Outcomes of endovascular treatment for aortic pseudoaneurysm in Behcet's disease

ObjectiveTo evaluate the effectiveness of endovascular stent grafting for surgical management of aortic pseudoaneurysm in patients with Behcet's disease (BD).MethodsWe present a single-institution retrospective cohort of patients with aortic pseudoaneurysm and BD treated with aortic stent grafting. Computed tomography imaging was obtained preoperatively in all patients and once within 2 weeks postoperatively, and then annually. Clinical follow-up and erythrocyte sedimentation rate were used to follow BD activity. Immunosuppressant therapy was instituted prior to endovascular treatment unless a contraindication existed.ResultsFrom 1998 to 2012, 10 patients (eight male, two female; median age, 39) with BD and aortic pseudoaneurysm were treated with endovascular stent grafting at this institution. Ninety percent of these patients received immunosuppressive therapy before and after surgical treatment. The median follow-up period was 57 months (interquartile range, 43-72). The locations of the 12 pseudoaneurysms treated in this cohort were infrarenal abdominal aorta (seven), descending thoracic aorta (four), and aortic arch (one). Median pseudoaneurysm size was 4.5 cm (interquartile range, 3.4-5.9). At long-term follow-up, complete resolution of the aortic pseudoaneurysm was noted in all patients. No endoleaks occurred. Newly developed pseudoaneurysm at the distal margin of the stent graft was noted in one patient 17 months after the stent graft procedure. One patient required a subsequent stent graft placement for an expanding pseudoaneurysm of the subclavian artery. No patient deaths occurred during the follow-up period.ConclusionsEndovascular treatment of aortic pseudoaneurysm with stent-grafting in patients with BD is safe and effective with long-term durability

Immobilized Polydiacetylene Lipid Vesicles on Polydimethylsiloxane Micropillars as a Surfactin-Based Label-Free Bacterial Sensor Platform

Accurate detection and sensing of bacteria are becoming increasingly important not only in microbiology but in a variety of fields including medicine, food, public health, and environmental science. However, even new rapid methods are not convenient enough. Here, we describe a simple and efficient label-free bacterial detection system using the polydiacetylene (PDA) liposomes immobilized on the 3D polydimethylsiloxane (PDMS) micropillars. Our system utilizes the colorimetric response of amine functionalized PDA vesicles to surfactin, a bacterial cyclic lipopeptide commonly released by Gram-positive Bacillus species as an antibiotic. To improve the sensitivity of PDA vesicles to surfactin by increasing the number and surface area of immobilized vesicles, the PDA vesicles were immobilized on the micropillar structure to give a hierarchical 3D PDA vesicle structure. For the fabrication of the 3D micropillar structure, polydimethylsiloxane (PDMS) was used to overcome the limitations imposed by silicon-based fabrication. In contrast to the 2D-PDA-PDMS system, which could only hardly detect the presence of 500 μM surfactin, the 3D-PDA-PDMS system could efficiently detect the presence of 5 μM surfactin and the initial presence of 4 × 101 cells/ml of Bacillus subtilis NCIB3610, which actively produces surfactin. Furthermore, bacterial strains that are known to produce no surfactin, such as Staphylococcus aureus Newman, Escherichia coli DH5α, and Pseudomonas aeruginosa PA14 were not detected by our system suggesting that the 3D-PDA-PDMS system is highly specific to surfactin but not to other chemicals produced by bacteria. Taken together, our results suggest that the 3D-PDA-PDMS system can sensitively and selectively be used for the high throughput detection and screening of biotechnologically important surfactin-producing bacterial strains

Chylous Leakage: A Rare Complication after Axillary Lymph Node Dissection in Breast Cancer and Surgical Management

Chylous leakage is an extremely rare complication of surgery for breast cancer. We experienced a case of chylous leakage after axillary lymph node dissection. A 38-year-old woman with invasive ductal carcinoma in the left breast underwent a modified radical mastectomy after four cycles of neoadjuvant chemotherapy. The postoperative serosanguinous drainage fluid became "milky" on the fourth postoperative day. After trying conservative management, we re-explored the axilla and ligated the lymphatic trunk. Although the success of many cases supports conservative management, timely surgical intervention represents an alternative in cases where leakage persists or where the output is high

Indications for open hepatectomy in the era of laparoscopic liver resection: a high volume single institutional study

Background/Aim Since the introduction of laparoscopy for liver resection in the 1990s, the performance of laparoscopic liver resection (LLR) has been steadily increasing. However, there is currently no data on the extent to which laparoscopy is used for liver resection. Herein, we investigated the extent to which laparoscopy is performed in liver resection and sought to determine whether surgeons prefer laparoscopy or laparotomy in the posterosuperior (PS) segment. Methods For this retrospective observational study, we enrolled patients who had undergone liver resection at the Samsung Medical Center between January 2020 and December 2021. The proportion of LLR in liver resection was calculated, and the incidence and causes of open conversion were investigated. Results A total of 1,095 patients were included in this study. LLR accounted for 79% of the total liver resections. The percentage of previous hepatectomy (16.2% vs. 5.9%, P<0.001) and maximum tumor size (median 4.8 vs. 2.8, P<0.001) were higher in the open liver resection (OLR) group. Subgroup analysis revealed that tumor size (median 6.3 vs. 2.9, P<0.001) and surgical extent (P<0.001) in the OLR group were larger than those in the LLR group. The most common cause of open conversion (OC) was adhesion (57%), and all OC patients had tumors in the PS. Conclusions We investigated the recent preference of practical surgeons in liver resection, and found that surgeons preferred OLR to LLR when treating a large tumor located in the PS

Genetic diagnosis of inborn errors of immunity using clinical exome sequencing

Inborn errors of immunity (IEI) include a variety of heterogeneous genetic disorders in which defects in the immune system lead to an increased susceptibility to infections and other complications. Accurate, prompt diagnosis of IEI is crucial for treatment plan and prognostication. In this study, clinical utility of clinical exome sequencing (CES) for diagnosis of IEI was evaluated. For 37 Korean patients with suspected symptoms, signs, or laboratory abnormalities associated with IEI, CES that covers 4,894 genes including genes related to IEI was performed. Their clinical diagnosis, clinical characteristics, family history of infection, and laboratory results, as well as detected variants, were reviewed. With CES, genetic diagnosis of IEI was made in 15 out of 37 patients (40.5%). Seventeen pathogenic variants were detected from IEI-related genes, BTK, UNC13D, STAT3, IL2RG, IL10RA, NRAS, SH2D1A, GATA2, TET2, PRF1, and UBA1, of which four variants were previously unreported. Among them, somatic causative variants were identified from GATA2, TET2, and UBA1. In addition, we identified two patients incidentally diagnosed IEI by CES, which was performed to diagnose other diseases of patients with unrecognized IEI. Taken together, these results demonstrate the utility of CES for the diagnosis of IEI, which contributes to accurate diagnosis and proper treatments

Percutaneous cryoablation in early stage hepatocellular carcinoma: analysis of local tumor progression factors

PURPOSEWe aimed to evaluate the effectiveness and safety of percutaneous cryoablation (PC) for early or very early stage hepatocellular carcinoma (HCC) and assess the risk factors for local tumor progression (LTP) after PC.METHODSA total of 45 treatment-naïve patients treated with PC for early or very early stage HCCs were included in this retrospective study. The safety of PC was assessed by evaluating procedure-related complications and comparing hepatic function before and after the procedure. The effectiveness was assessed by evaluating technical success, LTP rates, and disease progression (DP) rates. Prognostic factors associated with LTP after PC were also analyzed.RESULTSTechnical success and complete response were achieved in all patients (100%) by 1 month after PC. During a mean of 28.1±15.6 months of follow-up, the incidences of LTP and DP were 11.1% and 37.8%, respectively. The LTP-free and DP-free survival rates were 93.3% and 84.4% at 1 year and 88.9% and 62.2% at 2 years, respectively. Hepatic function was normalized within 3 months after PC. There were no major complications and only one minor complication of small hematoma. On univariate and multivariate analysis, minimal ablative margin <5 mm was the only significant risk factor associated with LTP.CONCLUSIONPC is a safe and effective therapy for patients with early or very early stage HCC. Minimal ablative margin <5 mm was a significant prognostic factor for LTP

Stent insertion and balloon angioplasty for portal vein stenosis after liver transplantation: long-term follow-up results

PURPOSEIt is not easy to determine whether balloon angioplasty or stenting should be performed in patients with portal vein stenosis after liver transplantation. We aimed to propose appropriate indication by evaluating long-term outcomes of balloon angioplasty and stent insertion in adult liver transplant patients.METHODSWe retrospectively reviewed 31 patients with portal vein stenosis among 1369 patients who underwent adult liver transplantation from January 2001 to December 2015. When stenosis was confirmed by venography, angioplasty was performed first. When there was no flow improvement or pressure gradient was not decreased after angioplasty, stent insertion was performed. We also performed primary stent insertion without angioplasty for diffuse stenosis, kinking, external compression, and near occlusion of portal vein in venography. We assessed patency in patients who underwent percutaneous transluminal angioplasty and stent insertion through regular outpatient follow-up and evaluated technical and clinical success and long-term results.RESULTSTechnical success was 85% and 100% in balloon angioplasty and stent insertion, respectively. Clinical success was achieved in 78% of balloon angioplasties and in 100% of stent insertions. At 1, 5, and 10 years after balloon angioplasty, patency rates were 87%, 82%, and 68% respectively, and the rates of stent patency were all 100%. Portal vein size measured during the operation of patients with and without recurrence were 19±4.2 mm and 19±3.0 mm (P = 0.956), respectively. The balloon size of patients with and without recurrence were 11±1.95 mm and 14±1.66 mm, respectively (P = 0.013), when balloon angioplasty was performed after stenosis diagnosis.CONCLUSIONStent insertion can be considered when fibrotic changes are expected due to repeated inflammation and when the balloon size to be used is small. Balloon angioplasty seems less risky for anastomotic ruptures in portal vein stenosis in the early post liver transplantation period

Pneumatosis intestinalis after adult liver transplantation

Pneumatosis intestinalis is an uncommon disorder characterized by an accumulation of gas in the bowel wall. We described three cases undertaking liver transplantation. The patients developed diarrhea in three cases and high fever in two. An abdominal X-ray and computed tomography scan demonstrated extensive pneumatosis intestinalis in the colon with pneumoperitoneum mimicking hollow organ perforation. However, the patients had no abdominal symptoms and there was no evidence of peritonitis. The infection work-up was negative except one case with cytomegalovirus antigenemia. After one week of conservative management including bowel rest and antibiotic therapy, their pneumoperitoneum resolved spontaneously without any complication. Pneumatosis intestinalis should be considered as a differential diagnosis after adult liver transplantation with patients suffering from watery diarrhea and fever. Pneumoperitoneum, air-density in mesentery and retroperitoneum in patients with pneumatosis intestinalis without signs of peritonitis improved with conservative management, which included bowel rest and antibiotic therapy