Iatrogenic pseudoaneurysms are extremely rare in children. Conventional management of pseudoaneurysms in adults has included surgical repair, ultrasound-guided compression, and more recently, endovascular embolization. However, in infants and children, there is little information regarding the applicability of such treatment modalities, which have been effective in adults, because of its rarity. Here, we present the case of a 6-month-old infant who developed a postprocedural pseudoaneurysm of the external iliac artery, which was successfully treated with ultrasound-guided percutaneous thrombin injection.
Adult ; Aneurysm ; Aneurysm, False* ; Child ; Humans ; Iliac Artery* ; Infant* ; Thrombin*

PURPOSE: To compare the clinical results of BRTO in the gastric varices with those of TIPS. MATERIALS AND METHODS: From January 2004 to March 2006, eight patients who had been followed up for more than 1 month after BRTO were enrolled in this study. This study compared the clinical efficacy of BRTO with that of TIPS in 13 patients who had undergone TIPS from January 2000 to March 2006. The change in laboratory parameters before and after each procedure and the incidence of rebleeding, encephalopathy, asictes and varices were analyzed after each procedure. Results:In the BRTO group, the level of albumin increased, and the levels of ammonia and the Child-Pugh score decreased. The TIPS group showed no improvement in the liver function. In the BRTO group, the gastric varices were eradicated in 7 patients. Gastric variceal rebleeding and encephalopathy did not occur. However, the esophageal varices worsened in 6 patients. In the TIPS group, rebleeding (n=4), encephalopathy (n=7) and a worsening of the gastric (n=5) or esophageal varices (n=2) occurred. CONCLUSION: BRTO improves the metabolic activity of the liver and has a lower incidence of encephalopathy. Hence, BRTO is a good alternative to TIPS in the gastric varices accompanied by a gastrorenal shunt although a treatment for a worsening of the esophageal varices may be needed after BRTO.
Ammonia ; Esophageal and Gastric Varices* ; Humans ; Incidence ; Liver ; Portasystemic Shunt, Surgical* ; Varicose Veins

PURPOSE: A duodenal stump fistula is one of the most severe complications after gastrectomy for gastric cancer. We aimed to analyze the risk factors for this problem, and to identify the methods used for its prevention and management. METHODS: We retrospectively reviewed the clinical data of 716 consecutive patients who underwent curative gastrectomy with a duodenal stump for gastric cancer between 2008 and 2013. RESULTS: A duodenal stump fistula occurred in 16 patients (2.2%) and there were 2 deaths in this group. Univariate analysis revealed age >60 years (odds ratio [OR], 3.09; 95% confidence interval [CI], 0.99-9.66), multiple comorbidities (OR, 4.23; 95% CI, 1.50-11.92), clinical T stage (OR, 2.91; 95% CI, 1.045-8.10), and gastric outlet obstruction (OR, 8.64; 95% CI, 2.61-28.61) to be significant factors for developing a duodenal stump fistula. Multivariate analysis identified multiple comorbidities (OR, 3.92; 95% CI, 1.30-11.80) and gastric outlet obstruction (OR, 5.62; 95% CI, 1.45-21.71) as predictors of this complication. CONCLUSION: Multiple comorbidities and gastric outlet obstruction were the main risk factors for a duodenal stump fistula. Therefore, preventive methods and aggressive management should be applied for patients at high risk.
Comorbidity ; Fistula* ; Gastrectomy* ; Gastric Outlet Obstruction ; Humans ; Intestinal Fistula ; Multivariate Analysis ; Retrospective Studies ; Risk Factors* ; Stomach Neoplasms*

Purpose: To evaluate the long-term radiologic and clinical outcomes of stent-graft placement for the treatment of post-pancreaticoduodenectomy arterial hemorrhage (PPAH) based on the imaging findings of stent-graft patency and results of liver function tests. Materials and Methods: We retrospectively reviewed the medical records of nine consecutive patients who underwent stent-graft placement for PPAH between June 2012 and May 2017. We analyzed the immediate technical and clinical outcomes and liver function test results. Stentgraft patency was evaluated using serial CT angiography images. Results: All stent-grafts were deployed in the intended position for the immediate cessation of arterial hemorrhage and preservation of hepatic arterial blood flow. Technical success was achieved in all nine patients. Eight patients survived after discharge, and one patient died on postoperative day 28. The median follow-up duration was 781 days (range: 28–1766 days). Follow-up CT angiography revealed stent-graft occlusion in all patients. However, serum aspartate aminotransferase or alanine aminotransferase levels in all patients were well below those observed in hepatic infarction cases. Conclusion Stent-graft placement is a safe and effective treatment method for acute life-threatening PPAH. Liver function and distal hepatic arterial blood flow were maintained postoperatively despite the high incidence of stent-graft occlusion observed on follow-up CT.

Purpose: To evaluate the long-term radiologic and clinical outcomes of stent-graft placement for the treatment of post-pancreaticoduodenectomy arterial hemorrhage (PPAH) based on the imaging findings of stent-graft patency and results of liver function tests. Materials and Methods: We retrospectively reviewed the medical records of nine consecutive patients who underwent stent-graft placement for PPAH between June 2012 and May 2017. We analyzed the immediate technical and clinical outcomes and liver function test results. Stentgraft patency was evaluated using serial CT angiography images. Results: All stent-grafts were deployed in the intended position for the immediate cessation of arterial hemorrhage and preservation of hepatic arterial blood flow. Technical success was achieved in all nine patients. Eight patients survived after discharge, and one patient died on postoperative day 28. The median follow-up duration was 781 days (range: 28–1766 days). Follow-up CT angiography revealed stent-graft occlusion in all patients. However, serum aspartate aminotransferase or alanine aminotransferase levels in all patients were well below those observed in hepatic infarction cases. Conclusion Stent-graft placement is a safe and effective treatment method for acute life-threatening PPAH. Liver function and distal hepatic arterial blood flow were maintained postoperatively despite the high incidence of stent-graft occlusion observed on follow-up CT.

Secondary esophageal carcinoma usually originates from a primary site in either the lung or breast. Only one case of metastatic esophageal cancer with a radiologic evidence that it was originated from the rectal cancer had been reported. We report an unusual case of a 80-year-old man with secondary esophageal carcinoma originated from the rectal cancer. It was diagnosed by histopathologic confirmation using immunohistochemical staining including CK20 and CK7 by comparing the histopathologic findings of surgical specimen of rectal cancer and endoscopic biopsy tissue from the esophagus. To the best of our knowledge, this is the first case of secondary esophageal cancer arising from rectum in Korea.
Aged, 80 and over ; Biopsy ; Breast ; Esophageal Neoplasms* ; Esophagus ; Humans ; Korea ; Lung ; Rectal Neoplasms* ; Rectum

OBJECTIVES: In order to understand the biological basis of neurodevelopmental perspectives of mental disorders, the authors investigated the developmental and regional changes in the phosphorylation of the transcription factor CREB following the electroconvulsive shock(ECS) in rat brain. METHODS: Rats of various age groups (7, 14, 21 days postnatal and adults) were given ECS and their hippocampi and cerebella were dissected at specified time points. The content of CREB and phosphorylated CREB were measured by immunoblot analysis. RESULTS: The amount of CREB increased in the hippocampus and decreased in the cerebellum according to the age. Baseline levels of CREB phosphorylation in both tissues were increased from postnatal 14 days, and it was proportional to the amount of CREB protein in the cerebellum. In the hippocampus, ECS increased the phosphorylation of CREB at postnatal 21 days, but in the cerebellum, ECS did not increased the phosphorylation of CREB in any age group. CONCLUSION: CREB mediated signal transduction pathways showed developmental and tissue-specific changes. ECS increased the phosphorylation of CREB in the hippocampus by postnatal 21 days, but not in the cerebellum. CREB activation is supposed to be related with the inducdion of c-fos after ECS in the hippocampus. However, the Ser-133 phosphorylation of CREB could not completely explain the developmental and tissue specificity of c-fos induction.
Animals ; Brain* ; Cerebellum ; Cyclic AMP Response Element-Binding Protein ; Electroshock* ; Hippocampus ; Humans ; Mental Disorders ; Organ Specificity ; Phosphorylation* ; Rats* ; Signal Transduction ; Transcription Factors

We report a case of percutaneous transhepatic stent placement for the treatment of hepatic venous outflow obstruction after extracorporeal hepatic resection and autotransplantation. A 63-year-old woman with a large mass in the liver was asymptomatic with no hepatic virus infection. Because the tumor was unresectable by conventional means, we used extracorporeal hepatic resection and autotransplantation for operation. Two days after surgery, hepatic venous outflow obstruction of the right and right inferior hepatic veins was suspected on computed tomography. After failure of the transjugular approach, hepatic venous stenting was performed successfully via the percutaneoustranshepatic approach.
Autografts* ; Budd-Chiari Syndrome ; Female ; Hepatic Veins ; Humans ; Liver ; Middle Aged ; Stents* ; Transplantation, Autologous*

This report details a case of post-traumatic pseudocyst in the spleen that was successfully treated with sclerotherapy using ethanol. A sixteen-year-old boy visited our hospital for a follow-up examination of a splenic cyst. He had experienced blunt trauma to the abdomen three years prior to presentation. An abdominal computed tomography scan revealed a large cyst of the lower pole of the spleen. The cyst was 6.8x9.5x7.0 cm and conservative management was tried. A follow-up ultrasonographic examination three years later revealed that the size of the cyst was unchanged and another treatment was needed to prevent complications. One session of sclerosis with ethanol (90 mL of 99% ethanol) percutaneously was applied to the cyst. A follow-up after four months revealed that the cyst had completely resolved.
Abdomen ; Ethanol ; Follow-Up Studies ; Humans ; Male ; Sclerosis ; Sclerotherapy* ; Spleen*

PURPOSE: To determine the clinical utility of coronary CT angiography (CCTA) with low-dose chest CT in the evaluation of patients with atypical chest pain. MATERIALS AND METHODS: Ninety-six patients (mean age 60.2 years; age range, 41-68 years; 70 males) were referred for CCTA with low-dose chest CT (16-slice MDCT, Siemens) for an evaluation of atypical chest pain. When significant stenoses (lumen diameter reduction > 50%) were detected on CCTA, invasive coronary angiography (CA) was performed as the standard of reference. In all patients, medical chart review or telephone contact with patients was used to evaluate the contribution of CCTA with low-dose chest CT to the final clinical diagnosis, at least 6 months after performing CCTA. RESULTS: Among 96 patients, seven patients (7%) had significant stenoses as detected on CCTA, whereas two patients (2%) had significant stenoses and five patients had insignificant stenoses or no stenosis, as detected on conventional catheter angiography. In 18 (19%) of the 89 patients without significant stenosis detected on CCTA, this protocol provided additional information that suggested or confirmed an alternate clinical diagnosis. CONCLUSION: In patients with atypical chest pain, CCTA with low-dose chest CT could help to exclude ischemic heart disease and could provide important ancillary information for the final diagnosis.
Angiography ; Catheters ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Humans ; Myocardial Ischemia ; Telephone ; Thorax ; Tomography, X-Ray Computed