Cardiovascular event risk estimated after coronary revascularization and optimal medical therapy: J-ACCESS4 prognostic study.

BACKGROUND: An assessment of cardiac events and survival using quantitative gated myocardial single-photon emission computed tomography (SPECT) (J-ACCESS) associated several risk factors with cardiac events in Japan. The clinical course after revascularization and/or optimal medical therapy (OMT) was followed in patients with coronary artery disease (CAD) at moderate-to-high risk estimated by software incorporating the J-ACCESS risk model. The present study aimed to determine the relevance of changes in estimated risk to outcomes of these therapies. METHODS: This study included 494 patients with possible or definite CAD who underwent initial pharmacological stress 99mTc-tetrofosmin myocardial perfusion SPECT (MPS) before and eight months after therapy. Major cardiac event risk during 3 years of follow-up was calculated using an equation based on that in the J-ACCESS study. Patients with ≥ 10% cardiac event risk estimated at the first MPS (n = 31) were analyzed and followed up for at least 1 year. RESULTS: Estimated risk was reduced by ≥ 5% in 14 patients (45%) after therapy. During a follow-up period of 22.1 ± 6.7 months, one patient without such reduction had a major cardiac event. Mean %summed stress scores significantly decreased from baseline to follow-up in patients with and without risk reduction. Left ventricular ejection fraction (LVEF [%]) at rest was significantly increased at the second, compared with the first MPS between patients with, than without risk reduction (57 ± 17 vs. 45 ± 16%, p = 0.001 and 50 ± 11 vs. 49 ± 9%, p = 0.953, respectively). CONCLUSIONS: A reduction in cardiac ischemia and an increase in LVEF by revascularization and/or OMT were necessary to avoid cardiac events among patients with moderate-to-high estimated risk, and changes in event risk were quantifiable.

Risk stratification based on J-ACCESS risk models with myocardial perfusion imaging: Risk versus outcomes of patients with chronic kidney disease.

BACKGROUND: This study aimed to validate the accuracy of major-event risk models created in the multicenter J-ACCESS prognostic study in a new cohort of patients with chronic kidney disease (CKD). METHODS AND RESULTS: Three multivariable J-ACCESS risk models were created to predict major cardiac events (cardiac death, non-fatal acute coronary syndrome, and severe heart failure requiring hospitalization): Model 1, four variables of age, summed stress score, left ventricular ejection fraction and diabetes; Model 2 with five variables including estimated glomerular filtration rate (eGFR, continuous); and Model 3 with categorical eGFR. The validation data used three-year (3y) cohort of patients with CKD (n = 526, major events 11.2%). Survival analysis of low (< 3%/3y), intermediate (3% to 9%/3y), and high (> 9%/3y)-risk groups showed good stratification by all three models (actual event rates: 3.1%, 9.9%, and 15.9% in the three groups with eGFR ≥ 15 mL/min/1.73 m2, P = .0087 (Model 2). However, actual event rates were equally high across all risk groups of patients with eGFR < 15 mL/min/1.73 m2. CONCLUSION: The J-ACCESS risk models can stratify patients with CKD and eGFR ≥ 15 mL/min/1.73 m2, but patients with eGFR < 15 mL/min/1.73 m2 are potentially at high risk regardless of estimated risk values.

The difference of risk factors predicting cardiac events in patients with chronic kidney disease between with and without diabetes.

OBJECTIVE: Chronic kidney disease (CKD) and diabetes are both associated with cardiovascular disease, but the effects of diabetes in patients with CKD remain unknown. This study aimed to compare the risk factors of cardiac events between patients with CKD accompanied and not by diabetes using myocardial perfusion imaging. METHODS: We initially classified 529 patients with CKD from the Japanese Assessment of Cardiac Events and Survival Study-3 (J-ACCESS-3) study who had been assessed by gated single-photon emission-computed tomography based on whether they had diabetes (n = 220) or not (n = 309) and then separated them into four subgroups based on the ejection fraction (EF) calculated by quantitative gated SPECT. After 3-year follow-up, the incidence of major cardiac events (cardiac death, sudden death, non-fatal myocardial infarction, and heart failure requiring hospitalization), risk factors among each group, and the ability of myocardial perfusion image to predict prognosis were evaluated. RESULTS: Major cardiac events occurred in 12.7% and 10.3% of patients with and without diabetes (not significant), and heart failure requiring hospitalization was the most frequent (75% and 78%, respectively) in both groups. Event-free survival rates were lower in the subgroups with low EF and high summed stress scores (SSS). Independent risk factors comprised currently smoking and a higher SSS, among patients with diabetes, while higher left ventricular end diastolic volumes and serum C-reactive protein values among those without diabetes. CONCLUSIONS: In patients with CKD, while the risk factors of major cardiac events differ between in patients with and without diabetes, quantitation with gated MPI could be used effectively in both groups.

Prognostic value of normal stress myocardial perfusion imaging and ventricular function in Japanese patients with chronic kidney disease: a study based on the J-ACCESS-3 database.

BACKGROUND: The purpose of this study is to test the hypothesis that a normal myocardial perfusion imaging (MPI) study in chronic kidney disease (CKD) can provide benign prognostic information for the prediction of major cardiovascular events. METHODS: The study group consisted of 431 CKD patients (males, 64%; mean age, 72 ± 11 years) with normal SPECT imaging. Based on SPECT image and QGS data, 331 had a summed stress score of 3 or less, a summed difference score of 1 or less and normal cardiac function (males; end-systolic volume (ESV) ≤ 60 ml, females; ESV ≤ 40 ml, males, ejection fraction (EF) ≥ 49%; females, EF ≥ 50%). RESULTS: During a 3-year follow-up period, there were a total of 27 major cardiovascular events, including cardiac death (n = 3), sudden death (n = 3), and acute coronary syndrome (n = 3), and 19 were hospitalized because of congestive heart failure. Kaplan-Meier analysis showed that the number of major cardiovascular events in patients with higher eGFR of ≥ 15 ml/min) were very few, and regarded as low risk. According to the eGFR status, namely < 15 (n = 58), 15 to < 30 (n = 97), 30 to < 45 (n = 131), ≥ 45 (n = 45), the higher cardiac event rate was observed in patients with eGFR of < 15 ml/min among the four groups. The major cardiovascular event rate in patients with the lowest eGFR (< 15) was twice as much than that in patients with eGFR of ≥ 30 ml/min. Lower hemoglobin (males, < 12 g/dl; females, < 11 g/dl) and higher CRP (CPR ≥ 0.3 mg/dl) were also the predictors of increased risk. CONCLUSIONS: Normal stress SPECT images confer a benign prognosis in patients with CKD, but care must be taken for severely reduced renal function, which was associated with higher cardiac event.

Metabolic syndrome is not a predictor for cardiovascular events in Japanese patients with diabetes mellitus asymptomatic for coronary artery disease: a retrospective analysis of the J-ACCESS-2 study.

PURPOSE: Patients with metabolic syndrome (MetS) have potentially higher risk for cardiovascular events. The aim of this study was to evaluate the effect of MetS on cardiac events in type-2 diabetic patients asymptomatic for coronary artery disease (CAD) in a Japanese population. METHODS: A total of 485 patients from a J-ACCESS-2 investigation with stress-gated myocardial perfusion imaging (MPI) and quantitative-gated MPI analysis were examined. Cardiovascular hard events (cardiac death and acute coronary syndrome) and total events during a 3-year follow-up were analyzed. RESULTS: The MetS group (n = 229) had higher incidence of hypertension, dyslipidemia, and ventricular dilatation than the non-MetS group (n = 256). The hard events were 8 and 12 for the MetS and non-MetS groups (P = n.s.), and total events were 31 and 31 for each of these groups, respectively (P = n.s.). Significant variables related to total cardiovascular events included age, current smoking, insulin use, total cholesterol, ejection fraction, summed stress score ≥ 9, and summed difference score ≥ 2. Cox proportional hazard analysis and Kaplan-Meier survival analysis showed that only the summed stress score was related to total events (P = .01), and the presence and the number of items for MetS criteria were not. CONCLUSION: In patients with type 2 diabetes asymptomatic for CAD, cardiovascular events and ischemia are as common in diabetic patients without MetS as in those with MetS. A high MPI defect score is related to total events including cardiac and cerebrovascular events.

New semi-quantitative 123I-MIBG estimation method compared with scoring system in follow-up of advanced neuroblastoma: utility of total MIBG retention ratio versus scoring method.

OBJECTIVE: The purpose of this study is to evaluate a new semi-quantitative estimation method using (123)I-MIBG retention ratio to assess response to chemotherapy for advanced neuroblastoma. METHOD: Thirteen children with advanced neuroblastoma (International Neuroblastoma Risk Group Staging System: stage M) were examined for a total of 51 studies with (123)I-MIBG scintigraphy (before and during chemotherapy). We proposed a new semi-quantitative method using MIBG retention ratio (count obtained with delayed image/count obtained with early image with decay correction) to estimate MIBG accumulation. We analyzed total (123)I-MIBG retention ratio (TMRR: total body count obtained with delayed image/total body count obtained with early image with decay correction) and compared with a scoring method in terms of correlation with tumor markers. RESULT: TMRR showed significantly higher correlations with urinary catecholamine metabolites before chemotherapy (VMA: r(2) = 0.45, P < 0.05, HVA: r(2) = 0.627, P < 0.01) than MIBG score (VMA: r(2) = 0.19, P = 0.082, HVA: r(2) = 0.25, P = 0.137). There were relatively good correlations between serial change of TMRR and those of urinary catecholamine metabolites (VMA: r(2) = 0.274, P < 0.001, HVA: r(2) = 0.448, P < 0.0001) compared with serial change of MIBG score and those of tumor markers (VMA: r(2) = 0.01, P = 0.537, HVA: 0.084, P = 0.697) during chemotherapy for advanced neuroblastoma. CONCLUSION: TMRR could be a useful semi-quantitative method for estimating early response to chemotherapy of advanced neuroblastoma because of its high correlation with urine catecholamine metabolites.

Nodal counts on MDCT as a surrogate marker for surgical curability in gastric cancer.

BACKGROUND: Thin-slice multidetector row computed tomography (MDCT) has emerged as a promising diagnostic modality in various cancers. This study was designed to evaluate the utility of metastatic nodal counts on MDCT as a surrogate maker for surgical curability in gastric cancer. METHODS: Between 2005 and 2007, a total of 92 patients with gastric cancer underwent preoperative MDCT at a slice thickness of 1.0 mm at our hospital. All regional lymph nodes showing metastatic involvement were preoperatively counted. RESULTS: Although the total counts of metastatic lymph nodes on MDCT were significantly smaller than those found by histopathology (P = 0.00001), there was a significant correlation between nodal counts on MDCT and histopathology by Spearman's analysis [P < 0.0001, pathologic counts = 1.63x (counts on MDCT) + 2.5]. Nodal counts on MDCT of ≥4 were analyzed as putative pathologic nodal counts of ≥8 by the equation, and pathologic metastatic nodal counts of ≥8 were most significantly correlated with noncurative resection (P < 0.0001). According to the logistic regression analysis, nodal counts on MDCT of ≥4 were a significant independent variable for noncurative resection (P = 0.0052, odds ratio 26.68). Nodal counts on MDCT of ≥4 could distinguish noncurative patients from curative patients with 94.4% sensitivity and 71.6% specificity. CONCLUSIONS: Nodal counts on MDCT could be a reliable surrogate maker for surgical curability of gastric cancer. This marker might enable us to select prospective candidates for additional or alternative treatments in gastric cancer.

CT-guided percutaneous drainage within intervertebral space for pyogenic spondylodiscitis with psoas abscess.

BACKGROUND: Reports on CT-guided percutaneous drainage within the intervertebral space for pyogenic spondylodiscitis with a secondary psoas abscess are limited. PURPOSE: To evaluate CT-guided percutaneous drainage within the intervertebral space for pyogenic spondylodiscitis and a secondary psoas abscess in which the two sites appear to communicate. MATERIAL AND METHODS: Eight patients with pyogenic spondylodiscitis and a secondary psoas abscess showing communication with the intradiscal abscess underwent CT-guided percutaneous drainage within the intervertebral space. The clinical outcome was retrospectively assessed. RESULTS: An 8-French pigtail catheter within the intervertebral space was successfully placed in all patients. Seven patients responded well to this treatment. The one remaining patient who had developed septic shock before the procedure died on the following day. The mean duration of drainage was 32 days (13-70 days). Only one patient with persistent back pain underwent surgery for stabilization of the spine after the improvement of inflammation. Among seven patients responding well, long-term follow-up (91-801 days, mean 292 days) was conducted in six patients excluding one patient who died of asphyxiation due to aspiration unrelated to the procedure within 30 days after the procedure. In these six patients, no recurrence of either pyogenic spondylodiscitis or the psoas abscess was noted. CONCLUSION: CT-guided percutaneous drainage within the intervertebral space can be effective for patients with pyogenic spondylodiscitis and a secondary psoas abscess if the psoas abscess communicates with the intradiscal abscess.

Clinical evaluation of JCGC and TNM staging on multidetector-row computed tomography in preoperative nodal staging of gastric cancer.

BACKGROUND/AIMS: Multidetector row computed tomography (MDCT) has emerged as a new diagnostic technology in various cancers. The aim was to evaluate its clinical compatibility with the 13th Japanese Classification of Gastric Carcinoma (JCGC), the 6th TNM and the new 14th JCGC/ 7th TNM systems in preoperative nodal staging (N-stage) of gastric cancer. METHODOLOGY: Between January 2005 and December 2007, 92 consecutive patients with gastric cancer underwent preoperative MDCT at a slice thickness of 1.0 mm. RESULTS: The 13th JCGC N-stage on MDCT demonstrated the potential correlation with pathological findings (p=0.057). However, preoperative 6th TNM and the new 14th JCGC/7th TNM N-stage on MDCT from N1 to N3 did not significant correlate with pathological findings (p=0.979, 0.847) because the number of metastatic lymph nodes detected preoperatively on MDCT was significantly smaller than that detected on pathological diagnosis (p<0.0001). CONCLUSIONS: Nodal staging in the 13th JCGC staging system correlates with histological examination better than the 6th TNM and 14th JCGC/7th TNM staging systems. The optimal preoperative nodal staging using the current 14th JCGC/7th TNM staging system on MDCT needs further investigation.

Experience of fluoroscopy-aided thoracoscopic resection of pulmonary nodule localised with Lipiodol in a child.

We report the case of a 12-year-old boy with a huge liver tumour 20 cm in diameter with multiple lung metastases. Six months after systemic chemotherapy was initiated, all tumours had disappeared with the exception of the liver tumour and a tiny lung tumour 2.5 mm in diameter. Fluoroscopy-assisted thoracoscopic resection of the pulmonary nodule was performed to evaluate whether viable tumour tissue remained in the lung lesion. Before moving the patient to the operating room, the nodule was marked by Lipiodol under CT fluoroscopic guidance with the patient under local anaesthesia. This procedure allowed correct visualisation of the area that should be resected.

Optimal duration of androgen deprivation in combination with radiation therapy for Japanese men with high-risk prostate cancer.

OBJECTIVES: To evaluate the efficacy and toxicity of external beam radiation therapy (EBRT) combined with androgen deprivation therapy (ADT) for Japanese high-risk prostate cancer (PCa) patients in a single institution. METHODS: Seventy-five high-risk PCa patients were treated by three-dimensional conformal radiotherapy of 70 Gy combined with neoadjuvant, concurrent and adjuvant ADT. RESULTS: Median age was 72 (59-82) years. Median initial serum prostate-specific antigen (PSA) was 19.0 (4.7-200) ng/ml. Median duration of the entire ADT was 27 (8-63) months. Median follow-up after initiating ADT and after completing EBRT was 66 (41-105) and 59 (36-94) months, respectively. Five-year overall, clinical progression-free, and biochemical progression-free survival rates were 98.3, 97.2, and 87.4%; 2 (2.7%) cancer deaths, 3 (4.0%) clinical progressions, and 11 (14.7%) biochemical progressions. Multivariate analysis suggested a total duration of ADT shorter than 24 months as an independent risk factor of biochemical progression (p = 0.01). Grade 3 toxicities related to EBRT were observed: 1 patient with proctitis and rectal bleeding and 1 patient with rectal bleeding. CONCLUSIONS: It is suggested that 70 Gy EBRT combined with ADT confers disease-free survival benefit with tolerable adverse events for Japanese high-risk PCa patients. ADT of 24 months or longer might be recommended to minimize biochemical progression.

Evaluation of hepatocyte growth factor plasmid therapeutic effect by 99mTc-hexakis-2-methyoxy-isobutylisonitrile blood flow scintigraphy in a rat model of hind limb ischemia.

OBJECTIVE: This study was conducted in an attempt to use blood flow scintigraphy with 99mTc-hexakis-2-methyoxy-isobutylisonitrile (99mTc-MIBI) for the evaluation of the angiogenic effect of hepatocyte growth factor (HGF) plasmid in a rat model of hind limb ischemia. MATERIALS AND METHODS: The femoral artery of the left hind limb of each rat was ligated to create a model of hind limb ischemia. Three weeks later, HGF plasmid (1.5 mg/1.1 ml/body) or saline (1.1 ml/body) was administered intramuscularly into three sites of the ischemic hind limb. Two and 4 weeks after the treatment, blood flow through the hind limb was measured by 99mTc-MIBI scintigraphy. In addition, the number of capillary endothelial cells obtained by immunostaining for CD31 was counted. RESULTS: After 99mTc-MIBI scintigraphy in the HGF plasmid-treated group, the blood flow ratio increased significantly from the pretreatment ratio 63.8 to 73.4%, 2 weeks after treatment (P<0.05) and to 97.8%, 4 weeks after treatment (P<0.05). The number of CD31-positive endothelial cells was significantly higher in the HGF plasmid-treated group than in the control group. CONCLUSIONS: The experimental study using a rat model of hind limb ischemia showed usefulness of 99mTc-MIBI scintigraphy to evaluate the angiogenic effect of HGF plasmid treatment.

Percutaneous radiofrequency ablation for pulmonary metastases from hepatocellular carcinoma: results of a multicenter study in Japan.

PURPOSE: To retrospectively evaluate technical success, effectiveness, complications, patient survival, and prognostic factors with percutaneous radiofrequency (RF) ablation for pulmonary metastases resulting from hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Thirty-two patients from six institutions were included, with a total of 83 pulmonary metastases treated in 65 sessions. RF ablation was always performed percutaneously with computed tomography (CT) guidance. Primary endpoints were technical success and technique effectiveness. Technique effectiveness was evaluated based on sequential follow-up CT images. Secondary study endpoints were complications, patient survival, and determination of prognostic factors. Complications were classified as major or minor. Prognostic factors were determined by analyzing multiple variables with the log-rank test. RESULTS: Technical success rate was 100%. Primary technique effectiveness rates were 92% each at 1, 2, and 3 years. Major and minor complications occurred after 16 (25%) and 23 (35%) of the 65 sessions, respectively. The median follow-up period was 20.5 months. Overall survival rates were 87% at 1 year and 57% each at 2 and 3 years (median and mean survival times, 37.7 mo and 43.2 mo, respectively). Significantly better survival rates were obtained in cases of (i) no viable intrahepatic recurrence (P < .001), (ii) Child-Pugh class A disease (P < .001), (iii) absence of liver cirrhosis (P < .001), (iv) absence of hepatitis C virus infection (P = .006), and (v) α-fetoprotein level of 10 ng/mL or lower (P = .007) at the time of RF ablation. CONCLUSIONS: RF ablation appears effective, with an acceptable safety profile, in selected patients with pulmonary metastases resulting from HCC.

Incremental value of T2-weighted and diffusion-weighted MRI for prediction of biochemical recurrence after radical prostatectomy in clinically localized prostate cancer.

BACKGROUND: For men with clinically localized prostate cancer and candidates to receive radical prostatectomy (RP) a main concern is a cancer recurrence after treatment. Although previous studies have demonstrated the diagnostic utility of diffusion-weighted imaging (DWI) for prostate cancer, the prognostic value of pretreatment DWI has not been investigated yet. PURPOSE: To investigate the incremental value of MRI-based T staging using DWI and T2-weighted imaging (T2WI) as compared with the clinical parameters in prediction of biochemical recurrence (BCR) after RP for clinically localized prostate cancer. MATERIAL AND METHODS: Sixty MR examinations, obtained before RP between April 2002 and March 2009, were retrospectively reviewed using T2WI alone, DWI alone, or T2WI + DWI for T staging according to the 2002 American Joint Committee on Cancer guidelines. The relationship between MRI stage and BCR was evaluated using Kaplan-Meier survival estimates. Multivariate analysis and receiver operating characteristics (ROC) curve analysis were used to investigate the incremental value over the standard clinical variables in prediction of BCR. RESULTS: As of August 2009, 12 (20%) patients had BCR. Based on T2WI + DWI, both T3a (compared to OC disease) and T2 (compared to T1c) showed significantly higher BCR rates (p=0.047 and 0.025, respectively). Multivariate analysis and area under ROC curve analysis confirmed the additional value of MRI staging to the conventional clinical variables in prediction of BCR. CONCLUSION: The combination of T2WI and DWI on performing pretreatment MRI helped predict BCR after RP in clinically localized prostate cancer.

Value of embolisation of collateral veins from gastric varices before balloon-occluded retrograde transvenous obliteration.

OBJECTIVE: The purpose of our investigation was to determine the safety and usefulness of embolisation procedures in balloon occluded retrograde transvenous obliteration (BRTO) as treatment of gastric varices after portal hypertension. MATERIALS AND METHODS: Between June 2004 and August 2009, 40 patients underwent BRTO for gastric varices that occurred after portal hypertension in our institution. When large collateral vessels of gastric varices had developed as drainage veins other than the gastro-renal shunt, these collateral vessels were embolised prior to BRTO. RESULTS: Embolisation was performed for 18 collateral vessels in 16 cases before BRTO. Embolised collateral vessels were the left inferior phrenic vein (n = 14), intercostal vein (n = 3), and ascending lumbar vein communicating with the gastro-renal shunt (n = 1). Mean number of micro-coils used was 5.7 in left inferior phrenic veins, 4.7 in intercostal veins and 4 in the ascending lumbar vein. In 36 (90%) patients, contrast-enhanced abdominal CT after BRTO showed that the gastric varices were well obliterated. The rate of occurrence of cases in which the remnant of the enhanced area in the gastric varices was seen even after BRTO was statistically higher in cases requiring embolisation of collateral vessels than in those who did not (4/16 versus 0/24, P = 0.0199 according to Fisher's exact probability test). Recurrence of gastric varices was determined by endoscopy in 1 (2.5%) case necessitating embolisation of collateral vessels. There were no serious complications. CONCLUSION: Embolisation of collateral vessels before BRTO is a safe and useful procedure. However, especially in cases having collaterals sufficiently large to require embolisation, careful follow-up for recurrence of gastric varices is necessary.

Stereotactic body radiation therapy for head and neck tumor: disease control and morbidity outcomes.

We evaluated the efficacy and safety of stereotactic body radiation therapy (SBRT) for patients with head and neck tumors. From April 2005 through April 2008, 34 patients with head and neck tumors were treated with CyberKnife SBRT. Twenty-one of them had prior radiotherapy. Treatment sites were orbit (n = 7), cervical lymph nodes (n = 6), nasopharynx (n = 5), oropharynx (n = 4) and others (n = 12). The prescribed dose ranged from 19.5 to 42 Gy (median, 30 Gy) in 3-8 fractions for consecutive days. The target volume ranged from 0.7 to 78.1 cm(3) (median, 11.6 cm(3)). The median follow-up was 16 months. Treatment was well tolerated without significant acute complications in any cases. Complete response rate and partial response rate were 32.4% and 38.6%, respectively. The overall survival rates were 70.6% and 58.3% at 12 and 24 months, respectively. The overall survival was better in patients without prior radiotherapy within the previous 24 months or in case of smaller target volume. Six patients suffered severe late complications. All these patients had prior radiotherapy, and 2 of them developed massive hemorrhage in the pharynx and both died of this complication 5 and 28 months, respectively, after SBRT. Our preliminary results suggest that SBRT is an effective treatment modality for head and neck tumors. However, re-irradiation has significant risk of severe and even fatal late complications in the form of necrosis and hemorrhage in re-irradiated areas.

Endovascular repair of a perforation of the vena caval wall caused by the retrieval of a Gunther Tulip filter after long-term implantation.

Symptomatic penetration of the inferior vena cava (IVC) wall reportedly occurs in 0.3% of patients in whom a filter has been implanted, and it causes injury to the adjacent structures (Bogue et al. in Pediatr Radiol 39(10):1110-1113, 1; Brzezinski et al. in Burns 32(5):640-643, 2). We succeeded in the endovascular repair of perforation of the IVC wall occurring during the retrieval of a penetrated Gunther tulip vena cava filter (Cook, Bjaeverskov, Denmark) after long-term implantation.

Transcatheter arterial embolization for spontaneous rupture of the omental artery.

We encountered a rare case of spontaneous rupture of the omental artery. A 25-year-old man without any episode of abdominal trauma or bleeding disorders came to the emergency unit with left upper abdominal pain. Hematoma with extravasation of the greater omentum and a hemoperitoneum was confirmed on abdominal contrast-enhanced computed tomography. Bleeding from the omental artery was suspected based on these findings. Transcatheter arterial embolization was successfully performed after extravasation of the omental artery, which arises from the left gastroepiploic artery, was confirmed on arteriography. Partial ometectomy was performed 10 days after transcatheter arterial embolization, revealing that the hematoma measured 10 cm in diameter in the greater omentum. Pathological examination showed rupture of the branch of an omental artery without abnormal findings, such as an aneurysm or neoplasm. Thus, we diagnosed him with spontaneous rupture of the omental artery. The patient recovered and was discharged from the hospital 10 days after the surgery, with a favorable postoperative course.

Diaphragmatic hernia after radiofrequency ablation for hepatocellular carcinoma.

We describe a 71-year-old woman with a hepatocellular carcinoma who underwent percutaneous radiofrequency ablation (RF) with a single internally cooled electrode under computed tomography (CT) fluoroscopic guidance. Nine months after the procedure, CT images showed herniation of the large intestine into the right pleural cavity. To our knowledge this complication of RF performed with a single internally cooled electrode under CT guidance has not been previously reported.