Transcatheter embolization of an aortobronchial fistula with N-butyl cyanoacrylate

Aortobronchial fistula is a fatal complication after thoracic aortic surgery. So far, treatment options for aortobronchial fistula have included surgical and endovascular stent-graft methods. Herein, a case of an aortobronchial fistula with life-threatening hemoptysis managed with transcatheter embolization of the fistula with N-butyl cyanoacrylate is reported. For the patient with an aortobronchial fistula who cannot be treated by surgical or endovascular stent-graft methods, transcatheter embolization of the fistula may be the only available life-saving method.     

Surgical techniques and therapeutic results of anatomical reconstruction of coracoclavicular ligaments for acromioclavicular joint dislocations

Backgrounds

Generally, the surgical treatment for traumatic acromioclavicular joint dislocation is recommended for type 5 according to Rockwood’s classification. We believe that anatomical restoration of coracoclavicular ligament could best restore the function of the acromioclavicular joint. We attempted to correctly reconstruct the anatomy of the coracoclavicular ligament (trapezoid and conoid ligaments) in which the ipsilateral palmaris longus tendon and Endobutton were used as the reconstructing ligament and fixation material, respectively.

Study designs

Cross-sectional study.

Methods

The subjects were 16 patients (15 men and one woman). The mean age at the time of the surgery was 38.6?years. The mean time of the surgery from the injury was 16.3?days. The mean duration of postoperative follow-up was one?year and 5?months.

Results

The reduction in the acromioclavicular joint was complete in 10 of 16 patients. Meanwhile, the subluxation that represented less than 5?mm superior translation of the clavicle, occurred only in 5, that represented 5–10?mm superior translation in none, and the complete dislocation occurred in one patient. Concerning the range of motion, mean forward flexion was 171°, mean abduction was 165°, mean internal rotation was Th11, and mean horizontal adduction was 132°. Pain, fatigues on the shoulder girdle, and impairments with shoulder motion on the affected side disappeared one?month after surgery.

Conclusion

Although it requires excision of the ipsilateral palmaris longus for graft, we believe that anatomical restoration of both coracoclavicular ligaments could best restore the function of the acromioclavicular joint.     

Heat-shock preconditioning protects fatty livers in genetically obese Zucker rats from microvascular perfusion failure after ischemia reperfusion

Reduced tolerance of steatotic livers to ischemic injury is considered to correlate with impaired microcirculation. The aim of this study was to investigate the impact of heat-shock preconditioning (HSPC) on microcirculatory failure after ischemia/reperfusion (I/R) in steatotic livers by means of intra-vital fluorescence microscopy. Obese Zucker rats were used. In the HS group, rats underwent whole-body hyperthermia followed by 60-min partial liver ischemia. In group IR, rats were exposed only to ischemia. Microcirculation parameters (sinusoidal perfusion rate, sinusoidal diameter, leukocyte-endothelial interaction) were significantly better preserved in the HS group than in the IR group. Liver enzymes, oxygenated glutathione/reduced glutathione (GSSG/GSH) ratio, and electron microscopy showed less damage in the HS group. A marked expression of heat shock protein 72 (HSP72) and heme oxygenase (HO-1) was found only in the livers of group HS. HSPC mitigated the I/R injury of steatotic livers by preventing post-ischemic failure of microcirculation. This beneficial effect was found to be associated with the induction of HSP72 and HO-1.     

Evaluation of motion correction effect and image quality with the periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) (BLADE) and parallel imaging acquisition technique in the upper abdomen

PURPOSE: To evaluate motion correction effect and image quality in the upper abdomen with the periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) (BLADE) and parallel imaging acquisition technique. MATERIALS AND METHODS: A total of 50 consecutive patients underwent abdominal MR imaging. Fat-saturated T2-weighted turbo spin-echo sequences were obtained by respiratory triggering. The subjects were examined with three different conditions of echo train length (ETL), blade width, and percent k-space coverage in the same scanning time: 19/30/100%, 30/30/100%, and 30/52/175%, which were designated as L/C(1), L/C(2), and L/C(3), respectively. The parallel imaging acquisition technique was used to either reduce ETL from 30 to 19 in L/C(1) or increase k-space coverage from 100% to 175% in L/C(3) compared with L/C(2). Motion and streak artifacts, and overall image quality were evaluated visually by two radiologists, independently. RESULTS: Motion and streak artifacts were mostly reduced in L/C(3) condition. The L/C(3) image also gave the best overall image quality compared with other conditions (P < 0.001). The inter-rater reliability for each evaluation agreed well. CONCLUSION: In upper abdominal BLADE MRI, it was possible to reduce image artifacts and obtain better image quality by increasing the k-space coverage with parallel imaging in the same scanning time.     

Influence of stability on range of motion after cruciate-retaining TKA

BACKGROUND: A loosely balanced total knee arthroplasty (TKA) is reported to produce a good postoperative range of motion (ROM), but too much laxity is thought to be the cause of persistent pain and worsened functionality. METHODS: The anteroposterior and mediolateral laxity values were measured to evaluate the influence of stability after cruciate-retaining (CR) TKA on ROM and the modified Knee Society score at 4-8 years after the operation. Twenty-one knees in 15 patients with an average age of 68 years who had undergone a CR TKA for osteoarthrosis were examined. The mean preoperative and postoperative ROM was 124 degrees and 112 degrees, respectively. The mean anteroposterior and mediolateral laxity values were 9.7 mm and 10.6 degrees, respectively. RESULTS: No correlation was found between the postoperative ROM and laxity or between the modified Knee Society score and laxity. A loosely balanced TKA did not produce a good postoperative ROM. No parameters suggested that lax knees showed a higher pain score and lower functional score than stable knees.     

Cyclin‐Dependent Kinase Inhibitor‐1‐Deficient Mice are Susceptible to Osteoarthritis Associated with Enhanced Inflammation

Osteoarthritis (OA) is a multifactorial disease, and recent data suggested that cell cycle–related proteins play a role in OA pathology. Cyclin‐dependent kinase (CDK) inhibitor 1 (p21) regulates activation of other CDKs, and recently, we reported that p21 deficiency induced susceptibility to OA induced by destabilization of the medial meniscus (DMM) surgery through STAT3‐signaling activation. However, the mechanisms associated with why p21 deficiency led to susceptibility to OA by the STAT3 pathway remain unknown. Therefore, we focused on joint inflammation to determine the mechanisms associated with p21 function during in vitro and in vivo OA progression. p21‐knockout (p21^?/?) mice were used to develop an in vivo OA model, and C57BL/6 (p21^+/+) mice with the same background as the p21^?/? mice were used as controls. Morphogenic changes were measured using micro‐CT, IL‐1β serum levels were detected by ELISA, and histological or immunohistological analyses were performed. Our results indicated that p21‐deficient DMM‐model mice exhibited significant subchondral bone destruction and cartilage degradation compared with wild‐type mice. Immunohistochemistry results revealed p21^?/? mice susceptibility to OA changes accompanied by macrophage infiltration and enhanced MMP‐3 and MMP‐13 expression through IL‐1β‐induced NF‐κB signaling. p21^?/? mice also showed subchondral bone destruction according to micro‐CT analysis, and cathepsin K staining revealed increased numbers of osteoclasts. Furthermore, p21^?/? mice displayed increased serum IL‐1β levels, and isolated chondrocytes from p21^?/? mice indicated elevated MMP‐3 and MMP‐13 expression with phosphorylation of IκB kinase complex in response to IL‐1β stimulation, whereas treatment with a specific p‐IκB kinase inhibitor attenuated MMP‐3 and MMP‐13 expression. Our results indicated that p21‐deficient DMM mice were susceptible to alterations in OA phenotype, including enhanced osteoclast expression, macrophage infiltration, and MMP expression through IL‐1β‐induced NF‐κB signaling, suggesting that p21 regulation may constitute a possible therapeutic strategy for OA treatment. © 2017 American Society for Bone and Mineral Research.     

Periprocedural hemodynamic instability with carotid angioplasty and stenting

BACKGROUND: Carotid angioplasty and stenting is used for treatment of carotid stenosis. Stent deployment may induce HDI and thereby cause systemic or neurologic deficits. This study defines characteristics and predictors of HDI with CAS. METHODS: A total of 132 patients who had undergone CAS were evaluated for periprocedural and postprocedural HDI (hypertension, systolic blood pressure >160 mm Hg; hypotension, systolic blood pressure <90 mm Hg; or bradycardia, heart rate <60 beats per minute). RESULTS: Frequencies of HDI were 6.8% for hypertension, 32.6% for hypotension, and 15.9% for bradycardia. In addition, CAS of the right side (P < .01), carotid bulb lesions (P < .05), eccentric posterior carotid plaque (P < .0001), and general anesthesia (P < .05) were associated significantly with postprocedural HDI. Male sex (OR, 3.4; 95% CI, 1.8-67.2; P < .001), age of 80 years or older (OR, 0.4; 95%CI, 0.1-1.4; P = .011), and plaque ulceration (OR, 0.5; 95% CI, 0.1-9.5; P = .008) independently predicted postprocedural hypertension. Male sex (OR, 2.5; 95% CI, 1.3-24.9; P < .001), preprocedural major stroke (OR, 0.1; 95% CI, 0.01-0.8; P = .002), carotid bulb lesions (OR, 1.6; 95% CI, 1.1-25.9; P = .024), and contralateral carotid occlusion (OR, 0.6; 95% CI, 0.2-4.9; P = .040) all predicted postprocedural hypotension. Bradycardia was associated with diabetes mellitus (OR, 0.7; 95% CI, 0.3-2.4; P = .033), preprocedural TIA (OR, 1.7; 95% CI, 1.4-17.9; P = .020), and minor stroke (OR, 1.5; 95% CI, 1-10.9; P = .037). In 5 patients, HDI predisposed neurologic or systemic deterioration. CONCLUSIONS: Hemodynamic instability is common with CAS; hypotension and bradycardia are more frequent than hypertension. Some clinical, angiographic, and procedural variables can predict these HD changes.     

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.     

Docetaxel inhibits bone resorption through suppression of osteoclast formation and function in different manners

Osteoclasts are formed from the monocyte-macrophage lineage in response to receptor activator of nuclear factor κB ligand (RANKL) expressed by osteoblasts. Bone is the most common site of breast cancer metastasis, and osteoclasts play roles in the metastasis. The taxane-derived compounds paclitaxel and docetaxel are used for the treatment of malignant diseases, including breast cancer. Here we explored the effects of docetaxel on osteoclastic bone resorption in mouse culture systems. Osteoclasts were formed within 6 days in cocultures of osteoblasts and bone marrow cells treated with 1,25-dihydroxyvitamin D₃ plus prostaglandin E₂. Docetaxel at 10⁻⁸ M inhibited osteoclast formation in the coculture when added for the entire culture period or for the first 3 days. Docetaxel, even at 10⁻⁶ M added for the final 3 days, failed to inhibit osteoclast formation. Osteoprotegerin, a decoy receptor of RANKL, completely inhibited osteoclast formation when added for the final 3 days. Docetaxel at 10⁻⁸ M inhibited the proliferation of osteoblasts and bone marrow cells. RANKL mRNA expression induced by 1,25-dihydroxyvitamin D₃ plus prostaglandin E₂ in osteoblasts was not affected by docetaxel even at 10⁻⁶ M. Docetaxel at 10⁻⁶ M, but not at 10⁻⁸ M, inhibited pit-forming activity of osteoclasts cultured on dentine. Actin ring formation and l-glutamate secretion by osteoclasts were also inhibited by docetaxel at 10⁻⁶ M. Thus, docetaxel inhibits bone resorption in two different manners: inhibition of osteoclast formation at 10⁻⁸ M and of osteoclast function at 10⁻⁶ M. These results suggest that taxanes have beneficial effects in the treatment of bone metastatic cancers. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Prognoses and treatment strategies for synchronous peritoneal dissemination of colorectal carcinoma

Purpose

We devised a simple dichotomous classification system and showed sufficient reproducibility to indicate treatment strategies for peritoneal metastasis of colorectal cancer.

Methods

We included 67 patients with peritoneal metastasis of colorectal cancer and classified them according to the largest lesion size, number of lesions and number of regional peritoneal metastases. The oncological data were recorded and compared.

Results

According to the univariate analyses, the prognoses were significantly better in patients with ≤3 disseminated lesions than in those with ≥4, and in patients with disseminated lesions in only one region than in those with ≥2 lesions. A multivariate analysis showed that primary tumor resection and the presence of peritoneal metastases in only one region were favorable factors for the patient survival. Patients with disseminated lesions in only one region (localized group) and those with nonlocalized lesions had three-year survival rates of 45.6 and 12.2 %, respectively. Finally, primary tumor resection improved the prognoses in both the localized and nonlocalized groups.

Conclusions

Colorectal cancer patients were categorized into localized and nonlocalized groups according to the number of regions with peritoneal metastasis, and significant prognostic associations were demonstrated. Subsequent analyses of the oncological data suggested that primary tumor resection contributes to an improved prognosis in all patients with synchronous peritoneal metastases.