Clinical role of (18)F-FDG PET for initial staging of patients with extrahepatic bile duct cancer

In extrahepatic bile duct cancer, preoperative evaluation is important because only surgical excision of all detectable tumours is associated with improvement in 5-year survival. However, morphological imaging techniques, including computed tomography (CT), are still insufficient for accurate staging. The purpose of this study was to assess the additional value, in relation to CT, of 2-[(18)F]fluoro-2-deoxy- D-glucose positron emission tomography ((18)F-FDG PET) for the evaluation of extrahepatic bile duct cancer. Thirty patients with extrahepatic bile duct cancer underwent both (18)F-FDG PET and CT for initial staging. The results of the two modalities for evaluation of primary tumours and regional lymph nodes were compared with the final diagnoses based on pathological or clinical findings. The primary tumours were interpreted as malignant on the basis of CT in 24 (80%) of the patients, while (18)F-FDG PET revealed increased (18)F-FDG uptake in 18 (60%) of them. On the other hand, (18)F-FDG PET showed focal accumulation of (18)F-FDG in the bile duct in three of the six patients with equivocal findings on CT. The sensitivity, specificity and accuracy of CT for regional lymph node metastases were 54%, 59% and 57%, while those of (18)F-FDG PET were 38%, 100% and 73%, respectively. The specificity of (18)F-FDG PET for regional lymph node metastases was significantly higher than that of CT ( P<0.01). Of 14 patients with N1 or N2 disease diagnosed by CT, only seven (50%) had a final diagnosis of regional lymph node metastasis. In these 14 patients, (18)F-FDG PET accurately evaluated the N component of the disease in 12 patients (86%). In conclusion, in the initial staging of patients with extrahepatic bile duct cancer, (18)F-FDG PET offers additional value in relation to CT in evaluating both the primary tumour and regional lymph nodes.     

Fast MR imaging in obstetrics.

Ultrasonography (US) is the initial imaging modality of choice for evaluation of patients in obstetrics. However, the results of US are not always sufficient. Magnetic resonance (MR) imaging, which uses no ionizing radiation, may be an ideal method for further evaluation. Although MR imaging is not recommended during the first trimester and use of contrast material is not recommended in pregnant patients, fast MR imaging is useful in various obstetric settings and can provide more specific information with excellent tissue contrast and multiplanar views. In pregnant patients with acute conditions, various diseases (eg, red degeneration of a uterine leiomyoma) may be diagnosed. MR imaging allows characterization of pelvic masses discovered during pregnancy and diagnosis of postpartum complications (eg, abscess, hematoma, ovarian vein thrombosis). In pregnant patients with hydronephrosis, MR urography can demonstrate the site of obstruction and the cause (eg, a ureteral stone). MR pelvimetry may be beneficial in cases of breech presentation. Contrast material-enhanced dynamic MR imaging allows one to evaluate the vascularity of a placental polyp, detect the viable component of a gestational trophoblastic tumor, and diagnose a uterine arteriovenous malformation. MR imaging enables diagnosis of rare forms of ectopic pregnancy and early diagnosis of ectopic pregnancy.     

Shaken baby syndrome manifesting as chronic subdural hematoma: importance of single photon emission computed tomography for treatment indications--case report

A boy with shaken baby syndrome first presented at age 3 months with acute subdural hematoma (SDH) and was treated by subdural tapping at a local hospital. Chronic SDH was identified at a rehabilitation center at age 19 months. The chronic SDH appeared to have developed within the preceding 16 months. His physical and mental development was already delayed. Magnetic resonance (MR) imaging revealed a 20-mm thick right chronic SDH with midline shift and small bilateral subdural effusions. The chronic SDH had compressed the right cerebral hemisphere. MR imaging also disclosed bilateral cerebral atrophy. 99mTc-ethylcysteinate dimer single photon emission computed tomography (SPECT) revealed decreased cerebral blood flow (CBF) in the non-hematoma hemisphere, although CBF is said to decrease on the chronic SDH side, especially if midline shift is present. Burr hole craniotomy with external drainage was performed, but the patient showed no change in CBF postoperatively, although the volume of hematoma decreased. The patient was clinically unchanged immediately after the operation. In this case, SPECT measurement of CBF was important in evaluating the pathophysiology of the delays in physical and mental growth. Atrophy of the bilateral hemispheres was the major mechanism in the decreased CBF, not the compression by chronic SDH. MR imaging and SPECT can determine the surgical indications for chronic SDH in patients with cortical atrophy.     

A case of transitional cell carcinoma of the renal pelvis with adenocarcinoma producing CEA and CA19-9

We report a case of invasive renal pelvic tumor with high serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9). An 86-year-old man presented with macrohematuria. Retrograde pyelography demonstrated a filling defect in right upper calyx, suspected of renal pelvic tumor. The levels of serum CEA and CA 19-9 were elevated to 28.0 ng/ml and 122 U/ml, respectively. No abnormalities were found in the gastrointestinal tract. Right nephroureterectomy was performed, and histopathological diagnosis was transitional cell carcinoma, grade 2>grade 3, accompanied with adenocarcinoma immuno-stained for CEA and CA19-9. A part of the tumor showed a tubular growth pattern. Both serum levels of CEA and CA 19-9 immediately decreased to the normal range after the operation, but increased again with lung and hepatic metastases.     

Coronary malperfusion due to flap suffocation after acute type A dissection surgery

A 24-year-old man presented with chest pain. He was diagnosed as having a type A acute aortic dissection and an annulo-aortic aneurysm. After emergency surgery for an aortic root replacement, his electrocardiogram showed ST-segment depression and T-wave inversion. Echocardiography showed asynergy of the left ventricle without coronary ostial pathology. Heart catheterization revealed no coronary stenosis, but the true lumen of the residual ascending aorta had extreme diastolic narrowing due to flap suffocation. This resulted in coronary malperfusion. The pullback pressure curve confirmed the mechanism. The patient underwent a surgical re-intervention for a total arch repair, which diminished the coronary malperfusion. At a follow-up appointment four years and four months later, the patient was doing well.     

Post injury changes in the properties of mesenchymal stem cells derived from human anterior cruciate ligaments

Purpose

The anterior cruciate ligament (ACL) rarely heals spontaneously after rupture. Mesenchymal stem cells (MSCs) contribute to healing in various tissues, therefore, they may also have a key role in healing after ACL rupture. The purpose of this study was to investigate the properties of MSCs in ruptured ACLs.

Methods

Human ACL samples were harvested from patients undergoing primary ACL reconstruction, and samples were classified by the number of days post rupture (phase I <21 days; phase II 21–56 days; phase III 57–139 days phase IV ≥140 days). We evaluated the characteristics of MSCs, such as colony-forming capacity, differentiation potential and cell-surface markers.

Results

There was a tendency for high colony-forming capacity during phases I and II, which tended to decrease in phase III. Chondrogenic, adipogenic and osteogenic differentiation potential was maintained until phase II but decreased in phase III. Most surface-epitope expression was consistent from phase I to III: positive for CD44, CD73, CD90 and CD105; negative for CD11b, CD19, CD34, CD45 and human leukocyte antigen-D-related (HLA-DR). The presence of these surface markers proved the existence of MSCs in ruptured ACL tissue.

Conclusions

Our results suggest that colony-forming and differentiation potential decrease over time. It is important to consider changes in properties of MSCs and use ACL tissue in the acute phase of rupture when biological manipulation is required.     

Cross-sectional area of the posterior extensor muscles of the cervical spine in whiplash injury patients versus healthy volunteers--10 year follow-up MR study

IntroductionLong-term follow-up studies focusing on the posterior extensor muscles in patients suffering from whiplash injury are scarce. The purpose of this study was to elucidate the changes in the posterior extensor muscles 10 years after whiplash injury.MethodsTwenty-three patients who had suffered from whiplash injury in 1994–1996 and had undergone MRI using a 1.5-T superconductive imager participated in this follow-up study (13 males, 10 females, mean age 51.8 years, mean follow-up 11.5 years). In addition, 60 healthy volunteers who had undergone MRI in the same period were included as controls (36 males, 24 females, mean age 47.8 years, mean follow-up 11.1 years). All participants underwent follow-up MRI. The cross-sectional areas of the deep posterior muscles (CSA) including the multifidus, semispinalis cervicis, semispinalis capitis, and splenius capitis were digitally measured at C3-4, C4-5, and C5-6 using NIH image. The long-term changes in the CSA were compared between the two groups. In addition, correlations between the CSA and cervical spine-related symptoms were evaluated.ResultsThe mean total CSA per patient (the sum of the area from C3-4 to C5-6) was 4811.6 ± 878.4 mm² in the whiplash patients and 4494.9 ± 1032.7 mm² in the controls at the initial investigation (p = 0.20), and 5173.4 ± 946.1 mm² and 4713.0 ± 1065.3 mm² at the follow-up (p = 0.07). The mean change in CSA over time was 361.8 ± 804.9 mm² in the whiplash patients and 218.1 ± 520.7 mm² in the controls (p = 0.34). Ten whiplash patients (43.5%) had neck pain and 11 (47.8%) had shoulder stiffness. However, there was no difference in the change in CSA over time between the symptomatic and asymptomatic patients.ConclusionsThere was no significant difference in the change in CSA between whiplash patients and healthy volunteers after a 10-year follow-up period. In both groups, the cross-sectional area slightly increased at follow-up. In addition, there was no association between the change in CSA and clinical symptoms such as neck and shoulder pain. These results suggest that whiplash injury is not associated with symptomatic atrophy of the posterior cervical muscles over the long term.     

A novel approach for the treatment of pelvic abscess: transrectal endoscopic drainage facilitated by transanal endoscopic microsurgery access

Background

Postoperative pelvic abscesses in patients submitted to colorectal surgery are challenging. The surgical approach may be too risky, and image-guided drainage often is difficult due to the complex anatomy of the pelvis. This article describes novel access for drainage of a pelvic collection using a minimally invasive natural orifice approach.

Methods

A 37?year-old man presented with sepsis due to a pelvic abscess during the second postoperative week after a Hartmann procedure due to perforated rectal cancer. Percutaneous drainage was determined by computed tomography to be unsuccessful, and another operation was considered to be hazardous. Because the pelvic fluid was very close to the rectal stump, transrectal drainage was planned. The rectal stump was opened using transanal endoscopic microsurgery (TEM) instruments. The endoscope was advanced through the TEM working channel and the rectal stump opening, accessing the abdominal cavity and pelvic collection.

Results

The pelvic collection was endoscopically drained and the local cavity washed with saline through the scope channel. A Foley catheter was placed in the rectal stump. The patient’s recovery after the procedure was successful, without the need for further intervention.

Conclusions

Transrectal endoscopic drainage may be an option for selected cases of pelvic fluid collection in patients submitted to Hartmann’s procedure. The technique allows not only fluid drainage but also visualization of the local cavity, cleavage of multiloculated abscesses, and saline irrigation if necessary. The use of TEM instrumentation allows safe access to the peritoneal cavity.     

Epidemiology of degenerative lumbar scoliosis: a community-based cohort study

STUDY DESIGN.: A 12-year prospective study of pre-existing and de novo degenerative lumbar scoliosis (DLS) among community-based female volunteers. OBJECTIVE.: To investigate serial entire spine radiographs of healthy female volunteers and to clarify radiographical characteristics and predictors of pre-existing and de novo DLS. SUMMARY OF BACKGROUND DATA.: DLS is among the most frequent spinal defomities in the aging spine; however, the onset or the natural course of this condition has not been elucidated. METHODS.: A total of 144 female volunteers were recruited from population register. Radiographical measurements using entire spine radiographs included thoracic kyphosis (T4-12), lumbar lordosis (LL) (L1-5), sacral inclination angle, pelvic incidence, sagittal balance (C7 plumb), coronal L4 endplate angle (L4 tilt), and scoliotic angle by Cobb method. More than 10° of scoliosis was diagnosed as DLS. L4 vertebral size was measured (divided by body height) as well as lateral osteophyte formation and lateral disc wedge angle. RESULTS.: Mean baseline age and follow-up period were 54.4 years and 12.1 years, respectively. Pre-existing DLS (pre-DLS) was found in 42 subjects (29.2%) at baseline. Among pre-DLS, 11 subjects (26%) showed more than 5° progression in scoliosis. De novo DLS has developed in 30 subjects (29.4%) among those without baseline scoliosis.Cox proportional hazards models revealed younger age, smaller L4 size, lower LL, greater DLS angle, and L4 tilt at baseline to be the risk factors of progression of pre-DLS and smaller L4 size, unilateral osteophyte formation, and lateral disc wedging to the risk of development of de novo DLS. CONCLUSION.: This study indicated that younger age, smaller L4 size, lower LL, greater DLS angle, and L4 tilt at baseline should be evaluated as predictors of progression of pre-DLS. Early signs of asymmetric disc degeneration and smaller L4 size should also be evaluated as predictors of development of de novo DLS.     

单心动周期实时三维超声心动图评价ASD右心室收缩功能

【摘要】 目的 应用单心动周期实时三维超声心动图（sRT3DE）评价房间隔缺损 （ASD）患者治疗前后右心室收缩功能及其影响因素。方法 选取本院2017年1月～2018年6月收治的45例ASD患者为ASD组,45例健康志愿者为对照组。比较两组二维超声测量右心室舒张末内径（RVd）与右心室面积变化分数（RVFAC）,sRT3DE测量右心室舒张末容积（RVEDV）、右心室收缩末容积（RVESV）、右心室每搏量（RVSV）、右心室射血分数（RVEF）,比较ASD组封堵术前后及对照组右室收缩功能参数之间的差异,并分析RVEF与ASD大小、RVEDV、RVESV、RVSVASD的相关性,以及RVEF与RVFAC间相关性。结果 RVd、RVEDV、RVESV、RVSV测值比较,ASD术前＞ASD术后＞对照组,差异有统计学意义（P＜001）;RVFAC与RVEF测值比较,ASD术前＜ASD术后＜对照组,差异有统计学意义（P＜001）。ASD治疗前RVEF与ASD大小、RVEDV、RVESV呈负相关（r= 0439、 0310、 0688,P＜005）,与RVSV无相关性（P＞005）。RVEF与FAC呈良好正相关（r=0853,P＜005）。结论 sRT3DE能准确评价ASD治疗前后右心室收缩功能,ASD右室收缩功能与RVESV具有良好相关性。