[Ciliated Muconodular Papillary Tumor of the Lung:Report of a Case].

Ciliated muconodular papillary tumor( CMPT) is a rare true pulmonary tumor consisting of bronchiolar cellular elements. Although this tumor cannot be classified as benign or malignant, it is mostly believed to be a benign bronchiolar adenoma. Recently, CMPT has been divided into two subtypes: proximal and distal. Herein, we report a case of a proximal type of CMPT containing abundant mucus cells in a 70-year-old woman. Thoracoscopic resection of the tumor in the left lower lobe was successfully performed, and the patient has been well without recurrence or metastasis for more than three years after surgery.

Incidence of esophageal injury after pulmonary vein isolation in patients with a low body mass index and esophageal temperature monitoring at a 39 °C setting.

BACKGROUND: Esophageal injury following catheter ablation of atrial fibrillation (AF) is reported to occur in 35% of patients. Even with a low energy setting (20-25 W), lesions develop in 10% of patients. Body mass index (BMI) has been reported to be a predictor of esophageal injury, indicating that patients with a low BMI (<24.9 kg/m(2)) are at a higher risk. We hypothesized that catheter ablation with a lower energy setting of 20 W controlled by esophageal temperature monitoring (ETM) at 39 °C could prevent esophageal injury even in patients with a BMI <24.9 kg/m(2). METHODS: Twenty patients with AF were included (age, 63±8 years; BMI, 22.9±1.3 kg/m(2), left atrium diameter, 44±11 mm). If the esophageal temperature probe registered a temperature of >39 °C, radiofrequency (RF) application was stopped immediately. RF application could be performed in a "point by point" manner for a maximum of 20 s. Endoscopy was performed 1-5 days after ablation. RESULTS: Esophageal mucosal injury was not observed in any patient in the study. CONCLUSIONS: Catheter ablation using ETM reduced the incidence of esophageal injuries, even in patients with a low BMI.

Visualizing radiofrequency lesions using delayed-enhancement magnetic resonance imaging in patients with atrial fibrillation: A modification of the method used by the University of Utah group.

BACKGROUND: Atrial tissue fibrosis has previously been identified using delayed-enhancement MRI (DE-MRI) in patients with atrial fibrillation (AF). Although the clinical importance of DE-MRI is well recognized, the visualization of atrial fibrosis and radiofrequency (RF) lesions has still not been achieved in Japan, primarily because of the differences in contrast agents, volume-rendering tools, and technical experience. The objective of this study was to visualize RF lesions by using commercially available tools. METHODS: DE-MRI was performed in 15 patients who had undergone AF ablation (age, 59±4 years, left atrium diameter, 40±2 mm). Specific parameters for MR scanning obtained from previous reports were modified. RESULTS: Of the 15 images, the images of three patients were uninterpretable owing to low image quality. RF lesions could be visualized in 8 (67%) of the 12 patients. CONCLUSIONS: In the current study, we successfully demonstrated that RF lesions could be visualized in Japanese patients using DE-MRI, although only commercially available tools were used.

Visualization of the radiofrequency lesion after pulmonary vein isolation using delayed enhancement magnetic resonance imaging fused with magnetic resonance angiography.

BACKGROUND: The radiofrequency (RF) lesions for atrial fibrillation (AF) ablation can be visualized by delayed enhancement magnetic resonance imaging (DE-MRI). However, the quality of anatomical information provided by DE-MRI is not adequate due to its spatial resolution. In contrast, magnetic resonance angiography (MRA) provides similar information regarding the left atrium (LA) and pulmonary veins (PVs) as computed tomography angiography. We hypothesized that DE-MRI fused with MRA will compensate for the inadequate image quality provided by DE-MRI. METHODS: DE-MRI and MRA were performed in 18 patients who underwent AF ablation (age, 60±9 years; LA diameter, 42±6 mm). Two observers independently assessed the DE-MRI and DE-MRI fused with MRA for visualization of the RF lesion (score 0-2; where 0: not visualized and 2: excellent in all 14 segments of the circular RF lesion). RESULTS: DE-MRI fused with MRA was successfully performed in all patients. The image quality score was significantly higher in DE-MRI fused with MRA compared to DE-MRI alone (observer 1: 22 (18, 25) vs 28 (28, 28), p<0.001; observer 2: 24 (23, 25) vs 28 (28, 28), p<0.001). CONCLUSIONS: DE-MRI fused with MRA was superior to DE-MRI for visualization of the RF lesion owing to the precise information on LA and PV anatomy provided by DE-MRI.

[Disseminated carcinomatosis of the bone marrow in two patients with prostate cancer].

Disseminated carcinomatosis of the bone marrow is caused by metastasis to the bone marrow and can cause disseminated intravascular coagulation (DIC), leucoerythroblastosis, and microangiopathic hemolytic anemia (MHA). The prognosis of this syndrome is poor. We report herein two rare cases of disseminated carcinomatosis of the bone marrow in association with prostate cancer. Case 1 involved a 61-year-old man admitted to our department with elevated prostate-specific antigen (PSA) levels. Prostate biopsy revealed prostate cancer, and imaging studies were performed. Under a diagnosis of prostate cancer (T3N1Mx), the patient was treated using hormonotherapy, but died 2 months after admission due to gastrointestinal bleeding of unknown cause, refractory DIC, and cachexia. Bone marrow biopsy after his death revealed metastasis of the prostate cancer to the bone marrow. Case 2 involved a 68-year-old man admitted to our department with gross hematuria. Cystoscopy revealed non-papillary tumor in the prostatic urethra. Transurethral biopsy was performed and histology identified prostate cancer. Treatment was initiated with hormonotherapy and zoledronate. After 8 months, he complained of general fatigue and blood testing identified anemia and thrombocytopenia. Bone marrow biopsy revealed adenocarcinoma in the bone marrow. Alternative androgen therapy and chemotherapy with docetaxel was started, and the patient recovered from pancytopenia and general fatigue.