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Objective@#The purpose of this nationwide age- and sex- matched longitudinal study was to determine the pyogenic spondylitis (PS) increases the incidence of ischemic stroke (IS) in Korea. @*Methods@#From the National Health Insurance Service (NHIS), we collected the patient data for the period from January 1, 2004 to December 31, 2015. PS was classified according to the International Classification of Disease codes M46.2-M46.8, M49.2, and M49.3. By using a 1:5 age- and sex- stratified matching, a total of 628 patients and 3140 control subjects were included in the study. The IS incidence rates in PS and control group was calculated by using the Kaplan-Meier method. The outcome of hazard ratio of IS was estimated by Cox proportional hazards regression analyses. This study did not exclude PS as a result of postoperative complications. @*Results@#According to the study, 51 patients (8.12%) in the PS group and 201 patients (6.4%) in the control group experienced IS. The adjusted hazard ratio of IS in the PS group was 3.419 (95% CI: 2.473-4.729) after adjusting individual medical condition and demographics. Following the results of subgroup analysis, the risk ratio of IS was greater in most of the subgroup categories (male, female, age 65, non-diabetic, hypertensive, non-hypertensive, dyslipidemic and non-dyslipidemic subgroup). However, the risk of IS did not differ significantly in diabetic subgroup (95% CI: 0.953-4.360). @*Conclusions@#The risk rate of IS increased in patient with pyogenic spondylitis.
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Objective@#: The goal of the following statewide age and gender-coordinated cohort study in Korea is to find out if there is a link between acute myocardial infarction (AMI) and Parkinson’s disease (PD). @*Methods@#: Utilizing the National Health Insurance Sharing Service cohort, patient data were collected. Six thousand four hundred seventy-five individuals with PD were distinguished by utilizing the International Classification of Diseases 10 code G20 and have enrolled in the PD group. The number of participants decreased to 5259 after excluding 1039 patients who were hospitalized less than one time or who visited an outpatient clinic less than twice. Then, 26295 individuals were selected as part of the control group after case control matching was conducted through 1 : 5 age- and gender-coordinated matching. The Cox proportional hazard regression analysis and Kaplan-Meier method were utilized to analyze the likelihood of AMI in PD. @*Results@#: After controlling for age and gender, the hazard ratio of AMI in the PD group was 3.603 (95% confidence interval [CI], 2.837–4.577). After that, the following hazard ratio of AMI in the PD group was modified against for co-morbid medical disorders, resulting in 3.551 (95% CI, 2.795–4.511). According to a subgroup analysis, in males and females aged <65 and aged ≥65 and in the non-diabetes and diabetes, hypertension and non-hypertension, dyslipidemia and non-dyslipidemia subgroups, the AMI incidence rates were dramatically higher in the PD group compared to that of the control. @*Conclusion@#: Individuals with PD have a greater chance of AMI, according to this cross-national study.
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Objective@#The aim of this nationwide age- and sex- matched longitudinal follow up study is to determine the risk of Parkinson’s disease (PD) associated with ischemic stroke in Korea. @*Methods@#Patient data were collected from the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS). PD was identified using the International Classification of Diseases (ICD) 10-CM code G 20. In total, 6,475 patients were enrolled in the PD group from the NHISS. After subtracting 1,039 patients who underwent hospitalization less than once or those who visited an outpatient clinic less than two times, 5,259 patients who were diagnosed after January 1, 2004 ultimately participated in this study. After case-control match was done through 1:5 age- and sex- stratified matching, 26,295 individuals were chosen as control. Kaplan-Meier method and Cox proportional hazard regression analysis were performed to evaluate the risk of ischemic stroke in PD. @*Results@#The hazard ratio of ischemic stroke in the PD group was 3.848 (95% confidence interval (confidence interval [CI]): 3.14-4.70) after adjusting for age and sex. The adjusted hazard ratio of ischemic stroke in PD group was 3.885 (95% CI: 3.17-4.75) after adjusting for comorbidities. According to subgroup analysis, in male and female and non-diabetes and diabetes and non-hypertension and hypertension and dyslipidemia and non-dyslipidemia subgroups, ischemic stroke incidence rates were significantly higher in the PD group than those in the control group. @*Conclusions@#This nationwide longitudinal study suggests an increased risk of ischemic stroke in PD patients.
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Objective@#The aim of this nationwide age- and sex- matched longitudinal follow up study is to determine the risk of Parkinson’s disease (PD) associated with ischemic stroke in Korea. @*Methods@#Patient data were collected from the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS). PD was identified using the International Classification of Diseases (ICD) 10-CM code G 20. In total, 6,475 patients were enrolled in the PD group from the NHISS. After subtracting 1,039 patients who underwent hospitalization less than once or those who visited an outpatient clinic less than two times, 5,259 patients who were diagnosed after January 1, 2004 ultimately participated in this study. After case-control match was done through 1:5 age- and sex- stratified matching, 26,295 individuals were chosen as control. Kaplan-Meier method and Cox proportional hazard regression analysis were performed to evaluate the risk of ischemic stroke in PD. @*Results@#The hazard ratio of ischemic stroke in the PD group was 3.848 (95% confidence interval (confidence interval [CI]): 3.14-4.70) after adjusting for age and sex. The adjusted hazard ratio of ischemic stroke in PD group was 3.885 (95% CI: 3.17-4.75) after adjusting for comorbidities. According to subgroup analysis, in male and female and non-diabetes and diabetes and non-hypertension and hypertension and dyslipidemia and non-dyslipidemia subgroups, ischemic stroke incidence rates were significantly higher in the PD group than those in the control group. @*Conclusions@#This nationwide longitudinal study suggests an increased risk of ischemic stroke in PD patients.
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The short release half-life of carbon monoxide (CO) is a major obstacle to the effective therapeutic use of carbon monoxide-releasing molecule-2 (CORM-2). The potential of CORM-2-entrapped ultradeformable liposomes (CORM-2-UDLs) to enhance the release half-life of CO and alleviate skin inflammation was investigated in the present study. CORM-2-UDLs were prepared by using soy phosphatidylcholine to form lipid bilayers and Tween 80 as an edge activator. The deformability of CORM-2-UDLs was measured and compared with that of conventional liposomes by passing formulations through a filter device at a constant pressure. The release profile of CO from CORM-2-UDLs was evaluated by myoglobin assay.
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OBJECTIVE: We attempted to discover that Ankylosing spondylitis (AS) has a comprehensive relationship with congestive heart failure and death.METHODS: We used a nationwide database managed by the Korean National Health Insurance Service from 2010 to 2014. Twelve thousand nine hundred eighty-eight patients with a diagnosis of AS and 64940 age- and sex- stratified matching subjects without AS were enrolled in the AS and control groups. Incidence probabilities of 6 years congestive heart failure and death in each group were calculated. The Cox proportional hazard regression analysis was used to estimate the hazard ratio. We divided the AS and control groups into subgroups according to sex, age, income, and comorbidities.RESULTS: During the follow-up period, 102 patients (0.79%) in the AS group and 201 patients (0.32%) in the control group developed congestive heart failure (p < ;0.0001). In addition, 211 (1.62%) subjects in the AS group died during the follow-up period compared to 639 (0.98%) subjects in the control group (p < ;0.0001). The adjusted hazard ratio of congestive heart failure and death in the AS group was 2.28 (95% confidence interval [CI], 1.80–2.89) and 1.66 (95% CI, 1.42–1.95), respectively. The hazard ratios of congestive heart failure and death were significantly increased in all of the subgroups.CONCLUSION: The incidence rates of congestive heart failure and death were increased in AS patients.
Subject(s)
Humans , Cardiovascular Diseases , Cohort Studies , Comorbidity , Diagnosis , Epidemiology , Estrogens, Conjugated (USP) , Follow-Up Studies , Heart Failure , Incidence , Korea , National Health Programs , Spondylitis, AnkylosingABSTRACT
OBJECTIVE: We attempted to discover that Ankylosing spondylitis (AS) has a comprehensive relationship with congestive heart failure and death. METHODS: We used a nationwide database managed by the Korean National Health Insurance Service from 2010 to 2014. Twelve thousand nine hundred eighty-eight patients with a diagnosis of AS and 64940 age- and sex- stratified matching subjects without AS were enrolled in the AS and control groups. Incidence probabilities of 6 years congestive heart failure and death in each group were calculated. The Cox proportional hazard regression analysis was used to estimate the hazard ratio. We divided the AS and control groups into subgroups according to sex, age, income, and comorbidities. RESULTS: During the follow-up period, 102 patients (0.79%) in the AS group and 201 patients (0.32%) in the control group developed congestive heart failure (p < ;0.0001). In addition, 211 (1.62%) subjects in the AS group died during the follow-up period compared to 639 (0.98%) subjects in the control group (p < ;0.0001). The adjusted hazard ratio of congestive heart failure and death in the AS group was 2.28 (95% confidence interval [CI], 1.80–2.89) and 1.66 (95% CI, 1.42–1.95), respectively. The hazard ratios of congestive heart failure and death were significantly increased in all of the subgroups. CONCLUSION: The incidence rates of congestive heart failure and death were increased in AS patients.
Subject(s)
Humans , Cardiovascular Diseases , Cohort Studies , Comorbidity , Diagnosis , Epidemiology , Estrogens, Conjugated (USP) , Follow-Up Studies , Heart Failure , Incidence , Korea , National Health Programs , Spondylitis, AnkylosingABSTRACT
BACKGROUND AND PURPOSE: MicroRNA (miRNA) expression has been examined in multiple conditions, including various cancers, neurological diseases, and cerebrovascular diseases, particularly stroke. Existing evidence indicates that miRNA biosynthesis and function play crucial roles in ischemic stroke physiology and pathology. In this study, we selected six known polymorphisms in miRNA-biogenesis genes; DICER rs13078A>T, rs3742330A>G; DROSHA rs10719T>C, rs6877842G>C; Ran GTPase (RAN) rs14035C>T; exportin 5 (XPO5) rs11077A>C. METHODS: We analyzed the associations between these polymorphisms and disease status and clinical factors in 585 ischemic stroke patients and 403 controls. Genotyping was performed with the polymerase chain reaction-restriction fragment length polymorphism method. RESULTS: The DICER rs3742330A>G (AA vs. AG+GG: adjusted odds ratio [AOR], 1.360; 95% confidence interval [CI], 1.024 to 1.807; P=0.034) and DROSHA rs10719T>C polymorphisms (TT vs. CC: AOR, 2.038; 95% CI, 1.113 to 3.730; P=0.021) were associated with ischemic stroke prevalence. During a mean follow-up of 4.80±2.11 years, 99 (5.91%) of the stroke patients died. In multivariate Cox proportional hazard regression models, a significant association was found between RAN rs14035 and survival of large artery disease patients with ischemic stroke (CC vs. TT: adjusted hazard ratio, 5.978; P=0.015). CONCLUSIONS: An association was identified between the DICER and DROSHA polymorphisms and ischemic stroke. Specifically, polymorphisms (rs3742330 and rs10719) were more common in stroke patients, suggesting that they may be associated with an increased risk of ischemic stroke.
Subject(s)
Humans , Arteries , Cerebrovascular Disorders , Follow-Up Studies , GTP Phosphohydrolases , Methods , MicroRNAs , Mortality , Odds Ratio , Pathology , Physiology , Polymorphism, Genetic , Prevalence , StrokeABSTRACT
OBJECTIVE: Epidural injection of hyaluronic acid may prevent adhesion formation after spine surgery, but the compounds used to stabilize hyaluronidase could interfere with its anti-adhesion effects. The present study was conducted as a clinical trial to evaluate the efficacy and safety of an experimental medical gel in preventing adhesion formation. METHODS: This study was designed as a multicenter, randomized, double-blind, and comparative controlled clinical trial with an observation period of 6 weeks. Subjects were randomly assigned into two groups: group A with sodium hyaluronate + 1,4-butanediol diglycidyl ether (BDDE) and group B with sodium hyaluronate + sodium carboxymethylcellulose (CMC). Visual analogue scale (VAS) of back and leg pain and the Oswestry disability index (ODI) and scar score ratings were assessed after surgery. RESULTS: Mean scar grade was 2.37+/-1.13 in group A and 2.75+/-0.97 in group B, a statistically significant difference (p=0.012). VAS of back and leg pain and ODI scores decreased significantly from baseline to 3 and 6 weeks postoperatively in both groups (p0.3). The number of adverse reactions related to the anti-adhesion gels was not statistically different (p=0.569), but subsequent analysis of nervous adverse reactions showed group B was superior with a statistically difference (p=0.027). CONCLUSION: Sodium hyaluronate with BDDE demonstrated similar anti-adhesion properties to sodium hyaluronate with CMC. But, care should be used to nervous adverse reactions by using sodium hyaluronate with BDDE.
Subject(s)
Carboxymethylcellulose Sodium , Cicatrix , Diskectomy , Ether , Gels , Hyaluronic Acid , Hyaluronoglucosaminidase , Injections, Epidural , Leg , SpineABSTRACT
PURPOSE: Methylenetetrahydrofolate reductase (MTHFR) is the main regulatory enzyme for homocysteine metabolism. In the present study, we evaluated whether the MTHFR 677C>T and 1298A>C gene polymorphisms are associated with SBI and plasma homocysteine concentration in a Korean population. MATERIALS AND METHODS: We enrolled 264 patients with SBI and 234 healthy controls in South Korea. Fasting plasma total homocysteine (tHcy) concentrations were measured, and genotype analysis of the MTHFR gene was carried out. RESULTS: The plasma tHcy levels were significantly higher in patients with SBI than in healthy controls. Despite a significant association between the MTHFR 677TT genotype and hyperhomocysteinemia, the MTHFR 677C>T genotypes did not appear to influence susceptibility to SBI. However, odds ratios of the 1298AC and 1298AC + CC genotypes for the 1298AA genotype were significantly different between SBI patients and normal controls. The frequencies of 677C-1298A and 677C-1298C haplotypes were significantly higher in the SBI group than in the control group. CONCLUSION: This study demonstrates that the MTHFR 1298A>C polymorphism is a risk factor for SBI in a Korean population. The genotypes of 677C>T and 1298A>C polymorphisms interact additively, and increase the risk of SBI in Korean subjects.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Asian People , Brain Infarction/genetics , Genotype , Haplotypes , Homocysteine/metabolism , Methylenetetrahydrofolate Reductase (NADPH2)/genetics , Polymorphism, Genetic/geneticsABSTRACT
Although prompt diagnosis and emergent surgical intervention are important in acute spinal subdural hematoma (SSDH), some cases with spontaneous remission of symptom and hematoma without surgery have been reported. We present a case of acute nontraumatic SSDH presenting with transient left hemiplegia for 4 hours. A magnetic resonance imaging study of cervical spine confirmed SSDH with C3-6 cervical cord compression at the left side. The patient had conservative management without recurrence. Although hemiplegia is an unusual clinical manifestation of SSDH, it should be differentiated from that of cerebrovascular origin promptly. Conservative management may be an alternative therapeutic option for selective cases with transient neurological deficits.
Subject(s)
Humans , Hematoma , Hematoma, Subdural, Spinal , Hemiplegia , Magnetic Resonance Imaging , Recurrence , Remission, Spontaneous , SpineABSTRACT
Acute stroke with isolated monoparesis manifesting as distal weakness of a single lower extremity has rarely been described. We report two patients with small cortical infarction who had distal weakness of a single lower extremity. In both cases, diffusion-weighted image (DWI) was used to detect small lesions in the contralateral cortex. These cases illustrate that small cortical infarction can cause isolated monoparesis limited to distal part of the leg and it may be misdiagnosed as spinal lesions, especially when lower back pain and transient sensory symptoms are accompanied. In case of the abrupt onset of weakness limited to one lower limb, the possibility of stroke should be considered and careful attention to identify cortical lesions using magnetic resonance imaging, especially DWI is required.
Subject(s)
Humans , Cerebral Infarction , Infarction , Leg , Low Back Pain , Lower Extremity , Magnetic Resonance Imaging , Paresis , StrokeABSTRACT
Dissecting aneurysms frequently involve the vertebral arteries and their branches, but those involving the posterior inferior cerebellar artery (PICA) and not vertebral artery at all are extremely rare. We present a case of an isolated dissecting aneurysm of the PICA without involvement of vertebral artery. A 54-year-old man presented with dizziness and headache. MR imaging of the brain showed a cerebellar infarction of the left PICA territory. MR angiographic and cerebral angiographic studies revealed a dissecting fusiform aneurysm involving the left proximal PICA. Subsequently, the patient underwent GDC embolization. A postembolization angiogram demonstrated complete obliteration of the aneurysm. In this report, the treatment modalities for this rare condition is described with review of the literature.
Subject(s)
Humans , Middle Aged , Aneurysm , Aortic Dissection , Arteries , Brain , Dizziness , Headache , Infarction , Magnetic Resonance Imaging , Pica , Vertebral ArteryABSTRACT
OBJECTIVE: Acute stroke caused by cerebral artery occlusion or rupture is the most important vascular central nervous system disorder in Korea and remains a leading cause of death and disability despite significant clinical benefits after current treatment modalities. Therefore, it is crucial to develop new alternative therapeutic strategies. The most encouraging approach is directed towards cell transplantation into damaged regions. We discuss the ideal candidate for cell transplantation in current status and preliminary results of peripheral blood stem cells transplantation for acute stroke. METHODS: Five patients with acute stroke (three patients with deep intracerebral hemorrhage and two patients with middle cerebral artery occlusion) underwent peripheral blood stem cells transplantation stereotactically. RESULTS: Cell transplantation of three patients did not improve motor function recovery, as evidenced by NIHSS. However, interestingly, cell transplantation significantly increased CSF levels of vascular endothelial growth factor (VEGF). CONCLUSION: Cell transplantation did correlate positively with elevated growth factor levels in CSF, but not with improved motor function.
Subject(s)
Humans , Cause of Death , Cell Transplantation , Central Nervous System , Cerebral Arteries , Cerebral Hemorrhage , Granulocyte Colony-Stimulating Factor , Hematopoietic Stem Cells , Korea , Middle Cerebral Artery , Recovery of Function , Rupture , Stem Cells , Stroke , Transplants , Vascular Endothelial Growth Factor AABSTRACT
PURPOSE: Thymidylate synthase (TS) gene encodes a tightly regulated enzyme that catalyzes the conversion of deoxyuridylate to thymidylate, and contains a tandem repeat polymorphism, of which a triple repeat is associated with increased expression of TS. TS is a key enzyme in the folate metabolism and compete with methylenetetrahydrofolate reductase (MTHFR) for limiting supplies of folate required for the remethylation of homocysteine. We studied to clarify the association between MTHFR C677T and TS polymorphism and prognosis in epilepsy. METHODS: 119 patients with antiepileptic drug more than one year were included. We investigated the MTHFR C677T and TS polymorphism using PCR, and analyzed the association between plasma homocysteine, folate levels, clinical profiles (especially seizure frequencies) and polymorphism. RESULTS: In seizure frequencies during one year, TT type in MTHFR and 3R3R type in TS polymorphism had higher frequencies than any other types without statistical significance. In plasma homocysteine levels, TT type had significantly higher homocsyteine levels than any other types, but 3R3R type had higher homocsyteine levels than any other types without statistical significance. Combined analysis of MTHFR C677T and TS polymorphism revealed that plasma homocysteine levels (18.22+/-8.32 micromol/l; p=0.039) and seizure frequencies (6.38+/-7.35/year; p=0.04) in patients with TT/3R3R were significantly higher than any other groups. A significant correlation between plasma homocysteine levels and seizure frequencies also was shown in multivariate linear regression analysis (B=0.160, Std error=0.069, adjusted R2=0.039, p=0.021). CONCLUSION: Epileptic patients with hyperhomocysteinemia, especially when combined with mutant allele for MTHFR and TS genes, have higher seizure frequencies. Therefore, our results suggest that the genotyping for the MTHFR and TS polymorphism may become a useful indicator in determining prognosis of epilepsy.
Subject(s)
Humans , Alleles , Epilepsy , Equipment and Supplies , Folic Acid , Homocysteine , Hyperhomocysteinemia , Linear Models , Metabolism , Methylenetetrahydrofolate Reductase (NADPH2) , Plasma , Polymerase Chain Reaction , Prognosis , Seizures , Tandem Repeat Sequences , Thymidylate SynthaseABSTRACT
The aneurysm nature and configuration in a giant aneurysm of the PCA is important and careful angiographic examination is needed. We present a case of dissecting aneurysm of the posterior cerebral artery masquerading as saccular giant aneurysm. A 17-year-old man presented with subarachnoid haemorrhage. Cerebral angiograms on admission showed a giant saccular aneurysm with wide neck at P1-P2 junction. The patient underwent endovascular coils embolization and extraventricular drainage of cerebrospinal fluid successfully. However, the patient was aggravated neurologically and got the rebleeding on postembolization 8 days. Repeat cerebral angiograms revealed dilated P1 segment with aneurysmal change of P2 segment. We report the angiographic feature and unusual clinical course and discuss the endovascular treatment of dissecting aneurysms.
Subject(s)
Adolescent , Humans , Aneurysm , Aortic Dissection , Cerebrospinal Fluid , Drainage , Intracranial Aneurysm , Neck , Passive Cutaneous Anaphylaxis , Posterior Cerebral ArteryABSTRACT
Compartment syndrome has a wide spectrum from muscle pain to a life-threatening condition, such as acute renal failure and disseminated intravascular coagulation (DIC). Intracerebral hemorrhage (ICH) due to compartment syndrome has not been reported. We report a patient who presented with ICH leading to death. A 25-year-old female with no significant past history developed extensive compartment syndrome followed by rhabdomyolysis, acute renal failure, DIC, and ICH. Although the patient underwent a fasciotomy and hemodialysis and received aggressive resuscitation with massive transfusions of blood and intravenous fluids, she died. This case stresses the importance of early diagnosis and prompt treatment of compartment syndrome to prevent devastating complications.
Subject(s)
Adult , Female , Humans , Acute Kidney Injury , Arm , Cerebral Hemorrhage , Compartment Syndromes , Dacarbazine , Disseminated Intravascular Coagulation , Early Diagnosis , Myalgia , Renal Dialysis , Resuscitation , RhabdomyolysisABSTRACT
Compartment syndrome has a wide spectrum from muscle pain to a life-threatening condition, such as acute renal failure and disseminated intravascular coagulation (DIC). Intracerebral hemorrhage (ICH) due to compartment syndrome has not been reported. We report a patient who presented with ICH leading to death. A 25-year-old female with no significant past history developed extensive compartment syndrome followed by rhabdomyolysis, acute renal failure, DIC, and ICH. Although the patient underwent a fasciotomy and hemodialysis and received aggressive resuscitation with massive transfusions of blood and intravenous fluids, she died. This case stresses the importance of early diagnosis and prompt treatment of compartment syndrome to prevent devastating complications.
Subject(s)
Adult , Female , Humans , Acute Kidney Injury , Arm , Cerebral Hemorrhage , Compartment Syndromes , Dacarbazine , Disseminated Intravascular Coagulation , Early Diagnosis , Myalgia , Renal Dialysis , Resuscitation , RhabdomyolysisABSTRACT
A 49-year-old man presented with right basal ganglia hemorrhage due to a ruptured distal lenticulostriate artery aneurysm associated with ipsilateral occlusion of M1 segment of middle cerebral artery with moyamoya-type vessels. Conservative treatment was initially selected. However, the patient suddenly became drowsy with left hemiparesis due to recurrent bleeding 14 days after admission, and excision of the aneurysm was urgently performed via right frontotemporal craniotomy. The follow-up angiography showed successful resolution of the aneurysm. This report describes a rare case of a distal lenticulostriate artery aneurysm associated with ipsilateral middle cerebral artery occlusion with moyamoya-type vessels, which resulted in intracerebral hemorrhage on the right basal ganglia and intraventricular hemorrhage.
Subject(s)
Humans , Middle Aged , Aneurysm , Angiography , Arteries , Basal Ganglia , Basal Ganglia Hemorrhage , Cerebral Hemorrhage , Craniotomy , Follow-Up Studies , Hemorrhage , Infarction, Middle Cerebral Artery , Intracranial Aneurysm , Middle Cerebral Artery , ParesisABSTRACT
A 45-year-old male presented with left pulsatile tinnitus and left conjunctival chemosis after blunt head trauma. Cerebral angiography demonstrated a left carotid-cavernous sinus fistula associated with a persistent primitive trigeminal artery. The fistula was packed with detachable coils through the transvenous approach and was successfully occluded without complication, while preserving the patency of the persistent primitive trigeminal artery. The patient's symptoms resolved soon after treatment. Persistent primitive trigeminal artery can be associated with a traumatic cavernous sinus fistula and transvenous coil embolization can be a safe and effective method to immediately occlude the fistula.