Retroperitoneal abscess associated with closed pelvic ring fracture diagnosed by fine free air on initial trauma pan computed tomography scan.

The patient was a 49-year-old male. He had a closed fracture of the pelvic ring that was treated successfully by avoiding anterior pelvic ring stabilization because of the presence of microscopic free air in the retroperitoneal space behind the pubic bone on initial whole-body trauma computed tomography scan. For his pelvic ring injury, transiliac rod and screw fixation was performed without the need for a pubic symphysis plate by developing the retroperitoneal space. His retroperitoneal abscess was treated by minimally invasive treatment of retroperitoneal abscess with computed tomography-guided percutaneous drainage. At 2 years postoperatively, there was no fever or elevated inflammatory response suspicious of retroperitoneal abscess recurrence. In this case, the presence of microscopic free air influenced the choice of treatment. Even in closed pelvic ring fractures, the presence of free air should be carefully considered when reading images.

Imaging approaches for the diagnosis of genetic diseases affecting the female reproductive organs and beyond.

This review aims to provide an overview of neoplastic lesions associated with genetic diseases affecting the female reproductive organs. It seeks to enhance our understanding of the radiological aspects in diagnosing genetic diseases including hereditary breast and ovarian cancer syndromes, Lynch syndrome, Peutz-Jeghers syndrome, nevoid basal cell carcinoma syndrome, and Swyer syndrome, and explores the patterns and mechanisms of inheritance that require elucidation. Additionally, we discuss the imaging characteristics of lesions occurring in other regions due to the same genetic diseases.

Imaging findings in inflammatory disease of the genital organs.

This review focuses on inflammatory diseases of female and male genital organs and discusses their epidemiology, pathogenesis, clinical presentation, and imaging findings. The female section covers pelvic inflammatory disease (PID) primarily caused by sexually transmitted infections (STIs) that affect the uterus, fallopian tubes, and ovaries. Unusual causes such as actinomycosis and tuberculosis have also been explored. The male section delves into infections affecting the vas deferens, epididymis, testes, prostate, and seminal vesicles. Uncommon causes such as tuberculosis, and Zinner syndrome have also been discussed. In addition, this review highlights other conditions that mimic male genital tract infections such as vasculitis, IgG4-related diseases, and sarcoidosis. Accurate diagnosis and appropriate management of these inflammatory diseases are essential for preventing serious complications and infertility. Imaging modalities such as ultrasound, magnetic resonance imaging, and computed tomography play a crucial role in diagnosis. Understanding the diverse etiologies and imaging findings is vital for the effective management of inflammatory diseases of the genital organs.

Fibrolipomatous hamartoma with macrodactyly and carpal tunnel syndrome.

A 26-year-old man presented with congenital left thumb macrodactyly. MRI showed diffuse enlargement of the left median nerve from the wrist to the digits, with particularly severe swelling of the thumb; US revealed the median nerve swelling comprised enlarged hypoechoic nerve bundles and increased hyperechoic areas around the nerve bundles. These typical cable-like and spaghetti-like appearances led to the diagnosis of fibrolipomatous hamartoma (FLH). Only debulking was performed for cosmetic reasons and enlarged nerves contiguous to the skin of the distal phalanx were cauterized and dissected. The diagnosis of FLH was confirmed pathologically. FLH is a rare, congenital disorder characterized by anomalous overgrowth of fibroadipose tissue between and around nerve bundles. Patients with median nerve involvement often present with carpal tunnel syndrome. Once its characteristic image is obtained, biopsy is not necessary.

Anatomical features of ossa cordis in the Steller sea lion.

Irregular triangular cartilage or bone fragments are sometimes found in the fibrous triangle of the heart. Ossa cordis and/or cartilago cordis has been demonstrated in various terrestrial animal species. Regarding marine mammals, sperm whales lack heart bones, and there have been no studies on bones or cartilage in pinniped hearts. Therefore, we examined the ossa cordis and/or cartilago cordis of the Steller sea lion. Eleven Steller sea lion hearts were examined morphologically and histologically. Before dissection, some hearts were imaged by CT to confirm the presence of ossa cordis or cartilago cordis. As a result, ossa cordis-like fragments were confirmed in four adults and one pup. All of the fragments were found at the right fiber triangle, and one adult had ossified tissue, including adipose tissue in the bone marrow cavity. The ossa cordis probably support the aorta because they surround the aorta as in other terrestrial animals. Steller sea lions can dive to a few hundred meters, but they need to rest on land frequently. Hence, their ossa cordis help maintain heart function during the tachycardia that occurs upon repeated surfacing and movements on land after diving in water.

Pelvic arterial embolisation with cyanoacrylate during caesarean hysterectomy for placenta accreta.

PURPOSE: To compare n-butyl cyanoacrylate (NBCA) and gelatine sponge (GS) as embolic materials for prophylactic pelvic arterial embolisation during caesarean hysterectomy for placenta accreta spectrum (PAS). MATERIAL AND METHODS: This retrospective study comprised 12 women (age range, 23-42 years; mean, 34.1 years) who underwent caesarean hysterectomy for PAS. Following caesarean delivery, bilateral uterine and non-uterine parasitic arteries were embolized with GS in the first four cases (GS group) and primarily with NBCA mixed with iodized oil in the subsequent eight cases (NBCA group). Procedure time for embolisation and hysterectomy and total blood loss were compared between the two groups using Welch's t-test. RESULTS: Although procedure time for embolisation tended to be longer in the NBCA group than in the GS group (111 ± 47 min versus 71 ± 32 min, p=.11), that for hysterectomy was significantly reduced in the NBCA group when compared to the GS group (158 ± 42 min versus 236 ± 39 min, p=.02). Total blood loss was significantly lower in the NBCA group than in the GS group (1375 ± 565 mL versus 2668 ± 587 mL, p=.01). CONCLUSION: Procedure time for hysterectomy and total blood loss during caesarean hysterectomy can be reduced by using NBCA instead of GS in prophylactic pelvic arterial embolisation for PAS.

Prolonged caloric restriction ameliorates age-related atrophy in slow and fast muscle fibers of rat soleus muscle.

Aging causes loss of skeletal muscle mass and function, which is called sarcopenia. While sarcopenia impairs the quality of life of older adults and is a major factor in long-term hospitalization, its detailed pathogenic mechanism and preventive measures remain to be identified. Caloric restriction (CR) suppresses age-related physiological and pathological changes in many species and prolongs the average and healthy life expectancy. It has recently been reported that CR suppresses the onset of sarcopenia; however, few studies have analyzed the effects of long-term CR on age-related skeletal muscle atrophy. Thus, we investigated the aging and CR effects on soleus (SOL) muscles of 9-, 24-, and 29-month-old ad libitum-fed rats (9AL, 24AL, and 29AL, respectively) and of 29-month-old CR (29CR) rats. The total muscle cross sectional area (mCSA) of the entire SOL muscle significantly decreased in the 29AL rats, but not in the 24AL rats, compared with the 9AL rats. SOL muscle of the 29AL rats exhibited marked muscle fiber atrophy and increases in the number of muscle fibers with a central nucleus, in fibrosis, and in adipocyte infiltration. Additionally, although the decrease in the single muscle fiber cross-sectional area (fCSA) and the muscle fibers' number occurred in both slow-type and fast-type muscle fibers, the degree of atrophy was more remarkable in the fast-type fibers. However, CR suppressed the muscle fiber atrophy observed in the 29AL rats' SOL muscle by preserving the mCSA and the number of muscle fibers that declined with aging, and by decreasing the number of muscle fibers with a central nucleus, fibrosis and denervated muscle fibers. Overall, these results revealed that advanced aging separately reduces the number and fCSA of each muscle fiber type, but long-term CR can ameliorate this age-related sarcopenic muscle atrophy.

Preoperative Diagnosis of a Torsioned Accessory Spleen.

We report a case of a 12-year-old boy with an accessory spleen torsion. He presented with left-sided abdominal pain after trauma. A 4 cm oval mass without contrast enhancement was detected on contrast-enhanced computed tomography (CT), and ultrasound (US) showed a 4 cm oval mass below the spleen. The mass mainly consisted of high echoes similar to the spleen; the central part showed irregularly low echoes. Subsequent follow-up daily US examinations showed gradual expansion of the central low echoes with conspicuous hyperechoic dots. Discontinuation of the branch from the splenic artery to the mass was observed, both, on US and CT. These findings led to the diagnosis of a hemorrhagic infarct caused by torsion of the accessory spleen. Laparoscopy showed adherence of the accessory spleen to the omentum and colon by twisting four times around its axis. It was resected and confirmed the diagnosis of a torsioned accessory spleen.

Liver Cirrhosis Complicated by Spontaneous Bacterial Peritonitis Caused by the Burkholderia cepacia Complex.

A 79-year-old man with underlying alcoholic liver cirrhosis presented with complaints of a fever, abdominal pain, and difficulty walking. A diagnostic work-up revealed liver atrophy and chylous ascites, and spontaneous bacterial peritonitis (SBP) was diagnosed based on the cell and neutrophil counts. The Burkholderia cepacia complex (Bcc) was detected on blood and ascitic fluid cultures. Although broad-spectrum antibiotic therapy was initiated, the infection was difficult to control, and the patient died of multiple organ failure. Bcc is often multidrug-resistant and difficult to treat. SBP caused by Bcc has been rarely reported and may have a serious course, thus necessitating caution.

Successful transcatheter arterial embolization for ruptured adrenocortical tumor in a pediatric patient.

Adrenocortical tumors (ACTs) are rare in children and should be treated as malignant tumors. A 12-year-old female patient was referred to our institute for acute abdomen and hypovolemic shock. She had symptoms of virilization, including lowered voice, beard growth, and hirsutism. An elevated level of dehydroepiandrosterone sulfate was observed, and computed tomography scan showed a large left adrenal mass with massive hemorrhage. Emergency transcatheter arterial embolization was successfully performed using N-buthyl-2-cyanoacrylate as an embolic material. She underwent surgical resection on the following day. Histopathological analysis showed strong degeneration of the tumor and its necrosis, and the tumor was diagnosed as ACT of unknown grade. To our knowledge, this is the first case of a ruptured ACT treated with transcatheter arterial embolization in a pediatric patient.

Low melting oxide glasses prepared at a melt temperature of 500 °C.

Transparent low-melting inorganic glass is an attractive industrial material based on its high thermal and light resistance compared with conventional engineering plastics. If the melting temperature of inorganic glass could be decreased, the doping of guest materials or compression moulding on the glass surface would be easier. Although phosphate glass is considered as a potential candidate because of its transparency in the visible region and low-melting behaviour, water durability often becomes a problem for implementation. Here, we prepared inorganic low-melting phosphate glass at a temperature of 500 °C via a melting and quenching methodology. It was found that tin-doped phosphate glasses exhibited higher thermal and light resistance properties than polycarbonates. Colourless transparent oxide glasses without organic components are capable of bringing about new possibilities for the application of inorganic glasses.

[A Case of Colitic Cancer with a Total Proctocolectomy in the Second Term].

The patient was 70-years-old women, 27 years ago, she was diagnosed with total colitis-type ulcerative colitis. Eighteen years after the diagnosis, she self-suspended his hospital visit because her condition was stable. After 4 years, ulcerative colitis rekindled, she resumed taking a 5-ASA. And 2 years later, colonoscopy revealed type 3 tumor in the descending colon. Tumor biopsy indicated an adenocarcinoma(tub1, tub2)derived from ulcerative colitis. Originally total proctocolectomy is necessary, but patient strongly hoped to leave the colon. We performed laparoscopic left hemicolonectomy(D2, SST). The pathological diagnosis was pT3, pN2, pM0, pStage Ⅲc. After the operation, chemotherapy(mFOLFOX6)was carried out for 6 months. We regularly checked tumor markers and followed up with a colonoscopy once every 6 months. But 3 years and 9 months after surgery, ulcerative colitis rekindled and adenocarcinoma in the transverse colon found by colonoscopy. We performed total proctocolectomy with ileal J-pouch anal-canal anastomosis. Four months after the second operation, advanced defecation disorder has not been observed.

Carcinosarcoma of the ovary: MR and clinical findings compared with high-grade serous carcinoma.

PURPOSE: To clarify imaging and clinical characteristics of ovarian carcinosarcoma (CS) compared with high-grade serous carcinoma (HGSC). METHODS: We retrospectively reviewed MR imagings of 12 patients with CS and 30 patients with HGSC and evaluated tumor size, shape, appearance, nature of cystic and solid components, hemorrhage, and necrosis. Age, premenopausal or postmenopausal, histologic subtype, presence of endometriosis, tumor markers, and stage were also evaluated. These parameters were compared using the Mann-Whitney U test and the chi-square test/Fisher's exact test. RESULTS: The mean size of CSs was 13.6 cm, and significantly larger than that of HGSCs (mean 9.0 cm, p = 0.022). The stained-glass appearance (67% vs. 23%, p = 0.013), hemorrhage (100% vs. 50%, p = 0.003), necrosis (75.0% vs. 13%, p = 0.000), and endometriosis (33% vs. 7%, p = 0.012) were significantly more common in CSs. The postmenopausal ratio of CSs was 100% and significantly higher than that of HGSCs (70.0%, p = 0.041). Among the tumor makers, only CA-125 was significantly lower in CSs than in HGSCs (mean 715.1 U/ml vs. 1677.1 U/ml, p = 0.009). The stage distribution was similar and was not significantly different. CONCLUSION: CSs formed larger masses, and the stained-glass appearance, hemorrhage, and necrosis were more frequently observed in CSs.

Anesthetic Management of a Patient With a Vagal Nerve Stimulator.

Vagal nerve stimulation (VNS) is an established adjunctive treatment for patients with refractory epilepsy. VNS is effective in many cases, but few patients achieve complete elimination of seizures. Furthermore, VNS can cause respiratory complications, such as obstructive sleep apnea. This report describes the successful anesthetic management of a 28-year-old woman with a VNS device who underwent dental treatment under general anesthesia. She was morbidly obese and had undergone placement of a VNS device secondary to drug-resistant epilepsy 2 years prior but continued to experience daily epileptic seizures. Because of concerns about the risk of perioperative epileptic seizures and apneic events, use of the dedicated VNS device magnet was planned if such complications occurred. Total intravenous anesthesia was induced with propofol and remifentanil and a bispectral index sensor was used to help monitor brain wave activity for evidence of seizures along with the depth of anesthesia. Postoperatively, the patient received positional therapy and supplemental oxygen while being closely monitored in recovery. The anesthetic course was completed uneventfully without need of the VNS magnet. A thorough understanding of the mechanics of a VNS device, including proper use of the VNS magnet, is critical for an anesthesiologist during the perioperative period.

Early weaning increases anxiety via brain-derived neurotrophic factor signaling in the mouse prefrontal cortex.

Deprivation of maternal care during early development markedly affects emotional development, but the underlying neuromolecular mechanisms are not fully understood. In a mouse model of disrupted mother-infant relationship, early weaning causes long-term impacts on pups to exhibit increased corticosterone secretion, anxiety, and stress responses in their adulthood. Revealing the molecular mechanisms behind it would beneficial to ameliorating mental problems caused by abuse in childhood. We report that normalizing circulating corticosterone in early-weaned mice, either in adulthood or soon after weaning, ameliorated anxiety levels assessed in the plus maze test. Administering a glucocorticoid receptor antagonist into the prefrontal cortex (PFC) reversed the effects of early weaning, whereas administering corticosterone increased anxiety levels, suggesting that the PFC is corticosterone's target brain region. In the PFCs of early-weaned mice, we observed prolonged reductions in the expression of brain-derived neurotrophic factor (BDNF) and associated mRNAs. Anxiety in early-weaned mice was ameliorated by pretreatment with BDNF or a BDNF receptor agonist. In summary, early weaning increased anxiety levels by modulating glucocorticoid and BDNF signaling in the PFC.

Excretion of necrotic hepatocellular carcinoma tissues into the biliary system after transcatheter arterial chemoembolization.

AIM: To evaluate the incidence and condition of necrotic tumor excretion into the biliary system in patients with hepatocellular carcinoma (HCC) >5 cm treated with conventional transcatheter arterial chemoembolization (TACE). METHODS: Eighty-three patients who underwent TACE for newly developed HCC >5 cm without an intraductal tumor thrombus and were followed-up by computed tomography for longer than 6 months were eligible. According to the location, the maximum tumors were divided into central (in contact with the left or right hepatic duct, n = 39) or peripheral (not in contact with them, n = 44). When high-density material in the biliary system that was not seen on pretreatment computed tomography was identified, it was determined as excreted necrotic tumor tissue containing iodized oil. The incidence, interval between TACE and occurrence of the necrotic tumor excretion, and clinical course were evaluated. RESULTS: Tumor excretion into the biliary system was identified in nine (10.8%) patients with a central tumor (mean diameter, 85.0 ± 29.6 mm) 28-433 days (mean, 219.3 ± 128.2) after the initial TACE. In one patient, the necrotic tumor cast caused cholangitis 1203 days after the initial TACE, and was endoscopically removed. Infection of the embolized tumor developed in two cases and percutaneous drainage was carried out 105 and 158 days later, respectively. CONCLUSIONS: Excretion of necrotic tumors into the biliary system after TACE was not rare in patients with centrally located HCC >5 cm. The detached tumor rarely caused symptoms and the communication between the tumor and bile duct caused the infection of tumors.

Involvement of lysosomal dysfunction in autophagosome accumulation and early pathologies in adipose tissue of obese mice.

Whether obesity accelerates or suppresses autophagy in adipose tissue is still debatable. To clarify dysregulation of autophagy and its role in pathologies of obese adipose tissue, we focused on lysosomal function, protease maturation and activity, both in vivo and in vitro. First, we showed that autophagosome formation was accelerated, but autophagic clearance was impaired in obese adipose tissue. We also found protein and activity levels of CTSL (cathepsin L) were suppressed in obese adipose tissue, while the activity of CTSB (cathepsin B) was significantly enhanced. Moreover, cellular senescence and inflammasomes were activated in obese adipose tissue. In 3T3L1 adipocytes, downregulation of CTSL deteriorated autophagic clearance, upregulated expression of CTSB, promoted cellular senescence and activated inflammasomes. Upregulation of CTSB promoted additional activation of inflammasomes. Therefore, we suggest lysosomal dysfunction observed in obese adipose tissue leads to lower autophagic clearance, resulting in autophagosome accumulation. Simultaneously, lysosomal abnormalities, including deteriorated CTSL function and compensatory activation of CTSB, caused cellular senescence and inflammasome activation. Our findings strongly suggest lysosomal dysfunction is involved in early pathologies of obese adipose tissue.

Performance of novel virtual parenchymal perfusion software visualizing embolized areas of transcatheter arterial chemoembolization for hepatocellular carcinoma.

AIM: To evaluate the performance of novel virtual parenchymal perfusion (VPP) software in conventional transcatheter arterial chemoembolization (cTACE) for hepatocellular carcinoma. METHODS: VPP was retrospectively applied to 43 hepatocellular carcinomas treated with cTACE. The virtual embolized area (VEA) was estimated after positioning a virtual injection point on images of non-selective cone-beam computed tomography during hepatic arteriography, at the same position in superselective cTACE. The real embolized area (REA) was defined as the area where iodized oil was retained on 1-week computed tomography after cTACE. Three dimensions across the tumor (maximum [a] and minimum [b] in the axial and craniocaudal [c]) directions, and the volume of the VEA and REA were compared using linear regression analysis. It was also evaluated whether an adequate safety margin ≥5 mm could be predicted by VPP. RESULTS: The mean lengths of a, b, and c of the VEA and REA were 54.6 ± 15.9 mm (range 24.9-91.0 mm) and 55.0 ± 15.7 mm (range 23.9-92.8 mm; r = 0.9448, P < 0.001), 35.4 ± 11.7 mm (range 16.1-66.0 mm) and 35.4 ± 13.2 mm (range 12.2-69.2 mm; r = 0.9369, P < 0.001), and 42.1 ± 11.6 mm (range 25.0-75.7 mm) and 42.9 ± 11.7 mm (range 25.7-78.7 mm; r = 0.9092, P < 0.001), respectively. The mean volume of the VEA and REA was 71.8 ± 44.8 mL and 75.5 ± 46.9 mL, respectively (r = 0.9913, P < 0.0001). VPP showed no safety margins in seven tumors, including all three actually embolized without safety margins. CONCLUSION: The VEA estimated using VPP showed a good correlation with the REA of cTACE.

Estrogens Exacerbate Nociceptive Pain via Up-Regulation of TRPV1 and ANO1 in Trigeminal Primary Neurons of Female Rats.

Several trigeminal pain disorders show sex differences, and high levels of estrogens may underlie these differences. The interaction between transient receptor potential vanilloid 1 (TRPV1) and anoctamin 1 (ANO1) plays an important role in peripheral nociception. However, whether TRPV1 and ANO1 are involved in estrogen-modulated trigeminal pain sensitivity is unclear. In this study, we examined estradiol (E2) modulation of nociception through behavioral and immunohistological experiments after application of capsaicin (Cap), a selective TRPV1 agonist, onto the ocular surface in ovariectomized rats treated with high-dose E2 (HE) or low-dose E2 (LE) for 2 days. In addition, we used real-time PCR to study the effects of E2 on the expression levels of TRPV1 and ANO1 mRNA in trigeminal ganglia. In the behavioral experiment, the HE group showed significant potentiation of Cap-evoked nocifensive behavior compared with the LE group. Immunohistochemistry showed that Cap evoked a significantly greater number of cells that were immunoreactive for c-Fos, a marker of nociceptive activation, in the trigeminal subnucleus caudalis/upper cervical cord in the HE group than in the LE group. The number of c-Fos-immunoreactive cells in the ventral trigeminal interpolaris/caudalis were similar in the 2 groups. Real-time PCR showed that the levels of TRPV1 and ANO1 mRNA in the HE group were significantly higher than levels in the LE group. Thus, high levels of estrogens may be a risk factor for Cap-evoked nociceptive pain, and estrogen-dependent increases in TRPV1 and ANO1 are likely involved in modulating the nociceptive response in the trigeminal area.