Assessment of the deformation rate of venous diameter during internal jugular vein puncture using a newly developed thin-tip three-dimensional needle.

BACKGROUND: The internal jugular vein (IJV) is one of the most used sites for central venous access. Some authors revealed the association of a higher deformation rate of the IJV wall with posterior wall penetration, which may cause a hemorrhagic complication. A newly developed thin-tip needle (three-dimensional (3D) needle) reduced the deformation rate in an ex vivo study. Therefore, we conducted a clinical study to investigate its efficacy in reducing vessel deformity during IJV puncture. METHODS: This study retrospectively enrolled 80 adult patients who received central venous port (CVP) implantation via the IJV from April 1, 2022, to November 10, 2023, in our institution. Traditional needle-and-catheter was used for ultrasound (US)-guided IJV puncture (usual group) for the former 40 patients before July 18, 2023. Afterward, the 3D needle was used for the latter 40 patients (3D needle group). US images were stored and analyzed to calculate the deformation rate. RESULTS: The deformation rate was 58.6% (13.2-100) for the usual needle and 41.8% (10.6-100) for the 3D needle (p = 0.0034). Patients who required several punctures included 2 for the usual needle and 12 for the 3D needle, respectively (p = 0.0032). All patients and the usual needle group demonstrated a weak negative correlation between the deformation rate and pre-puncture vessel diameter (r = 0.24 and 0.41, respectively), with no correlation in the 3D needle group. CONCLUSION: The deformation rate of the IJV wall was smaller in the 3D needle group than in the usual needle group. The use of a 3D needle would be safer when puncturing the IJV.

Selective Angiographic Evaluation in Patients with Simple-Type Pulmonary Arteriovenous Malformations Treated with Vascular Plug.

PURPOSE: To evaluate the angiographic recanalization rate of patients who underwent embolization juxta-proximal to the sac with AMPLATZER Vascular Plug type IV (AVP IV) for a simple pulmonary arteriovenous malformation (PAVM). MATERIAL AND METHODS: Ten patients (7 females and 3 males; median age, 47 years [range 28-83 years]) with 19 simple-type PAVMs who underwent embolization using an AVP IV between May 2015 and November 2021 were included in this retrospective study. The median feeding artery diameter on computed tomography was 4.0 mm (range 3-5.9 mm), and the median ratio of AVP IV size to feeding artery diameter on computed tomography was 1.5 (range 1.3-2.1). Technical success was defined by AVP IV placement at the junction between the pulmonary artery and the sac, or the pulmonary artery within 1 cm from the junction and beyond the last normal branch. The primary endpoint was the PAVM recanalization rate in selective or segmental pulmonary angiography performed 1 year post-embolization. RESULTS: The technical success rate of embolization juxta-proximal to the sac for simple-type PAVMs was 100%. None of the 19 lesions showed recanalization in pulmonary angiography performed 1 year after embolization. One patient experienced hemoptysis and pneumonia. CONCLUSION: Embolization of simple-type PAVMs' feeding vessel using AVP IV is safe and effective, with a high technical success rate and no recanalization on pulmonary angiography performed at 1 year post-embolization.

Transcatheter Arterial Embolization for Blunt Splenic Injury With Resuscitative Endovascular Balloon Occlusion of the Aorta: The Significance of Early Involvement of Radiologists.

Splenectomy is a common procedure for managing splenic injury in patients with unstable vital signs. Transcatheter arterial embolization (TAE) has emerged as a limited alternative to splenectomy, although the role of TAE can be expanded upon the stabilization of vital signs. The current case report discusses a man in his 50s, in shock after a motor vehicle accident, who was successfully stabilized using resuscitative endovascular balloon occlusion of the aorta (REBOA), followed by splenic artery embolization (SAE) instead of splenectomy, with early involvement of diagnostic and interventional radiologists from the initial stage of care. We also discuss the difficulties of SAE under REBOA and the significance of the early involvement of radiologists in trauma care.

Small renal cell carcinoma accompanied by extensive inferior vena cava tumor thrombus diagnosed by percutaneous transvenous biopsy.

Introduction: Up to 10% of patients with renal cell carcinoma present with tumor thrombus in the inferior vena cava. We report that a case of small renal cell carcinoma with tumor thrombus extending above the diaphragm for which transvenous biopsy was performed for diagnosis. Case presentation: A 79-year-old man performed computed tomography to evaluate hepatic dysfunction, which revealed intravenous tumor extending above the diaphragm and a 15-mm-sized exophytic tumor in right kidney. Imaging suggested that the renal tumor was renal cell carcinoma. As this tumor was small and exophytic, confirmation of the intravenous tumor being tumor thrombus associated with renal cell carcinoma was difficult. We simultaneously performed transvenous biopsy on the intravenous tumor and percutaneous biopsy on the renal tumor for obtaining histologic diagnoses. The final diagnosis was small renal cell carcinoma accompanied by tumor thrombus above the diaphragm. Conclusion: Transvenous biopsy may be useful for the definitive diagnosis of inferior vena cava-tumor thrombus in cases of small renal cell carcinoma.

Clinical outcomes of image-guided percutaneous drainage of pericardial effusion in cancer patients: A single-center retrospective analysis.

AIM: Catheter removal, survival, and recurrence rates after percutaneous pericardial effusion drainage in cancer patients are not fully understood. We evaluated the clinical outcomes of image-guided percutaneous pericardial effusion drainage in cancer patients. METHODS: From January 2014 to September 2017, 113 percutaneous drainages for symptomatic pericardial effusion were performed in 100 cancer patients (median 60 years; range, 7-84 years) using ultrasound or angio-computed tomography. An 8-Fr drainage catheter was placed using the Seldinger technique via the subxiphoid (n = 73), apical (n = 23), or left parasternal (n = 17) routes. Success rates, complications, and postprocedural clinical outcomes of drainages were retrospectively assessed. RESULTS: The technical and clinical success rates were 100% and 99%, respectively, without major complications. The median duration of catheterization and evacuated pericardial effusion volume were 6 days (range, 1-72 days) and 970 ml (range, 140-7635 ml), respectively. Catheters were removed after the first drainage in 86 cases (86%). Symptomatic pericardial effusion recurred in nine patients after catheter removal, in whom redrainages were performed 13 times with a median duration to redrainage time of 48 days (range, 13-529 days). During the follow-up period (median 106 days [range, 1-1396 days]), 61 patients died. The median survival was 140 days (95% confidence interval [CI], 95-276 days), and the median catheter-free survival was 111 days (95% CI, 60-152 days). CONCLUSIONS: Image-guided percutaneous pericardial effusion drainage for cancer patients is safe and helps alleviate symptoms. Additionally, catheter removal is possible in most patients, allowing a catheter-free period for patients.

Development of ileocolic artery pseudoaneurysm after renal biopsy.

The rate of bleeding complications related to percutaneous native renal biopsy is low, and pseudoaneurysms of the extrarenal arteries are rare. There have been a few reports of extrarenal artery injuries related to renal biopsy; however, to the best of our knowledge, there have not been any reports of injuries to the ileocolic artery or multiple injuries to extrarenal arteries. Herein, we report the case of an 87-year-old man who developed multiple vascular injuries: an arteriovenous fistula at the lower pole of the right kidney, pseudoaneurysms of the second lumbar artery, and an ileocolic artery 19 days after renal biopsy. Although identifying an ileocolic artery pseudoaneurysm was slightly delayed due to its rarity, all vascular injuries were successfully embolized with microcoils.

Successful treatment of chylous ascites by superselective embolization of the inflowing lymphatic vessels using a steerable microcatheter: a case study.

Background: Chylous ascites resulting from postoperative lymphatic leaks are uncommon but difficult to treat in cases with unsuccessful conservative treatment. Case report: We report the case of an 80-year-old woman who had previously undergone multiple procedures for peritoneal dissemination 3.5 months after a laparoscopic bilateral salpingo-oophorectomy for ovarian cancer. After hospital discharge, she gradually gained weight, and examination findings indicated lymphatic leakage. We performed drainage using an 8.5-French Dawson-Mueller catheter, but more aggressive treatment was deemed necessary. We determined that it would be difficult to fill the large space, in which the leaking lymph fluid was accumulating, with embolic materials. Therefore, we performed superselective embolization of these inflowing lymphatic vessels to allow control of the chylous ascites. To overcome the technical difficulty associated with the insertion of a microcatheter from a large leakage cavity into a small inflow lymphatic vessel, we adopted a triple coaxial system that utilizes a steerable microcatheter. Successful embolization resulted in marked decrease in drainage. Follow-up computed tomography revealed no evidence of reaccumulation of chylous ascites. A three-month follow-up revealed no recurrence of lymphatic leakage. Conclusions: To our knowledge, this is the first report on the treatment of large retropenitoneal chylous leakage by superselective embolization of the inflowing lymphatic vessels using steerable microcatheters. This method allows large lymphatic leaks to be treated with only a small amount of N-butyl 2-cyanoacrylate mixture and without the use of coils, and we firmly believe that it should be considered for the treatment of large refractory chylous ascites.

Inspiratory and expiratory CT analyses of the diaphragmatic crus in chronic obstructive pulmonary disease.

PURPOSE: This study aimed to investigate the association between the results of pulmonary function tests (PFTs) in patients with chronic obstructive pulmonary disease (COPD) and the size of their diaphragmatic crus (DC) using inspiratory and expiratory CT. MATERIALS AND METHODS: Thirty-three patients who underwent inspiratory and expiratory CT and PFTs between July and December 2019 were studied retrospectively. The short axis, long axis, and cross-sectional area (CSA) of the bilateral DC were measured, and the percentage change of the DC after expiration (% change of DC) in the size was calculated. The correlation between the results of the PFTs (forced expiratory volume in 1 s [FEV1], FEV1/forced vital capacity [FVC], and percent predicted FEV1 [%FEV1]) and the size and % change of DC was statistically analyzed. RESULTS: Significant correlations were observed between the short axis of the right and left DC at expiration and PFTs (FEV1, r = -0.35, -0.48, p = 0.04, .007; FEV1/FVC, r = -0.52, -0.65, p = 0.002, < .001; %FEV1, r = -0.56, -0.60, p < 0.001, < 0.001; respectively), between the CSA of the right DC at expiration and PFTs (FEV1/FVC, r = -0.42, p = 0.01; %FEV1, r = -0.41, p = 0.017; respectively), and between the % change of the short axis of the left DC and the CSA of the left DC and PFTs (FEV1, r = 0.64, 0.56, p < 0.001, .001; %FEV1, r = 0.52, 0.51, p = 0.004, 0.004; respectively). The smaller the short axis of the DC and CSA at expiration and the larger the % change in DC of the CSA, the lower the airflow limitation. CONCLUSION: There were significant correlations between airflow limitation and the short axis of the bilateral DC at expiration, and the % change in the DC of the CSA. Certain CT measurements of the DC may reflect airflow limitation in patients with COPD.

Preloading Coil in Plug Method (p-CIP) with the AVP 2 for large Portosystemic Shunt Embolization.

Hepatic encephalopathy caused by a large portosystemic shunt (PSS) can be treated by endovascular embolization of the shunt. The PSS diameter can be >20 mm; it occasionally poses technical difficulties. Here, a 72-year-old woman with liver cirrhosis, hyperammonemia, and large spleno-renal shunt underwent shunt embolization using an Amplatzer vascular plug 2 (AVP2) and metallic coils. The preloading coil in plug method (p-CIP), which facilitated embolization inside the AVP2 without cannulation from outside, was employed to overcome technical difficulties. We propose the use of p-CIP with an AVP2 as a tool for treatment of hepatic encephalopathy with PSS.

The value of angio-CT system on splanchnic nerve neurolysis.

PURPOSE: We aimed to evaluate the effectiveness and safety of splanchnic nerve neurolysis (SNN) with angio-CT, a hybrid system combining computed tomography (CT) with X-ray fluoroscopy. METHODS: Thirty-three SNN procedures with angio-CT performed in 30 patients with severe epigastric cancer pain (11 males and 19 females; median age, 57 years; age range, 19-79 years) between January 2010 and July 2017 were retrospectively evaluated. The primary endpoints were the technical success and adverse event rates. The secondary endpoints included the clinical success rate, defined as a reduction in the numerical rating scale for pain score or a decrease in the consumption of analgesics on day 1 and at 1-2 weeks after the procedure; procedure time; the number of needle punctures; amount of ethanol required; and the distribution of contrast medium in the retrocrural space. These endpoints were compared with previous studies that did not employ the angio-CT system. RESULTS: The technical success rate was 96.97%. There were two procedure-related adverse events (one retroperitoneal hemorrhage, one pneumothorax). The clinical success rates on day 1 and at 1-2 weeks after the procedure were 84.38% and 87.5%, respectively. The median procedure time was 60 minutes. The median number of needles used was 2. The median amount of ethanol used was 20 mL. CONCLUSION: SNN under angio-CT is safe and effective, with excellent technical and clinical success rates and acceptable adverse event rates. These results are comparable with previous studies that did not involve angio-CT. However, the use of angio-CT allows for easier needle positioning and an earlier response to complications compared with conventional methods.

A Technical Improvement for Percutaneous Puncture of the Intervertebral disc by Passing Lateral to the Superior Articular Process Using the Isocenter Puncture Method.

Purpose: Percutaneous intervertebral disc puncture is useful in various situations. The isocenter puncture method enables easy, accurate, and safe punctures under fluoroscopic guidance. Herein, we present a clinical application of this technique that improves upon percutaneous puncture of intervertebral discs. Material and Methods: We performed percutaneous punctures of intervertebral discs slightly lateral to the superior articular process using the isocenter puncture method in 19 cases (10 men, 9 women; mean age, 64.5 years; range, 23-87 years). We assessed the technical success rate, procedure time, and complications. Results: We achieved successful punctures in all cases, with a median puncture time of 14.5 min (mean, 18.7 ± 11.3 min; range, 8-49 min). No patients complained of complications that were permanent or required treatment. Conclusions: Improved puncture of intervertebral discs seems to be possible using the isocenter puncture method.

A monoclonal antibody-based indirect competitive enzyme-linked immunosorbent assay to quantify swertiamarin and related compounds in Swertia japonica Makino.

INTRODUCTION: Swertia japonica Makino (S. japonica) has a long history of use as a folk medicine, and it is one of the three essential Japanese folk medicines. S.japonica has been reported to have various biological activities. The biologically active secoiridoid glycoside swertiamarin (SM) has been isolated from S. japonica. The efficacy of this plant is attributed to SM and related secoiridoid glycosides. To control the quality of S. japonica for medicinal use, a method for the determination of SM and other secoiridoid glycosides in the plant is needed. OBJECTIVE: To produce an anti-SM monoclonal antibody (MAb) and develop an indirect competitive enzyme-linked immunosorbent assay (icELISA) for S. japonica standardisation and quality control. METHODOLOGY: SM was conjugated to cationised bovine serum albumin (cBSA), and the SM-cBSA conjugate was used to immunise BALB/c mice. Splenocytes from the immunised mice were then fused with SP2/0 myeloma cells to produce hybridoma cells that expressed anti-SM MAb. RESULTS: The developed icELISA was sufficiently sensitive and had a quantitative range of 0.78 to 12.5 µg/mL. Coefficients of variation below 10% indicated good repeatability. Recoveries in a spike and recovery assay ranged from 91.84% to 115.50%, which confirmed that the icELISA was accurate. The SM content measured using the icELISA was in agreement with the results of a high-performance liquid chromatography-ultraviolet (HPLC-UV) assay. CONCLUSION: The icELISA is suitable for the high-throughput analysis of SM and other secoiridoid glycosides in S. japonica. The method is fast, economical, and reliable for S. japonica quality control.

Inferior mesenteric arteriovenous fistula during treatment with bevacizumab in colorectal cancer patient: A case report.

BACKGROUND: Fistula formation is a severe adverse event related to antiangiogenetic agents such as bevacizumab and inferior mesenteric arteriovenous fistula (IMAVF) is a result of acquired factor, especially colon surgery. However, IMAVF occurs very rarely and there are few reports in patients during chemotherapy. We report a case of a patient who developed IMAVF during treatment with bevacizumab in metastatic colorectal cancer (mCRC) after colon surgery. CASE SUMMARY: An 81-year-old man was diagnosed with descending colon cancer and underwent left hemicolectomy without any complications. He was definitely diagnosed with high-risk stage 2 and received tegafur-uracil plus leucovorin as adjuvant chemotherapy. Three years and 6 mo after the operation, the cancer relapsed with peritoneal dissemination. The patient underwent CyberKnife radiosurgery targeting the recurrent tumor and received chemotherapy with S-1 plus bevacizumab. At 1 year after chemotherapy, he complained of severe diarrhea, which is suspected drug-induced colitis. As diarrhea worsened despite the termination of treatment, he underwent colonoscopy and computed tomography (CT) scans that revealed edematous change from sigmoid to rectosigmoid colon. CT scans also revealed an aneurysm adjacent to the inferior mesenteric vein and multidetector CT angiography showed the IMAVF. Elective angiography confirmed the diagnosis of an IMAVF and it was successfully treated by arterial embolization. The patient resumed chemotherapy with only S-1 6 mo after embolization. CONCLUSION: Clinicians should keep in mind the probability of severe diarrhea arose from IMAVF in mCRC patients treated with bevacizumab.

Spinal Cord Infarction after Transcatheter Embolization of Pelvic Arteriovenous Malformation.

An 80-year-old woman presented with abdominal and right lower limb pain. Radiological examination revealed pelvic arteriovenous malformations (pAVMs). Although transarterial embolization was repeated, dilation of the common iliac vein worsened. Four sessions of embolization were performed for the internal iliac vein. Paraplegia gradually occurred a day after the final procedure. Magnetic resonance imaging revealed thoracic spinal cord edema and paraspinal vasodilatation, suggesting spinal cord infarction. Additional angiography revealed a radiculomedullary vein draining into the spinal canal from the pAVM; hence, surgical interruption was performed. Incomplete venous embolization of the pAVM caused spinal cord congestion and infarction.

Magnetic particles-based enzyme immunoassay for rapid determination of secoiridoid glycoside, amarogentin.

Amarogentin (AG) is one of the bitter secoiridoid glycosides, which exerts various pharmacological activities as a bitter stomachic. Recently, there is an increasing demand for AG-containing plants in Japan due to their use as folk medicines and food additives; hence, it is crucial to develop analytical techniques that are specific for AG. In this study, a new magnetic particles-based enzyme immunoassay (MPs-EIA) using a specific monoclonal antibody against AG (MAb 1E9) for the rapid determination of AG in plants of the family Gentianaceae was described. AG directly immobilized onto magnetic particles (MPs) was used as a competitor for free AG against MAb 1E9, thereby increasing the surface area of the solid phase and decreasing the immunoreaction time. In addition, the blocking step required in case of the conventional enzyme-linked immunosorbent assay could be avoided in the proposed MPs-EIA, which enables an even more rapid performance for the immunoassay. In the developed MPs-EIA, AG exhibited linearity in the range of 15.6-500 ng mL-1, with a limit of detection of 8.58 ng mL-1. Validation analysis revealed that MPs-EIA is a sufficiently sensitive and rapid for the quantitative analysis of AG in plant samples. To the best of our knowledge, this is the first MPs-EIA that has been applied to plant samples.

Sensitive quantitative analysis of the bitter glycoside amarogentin by specific monoclonal antibody-based indirect competitive enzyme-linked immunosorbent assay.

Amarogentin (AG) is a naturally occurring secoiridoid glycoside produced mainly in the plant genera Swertia and Gentiana. Extracts of these plants have a long history of use in Japan as bitter stomachics because of their strong bitterness. Because the AG content directly reflects the potential activity of the extract, the quality control of these plant extracts through the quantitative analysis of AG is important. In the present study, we aimed to develop a quantitative analysis of AG using a monoclonal antibody (MAb) against AG (MAb 1E9) in the plant family Gentianaceae. Surprisingly, production of MAb 1E9 was successfully achieved by immunizing AG-bovine serum albumin (BSA) conjugates into mice although the number of AG bound to BSA was only one. The characterization of MAb 1E9 revealed that it shows high specificity to AG, enabling the development of an icELISA for the specific determination of AG. In addition, the detectable concentration of AG in the developed icELISA ranged from 1.95 to 62.5 ng mL-1 with a limit of detection of 1.28 ng mL-1, which is approximately 30-625 times higher in sensitivity compared with the conventional HPLC method. Validation analysis revealed that the icELISA using MAb 1E9 is precise (intra-assay variation <3.9%, inter-assay variation <8.8%) and accurate (recovery rates of spiked samples were between 91.0% and 106.4%). This method can be used for the quality control of plant extracts using AG as an index.