39 results on '"Dong Jae Shim"'
Search Results
2. Chemoembolization combined radiofrequency ablation vs. chemoembolization alone for treatment of beyond the Milan criteria viable hepatocellular carcinoma (CERFA): study protocol for a randomized controlled trial
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Soon Kyu Lee, Hyun Yang, Jung Hyun Kwon, Dong Jae Shim, Doyoung Kim, Soon Woo Nam, Sun Hong Yoo, Si Hyun Bae, Ahlim Lee, Young Joon Lee, Changho Jeon, Jeong Won Jang, Pil Soo Sung, Ho Jong Chun, Su Ho Kim, Joon-Il Choi, Jung Suk Oh, and Yun-Jung Yang
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Hepatocellular carcinoma ,Radiofrequency ablation ,Transcatheter arterial chemoembolization ,Randomized controlled trial ,Medicine (General) ,R5-920 - Abstract
Abstract Background Many previous studies evaluated a combination of transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) for treating early hepatocellular carcinoma (HCC); however, studies evaluating combination therapy for beyond-the-Milan criteria HCC are scarce. Methods A total of 120 patients with beyond-the-Milan criteria HCC who have viable tumour after first TACE will be enrolled in this multi-institutional, parallel, pragmatic, randomized controlled trial. Patients with metastasis, vascular invasion, or a sum of tumour diameter > 8 cm will be excluded. Eligible patients will be randomly assigned to combination TACE and RFA therapy or TACE monotherapy groups. Patients in the combination therapy group will receive a second TACE and subsequent RFA at the viable tumour. Patients in the TACE monotherapy group will receive only second TACE. Patients in both groups will undergo magnetic resonance imaging 4–6 weeks after second TACE. The primary endpoint is 1-month tumour response, and secondary endpoints are progression-free survival, overall response rate, number of treatments until CR, overall survival, and change in liver function. Discussion Although TACE can be used to treat intermediate-stage HCC, it is difficult to achieve CR by first TACE in most intermediate-stage patients. Recent studies show a survival advantage of combination therapy over monotherapy. However, most studies evaluating combination therapy included patients with a single tumour sized
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- 2023
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3. Placement of a Subclavian Tunneled Hemodialysis Catheter with the Patient’s Arm Raised May Reduce the Risk of Complications: Two Cases Report
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Jimin Yoo, Dong Jae Shim, Doyoung Kim, Seung Hwan Baek, Chang Suk Park, and Jeong Whee Lee
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renal dialysis ,catheters ,subclavian vein ,hemothorax ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
The subclavian vein is an uncommon route for tunneled hemodialysis catheter (tHDC) placement because of its potency for future dialysis access. However, when favored access routes have been exhausted because of repeated catheterization or limited life expectancy, the subclavian vein can be used for urgent hemodialysis. A subclavian catheterization has a technical problem. The subclavian vein often forms a right angle with the vena cava, and advancing stiff peel-away sheath can cause a vascular injury. However, raising the patient’s arm can alter the position of the guidewire and, therefore, change the angle of the vein favorable for tHDC placement. Herein, we report two patients who underwent subclavian catheterization; one experienced an injury to the superior vena cava after undergoing the conventional procedure, whereas the other patient with raised arm during the catheterization procedure had safe catheter placement.
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- 2023
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4. Subcutaneous tunnelling versus conventional insertion of peripherally inserted central catheters in hospitalized patients (TUNNEL-PICC): a study protocol for a randomized controlled trial
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Yohan Kwon, Eung Tae Kim, Soo Buem Cho, Jae Hwan Lee, and Dong Jae Shim
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Peripherally inserted central venous catheter ,Central venous catheterization ,Central line-associated bloodstream infections ,Catheter-related bloodstream infections ,Medicine (General) ,R5-920 - Abstract
Abstract Background Peripherally inserted central catheters (PICCs) are now widely used in modern medicine, and associated complications have also increased. Central line-associated bloodstream infection (CLABSI) is the most serious complication because it can cause extended hospital stays and increase costs. Furthermore, it can contribute to dire consequences for critically ill patients. Subcutaneous tunnelling for central venous catheters is an accepted method to reduce the risk of CLABSI. However, it is not generally adopted for PICC placement in most hospitals because its safety and efficacy have not been thoroughly evaluated. Methods In this multi-institutional, prospective, non-blinded pragmatic randomized controlled trial, 1694 patients treated at five referral hospitals will be assigned to one of two parallel arms (conventional and tunnelled PICC groups) using computer-generated stratified randomization. The conventional group will undergo PICC placement by routine practice. In the tunnelled PICC (tPICC) group, additional subcutaneous tunnelling will be applied. Patients will be followed until PICC removal or the end of this study. The primary endpoint is whether subcutaneous tunnelling reduced the rate of CLABSI compared to the conventional method. The secondary endpoints are technical success rates, complications including exit-site bleeding or infection, and the procedure time between the groups. Discussion Subcutaneous tunnelling is a widely used method to reduce catheter-associated infection. However, it has not been thoroughly applied for PICC. A randomized trial is needed to objectively assess the effects of the subcutaneous tunnel in PICC placement. This TUNNEL-PICC trial will provide evidence for the effectiveness of subcutaneous tunnelling in decreasing the risk of CLABSI. Trial registration Clinical Research Information Service (CRiS) KCT0005521
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- 2022
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5. Endovascular Treatment of a Systemic-to-Pulmonary Artery Fistula: A Case Report
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Eunbyul Lee, Dong Jae Shim, Doyoung Kim, and Jung Whee Lee
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vascular fistula ,therapeutic embolization ,arterio-arterial fistula ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Systemic-to-pulmonary artery fistulas are rare. This condition may be congenital, post-traumatic, or post-inflammatory and can cause infection, hemorrhage, or pulmonary hypertension. Here, we report a case of an intercostal-to-pulmonary artery fistula, incidentally detected during the evaluation of dyspnea in a 67-year-old female. Retrograde transcatheter coil embolization in a dilated draining pulmonary artery was initially attempted. However, another draining pulmonary artery developed after 5 months. The intercostal arteries or systemic feeders were successfully embolized through a transarterial access. At the 10-month follow-up, the abnormally dilated vessels had regressed, and dyspnea had improved. Sequential or simultaneous retro- and antegrade transcatheter embolization may successfully treat pleural arterio-arterial fistulas.
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- 2021
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6. Transjugular insertion of biliary stent in patients with malignant biliary obstruction complicated by ascites with/without coagulopathy: a prospective study of 12 patients
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Dong Jae Shim, Dong Il Gwon, Gi-Young Ko, Hyun-Ki Yoon, and Kyu-Bo Sung
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
PURPOSEIn patients with malignant biliary obstruction complicated by massive ascites, when endoscopy fails, safe routes for biliary decompression are needed as an alternative to percutaneous approach. We aimed to evaluate the safety and effectiveness of transjugular insertion of biliary stent (TIBS) in patients with malignant biliary obstruction complicated by massive ascites with or without coagulopathy.METHODSFrom March 2012 to December 2017, a total of 12 consecutive patients with malignant biliary obstructions treated with TIBS were enrolled in this study. Five patients had jaundice and cholangitis, while seven had jaundice only. Clinical parameters including technical and clinical success rates and complications following TIBS were evaluated. Overall survival and stent occlusion-free survival were assessed using Kaplan-Meier analysis.RESULTSThe indications for transjugular approach were massive ascites with (n=2) or without (n=10) coagulopathy. TIBS was technically successful in 11 of 12 patients. Clinical success was defined as successful internal drainage and was achieved in eight patients. The mean serum bilirubin level was initially 13.9±6.3 mg/dL and decreased to 4.9±5.3 mg/dL within 1 month after stent placement (P = 0.037). Two patients had procedure-related complications (hemobilia). During the follow-up period (mean, 30 days; range, 1–146 days), all 12 patients died of disease progression. The median overall survival and stent occlusion-free survival times were 19 days (95% confidence interval [CI], 16–22 days) and 19 days (95% CI, 12–26 days), respectively. There was no stent dysfunction in the eight patients that had successful internal drainage.CONCLUSIONTIBS appears to be safe, technically feasible, and clinically effective for patients with malignant biliary obstruction complicated by massive ascites with or without coagulopathy.
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- 2019
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7. Critical Role of Clinical Suspicion in the Diagnosis of Arterio-Ureteral Fistula
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Doyoung Kim and Dong Jae Shim
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Published
- 2021
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8. Angiography-guided percutaneous thrombin injection for haemostasis of active bleeding complicated by femoral access: a case report
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Jinho Jeong, Dong Jae Shim, Kwan Yong Lee, Sun Ki Kim, and Jeong Whee Lee
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Medicine (General) ,R5-920 - Abstract
Active bleeding from a small branch of the femoral artery can occur after catheterisation and may be difficult to treat. Stent-graft placement or embolisation after catheterisation can be a useful solution. However, stent-graft placement is often challenging for the treatment of bleeding around bifurcations, and it may be limited by available stent-graft sizes during emergencies. Embolisation can also be difficult if the vessel diameter is too small to catheterise or if the branching angle is too acute. Thrombin injection is accepted as a safe and effective treatment for iatrogenic or traumatic pseudoaneurysm. However, large haematomas can deter ultrasonographic guidance. We herein report the successful treatment of active bleeding from a small branch of the superficial femoral artery after femoral access by percutaneous direct puncture under angiographic guidance and thrombin injection at the bleeding focus.
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- 2020
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9. Transarterial Infusion of Epirubicin and Cisplatin Combined With Systemic Infusion of 5-Flurouracil Versus Sorafenib for Hepatocellular Carcinoma With Refractoriness of Transarterial Chemoembolization Using Doxorubicin
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Sun Hong Yoo MD, PhD, Jung Hyun Kwon MD, PhD, Soon Woo Nam MD, PhD, Jong Yul Lee MD, Young Woon Kim MD, Dong Jae Shim MD, Sung Won Lee MD, and Jeong Won Jang MD, PhD
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Transarterial chemoembolization using doxorubicin (TACE-DOX) is an effective therapy for advanced hepatocellular carcinoma (HCC). However, there are limited options for patients with TACE refractoriness. We compared the effectiveness between sorafenib and transarterial chemolipiodolization using epirubicin and cisplatin combined with systemic infusion of 5-fluorouracil (5-FU; TACL-ECF) in patients with previous TACE-DOX refractoriness. We retrospectively analyzed 742 consecutively enrolled cohort patients who received TACE-DOX as the first-line therapy for HCC. Among the 94 patients who failed with TACE-DOX, 49 patients were treated with TACL-ECF and 45 patients were treated with sorafenib as a rescue therapy. The TACL-ECF regimen comprised transarterial infusion of epirubicin and cisplatin combined with systemic infusion of 5-FU. Of the 94 patients, 22 and 72 patients were in Barcelona Clinic Liver Cancer stages B and C, respectively; 66% patients were classified as having Child-Pugh class A (CPC A). Overall survival (OS) after rescue therapy did not differ between the sorafenib and TACL-ECF groups (4.1 months vs 6.4 months, P = .355). Progression-free survival (PFS) did not differ between the sorafenib and TACL-ECF groups (2.8 months vs 3.5 months, P = .629). Adverse events of CTC grade 3/4 occurred more frequently in the sorafenib group than in the TACL-ECF group ( P = .024). The present study showed that the OS and PFS did not differ between patients given rescue TACL-ECF therapy and those given sorafenib therapy. The TACL-ECF treatment was better tolerated than sorafenib. The TACL-ECF might be considered as an alternative therapy for the patients with TACE-DOX refractoriness, especially CPC B and sorafenib-intolerant patients.
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- 2020
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10. Prevalence and predictors of peripherally inserted central catheter-associated bloodstream infections in adults: A multicenter cohort study.
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Jae Hwan Lee, Eung Tae Kim, Dong Jae Shim, Il Jung Kim, Jong Hyun Byeon, In Joon Lee, Hyun Beom Kim, Young Ju Choi, and Jin Hong Lee
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Medicine ,Science - Abstract
ObjectiveTo evaluate the prevalence and predictors of peripherally inserted central catheter-associated bloodstream infection (PBSI) and PBSI-related death in hospitalized adult patients.Materials and methodsA retrospective multicenter cohort of consecutive patients who underwent PICC placement from October 2016 to September 2017 at four institutes was assembled. Using multivariable logistic and Cox-proportional hazards regression models, all risk factors were analyzed for their association with PBSI. Multivariable logistic models were used to evaluate predictors of PBSI-related death.ResultsDuring the study period, a total of 929 PICCs were inserted in 746 patients for a total of 17,913 catheter days. PBSI occurred in 58 patients (6.2%), with an infection rate of 3.23 per 1,000 catheter days. Number of catheter lumens [double lumen, odds ratio (OR) 5.295; 95% confidence interval (CI), 2.220-12.627; hazard ration (HR) 3.569; 95% CI, 1.461-8.717], PICC for chemotherapy (OR 4.94; 95% CI, 1.686-14.458; HR 7.635; 95% CI, 2.775-21.007), and hospital length of stay (OR 2.23; 95% CI, 1.234-4.049; HR 1.249; 95% CI, 0.659-2.368) were associated with PBSI. Risk factors, such as receiving chemotherapy (OR 54.911; 95% CI, 2.755-1094.326), presence of diabetes (OR 11.712; 95% CI, 1.513-90.665), and advanced age (OR 1.116; 95% CI 1.007-1.238), were correlated with PBSI-related death.ConclusionOur results indicated that risk factors associated with PBSI included the number of catheter lumens, the use of PICCs for chemotherapy, and the hospital length of stay. Furthermore, PBSI-related death was common in patients undergoing chemotherapy, diabetics, and elderly patients.
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- 2019
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11. Retrograde Distal Thoracic Duct Leak Embolization via Access Through Lymphocele After Thyroidectomy and Neck Dissection.
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Lee, Edward Wolfgang, Dong Jae Shim, Doyoung Kim, and Seung Hwan Baek
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- 2024
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12. Effect of Stent Placement on Survival in Patients with Malignant Portal Vein Stenosis: A Propensity Score–Matched Study
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Dong Jae Shim, Jong Woo Kim, Doyoung Kim, Gi-Young Ko, Dong Il Gwon, Ji Hoon Shin, and Yun-Jung Yang
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Male ,Portal Vein ,Intervention ,Constriction, Pathologic ,equipment and supplies ,surgical procedures, operative ,Treatment Outcome ,Liver ,Neoplasm ,Humans ,Radiology, Nuclear Medicine and imaging ,Original Article ,Stents ,cardiovascular diseases ,Propensity Score ,Aged ,Retrospective Studies - Abstract
Objective Percutaneous portal vein (PV) stent placement can be an effective treatment for symptoms associated with portal hypertension. This study aimed to evaluate the effect of PV stenting on the overall survival (OS) in patients with malignant PV stenosis. Materials and Methods Two groups of patients with malignant PV stenosis were compared in this retrospective study involving two institutions. A total of 197 patients who underwent PV stenting between November 2016 and August 2019 were established as the stent group, whereas 29 patients with PV stenosis who were treated conservatively between July 2013 and October 2016 constituted the no-stent group. OS was compared between the two groups before and after propensity score matching (PSM). Risk factors associated with OS were evaluated using the Cox proportional hazards model. Procedure-associated adverse events were also evaluated. Results The stent group finally included 100 patients (median age, 65 [interquartile range, 58–71] years; 64 male). The no-stent group included 22 patients (69 [61–75] years, 13 male). Stent placement was successful in 95% of attempted cases, and the 1- and 2-year stent occlusion–free survival rate was 56% (95% confidence interval, 45%–69%) and 44% (32%–60%), respectively. The median stent occlusion–free survival time was 176 (interquartile range, 70–440) days. OS was significantly longer in the stent group than in the no-stent group (median 294 vs. 87 days, p < 0.001 before PSM, p = 0.011 after PSM). The 1- and 3-year OS rates before PSM were 40% and 11%, respectively, in the stent group. The 1-year OS rate after PSM was 32% and 5% in the stent and no-stent groups, respectively. Anemia requiring transfusion (n = 2) and acute thrombosis necessitating re-stenting (n = 1) occurred in three patients in the stent group within 1 week. Conclusion Percutaneous placement of a PV stent may be effective in improving OS in patients with malignant PV stenosis.
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- 2022
13. Percutaneous stone removal using a compliant balloon after papillary balloon dilatation
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Chanyeong Park, Ho Jong Chun, Il Jung Kim, Su Ho Kim, Dong Jae Shim, and Do Young Kim
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medicine.medical_specialty ,Percutaneous ,Common bile duct ,business.industry ,Hemobilia ,Balloon ,Dilatation ,Catheterization ,Surgery ,Balloon dilatation ,Kidney Calculi ,03 medical and health sciences ,Treatment Outcome ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Humans ,Medicine ,030211 gastroenterology & hepatology ,Percutaneous transhepatic biliary drainage ,Stone removal ,business ,Retrospective Studies - Abstract
To evaluate the safety and efficacy of percutaneous stone removal using a compliant balloon after papillary balloon dilatation.Between March 2014 and May 2020, 123 patients with choledocholithiasis, in whom endoscopy was unsuccessful, were enrolled in this study. The ampulla of Vater was dilated using a noncompliant balloon, and stone removal was attemptedBiliary stones were completely removed in 118 of 123 patients. Major complications occurred in five patients. One patient experienced duodenal bleeding, which was successfully treated by endoscopy. Hemobilia occurred in three patients, which required transfusion, and one patient experienced four days of abdominal pain. Minor complications, including self-limiting pain, effusion, minimal hemobilia, elevated amylase and fever, occurred in 21 patients. Stone size was the only significant risk factor associated with the rate of complications (Odds ratio: 1.14, 95% confidence interval = 1.04, 1.26). Bilirubin and white blood cell levels significantly decreased after the procedure.Percutaneous stone removal using a compliant balloon after papillary balloon dilatation is a safe and effective method in patients in whom endoscopic or surgical treatment is not feasible.
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- 2021
14. Percutaneous Fluoroscopy-Guided Extrahepatic Splenocaval Shunt Creation
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Jung Suk Oh, Dong Jae Shim, and Hae Giu Lee
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medicine.medical_specialty ,Percutaneous ,medicine.diagnostic_test ,business.industry ,Shunt (medical) ,Portal System ,Fluoroscopy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
15. In Situ Left Lateral Sectionectomy in Deceased Donor Liver Transplantation: Could This Be Another Solution for a Large-for-Size Graft? A Case Report
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Dong Jae Shim, Yumi Kim, Yong Kyong Kwon, Bong Jun Kwak, and Young Chul Yoon
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Adult ,Male ,medicine.medical_specialty ,Abdominal compartment syndrome ,medicine.medical_treatment ,Liver transplantation ,Inferior vena cava ,medicine ,Coagulopathy ,Hepatectomy ,Humans ,Transplantation ,Deceased donor ,business.industry ,Liver Failure, Acute ,Middle Aged ,medicine.disease ,Liver Transplantation ,Surgery ,medicine.anatomical_structure ,Blood pressure ,medicine.vein ,Tissue and Organ Harvesting ,Abdomen ,Female ,Liver function ,business - Abstract
Background Large-for-size (LFS) graft should be avoided when performing an adult deceased donor liver transplantation (DDLT) as it is associated with abdominal compartment syndrome, severe graft injury, and primary graft nonfunction. When inadvertently facing with LFS graft intraoperatively, the most commonly reported approach has been a surgical reduction of the right lobe despite its technical difficulty in addition to ongoing coagulopathy after graft reperfusion. We report a case where we performed a left lateral sectionectomy instead of a right lobe modification. Case Report A 44-year-old 58.4 kg female patient was admitted with drug-induced acute hepatic failure and underwent an emergency DDLT. The donor was a 51-year-old 60.0 kg man. At the time of procurement, the liver was noted to be hypertrophic. The estimated graft/recipient weight ratio was 3.49%. After completing the vascular and bile duct anastomosis, the abdomen could not be closed due to its large graft size. Because of the hypertrophic left lateral lobe and ongoing coagulopathy, we decided to perform an in situ left lateral sectionectomy rather than right posterior sectionectomy or right hemihepatectomy. The next day, the liver function failed to improve, and the patient’s blood pressure began to decline gradually. Computed tomography showed severe inferior vena cava (IVC) compression by the graft, and the patient underwent transjugular IVC stent placement. Soon after, the patient’s blood pressure improved and liver function gradually normalized. The patient was discharged uneventfully on postoperative day 45. Conclusion Under specific conditions, in situ left lateral sectionectomy is a solution for unexpected LFS graft during DDLT.
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- 2019
16. Prostatic Artery Embolization for Lower Urinary Tract Symptoms via Transradial Versus Transfemoral Artery Access: Single-Center Technical Outcomes
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Ryun Gil, Dong Jae Shim, Doyoung Kim, Dong Hwan Lee, Jung Jun Kim, and Jung Whee Lee
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Femoral Artery ,Male ,Treatment Outcome ,Lower Urinary Tract Symptoms ,Radial Artery ,Prostate ,Prostatic Hyperplasia ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization, Therapeutic ,Retrospective Studies - Abstract
To evaluate the safety and feasibility of prostatic artery embolization (PAE) via transradial access (TRA) compared with transfemoral access (TFA).This retrospective study included 53 consecutive men with lower urinary tract symptoms (LUTS) who underwent PAE between September 2018 and September 2021. Thirty-one patients (mean age ± standard deviation: 70.6 ± 8.4 years) were treated with TFA, including 14 patients treated before adopting TRA. Since December 2019, TRA has also been attempted with the procedure's selection criteria of patent carpal circulation and a height ≤ 172 cm, with 22 patients treated via TRA (69.1 ± 9.6 years). Parameters of technical success (defined as successful bilateral embolization), clinical success (defined as LUTS improvement), procedural time, radiation dose, and adverse events were compared between the two groups using the Fisher's exact test, independent sampleAll patients received at least one-side PAE. Technical success of PAE was achieved in most patients (TRA, 21/22; TFA, 30/31;PAE via TRA is a safe and feasible method comparable to conventional TFA. It can be safely implemented by selecting patients with patent carpal circulation and adequate height.
- Published
- 2021
17. Subcutaneous tunnelling versus conventional insertion of peripherally inserted central catheters in hospitalized patients (TUNNEL-PICC): a study protocol for a randomized controlled trial
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Yohan Kwon, Eung Tae Kim, Soo Buem Cho, Jae Hwan Lee, and Dong Jae Shim
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Catheterization, Central Venous ,Risk Factors ,Catheterization, Peripheral ,Pragmatic Clinical Trials as Topic ,Medicine (miscellaneous) ,Central Venous Catheters ,Humans ,Multicenter Studies as Topic ,Pharmacology (medical) ,Prospective Studies ,Randomized Controlled Trials as Topic - Abstract
Background Peripherally inserted central catheters (PICCs) are now widely used in modern medicine, and associated complications have also increased. Central line-associated bloodstream infection (CLABSI) is the most serious complication because it can cause extended hospital stays and increase costs. Furthermore, it can contribute to dire consequences for critically ill patients. Subcutaneous tunnelling for central venous catheters is an accepted method to reduce the risk of CLABSI. However, it is not generally adopted for PICC placement in most hospitals because its safety and efficacy have not been thoroughly evaluated. Methods In this multi-institutional, prospective, non-blinded pragmatic randomized controlled trial, 1694 patients treated at five referral hospitals will be assigned to one of two parallel arms (conventional and tunnelled PICC groups) using computer-generated stratified randomization. The conventional group will undergo PICC placement by routine practice. In the tunnelled PICC (tPICC) group, additional subcutaneous tunnelling will be applied. Patients will be followed until PICC removal or the end of this study. The primary endpoint is whether subcutaneous tunnelling reduced the rate of CLABSI compared to the conventional method. The secondary endpoints are technical success rates, complications including exit-site bleeding or infection, and the procedure time between the groups. Discussion Subcutaneous tunnelling is a widely used method to reduce catheter-associated infection. However, it has not been thoroughly applied for PICC. A randomized trial is needed to objectively assess the effects of the subcutaneous tunnel in PICC placement. This TUNNEL-PICC trial will provide evidence for the effectiveness of subcutaneous tunnelling in decreasing the risk of CLABSI. Trial registration Clinical Research Information Service (CRiS) KCT0005521
- Published
- 2021
18. Impact of subcutaneous tunnels on peripherally inserted catheter placement: a multicenter retrospective study
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Il Jung Kim, Jae Hwan Lee, Soon Gu Cho, Jong Hyun Byeon, Eung Tae Kim, Dong Jae Shim, and Hun Jae Lee
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Peripherally inserted central catheter ,Thrombophlebitis ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,law ,Catheterization, Peripheral ,Republic of Korea ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Vein ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Incidence ,Retrospective cohort study ,Interventional radiology ,General Medicine ,medicine.disease ,Intensive care unit ,Confidence interval ,Surgery ,medicine.anatomical_structure ,Catheter-Related Infections ,030220 oncology & carcinogenesis ,Female ,Radiology ,business ,Central venous catheter - Abstract
To evaluate the impact of subcutaneous tunneling on peripherally inserted central catheter (PICC) placement in terms of central line–associated bloodstream infections (CLABSIs). Our dual-facility central institutional review board approved this retrospective study. We compared 302 of 327 consecutive recipients (mean age [± SD], 68.0 ± 15.9 years; men, 134; women, 168) of tunneled PICCs (October 2017 to May 2018) with 309 of 328 consecutive recipients (mean age, 68.7 ± 14.6 years; men, 142; women, 167) of conventional PICCs (April 2016 to September 2017). Tunnels were made near puncture sites (~ 1 in. away) using hemostats or puncture needles. In each group, procedure times and rates of complications, including CLABSI, entry-site infection, dislocation, thrombophlebitis, and occlusion, were examined. Risk factors for CLABSI were analyzed via logistic and Cox regression models. Subcutaneous tunnels were achieved in all patients, enabling successful peripheral vein cannulations. Group procedure times were similar (p = 0.414). CLABSI proved to be significantly less frequent after tunneling (8/6972 catheter-days) than after conventional (28/7574 catheter-days) PICC placement (adjusted hazard ratio = 0.328; 95% confidence interval, 0.149–0.721). Other risk factors (i.e., age, gender, comorbidity, PICC duration, veins, hospital stay, and intensive care unit stay) showed no significant correlations with CLABSI. Compared with conventional means, a subcutaneous tunneling approach for PICC placement significantly reduces the rate of CLABSI. • Subcutaneous tunnels created to place peripherally inserted central catheters significantly reduced catheter-associated bloodstream infections. • Subcutaneous tunnel creation did not significantly prolong procedural time. • There were no subcutaneous tunnel-related complications.
- Published
- 2018
19. Prostatic Artery Embolization for Lower Urinary Tract Symptoms via Transradial Versus Transfemoral Artery Access: Single-Center Technical Outcomes.
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Ryun Gil, Dong Jae Shim, Doyoung Kim, Dong Hwan Lee, Jung Jun Kim, and Jung Whee Lee
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- 2022
- Full Text
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20. Transarterial Infusion of Epirubicin and Cisplatin Combined With Systemic Infusion of 5-Flurouracil Versus Sorafenib for Hepatocellular Carcinoma With Refractoriness of Transarterial Chemoembolization Using Doxorubicin
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Dong Jae Shim, Young Woon Kim, Jeong Won Jang, Sung Won Lee, Jong Yul Lee, Jung Hyun Kwon, Soon Woo Nam, and Sun Hong Yoo
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Sorafenib ,Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,cisplatin ,transarterial chemoembolization refractoriness ,lcsh:RC254-282 ,Gastroenterology ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Doxorubicin ,5-fluorouracil ,Chemoembolization, Therapeutic ,Adverse effect ,neoplasms ,Aged ,Epirubicin ,Retrospective Studies ,Cisplatin ,Aged, 80 and over ,business.industry ,Liver Neoplasms ,Hematology ,General Medicine ,hepatocellular carcinoma ,Middle Aged ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,Combined Modality Therapy ,digestive system diseases ,Survival Rate ,Original Research Paper ,Regimen ,Treatment Outcome ,Oncology ,Drug Resistance, Neoplasm ,Hepatocellular carcinoma ,Disease Progression ,Female ,Fluorouracil ,Liver cancer ,business ,medicine.drug - Abstract
Transarterial chemoembolization using doxorubicin (TACE-DOX) is an effective therapy for advanced hepatocellular carcinoma (HCC). However, there are limited options for patients with TACE refractoriness. We compared the effectiveness between sorafenib and transarterial chemolipiodolization using epirubicin and cisplatin combined with systemic infusion of 5-fluorouracil (5-FU; TACL-ECF) in patients with previous TACE-DOX refractoriness. We retrospectively analyzed 742 consecutively enrolled cohort patients who received TACE-DOX as the first-line therapy for HCC. Among the 94 patients who failed with TACE-DOX, 49 patients were treated with TACL-ECF and 45 patients were treated with sorafenib as a rescue therapy. The TACL-ECF regimen comprised transarterial infusion of epirubicin and cisplatin combined with systemic infusion of 5-FU. Of the 94 patients, 22 and 72 patients were in Barcelona Clinic Liver Cancer stages B and C, respectively; 66% patients were classified as having Child-Pugh class A (CPC A). Overall survival (OS) after rescue therapy did not differ between the sorafenib and TACL-ECF groups (4.1 months vs 6.4 months, P = .355). Progression-free survival (PFS) did not differ between the sorafenib and TACL-ECF groups (2.8 months vs 3.5 months, P = .629). Adverse events of CTC grade 3/4 occurred more frequently in the sorafenib group than in the TACL-ECF group ( P = .024). The present study showed that the OS and PFS did not differ between patients given rescue TACL-ECF therapy and those given sorafenib therapy. The TACL-ECF treatment was better tolerated than sorafenib. The TACL-ECF might be considered as an alternative therapy for the patients with TACE-DOX refractoriness, especially CPC B and sorafenib-intolerant patients.
- Published
- 2020
21. Use of Amplatzer Vascular Plug to Embolize Errant Chest Tube Tract in Liver
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Dong Jae Shim and Jong Hyun Byeon
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Chest tube ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,medicine ,Radiology, Nuclear Medicine and imaging ,Vascular plug ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
22. Common Peroneal Neuropathy With Anterior Tibial Artery Occlusion: A Case Report
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Da-Ye Kim, Dong Jae Shim, Sung Soo Jeon, and Min-Wook Kim
- Subjects
Foot drop ,medicine.medical_specialty ,Peroneal neuropathies ,medicine.medical_treatment ,Ischemia ,Case Report ,Mononeuropathy ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine.artery ,Occlusion ,medicine ,business.industry ,Rehabilitation ,valvular heart disease ,Percutaneous coronary intervention ,Vascular surgery ,medicine.disease ,Surgery ,Anterior tibial artery ,medicine.symptom ,Tibial arteries ,business ,030217 neurology & neurosurgery - Abstract
Peroneal neuropathy is a common mononeuropathy of the lower limb. Some studies have reported cases of peroneal neuropathy after vascular surgery or intervention. However, no cases of peroneal neuropathy with occlusion of a single peripheral artery have been previously reported. A 73-year-old man was referred with a 3-week history of left-sided foot drop. He had a history of valvular heart disease and arrhythmia, and had previously been treated with percutaneous coronary intervention. Computed tomography angiogram of the lower extremity showed proximal occlusion of the left anterior tibial artery. An electrodiagnostic study confirmed left common peroneal neuropathy. After diagnosis, anticoagulation therapy was started and he received physical therapy.
- Published
- 2017
23. Transhepatic Tract Embolisation After Biliary Intervention Using n-Butyl Cyanoacrylate and Autologous Blood: A Retrospective Analysis of 42 Patients
- Author
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Ki Jun Kim, Sun Ki Kim, Dong Jae Shim, Jong Hyun Byeon, Jung Min Hwang, and Yu Ri Shin
- Subjects
Adult ,Male ,medicine.medical_specialty ,Abdominal pain ,Percutaneous ,Adolescent ,medicine.medical_treatment ,Autologous blood ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,Blood Transfusion, Autologous ,Young Adult ,0302 clinical medicine ,Ethiodized Oil ,law ,medicine ,Fluoroscopy ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,Aged, 80 and over ,Cholestasis ,medicine.diagnostic_test ,business.industry ,N-butyl-cyanoacrylate ,Stent ,Enbucrilate ,Middle Aged ,Embolization, Therapeutic ,Surgery ,Treatment Outcome ,Cyanoacrylate ,Lipiodol ,Drainage ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
We evaluated the safety and efficacy of transhepatic tract embolisation after a biliary intervention using n-butyl cyanoacrylate (NBCA) and autologous blood. Between January 2017 and December 2018, 42 consecutive patients (mean age: 71 ± 15 years, 24 men) with malignant (n = 26) or benign (n = 16) biliary obstructions underwent percutaneous biliary intervention followed by tract embolisation within 2 weeks. Forty-six transhepatic tracts (4 bilateral) in 42 patients were embolised using a NBCA and lipiodol mixtures (1:1–1:2 ratios) after intraductal infusion of peripherally obtained autologous blood. The indwelling catheter diameters were 8.5–14 Fr. The median interval between percutaneous biliary drainage and tract embolisation was 10 days (range 3–14 days). Glue-cast formation via fluoroscopy and immediate complications were reviewed retrospectively in medical records. Follow-up data (median: 135, range 11–720 days) including computed tomography (CT) images (n = 17) were evaluated for delayed complications and glue-cast formation. Successful glue-cast formations were achieved in all 46 tracts. No patients experienced haemorrhage, and only one patient had external bile leakage. Eight patients complained of abdominal pain (numerical scale ≤ 5) immediately after embolisation, which was controlled by analgesics. Two patients had transient fever. Segmental (n = 11) or sub-segmental (n = 6) glue-cast patterns were identified along the transhepatic tract by follow-up CT. No biliary obstructions were caused by inadvertent glue spread. Fragmented glue was detected outside the stent in one patient. Transhepatic parenchymal tract embolisation with NBCA and autologous blood is a safe and feasible method for preventing bile leakage. Level 4, Case Series.
- Published
- 2019
24. Prevalence and predictors of peripherally inserted central catheter-associated bloodstream infections in adults: A multicenter cohort study
- Author
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Jae Hwan Lee, Dong Jae Shim, Jong Hyun Byeon, Jinhong Lee, Eung Tae Kim, Hyun Beom Kim, Young Ju Choi, In Joon Lee, and Il Jung Kim
- Subjects
Male ,Nosocomial Infections ,030501 epidemiology ,Hematologic Cancers and Related Disorders ,0302 clinical medicine ,Endocrinology ,Risk Factors ,Prevalence ,Medicine and Health Sciences ,Medicine ,030212 general & internal medicine ,Aged, 80 and over ,Multidisciplinary ,Pharmaceutics ,Hazard ratio ,Hematology ,Middle Aged ,Hospitals ,Catheter ,Intensive Care Units ,Infectious Diseases ,Oncology ,Cohort ,Engineering and Technology ,Female ,0305 other medical science ,Cohort study ,Research Article ,Biotechnology ,Adult ,medicine.medical_specialty ,Catheterization, Central Venous ,Catheters ,Endocrine Disorders ,Science ,Bioengineering ,Peripherally inserted central catheter ,03 medical and health sciences ,Drug Therapy ,Internal medicine ,Diabetes Mellitus ,Humans ,Chemotherapy ,Aged ,Retrospective Studies ,business.industry ,Biology and Life Sciences ,Cancers and Neoplasms ,Retrospective cohort study ,Bloodstream Infections ,Odds ratio ,Length of Stay ,Confidence interval ,Health Care ,Health Care Facilities ,Catheter-Related Infections ,Metabolic Disorders ,Medical Devices and Equipment ,business - Abstract
ObjectiveTo evaluate the prevalence and predictors of peripherally inserted central catheter-associated bloodstream infection (PBSI) and PBSI-related death in hospitalized adult patients.Materials and methodsA retrospective multicenter cohort of consecutive patients who underwent PICC placement from October 2016 to September 2017 at four institutes was assembled. Using multivariable logistic and Cox-proportional hazards regression models, all risk factors were analyzed for their association with PBSI. Multivariable logistic models were used to evaluate predictors of PBSI-related death.ResultsDuring the study period, a total of 929 PICCs were inserted in 746 patients for a total of 17,913 catheter days. PBSI occurred in 58 patients (6.2%), with an infection rate of 3.23 per 1,000 catheter days. Number of catheter lumens [double lumen, odds ratio (OR) 5.295; 95% confidence interval (CI), 2.220-12.627; hazard ration (HR) 3.569; 95% CI, 1.461-8.717], PICC for chemotherapy (OR 4.94; 95% CI, 1.686-14.458; HR 7.635; 95% CI, 2.775-21.007), and hospital length of stay (OR 2.23; 95% CI, 1.234-4.049; HR 1.249; 95% CI, 0.659-2.368) were associated with PBSI. Risk factors, such as receiving chemotherapy (OR 54.911; 95% CI, 2.755-1094.326), presence of diabetes (OR 11.712; 95% CI, 1.513-90.665), and advanced age (OR 1.116; 95% CI 1.007-1.238), were correlated with PBSI-related death.ConclusionOur results indicated that risk factors associated with PBSI included the number of catheter lumens, the use of PICCs for chemotherapy, and the hospital length of stay. Furthermore, PBSI-related death was common in patients undergoing chemotherapy, diabetics, and elderly patients.
- Published
- 2018
25. Critical Role of Clinical Suspicion in the Diagnosis of Arterio-Ureteral Fistula
- Author
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Do Young Kim and Dong Jae Shim
- Subjects
Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,business.industry ,Family medicine ,R895-920 ,medicine ,Radiology, Nuclear Medicine and imaging ,business - Published
- 2021
26. Endovascular Management for the Treatment of Pancreas Transplant Venous Thrombosis: A Single-Center Experience
- Author
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Sung Shin, Jiaywei Tsauo, Duck Jong Han, Yook Kim, Dong Jae Shim, Young Hoon Kim, Gi-Young Ko, Heung Kyu Ko, and Kichang Han
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,Computed Tomography Angiography ,medicine.medical_treatment ,030230 surgery ,Pancreas transplantation ,Mesenteric Vein ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,Mesenteric Veins ,0302 clinical medicine ,Republic of Korea ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Superior mesenteric vein ,Thrombus ,Retrospective Studies ,Thrombectomy ,Computed tomography angiography ,Venous Thrombosis ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,Anticoagulants ,Phlebography ,medicine.disease ,Thrombosis ,Surgery ,Venous thrombosis ,Treatment Outcome ,surgical procedures, operative ,Splenic Vein ,Splenic vein ,Female ,Pancreas Transplantation ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose To investigate the safety and efficacy of mechanical thrombectomy used as a tool for graft rescue in patients with pancreas graft venous thrombosis (PGVT). Materials and Methods Graft venous thrombosis was discovered in 36 (33%) of 110 patients who underwent pancreas transplantation. Percutaneous aspiration thrombectomy was performed in seven patients (mean age, 31 y; range, 15–36 y) who had complete or severe thrombosis of the splenic vein or superior mesenteric vein seen on postoperative computed tomography. Results Successful evacuation of PGVT was possible in six of seven patients; the thrombus was partially evacuated in one patient. In this patient, subsequent anticoagulation salvaged the graft, rendering primary and secondary technical success rates as 86% and 100%, respectively. As pancreas grafts were successfully functioning in all seven patients within 1 month after endovascular treatment, the clinical success rate was 100%. There were no procedure-related complications. At the last follow-up evaluation, all seven patients were alive with no graft loss (mean follow-up time, 9.4 mo; range, 3.6–22.2 mo). Conclusions Endovascular treatment may be considered in patients with severe PGVT to prevent early graft loss.
- Published
- 2016
27. Management of jejunal bleeding by jejunal variceal embolization and portal venous recanalization after pylorus-preserving pancreaticoduodenectomy
- Author
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Dong Jae Shim and Ji Hoon Shin
- Subjects
medicine.medical_specialty ,Oncology ,Hepatology ,business.industry ,Pylorus preserving pancreaticoduodenectomy ,medicine.medical_treatment ,Gastroenterology ,Portal vein ,medicine ,Radiology, Nuclear Medicine and imaging ,Embolization ,Radiology ,business - Published
- 2015
28. Angiography-guided percutaneous thrombin injection for haemostasis of active bleeding complicated by femoral access: a case report
- Author
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Kwan Yong Lee, Jinho Jeong, Sun Ki Kim, Dong Jae Shim, and Jeong Whee Lee
- Subjects
Medicine (General) ,medicine.medical_specialty ,Percutaneous ,false ,Case Report ,Femoral artery ,030204 cardiovascular system & hematology ,Biochemistry ,03 medical and health sciences ,R5-920 ,0302 clinical medicine ,Thrombin ,Aneurysm ,Femoral access ,medicine.artery ,medicine ,Humans ,Effective treatment ,Hemostasis ,medicine.diagnostic_test ,business.industry ,Biochemistry (medical) ,Angiography ,food and beverages ,Cell Biology ,General Medicine ,medicine.disease ,Surgery ,Femoral Artery ,Vessel diameter ,surgical procedures, operative ,030220 oncology & carcinogenesis ,haemorrhage ,business ,Aneurysm, False ,medicine.drug - Abstract
Active bleeding from a small branch of the femoral artery can occur after catheterisation and may be difficult to treat. Stent-graft placement or embolisation after catheterisation can be a useful solution. However, stent-graft placement is often challenging for the treatment of bleeding around bifurcations, and it may be limited by available stent-graft sizes during emergencies. Embolisation can also be difficult if the vessel diameter is too small to catheterise or if the branching angle is too acute. Thrombin injection is accepted as a safe and effective treatment for iatrogenic or traumatic pseudoaneurysm. However, large haematomas can deter ultrasonographic guidance. We herein report the successful treatment of active bleeding from a small branch of the superficial femoral artery after femoral access by percutaneous direct puncture under angiographic guidance and thrombin injection at the bleeding focus.
- Published
- 2020
29. Prevalence and predictors of peripherally inserted central venous catheter associated bloodstream infections in cancer patients
- Author
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Jae Hwan Lee, Il Jung Kim, Jong Hyun Byeon, Hyun Beom Kim, Dong Jae Shim, Eung Tae Kim, and Min Uk Kim
- Subjects
medicine.medical_specialty ,Chemotherapy ,business.industry ,Proportional hazards model ,medicine.medical_treatment ,Hazard ratio ,Cancer ,Retrospective cohort study ,General Medicine ,medicine.disease ,Peripherally inserted central catheter ,03 medical and health sciences ,Catheter ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,Medicine ,030212 general & internal medicine ,business ,Cohort study - Abstract
Despite increasing use, the exact prevalence and predictors of peripherally inserted central catheter-associated bloodstream infection (PICC-CLABSI) in hospitalized patients with cancer are not elucidated.This retrospective cohort study included consecutive patients who underwent peripherally inserted central catheter (PICC) placement in 4 institutions (during 12 months in 3 hospitals and 10 months in 1 hospital). The prevalence of PICC-CLABSI was evaluated. The association between predictors and PICC-CLABSI were analyzed using Cox proportional hazards regression models and Kaplan-Meier survival analysis with log-rank tests.During the study period, 539 PICCs were inserted in 484 patients for a total of 10,841 catheter days. PICC-CLABSI occurred in 25 (5.2%) patients, with an infection rate of 2.31 per 1000 catheter days. PICC for chemotherapy (hazards ratio [HR] 11.421; 95% confidence interval (CI), 2.434-53.594; P = .019), double lumen catheter [HR 5.466; 95% CI, 1.257-23.773; P = .007], and PICC for antibiotic therapy [HR 2.854; 95% CI, 1.082-7.530; P = .019] were associated with PICC-CLABSI.PICC for chemotherapy or antibiotics, and number of catheter lumens are associated with increased risk of PICC-CLABSI in cancer patients. Careful assessment of these factors might help prevent PICC-CLABSI and improve cancer patients care.
- Published
- 2020
30. Preoperative discrimination of tumour stage in clear cell carcinoma of the ovary using computed tomography and magnetic resonance imaging
- Author
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Ki Jun Kim, Sung Eun Rha, Hae Lee Joo, Dong Jae Shim, Chang Suk Park, and Yu Ri Shin
- Subjects
Adult ,medicine.medical_specialty ,Endometriosis ,Computed tomography ,Ovary ,Tumour stage ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Ascites ,Preoperative Care ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Stage (cooking) ,Aged ,Neoplasm Staging ,Ovarian Neoplasms ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Clear cell carcinoma ,Female ,Radiology ,medicine.symptom ,business ,Tomography, X-Ray Computed ,Adenocarcinoma, Clear Cell - Abstract
Clear cell carcinoma (CCC) of the ovary shows distinct clinical characteristics depending on the stage. We aimed to investigate the imaging predictability for tumour stage in CCC.Fifty-six tumours in 48 patients with pathologically proven CCC were enrolled. CCCs were divided into early and advanced stage based on the International Federation of Gynecology and Obstetrics staging. Two reviewers assessed diverse computed tomography (CT) and magnetic resonance imaging (MRI) findings associated with CCC: laterality, size, margin, cystic component features (internal architecture, CT attenuation, and T1 signal intensity of MRI), solid component features (amount, shape, growth pattern, signal intensity, enhancement pattern, and diffusion restriction), and secondary manifestations (ascites, endometriosis, and venous thromboembolism).There was a statistically significant difference between early and advanced CCC in laterality (p = 0.011), CT attenuation (p = 0.03), and T1 signal intensity of the cystic component (p = 0.04), T2 signal intensity of the solid component (p = 0.006), ascites (p 0.001), coexisting endometriosis (p = 0.032), and venous thromboembolism (p = 0.011). Early-stage CCC tended to show unilaterality, higher CT attenuation values and T1 hyperintensities of the cystic component and endometriosis. Advanced-stage CCC showed bilaterality, T2 hyperintensities of the solid component, ascites, and venous thromboembolism. Laterality, CT attenuation of the cystic component, T2 signal intensity of the solid component, coexisting endometriosis, and ascites are independent predictors for advanced CCC.Imaging features can be a significant predictor for the discrimination of preoperative tumour staging in CCC.
- Published
- 2018
31. Sustained multiple organ ischaemia after transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma
- Author
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Yu Ri Shin, Eun Su Park, Young Woon Kim, Dong Jae Shim, Jeong Won Jang, Soon Woo Nam, Hyun Suk Jung, and Jung Hyun Kwon
- Subjects
Cancer Research ,Abdominal pain ,medicine.medical_specialty ,Ischemia ,Connective tissue ,transarterial chemoembolization ,ischemia ,Gastroenterology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Immunology and Microbiology (miscellaneous) ,Internal medicine ,medicine ,doxorubicin-loaded beads ,medicine.diagnostic_test ,business.industry ,Bile duct ,General surgery ,Cancer ,General Medicine ,Articles ,hepatocellular carcinoma ,medicine.disease ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Angiography ,Duodenum ,medicine.symptom ,business - Abstract
Transarterial chemoembolization (TACE) with drug-eluting beads (DC beads) may enhance drug delivery to tumours and reduce systemic toxicity. TACE with DC beads leads to significantly fewer serious side-effects compared with conventional TACE. A 66-year-old man with hepatocellular carcinoma (HCC) complained of continuous abdominal pain 1 month after TACE with DC beads. At the time of TACE, angiography revealed severe stenosis of both hepatic arteries. The diagnostic work up on admission suggested severe bile duct injury with regional bile duct dilatation, segmental liver and spleen infarction, necrotizing pancreatitis, as well as gastric and duodenal ulcers. The pathology specimens of the duodenum contained DC beads that had passed through small vessels in the connective tissue. The patient's condition appeared to improve after 2 weeks of antibiotic treatment and supportive care, but new multifocal liver and spleen infarction subsequently developed. After 2 months, he was well enough to be discharged. His HCC partially responded to the TACE with DC beads but eventually progressed and he died after 11 months. The present case report highlights unexpected ongoing multiple organ ischaemia in a 66-year-old man treated for HCC using TACE with DC beads. The use of TACE with DC beads should be carefully considered in patients with vascular strictures or aberrant blood supply.
- Published
- 2017
32. Long-Term Outcome of Portal Vein Stent Placement in Pediatric Liver Transplant Recipients: A Comparison with Balloon Angioplasty
- Author
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Heung Kyu Ko, Dong Il Gwon, Dong Jae Shim, Kyu-Bo Sung, and Gi-Young Ko
- Subjects
Male ,medicine.medical_specialty ,Percutaneous ,Adolescent ,medicine.medical_treatment ,Constriction, Pathologic ,030230 surgery ,Liver transplantation ,Balloon ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Angioplasty ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Vascular Diseases ,Superior mesenteric vein ,Child ,Retrospective Studies ,business.industry ,Portal Vein ,Stent ,Infant ,medicine.disease ,Surgery ,Liver Transplantation ,Stenosis ,Treatment Outcome ,Child, Preschool ,Inferior mesenteric vein ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon - Abstract
To evaluate the long-term efficacy of stent placement versus balloon angioplasty for portal vein (PV) stenosis in pediatric liver transplant (LT) recipients.Fifty patients (18 years old; median, 14 months) who underwent percutaneous transhepatic balloon angioplasty (n = 12), transhepatic stent placement (n = 18), or intraoperative transmesenteric stent placement (n = 20) between 1994 and 2015 were retrospectively analyzed. The median intervals from LT to percutaneous transhepatic angioplasty, stent, and intraoperative stent were 145 days (range, 27-2072), 98 days (range, 5-2289), and 0 days (range, 0-14), respectively. The primary study endpoint was the primary patency of each group. Secondary study endpoints included procedural complications, functional stent stenosis, and stent fractures.The median clinical follow-up periods were 81 months (range, 13-179), 118 months (range, 65-181), and 112 months (range, 47-168) in each group, respectively. In the angioplasty group, the 1-, 5-, and 10-year primary patency rates were all 75% ± 13%. The corresponding rates were all 100% in the percutaneous transhepatic stent group and 90% ± 7%, 90% ± 7%, and 85% ± 8%, respectively, in the intraoperative transmesenteric stent group (P = .103). Major procedural complications occurred in 4 patients, including 1 case with PV tear after percutaneous transhepatic post-stent angioplasty, and 3 cases with acute PV thrombosis after intraoperative transmesenteric stent. Functional stent stenosis and stent fractures occurred in 1 and 2 patients, respectively.No statistically significant difference was observed between the 3 groups in terms of the long-term primary patency rates. Therefore, angioplasty should be considered first to treat PV stenosis in pediatric LT recipients.
- Published
- 2017
33. Percutaneous Metallic Stent Placement for Palliative Management of Malignant Biliary Hilar Obstruction
- Author
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Dong Il Gwon, Jong Woo Kim, Ji Hoon Shin, Heung Kyu Ko, Kichang Han, Hyun-Ki Yoon, Gi-Young Ko, Yook Kim, Kyu-Bo Sung, Jin Hyoung Kim, and Dong Jae Shim
- Subjects
Adult ,Male ,medicine.medical_specialty ,Percutaneous ,Obstructive jaundice ,Fistula ,medicine.medical_treatment ,Peritonitis ,Intervention ,Biliary stent ,030218 nuclear medicine & medical imaging ,Cholangiocarcinoma ,Klatskin tumor ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,Aged, 80 and over ,Cholestasis ,business.industry ,Palliative Care ,Percutaneous transhepatic biliary drainage ,Stent ,Middle Aged ,medicine.disease ,equipment and supplies ,Confidence interval ,Surgery ,Survival Rate ,Biliary hilar malignancy ,Stent placement ,surgical procedures, operative ,Treatment Outcome ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,Cholecystitis ,Drainage ,PTBD ,Female ,Stents ,Original Article ,business - Abstract
Objective To investigate the outcomes of percutaneous metallic stent placements in patients with malignant biliary hilar obstruction (MBHO). Materials and methods From January 2007 to December 2014, 415 patients (mean age, 65 years; 261 men [62.8%]) with MBHO were retrospectively studied. All the patients underwent unilateral or bilateral stenting in a T, Y, or crisscross configuration utilizing covered or uncovered stents. The clinical outcomes evaluated were technical and clinical success, complications, overall survival rates, and stent occlusion-free survival. Results A total of 784 stents were successfully placed in 415 patients. Fifty-five patients had complications. These complications included hemobilia (n = 19), cholangitis (n = 13), cholecystitis (n = 11), bilomas (n = 10), peritonitis (n = 1), and hepatic vein-biliary fistula (n = 1). Clinical success was achieved in 370 patients (89.1%). Ninety-seven patients were lost to follow-up. Stent dysfunction due to tumor ingrowth (n = 107), sludge incrustation (n = 44), and other causes (n = 3) occurred in 154 of 318 patients. The median overall survival and the stent occlusion-free survival were 212 days (95% confidence interval [CI], 186-237 days) and 141 days (95% CI, 126-156 days), respectively. The stent type and its configuration did not affect technical success, complications, successful internal drainage, overall survival, or stent occlusion-free survival. Conclusion Percutaneous stent placement may be safe and effective for internal drainage in patients with MBHO. Furthermore, stent type and configuration may not significantly affect clinical outcomes.
- Published
- 2017
34. Portal vein stent placement with or without varix embolization of jejunal variceal bleeding after hepatopancreatobiliary surgery
- Author
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Dong Jae Shim, Dong-Il Gwon, Heung-Kyu Ko, Yook Kim, Gi-Young Ko, Kichang Han, and Ji Hoon Shin
- Subjects
Male ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Esophageal and Gastric Varices ,030218 nuclear medicine & medical imaging ,Varicose Veins ,03 medical and health sciences ,0302 clinical medicine ,Extrahepatic portal hypertension ,Postoperative Complications ,Varicose veins ,Hypertension, Portal ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization ,Pancreas ,Aged ,Retrospective Studies ,Varix ,Radiological and Ultrasound Technology ,business.industry ,Portal Vein ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Surgery ,medicine.anatomical_structure ,Jejunum ,Treatment Outcome ,Liver ,030220 oncology & carcinogenesis ,Duodenum ,Portal hypertension ,Female ,Stents ,Radiology ,medicine.symptom ,business ,Gastrointestinal Hemorrhage ,Follow-Up Studies - Abstract
Background Extrahepatic portal hypertension after surgery involving the duodenum or jejunum might result in massive ectopic variceal bleeding. Purpose To report the results of portal vein stent placement with the addition of variceal embolization. Material and Methods Between January 2000 and June 2015, portal vein stent placement was attempted in 477 patients. Of these, 22 patients (age, 63 ± 10 years) with jejunal variceal bleeding caused by portal vein obstruction after surgery were included in this study. Computed tomography (CT) findings before and after treatment and the rates of technical and clinical success, complications, and clinical outcomes were retrospectively evaluated. Results Stent placement was successful in 19 of 22 patients. Additional variceal embolization was performed in five cases. Clinical success, defined as the cessation of bleeding without recurrence within 1 month, was achieved in 18 of 19 patients with technical success. One patient developed recurrent bleeding 4 days after stent placement and was successfully treated with additional variceal embolization. There were no procedure-related complications. A regression of the jejunal varices was noted in 14 of 19 patients on follow-up CT scans. During the follow-up period (258 days; range, 7–1196 days), stent occlusion and recurrent bleeding occurred in six and four patients, respectively, of the 19 patients who achieved technical success. Statistical analyses revealed no significant differences regarding stent patency between benign and malignant strictures. Conclusion Percutaneous, transhepatic, portal vein stent placement with or without jejunal variceal embolization appears to be a safe and effective treatment for jejunal variceal bleeding after surgery.
- Published
- 2016
35. Percutaneous Metallic Stent Placement for Palliative Management of Malignant Biliary Hilar Obstruction.
- Author
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Dong Jae Shim, Dong Il Gwon, Kichang Han, Yook Kim, Gi-Young Ko, Ji Hoon Shin, Heung Kyu Ko, Jin Hyoung Kim, Jong Woo Kim, Hyun-Ki Yoon, and Kyu-Bo Sung
- Published
- 2018
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36. The detection of pulmonary embolisms after a coronary artery bypass graft surgery by the use of 64-slice multidetector CT
- Author
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Dong Jae Shim, Sam-Sae Oh, Chan-Young Na, Chang Keun Lee, and Yang Min Kim
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Coronary Artery Bypass, Off-Pump ,Multidetector ct ,Coronary Angiography ,Risk Assessment ,law.invention ,law ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Republic of Korea ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Coronary Artery Bypass ,Cardiac imaging ,Vascular Patency ,Aged ,Retrospective Studies ,Aged, 80 and over ,Chi-Square Distribution ,business.industry ,Incidence (epidemiology) ,Incidence ,Age Factors ,Coronary ct angiography ,Length of Stay ,Middle Aged ,medicine.disease ,Intensive care unit ,Pulmonary embolism ,Surgery ,Intensive Care Units ,surgical procedures, operative ,medicine.anatomical_structure ,Logistic Models ,Treatment Outcome ,Embolism ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary Embolism ,Tomography, X-Ray Computed ,Artery - Abstract
The purpose of this study was to examine the incidence of pulmonary embolism (PE) after a coronary artery bypass graft (CABG) using 64-slice multidetector CT (MDCT), and to determine the correlations between the occurrence of a PE and the clinical or surgical parameters. Three hundred and twenty-six consecutive patients, who underwent coronary CT angiography using 64-slice MDCT to assess the graft patency after CABG, were enrolled in this study. Additional axial CT images, which were reconstructed by adopting a large field of view and thinner image slices, were reviewed for the presence of PE. The relationship between the occurrence of a PE and the type of surgery (off-pump CABG versus conventional CABG), number of target vessels, use of a saphenous vein graft, and length of stay in the intensive care unit (ICU) were evaluated. PE was detected on the CT images of 33 patients (10.1%), which involved the lobar or more proximal arteries in seven patients and the segmental or subsegmental arteries in 26. PE occurred more frequently after off-pump CABG (16.5%, 14/85) than after conventional CABG (7.9%, 19/241) (P = 0.024). Patients with PE were older (67 years vs. 62.7 years) and had longer stays in the ICU (5.6 days vs. 3.8 days) than those without (P = 0.013 and P = 0.007, respectively). No significant difference was observed in the number of target vessels and use of a saphenous vein graft between patients with and without an embolism. In a multi-variable analysis, the age of the patient, surgical methods, and ICU stay were independent predictors for the occurrence of PE (P = 0.013, P = 0.017, and P = 0.005, respectively). MDCT helps detect PE in patients after CABG. It is encountered more frequently after off-pump CABG than after conventional CABG and in older patients with longer ICU stays.
- Published
- 2011
37. Common Peroneal Neuropathy With Anterior Tibial Artery Occlusion: A Case Report.
- Author
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Sungsoo Jeon, Da-Ye Kim, Dong Jae Shim, and Min-Wook Kim
- Subjects
VASCULAR surgery complications ,NEUROPATHY ,ARRHYTHMIA ,COMPUTED tomography ,TIBIAL arteries ,PATIENTS - Abstract
Peroneal neuropathy is a common mononeuropathy of the lower limb. Some studies have reported cases of peroneal neuropathy after vascular surgery or intervention. However, no cases of peroneal neuropathy with occlusion of a single peripheral artery have been previously reported. A 73-year-old man was referred with a 3-week history of left-sided foot drop. He had a history of valvular heart disease and arrhythmia, and had previously been treated with percutaneous coronary intervention. Computed tomography angiogram of the lower extremity showed proximal occlusion of the left anterior tibial artery. An electrodiagnostic study confirmed left common peroneal neuropathy. After diagnosis, anticoagulation therapy was started and he received physical therapy. [ABSTRACT FROM AUTHOR]
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- 2017
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38. Usefulness of Helical CT in the Diagnosis of Strangulation in Small Bowel Obstruction
- Author
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Soon Gu Cho, Yong Sun Jeon, Young Hye Kang, Chang Keun Lee, Sun Keun Choi, Dong Jae Shim, and Won Hong Kim
- Subjects
Venous engorgement ,medicine.medical_specialty ,business.industry ,digestive, oral, and skin physiology ,Ischemia ,Infarction ,medicine.disease ,digestive system diseases ,Helical ct ,Bowel obstruction ,Intussusception (medical disorder) ,Ascites ,medicine ,Radiology ,medicine.symptom ,Differential diagnosis ,business - Abstract
Purpose: We wished to evaluate the usefulness of helical CT for the diagnosis of strangulation of the dilated small bowels. Materials and Methods: The CT scans of 31 patients with small bowel obstruction from various causes were reviewed retrospectively. Thirteen of these patients were confirmed as small bowel strangulation by surgery and pathology. Fourteen patients underwent surgery, but they had no strangulation. Three patients were reduced by using a nasogastric tube and one infant with intussusception was reduced by air reduction. The following CT findings of strangulation were evaluated: reduced bowel wall enhancement by visual assessment and measuring the HU, ascites, thickening of bowel wall, abnormal mesenteric vessel location and whirlpool appearance, and mesenteric venous engorgement. For the precise evaluation of reduced bowel wall enhancement, the HUs were measured by 1 of ROI, and the differences of HUs between the well enhanced bowel and poorly enhanced bowel were compared. Results: For the diagnosis of strangulation, measurement of HU of the bowel wall could improve the sensitivity from 69% to 100%. The specificity of both methods, by visual assessment and measurement of HU, was 94%. Ascites had a sensitivity of 69% and specificity of 44%. Thickening of bowel wall had a sensitivity of 38% and specificity of 78%. Abnormal mesenteric vessel location and whirlpool appearance had a sensitivity of 38% and specificity of 83%. Mesenteric venous engorgement had a sensitivity of 31% and specificity of 72%. Conclusion: Measurement of HU of the bowel wall after contrast enhancement can be a useful method in the differential diagnosis between the strangulated and non-strangulated bowels in patients with small bowel obstruction.
- Published
- 2004
39. The Analysis of Pathogenesis in the Hypertensive Encephalopathy using Diffusion-Weighted MR Imaging
- Author
-
Young Kook Cho, Hyungjin Kim, Myung Kwan Lim, Dong Jae Shim, and Chang Hae Suh
- Subjects
Pathogenesis ,medicine.medical_specialty ,Hypertensive encephalopathy ,business.industry ,medicine ,Radiology ,business ,Diffusion-Weighted MR Imaging ,medicine.disease ,Brain disease - Published
- 2001
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