The incidence of contrast-induced nephropathy (CIN) following transarterial chemoembolisation (TACE) in patients with hepatocellular carcinoma (HCC).

PURPOSE: The purpose of this retrospective study was to investigate the incidence of contrast-induced nephropathy (CIN) caused by transarterial chemoembolisation (TACE) in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: One hundred forty-one patients treated between 2005 and 2008 undergoing 305 consecutive sessions of TACE were enrolled. CIN was defined as an increase in the serum creatinine level of more than 0.5 mg/dl or more than 25 % from baseline within 3 days after TACE without any other identifiable cause of acute kidney injury. RESULTS: CIN by the present definition was observed after 2.6 % of the TACE sessions. No patient showed clinical signs or symptoms of acute renal failure, or required haemodialysis. None of the patients with an estimated glomerular filtration rate of <60 ml/min/1.73 m(2) developed CIN. CONCLUSION: The present study suggests that TACE is a relatively safe procedure in terms of the risk of CIN under vigorous periprocedural hydration and that the incidence of CIN is comparable to that of AKI associated with intravenous CM administration. KEY POINTS: • CIN would be lower for non-coronary arterial intervention than for coronary intervention. • The present study suggests that the CIN rates following TACE are low. • The incidence of CIN is comparable to that after intravenous CM administration.

CT findings of small bowel strangulation: the importance of contrast enhancement.

The purpose of this study is to illustrate computed tomography (CT) findings suggestive of small bowel strangulation. We have performed the precontrast and postcontrast CT with single and multidetector CT scanners and evaluated the bowel wall changes and mesentery changes and correlated them with the operative findings. The direct CT findings suggestive of small bowel strangulation included high-density bowel wall on precontrast scans; lack of, or diminished contrast enhancement of the involved bowel wall; localized mesenteric fluid accumulation (mesenteric congestion); and localized pneumatosis. The indirect CT signs included C- or U-shaped loops with mesenteric vessels converging toward the obstruction site, ascites, target sign, two adjacent collapsed round loops, and whirl sign. We particularly emphasize the importance of contrast enhancement of bowel mucosa for early diagnosis to differentiate strangulation from a mechanical obstruction without bowel ischemia, and also the importance to differentiate proximal secondary gas-filled dilated small bowel loops from distal primary involved fluid-filled small bowel loops because these two types of small bowel loops are present in the single peritoneal cavity. As early recognition of small bowel strangulation may help improve the patient outcome because the involved bowel loops can be preserved without resection, it is essential to become familiar with the CT signs suggested small bowel obstruction strangulation.

Radiological diagnosis of large-bowel obstruction: neoplastic etiology.

Large-bowel obstruction (LBO) is a relatively common abdominal emergency. The CT exam has become the most important imaging modality for the diagnosis of LBO, following abdominal ultrasound and plain radiography. The recent multi-detector CT (MD-CT) is able to clarify the etiology of LBO and to help in deciding how to treat LBO. Therefore, it is important for the radiologists to become familiar with the imaging findings of LBO, including plain radiograph and CT, due to various causes. In this article, we have shown the characteristics of the radiological findings including plain radiograph, barium study, and CT as well as their correlations with pathologic findings of LBO. The etiology of LBO is usually divided into neoplastic diseases and nonneoplastic diseases. However, the most common cause is the neoplastic etiology. Now, we can afford the critical information concerning the level of obstruction, its cause, the viability of the involved bowel loops, and a decision-making regarding the therapy for patients with LBO, using MD-CT high technology.

Fatal pneumonia associated with temozolomide therapy in patients with malignant glioma.

This report presents the cases of three patients with fatal pneumonia that was highly suspected to be Pneumocystis pneumonia (PCP) based on serological diagnosis. Their chest radiographs showed bilateral pneumonia and each had presented with severe respiratory failure requiring mechanical ventilation when they arrived at the hospital. Although bronchoscopical sampling could not be performed, their chest computed tomography imaging and a marked elevation of serum KL-6 and ß-D-glucan levels were characteristic of Pneumocystis pneumonia. All three were found to have been treated with temozolomide after surgery for malignant glioma. Temozolomide can cause Pneumocystis pneumonia. The three patients did not receive prophylactic medication against Pneumocystis pneumonia during treatment with temozolomide, and their histories suggested that all had delayed seeking treatment. It may be difficult to diagnose Pneumocystis pneumonia because the symptoms are not specific for Pneumocystis pneumonia and they tend to be similar to those of common respiratory infectious diseases. Therefore, patients who receive temozolomide therapy have the potential to develop fatal pneumonia and should be carefully observed. The patients should also be adequately informed about Pneumocystis pneumonia, and prophylaxis against Pneumocystis pneumonia should be considered proactively before treatment with temozolomide is initiated.

[A case of suspected idiopathic pulmonary upper lobe fibrosis (Amitani disease) with acute exacerbation].

An 82-year old man was admitted to our hospital for evaluation of progressive general malaise. He had previously been in good health. His chest roentgenogram showed reticular shadows and we suspected interstitial lung disease. On admission, his roentgenographic images showed deterioration compared with previous images. Acute lung injury was diagnosed by transbronchial lung biopsy, and steroid administration was started. He initially responded to treatment, but bilateral spontaneous pneumothorax occurred. Despite treatment, he died of respiratory failure. Amitani disease (idiopathic pulmonary upper lobe fibrosis) was suspected based on postmortem pathology, but his lung parenchyma was poor due to the presence of changes producing diffuse alveolar damage. We report and discuss this case because there are apparently no previous similar cases.

Ag(core)-AgCl(shell) standard microelectrode-loaded TiO2.

Micrometer-sized Ag(core)-AgCl(shell) composite crystals have been formed on TiO2 thin films by a two-st epelectrochemical method to provide information on the thermodynamic condition for efficient photoinduced interfacial electron transfer.

Usefulness of transanal tube placement for prevention of anastomotic leakage following laparoscopic low anterior resection.

INTRODUCTION: Anastomotic leakage (AL) is a major complication of laparoscopic low anterior resection (LLAR) for rectal cancer. Although several recent reports have suggested that transanal tube placement can prevent AL, this practice is still controversial. Additionally, the mechanism by which a transanal tube prevents AL is unknown. The aim of this study was to evaluate the efficacy of transanal tube placement for prevention of AL following LLAR. METHODS: This was a retrospective study that included 69 patients who underwent LLAR between February 2012 and January 2016. After an anastomosis using a double stapling technique, a transanal tube was placed in 28 patients. A diverting stoma was created in 26 patients. Univariate and multivariate analyses of clinicopathological characteristics were performed. RESULTS: The overall incidence of AL was 15.9% (11/69). Univariate analysis showed that transanal tube placement (P = 0.022) and early postoperative diarrhea (P < 0.001) were associated with AL. The duration of the postoperative hospital stay for patients with transanal tube placement (13.1 ± 4.1 days) was significantly shorter than for patients without a transanal tube (22.7 ± 12.3 days; P < 0.001). However, transanal tube placement did not reduce postoperative diarrhea. Creation of a diverting stoma did not affect the incidence of AL. Multivariate analysis revealed that the absence of a transanal tube (odds ratio = 33.5, P = 0.018) and the occurrence of postoperative diarrhea (odds ratio = 86.3, P = 0.001) were independent risk factors for AL. CONCLUSION: Transanal tube placement prevents AL after LLAR. Furthermore, this protective effect may be due to a reduction in the unfavorable incidence of early postoperative diarrhea.

Role of IL-2 and helper T-lymphocytes in limiting periapical pathosis.

The purpose of this study was to examine the role of IL-2 and helper T-lymphocytes in the development of periradicular lesions in rats. In control animals, periradicular lesions developed within 28 days following pulpal infection. Immunologically, some anti IL-2 and anti CD4-reactive helper T-lymphocytes infiltrated the periapical tissue at 14 days, and their numbers increased at 28 days. In experimental animals, tacrolimus (FK506) was injected every day to inhibit the IL-2 production by helper T-cells. Histologically, the pulpal necrosis and periradicular inflammation in tacrolimus-treated rats were more severe than those in the control rats. Furthermore, the areas of pulpal necrosis and periradicular lesion in the immunosuppressed rat were significantly greater than those in the normal ones. The numbers of IL-2- and CD4-positive cells in the lesion of the experimental rats were statistically lower than those of the control ones. These results show that the decrease in IL-2 might have promoted the development of periradicular lesions.

Dynamic helical CT mammography of breast cancer.

PURPOSE: The purpose of this study was to determine whether dynamic helical computed tomography (CT)-mammography could assist in selecting the most appropriate surgical method in women with breast cancer. MATERIALS AND METHODS: Preoperative contrast-enhanced helical CT scanning of the breast was performed on 133 female patients with suspicion of breast cancer at the same time as clinical, mammographic, and/or ultrasonographic examinations. The patients were scanned in the prone position with a specially designed CT-compatible device. A helical scan was made with rapid intravenous bolus injection (3 ml/s) of 100 ml of iodine contrast material. Three-dimensional maximum intensity projection (MIP) images were reconstructed, and CT findings were correlated with surgical and histopathological findings. RESULTS: Histopathological analysis revealed 84 malignant lesions and seven benign lesions. The sensitivity, specificity, and accuracy levels of the CT scanning were 94.6%, 58.6%, and 78.9%. Helical scanning alone revealed additional contralateral carcinomas in three of four patients and additional ipsilateral carcinomas in three of five patients. However, the technique gave false-positive readings in 24 patients. The preoperative CT-mammogram altered the surgical method in six patients. CONCLUSION: Dynamic helical CT-mammography in the prone position may be one of the choices of adjunct imaging in patients with suspected breast cancer scheduled for surgery.

Pulmonary mucosa-associated lymphoid tissue lymphoma associated with pulmonary sarcoidosis: a case report and literature review.

Differentiating low-grade lymphoma from preexisting sarcoidosis is difficult because of their pathological similarity. This article describes a case of pulmonary mucosa-associated lymphoid tissue lymphoma associated with pulmonary sarcoidosis. The patient, a 45-year-old Japanese man, presented with a 10-year history of pulmonary sarcoidosis and 5-year history of ocular sarcoidosis with histologic findings. Because only the right S3 lung nodule had gradually enlarged, partial resection was performed. Pathological study revealed noncaseous epithelioid granulomas with lymphoplasmacytic proliferation but also marked lymphoid cell proliferation with lymphoepithelial lesion findings that differed from findings of typical sarcoid lesions. Our lymphoepithelial lesion evaluation via immunohistochemistry and analysis of Ig heavy-chain gene rearrangements with assessment of Propionibacterium acnes-specific antibody reactions allow us to report, for the first time, this case of pulmonary mucosa-associated lymphoid tissue lymphoma associated with pulmonary sarcoidosis in exactly the same location, which may be significant for differentiating these diseases and understanding their pathogenic association.

Effects of oral 5-fluorouracil drugs on hepatic fat content in patients with colon cancer.

RATIONALE AND OBJECTIVES: The association between hepatic steatosis and oral 5-fluorouracil (5-FU) agents is clinically recognized but has not been systematically studied. The aim of this study was to determine the effects of 5-FU on hepatic fat content in patients undergoing oral 5-FU therapy and to compare the effects in three subgroups of 5-FU drugs. MATERIALS AND METHODS: Fifty-one patients with postoperative colon cancer (mean 61.1 years) were retrospectively studied. Forty-three patients were given adjuvant oral 5-FU therapy for a mean 3.3 years (5-FU group), and eight patients were not (control group). All patients underwent preoperative and postoperative abdominal computed tomography (CT) studies. The liver/spleen ratio was calculated from the CT attenuation values for the liver and spleen. We also compared the effects on hepatic appearance under CT of three 5-FU drugs: fluorouracil (n = 13), doxifluridine (n = 14), or UFT (a mixture of tegafur and uracil; n = 9). RESULTS: In the 5-FU group, the mean CT values for the liver were significantly reduced relative to values before therapy (P < .01) and to those of the control group (P < .0001). Fifteen of 43 patients (34.9%) developed steatosis. Of the three 5-FU drugs, fluorouracil and doxifluridine caused a significant decrease in hepatic CT values. CONCLUSION: 5-FU caused a significant decrease in CT attenuation, indicating an increase in hepatic fat content, and was associated with very frequent hepatic steatosis. UFT seemed less likely to cause hepatic fatty infiltration. CT examination was useful for early detection of drug-induced side effects on liver even before lab abnormality or clinical manifestation is observed.

Functional evaluation of the postoperative gastrointestinal tract using kinematic MR imaging: Quantitative assessment of peristaltic activity.

The purpose of this study is to demonstrate the feasibility of kinematic MR imaging in visualizing peristaltic activity in the reconstructed gastrointestinal tract with quantitative measurements. Sixteen patients with gastrointestinal reconstruction were studied with kinematic MR imaging using HASTE and/or true FISP. Peristaltic waves were noted in the retrosternal gastric segment after gastric pull through (frequency = 3.0 +/- 0.5 times/min, velocity = 2.6 +/- 0.6 mm/s) and in the residual antrum after cardiectomy (frequency = 3 times/min, velocity = 4.0 mm/s). Peristaltic waves were not apparent in the residual fundus after distal gastrectomy and in the reconstructed jejunum after pancreatoduodenectomy and gastrojejunostomy.

A case of primary adenocarcinoma of the third portion of the duodenum resected by laparoscopic and endoscopic cooperating surgery.

INTRODUCTION: We report a case of primary adenocarcinoma in the third portion of the duodenum (D3) curatively resected by laparoscopic and endoscopic cooperating surgery (LECS). PRESENTATION OF CASE: A 65-year-old woman had a routine visit to our hospital for a follow-up of rectal cancer resected curatively 2 years ago. A routine screening gastroduodenal endoscopy revealed an elevated lesion of 20mm in diameter in the D3. The preoperative diagnosis was adenoma with high-grade dysplasia; however, suspicion about potential adenocarcinoma was undeniable. Curative resection was performed by LECS. Pathological examination revealed intramucosal adenocarcinoma arising from normal duodenal mucosa. The tumor was stage I (T1/N0/M0) in terms of the tumor, nodes, metastasis (TNM) classification. LECS for duodenal tumor has seldom been reported previously, and this is the first report of LECS for primary adenocarcinoma in the D3. The transverse mesocolon was removed from the head of pancreas to expose the duodenum, and the accessory right colic vein was cut; this was followed by the Kocher maneuver for mobilization of the lesion site. DISCUSSION: LECS enabled en bloc resection with adequate surgical margins and secure intra-abdominal suturing. Thorough mobilization of the mesocolon and pancreas head is essential for this procedure because it facilitates correct resection and suturing. CONCLUSION: LECS is a feasible treatment option for duodenal neoplasms, including intramucosal adenocarcinoma, even though it exists in the D3.

Accumulation of 99mTc-PMT in renal metastasis of hepatocellular carcinoma.

We describe here a case in which 99mTc-Sn-N-pyridoxy-5-methyltryptophan (99mTc-PMT) scintigraphy was useful in diagnosing renal metastasis of hepatocellular carcinoma (HCC). A 62-year-old man who had undergone hepatectomy for HCC presented 6 years after initial diagnosis with left flank pain and was found on CT and MRI to have a tumor in the left kidney. Hepatobiliary scintigraphy using 99Tc-PMT was performed, and 99mTc-PMT accumulation was found in the tumor. Nephrectomy was performed and metastasis of HCC was confirmed.

[Home oxygen therapy for terminal lung cancer cases].

Home oxygen therapy (HOT) was introduced as part of the terminal care of 52 lung cancer patients attending our hospital from 1997 to 2000, all of whom subsequently died from their illnesses. We administered a questionnaire about HOT to their bereaved family members. The results confirmed that many of those interviewed thought that HOT improved their quality of life, but probably made the patients more aware of the progression of their disease. As the incidence of lung cancer has been increasing, lung cancer patients have begun to form an increasing proportion of patients receiving HOT in recent years. In addition, the number of patients with a PaO2 of > or = 60 torr at rest at the start of HOT has been increasing. It may be necessary when dealing with terminal lung cancer patients, in whom PaO2 can decrease rapidly over a relatively short period of time, to explore indication criteria for HOT different from those conventionally employed.

Catheter-directed thrombolysis through the operatively recanalized umbilical vein for acute extensive portal vein thrombosis: report of a case.

Acute portal vein thrombosis is a rare but severe complication of intra-abdominal infection. It can be life-threatening, given the risk of developing liver abscess and subsequent liver failure. Various types of hereditary thrombophilia are known risk factors for acute portal vein thrombosis. In addition to surgical treatment and potent antibiotic therapy, systemic administration of anticoagulants and locoregional trans-catheter delivery of thrombolytic agents are known to be effective. We present a case report of acute portal vein thrombosis with pylephlebitis caused by acute appendicitis, successfully treated with catheter-directed thrombolysis through the operatively recanalized umbilical vein. The umbilical vein is a promising access route to the portal vein. Therefore, this procedure is an effective and preferred treatment option for portal septic thrombosis, particularly because it does not require puncture of the liver parenchyma or catheterization through an infected peritoneal cavity.

A case of neurofibromatosis type 1 coinciding with bilateral pheochromocytomas, multiple gastrointestinal stromal tumors, and malignant peripheral nerve sheath tumor.

Neurofibromatosis type 1 (NF1) is associated with benign and malignant neoplasms, but the coincidence of abdominal neoplasms is rare. A 65-year-old woman with NF1 had episodes of nausea, tachycardia, hypertension, and loss of consciousness. Bilateral adrenal tumors were detected by abdominal computed tomography, and plasma and urinary catecholamine levels were elevated. Open bilateral adrenalectomy and histological findings revealed bilateral pheochromocytomas (PCCs). Furthermore, malignant peripheral nerve sheath tumor (MPNST) and multiple gastrointestinal stromal tumors (GISTs) were incidentally found in the abdominal cavity. Early diagnosis of abdominal neoplasms in NF1 patients is important because of the risk of malignancy, organic complications and hemorrhagic-obstructive complications.

An effective training program for chest tube drainage for medical interns in a clinical simulation laboratory.

The Department of Respiratory Medicine of Nippon Medical School Hospital and the Working Committee of Clinical Simulation Laboratory have held training sessions for chest tube drainage since 2007. The training program consists of the preparation of a training manual, a small-group session, and a review of the process of chest tube drainage using a checklist of steps after the session. A total of 21 medical interns of Nippon Medical School Hospital participated in training sessions from April 2010 through February 2011. A questionnaire survey at the end of the session revealed that most participants rated highly both the explanations given by the instructors and the descriptions in the manual for comprehensibility. Only 3 interns felt that they had successfully acquired the clinical skill, and the other 18 interns felt that they had somewhat acquired the skill. Research after the interns had completed the program of the department showed that 80% of interns had performed chest tube drainage for patients during the rotation. The interns assessed the training program as useful, and some interns felt they could perform the skill with confidence or without anxiety. Other systematic programs of skill training for medical interns are recommended to ensure definite acquisition of basic skills.

Radiological diagnosis of large-bowel obstruction: nonneoplastic etiology.

Large-bowel obstruction (LBO) is a relatively common abdominal emergency. Computed tomography (CT) diagnosis of LBO is often easy, but it is essential to clarify LBO etiology and to decide how to treat it. Therefore, it is important for the radiologist to become familiar with the imaging findings of LBO, including plain radiography and CT, to determine its various causes, as well as the many diseases mimicking LBO. In this article, we show the characteristics of radiological findings of plain radiograph, barium study, and CT and their correlations with pathologic findings. LBO etiology comprises two main categories: neoplastic and nonneoplastic disease. However, the primary causes of LBO are neoplastic etiologies, and nonneoplastic causes are relatively uncommon and unfamiliar to many radiologists in clinical practice. Therefore, in this review, we present nonneoplastic etiology of LBO and diseases simulating LBO and provide critical information concerning the causes of LBO and viability of the involved bowel loops.