Examination of Some Factors Affected Right-to-left Shunt Rate and the Normal Value of Right-to-left Shunt Rate in Lung Perfusion Scintigraphy.

PURPOSE: Diagnosis for right-to-left shunt was determined by the assessment of shunt-rate, which was obtained by using 99 mTc-macroaggregated albumin. However, it is difficult to diagnose right-to-left shunt, using the normal level of shunt-rate measured by using conventional methods. To solve this problem, we investigated ourselves the normal level of shunt-rate. METHOD: We researched 20 patients with pulmonary embolism, and they didn't have right-to-left shunt. We investigated three points for the normal level of shunt-rate. First, we examined the region of interest (ROI) area of the lungs to modify the upper level of gray scale. Second, we confirmed the difference between the whole visual field and body contour of the ROI area. Third, we examined the necessity whether we correct the background of whole body and the lungs. RESULT: We resulted three points. First, stable right-to-left shunt rate is got to set that the upper level of gray scale is 35%. Second, there is no significant difference between the whole visual field and body contour of the ROI area. Third, correcting background isn't needed to get right-to-left shunt rate. The normal level of the shunt-rate was 12.6±2.8% in the condition. CONCLUSION: We are able to decide the optimal condition for the normal level of shunt-rate. It is important to evaluate the normal level of the shunt-rate fixed on each factor in each hospital.

Metachronous multiple adenocarcinomas of the pancreas.

We report a rare case of metachronous multiple adenocarcinoma of the pancreas. A 59-year-old Japanese man visited our institute for a routine workup as a hepatitis C virus carrier, resulting in detection of a 3-cm tumor in the pancreatic body by screening echogram. Results from several imaging modalities were consistent with pancreatic carcinoma. Distal pancreatectomy along with dissection of partial gastrectomy, transverse colectomy, and lymph node dissection were performed in November 2003. Histological examination confirmed a pancreatic ductal adenocarcinoma with a clear surgical margin and negative lymph node metastases. Gemcitabine was administered for 5 years, then suspended because no recurrent signs were found. The patient returned to our hospital in March 2009, with obstructive jaundice along with a 2-cm tumor in the head of the remnant pancreas. The condition of the patient was carefully investigated and extra-pancreatic metastatic lesions were not found; a pancreaticoduodenectomy was then carried out. Histological examination revealed a diagnosis of pancreatic adenocarcinoma arising from the remnant pancreas gland.

Metachronous double cancer after curative resection for pancreatic adenocarcinoma: report of four cases.

We experienced four cases of metachronous double cancer after curative resection for pancreatic adenocarcinoma without the background of intraductal papillary mucinous neoplasm. Case 1, a 67-year-old Japanese female developed tongue cancer 53 months after a pylorus-preserving Whipple resection for pancreatic head adenocarcinoma. Case 2, a 66-year-old female developed multiple breast cancers 52 months after a pylorus-preserving pancreaticoduodenectomy for pancreatic head adenocarcinoma. Case 3, a 59-year-old male developed an adenocarcinoma in the remnant pancreatic head 63 months after a distal pancreatectomy for pancreatic body cancer. Case 4, a 68-year-old male developed lung cancer 92 months after a Whipple procedure for pancreatic head adenocarcinoma. Gemcitabine was administered to three patients as adjuvant chemotherapy at an average administrated dose of 38,199 mg per body surface area. Since primary pancreatic ductal adenocarcinoma is aggressive and always associated with a devastating outcome, metachronous double cancer is scarcely seen. All four cases received curative-intent surgery for each metachronous cancer and were alive for at least 20 months.

Gastric outlet obstruction caused by a heterotopic pancreas in a pregnant woman: report of a case.

A 26-year-old Japanese woman who was 23 weeks pregnant presented with nausea, vomiting, and abdominal pain. Gastroduodenal endoscopic examination revealed an oval-shaped submucosal tumor obstructing the gastric outlet at the prepyloric area in the stomach. Magnetic resonance imaging showed a 5-cm cystic tumor and we suspected a degenerated gastrointestinal stromal tumor. No other radiological tests were done because of the associated risks to the fetus. Distal gastrectomy was performed and a histological diagnosis of heterotopic pancreas was confirmed. The patient had an uneventful postoperative course and was discharged 19 days after her operation. She delivered a healthy, full-term male infant 3 months later. This case of an ectopic pancreas obstructing the gastric outlet in a pregnant woman is reported and discussed due to its rarity.

Pancreatic tuberculosis.

A 63-year-old Japanese man visited our institute with fever of unknown origin. Findings on preoperative imaging modalities were consistent with pancreatic carcinoma, but a positive tuberculin skin test indicated tuberculosis infection. Negative results for MycobacteriumDNA polymerase chain reaction from sputum and bone-marrow aspiration biopsy specimens ruled out pulmonary and miliary tuberculosis, respectively. Positron emission tomography (PET) with 2-[fluorine-18]-fluoro-2-deoxy- d-glucose (FDG) showed multiple labeled spots within the pancreas body and chest. Distal pancreatectomy was performed with a diagnosis of suspected pancreatic carcinoma, but the histological and microbiological diagnosis was Mycobacterium infection. A rare case of pancreatic tuberculosis evaluated by FDG PET is reported and discussed herein.