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Shiro Miyayama,Masashi Yamashiro,Rie Ikeda,Junichi Matsumoto,Nobuhiko Ogawa,Kazuo Notsumata 소화기인터벤션의학회 2022 Gastrointestinal Intervention Vol.11 No.1
Background: Bleeding from duodenal varices is a rare but life-threatening complication of portal hypertension. The treatment of duodenal varices remains difficult and a definitive treatment strategy has not been established. The aim of this study was to report the technical aspects and outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) using 5% ethanolamine oleate with iopamidol (EOI) for duodenal varices. Methods: Six consecutive patients with duodenal varices treated using BRTO were eligible. Endoscopic treatment was performed first in three patients with active bleeding. After coil embolization of collateral veins, stepwise EOI infusion was performed at intervals of 10–30 minutes under balloon occlusion until the main efferent vein, varices, and the main afferent vein were filled with EOI and clots. The techniques and outcomes of BRTO were retrospectively evaluated. Results: The main efferent vein of duodenal varices was the right (n = 4) or left (n = 2) gonadal vein. In three patients with ruptured varices, BRTO was performed after achieving hemostasis by endoscopic treatment. In five patients, 1–4 (mean, 2.4 ± 1.1) collateral veins were embolized with coils before EOI infusion. Furthermore, 11–21 mL (mean, 15.3 ± 4.2 mL) of EOI was infused by 3–5 (mean, 3.5 ± 1.0) stepwise infusions via the efferent vein under balloon occlusion. The duration of EOI infusion under balloon occlusion ranged from 82 to 118 minutes (mean, 87.8 ± 13.6 minutes). The varices were thrombosed in all but one patient. In the remaining patient, the varices were thrombosed by additional BRTO under overnight balloon occlusion performed 19 days later. The only complications were a transient fever and hematuria. All duodenal varices disappeared during a followup of 4–32 months (mean, 16.2 ± 11.1 months) after BRTO. Conclusion: BRTO using EOI is an effective treatment for duodenal varices.
Shiro Miyayama,Masashi Yamashiro,Rie Ikeda,Junichi Matsumoto,Nobuhiko Ogawa,Kazuo Notsumata 소화기인터벤션의학회 2022 International journal of gastrointestinal interven Vol.11 No.1
Background: Bleeding from duodenal varices is a rare but life-threatening complication of portal hypertension. The treatment of duodenal varices remains difficult and a definitive treatment strategy has not been established. The aim of this study was to report the technical aspects and outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) using 5% ethanolamine oleate with iopamidol (EOI) for duodenal varices. Methods: Six consecutive patients with duodenal varices treated using BRTO were eligible. Endoscopic treatment was performed first in three patients with active bleeding. After coil embolization of collateral veins, stepwise EOI infusion was performed at intervals of 10–30 minutes under balloon occlusion until the main efferent vein, varices, and the main afferent vein were filled with EOI and clots. The techniques and outcomes of BRTO were retrospectively evaluated. Results: The main efferent vein of duodenal varices was the right (n = 4) or left (n = 2) gonadal vein. In three patients with ruptured varices, BRTO was performed after achieving hemostasis by endoscopic treatment. In five patients, 1–4 (mean, 2.4 ± 1.1) collateral veins were embolized with coils before EOI infusion. Furthermore, 11–21 mL (mean, 15.3 ± 4.2 mL) of EOI was infused by 3–5 (mean, 3.5 ± 1.0) stepwise infusions via the efferent vein under balloon occlusion. The duration of EOI infusion under balloon occlusion ranged from 82 to 118 minutes (mean, 87.8 ± 13.6 minutes). The varices were thrombosed in all but one patient. In the remaining patient, the varices were thrombosed by additional BRTO under overnight balloon occlusion performed 19 days later. The only complications were a transient fever and hematuria. All duodenal varices disappeared during a followup of 4–32 months (mean, 16.2 ± 11.1 months) after BRTO. Conclusion: BRTO using EOI is an effective treatment for duodenal varices.
Progressive Relapse of Ligamentum Flavum Ossification Following Decompressive Surgery
Kei Ando,Shiro Imagama,Zenya Ito,Kazuyoshi Kobayashi,Junichi Ukai,Akio Muramoto,Ryuichi Shinjo,Tomohiro Matsumoto,Hiroaki Nakashima,Naoki Ishiguro 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.6
Thoracic ossification of the ligamentum flavum (T-OLF) is a relatively rare spinal disorder that generally requires surgical intervention, due to its progressive nature and the poor response to conservative therapy. The prevalence of OLF has been reported at 3.8%–26%, which is similar to that of cervical ossification of the posterior longitudinal ligament (OPLL). The progression of OPLL after cervical laminoplasty for the treatment of OPLL is often shown in long-term follow-up. However, there have been no reports on the progression of OLF following surgery. We report a case of thoracic myelopathy secondary to the progressive relapse of OLF following laminectomy.