Transradial approach for coil embolization of a ruptured intracranial aneurysm during pregnancy to minimize fetal radiation exposure.

Endovascular treatment of aneurysmal subarachnoid hemorrhage during pregnancy involves a risk of intraoperative radiation exposure to the fetus. The transradial approach does not require fluoroscopy of the maternal abdominopelvic region, which reduces fetal radiation exposure. We report a case of a female at 21 gestation weeks who developed subarachnoid hemorrhage due to a ruptured right posterior communicating artery aneurysm. The patient underwent balloon-assisted coil embolization via the transradial approach, which achieved aneurysmal obliteration with minimal fetal radiation exposure and without puncture site complications. The patient was free from neurological sequelae. Further, the patient delivered a healthy newborn through an elective cesarean section at 37 gestation weeks without any complications. The transradial approach allows endovascular treatment of ruptured intracranial aneurysms during pregnancy, with minimal risks of fetal radiation exposure.

Effects of acute angle, proximal bending, and distal bending in the deployment vessels on incomplete low-profile visualized intraluminal support (LVIS) expansion: an in vitro study.

BACKGROUND: A low-profile visualized intraluminal support (LVIS) device may incompletely expand during stent deployment in tortuous vessels. However, the cause of incomplete expansion remains uninvestigated. We aimed to examine in vitro the factors causing incomplete expansion in LVIS deployment by using various vessel models. METHODS: A linear model group was created by connecting linear silicone tubes (inner diameter 4 mm) at both sides of the LVIS deployment vessel (inner diameter 4 mm) with different curvature angles of 10-140° at 10° intervals. For comparison, proximal and distal bending model groups were created, both with 90° bending on the proximal/distal larger curvature side of the deployment vessel. A single operator macroscopically deployed an LVIS (4.5×32 mm) four times in each model and 56 times in each group. RESULTS: In each model group the LVIS deployment vessel with a narrow curvature angle incompletely expanded. Incomplete expansion occurred significantly more frequently in the distal bending model group (34%, 19/56) compared with that in the linear model group (14.3%, 8/56; p<0.001), as well as in the proximal bending model group (59%, 33/56) compared with that in the distal bending model group (p<0.05). Compared with the linear model group, the proximal bending model group had a significantly reduced angle between the LVIS and the direction of the LVIS pushing force, but no significant change was found in the distal bending model group compared with that in the linear model group. CONCLUSIONS: Factors such as acute angle, distal bending, and proximal bending of the deployment vessel can cause incomplete LVIS expansion.

Usefulness of 18F-fluorodeoxyglucose positron emission tomography for diagnosing disease activity and monitoring therapeutic response in patients with pulmonary mycobacteriosis.

PURPOSE: To evaluate the usefulness of (18)F-FDG PET in the imaging of pulmonary lesions related to disease activity and in monitoring responses to treatment in patients with pulmonary mycobacteriosis (PM). MATERIALS AND METHODS: We used high-resolution computed tomography (HRCT) and (18)F-FDG PET to evaluate 47 consecutive untreated patients with PM, 25 with tuberculosis (TB) and 22 with Mycobacterium avium-intracellulare complex (MAC), who presented with small peripheral pulmonary nodules

Evaluation of dual-time-point 18F-FDG PET for staging in patients with lung cancer.

UNLABELLED: (18)F-FDG PET is increasingly used for lung cancer; however, some insufficient results have been reported. The purpose of this study was to evaluate the efficacy of dual-time-point (18)F-FDG PET for staging lung cancer and for differentiating metastatic from nonmetastatic lung cancer lesions. METHODS: One hundred fifty-five lung cancer patients with known or suspected mediastinal and hilar lymph node involvement or distant metastases underwent whole-body (18)F-FDG PET at 2 time points: scan 1 at 60 min (early imaging) and scan 2 at 180 min (delayed imaging) after (18)F-FDG injection. (18)F-FDG PET findings of nodal and distant metastases were evaluated using conventional imaging, clinical follow-up findings, and the results of autopsy or biopsy. RESULTS: A total of 580 lesions (155 primary lesions, 315 metastatic lesions, and 110 nonmetastatic lesions) were used for analysis. A closer correlation between the primary lesions and metastases was observed for the retention index (RI) standardized uptake value (SUV) than for early and delayed SUV. There was no relationship between the RI SUV results of primary lesions and those of nonmetastatic lesions. The RI SUV of metastatic lesions was approximately 0.5-2 times the RI SUV of primary tumors. We found that the accuracy of (18)F-FDG PET was improved when RI SUV was used for detecting lymph node and distant metastases, because of the significant improvement in specificity relative to early and delayed SUV. CONCLUSION: RI SUV raised the accuracy for diagnosis of metastases and was superior to early and delayed imaging in terms of differentiating malignancy from nonmetastatic uptake.

[FDG-PET findings of nodular pulmonary amyloidosis with a long-term observation].

A 60-year-old woman was referred to our hospital because of an abnormal chest radiograph in May, 2000. She was found to have rheumatoid arthritis in March, 1998, and pharmacologic therapy with anti-rheumatic drug was started. The chest CT scan revealed bilateral multiple lung nodular lesions of various sizes up to 30 mm. F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) demonstrated a lesion with intense FDG activity in the right lung with a standardized uptake value (SUV) of 10.1. Fiberoptic bronchoscopy revealed no endobronchial lesions. Video-assisted thoracoscopic surgery was done to ascertain the pathological diagnosis. Histological examination showed that the pulmonary nodules were composed of amyloid A (AA) protein. Secondary Sjögren syndrome was subsequently diagnosed. A diagnosis of localized nodular pulmonary amyloidosis with AA type amyloid protein was made, and therapy with anti-rheumatic drugs was continued. After six years of therapy, the size of pulmonary amyloidoma was reduced, and the accumulation of FDG returned to normal. We reported this interesting case in which FDG-PET apparently reflected the disease activity of pulmonary amyloidosis.

[Evaluation of FDG-PET imaging for the detection of gastrointestinal tract cancer in patients with suspected lung cancer].

This study evaluated 18F-FDG-PET imaging for the detection of gastrointestinal tract cancer in patients with suspected lung cancer. A total of 351 patients who had abnormal lung shadows and who underwent whole-body FDG-PET between June 1998 and January 2006 were retrospectively entered for analysis. Gastrointestinal tract cancers were subsequently found in 15 patients (4.3%) who had been found to have lung diseases consisting of 7 inflammatory changes, 6 lung cancers, and 2 metastatic lung carcinomas, 9 colon cancers, 4 gastric cancers, and 2 esophageal cancers. Five patients (2 colon cancers, 2 gastric cancers, and 1 esophageal cancer) had early stage carcinoma. In this study, FDG-PET was useful not only for the diagnosis and staging of lung cancer, but also for the detection of unexpected gastrointestinal tract cancers. FDG-PET may be most suitable for cancer screening.

[A case of bilateral diaphragmatic paralysis clinically suggestive of brachial neuritis].

A 55-year-old man complained of acute onset of shoulder pain and dyspnea in the supine position. A diagnosis of bilateral diaphragmatic paralysis was made based on clinical inspection of his breathing pattern, radiographic appearance, and pulmonary function tests. He had had no traumatic or thoracic surgery or inflammatory episode. He did not suffer from diabetes, other central neural diseases, or any neoplastic disease. From the clinical feature and electromyographic findings, phrenic nerve involvement of brachial neuritis without any other muscle involvement was considered as a causative disease. When he received non-invasive intermittent positive-pressure ventilation by nasal mask in a supine position, his dyspnea was substantially attenuated and Carbon dioxide retention was lessened. After 1 year, his shoulder pain is still persisting and radiographic findings are not remarkably improved.

Reappraisal of clindamycin IV monotherapy for treatment of mild-to-moderate aspiration pneumonia in elderly patients.

BACKGROUND: As the number of elderly people has increased in Japan, the occurrence of aspiration pneumonia has also increased. Guidelines for the treatment of pneumonia have been proposed, in which the use of antibiotics, such as beta-lactam plus beta-lactamase inhibitor, clindamycin, and carbapenem, has been recommended as effective against anaerobic bacteria in the treatment of aspiration pneumonia. However, to our knowledge, a prospective comparison of these antibiotics regarding their clinical efficacy in aspiration pneumonia has not been performed. STUDY OBJECTIVES: We compared the effects of IV administration of a half dose of ampicillin/sulbactam (SBT/ABPC), normal dose of SBT/ABPC, IV clindamycin, and IV panipenem/betamiprom (PAPM/BP) for treatment of mild-to-moderate aspiration pneumonia in elderly patients. DESIGN: Randomized prospective study. PATIENTS: One hundred adult patients with compatible signs and symptoms of aspiration pneumonia. ASSESSMENTS: Patients were assessed before, during, and after treatment regarding symptoms, as well as results of laboratory values, chest radiograph examinations, and sputum bacterial cultures. RESULTS: We found few differences between the groups regarding cure rate, duration of IV medication, and occurrence of adverse effects with the tested therapies. However, clindamycin therapy was less expensive and was associated with a lower rate of posttreatment occurrence of methicillin-resistant Staphylococcus aureus. CONCLUSIONS: Clindamycin therapy for mild-to-moderate aspiration pneumonia is clinically effective, and provides economic advantages as compared to SBT/ABPC or PAPM/BP therapy.