Impact of aortoceliac angle in implantation of subcutaneous hepatic artery port-catheter system for hepatic arterial infusion chemotherapy via femoral approach.

BACKGROUND: In patients with an acute aortoceliac angle, the diagnostic catheter often fails to enter the common hepatic artery. PURPOSE: To retrospectively evaluate the impact of aortoceliac angle on the implantation of a port-catheter system via a femoral approach for hepatic arterial infusion chemotherapy (HAIC) in patients with advanced hepatocellular carcinoma (HCC). MATERIAL AND METHODS: A total of 399 patients with advanced HCC underwent percutaneous implantation of a port-catheter system for HAIC. Among these patients, 383 underwent successful implantation via a femoral artery approach (success group). In 16 patients, port-catheter systems were implanted via a subclavian artery approach (failure group) after failure of the initial attempt via the femoral artery due to failed catheter tip fixation to the gastroduodenal artery. We statistically analyzed aortoceliac angle, ostial celiac stenosis, sex, age, weight, height, and body mass index (BMI) between groups. RESULTS: The average aortoceliac angle, weight, and BMI were significantly different between the two groups (P < 0.001, P = 0.02, P < 0.001, respectively). Among them, only the aortoceliac angle was a significant risk factor in logistic regression analysis. The smaller the aortoceliac angle, the more often the femoral approach failed (P < 0.001, odds ratio = 0.817, 95% confidence interval = 0.752-0.887). There were no significant differences in ostial celiac stenosis, sex, or age between the two groups (P = 0.549, 0.056, 0.173, and 0.773, respectively). CONCLUSION: For patients with an acute aortoceliac angle, the femoral approach is likely to fail. A subclavian artery approach should be preferentially considered for percutaneous implantation of a port-catheter system in such patients.

Management of Clinically and Mammographically Occult Benign Papillary Lesions Diagnosed at Ultrasound-Guided 14-Gauge Breast Core Needle Biopsy.

OBJECTIVES: To determine how to manage clinically and mammographically occult benign papillary lesions diagnosed at ultrasound (US)-guided 14-gauge breast core needle biopsy (CNB) by evaluating their upgrade rates. METHODS: From our pathologic database of US-guided 14-gauge breast CNB, 69 benign papillomas and 9 atypical papillomas with available subsequent excisional findings (surgery or vacuum-assisted removal with additional US follow-up for ≥2 years) or US follow-up alone (≥2 years) were included in this study. We analyzed their upgrade rates by using excisional or US follow-up findings, with no change at 2 years as the reference standard. Patient age, lesion size, lesion distance from the nipple, multiplicity, imaging-histologic concordance, and histologic findings were compared between groups with and without upgrades by statistical analysis. RESULTS: Surgical excision was performed in 53 (67.9%) of 78 benign papillary lesions and revealed 5 upgrades (11.4%) to atypical papillomas in 44 benign papillomas and 2 upgrades (22.2%) to ductal carcinomas in situ in 9 atypical papillomas. Among 12 benign papillomas (15.4%) with vacuum-assisted removal and US follow-up (≥2 years), 1 (8.3%) was upgraded to atypical papilloma. The remaining 13 benign papillomas (16.7%) were followed with US and were stable after a 2-year follow-up period. There were no significant differences in the variables between the groups. CONCLUSIONS: Uniform surgical excision is not a reasonable management strategy for clinically and mammographically occult benign papillary lesions diagnosed at US-guided 14-gauge breast CNB. Clinically and mammographically occult benign papillary lesions may be subsequently managed by vacuum-assisted removal or imaging follow-up if atypia is not found.

Operation Protocols To Improve Durability of Protonic Ceramic Fuel Cells.

To develop reliable and durable protonic ceramic fuel cells (PCFCs), the impacts of the operation protocols of PCFCs on the cell durability are investigated through analyses of the main degradation mechanisms. We herein propose three appropriately designed control protocols, including cathode air depletion, shunt current, and fuel cell/electrolysis cycling, to fully circumvent the operating-induced degradation of PCFCs. For this purpose, anode-supported cells, comprised of a NiO-BaCe0.7Zr0.1Y0.1Yb0.1O3-δ anode, BaCe0.7Zr0.1Y0.1Yb0.1O3-δ electrolyte, and NdBa0.5Sr0.5Co1.5Fe0.5O5+δ-Nd0.1Ce0.9O2-δ composite cathode, are prepared, and their long-term performances are evaluated under a galvanostatic condition of 0.5 A·cm-2 at 650 °C. The cell voltages of the protected cells using the operation protocols to prevent performance degradation are stably maintained under the applied current density for more than 1200 h without any noticeable degradation, whereas the performance of the unprotected cell gradually decreased with time, and the decay ratio was 14.9% over 850 h. The significant performance decay of the unprotected cell is strongly associated with the cathode degradation phenomenon, which was caused by the water vapor continuously produced during the electrochemical reactions. Hence, the performance recovery of the PCFCs with the operation protocols is achieved by incrementally decreasing the cathode potential (close to a value of zero) to minimize the effect of high PH2O and PO2 during the PCFC operations.

Ultrasonographic findings of posterior interosseous nerve syndrome.

PURPOSE: The purpose of this study was to evaluate the ultrasonographic findings associated with posterior interosseous nerve (PIN) syndrome. METHODS: Approval from the Institutional Review Board was obtained. A retrospective review of 908 patients' sonographic images of the upper extremity from January 2001 to October 2010 revealed 10 patients suspicious for a PIN abnormality (7 male and 3 female patients; mean age of 51.8±13.1 years; age range, 32 to 79 years). The ultrasonographic findings of PIN syndrome, including changes in the PIN and adjacent secondary changes, were evaluated. The anteroposterior diameter of the pathologic PIN was measured in eight patients and the anteroposterior diameter of the contralateral asymptomatic PIN was measured in six patients, all at the level immediately proximal to the proximal supinator border. The size of the pathologic nerves and contralateral asymptomatic nerves was compared using the Mann-Whitney U test. RESULTS: Swelling of the PIN proximal to the supinator canal by compression at the arcade of Fröhse was observed in four cases. Swelling of the PIN distal to the supinator canal was observed in one case. Loss of the perineural fat plane in the supinator canal was observed in one case. Four soft tissue masses were noted. Secondary denervation atrophy of the supinator and extensor muscles was observed in two cases. The mean anteroposterior diameter of the pathologic nerves (n=8, 1.79±0.43 mm) was significantly larger than that of the contralateral asymptomatic nerves (n=6, 1.02±0.22 mm) (P=0.003). CONCLUSION: Ultrasonography provides high-resolution images of the PIN and helps to diagnose PIN syndrome through visualization of its various causes and adjacent secondary changes.

Evaluation of sclerotherapy for the treatment of infected postoperative lymphocele.

OBJECTIVE: To evaluate the efficacy and safety of sclerotherapy as the treatment of infected postoperative lymphocele in gynecologic malignancy patients. MATERIALS AND METHODS: Percutaneous catheter drainage (PCD) with or without sclerotherapy was performed for postoperative lymphocele in 75 patients from 2002 to 2014. Eighty-eight lymphoceles (43 non-infected as group A, 45 infected as group B) in 75 patients (mean age ± SD; 50.3 ± 11.3) were included. Sclerotherapy was performed in 17 (39.5%, group A-S) lymphoceles in group A and 14 (31.1%, group B-S) in group B. Absolute ethanol was the most frequently used sclerosant (28 of total 36 sessions). Mean follow-up period was 37 months (range: 1-154). RESULTS: Sclerotherapy was clinically successful in 13 lymphoceles in both group A-S (76.5%) and group B-S (92.9%) without statistical significance. Compared to the pre-sclerotherapy period, group B-S demonstrated significantly decreased drainage volume after sclerotherapy (662.7 ml vs. 100.6 ml, p = 0.019). Group A-S failed to demonstrate significant decrease in drainage volume after sclerotherapy. Recurrence occurred in 4 patients in group A-S and 1 in group B-S, without statistical significance. No major complication was noted. CONCLUSION: Sclerotherapy significantly reduces the drainage volume, and might help shorten catheter placement time in infected lymphoceles.

Shear-Wave Elastography Features of Primary Non-Hodgkin's Lymphoma of the Breast: A Case Report and Literature Review.

Lymphoma is a rare malignancy of the breast, comprising approximately 0.04 to 0.5% of breast malignancies. Because the clinical findings of breast lymphoma are nonspecific and similar to those of breast carcinoma, it is important to distinguish breast lymphoma from other breast disease on the basis of radiologic findings. Elastography is an interesting imaging tool that reflects the tissue stiffness, increasingly being used in the evaluation of breast tumours. However, only a limited number of studies have focused on the elastographic findings of breast lymphoma. In this report, we review the radiologic characteristics of primary breast lymphoma including elastographic feature. A 57-year-old woman presented with a painless palpable mass of the left breast. Ultrasonography revealed an irregular-shaped complex cystic and solid mass with increased vascularity in upper outer breast. On shear wave elastography, the mass was relatively stiff with maximum elasticity value (Emax) of 100.5 kilopascal (kPa). The mass was confirmed as diffuse large B-cell lymphoma by US-guided core needle biopsy.