• Clinical Endoscopy
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• 제56권2호
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• pp.143-154
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• 2023

Advanced malignant hilar biliary obstruction (MHBO) with inaccessible papilla poses a significant challenge to endoscopists, as drainage of multiple liver segments may be warranted. Transpapillary drainage may not be feasible in patients with surgically altered anatomy, duodenal stenosis, prior duodenal self-expanding metal stent, and after initial transpapillary drainage, but require re-intervention for draining separated liver segments. Endoscopic ultrasound-guided biliary drainage (EUS-BD) and percutaneous trans-hepatic biliary drainage are the feasible options in this scenario. The major advantages of EUS-BD over percutaneous trans-hepatic biliary drainage include a reduction in patient discomfort and internal drainage away from the tumor, thus reducing the possibility of tissue or tumor ingrowth. With innovations, EUS-BD is helpful not only for bilateral communicating MHBO but also for non-communicating systems with bridging hilar stents or isolated right intra-hepatic duct drainage by hepatico-duodenostomy. EUS-guided multi-stent drainage with specially designed cannulas and guidewires has become a reality. A combined approach with endoscopic retrograde cholangiopancreatography for re-intervention, interventional radiology, and intraductal tumor ablative therapies has been reported. Stent migration and bile leakage can be minimized with proper stent selection and technique, and stent blocks can be managed with EUS-guided interventions in a majority of cases. Future comparative studies are required to establish the role of EUS-guided interventions in MHBO as rescue or primary therapy.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권2호
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• pp.187-196
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• 2021

Purpose: The rising prevalence of childhood obesity in the past decades has caused non-alcoholic fatty liver disease (NAFLD) to become the most common cause of pediatric chronic liver disease worldwide. This study was aimed at determining the effect of vitamin D (Vit D) on ultrasonography and laboratory indices of NAFLD and some blood biochemical indicators in children. Methods: In this interventional study liver ultrasonography was performed in 200 children with overweight and obesity. A 108 had fatty liver among which 101 were randomly divided into two groups of study (n=51) and control (n=50). The study group was treated with Vit D, 50000 U once a week whereas the control group received placebo with the same dose and package, both for 12 weeks. At the end of the intervention lab tests and ultrasound study was performed once again to evaluate the response to treatment. Results: It was found out that Vit D supplementation improved the fatty liver grade in the study group. The mean changes in hemoglobin (Hb), uric acid, highdensity lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), insulin, albumin and alanine aminotransferase (ALT) was significantly higher in the study group compared to controls (p<0.05). After the intervention and means adjustment, a significant difference was obtained in HDL-C, insulin, LDL-C and homeostasis model assessment of insulin resistance (HOMA-IR) between the two groups. Conclusion: Vit D supplementation in addition to improving the fatty liver grade in ultrasonography and increasing the blood Vit D level, increases the HDL and Hb level besides decreasing uric acid, LDL, HOMA-IR, insulin and ALT levels.

• 한국임상수의학회지
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• 제41권3호
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• pp.157-164
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• 2024

The standard radiation protection method in the angiography suite involves the use of a thyroid shield, a lead apron, and lead glasses. However, exposure to substantial amounts of ionizing radiation can cause cataracts, tumors, and skin erythema. A newly developed curtain-type radiation protection device consists of a curtain drape composed of a five-layer bismuth and lead acrylic head-shielding plate, with both bearing an equivalent 0.25 mm lead thickness. In this study, a quality assurance phantom was used as the patient to create radiation scatter from the radiographic source, and an anthropomorphic mannequin phantom was used as the interventionalist to measure the radiation dose at seven different anatomical locations. Thermoluminescent dosimeters were used to measure the radiation dose. The experimental groups consisted of all-sided or one-sided curtain set-ups, the presence or absence of a conventional shielding system, and the orientation of beam irradiation. Consequently, the curtain-type radiation protection device exhibited better radiation protection range and capabilities than conventional radiation protection systems, especially in safeguarding the forehead, eyes, arms, and feet, with minimal radiation exposure. Moreover, the mean shielding ratios of the conventional shielding system and curtain-type radiation protection device were measured at 51.94% and 93.86%, respectively. Additionally, no significant decrease in the radiation protection range or capability was observed, even with changes in the beam orientation or one-sided protection. Compared with a conventional shielding system, the curtain-type radiation protection device decreased radiation exposure doses and improved comfort. Therefore, it is a potential new radiation protection device for veterinary interventional procedures.

• Korean Journal of Radiology
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• 제20권8호
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• pp.1285-1292
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• 2019

Objective: To evaluate the safety and efficacy of the coil-protected technique for liquid embolization in neurovascular malformations. Materials and Methods: Twenty-two patients who underwent coil-protected liquid embolization for symptomatic cranial (n = 13) and spinal (n = 9) arteriovenous fistula (AVF) or arteriovenous malformations (AVMs) were identified. A total of 36 target feeder vessels were embolized with N-butyl cyanoacrylate and/or Onyx (Medtronic). This technique was used to promote delivery of a sufficient amount of liquid embolic agent into the target shunt or nidus in cases where tortuous feeding arteries preclude a microcatheter wedging techniqu and/or to prevent reflux of the liquid embolic agent in cases with a short safety margin. The procedure was considered technically successful if the target lesion was sufficiently filled with liquid embolic agent without unintentional reflux. Angiographic and clinical outcomes were retrospectively evaluated. Results: Technical success was achieved for all 36 target feeders. Post-embolization angiographies revealed complete occlusion in 16 patients and near-complete and partial occlusion in three patients each. There were no treatment-related complications. Of the six patients who showed near-complete or partial occlusion, five received additional treatments: two received stereotactic radiosurgery for cerebral AVM, two underwent surgical removal of cerebral AVM, and one underwent additional embolization by direct puncture for a mandibular AVM. Finally, all patients showed complete (n = 19) or near-complete (n = 3) occlusion of the target AVF or AVM on follow-up angiographies. The presenting neurological symptoms improved completely in 15 patients (68.2%) and partially in seven patients (31.8%). Conclusion: The coil-protected technique is a safe and effective method for liquid embolization, especially in patients with various neurovascular shunts or malformations who could not be successfully treated with conventional techniques.

• Korean Journal of Radiology
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• 제1권2호
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• pp.65-72
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• 2000

Objective: To compare the efficacy of suprapapillary and transpapillary methods of transhepatic biliary metallic stent placement in malignant biliary strictures and to specify the indications of each method applied. Materials and Methods: Stents were placed in 59 patients. Strictures were categorized as type A (within 3 cm of the ampulla, n = 27), type B (over 3 cm from ampulla, n = 7), type C (within 3 cm of the bending portion, n = 9), or type D (over 3 cm above the bending portion, n=16). The stenting method was suprapapillary in 34 cases and transpapillary in 25. The rates of initial and long-term patency and of early recurrence were compared. Results: Initial patency rates for the suprapapillary and transpapillary methods were 1/7 (14.3%) and 20/20 (100%) respectively for type A (p < 0.0001), 4/5 (80.0%) and 2/2 for type B, 3/7 (42.9%) and 2/2 for type C, and 15/16 (93.8%) and 0/0 for type D. Early recurrence rates were 7/30 (23.3%) using the suprapapillary method and 4/29 (13.8%) using the transpapillary method (p = 0.51). The long-term patency rate did not differ significantly according to either type (p = 0.37) or method (p = 0.62). Conclusion: For good initial patency, the transpapillary method is recommended for strictures of the distal extrahepatic duct near the ampulla and just above the bending portion. Long-term patency is not influenced by the stenting method employed.

• 대한방사선기술학회지:방사선기술과학
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• 제37권1호
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• pp.15-20
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• 2014

인터벤션 시술을 위한 생분해성 고분자 재료의 임상적용 가능성을 평가하기 위한 예비실험을 진행하고자 한다. 생분해성 고분자막은 분말상태의 히알루론산을 수산화나트륨 용액에 가열교반기를 이용하여 수용액으로 제조하였다. 제조된 수용제는 조영제를 3가지(10, 20, 30 vol%)로 다르게 하여 첨가하고, 12시간 동안 100-200rpm의 속도로 실온에서 수직교반을 시행하였다. $-80^{\circ}C$에서 24시간 동안 동결건조 한 후, 동결건조된 시료는 막으로 성형하기 위해 유압프레스로 가압하여 제조하였다. 조영제의 함량을 달리하여 제작된 막은 주사전자 현미경을 이용한 육안 검사와 방사선 투과도 시험을 시행하였으며, 육안 검사상 조영제의 함량이 많을수록 표면이 거칠어지는 경향을 보였으며, 방사선투과도 시험은 방사선 투시, 단순촬영, 연속촬영의 조건에서 모두 유사한 방사선투과도를 보였다. 결론적으로 본 예비연구에서 히알루론산으로 제조된 생분해성 막은 임상에서의 사용가능성을 가지고 있는 재료임을 확인할 수 있었다.

• Korean Journal of Radiology
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• 제24권2호
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• pp.145-154
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• 2023

Objective: We aimed to evaluate the efficacy of EmboTrap II in terms of first-pass recanalization and to determine whether it could yield favorable outcomes. Materials and Methods: In this multicenter, prospective study, we consecutively enrolled patients who underwent mechanical thrombectomy using EmboTrap II as a front-line device. The primary outcome was the first pass effect (FPE) rate defined by modified Thrombolysis In Cerebral Infarction (mTICI) grade 2c or 3 by the first pass of EmboTrap II. In addition, modified FPE (mFPE; mTICI grade 2b-3 by the first pass of EmboTrap II), successful recanalization (final mTICI grade 2b-3), and clinical outcomes were assessed. We also analyzed the effect of FPE on a modified Rankin Scale (mRS) score of 0-2 at 3 months. Results: Two hundred-ten patients (mean age ± standard deviation, 73.3 ± 11.4 years; male, 55.7%) were included. Ninety-nine patients (47.1%) had FPE, and mFPE was achieved in 150 (71.4%) patients. Successful recanalization was achieved in 191 (91.0%) patients. Among them, 164 (85.9%) patients underwent successful recanalization by exclusively using EmboTrap II. The time from groin puncture to FPE was 25.0 minutes (interquartile range, 17.0-35.0 minutes). Procedure-related complications were observed in seven (3.3%) patients. Symptomatic intracranial hemorrhage developed in 14 (6.7%) patients. One hundred twenty-three (58.9% of 209 completely followed) patients had an mRS score of 0-2. Sixteen (7.7% of 209) patients died during the follow-up period. Patients who had successful recanalization with FPE were four times more likely to have an mRS score of 0-2 than those who had successful recanalization without FPE (adjusted odds ratio, 4.13; 95% confidence interval, 1.59-10.8; p = 0.004). Conclusion: Mechanical thrombectomy using the front-line EmboTrap II is effective and safe. In particular, FPE rates were high. Achieving FPE was important for an mRS score of 0-2, even in patients with successful recanalization.

• 대한영상의학회지
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• 제83권2호
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• pp.400-405
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• 2022

위장관기질종양(gastrointestinal tumor; 이하 GIST)은 종종 위장관 출혈의 원인이 되는 드물지 않은 질환이지만 소장에 생기는 경우 내시경 및 전산화단층촬영(이하 CT)에서 발견이 어려울 수 있다. 본 증례에서 환자는 수술 전 총 3회의 CT를 시행 받았으나, 병변은 매번 복강의 다른 부위에 위치해 있었고, 허탈된 소장과 구분이 어려워 처음 2번의 CT에서는 발견하지 못했다. 혈관조영술에서 병변이 보였지만, 고령의 환자에서 원인불명 위장관 출혈의 가장 흔한 원인인 혈관기형으로 잘못 해석되어 올바른 진단과 치료가 3년간 지연되었다. 본 증례를 통해, GIST의 정확한 진단 및 치료 전략 수립을 위해 혈관조영술 소견을 강조하고자 한다.

• 대한영상의학회지
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• 제82권3호
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• pp.541-550
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• 2021

발을 향해 가는 혈류의 중요한 길목인 무릎 밑 동맥은 다리 혈관 중 가장 가늘며, 협착 등의 병변이 발생하거나 폐쇄가 발생하게 되면 중증하지허혈을 유발할 수 있다. 중증하지허혈이란 말초동맥 질환의 가장 심한 임상 양상 중 하나로서 휴지기 동통, 족부궤양 또는 괴저의 형태로 나타난다. 일반적으로 동맥경화 질환의 진행은 미만성으로 나타나며 대다수의 환자에서 무릎 밑 동맥을 침범한다. 치료의 목표는 동맥혈류 재개통과 사지구제이다. 기술적으로 가능한 경우, 그리고 환자가 걷지 못하는 상태가 아니라면 중증하지허혈이 있는 환자는 혈관의 재개통이 즉시 이루어져야 한다. 따라서 혈관 내 치료는 무릎 밑 동맥을 포함한 모든 환자의 표준 치료가 될 것이며, 혈관재건술을 시행하는 외과의의 임상적 역할은 줄어들 것이다.

• 대한영상의학회지
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• 제81권6호
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• pp.1459-1465
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• 2020

항암치료를 위해 흉강 내 속목정맥의 천자를 통한 피하매몰 중심정맥 케모포트(implantable central venous chemoport) 도관의 설치 중 발생할 수 있는 의인성 속목정맥 천공은 매운 드문 합병증 중의 하나로 혈흉이나 출혈성 쇼크를 일으킬 수 있으며, 부적절한 항암제 주입으로 인한 늑막삼출이 발생할 수 있다. 따라서 항암제 주입 전 조기에 진단하여 응급 개흉술을 통해 천공된 속목정맥을 봉합하는 것이 치료 원칙이다. 저자들은 우측 속목정맥을 통한 피하매몰 중심정맥 케모포트의 설치 후 발생한 속목정맥 천공 환자에서 부적절한 항암제 주입으로 인해 발생한 늑막삼출과 혈흉을 개흉술을 시행하지 않고 경피적 배액술 후 코일과 N-butyl cyanoacrylate를 이용한 색전술을 통해 성공적으로 치료한 1예를 경험하였기에 이를 보고하고자 한다.