Management for iatrogenic femoral pseudoaneurysms by embolisation of the aneurysmal neck from the contralateral femoral artery: A report of five cases.

Femoral pseudoaneurysms are typically associated with femoral arterial catheterisation. Treating iatrogenic morbidity requires curing the disease, without causing any additional complications. Occlusion of the aneurysmal neck is ideal to seal post-catheterised pseudoaneurysms along with maintaining the femoral arterial flow. However, few reports have suggested neck embolisation for post-catheterised pseudoaneurysms. We describe five cases of iatrogenic femoral pseudoaneurysms in patients successfully treated with embolisation through the aneurysmal neck. This technique may be an alternative therapeutic option in managing femoral pseudoaneurysms.

Embolization of medium-sized vessels with the penumbra occlusion device: evaluation of anchoring function.

BACKGROUND: The penumbra occlusion device (POD) is a recently developed metallic coil with a unique anchor segment. The purpose of this study was to investigate the anchoring function of the POD for embolization of medium-sized vessels in detail. MATERIALS AND METHODS: We reviewed a series of cases of proximal embolization of medium-sized vessels in which the POD was used. Endovascular outcomes and complications were assessed. The distance between the distal end of the first-indwelled POD and the microcatheter tip was defined as the "landing distance," and this was also evaluated via fluoroscopic analysis. RESULTS: POD deployment was successful in 17 of 18 patients. The median landing distance was 9.6 mm, and no distal POD migration was observed after the formation of anchor loops. CONCLUSIONS: The specific anchoring function of the POD enables effective proximal occlusion of medium-sized vessels.

[A Case of Recurrent Malignant Lymphoma Occurring at an Implanted Central Venous Port].

A man in his 40s presented with fever and nasal congestion. NK-T cell lymphoma was pathologically diagnosed. A central venous(CV)port was implanted via a right subclavian approach. Four months later, redness and swelling were observed around the implanted CV port. Initially, an infection of the CV port was suspected, and the CV port was removed. Regardless of the removal of the port, the wound healing was refractory, and an ulcer formed. Surgical biopsy from the ulcer showed skin infiltration of NK-T cell lymphoma. In cases ofref ractory wound healing around an implanted CV port in patients with lymphoma, lymphoma recurrence and port infection should be considered.

The influence of a peritoneovenous shunt for cirrhotic and malignant intractable ascites on renal function.

BACKGROUND: Peritoneovenous shunts (PVS) are widely used for palliation of intractable ascites caused by peritoneal carcinomatosis (PC) or liver cirrhosis (LC). Some patients who need PVS have renal dysfunction. However, renal dysfunction is considered a relative contraindication. Therefore, it is important to assess renal function before PVS placement. PURPOSE: To evaluate the relationship between PVS and renal function. MATERIAL AND METHODS: Between October 2007 and July 2015, 60 patients (PC = 47; LC = 10; others = 3) underwent PVS placement for intractable ascites. Changes in estimated glomerular filtration rate (eGFR) and other adverse events (AEs) were retrospectively analyzed. RESULTS: Changes in eGFR before, one day after, and one week after PVS placement could be evaluated in 46 patients. The median eGFR before, one day after, and one week after was 56.5, 59.1, and 64.7 mL/min/1.73 m2, respectively (P < 0.05). These values were 61.6, 72, and 67.1 mL/min/1.73 m2, respectively, in PC patients (n = 34; P < 0.05) and 28.5, 27, and 37.2 mL/min/1.73 m2, respectively, in LC patients (n = 10; P < 0.05). In 17 patients with moderate to severe renal dysfunction (eGFR < 45), these values were 23.4, 23.7, and 30.5 mL/min/1.73 m2, respectively. The most frequent AE was PVS catheter obstruction, which occurred in 12 patients (20.7%). Clinical disseminated intravascular coagulation occurred in six patients (10.3%) and caused death in three patients (5.2%). CONCLUSION: PVS placement for intractable ascites is associated with various AEs. However, PVS appeared to promote renal function, especially in patients with renal impairment.

Clinical evaluation of (18)F-fludeoxyglucose positron emission tomography/CT using point spread function reconstruction for nodal staging of colorectal cancer.

OBJECTIVE: For patients with colorectal cancer, lymph node metastasis is a very important factor for prognostic and treatment determinations. Fluorine-18 fludeoxyglucose positron emission tomography/CT ((18)F-FDG-PET/CT) is among the useful tools for detecting lymph node metastasis. Recently, a new (18)F-FDG-PET/CT reconstruction technique for improving spatial resolution and signal-to-noise ratios, point spread function (PSF), has become available. We assessed the effect of PSF reconstruction on standardized uptake values and its diagnostic accuracy for lymph node staging in patients with colorectal cancer. METHODS: We retrospectively analysed records from patients with colorectal cancer who underwent (18)F-FDG-PET/CT for pre-operative staging. All positron emission tomography CT (PET/CT) examinations were reconstructed using ordered subset expectation maximization (OSEM) and OSEM + PSF. We compared sensitivities, specificities, positive-predictive values (PPVs), negative-predictive values (NPVs) and accuracies of conventional PET/CT (reconstructed with OSEM) and PSF-PET/CT (reconstructed with OSEM + PSF) for identifying lymph node metastases. We also analysed the diagnostic confidence level on a 5-point scale. RESULTS: With conventional PET/CT, the sensitivity, specificity, PPV, NPV and accuracy were 53.1%, 99.1%, 94.4%, 88.3% and 89.1%, respectively. With PSF PET/CT, the corresponding values were 65.6%, 99.1%, 95.4%, 91.2% and 91.8%, respectively. Conventional PET/CT and PSF PET/CT did not differ significantly in terms of N-stage definition (p = 0.125). However, the diagnostic confidence level of PSF PET/CT was significantly higher than that of conventional PET/CT (p < 0.01). CONCLUSION: PSF reconstruction might slightly increase sensitivity without impairing specificity. Moreover, this technique is expected to facilitate more confident radiological decisions when compared with conventional PET/CT. Advance in knowledge: This study demonstrates the clinical effectiveness of PSF PET/CT for lymph node staging in colorectal cancer.

[Failure to Remove Long-Term Indwelling Central Venous Catheters in Two Patients].

The use ofa central venous(CV)port system has become common for the treatment of patients with tumors. We report on the failure to remove CV catheters in 2 patients. The first patient was a 50 years woman with acute myeloid leukemia. She underwent CV port implantation via the left brachial approach 11 years previously. The second patient was an 80 years man with a lower gingival carcinoma. He underwent CV port implantation via the left brachial approach 6 years previously. CV catheter removal was attempted in both patients, but was unsuccessful because of strong adhesion to the vessel wall. Based on our experience, if catheter removal is impossible, its retention is more suitable.

Expression of genes encoding late nodulins characterized by a putative signal peptide and conserved cysteine residues is reduced in ineffective pea nodules.

Five nodulin genes, PsN1, PsN6, PsN314, PsN335, and PsN466, with reduced expression in ineffective nodules on the pea (Pisum sativum) mutant E135 (sym13) were characterized. They encode small polypeptides containing a putative signal peptide and conserved cysteine residues and show homology to the nodulins PsENOD3/14 and PsNOD6. For each gene, multiple bands were detected by genomic Southern analysis. Northern analysis showed that all five genes were expressed exclusively in nodules and that their temporal expression patterns were similar to that of the leghemoglobin (Lb) gene during nodule development. Their transcripts were localized predominantly from the interzone II-III to the distal part of nitrogen-fixing zone III in effective nodules, resembling the Lb gene. However, transcripts in ineffective E135 nodules were localized in narrower regions than those in the effective nodules. These results indicate that these nodulins are abundant in pea nodules and that their successive expression during nodule development is associated with nitrogen-fixing activity.