232 results on '"Charles Y. Kim"'
Search Results
2. Evaluation of repeat distal transradial access in the anatomic snuffbox
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James Ronald, Nicholas Durocher, Jonathan G. Martin, Tony P. Smith, Charles Y. Kim, and Alan A. Sag
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
PurposeThere is increasing interest in the distal radial artery in the anatomic snuffbox as an alternative arterial access point, but the durability of the distal radial artery to support repetitive accesses over multiple procedures is not well established. The purpose of this study was therefore to evaluate success rates for repeated left-sided distal transradial access (ldTRA) in the anatomic snuffbox.MethodsIn this single institution retrospective study, all patients undergoing radioembolization treatments from January 1st, 2019 to May 1st, 2020 were prospectively evaluated for ldTRA. ldTRA was performed by 15 different operators. Exclusion criteria were a left radiocephalic hemodialysis fistula, inability to properly position the arm, Barbeau D waveform, or failed prior ldTRA due to tortuosity. Barbeau patterns, arterial sizes, and success rates at the first, second, and third ldTRA were compared.ResultsFifty patients were evaluated for ldTRA and 44, 39, and 10 underwent one, two, and three ldTRA attempts for a total of 93 procedures. There was no significant change in Barbeau patterns between the first and second (p = 0.13) or first and third (p = 1.0) ldTRA. There was no significant change in artery size between the first (mean, 2.3 mm; range, 1.5–3.4 mm) and second (mean, 2.3 mm; range, 1.6–3.3 mm) (p = 0.59) and first and third (mean, 2.4 mm; range, 1.9–3.3) (p = 0.45) ldTRA. The success rate was not significantly different between the first (93%, 41/44, 95% CI 81%–99%), second (95%, 37/39, 95% CI 83%–99%), and third (100%, 10/10, 95% CI 69%–100%) procedure (p = 1.0). The asymptomatic occlusion rate was 4.1% (2/49, 95% CI 0%–14%), and subsequent ldTRA was successfully completed in both patients with occlusions. There were no hemorrhagic or ischemic complications.ConclusionSuccess rates are indistinguishable among first, second, and third time ldTRA suggesting that this is a durable access point.
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- 2021
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3. Recent update of percutaneous radiologic jejunostomy
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Charles Y. Kim and Ji Hoon Shin
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enteral nutrition ,enterostomy ,jejunostomy ,Medicine ,Internal medicine ,RC31-1245 ,Specialties of internal medicine ,RC581-951 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Although percutaneous radiologic jejunostomy has not been widely accepted as a primary insertion technique due to the technical difficulty for inexperienced operators, it may be a crucial procedure for patients with previous gastrectomy or an otherwise inaccessible stomach, particularly in patients who are not candidates for a surgical jejunostomy. Targeting the appropriate target jejunal loop and affixing the bowel with a t-fastener anchor are the most important and challenging technical steps. Technical success rate ranged from 92% to 100% based on 19 to 106 patients in several representative reports, with major complications ranging from 3.9% to 13.0%.
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- 2021
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4. Preemptive VAE—An Important Tool for Managing Blood Loss in MVT Candidates With PMT
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Deeplaxmi P. Borle, MD, Samuel J. Kesseli, MD, Andrew S. Barbas, MD, Aparna S. Rege, MD, Deepak Vikraman, MD, Ravindra Kadiyala, MD, Charles Y. Kim, MD, Tony P. Smith, MD, Paul V. Suhocki, MD, and Debra L. Sudan, MD
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Surgery ,RD1-811 - Abstract
Background. Explantation of native viscera in multivisceral transplant candidates, particularly in those with extensive portomesenteric thrombosis (PMT), carries considerable morbidity due to extensive vascularized adhesions. Preemptive visceral angioembolization has been previously described as a technique to minimize excessive blood loss during mobilization of the native viscera but is not well described specifically in patients with extensive PMT. Methods. In a series of 5 patients who underwent mutivisceral transplant for PMT from June 2015 to November 2018, we performed preoperative superior mesenteric, splenic, and hepatic artery embolization to reduce blood loss during explanation and evaluated the blood loss and blood product utilization, as well as 30-day rates of infectious complications. Results. Following preemptive embolization, median total blood loss was 6000 mL (range 800–7000 mL). The median transfusion requirements were as follows: 16 units packed red blood cells (range 2–47), 14 units fresh frozen plasma (range 0–29), 2 units cryoprecipitate (range 1–14), 4 units platelets (range 2–10), and 500 mL cell saver autotransfusion (range 0–1817). In the first 30 postoperative days, 2 out of 5 patients developed positive blood cultures and 3 out of 5 developed complex intra-abdominal infections. Two patients developed severe graft pancreatitis resulting in mycotic aneurysm of the aortic conduit; bleeding from the aneurysm led to 1 patient mortality. Conclusions. Preoperative embolization is an effective modality to mitigate exsanguinating blood loss during multivisceral transplant in patients with portomesenteric thrombosis; however, it is unclear if the resultant native organ ischemia during explant carries clinically relevant consequences.
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- 2021
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5. Provocative mesenteric angiography for diagnosis and treatment of occult gastrointestinal hemorrhage
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Charles Y. Kim
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Gastrointestinal bleeding ,Gastrointestinal hemorrhage ,Hemorrhage ,Thrombolytic therapy ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Occult gastrointestinal (GI) hemorrhage can be a great challenge to both patients and physicians, exerting a great toll on patients and the healthcare system. While diagnostic capabilities for diagnosing GI bleeding are improving, particularly with the establishment of computed tomography angiography and capsule endoscopy as routine modalities, patients with intermittent massive GI bleeding continue to pose a diagnostic and management dilemma. In this review, the concept, efficacy, and safety of provocative mesenteric angiography is described. The body of literature suggests that this procedure is safe and effective in this patient population with little to no alternative options.
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- 2018
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6. ACR Appropriateness Criteria® Thoracoabdominal Aortic Aneurysm or Dissection: Treatment Planning and Follow-Up
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Benjamin N. Contrella, Minhajuddin S. Khaja, Bill S. Majdalany, Charles Y. Kim, Sanjeeva P. Kalva, Adam W. Beck, William F. Browne, Rachel E. Clough, Maros Ferencik, Fernando Fleischman, Andrew J. Gunn, Sean M. Hickey, Asha Kandathil, Karen M. Kim, Eric J. Monroe, Cassius Iyad Ochoa Chaar, Matthew J. Scheidt, Amanda R. Smolock, Scott D. Steenburg, Kathleen Waite, Jason W. Pinchot, and Michael L. Steigner
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Radiology, Nuclear Medicine and imaging - Published
- 2023
7. ACR Appropriateness Criteria® Management of Vertebral Compression Fractures: 2022 Update
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Majid A. Khan, Jack W. Jennings, Jonathan C. Baker, Amanda R. Smolock, Lubdha M. Shah, Jason W. Pinchot, Daniel E. Wessell, Charles Y. Kim, Leon Lenchik, Matthew S. Parsons, Gina Huhnke, Simon Shek-Man Lo, Yi Lu, Christopher Potter, Charles Reitman, Arjun Sahgal, Akash Sharma, Naga M. Yalla, Francesca D. Beaman, Baljendra S. Kapoor, and Judah Burns
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Radiology, Nuclear Medicine and imaging - Published
- 2023
8. Intravascular Ultrasound-Guided Transvenous Biopsy of Retroperitoneal Lymph Nodes: Diagnostic Accuracy and Safety Compared with CT-Guided Percutaneous Biopsy
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Joseph Buchholz, Brendan C. Cline, Jonathan G. Martin, Charles Y. Kim, and James Ronald
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2023
9. Updates on <scp>LI‐RADS</scp> Treatment Response Criteria for Hepatocellular Carcinoma: Focusing on <scp>MRI</scp>
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Richa Patel, Anum Aslam, Neehar D. Parikh, Benjamin Mervak, Eman Mubarak, Lily Higgins, Kayli Lala, Jack F. Conner, Valerie Khaykin, Mustafa Bashir, Richard Kinh Gian Do, Lauren M. B. Burke, Elainea N. Smith, Charles Y. Kim, Kimberly L. Shampain, Dawn Owen, and Mishal Mendiratta‐Lala
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Radiology, Nuclear Medicine and imaging - Published
- 2023
10. Tips and Techniques for Traversing the Impassable Biliary Stricture
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Nicholas T. Befera, Brendan C. Cline, Jonathan G. Martin, Paul V. Suhocki, and Charles Y. Kim
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Gastroenterology ,Radiology, Nuclear Medicine and imaging ,Surgery - Abstract
Biliary obstruction is a common indication for referral to interventional radiology, particularly when endoscopic retrograde cholangiopancreatography has failed or is not possible due to postsurgical anatomy. The standard approach to percutaneous transhepatic biliary drainage involves gaining needle access to a peripheral bile duct, followed by advancement of a guidewire and drainage catheter across the obstruction and into bowel to allow internal drainage. While most cases of biliary obstruction are managed successfully with this conventional approach, in some situations it is not possible to traverse the occlusion with a guidewire and catheter, and thus advanced techniques may be required. This article has reviewed the available strategies for managing the impassable biliary obstruction.
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- 2023
11. ACR Appropriateness Criteria® Management of Liver Cancer: 2022 Update
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Erica M. Knavel Koepsel, Amanda R. Smolock, Jason W. Pinchot, Charles Y. Kim, Osmanuddin Ahmed, Murthy R.K. Chamarthy, Elizabeth M. Hecht, Gloria L. Hwang, David E. Kaplan, Join Y. Luh, Jorge A. Marrero, Eric J. Monroe, George A. Poultsides, Matthew J. Scheidt, and Eric J. Hohenwalter
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Radiology, Nuclear Medicine and imaging - Published
- 2022
12. Direct Percutaneous Intercostal Artery Access for Thoracic Type II Endoleak Embolization
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James Ronald, Branten Page, Charles Y. Kim, and Chandler A. Long
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Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Endoleak ,Endovascular Procedures ,Humans ,Aorta, Thoracic ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,Embolization, Therapeutic ,Aortic Aneurysm, Abdominal - Published
- 2022
13. Safety Profile of Particle Embolization for Treatment of Acute Lower Gastrointestinal Bleeding
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Charles Y. Kim, Rui Dai, Elisabeth R. Seyferth, Nicholas T. Befera, Alan A. Sag, Jonathan G. Martin, Waleska M. Pabon-Ramos, Paul V. Suhocki, Tony P. Smith, and James Ronald
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Male ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Angiography ,Colonoscopy ,Retrospective cohort study ,Bowel resection ,Embolization, Therapeutic ,Surgery ,Safety profile ,Acute lower gastrointestinal bleeding ,Treatment Outcome ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Embolization ,Gastrointestinal Hemorrhage ,Cardiology and Cardiovascular Medicine ,Adverse effect ,business ,Aged ,Retrospective Studies - Abstract
Purpose To assess ischemic adverse events following particle embolization when used as a second-line embolic to coil embolization for treatment of acute lower gastrointestinal bleeding(LGIB). Materials and Methods This single-institution retrospective study examined 154 procedures where embolization was attempted for LGIB. In 122 patients (64 males, mean age 69.9 years), embolization was successfully performed using microcoils in 73 procedures, particles in 34 procedures, and both microcoils and particles in 27 procedures. Particles were used as second-line only when coil embolization was infeasible or inadequate. Technical success was defined as angiographic cessation of active extravasation after embolization. Clinical success was defined as absence of recurrent bleeding within 30 days of embolization. Results Technical success for embolization of LGIB was achieved in 87.0% of cases (134/154), and clinical success was 76.1%(102/134) among technically successful cases. Clinical success was 82.2%(60/73) for coils alone and 68.9%(42/61) for particles +/- coils. Severe adverse events involving embolization-induced bowel ischemia occurred in 3 of 56 patients who underwent particle embolization +/- coils (5.3%) versus zero out of 66 patients when coils alone were used (P=0.09). In patients who had colonoscopy or bowel resection within 2 weeks of embolization, ischemic findings attributable to the embolization were found in 3 of 15 who underwent embolization with coils alone, versus 8 of 18 who underwent embolization with particles +/- coils (p=0.27). Conclusion Particle embolization for treatment of LGIB as second line to coil embolization was associated with a 68.9% clinical success rate and a 5.3% rate of ischemia-related adverse events.
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- 2022
14. Proton pump inhibitor use is associated with increased rates of post-TIPS hepatic encephalopathy: Replication in an independent patient cohort
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Andrew J. Muir, Charles Y. Kim, Paul V. Suhocki, Nicholas T. Befera, Waleska M. Pabon-Ramos, Rui Dai, Alan A. Sag, Jonathan G. Martin, James Ronald, and Tony P. Smith
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Liver Cirrhosis ,Male ,medicine.medical_specialty ,medicine.drug_class ,Proton-pump inhibitor ,Rate ratio ,Gastroenterology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Poisson regression ,Hepatic encephalopathy ,Survival analysis ,Retrospective Studies ,business.industry ,Hazard ratio ,Proton Pump Inhibitors ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Hepatic Encephalopathy ,030220 oncology & carcinogenesis ,Cohort ,symbols ,Portasystemic Shunt, Transjugular Intrahepatic ,business - Abstract
Purpose Proton pump inhibitor (PPI) use is a potential risk factor for hepatic encephalopathy (HE), but few studies have examined the effect on post-TIPS HE. The purpose of this study was to determine whether PPIs are associated with increased rates of post-TIPS HE in an independent patient cohort. Materials and methods This single-institution retrospective study analyzed 86 patients (54 male, mean age 58.2) following TIPS from 1/1/2017 to 12/31/2019. Dates of PPI usage and episodes of new or worsening HE were recorded. Poisson regression with generalized estimating equations was used to test for association between PPI use and post-TIPS HE and to test for dose dependence. Post-TIPS HE was also analyzed using the Andersen-Gill survival model for recurrent events. Results There were 1.88 episodes of new or worsening post-TIPS HE per person-year among 35 patients on uninterrupted PPIs therapy, 1.95 on PPIs and 0.94 off PPIs among 35 patients on intermittent therapy, and 0.47 among 16 patients never on PPIs. PPI use was significantly associated with post-TIPS HE in both univariable (incidence rate ratio (IRR) = 2.62; CI = 1.41–4.84; p = 0.002) and multivariable (IRR = 2.31; CI = 1.37–3.89; p = 0.002) regression. Analysis of only those patients on PPIs showed increased rates of HE with higher doses (IRR = 1.17 per 10 mg omeprazole equivalent; CI = 1.04–1.33; p = 0.011). Recurrent events survival analysis supported the association between PPI use and HE in univariable (hazard ratio (HR) = 2.17; CI = 1.19–3.95; p = 0.011) and multivariable (HR = 1.87; CI = 1.12–3.13; p = 0.017) analysis. Conclusion In an independent patient cohort PPI use was associated with increased rates of new or worsening post-TIPS HE.
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- 2021
15. Development of a Novel Recurrent Gastrointestinal Bleeding Model in Swine for Provocative Mesenteric Angiography
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Brendan Cline, Jessica K. Stewart, Scott Perkins, and Charles Y. Kim
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medicine.medical_specialty ,Percutaneous ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Digital subtraction angiography ,Extravasation ,Surgery ,03 medical and health sciences ,Catheter ,0302 clinical medicine ,Incision Site ,030220 oncology & carcinogenesis ,Laparotomy ,medicine.artery ,Hemostasis ,medicine ,030211 gastroenterology & hepatology ,Radiology, Nuclear Medicine and imaging ,Superior mesenteric artery ,business - Abstract
Purpose The purpose of this study was to develop a novel swine model of recurrent gastrointestinal bleeding that could potentially be utilized for the study of provocative mesenteric angiography. Methods Animal experiments were approved by the Institutional Animal Care and Use Committee. The superior mesenteric artery was catheterized via percutaneous transfemoral access. Via laparotomy, multiple small incisions were created in the small bowel wall of four swine. After hemostasis was achieved, varying amounts of thrombolytics were infused into the superior mesenteric artery via a 5 french catheter. The number of incisions with observable rebleeding and interval until rebleeding were ascertained. Results In a test animal, active extravasation was confirmed to be detectable on digital subtraction angiography at a small bowel incision site. After tissue plasminogen activator (tPA) administration into the superior mesenteric artery, rebleeding from the incisions was visually observed in 11 of 30 small bowel incisions (37%). Provoked bleeding occurred at a median of 6 minutes (mean: 5 minutes and 52 seconds) after completion of tPA injection with a range of approximately 1 to 10 minutes. Conclusion This pilot study proposes a feasible model for provocative mesenteric angiography in swine.
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- 2021
16. ACR Appropriateness Criteria® Radiologic Management of Portal Hypertension
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O. Ahmed, Sumeet K Asrani, Charles Y. Kim, Karin E Dill, Eric J. Hohenwalter, Vascular Imaging, Matthew J Scheidt, Jens Eldrup-Jorgensen, Bill S. Majdalany, Brooks D Cash, A Tuba Kendi, David M. Sella, Jason W Pinchot, and Sanjeeva P. Kalva
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medicine.medical_specialty ,Cirrhosis ,business.industry ,Portal venous pressure ,Disease ,medicine.disease ,Appropriate Use Criteria ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Hepatorenal syndrome ,030220 oncology & carcinogenesis ,medicine ,Portal hypertension ,Radiology, Nuclear Medicine and imaging ,Upper gastrointestinal bleeding ,Intensive care medicine ,business ,Medical literature - Abstract
Cirrhosis is a heterogeneous disease that cannot be studied as a single entity and is classified in two main prognostic stages: compensated and decompensated cirrhosis. Portal hypertension, characterized by a pathological increase of the portal pressure and by the formation of portal-systemic collaterals that bypass the liver, is the initial and main consequence of cirrhosis and is responsible for the majority of its complications. A myriad of treatment options exists for appropriately managing the most common complications of portal hypertension, including acute variceal bleeding and refractory ascites. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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- 2021
17. Recent update of percutaneous radiologic jejunostomy
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Ji Hoon Shin and Charles Y. Kim
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medicine.medical_specialty ,Percutaneous ,Hepatology ,business.industry ,medicine.medical_treatment ,enteral nutrition ,enterostomy ,jejunostomy ,Gastroenterology ,Specialties of internal medicine ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC31-1245 ,Surgery ,RC581-951 ,Oncology ,Jejunostomy ,medicine ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,Internal medicine ,RC254-282 - Abstract
Although percutaneous radiologic jejunostomy has not been widely accepted as a primary insertion technique due to the technical difficulty for inexperienced operators, it may be a crucial procedure for patients with previous gastrectomy or an otherwise inaccessible stomach, particularly in patients who are not candidates for a surgical jejunostomy. Targeting the appropriate target jejunal loop and affixing the bowel with a t-fastener anchor are the most important and challenging technical steps. Technical success rate ranged from 92% to 100% based on 19 to 106 patients in several representative reports, with major complications ranging from 3.9% to 13.0%.
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- 2021
18. Sharp Recanalization of Chronic Central Venous Occlusions of the Thorax Using a Steerable Coaxial Needle Technique from a Supraclavicular Approach
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Paul V. Suhocki, Jonathan G. Martin, Tony P. Smith, Charles Y. Kim, Waleska M. Pabon-Ramos, James Ronald, Alan A. Sag, and Christopher J.R. Gallo
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Thorax ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Ultrasound ,Stent ,Hemothorax ,medicine.disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Blunt ,Angioplasty ,Occlusion ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Coaxial ,Cardiology and Cardiovascular Medicine ,business - Abstract
To evaluate the technical success and safety of a steerable coaxial sharp recanalization technique that utilizes routine needles in patients with refractory thoracic central venous occlusions. This retrospective study was performed on 36-attempted sharp recanalizations in 35 patients (mean age 50 years, 23 male) performed via a supraclavicular approach. In all cases, an 18-gauge trocar needle was custom curved to provide directional control during fluoroscopic triangulation. A 22-gauge Chiba needle was then advanced coaxially across the occlusion. A tractogram was performed to assess for traversal of unintended structures. Procedures were completed by catheter placement, angioplasty, or stenting follow successful recanalizations. Sharp recanalization using this steerable coaxial needle technique demonstrated a technical success rate of 94% (34/36). The mean occlusion length was 30 mm (range 3–53 mm). In 11 patients, success was achieved using this technique after failure of other advanced techniques. In five procedures, stent interstices were traversed. Sharp recanalization was the direct cause of one major complication consisting of pleural transgression causing mild hemothorax treated successfully with a stent graft. The proposed technique is effective and safe for patients who have failed traditional blunt recanalization techniques. Level 4, Case Series.
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- 2021
19. Hemodialysis catheter integrity during mechanical power injection of iodinated contrast medium for computed tomography angiography
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F. Gregory Murphy, Rendon C. Nelson, Charles Y. Kim, Amy E. King, Fides R. Schwartz, Laurens E. Howle, and D. Lewis
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Catheterization, Central Venous ,Catheters ,Computed Tomography Angiography ,Urology ,medicine.medical_treatment ,Hemodialysis Catheter ,Contrast Media ,Iopamidol ,030218 nuclear medicine & medical imaging ,Iodinated contrast media ,03 medical and health sciences ,0302 clinical medicine ,Iodinated contrast ,Renal Dialysis ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Computed tomography angiography ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Catheter ,030220 oncology & carcinogenesis ,Injections, Intravenous ,Angiography ,Hemodialysis ,business ,Nuclear medicine ,medicine.drug - Abstract
CT angiography (CTA) requires vascular access with flow rates of 5–7 mL/s. Hemodialysis (HD) is performed at 6–10 mL/s. The purpose of our study is to evaluate the structural integrity of HD catheters in the administration of contrast media via a mechanical power injector under varying conditions. Four HD catheters were evaluated in an in vitro study. Tested were contrast media type (iopamidol 300 and 370 mgI/mL), temperature (25 and 37 °C), catheter diameter (14 Fr to 16 Fr all with double-lumen capacity), catheter length (19–32 cm), and simultaneous double-lumen or single-lumen injection within each of the catheters. Peak plateau pressures (psi) were recorded with flow rates from 5 to 20 mL/s in 5 mL/s increments. In total, 864 unique injections were performed. No catheter failure (bulging/rupture) was observed in 864 injections. Maximum pressure for single-lumen injection was 51.7 psi (double-lumen: 26.3 psi). Peak pressures were significantly lower in simultaneous double-lumen vs. single-lumen injections (p
- Published
- 2021
20. Juxtametallic Bipolar Bone Radiofrequency Ablation: Thermal Monitoring in an Ex-Vivo Model with Specimen MRI and Histopathologic Correlation
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Alan A. Sag, William A.L. Sperduto, William Eward, James Ronald, Haley Davis, Xiaoyin Sara Jiang, David S. Enterline, Julia Visgauss, Brian Brigman, C. Rory Goodwin, Yawar J. Qadri, and Charles Y. Kim
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Titanium ,Liver ,Swine ,Catheter Ablation ,Animals ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,Stainless Steel ,Magnetic Resonance Imaging - Abstract
To measure the ablation zone temperature and nontarget tissue temperature during radiofrequency (RF) ablation in bone containing metal instrumentation versus no metal instrumentation (control group).Ex vivo experiments were performed on 15 swine vertebrae (control, n = 5; titanium screw, n = 5; stainless steel screw, n = 5). Screws and RF ablation probe were inserted identically under fluoroscopy. During RF ablation (3 W, 5 minutes), temperature was measured 10 mm from RF ablation centerpoint and in muscle contacting the screw. Magnetic resonance (MR) imaging, gross pathologic, and histopathologic analyses were performed on 1 specimen from each group.Ablation zone temperatures at 2.5 and 5 minutes increased by 12.2 °C ± 2.6 °C and 21.5 °C ± 2.1 °C (control); 11.0 °C ± 4.1 °C and 20.0 °C ± 2.9 °C (juxta-titanium screw), and 10.0 °C ± 3.4 °C and 17.2 °C ± 3.5 °C (juxta-stainless steel) screw; differences among groups did not reach significance by analysis of variance (P = .87). Mixed-effects linear regression revealed a statistically significant increase in temperature over time in all 3 groups (4.2 °C/min ± 0.4 °C/min, P.001). Compared with the control, there was no significant difference in the temperature change over time for titanium (-0.3 °C/min ± 0.5 °C/min, P = .53) or steel groups (-0.4 °C/min ± 0.5 °C/min, P = .38). The mean screw temperature at the final time point did not show a statistically significant change compared with baseline in either the titanium group (-1.2 °C ± 2.3 °C, P = .50) or steel group (2.6 °C ± 2.9 °C, P = .11). MR imaging and pathologic analyses revealed homogeneous ablation without sparing of the peri-hardware zones.Adjacent metallic instrumentation did not affect the rate of or absolute increase in temperature in the ablation zone, did not create peri-metallic ablation inhomogeneities, and did not result in significant nontarget heating of muscle tissue in contact with the metal instrumentation.
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- 2022
21. Hepatocellular carcinoma Liver Imaging Reporting and Data Systems treatment response assessment: Lessons learned and future directions
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Mishal Mendiratta-Lala, Ahmed M Gabr, Resmi A. Charalel, Richard K. G. Do, David C. Madoff, Charles Y. Kim, Avinash Kambadakone, Frank H. Miller, Bradley Spieler, and Anum Aslam
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Oncology ,medicine.medical_specialty ,Treatment response ,Hepatocellular carcinoma ,Stereotactic body radiotherapy ,Disease free ,Locoregional therapy ,Systemic therapy ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Arterial phase hyper enhancement ,Internal medicine ,medicine ,Liver imaging ,Hepatology ,business.industry ,Minireviews ,medicine.disease ,Liver Imaging Reporting and Data Systems Treatment Response equivocal ,Tumor progression ,030220 oncology & carcinogenesis ,Liver Imaging Reporting and Data Systems Treatment Response Algorithm ,030211 gastroenterology & hepatology ,Post treatment ,business - Abstract
Hepatocellular carcinoma (HCC) is a leading cause of morbidity and mortality worldwide, with rising clinical and economic burden as incidence increases. There are a multitude of evolving treatment options, including locoregional therapies which can be used alone, in combination with each other, or in combination with systemic therapy. These treatment options have shown to be effective in achieving remission, controlling tumor progression, improving disease free and overall survival in patients who cannot undergo resection and providing a bridge to transplant by debulking tumor burden to downstage patients. Following locoregional therapy (LRT), it is crucial to provide treatment response assessment to guide management and liver transplant candidacy. Therefore, Liver Imaging Reporting and Data Systems (LI-RADS) Treatment Response Algorithm (TRA) was created to provide a standardized assessment of HCC following LRT. LI-RADS TRA provides a step by step approach to evaluate each lesion independently for accurate tumor assessment. In this review, we provide an overview of different locoregional therapies for HCC, describe the expected post treatment imaging appearance following treatment, and review the LI-RADS TRA with guidance for its application in clinical practice. Unique to other publications, we will also review emerging literature supporting the use of LI-RADS for assessment of HCC treatment response after LRT.
- Published
- 2020
22. Gel Phantom Models for Radiofrequency and Microwave Ablation of the Liver
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Charles Y. Kim, Willa J. Chen, and Q. Wang
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Materials science ,Radiofrequency ablation ,medicine.medical_treatment ,Microwave ablation ,Gastroenterology ,Thermal ablation ,Ablation ,01 natural sciences ,Article ,Imaging phantom ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,0103 physical sciences ,medicine ,Radiology, Nuclear Medicine and imaging ,Surgery ,010301 acoustics ,Biomedical engineering - Abstract
Heat-based percutaneous thermal ablation techniques have emerged as popular and effective treatments for liver cancer. As the technology continues to evolve, there is a need for optimized methods for experimentation to identify advantageous modifications and developments. Given that assessing and comparing resulting ablation zones in animal models are costly and resource-intensive, in vitro gel phantom models can serve an important role for early-stage experimentation. There exist several gel phantom recipes that have been reported in the literature. In this review, we will review the various recipes, the pros and cons to the existing models, and future potential directions.
- Published
- 2020
23. Implementation of a Hepatic Artery Infusion Program: Initial Patient Selection and Perioperative Outcomes of Concurrent Hepatic Artery Infusion and Systemic Chemotherapy for Colorectal Liver Metastases
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Hope E. Uronis, Kyle J. Napier, Benjamin Wildman-Tobriner, Sarah A. Reed, Michael E. Lidsky, John M. Creasy, Sabino Zani, John H. Strickler, Peter J. Allen, S. David Hsu, Charles Y. Kim, and Terence Z. Wong
- Subjects
Chemotherapy ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Perioperative ,030230 surgery ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,Oncology ,Interquartile range ,Response Evaluation Criteria in Solid Tumors ,030220 oncology & carcinogenesis ,Seroma ,medicine ,Hepatectomy ,business ,Colectomy - Abstract
Hepatic artery infusion (HAI) combined with systemic chemotherapy is a treatment strategy for patients with unresectable liver-only or liver-dominant colorectal liver metastases (CRLM). Although HAI has previously been performed in only a few centers, this study aimed to describe patient selection and initial perioperative outcomes during implementation of a new HAI program. The study enrolled patients with CRLM selected for HAI after multi-disciplinary review November 2018–January 2020. Demographics, prior treatment, and perioperative outcomes were assessed. Objective hepatic response was calculated according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. During a 14-month period, 21 patients with CRLM underwent HAI pump placement. Of these 21 patients, 20 (95%) had unresectable disease. Most of the patients had synchronous disease (n = 18, 86%) and had received prior chemotherapy (n = 20, 95%) with extended treatment cycles (median 16; interquartile range, 8–22; range, 0–66). The median number of CRLMs was 7 (range, 2–40). Operations often were performed with combined hepatectomy (n = 4, 19%) and/or colectomy/proctectomy (n = 11, 52%). The study had no 90-day mortality. The overall surgical morbidity was 19%. The HAI-specific complications included pump pocket seroma (n = 2), hematoma (n = 1), surgical-site infection (n = 1), and extrahepatic perfusion (n = 1). HAI was initiated in 20 patients (95%). The hepatic response rates at 3 months included partial response (n = 4, 24%), stable disease (n = 9, 53%), and progression of disease (n = 4, 24%), yielding a 3-month hepatic disease control rate (DCR) of 76%. Implementation of a new HAI program is feasible, and HAI can be delivered safely to selected patients with CRLM. The initial response and DCR are promising, even for patients heavily pretreated with chemotherapy.
- Published
- 2020
24. ACR Appropriateness Criteria® Radiologic Management of Gastric Varices
- Author
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Aaron R Braun, David M. Sella, O. Ahmed, Eric J. Hohenwalter, Charles Y. Kim, Barry W. Feig, Brooks D. Cash, Jason W Pinchot, Clifford R. Weiss, Kristofer Schramm, Sanjeeva P. Kalva, Matthew J Scheidt, and Erica M. Knavel Koepsel
- Subjects
medicine.medical_specialty ,business.industry ,Gastric varices ,medicine.disease ,Appropriate Use Criteria ,Splenic vein ,medicine ,Etiology ,Radiology, Nuclear Medicine and imaging ,Upper gastrointestinal bleeding ,business ,Intensive care medicine ,Grading (tumors) ,Medical literature - Abstract
Hemorrhage, resulting from gastric varies, can be challenging to treat, given the various precipitating etiologies. A wide variety of treatment options exist for managing the diverse range of the underlying disease processes. While cirrhosis is the most common cause for gastric variceal bleeding, occlusion of the portal or splenic vein in noncirrhotic states results in a markedly different treatment paradigm. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
- Published
- 2020
25. ACR Appropriateness Criteria® Radiologic Management of Urinary Tract Obstruction
- Author
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O. Ahmed, Marc A. Bjurlin, David M. Sella, Jason W Pinchot, Kristofer Schramm, Clifford R. Weiss, Aaron R Braun, Charles Y. Kim, Jonathan M. Lorenz, Matthew J Scheidt, Eric J. Hohenwalter, and Erica M. Knavel Koepsel
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Interventional radiology ,medicine.disease ,Appropriate Use Criteria ,030218 nuclear medicine & medical imaging ,Clinical trial ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous nephrostomy ,030220 oncology & carcinogenesis ,medicine ,Radiology, Nuclear Medicine and imaging ,Intensive care medicine ,business ,Urinary tract obstruction ,Obstructive uropathy ,Medical literature - Abstract
Acute obstructive uropathy is a medical emergency, which often is accompanied by acute renal failure or sepsis. Treatment options to resolve the acute obstructive process include conservative medical management, retrograde ureteral stenting, or placement of percutaneous nephrostomy or nephroureteral catheters. It is important to understand the various treatment options in differing clinical scenarios in order to guide appropriate consultation. Prompt attention to the underlying obstructive process is often imperative to avoid further deterioration of the patient's clinical status. A summary of the data and most up-to-date clinical trials regarding treatment options for urinary tract obstruction is outlined in this publication. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
- Published
- 2020
26. ACR Appropriateness Criteria® Radiologic Management of Infected Fluid Collections
- Author
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Clifford R. Weiss, Christopher R. Bailey, Eric J. Hohenwalter, Jason W. Pinchot, Osmanuddin Ahmed, Aaron R. Braun, Brooks D. Cash, Samir Gupta, Charles Y. Kim, Erica M. Knavel Koepsel, Matthew J. Scheidt, Kristofer Schramm, David M. Sella, and Jonathan M. Lorenz
- Subjects
Radiology, Nuclear Medicine and imaging - Published
- 2020
27. Length of Stay Predicts Risk of Early Infection for Hospitalized Patients Undergoing Central Venous Port Placement
- Author
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Linnan Tang, Tony P. Smith, James Ronald, Alan A. Sag, Jonathan G. Martin, Waleska M. Pabon-Ramos, Paul V. Suhocki, and Charles Y. Kim
- Subjects
Adult ,Male ,Catheterization, Central Venous ,medicine.medical_specialty ,Time Factors ,Hospitalized patients ,Risk Assessment ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,Catheters, Indwelling ,0302 clinical medicine ,Port (medical) ,Risk Factors ,Internal medicine ,Central Venous Catheters ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Young adult ,Survival analysis ,Aged ,Retrospective Studies ,Aged, 80 and over ,Inpatients ,business.industry ,Decision Trees ,Hazard ratio ,Retrospective cohort study ,Length of Stay ,Middle Aged ,Patient Discharge ,Confidence interval ,Catheter-Related Infections ,030220 oncology & carcinogenesis ,Female ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment - Abstract
To compare early totally implantable central venous port catheter-related infection rates after inpatient vs outpatient placement and to determine whether the risk associated with inpatient placement is influenced by length of hospital stay.In this single-institution retrospective study, 5,301 patients (3,618 women; mean age 57 y) underwent port placement by interventional radiologists between October 2004 and January 2018. The 30-day infection rate was compared between inpatients and outpatients using survival analysis. Among inpatients, the effect of time from admission to port placement and from placement to discharge was analyzed using a survival regression tree.The 30-day infection rate was 3.6% (95% confidence interval [CI] = 1.9%-6.1%) among 386 inpatients and 1.0% (95% CI = 0.7%-1.3%) among 4,915 outpatients (hazard ratio [HR] = 3.6, 95% CI = 2.0-6.6, P.001). Inpatient placement was a significant risk factor after accounting for covariates in multivariate analysis (HR = 2.2, 95% CI = 1.0-4.7, P = .05) and controlling for demographic differences by propensity score matching (HR = 2.8, 95% CI = 1.0-7.8, P = .04). Infection rate was 11% (95% CI = 4.7%-22%) among 65 inpatients in whom time from admission to placement was ≥ 7 days, 5.1% (95% CI = 1.9%-11%) among 129 inpatients in whom admission to placement was7 days and time to discharge was3 days, and 0% (95% CI = 0%-2.1%) among 192 inpatients in whom admission to placement was7 days and time to discharge was ≤ 3 days (P.001).Inpatient port placement was associated with a higher risk of early infection. However, a clinical decision tree based on shorter length of stay before and after placement may identify a subset of hospitalized patients not at increased risk for infection.
- Published
- 2020
28. Treatment of Arm Swelling in Hemodialysis Patients with Ipsilateral Arteriovenous Access and Central Vein Stenosis: Conversion to the Hemodialysis Reliable Outflow Graft versus Stent Deployment
- Author
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Brendan Cline, Charles Y. Kim, Ellen D. Dillavou, Tony P. Smith, Shawn M. Gage, James Ronald, Waleska M. Pabon-Ramos, and Jeffrey H. Lawson
- Subjects
medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Fistula ,Anastomosis ,Prosthesis Design ,Arm swelling ,030218 nuclear medicine & medical imaging ,Upper Extremity ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Arteriovenous Shunt, Surgical ,0302 clinical medicine ,Renal Dialysis ,Stent deployment ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Vein ,Vascular Patency ,Retrospective Studies ,business.industry ,Graft Occlusion, Vascular ,Retrospective cohort study ,medicine.disease ,Blood Vessel Prosthesis ,Surgery ,Stenosis ,Treatment Outcome ,surgical procedures, operative ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Stents ,Hemodialysis ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon - Abstract
To compare outcomes after conversion of arteriovenous (AV) access to Hemodialysis Reliable Outflow (HeRO) graft vs stent deployment in patients with arm swelling owing to ipsilateral central vein stenosis.This single-center retrospective study comprised 48 patients (19 men, mean age 58 y) with arm swelling ipsilateral to AV access and central vein stenosis over a 13-year period who had clinical follow-up and without prior central stents. Twenty-one patients underwent placement of a HeRO graft with anastomosis of the HeRO graft to the existing graft or fistula, and 27 patients underwent central venous stent deployment. Symptomatic improvement in arm swelling and access patency rates after intervention were ascertained from medical records.Improvement in swelling within 1 month after HeRO conversion and stent deployment was found in 95% and 89%, respectively (P = .62). Swelling eventually recurred in 16 patients (59%) treated with stents compared with 1 patient (5%) who underwent HeRO conversion (P.001). Primary access patency was statistically significantly longer after HeRO conversions than stent deployments, with 6- and 12-month primary patency rates of 89% and 72% vs 47% and 11% (P.001). HeRO conversions also resulted in longer 6- and 12-month secondary access patency rates (95% and 95% vs 79% and 58%, P = .006). Mean number of interventions per 1,000 access days to maintain secondary patency was 2.7 for the HeRO group vs 6.3 for the stent group.Although stent deployment and HeRO graft conversion are effective for alleviating arm swelling in the short term in patients receiving hemodialysis with clinically significant arm swelling and functioning AV access, the HeRO graft has more durable results.
- Published
- 2020
29. Sonifying Data from the Human Microbiota: Biota Beats
- Author
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David S. Kong, Charles Y. Kim, Gautam Salhotra, Keerthi Shetty, Alexandria Guo, and Sara Sprinkhuizen
- Subjects
0301 basic medicine ,03 medical and health sciences ,Ecology ,Computer science ,030106 microbiology ,0103 physical sciences ,Media Technology ,Human microbiome ,Biota ,010306 general physics ,01 natural sciences ,Music ,Computer Science Applications - Abstract
This article presents a musical interface that enables the sonification of data from the human microbiota, the trillions of microorganisms that inhabit the human body, into sound and music. The project is concerned with public engagement in science, particularly the life sciences, and developing cultivation technologies that take advantage of the ubiquitous and accessible nature of the human microbiota. In this article we examine the collaboration between team members proficient in musical composition and those with expertise in biology, sonification, and data visualization, producing an individualized piece of music designed to capture basic biological data and user attention. Although this system, called Biota Beats, sonifies ubiquitous data for educational science projects, it also establishes a connection between individuals and their bodies and between a community and its context through interactive music experiences, while attempting to make the science of the human microbiome more accessible. The science behind standardizing sonified data for scientific, human analysis is still in development (in comparison to charts, graphs, spectrograms, or other types of data visualization). So a more artistic approach, using the framework of musical genres and their associated themes and motifs, is a convenient and previously established way to capitalize on how people naturally perceive sound. Further, to forge a creative connection between the human microbiota and the music genre, a philosophical shift is necessary, that of viewing the human body and the digital audio workstation as ubiquitous computers.
- Published
- 2020
30. Relative Sarcopenia With Excess Adiposity Predicts Survival After Transjugular Intrahepatic Portosystemic Shunt Creation
- Author
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Paul V. Suhocki, Mustafa R. Bashir, Islam H Zaki, Matthew R. Kappus, Erol Bozdogan, Tony P. Smith, Steven S Choi, James Ronald, Charles Y. Kim, and Jonathan G. Martin
- Subjects
Adult ,Male ,Sarcopenia ,medicine.medical_specialty ,medicine.medical_treatment ,Rate ratio ,Gastroenterology ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Obesity ,Risk factor ,Survival analysis ,Adiposity ,Aged ,Retrospective Studies ,Aged, 80 and over ,First episode ,Univariate analysis ,business.industry ,Hazard ratio ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Survival Rate ,030220 oncology & carcinogenesis ,Female ,Portasystemic Shunt, Transjugular Intrahepatic ,business ,Transjugular intrahepatic portosystemic shunt - Abstract
OBJECTIVE. The purpose of this study was to assess the impact of relative sarcopenia with excess adiposity on mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS. In this single-institution retrospective study, patients underwent abdominal CT scans within 100 days before or 30 days after TIPS creation. Subcutaneous and visceral adipose tissue and muscle were segmented at the L3 vertebral level. Relative sarcopenia with excess adiposity was defined as the lowest sex-specific quartile of muscle area divided by muscle plus adipose. Dates of death, liver transplantation, TIPS occlusion, and hepatic encephalopathy (HE) after TIPS creation were identified. Mortality was evaluated using competing risks survival analysis. Number of HE episodes and time to first episode were analyzed using negative binomial regression and competing risks survival analysis, respectively. RESULTS. A total of 141 patients (91 men; mean age, 56 years) were included in this study. In univariate analyses, Model for End-Stage Liver Disease (MELD) score (hazard ratio [HR], 1.09 per point; CI, 1.05-1.13; p < 0.001) and relative sarcopenia with excess adiposity (HR, 2.70; CI, 1.55-4.69; p < 0.001) were significant risk factors for shorter survival after TIPS. In multivariate analysis, both MELD score (HR, 1.09; CI, 1.03-1.15; p = 0.003) and relative sarcopenia with excess adiposity (HR, 2.65; CI, 1.56-4.51; p < 0.001) were significant predictors of worse survival. The C-index at 30 days was 0.71 for MELD score, 0.72 for relative sarcopenia with excess adiposity, and 0.80 for a model including both. There was no association between relative sarcopenia with excess adiposity and number of HE episodes (incidence rate ratio, 1.08; CI, 0.49-2.40; p = 0.84) or time to first HE episode (HR, 0.89; CI, 0.51-1.54; p = 0.67). CONCLUSION. Relative sarcopenia with excess adiposity is a risk factor for mortality after TIPS and contributes additional prognostic information beyond MELD score.
- Published
- 2020
31. Spinal Arterial Blood Supply Does Not Arise from the Bronchial Arteries: A Detailed Analysis of Angiographic Studies Performed for Hemoptysis
- Author
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James Ronald, Charles Y. Kim, Nicholas T. Befera, and Tony P. Smith
- Subjects
Adult ,Male ,Hemoptysis ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Bronchial Arteries ,Radiography, Interventional ,Young Adult ,Predictive Value of Tests ,medicine.artery ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization ,Child ,Spinal cord injury ,Aged ,Retrospective Studies ,Aged, 80 and over ,Aorta ,medicine.diagnostic_test ,business.industry ,Angiography ,Interventional radiology ,Middle Aged ,Spinal cord ,medicine.disease ,Embolization, Therapeutic ,Spine ,medicine.anatomical_structure ,Regional Blood Flow ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Bronchial artery ,Artery - Abstract
Purpose To determine the angiographic prevalence of spinal arteries originating directly from the bronchial arteries in the setting of embolization for hemoptysis. Materials and Methods Over a 14-year interval, 205 patients underwent angiography for hemoptysis. Twenty-five patients were excluded because their bronchial arteries were not visualized. The remaining 180 patients underwent a total of 254 angiographic procedures (range, 1–8 per patient). Images were reviewed jointly by 2 interventional radiologists with formal fellowship training in both peripheral and neurological interventional radiology. All catheterized arteries were evaluated for arterial contribution to the spinal cord. For patients with multiple studies, each unique artery was reported only once. Embolization was performed during at least 1 procedure in 158 patients (88%). Electronic record review was used to assess neurological sequelae after the procedure. Results One or 2 bronchial arteries originating from the aorta were identified in 57 patients (32%) on the right and in 75 patients (42%) on the left. Conjoined bronchial arteries were found in 76 patients (42%). Spinal arterial supply was absent in all. A total of 102 patients (57%) had at least 1 right and 11 patients (6%) at least 1 left intercostobronchial artery. Spinal arterial supply from the intercostal portion of an intercostobronchial artery was found in 6 patients (5 right, 1 left). Medical record review revealed no postprocedure symptoms referable to spinal cord injury in any patient. Conclusions Spinal arterial supply does not originate directly from the bronchial artery but can originate from the intercostal portion of an intercostobronchial artery.
- Published
- 2019
32. Recognition and management of dermatologic complications from interventional radiology procedures
- Author
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S. Ravichandran, Charles Y. Kim, M. Ramirez, L. Ronald, Waleska M. Pabon-Ramos, Tony P. Smith, and James Ronald
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Radiography, Interventional ,Cryosurgery ,Tumor ablation ,Drug Hypersensitivity ,Ischemia ,Photography ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization ,Child ,Radiation Injuries ,Aged ,Dermatologic Complication ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Skin Injury ,General surgery ,Interventional radiology ,General Medicine ,Middle Aged ,Embolization, Therapeutic ,Catheter-Related Infections ,Child, Preschool ,Fluoroscopy ,Female ,Radiodermatitis ,Burns ,business - Abstract
A variety of dermatologic complications can occur after interventional radiology procedures, including fluoroscopy-induced radiation dermatitis, thermal skin injury from tumor ablation, non-target embolization to the skin, allergic reactions related to interventional radiology procedures, and dermatitis and infections at catheter sites. Yet, interventional radiologists typically lack training in dermatology. This review focuses on recognition of dermatologic complications and introduces basic principles for management of these complications. By taking a more active role in the diagnosis, management, and follow-up of dermatologic complications, interventional radiologists can improve the care for patients suffering iatrogenic skin inury.
- Published
- 2019
33. Coaxial Stent Graft inside a Constraining Stent for Transjugular Intrahepatic Portosystemic Shunt Reduction
- Author
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James Ronald, Charles Y. Kim, Meghana Konanur, Rui Dai, Nicholas Befera, James Knutson, and Brendan C. Cline
- Subjects
Treatment Outcome ,Hepatic Encephalopathy ,Humans ,Stents ,Radiology, Nuclear Medicine and imaging ,Portasystemic Shunt, Transjugular Intrahepatic ,Plastic Surgery Procedures ,Cardiology and Cardiovascular Medicine ,Polytetrafluoroethylene - Abstract
A technique to create a coaxial, self-expanding stent graft inside a constraining, bare-metal, balloon-expandable stent for transjugular intrahepatic portosystemic shunt (TIPS) reduction is described. The key steps are performed on a back table rather than inside the patient, and the resulting construct is deployed using standard unsheathing maneuvers. The construct was used in 4 patients to make 6 TIPS diameter reductions (mean postreduction diameter, 6 mm; range, 0-8 mm), all resulting in increases in the portosystemic pressure gradient (mean increase, 6 mm Hg; range, 1-19 mm Hg). On average, hepatic encephalopathy improved 1 point on the West Haven scale (range, 0-2).
- Published
- 2022
34. Clinical Predictors of a Positive Ct Angiogram Study Used for the Evaluation of Acute Gastrointestinal Hemorrhage
- Author
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Zachary Spiritos, Anthony Horton, Alice Parish, Donna Niedzwiecki, Geargin Wilson, Charles Y. Kim, and Daniel Wild
- Subjects
Physiology ,Gastroenterology - Abstract
Acute gastrointestinal (GI) bleeding is one of the leading causes of emergency department visits and hospital admissions. CT angiography (CTA) has had an expanding role in the evaluation of acute GI bleeding because it is rapidly performed, widely available, reasonably sensitive and provides precise localization when positive. We attempted to identify patient and clinical characteristics that predict CTA results in order to help guide the utilization of this modality in patients with acute GI bleeding.In this retrospective study, we analyzed all CTAs performed for the evaluation of GI bleeding in the Duke University healthcare system between October 2019 and March 2020. We captured patient characteristics including age, sex, vital signs, hemoglobin, platelets, PT/INR, and anticoagulation status. Study indications were grouped by suspected source of bleeding: upper GI bleeding (hematemesis or coffee-ground emesis) vs small bowel bleeding (melena or "dark stools") vs lower GI bleeding (hematochezia or bright red blood per rectum (BRBPR)). Chi-square, Wilcoxon, t test, and multivariate logistic regression were used to describe and assess the relationship between patient characteristics and study outcomes (Table 1). Table 1 Univariate analysis of patient characteristics by CT angiography outcome Patient Characteristics by Positive CT for GI Bleed No (N = 274) Yes (N = 43) Total (N = 317) p value Gender 0.45In patients who present to the hospital with GI bleeding, CTA can be a helpful triage tool that is most helpful in older patients with suspected lower GI bleeding with a drop in hemoglobin from baseline. Other clinical factors including MAP and the use of anticoagulants were not predictive of a positive CTA.
- Published
- 2021
35. Evaluation of repeat distal transradial access in the anatomic snuffbox
- Author
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Charles Y. Kim, Alan A. Sag, James Ronald, Jonathan G. Martin, Tony P. Smith, and Nicholas Durocher
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Fistula ,Retrospective cohort study ,Hemorrhage ,Wrist ,medicine.disease ,Asymptomatic ,Surgery ,medicine.anatomical_structure ,Renal Dialysis ,medicine.artery ,Occlusion ,Radial Artery ,Interventional Radiology ,Medicine ,Humans ,Hemodialysis ,Radial artery ,medicine.symptom ,business ,Artery ,Retrospective Studies - Abstract
Purpose There is increasing interest in the distal radial artery in the anatomic snuffbox as an alternative arterial access point, but the durability of the distal radial artery to support repetitive accesses over multiple procedures is not well established. The purpose of this study was therefore to evaluate success rates for repeated left-sided distal transradial access (ldTRA) in the anatomic snuffbox. Methods In this single institution retrospective study, all patients undergoing radioembolization treatments from January 1st, 2019 to May 1st, 2020 were prospectively evaluated for ldTRA. ldTRA was performed by 15 different operators. Exclusion criteria were a left radiocephalic hemodialysis fistula, inability to properly position the arm, Barbeau D waveform, or failed prior ldTRA due to tortuosity. Barbeau patterns, arterial sizes, and success rates at the first, second, and third ldTRA were compared. Results Fifty patients were evaluated for ldTRA and 44, 39, and 10 underwent one, two, and three ldTRA attempts for a total of 93 procedures. There was no significant change in Barbeau patterns between the first and second (p = 0.13) or first and third (p = 1.0) ldTRA. There was no significant change in artery size between the first (mean, 2.3 mm; range, 1.5-3.4 mm) and second (mean, 2.3 mm; range, 1.6-3.3 mm) (p = 0.59) and first and third (mean, 2.4 mm; range, 1.9-3.3) (p = 0.45) ldTRA. The success rate was not significantly different between the first (93%, 41/44, 95% CI 81%-99%), second (95%, 37/39, 95% CI 83%-99%), and third (100%, 10/10, 95% CI 69%-100%) procedure (p = 1.0). The asymptomatic occlusion rate was 4.1% (2/49, 95% CI 0%-14%), and subsequent ldTRA was successfully completed in both patients with occlusions. There were no hemorrhagic or ischemic complications. Conclusion Success rates are indistinguishable among first, second, and third time ldTRA suggesting that this is a durable access point.
- Published
- 2021
36. Racial disparities in transjugular intrahepatic portosystemic shunt procedure outcomes
- Author
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James H Helzberg, Alice Parish, Donna Niedzwiecki, Charles Y Kim, Yuval A Patel, Julius M Wilder, and Andrew J Muir
- Subjects
Hepatology ,cirrhosis ,Gastroenterology ,portal hypertension ,chronic liver disease ,RC799-869 ,Diseases of the digestive system. Gastroenterology ,Esophageal and Gastric Varices ,Cohort Studies ,Hypertension, Portal ,Humans ,Portasystemic Shunt, Transjugular Intrahepatic ,Gastrointestinal Hemorrhage - Abstract
ObjectiveThe transjugular intrahepatic portosystemic shunt (TIPS) procedure is an important intervention for management of complications of portal hypertension. The objective of this study was to identify predictors of mortality from the TIPS procedure with a focus on race and ethnicity.DesignTIPS procedures from 2012 to 2014 in the National Inpatient Sample were identified. Weighting was applied to generate nationally representative results. In-hospital mortality was the primary outcome of interest. χ2 and Student’s t-tests were performed for categorical and continuous variables, respectively. Predictors of mortality following TIPS were assessed by survey-weighted logistic regression.Results17 175 (95% CI 16 254 to 18 096) TIPS cases were identified. Approximately 71% were non-Hispanic (NH) white, 6% were NH black, 16% were Hispanic and 7% were other. NH black patients undergoing TIPS had an in-hospital mortality rate of 20.1%, nearly double the in-hospital mortality of any other racial or ethnic group. NH black patients also had significantly longer median postprocedure and total lengths of stay (p=0.03 and pConclusionThis cohort study presents important findings in end-stage liver disease care, with clear racial disparities in in-hospital outcomes following the TIPS procedure. Specifically, black patients had significantly higher in-hospital mortality and longer lengths of stay. Further research is needed to understand how we can better care for black patients with liver disease.
- Published
- 2021
37. Transient Reperfusion-Like Injury following Endovascular Treatment of Chronic Mesenteric Ischemia
- Author
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Antony J. Hayes, Tony P. Smith, Andre M. Agassi, and Charles Y. Kim
- Subjects
Chronic mesenteric ischemia ,business.industry ,Anesthesia ,Medicine ,Radiology, Nuclear Medicine and imaging ,Transient (computer programming) ,Endovascular treatment ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
38. ACR Appropriateness Criteria® Radiologic Management of Biliary Obstruction
- Author
-
Matthew G. Gipson, Eric J. Hohenwalter, Aaron R Braun, Waddah B. Al-Refaie, Brooks D. Cash, Jason W Pinchot, Jonathan M. Lorenz, Clifford R. Weiss, Charles Y. Kim, Matthew J Scheidt, Kristofer Schramm, David M. Sella, and Alexandra H. Fairchild
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Percutaneous ,business.industry ,Decompression ,General surgery ,Jaundice ,Appropriate Use Criteria ,Appropriateness criteria ,medicine ,Etiology ,Radiology, Nuclear Medicine and imaging ,medicine.symptom ,business ,Grading (tumors) ,Medical literature - Abstract
Biliary obstruction is a serious condition that can occur in the setting of both benign and malignant pathologies. In the setting of acute cholangitis, biliary decompression can be lifesaving; for patients with cancer who are receiving chemotherapy, untreated obstructive jaundice may lead to biochemical derangements that often preclude continuation of therapy unless biliary decompression is performed (see the ACR Appropriateness Criteria® topic on "Jaundice"). Recommended therapy including percutaneous decompression, endoscopic decompression, and/or surgical decompression is based on the etiology of the obstruction and patient factors including the individual's anatomy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
- Published
- 2019
39. Occult Left Common Iliac Vein Compression Increases Postoperative Venous Thromboembolism Risk Following Total Hip Arthroplasty
- Author
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Kevin C. Wall, Charles Y. Kim, Michael A. Bergen, and Grant E. Garrigues
- Subjects
medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Deep vein ,Population ,Right Common Iliac Artery ,Iliac Vein ,Iliac Artery ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Odds Ratio ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Postoperative Period ,cardiovascular diseases ,Arthroplasty, Replacement, Knee ,education ,Venous Thrombosis ,030222 orthopedics ,education.field_of_study ,business.industry ,Venous Thromboembolism ,equipment and supplies ,Left Common Iliac Artery ,medicine.disease ,May–Thurner syndrome ,Magnetic Resonance Imaging ,Thrombosis ,Arthroplasty ,Surgery ,Pulmonary embolism ,medicine.anatomical_structure ,Case-Control Studies ,Pulmonary Embolism ,Tomography, X-Ray Computed ,business - Abstract
BACKGROUND Left common iliac vein (LCIV) compression by the right or left common iliac artery (RCIA, LCIA) is known to cause venous thromboembolism (VTE), but the extent to which occult LCIV compression synergizes with lower extremity orthopedic surgery is unknown. We hypothesize that occult LCIV compression is associated with increased VTE risk following total hip or knee arthroplasty (THA, TKA). METHODS This case-control study involves all patients at our institution who underwent primary or revision THA or TKA from 2009 to 2017 who had computed tomography or magnetic resonance imaging of the abdomen or pelvis available preoperatively. VTE cases (pulmonary embolism or left-sided deep vein thrombosis) within 30 days of surgery were matched to a control by age, gender, body mass index, Charlson Comorbidity Index, surgical site, and hypercoagulable risk factors. LCIV compression by the right common iliac artery and/or the left common iliac artery was measured in a blinded fashion and was considered present at 50% diameter reduction. RESULTS One hundred twelve patients (22 cases, 90 controls) were included for analysis. Nineteen (86.4%) cases and 46 (51.1%) controls demonstrated LCIV compression. The overall sample odds ratio of postoperative VTE in the presence of LCIV compression was 5.97 (95% confidence interval 1.59-33.67, P = .003). In patients who underwent THA (n = 75), LCIV compression was highly predictive of VTE (odds ratio ∞, 95% confidence interval 2.83-∞, P < .001). Compression in the TKA patients did not significantly predict VTE. CONCLUSION Compression of the LCIV significantly increases odds of developing postoperative VTE following THA. This effect may suggest a new method of stratifying VTE risk in the orthopedic population to reduce VTE-associated morbidity and mortality.
- Published
- 2019
40. Proton Pump Inhibitor Use Is Associated with an Increased Frequency of New or Worsening Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation
- Author
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Paul V. Suhocki, Meghana Konanur, Tzu-Hao Lee, James Ronald, Tony P. Smith, Waleska M. Pabon-Ramos, Charles Y. Kim, D. Lewis, Cole Ziegler, Melissa D. Hall, and Steven S Choi
- Subjects
Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Time Factors ,medicine.drug_class ,medicine.medical_treatment ,Proton-pump inhibitor ,Rate ratio ,Risk Assessment ,Gastroenterology ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Young adult ,Hepatic encephalopathy ,Omeprazole ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Proton Pump Inhibitors ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Treatment Outcome ,Hepatic Encephalopathy ,030220 oncology & carcinogenesis ,Female ,Portasystemic Shunt, Transjugular Intrahepatic ,Cardiology and Cardiovascular Medicine ,business ,Transjugular intrahepatic portosystemic shunt ,medicine.drug - Abstract
PURPOSE To determine whether proton pump inhibitor (PPI) use increases the rate of new or worsening hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS In this retrospective study, 284 of 365 patients who underwent TIPS creation from January 1, 2005, to December 31, 2016, were analyzed (186 male, mean age 56 y, range 19-84 y). Dates of PPI use and dates of new or worsening HE, defined as hospitalization or escalation in outpatient medical management, were extracted from medical records. Mixed-effects negative binomial regression was used to test for an association between PPI usage and HE. RESULTS After TIPS creation, among 168 patients on PPIs chronically, there were 235 episodes of new or worsening HE in 106,101 person-days (0.81/person-year). Among 55 patients never on PPIs, there were 37 episodes in 31,066 person-days (0.43/person-year). Among 61 patients intermittently taking PPIs, there were 78 episodes in 37,710 person-days while on PPIs (0.75/person-year) and 25 episodes in 35,678 person-days while off PPIs (0.26/person-year). In univariate regression, PPI usage was associated with a 3.34-fold increased rate of new or worsening HE (incidence rate ratio [IRR] 3.34; P < .001). In multivariate regression, older age (IRR 1.05; P < .001), male sex (IRR 1.58; P = .023), higher Model for End-Stage Liver Disease score (IRR 1.06; P = .015), previous HE or HE-preventive medication use (IRR 1.51; P = .029), and PPI use (IRR 3.19; P < .001) were significant risk factors. Higher PPI doses were associated with higher rates of HE (IRR 1.16 per 10 mg omeprazole equivalent; P = .046). CONCLUSIONS PPI usage is associated with increased rates of new or worsening HE after TIPS creation.
- Published
- 2019
41. No Increased Mortality After TIPS Compared with Serial Large Volume Paracenteses in Patients with Higher Model for End-Stage Liver Disease Score and Refractory Ascites
- Author
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Tony P. Smith, Charles Y. Kim, Matthew R. Kappus, Steven S Choi, Paul V. Suhocki, Jonathan G. Martin, James Ronald, Alan A. Sag, Rajiv Rao, and Waleska M. Pabon-Ramos
- Subjects
Adult ,Male ,endocrine system ,medicine.medical_specialty ,medicine.medical_treatment ,Gastroenterology ,030218 nuclear medicine & medical imaging ,End Stage Liver Disease ,Young Adult ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Model for End-Stage Liver Disease ,Internal medicine ,Ascites ,medicine ,Humans ,Paracentesis ,Radiology, Nuclear Medicine and imaging ,Hepatic encephalopathy ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Proportional hazards model ,Hazard ratio ,Middle Aged ,medicine.disease ,Survival Analysis ,body regions ,Female ,Portasystemic Shunt, Transjugular Intrahepatic ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Varices ,Transjugular intrahepatic portosystemic shunt - Abstract
To compare survival after transjugular intrahepatic portosystemic shunt (TIPS) creation versus serial large volume paracenteses (LVP) in patients with refractory ascites and higher Model for End-Stage Liver Disease (MELD) scores.In this retrospective study, from 1/1/2013 to 10/1/2018, 478 patients (294 male; mean age 58, range 23-89) underwent serial LVP (n = 386) or TIPS (n = 92) for ascites. Propensity-matched cohorts were constructed based on age, MELD, Charlson comorbidity index, varices, and hepatic encephalopathy. Survival was analyzed using a Cox proportional hazards model in which MELD score and TIPS were treated as time-dependent covariates. An interaction term was used to assess the impact of TIPS versus serial LVP on survival as a function of increasing MELD.In the overall patient sample, higher MELD score predicted worse survival after either serial LVP or TIPS [hazard ratio (HR) = 1.13; p 0.001], but there was no significant interaction between TIPS and higher MELD score conferring worse survival (HR = 1.01; p = 0.55). In 92 propensity-matched serial LVP and 92 TIPS patients, higher MELD score predicted worse survival after either serial LVP or TIPS (HR = 1.19; p 0.001), but there was no significant survival interaction between TIPS and higher MELD (HR = 0.97; p = 0.22). In 30 propensity-matched serial LVP patients and 30 TIPS patients with baseline MELD greater than 18, TIPS did not predict worse survival (HR = 0.97; p = 0.94).Higher MELD predicts poorer survival after either serial LVP or TIPS, but TIPS creation is not associated with worse survival compared to serial LVP in patients with higher MELD scores LEVEL OF EVIDENCE: Level 4, case series.
- Published
- 2019
42. Preemptive VAE—An Important Tool for Managing Blood Loss in MVT Candidates With PMT
- Author
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Aparna Rege, Samuel J. Kesseli, Debra L. Sudan, Tony P. Smith, Deeplaxmi Borle, Deepak Vikraman, Paul V. Suhocki, Charles Y. Kim, Andrew S. Barbas, and Ravindra Kadiyala
- Subjects
Transplantation ,medicine.medical_specialty ,Intestinal Transplantation ,RD1-811 ,business.industry ,medicine.medical_treatment ,030230 surgery ,medicine.disease ,Thrombosis ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Blood product ,Cryoprecipitate ,medicine ,030211 gastroenterology & hepatology ,Hepatic artery embolization ,Fresh frozen plasma ,Embolization ,business ,Packed red blood cells ,Autotransfusion - Abstract
Background. Explantation of native viscera in multivisceral transplant candidates, particularly in those with extensive portomesenteric thrombosis (PMT), carries considerable morbidity due to extensive vascularized adhesions. Preemptive visceral angioembolization has been previously described as a technique to minimize excessive blood loss during mobilization of the native viscera but is not well described specifically in patients with extensive PMT. Methods. In a series of 5 patients who underwent mutivisceral transplant for PMT from June 2015 to November 2018, we performed preoperative superior mesenteric, splenic, and hepatic artery embolization to reduce blood loss during explanation and evaluated the blood loss and blood product utilization, as well as 30-day rates of infectious complications. Results. Following preemptive embolization, median total blood loss was 6000 mL (range 800–7000 mL). The median transfusion requirements were as follows: 16 units packed red blood cells (range 2–47), 14 units fresh frozen plasma (range 0–29), 2 units cryoprecipitate (range 1–14), 4 units platelets (range 2–10), and 500 mL cell saver autotransfusion (range 0–1817). In the first 30 postoperative days, 2 out of 5 patients developed positive blood cultures and 3 out of 5 developed complex intra-abdominal infections. Two patients developed severe graft pancreatitis resulting in mycotic aneurysm of the aortic conduit; bleeding from the aneurysm led to 1 patient mortality. Conclusions. Preoperative embolization is an effective modality to mitigate exsanguinating blood loss during multivisceral transplant in patients with portomesenteric thrombosis; however, it is unclear if the resultant native organ ischemia during explant carries clinically relevant consequences.
- Published
- 2021
43. Blunt Transmediastinal Dissection with Radiofrequency Wire Reentry for Extravascular Bypass of Thoracic Central Venous Occlusions Refractory to Recanalization
- Author
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Rui Dai and Charles Y. Kim
- Subjects
Male ,medicine.medical_specialty ,Perforation (oil well) ,Dissection (medical) ,Constriction, Pathologic ,030218 nuclear medicine & medical imaging ,Constriction ,Veins ,03 medical and health sciences ,0302 clinical medicine ,Blunt ,Refractory ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Major complication ,Vascular Diseases ,Aged ,Retrospective Studies ,business.industry ,Dissection ,Endovascular Procedures ,Reentry ,Equipment Design ,Middle Aged ,Thorax ,medicine.disease ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,Chronic Disease ,Right atrium ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Vascular Access Devices - Abstract
Extravascular perforation is a risk of recanalizing chronic central venous occlusions. The authors describe an endovascular technique to bypass venous occlusions using a combination of a hydrophilic guide wire and radiofrequency wire in 7 patients to achieve central venous access to the right atrium without major complications.
- Published
- 2020
44. Socioeconomic Status Is Associated with the Risk of Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation
- Author
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Charles Y. Kim, Andrew J. Muir, Rui Dai, James H. Helzberg, Tzu-Hao Lee, Jonathan G. Martin, James Ronald, and Julius M. Wilder
- Subjects
Male ,medicine.medical_treatment ,Rate ratio ,Severity of Illness Index ,030218 nuclear medicine & medical imaging ,End Stage Liver Disease ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Socioeconomic status ,Hepatic encephalopathy ,Survival analysis ,Aged ,Retrospective Studies ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Confidence interval ,United States ,Quartile ,Social Class ,030220 oncology & carcinogenesis ,Hepatic Encephalopathy ,Portasystemic Shunt, Transjugular Intrahepatic ,Cardiology and Cardiovascular Medicine ,business ,Transjugular intrahepatic portosystemic shunt ,Demography - Abstract
PURPOSE To determine whether socioeconomic status (SES) is associated with hepatic encephalopathy (HE) risk after transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS This single-institution retrospective study included 368 patients (mean age = 56.7 years; n = 229 males) from 5 states who underwent TIPS creation. SES was estimated using the Agency for Healthcare Research and Quality SES index, a metric based on neighborhood housing, education, and income statistics. Episodes of new or worsening HE after TIPS creation, defined as hospitalization for HE or escalation in outpatient medical therapy, were identified from medical records. Multivariable ordinal regression, negative binomial regression, and competing risks survival analysis were used to identify factors associated with SES quartile, the number of episodes of new or worsening HE per unit time after TIPS creation, and mortality after TIPS creation, respectively. RESULTS There were 83, 113, 99, and 73 patients in the lowest, second, third, and highest SES quartiles, respectively. In multivariable regression, only older age (β = 0.04, confidence interval [CI] = 0.02-0.05; P < .001) and white, non-Hispanic ethnicity (β = 0.64, CI = 0.07-1.21; P = .03) were associated with higher SES quartile. In multivariable regression, lower SES quartile (incidence rate ratio [IRR] = 0.80, CI = 0.68-0.94; P = .004), along with older age, male sex, higher model for end-stage liver disease score, nonalcoholic steatohepatitis, and proton pump inhibitor use were associated with higher rates of HE after TIPS creation. Ethnicity was not associated with the rate of HE after TIPS creation (IRR = 0.77, CI = 0.46-1.29; P = .28). In multivariable survival analysis, neither SES quartile nor ethnicity predicted mortality after creation of a TIPS. CONCLUSION Lower SES is associated with higher rates of new or worsening HE after TIPS creation.
- Published
- 2020
45. Percutaneous gastrojejunostomy tubes: Identification of predictors of retrograde jejunal limb migration into the stomach
- Author
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Andre M. Agassi, Waleska M. Pabon-Ramos, Tony P. Smith, Charles Y. Kim, Paul V. Suhocki, Alan A. Sag, Jonathan G. Martin, Christopher J.R. Gallo, James Ronald, and David Y. Johnson
- Subjects
Male ,medicine.medical_specialty ,Gastric Bypass ,Lower risk ,Percutaneous gastrojejunostomy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Enteral Nutrition ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Gastric antrum ,Antrum ,Intubation, Gastrointestinal ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Stomach ,Infant ,Interventional radiology ,Pylorus ,Surgery ,medicine.anatomical_structure ,Fundus (uterus) ,030220 oncology & carcinogenesis ,business - Abstract
To identify whether technically modifiable factors during gastrojejunostomy (GJ) tube insertion are predictive of retrograde jejunal limb migration into the stomach.Retrospective review of our procedural database over a 5-year period revealed 988 successful primary GJ tube insertions. Medical records and imaging were reviewed for cases of retrograde jejunal limb migration. Primary analysis was performed on 74 patients with retrograde tip migration within 3 months after placement (37 males, mean age = 57). Comparison was performed on 67 control patients (34 males, mean age = 51) who had radiologically confirmed GJ tube stability for at least 6 months. Procedural fluoroscopic images were analyzed for multiple GJ tube configuration parameters. The stomach was designated into antrum, body, and fundus. Predictors of retrograde tip migration were analyzed with univariate and multivariate logistic regression analysis.A total of 110 patients (11.1%) had retrograde jejunal limb migration, with 74 (7.5%) occurring within 3 months of placement. On multivariate analysis, the factors associated with a significantly lower risk of tip malposition included gastric puncture site in the antrum (OR: 0.27, 95% CI: 0.13-0.56, p 0.001) and GJ tract angle less than 30 degrees away from the pylorus (OR: 0.35, 95% CI: 0.16-0.76, p = 0.008). No patient in either cohort had a major complication within 30 days of procedure.To minimize the risk of retrograde tip migration, GJ tubes should be inserted into the gastric antrum with an entry tract oriented as directly towards the pylorus as possible.
- Published
- 2020
46. Sharp Recanalization of Chronic Central Venous Occlusions of the Thorax Using a Steerable Coaxial Needle Technique from a Supraclavicular Approach
- Author
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Christopher J R, Gallo, James, Ronald, Waleska M, Pabon-Ramos, Paul V, Suhocki, Alan A, Sag, Jonathan G, Martin, Tony P, Smith, and Charles Y, Kim
- Subjects
Adult ,Male ,Catheterization, Central Venous ,Angioplasty ,Middle Aged ,Thorax ,Treatment Outcome ,Chronic Disease ,Humans ,Female ,Stents ,Vascular Diseases ,Aged ,Retrospective Studies - Abstract
To evaluate the technical success and safety of a steerable coaxial sharp recanalization technique that utilizes routine needles in patients with refractory thoracic central venous occlusions.This retrospective study was performed on 36-attempted sharp recanalizations in 35 patients (mean age 50 years, 23 male) performed via a supraclavicular approach. In all cases, an 18-gauge trocar needle was custom curved to provide directional control during fluoroscopic triangulation. A 22-gauge Chiba needle was then advanced coaxially across the occlusion. A tractogram was performed to assess for traversal of unintended structures. Procedures were completed by catheter placement, angioplasty, or stenting follow successful recanalizations.Sharp recanalization using this steerable coaxial needle technique demonstrated a technical success rate of 94% (34/36). The mean occlusion length was 30 mm (range 3-53 mm). In 11 patients, success was achieved using this technique after failure of other advanced techniques. In five procedures, stent interstices were traversed. Sharp recanalization was the direct cause of one major complication consisting of pleural transgression causing mild hemothorax treated successfully with a stent graft.The proposed technique is effective and safe for patients who have failed traditional blunt recanalization techniques.Level 4, Case Series.
- Published
- 2020
47. Percutaneous Gastrojejunostomy Tube Insertion in Patients with Surgical Gastrojejunal Anastomoses: Analysis of Success Rates and Durability
- Author
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Tony P. Smith, James Ronald, David Y. Johnson, Andre M. Agassi, Dan G. Blazer, Jonathan G. Martin, Christopher J.R. Gallo, Paul V. Suhocki, Charles Y. Kim, Alan A. Sag, and Waleska M. Pabon-Ramos
- Subjects
Male ,medicine.medical_specialty ,Gastroparesis ,Time Factors ,Technical success ,Gastric Bypass ,Punctures ,Anastomosis ,Radiography, Interventional ,Percutaneous gastrojejunostomy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Enteral Nutrition ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Aged ,Aged, 80 and over ,business.industry ,Stomach ,Anastomosis, Surgical ,Mean age ,Middle Aged ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Gastric Emptying ,030220 oncology & carcinogenesis ,Tube placement ,Female ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
Patients with a gastrojejunal anastomosis pose challenging anatomy for percutaneous gastrojejunostomy (GJ)-tube placement. A retrospective review of 24 patients (mean age 67.8 years, 13 males) with GJ anastomoses who underwent attempted GJ tube placement revealed infeasible placement in 6 patients (25%) due to an inadequate window for puncture. When a gastric puncture was achieved, GJ tube insertion was technically successful in 83% (15/18) of attempts, resulting in an overall technical success rate of 63% (15/24). The most common tube-related complication was the migration of the jejunal limb into the stomach, which occurred in 40% (6/15) of successful cases. No major procedure related complications were encountered.
- Published
- 2020
48. Ferumoxytol-enhanced MR Venography of the Central Veins of the Thorax for the Evaluation of Stenosis and Occlusion in Patients with Renal Impairment
- Author
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James Ronald, David Y. Johnson, Mustafa R. Bashir, Charles Y. Kim, Joseph G. Mammarappallil, Hamid Chalian, and Christopher J.R. Gallo
- Subjects
Thorax ,medicine.medical_specialty ,business.industry ,medicine.disease ,Ferumoxytol ,Stenosis ,medicine.anatomical_structure ,Occlusion ,Commentary ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Central veins ,Mr venography ,Radiology ,business ,Vein ,Original Research - Abstract
PURPOSE: To assess the diagnostic performance of ferumoxytol-enhanced MR venography for the detection of thoracic central vein stenosis or occlusion with conventional venography as the reference standard. MATERIALS AND METHODS: In this retrospective study, consecutive patients from May 2012 to December 2018 underwent dedicated ferumoxytol-enhanced MR venography of the thoracic central veins and conventional venography within 6 months for detecting central venous stenosis. The central veins were divided into seven segments for evaluation. MR venography images were evaluated by three radiologists for presence of stenosis or occlusion. Interobserver agreement was assessed using Fleiss κ. RESULTS: A total of 35 patients were included (mean age, 49 years; age range, 12–75 years; 18 females). Of the 122 total venous segments with corresponding conventional venography, 73 were stenotic or occluded. The sensitivity and specificity for detection of stenosis or occlusion was 99% and 98%, respectively. The sensitivity and specificity for detecting occlusion alone was 96% and 98%, respectively. MR venography readers demonstrated moderate agreement in their ability to grade stenosis or occlusion (κ = 0.59). There were no adverse events related to contrast agent administration. CONCLUSION: Ferumoxytol-enhanced MR venography demonstrated excellent sensitivity and specificity for detection of thoracic central vein stenosis or occlusion. © RSNA, 2020 See also the commentary by Finn in this issue.
- Published
- 2020
49. Arteriovenous Graft Delamination and Dissection as a Cause of Graft Dysfunction
- Author
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Scott R. Broadwell, Mark L. Lessne, Charles Y. Kim, and Rui Dai
- Subjects
medicine.medical_specialty ,Graft dysfunction ,business.industry ,Delamination ,medicine ,Radiology, Nuclear Medicine and imaging ,Dissection (medical) ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Article ,Surgery - Published
- 2020
50. Implementation of a Hepatic Artery Infusion Program: Initial Patient Selection and Perioperative Outcomes of Concurrent Hepatic Artery Infusion and Systemic Chemotherapy for Colorectal Liver Metastases
- Author
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John M, Creasy, Kyle J, Napier, Sarah A, Reed, Sabino, Zani, Terence Z, Wong, Charles Y, Kim, Benjamin, Wildman-Tobriner, John H, Strickler, S David, Hsu, Hope E, Uronis, Peter J, Allen, and Michael E, Lidsky
- Subjects
Hepatic Artery ,Treatment Outcome ,Patient Selection ,Antineoplastic Combined Chemotherapy Protocols ,Liver Neoplasms ,Humans ,Infusions, Intra-Arterial ,Fluorouracil ,Colorectal Neoplasms - Abstract
Hepatic artery infusion (HAI) combined with systemic chemotherapy is a treatment strategy for patients with unresectable liver-only or liver-dominant colorectal liver metastases (CRLM). Although HAI has previously been performed in only a few centers, this study aimed to describe patient selection and initial perioperative outcomes during implementation of a new HAI program.The study enrolled patients with CRLM selected for HAI after multi-disciplinary review November 2018-January 2020. Demographics, prior treatment, and perioperative outcomes were assessed. Objective hepatic response was calculated according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1.During a 14-month period, 21 patients with CRLM underwent HAI pump placement. Of these 21 patients, 20 (95%) had unresectable disease. Most of the patients had synchronous disease (n = 18, 86%) and had received prior chemotherapy (n = 20, 95%) with extended treatment cycles (median 16; interquartile range, 8-22; range, 0-66). The median number of CRLMs was 7 (range, 2-40). Operations often were performed with combined hepatectomy (n = 4, 19%) and/or colectomy/proctectomy (n = 11, 52%). The study had no 90-day mortality. The overall surgical morbidity was 19%. The HAI-specific complications included pump pocket seroma (n = 2), hematoma (n = 1), surgical-site infection (n = 1), and extrahepatic perfusion (n = 1). HAI was initiated in 20 patients (95%). The hepatic response rates at 3 months included partial response (n = 4, 24%), stable disease (n = 9, 53%), and progression of disease (n = 4, 24%), yielding a 3-month hepatic disease control rate (DCR) of 76%.Implementation of a new HAI program is feasible, and HAI can be delivered safely to selected patients with CRLM. The initial response and DCR are promising, even for patients heavily pretreated with chemotherapy.
- Published
- 2020
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