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Sasakura Y, Katsumori T, Nishizawa K, Nishimura T, Yoshikawa T, Takahata A, Yamada K. Incidence and changes in endometrial-leiomyoma fistula following uterine artery embolization: a single-center retrospective analysis. Eur Radiol 2023; 33:8157-8164. [PMID: 37284865 DOI: 10.1007/s00330-023-09794-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To investigate whether the number and size of endometrial-leiomyoma fistulas (ELFs) change following uterine artery embolization (UAE) for leiomyoma and the correlation between ELFs and vaginal discharge (VD). MATERIALS & METHODS This study was a retrospective analysis of 100 patients who underwent UAE at a single institution between May 2016 and March 2021. They all underwent MRI at baseline, 4 months, and 1 year after UAE. The number and size of the ELFs were compared with the MRI images each time. The ELF tumor characteristics and the correlation between the ELFs and VD were assessed. Additional gynecologic interventions due to VD associated with ELFs were evaluated. RESULTS No ELF was observed at baseline. Ten ELFs were noted in nine patients at 4 months, and 35 ELFs were noted in 32 patients 1 year after UAE. The ELFs significantly increased over time (p = 0.004, baseline vs. 4 months; p < 0.001, 4 months vs. 1 year). The ELF size did not significantly change over time (p = 0.941). The tumors developing ELFs after UAE were mainly located at the submucosal or intramural area contacting the endometrium at baseline, with a mean size of 7.1 (2.6) cm. Nineteen patients (19%) had VD 1 year after UAE. There was no significant correlation between VD and the number of ELFs (p = 0.80). No patients underwent additional gynecologic interventions due to VD associated with ELFs. CONCLUSION ELFs increased in number and did not disappear over time after UAE in most tumors. CLINICAL RELEVANCE STATEMENT Despite the MR imaging findings, within the limited data of this study, ELFs were not seemingly associated with clinical symptoms, including VD. KEY POINTS • Endometrial-leiomyoma fistula (ELF) is a complication of uterine artery embolization (UAE). • ELFs increased in number over time after UAE and did not disappear in most tumors. • Most tumors developing ELFs after UAE were located near/contacted the endometrium and were larger.
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Affiliation(s)
- Yasuteru Sasakura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 602-8566, Kyoto, Japan.
| | - Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Kaori Nishizawa
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Tomoaki Nishimura
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Tatsuya Yoshikawa
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Akiko Takahata
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Kei Yamada
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 602-8566, Kyoto, Japan
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2
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Nishimura T, Katsumori T, Yoshikawa T, Nishizawa K. Hemoptysis due to a lung metastasis of renal cell carcinoma: A case report. Radiol Case Rep 2023; 18:1073-1075. [PMID: 36684630 PMCID: PMC9849970 DOI: 10.1016/j.radcr.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/04/2022] [Indexed: 01/08/2023] Open
Abstract
A 53-year-old man with a history of surgery for renal cancer was referred to our hospital due to massive hemoptysis. Contrast-enhanced CT revealed a well-enhanced pulmonary nodule suggestive of a tumor (diameter of 16 mm), which was considered a causal lesion. Bronchial artery embolization was successfully performed and subsequently hemoptysis disappeared. However, hemoptysis recurred 6 months later, and the tumor was surgically resected. Pathological examination revealed the resected tumor was a lung metastasis of renal cell carcinoma, which directly invaded into pulmonary bronchus. Hemoptysis secondary to lung metastasis of renal cell carcinoma has rarely been reported in the literature.
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Affiliation(s)
- Tomoaki Nishimura
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan,Corresponding author.
| | - Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Tatsuya Yoshikawa
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Kaori Nishizawa
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
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3
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Nishizawa K, Katsumori T, Kotera Y, Yoshikawa T, Nishimura T. Sunitinib maleate administration before percutaneous CT-guided cryoablation for large renal cell carcinoma: A case report. Radiol Case Rep 2022; 17:4834-4837. [PMID: 36238214 PMCID: PMC9552030 DOI: 10.1016/j.radcr.2022.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022] Open
Abstract
A 60-year-old woman taking anti-platelet drugs was referred to the hospital for the treatment of advanced renal cell carcinoma. CT revealed that the tumor had a diameter of 5 cm and hyper-vascularity. Percutaneous CT-guided cryoablation (CA) was indicated. Since preprocedural arterial embolization failed to provide sufficient embolic effects, sunitinib maleate was administered. It provided good tumor devascularization and volume reduction, which corresponded to downstage. Therefore, the administration contributed to successfully performing subsequent percutaneous CT-guided CA with no serious hemorrhagic complications. Sunitinib maleate may be an alternative to conventional treatments before CA for renal cell carcinoma.
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Affiliation(s)
- Kaori Nishizawa
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan,Corresponding author.
| | - Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Yuya Kotera
- Department of Radiology, Matsushita Memorial Hospital, Sotozima 5-55, Moriguchi, Osaka, 570-8540, Japan
| | - Tatsuya Yoshikawa
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Tomoaki Nishimura
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
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4
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Tsuboi K, Katsumori T, Mino D, Kubota H, Yoshikawa T. Uro-lymphatic fistula associated with urolithiasis: A case report. Radiol Case Rep 2022; 17:1521-1523. [PMID: 35282326 PMCID: PMC8904381 DOI: 10.1016/j.radcr.2022.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022] Open
Abstract
Uro-lymphatic fistulas are rare, and involve communication between the renal collecting system and the lymphatic system. The disorder is usually caused by the obstruction of lymphatic vessels due to several diseases, leading to chyluria. Here, we report the case of a patient with a uro-lymphatic fistula, considered to be associated with urolithiasis.
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Affiliation(s)
- Keisuke Tsuboi
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
- Corresponding author.
| | - Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Daichi Mino
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Hiroaki Kubota
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Tatsuya Yoshikawa
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kyoto, 602-8566, Japan
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5
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Katsumori T. Seeking an Ideal Embolic Agent. Cardiovasc Intervent Radiol 2021; 45:216-217. [PMID: 34590160 DOI: 10.1007/s00270-021-02967-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan.
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6
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Hisano M, Katsumori T, Yoshikawa T, Yasumura T, Sasakura Y. Percutaneous Direct Lipiodol Marking for CT-Guided Cryoablation for Small Renal Tumors. J Vasc Interv Radiol 2021; 32:630-633. [PMID: 33795077 DOI: 10.1016/j.jvir.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/30/2020] [Accepted: 12/04/2020] [Indexed: 10/21/2022] Open
Affiliation(s)
- Mitsuhiro Hisano
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Tatsuya Yoshikawa
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Toshinori Yasumura
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Yasuteru Sasakura
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
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7
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Suzuki G, Machida K, Asato A, Seri S, Ikemoto C, Yamazaki H, Yamada K, Katsumori T. Definitive Radiotherapy for Penoscrotal Extramammary Paget's Disease: A Case Report with Long-Term Follow-Up. Clin Med Insights Case Rep 2021; 14:11795476211009251. [PMID: 33953632 PMCID: PMC8042548 DOI: 10.1177/11795476211009251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022]
Abstract
Penoscrotal extramammary Paget's disease (EMPD) is a rare intraepithelial adenocarcinoma in older male patients, and no effective nonsurgical treatment strategies are currently available. The aim of this study was to report the usefulness of external radiotherapy (RT) for penoscrotal EMPD in an inoperable elderly patient. This report presents the treatment of an 89-year-old man with widespread penoscrotal EMPD. A multidisciplinary treatment team decided on radical RT. The patient received a radiation dose of 61.8 Gy in 30 fractions through electron and photon beams. His treatment tolerance was good, and no severe toxicity had been observed up the last follow-up. At 6.5 years after the RT, the patient showed no evidence of recurrence. Definitive RT resulted in excellent disease control and minimal toxicity; thus, it could be a promising nonsurgical therapeutic option for penoscrotal EMPD, even in extremely elderly individuals.
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Affiliation(s)
- Gen Suzuki
- Department of Radiology, Saiseikai Shiga Hospital, Ritto, Shiga, Japan
- Department of Radiology, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Kazutaka Machida
- Department of Radiology, Saiseikai Shiga Hospital, Ritto, Shiga, Japan
| | - Akito Asato
- Department of Radiology, Saiseikai Shiga Hospital, Ritto, Shiga, Japan
| | - Sho Seri
- Department of Radiology, Saiseikai Shiga Hospital, Ritto, Shiga, Japan
| | - Chika Ikemoto
- Department of Dermatology, Saiseikai Shiga Hospital, Ritto, Shiga, Japan
| | - Hideya Yamazaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Kei Yamada
- Department of Radiology, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ritto, Shiga, Japan
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Yoshikawa T, Katsumori T, Hisano M, Yasumura T, Sasakura Y. Transcatheter arterial embolization for a symptomatic Tarlov cyst with hemorrhage due to an underlying arteriovenous fistula. Radiol Case Rep 2021; 16:1284-1287. [PMID: 33854665 PMCID: PMC8027132 DOI: 10.1016/j.radcr.2021.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/25/2022] Open
Abstract
Symptomatic sacral perineural cysts (Tarlov cysts) accompanied by intra-cyst hemorrhage are rare. The treatment strategies have not been established. We report a 57-year-old woman with severe back pain due to a Tarlov cyst accompanying intracyst hemorrhage. Computed tomography angiography revealed an arteriovenous fistula (AVF) at the area surrounding the cyst. The patient underwent transcatheter arterial embolization for the AVF. Thereafter, the hematoma and cyst decreased in size, and clinical symptoms markedly improved with no additional surgery. Transcatheter arterial embolization may be an effective alternative to surgery for Tarlov cysts with vascular disease, including AVF.
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9
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Yokoya S, Hino A, Oka H, Katsumori T. In Reply to the Letter to the Editor Regarding “Rare Spontaneous Disappearance of Intracranial Aneurysm”. World Neurosurg 2020; 143:630. [DOI: 10.1016/j.wneu.2020.08.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/22/2020] [Indexed: 10/23/2022]
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10
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Yokoya S, Nishii S, Takezawa H, Katsumori T, Takagi Y, Goto Y, Oka H, Shiomi N, Hino A. Organized Chronic Subdural Hematoma Treated with Middle Meningeal Artery Embolization and Small Craniotomy: Two Case Reports. Asian J Neurosurg 2020; 15:421-424. [PMID: 32656145 PMCID: PMC7335123 DOI: 10.4103/ajns.ajns_341_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/19/2020] [Indexed: 11/08/2022] Open
Abstract
The most preferred treatment for organized chronic subdural hematoma (OSDH) remains controversial. Although a large craniotomy has been reported to be necessary and effective for the treatment of an OSDH, a craniotomy is associated with postoperative hemorrhagic complications and recurrence. Although middle meningeal artery (MMA) embolization has been reported to be effective for a refractory chronic subdural hematoma (CSDH), its efficacy for an OSDH remains unclear. We report two cases of OSDH treated with MMA embolization followed by hematoma removal via a small craniotomy under local anesthesia with good progress. Case 1: A 71-year-old man underwent a single burr hole irrigation for a CSDH, which failed due to a solid hematoma. He underwent a small craniotomy under local anesthesia after an MMA embolization. During the craniotomy, a small hemorrhage from the hematoma and its outer membrane was observed. Postoperatively, the symptoms disappeared immediately, and the hematoma did not recur. Case 2: A 77-year-old man underwent a burr hole irrigation, but the hematoma was not evacuated because of an OSDH, and he remained in motor aphasia. After an MMA embolization, a craniotomy was performed under local anesthesia. Intraoperative hemorrhage was minimal, and after the craniotomy, his neurological symptoms improved without any recurrence. MMA embolization and hematoma removal with a small craniotomy could be a treatment option for an OSDH.
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Affiliation(s)
- Shigeomi Yokoya
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
| | - Sho Nishii
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
| | - Hidesato Takezawa
- Department of Neurology, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
| | - Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
| | - Yasufumi Takagi
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
| | - Yukihiro Goto
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
| | - Hideki Oka
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
| | - Naoto Shiomi
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
| | - Akihiko Hino
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
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Tsuji Y, Miura H, Katsumori T, Kizu O, Yokoya S, Yamada K. Reversible Cortical Hypointensity on T
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*‐Weighted MR Image After Embolization for Cerebral Dural Arteriovenous Fistula. J Magn Reson Imaging 2020; 52:311-313. [DOI: 10.1002/jmri.27005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Yusuke Tsuji
- Department of RadiologyKyoto Prefectural University of Medicine Kyoto Japan
| | - Hiroshi Miura
- Department of RadiologyKyoto Prefectural University of Medicine Kyoto Japan
| | | | - Osamu Kizu
- Department of RadiologySaiseikai Shiga Hospital Shiga Japan
| | - Shigeomi Yokoya
- Department of NeurosurgerySaiseikai Shiga Hospital Shiga Japan
| | - Kei Yamada
- Department of RadiologyKyoto Prefectural University of Medicine Kyoto Japan
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12
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Katsumori T, Yoshikawa T. Protection of CT suites from COVID‑19 infection in a tertiary emergency hospital. Jpn J Radiol 2020; 38:588-589. [PMID: 32248511 PMCID: PMC7127874 DOI: 10.1007/s11604-020-00964-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan.
| | - Tatsuya Yoshikawa
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
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13
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Ichijo Y, Miura H, Hirota T, Asai S, Hisano M, Hongo F, Ukimura O, Katsumori T, Yamada K. Ice Ball Cracks on CT During Cryoablation for Renal Tumors: A Retrospective Analysis. Cardiovasc Intervent Radiol 2020; 43:882-888. [DOI: 10.1007/s00270-020-02454-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/12/2020] [Indexed: 01/20/2023]
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14
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Katsumori T, Miura H, Yoshikawa T, Seri S, Kotera Y, Asato A. Intra-Arterial Lidocaine Administration for Anesthesia after Uterine Artery Embolization with Trisacryl Gelatin Microspheres for Leiomyoma. J Vasc Interv Radiol 2020; 31:114-120. [DOI: 10.1016/j.jvir.2019.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/12/2019] [Accepted: 09/14/2019] [Indexed: 10/25/2022] Open
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15
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Katsumori T, Yoshikawa T, Miura H. Insufficient Leiomyoma Infarction in Uterine Artery Embolization: Relationship with Tumor Location. J Vasc Interv Radiol 2019; 30:668-675.e1. [DOI: 10.1016/j.jvir.2018.11.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022] Open
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16
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Yamahana Y, Katsumori T, Miura H, Asai S, Yamada S, Takahata A, Yamada K. Susceptibility weighted MRI after uterine artery embolization for leiomyoma. Magn Reson Imaging 2019; 58:32-37. [PMID: 30654161 DOI: 10.1016/j.mri.2019.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate whether susceptibility-weighted MR imaging (SWI) findings are associated with tumor infarction on contrast-enhanced MRI (CE-MRI) after uterine artery embolization (UAE) for leiomyoma. METHODS This was a single institution, retrospective study. Between February 2016 and April 2017, 27 consecutive patients underwent UAE and completed SWI and CE-MRI before and 1 week after UAE. Two blinded readers independently reviewed the MRI of 261 tumors ≥1 cm in all patients. We evaluated the relationship between the hypointense peripheral rim observed on the tumor surface on post-procedural SWI and the infarction rates (≥90%, <90%) of each tumor based on post-procedural CE-MRI. Inter-reader correlation coefficients (ICC) and the sensitivity and specificity of the rim were measured. RESULTS Substantial inter-reader agreement was noted in post-procedural SWI interpretations (ICC = 0.681, 95% CI; 0.547, 0.771). The rim was observed in 66.7% (174/261) of tumors by reader 1 and 55.9% (146/261) of tumors by reader 2 on post-procedural SWI. Correlations were observed between the rim and ≥90% tumor infarction by readers 1 and 2 (Spearman's coefficient = 0.474 and 0.438, p < 0.001 and p < 0.001, respectively). The sensitivity and specificity of the rim to tumor infarction were 77.2 and 82.6% (reader 1), and 65.8 and 100% (reader 2), respectively. CONCLUSIONS The present study demonstrated that the hypointense peripheral rim was observed on some leiomyomas on SWI immediately after UAE. The rim correlated with tumor infarction on post-procedural CE-MRI. This SWI finding was helpful for evaluating embolic effects on leiomyomas in the acute phase after UAE.
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Affiliation(s)
- Yasuyuki Yamahana
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga 520-3046, Japan
| | - Hiroshi Miura
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Shunsuke Asai
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Sachimi Yamada
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Akiko Takahata
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Kei Yamada
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
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Katsumori T, Asai S, Yokota H, Miura H. Volume of embolic agents in uterine artery embolization for leiomyoma: relation to baseline MRI. MINIM INVASIV THER 2018; 28:186-193. [DOI: 10.1080/13645706.2018.1513408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Shunsuke Asai
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Hiroshi Miura
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Kikuchi A, Hino A, Oka H, Hashimoto Y, Yokoya S, Goto Y, Echigo T, Shiomi N, Katsumori T, Takezawa H, Kasuya H. [Subarachnoid Hemorrhage of Unknown Origin at Initial Imaging Investigation]. No Shinkei Geka 2018; 46:583-592. [PMID: 30049899 DOI: 10.11477/mf.1436203774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In some patients with spontaneous subarachnoid hemorrhage(SAH), initial imaging investigations may not be able to detect a bleeding source;repeat imaging may be necessary to reveal these lesions. We reviewed a consecutive series of 45 patients with SAH and negative initial digital subtraction angiograms(DSA)during a 15-year period. The aims were to document the frequency and reason for the negative initial investigations, to determine the appropriate modality and timing of repeat examinations, and to investigate the identified bleeding sources. Twenty-eight(62%)patients underwent repeat DSA, 35(78%)underwent magnetic resonance imaging(MRI), and 33(73%)underwent computed tomography angiography(CTA). Nine lesions(5 small aneurysms, 2 craniocervical junction arteriovenous fistulas, 1 arteriovenous malformation, and 1 internal carotid artery dissection)were identified on subsequent DSA after 2-3 weeks. Most aneurysms were identified on an atypical vascular tree. CTA or MRI alone were unable to disclose the culprit lesions. In retrospect, human errors including oversight were the major reasons for the negative initial investigation results. It is, however, difficult to search for a tiny vascular lesion that might be anywhere in the cranium. Repeat DSA is still the gold standard for the inspection of hidden bleeding sources in patients with SAH of unknown origin.
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Affiliation(s)
- Asami Kikuchi
- Department of Neurosurgery, Saiseikai Shiga Hospital
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Yokoya S, Hino A, Takezawa H, Katsumori T, Goto Y, Hashimoto Y, Oka H. Microsurgical Removal of Snagged Stent Retriever During Endovascular Embolectomy for Acute Ischemic Stroke. World Neurosurg 2018; 111:115-118. [DOI: 10.1016/j.wneu.2017.12.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 12/08/2017] [Accepted: 12/09/2017] [Indexed: 10/18/2022]
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Takezawa H, Katsumori T, Tamura A, Fujii A, Goto Y, Yokoya S, Oka H, Hashimoto Y, Hino A. Two neuro-interventionists treated twice or more patients than one neuro-interventionist did. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Katsumori T, Arima H, Asai S, Hayashi N, Miura H. Comparison of Pain Within 24 h after Uterine Artery Embolization with Tris-Acryl Gelatin Microspheres Versus Gelatin Sponge Particles for Leiomyoma. Cardiovasc Intervent Radiol 2017; 40:1687-1693. [DOI: 10.1007/s00270-017-1691-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
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Katsumori T, Miura H, Arima H, Hino A, Tsuji Y, Masuda Y, Nishimura T. Tris-acryl gelatin microspheres versus gelatin sponge particles in uterine artery embolization for leiomyoma. Acta Radiol 2016; 58:834-841. [DOI: 10.1177/0284185116674499] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Tris-acryl gelatin microspheres (TAGM) and gelatin sponge particles (GS) have been used in uterine artery embolization (UAE) for leiomyoma. No direct comparisons of both embolic agents have been reported. Purpose To compare the outcomes of UAE with TAGM with those of UAE with GS for uterine leiomyoma. Material and Methods This was a non-randomized, single-institute, non-inferiority study. Between July 2008 and August 2015, 67 consecutive patients with symptomatic leiomyoma underwent UAE. GS was used for the first 49 patients and TAGM was used for the following 18 patients. The primary endpoint was tumor infarction on contrast-enhanced magnetic resonance imaging (MRI) 1 week after UAE. The secondary endpoints were changes in symptoms and quality-of-life scores with UFS-QOL questionnaires at 4 months, and adverse events (AEs) in the 4 months after UAE. Results The baseline characteristics of both groups were similar. Complete or nearly complete tumor infarction (≥90%) was achieved in 94.4% (17/18) of the TAGM group and 93.6% (44/47) of the GS group. This difference (0.8%; 95% CI, –11.9% to 13.5%) indicated the non-inferiority of the TAGM group to the GS group, with a pre-specified non-inferiority margin of 20%. No significant differences were observed in improvements in symptoms or quality-of-life scores at 4 months ( P = 0.56 and P = 0.19) or in 4-month AEs ( P = 0.29). Conclusion The outcomes of UAE with TAGM were comparable to those of UAE with GS, suggesting that both embolic agents are acceptable for the treatment of leiomyoma.
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Affiliation(s)
| | - Hiroshi Miura
- Department of Radiology, Saiseikai Shiga Hospital, Shiga, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Akihiko Hino
- Department of Neurosurgery, Saiseikai Shiga Hospital, Shiga, Japan
| | - Yusuke Tsuji
- Department of Radiology, Saiseikai Shiga Hospital, Shiga, Japan
| | - Yoko Masuda
- Department of Radiology, Saiseikai Shiga Hospital, Shiga, Japan
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Katsumori T, Miura H, Tsuji Y, Masuda Y, Nishimura T. Comparison of first and second UAE for symptomatic uterine leiomyomas. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Hino A, Oka H, Hashimoto Y, Echigo T, Koseki H, Fujii A, Katsumori T, Shiomi N, Nozaki K, Arima H, Hashimoto N. Direct Microsurgical Embolectomy for Acute Occlusion of the Internal Carotid Artery and Middle Cerebral Artery. World Neurosurg 2015; 88:243-251. [PMID: 26748169 DOI: 10.1016/j.wneu.2015.12.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 12/23/2015] [Accepted: 12/24/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical embolectomy is the most promising therapy for physically removing emboli from major cerebral arteries. However, it requires an experienced surgical team, time-consuming steps, and is not incorporated into acute stroke therapy. METHODS We established seamless collaboration between services, refined surgical techniques, and conducted a prospective trial of emergency surgical embolectomy. Surgical indications included the presence of acute hemispheric symptoms, absence of low-density area on computed tomography, evidence of internal carotid artery terminus or proximal middle cerebral artery occlusion, and availability of resources to start surgery within 3 hours of symptom onset. The indications were confirmed by an interdisciplinary team. We assessed revascularization rates, time from admission to surgery and from surgery to recanalization, procedural complications, and clinical outcomes. RESULTS Between 2005 and 2014, 14 consecutive patients with acute proximal middle cerebral artery or internal carotid artery terminus occlusion underwent emergency surgical embolectomy. All patients showed complete recanalization. Twelve patients survived and 7 had fair functional outcome (Rankin Scale score, ≤3). No significant procedural adverse events occurred. The mean times from admission to start of surgery, from surgery to recanalization, and from onset to recanalization were 14 minutes, 79 minutes, and 223 minutes, respectively. CONCLUSIONS Our results suggest that microsurgical embolectomy can rapidly, safely, and effectively retrieve clots and deserves reappraisal, although the choice largely depends on local institutional expertise.
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Affiliation(s)
- Akihiko Hino
- Department of Neurosurgery, Saiseikai Shigaken Hospital, Ritto, Japan.
| | - Hideki Oka
- Department of Neurosurgery, Saiseikai Shigaken Hospital, Ritto, Japan
| | - Youichi Hashimoto
- Department of Neurosurgery, Saiseikai Shigaken Hospital, Ritto, Japan
| | - Tadashi Echigo
- Department of Neurosurgery, Saiseikai Shigaken Hospital, Ritto, Japan
| | - Hirokazu Koseki
- Department of Neurosurgery, Saiseikai Shigaken Hospital, Ritto, Japan
| | - Akihiro Fujii
- Department of Neurology, Saiseikai Shigaken Hospital, Ritto, Japan
| | | | - Naoto Shiomi
- Department of Emergency and Critical Care Center, Saiseikai Shigaken Hospital, Ritto, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
| | - Hisatomi Arima
- Center of Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Katsumori T, Kasahara T, Kin Y, Nozaki T. Infarction of Uterine Fibroids After Embolization: Relationship Between Postprocedural Enhanced MRI Findings and Long-Term Clinical Outcomes. Cardiovasc Intervent Radiol 2007; 31:66-72. [DOI: 10.1007/s00270-007-9187-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 08/22/2007] [Accepted: 09/11/2007] [Indexed: 11/29/2022]
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Kin Y, Katsumori T, Kasahara T, Nozaki T, Ito H, Nishimura T. Hemodynamics of ovarian veins: MR angiography in women with uterine leiomyomata. Eur J Radiol 2007; 63:408-13. [PMID: 17349763 DOI: 10.1016/j.ejrad.2007.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 01/22/2007] [Accepted: 02/01/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE The passive reflux into ovarian veins (OVs) is well known as a common finding in normal asymptomatic women. The purpose of this study was to investigate the hemodynamics of OVs in women with myomatous uterus. MATERIALS AND METHODS Thirty-two women with symptomatic uterine leiomyomata underwent time-of-flight MR (TOF-MR) angiography, including venography and arteriography, and contrast-enhanced MRI. The frequency of reflux into OVs on TOF-MR angiography was retrospectively assessed with uterine volume, and compared to that of normal women in previous publication. The statistical evaluation was performed using Fisher's exact test. RESULTS The mean uterine volume was 932 +/- 612 ml (range, 301-2627 ml). The reflux into left OVs was observed in 4 of 32 women (13%) and that into right OVs was noted in 0 of 32 women (0%). These rates were significantly lower than those of normal asyptomatic women in the previous publication (p<0.05). The reflux into OVs was observed in 0 of 19 women (0%) with 600 ml or larger myomatous uterus, whereas it was noted in 4 of the remaining 13 women (31%) with less than 600 ml myomatous uterus, with significant difference between the two groups (p=0.02). CONCLUSIONS We found that reflux into OVs was infrequent in the vast majority of women with myomatous uterus, especially those with larger uterus due to leiomyomata on the basis of TOF-MR angiography. These findings suggested myomatous uterus could affect the flow direction of OVs, and passive reflux into OVs might be prevented due to the influence of antegrade flow of OVs.
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Affiliation(s)
- Yoko Kin
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga 520-3046, Japan.
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Abstract
PURPOSE To assess whether the size distribution of gelatin sponge particles differed according to the method used to make them and the type of original sheet. METHODS Gelatin sponge particles of approximately 1-1.5 x 1-1.5 x 2 mm were made from either Spongel or Gelfoam sheets by cutting with a scalpel and scissors. Particles were also made of either Spongel or Gelfoam sheets by pumping with two syringes and a three-way stopcock. The size distribution of the particles in saline was compared among the groups. RESULTS (1) Cutting versus pumping: When Spongel was used, cutting produced lower rates of smaller particles < or = 500 microm and larger particles > 2000 microm compared with pumping back and forth 30 times (1.1% vs 37.6%, p < 0.0001; 2.2% vs 14.4%, p = 0.008). When Gelfoam was used, cutting produced lower rates of smaller and larger particles compared with pumping (8.5% vs 20.4%, p = 0.1809; 0% vs 48.1%, p < 0.0001). (2) Spongel versus Gelfoam: There was no significant difference in the size distribution of the particles between Spongel and Gelfoam (p = 0.2002) when cutting was used. CONCLUSION The size distribution of gelatin sponge particles differed according to the method used to make them. More uniform particle sizes can be achieved by cutting than by pumping.
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Affiliation(s)
- Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan.
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Kobayashi TK, Ueda M, Nishino T, Bamba M, Echigo T, Oka H, Hino A, Fuse I, Fujimoto M, Katsumori T, Kaneko C. Langerhans cell histiocytosis of the skull on cytologic squash preparations. Diagn Cytopathol 2007; 35:154-7. [PMID: 17415918 DOI: 10.1002/dc.20597] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We present a case in which a primary cytodiagnosis of Langerhans cell histiocytosis (LCH) of the skull was made using squash preparations. The patient, a 25-year-old male, presented with raised intracranial pressure and decreased visual acuity. Magnetic resonance imaging revealed a large skull lesion with osteolytic features in the left frontal bone. The patient underwent surgical resection by the extended basal frontal epidural approach. The squash preparation smears were cellular and demonstrated a mixed population of small, mature lymphocytes, eosinophils, and a high histiocytes content. The histiocytes occurred as isolated or loosely cohesive and clustered. They possessed abundant cytoplasm with rounded cell shape and had characteristic nuclear features, composed of fine chromatin and delicate nuclear membranes. The cytologic features of these histiocytes were consistent with Langerhans cells (LCs). A final impression of LCH of the skull was rendered. Subsequent histopathology confirmed the diagnosis. LCs reacted with both S-100 protein and CD1a immunohistochemically. The demonstration of Birbeck granules on electron microscopic study was also noted. Whenever squash preparation yields a mixed population of mature lymphocytes, eosinophils, and histiocytes, the cytologists should be aware of and consider LCH as a diagnostic possibility.
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Affiliation(s)
- Tadao K Kobayashi
- Department of Pathology, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc, Ritto, Shiga, Japan.
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Katsumori T, Kasahara T, Kin Y, Ichihashi S. Magnetic Resonance Angiography of Uterine Artery: Changes with Embolization Using Gelatin Sponge Particles Alone for Fibroids. Cardiovasc Intervent Radiol 2007; 30:398-404. [PMID: 17225969 DOI: 10.1007/s00270-006-0196-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess uterine artery recanalization, together with tumor devascularization, after embolization using gelatin sponge particles alone for fibroids. METHODS Twenty-seven patients underwent uterine artery embolization (UAE) for fibroids using only gelatin sponge particles. The angiographic endpoint of embolization was defined as near stasis of contrast medium in the ascending segment of the uterine artery. All patients underwent contrast-enhanced magnetic resonance angiography (MRA) before and 4 months after UAE, and contrast-enhanced magnetic resonance imaging (CE-MRI) before, 1 week after, and 4 months after UAE. The visualization of the uterine arteries before and 4 months after UAE was assessed using MRA. The infarction rates of the largest tumor were assessed using CE-MRI 1 week after UAE. RESULTS MRA 4 months after UAE showed 100% (53/53) of the descending and transverse segments, and 88% (43/49) of the ascending segments that had been noted on baseline MRA. The visualization of the ascending segments on MRA 4 months after UAE was identical to that on baseline MRA in 20 of 27 patients (74%). CE-MRI showed complete infarction of the largest tumor in 22 of 27 patients (81%), and 90-99% infarction of the largest tumor in the remaining 5 of 27 patients (19%). CONCLUSION Based on the MR study, in most cases uterine artery recanalization occurred, together with sufficient devascularization of fibroids, after UAE using gelatin sponge particles alone.
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Affiliation(s)
- Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga 520-3046, Japan.
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Katsumori T, Kasahara T. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial). Am J Obstet Gynecol 2006; 195:1190; author reply 1191. [PMID: 17000261 DOI: 10.1016/j.ajog.2005.12.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Accepted: 12/30/2005] [Indexed: 11/30/2022]
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Kobayashi TK, Bamba M, Oka H, Hino A, Fujimoto M, Katsumori T, Moritani S, Kushima R, Kaneko C. Granular cell tumour of the neurohypophysis on cytological squash preparations. Cytopathology 2006; 17:153-4. [PMID: 16719859 DOI: 10.1111/j.1365-2303.2006.00298.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Katsumori T, Kasahara T, Akazawa K. Long-Term Outcomes of Uterine Artery Embolization Using Gelatin Sponge Particles Alone for Symptomatic Fibroids. AJR Am J Roentgenol 2006; 186:848-54. [PMID: 16498120 DOI: 10.2214/ajr.05.0640] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the long-term outcomes of uterine artery embolization using only gelatin sponge particles for symptomatic fibroids. MATERIALS AND METHODS As part of an ongoing study of the procedure for fibroids, prospective data of the initial 96 consecutive women treated between December 1997 and December 2001, were collected in January 2005. It had been more than 3 years since embolization in all cases. The follow-up period ranged from 4 to 60 months (mean, 37.4 months). On the basis of serial questionnaires, we investigated the cumulative rates of symptom control, gynecologic interventions, and overall failure, using the Kaplan-Meier product limit estimator. Symptom control was defined as meaning patients whose symptoms had improved as indicated on the last questionnaire and who had not undergone any further gynecologic intervention because of symptoms. Overall failure was defined as meaning the patients who indicated that there had been no symptom improvement or recurrence or that they had undergone further gynecologic interventions. RESULTS Of all 96 women, 16 (17%) were lost to follow-up during the period. Cumulative rates of symptom control were 96.9% at 1 year, 89.5% at 3 years, and 89.5% at 5 years. Cumulative rates of complications related to the gynecologic intervention and overall gynecologic interventions were 2.1% and 4.2%, respectively, at 1 year, 2.1% and 5.4% at 3 years, and 2.1% and 10.5% at 5 years. Cumulative rates of overall failure were 4.2% at 1 year, 12.7% at 3 years, and 12.7% at 5 years. Major complications were noted in 3.1% (3/96). Of these three women, two required hospitalization for transvaginal resection of sloughing fibroids and one developed sexual dysfunction. Two women became pregnant, but both pregnancies resulted in miscarriage. CONCLUSION Uterine artery embolization using gelatin sponge particles alone can achieve long-term symptom control for fibroids in most cases.
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Affiliation(s)
- Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto-city, Shiga 520-3046, Japan
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Kobayashi TK, Bamba M, Ueda M, Nishino T, Muramatsu M, Moritani S, Katsumori T, Oka H, Hino A, Fujimoto M, Kushima R. Cytologic diagnosis of brain metastasis from hepatocellular carcinoma by squash preparation. Diagn Cytopathol 2006; 34:227-31. [PMID: 16470867 DOI: 10.1002/dc.20420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Hepatocellular carcinoma (HCC) metastasizes to the brain is rare instances. In published series and case reports of metastatic HCC, diagnosis of central nervous system metastases has been determined by histologic methods. We present a case of metastatic HCC of brain diagnosed by squash cytologic preparation. A 69-year-old male, HCV positive, suffering from post-hepatitic cirrhosis, initially diagnosed at age 68 with HCC presented with headaches of increasing frequency and severity. A computed tomography scan confirmed a 3-cm nodule in the right parietal lobe of the brain. Squash cytology was performed intraoperatively and preparations of a small tissue fragment resected from the mass showed medium-to-large-sized, well-cohesive clusters or sheets of uniform tumor cells. The tumor cells are highly cellular and contain solitary tumor cells in loose groupings as well as many fragments. They also appear somewhat bizarre and contain large, round, or ovoid nuclei with prominent nucleoli. Cytologic diagnosis of metastatic HCC was rendered reported and confirmed by a subsequent frozen section examination. To the best of our knowledge, this is the first reported case in which HCC was reported as brain metastasis, by using squash cytology. We suggest that intraoperative squash cytologic examination be viewed as a useful initial approach in the diagnosis of metastatic brain tumor.
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Affiliation(s)
- Tadao K Kobayashi
- Department of Pathology, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan.
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Abstract
OBJECTIVE The objective of our study was to assess the outcomes of uterine artery embolization as a treatment for pedunculated subserosal fibroids, which we defined as those in which the diameter of the stalk was 50% narrower than the diameter of the fibroid. MATERIALS AND METHODS During a 72-month period, 196 consecutive women underwent embolization for treatment of symptomatic uterine fibroids that were confirmed on baseline sagittal and axial MR images. We identified those women with pedunculated subserosal fibroids treated with embolization and retrospectively assessed complications and out-comes of embolization using a serial questionnaire and MRI. RESULTS Of the 196 women, 12 (age range, 34-48 years; mean age, 42.3 years) had one or more pedunculated subserosal fibroids. Fifteen pedunculated subserosal fibroids were identified on baseline MR images in the 12 patients. The mean tumor diameter was 8.3 cm (range, 4.0-15.5 cm; 95% confidence interval [CI], 6.7-9.9 cm). The mean stalk diameter was 3.1 cm (range, 2.0-5.5 cm; 95% CI, 2.5-3.7 cm). The follow-up period ranged from 5 to 51 months (mean, 18.1 months). No serious complications such as separation of the tumors from the uterus, torsion of the tumors, or infection occurred after embolization. Enhanced MR images obtained 1 week after embolization showed that complete devascularization of the tumors had been achieved in 73% (11/15) of the tumors. The rates of mean tumor volume reduction were 41% (range, 12-73%) 4 months and 53% (range, 31-85%) 1 year after embolization. The mean stalk diameter was 3.2 cm (range, 1.7-5.4 cm; 95% CI, 2.5-3.9 cm) 4 months and 2.9 cm (range, 1.1-4.2 cm; 95% CI, 1.8-3.9 cm) 1 year after embolization. No significant difference in stalk diameters was noted 4 months (p=0.617) or 1 year (p=0.963) after embolization compared with the diameters before the treatment. The rates of mean uterus volume reduction were 35% (range, 15-47%) 4 months and 47% (range, 35-60%) 1 year after embolization. Marked or moderate improvement in bulk-related symptoms was achieved in 100% (10/10) of the women at 4-month follow-up, 100% (5/5) at 1-year follow-up, and 100% (2/2) at 2-year follow-up. CONCLUSION We found no serious complications after embolization for pedunculated subserosal fibroids with stalk diameters of 2 cm or larger. Successful outcomes can be obtained in such tumors.
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Affiliation(s)
- Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga 520-3046, Japan
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Abstract
OBJECTIVE The objective of our study was to determine whether tumor size, specifically uterine fibroids of 10 cm or larger, predisposes a patient to an unacceptably high risk at uterine artery embolization. MATERIALS AND METHODS One hundred fifty-two consecutive women underwent embolization for uterine fibroids. Complications and outcomes were analyzed using questionnaires and serial MRI between women with one or more uterine fibroids of 10 cm or larger diameter (mean, 12.4 cm; range, 10-19 cm) (n = 47, group 1) and women with each uterine fibroid of less than 10 cm diameter (mean, 6.8 cm; range, 2-9.5 cm) (n = 105, group 2). RESULTS Thirty complications (19.7%, 30/152), which occurred in 27 women (17.8%, 27/152), were noted. However, 25 of 30 complications were minor, requiring no or nominal therapy. They occurred in 19.1% (9/47) of group 1 and in 15.2% (16/105) of group 2 women (p = 0.637). Major complications requiring major therapy, unplanned increased level of care, or unanticipated prolonged hospitalization (> 48 hr) or including permanent adverse sequelae were noted in 6.4% (3/47) of group 1 and in 1.9% (2/105) of group 2 women (p = 0.172). Of these five women, four underwent surgery because of sloughing fibroids. Permanent adverse sequelae were observed in one woman of group 1, who has had sexual dysfunction after embolization. No deaths occurred in either group. There was no significant difference in most outcomes or in intervals until the complete disappearance of postprocedural pain and full recovery between the two groups. CONCLUSION We found no increased risk to patients undergoing uterine artery embolization for fibroids on the basis of tumor size. Successful outcomes can be obtained for such lesions.
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Affiliation(s)
- Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga 520-3046, Japan
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Kobayashi TK, Moritani S, Katsumori T, Urabe M. Cytologic features of vaginal discharge obtained after uterine artery embolization for uterine leiomyomata. Acta Cytol 2003; 47:309-11. [PMID: 12685206 DOI: 10.1159/000326522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Katsumori T, Bamba M, Kobayashi TK, Moritani S, Urabe M, Nakajima K, Mihara T, Sugihara H. Uterine leiomyoma after embolization by means of gelatin sponge particles alone: report of a case with histopathologic features. Ann Diagn Pathol 2002; 6:307-11. [PMID: 12376924 DOI: 10.1053/adpa.2002.35745] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We describe the histopathologic features of uterine leiomyoma after uterine artery embolization (UAE) in a 42-year-old woman. This patient, who was taking antiplatelet drugs for the treatment of cerebral disease, successfully underwent UAE using only gelatin sponge particles for a symptomatic uterine leiomyoma. Although menorrhagia improved moderately after the procedure, she underwent abdominal hysterectomy 11 months later because of recurrent uterine bleeding. Histopathology revealed that most of the area of the uterine leiomyoma was characterized by extensive coagulation necrosis, which support the positive result of the procedure. No significant abnormalities were noted in either the myometrium or endometrium, which also suggested that UAE using only gelatin sponge particles is an appropriate procedure to preserve the uterus. The histologic and radiologic features of this case are discussed. To the best of our knowledge, this is the first reported case of uterine leiomyoma after UAE using only gelatin sponge particles as a primary embolic agent.
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Affiliation(s)
- Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ritto, Shiga, Japan
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Katsumori T, Nakajima K, Mihara T, Tokuhiro M. Uterine artery embolization using gelatin sponge particles alone for symptomatic uterine fibroids: midterm results. AJR Am J Roentgenol 2002; 178:135-9. [PMID: 11756107 DOI: 10.2214/ajr.178.1.1780135] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the safety and effectiveness of uterine artery embolization using gelatin sponge particles alone for women with symptomatic uterine fibroids. SUBJECTS AND METHODS During 38 months, 60 patients (age range, 32-52 years; mean age, 42.5 years) with symptomatic uterine fibroids underwent uterine artery embolization. Only gelatin sponge particles, approximately 500-1000 microm in diameter, were used in all patients. The improvement of clinical symptoms was assessed by questionnaire. Reduction of the largest tumor and uterine volume reductions were assessed using MR imaging. The follow-up period ranged from 1 to 38 months (mean, 10.6 months). RESULTS Menorrhagia improved markedly or moderately in 41 (98%) of 42 of patients 4 months after embolization and in 20 (100%) of 20 patients 1 year after embolization. Bulk-related symptoms improved markedly or moderately in 31 (97%) of 32 of patients 4 months after embolization and in 19 (100%) of 19 of patients 1 year after embolization. MR imaging revealed that the mean largest tumor volume reduction rates were 55% at 4 months and 70% at 1 year after embolization, and the mean uterine volume reduction rates were 40% at 4 months and 56% at 1 year after embolization. Follow-up MR imaging showed no new fibroids and no regrowth of existing fibroids. No major complications were observed in any women. CONCLUSION We suggest that uterine artery embolization with gelatin sponge particles alone is a safe and effective treatment for symptomatic fibroids. The outcomes bear comparison with those of uterine artery embolization using polyvinyl alcohol particles, which have been reported in the literature.
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Affiliation(s)
- Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto-cho, Kurita-gun, Shiga, 520-3046, Japan
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Katsumori T, Nakajima K, Tokuhiro M. Gadolinium-enhanced MR imaging in the evaluation of uterine fibroids treated with uterine artery embolization. AJR Am J Roentgenol 2001; 177:303-7. [PMID: 11461850 DOI: 10.2214/ajr.177.2.1770303] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether tumor volume reduction can be predicted by the infarction rate of uterine fibroids as seen on gadolinium-enhanced MR images obtained immediately after uterine artery embolization. MATERIALS AND METHODS In our study, 36 women with symptomatic uterine fibroids successfully underwent uterine artery embolization. Unenhanced and enhanced MR imaging was performed before the procedure and repeated at 1 week, 4 months, and 1 year after the procedure. We retrospectively reviewed enhanced MR images of uterine fibroids after uterine artery embolization. At 4 months after uterine artery embolization, we compared the rate of tumor volume reduction in patients with completely infarcted dominant fibroids with the rate of tumor volume reduction in patients with partially infarcted fibroids. RESULTS Enhanced MR images obtained 1 week after uterine artery embolization revealed that 100% infarction rates of the dominant uterine fibroids were achieved in 33 women (92%), and 70--90% infarction rates were seen in the remaining three (8%). They also revealed that of a total of 204 fibroids in these patients, 100% infarction was achieved in 199 fibroids (98%). Enhanced MR images obtained 4 months after uterine artery embolization showed that tumor volume reduction of the completely infarcted dominant fibroids (n = 23) was 60% +/- 18%, whereas that of the partially infarcted fibroids (n = 5) was 35% +/- 27% (p = 0.0367). CONCLUSION Gadolinium-enhanced MR imaging is a useful diagnostic technique for uterine fibroids after uterine artery embolization because it assesses the degree of infarction in the embolized fibroids, which corresponds to the subsequent tumor volume reduction.
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Affiliation(s)
- T Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto-cho, Kurita-gun, Shiga, 520-3046, Japan
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Kobayashi TK, Ueda M, Nishino T, Bamba M, Katsumori T, Kushima R. Cellular changes following uterine artery embolization for the treatment of adenomyosis. Cytopathology 2001; 12:270-2. [PMID: 11512547 DOI: 10.1046/j.1365-2303.2001.0328a.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kobayashi TK, Ueda M, Nishino T, Kushima R, Araki H, Katsumori T, Kaneko C. Papillary renal-cell carcinoma demonstrating prominent foamy macrophages by cytobrush scrapings: a case report. Diagn Cytopathol 2000; 23:216-8. [PMID: 10945914 DOI: 10.1002/1097-0339(200009)23:3<216::aid-dc17>3.0.co;2-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kobayashi TK, Ueda M, Nishino T, Kushima R, Kato K, Katsumori T. Inflammatory pseudotumor of the kidney: report of a case with fine needle aspiration cytology. Acta Cytol 2000; 44:478-80. [PMID: 10834015 DOI: 10.1159/000328503] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hino A, Fujimoto M, Iwamoto Y, Yamaki T, Katsumori T. False localization of rupture site in patients with multiple cerebral aneurysms and subarachnoid hemorrhage. Neurosurgery 2000; 46:825-30. [PMID: 10764255 DOI: 10.1097/00006123-200004000-00011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Patients with subarachnoid hemorrhage and multiple intracranial aneurysms present a unique challenge to the neurosurgeon. Unless all aneurysms can be clipped through a single craniotomy, the surgeon must accurately determine which aneurysm has ruptured. Misjudgment may result in disastrous postoperative rebleeding from the untreated but true ruptured lesion. We assessed the risk of false localization of the rupture site and subsequent rebleeding and documented the problems in predicting the true rupture site when patients have multiple intracranial aneurysms. METHOD We reviewed the records of a consecutive series of 93 patients treated over a period of 12 years who presented with their first subarachnoid hemorrhage and who had multiple intracranial aneurysms. The rupture site was determined on the basis of computed tomographic and angiographic findings, and the supposed ruptured aneurysm was clipped within 2 days of hemorrhage in each patient. Additional aneurysms that could not be accessed in the same surgical session were operated on at a later stage. All patients' records were reviewed, and all computed tomographic scans and angiograms, including repeat studies performed in some patients, were retrospectively reevaluated by the authors, who had no knowledge of the patients' clinical information. RESULTS The location of the aneurysm that ruptured was verified at the time of surgery or during the autopsy in 76 patients (82%). The aneurysm that ruptured was the one predicted as ruptured by the surgeon before surgery in 69 patients (91%) and in retrospect in 72 patients (95%). Five of the 6 patients in whom the ruptured aneurysm was not correctly identified were thought to have only a single aneurysm. Four patients rebled after surgery, and 2 patients died as a result of the rebleeding. CONCLUSION In the reported series, the most common cause of rebleeding soon after aneurysm surgery was failure to obliterate the ruptured aneurysm, usually because it was missed on the initial angiogram. The results support not only meticulous radiological investigation of all intracranial arteries before surgery but also thorough surgical inspection of the target aneurysm in all cases of subarachnoid hemorrhage even after one candidate lesion has been discovered.
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Affiliation(s)
- A Hino
- Department of Neurosurgery, Saiseikai Shigaken Hospital, Ritto, Shiga, Japan
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Hino A, Fujimoto M, Iwamoto Y, Yamaki T, Katsumori T. False Localization of Rupture Site in Patients with Multiple Cerebral Aneurysms and Subarachnoid Hemorrhage. Neurosurgery 2000. [DOI: 10.1227/00006123-200004000-00011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Hino A, Fujimoto M, Iwamoto Y, Takahashi Y, Katsumori T. An adult case of recurrent arteriovenous malformation after "complete" surgical excision: a case report. Surg Neurol 1999; 52:156-8; discussion 158-9. [PMID: 10447283 DOI: 10.1016/s0090-3019(99)00060-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Complete surgical excision of arteriovenous malformations (AVM) documented by postoperative angiography is considered a cure. However, recent reports have shown that AVMs in children may recur after negative postoperative angiograms, and some suggest that it may reflect the immaturity of their cerebrovasculature. This case report demonstrates that AVM in adults may also recur, despite postoperative angiograms confirming complete removal. CASE DESCRIPTION This 28-year-old man presented in 1994 with a focal motor seizure and was found to have an AVM in the right frontal lobe. He underwent surgical excision of the AVM; postoperative angiograms taken immediately after surgery and 15 days later showed no residual AVM. He remained free of symptoms after surgery and it was considered that a complete removal had been achieved. In 1998 he developed a subarachnoid hemorrhage, and subsequent angiograms revealed a small AVM in an adjacent location. CONCLUSION This is the oldest patient reported in the literature with a recurrence of AVM, despite postoperative angiograms confirming complete removal. Angiographically invisible immature vessels, which might have been left in the surgical field, might have formed a new malformation later. We still believe that such recurrence must be very rare after AVM surgery, but we now recommend follow-up angiography at yearly intervals to our patients.
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Affiliation(s)
- A Hino
- Department of Neurosurgery, Saiseikai Shigaken Hospital, Ritto, Shiga, Japan
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Jotsuka T, Hirota M, Tomioka T, Ohshima H, Katsumori T, Miyanari N, Nakano S, Okabe A, Izaki T, Tomiyasu S, Yamasaki K, Ogawa M. Giant cell carcinoma of the pancreas: a case report and review of the literature. Pancreas 1999; 18:415-7. [PMID: 10231849 DOI: 10.1097/00006676-199905000-00014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- T Jotsuka
- Department of Surgery, Arao City Hospital, Japan
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Abstract
BACKGROUND AND PURPOSE Neuroradiological investigations do not disclose a source of bleeding in some patients with spontaneous subcortical hemorrhage. These patients may harbor undetected vascular malformations and may be at risk of rebleeding in the future. We investigated patients with subcortical hemorrhage with use of repeat angiography and MRI to determine the incidence of occult vascular malformations and the risk of bleeding during follow-up. METHODS We reviewed a consecutive series of 137 patients with subcortical hemorrhage during a 10-year period (June 1987 through June 1997). If the patient was <65 years old and the first angiogram and/or MRI did not show a source of bleeding, repeat angiography was recommended. All angiographic and MRI studies were reviewed. The relationship between the identified bleeding source and clinical variables such as patient age, sex, and history of hypertension and the size and location of the hematoma were examined. RESULTS One hundred seven patients (78%) underwent angiography on admission, 10 (7%) had immediate surgery for hematoma without angiography, and 20 (15%) had neither angiography nor surgery. Overall, an etiology for the hemorrhage was found in 55 cases (40%). Vascular malformations were common in young patients without preexisting hypertension. A second angiogram was obtained in 22 patients, and 4 arteriovenous malformations were demonstrated. Rebleeding at the site of the initial hemorrhage was not observed after a mean follow-up of 68 months. CONCLUSIONS Angiography performed acutely after hemorrhage may not demonstrate vascular malformations. Consideration should be given to repeat angiography in patients who do not have a specific cause for hemorrhage.
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Affiliation(s)
- A Hino
- Department of Neurosurgery, Saiseikai Shigaken Hospital, Shiga, Japan
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Katsumori T, Katoh K, Takase K, Nishiue T, Tani N, Shirato M, Hino A, Fujimoto M, Maeda T. Intracerebral hemorrhage after transcatheter thrombolysis of non-occluding superior mesenteric artery thrombosis. Cardiovasc Intervent Radiol 1998; 21:419-21. [PMID: 9853149 DOI: 10.1007/s002709900290] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We performed transcatheter thrombolysis on a 64-year-old man with non-occluding superior mesenteric artery (SMA) thrombosis because his severe symptoms could not be controlled with medication. An enhanced computed tomography (CT) scan revealed intramural thrombosis in the SMA. We were concerned that the narrowing of the SMA lumen might progress to complete occlusion, resulting in a high likelihood of mortality. After dissolution of the SMA thrombosis, the original symptoms almost completely disappeared. However, intracranial hemorrhage occurred 8 hr after thrombolysis, requiring surgical intervention. Transcatheter thrombolysis is thought to be a useful treatment for SMA thrombosis, especially in elderly patients with a high operative risk; however, the possibility of intracerebral hemorrhage must be taken into consideration.
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Affiliation(s)
- T Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Japan
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Katsumori T, Nakajima K. A case of spontaneous hemorrhage of the abdominal wall caused by rupture of a deep iliac circumflex artery treated by transcatheter arterial embolization. Eur Radiol 1998; 8:550-2. [PMID: 9569320 DOI: 10.1007/s003300050432] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We report an uncommon case of spontaneous massive hemorrhage of the abdominal wall caused by rupture of a deep iliac circumflex (DIC) artery. Enhanced computed tomography (CT) demonstrated a marked extravasation in a huge hematoma of the abdominal wall. Although a pelvic arteriogram demonstrated no extravasation, a superselective DIC arteriogram subsequently revealed an extravasation of the artery. We successfully performed transcatheter arterial embolization for the artery. There have been few reports in the literature of spontaneous hemorrhage in the abdominal wall resulting from rupture of DIC artery, which were defined by diagnostic imaging and successfully treated by transcatheter arterial embolization.
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Affiliation(s)
- T Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto-chou, Kurita-gun, Shiga 520-30, Japan
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