Sonographically-guided Parasacrum Infrapiriformis Drainage of Deep Pelvic Abscesses: An Anatomical Safety Study Using SYNAPSE VINCENT.

Objectives: Deep pelvic abscesses are surrounded by the pelvic bones, bladder, gynecological organs, intestinal tract, and nerve and vascular systems, and are approached by various routes for drainage. The transgluteal approach is often performed under computed tomography guidance; however, if ultrasonography can be used to confirm the approach, it is considered more effective because it reduces radiation exposure and allows for real-time puncture under sonographic and fluoroscopic guidance. Methods: This retrospective study was conducted at Tobata Kyoritsu Hospital (Fukuoka, Japan) between April 1, 2021, and December 31, 2022. Sonographically guided transgluteal drainage with fluoroscopy was performed in five consecutive cases of deep pelvic abscesses using a 3D image analysis system (SYNAPSE VINCENT) to study the anatomy for safe puncture. Results: Three patients had postoperative abscesses from colorectal cancer, one caused by perforation of the appendicitis, and one caused by sigmoid diverticulitis. The average drainage duration was 11 days (SD = 6.7). No complications, such as bleeding or nerve damage, were observed. Conclusions: We constructed a 3D image of the puncture route of the trans greater sciatic foramen using SYNAPSE VINCENT to objectively comprehend the anatomy and puncture route. The ideal transgluteal approach is to insert the catheter as close to the sacrum as possible at the level of the infrapiriformis. The parasacrum infrapiriformis approach can be performed safely and easily using ultrasound guidance and fluoroscopy.

Immunophenotypes and Tumor Immune Microenvironment in Hepatocellular Carcinoma With Macrotrabecular Massive and Vessels Encapsulating Tumor Clusters.

BACKGROUND/AIM: Recently, vessels encapsulating tumor clusters (VETC) pattern and macrotrabecular massive (MTM) pattern of hepatocellular carcinoma (HCC) have been reported as aggressive histological types. These histological patterns showed an immunosuppressive tumor immune microenvironment (TIME). Since there have been no reports on the differences of these two subtypes simultaneously, this study examined the immunophenotypes and TIME of MTM-HCC and VETC-HCC immunohistochemically. PATIENTS AND METHODS: Seventy-four cases of previously diagnosed HCC, including 32 MTM-HCCs, 21 VETC-HCCs, and 21 conventional HCCs, were enrolled in immunohistochemical analysis. We conducted immunohistochemical analysis. RESULTS: We found that MTM-HCC showed less frequent expression of HepPar-1, which is one of the most common hepatocytic markers. In MTM-HCC, the frequency of high expression levels of Keratin19, carbonic anhydrase (CA) IX, and PD-L1 was higher compared to VETC-HCC and conventional HCC. PD-L1 expression was found in 34.4% of MTM-HCC, 0% of VETC-HCC, and 19.0% of conventional HCC. The rate of PD-L1 expression in MTM-HCC was significantly higher than the others (p=0.0015). PD-L1 expression was significantly associated with epithelial cell adhesion molecules and CA IX expression, which are representative markers of tumor stemness and hypoxic conditions, respectively. The CD8 infiltration in VETC-HCC was significantly lower than that in conventional HCC. CONCLUSION: MTM-HCC had different immunophenotypes and TIMEs compared to HCC with the VETC pattern. Although both had immunosuppressive TIME, the elements forming TIME were quite different. To enhance the immune checkpoint inhibitor efficacy, changing TIME from a suppressive to an active form is essential.

Prepancreatic postduodenal portal vein: a case report and literature review.

BACKGROUND: Among congenital anomalies of the portal venous system, prepancreatic postduodenal portal vein (PPPV) is very rare and has only been reported to date. Herein, we report a case of PPPV identified in preoperative examinations for hepatocellular carcinoma and a literature review. CASE PRESENTATION: A 63-year-old man was admitted to our hospital for treatment of a liver tumor. After examination, he was diagnosed with hepatocellular carcinoma with a diameter of 40 mm in segment 8. Contrast-enhanced computed tomography scan showed a portal vein passing between the duodenum and pancreas, hence called PPPV. At the hepatic hilus, the portal vein branched off in a complicated course with some porto-portal communications. We determined that anatomical resection with manipulation of the hepatic hilum in this case resulted in major vascular injury. Therefore, we performed partial liver resection, and the patient was discharged uneventfully on postoperative day 14. CONCLUSIONS: Although PPPV is an extremely rare congenital vascular variant, it is important to carefully identify vascular patterns preoperatively and to recognize the possibility of such an anomaly to avoid misidentification and inadvertent injuries during surgery.

[A Case of the Spontaneously Ruptured Recurrence Hepatic Angiosarcoma after Hepatic Resection].

A 67-year-old male was referred to our hospital in a state of shock. Transcatheter arterial embolization(TAE)was performed for the diagnosis of liver tumor rupture, followed by extended posterior area resection 18 days later. Histopathologically, he was diagnosed with hepatic angiosarcoma. The patient was discharged 18 days after the surgery, but readmitted on the 51st day due to bleeding shock caused by the rupture of a recurrent tumor in the liver. Although TAE was performed, the patient developed hepatic failure and died on postoperative day 81. Autopsy revealed multiple intrahepatic recurrence and peritoneal dissemination. Herein, we report a case of ruptured hepatic angiosarcoma that underwent hepatic resection after TAE and had a rapid outcome due to early postoperative rupture of recurrent lesion.

[A Case of Small Cell Neuroendocrine Carcinoma of the Gallbladder].

A 76-year-old female was referred to our hospital with a tumor of the gallbladder using ultrasonography. CT and MRI of the abdomen and endoscopic ultrasonography revealed thickened walls of the body of her gallbladder. Endoscopic retrograde cholangiopancreatography was performed, adenocarcinoma was suspected based on bile cytology, and extended cholecystectomy with lymphadenectomy was performed. The postoperative pathological diagnosis was small cell neuroendcrine carcinoma. Three months after the surgery, CT revealed that she had multiple recurrences in the distant lymph node, and she died two months later. Gallbladder neuroendocrine carcinoma is rare and which is thought to have a poor prognosis, so effective multidisciplinary treatment must be required for this disease. In this case, it might need not to hesitate to perform preoperative endoscopic ultrasound guided fine needle aspiration(EUS-FNA).

Linking synthesis and structure descriptors from a large collection of synthetic records of zeolite materials.

Correlating synthesis conditions and their consequences is a significant challenge, particularly for materials formed as metastable phases via kinetically controlled pathways, such as zeolites, owing to a lack of descriptors that effectively illustrate the synthesis protocols and their corresponding results. This study analyzes the synthetic records of zeolites compiled from the literature using machine learning techniques to rationalize physicochemical, structural, and heuristic insights to their chemistry. The synthesis descriptors extracted from the machine learning models are used to identify structure descriptors with the appropriate importance. A similarity network of crystal structures based on the structure descriptors shows the formation of communities populated by synthetically similar materials, including those outside the dataset. Crossover experiments based on previously overlooked structural similarities reveal the synthesis similarity of zeolites, confirming the synthesis-structure relationship. This approach is applicable to any system to rationalize empirical knowledge, populate synthesis records, and discover novel materials.