Flaming portal vein as a new color Doppler sign of portal gas: report of two cases

Portal gas is relatively rare, and the majority of reported cases have shown it to have a close relation to bowel diseases. At present, portal exploration usually begins with color Doppler sonography, and clinicians now possess a good understanding of color Doppler findings of a wide spectrum of portal abnormalities. However, the color Doppler sign we present in this article has not been reported before. We report two cases of ischemic bowel disease in which B-mode ultrasound showed multiple hyperechoic spots moving in the portal vein; the color Doppler appearance was as if the portal vein was on fire (flaming portal vein sign). Knowledge of this simple color Doppler sign helps to improve the diagnostic strategies in patients with portal gas.

[Complete response in an elderly patient with advanced gastric cancer treated with TS-1]

The patient was an 89-year-old woman whose complaints were anorexia and weight loss. As a result of various examinations, she was diagnosed with advanced gastric cancer, Borrmann 3. TS-1 was administered at 75 mg/day for two weeks followed by one-week discontinvation during hospitalization; This course was then repeated after discharge. Anorexia and weight loss improved after two weeks, and complete response (CR) was obtained after 10 months of treatment. No cancer cells were confirmed by endoscopic biopsy. During this period no severe toxicities occurred. This TS-1 administration schedule appears to be a feasible and effective therapy for elderly patients with advanced gastric cancer.

Effective extracorporeal shock wave lithotripsy for pancreatic duct stone

A 55-year-old man with alcoholic chronic pancreatitis was hospitalized for further treatment of intractable repeated upper abdominal pain. A laboratory data showed normal hepatobiliary enzymes and glucose tolerance test, but abnormal pancreatic enzymes including amylase, lipase, trypsin and elastase I. Pancreatic function diagnostant test was 71%. Abdominal ultrasound examination and computed tomography showed an approximately 4 mm main pancreatic duct stone and multiple small stones in the surrounding parenchyma, and the findings being compatible with chronic pancreatitis. Endoscopic retrograde cholangiopancreatrography revealed that there was a main pancreatic duct stone in the pancreas head, and that the caudal pancreatic duct could not be visualized due to the impacted stone. In addition, intrapancreatic bile duct showed no malignant irregularity, but pancreatitis-induced smooth narrowing. The patient underwent extracorporeal shock wave lithotripsy (ESWL) alone, because endoscopic manipulation for pancreatic stone removal was impossible due to tightly impacted stone with stenosis. Successful ESWL was achieved with the stone disappearance and without any complication.

B-Flow contrast US with Levovist in hepatic tumors: preliminary results

Usefulness of Levovist contrast ultrasonography by the B-Flow method was evaluated in cases of hepatic tumor. Subjects included 14 patients with moderately differentiated hepatocellular carcinoma and 4 patients with hepatic hemangioma. Each patients had a single tumor mass. Images showed strong staining in 11 of the 14 nodes in the hepatocellular carcinomas and all 4 hemangiomas. Staining was seen only in lesions located within 4 cm of the probe. Thus B-Flow ultrasonography using Levovist was proved useful for evaluating vascularity of superficially located.

Colour Doppler ultrasonography of a segmental branch of the portal vein is useful for early diagnosis and monitoring of the therapeutic course of veno-occlusive disease after allogenic haematopoietic stem cell transplantation

We report two cases in which visualization of the segmental branch of the hepatic portal vein with the colour Doppler ultrasonography (US) technique was useful for the early diagnosis of veno-occlusive disease. The change in blood flow in the segmental branch of the portal vein occurred 5 and 6 d before the clinical criteria were fulfilled in the two cases. Reverse flow in the segmental branch began partially in the liver at first, and then spread to the whole liver several days later. All the US findings in both cases disappeared after thrombolytic therapy.

Budd-Chiari syndrome complicated by hepatocellular carcinoma with no evidence of infection with hepatitis virus: a case report

Hepatocellular carcinoma occurs in patients with Budd-Chiari syndrome. However, the etiology of hepatocellular carcinoma accompanied with Budd-Chiari syndrome has not been elucidated. We report a case of Budd-Chiari syndrome with membranous obstruction of the inferior vena cava complicated by hepatocellular carcinoma in an 80 year-old man. There was no evidence of co-infection with hepatitis A, B, C, D, E, and G virus. Histologically, the non-cancerous liver tissue showed chronic venous congestion with no evidence of hepatitis virus-associated liver cirrhosis. This case suggests that chronic venous congestion of the liver may be one of the pathologic conditions that occurs in hepatocellular carcinoma.

The contribution of menopause to changes in body-fat distribution

OBJECTIVE

To investigate whether menopause contributes to changes in body-fat distribution, irrespective of aging or obesity.

METHODS

The subjects were 545 premenopausal (aged 16-55 years; mean +/- standard deviation, 37.7 +/- 9.1 years) and 219 postmenopausal (aged 45-65 years, 58.0 +/- 5.0 years) women. Baseline characteristics included age, body mass index (BMI), and menopausal status (premenopause or postmenopause). The ratio of trunk fat to leg fat (trunk-leg ratio) was estimated by dual-energy X-ray absorptiometry. The trunk-leg ratio and baseline characteristics were compared between the 2 groups. In all subjects (n = 764), possible correlations between the trunk-leg ratio and the baseline characteristics were determined using univariate and multivariate analysis. In postmenopausal women, the relationship of the trunk-leg ratio to YSM or age after adjusting for BMI was investigated.

RESULTS

The trunk-leg ratio and BMI were significantly higher in postmenopausal women than in premenopausal women. In all subjects, age and BMI were positively correlated with the trunk-leg ratio (r = 0.445 and 0.587, respectively, p < 0.0001). Menopause was also positively correlated with the trunk-leg ratio on univariate regression analysis (standardized regression coefficient = 0.369, p < 0.0001). On multiple regression analysis, age, BMI, and menopause were independently correlated with the trunk-leg ratio (p < 0.05). In postmenopausal women, age and YSM were positively correlated with the trunk-leg ratio, independent of the BMI (p < 0.01).

CONCLUSIONS

Menopause contributes to a change in body-fat distribution, irrespective of aging or obesity.

Evaluation of pancreatic exocrine function and zinc absorption in alcoholism

Zinc absorption in alcoholism was studied by a combination of zinc tolerance tests in 382 male patients with alcoholism (more than 140 g/day of ethanol) who had alcohol-induced disease of the liver or pancreas. In study 1, the serum zinc level was measured in all patients, and serum zinc and fecal chymotrypsin levels were compared in various disease groups. In study 2, 14 patients with liver cirrhosis (LC), 15 with chronic pancreatitis (CP), 7 with LC + CP, and 7 controls underwent oral zinc tolerance and zinc dipicolinate tolerance tests, zinc absorption and disorders of pancreatic exocrine functions were examined. In study 1, the serum zinc concentration was significantly lower in the CP and LC groups than in the control group, and the fecal chymotrypsin activity was significantly lower in the CP than in the control groups. In study 2, during the oral zinc tolerance test, the serum zinc concentration 3 hours after administration was significantly lower in the LC, CP and LC + CP groups than in the control group. In these groups, the serum zinc concentration was significantly lower in the abnormal fecal chymotrypsin group than in the control group at 2 and 3 hours after administration of zinc sulfate. In the oral zinc dipicolinate tolerance test, the serum zinc levels 2 and 3 hours after administration were significantly elevated in the control and all disease groups; there were no significant differences between the control and each disease group. These results suggest that reduction of pancreatic exocrine functions by alcohol and chronic reduction of synthesis of ligands such as picolinic acid in the liver are involved in the reduction of serum zinc in alcoholism.

[The diagnosis of the early stage of hepatocellular carcinoma by US-angiography with intraarterial Albunex (sonicated serum albumin) infusion]

Contrast-enhanced ultrasonography (arterial infusion) has been clinically established as a qualitative diagnosis imaging tool for hepatocellular carcinoma (HCC). Contrast-enhanced ultrasonography (CEUS) was performed after of Albunex (sonicated serum albumin) or Carbon Dioxide (CO2) microbubble by hand, into the hepatic artery as a diagnostic modality for the early HCC. Here, we discussed the diagnosis of the early HCC by CEUS using Albunex as a contrast medium. Briefly, a diagnosis of the early HCC was made CEUS examination of the hemodynamics of the arteries showed a hypovascular pattern. And tumor size was under 20 mm in diameter, the histopathologic examination was essential to reach a final diagnosis, well-differentiated HCC.

Inflammatory pseudotumor of the liver--MR imaging findings

Using retrospective studies, we have investigated the possibility of obtaining characteristic findings of inflammatory pseudotumor of the liver by magnetic resonance (MR) imaging. We examined 8 patients (involving 8 masses) who had been histologically diagnosed as having an inflammatory pseudotumor in the liver. The histological studies were performed on an excised specimen of 1 mass, and on aspiration needle biopsy specimens and the clinical courses of the other 7 masses. T1 weighted images (T1WI) and T2 weighted images (T2WI) were obtained on MR imaging. MR imagings were analyzed for visualized patterns, patterns of internal structure and patterns of contrast enhancement of dynamic MR imaging. The 8 masses were visualized as hypointense on T1WI and hyperintense on T2WI by MR imaging. Dynamic MR imaging revealed that 1 mass was markedly enhanced peripherally while another mass was homogeneously enhanced, and that enhancement was most marked immediately after injection of contrast medium and then gradually disappeared. Vessels were observed in 4 masses (the portal vein in 2 masses, the hepatic vein in 1 mass, and portal and hepatic veins in 1 mass), and these vessels were clearly visualized on T1WI. The MR imaging findings from the early stage of an inflammatory pseudotumor showed a pattern similar to that of hepatic tumors with rich blood flow. The portal vein or hepatic vein was found in the tumor in half the patients, suggesting that this characteristic was useful for diagnosis of an inflammatory pseudotumor in the liver.

A woman with three ectopic pregnancies after in-vitro fertilization and embryo transfer

Although a higher incidence of ectopic pregnancy has been reported after in-vitro fertilization (IVF) and embryo transfer, three ectopic pregnancies in the same woman is very rare. A patient of 32 years underwent IVF-embryo transfer six times within 3 years. Three of four conceptions resulted in ectopic pregnancies. The first involved simultaneous intrauterine and left tubal pregnancy, the second was a right tubal pregnancy, and the third was a right interstitial pregnancy. In IVF-embryo transfer, bilateral salpingectomy does not remove the risk of interstitial or cornual pregnancy.

The effect of body composition on bone density in pre- and postmenopausal women

OBJECTIVES

To investigate the relative contribution of body composition (lean and fat) to bone mineral density (BMD), 196 premenopausal and 128 postmenopausal Japanese women were enrolled.

METHODS

Total fat mass, total lean mass, lumbar BMD (L2-L4), and total body BMD were measured by dual-energy X-ray absorptiometry (DEXA, Hologic QDR 2000, MA. USA). Physical characteristics were also recorded for each subject. Correlation between BMD and variables were calculated for each of the two groups in single and stepwise regression analyses.

RESULTS

Total lean mass was significantly higher in premenopausal women than postmenopausal women (P < 0.0001), while body weight, body mass index, and total fat mass were not different between the two groups. In stepwise regression analysis, total lean mass was the most powerful determinant of lumbar BMD and total body BMD in premenopausal women. In postmenopausal women, total fat mass was the most significant determinant of lumbar BMD, while total lean mass was the most significant determinant of total body BMD.

CONCLUSIONS

These findings suggest that there is a difference between pre- and postmenopausal women in the relative contribution of lean and fat mass. Total lean mass is the most significant determinant of BMD in premenopausal women. On the other hand, total fat mass may have some advantages in maintaining BMD in postmenopausal women.

Correlation of body fat distribution with grade of endometrial cancer

To elucidate whether body fat distribution correlates with the grade of endometrial cancer, we studied 74 postmenopausal women with endometrial cancer (mean age 62.4 +/- 6.6 years, range 49-78 years). The subjects were divided into three groups as follows: well-differentiated adenocarcinoma (G1 group; N = 53), moderately differentiated adenocarcinoma (G2 group; N = 11), and poorly differentiated adenocarcinoma (G3 group; N = 10). Four body fat indices [total fat weight (g), body fat ratio (%), trunk fat weight (g), and weight ratio of trunk fat to leg fat (trunk/leg ratio)] were measured by dual-energy X-ray absorptiometry. Baseline characteristics and body fat indices in the three groups were compared. In all subjects, the correlations of these variables with the grade of adenocarcinoma were investigated using single and stepwise regression analyses. Total fat weight, body fat ratio, and trunk fat weight showed slight increases with the grade of differentiation. The trunk/leg ratio in G1 group was significantly higher than in G2 and G3 groups. The trunk/leg ratio was significantly correlated with the grade in stepwise regression analysis. Body fat distribution in women with endometrial cancer may correlate with the grade of the adenocarcinoma.

Three cases of renal angiomyolipoma

We report three non-typical cases of renal angiomyolipoma including clinical features, imaging examinations (with ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI) and angiography) and histological findings. Microaneurysms observed by angiography were common to the three cases and were considered to be an important finding in the diagnosis of renal angiomyolipoma. Moreover, the short tau inversion recovery (STIR) method of MRI, which suppresses photon signals of fat, was considered to be useful for the diagnosis. Case 1 was accompanied by spontaneous rupture, Case 2 was difficult to diagnose because of little fat tissue and Case 3 revealed a very small tumor.

Possible association of body-fat distribution with preeclampsia

OBJECTIVE

To investigate whether preeclampsia is associated with body-fat distribution.

METHODS

Twenty-two patients with preeclampsia (mean age: 31.9 +/- 6.0 years) and 126 controls without preeclampsia (mean age: 30.9 +/- 5.2 years) were enrolled in this study. We compared baseline characteristics and 4 body-fat indices measured by DEXA on Day 5 postpartum. The possible correlation between the variables and the development of preeclampsia was evaluated by multivariate analysis.

RESULTS

The body-fat ratio, the upper-half body-fat amount, upper-half-body body-fat amount ratio, and upper-/lower-half-body body-fat amounts ratio on Day 5 postpartum were significantly higher in the preeclampsia group. However, the upper-/lower-half-body body-fat amount ratio was best correlated with preeclampsia among variables in multivariate analysis.

CONCLUSION

Upper-body-fat distribution might be associated with the development of preeclampsia.

The relation between body-fat distribution and lipid metabolism in postmenopausal women

OBJECTIVE

To evaluate the relationship between body-fat distribution and lipid metabolism in postmenopausal women.

METHODS

Fifty-four women (mean: 61.8 +/- 7.8 years old) showing hyperlipidemia and 63 controls were enrolled in this study. Their baseline characteristics and body-fat indices, as measured by DEXA, were compared. The correlations between the serum-lipid levels and the variables were evaluated.

RESULTS

The amount of upper-half-body fat and the body-fat ratio were significantly higher in the hyperlipidemia group. In single-regression analysis, there were low levels of correlation between the serum TC levels and the amount of upper-half-body fat and the upper-body fat ratio. There was a low level of correlation between the serum TG level and the amount of upper-half-body fat, the upper-lower-half-body-fat ratios, and the upper-half-body-fat ratio. After adjusting for variables, the serum TC and TG levels best correlated with the amount of upper-half-body-fat (r = 0.458, r = 457, respectively).

CONCLUSION

In postmenopausal women, lipid metabolism is reflected in the amount of upper-half-body fat, irrespective of age and the body-mass index (BMI).

Effects of weight loss on bone mineral density in rats

OBJECTIVE

To evaluate the effects of weight loss on bone mineral density (BMD).

METHODS

Eight-week-old female rats were divided into 4 groups: Those in Group A received a restricted diet for 4 weeks; those in Group B received a restricted diet and were treated with estrogen; those in Group C were castrated; and those in Group D underwent sham operations. The rat's body weight (BW) and vaginal smears were checked, and their femoral BMD was measured.

RESULTS

The BW and BMD at 12 weeks were lower in Groups A and B than in Groups C and D; thereafter, however, these values increased for Groups A and B, but were still lower than those in Group D even at 20 weeks. In Group C, the BMD did not decrease, but it was significantly lower than that in Group D at 16 and 20 weeks. Group A showed continuous diestrus 2 weeks after dietary restriction began, but recovered to a 4-day cycle 2 weeks after the initiation of free food consumption.

CONCLUSION

Weight loss had a greater effect on BMD than hypoestrogenism.

Relationship between sonographic endometrial thickness and progestin-induced withdrawal bleeding

OBJECTIVE

To determine whether the response to the progestin challenge test can be predicted from the endometrial thickness measured sonographically.

METHODS

Progestin challenge tests were performed on 44 women with secondary amenorrhea, each of whom also had her endometrial thickness measured by transvaginal ultrasonography and her serum estradiol (E2) levels determined. The relationships between the response to the challenge test, endometrial thickness, and serum E2 levels were studied, as well as whether the presence or absence of withdrawal bleeding could be predicted from the endometrial thickness and serum E2 levels.

RESULTS

The endometrium was significantly thicker in 32 women who had withdrawal bleeding (10.3 +/-4.1 mm) than in the 12 who did not bleed (5.0 +/- 1.3 mm) (P < .001). The serum E2 level was also significantly higher in the positive group: 45.3 +/- 19.4 versus 18.6 +/- 8.0 pg/mL (P < .001). Endometrial thickness of 6.0 mm or more predicted the occurrence of withdrawal bleeding with an accuracy of 95.5%. Endometrial thickness was superior to the serum E2 level in predicting withdrawal bleeding.

CONCLUSION

Progestin-induced withdrawal bleeding can be predicted from the endometrial thickness measured sonographically.

Body fat distribution in women with polycystic ovary syndrome

OBJECTIVE

To investigate body fat distribution in women with polycystic ovary syndrome (PCOS).

METHODS

Body weight, body mass index (BMI), and six indices of body fat measured by dual-energy x-ray absorptiometry were compared in 40 women with PCOS and 97 age-matched controls. The possible correlations between the body fat characteristics and serum androgen levels were evaluated in the 40 PCOS women. Body fat distribution was classified into upper- (N = 24) and lower-half body type (N = 16), and androgen levels and the incidence of hirsutism were compared in the two types.

RESULTS

The BMI, body fat ratio, upper-half body fat ratio, and upper-half/lower-half body fat ratio were significantly higher in PCOS women than in controls. After adjustment for age, height, and body weight, the upper-half/lower-half body fat ratio was still significant (P < .001). The PCOS subjects exhibited a significant positive correlation between the upper-half/lower-half body fat ratio and dehydroepiandrosterone-sulfate (DHEA-S) levels (r = 0.607, P < .01) as well as testosterone levels (r = 0.585, P < .05). Dehydroepiandrosterone-sulfate and testosterone levels were significantly higher in those with the upper-half body type than in those with the lower-half body type (P < .001). After adjustment for confounding variables, only DHEA-S was still significantly higher in this body type (P < .05).

CONCLUSION

Serum DHEA-S levels seem to be associated with upper-half body fat distribution in women with PCOS, irrespective of body weight.

[A study of the drug distribution on intra-hepatic arterial infusion chemotherapy; how much difference between continuous infusion and rapid infusion?]

The subjects were 41 cases with implantable reservoir systems for unresectable hepatic tumors. We evaluated the difference in drug distribution between intra-hepatic arterial continuous infusion and rapid infusion using hepatic perfusion scintigraphy by 99mTc-macroaggregated albumin via reservoirs. The 41 cases were divided into 2 groups (A and B) according to the imaging of the perfusion scintigraphy. There were 17 cases in group A with equal distribution and 24 cases in group B with a different distribution between the continuous infusion and the rapid infusion. The 24 cases in group B were subdivided into groups according to the distribution of 99mTc-MAA in and around liver. In some cases the distribution pattern after rapid infusion improved more than with continuous infusion. These results suggested that the infusion method must be selected for every case.

Small hepatocellular carcinoma with intravascular tumor growth into the right atrium

A 66-year-old man with ascites and marked edema in the lower extremities was suspected of having secondary Budd-Chiari syndrome due to primary liver cancer, based on imaging diagnosis, i.e., ultrasonography, computed tomography, and inferior venacavogram. At autopsy, an encapsulated small liver cancer was found to have extended into the inferior vena cava and right atrium. There have been few reports of small hepatocellular carcinoma with intravascular tumor growth into the right atrium.

[Complication of gastro-duodenum with intra-hepatic arterial infusion chemotherapy using implantable reservoir system for hepatic tumors]

The subjects were 20 cases with implantable reservoir systems for unresectable hepatic tumors. We evaluated the correlation between a complication of the gastro-duodenum after intra-hepatic arterial chemotherapy and a gastro-duodenal distribution of anti-cancer drugs using the hepatic perfusion scintigram by 99mTc-macroaggregated albumin via reservoirs. The 20 cases were divided into 3 groups (A, B, C) according to the level of gastro-duodenal accumulation of 99mTc-MAA. In group A with the strongest accumulation in the gastro-duodenum, we frequently found a gastro-duodenal ulcer after intra-hepatic arterial chemotherapy. There was a significant difference between group A and group C, the latter without a gastro-duodenal accumulation. These results suggested that the hepatic perfusion scintigram via reservoir was a useful examination to expect and prevent the complication of gastro-duodenum on intra-hepatic arterial infusion (especially continuous infusion) chemotherapy.

[Clinical evaluation of aztreonam in the field of obstetrics and gynecology]

Aztreonam (AZT) was evaluated for its clinical efficacy in a total of 10 cases, namely 3 cases of endometritis, 6 cases of intrapelvic infections, 1 case of puerperal pyelonephritis. The clinical results of AZT were as follows; excellent in 5 cases and moderate in 5 cases, the overall efficacy rate was 100%. No clinical side effect was observed, however in laboratory finding slightly elevated transaminase (GOT, GPT) was observed in 1 case.