Gross hemorrhage is the most serious complication of anticoagulant therapy. We report the discovery and treatment of a large pseudoaneurysm of the superior gluteal artery in one patient who had been receiving oral anticoagulant therapy. We diagnosed the pseudoaneurysm by contrast-enhanced computed tomography, and embolized the artery with stainless steel coils. The exact cause of the pseudoaneurysm remains unclear, however, minor trauma appears most likely.

Aneurysm, False↗

PubMedDate not supplied

Fatty infiltration of the liver distal to a metastatic liver tumor.

We report a case of focal fatty infiltration of the liver parenchyma adjacent to a metastatic liver tumor from an islet cell tumor. The decreased portal flow by the tumor and insulin produced by the tumor cells might be causes of focal fatty infiltration.

Adenoma, Islet Cell↗

PubMedDate not supplied

Amelioration of frozen gait by tandospirone, a serotonin 1A agonist, in a patient with pure akinesia developing resistance to L-threo-3,4-dihydroxyphenylserine.

A 71-year-old woman presented with severe akinesia, frozen gait, and compromised postural reflexes, without rigidity, tremor, or vertical gaze disturbance. With a working diagnosis of pure akinesia, we administered amantadine (150 mg/d) and L-threo-3,4-dihydroxyphenylserine (DOPS) (600 mg/d), which alleviated her symptoms. When frozen gait recurred 2 months later, we increased the dose of L-threo-DOPS to 900 mg/d and added levodopa (300 mg/d) combined with carbidopa, but this failed to improve the patient's symptoms. We then combined administration of tandospirone, a serotonin (5-HT) 1A agonist with L-threo-DOPS (600 mg/d), resulting in marked clinical improvement. Tandospirone is reported to activate noradrenergic neurons via the 5-HT 1A receptor, which could account for such striking improvement in a patient previously responsive to the noradrenergic precursor L-threo-DOPS given alone.

Aged↗

PubMedDate not supplied

Dynamic MRI using a surface coil in chronic cholecystitis and gallbladder carcinoma: radiologic and histopathologic correlation.

PURPOSE: The purpose of this study was to determine whether dynamic MRI could differentiate gallbladder carcinoma from chronic cholecystitis. METHOD: The dynamic MR findings of 50 patients with pathologically proven chronic cholecystitis and 13 with gallbladder carcinomas were correlated with the pathological findings. RESULTS: In chronic cholecystitis with thickened wall, mucosa and muscle were shown in early images as smoothly delineated enhancement except in one case, and the subserosa with fibrosis was enhanced in late or delayed images. Unenhanced foci in the wall correlated with Rokitansky-Aschoff sinuses or mural stones. In carcinomas, all tumors showed irregularly delineated enhancement in early images. In late or delayed images, noncancerous portions were also enhanced. The outer margin of early enhancement correlated with the extension of the tumor. CONCLUSION: Dynamic MRI is useful for the differentiation of chronic cholecystitis from carcinoma and for the evaluation of its local extension.

Adult↗

PubMedDate not supplied

Histological influence on contrast-enhanced CT of pancreatic ductal adenocarcinoma.

PURPOSE: The purpose of our study was to examine the influence of the histology of pancreatic ductal adenocarcinoma on its appearance with contrast-enhanced CT. METHOD: Early-phase and late-phase dynamic CT images were obtained in 34 patients who underwent pancreaticoduodenostomy. The attenuating areas of the tumors (n = 58) on early- and late-phase images were classified as hyperattenuated, isoattenuated, hypoattenuated, or unenhanced. The histologic findings of these lesions were compared to the CT appearances. RESULTS: The isoattenuated areas on both early- and late-phase images histologically showed increasing cellularity of tumor cells (n = 1) or coexisting acinar tissues and tumor cells (n = 2) within the tumor. Hypoattenuated areas on early-phase images and isoattenuated or hyperattenuated areas on late-phase images (n = 27) showed dense fibrosis except in one tumor with an abscess. Hypoattenuated areas on early- and late-phase images and unenhanced areas (n = 28) showed mucin and/or necrosis within the tumor. CONCLUSION: The contrast-enhanced CT appearance of pancreatic ductal adenocarcinoma is influenced by the histologic features associated with tumor cells.

Aged↗

PubMedDate not supplied

Expression of thymidine phosphorylase as an effect prediction factor for uterine cervical squamous cell carcinoma after radiotherapy: an immunohistochemical study.

Prognoses in cases of uterine cervical squamous cell carcinoma treated with radiotherapy were investigated in association with immunohistochemical expression of an angiogenic factor, thymidine phosphorylase (TP). Forty-six cases of uterine cervical squamous cell carcinoma mainly treated with radiotherapy during 1992-2001 at our clinic were studied. All were diagnosed as stages IIB to IVA. Paraffin-embedded biopsy specimens excised before radiotherapy were stained immunohistochemically using anti-TP monoclonal antibody. The extent of staining in both tumor and interstitial cells was graded as (-), (+/-), (+), and (2+). Specimens with TP expression levels of (2+) and (+) were regarded as positively stained and those with TP expression levels of (+/-) and (-) as negatively stained. The efficacy of radiotherapy in both groups was analyzed by the Kaplan-Meier method. With tumor cells, 5-year survival rates for the positive (n= 38) and negative (n= 8) staining groups were 73.9% and 42.9%, respectively; the rate being significantly higher for the TP-positive group (log rank, P= 0.0096). Contrarily, with staining for interstitial cells, the 5-year survival rates for the positive (n= 20) and negative (n= 26) staining groups were 74.1% and 64.6%, respectively, with no significant difference (log rank, P= 0.406). The efficacy of radiotherapy in the group with positive staining of tumor cells was significantly better than in the negative staining group. Immunohistochemical expression of TP in tumor cells is suggested as a useful prognostic factor for uterine cervical squamous cell carcinomas treated with radiotherapy. Choosing therapy for individual cases by referring to factors including TP expression should contribute to an improved prognosis.

Aged↗

PubMedDate not supplied

Effect of intraperitoneal administration of heparin on advanced glycation end-products in CAPD.

OBJECTIVE: To evaluate the effect of intraperitoneal (IP) administration of heparin on clearance of advanced glycation end-products (AGEs) and peritoneal dialysis efficiency. DESIGN: Sequential self-controlled intervention study. SETTING: University hospital, Department of Nephrology. PATIENTS AND METHODS: Pyrraline, urea, and creatinine levels in plasma and dialysate, along with AGE-derived fluorescence intensity (excitation, 370 nm; emission, 440 nm) in dialysate were measured 0, 30, and 60 days after IP administration of heparin in 11 patients on continuous ambulatory peritoneal dialysis (CAPD). Pyrraline levels were determined by ELISA. RESULTS: Heparin induced a significant decrease in plasma pyrraline levels; the values on days 0, 30, and 60 were 162.0+/-89.8 micromol/L, 101.1+/-32.1 micromol/L (p < 0.01), and 94.0+/-19.8 micromol/L (p < 0.001), respectively. Heparin also induced a tendency of increased dialysate pyrraline levels and a significant increase in AGE-derived fluorescence intensity in the dialysate. The values for the latter on days 0, 30, and 60 were 51.0+/-9.3 AU (arbitrary units/ mg of collagen), 73.5+/-16.0 AU (p < 0.001), and 65.6+/-15.5 AU (p < 0.01), respectively. Furthermore, heparin administration resulted in a significant (p < 0.01) increase in the dialysate/plasma ratio of urea (means 0.80, 0.90, and 0.94 on days 0, 30, and 60, respectively). CONCLUSION: These results suggest that a beneficial effect of IP administration of heparin is in part due to its action on AGE kinetics, supporting a potential preventive strategy for peritoneal membrane distortion in CAPD.

Creatinine↗