Percutaneous transhepatic afferent loop balloon dilatation and indwelling catheter placement for benign afferent loop obstruction

Lyo Min Kwon,Myungsu Lee 소화기인터벤션의학회 2020 Gastrointestinal Intervention Vol.9 No.3

Benign afferent loop obstruction (ALO) is a complication that occurs after general surgery making Roux-en-Y or Billroth-II reconstruction and has typically been treated surgically. However, the surgery is difficult to conduct in about 25% of cases due to comorbidity and nonoperative management has been attempted. Here, we report two cases of benign ALO that were treated with percutaneous transhepatic afferent loop balloon dilatation and indwelling catheter, including one case with no improvement after surgery.

Percutaneous transhepatic afferent loop balloon dilatation and indwelling catheter placement for benign afferent loop obstruction

Lyo Min Kwon,Myungsu Lee 소화기인터벤션의학회 2020 International journal of gastrointestinal interven Vol.9 No.3

Benign afferent loop obstruction (ALO) is a complication that occurs after general surgery making Roux-en-Y or Billroth-II reconstruction and has typically been treated surgically. However, the surgery is difficult to conduct in about 25% of cases due to comorbidity and nonoperative management has been attempted. Here, we report two cases of benign ALO that were treated with percutaneous transhepatic afferent loop balloon dilatation and indwelling catheter, including one case with no improvement after surgery.

Glue Embolization of Lymphopseudoaneurysm for Chylous Ascites after Retroperitoneal Surgery

Kwon Lyo Min,Hur Saebeom,Jeong Chang Wook,Jae Hwan Jun,Chung Jin Wook 대한영상의학회 2021 Korean Journal of Radiology Vol.22 No.3

Objective: To assess the safety and efficacy of lymphopseudoaneurysm (LPA) glue (n-butyl cyanoacrylate [NBCA]) embolization in the management of chylous ascites after retroperitoneal surgery. Materials and Methods: A retrospective analysis from January 2014 to October 2018 was performed in six patients (4 females and 2 males; mean age, 45.3 ± 14.2 years; range, 26–61 years) who underwent LPA embolization for chylous ascites developing after retroperitoneal surgery involving the perirenal space (four donor nephrectomies, one partial nephrectomy, and one retroperitoneal lymphadenectomy). After placing a percutaneous drainage catheter into the LPA or adjacent lymphocele, embolization was performed by filling the LPA itself with a mixture of glue and Lipiodol (Guerbet). Results: Daily drainage from percutaneously placed drains exceeded 300 mL/day despite medical and surgical treatment (volume: mean, 1173 ± 1098 mL; range, 305–2800 mL). Intranodal lymphangiography was performed in four of the six patients and revealed leakage in 2 patients. Percutaneous embolization of the LPA was successful in all patients using an NBCA and Lipiodol mixture in a ratio of 1:1–1:2 (volume: mean, 4.3 ± 1.1 mL; range, 3–6 mL). Chylous ascites was resolved and the drainage catheter was removed in all patients within 4 days after the procedure (mean, 2.0 ± 1.8 days; range, 0–4 days). No procedure-related complications or recurrence of chylous ascites occurred during a mean follow-up period of 37.3 months (range, 21.1–48.4 months). Conclusion: Glue embolization of LPA has the potential to be a feasible and effective treatment method for the management of chylous ascites after retroperitoneal surgery.

Quantitative analysis in peritumoral volumes of brain metastases treated with stereotactic radiotherapy

Kim, Min Soo,Park, Sung Ho,Park, Eun Suk,Park, Jun Bum,Kwon, Soon Chan,Lyo, In Uk,Sim, Hong Bo Elsevier 2018 Journal of neuroradiology. Vol.45 No.5

<P>Conclusions. - It was possible to quantify changes in peritumoral volumes in patients with brain metastases after SRT by using DTI. ADC values of peritumoral volumes decreased significantly after SRT. Therefore, it was confirmed through DTI that performing SRT on tumor lesions has a positive effect on the structure and function of peritumoral volumes. (C) 2018 Elsevier Masson SAS. All rights reserved.</P>

Posttraumatic Syringomyelia with Holocord Involvement: A Case Report

Jong Min Lee,In Uk Lyo,Soon Chan Kwon,Hong Bo Sim 대한말초신경학회 2018 The Nerve Vol.4 No.2

Posttraumatic syringomyelia occurs in nearly half of all spinal cord injury (SCI) patients. However, there haves been very few cases of syringomyelia of the entire spinal cord, known as holocord syringomyelia. Here, we discuss a case of posttraumatic holocord syringomyelia in the light of the literature review. A 43-year-old man presented with ongoing motor weakness of the left upper extremity. He had a history of SCI with a spinal fusion operation 5 years ago. Magnetic resonance imaging (MRI) of the spine revealed an expansive high signal intensity lesion in the spinal cord from the medulla to T12. Total T8 laminectomy and syringopleural shunt placement were performed. The patient’s motor weakness of the left upper extremity recovered and the extent of syrinx decreased remarkably at the 1 year follow up MRI. Physicians should consider holocord syringomyelia as a possibility in patients with ongoing neurologic deficit with a history of SCI.

Clopidogrel Response Variability in Unruptured Intracranial Aneurysm Patients Treated with Stent-Assisted Endovascular Coil Embolization : Is Follow-Up Clopidogrel Response Test Necessary?

Kim, Min Soo,Park, Eun Suk,Park, Jun Bum,Lyo, In Uk,Sim, Hong Bo,Kwon, Soon Chan The Korean Neurosurgical Society 2018 Journal of Korean neurosurgical society Vol.61 No.2

Objective : The purpose of this study was to analyze the variability of clopidogrel responses according to duration of a clopidogrel drug regimen after stent-assisted coil embolization (SAC), and to determine the correlation between the variability of clopidogrel responses and thromboembolic or hemorrhagic complications. Methods : A total of 47 patients who underwent SAC procedures to treat unruptured intracranial aneurysms were enrolled in the study. Preoperatively, patients received more than seven days of aspirin (100 mg) and clopidogrel (75 mg), daily. P2Y12 reaction unit (PRU) was checked with the VerifyNow test one day before the procedure (pre-PRU) and one month after the procedure (post-PRU). PRU variability was calculated as the difference between the initial response and the follow-up response. Patients were sorted into two groups based on their response to treatment : responsive and hypo-responsive. Results : PRU variability was significantly greater in the hypo-responsive group when compared to the responsive group (p=0.019). Pre-PRU and serum platelets counts were significantly correlated with PRU variation (p=0.005 and p=0.004, respectively). Although thromboembolic complication had no significant correlated factors, hemorrhagic complication was correlated with pre-PRU (p=0.033). Conclusion : In conclusion, variability of clopidogrel responses during clopidogrel medication was correlated to serum platelet counts and the initial clopidogrel response. Thromboembolic and hemorrhagic complications did not show correlation with the variability of clopidogrel response, or the clopidogrel response after one month of medication; however, hemorrhagic complication was associated with initial clopidogrel response. Therefore, it is recommended to test patients for an initial clopidogrel response only, as further tests would be insignificant.

Relationship between Circadian Variation in Ictus of Aneurysmal Subarachnoid Hemorrhage and Physical Activity

Lee, Jong Min,Jung, Na Young,Kim, Min Soo,Park, Eun Suk,Park, Jun Bum,Sim, Hong Bo,Lyo, In Uk,Kwon, Soon Chan The Korean Neurosurgical Society 2019 Journal of Korean neurosurgical society Vol.62 No.5

Objective : The circadian pattern of the onset time of aneurysmal subarachnoid hemorrhage (aSAH) has been reported by various authors. However, the effect of the degree of physical exertion on the circadian pattern has not been studied in detail. Therefore, we conducted this study to investigate the effect of physical exertion on the circadian pattern of aSAH. Methods : Of the 335 patients presenting with aSAH from January 2012 to December 2017, 234 patients with identifiable onset time and metabolic equivalent (MET) values were enrolled. The onset time of aSAH was divided into 4-hour intervals. The patient's physical exertion was then assessed on a scale between 1 and 8 METs using generally accepted MET values, and categorized into two groups-light exertion (1 to 4 METs) and moderate to heavy exertion (5 to 8 METs)-to determine the effect of the degree of physical exertion on the onset time distribution of aSAH. Multivariate analysis was used to calculate the odds ratio (OR) between the two groups to determine the effect of the degree of physical exertion on each set of time periods. Results : There was a definite bimodal onset pattern that peaked at 08:00-12:00 hours followed by 16:00-20:00 hours (p<0.001). MET values at all time intervals were found to be significantly higher than the night time (00:00-04:00 hours) values (p<0.031). The MET value distribution showed a unimodal pattern that slightly differed from the bimodal distribution of the onset time of aSAH. There were no significant differences in the ORs of each time interval according to the degree of the MET value. Conclusion : This study reaffirmed that aSAH occurs in a bimodal pattern, especially showing the highest prevalence in the morning. Although aSAH could be related to daily activity, there were no significant changes in diurnal variations affected by the degree of physical exertion.

Arterio-Biliary Fistula as a Rare Life-Threatening Complication of Transjugular Intrahepatic Portosystemic Shunt: A Case Report

Ji Su Ko,Kwon Lyo Min,Kim Han Myun,김민정,Ha Hong Il,Park Ji Won,Woo Ji Young 대한영상의학회 2022 대한영상의학회지 Vol.83 No.3

A 46-year-old male with alcoholic liver cirrhosis underwent a transjugular intrahepatic portosystemic shunt (TIPS) for refractory ascites. On the 9th day after the procedure, he presented with melena and decreasing hemoglobin levels. Hemobilia due to fistula formation between the right intrahepatic bile duct and right hepatic artery was suspected on computed tomography. Angiography revealed a fistula of the small branches of the hepatic segmental arteries, and right intrahepatic bile duct was confirmed; embolization was successfully performed with a coil for the eighth segmental hepatic artery, a glue-lipiodol mixture for the fifth segmental hepatic artery, and gelfoam slurry for the right anterior hepatic artery. However, 2 days after embolization, the patient died owing to aggravated disseminated intravascular coagulopathy. When gastrointestinal bleeding occurs after TIPS, careful evaluation is immediately required, and hemobilia should be considered.

Hemorrhagic Synovial Cyst in the Cervical Spine: A Case Report and Review of Literature

Tae Hyeong Kim,Min Soo Kim,박은석,Jun Bum Park,Soon Chan Kwon,In Uk Lyo,Hong Bo Sim 대한말초신경학회 2017 The Nerve Vol.3 No.2

Synovial cysts of the cervical spine are rare entities and intra-cystic hemorrhage have been described in a few of these cases. Traumatic or non-traumatic origins of acute bleeding into the cyst cavity resulting in cyst enlargement and epidural compression have been reported. A 74-year-old woman presented with a 1-year history of bilateral leg weakness that has worsened within the recent couple of weeks. The spine magnetic resonance imaging revealed a heterogeneously enhanced mass which has compressed the spinal cord posteriorly at the C7-T1 level. A cervical laminectomy and removal of the mass were performed. Intra operative examination revealed that the mass contained a hematoma. The histology showed a hemorrhagic synovial cyst. The patient’s neurological condition slowly improved to stick-assisted gait after the surgical decompression. We present a case of lower cervical (C7-T1) synovial cyst with acute bleeding and sudden increase in the size of the lesion with spinal cord compression as well as a review of literature.

Characteristics of Cervical Spine Injuries Caused by Industrial Accidents: The Experience of a Single Regional Trauma Center in South Korea

Yoon Sun Geon,Sim Hong Bo,Lyo In Uk,Kwon Soon Chan,Kim Min Soo 대한말초신경학회 2023 The Nerve Vol.9 No.1

Objective: This study examined the characteristics of patients with cervical spine injuries caused by industrial accidents and analyzed the factors related to mortality.Methods: In total, 424 patients with cervical spine injuries who visited our hospital from 2016 to 2020 were divided into an industrial accident and non-industrial accident groups. Age, sex, fracture severity, facet injury, high cervical injury, spinal epidural hematoma, spinal cord injury, shock, arrival route, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), mortality, and trauma mechanism were compared between the two groups. Regression analysis was performed to determine the factors affecting mortality.Results: Industrial accident patients significantly differed from the rest of the study population in terms of the sex ratio (male ratio, 95.1% vs. 77.8%; p<0.001), arrival route (direct transport, 61.2% vs. 50.9%; p=0.017), and trauma mechanism (p<0.001). Among the trauma mechanisms, falls had the largest difference between industrial accident patients and all patients (55.3% and 28.1%, respectively). Significant associations with mortality were found for falls (odds ratio [OR], 22.330; p=0.015), ISS (OR, 1.056; p=0.008), GCS <9 (OR, 0.014; p<0.001), and shock (OR, 7.290; p<0.001).Conclusion: Falls were the most frequent trauma mechanism of cervical spine injuries in patients who experienced industrial accidents. The factors significantly correlated with mortality were falls, ISS, GCS <9, and shock.