The Experts below are selected from a list of 150 Experts worldwide ranked by ideXlab platform
Yasuo Nakajima - One of the best experts on this subject based on the ideXlab platform.
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phase i ii study of transjugular transhepatic Peritoneovenous venous Shunt a new procedure to manage refractory ascites in cancer patients japan interventional radiology in oncology study group 0201
American Journal of Roentgenology, 2011Co-Authors: Yasuaki Arai, Yoshito Takeuchi, Yoshitaka Inaba, Miyuki Sone, Hiroya Saitoh, Yasukazu Shioyama, Yasuo NakajimaAbstract:OBJECTIVE. This multicenter phase I/II study evaluated the safety and the efficacy of transjugular transhepatic Peritoneovenous Shunt (PVS), a new palliative treatment for malignant refractory ascites.SUBJECTS AND METHODS. Patients with refractory malignant ascites and patent hepatic veins and vena cava were included in this study. Eligible patients underwent the placement of transjugular transhepatic PVS catheter via the jugular vein into the abdominal cavity through the hepatic vein. In phase I, a step-by-step analysis of the safety was performed. The safety and the efficacy were determined through phases I and II.RESULTS. Thirty-three patients were entered in this study, nine in phase I and 24 in phase II. Transjugular transhepatic PVS was technically successful in all patients. No severe adverse events were observed during the placement procedure. After the placement, 22 adverse events (grade 2 or higher) occurred. Frequent adverse events were hypoalbuminemia (24%) and decrease in hemoglobin (18%), wh...
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phase i ii study of transjugular transhepatic Peritoneovenous venous Shunt a new procedure to manage refractory ascites in cancer patients japan interventional radiology in oncology study group 0201
American Journal of Roentgenology, 2011Co-Authors: Yasuaki Arai, Yoshito Takeuchi, Yoshitaka Inaba, Miyuki Sone, Hiroya Saitoh, Yasukazu Shioyama, Yasuo NakajimaAbstract:OBJECTIVE: This multicenter phase I/II study evaluated the safety and the efficacy of transjugular transhepatic Peritoneovenous Shunt (PVS), a new palliative treatment for malignant refractory ascites. SUBJECTS AND METHODS: Patients with refractory malignant ascites and patent hepatic veins and vena cava were included in this study. Eligible patients underwent the placement of transjugular transhepatic PVS catheter via the jugular vein into the abdominal cavity through the hepatic vein. In phase I, a step-by-step analysis of the safety was performed. The safety and the efficacy were determined through phases I and II. RESULTS: Thirty-three patients were entered in this study, nine in phase I and 24 in phase II. Transjugular transhepatic PVS was technically successful in all patients. No severe adverse events were observed during the placement procedure. After the placement, 22 adverse events (grade 2 or higher) occurred. Frequent adverse events were hypoalbuminemia (24%) and decrease in hemoglobin (18%), which resolved within 1 week without additional treatment. The clinical efficacy rate at 1 week after the procedure was 67%. Occlusion of the catheter due to fibrin sheath was observed in seven patients, and the revision of the system was performed. CONCLUSION: Transjugular transhepatic PVS is a safe and feasible procedure for managing refractory ascites in patients with cancer. Sufficient efficacy was observed in our initial experience, but a larger clinical trial is warranted.
Yasuaki Arai - One of the best experts on this subject based on the ideXlab platform.
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Feasibility of externalized Peritoneovenous Shunt (EPVS) for malignant ascites Open Access
2013Co-Authors: Hiroyuki Tokue, Yoshito Takeuchi, Yasuaki Arai, Keitaro Sofue, Noriaki Sakamoto, Yoshito Tsushima, Keigo EndoAbstract:Purpose: To evaluate a new modified Peritoneovenous Shunt therapy, the externalized Peritoneovenous Shunt (EPVS) system placement, used to treat patients with malignant ascites. Methods: We retrospectively reviewed 10 patients, who were not suited for conventional Peritoneovenous Shunts (PVS), with malignant ascites, which was refractory to medical therapies. Patient characteristics, technical success, efficacy, duration of EPVS placement, adverse events, and outcome were evaluated. Clinical efficacy of the EPVS was evaluated by the change in subjective symptoms. Results: The primary reasons for applying EPVS were severe anasarca in 4 patients, potential PVS dysfunction in 3 patients, poor performance status in 2 patients, and a history of PVS occlusion in 1 patient. EPVS was successfully placed in all patients, and it provided clinical efficacy in 8 patients (80%). Early death occurred within 7 days after EPVS placement in 2 patients because of renal failure. The median duration of EPVS placement was 10.4 days (range, 2-28 days). In 6 patients (60%), the EPVS was exchanged to conventional PVS sequentially, since the initial EPVS placement resulted in an improvement of the subjective symptoms of the patients, without serious complications. Conclusion: EPVS placement may be an option for patients with malignant ascites who may not be appropriate for conventional PVS placement
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phase i ii study of transjugular transhepatic Peritoneovenous venous Shunt a new procedure to manage refractory ascites in cancer patients japan interventional radiology in oncology study group 0201
American Journal of Roentgenology, 2011Co-Authors: Yasuaki Arai, Yoshito Takeuchi, Yoshitaka Inaba, Miyuki Sone, Hiroya Saitoh, Yasukazu Shioyama, Yasuo NakajimaAbstract:OBJECTIVE. This multicenter phase I/II study evaluated the safety and the efficacy of transjugular transhepatic Peritoneovenous Shunt (PVS), a new palliative treatment for malignant refractory ascites.SUBJECTS AND METHODS. Patients with refractory malignant ascites and patent hepatic veins and vena cava were included in this study. Eligible patients underwent the placement of transjugular transhepatic PVS catheter via the jugular vein into the abdominal cavity through the hepatic vein. In phase I, a step-by-step analysis of the safety was performed. The safety and the efficacy were determined through phases I and II.RESULTS. Thirty-three patients were entered in this study, nine in phase I and 24 in phase II. Transjugular transhepatic PVS was technically successful in all patients. No severe adverse events were observed during the placement procedure. After the placement, 22 adverse events (grade 2 or higher) occurred. Frequent adverse events were hypoalbuminemia (24%) and decrease in hemoglobin (18%), wh...
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phase i ii study of transjugular transhepatic Peritoneovenous venous Shunt a new procedure to manage refractory ascites in cancer patients japan interventional radiology in oncology study group 0201
American Journal of Roentgenology, 2011Co-Authors: Yasuaki Arai, Yoshito Takeuchi, Yoshitaka Inaba, Miyuki Sone, Hiroya Saitoh, Yasukazu Shioyama, Yasuo NakajimaAbstract:OBJECTIVE: This multicenter phase I/II study evaluated the safety and the efficacy of transjugular transhepatic Peritoneovenous Shunt (PVS), a new palliative treatment for malignant refractory ascites. SUBJECTS AND METHODS: Patients with refractory malignant ascites and patent hepatic veins and vena cava were included in this study. Eligible patients underwent the placement of transjugular transhepatic PVS catheter via the jugular vein into the abdominal cavity through the hepatic vein. In phase I, a step-by-step analysis of the safety was performed. The safety and the efficacy were determined through phases I and II. RESULTS: Thirty-three patients were entered in this study, nine in phase I and 24 in phase II. Transjugular transhepatic PVS was technically successful in all patients. No severe adverse events were observed during the placement procedure. After the placement, 22 adverse events (grade 2 or higher) occurred. Frequent adverse events were hypoalbuminemia (24%) and decrease in hemoglobin (18%), which resolved within 1 week without additional treatment. The clinical efficacy rate at 1 week after the procedure was 67%. Occlusion of the catheter due to fibrin sheath was observed in seven patients, and the revision of the system was performed. CONCLUSION: Transjugular transhepatic PVS is a safe and feasible procedure for managing refractory ascites in patients with cancer. Sufficient efficacy was observed in our initial experience, but a larger clinical trial is warranted.
Albert Y Yang - One of the best experts on this subject based on the ideXlab platform.
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early diagnosis of hepatic hydrothorax with associated occlusion of a peritoneo venous Shunt with tc 99m maa early diagnosis of hepatic hydrothorax with tc 99m maa
Nuclear Medicine and Molecular Imaging, 2014Co-Authors: Albert Y YangAbstract:A 53-year-old man with pancreatic adenocarcinoma and status post subtotal pancreaticoduodenectomy was referred to evaluate patency of a Peritoneovenous Shunt (Denver Shunt), which was placed for refractory ascites. The patient was injected with Tc-99m macroaggregated albumin (Tc-99m MAA) radiotracer, and immediate (30 min) and 4-h delayed scintigraphic images of the chest and abdomen obtained (Fig. 1a, b). Whereas a normal peritoneal scintigraphy would show radiotracer accumulation within the peritoneal cavity and further flow through the Denver Shunt to the system circulation, in this case there was nonvisualization of the Denver Shunt or cardiac and/or blood pool activities on both early and delayed images, suggesting obstruction of Denver Shunt. Meanwhile, tracer uptake in the right hemithorax was observed on the 4-h delayed image, which led to suspicion for hepatic hydrothorax. Of note, at the time of the nuclear medicine study, there was only a minimal right-sided pleural effusion on a chest X-ray obtained 2 h earlier (Fig. 1c, arrows). Fig. 1 After the intraperitoneal injection of 5.2 mCi Tc-99m MAA, anterior images of the chest and abdomen were obtained at 30 min (a) and 4 h (b). A chest X-ray obtained after 2 h (c) The patient received a new Denver Shunt replacement. However, a computed tomography (CT) scan of the chest obtained 2 weeks later demonstrated persistence of large ascites, and progression of hydrothorax into bilateral pleural spaces despite replacement of a new Denver Shunt (Fig. 2a). In addition, portal venous thrombosis was also noted (Fig. 2b). Despite replacement, no significant improvement in the ascites was observed; thus, the severe hepatic hydrothorax likewise recurred and was classified as refractory hydrothorax. In past studies, the Peritoneovenous Shunt had been used successfully for recurrent hepatic hydrothorax and ascites, but in this instance, it was unsuccessful [1]. The patient had persist large amount ascites and worsening bilateral pleural effusions, which were refractory to various treatments including thoracentesis and paracentesis, and died from septic shock 2 months later. Fig. 2 CT of the chest obtained 2 weeks later demonstrated persistence of large ascites (a, dashed white arrow), and progression of hydrothorax into bilateral pleural spaces (a, block white arrows) despite replacement of a new Denver Shunt (a, dashed ... Hepatic hydrothorax is the development of a pleural effusion in the setting of liver cirrhosis and portal hypertension, in the absence of cardiopulmonary disease [2]. Some cases have reported a hepatic hydrothorax without appreciable ascites [3, 4]. Although the exact mechanisms are not fully understood, hepatic hydrothorax probably results from the passage of ascites from the peritoneal cavity into the pleural cavity through small diaphragmatic defects [5, 6]. Though peritoneal scintigraphy with Tc-99m sulfur colloid can be used for detection of hepatic hydrothorax [7], our case demonstrated that Tc-99m MAA also can be used for this purpose, and was able to detect a minimal pleural effusion in the setting of severe uncontrolled ascites resulting from portal venous thrombosis. Though not as effective as replacing Shunt, urokinase has been reported to be able to restore Shunt patency [8]. Other treatment options for recurrent hydrothorax besides thoracentesis are transjugular intrahepatic portosystemic Shunt (TIPS), pleurodesis, and thoracoscopic surgery to repair the diaphragmatic defect [9, 10].
Yoshito Takeuchi - One of the best experts on this subject based on the ideXlab platform.
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Feasibility of externalized Peritoneovenous Shunt (EPVS) for malignant ascites Open Access
2013Co-Authors: Hiroyuki Tokue, Yoshito Takeuchi, Yasuaki Arai, Keitaro Sofue, Noriaki Sakamoto, Yoshito Tsushima, Keigo EndoAbstract:Purpose: To evaluate a new modified Peritoneovenous Shunt therapy, the externalized Peritoneovenous Shunt (EPVS) system placement, used to treat patients with malignant ascites. Methods: We retrospectively reviewed 10 patients, who were not suited for conventional Peritoneovenous Shunts (PVS), with malignant ascites, which was refractory to medical therapies. Patient characteristics, technical success, efficacy, duration of EPVS placement, adverse events, and outcome were evaluated. Clinical efficacy of the EPVS was evaluated by the change in subjective symptoms. Results: The primary reasons for applying EPVS were severe anasarca in 4 patients, potential PVS dysfunction in 3 patients, poor performance status in 2 patients, and a history of PVS occlusion in 1 patient. EPVS was successfully placed in all patients, and it provided clinical efficacy in 8 patients (80%). Early death occurred within 7 days after EPVS placement in 2 patients because of renal failure. The median duration of EPVS placement was 10.4 days (range, 2-28 days). In 6 patients (60%), the EPVS was exchanged to conventional PVS sequentially, since the initial EPVS placement resulted in an improvement of the subjective symptoms of the patients, without serious complications. Conclusion: EPVS placement may be an option for patients with malignant ascites who may not be appropriate for conventional PVS placement
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phase i ii study of transjugular transhepatic Peritoneovenous venous Shunt a new procedure to manage refractory ascites in cancer patients japan interventional radiology in oncology study group 0201
American Journal of Roentgenology, 2011Co-Authors: Yasuaki Arai, Yoshito Takeuchi, Yoshitaka Inaba, Miyuki Sone, Hiroya Saitoh, Yasukazu Shioyama, Yasuo NakajimaAbstract:OBJECTIVE. This multicenter phase I/II study evaluated the safety and the efficacy of transjugular transhepatic Peritoneovenous Shunt (PVS), a new palliative treatment for malignant refractory ascites.SUBJECTS AND METHODS. Patients with refractory malignant ascites and patent hepatic veins and vena cava were included in this study. Eligible patients underwent the placement of transjugular transhepatic PVS catheter via the jugular vein into the abdominal cavity through the hepatic vein. In phase I, a step-by-step analysis of the safety was performed. The safety and the efficacy were determined through phases I and II.RESULTS. Thirty-three patients were entered in this study, nine in phase I and 24 in phase II. Transjugular transhepatic PVS was technically successful in all patients. No severe adverse events were observed during the placement procedure. After the placement, 22 adverse events (grade 2 or higher) occurred. Frequent adverse events were hypoalbuminemia (24%) and decrease in hemoglobin (18%), wh...
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phase i ii study of transjugular transhepatic Peritoneovenous venous Shunt a new procedure to manage refractory ascites in cancer patients japan interventional radiology in oncology study group 0201
American Journal of Roentgenology, 2011Co-Authors: Yasuaki Arai, Yoshito Takeuchi, Yoshitaka Inaba, Miyuki Sone, Hiroya Saitoh, Yasukazu Shioyama, Yasuo NakajimaAbstract:OBJECTIVE: This multicenter phase I/II study evaluated the safety and the efficacy of transjugular transhepatic Peritoneovenous Shunt (PVS), a new palliative treatment for malignant refractory ascites. SUBJECTS AND METHODS: Patients with refractory malignant ascites and patent hepatic veins and vena cava were included in this study. Eligible patients underwent the placement of transjugular transhepatic PVS catheter via the jugular vein into the abdominal cavity through the hepatic vein. In phase I, a step-by-step analysis of the safety was performed. The safety and the efficacy were determined through phases I and II. RESULTS: Thirty-three patients were entered in this study, nine in phase I and 24 in phase II. Transjugular transhepatic PVS was technically successful in all patients. No severe adverse events were observed during the placement procedure. After the placement, 22 adverse events (grade 2 or higher) occurred. Frequent adverse events were hypoalbuminemia (24%) and decrease in hemoglobin (18%), which resolved within 1 week without additional treatment. The clinical efficacy rate at 1 week after the procedure was 67%. Occlusion of the catheter due to fibrin sheath was observed in seven patients, and the revision of the system was performed. CONCLUSION: Transjugular transhepatic PVS is a safe and feasible procedure for managing refractory ascites in patients with cancer. Sufficient efficacy was observed in our initial experience, but a larger clinical trial is warranted.
Miyuki Sone - One of the best experts on this subject based on the ideXlab platform.
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phase i ii study of transjugular transhepatic Peritoneovenous venous Shunt a new procedure to manage refractory ascites in cancer patients japan interventional radiology in oncology study group 0201
American Journal of Roentgenology, 2011Co-Authors: Yasuaki Arai, Yoshito Takeuchi, Yoshitaka Inaba, Miyuki Sone, Hiroya Saitoh, Yasukazu Shioyama, Yasuo NakajimaAbstract:OBJECTIVE. This multicenter phase I/II study evaluated the safety and the efficacy of transjugular transhepatic Peritoneovenous Shunt (PVS), a new palliative treatment for malignant refractory ascites.SUBJECTS AND METHODS. Patients with refractory malignant ascites and patent hepatic veins and vena cava were included in this study. Eligible patients underwent the placement of transjugular transhepatic PVS catheter via the jugular vein into the abdominal cavity through the hepatic vein. In phase I, a step-by-step analysis of the safety was performed. The safety and the efficacy were determined through phases I and II.RESULTS. Thirty-three patients were entered in this study, nine in phase I and 24 in phase II. Transjugular transhepatic PVS was technically successful in all patients. No severe adverse events were observed during the placement procedure. After the placement, 22 adverse events (grade 2 or higher) occurred. Frequent adverse events were hypoalbuminemia (24%) and decrease in hemoglobin (18%), wh...
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phase i ii study of transjugular transhepatic Peritoneovenous venous Shunt a new procedure to manage refractory ascites in cancer patients japan interventional radiology in oncology study group 0201
American Journal of Roentgenology, 2011Co-Authors: Yasuaki Arai, Yoshito Takeuchi, Yoshitaka Inaba, Miyuki Sone, Hiroya Saitoh, Yasukazu Shioyama, Yasuo NakajimaAbstract:OBJECTIVE: This multicenter phase I/II study evaluated the safety and the efficacy of transjugular transhepatic Peritoneovenous Shunt (PVS), a new palliative treatment for malignant refractory ascites. SUBJECTS AND METHODS: Patients with refractory malignant ascites and patent hepatic veins and vena cava were included in this study. Eligible patients underwent the placement of transjugular transhepatic PVS catheter via the jugular vein into the abdominal cavity through the hepatic vein. In phase I, a step-by-step analysis of the safety was performed. The safety and the efficacy were determined through phases I and II. RESULTS: Thirty-three patients were entered in this study, nine in phase I and 24 in phase II. Transjugular transhepatic PVS was technically successful in all patients. No severe adverse events were observed during the placement procedure. After the placement, 22 adverse events (grade 2 or higher) occurred. Frequent adverse events were hypoalbuminemia (24%) and decrease in hemoglobin (18%), which resolved within 1 week without additional treatment. The clinical efficacy rate at 1 week after the procedure was 67%. Occlusion of the catheter due to fibrin sheath was observed in seven patients, and the revision of the system was performed. CONCLUSION: Transjugular transhepatic PVS is a safe and feasible procedure for managing refractory ascites in patients with cancer. Sufficient efficacy was observed in our initial experience, but a larger clinical trial is warranted.