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Spontaneous tumor rupture is a serious but rare complication of hepatocellular carcinoma (HCC) and has a low survival rate. Here, we report a case of massive HCC that ruptured and was treated successfully with transarterial chemoembolization (TACE). A 55-year-old man with abdominal pain was diagnosed with a 12-cm-wide ruptured HCC at segment 8. The overall liver function was scored as Child-Pugh A, but the single nodule tumor had ruptured; therefore, TACE treatment was initiated. After the first TACE treatment, residual tumors were found; thus, secondary TACE was performed 5 months later. No new lesions or extrahepatic metastases were found 16 months after the first TACE treatment, so hepatic resection was performed for curative treatment. The postoperative pathology results did not reveal any cancer cells; hence, TACE alone resulted in a cure. We report this case because the cure has been maintained for more than 3 years after resection. (J Liver Cancer 2020;20:154-159) more...

Aims The incidence and mortality of hepatocellular carcinoma (HCC) have decreased over time in South Korea, where hepatitis B virus (HBV) in endemic. This study investigated the changes in the characteristics and clinical outcomes of HCC patients in Korea. Methods Patients initially diagnosed with HCC and treated at the National Cancer Center, Korea between 2000 and 2015 (n = 4,291) were followed up until February 2017. Differences in patient characteristics and outcomes were compared between chronological cohorts: cohort A (2000–2004, n = 1,157) vs. B (2005–2009, n = 1,678) vs. C (2010–2015, n = 1,456). Results The median age of the patient cohort was 57 years (range, 13–98 years), and male predominance was noted (81.6%). HBV infection was the most common etiology (74.8%). The proportion of patients diagnosed with good liver function and small tumors (ppvs. 20.4 vs. 64.5 months, p Conclusions The survival of patients with HCC, especially HBV-related HCC, has improved significantly over time in Korea. more...

To investigate clinical outcomes of percutaneous transhepatic treatment for biliary stricture after duct-to-duct biliary anastomosis in living donor liver transplantation (LDLT).This retrospective study examined baseline characteristics, procedural details, clinical outcomes, drainage catheter removal rate within 8 months, and recurrence after catheter removal using patients' medical records and images. Risk factors for failure of drainage catheter removal within 8 months and recurrence of biliary stricture after drainage catheter removal were assessed via univariable and multivariable analyses.A total of 112 patients (53.4 ± 8.79 years, 91 men) were evaluated. Multiple drainage catheters were placed in 75 patients (70.0%). Drainage catheters were successfully removed in 107 patients (95.5%). Failure of drainage catheter removal within 8 months was associated with hepatic artery complications (p = 0.034) and strictures requiring alternative passage techniques (p = 0.034). The cumulative primary patency rates after drainage catheter removal at 1, 2, 3, and 5 years were 85.4%, 79.8%, 75.8%, and 68.4%, respectively. Recurrence of biliary stricture was associated with the presence of an untreated isolated sectoral duct (aHR, 3.632; 95% CI, 1.086-12.150, p = 0.037) and with concurrent bile leaks (aHR, 2.475; 95% CI, 1.090-5.621, p = 0.031).Percutaneous transhepatic treatment was effective for the treatment of biliary strictures after duct-to-duct biliary anastomosis in LDLT. Multiple drainage catheter maintenance was needed because multiple strictures often occurred in these patients.• Percutaneous transhepatic treatments are useful and effective for the treatment of biliary stricture after duct-to-duct biliary anastomosis in living donor liver transplantation (LDLT), although an endoscopic approach is available for this type of reconstruction. • Multiple drainage catheters were frequently placed in these patients because of multiple complex strictures. • We found that recurrence after drainage catheter removal was associated with isolation of the sectoral duct and with concurrent bile leaks. more...

To investigate clinical outcomes and safety of extraluminal recanalization for duct-to-duct anastomotic obstruction after living donor liver transplantation (LDLT). Extraluminal recanalization was performed as a salvage procedure after failure of intraluminal cannulation in eight patients who underwent percutaneous transhepatic treatment of duct-to-duct anastomotic obstruction 11.0 ± 5.27 months after LDLT between October 2012 and April 2019. Technical details, safety, and outcomes of extraluminal recanalization were investigated. Total ten sessions of extraluminal recanalization were performed in the eight patients with the stiff backend of a 0.035 inch hydrophilic guide wire, 22-gauge Chiba needle, or Colapinto needle. Percutaneous common bile duct access was performed in three sessions to obtain a straight course for the puncture. There was one instance of subcapsular and intraparenchymal hematoma requiring placement of an additional drainage catheter and conservative treatment. During a follow-up period ranging from 18.4 to 100.7 months, the drainage catheter was removed in seven of the eight patients, including three patients who had recurrent stricture requiring repeat percutaneous treatment and one who underwent a routine change of an endoscopic retrograde biliary drainage catheter. Extraluminal recanalization can be an effective and safe salvage procedure after failed intraluminal cannulation of duct-to-duct anastomotic obstruction in LDLT. more...

Sixty-four-year-old female who underwent hemi-hepatectomy for intrahepatic cholangiocarcinoma a year ago presented with biliary sputum, cough and fever. Cross-sectional imaging showed a recurred tumor involving right diaphragmatic area and an abscess formation in liver dome with adjacent right lower lobe of lung. Percutaneous transhepatic biliary drainage and percutaneous drainage of lung abscess were performed. Tubogram showed connections between the lung abscess cavity and multiple distal bronchi, suggesting bronchobiliary fistulas. Two weeks of drainage treatment did not relieve symptoms. We successfully treated intractable bronchobiliary fistula via image-guided percutaneous access to closest distal bronchi near abscess with subsequent tandem placement of vascular plugs. more...

Purpose To evaluate the feasibility and midterm results of endovascular treatment of hepatic artery occlusion within 24 hours after living-donor liver transplantation (LDLT). Materials and Methods From January 2012 to June 2014, 189 consecutive patients at a single institution underwent LDLT with right-lobe grafts. Among them, 10 were diagnosed with hepatic artery occlusion within 24 hours after LDLT. All 10 underwent endovascular treatment, including drug-eluting stent placement (n = 2), intraarterial thrombolysis (n = 5), or both (n = 3). Every patient received regular follow-up with multidetector computed tomography (CT). Data on primary technical success, primary and assisted primary patency, and biliary complications were analyzed. Results Primary technical success was achieved in all 10 cases. Primary patency rates at 1 week, 3 months, and 6 months were all 70% (7 of 10), and the respective assisted primary patency rates were all 80% (8 of 10). Bleeding at the anastomotic site developed in 2 failed cases, prompting repeat liver transplantation. All 8 successfully recanalized cases showed hepatic artery patency on CT throughout follow-up (mean, 643.6 d; range, 236–1,081 d). Six of these cases had anastomotic biliary stricture, 4 of which were successfully treated by multisession biliary intervention. One patient had nonanastomotic biliary stricture and died of hepatic failure despite lifelong external drainage. Conclusions Endovascular treatment could be an alternative therapeutic option for patients with hepatic artery occlusion within 24 hours after LDLT. It could help achieve long-term patency of the hepatic artery, but biliary stricture can potentially occur, and bleeding at the anastomotic site is a serious complication. more...

INTRODUCTION: Intermittent pneumatic compression (IPC) is now a widely used therapy for the prophylaxis of deep vein thrombosis and pulmonary embolism. In general, the IPC sequence is composed of sequential compression and simultaneous deflation. Typically, veins are considered to be squeezed and emptied during the compression phase and to be refilled during the deflation phase. However, because the stop or sudden increase in blood flow can be dangerous, a further investigation is needed with respect to the blood flow. MATERIALS AND METHODS: We demonstrated a new compression protocol based on the investigation results of venous blood flow during IPC. This new compression protocol involves successive compression without the deflation phase; thus, the expelled blood volume flow during a given period can be maximized. To investigate the blood flow during IPC, sonography movie clips and in-laboratory developed blood flow analysis software was used. RESULTS: The increases in the peak volume flow during IPC were 49% (±24%) and 25% (±29%) with the conventional protocol and the new protocol, respectively, whereas the total volume flow (TVF) was not significantly changed (−1.0% and −13.0%, respectively). With the new protocol, the peak velocity (PV) was 49% lower than that with the conventional protocol. Thus, the new protocol has an effect of maintaining TVF without resulting in a sudden large increase or decrease in PV. CONCLUSION: The new suggested protocol might improve safety because it can maintain the stability of blood flow by reducing the risk of blood stasis and a rapid change in blood flow. more...

ObjectiveTo evaluate the prevalence and predictors of peripherally inserted central catheter-associated bloodstream infection (PBSI) and PBSI-related death in hospitalized adult patients.Materials and methodsA retrospective multicenter cohort of consecutive patients who underwent PICC placement from October 2016 to September 2017 at four institutes was assembled. Using multivariable logistic and Cox-proportional hazards regression models, all risk factors were analyzed for their association with PBSI. Multivariable logistic models were used to evaluate predictors of PBSI-related death.ResultsDuring the study period, a total of 929 PICCs were inserted in 746 patients for a total of 17,913 catheter days. PBSI occurred in 58 patients (6.2%), with an infection rate of 3.23 per 1,000 catheter days. Number of catheter lumens [double lumen, odds ratio (OR) 5.295; 95% confidence interval (CI), 2.220-12.627; hazard ration (HR) 3.569; 95% CI, 1.461-8.717], PICC for chemotherapy (OR 4.94; 95% CI, 1.686-14.458; HR 7.635; 95% CI, 2.775-21.007), and hospital length of stay (OR 2.23; 95% CI, 1.234-4.049; HR 1.249; 95% CI, 0.659-2.368) were associated with PBSI. Risk factors, such as receiving chemotherapy (OR 54.911; 95% CI, 2.755-1094.326), presence of diabetes (OR 11.712; 95% CI, 1.513-90.665), and advanced age (OR 1.116; 95% CI 1.007-1.238), were correlated with PBSI-related death.ConclusionOur results indicated that risk factors associated with PBSI included the number of catheter lumens, the use of PICCs for chemotherapy, and the hospital length of stay. Furthermore, PBSI-related death was common in patients undergoing chemotherapy, diabetics, and elderly patients. more...

AIM To compare the therapeutic efficacy and safety of transarterial chemoembolisation (TACE) for hepatocellular carcinoma (HCC) within the Milan criteria with or without the use of cone-beam computed tomography (CBCT). MATERIALS AND METHODS Patients with HCC within the Milan criteria who underwent conventional angiography-guided TACE (Angio-TACE group: 58 patients from January 2010 to December 2011) were compared with those who underwent CBCT-guided TACE (CBCT-TACE group: 55 patients from January 2013 to December 2014). Local progression-free survival (LPFS), progression-free survival (PFS), and overall survival (OS) were compared. Adverse events after TACE were also investigated. RESULTS Baseline characteristics were balanced between the two groups. LPFS was significantly longer in the CBCT-TACE group than in the Angio-TACE group (median: not reached for 36 versus 19.2 months, respectively; Log-rank p=0.029). In multivariable Cox regression analysis, CBCT guidance had a significantly lower risk of local progression or death (adjusted hazard ratio: 0.585; 95% confidence interval, 0.344–0.995; p=0.048); however, there was no significant difference in PFS (3-year PFS: 15.9% versus 26.8%, respectively; p=0.122) or OS (3-year OS: 85% versus 88.2%, respectively; p=0.761) between the Angio-TACE and CBCT-TACE groups. Post-embolisation syndrome occurred significantly less frequently in the CBCT-TACE group (p=0.002). CONCLUSION CBCT-guided TACE could improve local tumour control for HCC within Milan criteria and showed fewer cases of post-embolisation syndrome. more...

Despite increasing use, the exact prevalence and predictors of peripherally inserted central catheter-associated bloodstream infection (PICC-CLABSI) in hospitalized patients with cancer are not elucidated.This retrospective cohort study included consecutive patients who underwent peripherally inserted central catheter (PICC) placement in 4 institutions (during 12 months in 3 hospitals and 10 months in 1 hospital). The prevalence of PICC-CLABSI was evaluated. The association between predictors and PICC-CLABSI were analyzed using Cox proportional hazards regression models and Kaplan-Meier survival analysis with log-rank tests.During the study period, 539 PICCs were inserted in 484 patients for a total of 10,841 catheter days. PICC-CLABSI occurred in 25 (5.2%) patients, with an infection rate of 2.31 per 1000 catheter days. PICC for chemotherapy (hazards ratio [HR] 11.421; 95% confidence interval (CI), 2.434-53.594; P = .019), double lumen catheter [HR 5.466; 95% CI, 1.257-23.773; P = .007], and PICC for antibiotic therapy [HR 2.854; 95% CI, 1.082-7.530; P = .019] were associated with PICC-CLABSI.PICC for chemotherapy or antibiotics, and number of catheter lumens are associated with increased risk of PICC-CLABSI in cancer patients. Careful assessment of these factors might help prevent PICC-CLABSI and improve cancer patients care. more...

1. McLeod RA, Dahlin DC, Beabout JW. The spectrum of osteoblastoma. AJR Am J Roentgenol 1976; 126:321–325. 2. Gordon SC, MacIntosh RB, Wesley RK. A review of osteoblastoma and case report of metachronous osteoblastoma and unicystic ameloblastoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 91:570–575. 3. Weber MA, Sprengel SD, Omlor GW, et al. Clinical long-term outcome, technical success, and cost analysis of radiofrequency ablation for the treatment of osteoblastoma and spinal osteoid osteoma in comparison to open surgical resection. Skeletal Radiol 2015; 44:981–993. 4. Kurup AN, Morris JM, Boon AJ, et al. Motor evoked potential monitoring during cryoablation of musculoskeletal tumors. J Vasc Interv Radiol 2014; 25:1657–1664. more...

Background and Aims To evaluate the clinical outcomes of patients with hepatocellular carcinoma (HCC) and compare the findings with that of a previous cohort. Methods Overall, 1972 HCC patients diagnosed and treated at the National Cancer Center, Korea between 2004 and 2009 were enrolled. The data of this cohort were compared with those of a previous cohort (2000–2003) from the same institution. Results In all (mean age, 56.4 years; 1642 men), 74.6% was hepatitis B virus (HBV) positive, 81.6% were Child–Pugh (CP) class A, and 64.4% was Barcelona Clinic Liver Cancer (BCLC) stage C. The modified Union for International Cancer Control (mUICC) stage I, II, III, IVa, and IVb was found in 8.9%, 29.6%, 24.8%, 23.1%, and 13.6% patients, respectively. The most common initial treatment was transarterial chemotherapy (58.3%), followed by resection (18.6%). The 5-year survival rate of BCLC stage 0, A, B, and C were 79.6%, 67.2%, 33.9%, and 17.1%, respectively. The performance status, BCLC stage, mUICC stage, CP class, model for end-stage liver disease score, tumor characteristics, portal vein tumor invasion, and serum alpha-fetoprotein level proved to be independent prognostic variables. Overall survival in the present cohort was better than that in the previous cohort (hazard ratio, 0.829; 95% confidence interval, 0.754–0.912), especially for advanced HCC patients with HBV-positive status. Conclusions This cohort study provides valuable insights into the characteristics of HCC in Korean patients. Our findings may help develop clinical trials, treatment strategies, and prognosis systems for HCC patients in HBV-endemic areas. more...

Objective To assess the clinical efficacy, safety, and risk factors influencing local tumor progression, following CT-guided radiofrequency ablation (RFA) of recurrent or residual hepatocellular carcinoma (HCC), around iodized oil retention. Materials and methods Sixty-four patients (M : F = 51 : 13, 65.0 ± 8.2 years old) with recurrent or residual HCC (75 index tumors, size = 14.0 ± 4.6 mm) had been treated by CT-guided RFA, using retained iodized oil as markers for targeting. The technical success, technique effectiveness rate and complications of RFA were then assessed. On pre-ablative and immediate follow-up CT after RFA, we evaluated the size of enhancing index tumors and iodized oil retention, presence of abutting vessels, completeness of ablation of iodized oil retention, and the presence of ablative margins greater than 5 mm. Also, the time interval between transarterial chemoembolization and RFA was assessed. The cumulative local tumor progression rate was calculated using the Kaplan-Meier method, and the Cox proportional hazards model was adopted, to clarify the independent factors affecting local tumor progression. Results The technical success and technique effectiveness rate was 100% and 98.7%, respectively. Major complications were observed in 5.6%. The cumulative rates of local tumor progression at 1 and 2 years were 17.5% and 37.5%, respectively. In multivariate analyses, partial ablation of the targeted iodized oil retention was the sole independent predictor of a higher local tumor progression rate. Conclusion CT-guided RFA of HCC around iodized oil retention was effective and safe. Local tumor progression can be minimized by complete ablation of not only index tumors, but targeted iodized oil deposits as well. more...

Portal vein embolization (PVE) is increasingly performed worldwide to reduce the possibility of liver failure after extended hepatectomy, by inducing future liver remnant (FLR) hypertrophy and atrophy of the liver planned for resection. The procedure is known to be very safe and to have few procedure-related complications. In this study, we described 2 elderly patients with Bismuth–Corlette type IV Klatskin tumor who underwent right trisectional PVE involving the embolization of the right portal vein, the left medial sectional portal branch, and caudate portal vein. Within 1 week after PVE, patients went into sepsis combined with bile leak and died within 1 month. Sepsis can cause acute liver failure in patients with chronic liver disease. In this study, the common patient characteristics other than sepsis, that is, trisectional PVE; chronic alcoholism; aged >65 years; heart-related comorbidity; and elevated serum total bilirubin (TB) level (7.0 mg/dL) at the time of the PVE procedure in 1 patient, and concurrent biliary procedure, that is, percutaneous transhepatic biliary drainage in the other patient might have affected the outcomes of PVE. These cases highlight that PVE is not a safe procedure. Care should be taken to minimize the occurrence of infectious events because sepsis following PVE can cause acute liver failure. Additionally, prior to performing PVE, the extent of PVE, chronic alcohol consumption, age, comorbidity, long-lasting jaundice, concurrent biliary procedure, etc. should be considered for patient safety. more...

We investigated tissue responses to endoskeleton stent grafts for saccular abdominal aortic aneurysms (AAAs) in canines. Saccular AAAs were made with Dacron patch in 8 dogs, and were excluded by endoskeleton stent grafts composed of nitinol stent and expanded polytetrafluoroethylene graft. Animals were sacrificed at 2 months (Group 1; n = 3) or 6 months (Group 2; n = 5) after the placement, respectively. The aortas embedding stent grafts were excised en bloc for gross inspection and sliced at 5 to 8 mm intervals for histopathologic evaluation. Stent grafts were patent in all except a dog showing a thrombotic occlusion in Group 2. In the 7 dogs with patent lumen, the graft overhanging the saccular aneurysm was covered by thick or thin thrombi with no endothelial layer, and the graft over the aortic wall was completely covered by neointima with an endothelial layer. Transgraft cell migration was less active at an aneurysm than at adjacent normal aorta. In conclusion, endoskeleton stent grafts over saccular aneurysms show no endothelial coverage and poor transgraft cell migration in a canine model. more...

Background: In cases of endoscopic intervention treatment for biliary stricture which fail, a percutaneous approach can be subsequently attempted. However, the quality of life is lower for those patients with percutaneous transhepatic biliary drainage (PTBD) tubes than those with endoscopic retrograde biliary drainage tubes. In this study, we report the outcome of the application of percutaneous transhepatic biliary stenting (PTBS) for use in subsequent endoscopic treatment of biliary stricture after living donor liver transplantation (LDLT). Methods: Of 165 patients who underwent LDLT, 40 (24.2%) were diagnosed with anastomotic biliary strictures. Of these patients, seven agreed to treatment using PTBS using a plastic stent with endoscopic follow-up instead of treatment by insertion of a PTBD tube, and were enrolled in this study. Results: In all seven patients, the use of this technique enabled effective advancement of a guide wire and successful placement of one or two plastic stents (7 or 10 Fr) into the PTBD tract. There were no PTBS-related complications associated with the procedure. The median duration for stent use was 40.3 weeks (range; 27.6~65.0). Upon final removal of all stents, the stricture had been resolved in four (57%) of the seven patients. Conclusions: Our study data suggested that, after failed use of ERCP in the treatment of biliary stricture after LDLT, the use of PTBS and ERCP may be an effective and safe treatment. more...

Background & Aims Transarterial chemoembolization (TACE) is an important palliative treatment for unresectable hepatocellular carcinoma (HCC), but TACE-induced ischemic injury can upregulate angiogenic factors and is associated with poor prognosis. The aim of this study was to evaluate the safety and efficacy of concurrent conventional TACE and sorafenib in patients with unresectable HCC. Methods The primary objectives of this prospective, single-arm, phase II study were to evaluate safety and time to progression (TTP). Sorafenib was given 3days after TACE and was administered for up to 24weeks. Repeated TACE was performed on demand. Tumor response was assessed every 8weeks. Results Fifty patients were treated and followed from July 2009 to May 2011. All patients were in Barcelona Clinic Liver Cancer (BCLC) stage B (82%) or C (18%). The median time of follow-up was 14.9months and a median of 1 TACE session was given (range, 1–4). The median dose intensity of sorafenib was 68.7% (range, 37.3–100) of 800mg daily. The most common reasons for dose reduction were hand–foot syndrome and thrombocytopenia. Thirty patients completed the study and 17 patients discontinued sorafenib due to disease progression. The overall median TTP was 7.1months (95% confidence interval (CI), 4.8–7.5months): 7.3months in BCLC stage B; 5.0months in BCLC stage C. The 6-month progression-free survival rate was 52% (95% CI, 37.3–66.1). Conclusions Concurrent treatment of unresectable HCC with conventional TACE and sorafenib demonstrates a manageable safety profile and a possibility of promising efficacy. more...

Background and Aim: Patients with hepatocellular carcinoma (HCC) that is refractory to repeated transarterial chemoembolization (TACE) are considered for systemic therapy, but TACE refractoriness is not well defined. The aim of this study was to determine the characteristics of patients whose HCC is refractory to repetitive TACE. Methods: We evaluated 264 patients with intermediate-stage HCC who underwent TACE between January 2006 and September 2009. We designated the development of vascular invasion or extrahepatic spread during follow up as “stage progression” (SP), and hypothesized that SP might be the surrogate end-point for TACE refractoriness. Results: The median follow up was 18.2 months, and median number of TACE was 3.0 (range, 1–13). Median time-to-progression was 5.5 months (95% confidence interval, 4.8–6.2), and median overall survival was 25.3 months (95% confidence interval, 21.6–29.0). We classified the patients according to disease course as: no progressive disease (PD(−); n = 33); PD without SP (PD(+)SP(−); n = 113); PD followed by SP (PDSP; n = 47); and simultaneous PD and SP (PDS n = 64). PD(−) and PD(+)SP(−) groups showed no difference in overall survival, PDSP group had worse overall survival than PD(−) and PD(+)SP(−) groups, and PD&SP group had the worst overall survival. The significant prognostic factors for SP-free survival were development of PD and need for three sessions of TACE during the first 6 months. Conclusions: SP-free survival can be regarded as an end-point for TACE refractoriness. Development of progression or need for three sessions of TACE within the first 6 months could be predictive of TACE refractoriness. more...

To evaluate the clinical benefits of noncontrast chest computed tomography (CT) immediately after transarterial chemoembolization in patients with hepatocellular carcinoma and to assess the effect of radiation reduction on image quality in low-dose scanning.From June to October 2010, we performed standard-dose, noncontrast chest CTs immediately after transarterial chemoembolization in 160 patients and low-dose CTs in 88 patients. We reviewed the entire noncontrast chest CTs and follow-up CTs to reveal the clinical benefits of CT evaluation immediately after transarterial chemoembolization. Using two independent readers, we also retrospectively evaluated the radiation dose and image quality in terms of the image noise, contrast between the liver parenchyma and iodized oil and diagnostic acceptability for the evaluation of treatment response after transarterial chemoembolization.In 5.2% of the patients, additional treatment was performed immediately after the interpretation of the noncontrast chest CT, and additional pulmonary lesions were found in 8.5% of the patients. The measured mean dose-length product for the low-dose scanning was 18.4% of that of the standard-dose scanning. The image noise was significantly higher with the low-dose scanning (p0.001). However, all of the low-dose CT scans were diagnostically acceptable, and the mean scores for the subjective assessments of the contrast and diagnostic acceptability showed no significant differences for either reader.A noncontrast chest CT immediately after transarterial chemoembolization has some clinical benefits for immediate decision making and detecting pulmonary lesions. Low-dose, noncontrast chest CTs immediately after transarterial chemoembolization consistently provide diagnostically acceptable images and information on treatment response in patients who have undergone transarterial chemoembolization. more...

Background and Aim: Although sorafenib is recommended for patients with advanced hepatocellular carcinoma (HCC), a substantial portion of HCC patients in Asia are still treated with other treatments, mainly due to the prohibitive cost of sorafenib. We aimed to evaluate the clinical outcome of patients treated with sorafenib and those treated with other modalities in a single-center cohort. Methods: We reviewed the medical records of two groups of consecutive patients with advanced HCC, according to applied treatment modalities, between January 2007 and September 2009 as follows: patients who received sorafenib for 6 weeks or more (n = 123) and patients who were treated with one or more of other treatments, including transarterial chemoembolization, radiation, and cytotoxic chemotherapy (n = 253). Results: Overall survival did not differ significantly between these two groups (8.4 vs 8.2 months; P = 0.601). Significant prognostic factors were high α-fetoprotein (≥ 200 ng/mL), massive/infiltrative intrahepatic tumors, macrovascular invasion, extrahepatic spread, and higher tumor-node-metastasis stage. Subgroup analysis, according to these factors, showed that sorafenib resulted in superior survival in patients with extrahepatic spread (hazard ratio [HR] = 0.539; P = 0.003) and massive/infiltrative tumors (HR = 0.680; P = 0.036). In the absence of each prognostic factor, other treatments were better than sorafenib. Conclusions: Considering the survival benefit for sorafenib over other treatments in patients with extrahepatic spread and massive/infiltrative intrahepatic tumors, these characteristics might be regarded as compelling indications for sorafenib. more...

OBJECTIVE The objective of the study was to analyze computed tomography (CT) appearance and clinical features of adjacent-organ injuries related to expanded polytetrafluoroethylene (ePTFE) grafts after living-donor liver transplantation (LDLT). METHODS We evaluated follow-up CT images of 204 patients who underwent venoplasty with ePTFE during LDLT and encountered 4 patients (1.96%) with adjacent-organ injuries related to ePTFE. Clinical imaging records were reviewed in terms of imaging findings and possible risk factors. RESULTS In 3 patients, ePTFE graft perforated gastric antrum or duodenal bulb; in another patient, the common bile duct was injured. The mean interval between transplantation and identification of injury was 30 months. In patients with adjacent-organ injuries, biliary or perihepatic interventional treatments, adhesion of bowel and early occlusion of ePTFE grafts were commonly observed. CONCLUSIONS Adjacent-organ injuries by ePTFE graft after LDLT were rare but present. Interventional procedures, adhesion of the bowel wall and early occlusion of the grafts were possible risk factors. more...

This study was designed to investigate the effects of stenting across the branching arteries on the patency and stent-tissue responses over the branching arterial orifices.Thirteen dogs were observed after placing aortic stents across the celiac arteries (CA), superior mesenteric arteries (SMA), and renal arteries (RA). The animals were grouped according to stent types: large-cell group (n = 6) and small-cell group (n = 7). Angiography was performed to evaluate the branching artery patency at 2, 6, and 12 months after stent insertion, and the stent-tissue responses covering the orifices were evaluated on histopathologic examination.All branching arteries were patent on follow-up angiography; however, three patterns of stent-tissue responses over the orifices were observed: neointimal layering, bridging septa, and papillary hyperplasia. Although neointimal layering and bridging septa were evenly observed, severe papillary hyperplasia was more frequent at SMA and CA than RA. Four RA showed less than 50% ostial patency, and localized infarct was observed in six kidneys (24%). The ostial patency tended to decrease with small-cell stent during the follow-up period.Various stent-tissue responses over the branching artery orifices are induced by the aortic stent covering the branching arteries and may not be easily detected by conventional angiography. Subclinical renal infarct also may occur despite patent renal angiography. more...

Supplemental Digital Content is available in the text, The aim of the present study was to evaluate the clinical significance of dual radiotracer studies, 11C-acetate and 18F-fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT), for the prediction of response and recurrence after transarterial chemoembolization (TACE). This study retrospectively included a total 42 hepatoceullar carcinoma (HCC) patients (median age, 59; range, 34–85 years old) who underwent 11C-acetate and 18F-FDG PET/CT concurrently. Tumor uptake normalized by liver uptake (TNR; maximum tumor SUV to mean normal liver SUV ratio) was obtained first. Then, FAratio, which is the ratio of 18F-FDG TNR (TNR_FDG) to 11C-acetate TNR, was obtained and correlated with response after TACE and recurrence-free survival (RFS), using a Cox multivariate proportional-hazard model. Among clinical factors, including the Hepatoma Arterial Embolization Prognostic score and positron emission tomography (PET) parameters, multiple regression analysis revealed FAratio and tumor size to be the only significant factors. As a PET parameter, FAratio exhibited the largest area under the curve in the prediction of response after TACE. In the Cox multivariate proportional-hazard model, TNR_FDG was the only significant predictive factor for RFS. In subgroup analysis, TNR_FDG was the only significant predictive factor for recurrence in intermediate stage patients. However, FAratio was the only significant predictive factor for recurrence in advanced stage patients. Dual radiotracer use of 11C-acetate and 18F-FDG PET/CT contributed to the prediction of response and recurrence after TACE. Used in addition to 18F-FDG, 11C-acetate PET/CT could give additional information in advanced stage patients. Based on the characteristics of tumor metabolism assessed by dual radiotracer PET/CT, treatment plans could be more personalized and optimized. more...

To investigate risk factors and prognostic significance of postembolization fever (PEF)--a temperature of more than 38.0 degrees C--after chemoembolization in patients with hepatocellular carcinoma (HCC).The authors retrospectively analyzed data from 442 patients with unresectable HCC who underwent their first session of chemoembolization without other procedure-related complications except postembolization syndrome between January 2005 and December 2006. Of the 442 patients, 362 (81.9%) were men and 80 (18.1%) were women; patients ranged in age from 28 to 86 years (median, 61 years).PEF after chemoembolization developed in 91 patients (20.6%). Occurrence of PEF was closely associated with several clinical-laboratorial variables, although not with response to chemoembolization. With use of logistic regression analysis, however, a tumor size larger than 5 cm was the only independent factor related to PEF development (odds ratio, 8.192; 95% confidence interval [CI]: 3.641, 18.435; P.001). Although PEF was not an independent predictor of progression-free survival, it significantly increased the risk of death by about 1.4-fold, in correlation with overall survival (hazard ratio, 1.378; 95% CI: 1.003, 1.893; P = .048).PEF after chemoembolization in patients with HCC was strongly correlated with large tumor size and was a significant independent predictor of overall survival. more...

The purpose of this study was to investigate the suitability of a new nitinol monofilament stent (Niti-S) for transjugular intrahepatic portosystemic shunt (TIPS) creation. TIPS was performed with a Niti-S stent in 22 patients for variceal bleeding (n = 20) or intractable ascites (n = 2). The efficacy, complication, and patency rates during the follow-up period (up to 27 months, mean 13.9 months) were evaluated. TIPS was successfully performed in all patients. The mean portosystemic pressure gradient decreased from 23.8 +/- 7.2 mmHg to 10.2 +/- 3.1 mmHg. No mortality or significant morbidity was encountered at 1 month. Variceal bleeding and/or ascites were controlled in all patients. Primary patency rates were 77.3% at 6 months and 71.8% at 1 year. Secondary patency rates were 95.4% up to 26 months. TIPS with the Niti-S stent produced short-term technical and clinical results comparable to the other commercially available stents. A prospective randomized comparison study is indicated. more...

AIM: The purpose of our study was to describe radiological manifestations of tuberculosis in patients with myelodysplastic syndromes. MATERIALS AND METHODS: Chest radiographs and CTs of 12 patients with tuberculosis among 195 consecutive patients with myelodysplastic syndrome, proved by bone marrow biopsy, were reviewed. Six of the 12 patients presented with tuberculosis and were subsequently found to have myelodysplastic syndrome. RESULTS: Chest radiographs and CTs revealed pulmonary tuberculosis in all 12 patients and extrapulmonary tuberculous involvement in six (50%). Initial chest radiographic findings of pulmonary tuberculosis included a primary pattern ( n = 6), a post-primary pattern ( n = 3), a miliary pattern ( n = 1), atypical infiltrates ( n = 1) and normal radiograph ( n = 1). Tuberculosis involved extrathoracic lymph nodes ( n = 5), liver ( n = 2), spleen ( n = 2), kidney ( n = 2), bowel ( n = 2), pericardium ( n = 2) peritoneum ( n = 1) and rib ( n = 1). CONCLUSION: Tuberculosis is a relatively common cause of infection in patients with myelodysplastic syndromes. The radiological appearance of pulmonary tuberculosis in myelodysplastic syndromes is often a primary pattern, and there is frequently extrapulmonary involvement. Kim, H-C., et al . (2002). Clinical Radiology 57 , 408–414. more...

BACKGROUND/AIMS Although adipocytes secrete inflammatory cytokines and adipokines, their role in reflux esophagitis is controversial. We investigated the association between visceral fat and inflammatory cytokines or adipokines in reflux esophagitis. METHODS Abdominal visceral fat and cytokines were measured in 66 individuals with reflux esophagitis and 66 age- and sex-matched controls. The mean values for visceral fat and cytokines were compared in cases and controls. Second, correlations between visceral fat and inflammatory cytokines were measured. Finally, multiple logistic regression models for odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate the effects of visceral fat and cytokines on reflux esophagitis. RESULTS Visceral fat, leptin, interleukin (IL)-6, and IL-1β were higher in reflux esophagitis compared to controls. Visceral fat showed a strong positive correlation with IL-6 (r = 0.523, P < 0.001), IL-8 (r = 0.395, P < 0.001), and IL-1β (r = 0.557, P < 0.001), and a negative correlation with adiponectin (r = -0.466, P < 0.001). With adjusted analysis, visceral fat/100 (OR, 4.32; 95% CI, 2.18-8.58; P < 0.001) and leptin (OR, 1.36; 95% CI, 1.10-1.69; P = 0.005) independently increased the risk of reflux esophagitis, but the effects of other cytokines were abolished. CONCLUSIONS Visceral fat may increase the risk of reflux esophagitis by increasing the levels of inflammatory cytokines. Leptin showed a positive association with reflux esophagitis that was independent of visceral fat. more...

To evaluate the clinical outcomes of patients with hepatocellular carcinoma (HCC) and compare the findings with that of a previous cohort.Overall, 1972 HCC patients diagnosed and treated at the National Cancer Center, Korea between 2004 and 2009 were enrolled. The data of this cohort were compared with those of a previous cohort (2000-2003) from the same institution.In all (mean age, 56.4 years; 1642 men), 74.6% was hepatitis B virus (HBV) positive, 81.6% were Child-Pugh (CP) class A, and 64.4% was Barcelona Clinic Liver Cancer (BCLC) stage C. The modified Union for International Cancer Control (mUICC) stage I, II, III, IVa, and IVb was found in 8.9%, 29.6%, 24.8%, 23.1%, and 13.6% patients, respectively. The most common initial treatment was transarterial chemotherapy (58.3%), followed by resection (18.6%). The 5-year survival rate of BCLC stage 0, A, B, and C were 79.6%, 67.2%, 33.9%, and 17.1%, respectively. The performance status, BCLC stage, mUICC stage, CP class, model for end-stage liver disease score, tumor characteristics, portal vein tumor invasion, and serum alpha-fetoprotein level proved to be independent prognostic variables. Overall survival in the present cohort was better than that in the previous cohort (hazard ratio, 0.829; 95% confidence interval, 0.754-0.912), especially for advanced HCC patients with HBV-positive status.This cohort study provides valuable insights into the characteristics of HCC in Korean patients. Our findings may help develop clinical trials, treatment strategies, and prognosis systems for HCC patients in HBV-endemic areas. more...

Splenic artery pseudoaneurysms can be caused by pancreatitis, trauma, or operation. Traditionally, the condition has been managed through surgery; however, nowadays, transcatheter arterial embolization is performed safely and effectively. Nevertheless, several complications of pseudoaneurysm embolization have been reported, including coil migration. Herein, we report a case of migration of the coil into the jejunal lumen after transcatheter arterial embolization of a splenic artery pseudoaneurysm. The migrated coil was successfully removed by performing endoscopic intervention. more...

[1] Llovet JM, Real MI, Montana X, Planas R, Coll S, Aponte J, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002;359:1734–1739. [2] Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon RT, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002;35:1164–1171. [3] Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet 2012;379:1245–1255. [4] Marelli L, Stigliano R, Triantos C, Senzolo M, Cholongitas E, Davies N, et al. Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol 2007;30:6–25. [5] Iwamoto S, Sanefuji H, Okuda K. Angiographic subsegmentectomy for the treatment of patients with small hepatocellular carcinoma. Cancer 2003;97:1051–1056. [6] Park JW, Koh YH, Kim HB, Kim HY, An S, Choi JI, et al. Phase II study of concurrent transarterial chemoembolization and sorafenib for patients with unresectable hepatocellular carcinoma. J Hepatol 2012;56:1336–1342. more...

Purpose To evaluate the safety and efficacy of Lipiodol lymphangiography and 3 adjunctive N -butyl cyanoacrylate (NBCA) glue embolization techniques for the management of postoperative lymphatic leakage. Materials and Methods This retrospective study included 27 patients with postoperative lymphatic leakage (17 with ascites, 3 with chylothorax, 6 with lymphoceles, and 1 with a skin fistula) who underwent Lipiodol lymphangiography for diagnostic and therapeutic purposes in 3 tertiary referral centers between August 2010 and January 2016. Adjunctive glue embolization was performed as needed by using 3 different techniques: "lymphopseudoaneurysm" embolization, closest upstream lymph node embolization, or direct upstream lymphatic vessel embolization. Results Sixteen patients were observed to determine the therapeutic effect of lymphangiography, and 8 patients (50%) recovered without further embolization. In 16 patients, including 11 who underwent immediate embolization after lymphangiography and 5 who underwent delayed embolization, a total of 28 embolizations (12 lymphopseudoaneurysms, 14 lymph nodes, and 2 lymphatic vessels) were performed. The technical and clinical success rates of the adjunctive embolizations were 89% (25 of 28) and 94% (15 of 16), respectively. The overall clinical success rate was 85% (23 of 27). The median time from initial lymphangiography to recovery was 5 days. No procedure-related major complications were reported. Conclusions Lipiodol lymphangiography and adjunctive glue embolization techniques appear safe and provide promising efficacy for the management of postoperative lymphatic leakage. more...

Purpose To evaluate the effectiveness and safety of performing radiofrequency ablation (RFA) using the moving tip technique to treat venous malformations (VMs) in the head and neck. Methods Ten patients (male:female ratio, 2:8; median age, 38 years; age range, 27-59 years) prospectively underwent RFA using the moving tip technique as the first treatment. Improvement of their clinical symptoms, volume reduction of the treated VMs as determined by ultrasound (US) or magnetic resonance imaging (MRI), and any patient complications were evaluated at 1, 3, 6, and 12 months after RFA. Results All patients underwent follow-up examinations 12 months after RFA. The following criteria were used to evaluate these patients: (1) symptomatic VMs were diagnosed by US, MRI, and the patients’ clinical history; (2) superficially located VMs were evaluated using a linear 12-MHz US probe to determine the tumor volume; and (3) localized and limited VMs were evaluated using the Hamburg classification. The mean symptom score of the 10-cm visual analog scale and the mean volume reduction of the VMs as measured by MRI at the 6-month follow-up examination were significantly decreased from 8.0 (range, 7.0-9.0) to 2.0 (range, 1.0-3.0) and from 18.8 (range, 8.3-28.2) cm 3 to 8.5 (range, 4.2-14.1) cm 3 , respectively ( P Conclusions RFA using the moving tip technique is an effective and safe method for treating localized VMs in the head and neck. more...

Patients with hepatocellular carcinoma (HCC) that is refractory to repeated transarterial chemoembolization (TACE) are considered for systemic therapy, but TACE refractoriness is not well defined. The aim of this study was to determine the characteristics of patients whose HCC is refractory to repetitive TACE.We evaluated 264 patients with intermediate-stage HCC who underwent TACE between January 2006 and September 2009. We designated the development of vascular invasion or extrahepatic spread during follow up as "stage progression" (SP), and hypothesized that SP might be the surrogate end-point for TACE refractoriness.The median follow up was 18.2 months, and median number of TACE was 3.0 (range, 1-13). Median time-to-progression was 5.5 months (95% confidence interval, 4.8-6.2), and median overall survival was 25.3 months (95% confidence interval, 21.6-29.0). We classified the patients according to disease course as: no progressive disease (PD(-); n = 33); PD without SP (PD(+)SP(-); n = 113); PD followed by SP (PD→SP; n = 47); and simultaneous PD and SP (PDSP; n = 64). PD(-) and PD(+)SP(-) groups showed no difference in overall survival, PD→SP group had worse overall survival than PD(-) and PD(+)SP(-) groups, and PDSP group had the worst overall survival. The significant prognostic factors for SP-free survival were development of PD and need for three sessions of TACE during the first 6 months.SP-free survival can be regarded as an end-point for TACE refractoriness. Development of progression or need for three sessions of TACE within the first 6 months could be predictive of TACE refractoriness. more...

Although sorafenib is recommended for patients with advanced hepatocellular carcinoma (HCC), a substantial portion of HCC patients in Asia are still treated with other treatments, mainly due to the prohibitive cost of sorafenib. We aimed to evaluate the clinical outcome of patients treated with sorafenib and those treated with other modalities in a single-center cohort.We reviewed the medical records of two groups of consecutive patients with advanced HCC, according to applied treatment modalities, between January 2007 and September 2009 as follows: patients who received sorafenib for 6 weeks or more (n=123) and patients who were treated with one or more of other treatments, including transarterial chemoembolization, radiation, and cytotoxic chemotherapy (n=253).Overall survival did not differ significantly between these two groups (8.4 vs 8.2 months; P=0.601). Significant prognostic factors were high α-fetoprotein (≥200 ng/mL), massive/infiltrative intrahepatic tumors, macrovascular invasion, extrahepatic spread, and higher tumor-node-metastasis stage. Subgroup analysis, according to these factors, showed that sorafenib resulted in superior survival in patients with extrahepatic spread (hazard ratio [HR]=0.539; P=0.003) and massive/infiltrative tumors (HR=0.680; P=0.036). In the absence of each prognostic factor, other treatments were better than sorafenib.Considering the survival benefit for sorafenib over other treatments in patients with extrahepatic spread and massive/infiltrative intrahepatic tumors, these characteristics might be regarded as compelling indications for sorafenib. more...

The authors present a case of histologically proven bronchus-associated lymphoid tissue (BALT) lymphoma of the lung in a patient with primary Sjogren's syndrome that manifested on thin-section CT scan as a mosaic pattern of inhomogeneous attenuation due to mixed small airway and infiltrative abnormalities more...

JVIR 2000; 11:902–904 THE majority of patients with malignant esophageal obstruction are incurable by surgical means at presentation (1). Many different methods of palliation have been attempted, including surgery, radiation therapy, chemotherapy, laser therapy, and combinations of these. Although complications of stent placement occur in as many as 25% of patients (2), selfexpandable metallic stents have an established place in the management of inoperable esophageal carcinoma (2–6). The common complications are chest pain, stent migration, reflux, blockage, and severe hemorrhage (4). However, perforation of the small bowel by a migrated esophageal stent is extremely rare, with only one case reported, to our knowledge (7). We have recently encountered a patient who developed duodenal perforation caused by a modified Gianturco stent (Song stent; Sooho Medi-Tec, Seoul, Korea). Migration of the stent into the duodenum resulted in intraperitoneal duodenal perforation. more...

To compare the efficiency of radiofrequency ablation (RFA) using the newly designed flexible laparoscopic radiofrequency electrode and the internally cooled needle electrode for creating an ablation zone in ex vivo and in vivo porcine livers.In the ex vivo ablation zone, 40 ablation areas were created using the flexible electrode (group A, n=5) and the needle electrode of the Cool-tip RF system (group B, n=5). These were done in an excised porcine liver with a 200 W generator. In each group, ablation durations were 3, 6, 9, and 12 min, respectively. The volume was compared in each group. In the in vivo ablation zone, under laparoscopy, we divided the surface of the porcine liver into four areas: anterior, cranial, right lateral, and caudal. At each area, a couple of RFA using the flexible and needle electrodes with 6 min ablation duration was performed, respectively, in line with 3 cm intervals in five porcine livers. A flexible electrode was administered in the peritoneal cavity via a laparoscopic cannula, and a needle electrode was administered via a transcutaneous route, which avoided a pulmonary injury. The volumes and shapes of the ablation zones in each group and area were compared in the excised liver.In the ex vivo experiments, the ablation volumes using the flexible and needle electrodes with 3, 6, 9, and 12 min ablation duration were 3.19±0.41 cm(3), 6.36±0.48 cm(3), 7.66±0.51 cm(3), 8.72±0.78 cm(3) (Group A) and 3.40±0.35 cm(3), 6.83±0.66 cm(3), 7.79±0.56 cm(3), 8.85±0.54 cm(3) (Group B). There was no statistical significance among all the ablated volumes in each group at the same duration. In the in vivo experiment, the differences in the short diameter and the volume of ablated zones in the caudal and right lateral areas were statistically significant (P0.05). In the cranial, right lateral, and caudal areas, the shape of the ablated zone using the needle electrode was elliptical. However, the ablated zone using the flexible electrode was spherical. The difference of the long and short diameter ratio in the cranial and right lateral areas was statistically significant (P0.05).The newly designed flexible laparoscopic RF electrode shows similar efficacies compared with the needle electrode in the ex vivo study. However, it shows superiority in efficacy and predictability with the increased volume and predictable shape of coagulation necrosis at the laparoscopic RFA in the porcine liver. more...

This study was designed to develop a preoperative predictor model using multidetector CT (MDCT) imaging findings for the prediction of surgical outcome in patients with advanced epithelial ovarian cancer (EOC). Seventy-seven patients with advanced EOC who had preoperative MDCT and who had undergone primary cytoreductive surgery between January 1999 and June 2008 were enrolled in the study. All MDCT examinations were analysed retrospectively, assessing nine imaging features without knowledge of the operative findings. The complete debulking rate and optimal debulking rate were 42.5% and 93.2%, respectively. Based on the use of univariate and multivariate analysis, one imaging feature that showed the presence of upper abdominal ascites was significantly associated with incomplete tumour resection (P = 0.019 on univariate analysis, P = 0.04 on multivariate analysis). The combination of the MDCT findings that showed the presence of upper abdominal ascites and diffuse subdiaphragmatic peritoneal nodularity was associated with an incomplete resection of a tumour (P = 0.04; specificity 80.0%; positive predictive value 76.9%). It is important that emphasis on the upper abdominal sites of the tumour is helpful when reporting preoperative MDCT results. more...

We prospectively investigated the association between a change of serum vascular endothelial growth factor (VEGF) level after transcatheter arterial chemoembolization (TACE) and hepatocellular carcinoma (HCC) patient prognosis. The study involved 147 patients with unresectable HCC treated at the National Cancer Center, Korea, between July and December 2005. Serum samples were collected from each patient before TACE, and 1-2 days and 1 month after TACE. Serum VEGF concentrations were measured using an enzyme-linked immunosorbent assay (ELISA). The log(e)(VEGF/platelets) increased transiently 1-2 days after TACE and declined thereafter. Frequency of previous TACE did not correlate with log(e)(VEGF/platelets). This study found that log(e)(VEGF/platelets) 1-2 days after TACE, but not log(e)(VEGF/platelets) at baseline, was strongly correlated with vascular or nodal invasion and AJCC (American Joint Committee on Cancer)/UICC (International Union Against Cancer) stage, and was significantly greater in men. Relative changes in serum VEGF/platelet levels 1-2 days after TACE (DeltaVEGF)0.5 were directly correlated with tumor size, vascular invasion and modified UICC and AJCC/UICC stage (P0.05 for each). Additionally, DeltaVEGF0.5 was significantly correlated with newly developed extrahepatic metastases one and six months after TACE (P = 0.005 and 0.003, respectively). Progression free survival of patients with DeltaVEGF0.5 was significantly worse (P0.001) and DeltaVEGF0.5 was an independent prognostic factor for PFS (hazard ratio, 3.111; P0.001). This study showed that a high increment in serum VEGF level 1-2 days after TACE in HCC patients was associated with distant metastasis and unfavorable outcomes. more...

Extrahepatic metastasis in patients with hepatocellular carcinoma (HCC) occurs frequently. The most common site of metastasis is the lung, followed by regional lymph nodes and bones. However, gastrointestinal metastasis of HCC is a rare condition and solitary polypoid metastatic lesion on stomach without any evidence of direct invasion from primary mass is very rare. These metastatic lesions are usually asymptomatic, and most are discovered at postmortem examination or are found incidentally during laparotomy. The choice of treatment for gastrointestinal metastatic lesion of HCC includes surgery, transarterial chemoembolization, and local injection but the treatment is often difficult and unsuccessful. We report a case of 69 years old man who presented disappearance of a polypoid metastatic lesion of HCC on the gastric fundus by transarterial chemoembolization. more...

To identify the dose-volumetric parameters associated with the risk of radiation-induced hepatic toxicity (RIHT) in hepatocellular carcinoma patients treated with three-dimensional conformal radiotherapy.A total of 105 hepatocellular carcinoma patients underwent three-dimensional conformal radiotherapy (total dose range, 44-58.5 Gy; median, 54). RIHT was scored within 4 months of completing three-dimensional conformal radiotherapy. The dose-volume parameters analyzed were the gross tumor volume; normal liver volume; total liver volume; radiation dose; mean dose to the normal liver; percentage of the normal liver volume receivingor =20,or =25,or =30,or =35, andor =40 Gy; percentage of the total liver volume receivingor =20,or =25,or =30,or =35, andor =40 Gy; and the normal tissue complication probability.Of the 105 patients, Grade 1 RIHT was observed in 21 (20.0%), Grade 2 in 7 (6.7%), Grade 3 in 5 (4.8%), and Grade 4 in 1 (1.0%) patient. No fatal Grade 5 RIHT developed. On multivariate analysis for predicting Grade 2 or worse RIHT, the total liver volume receivingor =30 Gy was the only significant parameter (p0.001). Grade 2 or worse RIHT was observed in only 2 (2.4%) of 85 patients with a total liver volume receiving 30 Gy ofor =60% and in 11 (55.0%) of 20 patients with60% (p0.001).The total liver volume receivingor =30 Gy appears to be a useful dose-volumetric parameter for predicting the risk of RIHT. This volume should be limited toor =60% whenever possible to minimize the risk of Grade 2 or worse RIHT. more...

Objective: To evaluate the utility and advantages of the coaxial snare technique in the retrieval of tubular foreign bodies. Materials and Methods: Using the coaxial snare technique, we attempted to retrieve tubular foreign bodies present in seven patients. The bodies were either stents which were malpositioned or had migrated from their correct position in the vascular system (n=2), a fragmented venous introducer sheath (n=1), fragmented drainage catheters in the biliary tree (n=2), or fractured external drainage catheters in the urinary tract (n=2). After passing a guidewire and/or a dilator through the lumina of these foreign bodies, we introduced a loop snare over the guidewire or dilator, thus capturing and retrieving them. Results: In all cases, it was possible to retrieve or reposition the various items, using a minimum-sized introducer sheath or a tract. No folding was involved. In no case were surgical procedures required, and no complications were encountered. Conclusion: The coaxial snare technique, an application of the loop snare technique, is a useful and safe method for the retrieval of tubular foreign bodies, and one which involves minimal injury to the patient. more...