BACKGROUND/AIMS: Various strategies to expand the ablation zone have been attempted using hepatic radiofrequency ablation (RFA). The optimal strategy, however, is unknown. We compared hepatic RFA with an internally cooled wet (ICW) electrode and vascular inflow occlusion. METHODS: Eight dogs were assigned to one of three groups: only RFA using an internally cooled electrode (group A), RFA using an ICW electrode (group B), and RFA using an internally cooled electrode with the Pringle maneuver (group C). The ablation zone diameters were measured on the gross specimens, and the volume of the ablation zone was calculated. RESULTS: The ablation zone volume was greatest in group B (1.82+/-1.23 cm3), followed by group C (1.22+/-0.47 cm3), and then group A (0.48+/-0.33 cm3). The volumes for group B were significantly larger than the volumes for group A (p=0.030). There was no significant difference in the volumes between groups A and C (p=0.079) and between groups B and C (p=0.827). CONCLUSIONS: Both the usage of an ICW electrode and hepatic vascular occlusion effectively expanded the ablation zone. The use of an ICW electrode induced a larger ablation zone with easy handling compared with using hepatic vascular occlusion, although this difference was not statistically significant.
Animals ; Catheter Ablation ; Dogs ; Electrodes ; Handling (Psychology) ; Liver

A congenital intrahepatic portosystemic shunt is a rare anomaly; but, the number of diagnosed cases has increased with advanced imaging tools. Symptomatic portosystemic shunts, especially those that include hyperammonemia, should be treated; and various endovascular treatment methods other than surgery have been reported. Hepatic masses with either an intra- or extrahepatic shunt also have been reported, and the mass is another reason for treatment. Authors report a case of a congenital intrahepatic portosystemic shunt with a hepatic mass that was successfully treated using a percutaneous endovascular approach with vascular plugs. By the time the first short-term follow-up was conducted, the hepatic mass had disappeared.
Child ; Diagnosis, Differential ; Hepatic Encephalopathy/*congenital/diagnosis/therapy ; Humans ; Liver Neoplasms/*congenital/diagnosis/therapy ; Male ; Portal Vein/*abnormalities ; *Septal Occluder Device ; Tomography, X-Ray Computed ; Ultrasonography, Doppler, Color ; Ultrasonography, Interventional

PURPOSE: To evaluate the usefulness of MDCT angiography in the diagnosis of vertebrobasilar artery dissection. MATERIALS AND METHODS: Between July 2003 and December 2005, 39 patients who underwent MDCT angiography and digital subtraction angiography with a history of suspicious vertebrobasilar artery dissection were selected. A blind interpretation of images was made by two observers, retrospectively. A diagnosis of dissection in MDCT angiography was made according to the following criteria: presence of an intimal flap, aneurysmal dilatation, abrupt or tapered luminal narrowing, alternatively dilated and narrowed lumen. The sensitivity and specificity of MDCT angiography in depicting vertebrobasilar artery dissection were determined. RESULTS: 43 vertebrobasilar artery dissections were diagnosed by MDCT angiography in 39 patients. The interobserver agreement was good (kappa =0.92). A diagnosis was made by the presence of an intimal flap (n=16, 36%), abrupt or tapered luminal narrowing (n=16, 36%), aneurysmal dilatation (n=13, 30%), alternatively dilated and narrow lumen (n=14, 32%). The sensitivities and specificities of MDCT angiography were 91%, 88% as determined by the first radiologist, and were 89%, 87% as determined by a second radiologist, respectively. CONCLUSION: MDCT angiography is a useful method for the diagnosis of vertebrobasilar artery dissection.
Aneurysm ; Angiography* ; Angiography, Digital Subtraction ; Arteries* ; Diagnosis* ; Dilatation ; Humans ; Phenobarbital ; Retrospective Studies ; Sensitivity and Specificity ; Vertebral Artery

Malignant airway obstruction and hemoptysis are common in lung cancer patients. Recently, airway stent is commonly used to preserve airway in malignant airway obstruction. Hemoptysis can be managed through various methods including conservative treatment, endobronchial tamponade, bronchoscopic intervention, embolization and surgery. In our case studies, we sought to investigate the effectiveness of airway stents for re-opening the airway as well as tamponade effects in four patients with malignant airway obstruction and bleeding caused by tumors or lymph node invasions.
Aged ; Airway Obstruction/*etiology/pathology/*therapy ; Alloys ; Bronchoscopy ; Carcinoma, Non-Small-Cell Lung/*complications ; Fatal Outcome ; Fluoroscopy ; Hemoptysis/*etiology/pathology/*therapy ; Humans ; Lung Neoplasms/*complications ; Male ; Middle Aged ; *Stents

Hemoptysis in patients with lung cancer is not uncommon and sometimes have dangerous consequences. Hemoptysis has been managed with various treatment options other than surgery and medicine, such as endobronchial tamponade, transcatheter arterial embolization and radiation therapy. However, these methods can sometimes be used only temporarily or are not suitable for a patient's condition. We present a case in which uncontrollable hemoptysis caused by central lung cancer was successfully treated by inserting a covered self-expanding bronchial stent. The patient could be extubated and was able to undergo further palliative therapy. No recurrent episodes of hemoptysis occurred for the following three months. As our case, airway stenting is a considerable option for the tamponade of a bleeding lesion that cannot be successfully managed with other treatment methods and could be used to preserve airway patency in a select group of patients.
*Bronchi ; Carcinoma, Non-Small-Cell Lung/*complications/therapy ; Hemoptysis/etiology/radiography/*therapy ; Humans ; Intubation ; Lung Neoplasms/*complications/therapy ; Male ; Middle Aged ; Palliative Care ; *Stents ; Tomography, X-Ray Computed

Acalculous hemorrhagic cholecystitis is a rare complication of acute cholecystitis and is associated with a high mortality rate. We present a case of acalculous hemorrhagic cholecystitis with hematoma in the gallbladder lumen, which was diagnosed using magnetic resonance imaging (MRI). The T1- & T2-weighted MRI revealed gallbladder distension with a hypointense intraluminal hematoma. The excellent tissue contrast provided by MRI is useful for detecting hematomas in the cases of hemorrhagic cholecystitis.
Acalculous Cholecystitis ; Cholecystitis ; Cholecystitis, Acute ; Gallbladder ; Hematoma ; Magnetic Resonance Imaging

PURPOSE: We aimed to evaluate the early (<30 days) results and to analyze risk factors for the development of stroke and new brain infarction (NBI) after carotid endarterectomy (CEA). METHODS: From September 2003 to August 2008, 233 CEAs were performed on 222 patients with critical internal carotid artery (ICA) stenosis in a single center. Patient characteristics, history of neurological symptoms, procedural details, and postoperative complications were examined based on the medical records. The incidence and risk factors for early postoperative stroke were evaluated. After excluding CEAs without performing diffusion-weighted brain MRI, 128 CEAs were investigated for frequency and the risk factors of NBI were analyzed. Chi-square test, Fisher's exact test, Student T-test, and logistic regression model were used for statistical analysis. RESULTS: Of a total of 233 CEAs, any and ipsilateral stroke rates were 1.3% and 0.4%, respectively. There was no early postoperative mortality. Early postoperative complications included 4.3% in transient cranial nerve injury, 1.7% in myocardial infarction, and 3.4% in hematoma. In univariate analysis, the significant risk factor for stroke was plaque ulceration (P=0.04). The frequency of NBI and ipsilateral NBI were 8.4% and 3.1%, respectively. The ulceration on ipsilateral ICA revealed statistically significant risk factors for the development of NBI (RR, 5.29; 95% CI, 1.024~27.325; P=0.04). CONCLUSION: Our study showed a lower incidence of stroke and NBI after carotid endarterectomy and that it is safe procedure for the treatment of patients with severe (>70%) carotid stenosis. We also found that plaque with ulceration was a significant risk factor for the development of postoperative NBI.
Brain ; Brain Infarction ; Carotid Arteries ; Carotid Artery, Internal ; Carotid Stenosis ; Constriction, Pathologic ; Cranial Nerve Injuries ; Endarterectomy ; Endarterectomy, Carotid ; Hematoma ; Humans ; Incidence ; Logistic Models ; Medical Records ; Myocardial Infarction ; Postoperative Complications ; Risk Factors ; Stroke ; Ulcer

Catamenial hemoptysis is a rare condition, characterized by recurrent hemoptysis associated with the presence of intrapulmonary or endobronchial endometrial tissue. Therapeutic strategies proposed for intrapulmonary endometriosis with catamenial hemoptysis consist of medical treatments and surgery. Bronchial artery embolization is a well-established modality in the management of massive or recurrent hemoptysis, but has seldom been used for the treatment of catamenial hemoptysis. We report a case of catamenial hemoptysis associated with pulmonary parenchymal endometriosis, which was successfully treated by a bronchial artery embolization.
Bronchial Arteries* ; Embolization, Therapeutic ; Endometriosis ; Female ; Hemoptysis*

Endoscopic retrograde cholangiopancreatography (ERCP) fails occasionally due to a surgically altered anatomy, periampullary diverticulum, difficult cannulation, or poor general condition of the patient. In these cases, alternative treatment options are necessary, including percutaneous transhepatic biliary drainage (PTBD) or percutaneous transhepatic gallbladder biliary drainage (PTGBD). Here, we report a case of cholangitis treated with percutaneous transhepatic gallbladder papillary balloon dilatation (PTGBPBD). A 61-year-old male was admitted for cholangitis associated with biliary sludge. ERCP cannulation had failed due to the position of the papilla within a large periampullary diverticulum, and PTBD had failed due to a non-dilated intrahepatic bile duct. Following PTGBD, papillary balloon dilatation was completed successfully through the PTGBD tract. The patient tolerated the procedure and was discharged without complications. We conclude that PTGBPBD is an acceptable and safe procedure in a patient with cholangitis who underwent failed ERCP or PTBD procedures.
Bile ; Bile Ducts, Intrahepatic ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Dilatation* ; Diverticulum ; Drainage ; Gallbladder* ; Humans ; Male ; Middle Aged

Endoscopic retrograde cholangiopancreatography (ERCP) fails occasionally due to a surgically altered anatomy, periampullary diverticulum, difficult cannulation, or poor general condition of the patient. In these cases, alternative treatment options are necessary, including percutaneous transhepatic biliary drainage (PTBD) or percutaneous transhepatic gallbladder biliary drainage (PTGBD). Here, we report a case of cholangitis treated with percutaneous transhepatic gallbladder papillary balloon dilatation (PTGBPBD). A 61-year-old male was admitted for cholangitis associated with biliary sludge. ERCP cannulation had failed due to the position of the papilla within a large periampullary diverticulum, and PTBD had failed due to a non-dilated intrahepatic bile duct. Following PTGBD, papillary balloon dilatation was completed successfully through the PTGBD tract. The patient tolerated the procedure and was discharged without complications. We conclude that PTGBPBD is an acceptable and safe procedure in a patient with cholangitis who underwent failed ERCP or PTBD procedures.
Bile ; Bile Ducts, Intrahepatic ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Dilatation* ; Diverticulum ; Drainage ; Gallbladder* ; Humans ; Male ; Middle Aged