Epithelioid angiomyolipoma of the pancreas: A case report and review of the literature.

BACKGROUND: Angiomyolipomas (AMLs), belonging to the family of mesenchymal tumors, are considered benign lesions that occur mostly in the kidney or as a part of tuberous sclerosis. Epithelioid AML (EAML) is a rare type of AML that appears to have malignant potential. Extrarenal AMLs usually occur in the liver according to the retrieved literature reports. There have been only two previous reports of monofocal primary AML of the pancreas; however, no cases of primary monotypic EAML of the pancreas have been reported. CASE SUMMARY: An asymptomatic 59-year-old woman incidentally revealed a tumor during abdominal ultrasound examination. Routine blood tests and physical examination were within normal limits. Abdominal ultrasound revealed a 1.9-cm hypoechogenic mass in the tail of the pancreas, clearly visualized by endoscopic ultrasound. However, contrast-enhanced abdominal computed tomography scans did not demonstrate the lesion. A subsequent gadolinium-enhanced magnetic resonance imaging scan showed that the lesion had some characteristic manifestations. The lesion was initially thought to be a neuroendocrine tumor (asymptomatic PanNET). After surgical resection, histopathology and immunohistochemistry confirmed the diagnosis of EAML. At the 6-mo follow-up, no recurrence, spread, or metastasis was identified on computed tomography or magnetic resonance imaging. CONCLUSION: The preoperative diagnosis of pancreatic AML is extremely difficult. Imaging techniques are essential for providing valuable morphological features for differential diagnosis.

Evaluation of computed tomography vascular reconstruction for the localization diagnosis of perigastric mass.

BACKGROUND: The aim of this study was to evaluate the utility of computed tomography (CT) vascular reconstruction in the localization diagnosis of perigastric mass. METHODS: Fifty-eight patients with pathologically detected perigastric mass underwent abdominal dynamic contrast-enhanced CT. CT vascular reconstructions were produced from arterial phase data using volume rendering (VR), multiplanar reconstruction (MPR), and maximal intensity projection (MIP). Image analysis was focused on the relationship between the mass, perigastric arteries, and the gastric wall. Localization diagnosis values were compared between CT vascular reconstruction and dynamic-enhanced CT images. RESULTS: Among the 58 cases of perigastric mass, 41 cases originated from the stomach, 7 cases from the left liver lobe, 6 from the pancreas, 2 from lessor omental bursa, 1 from transverse mesocolon, and 1 from left adrenal gland. The accuracy of CT vascular reconstruction images in the localization diagnosis of perigastric mass was higher than that of dynamic-enhanced CT images (98.3% and 86.2%, respectively, P = .04). On the reference level, 35 (35/41) patients with stomach-originated masses showed the mass adjacent perigastric arteries pushed away from the stomach (arterial displacement sign), and 15 (15/17) patients with nonstomach-originated masses showed perigastric arteries between the mass and the stomach (arterial entrapment sign). The sensitivity, specificity, positive predictive value, and negative predictive value of the localization diagnosis of perigastric mass with arterial displacement sign were 85.4%, 100%, 100%, and 73.9%, respectively, and with arterial entrapment sign, 88.2%, 100%, 100%, and 95.3%, respectively. CONCLUSION: CT vascular reconstruction can clearly depict the relationship between perigastric mass and adjacent perigastric arteries, which may help us more accurately differentiate between stomach-originated and nonstomach-originated masses compared with original dynamic-enhanced CT images.

Congenital Intracerebral Pial Arteriovenous Fistula: A Case Report.

Pial arteriovenous fistula (AVF) is an extremely rare intracranial vascular lesion. The pediatric type of AVF has a high percentage of varix, leading to mass effect with symptoms. We report a 12-year-old boy who was admitted due to sudden confusion and urinary incontinence. Computed tomography, magnetic resonance imaging, and magnetic resonance angiography (MRA) confirmed the diagnosis of congenital pial AVF. Digital subtraction angiography (DSA) revealed the lesion originating from the left middle cerebral artery and draining into the superior sagittal sinus. The AVF was successfully obliterated with six microcoils and 2.5-mL ethylene vinyl alcohol copolymer using a middle cerebral artery approach. This patient was discharged without neurologic deficits. The AVF became smaller and ultimately disappeared on the DSA and MRA at follow-up.

Effect of gallium nitrate on the expression of osteoprotegerin and receptor activator of nuclear factor­κB ligand in osteoblasts in vivo and in vitro.

Osteoporosis is characterized by the progressive loss of bone mass and the micro­architectural deterioration of bone tissue, leading to bone fragility and an increased risk of fracture. Gallium has demonstrated efficacy in the treatment of several diverse disorders that are characterized by accelerated bone loss. Osteoblasts orchestrate bone degradation by expressing the receptor activator of NF­κB ligand (RANKL), however they additionally protect the skeleton by secreting osteoprotegerin (OPG). Therefore, the relative concentration of RANKL and OPG in bone is a key determinant of bone mass and strength. The current study demonstrated that gallium nitrate (GaN) is able to counteract bone loss in an experimental model of established osteoporosis. Ovariectomized (OVX) rats exhibited significantly increased bone mineral density following GaN treatment for 4 and 8 weeks by 19.3 and 37.3%, respectively (P<0.05). The bone volume of the OVX + GaN group was increased by 40.9% (P<0.05) compared with the OVX group. In addition, the current study demonstrated that GaN stimulates the synthesis of OPG however has no effect on the expression of RANKL in osteoblasts, as demonstrated by RT­qPCR, western blotting and ELISA, resulting in an increase in the OPG/RANKL ratio and a reduction in osteoclast differentiation in vivo and in vitro.

Fatsioside A inhibits the growth of glioma cells via the induction of endoplasmic reticulum stress-mediated apoptosis.

Malignant gliomas are a common type of primary tumor of the central nervous system. In spite of current intensive therapy, the prognosis of patients with malignant glioma remains poor, hence the development of novel therapeutic modalities is necessary. Cell apoptosis is a frequent target in the development of anti­cancer drugs. Fatsioside A, a novel baccharane­type triterpenoid glycoside, is extracted from the fruits of Fatsia japonica. Previous studies have shown that Fatsioside A induces growth inhibition, cell cycle arrest and apoptosis in C6 rat glioma cells and U251 human glioma cells. However, to the best of our knowledge, no detailed studies have reported its effect on U87MG glioma cells and its exact mechanisms remain unknown. In the current study, the growth inhibitory effect of Fatsioside A on U87MG cells was evaluated and the underlying molecular mechanisms were explored. Through the use of flow cytometry and a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, it was determined that Fatsioside A markedly inhibits the growth of U87MG cells. Mechanistic studies demonstrated that Fatsioside A induces growth inhibition of U87MG cells via the induction of endoplasmic reticulum (ER) stress, which was supported by the upregulation of ER stress markers, including elevated levels of phosphorylation of PERK and eIF2α, the increased expression levels of CHOP and the accelerated cleavage of caspase­4. The downregulation of CHOP via CHOP­specific siRNA reduced the growth­inhibitive effect of Fatsioside A on U87MG cells, further confirming the role of the ER stress response in mediating Fatsioside A­induced growth inhibition. In conclusion, Fatsioside A inhibits glioma cell growth via the induction of ER stress­mediated apoptosis. This may provide a molecular basis for the development of Fatsioside A into a drug candidate for the treatment of malignant glioma.

Comparison of hamstring tendon autograft and tibialis anterior allograft in arthroscopic transtibial single-bundle posterior cruciate ligament reconstruction.

PURPOSE: To compare the outcomes between hamstring tendon autograft and tibialis anterior allograft in arthroscopic transtibial single-bundle posterior cruciate ligament (PCL) reconstruction. METHODS: Thirty-seven patients undergoing isolated single-bundle PCL reconstruction were enrolled in this study, and their data were retrospectively analyzed. They were divided into group A [4-strand hamstring tendon autograft (4SHG), n = 18] and group B [2-strand tibialis anterior allograft (2STAG), n = 19] and followed up for 2 years at least. Several parameters including the International Knee Documentation Committee score, Lysholm knee score, Tegner activity rating and knee laxity arthrometer were evaluated, and physical examination was performed preoperatively and postoperatively, and postoperative complications were also observed in all patients. Meanwhile, the postoperative posterior instability was compared between the affected knee and the contra-lateral knee. RESULTS: Compared with preoperative knee laxity and function, both groups had significant improvement postoperatively (P < 0.01). However, there were no significant differences in knee laxity and function between both groups (n.s.). Compared with contra-lateral knee, the posterior stability was worse in the affected knee (P < 0.01). CONCLUSIONS: The outcomes were similar between 4SHG or 2STAG in PCL reconstruction. Compared with contra-lateral knees, the affected knees have slight residual knee laxity in both groups. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

[Visualization of endolymphatic hydrops in 3D-FLAIR MRI after intratympanic Gd-DTPA administration in Meniere's disease patients].

OBJECTIVE: To study the feasibility of endolymphatic visualization and the diagnosis of Meniere's disease by applying intratympanic gadolinium administration through the tympanic membrance and three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI). To study the relationship between the endolymphatic hydrops visualized by MRI and audio-vestibular functional tests, such as pure tone audiometry (PTA), electrocochleography (EcoG), caloric test and vestibular evoked myogenic potential (VEMP). METHODS: With a three Tesla magnetic resonance imaging (MRI) unit, 3D-FLAIR imaging was performed 24 hours after intratympanic gadolinium through the tympanic membrance in 32 patients with clinically diagnosed unilateral Meniere's Disease. We visualized the enhanced imaging of perilymphatic space in bilateral cochlea, vestibular and (or) canal, scoring scala tympani and scala vestibule of bilateral cochlear basal turn respectively and measuring the developing area of bilateral vestibule and the signal intensity ratio (SIR) between the vestibule and the brain stem subjectively. PTA, EcoG, caloric test and VEMP were performed. The relationship between the endolymphatic hydrops visualized by MRI and audio-vestibular functional tests were studied. RESULTS: The gadolinium appeared in almost all parts of the perilymph in cochlea, vestibular and (or) canals in all 32 patients' inner ears, so the endolymphatic space was clearly shown on 3D-FLAIR imaging. The scala vestibuli score value between the affected side and the healthy side were statistically significant (Z = 4.309, P < 0.05) . The developing vestibular area between the affected side and the healthy side [(6.04 ± 2.89) mm(2), (8.28 ± 3.04)mm(2)] were statistically significant (t = 3.322, P < 0.05) . Abnormal vestibular evoked myogenic potentials were significantly correlated with the developing vestibular area of the affected side (F = 11.96, P < 0.05) . Abnormal electrocochleography were significantly correlated with scala vestibuli score value of cochlear basal turn in the affected side (Z = 3.17, P < 0.05) . No significant correlation was found between the scala vestibuli score value or the developing vestibular area and caloric test or PTA findings. CONCLUSIONS: 3D-FLAIR MRI with intratympanic gadolinium injection through the tympanic membrance can discriminate the border between the perilymph and the endolymph and show endolymphatic hydrops. This method may provide radiographic reference for the diagnosis of Meniere's disease. The results of VEMP and electrocochleography might have appropriate correlation with degree of vestibular and cochlear hydrops.

[Comparative study on diagnosis of fetal dysplasia of spine and spinal cord between B ultrasonography and magnetic resonance imaging].

OBJECTIVE: To compare the value of ultrasound and magnetic resonance imaging (MRI) in detecting fetal spine and spinal cord dysplasia. METHODS: Thirty women with complicated pregnancies, age from 22 to 41 years, gestation from 23-38 weeks, were studied with MRI within 72 hours after ultrasound studies and revealed 19 cases of fetal spine with irregular, 7 cases of vertebral canal widened partly and 4 cases of anomalies of spinal curvature. Autopsy or imaging was conducted when pregnancy was terminated. A close follow-up was given for cases continuing pregnancy within 12 months after delivery. RESULTS: (1) Nineteen cases of fetal spine with irregular in ultrasound, the coincidence of antenatal sonographic diagnosis was 42% (8/19), the coincidence of antenatal MRI diagnosis was 89% (17/19). Seven cases of vertebral canal widened partly in ultrasound, the coincidence of antenatal sonographic diagnosis was 0, the coincidence of antenatal MRI diagnosis was 7/7. Four cases of anomalies of spinal curvature in ultrasound, the coincidence of antenatal sonographic diagnosis was 2/4, the coincidence of antenatal MRI diagnosis was 3/4.(2) By MRI study, one cases were conformed their ultrasound diagnosis, eleven cases were completed their ultrasound diagnosis, nine cases were made the same diagnosis as ultrasound and six cases were corrected diagnosis. By MRI and ultrasound study one case of hemivertebra, one case of butterfly vertebra and one case of dorsal dermal sinus were missed diagnosis. Ultrasound had limits and low specificity especially in fetal spinal cord. CONCLUSIONS: MRI can show the spinal cord and its lesion intuitively and has advantages in displaying fetal anomaly of spine and spinal cord. MRI is a valuable complement to sonography in difficult cases and diagnostic accuracy can be significantly improved.

[Clinical analysis in treating lumbar intervertebral disc herniation with nucleus pulposus resection through small incision and lamina fenestration].

OBJECTIVE: To analyze effect of treatment of lumbar intervertebral disc herniation with nucleus pulposus resection through small incision and lamina fenestration,and to explore operative advantage and mattars needing attention. METHODS: Ninety-six patients with lumbar intervertebral disc herniation, including 48 males and 48 females with an average age of 46.4 years (ranging for 16-75 years) and an average course of 5 years (ranging from 1 month to 30 years), were treated with nucleus pulposus resection through small incision and lamina fenestration. The clinical effects were analyzed according to JOA scoring criteria of lower back pain. RESULTS: All patients were followed up from 6 months to 3.5 years with an average of 1.2 years. According to JOA scoring criteria, 34 cases obtained excellent result, 55 good, fair 7. The rate of excellent and good was 92.71% and the mean improvement rate was 54.53%. CONCLUSION: Nucleus pulposus resection through small incision and lamina fenestration can obtain satisfactory outcome in treating lumbar intertebral disc herniation. The incidence of lumbar instability and postoperative complications were low. It is one of the better method for the treatment of lumbar intertebral disc herniation.