A case of Crohn's disease limited to the appendix,showing a portentous ultrasonographic finding

A case of Crohn's disease limited to the appendix is reported. A preoperative ultrasonic study of the lower right abdomen revealed an interesting appearance that we named the “milky way sign.” Microscopic findings in the resected specimen confirmed that the sign represented adipose tissue of the mesoappendix that had become involved by transmural inflammation. This seems to be highly suggestive of Crohn's disease.     

Diagnostic accuracy of late iodine enhancement on cardiac computed tomography with a denoise filter for the evaluation of myocardial infarction

We evaluated the image quality and diagnostic performance of late iodine enhancement (LIE) in dual-source computed tomography (DSCT) with low kilo-voltage peak (kVp) images and a denoise filter for the detection of acute myocardial infarction (AMI) in comparison with late gadolinium enhancement (LGE) magnetic resonance imaging (MRI). The Hospital Ethics Committee approved the study protocol. Before discharge, 19 patients who received percutaneous coronary intervention after AMI underwent DSCT and 1.5 T MRI. Immediately after coronary computed tomography (CT) angiography, contrast medium was administered at a slow injection rate. LIE-CT scans were acquired via dual-energy CT and reconstructed as 100-, 140-kVp, and mixed images. An iterative three-dimensional edge-preserved smoothing filter was applied to the 100-kVp images to obtain denoised 100-kVp images. The mixed, 140-kVp, 100-kVp, and denoised 100-kVp images were assessed using contrast-to-noise ratio (CNR), and their diagnostic performance in comparison with MRI and infarcted volumes were evaluated. Three hundred four segments of 19 patients were evaluated. Fifty-three segments showed LGE in MRI. The median CNR of the mixed, 140-, 100-kVp and denoised 100-kVp images was 3.49, 1.21, 3.57, and 6.08, respectively. The median CNR was significantly higher in the denoised 100-kVp images than in the other three images (P < 0.05). The denoised 100-kVp images showed the highest diagnostic accuracy and sensitivity. The percentage of myocardium in the four CT image types was significantly correlated with the respective MRI findings. The use of a denoise filter with a low-kVp image can improve CNR, sensitivity, and accuracy in LIE-CT.     

Carcinosarcoma,an atypical subset of gallbladder malignancies

Carcinosarcoma represents an atypical subset of gallbladder malignancies, and sonographic imaging features have not yet been precisely defined. Previously reported cases have shown a heterogeneously echogenic solid mass protruding into and filling the gallbladder lumen. We present herein a case of carcinosarcoma and propose another finding suggestive of this tumor. The patient was a woman in her 70s. Abdominal sonography revealed that the gallbladder lumen was half-filled by a large mass (maximum diameter, 68 mm) showing heterogeneous echogenicity slightly higher than that of bile. However, despite the large size of the mass, gallbladder shape was well-preserved. Considering the findings on computed tomography, cholecystectomy was performed under a diagnosis of gallbladder malignancy. Pathological examination revealed two types of malignant histology: a sarcomatous element of malignant spindle cells and a carcinomatous element of adenocarcinoma tissue. Foci of malignant cartilage and bone areas were also found sporadically. Accompanied by immunohistochemical examination, the mass was diagnosed as carcinosarcoma. The present case showed somewhat different imaging findings from those of ordinary gallbladder carcinoma. Carcinosarcoma should be considered when a well-preserved shape of the gallbladder is recognized along with protrusion of a large heterogeneously echogenic mass into and filling the gallbladder lumen.     

Peripheral blood stem cell autotransplantation in treatment of childhood cancer

The levels of circulating hematopoietic progenitor cells were measured sequentially in eight children receiving chemotherapy for acute leukemia or neuroblastoma. Significant increases in the progenitor levels (up to 50-fold in CFU-GM numbers) were observed during post-chemotherapy cytopenia in all cases, but differences among individuals in the kinetics of recovery of less committed progenitors (CFU-mix) contrasted with the synchronized-mode of expansion of committed progenitors (CFU-GM). Peripheral blood cells were collected by repeated continuous-flow leukaphereses from three of the children during post-chemotherapy expansion of the progenitor pool and were cryopreserved after fractionation procedures. Infusion of these stored cells into the patients after marrow-ablative chemotherapy established trilineage hematopoiesis. This use of stem cell rescue should be useful as an alternative to bone marrow transplantation and extends the application of cure-oriented salvage therapy to childhood cancers.     

Development of a New Device for Diagnosis of Hypoxemia and Arrhythmia by SaO2 ECG Holter Monitoring

Background: We have developed a system to monitor, simultaneously and continuously, ambulatory SaO₂ measured using a pulse-oximeter and ECG data for 24 hours. Methods: The ambulatory SaO₂-ECG monitoring system consisted of a portable monitoring device (SM50) with two channels for ECG data and one channel for SaO₂ data input; a sensor for SaO₂ recording; and a pulse-oximeter. An ambulatory monitoring analyzer was used. The SaO₂ report from the present analyzer included two types of data (i.e., a profile of heart rate [HR], pulse rate [PR], and SaO₂ value per min), and a trend graph of HR, arrhythmia, ST level and slope, PR, and SaO₂ per minute. We also designed and produced an analytical program to automatically remove noise errors relating to the SaO₂ measurement. Results: Using this system, we performed a clinical study on ten healthy volunteers (Group N) and seven patients with chronic pulmonary diseases (Group CPD) to evaluate the usefulness of the system as a diagnostic means for respiratory failure and arrhythmia. Group N showed a stable value of 90% or over in SaO₂ during the 24-hour monitoring while Group CPD showed values under 90% SaO₂ in all patients at rest during the night or after a 15-minute walk. Transient atrial tachycardia (TAT) was observed in 3 of 7 CPD patients, and each episode was preceded by a decrease of SaO₂. The occurrence of a single or double ventricular extrasystole was high in Group CPD compared with Group N (1.21 ± 0.89 vs 0.6%± 0.3%, P < 0.05), its occurrence was not associated with a decrease in SaO₂. Conclusions: In outpatients, especially patients who are taken care of at home, the present system will certainly contribute greatly to the diagnosis of respiratory failure and arrhythmia as well as to evaluate the effects on these diseases of therapy. In addition it is suggested that in CPD, patients’hypoxemia may induce TAT.     

Cutaneous metastases from transitional cell carcinoma of the bladder

Two cases of transitional cell carcinoma of the bladder with cutaneous metastases are reported. In one patient, multiple nodular metastatic lesions appeared simultaneously with urethral recurrence after total cystectomy. In another patient, diffuse inflammatory metastatic lesion was generated after radiotherapy for pelvic lymph nodes. The pathways of metastatic dissemination from the transitional cell carcinoma of the bladder are discussed.     

Fulminant hepatitis cured by plasma exchange in a patient with acute leukemia--a case report

A 16-year-old male with acute myelogenous leukemia (M1) presented with fulminant hepatitis (massive hepatic necrosis). He achieved a complete remission with the administration of AdVP (doxorubicin, vincristine and prednisolone), and thereafter received consolidation or intensification therapy 5 times in combination with AdVP plus enocitabine. A bone marrow examination carried out before the 6th round of chemotherapy revealed a slight increase of myeloblast (7%). L-AdVP (including l-asparaginase in addition to AdVP) was administered with a good result. However, 13 days after the end of the therapy he complained of acute abdominal pain, headache and fever. The following day, his consciousness level became lower and severe jaundice appeared. The serum transaminase level highly elevated with PT and aPTT severely elongated. He was diagnosed as having fulminant hepatitis. Elevation of the titer of IgM-HBc suggested that the fulminant hepatitis was attributed to HBV, which was probably transmitted by blood transfusion done in the first induction therapy and stayed latent during immunosuppressive chemotherapy. After receiving 10 sessions of plasma exchange (3.2 l/day), he recovered, free from any major complications except posttransfusion hepatitis. In his serum taken at 1 month after the recovery of posttransfusion hepatitis, HCV (Chiron) antibody was detected. There have been few reports concerning fulminant hepatitis associated with acute leukemia. In this case, plasma exchange was very effective in treating fulminant hepatitis.