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Transjugular intrahepatic portosystemic shunt vs conservative treatment for recurrent ascites:A propensity score matched comparison

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World Journal of Gastroenterology 2022年第41期28卷 5944-5956页

作者： Martin Philipp Theresia Blattmann Jörn Bienert Kristian Fischer Luisa Hausberg Jens-Christian Kröger Thomas Heller Marc-AndréWeber Georg Lamprecht Department of Medicine Division of Gastroenterology and EndocrinologyRostock University Medical CenterRostock 18057Germany Institute of Diagnostic and interventional radiology Pediatric Radiology and NeuroradiologyRostock University Medical CentreRostock 18057Germany

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS) placement is an effective intervention for recurrent tense ascites. Some studies show an increased risk of acute on chronic liver failure(ACLF) associated with TIPS placement. It is not clear whether ACLF in this context is a consequence of TIPS or of the pre-existing liver *** To better understand the risks of TIPS in this challenging setting and to compare them with those of conservative *** Two hundred and fourteen patients undergoing their first TIPS placement for recurrent tense ascites at our tertiary-care center between 2007 and 2017 were identified(TIPS group). Three hundred and ninety-eight patients of the same time interval with liver cirrhosis and recurrent tense ascites not undergoing TIPS placement(No TIPS group) were analyzed as a control group. TIPS indication,diagnosis of recurrent ascites, further diagnoses and clinical findings were obtained from a database search and patient records. The in-hospital mortality and ACLF incidence of both groups were compared using 1:1 propensity score matching and multivariate logistic *** After propensity score matching, the TIPS and No TIPS groups were comparable in terms of laboratory values and ACLF incidence at hospital admission. There was no detectable difference in mortality(TIPS: 11/214, No TIPS 13/214). During the hospital stay, ACLF occurred more frequently in the TIPS group than in the No TIPS group(TIPS: 70/214, No TIPS: 57/214, P = 0.04). This effect was confined to patients with severely impaired liver function at hospital admission as indicated by a significant interaction term of Child score and TIPS placement in multivariate logistic regression. The TIPS group had a lower ACLF incidence at Child scores < 8 points and a higher ACLF incidence at ≥ 11 points. No significant difference was found between groups in patients with Child scores of 8 to 10 *** TIPS placement for recurrent tense as

关键词： Liver cirrhosis Ascites Transjugular intrahepatic portosystemic shunt Acute on chronic liver failure Mortality Propensity score

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Rarity among benign gastric tumors: Plexiform fibromyxoma-Report of two cases

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World Journal of Gastroenterology 2017年第31期23卷 5817-5822页

作者： Kinga Szurian Holger Till Eva Amerstorfer Nicole Hinteregger Hans-Jorg Mischinger Bernadette Liegl-Atzwanger Iva Brcic Institute of Pathology Medical University of Graz Department of Paediatric and Adolescent Surgery Medical University of Graz Department of radiology Division of NeuroradiologyVascular and Interventional RadiologyMedical University of Graz Department of Surgery Medical University of Graz

Plexiform fibromyxoma is a very rare mesenchymal tumor of the stomach, found almost exclusively in the antrum/pylorus region. The most common presenting symptoms are anemia, hematemesis, nausea and unintentional weight loss, without sex or age predilection. We describe here two cases of plexiform fibromyxoma, involving a 16-year-old female and a 34-year-old male. Both patients underwent complete resection(R0) by distal gastrectomy and retrocolic gastrojejunostomy(according to Billroth 2); for both, the postoperative course was uneventful. Histology showed multiple intramural and subserosal nodules with characteristic plexiform growth, featuring bland spindle cells situated in an abundant myxoid stroma with low mitotic activity. Immunohistochemistry showed α-smooth muscle actin-positive spindle cells, focal positivity for CD10, and negative staining for KIT, DOG1, CD34, S100, β-catenin, STAT-6 and anaplastic lymphoma kinase. One of the cases showed focal positivity for h-caldesmon and desmin. Upon followup, no sign of disease was found. In the differential diagnosis of plexiform fibromyxoma, it is important to exclude the more common gastrointestinal stromal tumors as they have greater potential for aggressivebehavior. Other lesions, like neuronal and vascular tumors, inflammatory fibroid polyps, abdominal desmoid-type fibromatosis, solitary fibrous tumors and smooth muscle tumors, must also be excluded.

关键词： Plexiform fibromyxoma Plexiform angiomyxoid myofibroblastic tumor Gastrointestinal stromal tumor Stomach Benign gastric tumor

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Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project

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Asian Journal of Urology 2024年第2期11卷 271-279页

作者： Andrea Cocci Marta Pezzoli Fernando Bianco Franco Blefari Pierluigi Bove Francois Cornud Gaetano De Rienzo Paolo Destefanis Danilo Di Trapani Alessandro Giacobbe Luca Giovanessi Antonino Laganà Giovanni Lughezzani Guglielmo Manenti Gianluca Muto Gianluigi Patelli Novello Pinzi Stefano Regusci Giorgio I.Russo Juan I.M.Salamanca Matteo Salvi Luigi Silvestri Fabrizio Verweij Eric Walser Riccardo GBertolo Valerio Iacovelli Alessandro Bertaccini Debora Marchiori Hugo Davila Pasquale Ditonno Paolo Gontero Gennaro Iapicca Theo M De Reijke Vito Ricapito Pierluca Pellegrini Andrea Minervini Sergio Serni Francesco Sessa Department of Urology Careggi HospitalUniversity of FlorenceFlorenceItaly Urology Section University of FlorenceFlorenceItaly Urological Research Network MiamiFLUSA Urology Section Prato HospitalPratoItaly Torvergata Oncoscience Research Centre of Excellence TORDepartment of Experimental MedicineUniversity of Rome Tor VergataRomeItaly Department of Urology San Carlo di Nancy HospitalRomeItaly Department of radiology Hôpital CochinParis Descartes UniversityParisFrance Urology and Andrology Unit II Department of Emergency and Organ TransplantationUniversity of BariBariItaly Unit of Urology Cittàdella Salute e della Scienza HospitalUniversity of TurinTurinItaly Urology Unit Buccheri La Ferla Fatebenefratelli HospitalPalermoItaly Department of Urology Humanitas Gradenigo HospitalTurinItaly Urology Unit Surgical DepartmentFondazione Poliambulanza Istituto OspedalieroBresciaItaly Departement of Urology “S.Giovanni Evangelista”HospitalTivoliItaly Humanitas Clinical and Research CentereIRCCS Department of UrologyRozzanoItaly Department of Biomedical Sciences Humanitas UniversityPieve EmanueleItaly Department of Biomedicine and Prevention University of Rome“Tor Vergata”RomeItaly Department of Diagnostic Imaging and interventional radiology University of Rome“Tor Vergata”RomeItaly Department of interventional radiology Pesenti-Fenaroli Hospital-ASST Bergamo EstAlzano LombardoItaly Department of Urology University of SienaSienaItaly Swiss International Prostate Center GenevaSwitzerland Clinique Générale Beaulieu GenevaSwitzerland Department of Urology University of CataniaItaly Department of Urology Puerta de Hierro-Majadahonda University HospitalMadridSpain Lyx Institute of Urology Universidad Francisco de VitoriaMadridSpain Department of Medico-Surgical Sciences and Biotechnologies Sapienza University of RomeFaculty of Pharmacy and MedicineUrology Unit ICOTLatinaItaly Department of Urology European Institute of Oncology(IEO)IRCCSMilanItaly Department of radiology D

Objective: To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus ***: Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and ***: Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from 80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading t

关键词： Transperineal laser ablation Prostatecancer Benignprostatic hyperplasia Delphi consensus

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Locoregional treatments for hepatocellular carcinoma: Current evidence and future directions

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World Journal of Gastroenterology 2019年第32期25卷 4614-4628页

作者： Riccardo Inchingolo Alessandro Posa Martin Mariappan Stavros Spiliopoulos division of interventional radiology Department of RadiologyMadonna delle Grazie HospitalMatera 75100Italy Department of radiology King′s College HospitalLondon SE5 9RSUnited Kingdom Department of radiology IRCSS Fatebenefratelli HospitalRoma 00186Italy interventional radiology Department Aberdeen Royal Infirmary HospitalAberdeen AB25 2ZNUnited Kingdom 2nd radiology Department School of MedicineNational and Kapodistrian University of AthensChaidari Athens 12461Greece

Liver cancers are the second most frequent cause of global cancer-related mortality of which 90%are attributable to hepatocellular carcinoma(HCC).Despite the advent of screening programmes for patients with known risk factors,a substantial number of patients are ineligible for curative surgery at presentation with limited outcomes achievable with systemic chemotherapy/external *** has led to the advent of numerous minimally invasive options including but not limited to trans-arterial chemoembolization,radiofrequency/microwave ablation and more recently selective internal radiation therapy many of which are often the first-line treatment for select stages of HCC or serve as a conduit to liver *** authors aim to provide a comprehensive overview of these various image guided minimally invasive therapies with a brief focus on the technical aspects accompanied by a critical analysis of the literature to assess the most up-to-date evidence from comparative systematic reviews and meta-analyses finishing with an assessment of novel combination regimens and future directions of travel.

关键词： Hepatocellular carcinoma Cirrhosis Liver interventional oncology Transarterial chemo embolization Selective internal radiation therapy Ablation

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Intraoperative radiofrequency ablation with or without tumorectomy for hepatocellular carcinoma in locations difficult for a percutaneous approach

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Hepatobiliary & Pancreatic Diseases International 2009年第6期8卷 591-596页

作者： Hyung Ook Kim Seung Kwon Kim Byung Ho Son Chang Hak Yoo Hyun Pyo Hong Yong Kyun Cho Byung Ik Kim Departments of Surgery Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine radiology Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine division of interventional radiology Mallinckrodt Institute of RadiologyWashington University School of Medicine Internal Medicine Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine

BACKGROUND:Although hepatic resection is widely accepted as a proper modality for treating hepatocellular carcinoma(HCC),a majority of patients are unable to undergo surgical resection due to various tumor and patient *** ablation(RFA)has mostly been used as a therapeutic alternative to resection for treating *** objective of this study was to evaluate the results of intraoperative RFA for HCCs in locations difficult for a percutaneous ***:Eight patients(male,seven;age,49-67 years) with 8 HCCs in difficult locations were treated by intraoperative *** of the patients had local tumor progression after initial transarterial chemoembolization or ultrasound(US)guided percutaneous *** locations of the tumors were hepatic dome in six patients,posterior subcapsule in one,and caudate lobe in *** tumor size was 2.0 to 6.4 cm(mean,3.9 cm).Intraoperative RFA was performed at the tumor itself and an anticipated resection line under US guidance with 3 cm monopolar single or clustered internally cooled *** resection was performed in six *** month later,treatment response was assessed by contrast material-enhanced computed tomography(CT).CT studies were performed every 2 or 3 months after ***:RFA was technically successful in all tumors,and the contrast-enhanced CT images acquired one month later showed complete disappearance of tumor *** pneumothorax *** a median follow-up of 18 months(range,6-30 months),no tumors showed local *** the follow-up period,four new recurrent tumors were observed in three *** patients were alive at the time of this report and the other four died of hepatorenal syndrome,liver failure,and progression of new recurrent ***:Intraoperative RFA with tumor resection can be an alterative treatment option for HCC in locations difficult for a percutaneous approach.

关键词： hepatocellular carcinoma radiofrequency ablation intraoperative

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Optimized nerve block techniques while performing percutaneous hepatic ablation: Literature review and practical use

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Journal of interventional Medicine 2020年第4期3卷 161-166页

作者： DM Liu A Hadjivassiliou D Valenti SG Ho D Klass JB Chung PT Kim LM Boucher Faculty of Medicine University of British ColumbiaCanada Miller School of Medicine University of MiamiUSA Department of radiology-division of interventional radiology Vancouver General HospitalCanada Department of radiology Vancouver General HospitalCanada Department of Surgery division of Hepatopancraticobiliary Surgery/Liver Transplantation Vancouver General HospitalVancouverCanada Faculty of Medicine McGill UniversityDepartment of RadiologyDivision of Interventional RadiologyMcGill University Health CentreMontrealCanada Faculty of Applied Science University of British ColumbiaCanada

Percutaneous image guided thermal ablation has become a cornerstone of therapy for patients with oligometastatic disease and primary liver *** from percutaneous ethanol injection(PEI),thermal ablation utilizing radiofrequency ablation(RFA)and microwave ablation(MWA)have become the standard approach in the treatment of isolated lesions that fit within the size criteria for curative intent therapy(typically 3-4 cm).With the evolution of more intense thermal ablation,such as MWA,the dramatic increase in both the size of ablation zone and intensity of heat generation have extended the limits of this *** a result of these innovations,intra-procedural and post-procedural pain have also significantly increased,requiring either higher levels of intravenous sedation or,in some institutions,general *** addition to the increase in therapeutic intensity,the use of intravenous sedation during aggressive ablation procedures carries the risk of over-sedation when the noxious insult(*** ablation)is removed,adding further difficulty to post-procedural recovery and ***,high subdiaphragmatic lesions become challenging in this setting due to issues relating to sedation and compliance with breath hold/breathing *** general anesthesia may mitigate these complications,the added resources associated with providing general anesthesia during ablation is not cost effective and may result in substantial delays in *** reduction of Aerosol Generating Medical Procedures(AGMP),such as intubation due to the COVID-19 Pandemic,must also be taken into *** to the potential increased risk of infection transmission,alternatives to general anesthesia should be considered when safe and *** abdominal regional nerve block techniques have been used to manage pain related to trauma,surgery,and cancer;however,blocks of this nature are not well described in the interventional radiology ***

关键词： anesthesia ablation corners

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Nationwide trends and predictors of inpatient mortality in 83884 transjugular intrahepatic portosystemic shunt

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World Journal of Gastroenterology 2016年第25期22卷 5780-5789页

作者： Edward Wolfgang Lee Andrew Kuei Sammy Saab Ronald W Busuttil Francisco Durazo Steven-Huy Han Mohamed M El-Kabany Justin P Mc Williams Stephen T Kee Department of radiology Division of Interventional Radiology Ronald Reagan Medical Center at UCLA David Geffen School of Medicine at UCLA Department of Medicine Division of Hepatology Pfleger Liver Institute University of California at Los Angeles Dumont-UCLA Transplant Center Pfleger Liver Institute Division of Liver and Pancreas Transplantation Department of Surgery David Geffen School of Medicine at University of California Los Angeles

AIM: To evaluate and validate the national trends and predictors of in-patient mortality of transjugular intrahepatic portosystemic shunt (TIPS) in 15 ***: Using the National Inpatient Sample which is a part of Health Cost and Utilization Project, we identified a discharge-weighted national estimate of 83884 TIPS procedures performed in the United States from 1998 to 2012 using international classification of diseases-9 procedural code 39.1. The demographic, hospital and co-morbility data were analyzed using a multivariant analysis. Using multi-nominal logistic regression analysis, we determined predictive factors related to increases in-hospital mortality. Comorbidity measures are in accordance to the Comorbidity Software designed by the Agency for Healthcare Research and ***: Overall, 12.3% of patients died during hospitalization with downward trend in-hospital mortality with the mean length of stay of 10.8 ± 13.1 d. Notable, African American patients (OR = 1.809 vs Caucasian patients, P < 0.001), transferred patients (OR = 1.347 vs non-transferred, P < 0.001), emergency admissions (OR = 3.032 vs elective cases, P < 0.001), patients in the Northeast region (OR = 1.449 vs West, P < 0.001) had significantly higher odds of in-hospital mortality. Number of diagnoses and number of procedures showed positive correlations with in-hospital death (OR = 1.249 per one increase in number of procedures). Patients diagnosed with acute respiratory failure (OR = 8.246), acute kidney failure (OR = 4.359), hepatic encephalopathy (OR = 2.217) and esophageal variceal bleeding (OR = 2.187) were at considerably higher odds of in-hospital death compared with ascites (OR = 0.136, P < 0.001). Comorbidity measures with the highest odds of in-hospital death were fluid and electrolyte disorders (OR = 2.823), coagulopathy (OR = 2.016), and lymphoma (OR = 1.842).CONCLUSION: The overall mortality of the TIPS procedure is stea

关键词： Transjugular intrahepatic portosystemic shunt Mortality Inpatient United States National Inpatient Sample database Health Cost and Utilization Project

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Gadoxetic acid magnetic-enhanced resonance imaging in the diagnosis of cholangiocarcinoma

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World Journal of Gastroenterology 2020年第29期26卷 4261-4271页

作者： Riccardo Inchingolo Cesare Maino Marco Gatti Eleonora Tricarico Michele Nardella Luigi Grazioli SandroSironi Davide Ippolito Riccardo Faletti division of interventional radiology Department of RadiologyMadonna delle Grazie HospitalMatera 75100Italy Department of Diagnostic radiology School of MedicineUniversity of Milano-BicoccaMonza 20900Italy Department of Surgical Sciences Radiology UnitUniversity of TurinTurin 10126Italy Department of radiology Spedali CiviliUniversity of BresciaBrescia 25123Italy Department of radiology Papa Giovanni XXIII HospitalUniversity Milano-BicoccaBergamo 20110Italy

The use of liver magnetic resonance imaging is increasing thanks to itsmultiparametric sequences that allow a better tissue characterization, and the useof hepatobiliary contrast agents. This review aims to evaluate gadoxetic acidenhanced magnetic resonance imaging in the diagnosis and staging ofcholangiocarcinoma and its different clinical and radiological classificationsproposed in the literature. We also analyze the epidemiology, risk factors incorrelation with clinical findings and laboratory data.

关键词： Hepatobiliary contrast materials Gadoxetic acid Cholangiocarcinoma Magnetic resonance imaging Liver Cirrhosis

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Transarterial chemoembolization using degradable starch microspheres and iodized oil in the treatment of advanced hepatocellular carcinoma: evaluation of tumor response, toxicity, and survival

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Hepatobiliary & Pancreatic Diseases International 2007年第3期6卷 259-266页

作者： Timm D Kirchhoff Joerg S Bleck Arne Dettmer Ajay Chavan Herbert Rosenthal Sonja Merkesdal Bernd Frericks Lars Zender Nisar P Malek Tim F Greten Stefan Kubicka Michael P Manns Michael Galanski Department of Diagnostic radiology Hannover Medical School Germany Department of Gastroenterology Hepatology and Endocrinology Hannover Medical School Germany Department of Diagnostic and interventional radiology Klinikum Oldenburg Germany division of Rheumatology Hannover Medical School Germany Department of radiology and Nuclear Medicine Campus B.F-Charité-University Medicine Berlin Germany

BACKGROUND: In a multidisciplinary conference patients with advanced non-resectable hepatocellular carcinoma (HCC) were stratified according to their clinical status and tumor extent to different regional modalities or to best supportive care. The present study evaluated all patients who were stratified to repeated transarterial chemoembolization (TACE) from 1999 until 2003 in terms of tumor response, toxicity, and survival. A moderate embolizing approach was chosen using a combination of degradable starch microspheres (DSM) and iodized oil (Lipiodol) in order to combine anti-tumoral efficiency and low toxicity. METHODS: Fourty-seven patients were followed up prospectively. TACE treatment consisted of cisplatin (50 mg/m2), doxorubicin (50 mg/m2), 450-900 mg DSM, and 5-30 ml Lipiodol. DSM and Lipiodol were administered according to tumor vascularization. Patient characteristics,toxicity, and complications were outlined. In multivariate regression analyses of pre-treatment variables from a prospective database, predictors for tumor response and survival after TACE were determined. RESULTS: 112 TACE courses were performed (2.4±1.5 courses per patient). Mean maximum tumor size was 75 (± 43) mm, in 68% there was bilobar disease. Best response to TACE treatment was: progressive disease (PD) 9%, stable disease (SD) 55%, partial remission (PR) 36%, and complete remission (CR) 0%. Multivariate regression analyses identified tumor size ≤75 mm, tumor number ≤5, and tumor hypervascularization as predictors for PR. The overall 1-, 2-, and 3-year-survival rates were 75%, 59%, and 41%, respectively, and the median survival was 26 months. Low α-fetoprotein levels (30 months, R2=36%). Grade 3 toxicity occurred in 7.1% (n=8), and grade 4 toxicity in 3.6% (n=4) of all courses in terms of reversible leukopenia and thrombocytopenia. The incidence of major

关键词： carcinoma, hepatocellular transarterial chemoembolization degradable starch microspheres Lipiodol tumor response survival

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Arterial embolization is the best treatment for pancreaticojejunal anastomotic bleeding after pancreatoduodenectomy

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World Journal of Gastroenterology 2009年第32期15卷 4090-4091页

作者： Romaric Loffroy Boris Guiu division of Vascular and interventional radiology University of DijonSchool of MedicineBocage Teaching Hospital2 bd du Maréchal de Lattre de TassignyBP 7790821079 Dijon CedexFrance

Massive pancreaticojejunal anastomotic bleeding, mainly from the gastroduodenal stump, is one of the most common complications of pancreato-duodenectomy. Selective angiography should be systematically the first step of investigative procedure in such situations. Pharmacoarteriography may be used if the bleeding point is not spontaneously identified, and allows safe and effective treatment with transcatheter arterial embolization compared to blind open surgical hemostasis. Coil embolization of the common or proper hepatic artery on either side of the bleeding point with "sandwich technique" is then the preferred technique to prevent retrograde filling. Surgery should be performed only as a last resort.

关键词： Pancreatoduodenectomy Complication Anastomotic bleeding Hepatic artery Transcatheterarterial embolization

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