Common and uncommon vascular injuries and endovascular treatment associated with pelvic blunt trauma: a real-world experience.

Pelvic fractures are common in cases of blunt trauma, which is strongly associated with mortality. Transcatheter arterial embolization is a fundamental treatment strategy for fatal arterial injuries caused by blunt pelvic trauma. However, vascular injuries due to blunt pelvic trauma can show various imaging findings other than arterial hemorrhage. We present a pictorial review of common and uncommon vascular injuries, including active arterial bleeding, pseudoaneurysm, arteriovenous fistula, arterial occlusion, vasospasm, and active venous bleeding. Knowledge of these vascular injuries can help clinicians select the appropriate therapeutic strategy and thus save lives.

Feasible and technical aspects of transcatheter arterial chemoembolization for non-resectable hepatocellular carcinoma using a 3.5-French catheter system.

PURPOSE: To evaluate the feasibility and technical aspects of transcatheter arterial chemoembolization (TACE) for non-resectable hepatocellular carcinoma (HCC) using a 3.5-French (Fr) catheter system. METHODS: This study included 328 consecutive cases of HCC among 232 patients who underwent TACE procedures using both a 3.5-Fr catheter system and a microcatheter fitted to a 3.5-Fr system between April 2009 and November 2011. We assessed the ability to reach the catheter into the proper hepatic artery (PHA), main hepatic branch, segmental artery, and subsegmental or sub-subsegmental artery. The feasibility was rated according to the following factors: (1) the number of arteries that could be used to reach the target artery/total number of procedures using the 3.5-Fr system, (2) the rate of successful completion of the procedures without changing over to the 4-Fr system and (3) the reasons for changing over the 4-Fr system. RESULTS: TACE of the PHA (27 sessions), RHA/LHA (103 sessions), segmental (31 sessions), or subsegmental/sub-subsegmental arteries (162 sessions) was performed. The rate of successfully reaching the target artery using the 3.5-Fr system was 93% (306/328 sessions). We were unable to reach the target artery in 22 sessions, including 11/8/3 procedures targeting the sub-subsegmental artery, subsegmental artery, and RHA/LHA, respectively. We changed over to the 4-Fr system in six sessions; therefore, the rate of successful completion of the procedures without changing over to the 4-Fr system was 98% (322/328 sessions). CONCLUSIONS: TACE of the target artery can be successfully performed using the 3.5-Fr system in most patients with HCC.

Continuous imaging of esophagogastric junction in patients with reflux esophagitis using 320-row area detector CT: a feasibility study.

BACKGROUND AND AIM: The function of the lower esophageal sphincter (LES) is evaluated using an esophageal manometric study. However, information regarding the surrounding organs is difficult to obtain with use of a sensor catheter. We investigated the utility of 320-row area detector computed tomography (CT) to evaluate morphological changes of the esophagogastric junction and surrounding organs. METHODS: The study subjects were 18 healthy volunteers and 29 patients with reflux esophagitis (RE). Immediately after swallowing a diluted contrast agent, continuous imaging of the esophagogastric junctional area was performed for 15 s. Using CT images, the presence or absence of esophageal hiatal hernia, His angle before and after swallowing, size of the diaphragmatic hiatus, morphologically identified-LES (MI-LES) length, intraluminal horizontal area of MI-LES during relaxation phase, MI-LES thickness, abdominal esophagus length, subcutaneous fat area, visceral fat area, and esophagogastric junction fat area were evaluated. RESULTS: Analysis of CT images showed more frequent occurrence of hiatal hernia, greater His angle, and a larger diaphragmatic hiatus in patients with severe RE, while the lengths of MI-LES and abdominal esophagus were shorter in those patients. Visceral and esophagogastric junction fat areas tended to be greater in patients with RE. In all subjects, the posterior wall of the MI-LES was thicker than the anterior wall. CONCLUSION: Continuous imaging with 320-row area detector CT is useful to evaluate morphological changes in the esophagogastric junction area in both normal individuals and patients with reflux esophagitis.

Ruptured left colic arterial aneurysm treated by transcatheter arterial embolization alone and without a subsequent laparotomy: report of a case.

We herein report the case of a 49-year-old male patient with a ruptured aneurysm originating in the left colic artery, which was successfully treated by transcatheter arterial embolization (TAE) Abdominal computed tomography revealed a large hematoma with a central small aneurysm in the left upper abdomen. Celiac and superior mesenteric arteriography showed no dye extravasation. Subsequent aortography showed an aneurysm arising from the branch of the left colic artery that was successfully treated by selective TAE. Further surgery for subsequent ischemia was not performed. In cases presenting with an unclear source of intraabdominal bleeding, an aneurysm of the inferior mesenteric arterial branch should be considered. Transcatheter arterial embolization is a plausible initial treatment option as an effective therapeutic approach because it provides a curative and less invasive alternative to other therapies. Based on our experience and a review of the literature, surgery may not necessarily be imperative, even in cases of a ruptured aneurysm of a colic arterial branch after TAE.

Potential hippocampal region atrophy in diabetes mellitus type 2: a voxel-based morphometry VSRAD study.

PURPOSE: Among diabetes mellitus type 2 (DM2) patients, the frequency of cognitive dysfunction is higher and the relative risk of Alzheimer's disease (AD) is approximately twice that of nondiabetics. Cognitive impairment symptoms of AD are induced by limbic system dysfunction, and an early-stage AD brain without dementia has the potential for atrophy in the hippocampal region. In this study, we estimated potential hippocampal region atrophy in DM2 and pursued the association between DM2 and cognitive impairment/AD. MATERIALS AND METHODS: Voxel-based morphometry analysis was performed in 28 diabetics (14 men, 14 women; ages 59-79 years, mean 70.7 years) and 28 sex- and agematched (+/-1 year) nondiabetics. Severity of gray matter loss in the hippocampal region and whole brain were investigated. Group analysis was performed using twotailed unpaired t-test; significance was assumed with less than 1% (P < 0.01) of the critical rate. RESULTS: There was a significant difference between diabetics and nondiabetics regarding the severity of hippocampal region atrophy and whole-brain atrophy. Only diabetics showed a positive correlation for severity of hippocampal region atrophy and whole-brain atrophy (rs = 0.69, P < 0.0001). CONCLUSION: Aged DM2 patients have the potential for hippocampal region atrophy, and its dysfunction can be related to the expression of a cognitive impairment that resembles AD.