Chronological Course and Clinical Features after Denver Peritoneovenous Shunt Placement in Decompensated Liver Cirrhosis.

BACKGROUND: Refractory ascites affects the prognosis and quality of life in patients with liver cirrhosis. Peritoneovenous shunt (PVS) is a treatment procedure of palliative interventional radiology for refractory ascites. Although it is reportedly associated with serious complications (e.g., heart failure, thrombotic disease), the clinical course of PVS has not been thoroughly evaluated. OBJECTIVES: To evaluate the relationship between chronological course and complications after PVS for refractory ascites in liver cirrhosis patients. MATERIALS AND METHODS: This was a retrospective study of 14 patients with refractory ascites associated with decompensated cirrhosis who underwent PVS placement between June 2011 and June 2023. The clinical characteristics, changes in cardiothoracic ratio (CTR), and laboratory data (i.e., brain natriuretic peptide (BNP), D-dimer, platelet) were evaluated. Follow-up CT images in eight patients were also evaluated for ascites and complications. RESULTS: No serious complication associated with the procedure occurred in any case. Transient increases in BNP and D-dimer levels, decreased platelet counts, and the worsening of CTR were observed in the 2 days after PVS; however, they were improved in 7 days in all cases except one. In the follow-up CT, the amount of ascites decreased in all patients, but one patient with a continuous increase in D-dimer 2 and 7 days after PVS had thrombotic disease (renal and splenic infarction). The mean PVS patency was 345.4 days, and the median survival after PVS placement was 474.4 days. CONCLUSIONS: PVS placement for refractory ascites is a technically feasible palliative therapy. The combined evaluation of chronological changes in BNP, D-dimer, platelet count and CTR, and follow-up CT images may be useful for the early prediction of the efficacy and complications of PVS.

Safety and Effectiveness of Endovascular Treatment of Complications Associated with Persistent Sciatic Artery: A Qualitative Systematic Review.

PURPOSE: To evaluate the safety and effectiveness of endovascular therapy with stent grafts (SGs) to treat complications associated with persistent sciatic artery (PSA) by conducting a systematic review. MATERIALS AND METHODS: The MEDLINE, Web of Science, Scopus, and Ichushi Web databases were searched to identify articles focusing on endovascular treatment with SGs for complications associated with PSA published from inception to September 15, 2023. The review included 31 case reports, 2 case series, and 7 conference proceedings. Forty patients (median age, 67 years [range, 22-88 years]; 25 women) with 41 limbs underwent endovascular treatment with 65 SGs for ischemia (n = 26), aneurysm (n = 13), and trauma (n = 2). Prior treatments were systemic anticoagulation (n = 7), thrombolysis (n = 5), thrombectomy (n = 3), and amputation (n = 1), whereas concurrent treatments were thrombolysis (n = 6) and thrombectomy (n = 2). The median number of SGs implanted was 2 (range, 1-4). Early outcomes were technical success and adverse events (AEs). Late outcomes were primary patency, secondary patency, freedom from reintervention, and clinical success. RESULTS: The technical success rate was 100%. Intervention-specific AEs were reported in 4 cases; however, there were no severe AEs. The clinical success rates at 1 and 2 years were 100% and 95.7%, respectively. The primary patency rates at 1 and 2 years were 81.5% and 67.6%, respectively, and the secondary patency rates at 1 and 2 years were 94.5% and 81.6%, respectively. CONCLUSIONS: Endovascular treatment with SGs for complications associated with PSA is safe and effective with acceptable midterm patency and durability, and is supportable as the first-choice treatment.

Characteristics of Suspicious Breast Lesions Visible Only on MR Imaging: Is It Possible to Classify into Immediate Biopsy and Careful Observation Groups?

PURPOSE: To investigate the characteristics of suspicious MRI-only visible lesions and to explore the validity of subcategorizing these lesions into the following two groups: lesions that would require immediate biopsy (4Bi) and lesions for which careful clinical follow-up could be recommended (4Fo). METHODS: A retrospective review of 108 MRI-only visible lesions in 106 patients who were diagnosed as Breast Imaging Reporting and Data System (BI-RADS) category 4 between June 2018 and June 2022 at our institution was performed by two radiologists. The breast MR images were evaluated according to BI-RADS and additional MRI descriptors (linear ductal, branching, and apparent diffusion coefficient values). The lesions were categorized by previously reported classification systems, and the positive predictive values (PPVs) for the different categories were determined and compared. Subsequently, a new classification system was developed in this study. RESULTS: The total malignancy rate was 31% (34/108). No significant differences between benign and malignant lesions were identified for focus and mass lesions. For non-mass lesions, linear ductal and heterogeneous internal enhancement suggested a benign lesion (P = 0.0013 and P = 0.023, respectively), and branching internal enhancement suggested malignancy (P = 0.0066). Segmental distribution suggested malignancy (P = 0.0097). However, the PPV of segmental distribution with heterogeneous enhancement was significantly lower than that of category 4 segmental lesions with other enhancement patterns (11% vs. 59%; P = 0.0198).As a new classification, the distribution of focal, linear, and segmental was given a score of 0, 1, or 2, and the internal enhancement of heterogeneous, linear-ductal, clumped, branching, and clustered-ring enhancement was given a score of 0, 1, 2, 3, and 4, respectively. When categorized using a scoring system, a statistically significant difference in PPV was observed between 4Fo (n = 27) and 4Bi (n = 33) (7% vs. 61%, P = 0.000029). CONCLUSION: The new classification system was found to be highly capable of subcategorizing BI-RADS category 4 MRI-only visible non-mass lesions into 4Fo and 4Bi.

Application of liquid scintillation light guide (LSLG) to scattered X-ray measurement from dental panoramic radiography system.

A 1.2 m flexible liquid scintillation light guide (LSLG) detector connected to a portable electric device was developed and applied to monitor X-rays scattered from a panoramic dental X-ray imaging apparatus. The X-ray absorption of the LSLG tube was simulated for 20 and 40 keV X-rays. The LSLG detector was calibrated by comparing doses measured by a 3-inch NaI(Tl) detector using Am-241 and Cs-137 sources. A linear relationship was obtained between dose rates (µSv/h) and count rates (cps). The elapsed time profile of scattered radiation from a panoramic dental X-ray imaging apparatus was determined. Local absorbed doses were measured with small OSL dosimeters on the LSLG tube suspended over the shoulder and the eyeglass. Behind the ears and neck (in the center of the LSLG tube) showed high doses. The LSLG detector was useful for real-time monitoring of scattered X-rays.

Outcomes of C-arm cone-beam CT-guided percutaneous procedures for thoracolumbar spondylodiscitis: a comparison between with and without intradiscal drainage.

INTRODUCTION: Percutaneous intradiscal drainage had little established evidence to date. We assessed the outcomes of C-arm cone-beam CT-guided (CBCT-guided) procedures for spondylodiscitis and compare procedures with and without intradiscal drainage. MATERIAL AND METHODS: A retrospective review was conducted on patients who underwent CBCT-guided procedures for spondylodiscitis with fluid collection in the intradiscal space between January 2010 and September 2021. Included patients were divided into two groups: with and without 'intradiscal drainage' (ID and non-ID, respectively). RESULTS: A total of 87 patients with thoracolumbar discitis (mean age 73.4 ± 12.3 years, 35 females) were included. There was no significant difference in clinical outcomes between groups. Although insignificant, a subgroup analysis of patients with discitis and psoas abscess showed a higher infection control success rate (81% (17/21) vs 58% (7/12), p = .23) and faster median C-reactive protein improvement (CRP <3 mg/dL: 12 vs 42 days, p = .11, CRP <1 mg/dL: 27 vs 45 days, p = .097) of ID than of non-ID. CONCLUSIONS: Findings did not clarify the role of intradiscal drainage when it was indicated in all cases of spondylodiscitis with fluid collection. Future studies with larger sample sizes of selected discitis cases are expected to demonstrate the superiority of intradiscal drainage.

Node-by-node diagnosis for multiple ipsilateral nodules by segmental adrenal venous sampling in primary aldosteronism.

OBJECTIVES: In patients with primary aldosteronism (PA), multiple adrenocortical nodules may be present on the surgical side. The aim of this study was to clarify the pathological diagnosis and the node-by-node diagnostic capability of segmental adrenal venous sampling (sAVS). DESIGN: Retrospective study. PATIENTS: A total of 162 patients who underwent adrenalectomy following sAVS were studied. MEASUREMENTS: Multiple nodules on the surgical side were extracted while referring to contrast-enhanced computed tomography images. We also performed a detailed histopathological analysis of the resected specimens from patients undergoing sAVS, which included immunohistochemistry for CYP11B2. RESULTS: In 11 (6.8%) patients, two to three nodules were detected on the surgical side. All patients were diagnosed by sAVS with at least one aldosterone-producing adenoma (APA) for localized aldosterone elevation in tributaries. Seven patients showed a lateralization index value of ≥4 after ACTH stimulation. Histopathologically and clinically, two patients had two or three CYP11B2-positive APAs, and the other nine patients both APAs and non-APAs. The positive predictive value of the most suspected APA, that is, the drainer that showed the highest aldosterone level by sAVS, was 11/11 (100%, 95% confidence interval [CI]: 71.5%-100%), while that for the second and third suspected APA was 3/7 (42.9%, 95% CI: 9.9%-81.6%), and they were significantly different (p = .01). Further, the positive predictive value of non-APA was 4/4 (100%, 95% CI: 39.8%-100%). CONCLUSIONS: The sAVS could correctly diagnose the aldosterone production in multiple ipsilateral adrenal nodules.

CHARACTERISATION OF RADIOACTIVE CAESIUM IN SEDIMENTS AT THE NOGAWA RIVER, JAPAN.

The TEPCO Fukushima Daiichi Nuclear Power Plant accident that occurred in March 2011 resulted in the release of radioactive caesium into the environment. The radioactive caesium has been detected in the Tama River watershed. Previous investigations have shown that the concentration of radioactive caesium in sediment was relatively high in the Nogawa River. In this study, the relationship between the concentration of radioactive caesium in the sediment and the sediment characteristics was investigated. We found that 137Cs concentration in the tributary sediment has difficulty migrating downstream, while exhibiting a strong correlation with the amount of organic matter and a correlation with the clay, silt layer. Based on the results, we inferred that 137Cs is deposited together with the organic matter and clay, silt layer in the sediment and migrates at a slower pace than that in the mainstem.

FIXED-POINT OBSERVATION AND CHARACTERIZATION OF RADIOACTIVE CS IN SOIL COLLECTED AT KAWASAKI, JAPAN.

Radioactive Cs derived from the Fukushima Daiichi Nuclear Power Plant accident was detected in soils sampled at Kawasaki, Japan. Radioactive Cs adsorbed on soil is hard to be removed. Fixed-point observation of radioactive Cs concentration was performed on two observation sites of Meiji University. The soil samples were also analyzed for the distribution of radioactive Cs concentration and chemical form. 10 years after the accident, the activity concentration of radioactive Cs in soil samples at the Ikuta Campus of Meiji University ranged from 127 to 448 Bq kg-1. The sequential extraction method results indicated that most radioactive Cs in the surface soil exists in a poorly soluble form.

The use of viabahn VBX stent-grafts for the treatment of extrahepatic portal vein hemorrhage.

Percutaneous transhepatic stent-graft placement usually requires more than a 12 F sheath, which has a higher potential risk of peritoneal hemorrhage. A case of postoperative portal vein hemorrhage after pancreaticoduodenectomy treated using a Viabahn VBX balloon expanding stent-graft is described in this report. The stent-graft was delivered using an 8 F sheath through a transhepatic approach and deployed from the superior mesenteric vein to the main portal vein. Hemostasis was achieved and graft patency was confirmed one year after the procedure.

Radiological characteristics and diagnostic impact of duplicated right adrenal veins on adrenal venous sampling in primary aldosteronism.

PURPOSE: We aimed to analyze the prevalence and radiological characteristics of duplicated right adrenal veins (DRAVs) and evaluate the diagnostic impact of adrenal venous sampling (AVS) in primary aldosteronism. METHODS: DRAVs were retrospectively identified among patients who underwent segmental AVS between April 2017 and March 2020. DRAVs were defined as main or accessory according to the drainage area. The diameter, position, hormone levels, and treatment plan based on AVS were compared between main and accessory RAVs, using the Wilcoxon rank-sum test. RESULTS: Fourteen of 432 patients (3.2%) were diagnosed with DRAVs. On venography, the mean diameters of the main and accessory side were 3±0.63 mm and 2.1±0.41 mm, respectively, and were significantly different (p < 0.001). The mean relative position in craniocaudal direction of main and accessory veins from the adrenal caudal edge on computed tomography was 65.5%±16.0%, and 48.1%±16.8%, respectively, which was significantly different (p = 0.007). The left-right positions and hormone levels were not significantly different. Based on conventional AVS, the treatment plan between DRAVs was not changed in six of eight patients, but changed from surgery to medication in two patients with right aldosterone-producing adenoma (APA)/microadenoma based on segmental AVS findings. CONCLUSION: DRAVs, in which the main RAV was thicker and more cranially located than the accessory RAV were rare. Depending on blood sampled from either of DRAVs, the diagnosis made through conventional AVS might change treatment approach from surgery to medication, especially with right APA. Hence, their identification is important to make an accurate subtyping by AVS.

Perivascular radiolucent line during recanalization of superficial femoral artery.

During the recanalization of chronic total occlusions in the superficial femoral artery, severe calcification adds technical difficulty in guidewire crossing due to poor ultrasound visualization and uncontrollable guidewire manipulation. Herein, we present the case of a 70-year-old man with chronic total occlusion of the superficial femoral artery to report the "perivascular radiolucent line" indicating aspirated air in the subintimal space, which could be noted after a failed subintimal angioplasty. The perivascular radiolucent line helped a safe guidewire tail crossing by making the vascular wall visible. Physicians should be aware of the perivascular radiolucent line in case of failed subintimal angioplasty.

Chemical State Analysis of Heavy Metals and Radioactive Cesium in Municipal Solid Waste Incineration Fly Ash Contaminated with Radioactive Cesium Released by the FDNPP Accident.

The chemical states of heavy metals and radioactive Cs were estimated in fly ash sampled at Fukushima prefecture, Japan. Estimating the speciation of incinerator fly ash is important to ensure an appropriate and efficient management of fly ash generated from disaster-related waste. In this study, fly ash collected at a waste incineration facility in Fukushima prefecture was treated using a sequential extraction test. The test results indicated that the solubility behavior of radioactive Cs was similar to that of NaCl and KCl, and approximately 60% of radioactive Cs was included as water-soluble chloride compounds in the fly ash sample. Most heavy metals eluted in three fractions, in the extraction steps for carbonate-bound, free oxide, and bound to organic matter species. The chemical states of elements in the three non-water-soluble fractions and residue showed minimal elution into the environment. Therefore, most heavy metals in the fly ash exhibited minimal elution into the environment.

A Rare Independent Left Inferior Phrenic Vein Sampling in a Left Adrenal Aldosterone-Producing Adenoma.

This report presents a case of left adrenal aldosterone-producing adenoma (APA) diagnosed by segmental adrenal venous sampling in a patient with primary aldosteronism and a rare venous anomaly in which the left inferior phrenic vein (LIPV) and adrenal central vein entered the left renal vein separately. The outflow of tumor blood into the LIPV and the specimen from the LIPV that showed much higher aldosterone level than that from the adrenal central vein and tributaries were useful for proving the aldosterone hypersecretion from the APA. Sampling from the LIPV could be of diagnostic value for left APA.

Water repellents for the leaching control of heavy metals in municipal solid waste incineration fly ash.

Suppression of heavy metal elution from municipal solid waste incineration (MSWI) fly ash by cement or geopolymer solidification was studied. When these approaches are implemented, however, the volume of the solidified body increases as a consequence of the solidifying agent addition. Considering that residual landfill disposal capacity is decreasing in the long term, a novel method to suppress the elution of heavy metals from MSWI fly ash without decreasing the disposal capacity is needed. We studied four different water repellents and the results indicated that heavy metal elution can easily be suppressed by impregnating the incineration fly ash with commercially available silane oligomers, alkyl alkoxysilane compounds, and water repellents like fatty acids.

Characterization of soluble and insoluble radioactive cesium in municipal solid waste incineration fly ash.

Soluble and insoluble radioactive cesium in municipal solid waste incineration fly ash were analyzed by X-ray diffraction and gamma-ray spectrometry. A total of 60% of soluble radioactive cesium was determined using the Tessier extraction method, and it was almost same extraction rate with Japanese leaching test No.13. In addition, chloride compounds such as halite (NaCl) and sylvite (KCl) showed same behavior with soluble radioactive cesium, therefore, soluble radioactive cesium existed as a chloride (CsCl) with water solubility characteristics. Almost insoluble radioactive cesium trapped into silicate of crystalline phase or amorphous phase was eluted by hydrogen fluoride treatment. Radioactive 137Cs was released in three stages by heating treatment (untreated - 400 °C, 600 °C-800 °C, and 800 °C-1000 °C) according to decreasing amorphous content. The relationship between the concentrations of radioactive 137Cs and amorphous phase exhibited good linearity (R = 0.9278). Insoluble radioactive 137Cs was contained in inner part of the amorphous phase, and free radioactive cesium was determined from the concentration of the amorphous phase.

Chimney Endografting for Zone 2 Thoracic Endovascular Aortic Repair Using The Reorientation Technique.

The purpose of this report was to describe the reorientation of the chimney graft technique to downsize brachial artery access during thoracic endovascular aortic repair and thus preserve left subclavian artery flow. In the case described herein, the chimney graft was advanced not from the brachial or axillary artery, but from the common femoral artery, over a brachiofemoral pull-through wire. The chimney graft was then turned out into the ascending aorta by balloon dilatation via percutaneous brachial access ("reorientation"). Despite the use of a large-diameter chimney graft, the chimney technique with percutaneous brachial access was successfully performed using the reorientation technique.

Crystal Morphology Analysis for Heavy Elements in Municipal Solid Waste Incineration Fly and Bottom Ash by X-ray Characterization Techniques.

The elemental and crystalline phase compositions of fly ash collected before and after spraying of the ash with slaked lime (first and second fly ash) and the bottom ash of municipal solid waste collected at an incineration plant were analyzed using powder briquette by X-ray fluorescence spectrometry and Rietveld refinement by X-ray diffraction. The crystalline and amorphous phase contents were quantified by adding 10% corundum as an internal standard. In the first fly ash, SiO2, Cl, and CaO were the main components, and several thousand ppm (µg/g) of Zn and Pb were detected. Anhydrite, gehlenite, and amorphous phases were the main phases in the first fly ash samples. The components of the first fly ash originated exclusively from the incineration of municipal solid waste in a furnace. The crystal morphologies of the heavy elements in the ash samples were estimated by determining the correlations among the concentrations of all the elements. The heavy elements in the bottom ash showed no strong correlations with other elements; therefore, the heavy elements in the bottom ash were present in an amorphous phase.