Pelvic arterial embolisation with cyanoacrylate during caesarean hysterectomy for placenta accreta.

PURPOSE: To compare n-butyl cyanoacrylate (NBCA) and gelatine sponge (GS) as embolic materials for prophylactic pelvic arterial embolisation during caesarean hysterectomy for placenta accreta spectrum (PAS). MATERIAL AND METHODS: This retrospective study comprised 12 women (age range, 23-42 years; mean, 34.1 years) who underwent caesarean hysterectomy for PAS. Following caesarean delivery, bilateral uterine and non-uterine parasitic arteries were embolized with GS in the first four cases (GS group) and primarily with NBCA mixed with iodized oil in the subsequent eight cases (NBCA group). Procedure time for embolisation and hysterectomy and total blood loss were compared between the two groups using Welch's t-test. RESULTS: Although procedure time for embolisation tended to be longer in the NBCA group than in the GS group (111 ± 47 min versus 71 ± 32 min, p=.11), that for hysterectomy was significantly reduced in the NBCA group when compared to the GS group (158 ± 42 min versus 236 ± 39 min, p=.02). Total blood loss was significantly lower in the NBCA group than in the GS group (1375 ± 565 mL versus 2668 ± 587 mL, p=.01). CONCLUSION: Procedure time for hysterectomy and total blood loss during caesarean hysterectomy can be reduced by using NBCA instead of GS in prophylactic pelvic arterial embolisation for PAS.

[A Case of Colitic Cancer with a Total Proctocolectomy in the Second Term].

The patient was 70-years-old women, 27 years ago, she was diagnosed with total colitis-type ulcerative colitis. Eighteen years after the diagnosis, she self-suspended his hospital visit because her condition was stable. After 4 years, ulcerative colitis rekindled, she resumed taking a 5-ASA. And 2 years later, colonoscopy revealed type 3 tumor in the descending colon. Tumor biopsy indicated an adenocarcinoma(tub1, tub2)derived from ulcerative colitis. Originally total proctocolectomy is necessary, but patient strongly hoped to leave the colon. We performed laparoscopic left hemicolonectomy(D2, SST). The pathological diagnosis was pT3, pN2, pM0, pStage Ⅲc. After the operation, chemotherapy(mFOLFOX6)was carried out for 6 months. We regularly checked tumor markers and followed up with a colonoscopy once every 6 months. But 3 years and 9 months after surgery, ulcerative colitis rekindled and adenocarcinoma in the transverse colon found by colonoscopy. We performed total proctocolectomy with ileal J-pouch anal-canal anastomosis. Four months after the second operation, advanced defecation disorder has not been observed.

Preoperative Diagnosis of a Torsioned Accessory Spleen.

We report a case of a 12-year-old boy with an accessory spleen torsion. He presented with left-sided abdominal pain after trauma. A 4 cm oval mass without contrast enhancement was detected on contrast-enhanced computed tomography (CT), and ultrasound (US) showed a 4 cm oval mass below the spleen. The mass mainly consisted of high echoes similar to the spleen; the central part showed irregularly low echoes. Subsequent follow-up daily US examinations showed gradual expansion of the central low echoes with conspicuous hyperechoic dots. Discontinuation of the branch from the splenic artery to the mass was observed, both, on US and CT. These findings led to the diagnosis of a hemorrhagic infarct caused by torsion of the accessory spleen. Laparoscopy showed adherence of the accessory spleen to the omentum and colon by twisting four times around its axis. It was resected and confirmed the diagnosis of a torsioned accessory spleen.

Performance of novel virtual parenchymal perfusion software visualizing embolized areas of transcatheter arterial chemoembolization for hepatocellular carcinoma.

AIM: To evaluate the performance of novel virtual parenchymal perfusion (VPP) software in conventional transcatheter arterial chemoembolization (cTACE) for hepatocellular carcinoma. METHODS: VPP was retrospectively applied to 43 hepatocellular carcinomas treated with cTACE. The virtual embolized area (VEA) was estimated after positioning a virtual injection point on images of non-selective cone-beam computed tomography during hepatic arteriography, at the same position in superselective cTACE. The real embolized area (REA) was defined as the area where iodized oil was retained on 1-week computed tomography after cTACE. Three dimensions across the tumor (maximum [a] and minimum [b] in the axial and craniocaudal [c]) directions, and the volume of the VEA and REA were compared using linear regression analysis. It was also evaluated whether an adequate safety margin ≥5 mm could be predicted by VPP. RESULTS: The mean lengths of a, b, and c of the VEA and REA were 54.6 ± 15.9 mm (range 24.9-91.0 mm) and 55.0 ± 15.7 mm (range 23.9-92.8 mm; r = 0.9448, P < 0.001), 35.4 ± 11.7 mm (range 16.1-66.0 mm) and 35.4 ± 13.2 mm (range 12.2-69.2 mm; r = 0.9369, P < 0.001), and 42.1 ± 11.6 mm (range 25.0-75.7 mm) and 42.9 ± 11.7 mm (range 25.7-78.7 mm; r = 0.9092, P < 0.001), respectively. The mean volume of the VEA and REA was 71.8 ± 44.8 mL and 75.5 ± 46.9 mL, respectively (r = 0.9913, P < 0.0001). VPP showed no safety margins in seven tumors, including all three actually embolized without safety margins. CONCLUSION: The VEA estimated using VPP showed a good correlation with the REA of cTACE.

Excretion of necrotic hepatocellular carcinoma tissues into the biliary system after transcatheter arterial chemoembolization.

AIM: To evaluate the incidence and condition of necrotic tumor excretion into the biliary system in patients with hepatocellular carcinoma (HCC) >5 cm treated with conventional transcatheter arterial chemoembolization (TACE). METHODS: Eighty-three patients who underwent TACE for newly developed HCC >5 cm without an intraductal tumor thrombus and were followed-up by computed tomography for longer than 6 months were eligible. According to the location, the maximum tumors were divided into central (in contact with the left or right hepatic duct, n = 39) or peripheral (not in contact with them, n = 44). When high-density material in the biliary system that was not seen on pretreatment computed tomography was identified, it was determined as excreted necrotic tumor tissue containing iodized oil. The incidence, interval between TACE and occurrence of the necrotic tumor excretion, and clinical course were evaluated. RESULTS: Tumor excretion into the biliary system was identified in nine (10.8%) patients with a central tumor (mean diameter, 85.0 ± 29.6 mm) 28-433 days (mean, 219.3 ± 128.2) after the initial TACE. In one patient, the necrotic tumor cast caused cholangitis 1203 days after the initial TACE, and was endoscopically removed. Infection of the embolized tumor developed in two cases and percutaneous drainage was carried out 105 and 158 days later, respectively. CONCLUSIONS: Excretion of necrotic tumors into the biliary system after TACE was not rare in patients with centrally located HCC >5 cm. The detached tumor rarely caused symptoms and the communication between the tumor and bile duct caused the infection of tumors.

Flies without trehalose.

Living organisms adapt to environmental changes through metabolic homeostasis. Sugars are used primarily for the metabolic production of ATP energy and carbon sources. Trehalose is a nonreducing disaccharide that is present in many organisms. In insects, the principal hemolymph sugar is trehalose instead of glucose. As in mammals, hemolymph sugar levels in Drosophila are regulated by the action of endocrine hormones. Therefore, the mobilization of trehalose to glucose is thought to be critical for metabolic homeostasis. However, the physiological role of trehalose as a hemolymph sugar during insect development remains largely unclear. Here, we demonstrate that mutants of the trehalose-synthesizing enzyme Tps1 failed to produce trehalose as expected but survived into the late pupal period and died before eclosion. Larvae without trehalose grew normally, with a slight reduction in body size, under normal food conditions. However, these larvae were extremely sensitive to starvation, possibly due to a local defect in the central nervous system. Furthermore, Tps1 mutant larvae failed to grow on a low-sugar diet and exhibited severe growth defects on a low-protein diet. These diet-dependent phenotypes of Tps1 mutants demonstrate the critical role of trehalose during development in Drosophila and reveal how animals adapt to changes in nutrient availability.

Efficacy of automated tumor-feeder detection software using cone-beam computed tomography technology in transarterial embolization through extrahepatic collateral vessels for malignant hepatic tumors.

AIM: We evaluated the performance of automated tumor-feeder detection (AFD) software using cone-beam computed tomography technology in identifying tumor-feeders of extrahepatic collaterals. METHODS: AFD was prospectively used in superselective transarterial chemoembolization (TACE) or embolization (TAE) of extrahepatic collaterals for 29 hepatocellular carcinomas and one liver metastasis (mean tumor diameter ± standard deviation, 28 ± 15.6 mm) in 25 patients. The detectability of extrahepatic tumor-feeders with non-selective digital subtraction angiography (DSA) and AFD was evaluated and compared using a χ(2) -test. Tumor response of target lesions in each patient at 2-3 months after treatment was evaluated using the modified Response Evaluation Criteria in Solid Tumors. Complications were also evaluated. RESULTS: Of 46 tumor-feeders, non-selective DSA and AFD could identify 26 and 44, respectively (P < 0.001). Regarding the origin of tumor-feeders, both non-selective DSA and AFD could identify 14 of 15, six of seven and two of two tumor-feeders of the right inferior phrenic, omental and right renal capsular artery, respectively. In the cystic and left gastric or right colic artery, AFD could identify 13 of 13 and nine of nine tumor-feeders but non-selective DSA could identify only three of 13 and one of nine, respectively (P < 0.001). Complete response was obtained in 15 patients, partial response in six, stable disease in three and progressive disease in one. No severe complications developed except for right pleural effusion after embolization of the right inferior phrenic artery. CONCLUSION: AFD has a sufficient ability to identify extrahepatic tumor-feeders and may improve the safety and local effects of TACE/TAE of extrahepatic collaterals.

Evaluation of tumor recurrence after superselective conventional transcatheter arterial chemoembolization for hepatocellular carcinoma: Comparison of computed tomography and gadoxetate disodium-enhanced magnetic resonance imaging.

AIM: To retrospectively evaluate the detectability of tumor recurrence with computed tomography (CT) and magnetic resonance imaging (MRI) after superselective conventional transcatheter arterial chemoembolization (cTACE) for hepatocellular carcinoma (HCC). METHODS: The detectability of tumor recurrence with CT and gadoxetate disodium-enhanced MRI obtained within 30 days (mean, 16.9 ± 10.1) were compared in 38 patients with recurrent HCC after superselective cTACE. Tumor recurrence was divided into local and distant recurrence. Local recurrence was also divided into intratumoral and peritumoral recurrence. RESULTS: Tumor recurrence (maximum diameter, 19.7 ± 10.1 mm) was demonstrated by images 12.4 ± 11.7 months after cTACE. CT could depict 16 (76.2%) of 21 intratumoral recurrences in 12 patients and 14 (53.8%) of 26 peritumoral recurrences in 11, as well as 39 (55.7%) of 70 distant recurrences in 15 (75%) of 20 patients. Arterial phase MRI could depict 20 (95.2%) of 21 intratumoral recurrences in 14 patients and all 26 (100%) peritumoral recurrences in 21, as well as 60 (85.7%) distant recurrences in all 20 (100%) patients. The detectability of tumor recurrence with MRI was significantly higher than that with CT (P = 0.00549). On MRI, pseudolesions were observed in five (13.2%) patients and artifacts in the arterial phase in five (13.2%). Regarding the diagnostic performance, CT was superior to MRI in two (5.3%) patients and MRI was superior to CT in 19 (50%). They were almost equal in 17 (44.7%). CONCLUSION: The detectability of tumor recurrence after superselective cTACE with gadoxetate disodium-enhanced MRI was superior to that of CT.

Usefulness of automated feeder-detection software for identification of access routes to small pancreaticoduodenal artery aneurysms during embolotherapy.

The mortality rate of patients with ruptured pancreaticoduodenal artery aneurysms is high; therefore, it is recommended to treat pancreaticoduodenal artery aneurysms regardless of their size. In small pancreaticoduodenal artery aneurysms, however, identification of the access route on two-dimensional arteriography is sometimes difficult because of the superimposition of many hypertrophied branches of pancreaticoduodenal arteries on the aneurysm. We report two cases of ruptured pancreaticoduodenal artery aneurysm embolized successfully with metallic coils, assisted by automated feeder-detection software using cone-beam computed tomography data. This new technology may reduce physicians' workload during the procedure.

Ultraselective transcatheter arterial chemoembolization for small hepatocellular carcinoma guided by automated tumor-feeders detection software: technical success and short-term tumor response.

PURPOSE: To analyze the technical success and tumor response of ultraselective transcatheter arterial chemoembolization (TACE) for small hepatocellular carcinoma (HCC) using automated tumor-feeders detection (AFD) software. METHODS: Prototype AFD software was prospectively applied to cone-beam computed tomography images acquired during TACE for 155 consecutive HCCs ≤50 mm in 81 patients. The detectability of tumor-feeding subsubsegmental arteries was analyzed. Technical success of TACE was classified into three grades according to 1-week CT; the tumor was embolized with a safety margin (5 mm wide for tumors <25 mm, and 10 mm wide for tumors ≥25 mm) (grade A), without a margin in parts (grade B), or the entire tumor was not embolized (grade C). Tumor response at 2-3 months after TACE was also evaluated in 71 patients using the modified Response Evaluation Criteria in Solid Tumors. RESULTS: One-hundred and twenty-eight (82.6%) tumors were classed as grade A, 17 (11%) as grade B, and 10 (6.5%) as grade C. AFD software could identify 211 (85.4%) of 247 tumor-feeders but not 36 (14.6%). Eighteen (7.9%) were false positive. The tumor response of target lesions in each patient was complete response (CR) in 49 (69%) patients, partial response (PR) in 19 (26.8%), and stable disease (SD) in 3 (4.2%). The overall tumor response was CR in 39 (54.9%) patients, PR in 15 (21.2%), SD in 1 (1.4%), and progressive disease in 16 (22.5%). CONCLUSIONS: AFD software has sufficient performance to identify tumor-feeders and contributes to the high technical success in ultraselective TACE.

Retroperitoneal abscess associated with closed pelvic ring fracture diagnosed by fine free air on initial trauma pan computed tomography scan.

The patient was a 49-year-old male. He had a closed fracture of the pelvic ring that was treated successfully by avoiding anterior pelvic ring stabilization because of the presence of microscopic free air in the retroperitoneal space behind the pubic bone on initial whole-body trauma computed tomography scan. For his pelvic ring injury, transiliac rod and screw fixation was performed without the need for a pubic symphysis plate by developing the retroperitoneal space. His retroperitoneal abscess was treated by minimally invasive treatment of retroperitoneal abscess with computed tomography-guided percutaneous drainage. At 2 years postoperatively, there was no fever or elevated inflammatory response suspicious of retroperitoneal abscess recurrence. In this case, the presence of microscopic free air influenced the choice of treatment. Even in closed pelvic ring fractures, the presence of free air should be carefully considered when reading images.

Imaging approaches for the diagnosis of genetic diseases affecting the female reproductive organs and beyond.

This review aims to provide an overview of neoplastic lesions associated with genetic diseases affecting the female reproductive organs. It seeks to enhance our understanding of the radiological aspects in diagnosing genetic diseases including hereditary breast and ovarian cancer syndromes, Lynch syndrome, Peutz-Jeghers syndrome, nevoid basal cell carcinoma syndrome, and Swyer syndrome, and explores the patterns and mechanisms of inheritance that require elucidation. Additionally, we discuss the imaging characteristics of lesions occurring in other regions due to the same genetic diseases.

Imaging findings in inflammatory disease of the genital organs.

This review focuses on inflammatory diseases of female and male genital organs and discusses their epidemiology, pathogenesis, clinical presentation, and imaging findings. The female section covers pelvic inflammatory disease (PID) primarily caused by sexually transmitted infections (STIs) that affect the uterus, fallopian tubes, and ovaries. Unusual causes such as actinomycosis and tuberculosis have also been explored. The male section delves into infections affecting the vas deferens, epididymis, testes, prostate, and seminal vesicles. Uncommon causes such as tuberculosis, and Zinner syndrome have also been discussed. In addition, this review highlights other conditions that mimic male genital tract infections such as vasculitis, IgG4-related diseases, and sarcoidosis. Accurate diagnosis and appropriate management of these inflammatory diseases are essential for preventing serious complications and infertility. Imaging modalities such as ultrasound, magnetic resonance imaging, and computed tomography play a crucial role in diagnosis. Understanding the diverse etiologies and imaging findings is vital for the effective management of inflammatory diseases of the genital organs.

RPAP3 splicing variant isoform 1 interacts with PIH1D1 to compose R2TP complex for cell survival.

We previously characterized RNA polymerase II-associated protein 3 (RPAP3) as a cell death enhancer. Here we report the identification and characterization of splicing isoform of RPAP3, isoform 1 and 2. We investigated the interaction between RPAP3 and PIH1 domain containing protein 1 (PIH1D1), and found that RPAP3 isoform 1, but not isoform 2, interacted with PIH1D1. Furthermore, knockdown of RPAP3 isoform 1 by small interfering RNA down-regulated PIH1D1 protein level without affecting PIH1D1 mRNA. RPAP3 isoform 2 potentiated doxorubicin-induced cell death in human breast cancer T-47 cells although isoform 1 showed no effect. These results suggest that R2TP complex is composed of RPAP3 isoform 1 for its stabilization, and that RPAP3 isoform 2 may have a dominant negative effect on the survival potency of R2TP complex.

Identification of small hepatocellular carcinoma and tumor-feeding branches with cone-beam CT guidance technology during transcatheter arterial chemoembolization.

PURPOSE: To evaluate the performance of transcatheter arterial chemoembolization guidance software that uses cone-beam computed tomography (CT) technology in identifying small hepatocellular carcinoma (HCC) tumors and feeding branches. MATERIALS AND METHODS: Cone-beam CT and manual feeder vessel detection (MFD) software were used in chemoembolization of 68 HCCs 30 mm or smaller (mean ± standard deviation, 15.3 mm ± 5.2). Detectability of tumors and tumor-feeding sub-subsegmental arteries was compared versus that of nonselective digital subtraction angiography (DSA). Technical success of chemoembolization was divided into three grades according to 1-week CT findings: entire tumor embolized with at least a 5-mm-wide margin (ie, complete), tumor embolized without a margin in parts (ie, adequate), or entire tumor not embolized (ie, incomplete). All cone-beam CT data were also reanalyzed with automatic feeder vessel detection (AFD) software that was developed later. RESULTS: Cone-beam CT could depict all tumors, including eight that were first discovered during chemoembolization. Sixty-one tumors (89.7%) were detected on CT during arterial portography and during hepatic arteriography, and seven (10.3%) were detected with one or the other. Nonselective DSA depicted 49 tumors (72.1%). Among 100 tumor-feeding vessels, 81 were identified with MFD and 38 with nonselective DSA. Detectability of tumors with CT and tumor-feeding branches with MFD was significantly better than with nonselective DSA (both P<.001). Fifty-nine tumors (86.8%) were completely embolized and nine (13.2%) were adequately embolized. AFD identified 96 feeder vessels; 88 (88%) represented true-positive findings. CONCLUSIONS: Transcatheter arterial chemoembolization guidance software with cone-beam CT technology has a sufficient performance level to detect small HCCs and their feeding branches.

Blood supply of the main bile duct from the caudate artery and medial subsegmental artery of the hepatic artery: Evaluation using images obtained during transcatheter arterial chemoembolization for hepatocellular carcinoma.

AIM: Main bile duct necrosis develops after transcatheter arterial chemoembolization (TACE) through the caudate artery (A1) and medial subsegmental artery (A4) of the hepatic artery in the treatment of hepatocellular carcinoma. The aim of this study was to evaluate the bile duct branch (BD branch) from A1 and A4. METHODS: We evaluated the origin and vascular territory of the BD branch in 11 patients who underwent selective A1 and/or A4 arteriography using arteriograms, cone-beam computed tomography (CBCT) and CT obtained 1 week after TACE. Follow-up CT and/or magnetic resonance imaging were also evaluated. RESULTS: The BD branch arose from the first branch (n = 4), the second branch (n = 1), and both the first and second branches (n = 1) of A1, and from the first branch of A4 (n = 5). It supplied the bilateral hepatic ducts and common hepatic duct (CHD) (n = 4), the right hepatic duct (RHD) and CHD (n = 2), RHD, CHD and common bile duct (n = 1), the left hepatic duct (LHD) and CHD (n = 2), and LHD alone (n = 2). Anastomosis between A1 or A4 and other branches was demonstrated in seven patients. Bile duct stricture developed in all nine patients 2-8 months after TACE of the BD branch and percutaneous transhepatic bile duct drainage and metallic stent placement was required in one because of jaundice. CONCLUSION: The BD branch arises from the proximal portion of A1 and A4 and mainly supplies the hepatic ducts and CHD.

Fibrolipomatous hamartoma with macrodactyly and carpal tunnel syndrome.

A 26-year-old man presented with congenital left thumb macrodactyly. MRI showed diffuse enlargement of the left median nerve from the wrist to the digits, with particularly severe swelling of the thumb; US revealed the median nerve swelling comprised enlarged hypoechoic nerve bundles and increased hyperechoic areas around the nerve bundles. These typical cable-like and spaghetti-like appearances led to the diagnosis of fibrolipomatous hamartoma (FLH). Only debulking was performed for cosmetic reasons and enlarged nerves contiguous to the skin of the distal phalanx were cauterized and dissected. The diagnosis of FLH was confirmed pathologically. FLH is a rare, congenital disorder characterized by anomalous overgrowth of fibroadipose tissue between and around nerve bundles. Patients with median nerve involvement often present with carpal tunnel syndrome. Once its characteristic image is obtained, biopsy is not necessary.

Anatomical features of ossa cordis in the Steller sea lion.

Irregular triangular cartilage or bone fragments are sometimes found in the fibrous triangle of the heart. Ossa cordis and/or cartilago cordis has been demonstrated in various terrestrial animal species. Regarding marine mammals, sperm whales lack heart bones, and there have been no studies on bones or cartilage in pinniped hearts. Therefore, we examined the ossa cordis and/or cartilago cordis of the Steller sea lion. Eleven Steller sea lion hearts were examined morphologically and histologically. Before dissection, some hearts were imaged by CT to confirm the presence of ossa cordis or cartilago cordis. As a result, ossa cordis-like fragments were confirmed in four adults and one pup. All of the fragments were found at the right fiber triangle, and one adult had ossified tissue, including adipose tissue in the bone marrow cavity. The ossa cordis probably support the aorta because they surround the aorta as in other terrestrial animals. Steller sea lions can dive to a few hundred meters, but they need to rest on land frequently. Hence, their ossa cordis help maintain heart function during the tachycardia that occurs upon repeated surfacing and movements on land after diving in water.

Successful transcatheter arterial embolization for ruptured adrenocortical tumor in a pediatric patient.

Adrenocortical tumors (ACTs) are rare in children and should be treated as malignant tumors. A 12-year-old female patient was referred to our institute for acute abdomen and hypovolemic shock. She had symptoms of virilization, including lowered voice, beard growth, and hirsutism. An elevated level of dehydroepiandrosterone sulfate was observed, and computed tomography scan showed a large left adrenal mass with massive hemorrhage. Emergency transcatheter arterial embolization was successfully performed using N-buthyl-2-cyanoacrylate as an embolic material. She underwent surgical resection on the following day. Histopathological analysis showed strong degeneration of the tumor and its necrosis, and the tumor was diagnosed as ACT of unknown grade. To our knowledge, this is the first case of a ruptured ACT treated with transcatheter arterial embolization in a pediatric patient.

Low melting oxide glasses prepared at a melt temperature of 500 °C.

Transparent low-melting inorganic glass is an attractive industrial material based on its high thermal and light resistance compared with conventional engineering plastics. If the melting temperature of inorganic glass could be decreased, the doping of guest materials or compression moulding on the glass surface would be easier. Although phosphate glass is considered as a potential candidate because of its transparency in the visible region and low-melting behaviour, water durability often becomes a problem for implementation. Here, we prepared inorganic low-melting phosphate glass at a temperature of 500 °C via a melting and quenching methodology. It was found that tin-doped phosphate glasses exhibited higher thermal and light resistance properties than polycarbonates. Colourless transparent oxide glasses without organic components are capable of bringing about new possibilities for the application of inorganic glasses.