Recurrent Post-Traumatic Adrenal Bleeding after Transcatheter Arterial Embolization: A Case Report.

Adrenal gland trauma is uncommon and is diagnosed at an increasing frequency using CT scans. However, owing to the rarity of this injury and its diverse clinical presentations and prognoses, there is no consensus on its management. In this case report, a 73-year-old male patient experienced recurrent bleeding in the right adrenal gland due to an in-car traffic accident, which was treated with repeated transcatheter arterial embolization.

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Interventional management is commonly used for traumatic injuries to the abdominal solid organs. The American Association for the Surgery of Trauma (AAST) and the World Society of Emergency Surgery (WSES) recently published guidelines for the management and treatment of liver, spleen, and kidney injuries, emphasizing the importance of interventions. Here, we discuss the characteristics of each organ and the procedure method for each organ that interventional radiologists need to know when treating trauma patients.

Compression automation of circular stapler for preventing compression injury on gastrointestinal anastomosis.

BACKGROUND: Conventional manual compression relies on the surgeon's subjective sensations, so excessive compression can cause tissue injury to the stapling line of the intestinal anastomosis. METHODS: Automatic compression monitoring and compression control system was developed for circular stapler. The tissue injury related compression variables were evaluated and accommodated by compression control device. The compression injury-reducing performance was verified on collagen sheets of in vitro experiments. RESULTS: Excessive pressure and tissue deformation were associated with compression-induced tissue damages. The safe pressure range was very narrow in weaker tissue than normal collagen. The automatic system performed proper compression within a safe pressure range without tissue injury. CONCLUSIONS: Manual compression of circular stapler could cause tissue injuries by excessive pressure and tissue deformation. Our automatic compression system is designed to control peak pressure to prevent the compressive tissue injury.

Successful endovascular embolization for traumatic subcutaneous abdominal wall hematoma via the superficial inferior epigastric artery: a case report.

Abdominal wall hematoma (AWH) after blunt trauma is common, and most cases can be treated conservatively. More invasive treatment is required in patients with traumatic AWH if active bleeding is identified or there is no response to medical treatment. Herein, we report a case of endovascular embolization for traumatic subcutaneous AWH. Almost endovascular treatment for AWH is done through the deep inferior epigastric artery. However, in this case, the superficial inferior epigastric artery was the bleeding focus and embolization target. After understanding the vascular system of the abdominal wall, an endovascular approach and embolization is a safe and effective treatment option for AWH.

Acute Impact of the Coronavirus Disease Outbreak on Behavioral Patterns and Emotional States of Pediatric Psychiatric Patients and Caregivers in Daegu, South Korea.

OBJECTIVE: This study aimed to investigate the changes in interpersonal relationships, behavioral patterns, and emotional states of children and adolescents with psychiatric disorders and their caregivers immediately after the coronavirus disease of 2019 (COVID-19) outbreak in Daegu, South Korea. METHODS: A total of 147 patients and 147 caregivers participated in the Survey for Outing and Time Usage for Child, Adolescent, and Parents and the COVID-19 Visual Analog Scale for Emotion. We classified the patients and their caregivers into the internalizing disorder (ID) and externalizing disorder (ED) groups and compared the changes. RESULTS: Parent-child relationships for adolescent patients and caregivers were interrupted, and friend relationships in all participants were disrupted, while sibling relationships improved in adolescent patients. They experienced negative emotional changes. Time spent outdoor decreased and digital screen time increased for all participants. Friend and parent-child relationships were interrupted in the ED group compared to those in the ID group. ED patients experienced negative changes in emotional states, while ID patients showed no significant changes. CONCLUSION: Results are meaningful as a reference for predicting changes in interpersonal relationships and mental status of pediatric psychiatric patients and for determining healthcare system adaptations to allow mental health support during the COVID-19 outbreak.

Characteristics of Individuals Who Converted to Dementia during a 5-Year Follow-Up.

INTRODUCTION: Early diagnosis of dementia is important; however, the diagnostic criteria for the preclinical stage of dementia, including biomarkers and pathophysiological markers, are not suitable for application in patients in real-world clinical settings. One potential noninvasive method to predict the risk of dementia conversion is the neuropsychological test. Therefore, in this study, we examined the results of various assessments, such as comprehensive neuropsychological tests, and the daily function of participants who were evaluated periodically for 5 years. METHODS: All participants were outpatients or inpatients with subjective cognitive complaints, who visited a local university hospital for neuropsychiatric evaluation, between January 2011 and January 2019. Of a total of 1,652 subjects who underwent initial screening during this period, 107 were nondemented individuals. These participants underwent periodic comprehensive cognitive tests for up to 5 years. Survival and factors affecting dementia conversion were analyzed using the time-dependent Cox regression analysis. Assessment items included demographic information, including age, sex, and education; 5 cognitive domains of a comprehensive neuropsychological test including memory, language, attention, visuospatial functions, and frontal (executive) function; Barthel's activities of daily living; the mini-mental state examination findings; and clinical dementia rating (CDR) scores. RESULTS: This study included 61 participants (21 women and 40 men) who developed dementia during the study period. Verification of the cognitive variables affecting dementia conversion revealed that better memory was associated with a lower risk of conversion (hazard ratio [HR] = 0.614, p = 0.005) and higher attention was associated with a higher risk of conversion (HR = 1.602, p = 0.023). In the analysis of the subscales of the CDR, a higher community affairs score (i.e., less social activities) was associated with a higher risk of conversion (HR = 10.814, p = 0.028). CONCLUSION: Individuals with prominent memory decline or problems with social activities should be carefully observed for dementia conversion. Cognitive intervention techniques for cognitive stimulation, such as social and leisure activities, as well as cognitive training need to be actively used for patients in whom dementia is a concern.

Embolization of Inferior Pancreaticoduodenal Artery Aneurysm with Celiac Stenosis or Occlusion: A Report of Three Cases and a Review of Literature.

True pancreaticoduodenal artery aneurysms are relatively rare, approximately 50% of which are associated with stenosis or occlusion of the celiac axis. It is imperative to treat the condition immediately after diagnosis, considering that its rupture has a mortality rate of approximately 50%. The current most commonly used method to treat pancreaticoduodenal artery aneurysms is transcatheter arterial embolization. Here, we report three cases of embolization of inferior pancreaticoduodenal artery aneurysm with celiac stenosis or occlusion along with a literature review.

Neuropsychological predictors of cognitive deterioration in non-demented individuals.

Introduction: Previous studies performed neuropsychological tests in non-demented patients, especially those with mild cognitive impairment (MCI), to predict dementia. Few recent studies reported that subjective cognitive decline (SCD) itself predicts dementia conversion. We evaluated certain characteristics and neuropsychological tests to predict cognitive deterioration in non-demented individuals.Methods: This study included 106 participants with subjective cognitive complaints (SCCs) classified as non-demented (90 MCI and 16 SCD). Data were collected at baseline and follow-up, wherein participants completed a comprehensive neuropsychological assessment to assess their cognitive and daily functions.Results: During the follow-up of all participants, 52 converted to dementia, while 54 did not. There were significant differences in age and education years, as well as language, memory, frontal lobe function, and Barthel's Activities of Daily Living Index between the groups. Correlation analysis showed a significant correlation between the deterioration of the Clinical Dementia Rating scores and baseline language, memory, and frontal lobe function scores.Conclusion(s): SCDs consistently worrying about their SCCs and those identified with SCD by their caregivers were prone to cognitive function deterioration over time. Changes in language, memory, and frontal lobe function in neurocognitive tests were significantly different between the dementia converters and non dementia converters group. Particularly, SCD and MCI individuals with significantly poor initial executive function and memory abilities should be closely monitored for future cognitive decline.

Dual-energy CT angiography-derived virtual non-contrast images for follow-up of patients with surgically clipped aneurysms: a retrospective study.

PURPOSE: To evaluate the diagnostic performance, image quality, artifacts, and radiation doses of virtual non-contrast (VNC) images, relative to true non-contrast (TNC) images, in patients with surgically clipped aneurysms. METHODS: Seventy-six patients who underwent unenhanced computed tomography (CT) and dual-energy (DE)-CT angiography after surgical clipping of 85 intracranial aneurysms were included in the study. Diagnostic performances of VNC and TNC images were compared with respect to sensitivity, specificity, and positive and negative predictive values. The results of quantitative and qualitative analyses were compared between VNC and TNC images. Radiation doses were also compared between VNC and TNC images. RESULTS: Diagnostic performance of VNC images was lower than that of TNC images; however, addition of contrast-enhanced images improved diagnostic performance. Image noise and mean attenuation of VNC images were significantly higher than those of TNC images in the centrum semiovale, cerebellum, and pons. The quality of VNC images was excellent or sufficient (85.5% for observer 1, 85.5% for observer 2), and complete acceptance of VNC images was achieved in 64.5% for observer 1 and in 71.0% for observer 2; however, the addition of contrast-enhanced images increased the level of acceptance (92.0% for observer 1, 90.9% for observer 2). Clip artifacts were significantly lower in VNC images than in TNC images. CT dose index, dose-length product, and effective dose were significantly lower without TNC images. CONCLUSION: VNC images showed lower diagnostic performance and image quality, and higher image noise than TNC images; however, VNC images could reduce clip artifacts and radiation doses.

Ultrasound Evaluation of Puncture Sites After Deployment of Two Different Types of Vascular Closure Devices: A Prospective Comparative Study.

PURPOSE: The aim of this study was to compare the ultrasonographic findings of femoral puncture sites and the complications of Perclose ProGlide® and FemoSeal™ after neurointerventional procedures. METHODS: In this prospective, single-center study, we randomly assigned 155 femoral puncture sites to treatment with Perclose ProGlide® or FemoSeal™. We hypothesized that the two different types of VCD cause different vascular changes. Ultrasonography of the femoral puncture sites was performed 24 h after the procedure and at an outpatient visit after 6 months. The intima-media thickness (IMT), vessel diameter, and minimal luminal diameter of the common femoral artery were measured; the perivascular soft tissue change and absorption of the hemostatic material were observed. The device failure rate and vascular complications associated with each device were also evaluated. RESULTS: Follow-up ultrasonography was performed at a median follow-up time of 187.0 days (range 147-240 days) after the initial ultrasonography. The IMT on follow-up ultrasonography was significantly higher in patients who received FemoSeal™ (P = 0.0000). Intimal hyperplasia and partial absorption of the hemostatic material were significantly more frequent in patients who received FemoSeal™. The vessel diameters on initial and follow-up ultrasonography were not significantly different, but the minimal diameter on follow-up ultrasonography was significantly lower in patients who received FemoSeal™. Device failure and pseudoaneurysms occurred at 9 and 3 puncture sites in patients who received Perclose ProGlide®, respectively. CONCLUSIONS: Intimal hyperplasia was more frequently observed in patients who received FemoSeal™. However, more device failures and pseudoaneurysms occurred in patients who received Perclose ProGlide®. LEVEL OF EVIDENCE: Step 2 (level 2).

Persistent trigeminal artery variant terminating in the posterior inferior cerebellar artery: a case report.

Persistent trigeminal artery (PTA) is a rare cerebrovascular variation of remnant fetal carotid-vertebrobasilar anastomoses. The PTA variant terminates in the cerebellar artery with no direct connection to the basilar artery. We present a rare case of a PTA variant that terminated directly into the ipsilateral posterior inferior cerebellar artery.

Difference in Tumor Area as a Predictor of a Pathological Complete Response for Patients With Locally Advanced Rectal Cancer.

PURPOSE: This study was conducted to discover the clinical factors that can predict pathologically complete remission (pCR) after neoadjuvant chemoradiotherapy (CRT), so that those factors may help in deciding on a treatment program for patients with locally advanced rectal cancer. METHODS: A total of 137 patients with locally advanced rectal cancer were retrospectively enrolled in this study, and data were collected retrospectively. The patients had undergone a total mesorectal excision after neoadjuvant CRT. Histologic response was categorized as pCR vs. non-pCR. The tumor area was defined as (tumor length) × (maximum tumor depth). The difference in tumor area was defined as pre-CRT tumor area - post-CRT tumor area. Univariate and multivariate logistic regression analyses were conducted to find the factors affecting pCR. A P-value < 0.05 was considered significant. RESULTS: Twenty-three patients (16.8%) achieved pCR. On the univariate analysis, endoscopic tumor circumferential rate <50%, low pre-CRT T & N stage, low post-CRT T & N stage, small pretreatment tumor area, and large difference in tumor area before and after neoadjuvant CRT were predictive factors of pCR. A multivariate analysis found that only the difference in tumor area before and after neoadjuvant CRT was an independent predictor of pCR (P < 0.001). CONCLUSION: The difference in tumor area, as determined using radiologic tools, before and after neoadjuvant CRT may be important predictor of pCR. This clinical factor may help surgeons to determine which patients who received neoadjuvant CRT for locally advanced rectal cancer should undergo surgery.

Factors Influencing the Outcome of Ultrasound-Guided Fine-Needle Aspiration for Salivary Gland Lesion Diagnosis.

OBJECTIVES: This study aimed to assess multiple factors influencing the outcomes of ultrasound (US)-guided fine-needle aspiration (FNA) of salivary gland lesions. METHODS: From 2008 to 2013, a single radiologist performed US-guided FNA of salivary gland lesions in 243 patients. With the exclusion of pure cysts, poor image quality, and insufficient static image cases, 218 salivary gland lesions in 218 patients were included. The composition, size, location, and vascularity of the lesions were retrospectively investigated on the basis of sonographic findings by the same radiologist. The relationship between sampling adequacy and multiple factors was compared, and the diagnostic accuracy of US-guided FNA of salivary gland lesions was calculated by using the final diagnosis as a reference standard. RESULTS: The sampling adequacy rate for US-guided FNA of the 218 salivary gland lesions was 96.8% (211 of 218). A significant difference was observed in the composition and vascularity of the lesions (P < .0001), whereas there was no significant difference in the patient age and sex, lesion size, lesion location, and needle size. The rate of inadequate sampling increased in predominantly cystic lesions compared with solid lesions as well as in low-vascularity lesions compared with high-vascularity lesions. Of the 218 lesions, 178 (81.7%) were ultimately diagnosed, and most were benign (162 of 178 [91.0%]). When 3 cases with indeterminate cytologic results were excluded, the sensitivity, specificity, positive and negative predictive values, and accuracy of US-guided FNA of salivary gland lesions were 64.3%, 98.8%, 81.8%, 97.0%, and 96.0%, respectively. CONCLUSIONS: When using US-guided FNA to diagnose salivary gland lesions, sampling adequacy depends on the composition or vascularity of the lesions.

Factors Correlating Outcome in Young Infants With Congenital Muscular Torticollis.

PURPOSE: No previous study using follow-up ultrasonography for evaluating the factors associated with the successful regression of congenital muscular torticollis in young infants has been published. This study aimed to assess clinical factors and sonographic features potentially influencing regression in patients with congenital muscular torticollis. METHODS: From January 2010 to December 2012, 80 infants underwent neck ultrasonography because of clinical suspicion of congenital muscular torticollis. We statistically analysed the correlation between complete resolution and clinicosonographic findings when complete resolution was defined as no visible lesion on follow-up ultrasonography. RESULTS: Of the 80 infants, 61 had congenital muscular torticollis and all were followed up by ultrasonography: 1) 34 underwent physiotherapy, and 27 of them (79.4%) revealed complete resolution in follow-up; 2) 27 did not undergo physiotherapy, and 15 of them (55.6%) showed complete resolution. A statistically significant correlation was found between physiotherapy and complete resolution, but not between complete resolution and patient sex; size, volume, and echogenicity of the lesion; and thickness ratio. CONCLUSIONS: Physiotherapy was the only factor influencing complete resolution in young infants with congenital muscular torticollis.

Risk Factors of a Pulmonary Thromboembolism After Colorectal Surgery.

PURPOSE: Previous studies have revealed that predictors and risk factors of pulmonary thromboembolism (PTE) are malignancy, immobilization, diabetes, and obesity in the postoperative patients. However, in patients undergoing colorectal cancer, studies of PTE have not been enough. Thus, we investigated the risk factors of PTE related to colorectal surgery. METHODS: From January 2009 to October 2014, 312 patients received colorectal surgery without other organ resection. The postoperative patients with PTE were 14 (4.5%), and they were classified by sex, age, and stage as a 1:3 paired match to the control group. A multiple logistic regression was performed to identify which factors were associated with PTE. RESULTS: One patient was in stage I, 3 in stage II, 9 in stage III, and 1 in stage IV. In the binary logistic regression analysis, history of diabetes mellitus (odds ratio, 6.498; P = 0.031) and being overweight (odds ratio, 10.018; P = 0.014) were independent risk factors for PTE in patients undergoing colorectal cancer. CONCLUSION: A history of diabetes mellitus and being overweight were independent risk factors of PTE after colorectal cancer.

Chemoembolization of extrahepatic collateral arteries for treatment of hepatocellular carcinoma in the caudate lobe of the liver.

PURPOSE: This study was designed to evaluate the efficacy and safety in performing chemoembolization of extrahepatic collateral arteries (EHC) for hepatocellular carcinoma (HCC) located in the caudate lobe. METHODS: Between January 2006 and November 2013, chemoembolization via EHC was performed in 35 patients with 35 caudate HCCs. Preprocedural and follow-up CT or MR scans, angiographic images, and medical records were reviewed retrospectively in consensus. Chi-square analysis was used to evaluate the relationship between tumor characteristics and type of EHC and that between tumor response and the characteristics of the tumor and chemoembolization. RESULTS: In 31 (88.6 %) patients, EHCs supplying the caudate HCC originated from the right inferior phrenic artery (RIPA). The remaining four HCCs were supplied by the gastroduodenal artery, dorsal pancreatic artery, and right and left gastric arteries. Superselective catheterization of tumor-feeding vessels from the EHC was achieved in 27 patients (77.1 %). There were no major complications. Individual tumor response supplied by the EHC at follow-up contrast-enhanced CT were as follows: complete response (n = 18), partial response (n = 9), stable disease (n = 3), and progressive disease (n = 3). Non-RIPA EHCs were significantly more common in patients who had previously received chemoembolization via the RIPA (50 %) than those who had not (6.5 %; P = 0.01). There was no significant predictive factor associated with tumor response. CONCLUSIONS: HCC in the caudate lobe can be supplied by several EHCs. Chemoembolization via these arteries can be performed safely and effectively.

Transcatheter embolotherapy with N-butyl cyanoacrylate for ectopic varices.

PURPOSE: To address technical feasibility and clinical outcome of transcatheter embolotherapy with N-butyl cyanoacrylate (NBCA) for bleeding ectopic varices. METHODS: The institutional review board approved this retrospective study and waived informed consent. From January 2004 to June 2013, a total of 12 consecutive patients received transcatheter embolotherapy using NBCA for bleeding ectopic varices in our institute. Clinical and radiologic features of the endovascular procedures were comprehensively reviewed. RESULTS: Preprocedural computed tomography images revealed ectopic varices in the jejunum (n = 7), stoma (n = 2), rectum (n = 2), and duodenum (n = 1). The 12 procedures consisted of solitary embolotherapy (n = 8) and embolotherapy with portal decompression (main portal vein stenting in 3, transjugular intrahepatic portosystemic shunt in 1). With regard to vascular access, percutaneous transhepatic access (n = 7), transsplenic access (n = 4), and transjugular intrahepatic portosystemic shunt tract (n = 1) were used. There was no failure in either the embolotherapy or the vascular accesses (technical success rate, 100 %). Two patients died within 1 month from the procedure from preexisting fatal medical conditions. Only one patient, with a large varix that had been partially embolized by using coils and NBCA, underwent rebleeding 5.5 months after the procedure. The patient was retreated with NBCA and did not undergo any bleeding afterward for a follow-up period of 2.5 months. The remaining nine patients did not experience rebleeding during the follow-up periods (range 1.5-33.2 months). CONCLUSION: Transcatheter embolotherapy using NBCA can be a useful option for bleeding ectopic varices.

Chemoembolization via the left internal mammary artery supplying hepatocellular carcinoma.

PURPOSE: To present radiologic findings that show favorable tumor response after chemoembolization via the left internal mammary artery (LIMA). MATERIALS AND METHODS: Between October 2002 and April 2013, 57 patients with hepatocellular carcinoma (HCC) underwent 69 sessions of chemoembolization via the LIMA. Imaging findings including tumor size, location, and visibility of tumor-feeding artery on cross-sectional images were retrospectively reviewed in consensus by two radiologists. Tumor response after chemoembolization via the LIMA was assessed by the modified Response Evaluation Criteria in Solid Tumors on follow-up multidetector computed tomography in consensus. RESULTS: The mean tumor size supplied by the LIMA was 6.8 cm (range, 1.0-21.0 cm). HCCs supplied by the LIMA tended to be located in the subcapsular area including exophytic features (57 of 57; 100%) and were more likely to be located in the left lobe of the liver (56 of 57; 98%). HCCs supplied by the LIMA were more likely to be multiple or infiltrative (52 of 57; 91%) and marginally recurred (43 of 57; 75%). Feeding arteries of the LIMA were identified in a high percentage of cases (49 of 66; 74%) on cross-sectional images obtained before embolization. Regarding tumor response, tumors that were newly developed or exclusively supplied by the LIMA showed better target tumor response (P = .011 and P < .0001, respectively). On multivariate analysis, tumors exclusively supplied by the LIMA showed significantly better target tumor response with odds ratio of 16.32. CONCLUSIONS: Chemoembolization via the LIMA has a favorable target tumor response when HCCs are exclusively supplied by the LIMA.

Imaging features of benign adenomyoepithelioma of the breast.

PURPOSE: The purpose of our study was to evaluate the imaging features of benign adenomyoepithelioma of the breast with a focus on sonographic (US) appearances. METHODS: Ten benign adenomyoepitheliomas in 9 patients were included in this study. Mammographic and US findings were analyzed retrospectively by 2 radiologists according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon. The BI-RADS final assessment category was also recorded. RESULTS: Of the 8 lesions for which mammography was available, 4 lesions presented with abnormal findings. Two lesions presented with an indistinct, irregular, isodense mass and a circumscribed, oval, isodense mass. The other 2 lesions presented with areas of focal asymmetry and asymmetry, respectively. On US, all of 10 lesions presented as a mass. The masses measured 0.5-1.2 cm (mean, 0.8 cm), were irregular (n = 8) or oval (n = 2) with microlobulated (n = 5), indistinct (n = 3), or angular (n = 2) margins. They were all hypoechoic, had non parallel orientation in 6 cases, and increased peripheral vascularity in 7 cases. The BI-RADS final assessment category was 4B in 6, and 4A in 4. CONCLUSIONS: Mammographic findings of benign adenomyoepithelioma were nonspecific. An irregular, non parallel orientation, microlobulated or indistinct margin, hypoechogenicity, and increased peripheral vascularity were the most frequent US features.

Immobilized CuO hollow nanospheres catalyzed alkyne-azide cycloadditions.

An approach for gram-scale synthesis of uniform Cu2O nanocubes by a one-pot polyol process was used. The CuO hollow nanostructures were prepared by adding aqueous ammonia solutions with Cu2O nanocube colloidal solutions. CuO hollow nanospheres on acetylene black (CuO/AB), were synthesized and used for the catalytic [3+2] cycloaddition of azides with terminal alkynes to provide products in good yields with high regioselectivity. The CuO/AB was readily separated by centrifugation and could be reused ten times under the present reaction conditions without any loss of catalytic activity. Transition metals loaded onto acetylene black are useful reagents for a wide variety of organic transformations. Moreover, these heterogeneous systems are promising industrial catalysts.