Usefulness of computed tomography with air insufflation of the stomach prior to percutaneous endoscopic gastrostomy procedure.

We examined the results of computed tomography (CT) with and without air insufflation of the stomach prior to performing percutaneous endoscopic gastrostomy (PEG). We retrospectively analyzed 366 patients who underwent PEG. CT images obtained with and without air insufflation were examined for the presence or absence of contact between the gastric anterior wall and abdominal wall. PEG outcome based on CT findings was also examined. CT with and without air insufflation was performed in 272 and 94 patients, respectively. Contact between the gastric anterior wall and abdominal wall was shown in 254 (93.4%) with and 45 (47.9%) without air insufflation, all of whom underwent a successful PEG procedure. In patients without contact between the gastric anterior wall and abdominal wall, PEG was not successful in 3 of 49 (6.1%) examined by CT without and 6 of 18 (33.3%) examined with air insufflation (p = 0.004). Values for diagnostic accuracy for contact between the gastric anterior wall and abdominal wall shown by CT with and without air insufflation in successful PEG cases were 0.96 and 0.51, respectively. In conclusion, CT with air insufflation more often revealed contact between the gastric anterior wall and abdominal wall as compared to CT without air insufflation, which may help to predict PEG procedure success.

Ulcerative colitis associated with isolated unilateral hypoglossal nerve palsy.

We herein describe a rare case of ulcerative colitis associated with unilateral hypoglossal nerve palsy. A 64-year-old woman developed severe active ulcerative colitis and was treated with prednisolone. The dose of oral prednisolone was reduced to 7.5 mg/day, following which the patient noticed slight dysphagia and a speech disturbance. She was diagnosed with unilateral hypoglossal nerve palsy, which was thought to be caused by mononeuritis. She was treated with intravenous methylprednisolone at a dose of 500 mg/day, which improved the neuropathy. When the neuropathy occurred, the patient was in a mildly active stage of ulcerative colitis. We concluded that the mononeuritis observed in the present case was likely an extraintestinal manifestation of ulcerative colitis.

[Pulmonary thromboembolism during the Niigata Chuetsu earthquake in 2004].

We encountered 2 cases of pulmonary thromboembolism developed during refuge for Niigata Chuetsu earthquake in 2004. Case 1 was a 76-year-old woman who moved to the back seat of a car for refuge since the earthquake struck on October 23rd, 2004. When she emerged from the car on the morning of October 25th, she felt sudden dyspnea and lost consciousness. On arrival at the hospital, she had low blood pressure and hypoxemia, hypocapnia, and metabolic acidosis. Based on her clinical history and her symptoms, pulmonary thromboembolism was suspected and heparinization was begun immediately. In our hospital, the chest CT angiography proved the diagnosis. She was transferred to a university hospital for further treatment. Case 2 was a 79-year-old woman. She spent only one night in a car. Fifteen days after the earthquake, chest tightness and dyspnea occurred. Although her symptoms were improved and disappeared, she came to our hospital. Chest CT images confirmed pulmonary thromboembolism, and treatment with heparin was begun. We think this pulmonary thromboembolism was related to the knee-bending position she had assumed in the car and decreased activity during refuge. This is a clinical condition which could happen during disasters in the future. We should recognize the likelihood of pulmonary thromboembolisms in the disasters in the future.

Thrombosis in inferior vena cava (IVC) due to intra-cystic hemorrhage into a hepatic local cyst with autosomal dominant polycystic kidney disease (ADPKD).

A 76-year-old man with autosomal dominant polycystic kidney disease (ADPKD) was admitted complaining of severe edema of bilateral lower extremities. Computed tomography (CT) of his abdomen revealed an enlarged hepatic cyst with intra-cystic hemorrhage, and massive thrombosis in the inferior vena cava (IVC). The extrinsic mechanical stress on the IVC seemed to induce thrombosis within the IVC, and the thrombosis was likely the cause of severe edema in lower extremities. In this report, we present a rare case of IVC thrombosis due to an enlarged cyst in ADPKD successful treated with anticoagulant therapy.

Carcinosarcoma of the esophagus characterized by myoepithelial and ductal differentiations.

We report a case of carcinosarcoma of the esophagus characterized by ductal and myoepithelial differentiation. A 61-year-old man was operated on for a polypoid tumor of the distal esophagus. Histologically, this tumor was composed of ductal structures and sarcomatous spindle cells surrounding the ducts at the central area of the tumor. The tumor was also composed of squamous cell and basaloid carcinoma in the periphery. Immunohistochemically, a few spindle cells surrounding the ductal structures showed immunopositivity for alpha-smooth muscle actin and S-100 protein. Electron microscopy revealed that the spindle cells had tonofilament and pinocytic vesicles in the cytoplasm, and basal lamina adjacent to the cytoplasmic membrane. Both of the results strongly supported the suggestion that the spindle cells may be myoepithelial cells. Basaloid carcinoma showed a gradual transition to chondrosarcomatous cells producing the matrix, which had both immunopositivities for S-100 protein and cytokeratin. Therefore, chondrosarcomatous cells may be derived from carcinoma cells. The histogenesis of this tumor may be associated with a totipotent stem cell of esophageal mucosa, which has the potential to differentiate into squamous cells, ductal cells or myoepithelial cells.