Left Hepatic Artery Pseudoaneurysm Caused by Acute Pancreatitis.

OBJECTIVE: The aim of this work was to report a case of left hepatic artery pseudoaneurysm due to acute pancreatitis following endoscopic papillectomy. CLINICAL PRESENTATION AND INTERVENTION: A 74-year-old female with an ampullary adenoma underwent papillectomy, which was complicated by acute pancreatitis. Computed tomography showed aneurysmal dilatation of the proximal left hepatic artery. An angiography with coli embolization was performed and was successful. The patient was doing well at the 1-year follow-up. CONCLUSION: This patient with left hepatic artery pseudoaneurysm following severe acute pancreatitis was successfully treated with coil embolization.

Suprapapillary versus transpapillary stent placement for malignant biliary obstruction: which is better?

PURPOSE: To compare the complications, stent patency, and patient survival with self-expandable metal stents (SEMSs) placed above or across the sphincter of Oddi in malignant biliary obstruction. MATERIALS AND METHODS: From January 2008 to December 2012, 155 patients were treated with percutaneous transhepatic SEMS placement. Seventy-four patients underwent suprapapillary stent placement (group A), and 81 patients underwent transpapillary stent placement (group B). Complications rates, stent patency, and patient survival were evaluated and analyzed for potential predictors. RESULTS: In group A, 68 covered and 28 uncovered SEMSs were placed, and, in group B, 78 covered and 19 uncovered SEMSs were placed. Thirty-six stent-related early complications were observed in a total of 154 patients (23.4%): pancreatitis (n = 23), cholangitis (n = 12), and cholecystitis (n = 1). The early complication rates for groups A and B were 14.9% (11 of 74) and 31.3% (25 of 80), respectively (P = .016). Pancreatitis occurred in three patients (4.1%) in group A and 20 patients (25.0%) in group B (P = .001). Stent location was a single independent predictor of pancreatitis (P < .001). Stent occlusions by tumor growth was more frequently observed in group A than in group B (P = .007), whereas stent occlusion by sludge incrustation was more frequently found in group B than in group A (P = .007). There was no significant difference in cumulative stent patency (P = .401) or patient survival (P = .792) between groups. CONCLUSIONS: To decrease the incidence of pancreatitis, suprapapillary placement of SEMSs is recommended for malignant biliary obstruction, but not in the lower 2 cm of the common bile duct.

Levoatriocardinal Vein Combined with Pulmonary Venous Varix Mimicking Arteriovenous Malformations: A Case Report.

The levoatriocardinal vein is an uncommon pulmonary venous abnormality that connects the left atrium or pulmonary vein with the systemic vein. It is distinct from partial anomalous pulmonary venous return in that the former forms a connection with the left atrium through the normal pulmonary vein whereas the latter involves pulmonary venous drainage to the systemic vein. Herein, we describe a case of the levoatriocardinal vein initially misdiagnosed as a pulmonary arteriovenous malformation using chest radiography and chest CT. The levoatriocardinal vein combined with pulmonary venous varix was confirmed using pulmonary angiography. To the best of our knowledge, this unusual coexistence of the levoatriocardinal vein and pulmonary venous varix has not been reported in English literature.

Hepatoprotective effect of a novel lactic acid-fermented garlic extract functional food product against acute liver injury.

Lactic acid-fermented garlic extract (LAFGE) has been shown to have hepatoprotective role in liver diseases. This study was conducted to evaluate the efficacy of a new LAFGE-based hepatoprotective functional food product (named D-18-007) formulated with other additive components, including l-arginine, l-ornithine, and the leaf extract of licorice and artichoke. In a rat model of d-galactosamine(GalN)/LPS-induced liver injury, the survival was significantly higher in animals treated with D-18-007 than in animals treated with LAFGE. The hepatic injury was alleviated by either LAFGE or D-18-007, but the overall effect was more significant in D-18-007, as shown by the necrosis, histology, and serum analyses. Also, the decrease in GalN/LPS-induced lipid peroxidation in the liver tissue was more significant in D-18-007 than LAFGE. The decrease in IL-6 protein in the liver was similar between LAFGE and D-18-007. Moreover, we compared the amount of the bile in normal animals and found that D-18-007 has better choleretic activity than LAFGE. Using this acute liver injury model, our results suggest that D-18-007 has an enhanced hepatoprotective effect in acute liver injury compared with LAFGE alone.

Therapeutic potential of stem cell-derived extracellular vesicles in osteoarthritis: preclinical study findings.

Extracellular vesicles (EVs) are nano-sized particles secreted by almost all cell types, and they mediate various biological processes via cell-to-cell communication. Compared with parental cells for therapeutic purposes, stem cell-derived EVs have several advantages such as reduced risk of rejection, less oncogenic potential, ease of long-term storage, lower chance of thromboembolism, and readiness for immediate use. Recent studies have demonstrated that EVs from stem cells, mostly from mesenchymal stem cells (MSCs) from various tissues, have anti-inflammatory, anti-oxidative, anti-apoptotic, and proliferative role in injured organs including osteoarthritic lesions. Herein, we provide a review about the up-to-date studies in preclinical application of stem cell-derived EVs in osteoarthritis animal arthritis models.

Effect of Hybrid Kernel and Iterative Reconstruction on Objective and Subjective Analysis of Lung Nodule Calcification in Low-Dose Chest CT.

Objective: To evaluate the differences in subjective calcification detection rates and objective calcium volumes in lung nodules according to different reconstruction methods using hybrid kernel (FC13-H) and iterative reconstruction (IR). Materials and Methods: Overall, 35 patients with small (< 4 mm) calcified pulmonary nodules on chest CT were included. Raw data were reconstructed using filtered back projection (FBP) or IR algorithm (AIDR-3D; Canon Medical Systems Corporation), with three types of reconstruction kernel: conventional lung kernel (FC55), FC13-H and conventional soft tissue kernel (FC13). The calcium volumes of pulmonary nodules were quantified using the modified Agatston scoring method. Two radiologists independently interpreted the role of each nodule calcification on the six types of reconstructed images (FC55/FBP, FC55/AIDR-3D, FC13-H/FBP, FC13-H/AIDR-3D, FC13/FBP, and FC13/AIDR-3D). Results: Seventy-eight calcified nodules detected on FC55/FBP images were regarded as reference standards. The calcium detection rates of FC55/AIDR-3D, FC13-H/FBP, FC13-H/AIDR-3D, FC13/FBP, and FC13/AIDR-3D protocols were 80.7%, 15.4%, 6.4%, 52.6%, and 28.2%, respectively, and FC13-H/AIDR-3D showed the smallest calcium detection rate. The calcium volume varied significantly with reconstruction protocols and FC13/AIDR-3D showed the smallest calcium volume (0.04 ± 0.22 mm3), followed by FC13-H/AIDR-3D. Conclusion: Hybrid kernel and IR influence subjective detection and objective measurement of calcium in lung nodules, particularly when both techniques (FC13-H/AIDR-3D) are combined.

Risk factors of delayed diagnosis of acute appendicitis in children: for early detection of acute appendicitis.

PURPOSE: This study examined the risk factors of a delayed diagnosis of acute appendicitis in children undergoing an appendectomy. METHODS: This retrospective study involved children aged below 18 years, who underwent an appendectomy. After dividing them into a delayed diagnosis group and nondelayed diagnosis group according to the time interval between the initial hospital visit and final diagnosis, the risk factors of delayed diagnosis were identified using logistic regression analysis. RESULTS: Among 712 patients, 105 patients (14.7%) were classified in the delayed diagnosis group; 92 patients (12.9%) were diagnosed using ultrasonography (US), and both US and computed tomography were performed in 38 patients (5.3%). More patients in the delayed diagnosis group underwent US (P=0.03). Spring season and prior local clinic visit were significantly associated with a delayed diagnosis. Fever and diarrhea were more common in the delayed diagnosis group (fever: odds ratio [OR], 1.37; 95% confidence interval [CI], 1.05-1.81; diarrhea: OR, 1.94; 95% CI, 1.08-3.46; P<0.05). These patients showed symptoms for a longer duration (OR, 2.59; 95% CI, 1.78-3.78; P<0.05), and the admission course (OR, 1.26; 95% CI, 1.11-1.44; P<0.05) and C-reactive protein (CRP) levels (OR, 1.47; 95% CI, 1.19-1.82; P<0.05) were associated with the delayed diagnosis. CONCLUSION: To decrease the rate of delayed diagnoses of acute appendicitis, symptoms such as fever and diarrhea, seasonal variations, admission course, and CRP levels should be considered and children with a longer duration of symptoms should be closely monitored.

Failed inferior vena cava filter retrieval by conventional method: Analysis of its causes and retrieval of it by modified double-loop technique.

OBJECTIVES: To evaluate the complications of the temporary implanted inferior vena cava (IVC) filter and the feasibility of double-loop technique for removal of complicated IVC filters. METHODS: From January 2012 to December 2013, a total of 25 patients with IVC filter were referred for IVC filter retrieval. There were 20 Celect®, 3 OptEase®, and 2 Günther-Tulip® filters. All of the patients were evaluated with a pre-procedural CT scan to identify any complications. The IVC filters which had failed to be retrieved by the conventional method were evaluated, and retrieval was attempted with double loop technique. RESULTS: Sixteen of 25 (64%) filters had complications; IVC wall penetration (n = 11, 44%), tilted within IVC (n = 6, 24%), embedded struts (n = 3, 12%), and fracture of the strut (n = 1, 4%). The complications were overlapped in five patients. Two of them (8%) had also complained of filter-related pain. The success rate of IVC filter retrieval by double-loop technique was 14/16 (87.5%). There was no major filter retrieval-related complications. CONCLUSIONS: The double-loop technique is a safe and feasible method for complicated IVC filter retrieval.