A case of thrombus of the descending aorta successfully diagnosed on preoperative endoscopic ultrasonography

A 45-year-old woman presented with left lower abdominal pain. A plain CT scan showed a slightly high-density, cord-like structure extending from the level of the diaphragm of the descending aorta to the superior mesenteric artery. Transgastric endoscopic ultrasonography (EUS) revealed a floating mass, smoothly attaching to the aortic intima and depicted as a hyperechoic region containing a mixture of hyperechoic and hypoechoic areas. EUS elastography revealed that the body of the mass consisted of medium soft tissue, with hard tissue at its base. On histopathological examination after surgery, the mass was found to consist mainly of fibrin, with no atypical cells. EUS examination should be used for the differential diagnosis between thrombi and tumors in the aorta.     

Impact of optical coherence tomography- and coronary angioscopy-assessed neointimal tissue characteristics on occurrence of periprocedural myonecrosis in patients with in-stent restenosis

Several characteristics of neointimal tissues, including neoatherosclerotic progression, have been reported in lesions with in-stent restenosis (ISR). However, the effects of these characteristics on outcomes after percutaneous coronary intervention (PCI) for ISR lesions remain unclear. We assessed the relationships between neointimal tissue characteristics and the occurrence of periprocedural myonecrosis (PMN) after PCI in ISR lesions. We investigated 72 ISR lesions in 72 patients with stable angina pectoris (SAP) who underwent pre- and post-revascularization optical coherence tomography (OCT) and coronary angioscopy (CAS). All lesions were classified as with PMN, defined by an elevated peak high-sensitivity cardiac troponin-T level during the 24-h post-PCI period, and without PMN. PMN was observed in 23 (31.9?%) lesions. PMN lesions had higher frequencies of OCT-derived thin-cap fibroatheroma (26.1 vs. 6.1?%, P?=?0.03), CAS-derived intensive yellow neointima (30.4 vs. 10.2?%, P?=?0.04), neointima with complex surface (60.9 vs. 28.6?%, P?=?0.01), and CAS-derived atheromatous appearance (CAS-AAP), defined as yellow plaque including complex thrombi underneath disrupted neointimal coverage after ballooning (47.8 vs. 16.3?%, P?=?0.008) at the most stenotic sites inside stents, compared to lesions without PMN. Multivariate logistic regression analysis identified CAS-AAP (odds ratio: 3.568, 95?% confidence interval: 1.109–11.475, P?=?0.033) as an independent predictor of PMN. For ISR lesions in SAP patients, an OCT- and CAS-based assessment of neointimal tissue characteristics might help to predict the occurrence of PMN.     

The roles of H. pylori infection and K-ras gene mutation in gastric carcinogenesis

To elucidate the significance of K-ras gene mutations in gastric carcinogenesis, we examined the mutations in gastric cancers and in Helicobacter pylori-associated chronic gastritis(H. pylori-CG). In gastric cancers, K-ras gene mutations were detected in intestinal type cancers, but not in diffuse type cancers. K-ras gene mutations in H. pylori-CG were significantly more frequent in gastric cancer patients than in cancer-free patients. These data suggest that K-ras gene mutations may be involved in the early stages of gastric carcinogenesis of the intestinal type. Recently, Uemura, et al. reported that H. pylori eradication suppressed gastric cancer development(Cancer Epidemiol Biomarkers Prev, 1997; N Engl J Med, 2001). Further examination is necessary to clarify the mechanism of suppression of gastric cancer development after H. pylori eradication.     

A new index for non-invasive assessment of liver fibrosis

AIM:To construct and evaluate a new non-invasive fibrosis index for assessment of the stage of liver f ibrosis. METHODS:A new f ibrosis index (Fibro-Stiffness index) was developed in 165 of 285 patients with chronic hepatitis C, and was validated in the other 120 patients where liver biopsy was performed. Its usefulness was compared with liver stiffness (LS) measured by FibroScan, the aminotransferase-to-platelet ratio index, the Forns index and the FibroIndex. RESULTS: The Fibro-Stiffness index consists of...     

New parameters to represent the position of the aorta relative to the spine for pedicle screw placement

Parameters of the position of the aorta in previous reports were determined for anterior surgery. This study evaluated the relative position of the aorta to the spine by new parameters, which could enhance the safety of pedicle screw placement. Three parameters were defined in a new Cartesian coordinate system. We selected an entry point of a left pedicle screw as the origin. The transverse plane was determined to include both the bases of the superior facet and to be parallel to the upper endplate of the vertebral body. A line connecting the entry points of both sides was defined as the X-axis. The angle formed by the Y-axis and a line connecting the origin and the center of the aorta was defined as the left pedicle–aorta angle. The length of a line connecting the origin and the aorta edge was defined as the left pedicle–aorta distance. Distance from the edge of the aorta to the X-axis was defined as the pedicular line–aorta distance. These parameters were measured preoperatively in 293 vertebral bodies of 24 patients with a right thoracic curve. We simulated the placement of the pedicle screw with variable length and with some direction error. We defined a warning pedicle as that when the aorta enters the expected area of the screw. Sensitivity analysis was performed to find the warning pedicle ratio in 12 scenarios. The left pedicle–aorta angle averaged 29.7° at the thoracic spine and −16.3° at the lumbar spine; the left pedicle–aorta distance averaged 23.7 and 55.2 mm; the pedicular line–aorta distance averaged 18.3 and 51.0 mm, respectively. The ratio of warning pedicles was consistently high at T4–5 and T10–12. When a left pedicle screw perforates an anterior/lateral wall of the vertebral body, the aorta may be at risk. These new parameters enable surgeons to intuitively understand the position of the aorta in surgical planning or in placement of a pedicle screw.     

Asymptomatic somatostatinoma of the pancreatic head: Report of a case

A 44-year-old man was attending routine follow-up 5 years after colon cancer resection, when ultrasonography detected a pancreatic tumor with a low echoic area. He had no symptoms. Computed tomography (CT) showed a protruding-type tumor, 4 cm in diameter, in the pancreatic head with central necrosis. Angiography revealed that the tumor was hypervascular. The serum somatostatin level was elevated, at 27 pg/ml (normal range, 1.0–12 pg/ml). As somatostatinoma of the pancreas was suspected, we performed pylorus-preserving pancreaticoduodenectomy. Histological and immunohistochemical staining confirmed somatostatinoma of the pancreas without nodal metastasis. Thus, if an endocrine tumor of the pancreas is suspected in a patient with a hypervascular tumor, the possibility of somatostatinoma should be included in the differential diagnosis.     

Surgical outcomes of foramen magnum decompression for syringomyelia associated with Chiari I malformation: relation between the location of the syrinx and body pain

Background  

There have been few reports about the relation between the morphology of syrinxes and body pain in syringomyelia associated with Chiari I malformation. To investigate this phenomenon, the relation between the location of the syrinx and body pain before and after foramen magnum decompression (FMD) were evaluated.