Endovascular Treatment of Blunt Traumatic Abdominal Aortic Occlusion With Kissing Stent Placement

Blunt traumatic abdominal aortic dissection is extremely rare and potentially deadly. We present the case of a 62-year-old man involved in a frontal car crash. After emergency undergoing laparotomy for bowel injuries, he was referred to our hospital due to acute ischemia of bilateral lower extremities on day 3 after the trauma. Computed tomography and aortography showed an aortobiiliac dissection with complete occlusion. This injury was successfully treated by endovascular treatment with "kissing"-technique stent placement, which appears to be a safe, effective, and minimally invasive treatment.     

Comparison of dose accuracy between 2D array detectors for pre-treatment IMRT QA

The dosimetric properties between various 2D array detectors were compared and were evaluated with regard to the accuracy in absolute dose and dose distributions for clinical treatment fields. We used to check the dose accuracy: 2D array detectors; MapCHECK (Sun Nuclear), EPID (Varian Medical Systems), EPID-based dosimetry (EPIDose, Sun Nuclear), COMPASS (IBA) and conventional system; EDR2 film (Eastman Kodak), Exradin A-14SL ion chamber (0.016 cc, Standard Imaging). First, we compared the dose linearity, dose rate dependence, and output factor between the 2D array detectors. Next, the accuracy of the absolute dose and dose distributions were evaluated for clinical fields. All detector responses for the dose linear were in agreement within 1%, and the dose rate dependence and output factor agreed within a standard deviation of ±1.2%, except for EPID. This is because EPID is fluence distributions. In all the 2D array detectors, the point dose agreed within 5% with treatment planning system (TPS). Pass rates of each detector for TPS were more than 97% in the gamma analysis (3 mm/3%). EPIDose was in a good agreement with TPS. All 2D array detectors used in this study showed almost the same accuracy for clinical fields. EPIDose has better resolution than other 2D array detectors and thus this is expected for dose distributions with a small field.     

Cone-beam computed tomography-derived adaptive radiotherapy

The purpose of this study was to evaluate the reliability of cone-beam computed tomography (CBCT)-derived adaptive radiotherapy. We evaluate planning computed tomography (pCT) and CBCT in 50 patients who had undergone image guided radiotherapy (IGRT) with CBCT. Irradiated sites included head, neck, chest, abdomen, and pelvis; there were 10 patients in each group. Treatment plans including 153 beam data were recalculated based on CBCT. To compare between pCT and CBCT, we estimated CT values of normal tissues, body contour, effective depth, and monitor units (MU) calculation. The maximum difference in CT values was observed in lung estimation. The 5 mm or more differences in depth were observed in 2 beams of 2 pelvic cases, but CBCT also demonstrated a shift of abdominal wall due to intestinal motility. There were downward trends for the effective depth and MU based on CBCT, especially in lung cases. However, the differences in prescribed dose due to MU calculation were less than 5% because all patients were treated with a multifield irradiation plan. CBCT provides not only precise daily setup but also accurate anatomical information on body contour. In addition, CBCT may be considered as a useful tool for dose calculation.     

Utility of sampling perfection with application optimized contrasts using different flip angle evolutions method in carotid artery plaque magnetic resonance imaging

In the carotid artery plaque diagnosis, it is said that properties evaluation is important. For this inspection, it is general to use electrocardiogram (ECG)-trigger-dark blood (DB)-fat suppression (fs)-turbo spin echo (TSE)-T1 weighted image (T1WI), T2WI, and magnetization prepared rapid gradient echo (MPRAGE) methods though many problems still remain. This time, a comparative study of the carotid artery plaque diagnosis that used the sampling perfection with application optimized contrasts was made. This used different flip angle evolutions method sampling perfection with application optimized contrasts using different flip angle evolutions (SPACE) method that was 3 dimension (3D) imaging procedure that used variable flip angle with the law so far. The subjects were normal volunteers, handmade phantoms changed by T1 and T2 value, and the five patients on five cases who had taken carotid endoarterectomy (CEA) (male, mean 70.6 yr). Findings by the pathologist were obtained for the CEA enforcement patient. There is an excellent result in the contrast ratio by phantom, the signal intensity ratio of a clinical patient, and the comparison with pathological findings. The SPACE method can solve various problems, be evaluated by a properties evaluation of the plaque, a grasp of the range, and an arbitrary section, and be devised as a useful imaging procedure.     

A novel combined adjuvant for nasal delivery elicits mucosal immunity to influenza in aging

Since a combination of flt3 ligand plasmid (pFL) and CpG-oligodeoxynucleotides (ODN)³ as a dendritic cell (DC)-targeting double mucosal adjuvant elicited ovalbumin-specific secretory IgA (S-IgA) antibody (Ab) responses, we examined whether this double adjuvant could induce influenza-specific protective immunity in aged mice. A double adjuvant plus A/Puerto Rico/8/34 (PR8) hemagglutinin (HA) induced increased numbers of CD11b⁺ CD11c⁺ DCs and both CD4⁺ Th1- and Th2-type responses in the nasopharyngeal-associated lymphoreticular tissue, nasal passages and cervical lymph nodes. Further, increased levels of PR8 HA-specific S-IgA Ab responses were detected in the upper respiratory tact (URT) of aged and young adult mice given nasal PR8 HA with this double adjuvant. Thus, when mice were challenged with PR8 virus via the nasal route, both aged and young adult mice given nasal vaccine exhibited complete protection. Further, IgA-deficient mice nasally immunized with a double adjuvant influenza vaccine failed to provide protection against PR8 challenge. These results indicate that a nasal double adjuvant successfully induces PR8 HA-specific IgA Ab responses in both young adult and aged mice, which are essential for the prevention of influenza infection in the murine URT.     

Diagnosis of biliary tract and ampullary carcinomas

Diagnostic methods for biliary tract carcinoma and the efficacy of these methods are discussed. Neither definite methods for early diagnosis nor specific markers are available in this disease. When this disease is suspected on the basis of clinical symptoms and risk factors, hemato-biochemical examination and abdominal ultrasonography are performed and, where appropriate, enhanced computed tomography (CT) and/or magnetic resonance cholangiopancreatography (MRCP) is carried out. Diagnoses of extrahepatic bile duct cancer and ampullary carcinoma are often made based on the presence of obstructive jaundice. Although rare, abdominal pain and pyrexia, as well as abnormal findings of the hepatobiliary system detected by hemato-biochemical examination, serve as a clue to making a diagnosis of these diseases. On the other hand, the early diagnosis of gallbladder cancer is scarcely possible on the basis of clinical symptoms, so when this cancer is found with the onset of abdominal pain and jaundice, it is already advanced at the time of detection, thus making a cure difficult. When gallbladder cancer is suspected, enhanced CT is carried out. Multidetector computed tomography (MDCT), in particular — one of the methods of enhanced CT — is useful for decision of surgical criteria, because MDCT shows findings such as localization and extension of the tumor, and the presence or absence of remote metastasis. Procedures such as magnetic resonance imaging, endoscopic ultrasonography, bile duct biopsy, and cholangioscopy should be carried out taking into account indications for these procedures in individual patients. However, direct biliary tract imaging is necessary for making a precise diagnosis of the horizontal extension of bile duct cancer.     

Dual-isotope myocardial SPECT in patients with redefined myocardial infarction

BACKGROUND: According to the redefinition of myocardial infarction (MI) by the ESC/ACC Committee, patients with unstable angina (UA) without significant elevation of creatine kinase (CK) but with elevation of troponin T should be diagnosed as MI. METHODS: One hundred and forty-six consecutive patients formerly diagnosed as UA, with peak CK levels0.10 ng/ml). Dual SPECT findings were analyzed qualitatively and quantitatively in blinded manner. RESULTS: Forty-seven patients (32%) were redefined as MI and 99 patients (68%) were redefined as UA. On admission, there were small but statistically significant elevations in laboratory parameters such as white blood cell count, C-reactive protein, CK and CK-MB in the redefined MI group compared with the redefined UA group. The proportion of patients with perfusion and metabolic abnormalities was significantly higher in the redefined MI group (Tl defect 36% vs. 4%, odds ratio: 13.5, p<0.001; BMIPP defect 64% vs. 23%, odds ratio: 5.8, p<0.001). Semi-quantitative evaluation revealed that the total Tl and BMIPP scores were significantly higher in the redefined MI patients (p<0.001). CONCLUSIONS: In the redefined MI patients, perfusion and metabolic abnormalities occurred frequently and more extensively. However, Tl/BMIPP dual SPECT had limited ability to detect minor myocardial infarcts classified as redefined MI. A more sensitive stratification combined with troponin T directed assignment should be established to incorporate the ongoing minor infarcts which could not be assessed by serial dual-scintigraphic evaluations.     

Comparison of active renin concentration and plasma renin activity as a prognostic predictor in patients with heart failure.

BACKGROUND: Plasma renin activity (PRA) may be limited to angiotensinogen levels, which decrease in patients with heart failure (HF) because of liver congestion. METHODS AND RESULTS: To evaluate whether the plasma active renin concentration (ARC) is a more useful prognostic predictor than PRA, the plasma levels of ARC, PRA, angiotensin II, aldosterone, brain natriuretic peptide (BNP), norepinephrine, and hemodynamic parameters were measured in 214 consecutive HF patients who were already taking angiotensin-converting enzyme inhibitors (ACEI) or angiotensin-receptor blockers (ARB). Median follow-up period was 1,197 days. Of the clinical variables, including pulmonary capillary wedge pressure, right atrial pressure, left ventricular ejection fraction, and neurohumoral factors, only high plasma levels of log ARC (p<0.0001) and log BNP (p=0.0009), but not log PRA, were significant independent prognostic predictors. Log ARC/PRA ratio was significantly higher in nonsurvivors than in survivors. Log ARC/PRA significantly correlated with pulmonary capillary wedge pressure (r=0.305, p<0.0001), right atrial pressure (r=0.222, p=0.0011), and log BNP (r=0.242, p=0.0004). CONCLUSIONS: Plasma ARC is superior to PRA and a high plasma ARC is an independent prognostic predictor in HF patients who are already receiving ACEI or ARB.