We report the preparation, structural characterization, and detailed lactide polymerization behavior of a new Zn(II) alkoxide complex, (L(1)ZnOEt)(2) (L(1) = 2,4-di-tert-butyl-6-{[(2'-dimethylaminoethyl)methylamino]methyl}phenolate). While an X-ray crystal structure revealed the complex to be dimeric in the solid state, nuclear magnetic resonance and mass spectrometric analyses showed that the monomeric form L(1)ZnOEt predominates in solution. The polymerization of lactide using this complex proceeded with good molecular weight control and gave relatively narrow molecular weight distribution polylactide, even at catalyst loadings of <0.1% that yielded M(n) as high as 130 kg mol(-)(1). The effect of impurities on the molecular weight of the product polymers was accounted for using a simple model. Detailed kinetic studies of the polymerization reaction enabled integral and nonintegral orders in L(1)ZnOEt to be distinguished and the empirical rate law to be elucidated, -d[LA]/dt = k(p)[L(1)ZnOEt][LA]. These studies also showed that L(1)ZnOEt polymerizes lactide at a rate faster than any other Zn-containing system reported previously. This work provides important mechanistic information pertaining to the polymerization of lactide and other cyclic esters by discrete metal alkoxide complexes.

Intrahepatic cholangiocarcinoma is the second most common primary hepatic tumor. Various risk factors have been reported for intrahepatic cholangiocarcinoma, and the radiologic and pathologic findings of this disease entity may differ depending on the underlying risk factors. Intrahepatic cholangiocarcinoma can be classified into three types on the basis of gross morphologic features: mass-forming (the most common), periductal infiltrating, and intraductal growth. At computed tomography (CT), mass-forming intrahepatic cholangiocarcinoma usually appears as a homogeneous low-attenuation mass with irregular peripheral enhancement and can be accompanied by capsular retraction, satellite nodules, and peripheral intrahepatic duct dilatation. Periductal infiltrating cholangiocarcinoma is characterized by growth along the dilated or narrowed bile duct without mass formation. At CT and magnetic resonance imaging, diffuse periductal thickening and increased enhancement can be seen with a dilated or irregularly narrowed intrahepatic duct. Intraductal cholangiocarcinoma may manifest with various imaging patterns, including diffuse and marked ductectasia either with or without a grossly visible papillary mass, an intraductal polypoid mass within localized ductal dilatation, intraductal castlike lesions within a mildly dilated duct, and a focal stricture-like lesion with mild proximal ductal dilatation. Awareness of the underlying risk factors and morphologic characteristics of intrahepatic cholangiocarcinoma is important for accurate diagnosis and for differentiation from other hepatic tumorous and nontumorous lesions.

The purpose of this study was to evaluate the long-term outcomes of endovascular treatment of central venous stenosis in patients with arteriovenous fistulas (AVFs) for hemodialysis. Five hundred sixty-three patients with AVFs who were referred for a fistulogram were enrolled in this study. Among them, 44 patients showed stenosis (n = 35) or occlusions (n = 9) in the central vein. For the initial treatment, 26 patients underwent percutaneous transluminal angioplasty (PTA) and 15 patients underwent stent placements. Periods between AVF formation and first intervention ranged from 3 to 144 months. Each patient was followed for 14 to 60 months. Procedures were successful in 41 of 44 patients (93.2%). Primary patency rates for PTA at 12 and 36 months were 52.1% and 20.0%, and assisted primary patency rates were 77.8% and 33.3%, respectively. Primary patency rates for stent at 12 and 36 months were 46.7% and 6.7%, and assisted primary patency rates were 60.0% and 20.0%, respectively. Fifteen of 26 patients with PTAs underwent repeated interventions because of restenosis. Fourteen of 15 patients with a stent underwent repeated interventions because of restenosis and combined migration (n = 1) and shortening (n = 6) of the first stent. There was no significant difference in patency between PTAs and stent placement (p > 0.05). Average AVF patency duration was 61.8 months and average number of endovascular treatments was 2.12. In conclusion, endovascular treatments of central venous stenosis could lengthen the available period of AVFs. There was no significant difference in patency between PTAs and stent placement.

Foam sclerotherapy using polidocanol is clinically safe and effective for the treatment of gastric fundal varices during BRTO.