The Use of CT-Guided Marking for the Laparoscopic Resection of a Solitary Retroperitoneal Metastasis of Colon Cancer.

Background: CT-guided marking technique is rarely used in abdominal or urologic surgery. We developed and performed a marking technique for a small tumor, undetectable by ultrasound, using CT guidance before laparoscopic resection of the tumor. Case Presentation: A 73-year-old woman with a history of breast cancer underwent right colectomy with D3 lymph node dissection for ascending colon cancer. Five years after the operation, a solitary tumor was found in the right pararenal region of the retroperitoneal space on enhanced abdominal CT. The tumor was 20 mm in diameter and undetectable by ultrasound, so we performed a marking technique using CT guidance before the operation. Placing the patient in a prone position on the CT table, a 22-gauge needle was inserted into the Gerota's fascia percutaneously and a mixed fluid containing India ink and Iopamidol was injected para to the tumor by the radiologist. During the surgery, the marker was clearly identified and the cutting line was determined to ensure a sufficient surgical margin. The tumor was laparoscopically resected as planned. The histopathologic diagnosis was adenocarcinoma, compatible with metastasis of colon cancer. The postoperative course was uneventful and the patient remained free of disease at 10 months after surgery. Conclusion: When resecting small tumors or tumors with an irregular margin, a marking technique is conducted before the surgery. But, preoperative CT-guided marking has not been applied generally for resection of intraabdominal lesion yet. CT-guided marking can be effective when performing minimally invasive and curable surgery on small tumors. This is the first report of an effective CT-guided marking before retroperitoneal laparoscopic tumorectomy. We believe that this technique provides an important therapeutic option for small tumors that may be undetectable by ultrasound.

Association of beer consumption with arsenic concentration in urine: a result from a cross-sectional study of the general Japanese population.

OBJECTIVES: The first aim of this study was to evaluate the association between time spent living near a contaminated area and concentration of arsenic (As) compounds in the urine among study subjects. The second aim is to assess the association between consumption of various foods or beverages and As concentration in urine among them. METHODS: Urine sampling was performed on 177 persons who voluntarily participated in the survey in May 2014. The median value of the sum of inorganic As (iAs) and total As (tAs) compounds was used for us to divide into two groups, such as the high and low iAs and high and low tAs groups. We analyzed data separately in two-age strata of age group A (the subjects <18 years old), and age group B (the subjects ≥18 years old). A multivariate analysis was performed with the logistic regression model to adjust for potential confounding variables. RESULTS: No link between time spent living near a contaminated area and urinary As concentration was observed in our study. For age group B, frequently drinking beer was significantly associated with risk of being in the high tAs group (p = 0.008). Compared to not drinking beer, odds ratios (95 % confidence intervals) of drinking beer <1 or 2 times per week, and drinking beer ≥3 or 4 times per week were 3.09 (1.32-7.24) and 3.00 (1.02-8.80), respectively, after adjusting for age, sex, and smoking index. CONCLUSION: Frequent consumption of beer may be associated with high tAs in age group B.

Initial experience with adaptive iterative dose reduction 3D to reduce radiation dose in computed tomographic urography.

OBJECTIVE: This study aimed to investigate the feasibility of low-dose computed tomographic (CT) urography with adaptive iterative dose reduction 3D (AIDR 3D). METHODS: Thirty patients underwent routine-dose CT scans with filtered back projection and low-dose CT scans with AIDR 3D in the excretory phase of CT urography. Visual evaluations were performed with respect to internal image noises, sharpness, streak artifacts, and diagnostic acceptability. Quantitative measures of the image noise and radiation dose were also obtained. All results were compared on the basis of body mass index (BMI). RESULTS: At visual evaluations, streak artifacts in the urinary bladder were statistically weaker on low-dose CT than on routine-dose CT in the axial and coronal images (P < 0.001 and P = 0.01). There were no statistical differences between routine-dose CT and low-dose CT for other evaluation items in all structures. Image noise was lower on low-dose CT than on routine-dose CT in all structures (P < 0.001). The overall average dose reduction was 45.0% in all patients. The average dose reduction for the patients with a BMI of less than 20, 20 to 25, greater than 25 kg/m was 43.0%, 44.0%, and 49.6%, respectively. CONCLUSION: Low-dose CT urography with AIDR 3D allows 45% reduction of radiation dose without degenerating of the image quality in the excretory phase independently to a BMI.

Lipiodol accumulation and transarterial chemoembolization efficacy for HCC patients.

BACKGROUND/AIMS: To elucidate the prognostic factors for hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE). METHODOLOGY: We studied 85 TACE-treated HCC patients, including 117 lesions, who fulfilled the Milan criteria. The area of iodized poppy-seed oil (lipiodol) accumulation on CT immediately after TACE was classified into three groups, by comparing with the area of HCC detected by CT during hepatic arteriography; accumulation surrounding the HCC lesion (group I), accumulation involving the entire area of the HCC lesion (group II), and accumulation that covered a portion of the HCC lesion (group III). RESULTS: Among 85 patients, the 1- and 2-year disease free survival (DFS) rates were 67% and 50% in group I, 49% and 29% in group II and 29% and 15% in group III. DFS rate was higher in group I than in groups II and III (p=0.016 and p<0.001). Difference in DFS by lipiodol accumulation pattern was evident in patients aged 75 or younger. CONCLUSIONS: Lipiodol accumulation pattern as evaluated by CT immediately after TACE may be a powerful indicator of the therapeutic efficacy of TACE in HCC patients.

Clinical utility of apparent diffusion coefficient (ADC) values in patients with prostate cancer: can ADC values contribute to assess the aggressiveness of prostate cancer?

PURPOSE: To retrospectively evaluate the relationship between apparent diffusion coefficient (ADC) values and Gleason score (GS) in prostate cancer. METHODS: A total of 60 patients who underwent radical prostatectomy for clinically localized prostate cancer were selected for this study. Diffusion-weighted magnetic resonance (MR) images were obtained using a 1.5 T system. ADC values were analyzed between three groups: GS of 6 or less (n = 7); GS of 7 (n = 37); and GS of 8 or higher (n = 16). ADC values of the three GS groups were statistically analyzed in order to determine the relationship with GS. In the 37 patients with GS = 7 the difference in ADC values between GS 3+4 and GS 4+3 was analyzed. RESULTS: Median ADC values (10⁻³ mm² /s) of the three GS groups were 1.04 (GS = 6 or less), 0.867 (GS = 7), and 0.729 (GS = 8 or higher). Although there was considerable overlap among the groups, the differences in ADC were statistically significant (P < 0.0001). There was a significant inverse correlation between GS and ADC values (z = -0.437, P < 0.0005). Median ADC values (10⁻³ mm² /s) of GS 3+4 and GS 4+3 patients were 0.88 and 0.814, respectively (P < 0.05). CONCLUSION: ADC values showed a negative correlation with GS. Pathologically, however, there was considerable intrasubject heterogeneity.

Neuronal cell injury in patients after cardiopulmonary resuscitation: evaluation by diffusion-weighted imaging and magnetic resonance spectroscopy.

Neuronal cell injury after global cerebral ischemic insult is not well understood in humans. We performed serial examination of diffusion-weighted imaging and magnetic resonance spectroscopy in three patients after cardiopulmonary resuscitation. The presence of the signal for lactate in magnetic resonance spectroscopy in the acute stage after cardiopulmonary resuscitation was closely correlated to irreversible damage. In addition, high intensity in diffusion-weighted magnetic resonance image in the acute stage also predicted a poor outcome. Lesions that were positive for these factors in the acute stage led to serious brain damage in the subacute and chronic stages. The results indicated that after cardiopulmonary resuscitation, diffusion-weighted magnetic resonance imaging and magnetic resonance spectroscopy is an extremely useful modality to estimate the prognosis of patients, which is not always easy using conventional methods.

Reconstruction of diaphragm using autologous fascia lata: an experimental study in dogs.

BACKGROUND: We investigated whether fascia lata is an appropriate material for reconstruction of the diaphragm. METHODS: A diaphragmatic defect (2 cm by 5 cm) was reconstructed with a patch of autologous fascia lata in the experimental group (n = 12) and with expanded polytetrafluoroethylene in the control group (n = 12). Maximal tensile strength at the sutured region was measured serially. RESULTS: The maximal tensile strength at the sutured region reconstructed with the fascia lata was 1.14 +/- 0.50 kgf 15 days and 2.04 +/- 0.94 kgf 30 days after operation. The values were higher than those of expanded polytetrafluoroethylene (p < 0.0001). These values of fascia lata were close to the original maximal tensile strength of the muscular region of the diaphragm (1.52 to 1.66 kgf). CONCLUSIONS: Reconstruction of diaphragm using autologous fascia lata is safe, easy, and inexpensive, and provides smooth wound healing. The only disadvantage is the necessity of a femoral incision for harvest; nevertheless, it may be worthwhile to use fascia lata in clinical trials to further assess its suitability as a reconstruction material.