Seung Kwon Kim

Differentiation of ampullary tumor from benign papillary stricture by thin-section multidetector CT

The objective of this paper was to determine the criteria for differentiation of ampullary tumor from benign papillary stricture using thin-section multidetector CT images. Multidetector CT images with 2.5xa0mm slice-thickness in 57 consecutive patients (24 with ampulla of Vater tumor and 33 with benign papillary stricture) with extrahepatic duct dilatation due to ampullary obstruction were reviewed retrospectively. The papilla/papillary mass was evaluated regarding size, homogeneity of enhancement, attenuation value, and the diameters of extrahepatic duct and main pancreatic duct were measured. The measurability, enhancement pattern, the attenuation value of papilla/papillary mass on portal venous phase, and the maximum diameters of extrahepatic duct and main pancreatic duct were different between two groups. Multiple logistic regression analysis showed the papilla/papillary mass size was the only independently differentiating variable of ampullary tumor from benign stricture (Pxa0=xa00.016) with an odds ratio of 2.424 (95% confidence interval, 1.179–4.903). The most appropriate cutoff value of papilla/papillary mass size was 12.3 mm with 91.7% sensitivity, 92.3% specificity, and 92.0% accuracy. Ampullary tumor and benign papillary stricture could be effectively differentiated by thin-section multidetector CT based on papilla/papillary mass size.

Multidetector computed tomography cholangiography with multiplanar reformation for the assessment of patients with biliary obstruction

Background:u2002 We sought to evaluate the diagnostic use of multidetector computed tomography (MDCT) cholangiography with multiplanar reformation (MPR) for the assessment of patients with biliary obstruction.

Percutaneous Metallic Stents in Patients with Obstructive Jaundice due to Hepatocellular Carcinoma

PURPOSEnTo evaluate the technical success and clinical efficacy of percutaneously placed self-expandable metallic stents in patients with obstructive jaundice due to hepatocellular carcinoma (HCC).nnnMATERIALS AND METHODSnFifteen men (mean age, 59.3 years) with obstructive jaundice resulting from HCC were treated with self-expandable metallic stents (28 stents in 19 sessions). The authors evaluated the technical success, clinical success (decrease of 30% of total serum bilirubin level or <2 mg/dL [34.2 micromol/L]), treatment efficacy according to lowest total serum bilirubin level, complications, and duration of stent patency.nnnRESULTSnTechnical success was achieved in all patients. Clinical success was achieved in 11 of the 15 patients (73%). After stent placement, seven patients (47%) had a low bilirubin level (<2 mg/dL [34.2 micromol/L]), three (20%) had an intermediate bilirubin level (2-10 mg/dL [34.2-171 micromol/L]), and five (33%) had a high bilirubin level (>10 mg/dL [171 micromol/L]). A low bilirubin level was achieved in all patients with Child-Pugh A disease and stage T2 or T3 HCC. Major complications such as hemobilia necessitating transfusion (n=1) or abscess formation (n=1) occurred in two of the 19 sessions (10%). The overall mean stent patency was 149.8 days (range, 12-790 days). The mean stent patency in patients with Child-Pugh class A disease (257.8 days) was significantly longer than that of patients with Child-Pugh class B and C disease (123.2 and 63 days, respectively) (P<.05).nnnCONCLUSIONSnThe percutaneous placement of a self-expandable metallic stent is a feasible and effective palliative treatment for patients with obstructive jaundice resulting from HCC, especially for those with Child-Pugh class A disease and stage T2 or T3 HCC.

Transrenal ureteral occlusion with the use of microcoils in five patients with ureterovaginal fistulas

BackgroundTo evaluate the feasibility and efficacy of transrenal ureteral occlusion with microcoils in patients with ureterovaginal fistulasMethodsFive women (median age 44 years, range 26–51 years) with ureterovaginal fistulas were treated by transrenal ureteral occlusion with microcoils. The underlying diseases were uterine fibroids (nxa0=xa03), a primitive neuroectodermal tumor of the uterine cervix (nxa0=xa01), and an ovarian cancer (nxa0=xa01). Microcoils with or without gelatin sponges, were placed antegradely through a percutaneous nephrostomy (PCN). A PCN tube was then placed to provide an external diversionResultsThe transrenal ureteral occlusion was technically successfully in all patients. Complete or near complete (<1 pad/day) dryness was obtained in all patients within 3xa0days. No complications other than a slight proximal migration of the microcoils in two patients occurred. The PCN tubes were removed in four of the five patients during the follow-up period with the subsequent procedures: antegrade ureteral stent placement, patent normal ureter, an ureteroneocystostomy and a laparoscopic end-to-end anastomosis of the ureterConclusionsTransrenal ureteral occlusion with microcoils with or without gelatin sponges is a safe and reliable method for the management of patients with ureterovaginal fistulas

Radiofrequency Ablation with a New Perfused-Cooled Electrode Using a Single Pump: An Experimental Study in Ex Vivo Bovine Liver

The purpose of this study was to assess the efficacy of a new perfused-cooled electrode that uses a single pump for creating a large ablation zone in explanted bovine liver. This was done by comparing with the radiofrequency (RF) ablation zones that were created with a monopolar cooled electrode to the RF ablation zones that were created by the new perfused-cooled electrode. We developed a new perfused-cooled electrode that uses a single pump by modifying a 17-gauge cooled electrode (Radionics) with a 2.5-cm outer metallic sheath (15-gauge) in order to allow use of the internal cooling water (5.85 % hypertonic saline) for the infused saline. Thirty ablation zones were created in explanted bovine livers (12-min ablation cycle; pulsed technique; 2000 mA, maximum) with three different regimens: group A, RF ablation with the 17-gauge cooled electrode; group B, RF ablation with the 15-gauge cooled electrode; group C, RF ablation with the perfused-cooled electrode. T2-weighted magnetic resonance (MR) imaging was obtained immediately after RF ablation for calculating volumes of the ablation zone. Following MR imaging, the ablation zones were excised and measured for transverse diameters and vertical diameters. The transverse diameter, vertical diameter, and the calculated volumes of the ablation zones on MR imaging were compared among the groups. Ablation zones created with the perfused-cooled electrode (group C) were significantly larger than those created with the 17-gauge cooled electrode (group A) and the 15-gauge cooled electrode (group B) according to the transverse diameter and vertical diameter on the gross specimens (p < 0.05): 3.6xa0±xa00.38 cm and 4.4xa0±xa00.20 cm in group A, 3.7xa0±xa00.08 cm and 4.6xa0±xa00.16 cm in group B, and 5.4xa0±xa00.65 cm and 6.0xa0±xa00.56 cm in group C, respectively. On the MR imaging, the calculated volumes of the ablation zones in group C were significantly larger than those in groups A and B (p < 0.05): 23.1xa0±xa08.7 cm3 in group A, 28.9xa0±xa05.7 cm3 in group B, and 80.0xa0±xa034 cm3 in group C, respectively. A new perfused-cooled electrode using a single pump could efficiently increase the size of the ablation zone in liver compared with a monopolar cooled electrode, and this was due to its simultaneous use of internal cooling and saline infusion.