Tomoyuki Ohta

Laparoscopic ventral rectopexy for rectoanal intussusception: postoperative evaluation with proctography.

BACKGROUND: Laparoscopic ventral rectopexy can relieve symptoms of obstructed defecation and fecal incontinence in patients with rectoanal intussusception. However, pelvic floor imaging after surgery has not been reported. OBJECTIVE: This study was designed to assess the outcome of patients who underwent laparoscopic ventral rectopexy for rectoanal intussusception, with special reference to the postoperative findings on evacuation proctography. DESIGN: This study was a retrospective analysis of prospectively collected data. SETTING: The study was conducted from 2012 to 2013 at the Department of Surgery, Kameda Medical Center, Japan. PATIENTS: We included 26 patients with symptomatic rectoanal intussusception. INTERVENTION: Laparoscopic ventral rectopexy was performed. MAIN OUTCOME MEASURE: Evacuation proctography was performed before and 6 months after the procedure. Defecatory function was evaluated using the Constipation Scoring System and Fecal Incontinence Severity Index. RESULTS: Of 26 patients with rectoanal intussusception preoperatively, 22 had symptoms of obstructed defecation and 21 complained of fecal incontinence. Postoperatively, rectoanal intussusception was eliminated in all patients, though 8 developed recto rectal intussusception. There was an overall reduction in both grade 2 rectocele size (median preop 26 mm vs. postop 11 mm; p < 0.0001) and pelvic floor descent (median preop 26 mm vs. postop 20 mm; p < 0.0001). 6 months after surgery, a reduction of at least 50% was observed in the Constipation Scoring System score for 9 patients (41%) with obstructive defecation and in the Fecal Incontinence Severity Index score for 14 incontinent patients (67%). LIMITATIONS: This was a preliminary study with a small sample size, no control group, and short follow-up time. CONCLUSION: Evacuation proctography showed anatomical correction in patients with rectoanal intussusception who underwent laparoscopic ventral rectopexy. However, the data also indicate that such correction does not necessarily result in meaningful symptomatic relief.

Natural Course of Autoimmune Pancreatitis Without Steroid Therapy Showing Hypoechoic Masses in the Uncinate Process and Tail of the Pancreas on Ultrasonography

Autoimmune pancreatitis, a unique form of chronic pancreatitis, is characterized by irregular narrowing of the pancreatic duct, swelling of the parenchyma, lymphoplasmacyte infiltration and fibrosis, hyperglobulinemia, positive autoantibody test results, and effectiveness of steroid therapy. 1-4 Although autoimmune pancreatitis has become widely recognized as a new clinical entity of the pancreatic diseases, and several authors have reported patients with autoimmune pancreatitis, particularly in Japan, 5-9 to our knowledge, the imaging findings of the natural course of autoimmune pancreatitis without steroid therapy have not been described previously. In addition, few cases of autoimmune pancreatitis show separated plural pancreatic lesions. 8,10 We describe a case of autoimmune pancreatitis found incidentally that showed separated plural pancreatic lesions and that was followed without steroid therapy.

Radiologic-pathological correlation of punctate hyperechoic foci by ultrasound in stereotactic vacuum-assisted breast biopsy samples

PurposeTo correlate punctate hyperechoic foci (PHF) on ultrasound (US) with microcalcifications detected by mammography (MMG) and at histopathology.Materials and methodsForty-eight subjects who underwent stereotactic vacuum-assisted breast biopsy (SVABB) for evaluation of breast microcalcifications between April and December 2008 were evaluated for 191 lesions obtained after SVABB. The concordance between PHF on US with microcalcifications detected on MMG and histopathology was therefore evaluated for 191 lesions. Values for sensitivity and specificity were determined against histopathology as the reference standard.ResultsIn 154 of 191 samples (80.6%), the PHF on US corresponded with microcalcifications on MMG and histopathology. The overall sensitivity and specificity were 85.3% and 80.0%, respectively, for US, and 89.7% and 90.7%, respectively, for MMG. There were no significant differences between values for US and MMG. At US, 12 PHF did not correlate with any microcalcifications at MMG or histopathology. Histopathology revealed collagen fibers in fatty tissue in 5 of 12 lesions and collagenization in 2 of 12 lesions.ConclusionThere was a general concordance between PHF on US and microcalcifications detected at MMG. However, in addition to microcalcifications, collagen fibers in fatty tissue and collagenization may account for some PHF. This possibility should be considered when interpreting US findings.

Diagnostic value of ultrasonography and TI-201/Tc-99m dual scintigraphy in differentiating between benign and malignant thyroid nodules

PurposeTo evaluate the performance of ultrasonography (US) and TI-201/Tc-99m dual (Tl/Tc) scintigraphy in differentiating between benign and malignant thyroid nodules.MethodsEighty-six patients diagnosed to have a thyroid tumor on postoperative histopathologic examination between June 2009 and February 2017 were included in this retrospective study. A radiologist reviewed the US and Tl/Tc scintigraphy reports along with all available clinical and histopathologic information. On Tl/Tc scintigraphy, a nodule in which uptake was higher in the delayed phase than in the surrounding parenchyma was defined as a delayed accumulation pattern and a nodule in which uptake was higher in the delayed phase than in the early phase was defined as a persistent pattern. The Tl/Tc scintigraphy images were evaluated in a blinded manner to assess reproducibility. A statistical analysis was performed to identify features associated with malignancy. Interobserver variability was calculated using the κ statistic.ResultsUS had higher sensitivity (81.2%), specificity (88.2%), and positive (96.6%) and negative (53.6%) predictive values than Tl/Tc scintigraphy. An ill-defined margin and microcalcification were independent predictors of a malignant thyroid nodule on multivariate logistic regression (P = 0.003 and P = 0.014, respectively). The persistent pattern had high specificity (85.7%) equivalent to that of US but had lower sensitivity (34.7%). The κ values for the delayed accumulation and persistent patterns were 0.66–0.78 and 0.32–0.50, respectively.ConclusionsAn ill-defined margin and microcalcification on US were independent predictors of a malignant thyroid nodule. A persistent pattern seen on Tl/Tc scintigraphy could contribute to the differential diagnosis.

Use of hand-held ultrasonography to confirm the correct placement of a central venous catheter tip

To avoid severe complications resulting from malpositioning of a central venous catheter, removal and recannulation of the catheter may be necessary, thus wasting medical equipment and increasing stress on the patient. Therefore, central venous catheters should be inserted correctly the first time. We tested whether real-time hand-held ultrasound-guided confirmation of the location of the tip of a central venous catheter inserted from the femoral vein could reduce the rate of malpositioning. Catheters were inserted using conventional methods for 65 patients, and using ultrasound guidance for 29 patients. For the latter group, when a central venous catheter was inserted, the ultrasound examiner first identified its tip located dorsal to the liver in the inferior vena cava and then fixed the catheter in position. We considered a central venous catheter to be malpositioned when its tip appeared in neither the inferior vena cava nor the right atrium–inferior vena cava junction in X-rays. Flexed or inverted catheters were also considered to be malpositioned. We compared the malpositioning rates for the ultrasound and conventional groups. Malpositioning was identified for two (6.9%) patients in the ultrasound group and 19 (29.2%) patients in the conventional group. The relative risk of ultrasound-guided versus conventional catheter insertion was 0.23 (95% confidence interval, 0.09–0.62). Our data suggest that real-time ultrasound monitoring is useful for avoiding malpositioning of central venous catheters inserted from the femoral vein.