Background/Aims: Biliary obstruction drainage in patients with hepatocellular carcinoma (HCC) is associated with symptom palliation, improved access to chemotherapy, and improved survival. Stent placement and exchange via endoscopic retrograde cholangiopancreatography biliary drainage risk traversing the HCC, a hypervascular tumor and causing bleeding. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) potentially prevents procedure-related bleeding. Therefore, we evaluated the efficacy and safety of EUS-HGS as an alternative treatment for biliary obstruction in patients with HCC. Methods: This was a retrospective study of all EUS-HGS procedures performed in patients with HCC at the Aichi Cancer Center Hospital, Japan, from February 2017 to August 2023. Results: A total of 14 EUS-HGS procedures (42.9% primary) were attempted in 10 HCC patients (mean age 71.5 years, 80.0% male). Clinical and technical success rates were 92.9% and 90.9%, respectively. The observed procedure details in the 13 successful procedures included B3 puncture (53.8%), 22-G needle (53.8%), fully covered self-expandable metal stent (100%), and mean procedure time (32.7 minutes). There was no bleeding. Mild complications occurred in 27.3%. All patients resumed oral intake within 24 hours. Conclusions EUS-HGS is a technically feasible and clinically effective initial or salvage drainage option for the treatment of biliary obstruction in patients with HCC.

Purpose: This study evaluated the sensitivity, specificity, and accuracy of computed tomographic angiography (CTA) versus handheld Doppler (HHD) in detecting perforators for anterolateral thigh (ALT) flap surgery. Methods: This study was conducted on 20 patients randomly assigned to two groups from April 2023 to November 2024: One group received CTA and HHD, while the other group received only HHD. Perforators were evaluated for their number, location, and source and compared with intraoperative findings. Results: The sensitivity and specificity of CTA were 86.0% and 98.0%, respectively, while those of HHD were 81.0% and 86.5%. CTA exhibited an accuracy of 92.0% for perforator identification, whereas that of HHD was 83.5%. Conclusion CTA offers higher sensitivity, specificity, and accuracy in identifying ALT flap perforators than HHD. Its superior imaging capabilities can enable improved surgical planning, minimizing intraoperative challenges, reducing the risk of complications, and potentially increasing flap survival rates. As such, CTA could be considered a valuable standard tool in preoperative planning for ALT flap surgery, particularly in cases where anatomical variation poses a challenge.

Purpose: This study evaluated the sensitivity, specificity, and accuracy of computed tomographic angiography (CTA) versus handheld Doppler (HHD) in detecting perforators for anterolateral thigh (ALT) flap surgery. Methods: This study was conducted on 20 patients randomly assigned to two groups from April 2023 to November 2024: One group received CTA and HHD, while the other group received only HHD. Perforators were evaluated for their number, location, and source and compared with intraoperative findings. Results: The sensitivity and specificity of CTA were 86.0% and 98.0%, respectively, while those of HHD were 81.0% and 86.5%. CTA exhibited an accuracy of 92.0% for perforator identification, whereas that of HHD was 83.5%. Conclusion CTA offers higher sensitivity, specificity, and accuracy in identifying ALT flap perforators than HHD. Its superior imaging capabilities can enable improved surgical planning, minimizing intraoperative challenges, reducing the risk of complications, and potentially increasing flap survival rates. As such, CTA could be considered a valuable standard tool in preoperative planning for ALT flap surgery, particularly in cases where anatomical variation poses a challenge.

Background/Aims: Biliary obstruction drainage in patients with hepatocellular carcinoma (HCC) is associated with symptom palliation, improved access to chemotherapy, and improved survival. Stent placement and exchange via endoscopic retrograde cholangiopancreatography biliary drainage risk traversing the HCC, a hypervascular tumor and causing bleeding. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) potentially prevents procedure-related bleeding. Therefore, we evaluated the efficacy and safety of EUS-HGS as an alternative treatment for biliary obstruction in patients with HCC. Methods: This was a retrospective study of all EUS-HGS procedures performed in patients with HCC at the Aichi Cancer Center Hospital, Japan, from February 2017 to August 2023. Results: A total of 14 EUS-HGS procedures (42.9% primary) were attempted in 10 HCC patients (mean age 71.5 years, 80.0% male). Clinical and technical success rates were 92.9% and 90.9%, respectively. The observed procedure details in the 13 successful procedures included B3 puncture (53.8%), 22-G needle (53.8%), fully covered self-expandable metal stent (100%), and mean procedure time (32.7 minutes). There was no bleeding. Mild complications occurred in 27.3%. All patients resumed oral intake within 24 hours. Conclusions EUS-HGS is a technically feasible and clinically effective initial or salvage drainage option for the treatment of biliary obstruction in patients with HCC.

Purpose: This study evaluated the sensitivity, specificity, and accuracy of computed tomographic angiography (CTA) versus handheld Doppler (HHD) in detecting perforators for anterolateral thigh (ALT) flap surgery. Methods: This study was conducted on 20 patients randomly assigned to two groups from April 2023 to November 2024: One group received CTA and HHD, while the other group received only HHD. Perforators were evaluated for their number, location, and source and compared with intraoperative findings. Results: The sensitivity and specificity of CTA were 86.0% and 98.0%, respectively, while those of HHD were 81.0% and 86.5%. CTA exhibited an accuracy of 92.0% for perforator identification, whereas that of HHD was 83.5%. Conclusion CTA offers higher sensitivity, specificity, and accuracy in identifying ALT flap perforators than HHD. Its superior imaging capabilities can enable improved surgical planning, minimizing intraoperative challenges, reducing the risk of complications, and potentially increasing flap survival rates. As such, CTA could be considered a valuable standard tool in preoperative planning for ALT flap surgery, particularly in cases where anatomical variation poses a challenge.

Background/Aims: Biliary obstruction drainage in patients with hepatocellular carcinoma (HCC) is associated with symptom palliation, improved access to chemotherapy, and improved survival. Stent placement and exchange via endoscopic retrograde cholangiopancreatography biliary drainage risk traversing the HCC, a hypervascular tumor and causing bleeding. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) potentially prevents procedure-related bleeding. Therefore, we evaluated the efficacy and safety of EUS-HGS as an alternative treatment for biliary obstruction in patients with HCC. Methods: This was a retrospective study of all EUS-HGS procedures performed in patients with HCC at the Aichi Cancer Center Hospital, Japan, from February 2017 to August 2023. Results: A total of 14 EUS-HGS procedures (42.9% primary) were attempted in 10 HCC patients (mean age 71.5 years, 80.0% male). Clinical and technical success rates were 92.9% and 90.9%, respectively. The observed procedure details in the 13 successful procedures included B3 puncture (53.8%), 22-G needle (53.8%), fully covered self-expandable metal stent (100%), and mean procedure time (32.7 minutes). There was no bleeding. Mild complications occurred in 27.3%. All patients resumed oral intake within 24 hours. Conclusions EUS-HGS is a technically feasible and clinically effective initial or salvage drainage option for the treatment of biliary obstruction in patients with HCC.

Objectives: This study aimed to investigate the elemental analysis and microhardness of a bioactive material (Activa) and marginal tooth structure after storage in different media. Materials and Methods: Fifteen teeth received cervical restorations with occlusal enamel and gingival dentin margins using the tested material bonded with a universal adhesive, 5 of them on the 4 axial surfaces and the other 10 on only the 2 proximal surfaces. The first 5 teeth were sectioned into 4 restorations each, then stored in 4 different media; deionized water, Dulbecco's phosphate buffered saline (DPBS), Tris buffer, and saliva. The storage period for deionized water was 24 hours while it was 3 months for the other media. Each part was analyzed by scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS) analysis for different substrates/distances and the wt% of calcium, phosphorus, silica, and fluoride were calculated. The other 10 teeth were sectioned across the restoration, stored in either Tris buffer or saliva for 24 hours or 3 months, and were evaluated for microhardness of different substrates/ areas. Data were analyzed using analysis of variance and Tukey’s post hoc test. Results: Enamel and dentin interfaces in the DPBS group exhibited a significant increase in calcium and phosphorus wt%. Both silica and fluoride significantly increased in tooth structure up to a distance of 75 μm in the 3-month-media groups than the immediate group.Storage media did not affect the microhardness values. Conclusions SEM-EDS analysis suggests an ion movement between Activa and tooth structure through a universal adhesive while stored in DPBS.