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ABSTRACT: The purpose of this study is to investigate the efficacy and safety of a novel double stent in patients with malignant extrahepatic biliary obstruction.
This prospective pilot study enrolled 45 consecutive patients with malignant extrahepatic biliary obstructions from January 2008 to December 2009. All patients were treated with a novel double stent system (covered stent in uncovered stent).
The double stents were successfully placed in all patients. Bilirubin levels decreased significantly after stent placement (p < 0.001). Median patient survival and stent patency times were 149 days (95% CI, 126-172 days) and 439 days (95% CI, 123-755 days), respectively. Cumulative stent patency rates at 3, 6, 9, and 12 months were 91%, 89%, 82%, and 82%, respectively. Five patients (11.1%) presented with stent occlusion due to tumor overgrowth (n = 3) or sludge incrustation (n = 2) and required repeat intervention. Tumor ingrowth, acute cholecystitis, pancreatitis, or stent migration was not observed in any of these patients.
Preliminary results indicate that percutaneous treatment of malignant extrahepatic biliary obstructions using a novel double stent is feasible, safe, and effective in achieving internal biliary drainage.
American Journal of Roentgenology 11/2011; 197(5):W942-7. · 2.78 Impact Factor
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ABSTRACT: The purpose of this study was to investigate the outcome of biliary metallic stent placement in patients with contralateral portal vein occlusion caused by advanced hilar malignancy and to compare the outcomes of unilateral and bilateral stent placement.
From January 2007 to December 2009, 41 patients with unilobar portal vein occlusion due to advanced hilar malignancy were enrolled in this retrospective study. All patients were treated with percutaneous placement of biliary metallic stents: unilateral stent placement in 23 patients, bilateral stent placement in 18 patients.
There were no significant differences in technical success (p > 0.999), successful drainage (p > 0.999), early cholangitis (p = 0.734), stent occlusion (p = 0.713), stent patency (p = 0.653), or patient survival (p = 0.493) between the two groups. In the patients who underwent unilateral stent placement, a slight decrease in diameter (mean diameter, 7.2 ± 3 mm before drainage, 6.2 ± 3 mm after stent placement) (p = 0.058) was observed in the intrahepatic bile duct of the undrained lobe with portal vein occlusion. Four of the patients who underwent unilateral stent placement had stent malfunctions, but the other 19 patients did not experience cholangitis or jaundice before death or the end of the study.
Unilateral biliary metallic stent placement in the lobe with a patent portal vein seems to be a safe and effective palliative treatment of patients with contralateral portal vein occlusion caused by advanced hilar malignancy, obviating bilateral stent placement in these patients.
American Journal of Roentgenology 10/2011; 197(4):795-801. · 2.78 Impact Factor
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ABSTRACT: To evaluate the frequency of hepatic arterial injury in 3110 patients who had undergone percutaneous transhepatic biliary drainage (PTBD) and assess the risk factors for hepatic arterial injury and the treatment outcome after transcatheter arterial embolization.
A total of 3110 patients who underwent 3780 PTBDs between January 2003 and December 2008 were retrospectively assessed. This study was approved by the Institutional Review Board. The incidence of hepatic arterial injury was determined and the risk factors associated with it were analyzed by using univariate and multiple logistic regression analyses. Hepatic angiography was performed to identify the bleeding focus, followed by transcatheter arterial embolization.
Hepatic arterial injuries occurred after 72 (1.9%) of 3780 PTBDs. When adjusted for benign disease, perihepatic ascites, platelet count of 50,000/mm(3) or less, international normalization ratio of 1.5 or greater, and left-sided puncture, multiple logistic regression analysis showed that left-sided PTBD (odds ratio, 2.017; 95% confidence interval: 1.257, 3.236; P = .004) was the only independent risk factor associated with hepatic arterial injury. The technical and clinical success rates of transcatheter arterial embolization were 100% and 95.8%, respectively. Minor complications were observed in 58 (80.6%) patients, 55 (76.4%) of whom had hepatic ischemia and three (4.2%) of whom had focal hepatic infarction. No major complication was observed in any patient.
Hepatic arterial injury is a relatively rare complication of PTBD. Because left-sided PTBD is the only independent risk factor associated with hepatic arterial injury, right-sided PTBD is preferable unless technical difficulty or secondary intervention necessitates left-sided PTBD. Moreover, transcatheter arterial embolization is a safe and effective method for treating hepatic arterial injury following PTBD.
Radiology 08/2011; 261(3):969-75. · 5.73 Impact Factor
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ABSTRACT: Serum levels of highly sensitive C-reactive protein (hsCRP), a vascular inflammatory marker, may predict the development of cardiovascular disease (CVD) and type 2 diabetes. Women with polycystic ovary syndrome (PCOS) are at greater risk for type 2 diabetes and CVD. The aim of this study was to compare hsCRP levels between normal weight women with PCOS and controls with a normal menstrual cycle and to determine the factors associated with serum hsCRP levels.
Thirty-nine lean PCOS patients and 24 healthy, regular cycling women were enrolled in this study. We performed anthropometric measurements, fat computed tomography (CT), and blood sampling to determine blood chemistry and levels of hsCRP, gonadotropins, testosterone, and sex-hormone binding globulin. We also conducted 75-g oral glucose-tolerance test and euglycemic hyperinsulinemic clamp to assess insulin sensitivity.
Serum hsCRP concentrations were higher in women with PCOS than in women with regular mensturation. However, this difference was no longer significant after adjusting for body mass index (BMI). hsCRP levels were correlated with waist circumference (r=0.46, p<0.01), BMI (r=0.46, p<0.01), visceral fat area (r=0.45, p<0.01), and systolic (r=0.42, p<0.05) and diastolic blood pressure (r=0.39, p<0.05). hsCRP also tended to be negatively associated with insulin-mediated glucose uptake (IMGU) (r=-0.31, p=0.07). A multiple regression analysis revealed that BMI (beta=0.29, p<0.05), systolic blood pressure (beta=0.39, p<0.01), and IMGU (beta=-0.31, p<0.05) predicted serum hsCRP levels in women with PCOS.
PCOS by itself does not seem to be associated with increased hsCRP levels, whereas known CVD risk factors affect serum hsCRP levels in PCOS.
The Korean Journal of Internal Medicine 12/2009; 24(4):350-5.
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ABSTRACT: The International Diabetes Federation consensus proposed an ethnically specific criteria of waist circumference (WC) for central obesity, but, the nationwide definition is still debated in Korea. For the detection of the optimal WC cutoff value, the nonadipose components of the metabolic syndrome (MS) were defined by modification of revised 2003 Rotterdam consensus as having two or more risk factors such as hypertension, hyperglycemia, and dyslipidemia without consideration of abdominal obesity. By using receiver-operating characteristic (ROC) curve analysis, cutoff points of WC and visceral fat area (VFA) for prediction of MS were 80 cm and 53.1 cm(2). WC cutoff points corresponding to VFA >53.1 and 100 cm(2) were 73.3 and 77.8 cm. The sensitivity and specificity of currently used value of WC 88 cm were 41.9 and 91.5%, suggesting that it could be too high in Korean population. Central obesity defined as WC >80 cm was significantly associated with nonadipose components of MS after adjustment for age, BMI, cholesterol, triglycerides, fasting insulin, and free testosterone levels. Central obesity with WC of >80 cm predicted the presence of nonadipose MS (odds ratio 16.6; 95% confidence interval (CI) 6.5-42.6). It was also significant (odds ratio 14.7; 95% CI 3.4-64.3) when we applied the WC value of 70 cm instead of 80 cm. In conclusion, WC of 80 and 70 cm could be appropriate cutoff points to identify the MS and visceral adiposity in Korean women with polycystic ovary syndrome (PCOS), respectively. Therefore, PCOS women with a WC over 70 cm should be closely monitored for the development of MS.
Obesity 09/2009; 18(3):593-7. · 4.28 Impact Factor
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ABSTRACT: In the era before reperfusion therapy, ventricular septal rupture complicated 1approximate3% of acute myocardial infarctions (AMI) usually 3-5 days after onset. Studies have reported a positive correlation between the incidence of septal perforation and total occlusion of the coronary arteries. A 70-year old female patient was referred to the emergency room with the diagnosis of acute anterior myocardial infarction (MI) and recent cerebral infarction. The coronary angiogram showed a 90% stenosis at the mid-portion of the left anterior descending artery (LAD), and the lesion was successfully treated by percutaneous coronary intervention (PCI) with stent implantation. After PCI, the anterior wall motion improved on the follow-up echocardiogram. However, on the 20th hospital day, the patient condition deteriorated suddenly with pulmonary congestion. The echocardiography revealed a 1.3 cm ventricular septal defect at the apical septum with a left-to-right shunt. We report this rare case of delayed septal rupture in a patient with patent LAD after PCI and recovery of wall motion.
The Korean Journal of Internal Medicine 10/2005; 20(3):243-6.
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ABSTRACT: The purpose of this study is to present the information on the duration of treatment and the cost of work-related low back pain. Using the compensation-database for 1997 work-related low back pain (n=9,277), this study estimated the duration of treatment, the cost of work-related low back pain, the relationship between them, and probability of being off treatment at different intervals. The mean and the median of the treatment duration are 252.6 days and 175 days. The mean and the median of the cost of total insurance benefit are 37,700,000 won and 14,400,000 won. The treatment duration of 51% of the study subjects was less than 6 months and their cost accounted for 10.2% of the total insurance benefit. The subjects who were treated more than 24 months were 5.8% but it accounted for 29.2% of the cost. It was found that approximately 50% of the subjects who will remain on treatment at the end of n months would be off treatment at the end of n+5 months. This study presents the point in time when the low back pain (LBP) workers need to prepare to return to work by forecasting their off-treatment period. From the treat duration and cost perspectives, this study may be utilized as evidence for active management of work-related LBP.
Journal of Korean Medical Science 03/2005; 20(1):127-31. · 0.99 Impact Factor
