Percutaneous placement of a retrievable fully covered metal stent with anchoring flaps for the treatment of biliary anastomotic stricture following LDLT.

To investigate the outcomes following percutaneous placement of a retrievable fully covered self-expanding metal stent (fcSEMS) with anchoring flaps at proximal and distal ends for the treatment of biliary anastomotic strictures following living-donor liver transplantation (LDLT). We retrospectively reviewed the medical records of nine patients who underwent this procedure at our centre between April 2020 and March 2021. Percutaneous stent placement was technically successful in 100% patients, and all stents were successfully retrieved. No proximal or distal stent migration or occlusion was observed during the mean (±SD) stent indwelling period of 191(± 77) days. Clinical success was 89%. There was one major bleeding complication related to the biliary approach and one minor stent-related complication of calculus/sludge. During the mean (±SD) follow-up period of 595 ± 207 days after stent retrieval, only one patient developed recurrent clinical biliary stricture and symptoms. Percutaneous placement of a retrievable fcSEMS with anchoring flaps is safe and feasible for the treatment of biliary anastomotic strictures following LDLT.

Clinical Outcomes of Transarterial Embolization for Chronic Achilles Tendinopathy Refractory to Conservative Treatment: A Pilot Study.

PURPOSE: To evaluate the effectiveness and safety of transarterial embolization (TAE) for chronic Achilles tendinopathy (AT) refractory to conservative treatment. MATERIALS AND METHODS: This retrospective study included 20 patients (12 men and 8 women; mean age, 30.3 years) who received TAE using imipenem/cilastatin sodium for refractory chronic AT from May 2019 to April 2021. Nine patients had bilateral involvement. A total of 29 procedures were performed (8 for nonathletes and 21 for athletes). If feasible, embolization was performed superselectively of the arterial branch demonstrating hypervascularity, early venous drainage, and/or supplying the pain site noted using a radiopaque marker. The visual analog scale (VAS, 0-10) score was used to assess pain symptoms at baseline and during the follow-up period (1 day; 1 week; 1, 3, and 6 months; and open period). Clinical success was defined as a decrease of >50% in the VAS score at 6 months when compared with baseline. RESULTS: In 25 (86.2%) of 29 procedures, clinical success was achieved. Significant decreases in the VAS scores were noted at 1 day, 1 week, 1 month, 3 months, and 6 months (6.86 at the baseline vs 3.48, 3.41, 3.10, 2.55, and 1.62, respectively; all P < .01). For patients available for the 12- and 24-month follow-ups (n = 19 and 6, respectively), the mean VAS scores significantly decreased (6.84 vs 2.00 and 7.33 vs 1.17, respectively; all P < .01). No serious adverse events were observed during follow-up. CONCLUSIONS: TAE may alleviate pain for patients with chronic AT refractory to the conservative treatment with a low risk of adverse events.

Diagnostic performance of dual-energy computed tomography for HCC after transarterial chemoembolization: Utility of virtual unenhanced and low keV virtual monochromatic images.

The purpose of this study is to evaluate the usefulness of virtual unenhanced (VUE) and low keV virtual monochromatic images (VMI) for diagnosing viable hepatocellular carcinomas (HCC) after transarterial chemoembolization (TACE). This retrospective study included 53 patients with suspected viable HCC after TACE who underwent multiphasic liver computed tomography including true unenhanced (TUE) phase and conventional (CV) enhanced phases on a dual-energy scanner. VUE images, 40 keV and 55 keV VMIs of enhanced phases were reconstructed using dual-energy computed tomography data. For every patient, six combination image sets (TUE-CV; TUE-55; TUE-40; VUE-CV; VUE-55; VUE-40) were evaluated by two readers and compared with the reference standard.There was no statistically significant difference (P > .05) in sensitivity or specificity among all image combinations. In most combinations, interobserver agreements were almost perfect. The diagnostic odds ratio showed a higher trend in combinations with conventional images. Currently, with regards to diagnostic performance, liver computed tomography including TUE and CV enhanced phases is recommended for tumor surveillance after TACE because VUE and VMIs do not have a distinct advantage compared to conventional images.

Treatment failure after rotational atherectomy and balloon angioplasty in recurrent cystic adventitial disease of the popliteal artery: a case report.

Cystic adventitial disease (CAD), which usually affects the popliteal artery, is a rare vascular condition in which fluid accumulates in the sub-adventitial layer, compressing the lumen. Historically, surgical treatment is preferred over endovascular or minimally invasive techniques, due to its lower recurrence rates. Here, the case of a 67-year-old male patient, in whom rotational atherectomy was performed for recurrent CAD following surgical cyst excision and patch angioplasty is reported. The patient's symptoms recurred one day after the rotational atherectomy procedure and repeat computed tomography angiography showed recurrence of the disease. Due to gradual worsening of the condition during 8 months of follow-up, left distal femoral artery to popliteal artery (below-the-knee) bypass surgery was performed using an ipsilateral reversed great saphenous vein graft. Follow-up has continued for 2 years without complications or requirement of additional treatment. This novel case is the first report of atherectomy attempted for recurrent CAD that led to an early recurrence. Our experience emphasises that additional surgical approaches should be selected over endovascular procedures for treating recurrent CAD.

Percutaneous cholecystostomy for acute cholecystitis after stent insertion in patients with malignant biliary obstruction: clinical outcomes of 107 patients.

BACKGROUND: The outcome of percutaneous cholecystostomy (PC) in malignant patients with acute cholecystitis (AC) after biliary stent insertion has not been investigated in a large group. PURPOSE: To evaluate the clinical outcomes of PC for AC after stent insertion in patients with malignant biliary obstruction. MATERIAL AND METHODS: From April 2007 to February 2019, 107 patients (57 men, 52 women; mean age = 67.5 years; age range = 27-93 years) who had undergone PC for AC after biliary stent insertion were retrospectively evaluated. Of the 107 patients, 86 underwent biliary stent insertion by the endoscopic approach and the remaining 21 patients by the percutaneous approach. All patients were classified into three groups: those with stent-induced AC; those with cancer-induced AC; and those with AC without mechanical cause (biliary stent, GB stone, or cancer invasion). The mean survival time, recurrence rate, symptom improvement, and cystic duct patency in each patient group were analyzed. RESULTS: Stent-induced AC (n = 40, 37.4%) developed with a mean onset time of six days (range = 0-14 days), AC without mechanical cause (n = 27, 25.2%), 87 days (range = 15-273 days), and cancer-induced AC (n = 40, 37.4%), 137 days (range = 15-447 days) after stent insertion. Symptom resolution and significant improvement in laboratory test values were achieved in 95 patients (88.8%) within four days after PC. CONCLUSION: PC is a technically safe and effective method for the treatment of AC after biliary stent insertion in patients with malignant biliary obstruction.

Synthesis and Surface Coating of LiMn2O4 Nanorods for the Cathode of the Lithium-Ion Battery.

MnO2 nanorods are prepared using a hydrothermal method, and used as precursors for the synthesis of LiMn2O4 nanorod-based active material for the cathode of lithium-ion batteries. The effects of additives, pressure, reactant concentration in the solution, and reaction time during the hydrothermal synthesis on the morphology of MnO2 are examined. For the synthesis of the LiMn2O4 nanorods, two synthetic methods, hydrothermal processing of the MnO2 precursor in a Li-containing solution, and the solid-state reaction of the precursor with LiOH·H2O powder are tested. The morphological and electrochemical properties of the resulting materials are then analyzed. The rate and cycle performances of the LiMn2O4 nanorods are considerably improved by a composite coating of Li-ion-conductive Li2O-2B2O3 and electrically conductive carbon. Because the conductive properties of these coating materials can be obtained with low crystallinity of them, superior coating performance is attainable with relatively low-temperature of after heating, which is advantageous in preserving the morphology of LiMn2O4 nanorods.

Usefulness of Cone-Beam CT-Based Liver Perfusion Mapping for Evaluating the Response of Hepatocellular Carcinoma to Conventional Transarterial Chemoembolization.

We investigated the cone beam computed tomography (CBCT)-based-liver-perfusion-mapping usefulness during transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) to access treatment response and predict outcomes. From October 2016 to September 2018, 42 patients with HCCs scheduled for conventional TACE were prospectively enrolled. Three reviewers evaluated the unenhanced and contrast-enhanced CBCT and CBCT-based-liver-perfusion-mapping of each tumor. Parenchymal blood volume (PBV) was measured. The operator's judgment on the technical results was recorded. Response outcome was determined on follow-up CT or magnetic resonance imaging, according to the modified Response Evaluation Criteria in Solid Tumors. Diagnostic performance for detection of a viable tumor was evaluated using multiple logistic regression with C-statistics. CBCT-based-liver-perfusion-mapping and the maximum PBV of the tumor were significant in multiple logistic regression analysis of response (p < 0.0001, p = 0.0448, respectively), with C-statistics of 0.9540 and 0.7484, respectively. Diagnostic accuracy of operator's judgment was 79.66% (95%CI 69.39%-89.93%). Diagnostic performance of CBCT-based-liver-perfusion-mapping showed a high concordance in three reviewers. The mean PBV of tumor, maximum PBV of tumor, and mean PBV of liver significantly decreased after TACE (each p < 0.001). In ROC curve analysis, the AUC for prediction of residual tumor by the maximum PBV of tumor after TACE was 0.7523, with 80.8% sensitivity and 60.6% specificity.

Ultrasonographic features of uterine cervical lesions.

Currently, ultrasound (US) is a valuable imaging tool for the initial assessment and evaluation of the female genital organs, uterus, and adnexa. However, it is easy to overlook the uterine cervix while conducting a pelvic US. Uterine cervical lesions may range from benign to malignant in nature. Therefore, meticulous examination with US may play a key role in assessing uterine cervical lesions. Although there is substantial overlap in the US findings across various uterine cervical lesions, some US features, in tandem with clinical characteristics, may suggest a specific diagnosis. Familiarity with the clinical settings and US characteristics of different uterine cervical lesions can support prompt and accurate diagnosis of suspicious lesions. This review article aims to describe the features of US and possible values for distinction of these lesions in the uterine cervix.

Transcatheter arterial embolisation for acute lower gastrointestinal haemorrhage: a single-centre study.

OBJECTIVE: To investigate the safety and efficacy of transcatheter arterial embolisation (TAE) in the management of lower gastrointestinal bleeding (LGIB) and to identify predictors of clinical outcomes. METHODS: Between December 2005 and April 2017, 274 patients underwent diagnostic angiography for signs and symptoms of LGIB; 134 patients with positive angiographic findings were retrospectively analysed. The technical success of TAE and clinical outcomes, including recurrent bleeding, major complications, and in-hospital mortality were evaluated. The associations of various clinical and technical factors with clinical outcomes were analysed. Predictors for clinical outcomes were evaluated using univariate and multivariate logistic regression analyses. RESULTS: A total of 134 patients (mean age, 59.7 years; range, 14-82 years) underwent TAE for LGIB. The bleeding foci were in the small bowel in 74 patients (55.2%), colon in 35 (26.1%), and rectum in 25 (18.7%). Technical success was achieved in 127 patients (94.8%). The clinical success rate was 63% (80/127). The rates of recurrent bleeding, major complications, and in-hospital mortality were 27.9% (31/111), 18.5% (23/124), and 23.6% (33/127), respectively. Superselective embolisation and the use of N-butyl cyanoacrylate (NBCA) were significant prognostic factors associated with reduced recurrent bleeding (OR, 0.258; p = 0.004 for superselective embolisation, OR, 0.313; p = 0.01 for NBCA) and fewer major complications (OR, 0.087; p ˂ 0.001 for superselective embolisation, OR, 0.272; p = 0.007 for NBCA). CONCLUSIONS: TAE is an effective treatment modality for LGIB. Superselective embolisation is essential to reduce recurrent bleeding and avoid major complications. NBCA appears to be a preferred embolic agent. KEY POINTS: • Transcatheter arterial Embolisation (TAE) is a safe and effective treatment for lower gastrointestinal tract haemorrhage. • Superselective embolisation is essential to improve outcomes. • N-butyl cyanoacrylate (NBCA) appears to be a preferred embolic agent with better clinical outcomes.

Splenic embolization for a giant splenic hemangioma in a child: a case report.

BACKGROUND: Splenic hemangioma is the most common benign tumor of the spleen. However, it remains a rare medical condition in children. Although the natural course of splenic hemangioma is slow growth, treatment for large splenic hemangiomas has been recommended due to the risk of spontaneous rupture causing life-threating hemorrhage. However, the optimal treatment for splenic hemangioma in children is unclear. CASE PRESENTATION: An 11-year-old girl had an enhancing mass, 61 × 54 × 65 mm in size and numerous daughter nodules throughout the entire spleen on a contrast-enhanced computed tomography scan of the abdomen and angiography. The patient was treated by complete embolization at the distal level of splenic artery, which resulted in total splenic infarction. Treatment-related complications were thrombocytosis and postembolization syndrome, including abdominal pain and, intermittent fever below 39 °C. There were no other serious complications, including bleeding. CONCLUSION: Splenic embolization may be a safe and less invasive intervention for children with a large splenic hemangioma. Further studies are needed to confirm the effectiveness of our approach.

Uterine Artery Embolization for Pedunculated Subserosal Leiomyomas: Evidence of Safety and Efficacy.

PURPOSE: To evaluate safety and efficacy of uterine artery embolization (UAE) for pedunculated subserosal (PS) leiomyomas. MATERIALS AND METHODS: Of 1,069 patients who underwent UAE for symptomatic leiomyomas or adenomyosis from 2007 to 2016, 55 patients (mean age 40.3 y ± 4.8) with 66 PS leiomyomas (mean diameter 6.61 cm ± 2.04) were enrolled. Each PS leiomyoma was categorized into 1 of 2 groups: high-risk PS leiomyoma (stalk diameter < 25% of diameter of leiomyoma) and low-risk PS leiomyoma (stalk diameter 25%-50% of diameter of leiomyoma). MR imaging was performed 3 months after UAE. Rates of infarction and volume reduction were compared between PS leiomyomas and non-PS dominant leiomyomas and between high-risk and low-risk PS leiomyomas. Complications related to PS leiomyomas were assessed. RESULTS: At a median follow-up of 96 days (range, 36-348 d) after UAE, none of the patients (0%) had complications related to PS leiomyomas, even among high-risk cases. Mean volume reductions of 38.2% and 38.4% were achieved for PS leiomyomas and non-PS dominant leiomyomas, respectively (P = .953). There were 3 (5.5%) minor adverse events, but none were related to PS leiomyoma. There was no significant difference in volume reduction and infarction rates between low-risk and high-risk PS leiomyomas. CONCLUSIONS: UAE is safe and effective in patients with PS leiomyomas even for high-risk cases (stalk diameter < 25% of diameter of leiomyoma). PS leiomyoma should not be considered a contraindication for UAE.

Safety and Efficacy of Transarterial Radioembolization Combined with Chemoembolization for Bilobar Hepatocellular Carcinoma: A Single-Center Retrospective Study.

BACKGROUND: Radioembolization induced liver disease (REILD) is a possible sequela of transarterial radioembolization (TARE), particularly in cases of whole-liver treatment. To mitigate this problem, the safety and efficacy of combined transarterial chemoembolization (TACE) and TARE were evaluated for patients with bilobar hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Nineteen patients (mean age 60 years; range 27-82 years) treated for HCC between June 2012 and September 2014 were included in the analysis. Each patient was treated with combined TARE and TACE for bilobar HCC, with or without portal vein thrombosis. The hepatic lobe with large HCC was treated with TARE, and the other lobe with small HCC(s) was treated with TACE. Laboratory and clinical data were investigated to determine REILD occurrence. Survival data were analyzed to compare the treatment efficacy of alternative treatment modalities, including TACE and sequential TARE. RESULTS: All patients underwent TARE for a dominant tumor in one lobe and TACE for small nodule(s) in the other lobe of the liver. The mean yttrium-90 microspheres used in TARE were 2.8 GBq (range; 1.0-3.5 GBq), and the mean doses of doxorubicin and iodized oil were 24.5 mg and 5.2 mL, respectively, for TACE. No statistical differences were noted between laboratory data measured before and after treatment, and no procedure-related major clinical complications occurred. The median time-to-progression of patients was 10.0 months, and the median overall survival was 27.3 months. CONCLUSION: Combined radioembolization and chemoembolization appears to be a safe and effective treatment modality for bilobar HCC.

Safety and effectiveness of transarterial embolization for splenic artery hemorrhage in patients undergoing radical gastrectomy.

Background Perigastric lymph nodes are dissected during gastrectomy, potentially resulting in life-threatening postoperative bleeding. Purpose To evaluate the safety and effectiveness of transarterial embolization (TAE) for bleeding from the splenic artery in patients who underwent gastrectomy. Material and Methods Between January 2004 and December 2016, 14,523 patients underwent gastrectomy at our institution, and ten patients (nine men; mean age = 64.7 years; age range = 51-80 years) underwent TAE for postoperative bleeding from the splenic artery. The location of bleeding was classified as either: (i) the main splenic artery (MSA) or (ii) the parenchymal splenic artery (PSA). The clinical outcomes of TAE were explored. Results Bleeding occurred at a median of 13.5 days (range = 4-34 days) after gastrectomy. The onset of bleeding was late in all patients and clinically manifested as abdominal bleeding in seven patients and luminal bleeding in three patients. Technical and clinical success rates were 100% and 70%, respectively. The three major complications occurred only in patients with MSA bleeding, resulting in two 30-day mortality cases and one splenic abscess with fistula formation to the jejunum. The causes of death were infarctions in the spleen and/or remnant stomach and sepsis. Conclusion TAE seems to be effective in stabilizing patients with bleeding from the splenic artery. Moreover, TAE with curative intent may be performed for bleeding from the PSA; however, further resection of the remnant stomach and/or spleen seems to be required to avoid sepsis and mortality in case of bleeding from the MSA.

Randomized Controlled Trial Comparing Radiologic Pigtail-Retained Gastrostomy and Radiologic Mushroom-Retained Gastrostomy.

PURPOSE: To prospectively compare 2 different types of percutaneous fluoroscopic gastrostomy procedures (pigtail-retained gastrostomy [PG] vs mushroom-retained gastrostomy [MG]). MATERIALS AND METHODS: Between March 2014 and February 2016, 100 patients were randomly assigned to receive 14-F PG or 20-F MG. Block randomization (block size 4) was performed, and sample size was calculated to assess the difference in minor complications. One patient withdrew from the study after allocation. Baseline characteristics were not significantly different between groups (P > .05). Technical success, defined as successful placement of gastrostomy tube, and procedural complications were evaluated. Procedural complications were divided into major and minor complications according to the Society of Interventional Radiology criteria. RESULTS: Technical success rate was 100%. In the PG group, the major complication rate was 2% (1 of 50); 1 patient had a misplaced PG in the peritoneal cavity between the gastric and abdominal walls and developed peritonitis that had to be surgically treated. The minor complication rate was 34% (17 of 50) in the PG group. In the MG group, the major complication rate was 0%, and the minor complication rate was 12.2% (6 of 49). The most common minor complication was tube occlusion. Minor complication rate was significantly higher in the PG group (P = .016). Mean fluoroscopy time was significantly longer in the MG group (P = .013). CONCLUSIONS: Both PG and MG demonstrated high technical success rates in all indications. MG had lower complication rates than PG at the cost of an increase in fluoroscopy times.