Impact of using scope holder on Interventional Endoscopy (with video).

Highlight Tsuchiya and colleagues developed a scope holder to maintain good scope positioning during interventional endoscopic ultrasound. The scope holder not only reduces the burden on the endoscopist but also reduces the radiation exposure of the caregiver. This is the first report on a scope holder for flexible endoscopes.

The feasibility of pancreatic duct stenting using a novel 4-Fr plastic stent with a 0.025-in. guidewire.

Pancreatic duct stenting is a well-established method for reducing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. However, there is no consensus on the optimal type of plastic stent. This study aimed to evaluate the feasibility and safety of a new 4-Fr plastic stent for pancreatic duct stenting. Forty-nine consecutive patients who placed the 4-Fr stent into the pancreatic duct (4Fr group) were compared with 187 consecutive patients who placed a conventional 5-Fr stent (control group). The primary outcome was technical success. Complications rate, including post-ERCP pancreatitis (PEP) were the secondary outcomes. Propensity score matching was introduced to reduce selection bias. The technical success rate was 100% in the 4Fr group and 97.9% in the control group (p = 0.315). Post-ERCP amylase level was significantly lower in the 4-Fr group than the control group before propensity score matching (p = 0.006), though without statistical significance after propensity score matching (p = 0.298). The rate of PEP in the 4Fr group (6.1%) was lower than the control group (15.5%), though without statistical significance before (p = 0.088) and after (p = 1.00) propensity score matching. Pancreatic duct stenting using a novel 4-Fr plastic stent would be at least similar or more feasible and safe compared to the conventional plastic stent.

[Successful Prophylactic Minocycline Treatment for Recurrent Helicobacter Cinaedi Sepsis during Chemotherapy in a Patient with Follicular Lymphoma].

A 63-year-old man with follicular lymphoma was administered standard R-CHOP chemotherapy. Six days after the second course of chemotherapy, the patient developed fever and chills. Blood cultures yielded rod-shaped gram-negative bacteria, but no further identification was obtained. High fever and chills returned on the fifth and sixth days after the third and fourth courses of R-CHOP, respectively. These blood cultures were also positive. Since we detected spiral-shaped gram-negative rods, we performed a prolonged culture during the febrile period after the fourth course of R-CHOP. This revealed the formation of characteristic film-like colonies, and Helicobacter cinaedi(H. cinaedi)bacteria was identified. After final identification, the patient was administered prophylactic minocycline treatment. Subsequent blood cultures were negative, fever did not recur, and we were able to complete 6 courses of R-CHOP. Although H. cinaedi has been reported to be a cause of sepsis in immunocompromised patients, standard correlation has not been established. Our case suggests that H. cinaedi should be considered when recurrent fever is observed after chemotherapy. Prophylactic antibiotic treatment with minocycline may prevent sepsis, as observed in our case.

[Bortezomib-associated acute congestive heart failure in a patient with multiple myeloma].

We report an 81-year-old woman with multiple myeloma who developed acute cardiac injury after receiving bortezomib. The patient received weekly intravenous bortezomib. She developed shortness of breath and bilateral pedal edema on day 19. Electrocardiography showed no ST-T changes but the cardio-thoracic ratio was increased, the ejection fraction was decreased, the ventricular septum showed hypokinesis and mitral regurgitation was noted. We stopped bortezomib and started acute congestive heart failure treatment. ST-T changes were detected after the patient's condition improved. There was no evidence of coronary stenosis on CT angiography. Acute cardiac injury is rare during bortezomib administration, but patients should be monitored carefully during treatment.

A simple algorithm for beam profile diagnostics using a thermographic camera.

A new algorithm for digital image processing apparatuses is developed to evaluate profiles of high-intensity DC beams from temperature images of irradiated thin foils. Numerical analyses are performed to examine the reliability of the algorithm. To simulate the temperature images acquired by a thermographic camera, temperature distributions are numerically calculated for 20 MeV proton beams with different parameters. Noise in the temperature images which is added by the camera sensor is also simulated to account for its effect. Using the algorithm, beam profiles are evaluated from the simulated temperature images and compared with exact solutions. We find that niobium is an appropriate material for the thin foil used in the diagnostic system. We also confirm that the algorithm is adaptable over a wide beam current range of 0.11-214 µA, even when employing a general-purpose thermographic camera with rather high noise (ΔT(NETD) ≃ 0.3 K; NETD: noise equivalent temperature difference).

(11)CH4 molecule production using a NaBH4 target for (11)C ion acceleration.

Solid-state materials suitable for use as proton irradiation targets were investigated for producing high-purity (11)CH4 molecules for heavy-ion cancer therapy. The radioactivity of gas produced by proton irradiation was measured for several target materials. Also, the radioactive molecular species of the produced gas were analyzed by radio gas chromatography. We found that 5 × 10(12) (11)C molecules could be collected by proton irradiation on a NaBH4 target. We also found that the (11)CH4 molecules were produced and collected directly from the irradiated target, owing to the hydrogen atoms bound in the solid-state NaBH4.

[Improvement of dose distributions at NIRS's 70 MeV proton eye treatment beam course]

In order to improve dose distributions at NIRS's 70 MeV proton eye treatment beam course, we introduced finer bar ridge filters, and examined the effects of range compensators. The pitch of new bar ridge filters was 5mm in contrast to 15mm pitch of old ones. A NC-machine recently available enabled this refinement. The spread out Bragg peak (SOBP) widths were 10, 15, 20 and 30 mm. The new ridge filters improved the field uniformity considerably. In the ridge filter design we assumed parallel beam condition in which the mono-energetic proton should proceed in parallel with the central axis, and bar ridges only changes the proton ranges. We searched empirically for the optimum wobbler radius in view of field flatness and depth dose distribution. Range shifter and compensator did not affect the field flatness and depth dose distribution at the optimum condition thus searched. We measured dose distribution in a phantom using a compensator of stairs-shape, which fairly modulated the beam. A 50% isodose line almost coincided with the compensator shape, and these results suggested that improvements of dose distributions should be possible using compensators. However width between 50% and 80% isodose lines depended on the thickness of phantom. This might be due to scattering in the compensator and suggests that it is necessary to calculate dose distribution taking account of such effects.