Small Bowel Obstruction Caused by the Ingestion of a Wooden Toothpick: The CT findings and a Literature Review.

We present a case in which the accidental ingestion of a toothpick caused duodenal perforation and small intestinal obstruction. A 58-year-old man visited our emergency room with acute abdominal pain. Computed tomography (CT) showed obstructive ileus as well as a foreign body penetrating the duodenum, which was identified as a toothpick and removed endoscopically. Unenhanced CT was superior in detecting the object. The patient has been doing well since the operation.

Complete nationwide survey on umbilical cord blood freezing bag breakage in Japan.

BACKGROUND AIMS: Although umbilical cord blood (UCB) has now become a common stem cell source, UCB bag breakage is a known risk in UCB transplantation (UCBT). This survey provides the first comprehensive data on the frequency and causes of UCB bag breakage in Japan. METHODS: Data regarding UCB bag breakage from all causes, identified between April 1, 2010, and September 3, 2013, were collected from all transplant centers registered for UCBT (209 hospitals) and all public cord blood banks (CBBs) (8 CBBs) in Japan. RESULTS: Seventeen incidents of UCB bag breakage at CBBs were confirmed, none of which resulted in bags being shipped to transplant centers. From among 3836 UCBT, 16 incidents (0.4%) of UCB bag breakage were confirmed at transplant centers. Although all these bags were used for transplantation, no direct health hazard was reported. The major cause of UCB bag breakage confirmed at transplant centers was considered to be external force (75%). In addition, 11 incidents of unexplained UCB bag breakage at sealing between compartments were reported. CONCLUSIONS: UCB bag breakage was confirmed at both CBBs and transplant centers. UCB bags should be handled with particular care and attention.

Sensory interaction between attractant diacetyl and repellent 2-nonanone in the nematode Caenorhabditis elegans.

In the nematode Caenorhabditis elegans, the odorant diacetyl is sensed by AWA sensory neurons in the amphid sensory organ and elicits an attractive response, whereas 2-nonanone is sensed by AWB amphid sensory neurons and elicits an avoidance response. In the present study, we report that nematodes exhibit a sensory interaction between the attractant diacetyl and repellent 2-nonanone. In the presence of food, the chemotactic response to 0.01% diacetyl in nematodes preexposed to 0.1% diacetyl was greater than that in nonexposed naive nematodes (P < 0.05). The response to diacetyl was also greater in nematodes preexposed to 3% 2-nonanone in the presence of food than that in naive nematodes (P < 0.01). In the absence of food, the response to diacetyl in nematodes preexposed to diacetyl or 2-nonanone was significantly lower than that in nonexposed control nematodes (P < 0.01). The avoidance response to 10% 2-nonanone in nematodes preexposed to each odorant in the presence or absence of food was lower than that in nonexposed nematodes (P < 0.05). To confirm the validity of our results, the chemotactic responses to diacetyl and 2-nonanone were observed using che-3, odr-4, and odr-10 mutants, which exhibited defective sensitivity to diacetyl or 2-nonanone. From the results of our experiments, we conclude that nematodes exhibit a sensory interaction between diacetyl and 2-nonanone and speculate that this interaction is driven by higher-level neuronal circuits that underlie sensory integration.

CT findings of spontaneous intraperitoneal rupture of the urinary bladder: two case reports.

We report two cases of spontaneous bladder rupture. Preoperative diagnosis was difficult and the correct diagnosis was made at surgery. Reviewing the initial abdominopelvic CT of our second patient, the bladder wall defect and blood attenuation near the bladder were observed. These findings were consistent with the operative findings, and would have led to correct preoperative diagnosis if we had had sufficient knowledge of spontaneous bladder rupture. Under urinary catheterization, ascites and free intraperitoneal air were identified in both patients. These findings were indistinguishable from those for bowel perforation, which was our preoperative diagnosis. Significant changes in ascites volume between pre and post urinary catheterization can be an indication of spontaneous bladder rupture.

Computed tomography findings of spontaneous perforation of pyometra.

We report herein a case of spontaneous perforation of pyometra leading to diffuse peritonitis. This pathological condition is rare, and preoperative diagnosis is difficult. We were able to make the correct diagnosis preoperatively using contrast-enhanced abdominopelvic computed tomography. Both intrauterine and extrauterine fluid collections and defects of the uterine fundus were key findings, and reconstructed sagittal and coronal images were useful. In elderly female patients presenting with acute abdomen, ruptured pyometra should be considered as a possibility.

Gallbladder hernia into the foramen of Winslow: CT findings.

We present a case of gallbladder hernia into the foramen of Winslow. During the diagnosis of hernia, ultrasonography, computed tomography and intravenous computed tomography, cholangiography of the abdomen were performed. Ultrasonography detected gallstone, but did not provide sufficient information to diagnose gallbladder hernia. Computed tomography yielded the correct diagnosis. At laparoscopic cholecystectomy, the diagnosis was confirmed.

Tumor-liver contrast and subjective tumor conspicuity of respiratory-triggered T2-weighted fast spin-echo sequence compared with T2*-weighted gradient recalled-echo sequence for ferucarbotran-enhanced magnetic resonance imaging of hepatic malignant tumors.

PURPOSE: To compare respiratory-triggered T2-weighted fast spin-echo (RTT2W-FSE) and gradient T2*-weighted recalled-echo (T2*W-GRE) images for visualization of malignant hepatic tumors using ferucarbotran-enhanced magnetic resonance (MR) imaging. MATERIALS AND METHODS: Ferucarbotran-enhanced RTT2W-FSE and breath-hold long-TE 2D-fast spoiled gradient recalled acquisition in the steady state (FSPGR) images as T2*W-GRE were used to evaluate 128 malignant hepatic tumors (77 metastases, 37 hepatocellular carcinomas, 14 other) in 62 patients. Tumor-to-liver contrast (TLC) was quantitatively compared using the paired Student's t-test, and the score of lesion conspicuity was qualitatively compared using Wilcoxon's signed rank test. RESULTS: The mean TLC of RTT2W-FSE was significantly higher than that of FSPGR (1.10 +/- 0.82 vs. 2.54 +/- 1.42) in all malignant tumors. The score of lesion conspicuity of RTT2W-FSE was significantly higher than that of FSPGR (4.84 +/- 0.52 vs. 4.52 +/- 0.99) in all malignant tumors. CONCLUSION: For ferucarbotran-enhanced MR imaging, compared to FSPGR images, RTT2W-FSE images provide greater TLC and subjective conspicuity for malignant tumors.

REG Ialpha is a reliable marker of chemoradiosensitivity in squamous cell esophageal cancer patients.

BACKGROUND: A reliable marker of chemoradiosensitivity that would enable appropriate and individualized treatment of thoracic squamous cell esophageal cancer has long been sought. We investigated whether regenerating gene (REG) Ialpha is such a marker. METHODS: We assessed expression of REG Ialpha in untreated endoscopic biopsy specimens and examined the correlation between REG Ialpha expression and the clinical responses to definitive chemoradiotherapy and prognosis. We also examined the relationship between REG Ialpha expression in the resected tumor and the prognosis of patients who received esophagectomy for thoracic squamous cell esophageal cancer. RESULTS: Among the 42 patients treated with definitive chemoradiotherapy, 8 of the 23 REG I-positive patients (35%) showed complete responses to chemoradiotherapy, while only one of the 19 REG I-negative patients did so. The survival rate among the REG I-positive patients was significantly better than among the REG I-negative patients. For the 76 patients treated surgically, there was no significant difference in the survival rates among the REG I-positive and REG I-negative patients. CONCLUSIONS: REG Ialpha expression in squamous cell esophageal carcinoma may be a reliable marker of chemoradiosensitivity. We anticipate that it will enable us to provide more appropriate and individualized treatment to patients of advanced esophageal squamous cell carcinoma.

Diffusion changes in a tumor and peritumoral tissue after stereotactic irradiation for brain tumors: possible prediction of treatment response.

OBJECTIVE: Changes in apparent diffusion coefficient (ADC) in a tumor and peritumoral tissue after stereotactic irradiation (STI) were evaluated, and then the therapeutic efficacy of ADC measurement was assessed. METHODS: In 20 tumors, diffusion-weighted imaging within 1 week before and 2-4 weeks after STI was performed. The normalized ADC (nADC) was measured. The nADCs in the tumor and peritumoral region before STI were compared with those after STI and the change in tumor nADC compared with the change in tumor size. RESULTS: The nADC of the tumors was significantly higher 2-4 weeks after STI compared with that before STI. The nADC of the peritumoral regions 2-4 weeks after STI did not differ significantly from that before STI. A significant difference in the nADC at 2-4 weeks after STI was observed between the responder and nonresponder groups. CONCLUSIONS: Changes in nADC as measured by diffusion-weighted imaging can predict response to STI.

Comparison of the MR findings on indirect MR arthrography in patients with rotator cuff tears with and without symptoms.

PURPOSE: To compare indirect magnetic resonance (MR) arthrography findings in patients with rotator cuff tears with and without symptoms. MATERIALS AND METHODS: Indirect MR arthrography results of 15 asymptomatic and 23 symptomatic rotator cuff tears were retrospectively reviewed, comparing the type and size of tears and amount of subacrominal-subdeltoid bursal fluid. RESULTS: There were 14 partial-thickness tears and one full-thickness tear in the asymptomatic group, with 4 small and 11 medium tears. In the symptomatic group, there were 16 partial-thickness and 7 full-thickness tears, with 14 small, 5 medium, and 4 large tears. In the asymptomatic group, the amount of subacrominal-subdeltoid bursal fluid was grade 0, 6 patients; grade 1, 6 patients; grade 2, 2 patients; and grade 3, 1 patient. In the symptomatic group, the amount of subacrominal-subdeltoid bursal fluid was grade 0, 4 patients; grade 1, 3 patients; grade 2, 8 patients; and grade 3, 8 patients. We found no statistically significant difference between symptomatic and asymptomatic tears in the kind and size of tears, and in the amount of subacrominal-subdeltoid bursal fluid. CONCLUSION: We found no difference in the MR findings between symptomatic and asymptomatic rotator cuff tears.

Dynamic contrast-enhanced magnetic resonance imaging in radiotherapeutic efficacy in the head and neck tumors.

PURPOSE: The purpose to this study is to identify correlations between pathology and dynamic contrast-enhanced magnetic resonance imaging (MRI) and to assess the utility of this technique in the evaluation of radiation response for head and neck cancer. MATERIALS AND METHODS: MRI was prospectively performed after radiotherapy in 27 patients with various head and neck tumors. After bolus injection of contrast material, a dynamic study was performed using a spoiled gradient-recalled imaging sequence. The maximum slope of increase (MSI) on the time-intensity curve was displayed as a color-coded image. The ratio of MSI (MSIR) was obtained for tumor and normal muscles. Pathological specimens were obtained after MRI in all cases. Histological grading of irradiation changes was classified into 5 grades (0-4). Correlations between MSIR and histological grade were examined. RESULTS: Histologically, 18 tumors were classified as grade 2 (presence of viable tumor cells), 4 were grade 3 (nonviable tumor cells), and 5 were grade 4 (no tumor cells). Although the mean +/- SD of MSIR in patients with histological grade 2 or 3 was 7.4 +/- 7.9, MSIR in patients with grade 4 was 1.8 +/- 0.73, representing a significant difference ( P < .05). Every patient with grade 4 displayed an MSIR of 2.5 or less, although 5 of 22 patients with grade 2 or 3 had an MSIR of 2.5 or less. CONCLUSIONS: MSI quantitatively reflects response to radiotherapy for head and neck cancer. Color-coded MSI display is feasible for depicting permeability changes after radiotherapy.

Thallium-201 SPECT in the evaluation of early effects on brain tumors treated with stereotactic irradiation.

PURPOSE: To determine whether thallium-201 SPECT can predict response to stereotactic irradiation (STI) earlier than magnetic resonance imaging (MRI), the change in tumor size measured by MRI was compared with the change in tumor activity measured by Tl-201 SPECT before and after STI. MATERIALS AND METHODS: Twenty-one tumors in 16 patients with intracranial tumors were treated by STI. Tl-201 SPECT was performed within 1 week before the beginning of STI and within 1 week after the end of STI in all patients. All patients underwent MRI within 1 week before the beginning of STI, and 14 patients (19 tumors) underwent MRI within 1 week after the end of STI. Follow-up MRI was performed 1 to 2 months after the end of STI in 14 patients (16 tumors). The activity of Tl-201 in the tumor divided by that of the uninvolved symmetric area was defined as the Tl-index. The change in tumor size immediately and 1 to 2 months after STI was compared with the change in Tl-index immediately after STI. RESULTS: No significant relationship between the ratio of tumor size immediately after STI and the ratio of Tl-index immediately after STI was found. A significant correlation (r = 0.69, P <0.05) between the ratio of tumor size 1 to 2 months after STI and the ratio of Tl-index immediately after STI was found. CONCLUSIONS: This study suggests that Tl-201 SPECT immediately after STI can predict treatment response 1 to 2 months after STI, and that Tl-201 SPECT can be an early indicator of treatment response.

[Findings of the subcoracoid bursa on MR arthrography and their clinical significance].

We studied visualization of the subcoracoid bursa by conducting a retrospective analysis of the MR arthrograms of 101 shoulders with surgical confirmation. MR arthrography showed the subcoracoid bursa in 28 shoulders, among which the bursa was revealed by inadvertent direct injection of contrast material into the bursa in 10 shoulders. Of the remaining 18 shoulders, 16 shoulders had rotator cuff tears, one had shoulder instability, and one had dislocation of the long head of the biceps tendon. Both the subcoracoid and subscapularis bursae are located in the subcoracoid space. The subcoracoid bursa does not communicate with the subscapularis bursa, but occasionally communicates with the subacromial-subdeltoid bursa. On MR arthrography, contrast material in the subcoracoid bursa indicates a pathologic condition such as rotator cuff tear. Careful examination of the subcoracoid bursa on MR arthrography helps to achieve better assessment of the rotator cuff.

Multi-shot echo-planar Flair imaging of brain tumors: comparison of spin-echo T1-weighted, fast spin-echo T2-weighted, and fast spin-echo Flair imaging.

Multi-shot echo-planar fluid-attenuated inversion-recovery (EPI-Flair) was compared with spin-echo T1-weighted (SE-T1W), fast SE T2-weighted (FSE-T2W), and fast Flair (F-Flair) in imaging brain tumors. In 32 patients with various different brain tumors, three reviewers independently evaluated image quality. Two reviewers evaluated the image quality of precontrast EPI-Flair to be significantly better than that of precontrast SE-T1W. Two reviewers evaluated the image quality of postcontrast EPI-Flair as superior to that of postcontrast SE-T1W. Artifacts on postcontrast EPI-Flair were significantly more prominent than those on postcontrast F-Flair. Multi-shot EPI-Flair appeared to be superior to SE-T1W, and almost equivalent to FSE-T2W in terms of image quality.