Gyoo Sik Jung

Malignant Duodenal Obstructions: Palliative Treatment Using Self-Expandable Nitinol Stents

PURPOSE To assess the efficacy of fluoroscopic per oral placement of self-expandable nitinol stents in the palliative treatment of malignant duodenal obstructions. MATERIALS AND METHODS Under fluoroscopic guidance, 82 patients (56 male and 26 female; mean age, 62.3 y) with malignant duodenal obstructions were treated with per oral placement of four types of self-expandable nitinol stents. All patients presented with severe nausea and recurrent vomiting, and their obstructions were inoperable. RESULTS Technical success was achieved in 78 of 82 patients (95.1%). After stent placement, food intake capacity improved in 74 of 78 patients (94.9%). Stent migration occurred in one patient 4 days after placement. A covered stent was placed to cover the ampulla of Vater in 15 patients without external biliary drainage; three of them (20%) became jaundiced. During the mean follow-up period of 74.7 days (range, 9-374 d), eight patients developed recurrent obstructive symptoms caused by tumor ingrowth (n=2) or tumor overgrowth (n=6). They were successfully treated by additional stent placement. The primary stent patency rates were 97.0%, 79.8%, and 44.0% at 30-, 90-, and 180 days, respectively (mean patency, 228.2 d; 95% CI, 153.9-302.5). CONCLUSIONS Fluoroscopic per oral placement of self-expandable nitinol stents is an effective palliative treatment for malignant duodenal obstructions.

Successful Chemotherapy Following Autologous Stem Cell Transplantation in Multiple Myeloma and Multi-organ Dysfunction with Infiltration of Eosinophils: A Case Report.

Eosinophils are derived from hematopoietic stem cells. Peripheral blood eosinophilia is defined as an absolute eosinophil count of ≥0.5×109/L. Eosinophilia is classified into primary or clonal eosinophilia, secondary eosinophilia, and idiopathic categories including idiopathic hypereosinophilic syndrome. Both hematopoietic and solid neoplasms may be associated with peripheral blood eosinophilia, but multiple myeloma is rarely associated with eosinophilia. We now report the case of a 31-year-old man with multiple myeloma associated with marked eosinophilia who developed multiple organ dysfunction with infiltration of eosinophils. He recovered after treatment with chemotherapy followed by autologous stem cell transplantation.

High Density Renal Medulla on Unenhanced CT : Significance and Relation with Hyd ration Status

Purpose : To assess the effect of hydration status on renal medullary attenuation and to evaluate theincidence of dense renal medulla, as seen on unenhanced CT. Material and Methods : We prospectively studiedunenhanced CT scans of 12 healthy volunteers. Obtained done after 10 hours and 15 hours of dehydration and afteroral intake of 2L of water. BUN/Cr, urine specific gravity, urine osmole and hematocrit were evaluated after 10hours of dehydration. CT images were reviewed for the presence of dense renal medulla and differential attenuationof dense renal and isodense medulla and cortex at the same level. The density changes of renal medulla afterhydration were evaluated. and CT findings were compared with the results of biochemical studies. In addition, weretrospectively reviewed the CT scans of 200 consecutive patients for evaluation of the incidence of dense renalmedulla. Results : In 8 of 12 volunteers, dense renal medulla was seen on CT scan after dehydration. Meanattenuation was 71.3 ±10.42HU after 10 hours of dehydration, 68.6 ±13.54HU after 15 hours, and 34.5 ±11.47HUafter hydration. No significant attenuation differences were detected between 10 hours and 15 hours ofdehydration, but significantly lower attenuation values were noted after hydration. For isodense medulla, the meanattenuation value was 35.7 ±7.9HU after 10 hours of dehydration, 39.58 ±9.66HU after 15 hours, and 36.58±7.77HU after hydration. The mean attenuation values of cortex were 35.9 ±5 . 9 5 H U after 10 hours ofdehydration, 37.58 ±5.95HU after 15 hours, and 37.08 ±9.75HU after hydration. With regard not only to durationof dehydration, but also ti hydration, no differences in attenuation values were noted for renal cortex orisodense renal medulla. However, higher density was noted in dense renal medulla than in isodense medulla orcortex for the same duration of dehydration. After hydration, complete resolution was seen at five of eight sitesand incomplete resolution at three of eight sites. There was no correlation between CT attenuation and laboratoryresults. Dense renal medulla was seen in 17 of 200 consecutive patients. Mean attenuation values were 64.06±8.38HU for dense renal medulla, 37.15 ±8 . 4 4 H U for isodense renal medulla and 35.36 ±8.13HU for cortex.Conclusion : For the same duration of dehydration, dense renal medulla showed a higher attenuation value thanisodense medulla or cortex, a finding which was completely or incompletely resolved after hydration. Inconsecutive patients, the incidence of dense renal medulla was 8.5% In conclusion, this in-cidence is aphysiological, variable, reflecting dehydration status.