Growth of asymptomatic unruptured aneurysms in follow-up study: report of three cases

The natural history of asymptomatic unruptured aneurysms that have not been subjected to surgery was studied radiologically using MRA and MRI and 3D-CT angiography (3D-CTA) commencing in 1993. We report on the growth of documented asymptomatic unruptured aneurysms in three patients. Growth of the aneurysms was followed by repeated MRA, MRI and 3D-CTA. In Case 1, a 71-year-old woman had been diagnosed as having a 3 mm unruptured anterior communicating artery aneurysm. The size of the aneurysm had expanded to 4 mm, 2 years later. This was detected during a follow-up MRA and confirmed by angiography. After this follow-up MRA, the aneurysm showed no change in size or shape for 8 years. Case 2 was that of a 75-year-old woman who had a 4.5 mm aneurysm involving the basilar artery and the superior cerebellar artery. 12 months later, an MRA was carried out as a follow-up study. This MRA revealed that the aneurysm had developed a bleb and was expanding. 8 months later the patient bled from the aneurysm and underwent surgery, but died. Before surgery, the diameter of the aneurysm, confirmed by angiogram, was 5.5 mm including the bleb. The third patient was a 66-year-old woman who had a 7 mm internal aneurysm involving the carotid artery and the posterior communicating artery. 3 years later a 3D-CTA detected the expansion of the aneurysm and development of an aneurysm bleb. 6 years later more expansion occurred and 3 months after that the patient bled from the aneurysm and underwent clipping. At that time, the diameter of the aneurysm, confirmed by angiography, was 13 mm including the bleb. In this follow-up study, patients with diagnosed asymptomatic unruptured aneurysms were followed up by MRA and MRI and 3D-CTA to determine risk factors for aneurysm rupture. We emphasize the fact that growth of an unruptured aneurysm and formation of blebs are important risk factors of aneurysm rupture.     

Giant-cell tumor of the tendon sheath involving the thoracic spine

Giant-cell tumor of the tendon sheath is a common benign lesion of the synovial membrane that frequently occurs in the hand. It is related to pigmented villonodular synovitis and the occurrence of pigmented villonodular synovitis or giant-cell tumor of the tendon sheath in the axial skeleton is very rare. To data, only three cases of giant-cell tumor of the tendon sheath involving cervical spine have been reported, compared with 26 cases of pigmented villonodular synovitis. Pigmented villonodular synovitis involving the thoracic spine is also extremely rare and our case represents the first reported case of a giant-cell tumor of the tendon sheath involving the thoracic spine. A 26-year-old man presented with left back pain without neurological deficit. Computed tomography and magnetic resonance imaging (MRI) revealed an osteolytic and expansive lesion in the left facet joint between the seventh and eighth thoracic vertebrae. A complete facetectomy and excision of the lesion followed by a posterior arthrodesis between Th5 and Th9 was performed. Postoperatively, the patient recovered with complete relief of symptoms, there was no evidence of recurrent disease or regrowth of the residual lesion, as investigated by plain radiographs and MRI within a follow-up period of two years. Although giant-cell tumor of the tendon sheath in the thoracic spine may be extremely uncommon, it should be considered in the differential diagnosis, especially when a benign lesion appears to originate in the face joint. Considering the high rate of recurrence, every effort should be made to achieve total excision.     

Adiponectin negatively correlates with alcoholic and non‐alcoholic liver dysfunction: Health check‐up study of Japanese men

Aim: Central obesity, insulin resistance and alcohol consumption are thought to be major risk factors for fatty liver formation. Adiponectin (APN) prevents fatty liver formation, and its serum levels are lower in subjects with central obesity and/or insulin resistance. The aim of this study was to explore the association among serum APN levels, central obesity, insulin resistance and liver dysfunction with or without fatty liver classified by alcohol consumption in healthy subjects. Methods: A total of 5588 Japanese male subjects who underwent a health check‐up were classified into three groups according to alcohol consumption: non‐ or light drinkers (15 g/day ≥ ethanol); mild drinkers (15 g/day < ethanol ≤ 30 g/day); and moderate‐ or heavy drinkers (30 g/day < ethanol). Central obesity and insulin resistance were assessed by waist circumference (WC) and Homeostasis Model of Assessment – Insulin Resistance (HOMA‐IR), respectively. Results: WC was significantly increased, while HOMA‐IR was significantly decreased according to the extent of alcohol consumption. Serum alanine aminotransferase levels were significantly lower and serum APN levels were significantly higher in mild drinkers than in the other two groups. Multiple linear regression analysis showed that serum APN level served as the significant and independent determinant for liver dysfunction in the subjects with fatty liver, irrespective of alcohol consumption. However, WC became a non‐significant determinant of liver dysfunction as alcohol consumption increased. Conclusion: Hypoadiponectinemia is a significant determinant for steatotic dysfunction for all levels of alcohol consumption, but central obesity was not a significant determinant for alcoholic fatty liver‐induced liver dysfunction.     

Indication for the use of an interposed graft during portal vein and/or superior mesenteric vein reconstruction in pancreatic resection based on perioperative outcomes

Purpose

Combined portal vein and/or superior mesenteric vein (PV/SMV) resection with pancreatic resection sometimes leads to prolonged survival for patients with pancreatic cancer. In this study, we evaluated perioperative outcomes of patients with PV/SMV reconstruction and considered indications for the use of a graft during this procedure.

Methods

We performed PV/SMV resection with pancreatic resection in 128 patients, including 14 using grafts. Complications associated with PV/SMV reconstruction and harvesting venous grafts and reconstructed PV/SMV patency during follow-up were assessed.

Results

Of the 128 patients, 5 underwent total pancreatectomy, 99 pancreaticoduodenectomy, and 24 distal pancreatectomy. In the 14 patients who underwent PV/SMV reconstruction with grafts, the grafts were harvested from the external iliac vein (EIV) in 10 patients and internal jugular vein (IJV) in the other 4. Five patients (3.9 %) had an intraoperative or postoperative acute thrombus or stenosis of reconstructed PV/SMV after direct end-to-end anastomosis. However, PV/SMV patency was excellent after reconstruction using grafts. There were no significant differences in other complications between groups with and without the use of grafts. Three patients (30 %) with EIV grafts had postoperative leg edema, and one of them required analgesics until his death because of leg pain caused by compartment syndrome, whereas no patients with IJV grafts had complications associated with sacrificing veins.

Conclusions

Depending on the length and/or position of the removed PV/SMV segment, interposed graft may be required for reconstruction in some patients, and the use of graft vein, particularly using IJV, is an appropriate procedure that is not associated with any complications.     

Impact of parametric imaging on contrast-enhanced ultrasound of breast cancer

Purpose

To prospectively evaluate the usefulness of contrast-enhanced ultrasound (CEUS) using parametric imaging for breast cancer in a multicenter study.

Methods

A total of 65 patients with breast cancer were included in this study. CEUS was performed, and still images on peak time (S), accumulated images (A) and parametric images (P) were generated from the raw data. Four blind reviewers ranked the best visible images as first place, and determined second and third place consecutively. We compared the average ranking of each image. The maximal diameter of the tumor determined on ultrasonography and MRI was compared with the corresponding pathological maximal diameter for 48 of the 65 patients. The correlation between the diameter determined by two experts and two beginners was analyzed.

Results

The average rank of visibility was as follows: P, 1.44; A, 2.04; and S, 2.52. The correlation between each image and the pathology was as follows: P, r = 0.664; A, r = 0.630; S, r = 0.717; and MRI, r = 0.936. There were no significant differences among the correlation between the experts and beginners in each image.

Conclusions

The use of parametric imaging improves the visibility of CEUS. The maximal diameter of the tumor determined on CEUS correlates substantially with the pathology.

     

Possible Neuroprotective Effects of l-Carnitine on White-Matter Microstructural Damage and Cognitive Decline in Hemodialysis Patients

Although l-carnitine alleviated white-matter lesions in an experimental study, the treatment effects of l-carnitine on white-matter microstructural damage and cognitive decline in hemodialysis patients are unknown. Using novel diffusion magnetic resonance imaging (dMRI) techniques, white-matter microstructural changes together with cognitive decline in hemodialysis patients and the effects of l-carnitine on such disorders were investigated. Fourteen hemodialysis patients underwent dMRI and laboratory and neuropsychological tests, which were compared across seven patients each in two groups according to duration of l-carnitine treatment: (1) no or short-term l-carnitine treatment (NSTLC), and (2) long-term l-carnitine treatment (LTLC). Ten age- and sex-matched controls were enrolled. Compared to controls, microstructural disorders of white matter were widely detected on dMRI of patients. An autopsy study of one patient in the NSTLC group showed rarefaction of myelinated fibers in white matter. With LTLC, microstructural damage on dMRI was alleviated along with lower levels of high-sensitivity C-reactive protein and substantial increases in carnitine levels. The LTLC group showed better achievement on trail making test A, which was correlated with amelioration of disorders in some white-matter tracts. Novel dMRI tractography detected abnormalities of white-matter tracts after hemodialysis. Long-term treatment with l-carnitine might alleviate white-matter microstructural damage and cognitive impairment in hemodialysis patients.     

Efficacy and Safety of Hemoglobin-Polyethylene Glycol Conjugate (Pyridoxalated Polyethylene Glycol Hemoglobin) as an Oxygen-Carrying Resuscitation Fluid

Abstract: The safety and efficacy of a conjugate of pyridoxalated hemoglobin and polyethylene glycol (pyridoxalated PEG hemoglobin) were evaluated after administration to rats. The LD₅₀ (lethal dose for 50% survival of group) of pyridoxalated polyethylene glycol (PEG) hemoglobin was >200 ml/kg. Any pro-or anticoagulation activity was not demonstrated in in vitro coagulation tests. One day after 70% exchange-transfusion with pyridoxalated PEG hemoglobin, slight elevations of the serum glutamic-oxaloacetic transaminase, serum glutamie-pyruvic transaminase, and blood urea nitrogen values, which were 101.7 ± 22.6 IU/L, 33.3 ± 7.2 IU/L, and 23.1 ± 1.4 mg/dl, respectively, were observed. However, these values were in the normal range after 3 days. With >90% exchange-transfusion, all rats exchange-transfused with pyridoxalated PEG hemoglobin survived for >2 weeks in contrast to the death of all the rats exchangetransfused with stroma-free hemoglobin or albumin.     

Myocardial and vascular uptake of a bone tracer associated with secondary hyperparathyroidism

A patient on chronic hemodialysis, with secondary hyperparathyroidism was referred for a radionuclide bone-imaging study. Deposition of ^99mTc-methylene diphosphonate (^99mTc-MDP) was apparent in the myocardium and abdominal blood vessels, as well as in the skeleton by four-color processed scintigraphy. Plain radiographs of the chest and abdomen demonstrated no calcification in the myocardium or abdominal blood vessels. Several possible mechanism for this uptake are discussed briefly.