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Nishinomiya, Japan

Takahashi S.,Osaka City University | Hoshino M.,Osaka City University | Takayama K.,Seikeikai Hospital | Iseki K.,Sato Hospital | And 8 more authors.
Osteoporosis International

Summary: This study demonstrated the predictive values of radiological findings for delayed union after osteoporotic vertebral fractures (OVFs). High-signal changes on T2WI were useful findings. Introduction: The purpose of the present study is to determine predictive radiological findings for delayed union by magnetic resonance imaging (MRI) and plain X-rays at two time points in the acute phase of OVFs. Methods: This multicenter cohort study was performed from 2012 to 2015. A total of 218 consecutive patients with OVFs ≤2 weeks old were enrolled. MRIs and plain X-rays were performed at the time of enrollment and at 1- and 6-month follow-ups. Signal changes on T1-weighted imaging (T1WI) were classified as diffuse low-, confined low-, or no-signal change; those on T2WI were classified as high (similar to the intensity of cerebrospinal fluid), confined low-, diffuse low-, or no-signal change. The angular motion of the fractured vertebral body was measured with X-rays. Results: A total of 153 patients completed the 6-month follow-up. A high-signal change on T2WI was most useful in predicting delayed union. Sensitivity, specificity, and positive predictive values were 53.3, 87.8, and 51.6 % at enrollment and 65.5, 84.8, and 51.4 % at the 1-month follow-up, respectively. The positive predictive value increased to 62.5 % with observation of high- or diffuse low-signal changes at both enrollment and the 1-month follow-up. The cutoff value of vertebral motion was 5 degrees. Sensitivity and specificity at enrollment were 52.4 and 74.1 %, respectively. Conclusions: This study demonstrated the radiological factors predicting delayed union after an OVF. T2 high-signal changes showed the strongest association with delayed union. Consecutive MRIs were particularly useful as a differential tool to predict delayed union following OVFs. © 2016 International Osteoporosis Foundation and National Osteoporosis Foundation Source

Hyodo E.,Columbia University | Iwata S.,Columbia University | Tugcu A.,Columbia University | Oe Y.,Columbia University | And 9 more authors.
European Heart Journal Cardiovascular Imaging

Aims: The planimetry method using three-dimensional (3D) echocardiography is useful for providing an accurate mitral annulus area (MAA) value. However, this method is relatively unavailable. Therefore, we evaluated the accuracy of conventional methods for MAA measurement compared with that of 3D planimetry. Methods and results: Two-dimensional (2D) and 3D transoesophageal echocardiography (TEE) were performed in 70 patients. The mitral annulus diameter (MAD) was measured using four standard TEE imaging planes: four-chamber (4Ch), two-chamber (2Ch), anterior-posterior (LAX), and commissure-commissure (CC). MAA was calculated using a single diameter based on that of a circle and using two diameters based on that of an ellipse. MAA measurements using the single 4Ch MAD method (r = 0.84, P < 0.001), and two anatomically orthogonal MAD method in 4Ch/2Ch (r = 0.93, P < 0.001) and LAX/CC (r = 0.97, P < 0.001) planes correlated with 3D planimetric MAA measurements. Further analysis with Bland-Altman plots revealed that the LAX/CC MAD measurement exhibited the closest limits of agreement with the 3D planimetric MAA measurement. Notably, in patients showing an elliptical annulus shape, only LAX/CC MAD, but not 4Ch or 4Ch/2Ch MAD, provided results comparable with those of 3D planimetric MAA measurements. However, in patients with a circular annulus shape, reliable MAA measurements can be achieved using either single 4Ch MAD or any biplane MAD. Conclusion: Conventional LAX/CC MAD can be recommended for MAA measurements in a diverse patient population. This method is applicable as an alternative to the 3D planimetric method, regardless of the mitral annulus shape. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2011. Source

We report a case of patient who recovered from liver failure with synchronous diffuse liver metastases of sigmoid colon cancer by a short-term high volume (6 g of 5-FU in a week) hepatic arterial infusion (STHV-HAI). After four times of STHV-HAI, she had sigmoidectomy and bilateral oohorectomy and continued a weekly hepatic arterial infusion therapy until now. The case was a 75-year-old lady. She admitted of general fatigue. Serum bilirubin was about 2 mg/dL, GOT about 200 U/L and CEA over 40 thousand ng/mL She started STHV-HAI next day of her admission. After 4-course, her liver function became normal and the amount of CEA level became about 1,000 ng/mL. We had the operation of sigmoidectomy and bilateral oohorectomy. After that, she received the HAl every week as an outpatient. The lowest level of CEA became at the 90 ng/mL The liver metastases were also almost CR. STHV-HAI will be safe and effective to a patient of liver metastases with ascites and jaundice. Source

Hasuike Y.,Nishinomiya Watanabe Hospital
Gan to kagaku ryoho. Cancer & chemotherapy

Herein, we report four cases of a single liver metastasis after gastric cancer resection. Initially, we chose to perform hepatic arterial infusion( HAI) with high-dose 5-fluorouracil( 5-FU)( 6,000 mg/week) or weekly 500-750 mg of 5-FU. Three patients showed a partial response (PR) and one patient showed no change (NC). Therefore, we performed hepatectomy or radiofrequency ablation( RFA) 300-350 days after HAI. All four patients received postoperative HAI. Two patients survived without recurrence for 12 and 21 months. One patient developed prostate cancer but survived for 22 months as an outpatient. Finally, one patient experienced recurrence in the residual liver, but at a site not supplied by the hepatic artery. This patient survived for 36 months as an outpatient. In conclusion, HAI, liver resection, and RFA are effective in the management of single liver metastasis from gastric cancer. Source

Hasuike Y.,Nishinomiya Watanabe Hospital
Gan to kagaku ryoho. Cancer & chemotherapy

We report the case of a 52-year-old woman with cholangiocellular carcinoma (CCC) involving the lymph node and lung metastases who was admitted to our hospital because of right abdominal pain and anorexia. We started systemic chemotherapy(SCT) comprising 5-fluorouracil(5-FU; 1 g) and gemcitabine(GEM; 1 g) biweekly. After 1 course of SCT, we treated her with high-dose hepatic arterial injection (6 g 5-FU/1 week). This chemotherapy regimen improved her symptoms. After placing an arterial port into the right femoral artery, we continued SCT comprising GEM biweekly and hepatic arterial injection(HAI) of 5-FU weekly. Finally, we opted for weekly HAI and simultaneous SCT of 5-FU and GEM biweekly. The SCT dose of 5-FU was 1,000 mg and the dose of GEM ranged from 800 to 1,000 mg. For HAI, the dose of 5-FU was changed to between 250 and 750 mg. Lymph node metastases disappeared and lung metastases were reduced by this treatment. Because the lung metastases had progressed after 10 months, we increased the SCT dose of 5-FU to 1,500 mg and the dose of GEM to 1,200 mg. We also added systemic mitomycin C and prolonged the injection time of systemic 5-FU from 3 hours to 3 days. The lung metastases were reduced by this treatment. Our patient is still alive and has worked for more than 1 year. We recommend combination therapy of SCT and HAI for CCC with metastases. Source

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