Uterine Cervical Adenosarcoma Showing an Endophytic Growth Pattern.

Adenosarcomas are biphasic neoplasms that usually originate in the uterine corpus and comprise a benign epithelial component and a malignant stromal component. Uterine adenosarcomas typically present with abnormal genital bleeding, an enlarged uterus, and a tumor that protrudes into the endometrial cavity. These tumors rarely protrude through the cervical os and are often misdiagnosed as cervical polyps. We present the case of a patient with cervical adenosarcoma with characteristics different from those reported in previous cases. This tumor showed endophytic growth, which is rare in cervical adenosarcomas. No watery discharge or obvious genital bleeding was noted. Although the tumor measured 4 cm, vaginal bleeding was noted only once at 6 months before diagnosis and was in the form of faint brown discharge.

Long-term outcomes of endovascular aortic aneurysm repair with the Zenith AAA endovascular graft: a single-center study.

PURPOSE: To present long-term results obtained with endovascular abdominal aortic aneurysm (AAA) repair (EVAR) using the Zenith AAA endovascular graft from a single institution. MATERIALS AND METHODS: Between 2007 and 2013, 95 consecutive patients (median age 77 years) underwent EVAR using Zenith. Data were prospectively collected and retrospectively analyzed until 2019. Primary outcomes were overall survival, freedom from AAA rupture, and freedom from AAA-related death. Secondary outcomes were freedom from late (> 30 days) re-intervention and surgical conversion, and freedom from aneurysm sac growth (> 5 mm). RESULTS: The initial technical success rate was 96.8%. There were no deaths or intraoperative conversions. Overall survival at 1, 3, 5, and 10 years was 90.8%, 81.7%. 74.3%, and 57.2%, respectively. AAA rupture occurred in one patient (1.1%). Freedom from AAA-related death was 100% during the follow-up period. Freedom from aneurysm sac growth at 1, 3, 5, and 10 years was 98.8%, 86.4%, 76.9%, 53.0%, respectively. Freedom from late re-intervention and open surgical conversion at 1, 3, 5, and 10 years was 98.9%, 88.9%, 86.7, and 57.9%, respectively. CONCLUSION: EVAR with Zenith endografts represents a safe and durable means of AAA repair, and risk of rupture and aneurysm-related death are low.

Endovenous Treatment for Acute Massive Pulmonary Thromboembolism.

Treatment for venous thromboembolic conditions differs significantly depending on whether the condition is acute or chronic. Endovenous treatment is now available for treating the most severe cases of acute massive pulmonary thromboembolism, and the goal is rapid central clot removal to relieve life-threatening pulmonary circulation. Endovenous catheter interventions include catheter-directed thrombolysis and catheter-assisted thrombus removal. The latter is divided into aspiration thrombectomy, fragmentation, and rheolytic thrombectomy. Data from cohort studies indicate that the clinical outcome and safety after open surgical treatment and endovenous treatment may be comparable. This paper reviews the current approaches to endovenous treatment for acute massive pulmonary thromboembolism, and presents our study of hybrid treatment using a combination of local fibrinolysis, mechanical fragmentation, and clot aspiration.

Treatment of nostril and nasal stenosis due to facial burn using a self-expandable metallic esophageal stent.

For the treatment of nasal and nostril stenosis caused by facial burn, it is necessary to perform rhinoplasty and nasal vestibuloplasty using various flaps, perform cicatrectomy of the nostrils with a rhinosurgical procedure, and prevent restenosis of the nostrils and nasal cavity for a certain period by methods such as placement of a nasal retainer or transnasal airway and gauze packing of the nasal cavity. With all methods, postoperative placement of a retainer or nasal treatment is necessary for the prevention of postoperative restenosis, and the patient's cooperation is essential. In a patient who did not cooperate in postoperative treatments due to autism and had recurrences of nasal and nostril stenosis after conventional surgical treatments, adequate patency of the nasal cavity and nostrils could be maintained with minimal postoperative treatment by placing a self-expandable metallic esophageal stent.

A new method for differentiating benign and malignant pleomorphic clustered calcifications in mammography.

OBJECTIVE: Retrospective study to determine whether new mammography imaging characteristics can improve identification of an isolated cluster of coarse heterogeneous and fine pleomorphic calcifications as benign or malignant. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. The study included 123 women (mean age, 50 years: age range, 34-79 years), in whom mammograms had found pleomorphic clustered calcifications, but without abnormal ultrasound findings and who underwent stereotactically-guided vaccum-assisted breast biopsy. Pleomorphic clustered calcifications were classified on the basis of 5 characteristics density, heterogeneity of density, number, heterogeneity of size, and distribution area size (DAS) of calcifications in the mediolateral oblique view (multiplication of the greatest length by the width of the total zone of clustered calcifications in mm(2)), and correlated with pathological findings. RESULTS: The chi-square test showed significant differences in whether a calcification was malignant or benign only in terms of DAS of calcification (p 0.009). There were significant differences in the association with malignancy of a DAS of 32- to 55 mm(2) (p=0.023, odds ratio=4.22), and the association more likely with a DAS of 56 mm(2) or larger (p=0.01, odds ratio=5.55) than with a DAS smaller than 18 mm(2) as a reference. CONCLUSION: The DAS is a new and reliable variable for differentiating between benign and malignant pleomorphic clustered calcifications. The DAS improves diagnostic accuracy and is useful for determining whether to proceed with biopsies.

Angiography-assisted computed tomography for the detection and intervention of a subtle aneurysm of the omentum.

Intra-abdominal hemorrhage caused by omental artery rupture is a rare condition traditionally diagnosed via exploratory laparotomy in hemodynamically unstable patients. We experienced a case in which contrast-enhanced multidetector computed tomography (MDCT) and digital subtraction angiography did not identify the rupture site, whereas CT during left omental arteriography depicted a small 4-mm aneurysm. The lesion was then embolized with microcoils and N-butyl cyanoacrylate lipiodol glue. We consider that performing a CT during selective arteriography could be useful in cases in which the rupture site is unclear with other imaging techniques such as contrast-enhanced MDCT and digital subtraction angiography.

Relationships among regional diastolic impairment, elongation of global time to peak filling rate, and global diastolic function using ECG-gated myocardial perfusion SPECT in heart failure.

OBJECTIVE: The relationships among regional diastolic impairment, the elongation of global time to peak filling rate (g-TPF), and global diastolic function were examined by a novel program using electrocardiography-gated myocardial perfusion single-photon emission computed tomography (SPECT) (GMPS) in heart failure (HF). METHODS: Fifteen control subjects and 70 HF patients, New York Heart Association functional classification I (N-1) 41 cases, classification II (N-II) 15 cases, and classification III (N-III) 14 cases, were examined by GMPS. Using the reference mean +2 SD (standard deviation) of g-TPF derived from control group (CG), HF patients were divided into a normal g-TPF group (NG) and elongated g-TPF group (EG). The distributions of g-TPF and regional (r-) TPF were estimated by histograms. The extension of regional diastolic impairment was estimated by the number of r-TPF elongated segments (NES). RESULTS: g-TPF and r-TPF mainly distributed from 100 ms to 220 ms and demonstrated a peak around 150 ms in CG and NG. g-TPF distributed from 240 ms to 560 ms, but r-TPF distributed from 90 ms to 690 ms and demonstrated two peaks around 150 ms and 350 ms in EG. NES significantly correlated with g-TPF (r=0.79, P=6x10(-10) in N-I; r=0.69 and P<0.005 in N-II; r=0.89, P=2x10(-5) in N-III). NES negatively correlated with first third filling fraction (1/3FF) (r=-0.83, P=3x10(-11) in N-I; r=-0.72, P<0.0005 in N-II) and first third filling rate (1/3FR) (r=-0.49, P=0.002 in N-I; r=-0.52, P=0.002 in N-II; r=-0.81, P<0.0005 in N-III). g-TPF significantly correlated with 1/3FF (r=-0.67, P=1.5x10(-6) in N-I; r=-0.69, P<0.005 in N-II) and 1/3FR (r=-0.41, P<0.01 in N-I; r=-0.69, P<0.01 in N-III). CONCLUSIONS: The development of regional early diastolic impairment makes g-TPF elongation and induces global dysfunction in early diastole.

Global and regional evaluation of systolic and diastolic left ventricular temporal parameters using a novel program for ECG-gated myocardial perfusion SPECT--validation by comparison with gated equilibrium radionuclide angiography and speckle-tracking radial strain from echocardiography.

BACKGROUND: A newly developed program, named cardioGRAF, enabled the evaluation of left ventricular (LV) systolic and diastolic temporal parameters for the estimation of heart failure using ECG-gated myocardial perfusion SPECT (GMPS). OBJECTIVE: The feasibility of those global (g-) and regional (r-) parameters was validated to compare with gated equilibrium radionuclide angiography (ERNA) and speckle-tracking radial strain (STS) from echocardiography. METHODS: Thirty-three patients were studied using GMPS and ERNA (n=11) or GMPS and STS (n=22). The following g- or r-parameters obtained by cardioGRAF and ERNA or STS were compared: time to end systole (TES), time from end systole to peak filling rate (TPF1), time from 0 to peak filling rate (TPF2), time to peak radial strain (TPS), time from peak strain to peak negative strain rate (TP-SR1), and time from 0 to peak negative strain rate (TP-SR2). RESULTS: All g-parameters were successfully obtained by cardioGRAF and ERNA. The results demonstrated good correlations (g-TES: r = 0.79, p < 0.005; g-TPF1: r = 0.75, p < 0.02; TPF2: r = 0.83, p < 0.005). The differences were 11.9 +/- 31.8 ms in g-TES, 19.9 +/- 65.4 ms in g-TPF1, and 37.7 +/- 67.4 ms in g-TPF2. All r-parameters were successfully obtained by cardioGRAF. Eight patients and 12 segments were excluded because of the inadequate quality of routine echocardiography for STS analysis. However, r-parameters obtained by cardioGRAF were significantly correlated with those of STS (r-TES and r-TPS: r = 0.61, p = 1 x 10(-8); r-TPF1 and r-TP-SR1: r = 0.69, p = 3 x 10(-11); r-TPF2 and r-TP-SR2: r = 0.76, p = 2 x 10(-15)). The differences were 22.1 +/- 38.2 ms between r-TES and r-TPS, 7.0 +/- 123.4 ms between r-TPF1 and r-TP-SR1, and 38.1 +/- 111.5 ms between r-TPF2 and r-TP-SR2. CONCLUSION: The feasibility of evaluating systolic and diastolic temporal parameters by a new program was validated. This program has the potential to evaluate both diastolic and systolic heterogeneous wall motions which express dyssynchrony in heart failure.