No abstract available.
Skin Neoplasms* ; Skin*

BACKGROUND/AIMS: Transjugular intrahepatic portosystemic shunt(TIPS) is a promising method of treatment for gastric and esophageall variceal bleeding. Immediate technical and short-term clinical results have been reportn!. This study is performed to evaluate long-term outcome after TIPS in patients who underwent the pracedure for variceal bleeding. METHODS: Forty patients who underwent TIPS hetween August 1991 and February 199S were followed up by clinical examination, upper gastrointestina! Endoscopy and Duplex sonogrphy. RESULTS: The mean portohepatic pressure gradient prior to TIPS was 30.1+/-8.7cmH ancl dropped to 16.6+/-6.7cmH2O after shunt(p<0.001). The cumulative survival rate was 67.5% at 6 months. 57.4% at 1 year, 37.1% at 2 years and 26.8% at 3 years. Survival after TIPS was inversely related to Child-Pugh class. The incidence of recurrent variceal bleeding was 25%. The causes of death were hepatic failure(53.6 %), recurrent variceal bleeding(28.6'%), sepsis(7.1 %) and unknown causes(10.7'%). CONCLUSION: TIPS is an effective method for treatment of variceal bleeding in unsuccessful cases by other treatments including endoscopic therapy and the most important prognostic factor is preprocedual hepatic resenre(Child-Pugh class), TIPS by itself is not defioite therapy, but in combination with careful follow-up surveillance and percutaneous shunt revision is very effective therapeutic strategy. TIPS is particularly valuable in tlreating patients with variceal bleeding hefor liver transplantation and in treating patients with poor liver function.
Cause of Death ; Endoscopy ; Esophageal and Gastric Varices ; Fibrinogen ; Follow-Up Studies* ; Hemorrhage* ; Humans ; Hypertension, Portal ; Incidence ; Liver ; Liver Transplantation ; Portasystemic Shunt, Surgical* ; Survival Rate

BACKGROUND: Intravascular ultrasound (IVUS) is one of the golden standards for the assessment of optimal angioplasty. Pressure-derived myocardial fractional flow reserve (FFRmyo) is a lesion-specific functional index of epicardial conduit and may be particularly useful for the assessment of optimal coronary angioplasty. The purpose of this study was to assess IVUS parameters and FFRmyo after successful angioplasty on coronary angiogram and compare them between balloon and stent group. METHODS: The study population consisted of 28 patients who underwent revascularization (14 cases of balloon angioplasty only, 14 cases of angioplasty with stent) from Jan. 1999 to Aug. 2000 at Inha University Hospital. After successful angioplasty on coronary angiogram, we measured minimal luminal diameter (MLD), minimal luminal area (MLA), lesion area stenosis (l-AST) and reference area stenosis (r-AST) with IVUS imaging. And we calculated FFRmyo from the ratio of mean coronary pressure distal to the stenosis (Pd) to the aortic mean pressure (Pa) during maximum coronary hyperemia (Pd/Pa). RESULTS: There was significant difference of MLD (2.2+/-0.4 vs 2.6+/-0.3), MLA (4.4+/-1.1 vs 6.4+/-1.7), r-AST (43.7+/-9.2 vs 29.8+/-9.4) and FFRmyo (0.89+/-0.07 vs 0.93+/-0.03) between balloon and stent group. All IVUS parameters (MLD, MLA, r-AST) are well correlated with FFRmyo after angioplasty (r=0.52, p<0.05, r=0.48, p<0.05 and r=-0.72, p<0.05 respectively). By multiple regression analysis, r-AST showed the best correlation with FFRmyo among IVUS parameters. CONCLUSION: Coronary angioplasty with stent showed more favorable MLD, MLA, r-AST and FFRmyo than balloon angioplasty. FFRmyo may be seemed to be alternative to IVUS for estimating the result of coronary angioplasty.
Angioplasty* ; Angioplasty, Balloon ; Constriction, Pathologic ; Fractional Flow Reserve, Myocardial ; Humans ; Hyperemia ; Phenobarbital ; Stents ; Ultrasonography*