Double-balloon endoscopy versus magnet-imaging enhanced colonoscopy for difficult colonoscopies, a randomized study.

BACKGROUND AND STUDY AIMS: Studies have estimated that failure of cecal intubation occurs with conventional colonoscopy in up to 10 % of cases. Double-balloon endoscopy (DBE) systems, magnetic endoscope imaging (MEI), and transparent cap have been shown to improve success rates for colonoscopy. This study evaluated the utility of DBE for complete examination of the colon compared with MEI plus cap (MEI-Cap) after incomplete or technically difficult colonoscopy in a randomized comparative manner. PATIENTS AND METHODS: A total of 94 patients with incomplete or technically difficult colonoscopy were randomly assigned to receive either DBE (n = 47) or colonoscopy with MEI-Cap (n = 47). The primary end point was cecal intubation rate within 30 minutes. Secondary end points included intubation time, pain score using a visual analog scale, abdominal pressure attempts, doses of sedative medication, and changes in patient position during colonoscopy. RESULTS: Patient characteristics were comparable in both groups. Cecal intubation rate within 30 minutes was significantly higher for DBE (45 /47, 95.7 %) than for MEI-Cap (34 /47, 72.3 %) (P = 0.0049). Mean time to reach the cecum was significantly lower in the DBE group (13.0 ±â€Š5.3 minutes) than in the MEI-Cap group (16.4 ±â€Š4.8 minutes; P = 0.0003). No complications were encountered in either group.   CONCLUSION: DBE is more useful for complete examination of the colon than MEI-Cap in patients with incomplete or technically difficult colonoscopy.

Attenuation correction in evaluating renal function in children and adults by a camera-based method.

UNLABELLED: Correction for soft-tissue attenuation is required to evaluate absolute renal function by a camera-based method, and an estimate of renal depth and an attenuation coefficient are commonly used for attenuation correction. The first goal of this study was to develop formulas for the calculation of renal depth in both children and adults. The second goal was to optimize the attenuation coefficient for the estimation of renal accumulation of a 99mTc-labeled agent. METHODS: Renal depth was measured by CT in 74 children and 232 adults and compared with the depth calculated using previously published equations. Multiple stepwise linear regression analysis was conducted using data from children and adults together, and new formulas to calculate renal depth were derived. Using the resulting equations, percentage renal uptake at 2-2.5 min was computed from 99mTc-diethylenetriamine pentaacetic acid (DTPA) renography in 40 children and 92 adults. Percentage renal uptake was assessed using various values of an attenuation coefficient, and an optimized attenuation coefficient was determined to maximize the correlation coefficient between percentage renal uptake and glomerular filtration rate (GFR) measured from 2 blood samples. RESULTS: Although the previously published equations appeared to be acceptable in predicting adult renal depth, they substantially underestimated pediatric renal depth. Renal depth (D, cm) was shown by stepwise regression analysis to depend on the ratio of body weight (W, kg) to body height (H, cm) and was successfully calculated in both children and adults using the derived equations (right: D = 16.778 x W/H + 0.752; left: D = 16.825 x W/H + 0.397). The correlation coefficient between percentage renal uptake of 99mTc-DTPA and measured GFR varied substantially according to the attenuation coefficient used and was the highest (0.947) with an attenuation coefficient of 0.087/cm. CONCLUSION: The equations presented here enabled estimation of renal depth irrespective of the patient's age. Attenuation correction using these equations and the optimized attenuation coefficient appears to aid in evaluating renal accumulation and, consequently, renal function in both children and adults.

Breast parenchymal activity on scintimammography: comparison between bone-seeking agents and 99mTc-sestamibi.

The aim of this study was to evaluate breast parenchymal activity on scintimammography with bone-seeking agents and 99mTc-MIBI. Scintimammography was performed with bone-seeking agents in 61 patients and with 99mTc-MIBI in 33 patients. Activity in the breast parenchyma contralateral to the suspected lesion was visually assessed by two independent observers. Increased breast parenchymal activity was shown in 19 of 61 patients examined with bone-seeking agents, while it was demonstrated in only two of 33 patients examined with 99mTc-MIBI. Breast parenchymal activity of bone-seeking agents was higher in patients aged 50 years or younger than in those older than 50. Increased parenchymal activity of bone-seeking agents may disturb visualization of primary breast cancer especially in relatively young patients. Low parenchymal activity is suggested to be a favorable characteristic of 99mTc-MIBI as a scintimammographic agent.

A case of jugular foramen chordoma with extension to the neck: CT and MR findings.

We describe a case of jugular foramen chordoma with extracranial extension into the carotid, parapharyngeal, and perivertebral spaces through the jugular foramen. Although this type of extension is unusual, the differential diagnosis of head and neck tumors includes unusual extension of chordoma as well as extension of meningioma and neurinoma from the posterior skull base.

Local recurrence of breast cancer demonstrated on 99mTc-MIBI scintigraphy.

We present a postmastectomy patient in whom a mass was palpated in the chest wall. It appeared to be difficult to determine whether the chest wall mass was local recurrence of breast cancer or granulation induced by mastectomy on computed tomography (CT). The mass was successfully demonstrated on 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy as an area of increased accumulation, and was considered to be a recurrent tumor. Surgical resection was performed, and the mass was histopathologically proven to be recurrence. 99mTc-MIBI scintigraphy may contribute to the detection of local recurrence or distant metastasis in addition to the diagnosis of primary breast cancer and axillary metastasis.

[3D-CT cystography of submucosal elevated lesion of the bladder: report of two cases].

We report 2 cases of rare inflammatory disease of the bladder arising from the bladder submucosa: eosinophilic cystitis in a 33-year-old woman and inflammatory pseudotumor of the bladder in a 41-year-old man. 3D-CT cystography demonstrated submucosal tumorous lesions clearly and enabled the evaluation of mucosae of lesions especially showed the bridging fold-like appearance of the submucosal tumorous lesion in eosinophilic cystitis.

Venous abnormalities in portal hypertension demonstrated by CT.

A total of 30 patients with portal hypertension examined by computed tomography (CT) was reviewed for identification of portosystemic collaterals and other changes in the portal venous system. CT demonstrated esophageal varices in 18 of 25 patients shown to have varices by other methods. Mediastinal venous masses secondary to a dilated azygos system and paraesophageal veins were also recognized by CT. Other collaterals, such as gastrorenal, paraumbilical pathways, and caput medusa, could be seen and instances of splenic vein dilatation and portal vein aneurysm were encountered. CT in portal hypertension can be useful in establishing that mass lesions may in fact be dilated veins.

[Two cases of alimentary tract perforation owing to ingested foreign bodies: diagnosis by CT].

We report the CT diagnosis of two cases of alimentary tract perforation caused by the ingestion of foreign bodies. The first case was a common fish bone perforation of the ileum with postoperative scar. The second case was a rare perforation caused by the impact of an uncooked rice cake on sigmoid colon diverticula. Helical CT scan clearly revealed the fish bone as a linear high-density area in the soft tissue between the right abdominal oblique muscles and ileum, and demonstrated the rice cake as high-density material in the bowel.

Fundamentals of transarterial embolization technique by drug-delivery embolic emulsion.

SUMMARY: We developed new embolic drug delivery emulsions to be utilized for malignant neoplasms. We combined additional water-soluble contrast materials (Ioxaglic acid, Iopamidol) with Glyceol, Poloxamer-188, or D-Mannitol to antitumor agent Lipiodol ultrafluid in order to generate stable emulsions. Some of these emulsions have been shown to cause pulmonary embolism in rabbits and to allow gradual diffusion of the antitumor agent in vitro. Good therapeutic utility is indicated. In particular, one emulsion containing D-Mannitol (Mizonokuchi emulsion), is expected to prolong drug delivery in malignant brain tumors.

Detection of paraesophageal varices by plain films.

Plain-film findings of paraesophageal varices were investigated in 352 patients with portal hypertension. Paraesophageal varices were suggested on routine chest films in 17 cases (4.8%) and on Bucky films in 30 cases (8.3%). Plain-film findings included posterior mediastinal mass shadows, obliteration of the descending aorta, and mass density adjacent to the descending aorta appearing to be intraparenchymal (lesions in the inferior pulmonary ligament). The importance of close observation of subtle findings on plain chest films is stressed.

Progressive bone resorption after pathological fracture of the femoral neck in Hunter's syndrome.

We report a case of Hunter's syndrome associated with a transverse fracture of the left femoral neck after minor trauma, followed by progressive resorption of the femoral head at 12 years of age and a stress fracture of the right femoral neck at 16 years of age. MRI performed at 15 years of age revealed intra-articular low intensity on T1-weighted and T2-weighted images of both hip joints. The MR finding may represent fibrous synovial thickening, which caused pressure erosion of the femoral neck, resultant pathological and/or stress fractures, and subsequent osteonecrosis with rapid absorption of the femoral head.

[3D-CT cystography with perspective volume-rendering].

We evaluated the clinical utility of 3D-CT cystography using the perspective volume rendering technique in 5 patients with disorders of the urinary bladder and prostate. Unlike the conventional orthostatic volume-rendering technique, the capability of optional visual point settlement in the urinary bladder precluded cutting a subset of acquired data for luminal inspection, and permitted observation closer to lesions. Consequently, the technique enabled the evaluation of the accurate size, shape, and relation to adjoining mucosa and the region shaded by bulky tumor. 3D-CT cystography using the perspective volume-rendering technique facilitated 3-D inspection of the bladder lumen.