J. Sanada

MRI findings of primary biliary cirrhosis: correlation with Scheuer histologic staging

Magnetic resonance imaging (MRI) findings of primary biliary cirrhosis (PBC; currently regarded as a vanishing bile duct syndrome) are not established. In this report, we describe our preliminary analysis of the relation between MRI findings and histopathologic staging of PBC and review clinical, morphologic, and MRI findings of PBC especially focusing on the staging of PBC.

Impact of New Quick Gold Nanoparticle-Based Cortisol Assay During Adrenal Vein Sampling for Primary Aldosteronism

CONTEXT Adrenal vein sampling (AVS) is essential for identifying a surgically curable form of primary aldosteronism (PA), but accurate placement of the sampling catheter is technically challenging. Intraprocedural cortisol measurement can confirm the catheters position, thereby increasing the AVS success rate. OBJECTIVE AND METHODS We developed a quick cortisol assay (QCA) that uses immunochromatography and gold nanoparticles and can be performed either semiquantitatively or quantitatively. The assay was evaluated in two studies. In a single-center study, PA patients were assigned to undergo AVS incorporating the semiquantitative QCA (n = 30), the quantitative QCA (n = 30), or without the QCA (n = 30), and the rates of successful AVS were determined. In a prospective multicenter randomized, controlled study, the success rates of AVS performed with (n = 148) or without (n = 145) the semiquantitative QCA were determined. RESULTS Cortisol concentrations were measured during AVS in 6 minutes or less in the radiology suite, without additional technical assistance, and significantly correlated with a conventional reference assay (R(2) = 0.994; P < .001). In the single-center study, the differences in the AVS success rates associated with semiquantitative and quantitative QCAs were not significant (both 93%); however, the success rates were significantly higher than the rate of successful AVS performed without using the QCA (63%; P < .001). The success rate of AVS performed in the multicenter study was 94% for the semiquantitative QCA, which was significantly higher than the rate for the patients without QCA (60%; P < .001). CONCLUSIONS Our novel QCA was rapidly and easily performed at the point of care and improved the rate of successful AVS.

Intrahepatic biliary calculi: correlation of unusual MR findings with pathologic findings

We report a case of intrahepatic biliary calculi. A localized dilated intrahepatic duct of the left lateral segment of the liver was filled with material that showed marked hyperintensity on T1- and T2-weighted magnetic resonance (MR) images. These MR findings are unusual for intrahepatic stones. Pathologically, the stones were muddy bilirubin calculi, the chemical and physical characteristics of which are surmised to have been the cause of the unusual MR findings.

Cystic duct remnant carcinoma with widespread invasion along the extrahepatic bile duct wall: dynamic CT findings

AbstractWe report a case of remnant cystic duct carcinoma with widespread invasion along the common bile duct wall. Thin-slice dynamic computed tomography showed circumferential wall thickening of the extrahepatic bile duct (from the common hepatic duct to the intrapancreatic common bile duct) and the remnant cystic duct. Pathologically, the extrahepatic bile duct wall was thickened due to submucosal tumor infiltration by cystic duct papillary adenocarcinoma.

Risk factor analysis of thoracic endovascular repair using the Matsui-Kitamura stent graft for acute aortic emergencies in the descending thoracic aorta

OBJECTIVE In recent years, thoracic endovascular aneurysm repair (TEVAR) has been attempted for acute aortic emergencies (AAEs). However, the risk factors for achieving good results have not been identified. Besides focusing on Acute Physiology and Chronic Health Evaluation (APACHE) II score as a general indicator of patient condition, we analyzed both preoperative factors and intraoperative/postoperative factors. The purpose of this study was to identify those factors affecting the results of TEVAR using our Matsui-Kitamura stent graft (MKSG) for AAEs involving descending thoracic aortic aneurysm. METHODS Between July 2000 and June 2008, a total of 32 patients (23 men, 9 women) with AAEs underwent endovascular repair. AAE was a result of aortic aneurysm rupture in 16 cases, rupture of penetrating atherosclerotic ulcer in 2 cases, traumatic aortic injury in 9 cases, complicated type B dissection in 4 cases, and aortic infiltration of sarcoma in 1 case. Low blood pressure in 6 patients, acute renal failure in 7 patients, anemia due to bleeding in 12 patients were found at the time of operation. Urgent TEVAR using the MKSG was performed. Perioperative and long-term results for these patients were investigated. RESULTS The delivery and technical success rate for TEVAR using the MKSG, was 100%. Perioperative mortality was 12.5%, and 5-year survival rate was 71%. In both univariate and multivariate analysis, the APACHE II score clarified a risk factor. Among the various elements of an APACHE II score, age, hematocrit, and total score were identified as significant factors. The mean of an APACHE II score was 9.5. Patients with an APACHE II score ≥ 10 showed significantly lower 5-year survival rates than patients with an APACHE II score ≤ 9. CONCLUSIONS Good results were obtained using TEVAR to treat AAEs with MKSGs, both perioperatively and during medium-term follow-up. Evaluation of risk factors for TEVAR of AAEs showed the utility of APACHE II score (particularly age, hematocrit, and total score) with a score ≥ 10 indicating high risk.

Stent-Graft Deployment to Treat a Perigraft Seroma Formed after Descending Thoracic Aortic Surgery

Purpose: To report a case of stent-graft implantation for a perigraft seroma that formed after descending thoracic aortic surgery. Case Report: A 70-year-old woman presented with a perigraft seroma after a descending thoracic aortic surgery 10 years ago in which a polytetrafluoroethylene graft was used. Chest radiography and computed tomography confirmed the presence of a large perigraft seroma. The previous graft was covered with a stent-graft to decrease graft porosity. At 1 year, postoperative examinations revealed a decrease in the size of the perigraft seroma. Conclusion: Stent-graft implantation could prove useful in cases of perigraft seromas where additional conventional surgery may pose difficulties.

Emergent Thoracic Endovascular Aortic Repair forAcute Type-B Aortic Dissection with Malperfusionby Matsui-Kitamura Stent Graft

Acute type-B aortic dissection with malperfusion is a serious cardiovascular condition associated with high morbidity and mortality. Recent studies have investigated the efficacy of thoracic endovascular aortic repair (TEVAR) as treatment for acute aortic dissection. In this report, we present a case of acute type-B aortic dissection complicated with malperfusion, which was successfully treated with emergent TEVAR for entry closure by a Matsui-Kitamura stent graft (MKSG). MKSG is a flexible custom-made curved stent graft. The main advantages of MKSG for emergent TEVAR include flexibility, shape, and small profile when compressed.

Elective Matsui-Kitamura Stent Graft Repair for Descending Thoracic Aortic Aneurysm and Chronic Type-B Aortic Dissection

BACKGROUND The position of thoracic endovascular aortic repair (TEVAR) compared to open surgery of the thoracic aorta has changed. This study evaluates outcomes after TEVAR performed electively using our original Matsui-Kitamura stent graft (MKSG) to treat descending thoracic aortic aneurysms (dTAA) and chronic type-B aortic dissection (type-B AD), and elucidates the risk factors for postoperative spinal cord ischemia (SCI). METHODS TEVAR was performed using an MKSG in 66 patients (age: 70.8+/-9.2 years). The underlying etiology was atherosclerotic change in 39 patients, chronic type-B aortic dissection in 23 patients, and other in 4 patients. RESULTS No perioperative deaths occurred. Three patients showed temporary paralysis due to postoperative SCI. Abdominal aortic aneurysm (AAA) surgery was a risk factor for postoperative SCI (P=0.04). The 5-year survival rate was 81.2%. CONCLUSION The present study demonstrated that TEVAR of patients with dTAA and chronic type-B AD using an MKSG can be performed with high technical success rates and low rates of severe acute complications. AAA surgery was a risk factor for postoperative SCI.

Right Posterior-Superior Subsegmental Hepatic Artery Originating from the Right Inferior Adrenal Artery

Many anatomic variants of the hepatic artery have been reported [1–5]. Hiatt et al. [5] studied hepatic arterial patterns in 1000 cases of donor livers, and classified them into six patterns. The hepatic arteries originated from the common hepatic artery in 75%; however, about 22% had a replaced or accessory hepatic artery. Michels et al. [6] divided aberrant arteries into two categories: an “accessory” artery and a “replaced” artery. The replaced right hepatic artery is seen primarily to branch from the superior mesenteric artery (SMA), with the incidence of this anomaly being about 17% [1]. Total replacement of the right hepatic artery occurs in about 12%, and partial replacement in about 5% [1]. Recently, during CT arteriography we encountered a case of a replaced right superior subsegmental artery originating from the right inferior adrenal artery, which was confirmed by conventional arteriography. To our knowledge, this type of hepatic arterial anomaly is very rare and has not been reported previously.

An Experimental Study of Type I Endoleak Repair With a Suturing Device

PURPOSE An experimental study was done to investigate repair of type I endoleaks in thoracic aortic aneurysms using the T-Fix suturing device (Smith & Nephew Co, Ltd, London, United Kingdom). DESCRIPTION A saccular descending aortic aneurysm was made in 5 pigs experimentally. A stent graft was deployed to produce a proximal type I endoleak. Under fluoroscopy, the aorta was punctured with the spinal needle with the T-Fix plastic bar, and the plastic bar was deployed with a push rod. A sufficient number of T-Fix sutures were used until angiography revealed that the type I endoleak had disappeared. EVALUATION No hemodynamic events occurred during the procedure. An average of 2.5 +/- 0.6 T-Fix sutures were required to eliminate the endoleak. The experimental T-Fix repair was performed without any complications. A new method of repairing type I endoleaks for thoracic aortic aneurysms was successfully performed using the T-Fix system. CONCLUSIONS Although the T-Fix repair currently has some anatomic and clinical limitations, improvement of the device should lead to the increased use of this repair.