Room-Temperature Low-Field Colossal Magnetoresistance in Double-Perovskite Manganite.

We have discovered room-temperature low-field colossal magnetoresistance (CMR) in an A-site ordered NdBaMn_{2}O_{6} crystal. The resistance changes more than 2 orders of magnitude at a magnetic field lower than 2 T near 300 K. When the temperature and magnetic field sweep from an insulating (metallic) phase to a metallic (insulating) phase, the insulating (metallic) conduction changes to the metallic (insulating) conduction within 1 K and 0.5 T, respectively. The CMR is ascribed to the melting of the charge and orbital ordering. The entropy change which is estimated from the B-T phase diagram is smaller than what is expected for the charge and orbital ordering. The suppression of the entropy change is attributable to the loss of the short-range ferromagnetic fluctuation of Mn spin moments, which is an important key of the high temperature and low magnetic field CMR effect.

Amyloid-Producing Odontogenic Tumors of the Facial Skin in Three Cats.

Amyloid-producing odontogenic tumors (APOTs) of the facial skin were diagnosed in 3 domestic cats. The neoplasms had the histopathological characteristics of the odontogenic tumor. The neoplastic cells were present in irregular islands, strands, and sheets. The peripheral neoplastic cells of the islands and strands were arranged in a palisading fashion, while the central cells were polyhedral to stellate and randomly arranged. Multiple spherules of homogeneous eosinophilic material were closely apposed to the neoplastic epithelial cells. The spherules stained with Congo red and produced an apple green birefringence under polarization microscopy, indicative of amyloid. Immunohistochemically, amyloid materials of the neoplasms reacted with polyclonal antibodies for ameloblastin, amelogenin, and sheathlin antibodies. Neoplastic epithelial cells also reacted with antiameloblastin, amelogenin, and sheathlin antibodies, with varied intensity. The histopathological and immunohistochemical characteristics of dermal neoplasms of the 3 cats were analogous to those of APOTs reported in the dog and the cat.

Measurements of cosmic-ray proton and helium spectra from the BESS-Polar long-duration balloon flights over Antarctica.

The BESS-Polar Collaboration measured the energy spectra of cosmic-ray protons and helium during two long-duration balloon flights over Antarctica in December 2004 and December 2007, at substantially different levels of solar modulation. Proton and helium spectra probe the origin and propagation history of cosmic rays in the galaxy, and are essential to calculations of the expected spectra of cosmic-ray antiprotons, positrons, and electrons from interactions of primary cosmic-ray nuclei with the interstellar gas, and to calculations of atmospheric muons and neutrinos. We report absolute spectra at the top of the atmosphere for cosmic-ray protons in the kinetic energy range 0.2-160 GeV and helium nuclei 0.15-80 GeV/nucleon. The corresponding magnetic rigidity ranges are 0.6-160 GV for protons and 1.1-160 GV for helium. These spectra are compared to measurements from previous BESS flights and from ATIC-2, PAMELA, and AMS-02. We also report the ratio of the proton and helium fluxes from 1.1 GV to 160 GV and compare to ratios from PAMELA and AMS-02.

Diagnostic performance of percutaneous lung biopsy using automated biopsy needles under CT-fluoroscopic guidance for ground-glass opacity lesions.

OBJECTIVE: The goal of our study was to evaluate the diagnostic performance of percutaneous lung biopsy under CT-fluoroscopic guidance for ground-glass opacity (GGO) lesions. METHODS: 85 percutaneous needle lung biopsies were performed in 73 patients. Specimens were obtained by core biopsy utilising an automated cutting needle and were evaluated histologically. Final diagnosis was confirmed by independent surgical pathology, independent culture results or clinical follow-up. RESULTS: Rates of adequate specimens obtained and of precise diagnosis by needle biopsy were 92.9% (79/85) and 90.6% (77/85) of evaluated lung lesions, respectively. Precise diagnosis was achieved in 87.1% (27/31) of lesions ≤10 mm in diameter, 90.0% (36/40) of lesions >10 mm to ≤20 mm and 100.0% (14/14) of lesions >20 mm. Precision in diagnosing GGO lesions according to the GGO component was 73.9% (17/23) for pure GGO lesions and 96.8% (60/62) for part-solid GGO lesions. Obtaining a precise diagnosis did not differ significantly according to the lesion size (p=0.3840), but differences were significant according to the GGO component (p=0.0047). Malignancy was accurately diagnosed in 35 of 36 malignant lesions for which surgery was later performed. The specific cell type determined from specimens obtained by needle biopsy was exactly the same as the final histological diagnosis obtained after surgery in 20 lesions. CONCLUSION: Tissue-core lung biopsy under CT-fluoroscopic guidance for a GGO lesion provides a high degree of diagnostic accuracy but is less reliable for determining the specific cell type. ADVANCES IN KNOWLEDGE: Percutaneous lung biopsy under CT-fluoroscopic guidance for GGO is useful in differentiating malignancy.

Search for antihelium with the BESS-Polar spectrometer.

In two long-duration balloon flights over Antarctica, the Balloon-borne Experiment with a Superconducting Spectrometer (BESS) collaboration has searched for antihelium in the cosmic radiation with the highest sensitivity reported. BESS-Polar I flew in 2004, observing for 8.5 days. BESS-Polar II flew in 2007-2008, observing for 24.5 days. No antihelium candidate was found in BESS-Polar I data among 8.4×10(6) |Z|=2 nuclei from 1.0 to 20 GV or in BESS-Polar II data among 4.0×10(7) |Z|=2 nuclei from 1.0 to 14 GV. Assuming antihelium to have the same spectral shape as helium, a 95% confidence upper limit to the possible abundance of antihelium relative to helium of 6.9×10(-8)} was determined combining all BESS data, including the two BESS-Polar flights. With no assumed antihelium spectrum and a weighted average of the lowest antihelium efficiencies for each flight, an upper limit of 1.0×10(-7) from 1.6 to 14 GV was determined for the combined BESS-Polar data. Under both antihelium spectral assumptions, these are the lowest limits obtained to date.

Measurement of the cosmic-ray antiproton spectrum at solar minimum with a long-duration balloon flight over antarctica.

The energy spectrum of cosmic-ray antiprotons (p's) from 0.17 to 3.5 GeV has been measured using 7886 p's detected by BESS-Polar II during a long-duration flight over Antarctica near solar minimum in December 2007 and January 2008. This shows good consistency with secondary p calculations. Cosmologically primary p's have been investigated by comparing measured and calculated p spectra. BESS-Polar II data show no evidence of primary p's from the evaporation of primordial black holes.

Comparison of fully automated and semi-automated biopsy needles for lung biopsy under CT fluoroscopic guidance.

OBJECTIVE: The aim of this study was to compare two different automated biopsy needles, a fully automated biopsy needle (Monopty; Bard, Covington, GA) and a semi-automated biopsy needle (Temno; Bauer Medical, Clearwater, FL), for lung biopsy. METHODS: 50 consecutive percutaneous lung biopsies using the Monopty needle between June 2006 and January 2007 and 66 consecutive lung biopsies for 1 nodule in each session using the Temno needle between February 2007 and August 2008 were performed under CT fluoroscopic guidance followed by histopathological evaluation. RESULTS: In 42/50 lung biopsies performed with the Monopty needle and 54/66 lung biopsies performed with the Temno needle, the final diagnosis was confirmed by independent surgical pathological findings or clinical follow-up. Sufficient samples for histopathological evaluation were obtained in all 50 (100%) biopsies using the Monopty needle and in 55 (83.3%) of the 66 biopsies using the Temno needle (p<0.01). Accurate diagnosis was achieved in 41 (97.6%) of 42 biopsies using the Monopty needle and in 45 (83.3%) of 54 biopsies using the Temno needle (p=0.04). Biopsy-induced complications were pneumothorax, haemoptysis and haemothorax in 44.0%, 10.0% and 6.0% of biopsies, respectively, using the Monopty needle and in 48.3%, 8.3% and 3.3%, respectively, using the Temno needle. CONCLUSION: There is a possibility that a fully automated biopsy needle such as the Monopty is more useful for CT scan-guided lung biopsy than semi-automated biopsy needles.

Hepatic artery-targeting guidewire technique during transjugular intrahepatic portosystemic shunt.

OBJECTIVE: This study evaluated the feasibility and safety of the transjugular intrahepatic portosystemic shunt (TIPS) procedure using the hepatic artery-targeting guidewire technique for the puncture step. METHODS: We retrospectively reviewed 11 consecutive patients (5 men and 6 women, aged 46-76 years (mean 64 years)) with portal hypertension in whom the TIPS procedure was performed. As the first step in the TIPS procedure in all cases, a micro-guidewire was inserted into the hepatic arterial branch accompanying the portal venous branch through a microcatheter coaxially advanced from a 5-French catheter positioned in the coeliac or common hepatic artery. At the puncture step, the tip of the metallic cannula was aimed 1 cm posterior to the distal part of this micro-guidewire, after which the TIPS procedure was performed. Success rate, number of punctures and complications were evaluated. RESULTS: The TIPS procedure was successfully performed in all 11 patients. The mean number of punctures until success in entering the targeted portal venous branch was 5 (range 1-14). In 3 patients (27%), the right portal venous branch was entered at the first puncture attempt. The hepatic artery was punctured once in one patient and the bile duct was punctured once in another patient. No serious procedure-induced complications occurred. CONCLUSION: The TIPS procedure can be accomplished safely, precisely and relatively easily using the hepatic artery-targeting guidewire technique.

Embolisation of the right gastric artery in patients undergoing hepatic arterial infusion chemotherapy using two possible approach routes.

We used a retrospective non-randomised study to investigate the clinical effect of selective embolisation of the right gastric artery before hepatic arterial infusion chemotherapy (HAIC) using a port-catheter system. We evaluated whether the hepatic artery or the left gastric artery is the better approach for selecting the right gastric artery. A total of 367 patients (244 men and 123 women; mean age, 64.1 years) with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system. In 294 of these patients, right gastric arterial embolisation with microcoils was attempted before placement of the port-catheter system to prevent gastric mucosal lesions. Approach was either through the hepatic artery (175 patients) or through the left gastric artery (119 patients), with success rates in catheterising the right gastric artery of 78.3% and 77.3%, respectively. If the attempt was unsuccessful, the catheter was redirected to the alternative approach, which increased the final success rate to 96.3%. Only seven patients experienced gastroduodenal mucosal lesions acutely after HAIC, as revealed by endoscopy. Embolisation of the right gastric artery is a feasible procedure that can reduce the incidence of gastric mucosal lesions associated with HAIC. Approach through either the hepatic artery or the left gastric artery is equally acceptable.

Role of manual aspiration in treating pneumothorax after computed tomography-guided lung biopsy.

BACKGROUND: Pneumothorax is the most common complication after computed tomography (CT)-guided lung biopsy. The presence of a pneumothorax per se does not complicate patient management, but an increasing pneumothorax, making chest tube placement necessary, is highly problematic. PURPOSE: To evaluate the efficacy and limitations of simple aspiration of air from the pleural space to prevent increased pneumothorax and avoid chest tube placement in cases of pneumothorax following CT-guided lung biopsy. MATERIAL AND METHODS: The subjects of our study were 642 consecutive lung lesions in 594 patients for which percutaneous needle lung biopsies were performed using CT guidance. While patients were on the CT scanner table, percutaneous manual aspiration was performed in all patients with a non-small pneumothorax demonstrated on post-biopsy chest CT images. The frequency of pneumothorax, management of each such case, and factors influencing the incidence of worsening pneumothorax that finally required chest tube placement were evaluated. RESULTS: Post-biopsy pneumothorax occurred in 243 of 642 (38%) procedures. Of the 243 cases, 112 were treated with manual aspiration immediately after biopsy. In 210 (86.4%), the pneumothorax had resolved completely on follow-up chest radiographs without chest tube placement. Only 33 patients required chest tube placement. Requirement of chest tube insertion significantly increased in parallel with the degree of pneumothorax as shown on post-biopsy CT images. The rate of chest tube insertion was statistically higher in subjects with values for aspirated air above 543 ml. CONCLUSION: Percutaneous manual aspiration of biopsy-induced pneumothorax performed immediately after biopsy may prevent worsening of pneumothorax and avoid chest tube placement. The amount of aspirated air can be predictive of the requirement for chest tube placement.

Evaluation of non-target arterial patency after implantation of hepatic arterial catheter using a modified implantation technique with the fixed catheter tip method.

AIM: To retrospectively investigate persistent hepatofugal blood flow in the gastroduodenal artery after implantation of a port-catheter system for repeated hepatic arterial infusion chemotherapy using a modified fixed catheter tip method. MATERIALS AND METHODS: A port-catheter system was percutaneously implanted in 150 patients (90 men and 60 women; mean age 64.6 years) with unresectable liver cancer. The persistence of blood flow beyond the end hole of the indwelling catheter via the port obtained immediately and 1-10 days after port-catheter placement was investigated using arteriography. RESULTS: In all cases, port-catheter placement was successfully performed. In 64 (42.7%) of the 150 participants, the gastroduodenal artery was detected on arteriography just after implantation. However, arteriography obtained 1-10 days (mean 4.3 days) after implantation revealed the gastroduodenal artery in only two of the 64 participants. In these two patients, persistent blood flow disappeared spontaneously 12 and 15 days after implantation, respectively. CONCLUSION: Closure of the lumen of the distal tip of the catheter beyond the side hole most often occurs spontaneously just after implantation. However, the findings of the present study indicate that closure will occur within 15 days at the latest. This suggests that delaying chemotherapy for about 2 weeks after implantation may be advisable.

The effectiveness of lymphangiography as a treatment method for various chyle leakages.

The purpose of this study was to assess the effectiveness of lymphangiography as a treatment for various chyle leakages. Pedal lymphangiography was performed in 9 patients (6 men and 3 women; mean age, 59 years) who were unlikely to be cured only by conservative treatment - a low-fat medium-chain triglyceride diet, total parenteral nutrition and insertion of a drainage tube - and in whom chylothorax (n = 5), chylous ascites (n = 2) and lymphatic fistulae (n = 2) were refractory to conservative treatment. In 7 of these 9 patients (78%), we could detect the chyle leakage sites. In 8 of the 9 patients (89%), lymphatic leakage was stopped after lymphangiography, and surgical re-intervention was avoided. No cases had a recurrence of chyle leakage during follow-up (range, 1-54 months). Lymphangiography is effective not only for diagnosis but also as treatment for various chyle leakages. Early lymphangiography is therefore recommended for patients with chyle leakages who are unlikely to be cured by conservative treatment only.

Silicone-induced foreign-body reaction after first metatarsophalangeal joint arthroplasty for Jaccoud's arthropathy.

We report a case of Jaccoud's arthropathy with forefoot plantar callosity. The lesser toe metatarsal heads were resected and Swanson's double-stemmed flexible-hinge implant arthroplasty of the first metatarsophalangeal joint was performed. An osteolytic defect had formed around the implant after 2 years. Surgical revision comprised implant removal and synovectomy. Histology revealed a foreign-body reaction with birefringent material in multinucleated giant cells. Because the capsuloligamentous system is fragile in Jaccoud's arthropathy, we recommend resection arthroplasty or arthrodesis of the first MP joint as an initial operative approach.

Balloon-occluded retrograde transvenous obliteration of a gastric varix via the left inferior phrenic vein.

We encountered a patient with a gastric varix that drained through the left inferior phrenic vein, which directly entered the inferior vena cava at the point just inferior to the diaphragm. In this patient, gastrorenal shunt was not seen. Balloon-occluded retrograde transvenous obliteration of the gastric varix was performed, in which 50% glucose and 5% ethanolamine oleate-iopamidol were injected as sclerosing agents while the balloon was inflated in the left inferior phrenic vein. 1 week after the procedure, the disappearance of enhancement in the gastric varix was confirmed on contrast-enhanced multidetector row CT. Furthermore, a significant reduction in the size of the varix was confirmed on endoscopic examination 4 months later.

Redistribution of multiple hepatic arteries into a single hepatic artery to perform repeated hepatic arterial infusion chemotherapy.

BACKGROUND: In patients with two or more intrahepatic arteries, multiple intrahepatic arteries should be converted into a single intrahepatic artery before repeated hepatic arterial infusion chemotherapy. However, the number of reports investigating this has been scanty. PURPOSE: To evaluate the usefulness of the redistribution of multiple hepatic arteries into a single hepatic artery for repeated hepatic arterial infusion chemotherapy (HAIC) through an indwelling port-catheter system for unresectable liver malignancies. MATERIAL AND METHODS: In 76 patients with unresectable advanced liver cancer, redistribution of multiple hepatic arteries into one hepatic artery was performed prior to port-catheter system implantation. Investigated were distribution in the liver, as evaluated with computed tomography (CT) during arteriography via the port after implantation, and management of cases in which distribution in the entire liver was not achieved. RESULTS: In 64 patients, good distribution in the entire liver was confirmed on CT arteriography via the port. In the remaining 12 patients, contrast material was heterogeneously distributed. The segments with poor distribution were segments VI, VII, VIII, and I. In the five patients with tumors in segments having poor distribution, the right inferior phrenic artery was successfully embolized and good distribution throughout the entire liver was thereafter achieved in all five. CONCLUSION: In cases with multiple hepatic arteries, redistribution procedures allow application of repeated HAIC through a single indwelling catheter while maintaining distribution over the entire liver. However, care regarding hepatopetal flow of the right inferior phrenic artery is necessary.

Prophylactic implantation of inferior vena cava filter during endovascular therapies for deep venous thrombosis of the lower extremity: is it necessary?

BACKGROUND: There is strong controversy as to whether to use filters temporarily in the inferior vena cava (IVC) during endovascular therapies for deep venous thrombosis (DVT) in the lower extremity. PURPOSE: To evaluate the necessity of implantation of a retrievable inferior vena cava filter during treatment of DVT in the lower extremity using various endovascular techniques. MATERIAL AND METHODS: Studied were all 37 consecutive sessions of endovascular treatments performed in 34 patients with symptomatic lower-limb DVT between April 2001 and October 2006. In all sessions, a Gunther tulip retrievable vena cava filter (GTF) was implanted during the procedures. The degree of trapped thrombus in the filter was evaluated by repeated venocavography. RESULTS: Implantation of a total of 66 GTFs was successfully performed in 37 sessions. Worsening of or new formation of pulmonary embolism was avoided in all patients. In 20 (54.1%) of the 37 sessions, a trapped thrombus in the filter was observed. In 14, the trapped thrombus was large, filling more than half the height of the filter. CONCLUSION: Temporary implantation of filters is effective in preventing pulmonary emboli during endovascular treatment of DVT in the lower extremities.

Percutaneous needle biopsy of lung nodules under CT fluoroscopic guidance with use of the "I-I device".

The aim of this study is to evaluate the feasibility and safety of CT fluoroscopic-guided needle biopsy with the use of the "I-I device", which was developed to assist in precisely advancing the needle while avoiding irradiation to the operator's hand. Using the "I-I device" under CT fluoroscopic guidance, 131 percutaneous needle lung biopsies were performed followed by histopathological evaluation. The final diagnosis was confirmed by independent surgical pathological findings or clinical follow-up. The rate of success in obtaining specimens adequate for histopathological analysis was 100% (131/131). For the 104 lesions that we were able to follow up, sensitivity, specificity and accuracy in diagnosing malignancy were 93.8%, 100% and 95.2%, respectively. In 51 lesions for which surgery was performed, the specific cell type was characterized in 98.0% (50/51; malignant, n = 38; benign, n = 12). The specific cell type was precisely diagnosed and confirmed after surgery in 36 malignant lesions and 8 benign lesions. Biopsy-induced complications were pneumothorax in 34.0% (44/131) and haemoptysis in 9.9% (13/131). None of the patients had serious complications. In conclusion, CT fluoroscopic-guided lung biopsy with use of the "I-I device" provides a high degree of diagnostic accuracy, allows specific characterization of lung nodules and can be performed safely.

Should balloon-occluded retrograde transvenous obliteration be the first-line interventional radiologic treatment for bleeding duodenal varices? A case report and review of the literature.

We report a 78-year-old woman who presented with repeated tarry stools, and having lower duodenal variceal bleeding caused by portal hypertension. Endoscopic therapy had been attempted, but was impossible because the endoscope could not be inserted into the lower duodenum. Thus, the lower duodenal variceal bleeding was treated with balloon-occluded retrograde transvenous obliteration in combination with embolization using microcoils. Complete hemostasis was achieved without complications, and neither the recurrence of varices nor rebleeding has occurred for the last 3 years. A review of the English-language literature reveals only 11 such cases. The world literature is reviewed.

Infusion of 50% glucose solution before injection of ethanolamine oleate during balloon-occluded retrograde transvenous obliteration.

The feasibility of infusion of 50% glucose solution before balloon-occluded retrograde transvenous obliteration (BRTO) to occlude collateral vessels draining gastric varices other than gastrorenal shunt was evaluated. In five patients with such collateral vessels, 50% glucose solution was infused from the balloon catheter inflated within the gastrorenal shunt. The degree of collateral vessels had decreased when BRTO was carried out so that sclerotic agents sufficiently occupied the gastric varices in all patients. In three patients, embolization of collateral vessels with coils was unnecessary. There were no complications. In conclusion, retrograde infusion of 50% glucose solution assists in effectively carrying out BRTO.

Percutaneous transluminal angioplasty using a pull-through technique for hepatic arterial occlusion at the time of port-catheter implantation.

We report a successful percutaneous transluminal angioplasty using a pull-through technique for the treatment of a hepatic arterial occlusion caused by iatrogenic subintimal dissection during the percutaneous placement of a port-catheter system.