PURPOSE: Percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) has some limitations such as poor sonic window and injury to adjacent organs. The laparoscopic approach has been suggested as an alternative option. The aim of this study was to show the safety and efficacy of laparoscopic RFA for single, small (≤3 cm), and primary or recurrent HCC that is not suitable for percutaneous RFA or surgical resection. METHODS: We reviewed the cases of 37 patients (32 men and 5 women, mean age 61 ± 8.1 years) who underwent laparoscopic RFA for single, small HCC (≤3 cm) that was unsuitable for percutaneous RFA or surgical resection. RESULTS: The technical success rate was 94.6% and 34 patients (95%) had no complications. There were no conversions to open RFA and no operative mortality. The primary effectiveness rate 1 month after the procedure was 100%. The overall recurrence rates at 3, 6, 12, and 24 months after the laparoscopic RFA were 8.1%, 14.4%, 25%, and 35.7%, respectively. The local tumor progression rate was 4.2% at 6 months and 8.7% at 9 months. CONCLUSION: Laparoscopic RFA is a safe and effective treatment for HCC cases that are unsuitable for percutaneous RFA.
Carcinoma, Hepatocellular* ; Catheter Ablation* ; Female ; Humans ; Laparoscopy ; Male ; Mortality ; Neoplasm Recurrence, Local ; Recurrence

PURPOSE: The purpose of this study was to investigate the effectiveness and safety of monitored anesthesia care (MAC) using dexmedetomidine for its sedative and analgesic effect during varicose vein surgery. METHODS: Forty-two patients, who underwent varicose vein surgery, were divided into the MAC group (n = 20) or the spinal anesthesia group (n = 22) for randomized clinical trial. In the MAC group, dexmedetomidine was administered by a loading dose of 1 microg/kg for 10 minutes, followed by a maintenance infusion of 0.2-1.0 microg/kg/hr. Ketamine was used for intermittent injection. In the spinal anesthesia group, midazolam was used for sedation. Intraoperative vital signs, the number of adverse events, and the satisfaction of patients and surgeons concerning the anesthetic condition were compared between the two groups. RESULTS: Systolic blood pressure was intraoperatively significantly different over time between the two groups. The groups had statistical differences in the change in heart rate with regard to time. In the postanesthetic care unit, patients and surgeons in the MAC group had a lower satisfaction score, compared to patients and surgeons in the spinal anesthesia group. However, in the recovery period, patients had a positive perception concerning MAC anesthesia. In addition, without significant adverse events, the MAC group had a shorter time to possible ambulation, which indicated an early recovery. CONCLUSION: We believe that MAC using dexmedetomidine in combination with ketamine may be an alternative anesthetic technique for varicose vein surgery with regard to a patient's preference and medical condition.
Anesthesia* ; Anesthesia, Spinal* ; Blood Pressure ; Dexmedetomidine* ; Heart Rate ; Humans ; Ketamine ; Midazolam ; Varicose Veins* ; Vital Signs ; Walking

PURPOSE: Radiofrequency ablation (RFA) has been used as an alternative to conventional high ligation and stripping surgery for the treatment of saphenous vein insufficiency. A Korean clinical registry was established in 2012. The purpose of our study is to report the clinical outcomes of RFA from the Korean RFA Registry. METHODS: Data were collected in a multicenter, retrospective registry. All patients were treated before March 31, 2013. The indication for RFA was clinical, etiology, anatomy, and pathophysiology (CEAP) clinical class C2-C6 and patients with disease-associated symptoms, complications, or cosmetic concerns. We retrospectively reviewed the clinical outcomes, such as CEAP score, venous clinical severity score (VCSS), and quality of life (QoL) score after RFA using ClosureFAST (Covidien) catheter. The paired and independent t-test using IBM SPSS ver. 19.0 (IBM Co.) was used for the statistical analysis to evaluate the clinical improvement after treatment. RESULTS: There were 698 patients (890 limbs) treated with RFA at 5 centers in Korea. The average age was 53.7+/-12.0 years (range, 19 to 89 years) with a body mass index of 23.1+/-2.8 kg/m2, 58.2% of the patients were female. All saphenous veins with reflux > or =0.5 seconds were ablated simultaneously. The most common complication was ecchymosis, which occurred in 41 patients (5.9%). All clinical parameters were significantly improved. At the mean follow-up of 13.9 months, the occlusion rate was 94.6% in great saphenous vein and 94.5% in small saphenous vein. CONCLUSION: RFA is an effective modality in the treatment of saphenous vein insufficiency. The clinical parameters including CEAP class, VCSS and QoL score showed significant improvement after RFA.
Body Mass Index ; Catheter Ablation ; Catheters ; Ecchymosis ; Female ; Follow-Up Studies ; Humans ; Korea ; Ligation ; Quality of Life ; Retrospective Studies ; Saphenous Vein ; Varicose Veins

Splenic metastasis from colon carcinoma are rare and usually occur in the presence of disseminated visceral metastasis. The liver is the most common site of metastatic spread from colon cancer. Several hypotheses have attempted to explain the low incidence of splenic metastasis. It should be difficult for colorectal cancer cells to reach the spleen through the portal venous system, in which the blood flow is usually from the spleen to the liver. Reticuloendothelial system or rhythmic contraction of the spleen may squeeze out the tumor in the spleen. The absence of afferent lymphatic to the spleen, phagocytic activity and humoral anticancer substances are considered to be other reason for low incidence of splenic metastasis. We report the case of 18F-FDG PET/CT finding in a 70-year-old woman who develop isolated splenic metastasis of sigmoid colon cancer.
Aged ; Colon ; Colon, Sigmoid* ; Colonic Neoplasms ; Colorectal Neoplasms ; Female ; Fluorodeoxyglucose F18* ; Humans ; Incidence ; Liver ; Mononuclear Phagocyte System ; Neoplasm Metastasis* ; Positron-Emission Tomography and Computed Tomography* ; Sigmoid Neoplasms* ; Spleen

POEMS syndrome is a rare disorder, also known as Crow-Fukase, PEP or Takatsuki syndrome. The acronym, POEMS, represents polyneuropathy, organomegaly, endocrinopathy, M protein and skin change. However, there are associated features not included in the acronym such as sclerotic bone lesions, Castleman disease, papilledema, thromobocytosis, peripheral edema, ascites, effusion, polycythemia, fatigue and clubbing. In most cases, osseous lesions in POEMS syndrome present as an isolated sclerotic deposit and that reveal as osteosclerotic myeloma. Several cases of 18F-FDG PET in multiple myeloma involvements were reported, but there was no previous literature that reported FDG PET findings in POEMS syndrome. We describe here a 66-year-old patient with POEMS syndrome who underwent 18F-FDG PET/CT image.
Aged ; Ascites ; Edema ; Fatigue ; Fluorodeoxyglucose F18* ; Giant Lymph Node Hyperplasia ; Humans ; Multiple Myeloma ; Papilledema ; POEMS Syndrome* ; Polycythemia ; Polyneuropathies ; Positron-Emission Tomography and Computed Tomography* ; Skin

BACKGROUND/AIMS: Although diagnosis and surgical treatment for distal common bile duct cancer have enormously advanced, survival is not satisfactory and its prognostic factors are still being debated. Thus, we evaluated the outcomes and prognostic factors after major resection for distal extrahepatic cholangiocarcinoma (dCC). METHODS: One hundred and fifty-four patients who underwent major resection such as pancreaticoduodenectomy for dCC were retrospectively analyzed. We investigated clinical features, postoperative complications, survival, and prognostic factors of dCC. CONCLUSIONS: One hundred and three (66.9%) male and 51 (33.1%) female patients were enrolled and their mean age was 59.6 (31-78) years. Among them, 97 patients (63.0%) underwent Whipple's procedure, 45 (29.2%) pylorus-preserving pancreaticoduodenectomy, 7 (4.5%) total pancreatectomy, and 5 (3.3%) hepatopancreaticoduodenectomy, respectively. Mean follow-up duration was 26.6 (0.4-108.5) months. The postoperative morbidity and mortality were 42.2% and 1.3%, respectively. Five-year survival rate was 32.8% and mean survival duration was 47.2 (39.1-55.3) months. Type of biliary drainage (percutaneous transhepatic biliary drainage), lymph node status (positive), and cellular differentiation (moderate or poor) were significant indicators for death in multivariate analysis of resectable dCC. CONCLUSIONS: Moderate or poor cellular differentiation and lymph node metastasis may be independent poor prognostic factors for resectable dCC.
Adult ; Aged ; Bile Duct Neoplasms/mortality/*surgery ; *Bile Ducts, Extrahepatic ; Biliary Tract Surgical Procedures ; Cholangiocarcinoma/mortality/*surgery ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Risk Factors ; Survival Rate

PURPOSE: The standard protocol using large volume of oral contrast media may cause gastrointestinal discomfort and contrast-related artifacts in PET/CT. The aim of this study was to evaluate the usefulness of low dose oral contrast in 18F-FDG PET/CT. MATERIALS AND METHODS: We retrospectively reviewed the whole-body PET/CT images in a total of 435 patients. About 200 ml of oral contrast agent (barium sulfate) was administered immediately before injection of 18F-FDG. The FDG uptake of intestines was analyzed by visual and semi-quantitative method on transaxial, coronal and saggital planes. RESULTS: Seventy (16%, 113 sites) of 435 images showed high FDG uptake (peak SUV > 4); 50 (74%, 84 sites) with diffuse and 20 (26%, 29 sites) with focal uptake. The most commonly delivered site of oral contrast media was small bowel (n=27, 39%). On PET/CT images, FDG uptake coexisted with oral contrast media in 26 patients (54%, 38 sites) with diffuse pattern and 9 (45%, 9 sites) with focal pattern, and by sites, those were 38 (45%) and 9 (31%), respectively. In small bowel regions, the proportion of coexistence reached as high as 61% (29/47 sites). A visual analysis of available non-attenuation corrected PET images of 27 matched regions revealed no contrast-related artifact. CONCLUSION: We concluded that the application of low dose contrast media could be helpful in the evaluation of abdominal uptake in the FDG PET/CT image.
Artifacts ; Contrast Media* ; Fluorodeoxyglucose F18* ; Humans ; Intestines ; Positron-Emission Tomography and Computed Tomography* ; Retrospective Studies

PURPOSE: Liver demonstrates heterogeneous FDG uptake and sometimes it shows abnormally increased uptake even though there is no malignant tissue. However, there was no previous study to correlate these various pattern of hepatic FDG uptake with benign liver disease. Therefore, we evaluated the significance of hepatic FDG uptake associated with various clinical factors including fatty liver, liver function tests and lipid profiles. MATERIALS AND METHODS: We reviewed a total of 188 patients (male/female: 120/68, mean age: 50+/-9) who underwent PET/CT for screening of malignancy. Patients with DM, impaired glucose tolerance, previous severe hepatic disease or long-term medication history were excluded. The FDG uptake in liver was analyzed semi-quantitatively using ROI on transaxial images (segment 8) and we compared mean standardized uptake value (SUV) between fatty liver and non-fatty liver group. We also evaluated the correlation between hepatic FDG uptake and various clinical factors including serum liver function test (ALT, AST), gamma-GT, total cholesterol and triglyceride concentration. The effect of alcoholic history and body mass index on hepatic FDG uptake was analyzed within the fatty liver patients. RESULTS: The hepatic FDG uptake of fatty liver group was significantly higher than that of non-fatty liver group. Serum total cholesterol and triglyceride concentration showed significant correlation with hepatic FDG uptake. However, there was no significant correlation between other factors (ALT, AST, and gamma-GT) and FDG uptake. Also there was no difference of mean SUV between normal and abnormal groups on the basis of alcoholic history and body mass index within fatty liver patients. Fatty liver and high serum triglyceride concentration were the independent factors affecting hepatic FDG uptake according to multivariate analysis. CONCLUSION: In conclusion, hepatic FDG uptake was strongly correlated with fatty liver and serum triglyceride concentration.
Alcoholics ; Body Mass Index ; Cholesterol ; Fatty Liver* ; Glucose ; Hepatitis ; Humans ; Liver ; Liver Diseases ; Liver Function Tests ; Mass Screening ; Multivariate Analysis ; Positron-Emission Tomography and Computed Tomography ; Triglycerides

The utilization of PET has been increased so fast since the usefulness of the PET has been proved in various clinical and research fields. Among the many applications, the PET is especially useful in oncology and most of the clinical PET scans are performed for the oncologic examination including the different diagnosis of malignant and benign tumors and assessment of the treatment effects and recurrent tumors. As the PET-CT scanners are widely available, there is increasing interest in the application of the PET images to the radiation treatment planning. Although the CT images are conventionally used for the target volume determination in the radiation treatment planning, there are fundamental limitation in use of only the anatomical information. Therefore, the volume determination of the functionally active tumor region using the PET would be important for the treatment planning. However, the accurate determination of the tumor boundary is not simple in PET due to the relatively low spatial resolution of the currently available PET scanners. In this study, computer simulations were performed to study the relationship between the lesion size, PET resolution, lesion to background ratio and the threshold of image intensity to determine the true tumor volume.
Computer Simulation* ; Diagnosis ; Positron-Emission Tomography ; Tumor Burden*

BACKGROUND: Patient controlled analgesia (PCA) is now a widely accepted method of postoperative pain control. It usually begins at postanesthetic care unit, but it takes time to achieve satisfactory level. We have studied the differences in the onset of analgesic effects between starting PCA preoperatively and starting PCA postoperatively. METHODS: Forty patients for subtotal gastrectomy were randomized to two groups. In group I, we started PCA at postanesthetic care unit, in group II, PCA was begun immediately after the induction of anesthesia. We visited each patient and measured 10 cm-visual analgue scale (VAS) score at 3, 6, 9, 12 and 15 hours after the end of operation. We also measured the time taken from the end of operation to extubation. RESULTS: There were no differences in VAS score between two groups on 3 hour. But at 6, 9, and 12 hour, VAS score was significantly lower in group II (P < 0.05). On 15 hour there was no difference between two groups again. There was no significant difference in extubation time between two groups. Preemptive analgesia was not observed in group II. CONCLUSIONS: We concluded that starting PCA immediately after induction of anesthesia can achieve effective analgesia more rapidly than starting PCA at postanesthetic care unit. VAS score was lower than 3 after 12 hours after the end of operation in group II and we speculated that starting PCA 15 hours prior to operation would maximize the analgesic effect of PCA because there was approximately three hours time difference between the two groups.
Analgesia ; Analgesia, Patient-Controlled* ; Anesthesia ; Gastrectomy ; Humans ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Visual Analog Scale