ObjectiveTo evaluate the feasibility, safety and the effectiveness of the complex assembly of open cell nitinol stents for biliary hilar malignancy.Materials and MethodsDuring the 10 month period between January and October 2007, 26 consecutive patients with malignant biliary hilar obstruction underwent percutaneous insertion of open cell design nitinol stents. Four types of stent placement methods were used according to the patients' ductal anatomy of the hilum. We evaluated the technical feasibility of stent placement, complications, patient survival, and the duration of stent patency.ResultsBilobar biliary stent placement was conducted in 26 patients with malignant biliary obstruction-T (n = 9), Y (n = 7), crisscross (n = 6) and multiple intersecting types (n = 4). Primary technical success was obtained in 24 of 26 (93%) patients. The crushing of the 1st stent during insertion of the 2nd stent occurred in two cases. Major complications occurred in 2 of 26 patients (7.7%). One case of active bleeding from hepatic segmental artery and one case of sepsis after procedure occurred. Clinical success was achieved in 21 of 24 (87.5%) patients, who were followed for a mean of 141.5 days (range 25-354 days). The mean primary stent patency period was 191.8 days and the mean patient survival period was 299 days.ConclusionApplying an open cell stent in the biliary system is feasible, and can be effective, especially in multiple intersecting stent insertions in the hepatic hilum.

ObjectiveTo evaluate the impact on wound healing and long-term clinical outcomes of endovascular revascularization in patients with critical limb ischemia (CLI).Materials and MethodsThis is a retrospective study on 189 limbs with CLI treated with endovascular revascularization between 2008 and 2010 and followed for a mean 21 months. Angiographic outcome was graded to technical success (TS), partial failure (PF) and complete technical failure. The impact on wound healing of revascularization was assessed with univariate analysis and multivariate logistic regression models. Analysis of long-term event-free limb survival, and limb salvage rate (LSR) was performed by Kaplan-Meier method.ResultsTS was achieved in 89% of treated limbs, whereas PF and CF were achieved in 9% and 2% of the limbs, respectively. Major complications occurred in 6% of treated limbs. The 30-day mortality was 2%. Wound healing was successful in 85% and failed in 15%. Impact of angiographic outcome on wound healing was statistically significant. The event-free limb survival was 79.3% and 69.5% at 1- and 3-years, respectively. The LSR was 94.8% and 92.0% at 1- and 3-years, respectively.ConclusionEndovascular revascularization improve wound healing rate and provide good long-term LSRs in CLI.

To examine the relationship between intra-access pressures and vascular stenosis, we measured the total (pT ) and static (pS ) pressures and the severity of stenosis before and after percutaneous transluminal angioplasty (PTA). The dynamic pressure (△p) and static intra-access pressure ratios (SIAPR) were calculated. We analyzed the clinical correlation of △p and SIAPR with the severity and location of stenosis, and searched potential predictive factors for the severity of stenosis using multivariate regression. While SIAPR was significantly decreased only in outflow stenosis after PTA (p < 0.0001), △p was significantly increased in both inflow and in outflow stenosis (p < 0.05). SIAPR was negatively correlated with the severity of stenosis only in outflow stenosis (p < 0.0001), and △p was significantly correlated with both inflow and outflow stenosis (p < 0.05). △p was an independent predictor for the severity of stenosis in both inflow and outflow stenosis (p < 0.05). Thus, our study suggests that △p may be more clinically useful than SIAPR not only in detecting access stenosis regardless of its location, but also providing information about the severity of stenosis.

Background and ObjectivesZZThe parotid abscess is a rare disease. It occurs mainly in patients with poor oral hygiene, dehydration, and immune compromised. This study aims to analyze clinical presentations of the parotid abscess treated with ultrasonography and fluoroscopy guided percutaneous drainage. Subjects and MethodZZA retrospective review of medical records were carried out for nine patients with parotid abscess treated with percutaneous drainage during the period from March 2007 to May 2013. ResultsZZOf the nine patients identified with parotid abscess, there were seven males and two females who were in the age range of 41 to 85 years (mean age of 61.8). The mean level of the serum amylase was 167.4 IU/L (ranging from 52 to 343). Of the nine patients, two were found with intra-parotid cystic tumor, one was infected with the Tuberculosis, and six were found with an unidentifed parenchymal infection. All except one patient were improved after percutaneous drainage. One patient, who suffered underlying diabetes, chronic renal failure and liver cirrhosis, died due to sepsis that rapidly progressed from parotid abscess despite percutaneous drainage. The mean period of hospitalization was 16.1 days. Bacteria isolations resulted in identification for 4 patients (44.4%). ConclusionZZParotid abscess could be successfully treated with ultrasonography and fluoroscopy guided percutaneous drainage unless it involved multiple regions or progressing rapidly. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(9):655-60 Key WordsZZAbscess ㆍCatheters ㆍDrainage ㆍParotid gland ㆍUltrasonography. Head and Neck Korean J Otorhinolaryngol-Head Neck Surg 2016;59(9):655-60 / pISSN 2092-5859 / eISSN 2092-6529 http://dx.doi.org/10.3342/kjorl-hns.2016.59.9.655 Korean J Otorhinolaryngol-Head Neck Surg █ 2016;59(9):655-60 deep neck abscesses. Korean J Otorhinolaryngol-Head and Neck Surg 2009;52(4):354-8. 5) Lee HS, Park JW, Lee YS, Nam SY. A case of facial nerve paralysis following parotid abscess treated by catheter drainage. Korean J Otorhinolaryngol-Head and Neck Surger 2014;57(6):415-9. 6) Takahashi A, Martini MZ, Seo J, de Oliveira Neto HG, Shinohara EH. Ultrasound-guided needle aspiration of parotid abscess. Indian J Dent Res 2012;23(3):423-5. 7) Ganesh R, Leese T. Parotid abscess in Singapore. Singapore Med J 2005;46(10):553-6. 8) Nusem-Horowitz S, Wolf M, Coret A, Kronenberg J. Acute suppurative parotitis and parotid abscess in children. Int J Pediatr Otorhinolaryngol 1995;32(2):123-7. 9) Chatterjee A, Varman M, Quinlan TW. Parotid abscess caused by Mycobacterium tuberculosis. Pediatr Infect Dis J 2001;20(9):912-4. 10) Smith DR, Hartig GK. Complete facial paralysis as a result of parotid abscess. Otolaryngol Head Neck Surg 1997;117(6):S114-7. 11) Kristensen RN, Hahn CH. Facial nerve palsy caused by parotid gland abscess. J Laryngol Otol 2012;126(3):322-4. 12) Work WP. Cysts and congenital lesions of the parotid gland. Otolaryngol Clin North Am 1977;10(2):339-43. 13) Biron VL, Kurien G, Dziegielewski P, Barber B, Seikaly H. Surgica...

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