An unusual developmental anomaly of duplicated portal vein.

BACKGROUND: Portal vein (PV) duplication is a rare developmental anomaly but has an important role in the diagnosis and management of disease for radiologists and surgeons. MATERIALS AND METHODS: A new variant of PV duplication with vein fenestration leading to choledochal stenosis and dilatation and thrombus was identified by computed tomography angiography (CTA) on a 59-year-old woman with a history of gallstones. RESULTS: A second PV originated from the superior mesenteric vein (SMV), split into two branches that encircling the common bile duct to form a vein fenestration, leading to choledochal stenosis and dilatation, with thrombus formation at the confluence. CONCLUSIONS: This case report adds to the existing body of knowledge about the variation of the PV system. We present an embryological perspective for the case, which suggests the possibility of similar occurrences.

Superparamagnetic core/shell GoldMag nanoparticles: size-, concentration- and time-dependent cellular nanotoxicity on human umbilical vein endothelial cells and the suitable conditions for magnetic resonance imaging.

BACKGROUND: GoldMag nanoparticles (GMNPs) possess the properties of colloid gold and superparamagnetic iron oxide nanoparticles, which make them useful for delivery, separation and molecular imaging. However, because of the nanometer effect, GMNPs are highly toxic. Thus, the biosafety of GMNPs should be fully studied prior to their use in biomedicine. The main purpose of this study was to evaluate the nanotoxicity of GMNPs on human umbilical vein endothelial cells (HUVECs) and determine a suitable size, concentration and time for magnetic resonance imaging (MRI). RESULTS: Transmission electron microscopy showed that GMNPs had a typical shell/core structure, and the shell was confirmed to be gold using energy dispersive spectrometer analysis. The average sizes of the 30 and 50 nm GMNPs were 30.65 ± 3.15 and 49.23 ± 5.01 nm, respectively, and the shell thickness were 6.8 ± 0.65 and 8.5 ± 1.36 nm, respectively. Dynamic light scattering showed that the hydrodynamic diameter of the 30 and 50 nm GMNPs were 33.2 ± 2.68 and 53.12 ± 4.56 nm, respectively. The r 2 relaxivity of the 50 nm GMNPs was 98.65 mM(-1) s(-1), whereas it was 80.18 mM(-1) s(-1) for the 30 nm GMNPs. The proliferation, cytoskeleton, migration, tube formation, apoptosis and ROS generation of labeled HUVECs depended on the size and concentration of GMNPs and the time of exposure. Because of the higher labeling rate, the 50 nm GMNPs exhibited a significant increase in nanotoxicity compared with the 30 nm GMNPs at the same concentration and time. At no more than 25 µg/mL and 12 hours, the 50 nm GMNPs exhibited no significant nanotoxicity in HUVECs, whereas no toxicity was observed at 50 µg/mL and 24 hours for the 30 nm GMNPs. CONCLUSIONS: These results demonstrated that the nanotoxicity of GMNPs in HUVECs depended on size, concentration and time. Exposure to larger GMNPs with a higher concentration for a longer period of time resulted in a higher labeling rate and ROS level for HUVECs. Coupled with r 2 relaxivity, it was suggested that the 50 nm GMNPs are more suitable for HUVEC labeling and MRI, and the suitable concentration and time were 25 µg/mL and 12 hours.

Anesthetic management of conjoined twins undergoing one-stage surgical separation: A single center experience.

OBJECTIVE: To summarize our experience in the anesthetic management of conjoined twins undergoing one-stage surgical separation. METHODOLOGY: Medical records of conjoined twins admitted to our hospital for treatment and considered for surgical separation from 1996 to present were retrospectively reviewed. Four cases of conjoined twins underwent one-stage surgical separation under general anesthesia. Preoperative evaluation was performed to determine the extent of anatomical conjunction and associated anomalies. Anesthesia was simultaneously induced in all conjoined twins. The intubation procedure was successfully performed with the head slightly rotated to each baby's side, followed by the administration of vecuronium. Anesthetic agents were administered according to the estimated weight of each baby. One case of conjoined twins underwent surgical separation with cardiopulmonary bypass due to shared hearts. Results : All conjoined twins were successfully separated. No significant respiratory or cardiac events occurred during surgery except for one twin, which died after separation because of complicated congenital heart disease. Conclusions : Accurate preoperative evaluation, respiratory and circulatory management, and close cooperation of the multidisciplinary team are important aspects of anesthetic management of conjoined twins surgery.

[Imaging diagnosis of the vertebral injury in earthquake].

OBJECTIVE: To explore the clinical value of imaging diagnosis of the vertebral injury in earthquake. METHODS: Twenty-two cases of the vertebral injury in earthquake with clinical and imaging data were analyzed retrospectively. All of the cases were performed X-ray plain film examination, CT in 20 cases and MRI in 15 cases. RESULTS: Imaging examination can establish definitive diagnosis in all cases. In the 22 cases, the vertebral compression fracture was found in 20 cases, and vertebral bursting fracture in 2 cases,single-level vertebral fracture in 12 case,and multiple-level vertebral fracture in 10 case. Among the 31 vertebral bodies of fracture, the fracture of cervical vertebra, thoracic vertebra, lumbar vertebra and sacral vertebra was found in 3, 12, 14, 2 vertebral bodies, respectively. CONCLUSION: Imaging examination is the most valuable examination method in diagnosis of the vertebral injury in earthquake. It can not only make definitive diagnosis, but also play an important role in selection of therapeutic method.

Establishing models of portal vein occlusion and evaluating value of multi-slice CT in hepatic VX2 tumor in rabbits.

AIM: To establish models of portal vein occlusion of hepatic VX2 tumor in rabbits and to evaluate the value of multi-slice CT. METHODS: Forty New Zealand rabbits were divided into 4 groups according to digital table: Immediate group (group A; transplantation of tumor immediately after the portal vein occlusion), 3-wk group (group B; transplantation of tumor at 3 wk after the portal vein occlusion), negative control group (group C) and positive control group (group D), 10 rabbits in each group. Hepatic VX2 tumor was transplanted with abdominal-embedding inoculation immediately after the portal vein occlusion and at 3 wk after the portal vein occlusion. Meanwhile, they were divided into negative control group (Left external branch of portal vein was occluded by sham-operation, and left exite was embedded and inoculated pseudoly) and positive control group (Transplanted tumor did not suffer from the portal vein occlusion). All rabbits were scanned with multi-slice CT. RESULTS: All 40 animals were employed in the final analysis without death. Tumor did not grow in both immediate group and 3-wk group. In 3-wk group, left endite was atrophied and growth of tumor was inhibited. The maximal diameter of tumor was significantly smaller than that in positive control group (2.55 +/- 0.46 vs 3.59 +/- 0.37 cm, t = 5.57, P < 0.001). Incidences of metastasis in the liver and lung were lower in 3-wk group than those in positive control group (10% vs 40%, and 90% vs 100%, respectively). The expression intensities of the vascular endothelium growth factor (VEGF) in groups A, B, C and D were 0.10 +/- 0.06, 0.66 +/- 0.21, 0.28 +/- 0.09 and 1.48 +/- 0.32, respectively. VEGF expression level in the test group A was significantly lower than that in the negative control group C (t = 5.07; P < 0.001). In addition, VEGF expression in the test group B was significantly lower than that in the positive control group D (t = 6.38; P < 0.001). Scanning with multi-slice CT showed that displaying rate of hepatic artery branches was obviously lower in grade III (40%) than that in grade I (70%) and II (100%) (P < 0.05); but there was no significant difference in displaying rate of the portal vein at various grades. Values of blood flow (BF) of the liver, blood volume (BV), mean transit time (MTT) and permeability of vascular surface (PS) were lower in the immediate group and 3-wk group than those in control groups, but values of hepatic arterial fraction (HAF) were increased. Significant positive correlations were existed between BF and BV (r = 0.905, P < 0.01), and between BF and PS (r = 0.967, P < 0.01), between BV and PS (r = 0.889, P < 0.01). A significant negative correlation existed between PV and HAF (r = -0.768, P < 0.01), between PS and HAF (r = -0.557, P < 0.01). The values of BF, BV and PS had a positive correlation with VEGF (r(BF) = 0.842, r(BV) = 0.579, r(PS) = 0.811, P < 0.01) . However, there was no significant correlation between the values of MTT and HAF and the VEGF expression (r(MTT) = 0.066, r(HAF) = -0.027). CONCLUSION: Ligating the left external branch of portal vein is an ideal way to establish models of portal vein occlusion in rabbits with hepatic VX2 tumor. Multi-slice CT plays a key role in evaluating effect of portal vein occlusion.

[Analysis of the causes of misdiagnosis on CT films of 45 patients with lung cancer].

BACKGROUND: To analyze the causes of computed tomographic misdiagnosis of pulmonary carcinoma. METHODS: From September 1991 to January 2002, 45 cases of pulmonary carcinoma misdiagnosed by CT were analyzed retrospectively. Twenty-six cases of pulmonary tuberculosis and 15 cases of pulmonary pneumonia misdiagnosed as pulmonary carcinoma by CT were studied as control subjects. All of these cases were confirmed by surgery and clinical course. The CT appearances of these cases were independently reviewed in a double blind method by three experienced radiologists. Then they discussed together in order to search for the factors of CT misdiagnosis and formed a consensus interpretation. RESULTS: Forty-five cases of pulmonary carcinoma were misdiagnosed as pulmonary tuberculosis in 19 cases, pneumonia in 14 cases, abscess in 4 cases, pleural mesothelioma in 2 cases, normal in 2 cases, and others in 4 cases. The fundamental manifestations of misdiagnosed cases were lobar or segmental shadows (26 cases), solitary mass or nodule (19 cases).The reasons of CT misdiagnosis were very confusing. The main factors were:(i) Missed diagnosis (2 cases, 4.5%). One case had an endobronchial mass and another had the erosion of rib. (ii) Twenty-four cases (53.3%) due to mis interpretation and lack of experience. (iii) The manifestations in CT were atypical (19 cases,42.2%). CONCLUSIONS: Not identifying accurately the CT appearances and excessively emphasizing the specificity of some signs are the main causes of the misdiagnosis. A reasonable and careful CT examination, summarizing analysis combined with clinical findings, and the accumulation of diagnostic experience will help to reduce the CT misdiagnostic rate of pulmonary carcinomas.