length to compare outcomes of sirolimus-eluting stent (SES) versus cutting balloon angioplasty for focal type (≤10 mm) and SES versus everolimus-eluting stent (EES) for diffuse type (>10 mm). The primary endpoint was in-segment late loss at 9 months. Overall 162 patients, 96 with focal ISR and 66 with diffuse ISR, were enrolled.
In focal lesions, in-segment late loss was significantly higher in the cutting balloon group (n = 48) than in the SES group (n = 48; 0.25 mm, interquartile range [IQR]: -0.01 to 0.68 mm vs. 0.06 mm, IQR: -0.08 to 0.17 mm; p = 0.04). Consequently, in-segment restenosis rate tended to be higher in the cutting balloon group than in the SES group (20.7% vs. 3.1%, p = 0.06) with comparable incidences of the composite of death, myocardial infarction, or target vessel revascularization at 12 months of clinical follow up (6.3% vs. 6.3%, p > 0.99). In 66 cases of diffuse ISR, in-segment late loss (0.11 mm, IQR: -0.02 to 0.30 mm; vs. 0.00 mm, IQR: -0.08 to 0.25 mm; p = 0.64), in-segment restenosis rate (5.0% vs. 14.3%, p = 0.32), and the composite incidence of death, myocardial infarction, or target lesion revascularization (9.6% vs. 8.8%, p > 0.99) did not differ between SES group (n = 32) and EES group (n = 34).
For lesions of focal DES restenosis, repeat implantation of SES is more effective in reducing late luminal loss and subsequent restenosis rate than cutting balloon angioplasty. For diffuse DES restenosis, implantation of SES or EES is comparably effective in terms of angiographic and clinical outcomes.
Journal of the American College of Cardiology 03/2012; 59(12):1093-100. · 14.16 Impact Factor
-
Yong-Giun Kim,
Duk-Woo Park,
Woo Seok Lee,
Gyung-Min Park,
Byung Joo Sun,
Chang Hoon Lee,
Ki Won Hwang,
Sung Won Cho,
Yoo Ri Kim,
Hae Geun Song, [......],
Seung-Whan Lee,
Young-Hak Kim,
Cheol Whan Lee,
Seong-Wook Park, Seungbong Han,
Sung-Ho Jung,
Suk Jung Choo,
Cheol Hyun Chung,
Jae-Won Lee,
Seung-Jung Park
[show abstract]
[hide abstract]
ABSTRACT: Diabetes mellitus is a major risk factor for coronary artery disease (CAD) and for diffuse and progressive atherosclerosis. We evaluated the outcomes of drug-eluting stent (DES) placement and coronary artery bypass grafting (CABG) in 891 diabetic patients (489 for DES implantation and 402 for CABG) and 2,151 nondiabetic patients (1,058 for DES implantation and 1,093 for CABG) with multivessel CAD treated from January 2003 through December 2005 and followed up for a median 5.6 years. Outcomes of interest included death; the composite outcome of death, myocardial infarction (MI), or stroke; and repeat revascularization. In diabetic patients, after adjusting for baseline covariates, 5-year risk of death (hazard ratio 1.01, 95% confidence interval 0.77 to 1.33, p = 0.96) and the composite of death, MI, or stroke (hazard ratio 1.03, 95% confidence interval 0.80 to 1.31, p = 0.91) were similar in patients undergoing DES or CABG. However, rate of repeat revascularization was significantly higher in the DES group (hazard ratio 3.69, 95% confidence interval 2.64 to 5.17, p <0.001). These trends were consistent in nondiabetic patients (hazard ratio 0.80, 95% confidence interval 0.55 to 1.16, p = 0.23 for death; hazard ratio 0.77, 95% confidence interval 0.56 to 1.05, p = 0.10 for composite of death, MI, or stroke; hazard ratio 2.77, 95% CI 1.95 to 3.91, p <0.001 for repeat revascularization). There was no significant interaction between diabetic status and treatment strategy on clinical outcomes (p for interaction = 0.36 for death; 0.20 for the composite of death, MI, or stroke; and 0.40 for repeat revascularization). In conclusion, there was no significant prognostic influence of diabetes on long-term treatment with DES or CABG in patients with multivessel CAD.
The American journal of cardiology 03/2012; 109(11):1548-57. · 3.58 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To date, drug-eluting stent (DES) implantation has not been compared with coronary artery bypass grafting (CABG) for ostial left main coronary artery (LMCA) lesions.
Of the 263 patients in the MAIN-COMPARE registry with ostial LMCA stenosis, 123 were treated with percutaneous coronary intervention (PCI) with DES and 140 with CABG. We compared their 5-year overall survival, composite outcomes of death, Q-wave myocardial infarction (MI) or stroke, and target vessel revascularization (TVR) rates.
Unadjusted analysis showed no significant differences between CABG and DES in overall survival rates (95% confidence interval (CI) for hazard ratio (HR): 0.44 to 1.77, P = 0.71), composite outcomes (death, Q-wave MI, or stroke)-free survival rates (95% CI for HR: 0.41-1.63, P = 0.56), and TVR-free survival rates (95% CI for HR: 0.79-5.03, P = 0.14). Multivariate adjusted Cox regression analysis also showed no significant between-group differences in TVR (95% CI for HR: 0.52-3.79, P = 0.49), death (95% CI for HR: 0.79-2.82, P = 0.22) and the composite of death, Q-wave MI, or stroke (95% CI for HR: 0.65-2.57, P = 0.46). These results were sustained after propensity score adjustment and propensity score matching analysis.
DES implantation for ostial LMCA lesions showed similar 5-year outcomes of death, major adverse events, and TVR compared with CABG. Although meticulous adjustments decreased baseline difference between the two treatments, the absence of statistical significance could be attributable to the size of the study sample and hidden bias.
Catheterization and Cardiovascular Interventions 01/2012; 80(2):206-12. · 2.29 Impact Factor
