Evaluation of cold atmospheric microwave plasma on skin physiological parameters and tolerability in dogs.

BACKGROUND: Cold atmospheric microwave plasma (CAMP) is a promising therapeutic option for treating skin infections and wounds. Changes in biophysical skin parameters and the tolerability in dogs after applying CAMP is unknown. OBJECTIVE: This study aimed to evaluate the in vivo effects of CAMP on skin biophysical parameters [hydration, transepidermal water loss (TEWL) and surface temperature] and tolerability in dogs. ANIMALS: Twenty client-owned dogs with normal skin. MATERIALS AND METHODS: Cold atmospheric microwave plasma treatment was performed for 30 s and 1, 2 and 4 min, respectively, at different sites of normal canine skin in the inguinal area. Hydration, TEWL and surface temperature were measured five, three and three times, respectively, before and after CAMP application. After treatment, pain and adverse effects were evaluated using a modified Melbourne Pain Scale and the modified short form Glasgow Composite Measure Pain Scale (modified CMPS-SF). RESULTS: Transepidermal water loss values significantly decreased with 4 min of treatment, and hydration decreased significantly with 2 min of treatment. Temperature increased significantly with increasing treatment time. For other parameters, no significant changes were observed. No significant pain response or adverse effects were observed in most dogs, aside from mild erythema in the treatment area after 4 min. CONCLUSION AND CLINICAL SIGNIFICANCE: Cold atmospheric microwave plasma treatment was well-tolerated and did not significantly change canine skin biophysical parameters. CAMP achieves basic recommendations for safe use and is a potential therapeutic option for various skin diseases in dogs.

Contexte - Le CAMP (Cold Atmospheric Microwave Plasma) est une option thérapeutique prometteuse pour le traitement des infections cutanées et des plaies. Les modifications des paramètres biophysiques de la peau et la tolérance chez les chiens après l'application de CAMP sont inconnues. Objectif - Cette étude visait à évaluer les effets in vivo du CAMP sur les paramètres biophysiques de la peau [hydratation, perte d'eau transépidermique (TEWL) et température de surface] et la tolérance chez le chien. Animaux - Vingt chiens de propriétaires à peau normale. Matériels et méthodes - Le traitement CAMP a été effectué pendant 30 s et 1, 2 et 4 min, respectivement, sur différents sites de peau canine normale dans la région inguinale. L'hydratation, la TEWL et la température de surface ont été mesurées cinq, trois et trois fois, respectivement, avant et après l'application de CAMP. Après le traitement, la douleur et les effets indésirables ont été évalués à l'aide d'une échelle de douleur de Melbourne modifiée et de la forme courte modifiée de l'échelle de mesure de la douleur composite de Glasgow (CMPS-SF modifiée). Résultats - Les valeurs de TEWL ont diminué de manière significative après 4 minutes de traitement et l'hydratation a diminué de manière significative après 2 minutes de traitement. La température a augmenté de manière significative avec l'augmentation du temps de traitement. Pour les autres paramètres, aucun changement significatif n'a été observé. Aucune réponse significative à la douleur ni aucun effet indésirable n'ont été observés chez la plupart des chiens, à l'exception d'un léger érythème dans la zone de traitement après 4 minutes. Conclusion et signification clinique - Le traitement CAMP a été bien toléré et n'a pas modifié de manière significative les paramètres biophysiques de la peau canine. CAMP répond aux recommandations de base pour une utilisation sûre et constitue une option thérapeutique potentielle pour diverses maladies de la peau chez les chiens.

Introducción- el plasma de microondas atmosférico frío (CAMP) es una opción terapéutica prometedora para el tratamiento de infecciones y heridas de la piel. Se desconocen los cambios en los parámetros biofísicos de la piel y la tolerabilidad en perros después de aplicar CAMP. Objetivo- este estudio tuvo como objetivo evaluar los efectos in vivo de CAMP en los parámetros biofísicos de la piel [hidratación, pérdida de agua transepidérmica (TEWL) y temperatura superficial] y la tolerabilidad en perros. Animales - Veinte perros de propietarios particulares con piel normal. Materiales y métodos - El tratamiento CAMP se realizó durante 30 s y 1, 2 y 4 min, respectivamente, en diferentes sitios de piel canina normal en el área inguinal. La hidratación, el TEWL y la temperatura superficial se midieron cinco, tres y tres veces, respectivamente, antes y después de la aplicación de CAMP. Después del tratamiento, el dolor y los efectos adversos se evaluaron mediante una escala de dolor de Melbourne modificada y la escala de dolor de medida compuesta de Glasgow de forma abreviada modificada (CMPS-SF modificada). Resultados- los valores de TEWL disminuyeron significativamente con 4 min de tratamiento y la hidratación disminuyó significativamente con 2 min de tratamiento. La temperatura aumentó significativamente con el aumento del tiempo de tratamiento. Para otros parámetros no se observaron cambios significativos. En la mayoría de los perros no se observaron reacciones significativas de dolor ni efectos adversos, aparte de un leve eritema en el área de tratamiento después de 4 min. Conclusión y significado clínico- el tratamiento con CAMP fue bien tolerado y no cambió significativamente los parámetros biofísicos de la piel canina. CAMP obtuvo recomendaciones básicas para un uso seguro y es una opción terapéutica potencial para diversas enfermedades de la piel en perros.

Contexto - O plasma frio atmosférico de micro-ondas (CAMP) é uma opção terapêutica promissora para o tratamento de infecções cutâneas e feridas. Não se sabe a respeito das alterações nos parâmetros biofísicos da pele e a tolerabilidade de cães após a aplicação de CAMP. Objetivo - Este estudo tem como objetivo avaliar os efeitos in vivo de CAMP nos parâmetros biofísicos da pele [hidratação, perda de água transepidérmica (TEWL) e temperatura da superfície] e a tolerabilidade em cães. Materiais e métodos - O tratamento com CAMP foi realizado por 30s e 1, 2 e 4 min, respectivamente, em diferentes locais da pele canina normal na região inguinal. Hidratação, TEWL e temperatura da superfície foram medidas cinco, três e três vezes, respectivamente, antes e após a aplicação do CAMP. Após o tratamento, a dor e os efeitos adversos foram avaliados usando uma escala de dor de Melbourne modificada e a escala de medida composta de dor de Glasgow modificada (CMPS-SF modificada). Resultados - Os valores de TEWL reduziram significativamente com o tratamento de 4 min, e a hidratação reduziu significativamente com dois minutos de tratamento. A temperatura aumentou significativamente com o aumento do tempo de tratamento. Não foram observadas alterações significativas para outros parâmetros. Não se observou uma resposta de dor significativa ou efeitos adversos na maioria dos cães, além de eritema leve na área tratada após 4 min. Conclusão e significância clínica - O tratamento com CAMP foi bem tolerado e não alterou significativamente os parâmetros biofísicos da pele canina. CAMP requer recomendações básicas de segurança na sua utilização e é uma opção terapêutica potencial para várias dermatopatias em cães.

CT Angiographic Evaluation of Congenital Anastomoses between Femoropopliteal Vein and Deep Femoral Vein: Types and Incidence.

PURPOSE: To evaluate congenital anastomotic channels between femoropopliteal veins and deep femoral veins with the use of computed tomographic (CT) venography. MATERIALS AND METHODS: CT venography of 488 limbs in 244 patients (105 men; mean age, 61 y; age range, 18-96 y) performed between January 2016 and December 2016 was retrospectively evaluated. The presence or absence of anastomotic channels (> 3 mm in diameter) connecting a femoropopliteal vein to a deep femoral vein was determined, and the observed channels were classified based on their location and course. RESULTS: Two types of anastomotic channels were observed in 32 patients (13%): a persistent sciatic vein (PSV) in 24 limbs of 15 patients (6%) and a retrofemoral channel (RFC) in 22 limbs of 19 patients (8%). A PSV anastomosed with the popliteal vein in the popliteal fossa, coursed posterior to the adductor magnus muscle, and drained into the deep femoral vein. An RFC anastomosed with the femoral vein at the level of the adductor hiatus, coursed posterior to the femoral shaft, and drained into the deep femoral vein. PSVs and RFCs were of similar size or larger than adjacent femoropopliteal veins in 50% (12 of 24) and 22% of limbs (4 of 22), respectively. CONCLUSIONS: Anastomotic channels connecting a femoropopliteal vein to a deep femoral vein are not a rare variation and may have an important role in collateral venous drainage of the lower extremities.

In vitro antibacterial activity of the manuka essential oil from Leptospermum scoparium combined with Tris-EDTA against Gram-negative bacterial isolates from dogs with otitis externa.

BACKGROUND: The increasing prevalence of antimicrobial resistance among bacteria in dogs with otitis externa has led to a need for novel therapeutic agents. HYPOTHESIS/OBJECTIVE: To examine the antibacterial effects of manuka oil combined with ethylenediaminetetraacetic acid-tromethamine (Tris-EDTA) against Gram-negative bacteria isolates from dogs with otitis externa. METHODS AND MATERIALS: A total of 53 clinical isolates including Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae ssp. pneumoniae and Proteus mirabilis. Antimicrobial susceptibility was determined using disk diffusion; the minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of manuka essential oil, with or without Tris-EDTA, were investigated. RESULTS: A total of 44 isolates were resistant to at least one antibiotic and 19 strains were multidrug-resistant, with resistance to at least one agent in three or more antimicrobial classes. The MICs and MBCs of manuka oil alone were ≥1% (v/v) and ≥2% (v/v), respectively. There was no antimicrobial effect of Tris-EDTA (1.125:0.3 mg/mL) without manuka oil. However, the combination of manuka oil with Tris-EDTA significantly decreased the MICs (ranging from 0.06% to 0.5%, v/v; P < 0.001) and MBCs (ranging from 0.06% to 1%, v/v; P < 0.001). There also was no significant difference between multidrug-resistant and nonresistant bacterial isolates in terms of the antimicrobial activity of manuka oil with Tris-EDTA. CONCLUSIONS AND CLINICAL IMPORTANCE: The study findings suggest that manuka oil, especially when combined with Tris-EDTA, may be a promising alternative therapeutic option for Gram-negative otic pathogens. Clinical studies are needed to assess potential for in vivo ototoxic effects and efficacy.

The blind pushing technique for peripherally inserted central catheter placement through brachial vein puncture.

OBJECTIVE: The objective of this study was to conduct a prospective clinical trial evaluating the technical feasibility and short-term clinical outcome of the blind pushing technique for placement of pretrimmed peripherally inserted central catheters (PICCs) through brachial vein access. METHODS: Patients requiring PICC placement at any of the three participating institutions were prospectively enrolled between January and December 2016. The review boards of all participating institutions approved this study, and informed consent was obtained from all patients. PICC placement was performed using the blind pushing technique and primary brachial vein access. The following data were collected from unified case report forms: access vein, obstacles during PICC advancement, procedure time, and postprocedural complications. RESULTS: During the 12-month study period, 1380 PICCs were placed in 1043 patients. Of these, 1092 PICCs placed in 837 patients were enrolled, with 834 PICCs (76%) and 258 PICCs (34%) placed through brachial vein and nonbrachial vein access, respectively. In both arms, obstacles were most commonly noted in the subclavian veins (n = 220) and axillary veins (n = 94). Successful puncture of the access vein was achieved at first try in 1028 PICCs (94%). The technical success rate was 99%, with 1055 PICCs (97%) placed within 120 seconds of procedure time and 1088 PICCs (99%) having the tip located at the ideal position. Follow-up Doppler ultrasound detected catheter-associated upper extremity deep venous thrombosis (UEDVT) for 18 PICCs in 16 patients and late symptomatic UEDVT for 16 PICCs in 16 patients (3.1%). Catheter-associated UEDVT was noted for 28 PICCs (82%) and 6 PICCs (18%) placed through brachial vein and nonbrachial vein access, respectively. The incidence of obstacles and the procedure time (<120 seconds) differed significantly between brachial vein and nonbrachial vein access (P = .001). There was no statistically significant difference between brachial vein and nonbrachial vein access in the incidence of UEDVT (odds ratio, 0.68; 95% confidence interval, 0.59-3.52; P = .22). CONCLUSIONS: The placement of pretrimmed PICCs by the blind pushing technique and primary brachial vein access is technically feasible and may represent an alternative to the conventional PICC placement technique, having low incidences of UEDVT and other complications, with no significant difference in outcomes between brachial vein and nonbrachial vein access.

Spontaneous Renal Artery Dissection as a Cause of Acute Renal Infarction: Clinical and MDCT Findings.

The purpose of this study was to assess the incidence of spontaneous renal artery dissection (SRAD) as a cause of acute renal infarction, and to evaluate the clinical and multidetector computed tomography (MDCT) findings of SRAD. From November 2011 to January 2014, 35 patients who were diagnosed with acute renal infarction by MDCT were included. We analyzed the 35 MDCT data sets and medical records retrospectively, and compared clinical and imaging features of SRAD with an embolism, using Fisher's exact test and the Mann-Whitney test. The most common cause of acute renal infarction was an embolism, and SRAD was the second most common cause. SRAD patients had new-onset hypertension more frequently than embolic patients. Embolic patients were found to have increased C-reactive protein (CRP) more often than SRAD patients. Laboratory results, including tests for lactate dehydrogenase (LDH) and blood urea nitrogen (BUN), and the BUN/creatinine ratio (BCR) were significantly higher in embolic patients than SRAD patients. Bilateral renal involvement was detected in embolic patients more often than in SRAD patients. MDCT images of SRAD patients showed the stenosis of the true lumen, due to compression by a thrombosed false lumen. None of SRAD patients progressed to an estimated glomerular filtration rate < 60 mL/min/1.73 m² or to end-stage renal disease during the follow-up period. SRAD is not a rare cause of acute renal infarction, and it has a benign clinical course. It should be considered in a differential diagnosis of acute renal infarction, particularly in patients with new-onset hypertension, unilateral renal involvement, and normal ranges of CRP, LDH, BUN, and BCR.

Lymphatic Embolization for the Treatment of Pelvic Lymphoceles: Preliminary Experience in Five Patients.

PURPOSE: To retrospectively assess the outcome of lymphatic embolization in the treatment of pelvic lymphoceles. MATERIALS AND METHODS: From July 2014 to December 2015, a retrospective analysis was performed in 5 consecutive female patients (mean age, 54.6 y; range, 45-65 y) who underwent lymphangiography for the management of symptomatic pelvic lymphoceles that developed after gynecologic surgery. Sclerotherapy had failed in 4 patients. Lymphangiography was performed through an inguinal lymph node to reveal disrupted lymphatic vessels draining into the lymphocele. This inflow vessel was targeted with a fine needle, and N-butyl cyanoacrylate (NBCA) was injected. Outcomes and complications were assessed by reviewing electronic medical records and computed tomography (CT). RESULTS: Lymphangiography revealed disrupted lymphatic vessels draining into the lymphocele in all patients. A single inflow vessel was seen in 3 patients and was subsequently embolized. Catheters were successfully removed upon decrease of drainage. Multiple inflow vessels were seen in the remaining 2 patients. Therapeutic effect was anticipated in 1 patient after lymphangiography alone, whereas only the dominant feeding vessel was embolized in the other. The initial procedures failed in both patients, prompting repeat embolization with adjunctive sclerotherapy. Both patients showed improvement and had their catheters removed. Follow-up CT was available in 3 patients. Two patients showed complete regression of lymphoceles, and 1 showed an asymptomatic lymphocele. No procedure-related complications occurred during a mean follow-up period of 35 weeks (range, 2-73 wk). CONCLUSIONS: Lymphatic intervention was technically feasible in treating lymphoceles. However, those with multiple inflow vessels were relatively difficult to treat.

Characteristics of Coronary Artery to Pulmonary Artery Fistula on Coronary Computed Tomography Angiography.

OBJECTIVE: The aim of the study was to evaluate the characteristics of coronary artery-to-pulmonary artery fistula (CPAF) found by coronary computed tomography (CT) angiography. METHODS: Among 10,121 cases of coronary CT angiography performed for 7 years, we found 32 cases of CPAF. We retrospectively evaluated the demographics, clinical symptoms, and anatomical characteristics such as the origin, number of origins, course, opening site of the fistula, and the presence of aneurysmal changes (defined as dilatation 1.5 times the diameter of the origin). We also categorized the fistula openings according to size compared with that of the proximal left anterior descending coronary artery. RESULTS: The patients were 14 men and 18 women with a mean (range) age of 56.5 (34-86) years. Nineteen patients had no related symptoms, and the other 13 patients had symptoms such as angina, chest discomfort, palpitations, or shoulder pain. Among these patients, 2 patients were diagnosed with coronary artery disease. The origins of CPAF were single (n = 15, 46.9%) or multiple (n = 17, 53.1%). The CPAFs arose most commonly from the conus branch of the right coronary artery (n = 20, 62.5%) and proximal left anterior descending (n = 17, 53.1%). All CPAFs coursed anteriorly to the main pulmonary artery and drained into the anterolateral aspect. Twenty-five patients (78.1%) exhibited aneurysmal changes. The openings were small in 13 (40.6%), medium in 13 (40.6%), and large in 6 (18.8%) patients. CONCLUSIONS: More than half of patients with CPAF had no related symptoms. Coronary artery-to-pulmonary artery fistula may have a single origin or multiple origins. All of the CPAFs coursed anteriorly to the main pulmonary artery and drained into the anterolateral aspect; the CPAFs identified here frequently exhibited aneurysmal changes.

Metallic stent placement for the management of tracheal carina strictures and fistulas: technical and clinical outcomes.

OBJECTIVE: The purpose of this article is to assess the technical and clinical outcomes of metallic stent placement in strictures and fistulas involving the carina. MATERIAL AND METHODS: We performed a retrospective analysis of patients who had undergone stenting for disease involving the carina. We initially reviewed the symptoms, underlying causes, and the types of stent configuration used. We also assessed the technical success rate of stenting, its effectiveness in achieving symptomatic relief, the incidence of stent-related complications, and stent patency. RESULTS: Thirty-two stenting procedures were performed in 23 patients (mean age, 56.3 years) for the treatment of strictures (n = 21), an esophagorespiratory fistula (n = 1), or both (n = 1) present in the carina. Three cases were associated with benign causes, whereas 20 were related to malignancies. Dyspnea was the most common symptom (n = 22). We placed metallic stents in four different configurations, among which placement in juxtacarinal segments was the most common configuration (n = 23). Technical success was achieved in 96.9% of cases, and symptomatic improvement was observed in 90.6% of cases. Stent-related complications were observed after 10 procedures (31.3%). Stent obstruction occurred in seven patients (21.9% of procedures), most commonly because of tumor progression. The mean follow-up period was 83.1 days, during which time 15 patients died as a result of disease progression, five were discharged without hope for improvement, two were discharged without symptomatic recurrence, and one was lost to follow-up. CONCLUSION: Airway stenting can be performed in the carina with high technical success using variable stent configurations. Although the rate of immediate symptomatic improvement is high, stent-related complications frequently occur.

Assessment of treatment success and short-term effectiveness using C-arm CT immediately after hepatic chemoembolization of HCC.

BACKGROUND/AIMS: To investigate semiquantitative analyses based on amount and morphology of iodized oil uptake about non-enhanced C-arm cone-beam CT(C-arm CT) immediately following hepatic chemoembolization of HCC. METHODOLOGY: We retrospectively reviewed 40 C-arm CT images taken immediately following chemoembolization in 29 consecutive patients who underwent hepatic chemoembolization for HCC lesions(n=97). Two radiologists scored iodized oil uptake in the index tumours from Grade 0(complete) to 4(invisible). To describe the morphologic characteristics of uptake, the lesions scored as Grade 1 to 3 were subclassified as 'defective' and 'not-defective' with respect to uptake. To evaluate the performance of this modality, we performed a receiver operating characteristic curve analysis. RESULTS: All treated lesions were classified into 'complete treatment'(n=50) and 'viable HCC'(n=47). Thirty-one lesions were evaluated as Grade 0, two as Grade 4, and the rest (n=64) as between Grades 1 and 3, and the lesions of Grade 3 or 4 were all viable. Of the defective uptake lesions(n=35), 28 lesions were also viable. The areas under the curves of the lesions were 0.827 to 0.860. CONCLUSIONS: The analysis of C-arm CT based on the amount and morphologic characteristics of iodized oil uptake may be useful to predict the effectiveness of the hepatic chemoembolization of HCC.

Safety and efficacy of G-CSF mobilization and collection of autologous peripheral blood stem cells in children with cerebral palsy.

We hypothesized that mobilized peripheral blood stem cells (PBSCs) could be useful for treating neurological impairments and therefore assessed the safety of administering G-CSF followed by collecting PBSC in children with cerebral palsy (CP). G-CSF (10 µg/kg/day) was administered subcutaneously for 5 days, and apheresis was performed to collect PBSC via central venous catheter. G-CSF-related events occurred in 3 patients (fever in 2, irritability in 1). No catheter-related complications were reported. None of the patients needed platelet transfusion or calcium replacement during apheresis. Mobilization with G-CSF followed by PBSC collection appears to be safe and feasible in CP children.

Percutaneous transsplenic embolization of jejunal varices in a patient with liver cirrhosis: a case report.

Bleeding jejunal varices are rare and could be life threatening. They are usually found in the presence of portal hypertension and prior history of gastrointestinal surgery. They can be effectively managed by radiological interventions such as transjugular intrahepatic portosystemic shunt or transhepatic embolization of varices. However, in patients with portal vein obstruction, an alternative access is necessary. We report a case of bleeding jejunal varices associated with postoperative adhesion in a patient with portal vein thrombosis which was successfully managed by percutaneous transsplenic embolization.

Correlation between complicated diverticulitis and visceral fat.

The aim of this study was to examine the relationship of complications related to diverticulitis and visceral obesity. The study was based on a retrospective case note review conducted at the Hanyang University Hospital. Patients were diagnosed with diverticulitis based on clinical symptoms and abdominal computed tomography (CT) findings and divided into two groups: those admitted with complicated diverticulitis and those with a simple diverticulitis episode. We compared the body mass index (BMI) and degree of visceral obesity, measured by abdominal CT. The study included 140 patients, 87 (62.1%) were simple diverticulitis and 53 (37.9%) were complicated diverticulitis. In the complicated diverticulitis group, 9 (6.4%) cases were recurrent, 29 (20.7%) were perforation or abscess patients, and 28 (20%) were patients with systemic inflammatory response syndrome (SIRS). Of the SIRS patients, 13 were involved in other complication groups. When comparing in the two groups, the complicated diverticulitis group had a significantly higher visceral fat area (128.57 cm(2) vs 102.80 cm(2), P = 0.032) and a higher ratio of visceral fat area/subcutaneous fat area (0.997 vs 0.799, P = 0.014). Visceral obesity is significantly associated with complications of diverticulitis.

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The authors report a successful thrombectomy using the AngioJet Rheolytic Thrombectomy System (AngioJet) and an embolic protection device in a patient with femorofemoral bypass graft occlusion. Lower extremity CT angiograms showed occlusion in the left-to-right femorofemoral bypass graft. A rheolytic thrombectomy using the AngioJet and balloon angioplasty restored blood flow to the right lower extremity, and distal embolization may be effectively prevented by placing an embolic protection device within the right superficial femoral artery during the procedure.

Celiac axis and common hepatic artery variations in 5002 patients: systematic analysis with spiral CT and DSA.

PURPOSE: To identify and evaluate the spectrum and prevalence of celiac axis (CA) and common hepatic artery (CHA) variations by using spiral computed tomography (CT) and digital subtraction angiography (DSA). MATERIALS AND METHODS: Institutional review board approval was obtained, and the requirement for informed patient consent was waived. The findings in 5002 patients who underwent spiral CT and DSA were retrospectively evaluated. CHA was defined as an arterial trunk containing at least one segmental hepatic artery and the gastroduodenal artery. The pattern of the aortic origin of the branches of the CA and superior mesenteric arteries was analyzed. The CHA anatomy was then investigated. RESULTS: Of 15 possible types of CA variation, 13 types were identified. A normal CA was noted in 4457 (89.1%) of the 5002 patients. Twelve types of CA variation were identified in 482 (9.64%) patients. In the remaining 63 (1.26%) patients, the CA anatomy was classified as ambiguous because the CHA was absent owing to separate origins of the hepatic arteries and the gastroduodenal artery (n = 55) or because the origin of the CHA could not be determined owing to persistent anastomotic channels (n = 8). Seven CHAs originating from the normal CA had a retroportal (n = 6) or transpancreatic (n = 1) course. All eight CHAs originating from the left gastric artery passed the fissure of the ligamentum venosum. The 148 CHAs originating from the superior mesenteric artery showed diverse relationships with the pancreas--being supra-, trans-, or infrapancreatic--and the superior mesenteric-portal venous axis--being pre- or retroportal. The 20 CHAs originating from the aorta had a normal suprapancreatic preportal course. CONCLUSION: Known or newly found CA and CHA variations could be systematically described in detail. The authors propose a hypothetical anatomic model for summarizing the observed CHA variations.

Outcome of Percutaneous Intervention in Dysfunctional Loop versus Straight Arteriovenous Grafts in Hemodialysis Patients.

OBJECTIVE: To compare the patency control of dysfunctioning forearm arteriovenous graft (AVG) using percutaneous transluminal angioplasty (PTA) in patients with loop versus straight grafts. MATERIALS AND METHODS: Between January 2012 and March 2017, hemodialysis patients with forearm AVG were treated with PTA at two hospitals. We reviewed technical and clinical success rates of each procedure. Procedure time and patency of the graft were compared for all patients as well as for subgroups of stenosis only and thrombosis using paired-sample t-test and Kaplan-Meier analysis. RESULTS: Sixty-six patients (mean age, 62.11 ± 11.85 years) underwent PTA. Thirty-eight patients (58%) had loop grafts and 28 (42%) had straight grafts. Among 66 patients, 54 (82%) had thrombosis. Technical success rate was 95.5% (only stenosis: 100%; thrombosis: 94%) and the mean procedure time was 48.00 ± 16.75 minutes in all patients. Although there was a tendency towards shorter procedure time in patients with loop grafts (45.24 ± 20.24 minutes) than those with straight grafts (51.85 ± 22.76 minutes), the difference was not statistically significant (p = 0.217), with or without thrombi. There was no statistical significance in primary and assisted primary patency (log rank 0.78, p = 0.38 in primary patency; log rank 0.88, p = 0.35 in assisted primary patency). CONCLUSION: Our study suggests there is no different patency outcome between straight and loop arteriovenous grafts after PTA.

Preoperative CT anthropometric measurements and pancreatic pathology increase risk for postoperative pancreatic fistula in patients following pancreaticoduodenectomy.

Postoperative pancreatic fistula (POPF) is a common complication following pancreaticoduodenectomy (PD). However, risk factors for this complication remain controversial. We conducted a retrospective analysis of 107 patients who underwent PD. POPF was diagnosed in strict accordance with the definition of the 2016 update of pancreatic fistula from the International Study Group on Pancreatic Fistula (ISGPF). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for POPF. A total of 19 (17.8%) subjects of pancreatic fistula occurred after PD, including 15 (14.1%) with grade B POPF and 4 (3.7%) with grade C POPF. There were 33 (30.8%) patients with biochemical leak. Risk factors for POPF (grade B and C) were larger area of visceral fat (odds ratio [OR], 1.40; p = 0.040) and pathology other than pancreatic adenocarcinoma or pancreatitis (OR, 12.45; p = 0.017) in the multivariate regression analysis. This result could assist the surgeon to identify patients at a high risk of developing POPF.

Association between erosive esophagitis and visceral fat accumulation quantified by abdominal CT scan.

BACKGROUND AND AIMS: There were no objective data presented about the association between erosive esophagitis and abdominal fat. We conducted this study to examine the association of abdominal fat and gastroesophageal reflux disease-related erosive esophagitis. METHODS: Between May 2004 and October 2005, a total of 100 erosive esophagitis patients diagnosed by upper endoscopy were evaluated in a prospective manner. All study patients and controls underwent abdominal computed tomography (CT) scan. Body fat distribution was assessed by CT with a 10-mm-thick slice at the level of the fourth lumbar vertebra. RESULTS: Erosive esophagitis patients presented with a significantly higher mean visceral fat (VF) area (104.68+/-39.47 vs. 75.90+/-49.10 cm2, P=0.014) than the control group. However, there was no association between erosive esophagitis and subcutaneous fat area (109.72+/-49.09 vs. 98.66+/-52.43 cm2, P=0.379) or total fat area (214.41+/-78.78 vs. 172.59+/-90.49 cm2, P=0.054). Multivariate logistic regression analysis demonstrated that high VF areas (P=0.0035), VF/subcutaneous fat area (P=0.005), hiatal hernia (P=0.001), high body mass index (P=0.047), high waist-to-hip ratio (P=0.042), and smoking (P=0.005) are independent risk factors of erosive esophagitis. CONCLUSIONS: These results suggest a role for visceral obesity, quantified by CT, as a risk factor for erosive esophagitis.

Perihepatitis with pelvic inflammatory disease (PID) on MDCT: characteristic findings and relevance to PID.

BACKGROUND: To evaluate the prevalence and image characteristics of perihepatitis, as well as the relationship with some computed tomography (CT) manifestations of pelvic inflammatory disease (PID). METHODS: Between January 2006 and December 2007, 93 consecutive patients examined with three-phase abdominal CT scans and clinically diagnosed and treated for PID were included. Three radiologists retrospectively reviewed CT scans with consensus, and examined the location (12 areas) and thickness (four grades) of enhancement of the hepatic surface. Several CT manifestations of PID were also evaluated and statistical analysis was performed to determine the relationship of these findings. RESULTS: Out of the 93 patients, 55 (59%) showed enhancement of the hepatic surface. The right anteroinferior hepatic surface was the most common site (89%) and lower hepatic division showed thicker parenchymal enhancement. Oophoritis (P = 0.020) and extension of mesenteric infiltration (P < 0.001) were revealed as statistically significant factors associated with the presence of perihepatitis in PID. CONCLUSIONS: Perihepatits commonly occurs in PID; 59% of PID patients in this study had perihepatitis. The predominant site was the right anteroinferior hepatic surface. Perihepatitis seems not to be associated with various CT findings of PID reflecting disease severity, except oophoritis and upper extension of mesenteric infiltration.

Monckeberg's sclerosis in a patient with systemic sclerosis.

Monckeberg's sclerosis (MS) is one of the non-inflammatory vascular diseases characterized by calcification of the media of small and medium-sized muscular arteries, but is distinct from atherosclerosis. We present a case of MS that was incidentally detected by plain X-ray in a patient with systemic sclerosis. We took CT angiographs of the patient's lower extremities for the differential diagnosis of vascular calcification, which was confirmed. To determine if systemic sclerosis is a risk factor for MS, we reviewed plain X-rays from 43 well-documented systemic sclerosis patients, but we did not detect any cases of MS. We therefore conclude that systemic sclerosis may not be a risk factor for MS.