Neurological deficit after simultaneous open abdominal aortic surgery and thoracic aortic endovascular therapy.

We examined a total of 12 cases; 8 cases were identified by searching the literature on Pubmed (excluding case reports published prior to 2000) and 4 cases were ones we personally encountered. We examined age, sex, history of smoking, and preoperative risk factors as preoperative factors, the access route and coverage of the descending aorta as perioperative factors, and complications and survival time as postoperative factors. Mean coverage of the thoracic aorta was 90.8 mm. In terms of perioperative deaths, 8.3% (1 patient) were due to coagulopathy. Perioperative complications occurred in 16.7% of cases (coagulopathy in 1 patient and paralysis in another). No patients experienced complications or underwent additional treatment during a mean follow-up of 22.9 months. This study suggested that simultaneous open abdominal aortic repair and thoracic aortic endovascular therapy is feasible and also involves few postoperative complications. Paraplegia and paralysis tended to occur less frequently than with two-stage surgery, but further study is needed to explain why this is true.

Elective Matsui-Kitamura stent graft repair for descending thoracic aortic aneurysm and chronic type-B aortic dissection.

BACKGROUND: The position of thoracic endovascular aortic repair (TEVAR) compared to open surgery of the thoracic aorta has changed. This study evaluates outcomes after TEVAR performed electively using our original Matsui-Kitamura stent graft (MKSG) to treat descending thoracic aortic aneurysms (dTAA) and chronic type-B aortic dissection (type-B AD), and elucidates the risk factors for postoperative spinal cord ischemia (SCI). METHODS: TEVAR was performed using an MKSG in 66 patients (age: 70.8+/-9.2 years). The underlying etiology was atherosclerotic change in 39 patients, chronic type-B aortic dissection in 23 patients, and other in 4 patients. RESULTS: No perioperative deaths occurred. Three patients showed temporary paralysis due to postoperative SCI. Abdominal aortic aneurysm (AAA) surgery was a risk factor for postoperative SCI (P=0.04). The 5-year survival rate was 81.2%. CONCLUSION: The present study demonstrated that TEVAR of patients with dTAA and chronic type-B AD using an MKSG can be performed with high technical success rates and low rates of severe acute complications. AAA surgery was a risk factor for postoperative SCI.

MRI findings of primary biliary cirrhosis: correlation with Scheuer histologic staging.

Magnetic resonance imaging (MRI) findings of primary biliary cirrhosis (PBC; currently regarded as a vanishing bile duct syndrome) are not established. In this report, we describe our preliminary analysis of the relation between MRI findings and histopathologic staging of PBC and review clinical, morphologic, and MRI findings of PBC especially focusing on the staging of PBC.

Contrast-enhanced MRA for investigation of cerebral arteriovenous malformations.

We evaluated contrast-enhanced MRA (enhanced 3-D fast gradient-echo [efgre3d] with spectral inversion recovery) for identification of 15 intracranial arteriovenous malformations (AVMs) in 14 patients. Demonstration of the feeding arteries was classified as good for 16 examinations on maximum-intensity projections and multiprojection volume reconstruction images. The nidus was seen well in all patients. Definition of the draining veins was good or fair except for one poor result. Therapeutic effects were clearly demonstrated in three follow-up series. Contrast-enhanced MRA using efgre3d is useful for delineation of AVMs and for follow-up after treatment.

Tumor-associated focal chronic pancreatitis from invasion of the pancreatic duct by common bile duct carcinoma: radiologic-pathologic correlation.

We report a case of tumor-associated focal chronic pancreatitis of the uncinate process of the pancreas. The chronic pancreatitis was secondary to stenosis of the main pancreatic duct from invasion by a common bile duct carcinoma. A feature distinguishing the chronic pancreatitis from pancreatic carcinoma was the localized dilatation of pancreatic duct branches evident in the focal lesion of the uncinate process.

Cystic duct remnant carcinoma with widespread invasion along the extrahepatic bile duct wall: dynamic CT findings.

We report a case of remnant cystic duct carcinoma with widespread invasion along the common bile duct wall. Thin-slice dynamic computed tomography showed circumferential wall thickening of the extrahepatic bile duct (from the common hepatic duct to the intrapancreatic common bile duct) and the remnant cystic duct. Pathologically, the extrahepatic bile duct wall was thickened due to submucosal tumor infiltration by cystic duct papillary adenocarcinoma.

CT during selective arteriography: anatomical assessment of unruptured intracranial aneurysms before endovascular treatment.

Our aim was to investigate the usefulness of helical CT during selective angiography (CT arteriography) in pretreatment assessment of unruptured intracranial aneurysms. We studied 47 unruptured aneurysms in 34 prospectively recruited patients for whom endovascular embolisation was initially considered. As pretreatment assessment, we performed rotational digital subtraction angiography (DSA) followed by CT arteriography. The findings on axial source images (axial images) and reconstructed three-dimensional CT angiography (3D-CTA) of CT arteriography were compared to those of rotational DSA, with particular attention to the neck of the aneurysm and arterial branches adjacent to it. Information provided by CT arteriography was more useful than that of rotational DSA as regards the neck in 25 (53%) of 47 cases and as regards branches in 18 (49%) of 37 aneurysms. On axial images, small arteries such as the anterior choroidal artery were seen in some cases. CT arteriography can provide valuable additional information about unruptured aneurysms, which cannot be obtained by rotational DSA alone. This technique is useful for obtaining anatomical information about aneurysm anatomy and for deciding the therapeutic strategy.

Peritumoral spared area in fatty liver: correlation between opposed-phase gradient-echo MR imaging and CT arteriography.

BACKGROUND: The purpose of the present study was to evaluate the magnetic resonance findings of a spared area of fatty liver caused by hepatic tumors and clarify the etiology of this phenomenon by computed tomographic (CT) arteriography. METHODS: Six patients with hepatic tumors (metastases from colon cancer, n = 3; breast cancer, n = 2; hepatocellular carcinoma, n = 1) were examined. In-phase (IP) and opposed-phase (OP) T1-weighted spoiled gradient-echo images were obtained. CT during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) were also performed. Pathologic confirmation was obtained in three patients with metastases from colon cancer. RESULTS: In all six patients, peritumoral ringlike or wedge-shaped hyperintense areas in relation to the tumor and the surrounding steatotic liver parenchyma were clearly visualized on OP images alone. This area appeared as a perfusion defect on CTAP and ringlike or wedge-shaped enhancement on CTHA. Pathologically, the peritumoral hyperintense areas on OP images were compatible with the spared area of fatty liver. CONCLUSION: A peritumoral spared area can be demonstrated with OP images. The etiology of the phenomenon is correlated with decreased portal flow and increased arterial flow in the peritumoral hepatic parenchyma.

CT arteriographic confirmation of focal hepatic fatty infiltration adjacent to the falciform ligament associated with drainage of inferior vein of Sappey: a case report.

We experienced a case of focal fatty infiltration in the anteromedial edge of the medial segment of the liver adjacent to the falciform ligament associated with advanced esophageal cancer. By using CT during selective right internal thoracic arteriography, we confirmed that the inferior vein of Sappey drained into the area of focal fatty infiltration. This is the first case to directly establish the relationship between drainage of the inferior vein of Sappey and occurrence of focal fatty infiltration of the liver.

Dynamic CT of hepatic abscesses: significance of transient segmental enhancement.

OBJECTIVE: The purpose of this study was to evaluate dynamic CT findings of hepatic abscesses, especially segmental hepatic enhancement, and to clarify the cause. MATERIALS AND METHODS: Twenty-four abscesses in eight patients were examined by early (30 sec) and late phase (90 sec) dynamic CT. Patients underwent abscess drainage (n = 1), hepatic resection (n = 2), or antibiotic therapy (n = 5). CT during arterial portography and CT during hepatic arteriography were performed in one patient. We retrospectively observed the frequency and changes of segmental hepatic enhancement on dynamic CT and determined its cause using radiologic and pathologic correlation. RESULTS: Sixteen abscesses (67%) showed transient segmental hepatic enhancement and three abscesses showed only segmental hepatic enhancement in the early phase. Four abscesses in one patient who underwent CT during arterial portography and CT during hepatic arteriography showed a segmental perfusion defect on CT during arterial portography and segmental enhancement on CT during hepatic arteriography. On follow-up dynamic CT performed 10-17 days after the initial CT, segmental hepatic enhancement surrounding hepatic abscesses decreased or disappeared in all abscesses. Pathologic examination of two patients showed marked inflammatory cell infiltration with stenosis of portal venules within the portal tracts surrounding hepatic abscesses without definite inflammation in the liver parenchyma. CONCLUSION: Segmental hepatic enhancement on dynamic CT is frequently associated with hepatic abscesses and may be caused by decreased portal flow resulting from inflammation of the portal tracts.

Accumulation of iodized oil within the nonneoplastic liver adjacent to hepatocellular carcinoma via the drainage routes of the tumor after transcatheter arterial embolization.

PURPOSE: After transcatheter arterial embolization (TAE) with iodized oil (Lipiodol), a relatively dense accumulation of Lipiodol is often seen in the nontumorous liver adjacent to a hypervascular hepatocellular carcinoma (HCC) nodule. We compared this phenomenon with the findings obtained with single-level dynamic CT during hepatic arteriography (SLDCTHA) and presumed its possible mechanism. METHODS: Fifty-six patients with HCC underwent hepatic angiography including SLDCTHA followed by segmental or subsegmental TAE with a mixture of an anticancer drug and Lipiodol. We compared the drainage area of the HCC depicted on SLDCTHA with the Lipiodol accumulation in the nontumorous liver adjacent to the HCC on CT after TAE (LpCT). RESULTS: In 26 of the 56 patients, a definite corona enhancement around the HCC, suggesting the drainage of blood from the tumor into the surrounding liver parenchyma, was seen on the late phase of SLDCTHA. In 17 of these 26 patients (65.4%), LpCT showed a more intense accumulation of Lipiodol in the nontumorous liver adjacent to the HCC that corresponded to the drainage area revealed on SLDCTHA. CONCLUSION: The drainage of blood from the HCC was considered to be a possible mechanism of the accumulation of Lipiodol in the nontumorous liver adjacent to the HCC.

MR imaging of focal splenic extramedullary hematopoiesis in polycythemia vera: case report.

We report a case with focal mass-like lesion of the spleen in polycythemia vera. Magnetic resonance imaging of the lesion showed homogeneous hyperintensity on T2-weighted images, with progressive enhancement on dynamic magnetic resonance images after bolus injection of gadolinium. The magnetic resonance features of focal splenic extramedullary hematopoiesis have not been previously reported.

Intrahepatic biliary calculi: correlation of unusual MR findings with pathologic findings.

We report a case of intrahepatic biliary calculi. A localized dilated intrahepatic duct of the left lateral segment of the liver was filled with material that showed marked hyperintensity on T1- and T2-weighted magnetic resonance (MR) images. These MR findings are unusual for intrahepatic stones. Pathologically, the stones were muddy bilirubin calculi, the chemical and physical characteristics of which are surmised to have been the cause of the unusual MR findings.

Nuclear cyclin D1 overexpression is a critical event associated with cell proliferation and invasive growth in gallbladder carcinogenesis.

Cyclin D1 overexpression is remarkably frequent in several human carcinomas and is believed to be a critical event in oncogenesis. We examined cyclin D1 expression, p53 expression, and the Ki-67 labeling index by immunostaining in human gallbladder mucosa in conditions varying from normal to malignant tissue. We also examined K-ras codon 12 mutations in these tissues with a two-step polymerase chain reaction. Nuclear cyclin D1 overexpression was observed in 48% of carcinomas occurring independently of adenoma, but not in adenomas, carcinomas arising in adenomas, or nonneoplastic lesions. Cytoplasmic cyclin D1 overexpression was observed in about 15% of abnormal specimens, irrespective of the type of epithelial abnormality. Carcinomas showing nuclear cyclin D1 overexpression had significantly higher Ki-67 labeling indexes than those with no overexpression. Moderately to poorly differentiated adenocarcinomas showed a higher incidence of nuclear cyclin D1 overexpression than papillary to well differentiated carcinomas. Specimens with cyclin D1 overexpression showed a high incidence of lymph permeation, venous permeation, and lymph node metastasis. We conclude that nuclear cyclin D1 overexpression is a critical event importantly associated with cell proliferation and invasive growth in gallbladder carcinogenesis, and that cyclin D1 immunostaining may become a useful marker for evaluating gallbladder carcinomas.

[Study of transforming growth factor-alpha expression in duodenal ulcer].

Various growth factors were also reported to promote healing of peptic ulcer. We have used a monoclonal antibody in conjunction with a standard immunohistochemical technique to characterize the expression of transforming growth factor-alpha (TGF-alpha) in duodenal ulcer. TGF-alpha immunoreactivity is found in Brunner's gland, also in immature gland and in duodenal epitheliums, but not in gastric metaplasia of the duodenum. TGF-alpha expression of healing and scar stage was higher than that of active stage. The presence or absence of Helicobacter pylori infection did not affect the expression of TGF-alpha in duodenal ulcer.

[Significance of atrial fibrillation, left atrial thrombus and severity of stenosis for risk of systemic embolism in patients with mitral stenosis].

The prognostic significance of atrial fibrillation, left atrial thrombus and the severity of mitral stenosis (MS) for systemic embolism was evaluated in 142 consecutive patients with MS (male 61, female 81; mean age 51 +/- 10 years) who were referred for cardiac catheterization. The relationships between systemic embolization, atrial fibrillation, left atrial thrombus and the size of mitral valve area obtained by the echocardiographic or Doppler method, or cardiac catheterization (Gorlin's formula) were studied. The effects of mitral regurgitation (MR) (Sellers II < or =) on systemic embolism or left atrial thrombus were also evaluated. Atrial fibrillation was observed in 117 patients (87%), 30 (28%) of whom had a history of systemic embolism. Four of 18 patients (22%) with sinus rhythm had a history of systemic embolism. Left atrial thrombus was observed in 63 patients (45%), including 17 (27%) with a history of systemic embolism. Seventeen (22%) of 76 patients without left atrial thrombus had a history of systemic embolism. Left atrial thrombus was detected in 17 of 41 (41%) patients with severe MS [mitral valve area (MVA) < or = 1.0 cm2], 8 of 25 (32%) patients with moderate MS (1.1 < MVA < or = 1.5 cm2), 2 of 14 (14%) patients with mild MS (MVA > or = 1.6 cm2), and embolization was complicated in 11% of cases of severe MS, 32% of cases of moderate MS and 21% of cases of mild MS. There was no significant difference between the 3 groups. Left atrial thrombus was more frequently observed in patients without MR than with MR (44% vs 13%, p < 0.05), but there was no significant difference in the incidence of embolism between the groups (28% vs 22%). Positive therapy intervention should be considered to prevent systemic embolism regardless of the presence or absence of sinus rhythm, MR, left atrial thrombus or severity of stenosis.

Mitochondrial encephalomyopathy (Kearns-Sayre syndrome) with complete atrioventricular block: a case report.

A pacemaker was implanted into a 17-year-old man with cardiac failure due to complete atrioventricular block complicated by mitochondrial encephalomyopathy (Kearns-Sayre syndrome). Due to the possible complication of latent myocardial dysfunction, it was decided to implant the dual chamber pacemaker (DDD) and the operation mode was set to DDD 70 ppm 1 year after implantation; this alleviated the cardiac failure. In this case, the necessity of preventive pacemaker implantation in the early stage of cardiac failure was recognized.