PURPOSE: The aim of the present study was to find the proper treatment for improving the survival of patients with hilar cholangiocarcinoma by analyzing many factors affecting the patients' survival. METHODS: Between January 1991 and April 2006, 152 patients with hilar cholangiocarcinoma and who underwent surgery were reviewed. One hundred fifteen patients underwent attempted curative resections, and 37 patients had findings that precluded any further intervention. Of the 115 patients who underwent curative resection, 38 patients underwent resection of the extrahepatic bile duct only and 77 patients underwent concomitant hepatectomy. The clinicopathogical data of these patients was analyzed. RESULTS: The 3 year overall survival and disease-free survival rates were 41.2% and 52.5%, respectively. The overall recurrence rate was 40.9% (47/115) and of patients with recurrence, those who had been treated aggressively survived longer than those who had been treated conservatively (P=.039). Of the patients' factors that affected survival, only preoperative weight loss was meaningful (P=.024). Of the histologic factors, tumor cell differentiation (P=.048) and the presence of lymph node metastasis (P=.028) were associated with survival. Of the perioperative factors, only achievement of complete tumor resection affected survival. On comparing between resection of the extrahepatic bile duct only and concomitant partial hepatectomy, the latter achieved more definitely negative histologic margins (63.6% vs 39.5%, respectively, P=.037) at the expense of a more prolonged operation time and hospital stay and greater complications. CONCLUSION: Preoperative weight loss, poor differentiation, lymph node metastasis and a positive histologic margin could be included in the poor prognostic factors affecting survival. Concomitant liver resection could be rationalized in that it could attain a more negative histologic margin for treating resectable hilar cholangiocarcinoma, but it could increase mortality and morbidity rates.
Bile Ducts, Extrahepatic ; Cell Differentiation ; Cholangiocarcinoma* ; Disease-Free Survival ; Hepatectomy ; Humans ; Length of Stay ; Liver ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Recurrence ; Weight Loss

No abstract available.
Radiography* ; Radionuclide Imaging* ; Sacroiliitis* ; Spondylitis, Ankylosing*

PURPOSE: The aim of this study is to evaluate the significance of tumor size as a predictor of biological tumor behavior and to get some information to decide on the proper operative modality by assessing the survival rate for HCC patients. METHODS: Between January 1995 and September 2006, 278 patients with hepatocellular carcinoma (HCC) underwent liver surgery at our hospital. Of the 278 cases, 176 cases (63.3%) underwent liver resection and 102 cases (36.4%) underwent liver transplantation (LT). All the patients were divided into 4 groups according to their tumor size; <2 cm, 2~5 cm, 5~10 cm and >10 cm. We analyzed the pathologic outcomes, survival rates and the outcome of each operative modality, as related to the tumor size. RESULTS: The incidence of vascular invasion increased with the tumor size (<2 cm: 4.6%, 2~5 cm: 23.3%, 5~10 cm: 32.6%, > 10 cm: 50.0%)(P<0.005). For the less than 2 cm sized tumor group, the Edmonson-Steiner (E-S) grade III or IV was present in 40.7% of the patients, as compared with 78.9% in the group of patients with a tumor larger than 10 cm (P=0.005). The patients with a larger tumor showed a poorer survival rate. Liver transplantation showed the longer disease free survival compared to liver resection, though there was no significant benefit in the survival rate. Patients with a small sized tumor showed a better outcome when they underwent liver transplantation and patients with a large sized tumor did better when they underwent liver resection. CONCLUSION: Tumor size can be used as a preoperative predictor of the pathologic outcome when considering that the larger size of tumor the patients had, the more prevalent was vascular invasion, the tumor cell grade was more advanced and the survival rate was poorer. For patients with small sized HCC, liver transplantation can be considered the appropriate treatment modality.
Carcinoma, Hepatocellular ; Disease-Free Survival ; Hepatectomy ; Humans ; Incidence ; Liver ; Liver Transplantation ; Survival Rate

PURPOSE: Pancreatic fistulas are a leading cause of mortality and morbidity following pancreaticoduodenectomy. The objective of this study was to evaluate the possibility of controlling pancreatic fistula formation by binding pancreaticojejunostomy into the operative procedure, as proposed by Peng, which results in a 3 cm invagination of the pancreatic remnant by the jejunal segment bearing electrically-destroyed mucosa reinforced by inner and outer sutures. METHODS: Prospectively collected data of patients undergoing pancreaticoduodenectomy in the Department of Surgery of Daejeon St. Mary's hospital between April 2007 and May 2009 were analyzed retrospectively. Thirty-one patients were included in the study; 16 patients underwent dunking pancreaticojejunostomy and 15 patients underwent binding pancreaticojejunostomy. RESULTS: The two groups were comparable with respect to demographic data, pre-operative characteristics, underlying pathologies, pancreatic textures, and duct diameters. The mean operative time did not differ between the two groups (388+/-29 min vs. 459+/-21 min, p=0.060). No difference existed in the post-operative course except for the degree of complications. In contrast to the dunking group, in which 2 cases of grade III/V pancreatic fistulas occurred, the binding group had no severe complications. In addition, transformation of amylase data measured from Jackson-Pratt drains into a natural logarithm demonstrated significant differences on post-operative (POD) days 1, 3, and 7 between the dunking and binding groups (POD1, 6.97+/-0.41 vs. 6.10+/-0.44 [p=0.037]; POD3, 6.97+/-0.41 vs. 6.10+/-0.44 [p=0.032]; POD7, 4.69+/-0.35 vs. 3.88+/-0.25 [p=0.034], respectively). CONCLUSION: Bindning pancreaticojejunostomy is equivalent to dunking pancreaticojejunostomy with respect to operative difficulties, and more effective in preventing complications related to pancreatic fistulas.
Amylases ; Humans ; Mucous Membrane ; Operative Time ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Pancreaticojejunostomy ; Prospective Studies ; Retrospective Studies ; Surgical Procedures, Operative ; Ursidae

PURPOSE: Pancreatic fistulas are a leading cause of mortality and morbidity following pancreaticoduodenectomy. The objective of this study was to evaluate the possibility of controlling pancreatic fistula formation by binding pancreaticojejunostomy into the operative procedure, as proposed by Peng, which results in a 3 cm invagination of the pancreatic remnant by the jejunal segment bearing electrically-destroyed mucosa reinforced by inner and outer sutures. METHODS: Prospectively collected data of patients undergoing pancreaticoduodenectomy in the Department of Surgery of Daejeon St. Mary's hospital between April 2007 and May 2009 were analyzed retrospectively. Thirty-one patients were included in the study; 16 patients underwent dunking pancreaticojejunostomy and 15 patients underwent binding pancreaticojejunostomy. RESULTS: The two groups were comparable with respect to demographic data, pre-operative characteristics, underlying pathologies, pancreatic textures, and duct diameters. The mean operative time did not differ between the two groups (388+/-29 min vs. 459+/-21 min, p=0.060). No difference existed in the post-operative course except for the degree of complications. In contrast to the dunking group, in which 2 cases of grade III/V pancreatic fistulas occurred, the binding group had no severe complications. In addition, transformation of amylase data measured from Jackson-Pratt drains into a natural logarithm demonstrated significant differences on post-operative (POD) days 1, 3, and 7 between the dunking and binding groups (POD1, 6.97+/-0.41 vs. 6.10+/-0.44 [p=0.037]; POD3, 6.97+/-0.41 vs. 6.10+/-0.44 [p=0.032]; POD7, 4.69+/-0.35 vs. 3.88+/-0.25 [p=0.034], respectively). CONCLUSION: Bindning pancreaticojejunostomy is equivalent to dunking pancreaticojejunostomy with respect to operative difficulties, and more effective in preventing complications related to pancreatic fistulas.
Amylases ; Humans ; Mucous Membrane ; Operative Time ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Pancreaticojejunostomy ; Prospective Studies ; Retrospective Studies ; Surgical Procedures, Operative ; Ursidae

PURPOSE: The aims of this study were to find the risk factor and outcomes of patients with an early recurrence (ER) of a hepatocellular carcinoma (HCC) after liver transplantation (LT) and the actual impact of transarterial chemoembolization (TACE) before LT for a HCC on patient survival and HCC recurrence. METHODS: Ninety-eight cases of adult LT, performed between September 1995 and January 2006, were evaluated. The risk factors and prognosis of patient with a HCC after transplantation for an ER, defined as a recurrence within 6 months of transplantation, and the effects of Pre-LT TACE on the disease-free and overall survival rates, as well as the patterns of recurrence after LT, were studied. RESULTS: A total of 18 patients (18.4%) experienced a HCC recurrence after LT; 10 and 8 patients had early and late recurrences, respectively. From a univariate analysis, the serum alpha-fetoprotein (P=0.003), tumor size (P=0.003), serosa invasion (P=0.000), tumor grade (P=0.011) and vascular invasion (P=0.014) were statistically significant risk factors for an ER. From a multivariate analysis, the presence of serosa invasion of a HCC was the only independent risk factor for an ER (P=0.009; OR=9.407: 95% CI, 1.764~50.164). There was no difference in the disease free sur-vival and overall survival rates between the TACE and without TACE groups, but the extrahepatic recurrence rate was higher in the TACE than without TACE group. CONCLUSION: Serosa invasion by a HCC is independently associated with an ER of HCC after LT. Pre-LT TACE does not influence the disease-free and overall survivals after LT for a HCC.
Adult ; alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Humans ; Liver Transplantation* ; Liver* ; Multivariate Analysis ; Prognosis ; Recurrence* ; Risk Factors* ; Serous Membrane ; Survival Rate

Background and Objectives: Intravascular ultrasound (IVUS) evaluation of coronary artery morphology is based on the lumen and vessel segmentation. This study aimed to develop an automatic segmentation algorithm and validate the performances for measuring quantitative IVUS parameters. Methods: A total of 1,063 patients were randomly assigned, with a ratio of 4:1 to the training and test sets. The independent data set of 111 IVUS pullbacks was obtained to assess the vessel-level performance. The lumen and external elastic membrane (EEM) boundaries were labeled manually in every IVUS frame with a 0.2-mm interval. The Efficient-UNet was utilized for the automatic segmentation of IVUS images. Results: At the frame-level, Efficient-UNet showed a high dice similarity coefficient (DSC, 0.93±0.05) and Jaccard index (JI, 0.87±0.08) for lumen segmentation, and demonstrated a high DSC (0.97±0.03) and JI (0.94±0.04) for EEM segmentation. At the vessel-level, there were close correlations between model-derived vs. experts-measured IVUS parameters;minimal lumen image area (r=0.92), EEM area (r=0.88), lumen volume (r=0.99) and plaque volume (r=0.95). The agreement between model-derived vs. expert-measured minimal lumen area was similarly excellent compared to the experts' agreement. The model-based lumen and EEM segmentation for a 20-mm lesion segment required 13.2 seconds, whereas manual segmentation with a 0.2-mm interval by an expert took 187.5 minutes on average. Conclusions The deep learning models can accurately and quickly delineate vascular geometry. The artificial intelligence-based methodology may support clinicians’ decisionmaking by real-time application in the catheterization laboratory.

Background and Objectives: Intravascular ultrasound (IVUS) evaluation of coronary artery morphology is based on the lumen and vessel segmentation. This study aimed to develop an automatic segmentation algorithm and validate the performances for measuring quantitative IVUS parameters. Methods: A total of 1,063 patients were randomly assigned, with a ratio of 4:1 to the training and test sets. The independent data set of 111 IVUS pullbacks was obtained to assess the vessel-level performance. The lumen and external elastic membrane (EEM) boundaries were labeled manually in every IVUS frame with a 0.2-mm interval. The Efficient-UNet was utilized for the automatic segmentation of IVUS images. Results: At the frame-level, Efficient-UNet showed a high dice similarity coefficient (DSC, 0.93±0.05) and Jaccard index (JI, 0.87±0.08) for lumen segmentation, and demonstrated a high DSC (0.97±0.03) and JI (0.94±0.04) for EEM segmentation. At the vessel-level, there were close correlations between model-derived vs. experts-measured IVUS parameters;minimal lumen image area (r=0.92), EEM area (r=0.88), lumen volume (r=0.99) and plaque volume (r=0.95). The agreement between model-derived vs. expert-measured minimal lumen area was similarly excellent compared to the experts' agreement. The model-based lumen and EEM segmentation for a 20-mm lesion segment required 13.2 seconds, whereas manual segmentation with a 0.2-mm interval by an expert took 187.5 minutes on average. Conclusions The deep learning models can accurately and quickly delineate vascular geometry. The artificial intelligence-based methodology may support clinicians’ decisionmaking by real-time application in the catheterization laboratory.

Background and Objectives: Intravascular ultrasound (IVUS) evaluation of coronary artery morphology is based on the lumen and vessel segmentation. This study aimed to develop an automatic segmentation algorithm and validate the performances for measuring quantitative IVUS parameters. Methods: A total of 1,063 patients were randomly assigned, with a ratio of 4:1 to the training and test sets. The independent data set of 111 IVUS pullbacks was obtained to assess the vessel-level performance. The lumen and external elastic membrane (EEM) boundaries were labeled manually in every IVUS frame with a 0.2-mm interval. The Efficient-UNet was utilized for the automatic segmentation of IVUS images. Results: At the frame-level, Efficient-UNet showed a high dice similarity coefficient (DSC, 0.93±0.05) and Jaccard index (JI, 0.87±0.08) for lumen segmentation, and demonstrated a high DSC (0.97±0.03) and JI (0.94±0.04) for EEM segmentation. At the vessel-level, there were close correlations between model-derived vs. experts-measured IVUS parameters;minimal lumen image area (r=0.92), EEM area (r=0.88), lumen volume (r=0.99) and plaque volume (r=0.95). The agreement between model-derived vs. expert-measured minimal lumen area was similarly excellent compared to the experts' agreement. The model-based lumen and EEM segmentation for a 20-mm lesion segment required 13.2 seconds, whereas manual segmentation with a 0.2-mm interval by an expert took 187.5 minutes on average. Conclusions The deep learning models can accurately and quickly delineate vascular geometry. The artificial intelligence-based methodology may support clinicians’ decisionmaking by real-time application in the catheterization laboratory.

PURPOSE: Even though adipose tissue-derived stem cells (ADSCs) have been spotlighted as a possible alternative for liver transplantation in an experimental setting, the mechanism by which ADSCs improve liver dysfunction remains poorly characterized. The objective of this study was to evaluate the therapeutic ability of undifferentiated ADSCs, and find a few clues on how ADSCs alleviate liver damage by comparing the transplantation routes. METHODS: In vitro generated human ADSCs were checked for surface markers and stage-specific genes for characterization. Afterwards, they were transplanted into C57BL/6 mice with CCl4-induced liver injury. The transplantations were made via tail vein, portal vein, and direct liver parenchymal injection. At 1 and 3 post-transplantation days, serum biochemical parameters and/or liver specimens were evaluated. RESULTS: We have shown here that ADSCs have the characteristics of mesenchymal stem cells, and belong to endodermal and/or early hepatic differentiation stage. After transplantation into the mice with acute liver failure, markers of liver injury, such as alanineaminotransferase, aspartateaminotransferase, as well as ammonia, decreased. Of these transplantation routes, transplantation via tail vein rendered the most prominent reduction in the biochemical parameters. CONCLUSION: Undifferentiated ADSCs have the ability to improve hepatic function in mice with acute liver injury. Moreover, our transplantation route study supports the theory that ADSCs in systemic circulation can exert endocrine or paracrine effects to ameliorate the injured liver.
Ammonia ; Animals ; Endoderm ; Humans ; Liver ; Liver Diseases ; Liver Failure ; Liver Failure, Acute ; Liver Transplantation ; Mesenchymal Stromal Cells ; Mice ; Portal Vein ; Stem Cell Transplantation ; Stem Cells ; Transplants ; Veins