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1.
Medicine (Baltimore) ; 100(34): e26681, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449453

RESUMO

RATIONALE: Recently, the number of osteosarcomas has been increasing in elderly patients due to human longevity. Lung metastases are the primary cause of death from osteosarcomas. Complete resection of lung metastases can prolong the survival. However, complete resection in elderly patients is often difficult due to high risk of operative complications. Computed tomography (CT) guided radiofrequency ablation (RFA) is a minimally invasive technique to destroy tumor nodules using heat. In this report, we present the first case older than 65 years applying RFA for lung metastases due to osteosarcoma. PATIENT CONCERNS: A 74-year-old male presented with 1-year history of heel pain. A conventional high-grade osteosarcoma in his calcaneus was diagnosed. Below-knee amputation was performed. However, lung metastases were found in both lungs 1 year after amputation. CT-guided lung RFA was chosen since surgical intervention for lung metastases was abandoned because of tumor multiplicity and medical comorbidities. A total of 18 lung metastases were treated by CT-guided RFA. The most frequent complication was pneumothoraxes in 4 of 8 (50%) procedures and chest tube drainage was required in 2 of these (2 of 8 (25%) procedures). DIAGNOSES: Six lung metastases of osteosaroma were found in both lungs at 1 year after surgery. INTERVENTIONS: CT-guided lung RFA was performed. A total of 18 lung metastases were treated in 8 lung RF procedures. OUTCOMES: The patient has been alive with disease for 5.5 years after the initial surgery. LESSONS: CT-guided lung RFA is effective for elderly patients with osteosarcoma lung metastases in spite of discouragement of lung metastasectomy due to multiplicity of metastases and medical-comorbidities.


Assuntos
Neoplasias Ósseas/patologia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Osteossarcoma/patologia , Ablação por Radiofrequência/métodos , Idoso , Calcâneo/patologia , Humanos , Masculino , Radiografia Intervencionista , Tomografia Computadorizada por Raios X
2.
Clin Case Rep ; 9(3): 1261-1265, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33768822

RESUMO

Combined therapy with adrenal arterial embolization and RF ablation may represent a useful therapeutic option with curative properties in select patients with pheochromocytoma.

3.
Artigo em Japonês | MEDLINE | ID: mdl-31327772

RESUMO

In April 2011, the International Radiological Protection Committee recommended that "The equivalent dose of the crystalline lens should not exceed 20 mSv/year, averaged over defined periods of 5 years, with no single year exceeding 50 mSv". Based on this recommendation, it is predicted that the equivalent dose limit of our crystalline lens can be lowered in the near future. Therefore, it is important to grasp the current situation of radiation exposure. The purpose of this study is to measure the crystalline lens of surgeons by focusing on the CT-fluoroscopy guided interventional radiology's (IVRs). We also examined whether the exposure dose of the crystalline lens can be correctly evaluated by measuring the unequal exposure dose of the neck, which is usually used for the unequal exposure measurement. Results of the analysis of 200 CT-fluoroscopy guided IVR procedures showed that the unequal exposure dose of the neck was significantly correlated with the exposure dose of the crystalline lens which was measured near the left eye ball (R=0.83). However, the exposure dose of the crystalline was 33% lower than those of the neck. Therefore, although the individual dosimeter worn on the neck can be used as the useful index of the exposure dose of the crystalline lens, the results can be overestimated.


Assuntos
Cristalino , Exposição à Radiação , Proteção Radiológica , Cabeça , Humanos , Pescoço , Doses de Radiação , Tomografia Computadorizada por Raios X
5.
Hepatol Int ; 12(Suppl 1): 102-111, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28875380

RESUMO

PURPOSE: To evaluate the recent topics of Ballloon-occluded retrograde trasnvenous obliteration(B-RTO). METHOD: We overviewed the recent scientific papers regarding B-RTO. RESULT: B-RTO is a treatment method for occluding varices retrogradely using a sclerosing agent under balloon occlusion of a major draining vein. It has been recognized as an effective treatment method for gastric varices. Hepatic function reserve is improved and liver volume is increased after B-RTO. In recent years, various technical options, such as plug-assisted retrograde transvenous obliteration, coil-assisted retrograde transvenous obliteration, or foam B-RTO, have also been reported. In performing B-RTO, portal hemodynamics must be thoroughly examined radiologically. Judging the classification of the grade of collateral venous hemodynamics is important to select the appropriate embolization technique of B-RTO and to successfully occlude varices. Finally, the word "portosystemic shunt syndrome" has been proposed and the condition should be considered while selecting a treatment for gastric varices. CONCLUSION: B-RTO is effective for gastrointestinal varices and portosystemic shunts.


Assuntos
Oclusão com Balão/métodos , Varizes Esofágicas e Gástricas/terapia , Hipertensão Portal/complicações , Derivação Portossistêmica Cirúrgica/efeitos adversos , Obturação Retrógrada/instrumentação , Elasticidade/efeitos dos fármacos , Embolização Terapêutica/métodos , Hemodinâmica , Humanos , Hipertensão Portal/fisiopatologia , Fígado/crescimento & desenvolvimento , Fígado/fisiologia , Testes de Função Hepática/métodos , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Soluções Esclerosantes/administração & dosagem , Soluções Esclerosantes/uso terapêutico , Resultado do Tratamento
6.
Jpn J Radiol ; 35(7): 366-372, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28501975

RESUMO

PURPOSE: To evaluate changes in liver perfusion after occlusion of spontaneous portosystemic shunt and to analyze mechanisms of liver profile improvement. MATERIALS AND METHODS: Liver function changes and portal venous and hepatic arterial blood flow were evaluated using perfusion CT before and after shunt occlusion in 23 patients who underwent percutaneous occlusion of spontaneous portosystemic shunt because of gastric varices (n = 15) or hepatic encephalopathy (n = 8). RESULTS: Portal venous blood flow was significantly higher at 1 week (278.7 ml/min, 92.7-636.7, p = 0.012), 1 month (290.0 ml/min, 110.1-560.1, p < 0.001) and 3 months (299.6 ml/min, 156.7-618.5, p = 0.033) after shunt occlusion than the baseline (220.9 ml/min, 49.5-566.7). Hepatic arterial liver blood flow became lower than the baseline (132.3 ml/min, 47.9-622.3) after shunt occlusion, but a significant decrease was observed only at 1 month later (107.9 ml/min, 45.8-263.6 p = 0.027). Serum albumin concentration became significantly higher than the baseline (3.4 mg/dl, 1.9-4.5) at 1 month (3.8 mg/dl, 2.3-4.3, p = 0.018) and 3 months (3.9 mg/dl, 2.6-4.3, p = 0.024) after shunt occlusion. CONCLUSION: Shunt occlusion increases portal venous blood flow and decreases hepatic arterial blood flow, thereby improving the liver profile.


Assuntos
Oclusão com Balão/métodos , Varizes Esofágicas e Gástricas/terapia , Encefalopatia Hepática/terapia , Fígado/irrigação sanguínea , Tomografia Computadorizada por Raios X/métodos , Idoso , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/fisiopatologia , Feminino , Hemodinâmica/fisiologia , Artéria Hepática/fisiologia , Encefalopatia Hepática/etiologia , Encefalopatia Hepática/fisiopatologia , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Veia Porta/fisiologia , Estudos Retrospectivos , Resultado do Tratamento
7.
Jpn J Radiol ; 35(4): 206-214, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28251498

RESUMO

PURPOSE: We evaluated anatomical variations of spontaneous splenorenal shunt (SSRS) and the prevalence of portosystemic shunts in patients with chronic liver disease by CT. MATERIALS AND METHODS: A total of 451 patients with chronic liver disease underwent contrast-enhanced computed tomography between October 2010 and April 2011. The prevalence of portosystemic shunts including SSRS and gastrorenal shunt, and the frequency of hepatic encephalopathy were examined. The course of the shunt and the point of confluence with the renal vein of the SSRS were analyzed. RESULTS: SSRSs or gastrorenal shunts were found in 11.1 and 5.0% of the patients, respectively. Anatomical variations were classified into three types according to the point of confluence as follows: type 1 = the SSRS joined the inferior phrenic vein (n = 33), type 2 = the SSRS joined the gonadal vein (n = 7), and type 3 = the SSRS joined the left renal vein (n = 14). The course of the SSRS from the splenic hilum was classified as medial (n = 46), posterior (n = 2), or anterolateral (n = 2). CONCLUSIONS: SSRSs were classified into three types depending on the confluence point with the renal vein, and into three types of course. These findings are useful for preoperative information.


Assuntos
Hepatopatias/diagnóstico por imagem , Derivação Esplenorrenal Cirúrgica , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Meios de Contraste , Feminino , Encefalopatia Hepática/diagnóstico por imagem , Humanos , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
9.
Acute Med Surg ; 3(1): 39-42, 2016 01.
Artigo em Inglês | MEDLINE | ID: mdl-29123747

RESUMO

Case: We report a case of hemorrhagic shock due to a ruptured gastric artery aneurysm successfully treated with transarterial embolization. A 72-year-old woman with cholangitis presented with hemoperitoneum following a ruptured aneurysm of the gastric artery. Outcome: Emergent computed tomography and angiography were carried out and the patient was found to have spontaneous bleeding from both branches of the left and right gastric arteries. Transcatheter embolization was carried out at the distal branch of both gastric arteries with a coil. The patient recovered well with no recurrent bleeding. Conclusions: Although rare, visceral artery rupture should be considered in the differential diagnosis of unexplained hemorrhagic shock with abrupt onset of hemoperitoneum. Computed tomography and angiography are useful tools for obtaining prompt and accurate localization of the bleeding points.

10.
Ann Nucl Med ; 28(4): 322-8, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24488705

RESUMO

OBJECTIVES: The purpose of this study was to evaluate the lesion frequency and incremental added benefit with "true whole-body" (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) of distal lower extremities. We compared this field of view with the typical whole-body view, from head to upper thighs, in numerous patients with known or suspected malignancy. METHODS: True whole-body (18)F-FDG PET/CT, from the top of the head to the bottom of the feet, was performed on 4574 consecutively registered patients with known or suspected malignancy. Using a variable sampling method, the PET images of head and torso were acquired for 90 s per bed position, and the images of lower extremities were acquired for 30 s per position, thus requiring between 22 and 24 min of emission scanning per patient. A log was maintained to record cases of abnormal findings in distal lower extremities outside the typical whole-body field of view. Suspected malignant lesions in distal lower extremities were verified by correlation with pathological findings and clinical follow-up. RESULTS: Abnormal findings in distal lower extremities were found in 647 (14.1 %; 95 % CI 13.1-15.2 %) of 4574 examinations. Increased FDG uptake was found in 559 examinations (12.2 %; 95 % CI 11.3-13.2 %). Lesions appeared malignant or equivocal in 67 examinations (1.5 %; 95 % CI 1.1-1.8 %) on the PET images. In 42 (0.9 %; 95 % CI 0.6-1.2 %) of 4574 examinations, these lesions were pathologically or clinically proven to be malignant. Detection of these malignancies resulted in changing clinical management in 21 (50 %) of 42 examinations. Definitive benign lesions were found in 492 examinations (10.7 %; 95 % CI 9.9-11.7 %) on the PET images. Abnormal findings were noted in 90 examinations (2.0 %; 95 % CI 1.6-2.4 %) consisting of 88 benign and 2 malignancies on the CT images alone. CONCLUSION: True whole-body (18)F-FDG PET/CT was not of high yield and appears to offer little additional benefit, as to detection of additional metastases and involvement, but it may affect clinical management in patients with known or suspected malignancy.


Assuntos
Imagem Multimodal/métodos , Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada por Raios X/métodos , Imagem Corporal Total/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Fluordesoxiglucose F18 , Pé/diagnóstico por imagem , Cabeça/diagnóstico por imagem , Humanos , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico por imagem , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Tempo , Adulto Jovem
11.
Artigo em Japonês | MEDLINE | ID: mdl-22975700

RESUMO

Cerebral perfusion computed tomography (CT) has been widespread, but abdominal perfusion CT has not been very popular because there has been a problem with regard to the limit of irradiation range and respiratory effects. Recently, it became easy to perform perfusion of abdominal organs because the use of multi detector row CT (MDCT) has been extensive. Along with it, the number of hospitals that perform liver perfusion CT has increased. However, patient dose of the liver perfusion CT is very high, making it very important to reduce patient dose. We created the virtual data that reduced the number of irradiation by partly reducing the data obtained on the liver perfusion CT. We compared the analysis results of all data with that of the partly reduced. It is possible to reduce the patient dose by reducing the number of irradiation because there was no significant difference in the analysis results.


Assuntos
Circulação Hepática/fisiologia , Tomografia Computadorizada por Raios X/métodos , Humanos , Doses de Radiação
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