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OBJECTIVE: To assess the two-year treatment outcomes of chemoembolization with drug-eluting embolics (DEE) for nodular hepatocellular carcinoma (HCC). MATERIALS AND METHODS: This study was a prospective, multicenter, registry-based, single-arm trial conducted at five university hospitals in Korea. Patients were recruited between May 2011 and April 2013, with a target population of 200. A DC Bead loaded with doxorubicin was used as the DEE agent. Patients were followed up for two years. Per-patient and per-lesion tumor response analysis, per-patient overall survival (OS) and progression-free survival (PFS) analysis, and per-lesion tumor control analysis were performed. RESULTS: The final study population included 152 patients, with 207 target lesions for the per-lesion analysis. At one-month, six-month, one-year, and two-year per-patient assessments, complete response (CR) rates were 40.1%, 43.0%, 33.3%, and 19.6%, respectively. The objective response (OR) rates were 91.4%, 55.4%, 35.1%, and 19.6%, respectively. The cumulative two-year OS rate was 79.7%. The cumulative two-year PFS rate was 22.4% and the median survival was 9.3 months. In multivariable analysis, the Child-Pugh score (p = 0.019) was an independent predictor of OS, and tumor multiplicity (p < 0.001), tumor size (p = 0.020), and Child-Pugh score (p = 0.006) were independent predictors of PFS. In per-lesion analysis, one-month, six-month, one-year and two-year CR rates were 57.5%, 58.5%, 45.2%, and 33.3%, respectively, and the OR rates were 84.1%, 65.2%, 46.6%, and 33.3%, respectively. The cumulative two-year per-lesion tumor control rate was 36.2%, and the median time was 14.1 months. The Child-Pugh score (p < 0.001) was the only independent predictor of tumor control. Serious adverse events were reported in 11 patients (7.2%). CONCLUSION: DEE chemoembolization for nodular HCCs in the Korean population showed acceptable survival, tumor response, and safety profiles after a two-year follow-up. Good liver function (Child-Pugh score A5) was a key predictor of per-patient OS, PFS, and per-lesion tumor control.

OBJECTIVES Endovascular treatment has emerged as a safe procedure for treating chronic DeBakey IIIb dissection. The objective of this study was to investigate the mid-term outcome and temporal pattern of aortic remodelling after endovascular treatment for DeBakey IIIb dissection. METHODS From 2012 to 2017, 85 patients who underwent endovascular aortic repair for DeBakey IIIb dissection were enrolled. The temporal pattern of aortic remodelling in terms of false lumen (FL) thrombosis [level 1 (∼T7), level 2 (T7 ∼ coeliac axis) and level 3 (coeliac trunk ∼ aortic bifurcation)] and aortic diameter [mid-thoracic level (T7), coeliac axis and the largest infrarenal abdominal aorta] was investigated on serial follow-up computed tomography scan. RESULTS Eighty-five patients underwent endovascular treatment during the study period. Male sex was a significant risk factor for repetitive reintervention and segments 2 and 3 FL thrombosis. The preoperative FL diameter at T7 was significantly associated with FL diameter regression. The number of visceral vessels from the FL and residual DeBakey IIIb dissection after type A repair were significant factors for FL growth at the coeliac trunk and at the largest infrarenal abdominal aorta. The overall mortality was 3 (3.6%). CONCLUSIONS Endovascular treatment is a safe strategy in the management of DeBakey IIIb dissection. However, unfavourable aortic remodelling and repetitive reintervention were expected in male patients with a large number of visceral vessels from the FL and residual DeBakey IIIb dissection after type A repair. Endovascular treatment should be cautiously considered, and close follow-up is required for these patients.

Concurrent intra-arterial chemotherapy and radiotherapy (iA-CCRT) can increase the response rate in hepatocellular carcinoma (HCC), but may cause a higher toxicity. We conducted this Phase I study to investigate the dose-limiting toxicity of iA-CCRT for HCC. In total, 52.5 Gy in 25 fractions was prescribed as planning target volume (PTV) 1 at dose level 1. The dose escalation was 0.2 Gy per fraction and up to 2.5 Gy, with 62.5 Gy at level 3. Concurrent intra-arterial 5-fluorouracil was administered during the first and fifth weeks of radiotherapy (RT). Toxicities were graded using the Common Toxicity Criteria for Adverse Events, version 4.0. Results: Seventeen patients with HCC were analyzed: four at dose level 1, 6 at level 2, and 7 at level 3. The mean irradiated dose administered to the uninvolved liver at each dose level was 21.3, 21.6, and 18.2 Gy, respectively. There was no grade &ge, 3 gastrointestinal toxicity, two patients experienced grade 3 hyperbilirubinemia. All patients had Child-Pugh class A disease, but 3 patients developed class B disease after iA-CCRT. During a median follow-up of 13 months, the median progression-free survival (PFS) and overall survival (OS) were 10 and 22 months, respectively. Patients treated at dose level 3 showed improved PFS and OS. Conclusions: Radiation dose escalation of iA-CCRT did not cause any significant toxicities in patients with advanced HCC. Further large-scale studies with long-term follow-up are needed to determine the efficacy and feasibility of higher doses of iA-CCRT.

To introduce complete thoracic aorta remodeling as a new therapeutic target of thoracic endovascular aortic repair for chronic DeBakey IIIb aneurysms, and analyze the predictors for complete thoracic aorta remodeling. From 2012 to 2017, 75 patients underwent thoracic endovascular aortic repair for chronic DeBakey IIIb aneurysms. Complete thoracic aorta remodeling was defined as thoracic false lumen thrombosis with false lumen diameter5 mm down to T-10 level. Major adverse aortic events were defined as aortic-related mortality, open conversion, and false lumen recanalization after thoracic false lumen thrombosis. Of the 75 patients included in this study, 60 (80.0%) demonstrated thoracic false lumen thrombosis; among them, overall mortality, open conversion, or false lumen recanalization after thoracic false lumen thrombosis occurred in two (3.3%), one (1.7%), and five (8.3%) patients, respectively. Nineteen (25.3%) of 75 patients who demonstrated complete thoracic aorta remodeling had no major adverse aortic events during follow-up. The number of visceral branches from the false lumen and residual intima tears were significant risk factors for complete thoracic aorta remodeling (HR 0.627, p = 0.041 and HR 0.754, p = 0.042). In chronic DeBakey IIIb aneurysms, complete thoracic aorta remodeling may be the ideal target for endovascular treatment rather than false lumen thrombosis. Additional procedures to eliminate the obstacles to complete thoracic aorta remodeling (number of visceral branches from the false lumen and residual intimal tears) and close follow-up after thoracic false lumen thrombosis may be needed to achieve the optimal outcome.

Objectives Non-surgical methods have high success rates for treating benign biliary strictures (BBSs), but treatment of proximal strictures is difficult. Recent studies have reported that fully covered self-expandable metal stents (FCSEMSs) are useful for treating refractory BBSs. We investigated the efficacy of a short and removable FCSEMS with an anti-migration design for treatment of proximal BBSs. Methods Fully covered self-expandable metal stents were inserted endoscopically in patients with BBSs after living donor liver transplantation (LDLT). Each FCSEMS was initially maintained for 3 months and subsequently exchanged every 3 months until the stricture resolved. Adverse events and stricture recurrence after FCSEMS removal were assessed during follow-up. Results A total of 63 patients with a median age of 57 years were enrolled in this study; 50 were male. The most common underlying disease was hepatocellular carcinoma and the previous operation was LDLT. The mean duration from surgery to diagnosis of stricture was 8.5 months, and the mean stent indwelling time was 4.2 months. The technical success and stricture resolution rate were 100%. The recurrence rate was 23.8% and the adverse event rate was 12.7%. All stents were removable, and asymptomatic stent migration was observed in four patients (6.4%). Conclusions The newly designed FCSEMS is effective in the treatment of proximal BBSs after LDLT.

Background We introduce a new endovascular procedure for favorable aortic remodeling in patients with chronic DeBakey IIIb (CDIIIb) aneurysms and present outcomes. Methods This study included 19 patients who underwent stentless thoracic endovascular aortic repair (TEVAR) for CDIIIb aneurysms between 2014 and 2016. Stentless TEVAR is defined as an endovascular procedure involving closure of communicating channels or obliteration of the false lumen itself using various materials. Thoracic false lumen thrombosis was defined as there was no flow in the false lumen of the thoracic aorta. Aortic diameter was measured at 3 levels (left subclavian artery, pulmonary artery bifurcation, and celiac axis). Results Fifteen of 19 (78.9%) patients demonstrated thoracic false lumen thrombosis. There was no mortality, and the mean follow-up duration was 16.8 months. False and true lumen diameters at the left subclavian and pulmonary artery levels significantly changed after the procedure (false lumen: 22.6 ± 16.6 versus 16.1 ± 14.4 mm, 23.2 ± 14.6 versus 18.0 ± 13.2 mm, p = 0.001 and p = 0.002, respectively; true lumen: 22.7 ± 8.7 versus 27.9 ± 6.3 mm, 19.0 ± 8.3 versus 24.3 ± 6.7 mm, p = 0.001 and p = 0.001, respectively). The number of visceral stent grafts and preoperative true lumen diameter at the pulmonary artery were independent predictors for thoracic false lumen thrombosis (hazard ratio, 3.445, 95% confidence interval, 1.494 to 7.946; p = 0.004; and hazard ratio, 1.106; 95% confidence interval, 1.029 to 1.189; p = 0.006, respectively). Conclusions Stentless TEVAR seems to be a safe procedure and enables favorable aortic remodeling. Thus, this technique can be useful in a selected group of patients with CDIIIb aneurysms.

This study compared the efficacy of a percutaneous transhepatic cholangioscopy (PTCS) catheter and a fully covered self-expandable metal stent (FCSEMS) for maintaining biliary tract patency after magnetic compression anastomosis (MCA).This study included patients with completely obstructed benign biliary stricture (BBS), which was resolved by MCA and subsequent insertion of a PTCS catheter or FCSEMS. We compared the restenosis-free time after removal of the PTCS catheter or FCSEMS, and the rate of complications.A total of 49 patients were analyzed. The mean ages of the patients in these groups were 50.1 and 49.6 years, respectively. The predisposing conditions causing complete BBS were liver transplantation (n = 38), abdominal surgery (n = 10) and trauma (n = 1). The mean indwelling durations were 176 and 128 days in the PTCS catheter and FCSEMS groups, respectively. The mean follow-up duration after removal of the PTCS catheter and FCSEMS were 2259 and 680.5 days, respectively. Three patients in the PTCS group and three patients in the FCSEMS group experienced stricture relapse. The mean duration between recurrence and stent removal were 924 and 265 days, respectively, and the numbers of stricture-free days did not differ significantly between the two groups. The adverse event rate did not differ significantly between the PTCS and FCSEMS groups (50% vs. 24.2%, respectively).FCSEMSs have an efficacy and safety similar to those of PTCS catheters for maintaining biliary tract patency after MCA, but are more convenient for patients.

We report a case of acute type I aortic dissection in which an emergency graft replacement of the ascending aorta and innominate artery was performed. We performed false lumen thrombosis through hybrid thoracic endovascular aortic repair to seal the primary entry tear, followed by false lumen obliteration at the level of the descending thoracic aorta, abdominal aorta, and right common iliac artery. Over a period of 4.5 years, we used Amplatzer vascular plugs and coils based on our computed tomography angiography follow-up protocol.

Objectives This study aimed to evaluate the impact of remnant re-entries in arch branches on postoperative change in the aortic arch and descending aortic diameters and the rate of major adverse aortic events. Methods Between January 2010 and December 2016, 249 patients underwent surgery for acute Type I aortic dissection. Patients who underwent total arch replacement, had Marfan syndrome or had intramural haematoma were excluded. Seventy-two patients with predischarge and follow-up computed tomography scans were enrolled. Patients with and without re-entries in the arch branches after surgery were assigned to the supra-aortic entry (SAE, n = 21) and no supra-aortic entry (n = 51) groups, respectively. Diameters were measured at 7 levels: the innominate artery, left common carotid artery, left subclavian artery, 20 mm distal to the left subclavian artery, pulmonary artery bifurcation, coeliac axis and maximal diameter of the descending thoracic aorta. Results Growth rates at the levels of the pulmonary artery bifurcation and 20 mm distal to the left subclavian artery were significantly higher in the SAE group than in the no supra-aortic entry group. The rate of freedom from major adverse aortic events (annual growth >5 mm or maximal diameter of the descending thoracic aorta >50 mm) at 5 years was significantly higher in the no supra-aortic entry group than in the SAE group. Conclusions Remnant SAE leads to unfavourable aortic remodelling after acute Type I aortic dissection repair.

Background and Aim Both balloon-occluded retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunt (TIPS) are considered effective treatments for gastric variceal bleeding (GVB). In this study, outcomes of these two procedures were compared in managing patients with GVB. Methods A total of 142 patients undergoing BRTO (n = 95) or TIPS (n = 47) between 2005 and 2012 at two tertiary centers were selected for retrospective review. Results Mean patient age (male, 115; female, 27) was 58.1 years. Alcoholic liver cirrhosis was the most common underlying cause (n = 63, 44.4%), followed by hepatitis B (n = 60, 42.3%) and hepatitis C (n = 7, 4.9%) viral infections. Concurrent hepatocellular carcinoma (HCC) was identified in 64 (45.1%) patients. During the follow-up period (mean, 28.2 months), 27 patients (19%) experienced re-bleeding. Cumulative re-bleeding rates after BRTO (8.6% at 1 year; 22.7% at 3 years) were significantly lower than those after TIPS (19.8% at 1 year; 48.2% at 3 years; P = 0.006, log-rank test). In multivariate analysis, TIPS (vs BRTO) was found independently predictive of re-bleeding (hazard ratio [HR] = 2.174; P = 0.048), in addition to concurrent HCC and poor baseline Child–Pugh score (both P

The purpose of this study was to compare the efficacy and safety of aripiprazole versus bupropion augmentation in patients with major depressive disorder (MDD) unresponsive to selective serotonin reuptake inhibitors (SSRIs).This is the first randomized, prospective, open-label, direct comparison study between aripiprazole and bupropion augmentation. Participants had at least moderately severe depressive symptoms after 4 weeks or more of SSRI treatment. A total of 103 patients were randomized to either aripiprazole (n = 56) or bupropion (n = 47) augmentation for 6 weeks. Concomitant use of psychotropic agents was prohibited. Montgomery Asberg Depression Rating Scale, 17-item Hamilton Depression Rating scale, Iowa Fatigue Scale, Drug-Induced Extrapyramidal Symptoms Scale, Psychotropic-Related Sexual Dysfunction Questionnaire scores were obtained at baseline and after 1, 2, 4, and 6 weeks of treatment.Overall, both treatments significantly improved depressive symptoms without causing serious adverse events. There were no significant differences in the Montgomery Asberg Depression Rating Scale, 17-item Hamilton Depression Rating scale, and Iowa Fatigue Scale scores, and response rates. However, significant differences in remission rates between the 2 groups were evident at week 6 (55.4% vs 34.0%, respectively; P = 0.031), favoring aripiprazole over bupropion. There were no significant differences in adverse sexual events, extrapyramidal symptoms, or akathisia between the 2 groups.The present study suggests that aripiprazole augmentation is at least comparable to bupropion augmentation in combination with SSRI in terms of efficacy and tolerability in patients with MDD. Both aripiprazole and bupropion could help reduce sexual dysfunction and fatigue in patients with MDD. Aripiprazole and bupropion may offer effective and safe augmentation strategies in patients with MDD who are unresponsive to SSRIs. Double-blinded trials are warranted to confirm the present findings.

Purpose To assess the efficacy and safety of transcatheter arterial chemoembolization with drug-eluting embolic (DEE) agents for nodular hepatocellular carcinoma (HCC). Materials and Methods The study design was a prospective multicenter registry-based, single-arm clinical trial that included 152 patients. One hundred three (67.8%) had a Child–Pugh class/score of A5, 114 (75.0%) had a performance status of 0, and 77 (50.7%) had Barcelona Clinic Liver Cancer (BCLC) stage A disease. The DEE chemoembolization procedures were performed with DC Bead particles loaded with doxorubicin solution. The primary endpoint of the study was 6-month tumor response assessed per modified Response Evaluation Criteria In Solid Tumors. Secondary endpoints were treatment safety and overall survival. Results At 1-month posttreatment assessment, complete response (CR) and objective response (OR; ie, CR or partial response) rates were 40.1% and 91.4%, respectively. At 6-month assessment, 121 patients remained for analysis, and CR and OR rates were 43.0% and 55.4%, respectively. The cumulative progression-free survival (PFS) rate at 6 months was 65.0%. Child–Pugh score, tumor multiplicity, and tumor size were independent predictors of PFS ( P = .020, P = .029, and P = .001, respectively). There was no 30-day mortality. The overall 6-month survival rate was 97.4%. There were no grade 4 adverse events or laboratory changes. Serious adverse events were reported in 7.2% of patients, and persistent deterioration of liver function was observed in 3.9%. Prominent biliary injury was demonstrated in 19.7% of patients. No liver abscess was observed. Conclusions DEE chemoembolization for nodular HCC had an acceptable safety profile and acceptable 6-month tumor response and survival rates.

We evaluated the effectiveness of aripiprazole among bipolar patients who had switched to this medication as a result of difficulty maintaining on their prestudy atypical antipsychotics (AAPs) because of subsyndromal mood symptoms or intolerance. This study included 77 bipolar patients who were in syndromal remission with an AAP as monotherapy or with an AAP combined with a mood stabilizer(s) who needed to switch from their present AAP because of subsyndromal symptoms or intolerance. At 24 weeks after switching to aripiprazole, the remission rates on the Montgomery-Åsberg Depression Rating Scale (MADRS) and on both the MADRS and the Young Mania Rating Scale were increased significantly in the full sample and in the inefficacy subgroup. In the inefficacy subgroup, the MADRS score change was significant during the 24 weeks of study. Total cholesterol and prolactin decreased significantly after switching to aripiprazole. The proportion of patients who had abnormal values for central obesity and hypercholesterolemia decreased significantly from baseline to week 24. These findings suggest that a change from the current AAP to aripiprazole was associated with improvement in subsyndromal mood symptoms and several lipid/metabolic or safety profile parameters in patients with bipolar disorder with tolerability concerns or subsyndromal mood symptoms.

OBJECTIVE To evaluate retrospectively the clinical effectiveness of FlightPlan for Liver (FPFL), an automated tumor-feeding artery detection software in cone-beam CT angiography (CBCTA), in identifying tumor-feeding arteries for the treatment of hepatocellular carcinoma (HCC) using three different segmentation sensitivities. MATERIALS AND METHODS The study included 50 patients with 80 HCC nodules who received transarterial chemoembolization. Standard digital subtracted angiography (DSA) and CBCTA were systematically performed and analyzed. Three settings of the FPFL software for vascular tree segmentation were tested for each tumor: the default, Group D; adjusting the proportion of segmented tumor area between 30 to 50%, Group L; and between 50 to 80%, Group H. RESULTS In total, 109 feeder vessels supplying 80 HCC nodules were identified. The negative predictive value of DSA, FPFL in groups D, L, and H was 56.8%, 87.7%, 94.2%, 98.5%, respectively. The accuracy of DSA, FPFL in groups D, L, and H was 62.6%, 86.8%, 93.4%, 95.6%, respectively. The sensitivity, negative predictive value (NPV), and accuracy of FPFL were higher in Group H than in Group D (p = 0.041, 0.034, 0.005). All three segmentation sensitivity groups showed higher specificity, positive predictive value, NPV, and accuracy of FPFL, as compared to DSA. CONCLUSION FlightPlan for Liver is a valuable tool for increasing detection of HCC tumor feeding vessels, as compared to standard DSA analysis, particularly in small HCC. Manual adjustment of segmentation sensitivity improves the accuracy of FPFL.

Background Transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) frequently causes feeding artery stenosis or occlusion that may interfere with repeated treatment. Purpose To investigate the incidence and predictors of hepatic arterial damage (HAD) after drug-eluting bead-TACE (DEB-TACE) in comparison with conventional TACE (Conv-TACE). Material and Methods We retrospectively analyzed 54 patients who underwent DEB-TACE for HCC as an initial treatment with follow-up angiography and 54 patients who underwent Conv-TACE using doxorubicin-lipiodol mixture and gelfoam particles for comparison. HAD was evaluated after a single session of TACE and graded as follows: grade I, no significant wall irregularity; grade II, overt stenosis; grade III, occlusion. Results The incidence of HAD was significantly higher in the DEB-TACE group than the Conv-TACE group when analyzed per branch (odds ratio [OR], 6.36; P Conclusion The incidence and grade of HAD were higher after DEB-TACE compared to Conv-TACE with doxorubicin dose as a possible risk factor. HAD was independent of overall survival in both groups.

A 62-year-old man was admitted, and thoracic endovascular aortic repair (TEVAR) procedure was performed to treat an accidentally detected aortic aneurysm, which was 63 mm in diameter. While performing TEVAR, the passage of the stentgraft introducer system was impossible due to the prolapse of the introducer system into a wide-necked aneurysm; this aneurysm was located at the greater curvature of the proximal descending thoracic aorta. In order to advance the introducer system, a compliant balloon was inflated. Thus, we created an artificial wall in the aneurysm with this inflated balloon. Finally, we were able to advance the introducer system into the target zone. Index terms: Thoracic aortic aneurysm; Thoracic endovascular aortic repair; Wide-necked aneurysm; Proximal descending thoracic aorta; Aortic arch; Balloon-supported passage of an introducer system

Background Tear-oriented surgical procedure is considered a standard treatment for acute DeBakey type I aortic dissection (AIAD). However, long-term surgical outcomes, including aortic growth and rate of major adverse aortic events (MAAEs), have yet to be clarified. Methods Of the 274 patients who underwent surgical repair for AIAD between 2009 and 2016, 105 patients with both predischarge and follow-up computed tomographic scans were enrolled. The surgical extent was determined by primary entry tear location. We measured aortic diameters (pulmonary artery bifurcation, maximum diameter of the descending thoracic aorta [maxDTA], and celiac axis) and compared MAAEs (aorta growth rate ≥ 5 mm/year or maxDTA ≥ 55 mm according to surgical extent). Results Twenty-nine patients underwent total arch replacement (TAR); 76 underwent non-TAR. In the non-TAR group, patients with or without residual tears in the arch vessels were classified as having complete arch repair (non-TAR-CAR, n = 52) or incomplete arch repair (non-TAR-IAR, n = 24). Considerable differences were found in the aortic growth rate between the TAR and non-TAR groups and the non-TAR-CAR and non-TAR-IAR groups. Freedom from MAAEs at 5 years was considerably higher in the non-TAR-CAR group than in the non-TAR-IAR group (84.5% versus 31.1%). However, no differences were observed in the aortic growth rate and freedom from MAAEs between the TAR and non-TAR-CAR groups. Conclusions Classic tear-oriented surgical procedure is insufficient for optimal long-term surgical outcomes, mainly regarding aortic dilation. CAR without residual arch vessel tears leads to favorable aortic remodeling in the residual DTA and prevents MAAEs after AIAD repair.

Background: Spinal cord injury (SCI) is reported to occur in 3–12% of thoracic endovascular aortic repair (TEVAR) cases, but is a potentially preventable complication of TEVAR for thoracoabdominal pathologies. Although many strategies have been devised to reduce the incidence of SCI, the effectiveness of prophylactic cerebrospinal fluid drainage (CSFD) and left subclavian artery (LSA) revascularization remains controversial. Methods: From 2012 to 2014, 162 patients underwent TEVAR at a single institution. We prospectively collected and retrospectively reviewed the data of 81 patients who underwent preoperative CSFD among the 162 patients. LSA revascularization was routinely used when LSA need to be covered. Preoperative characteristics, intraoperative variables, and outcomes were analyzed. Results: The mean (SD) age of the patients was 60.6 (12.5) years, and 57 patients (70%) were male. Twenty-five patients (31%) presented with degenerative aneurysm; 48 (59%), type B dissection; 5, (6%) penetrating aortic ulcer; and 3 (4%), intramural hematoma. Thirty-six patients (44%) underwent LSA revascularization before TEVAR. Two (2.5%) of the patients who underwent preoperative CSFD had SCI, of whom one recovered ambulatory status at discharge after hypertensive therapy and another had a permanent disability. Prior abdominal aortic aneurysm (AAA) repair tended to relate to SCI (P=0.065), and preoperative aortic rupture was a significant independent risk factor of SCI (P=0.002). Conclusions: Preemptive CSFD as an adjunctive procedure to TEVAR proved to be more effective than selective use of CSFD in other prior reports of SCI cases. Preoperative CSFD is recommended as a prophylactic procedure in patients at high risk of SCI during TEVAR.

Objective Although thoracic endovascular aortic repair (TEVAR) is commonly used for chronic DeBakey type IIIB (CDIIIB) dissections, aortic remodeling outcomes after the procedure have been unsatisfactory. Persistent retrograde flow to the false lumen (FL) through re-entry tears commonly causes treatment failure. The aim of this study was to clarify the safety and effect of the FL procedure (FLP) for aortic remodeling in patients with CDIIIB dissections. Methods From 2012 to 2016, there were 73 patients who underwent TEVAR for CDIIIB dissections. The surgery, accompanied by the FLP, was performed in 41 patients (group A, 56%); 32 patients (group B, 44%) underwent TEVAR alone. The FLP was defined as blocking the retrograde FL flow with commercial materials. Outcomes included whole thoracic aorta FL thrombosis and diameter change in the true lumen and FL. Diameters were measured at three levels (left subclavian artery, pulmonary artery bifurcation, and celiac axis). Results No in-hospital mortality was observed. There was one case each of paraplegia and stroke postoperatively. The whole thoracic aorta FL thrombosis rate was significantly higher in group A (83% vs 56%; P = .002). Significant aortic remodeling (true lumen expansion and FL regression) was observed in both groups. In multivariable Cox regression analysis, the FLP and the number of re-entries were independent predictors for thoracic FL thrombosis (hazard ratio, 2.339 [ P = .009] and 0.709 [ P Conclusions Full-coverage TEVAR with the FLP seems to be a safe endovascular treatment and promotes thoracic FL thrombosis for patients with CDIIIB dissections.

Background Concurrent chemoradiation therapy (CCRT) followed by hepatic arterial infusional chemotherapy (HAIC) was reported to be effective for advanced hepatocellular carcinoma (HCC) with portal vein thrombosis. However, transarterial chemoembolization (TACE) is not preferred in this setting. The aim of this study was to assess the factors affecting survival after CCRT, including additional TACE during repeated HAIC. Methods Thirty-eight patients who underwent CCRT as the initial treatment for Barcelona Clinic Liver Cancer stage C HCC with vascular invasion between 2009 and 2016 were reviewed retrospectively. During CCRT, 5-fluorouracil (5-FU) was infused via chemoport during the first and last five days of five weeks of external beam radiation therapy. After CCRT, repeated HAIC with cisplatin and 5-FU was performed monthly. Nineteen patients (50%) underwent additional TACE between repeated HAICs. Factors related to overall survival and progression free survival (PFS) were analyzed. Results The mean age of patients was 55 years (male:female, 33:5). Underlying liver diseases were hepatitis B, hepatitis C and non-B/C in 29, 1 and 8 patients, respectively. The median radiation dose was 4500 cGy. The objective response (OR) rate at one months after CCRT was 36.8%. The median PFS was 7.4 (range, 1.8 − 32.1) months. The median overall survival was 11.6 (range 2.8-65.7) months. Achieving an OR after CCRT (hazard ratio [HR], 0.028; P

Synaptosomal-associated protein 25 kDa ( SNAP25 ) is a promising candidate gene related to the treatment response to antipsychotics. Thus, the present study investigated the associations between polymorphisms of SNAP25 and the treatment response to amisulpride in patients with schizophrenia. This study enrolled 154 schizophrenic patients from six university hospitals in South Korea. All patients were assessed with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression-Severity (CGI-S) scale at baseline and week 6 of treatment. Additionally, 101 subjects were genotyped for the rs 8636 and rs 3746544 single nucleotide polymorphisms (SNPs) of SNAP25 . The genotype frequencies of rs 8636 SNP significantly differed between responders and non-responders, measured by PANSS total score, in additive, recessive, and overdominant models. These findings suggest that SNAP25 might be a useful marker for predicting the response to antipsychotics. Future studies should include a larger number of subjects, a comprehensive array of SNAP25 SNPs, and functional analyses.

Objectives We sought to identify the risk factors for abdominal aortic remodeling after thoracic endovascular aortic repair in patients with chronic DeBakey IIIb aneurysm. Methods From 2012 to 2016, 70 patients underwent thoracic endovascular aortic repair for chronic DeBakey IIIb aneurysm. The abdominal aortic diameter was measured at 3 different levels (celiac trunk, renal artery, and infrarenal aorta). Abdominal aorta status was classified as expansion or stable. Expansion status was assigned when the abdominal aortic diameter was increased over 5 mm at least 1 level. Otherwise, it was classified as stable status. Forty-six of 70 patients underwent more than 2 postoperative imaging studies. In those patients (n = 46), abdominal aortic volume was measured from celiac trunk to inferior mesenteric artery. A linear mixed-effect model was used to analyze the overall fate of abdominal aortic volume. Results No in-hospital mortality occurred. The mean follow-up and imaging follow-up duration were 26 and 17 months, respectively. Sixty-one patients (87.1%) demonstrated thoracic false-lumen thrombosis. Although false-lumen thrombosis was achieved, 15 patients (24.6%) demonstrated the expansion status. In volumetric analysis, the total abdominal aortic volume was increasing over time (0.603 cm3/mo; P Conclusions An enlarged abdominal aorta in chronic DeBakey IIIb aneurysm can be frequently recognized even after successful endovascular treatment. The residual intima tears were the only identified risk factor for change in a dissected abdominal aneurysm. We suggest careful abdominal aorta evaluation and additional procedures on the false lumen if necessary.

To determine the utility of the apparent diffusion coefficient (ADC) of uterine leiomyoma for prediction of the potential response to uterine artery embolization (UAE).This prospective study included 49 patients with uterine leiomyomas who underwent diffusion-weighted magnetic resonance (MR) imaging before UAE between May 2011 and January 2012. All patients also underwent 3-month follow-up MR imaging after UAE. Using conventional and diffusion-weighted MR imaging sequences, 72 uterine leiomyomas ≥ 3 cm were prospectively evaluated. The volume of each leiomyoma was calculated, and quantitative measurement of ADC was performed. Regression analysis was used to evaluate the relationship between ADC and volumetric response after UAE. Receiver operating characteristic curve analysis was performed to determine the sensitivity and specificity of ADC for prediction of the potential response to UAE. Interclass correlation coefficient analysis was used to assess interobserver variability between two radiologists.Volume reduction rates of leiomyomas after UAE ranged from 0.2%-89.1% (mean, 44.1%). ADC ranged from 0.559 × 10(-3) mm(2)/s to 1.814 × 10(-3) mm(2)/s (mean, 1.170 × 10(-3) mm(2)/s). ADC was statistically significantly related to volumetric response of leiomyomas (P = .014). Using a threshold of 1.092 × 10(-3) mm(2)/s, the sensitivity and specificity of ADC for prediction of50% volume reduction of the leiomyoma after UAE were 82.6% and 52.3%, respectively. Using a threshold of 1.023 × 10(-3) mm(2)/s, the sensitivity and specificity of ADC for prediction of30% volume reduction were 80.8% and 33.3%, respectively. The interclass correlation coefficient for measuring ADC of uterine leiomyomas between two radiologists was 0.98.ADC of uterine leiomyomas was significantly related to the volume reduction after UAE. ADC may be useful in predicting the potential response to UAE. A high ADC of the uterine leiomyoma may be associated with a greater volume reduction after UAE.

Background and Aims Although nonsurgical methods produce high clinical success rates in the treatment of benign biliary stricture (BBS), conventional methods are not always successful in cases of severe biliary stricture or complete obstruction. Therefore, the efficacy of magnetic compression anastomosis (MCA) for treatment of refractory BBS was evaluated in a single-center, nonrandomized study. Methods MCA was performed in patients with BBS that was not resolved by conventional endoscopic or percutaneous treatments. One magnet was delivered through the percutaneous transhepatic biliary drainage tract, and the other advanced through 1 of 3 different routes. After magnet approximation and recanalization, an internal drainage catheter was placed for 6 months. Results This study followed 39 patients who underwent MCA after the development of postoperative or traumatic strictures. Recanalization was achieved successfully in 35 patients. There was an acceptable procedure-related adverse event of mild cholangitis in 1 patient and no procedure-related mortalities. The average elapsed time from magnet approximation to removal was 57.4 days (range, 13-182 days), and the mean follow-up period after recanalization was 41.9 months (range, 7.1-73.4 months). Restenosis after MCA recurred in 1 patient, and partial restenosis occurred in another patient, but recanalization in these patients was successful using a guidewire via the percutaneous and endoscopic tracts. Conclusions MCA represents an alternative nonsurgical recanalization method for BBSs that cannot be treated by conventional methods. The rate of stricture recurrence after MCA was lower than that after conventional methods, likely because of the creation of a new fistula tract instead of dilation of a previous stricture.

Background and Aim: The clinical utility of alpha-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP) as a predictor of treatment outcome in patients with advanced hepatocellular carcinoma (HCC) receiving hepatic artery infusional chemotherapy (HAIC) or concurrent chemoradiation therapy (CCRT) has been poorly defined. Methods: Between January 2003 and December 2007, we enrolled 127 treatment-naive patients who received HAIC (n = 60) or CCRT (n = 67) as an initial treatment modality. An AFP or DCP response was defined as a reduction of more than 20% from the baseline level. Results: AFP responders showed significantly better overall survival (OS) than non-responders among patients with HAIC (median 17.3 vs 6.4 months, P

Background/Purpose Preoperative portal vein embolization was introduced to minimize complications after extended hepatectomy. This retrospective cohort study was conducted to compare outcomes with and without portal vein embolization before hepatectomy for hilar cholangiocellular carcinoma. Methods This study was conducted with 35 patients who underwent right extended hemihepatectomy for hilar cholangiocellular carcinoma from 2001 to 2008. Preoperative portal vein embolization was performed in 14 patients (embolization group) and not performed in 21 patients (non-embolization group). Results The groups did not differ in terms of sex, age, operative time, transfusion, postoperative serum bilirubin level, prothrombin time, and length of intensive care unit (ICU) stay. Although blood loss was higher in the embolization group than in the non-embolization group ( P = .009), no major complications were observed between embolization and resection. At presentation, future liver remnant was smaller in the embolization group (19.8%, range 16–35%) than in non-embolization group (28.3%, 15–47%; P = .001). After embolization, the volume of the future liver remnant increased significantly to 27.2% (range, 23–42%; P = .001). Future liver remnants just before operation were similar in both groups ( P > .99). There was no significant difference in terms of the rate of morbidity and in-hospital mortality. No statistically significant differences were observed in disease-free survival ( P = .52) and overall survival ( P = .30). Conclusions Portal vein embolizations do not increase the rate of morbidity, in-hospital mortality, local recurrence and system metastasis. Therefore it can be considered safe and effective for patients with small future liver remnants. Embolization can lessen postoperative liver failure and widen the indication of the surgical resection, especially in patients with marginal future liver remnants.

To evaluate the clinical safety and effectiveness of foam sclerotherapy using polidocanol for preoperative portal vein embolization (PVE) before hemihepatectomy of the liver.From March 2006 to October 2008, foam sclerotherapy using polidocanol was performed in 16 patients (male-to-female ratio of 12:4, age range 48-75 years [mean 62]) for PVE. Patients were diagnosed with Klatskin tumor (n = 13), gallbladder (GB) cancer (n = 2), or hepatocellular carcinoma (HCC) (n = 1). The foam was composed of a 1:2:1 ratio of 3% polidocanol (Aethoxysklerol; Kreussler Pharma, Wiesbaden, Germany), room air, and contrast media (Xenetix 350; Guerbet, Aulnay-Sous-Bois, France). The total amount of polidocanol used (2 to 8 mL [mean 4.6]) varied according to the volume of the target portal vein. We calculated the volume of future liver remnant (FLR) before and after PVE and evaluated complications associated with the use of polidocanol foam sclerotherapy for PVE.Technical success was achieved in all patients. All patients were comfortable throughout the procedure and did not experience pain during sclerotherapy. No periprocedural morbidity or mortality occurred. Patients underwent a liver dynamic computed tomography (CT) scan 2-4 weeks after PVE. FLR increased significantly after PVE using polidocanol foam from 19.3% (range 16-35%) before PVE to 27.8% (range 23-42%) after PVE (p = 0.001). All patients were operable for hemihepatectomy of the liver and achieved effective resection.Foam sclerotherapy using polidocanol is clinically safe and effective for preoperative PVE.

The purpose of this study was to evaluate, in vitro and in vivo, doxorubicin-loaded poly (vinyl alcohol-sodium acrylate) copolymer microspheres [QuadraSphere microspheres (QSMs)] for transcatheter arterial delivery in an animal model of liver cancer. Doxorubicin loading efficiency and release profile were first tested in vitro. In vivo, 15 rabbits, implanted with a Vx-2 tumor in the liver, were divided into three groups of five rabbits each, based on the time of euthanasia. Twenty-five milligrams of QSMs was diluted in 10 ml of a 10 mg/ml doxorubicin solution and 10 ml of nonionic contrast medium for a total volume of 20 ml. One milliliter of a drug-loaded QSM solution containing 5 mg of doxorubicin was injected into the tumor feeding artery. Plasma doxorubicin and doxorubicinol concentrations, and intratumoral and peritumoral doxorubicin tissue concentrations, were measured. Tumor specimens were pathologically evaluated to record tumor necrosis. As a control, one animal was blandly embolized with plain QSMs in each group. In vitro testing of QSM doxorubicin loadability and release over time showed 82–94% doxorubicin loadability within 2 h and 6% release within the first 6 h after loading, followed by a slow release pattern. In vivo, the doxorubicin plasma concentration declined at 40 min. The peak doxorubicin intratumoral concentration was observed at 3 days and remained detectable till the study’s end point (7 days). Mean percentage tumor cell death in the doxorubicin QSM group was 90% at 7 days and 60% in the bland QSM embolization group. In conclusion, QSMs can be efficiently loaded with doxorubicin. Initial experiments with doxorubicin-loaded QSMs show a safe pharmacokinetic profile and effective tumor killing in an animal model of liver cancer.

Optimal treatment for liver metastases from gastric cancer remains a matter of debate. The aim of our study is to evaluate the efficacy of radiofrequency ablation (RFA) for the treatment of liver-only metastases from gastric adenocarcinoma.We retrospectively reviewed medical records of 29 patients who developed liver-only metastases from gastric adenocarcinoma and subsequently underwent gastric resection and RFA (n = 20) or gastric resection and systemic chemotherapy (n = 9) between January 1995 and February 2008. Overall survival was estimated using the Kaplan-Meier method, and was compared using the log rank test to evaluate RFA efficacy.Twenty patients who underwent RFA showed a median overall survival of 30.7 months (range: 2.9 to 90.9 months), a median progression-free survival of 6.8 months (range: 0.8 to 45.2 months), and median overall one-, three-, and five-year survival rates were 66.8%, 40.1%, and 16.1% respectively. The RFA group showed a 76% decreased death rate compared to the chemotherapy-only group (30.7 months versus 7 months, hazard ratio, 0.24; p = 0.004). Most patients tolerated RFA well, and complications were found to be minor (transient fever (20%) and/or right upper quadrant pain (25%)). One case of treatment-related death occurred due to sepsis that originated from a liver abscess at the ablation site.The data suggest that a use of RFA as a liver-directed treatment may provide greater survival benefit than chemotherapy and is an alternative option for the treatment of liver-only metastases from gastric cancer.

PURPOSE—To assess whether the implantation site of VX2 carcinoma into rabbit liver affects successful vessel selection for transcatheter arterial interventions. MATERIALS AND METHODS—Twenty-four New Zealand White rabbits were randomly assigned to two groups. All implantations were performed by open laparotomy with minced tumor cells inserted into a 16-gauge Angiocath needle. Group I rabbits (n = 12) had tumor implanted into the left medial lobe of the liver and group II rabbits (n = 12) had tumor implanted into the left lateral lobe. Two weeks after implantation, selective angiography was performed for subsequent chemoembolization, which was part of a different study. Tested variables included maximum tumor diameter, tumor feeding artery size, and tumor vascularity. RESULTS—Successful tumor growth was achieved in all rabbits. Selective angiography was possible in 33.3% of rabbits in group I and 66.6% of rabbits in group II (P < .05). Tumor size and vascularity were similar between groups. Mean lengths of tumor feeder arteries from the bifurcation of the left hepatic artery were 4.1 mm ± 1.2 in group I (left medial lobe) and 10.8 mm ± 3.0 in group II (left lateral lobe; P < .05). The angulation of the left medial lobar artery (group I) off the left hepatic artery was acute in eight of 12 rabbits (66.6%), but only four of 12 rabbits in group II (33.3%) showed acute angulation of the left lateral lobar artery off the left hepatic artery (P < .05). Mean angiography time was significantly shorter in group II. CONCLUSIONS—For selective hepatic arterial interventions, the left lateral lobe of the liver may be favorable as an implantation site for VX2 tumors in rabbits.

Although thoracic endovascular aortic repair is regularly used to treat chronic DeBakey type IIIb aneurysms, persistent retrograde flow into the false lumen through distal reentry tears is a common cause of failure. We sought to determine the safety and efficacy of the false lumen procedure (FLP) for aortic remodeling with chronic DeBakey IIIb aneurysms.From 2012 to 2015, 25 patients with chronic DeBakey IIIb aneurysms underwent FLP using vascular plugs, stent grafts, coils, or glues. The FLP was performed as an adjunctive procedure after initial thoracic endovascular aortic repair in 9 patients, in combination with initial thoracic endovascular aortic repair in 13 patients, and as an isolated procedure in 3 patients. All patients were followed up for a mean duration of 10 months after the FLP. Outcomes included the degree of thrombosis and diameter change in the true lumen and false lumen. Diameters were measured at three levels: left subclavian artery, pulmonary artery bifurcation, and abdomen (celiac artery).No spinal cord injury, renal failure, or 30-day mortality was observed. Complete false lumen thrombosis after FLP was observed in 20 patients (80%). Compared with before FLP, the mean false lumen diameter for each level (before 22.23 ± 10.18 mm versus after 17.56 ± 10.84 mm; p0.001) significantly decreased, whereas the mean true lumen diameter for each level (20.45 ± 5.33 mm versus 25.12 ± 5.60 mm, p0.001) increased.False lumen procedures were safe, promoted complete thrombosis, and had favorable aortic remodeling in patients with chronic DeBakey IIIb aneurysms.

PURPOSE To evaluate the feasibility and effectiveness of endovascular stent-graft repair of infected aortic and arterial aneurysms. METHODS Eight patients (5 men; mean age 56.6 years, range 30-85) with infected saccular aneurysms in the brachiocephalic artery (n=1), proximal descending thoracic aorta (n=1), infrarenal abdominal aorta (n=3), common iliac artery (n=1), and common femoral artery (n=2) were treated with stent-graft placement and intravenous antibiotic treatment for at least 6 weeks followed by case-specific administration of oral suppressive antibiotics. All patients were considered to be in the high-surgical-risk group. RESULTS Exclusion of the infected aneurysm was successful in all patients. However, 2 patients died within 30 days of uncontrolled sepsis, and 1 patient died at 6 months after rupture of a persistently infected aneurysm (37% mortality rate). Over a follow-up that ranged to 8 years, the 5 survivors showed complete resolution of the infected aneurysms; no stent-graft infection was observed during follow-up. CONCLUSION The acceptable technical and clinical success of endovascular aneurysm repair makes this a promising treatment for infected aortic and arterial aneurysms. However, it is crucial that the infection is treated adequately prior to stent-graft placement.

A 37-year-old man was referred to Division of Nephrology for a new renal cystic lesion that was found on ultrasonography. Four years prior to presentation, a percutaneous renal biopsy had been performed. Computed tomography scan showed a 4.4-cm-sized renal artery pseudoaneurysm in the left kidney. Selective renal angiography revealed a pseudoaneurysm in the left lower pole of the kidney. The renal pseudoaneurysm was successfully embolized with coil. Follow-up Doppler ultrasonography showed no internal blood flow into the aneurysmal sac. His renal function remained stable after coil embolization.

Objective: To determine the feasibility of transcaval transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins. Materials and Methods: Transcaval TIPS, performed in six patients, was indicated by active variceal bleeding (n=2), recurrent variceal bleeding (n=2), intractable ascites (n=1), and as a bridge to liver transplantation (n=1). The main reasons for transcaval rather than classic TIPS were the presence of an unusually acute angle between the hepatic veins and the level of the portal bifurcation (n=3), hepatic venous occlusion (n=2), and inadequate small hepatic veins (n=1). Results: Technical and functional success was achieved in all patients. The entry site into liver parenchyma from the inferior vena cava was within 2 cm of the atriocaval junction. Procedure-related complications included the death of one patient due to hemoperitoneum despite the absence of contrast media spillage at tractography, and another suffered reversible hepatic encephalopathy. Conclusion: In patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins, transcaval TIPS creation is feasible.

We report a case of a 35-year-old woman who underwent uterine artery embolization (UAE) for symptomatic multiple uterine fibroids with collateral aberrant right ovarian artery that originated from the right external iliac artery. We believe that this is the first reported case in the literature of this collateral uterine flow by the right ovarian artery originated from the right external iliac artery. We briefly present the details of the case and review the literature on variations of ovarian artery origin that might be encountered during UAE.

We undertook this study to assess how well double-contrast radiography and CT allow radiologists to differentiate low-grade from high-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach.We retrospectively reviewed the upper gastrointestinal radiographs and contrast-enhanced CT scans of 57 patients with pathologically proven primary gastric lymphoma (low-grade [n = 29] and high-grade [n = 28] MALT lymphoma).On upper gastrointestinal radiography, ulceration (39%) was the most common finding in low-grade lymphoma, whereas polypoid appearance (38%) was the most common in high-grade lymphoma. In the 29 patients (33 lesions) with low-grade MALT lymphoma, upper gastrointestinal radiography revealed 13 ulcerative lesions (39%), 10 nodular lesions (30%), four infiltrative lesions (12%), two polypoid lesions (6%), and four combined lesions (12%). In the 28 patients (29 lesions) with high-grade lymphoma, upper gastrointestinal radiography revealed 11 polypoid lesions (38%), nine infiltrative lesions (31%), six ulcerative lesions (20%), one nodular lesion (3%), and two combined lesions (7%). On CT, thickening of the gastric wall in low-grade lymphoma (range, 0.3-2.5 cm; mean, 0.8 cm) was much less than that in high-grade lymphoma (range, 0.7-8.0 cm; mean, 2.5 cm). Abdominal lymphadenopathy was less frequent in low-grade lymphoma (14%) than in high-grade lymphoma (75%).Most low-grade lymphomas show superficial spreading lesions, such as mucosal nodularity, shallow ulcer, and minimal fold thickening, on upper gastrointestinal radiography, whereas most high-grade lymphomas show mass-forming lesions or severe fold thickening.

Hepatocellular carcinoma (HCC) is the most common malignant tumor of the liver. Although several therapeutic options have been advocated, transcatheter arterial chemoembolization (TACE) in particular has been widely performed in the treatment of HCC. Still, hepatic arteriography and portography are mandatory for evaluation of (a) the resectability and multiplicity of HCCs and (b) the hemodynamic status of the portal vein. Thereafter, TACE can be considered as the initial therapeutic modality. The possibility of nontarget organ complications during TACE (eg, ischemic cholecystitis, splenic infarction, gastrointestinal mucosal lesions, pulmonary embolism and infarction, spinal cord injury, ischemic skin lesions) should be taken seriously. A thorough understanding of the anatomic variants and hemodynamic features of the hepatic artery and portal vein is the first step in performing effective and safe TACE for HCC.

A recent genome-wide pharmacogenomics study showed that the rs7968606 single-nucleotide polymorphism (SNP) of the ankyrin repeat and sterile alpha motif domain-containing protein 1B (ANKS1B) gene approached the threshold of statistical significance. The aim of this study was to determine the association between the rs7968606 SNP of ANKS1B and the treatment response to amisulpride in schizophrenia patients. In total, 154 participants were enrolled from six university hospitals in Korea. All the subjects were interviewed before and after 6 weeks of amisulpride treatment with the aid of the positive and negative syndrome scale and the clinical global impression-severity scale. Genotyping for the rs7968606 SNP of ANKS1B was performed in 101 subjects. Both the decrease (t = -2.067, p = 0.041) and improvement rate (t = -1.990, p = 0.049) in the positive and negative syndrome scale general score differed significantly between T-allele carriers and noncarriers of this polymorphism after 6 weeks of amisulpride treatment. To the best of our knowledge, this is the first genetic association study of the relationship between the rs7968606 SNP of ANKS1B and the response of schizophrenia patients to treatment with amisulpride. Future larger-scale studies involving more SNPs of ANKS1B will improve the understanding of the pharmacogenetics underlying the treatment responses to amisulpride.

Background: Endovascular aneurysm repair (EVAR) has been suggested as treatment for inflammatory abdominal aortic aneurysms (IAAA), but the actual clinical and radiological outcomes need to be evaluated. Purpose: To report morphological changes in EVAR of IAAAs. Material and Methods: Ten male patients (mean age, 67 years; range, 54–78 years) with IAAA were treated with EVAR using endovascular stent-grafts between March 2001 and January 2012. We retrospectively compared computed tomography angiography (CTA) images taken immediately (30 days after the EVAR), short-term (up to 1 year), and mid-term (beyond 1 year) to CTA images taken before the EVAR. Clinical success was defined as successful deployment of the stent-graft without a type I or III endoleak. Morphologic responses of IAAA to EVAR were reviewed by measuring the changes in aneurysm sac maximum diameter (mm), periaortic fibrosis (PAF) thickness (mm), and PAF enhancement (Hounsfield units [HU] on delayed CTA) on serial images. Results: Ten IAAA patients treated with EVAR were followed for a mean of 42 months (range, 7–129 months). No aneurysm-related deaths were observed during the follow-up of 10 patients. Primary clinical success was achieved in seven patients, assisted primary clinical success in one patient, and secondary clinical success in two patients. Aneurysm sac maximum diameter decreased in all patients (mean percentage reduction of 7.6%, 8.5%, and 17.3% in immediate, short-term, and mid-term follow-up CTA, respectively). PAF thickness decreased in eight patients (10.4%, 16.8%, and 27.2% regression upon follow-up). PAF enhancement decreased in nine patients and increased in one patient (mean percentage decrease of 13.0%, 27.3%, and 40.8% upon follow-up). Conclusion: Treatment of IAAA with EVAR was effective and reduced aneurysmal sac diameter and the extent of PAF with acceptable morbidity.

Background and study aims: Endoscopic or percutaneous treatments are preferentially attempted for benign biliary stricture (BBS). However, these methods are not feasible if a guide wire cannot be passed through the stricture. This study evaluated the usefulness and technical requirements of magnetic compression anastomosis (MCA) in refractory BBS. Patients and methods: MCA was performed in patients with BBS that had not been resolved with conventional treatments. One magnet was delivered through the percutaneous transhepatic biliary drainage tract and the other magnet was advanced through three different routes. After magnet approximation and recanalization, an internal drainage catheter was placed for 6 months and then removed. Results: Seven patients underwent MCA, and recanalization was successfully achieved in five. MCA failure in two cases was attributed to long stenotic segments and parallel alignment of the axes of the magnets. The mean follow-up period after recanalization was 485.2 days. Five patients with successful recanalization showed no MCA-related complications or restenosis. Conclusions: MCA represents an alternative nonsurgical method of BBS recanalization that cannot be treated with conventional methods.

The aim of this prospective study was to reveal the efficacy and safety of Yttrium-90 (Y) radioembolization in Korean patients with hepatocellular carcinoma (HCC).A total of 40 HCC patients were prospectively recruited from 7 centers. The response to treatment was assessed on the basis of the modified Response Evaluation Criteria in Solid Tumors criteria. The time to progression and overall survival were also evaluated, and the assessment of safety was done according to National Cancer Institute Common Terminology Criteria, Version 3.0.Forty-two treatments of Y radioembolization were carried out. Median follow-up was 29 months. At 3 months, the complete response, partial response (PR), and stable disease were seen in 4 (10.0%), 19 (47.5%), and 15 (37.5%) patients, respectively. The response rate was 57.5% (23/40), and disease control rate was 95% (38/40) at 3 months. The response rate at 6 months was 63.9% (23/36), and disease control rate was 83.3% (30/36). The median time to progression was 18 months. During follow-up, 10 HCC-related deaths occurred and the 3-year survival rate was 75%. In 19 patients with Barcelona Clinic Liver Cancer-B stage, the 3-year survival rate was 50%. The tumor number (5) was the only significant predictor associated with survival. The most common adverse event was abdominal pain of mild to moderate degree, and all the complications were manageable. Twenty-six (65%) patients underwent other treatments such as transarterial chemoembolization because of local progression or remnant viable lesion.Y radioembolization might be a safe and effective treatment modality in intermediate-stage to advanced-stage HCC.

Objective This study aimed to assess the technical feasibility, procedural safety, and long-term therapeutic efficacy of a small-sized ambulatory thoracic vent (TV) device for the treatment of pneumothorax. Materials and methods From November 2012 to July 2013, 18 consecutive patients (3 females, 15 males) aged 16-64 years (mean: 34.7 ± 14.9 years, median: 29 years) were enrolled prospectively. Of these, 15 patients had spontaneous pneumothorax and 3 had iatrogenic pneumothorax. A Tru-Close TV with a small-bore (11- or 13-Fr) catheter was inserted under bi-plane fluoroscopic assistance. Results Technical success was achieved in all patients. Complete lung re-expansion was achieved at 24 hours in 88.9% of patients (16/18 patients). All patients tolerated the procedure and no major complications occurred. The patients' mean numeric pain intensity score was 2.4 (range: 0-5) in daily life activity during the TV treatment. All patients with spontaneous pneumothorax underwent outpatient follow-up. The mean time to TV removal was 4.7 (3-13) days. Early surgical conversion rate of 16.7% (3/18 patients) occurred in 2 patients with incomplete lung expansion and 1 patient with immediate pneumothorax recurrence post-TV removal; and late surgical conversion occurred in 2 of 18 patients (11.1%). The recurrence-free long-term success rate was 72.2% (13/18 patients) during a 3-year follow-up period from November 2012 to June 2016. Conclusion TV application was a simple, safe, and technically feasible procedure in an outpatient clinic, with an acceptable long-term recurrence-free rate. Thus, TV could be useful for the immediate treatment of pneumothorax.

Background/Aims Alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) have been used as diagnostic tools for hepatocellular carcinoma (HCC). However, prediction of outcome using AFP and DCP has not been elucidated. We investigated the clinical role of AFP and DCP as predictors of treatment outcome in patients with HCC undergoing trans-arterial chemoembolization (TACE). Methods Between January 2003 and December 2005, we enrolled 115 treatment-naïve patients who received TACE as an initial treatment modality. An AFP or DCP response was defined as a reduction of more than 50% from the baseline level 1 month after TACE. Patients with AFP Results The median age was 59 years and the male gender predominated (n = 81, 70.4%). AFP and DCP response was identified in 91 (79.1%) and 77 (66.9%) patients after TACE. Although progression-free survival (PFS) did not differ according to AFP response (P = 0.150), AFP responders showed significantly better overall survival (OS) than non-responders (34.9 vs. 13.2 months; P = 0.002). In contrast, DCP response did not influence either PFS or OS (all P > 0.05). Multivariate analyses showed that gamma-glutamyltranspeptidase and baseline AFP were predictors of PFS (all P P Conclusions AFP response and higher baseline DCP level are significant predictors of OS in treatment-naïve patients with HCC receiving TACE who showed pretreatment elevation of both AFP and DCP.

This study was intended to identify the neurotic traits related to sexual abuse in female high school students. The Neurosis Scale of Middlesex Hospital Questionnaire was conducted to 320 female high school students in Taegu, Korea from July 10 to July 17, 1994. The results were as follows: 1) The sexual abuse victim group showed significantly higher neurotic traits of Free floating anxiety (p

The authors applied ADDES-HV parent evaluation scale for the purpose of screening test to 538 2nd grade elementary school students from March 1994 to May. The results were as follows: There was no differences in scores of ADHD between schools. In comparing the male and female between three school students, male students showed signifieant high scores (p coefficient of patient group was 0.85(p