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Interventional Treatment of Varices: TIPS, BRTO, and PARTO
( Dongho Hyun ) 대한간학회 2019 Postgraduate Courses (PG) Vol.2019 No.1
Along with endoscopic approaches, interventional procedures have been deeply incorporated in the management of gastric varices over the past three decades. Nowadays transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) are no longer terms of interventional radiologists and get familiar with from hepatologists to even general physicians who take care of patients with liver cirrhosis. Recently as an alternative to BRTO, plug-assisted retrograde transvenous obliteration (PARTO) was first introduced in Korea. This time-saving method is getting popular worldwide. In the USA, another variant of BRTO, coil-assisted retrograde transvenous obliteration (CARTO) was invented to overcome shunts in large diameter. TIPS also has variants such as DIPS (direct intrahepatic portocaval shunt) and ultrasound guided percutaneous transhepatic portosystemic shunt creation. When varices have no accessible shunt, percutaneous transhepatic venous obliteration (PTVO) can be considered as a last resort. This lecture reviews basic concepts of and anatomic requirements for each method to help make a decision on whether these procedures are technically possible or not. Several representative cases are presented to enhance your understanding. From an interventional radiologist point of view, current issues on TIPS, BRTO, and PARTO will be addressed.
Dongho Hyun,Han-Bom Ryu,김미운 대한마취통증의학회 2011 Korean Journal of Anesthesiology Vol.61 No.4
Background: Inhalational anesthetics potentiate nondepolarizing muscle relaxants. Cisatracurium is a recently introduced neuromuscular blocker in Korea. We studied the effect of inhalational anesthesia and total intravenous anesthesia (TIVA) on neuromuscular blockades and hemodynamic responses by cisatracurium bolus injection. Methods: Forty patients undergoing elective surgery were randomly divided into isoflurane and propofolremifentanil groups. A bolus dose of cisatracurium of 0.15 mg/kg (3 × ED95) was administered after induction and the onset time and clinical duration of action were recorded. The nueromuscular blockade was monitored using train-offour (TOF) stimulation. Hemodynamic parameters were also recorded. Results: Onset time was 194.0 ± 39.1 sec in the isoflurane group and 226.5 ± 62.2 sec in the propofol-remifentanil group. Clinical duration of action was 49.2 ± 9.0 min in the isoflurane group and 43.0 ± 9.2 min in the propofolremifentanil group. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) immediately before intubation decreased in the propofol-remifentanil group. Heart rate (HR), SBP and DBP 1 and 3 min after tracheal intubation increased in the isoflurane group. Conclusions: Onset time was similar between isoflurane and propofol-remifentanil anesthesia. Clinical duration of action was significantly longer in isoflurane anesthesia. SBP and DBP immediately before intubation and HR,SBP and DBP 1 and 3 min after tracheal intubation were significantly different between the two groups.
Kim, Dongho,Goh, Hyun Gyung,Kim, Soo-Hyun,Choi, Soo-Young,Park, Sa-Hee,Jang, Eun-Jung,Kim, Dong-Wook Elsevier Science Publishers 2012 INTERNATIONAL JOURNAL OF HEMATOLOGY Vol.96 No.1
<P>Optimal responses during imatinib therapy are commonly defined following the European LeukemiaNet (ELN) recommendations. Achievements of these optimal responses have not, however, been comprehensively tested as response-related prognostic factors using single center data sets. We evaluated the parameters using long-term (median 63?months) outcomes from 363 chronic phase chronic myeloid leukemia patients treated with imatinib as frontline therapy at our center. Intention-to-treat analysis showed comparable rates of complete cytogenetic response (86?%), major molecular response (MMR, 54?%), and complete molecular response (MR(4.5), 8?%). Estimated overall survival, progression-free survival, and event-free survival at 7?years were 94, 88 and 84?%, respectively. Achievement of recommended optimal response at 6?months (major cytogenetic response) and 12?months (complete cytogenetic response) yielded significantly better overall, progression-free, and event-free survival. However, achievement of recommended optimal response at 18?months (MMR) provided marginal benefit only in event-free survival. Most ELN criteria were predictive of long-term outcomes, with the exception of the clinical significance of achieving MMR at 18?months. Treatment adherence in the early treatment period was one of the important independent predictors of favorable long-term outcome. Durable cytogenetic and molecular responses were maintained in a majority of patients treated with optimal dose intensity.</P>
Joo Hyun Oh,Dong Hyun Sinn,Gyu-Seong Choi,Jong Man Kim,Jae-Won Joh,Tae Wook Kang,Dongho Hyun,Wonseok Kang,Geum-Youn Gwak,Yong-Han Paik,Joon Hyeok Lee,Kwang Cheol Koh,Seung Woon Paik,Moon Seok Choi 대한외과학회 2020 Annals of Surgical Treatment and Research(ASRT) Vol.99 No.4
Purpose: Although surgical resection is usually considered for a single tumor, several reports have suggested that resection can be considered for multiple tumors. The objective of this study was to determine whether resection could provide better long-term outcome for patients with multiple hepatocellular carcinomas (HCCs) within Milan criteria. Methods: A total of 276 patients with multiple HCCs within Milan criteria with liver function preserved who underwent resection, radiofrequency ablation (RFA), or transarterial chemoembolization (TACE) between 2009 and 2013 were analyzed. Propensity-score (PS) matching was conducted. Results: Five-year overall survival (OS) and recurrence-free survival (RFS) were better in the resection group than that in the RFA or TACE group. Patients who underwent resection had more preserved liver function and different tumor characteristics compared to those received RFA or TACE. With similar baseline characteristics generated in the PS model, there was no difference in 5-year OS among 3 groups (79.5% vs. 72.3% or 62.0%, P = 0.232), but the 5-year RFS was better for patients who received resection than those who received RFA or TACE (51.9% vs. 22.0% or 0.0%, P < 0.001). Although the major complication rate was slightly higher than RFA or TACE, there was no significant difference between the 3 groups before and after PS matching. Conclusion: Resection was associated with better RFS than RFA or TACE and showed comparable OS in multiple HCC patients within the Milan criteria, but at a cost of slightly increased risk of complication. Resection can be considered as a first-line option if selected appropriately.
Baek, Dae Hyun,An, Su-Yeon,Park, Jae Hyun,Choi, Youngju,Park, Ki Dae,Kang, Jin Wook,Choi, Kyoung Suk,Park, Sung Hee,Whang, Min Young,Han, Jiyou,Kim, Jong-Hoon,Kim, Hyung Soo,Geum, Dongho,Yoo, Tae Moo Informa Healthcare 2012 Toxicology mechanisms and methods Vol.22 No.2
<P>We developed and analyzed a new surrogate endpoint of the mouse embryonic stem cell test (EST) for developmental neurotoxicity. To determine the sensitivity, specificity, and transferability of the new endpoint, a pre-validation team from three independent laboratories optimized and standardized the protocol for neuronal differentiation of mouse embryonic stem cells (mESCs) by measuring the neuronal differentiation rates of mESCs under different culture conditions, such as the presence or absence of basic fibroblast growth factor (bFGF) in the growth media and varying lengths of culture. In addition, a component ratio of neuronal cells was measured by using flow cytometry analysis of β-III tubulin (Tuj1)-positive cells and real-time polymerase chain reaction analysis of microtubule-associated protein 2 (MAP2) mRNA. Our results showed that the best growth was achieved by culturing mESCs for 12 d in N2B27 medium without bFGF or ascorbic acid. Lead (II) acetate and aroclor 1254 were used to test the usefulness of the new endpoint. When we used the known ID<SUB>50</SUB> values for lead (II) acetate in the EST model, it was classified as non-embryotoxic; however, when we used the new ID<SUB>50</SUB> values that we determined in this study, it was classified as weakly embryotoxic. Aroclor 1254 and penicillin G were also classified as weakly embryotoxic and non-embryotoxic compounds, respectively, when cardiac and neuronal differentiation ID<SUB>50</SUB> values were used. Therefore, our new surrogate endpoint for developmental neurotoxicity is not only sensitive and specific but also transferable among laboratories.</P>