Transarterial chemoembolization using drug-eluting bead compared with radiofrequency ablation for treatment of single small hepatocellular carcinoma: a pilot non-randomized trial.

Background/Aims: Surgical resection, transplantation, and radiofrequency ablation (RFA) are generally accepted as amenable treatments for small hepatocellular carcinoma (HCC). Recently drug-eluting beads (DEB) which had several treatment advantages were introduced for transarterial chemoembolization (TACE). The aim of this study was to evaluate feasibility and safety of DEB-TACE compared with RFA for the treatment of single small HCC. Methods: In this pilot non-randomized trial, we assessed retrospective data of 40 patients who underwent DEB-TACE (n=21) or RFA (n=19) for single small (≤3 centimeter in greatest dimension) HCC. The primary outcomes were tumor response and time to recurrence. The secondary outcome was treatment-related complications. Results: Complete response rate to DEB-TACE and RFA after first follow-up assessment was 90.5% and 94.7%, respectively (P=1.000). During mean follow-up of 87.6 months (95% confidence interval, 74.4-102), 7 patients experienced local recurrence. The 6- and 12-month cumulative local recurrence rate was 5.0% and 21.8% in DEB-TACE vs. 11.1% and 17.0% in RFA group (P=0.877). A total 14 distant intrahepatic recurrences were developed and 12- and 24-month cumulative distant intrahepatic recurrence rate was 20.6% and 42.7% in DEB-TACE vs. 17.2% and 36.3% in RFA group (P=0.844). Two patients experienced gangrenous cholecystitis after DEB-TACE requiring cholecystectomy as treatment-related adverse event. Conclusions: Tumor response and recurrence rate after single session of DEB-TACE or RFA were similar. DEB-TACE could be applied selectively in patients with a single small HCC if the other therapeutic modality is unfeasible.

Percutaneous cholecystostomy is appropriate as definitive treatment for acute cholecystitis in critically ill patients: a single center, cross-sectional study.

BACKGROUND/AIMS: Percutaneous cholecystostomy (PC) is an effective treatment for cholecystitis in high-risk surgical patients. However, there is no definitive agreement on the need for additional cholecystectomy in these patients. METHODS: All patients who were admitted to Cheju Halla General Hospital (Jeju, Korea) for acute cholecystitis and who underwent ultrasonography-guided PC between 2007 and 2012 were consecutively enrolled in this study. Among 82 total patients enrolled, 35 underwent laparoscopic cholecystectomy after recovery and 47 received the best supportive care (BSC) without additional surgery. RESULTS: The technical and clinical success rates for PC were 100% and 97.5%, respectively. The overall mean survival was 12.8 months. In the BSC group, mean survival was 5.4 months, and in the cholecystectomy group, mean survival was 22.4 months (p<0.01). However, there was no significant difference between these groups in multivariate analysis (relative risk [RR]=1.92; 95% CI, 0.77-4.77; p=0.16). However, advanced age (RR=1.05; 95% CI, 1.02-1.08; p=0.001) and higher class in the American Society of Anesthesiologists' physical status (RR=3.06; 95% CI, 1.37-6.83, p=0.006) were significantly associated with survival in the multivariate analysis. Among the 47 patients in the BSC group, the cholecystostomy tube was removed in 31 patients per protocol. Recurrent cholecystitis was not observed in either group of patients during the follow-up period. CONCLUSIONS: In high-risk surgical patients, PC without additional cholecystectomy might be the best definitive management. Furthermore, the cholecystostomy drainage catheter can be safely removed in certain patients.

Squamous cell carcinoma of the lung with simultaneous metastases to peritoneum and skeletal muscle.

Skeletal muscle and peritoneum are rare sites of metastases from lung cancer. We report a case of squamous cell lung cancer with concurrent metastases to skeletal muscle and peritoneum. A 71-year-old man was diagnosed with squamous cell carcinoma of the right lower lobe with metastasis to the right hilar lymph node at clinical stage T3N1M0. Because of poor performance status and comorbidity, he only received radiation therapy. Positron emission tomography-computed tomography for mid-assessment of response showed two abnormal hypermetabolic lesions in the peritoneum of the left upper quadrant area and the left thigh muscle. We performed a needle-approach biopsy in each lesion and found both of the lesions were metastases from lung cancer. The patient died after two months.

Transcatheter N-butyl cyanoacrylate embolization of pseudoaneurysms.

PURPOSE: To report clinical experience with N-butyl cyanoacrylate (NBCA) for embolization of pseudoaneurysms at various locations. MATERIALS AND METHODS: Retrospective study of patients with pseudoaneurysms treated with NBCA over a 4-year period was conducted. Seventeen consecutive patients were evaluated, including three women and 14 men ranging in age from 25 to 77 years (mean, 60.6 y). NBCA was the only embolic agent used in 15 patients; in two patients, a liquid coil and a microcoil were placed before administration of NBCA. NBCA was mixed with iodized oil in a 1:3 ratio to control its polymerization time and to make it radiopaque. Diagnostic angiography and embolization were performed at the same session. Embolized sites included gastrointestinal tract (n = 6), spleen (n = 5), liver (n = 2), kidney (n = 1), chest (n = 1), oral cavity (n = 1), and buttock (n = 1). RESULTS: NBCA embolization was successful in 16 of 17 patients (94%), with complete occlusion of pseudoaneurysms. In one patient with a gastroduodenal artery stump pseudoaneurysm, NBCA embolization failed, and a stent-graft (8 mm/40 mm) was placed in the hepatic artery, excluding the pseudoaneurysm and preserving the hepatic artery. No major complications occurred, and there were no recurrences of pseudoaneurysms. CONCLUSIONS: NBCA embolization was an effective method for the treatment of pseudoaneurysms.

A case of hepatocellular carcinoma in the caudate lobe successfully treated by transcatheter arterial chemoembolization using drug-eluting beads.

Hepatocellular carcinoma (HCC) in the caudate lobe remains one of the most intricate locations where various treatments tend to pose problems with regard to the optimal approach. Surgical resection has been regarded as the most effective treatment; however, isolated resection of the caudate lobe is strenuous and associated with a high rate of early recurrence. Percutaneous ablation might be technically difficult or impossible to perform due to the deep location of tumors and adjacent large vessels. Treatment with drug-eluting beads (DEB) can potentially enhance the therapeutic efficacy for patients with unresectable HCC by drawing on the slower, more consistent drug delivery process. We described a case of a 62-year-old man with HCC in the caudate lobe who was successfully treated by DEB.

MR imaging of hypoglycemic encephalopathy: lesion distribution and prognosis prediction by diffusion-weighted imaging.

INTRODUCTION: The aim of this study was to evaluate the patterns of hypoglycemic encephalopathy on diffusion-weighted imaging (DWI) and the relationship between the imaging patterns and clinical outcomes. METHODS: This retrospective study included 17 consecutive patients that had hypoglycemic encephalopathy with DWI abnormalities. The topographic distributions of the DWI abnormalities of the cortex, deep gray matter, and white matter structures were assessed. In addition, possible correlation between the patterns of brain injury on DWI and clinical outcomes was investigated. RESULTS: There were three patterns of DWI abnormalities: involvement of both gray and white matter (n = 8), selective involvement of gray matter (n = 4), and selective involvement of white matter (n = 5). There was no significant difference in the initial blood glucose levels among patients for each of the imaging patterns. Most patients (16/17) had bilateral symmetrical abnormalities. Among patients with bilateral symmetrical gray and/or white matter injuries, one had moderate to severe disability and 14 remained in a persistent vegetative state. The two patients with a focal unilateral white matter abnormality and a localized splenial abnormality recovered without neurological deficits. CONCLUSION: The results of this study showed that white matter was more sensitive to hypoglycemia than previously thought and there was no specific association between the patterns of injury and clinical outcomes whether the cerebral cortex, deep gray matter, and/or white matter were affected. Diffuse and extensive injury observed on the DWI predicts a poor neurologic outcome in patients with hypoglycemic injuries.

The endovascular management of saccular posterior inferior cerebellar artery aneurysms.

OBJECTIVE: The purpose of this retrospective study was to report the outcome of the endovascular treatment of eight patients with eight saccular posterior inferior cerebellar artery (PICA) aneurysms. MATERIALS AND METHODS: Over the last seven years (1999-2006), eight consecutive patients with saccular PICA aneurysms were treated by endovascular methods. Five of the aneurysms were presented with subarachnoid hemorrhaging, whereas three were discovered incidentally. Four of the aneurysms (3 ruptured and 1 incidental) were treated by intrasaccular coiling, whereas the remaining four (1 ruptured and 3 incidental) were treated by vertebral artery (VA) occlusion. RESULTS: Of the four aneurysms treated by intrasaccular coiling, three were completely packed with coils and one was partially packed. In three of four patients who underwent vertebral artery occlusions, follow-up digital subtraction angiographies demonstrated thrombosed aneurysms and PICA. No procedure-related morbidity occurred and no re-bleed was encountered during a follow-up examination (mean; 31 months). CONCLUSION: As a result of this study, we found that the endovascular management of saccular PICA aneurysms should be considered as safe and effective.

Multiple pyogenic spondylodiscitis with bilateral psoas abscesses accompanying osteomyelitis of lateral malleolus - a case report -.

A psoas abscess is a potentially life-threatening infection. Multiple pyogenic spondylodiscitis with bilateral psoas abscesses accompanying an osteomyelitis of the lateral malleolus is an extremely rare event. We present our experience with needle aspiration for the treatment of osteomyelitis of the lateral malleolus and CT-guided percutaneous catheter drainage for a psoas abscess in an elderly patient. Both infections were completely resolved without recurrence. A psoas abscess should be included in the differential diagnosis of a patient with low back pain during musculoskeletal infection. Percutaneous needle aspiration or CT-guided percutaneous catheter drainage is an effective method for treating certain musculoskeletal infections.

Cutting balloon angioplasty for resistant venous stenoses of Brescia-Cimino fistulas.

Peripheral cutting balloons with diameters of 5-8 mm were employed to dilate eight resistant stenoses among 62 venous stenoses in 48 Brescia-Cimino fistulas. The grade of stenosis after high-pressure balloon angioplasty ranged from 57% to 87% (median, 75%). The residual stenosis after cutting balloon angioplasty ranged from 0 to 24% (median, 10.5%). Two complications occurred among these eight cases, one of which was treated by stent placement. No repeated intervention was necessary during follow-up (range, 74-249 days; median, 141 days). Cutting balloon angioplasty was effective to overcome the resistance of venous stenosis in hemodialysis fistulas.