杉本 幸司 | ![]() |
スギモト コウジ | |
医学部附属病院 IVRセンター | |
教授 | |
医学 |
PURPOSE: The purpose is to investigate the major and minor complications of the pancreas after transcatheter arterial embolization (TAE) using n-butyl-2-cyanoacrylate (NBCA) for bleeding from pancreatic arteries. MATERIALS AND METHODS: Thirty-three patients who underwent TAE using NBCA for acute bleeding from pancreatic arteries and their parent arteries followed by contrast-enhanced computed tomography (CE-CT) were evaluated retrospectively. Complications and risk factors were assessed using Mann-Whitney U test or Fisher's exact test for the univariate analysis. Patients' characteristic, embolized artery, procedure details, and clinical outcomes were examined as possible risk factors. RESULTS: TAE was performed successfully in all patients. Minor pancreatic complications occurred in 10 patients (30%), including acute mild pancreatitis (n = 4) and focal lack of pancreatic parenchymal enhancement on CE-CT without pancreatitis (n = 6). No cases of major pancreatic complications, such as moderate/severe pancreatitis, were reported. Embolized artery was the only significant risk factor. The rate of complications per embolized artery were 15% (three out of 20 patients) in the arteries of the pancreatic head and 54% (seven out of 13 patients) in the arteries of pancreatic body and tail (p = 0.025). CONCLUSION: TAE using NBCA for acute bleeding from pancreatic arteries is efficacious and safe. Mild pancreatic complications were observed more frequently in case of embolization of the pancreatic body and tail region than the pancreatic head.
2021年10月06日, Japanese journal of radiology, 英語, 国内誌研究論文(学術雑誌)
PURPOSE: To evaluate the efficacy of superselective transcatheter arterial embolization (TAE) for intractable postpartum hemorrhage (PPH) due to genital tract trauma (GTT) after vaginal delivery. METHODS: We evaluated 27 patients who underwent TAE for intractable PPH due to GTT after vaginal delivery at our institution between January 2008 and December 2020. Patients were divided into two groups according to TAE procedure; TAE performed as close as possible to the bleeding point, at least more peripherally than the second branch of the anterior division of the internal iliac artery, was defined as superselective TAE (S-TAE). TAE performed from the proximal segment of the internal iliac artery was defined as proximal TAE (P-TAE). Patient characteristics, pre-procedural contrast-enhanced computed tomography (CE-CT), procedure details, technical/clinical success, and complications were evaluated separately for the S-TAE and P-TAE groups. RESULTS: The combined technical/clinical success rate was 92%. No major procedure-related complications were seen (mean follow-up: 6.12 ± 3.93 days). The combined technical/clinical success rate of S-TAE was 100% and of P-TAE was 67% (p = 0.04). S-TAE was performed more frequently in patients with pre-procedural CE-CT (p = 0.01) and use of permanent embolic materials (p = 0.003). CONCLUSION: S-TAE is safe and effective for intractable PPH due to GTT. Pre-procedural CE-CT may be useful for detecting the culprit artery and be helpful in performing S-TAE.
2021年07月24日, Emergency radiology, 英語, 国際誌研究論文(学術雑誌)
Background: Technological developments have led to an increased usage of external-body radiotherapy (RT) for the treatment of hepatocellular carcinoma (HCC). Transcatheter arterial chemoembolization (TACE) may be required later in patients treated with RT because of the high recurrence rate and multinodular presentation of HCC. However, despite the risk of liver function impairment, the cumulative liver damage correlated with TACE following a hepatic RT has not been adequately assessed. Purpose: To evaluate the feasibility of TACE following RT for HCC. Materials and methods: Sixty-seven patients with HCC who underwent TACE after RT were retrospectively evaluated between 2012 and 2018. We assessed increases in Child-Turcotte-Pugh (CTP) by ≥2 points at 1 month, the incidence of major complications, survival duration, and short-term mortality within 6 months after TACE. Furthermore, we evaluated the predictive factors for liver function impairment and short-term mortality. Results: Eight patients experienced a CTP increase ≥2 points at 1 month. There were no cases of liver abscesses or bilomas. Nine patients died within 6 months following TACE. The mean liver dose (MLD) was a significant predictor of liver function impairment at 1 month (p = 0.042). Low liver functional reserve, distant metastasis (p = 0.037), MLD (p = 0.046), TACE type (p = 0.025), and TACE within 3 months following RT (p = 0.007) were significant predictors of short-term mortality. Conclusions: Despite the feasibility of TACE following RT, clinicians should pay attention to impaired pretreatment liver function, following high dose RT, and the short duration between RT and TACE.
2021年07月, Acta radiologica open, 10 (7), 20584601211034965 - 20584601211034965, 英語, 国際誌研究論文(学術雑誌)
OBJECTIVE: This study sought to confirm if thoracic endovascular aortic repair (TEVAR) was an appropriate therapeutic strategy for blunt thoracic aortic injury (BTAI). METHODS: Between 3/2005 and 12/2020, 104 patients with BTAI were brought to our hospital. The severity of each trauma case was evaluated using the Injury Severity Score (ISS); aortic injuries were classified as type I to IV according to Society for Vascular Surgery guidelines. Initial treatment was categorized into four groups: nonoperative management (NOM), open aortic repair (OAR), TEVAR, or emergency room thoracotomy/cardiopulmonary resuscitation (ERT/CPR). RESULTS: The patients' mean age and ISS were 56.7 ± 20.9 years and 48.3 ± 20.4, respectively. Type III or IV aortic injury were diagnosed in 82 patients. The breakdown of initial treatments was as follows: NOM for 28 patients, OAR for four, TEVAR for 47, and ERT/CPR for 25. The overall early mortality rate was 32.7%. Logistic regression analysis confirmed ISS > 50 and shock on admission as risk factors for early mortality. The cumulative survival rate of all patients was 61.2% at 5 years after treatment. After initial treatment, eight patients receiving TEVAR required OAR. The cumulative rate of freedom from reintervention using TEVAR at 5 years was higher in approved devices than in custom-made devices (96.0 vs. 56.3%, p = 0.011). CONCLUSIONS: Using TEVAR as an initial treatment for patients with BTAI is a reasonable approach. Patients with severe multiple traumas and shock on admission had poor early outcomes, and those treated with custom-made devices required significant rates of reintervention.
2021年06月16日, General thoracic and cardiovascular surgery, 英語, 国内誌研究論文(学術雑誌)
Carbon dioxide (CO2) treatment is reported to have an antitumor effect owing to the improvement in intratumoral hypoxia. Previous studies were based on histological analysis alone. In the present study, the improvement in intratumoral hypoxia by percutaneous CO2 treatment in vivo was determined using 18F-fluoromisonidazole positron emission tomography-computed tomography (18F-FMISO PET-CT) images. Twelve Japanese nude mice underwent implantation of LM8 tumor cells in the dorsal subcutaneous area 2 weeks before percutaneous CO2 treatment and 18F-FMISO PET-CT scans. Immediately after intravenous injection of 18F-FMISO, CO2 and room air were administered transcutaneously in the CO2-treated group (n=6) and a control group (n=6), respectively; each treatment was performed for 10 minutes. PET-CT was performed 2 h after administration of 18F-FMISO. 18F-FMISO tumor uptake was quantitatively evaluated using the maximum standardized uptake value (SUVmax), tumor-to-liver ratio (TLR), tumor-to-muscle ratio (TMR), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Mean ± standard error of the mean (SEM) of the tumor volume was not significantly different between the two groups (CO2-treated group, 1.178±0.450 cm3; control group, 1.368±0.295 cm3; P=0.485). Mean ± SEM of SUVmax, TLR, MTV (cm3) and TLG were significantly lower in the CO2-treated group compared with the control group (0.880±0.095 vs. 1.253±0.071, P=0.015; 1.063±0.147361 vs. 1.455±0.078, P=0.041; 0.353±0.139 vs. 1.569±0.438, P=0.015; 0.182±0.070 vs. 1.028±0.338, P=0.015), respectively. TMR was not significantly different between the two groups (4.520±0.503 vs. 5.504±0.310; P=0.240). In conclusion, 18F-FMISO PET revealed that percutaneous CO2 treatment improved intratumoral hypoxia in vivo. This technique enables assessment of the therapeutic effect in CO2 treatment by imaging, and may contribute to its clinical application.
2021年03月, Oncology letters, 21 (3), 207 - 207, 英語, 国際誌研究論文(学術雑誌)
OBJECTIVES: This study aimed to assess the diagnostic accuracy of computed tomography (CT) and time-resolved magnetic resonance angiography (TR-MRA) for patency after coil embolization of pulmonary arteriovenous malformations (PAVMs) and identify factors affecting patency. METHODS: Data from the records of 205 patients with 378 untreated PAVMs were retrospectively analyzed. Differences in proportional reduction of the sac or draining vein on CT between occluded and patent PAVMs were examined, and receiver operating characteristic analysis was performed to assess the accuracy of CT using digital subtraction angiography (DSA) as the definitive diagnostic modality. The accuracy of TR-MRA was also assessed in comparison to DSA. Potential factors affecting patency, including sex, age, number of PAVMs, location of PAVMs, type of PAVM, and location of embolization, were evaluated. RESULTS: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CT were 82%, 81%, 77%, 85%, and 82%, respectively, when the reduction rate threshold was set to 55%, which led to the highest diagnostic accuracy. The sensitivity, specificity, PPV, NPV, and accuracy of TR-MRA were 89%, 95%, 89%, 95%, and 93%, respectively. On both univariable and multivariable analyses, embolization of the distal position to the last normal branch of the pulmonary artery was a factor that significantly affected the prevention of patency. CONCLUSIONS: TR-MRA appears to be an appropriate method for follow-up examinations due to its high accuracy for the diagnosis of patency after coil embolization of PAVMs. The location of embolization is a factor affecting patency. KEY POINTS: • Diagnosis of patency after coil embolization for pulmonary arteriovenous malformations (PAVMs) is important because a patent PAVM can lead to neurologic complications. • The diagnostic accuracies of CT with a cutoff value of 55% and TR-MRA were 82% and 93%, respectively. • The positioning of the coils relative to the sac and the last normal branch of the artery was significant for preventing PAVM patency.
2021年01月15日, European radiology, 31 (7), 5409 - 5420, 英語, 国際誌研究論文(学術雑誌)
BACKGROUND: Postoperative biliary strictures are commonly related to accidental bile duct injuries or occur at the site of biliary anastomosis. The first-line treatment for benign biliary strictures is endoscopic therapy, which is less invasive and repeatable. However, recanalization for biliary complete obstruction is technically challenging to treat. The present report describes a successful case of treatment by extraluminal recanalization for postoperative biliary obstruction using a transseptal needle. CASE PRESENTATION: A 66-year-old woman had undergone caudal lobectomy for the treatment of hepatocellular carcinoma. The posterior segmental branch of the bile duct was injured and repaired intraoperatively. Three months after the surgery, the patient had developed biliary leakage from the right hepatic bile duct, resulting in complete biliary obstruction. Since intraluminal recanalization with conventional endoscopic and percutaneous approaches with a guidewire failed, extraluminal recanalization using a transseptal needle with an internal lumen via percutaneous approach was performed under fluoroscopic guidance. The left lateral inferior segmental duct was punctured, and an 8-F transseptal sheath was introduced into the ostium of right hepatic duct. A transseptal needle was advanced, and the right hepatic duct was punctured by targeting an inflated balloon that was placed at the end of the obstructed right hepatic bile duct. After confirming successful puncture using contrast agent injected through the internal lumen of the needle, a 0.014-in. guidewire was advanced into the right hepatic duct. Finally, an 8.5-F internal-external biliary drainage tube was successfully placed without complications. One month after the procedure, the drainage tube was replaced with a 10.2-F drainage tube to dilate the created tract. Subsequent endoscopic internalization was performed 5 months after the procedure. At the 1-year follow-up examination, there was no sign of biliary obstruction and recurrence of hepatocellular carcinoma. CONCLUSIONS: Recanalization using a transseptal needle can be an alternative technique for rigid biliary obstruction when conventional techniques fail.
2020年12月03日, Surgical case reports, 6 (1), 304 - 304, 英語, 国際誌研究論文(学術雑誌)
BACKGROUND: Preoperative prediction of thromboembolic complications using magnetic resonance imaging (MRI) in coronary arteries and carotid arteries has been established. However, the technique has not been applied in peripheral arteries. This study aimed to assess the relationship between thromboembolic complications during endovascular treatment (EVT) for iliac artery occlusion and signal intensity on MRI. METHODS: This single-institution study included 52 iliac artery occlusions in 51 patients (mean age, 70.4 years) who underwent successful EVT between January 2010 and March 2018. MRI using an inversion recovery-prepared, steady-state free precession technique was performed preoperatively. Thromboembolic complications were defined as distal embolization and in-stent protrusion greater than 25% of the stent cross-sectional area confirmed by angiography and intravascular ultrasonography, regardless of symptoms. The highest signal intensity of iliac artery occlusion divided by the signal intensity of adjacent iliopsoas muscle (target-to-muscle ratio, TMR) was measured on MR images. Multivariate analysis was performed to clarify the predictors of thromboembolic complications during EVT. RESULTS: Thromboembolic complications observed in 11 vessels (21.2%) from 11 patients comprised distal embolization (n = 4) and in-stent protrusion (n = 7). A TMR cutoff value > 2.57 had a sensitivity of 90.9%, specificity of 78.0%, positive predictive value of 52.6%, and negative predictive value of 97.0% for detecting thromboembolic complications during EVT. In the multivariate analysis, TMR >2.57 was the only independent factor associated with thromboembolic complications (odds ratio, 30.10; 95% confidence interval, 3.26-278.00; P = 0.003). CONCLUSIONS: The presence of higher signal intensity in iliac artery occlusion on MRI is useful for predicting thromboembolic complications during EVT.
2020年11月28日, Annals of vascular surgery, 73, 211 - 221, 英語, 国際誌研究論文(学術雑誌)
PURPOSE: To evaluate the mid-term outcomes of transarterial embolization (TAE) for type II endoleak after endovascular abdominal aortic aneurysm repair (EVAR) and investigate the predictors of sac enlargement after embolization. MATERIALS AND METHODS: We conducted a retrospective analysis of 55 patients [48 men and 7 women, median age 79.0 (interquartile ranges 74-82) years] who underwent TAE for type II endoleak from 2010 to 2018. The aneurysmal sac enlargement, endoleaks, aneurysm-related adverse event rate, and reintervention rate were evaluated. Patients' characteristics and clinical factors were evaluated for their association with sac enlargement. RESULTS: Fifty-five patients underwent TAE with technical success and were subsequently followed for a median of 636 (interquartile ranges 446-1292) days. The freedom from sac enlargement rates at 1, 3, and 5 years was 73.2%, 32.0%, and 26.7%, respectively. After initial TAE, the recurrent type II, delayed type I, and occult type III endoleak were identified in 39 (71%), 5 (9%), and 3 (5%) patients, respectively. Although a patient had aorto-duodenal fistula, there was no aneurysm-related death. The freedom from reintervention rates was 84.6%, 35.7%, and 17.0%, respectively. In the multivariate analysis, sac diameter > 55 mm at initial TAE (hazard ratios, 3.23; 95% confidence intervals, 1.22-8.58; P < 0.05) was a significant predictor of sac enlargement. CONCLUSION: TAE for type II endoleak was not effective in preventing sac enlargement, and reinterventions were required among the mid-term follow-up. The sac diameter > 55 mm at initial TAE was a significant predictor of sac enlargement.
2020年05月, Cardiovascular and interventional radiology, 43 (5), 696 - 705, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
PURPOSE: To assess the utility of whole-aorta CT angiography (CTA) with 15 mL contrast material (CM) on time-resolved imaging for endovascular abdominal aortic repair (EVAR). METHODS: Twenty-six patients with a high-risk of post-contrast acute kidney injury (PC-AKI) underwent CTA with 15 mL CM using temporal maximum intensity projection (tMIP-CTA) generated from time-resolved imaging. The aortoiliac CT values were measured. Two observers measured the arterial diameters in unenhanced CT and tMIP-CTA images, and image quality was evaluated on a 5-point scale. The presence of the accessory renal artery, inferior mesenteric artery (IMA) occlusion, and instructions for use (IFU) of EVAR were evaluated. RESULTS: CT examinations were successfully performed, and no patients developed PC-AKI. The mean CT values of the whole aorta were 267.5 ± 51.4 HU, which gradually decreased according to the distal levels of the aorta. Bland-Altman analysis revealed excellent agreement for the external arterial diameter measurements between unenhanced CT and tMIP-CTA. Excellent interobserver agreement was achieved for the measurements of the external (ICCs, 0.910-0.992) and internal arterial diameters (ICCs, 0.895-0.993). Excellent or good overall image quality was achieved in 24 (92 %) patients. The presence of the accessory renal artery, IMA occlusion and the assessment of IFU were in 100 % agreement. Multivariate analysis revealed aortic volume as the most significant independent factor associated with strong aortic enhancement (p = 0.004). CONCLUSIONS: Whole-aorta tMIP-CTA on time-resolved imaging is useful for maintaining contrast enhancement and image quality for EVAR planning, and can substantially reduce the amount of CM.
2020年05月, European journal of radiology, 126, 108861 - 108861, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
Introduction: The underlying mechanism involved in the recurrence of hepatoma after hepatic arterial embolization (HAE) is not adequately examined. An immunosuppressive cytokine, transforming growth factor β1 (TGF-β1), can lead to tumor progression and is affected by hypoxia in various cancers. The study aimed to assess the effect of HAE on the expression of TGF-β1 in a rat hepatoma model. Methods: Sprague-Dawley rats bearing N1S1 hepatoma cells underwent HAE (HAE group, n = 5) or sham treatment (sham group, n = 4). The animals were euthanized at 48 h, and liver tissues were harvested. Immunohistochemistry (IHC) and quantitative polymerase chain reaction (qPCR) were performed to compare the expression of TGF-β1 and hypoxia-inducible factor 1α (HIF-1α) between the HAE and sham groups. In vitro experiments with the N1S1 cell line were also performed under normoxic (21% O2) or hypoxic (1% O2) conditions for 48 h, and the expression of TGF-β1 and HIF-1α was assessed with western blotting and enzyme-linked immunosorbent assay. Statistical data comparisons were performed by Student t test. Results: IHC showed that both the TGF-β1-positive and HIF-1α-positive tumor peripheral areas were larger in the HAE group (6.59 ± 2.49 and 10.26 ± 4.14%; p < 0.001, respectively) than in the sham group (0.34 ± 0.41 and 0.40 ± 0.84% respectively). Similarly, qPCR showed that the mRNA expression levels of TGF-β1 and HIF-1α were higher (1.95 ± 0.38-fold and 1.62 ± 0.37-fold; p < 0.001 and p = 0.002, respectively) in the HAE group than those in the sham group. TGF-β1 expression was suppressed when HIF-1α inhibitors were added (p = 0.001), and HIF-1α expression was upregulated when exogenous TGF-β1 was added (p = 0.033) in N1S1 cells. Conclusion: HAE enhanced local TGF-β1 expression in a rat hepatoma model. In vitro experiments suggest that HAE-induced hypoxic stress may trigger the interdependent expression of TGF-β1 and HIF-1α.
2020年01月, Liver cancer, 9 (1), 63 - 72, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
OBJECTIVE: The aim of this study was to assess the utility of 70-kilovoltage-peak (kVp) contrast-enhanced computed tomography (CECT) for visualization and identification of the right adrenal vein (RAV) in comparison with that of conventional 120-kVp CECT. METHODS: This retrospective study included patients who underwent adrenal venous sampling with concurrent biphasic 120-kVp (120-kVp group, n = 43) or 70-kVp (70-kVp group, n = 47) CECT. Signal-to-noise ratios, contrast-to-noise ratios, longitudinal lengths, conspicuity scores, RAV detection rates, and size-specific dose estimates were compared between the 2 groups. RESULTS: In comparison with the 120-kVp group, the 70-kVp group had significantly higher signal-to-noise and contrast-to-noise ratios (P < 0.001-P = 0.033), greater longitudinal lengths (P < 0.001-P = 0.002), superior conspicuity scores for the RAV (P < 0.001), higher RAV detection rates (P = 0.015-P = 0.033), and lower size-specific dose estimates (P < 0.001). CONCLUSIONS: Seventy-kilovoltage-peak CECT has advantages over conventional 120-kVp CECT and is potentially useful for noninvasive assessment of the precise anatomy of the RAV.
2020年01月, J Comput Assist Tomogr, 44 (1), 153 - 159[査読有り]
研究論文(学術雑誌)
OBJECTIVE: To evaluate the impact of white matter changes on neurologic outcomes after total arch replacement using antegrade cerebral perfusion. METHODS: White matter changes were assessed using a visual Fazekas scale on preoperative magnetic resonance images. From October 1999 to December 2016, 359 patients who had demonstrated changes on preoperative magnetic resonance imaging underwent elective total arch replacement using antegrade cerebral perfusion. Patients were classified into 3 severity groups: mild (100 patients), moderate (158 patients), and severe (101 patients). Mean follow-up time was 4.8 ± 3.6 years. Multivariate logistic regression methods were used to evaluate for an independent association between white matter changes and postoperative neurological outcomes. RESULTS: Hospital mortality was 2.8% (10/359), and no significant differences were found across the 3 groups (P = .604). Multivariate analysis demonstrated that the severity of white matter change was significantly associated with both postoperative permanent neurologic deficit (odds ratio, 5.77; 95% confidence interval, 1.58-38.4, P = .005) and transient neurologic deficit (odds ratio, 2.46; 95% confidence interval, 1.45-4.37, P < .001). CONCLUSIONS: White matter changes, defined using the visual Fazekas scale on preoperative magnetic resonance imaging, were significantly associated with significant postoperative adverse neurologic outcomes after total arch replacement using antegrade cerebral perfusion.
2019年04月, The Journal of thoracic and cardiovascular surgery, 157 (4), 1350 - 1357, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
PURPOSE: To assess the safety and efficacy of transarterial embolization (TAE) and to evaluate the utility of contrast-enhanced computed tomography (CE-CT) for life-threatening spontaneous retroperitoneal hemorrhage (SRH). METHODS: Nineteen patients underwent TAE following CE-CT for life-threatening SRH. CE-CT and angiographic findings, technical successes, and clinical successes were evaluated. The diagnostic performance of CE-CT for the detection of active bleeding arteries was also assessed by two independent readers. RESULTS: Active extravasation of contrast material was accurately observed in 78.9‒84.2% of the patients on CE-CT. Angiograms revealed active extravasation in 37 arteries of 15 patients (78.9%), and 4 patients showed no sign of active bleeding. Sensitivity, positive predictive value, and accuracy rate of CE-CT for the detection of active bleeding vessels was 59.5%, 62.9‒71.0% and 55.6‒60.0% respectively. The successful embolization of 48 intended arteries was achieved in all the patients, including empirical TAE in four patients. Hemodynamic stabilization was achieved in 17 patients (89.5%) with a significant decrease in transfusion (p < 0.001). CONCLUSION: TAE is a technically safe and clinically effective treatment method for life-threatening SRH. CE-CT has moderate capability for accurate identification of active bleeding arteries. TAE including arteries that potentially distribute anatomic territory of the hematoma is essential.
2019年04月, Japanese journal of radiology, 37 (4), 328 - 335, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
PURPOSE: To evaluate the incidence of type II endoleak (EL-II) and aneurysm enlargement after endovascular aneurysm repair (EVAR) using the Endurant stent graft in patients with abdominal aortic aneurysm (AAA) with occluded inferior mesenteric artery (IMA). MATERIALS AND METHODS: Between 2012 and 2017, 103 patients who underwent EVAR using the Endurant stent graft for AAA with occluded IMA (50 patients with prophylactic embolized IMA and 53 with spontaneous occluded IMA) were retrospectively reviewed. The incidence of EL-II and aneurysm enlargement was evaluated. Predictive factors for persistent EL-II were evaluated based on patient characteristics, preprocedural anatomical characteristics, intraprocedural details, and postprocedural complications. RESULTS: Incidence rates of early EL-II and persistent EL-II were 6.8% (7/103 patients) and 4.9% (5/103 patients), respectively. Aneurysm enlargement was found in 10 patients (9.7%), including all 5 patients with persistent EL-II, 3 with de novo EL-II, and 2 with no EL-II. The rates of freedom from aneurysm enlargement at 1, 2, and 3 years were 98.7%, 97.0%, and 93.1% for the group without persistent EL-II, and 80.0%, 60.0%, and 20.0% for the group with persistent EL-II (p < 0.001), respectively. The maximum aneurysm diameter (odds ratio (OR), 1.16; 95% confidence interval (CI), 1.01-1.34; p = 0.0362) and the number of patent lumbar arteries (OR, 2.72; 95% CI, 1.07-6.90; p = 0.0357) were predictive of persistent EL-II. CONCLUSIONS: The incidence of EL-II after EVAR using the Endurant stent graft for AAA with occluded IMA was low, but most early EL-II persisted and resulted in aneurysm enlargement. Level of Evidence Level 4, Case Series.
2019年04月, Cardiovascular and interventional radiology, 42 (4), 505 - 512, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
PURPOSE: To evaluate the advantages of intraprocedural CT during adrenal venous sampling (AVS) to confirm accurate catheterization of the right adrenal vein (RAV). MATERIALS AND METHODS: This single-institution study included 106 patients (mean age 52.4 years; range 28-74 years) with primary aldosteronism who performed contrast-enhanced CT (CECT) before AVS following AVS between January 2011 and March 2018. After catheterization of the RAV under fluoroscopic guidance, unenhanced CT images were obtained to confirm catheter position on unified CT angiography system. Catheter repositioning was performed when the catheter was inaccurately positioned. Venography findings were classified into two groups: (1) presumably cannulated in the RAV (presumed RAV group) and (2) obscured visualization of the RAV because of collateral vessels (obscured RAV group). Success rates of AVS were compared using Fisher's exact test. RESULTS: The overall success of AVS was achieved in 104 patients (98.1%). Catheter was deviated into the IVC during intraprocedural CT in four patients. Fourteen patients (14.0%) required catheter repositioning by intraprocedural CT images, and accurate catheterization in the RAV was eventually accomplished. The success rate of AVS was significantly higher in the presumed RAV group (90.1% [73/81]) than that in the obscured RAV group (68.4% [13/19]) (p = 0.024). If intraprocedural CT was not acquired during AVS, the success rate of AVS would have been significantly lower (84.9% [90/106]) compared with that use of intraprocedural CT (98.1% [104/106]) (p < 0.001). CONCLUSIONS: Intraprocedural unenhanced CT by referring to the preprocedural CECT before AVS enables the confirmation of accurate catheterization of the RAV. LEVEL OF EVIDENCE: Level 4, case series.
2019年04月, Cardiovascular and interventional radiology, 42 (4), 542 - 551, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
OBJECTIVES: The present study analyzed the prevalence of variations of the aortic arch branching in Japanese population, comparing patients with aortic arch disease with healthy controls. METHODS: Between from October 1999 and December 2015, 815 Japanese patients with aortic arch disease defined as aortic arch aneurysm (diameter ≥ 45 mm) and aortic dissection (group A) underwent aortic arch surgery in our institution. As a control group, 1506 traumatic screened patients were enrolled (group C). RESULTS: Aortic arch anomaly was diagnosed in 140 patients (17.2%) in the group A and in 222 patients (14.7%) in the group C (p = 0.125). Significant differences were found in the incidence of aberrant subclavian artery (A: 14 patients, 1.7%, vs. C: 8 patients, 0.5%, p = 0.006). Significantly more patients with aortic arch aneurysm in the group A had anomalies of the aortic arch compared with the group C (p = 0.009), including bovine aortic arch (p = 0.049) and aberrant subclavian artery (p < 0.001). In term of aneurysm location, bovine arch was detected in more patients with proximal arch aneurysm (15.7%, p = 0.043), whereas aberrant subclavian artery was in more patients with distal location (3.7%, p < 0.001). No difference was found in aortic arch anomaly in patients with acute or chronic dissection. CONCLUSION: Aberrant subclavian artery was a significant maker of aortic arch disease in Japanese populations. Bovine arch was a risk maker of proximal arch aneurysm, and aberrant subclavian artery was a risk factor of distal arch aneurysm.
2019年02月, General thoracic and cardiovascular surgery, 67 (2), 219 - 226, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
PURPOSE: To justify a classification system for angiographic images of uterine artery embolization (UAE) for postpartum hemorrhage (PPH) and identify new risk factors associated with failed embolization. MATERIALS AND METHODS: A retrospective analysis of 63 consecutive patients who underwent UAE for severe PPH was performed. Uterine artery angiography (UA) before embolization was classified into two types: type 1 was defined as complete staining and type 2 was defined as partial staining of the uterine arteries. The clinical outcome, UA classification, and other possible factors previously reported were evaluated. Univariate and multivariate analyses were performed to determine the factors related to clinical outcomes. RESULTS: Sixty-three patients were enrolled (type 1, 22; type 2, 41). The clinical success rates of the primary UAE session were 90.9% (20/22) for type 1 and 61.0% (25/41) for type 2 (p = 0.018). Univariate and multivariate analyses demonstrated that the only UA classification was significantly associated with primary UAE failure (p = 0.033). CONCLUSIONS: The UA classification is an independent predictive factor of the clinical success rate of the primary UAE session for PPH; thus, it is an intuitive and optimal predictor for interventional radiologists to decide whether additional therapy is necessary.
2018年06月, Japanese journal of radiology, 36 (6), 394 - 400, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
Introduction: Transcatheter arterial embolisation is often performed for the treatment of visceral artery aneurysms. Here, the case of a patient who developed the rare complication of coil migration into the intestinal tract is reported, and a review of the literature is presented. Case report: A 30 year old woman with a ruptured giant common hepatic artery aneurysm, who had been treated with transarterial coil embolisation 1 year previously, was admitted to hospital complaining of passing the coils on defecation. Abdominal Xray and gastroscopy showed the migration of the coils through a duodenal fistula. Open repair was performed with the coils successfully removed and the duodenal fistula closed with omentopexy. At the 3 year follow up, there were no signs or symptoms of complications. Conclusion: Based on observations from this case, although coil migration to the intestinal tract is exceedingly rare, aneurysm rupture with enteric fistula can lead to coil migration.
2018年, EJVES short reports, 39, 33 - 36, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
研究論文(学術雑誌)
BACKGROUND: We retrospectively reviewed the outcomes of distal bypass for critical limb ischemia and investigated the impact on outcomes of prior unsuccessful ipsilateral infrapopliteal endovascular treatment (EVT). METHODS: Between January 2005 and December 2014, we performed 142 infrainguinal bypasses for critical limb ischemia with ischemic gangrene (Rutherford classes V or VI), including 80 distal bypasses in 74 patients (male 54, female 20, median age 68.4 years, range 51-81 years). All distal bypasses used an autologous saphenous vein graft. Surgical outcomes were compared between 37 distal bypasses without prior infrapopliteal EVT (NEVT group) and 43 distal bypasses after unsuccessful infrapopliteal EVT (PEVT group). Infrapopliteal EVT was performed with balloon dilatation without stenting in all cases. RESULTS: There were no significant differences in preoperative conditions or risk factors between the NEVT and PEVT groups, except for the era of bypass surgery and dependence on hemodialysis. The 3-year primary and secondary patencies were 69% and 72% in the NEVT group and 78% and 80% in the PEVT group (P= 0.86, P= 0.79). The 3-year limb salvage rates were 81% in the NEVT group and 82% in the PEVT group (P= 0.52), and the 3-year amputation-free survival rates were 56% and 57% in the respective groups (P= 0.32). Standard errors of the mean for all Kaplan-Meier curves were < 10% within 3 years follow-up. CONCLUSIONS: The clinical outcomes of distal bypass without prior infrapopliteal EVT were not superior to those of distal bypass after unsuccessful ipsilateral infrapopliteal EVT. Therefore, unsuccessful infrapopliteal EVT does not have a negative impact on the outcome of subsequent ipsilateral distal bypass in patients with critical limb ischemia.
EDIZIONI MINERVA MEDICA, 2017年12月, JOURNAL OF CARDIOVASCULAR SURGERY, 58 (6), 828 - 834, 英語[査読有り]
研究論文(学術雑誌)
Objective: The aim of this study was to evaluate outcomes of combined popliteal-to-distal bypass and endovascular treatment (EVT) for femoropopliteal lesions in patients with critical limb ischemia (CLI). Patients and Methods: We reviewed data of 14 CLI patients who were treated by popliteal-to-distal bypass combined with femoropopliteal EVT. The femoropopliteal lesions included 3 TASC II-A, 8 TASC II-B, and 3TASC II-C but no TASC II-D, and balloon dilatation was performed in 9 cases and a stent was placed in 5 cases. The saphenous vein graft was used in all bypasses, and the target arteries were the dorsalis pedis artery in 12 cases and the posterior tibial artery in 2 cases. Results: At 12 and 24 months, primary patency rates were both 79%, primary assisted and secondary patency rates were both 93%, limb salvage rates were both 93%, and survival rates were 92% and 84%, respectively. Restenosis after femoropopliteal EVT occurred in 2 cases, and both were successfully revised by additional endovascular balloon dilatation. Conclusion: Combined popliteal-to-distal bypass and femoropopliteal EVT might be a useful therapeutic option for appropriately selected CLI patients. Intensive follow-up for endovascular treated lesions and vein graft is mandatory.
2017年09月25日, Annals of vascular diseases, 10 (3), 英語, 国内誌[査読有り]
研究論文(学術雑誌)
The present study aimed to evaluate the efficacy of an intra-arterially infused carbon dioxide (CO2)-saturated solution in sensitizing the anticancer effect of cisplatin in a rabbit VX2 liver tumor model. Forty VX2 liver tumor-bearing Japanese white rabbits were randomly divided into four groups and infused via the proper hepatic artery with a saline solution (control group), CO2-saturated solution (CO2 group), cisplatin solution (cisplatin group), or CO2-saturated solution and cisplatin solution (combined group). The tumor volume (TV) and the relative tumor volume (RTV), RTV = (TV on day 3 or 7)/(TV on day 0) x 100, were calculated using contrast-enhanced computed tomography. Hypoxia-inducible factor-1α (HIF‑1α) and carbonic anhydrase IX (CA IX) staining were used to evaluate cellular hypoxia. Cleaved caspase-3 and cleaved caspase-9 were analyzed to assess tumor apoptosis. The mean RTV on days 3 and 7 were 202.6±23.7 and 429.2±94.8%, respectively, in the control group; 172.2±38.1 and 376.5±61.1% in the CO2 group; 156.1±15.1 and 269.6±45.2% in the cisplatin group; and 118.3±28.1 and 210.3±55.1% in the combined group. RTV was significantly lower in the CO2 group than in the control group (day 3; P<0.05), and in the combined group than in the cisplatin group (days 3 and 7; P<0.05). HIF-1α and CA IX suppression, and increased cleaved caspase-3 and cleaved caspase-9 expression, were detected in the CO2 and combined groups, compared with the other two groups. An intra-arterially infused CO2-saturated solution inhibits liver VX2 tumor growth and sensitizes the anticancer effect of cisplatin.
2017年08月, International journal of oncology, 51 (2), 695 - 701, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
OBJECTIVES: The purpose of this study was to identify the cut-off value of sarcopenia based on the psoas muscle area index and evaluate early and late outcomes following elective total arch replacement in the elderly. METHODS: Sarcopenia was assessed by the psoas muscle area index [defined as the psoas muscle area at the L3 level on computed tomography (cm(2))/body surface area (m(2))]. The cut-off value for sarcopenia was defined as > 2 standard deviations below the mean psoas muscle area index value obtained from 464 normal control patients. Between October 1999 and July 2015, 266 patients who were >= 65 years and had undergone psoas muscle area index measurement underwent elective total arch replacement. These patients were classified into the sarcopenia (Group S, n = 81) and non-sarcopenia (Group N, n = 185) groups. RESULTS: The mean age was 76.2 +/- 5.6 years in Group S and 75.7 +/- 5.7 years in Group N (P = 0.553). Hospital mortality was 3.7% (3/81) in Group S and 2.2% (4/185) in Group N (P = 0.483). Mean follow-up was 48.3 +/- 38.7 months. Five-year survival was significantly worse in Group S (S: 63.2 +/- 6.6% vs N: 88.7 +/- 2.6%, P < 0.001). A multivariable Cox proportional hazard analysis showed that sarcopenia significantly predicted poor survival (hazard ratio 2.59; 95% confidence interval 1.27-5.29; P = 0.011). CONCLUSIONS: Sarcopenia did not predict hospital death following total arch replacement, but it was negatively associated with overall survival. Sarcopenia can be an additional risk factor to estimate the outcomes of thoracic aortic surgery.
OXFORD UNIV PRESS INC, 2017年06月, Eur J Cardiothorac Surg, 51 (6), 1135 - 1141, 英語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
A 79-year-old woman with a complaint of persistent upper abdominal pain was admitted to our hospital for the treatment of thrombosed acute type B aortic dissection. Computed tomography showed the complete static occlusion of the celiac artery. Because of progressive symptom with elevation of liver enzymes and metabolic acidosis 11 h after admission, endovascular revascularization was attempted on an emergent basis. After a failed catheterization of the celiac ostium in an antegrade fashion due to a hard occlusion, we succeeded in a retrograde recanalization through the pancreaticoduodenal arcade via the superior mesenteric artery with stent placement using a pull-through technique. This technique is useful and safe when an antegrade approach seems difficult.
ACTA MEDICAL BELGICA, 2017年, ACTA CHIRURGICA BELGICA, 117 (1), 45 - 48, 英語[査読有り]
研究論文(学術雑誌)
This study aimed to evaluate the efficacy of stereotactic body radiotherapy (SBRT) compared with three-dimensional conformal radiotherapy (3DCRT). Forty-three patients with portal vein tumor thrombosis (PVTT)/inferior vena cava tumor thrombosis (IVCTT) treated with SBRT (27 with CyberKnife (CK) and 16 with TrueBeam (TB)) from April 2013 to December 2014, and 54 treated with 3DCRT from June 2008 to March 2013 were evaluated. Dosimetric parameters, response to radiotherapy (RT) and survival outcomes were compared in total SBRT vs. 3DCRT, CK vs. 3DCRT and TB vs. 3DCRT, respectively. The median biologically effective dose 10 (BED10) values in total SBRT, CK, TB and 3DCRT were 73.4 Gy10, 75.0 Gy10, 60.5 Gy10 and 58.5 Gy10, respectively (P < 0.001 in total SBRT vs. 3DCRT, P < 0.001 in CK vs. 3DCRT, P = 0.004 in TB vs. 3DCRT). The tumor response rates were 67%, 70%, 62% and 46%, respectively (P = 0.04, P = 0.04, P = 0.25). The 1-year overall survival rates were 49.3%, 56.7%, 38.1% and 29.3%, respectively (P = 0.02, P = 0.02, P = 0.30), and the 1-year local progression rates were 20.4%, 21.9%, 18.8% and 43.6%, respectively (P = 0.01, P = 0.04, P = 0.10). The use of SBRT made it possible to achieve a higher BED10 compared with the use of 3DCRT. Improvements in local control and survival were achieved in the CK group and the total SBRT group. Our results suggest that SBRT may have the potential to be the standard RT technique for the treatment of PVTT/IVCTT.
2016年09月, Journal of radiation research, 57 (5), 512 - 523, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
Objectives: The aim was to evaluate computed tomography angiography (CIA) volumetric and diametric analysis after endovascular repair of descending thoracic aortic aneurysms (DTAAs) and its correlation with and applicability for clinical follow up. Methods: Fifty-four consecutive endovascular repairs for DTAA were retrospectively evaluated from 2008 to 2014. All patients underwent pre-operative CIA and at least one post-operative CIA at 6 months. Fifty-four preoperative and 137 post-operative CTAs were evaluated (using the Ziosoft 2 software) to analyze the aneurysm and thrombus volume, the maximum aneurysm diameter, and their changes at the last follow up CIA (mean 30.5 months; range 6.5-66.4 months). A statistical analysis was performed to assess the correlation between diameter and volume changes, as well as association with endoleaks. The cut off point to predict endoleaks was determined using a receiver operating characteristic (ROC) curve. The predictive accuracy of volume change versus diameter change for Type I endoleak was analyzed. Results: The mean pre-operative aneurysm diameter, aneurysm volume, and thrombus volume were 56.7 +/- 11.7 mm, 145.8 +/- 120.0 mL, and 48.8 +/- 54.8 mL, respectively. Within the observational period, a mean decrease of -27.9 +/- 30.5% in the aortic volume and -15.9 +/- 15.4% in diameter was observed. Correlation between aneurysm diameter and volume changes was good (r = 0.854). Volume and diameter changes were significantly different between groups with and without endoleaks (volume change 16.9 +/- 38.8% vs. -35.6 +/- 23.1%, p < .001; diameter change 8.0 +/- 12.1% vs. -18.8 +/- 14.3%, p < .001). A pre-operative thrombus volume percentage of <11.3% and increase in aneurysm volume +11.6% were predictive factors for Type II and Type I endoleak, respectively. The accuracy of a >10% volume increase in predicting a Type I endoleak was higher (accuracy 96.3%, sensitivity 75%, and specificity 98%) than a >5 mm diameter increase (accuracy 92.6%, sensitivity 25%, and specificity 98%). Conclusions: CT volumetric analysis is a more reliable modality for predicting endoleaks after endovascular repair for DTAA than diameter analysis. (C) 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
W B SAUNDERS CO LTD, 2015年07月, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 50 (1), 53 - 59, 英語[査読有り]
研究論文(学術雑誌)
We report three cases of hepatic artery pseudoaneurysm, which were all treated successfully using a combination of coil embolization and a side-holed 5F indwelling catheter for maintaining minimal hepatic artery blood flow with exclusion of the pseudoaneurysm. The tip of an infusion catheter was placed in the right hepatic artery and a side hole was positioned at the celiac axis. Coil embolization was then performed from the proper to the common hepatic artery using detachable coils. Hemostasis was achieved in all patients, with a final angiogram showing the hepatic arteries through the indwelling catheter. One major hepatic infarction and one focal liver abscess caused by reflux cholangitis manifested on postoperative days (PODs) 11 and 87, respectively. All patients survived and the indwelling catheter was removed on POD 136-382 without complication.
SPRINGER, 2015年06月, SURGERY TODAY, 45 (6), 772 - 776, 英語[査読有り]
研究論文(学術雑誌)
Introduction: Ameloblastoma is a benign odontogenic neoplasm of the jaw, rarely presenting as a malignant tumor. Although it is very important to discriminate ameloblastoma from ameloblastic carcinoma in order to decide the appropriate operative procedure, this is difficult using conventional CT and MRI. Case descriptions: We report a case of maxillar ameloblastoma in a 78-year-old man where FDG-PET/CT was useful for making this discrimination. CT demonstrated a 31 x 43 x 46-mm mass in the left posterior maxillary sinus with destruction of its posterior and lateral wall and alveolar bone. MRI demonstrated a hypo- to isointense heterogeneous pattern on T1WI, heterogeneous hyperintensity with a prominent high-signal spot on T2WI, high signal intensity on DWI reflecting restricted diffusion, and strong heterogeneous enhancement. Because FDG-PET/CT showed mild FDG uptake (SUVmax 2.40) by the mass, ameloblastoma, rather than ameloblastic carcinoma, was considered to be the correct diagnosis. Discussion and evaluation: It appears that ameloblastic carcinoma shows intense FDG uptake, whereas ameloblastoma shows mild or moderate FDG uptake, and only rarely intense FDG uptake. Our experience suggests that FDG-PET/CT may be effective for discriminating ameloblastoma from ameloblastic carcinoma. Especially, in cases showing mild FDG uptake, benign ameloblastoma would seem the most likely diagnosis. Conclusions: FDG-PET/CT may be useful as an adjunctive modality for diagnosis, treatment planning and surveillance of ameloblastoma and ameloblastic carcinoma.
SPRINGER INTERNATIONAL PUBLISHING AG, 2015年06月, SPRINGERPLUS, 4, 250, 英語[査読有り]
研究論文(学術雑誌)
To compare the results of endovascular treatment for unilateral iliac occlusion in types B and D, and confirm its validity for type D. Between 2000 and 2011, 108 patients underwent endovascular treatment for unilateral iliac occlusion. 77 were categorized as type B for occlusion of common iliac artery (CIA) or external iliac artery (EIA) and 31 were categorized as type D for occlusion of both CIA and EIA. The initial success rates, procedure time, penetration time, amount of contrast media used, complication rates, and cumulative primary patency rates were determined and compared between these groups. Between type D and B groups, the initial success rates were 87.1 % (type D) and 89.6 % (type B) (p = 0.9316). The procedure time was 137.0 +/- A 55.5 and 97.2 +/- A 47.2 min (p < 0.05). The penetration time was 49.1 +/- A 40.6 and 31.6 +/- A 30.1 min (p < 0.05). The amount of contrast agent used was 193.9 +/- A 103.1 and 156.5 +/- A 85.0 ml (p = 0.0722). The complication rates were 6.5 and 3.9 % (p = 0.8491). The cumulative primary patency rates, at 1, 3, and 5 years were 91, 85, and 85 % and 100, 96, and 93 %. Endovascular treatment can be indicated for unilateral occlusion of both CIA and EIA categorized as type D.
SPRINGER, 2015年02月, SURGERY TODAY, 45 (2), 162 - 167, 英語[査読有り]
研究論文(学術雑誌)
To classify the renal artery (RA) anatomy based on specific requirements for endovascular renal artery denervation (RDN) in patients with drug-resistant hypertension (RH). The RA anatomy of 122 consecutive RH patients was evaluated by computed tomography angiography and classified as two types: A (main RA a parts per thousand yen20 mm in length and a parts per thousand yen4.0 mm in diameter) or B (main RA < 20 mm in length or main RA < 4.0 mm in diameter). The A type included three subtypes: A1 (without accessory RAs), A2 (with accessory RAs < 3.0 mm in diameter), and A3 (with accessory RAs a parts per thousand yen3.0 mm in diameter]. A1 and A2 types were eligible for RDN with the Simplicity Flex catheter. Type B included twi subtypes based on the main RA length and diameter. Patients were accordingly classified into three eligibility categories: complete (CE; both RAs were eligible), partial (PE; one eligible RA), and noneligibility (NE; no eligible RA). Bilateral A1 type was the most prevalent and was observed in 48.4 % of the patients followed by the A1/A2 type (18 %). CE, PE, and NE were observed in 69.7, 22.9, and 7.4 % of patients, respectively. The prevalence of accessory RAs was 41 %. Of RH patients, 30.3 % were not eligible for bilateral RDN with the current Simplicity Flex catheter. This classification provides the basis for standardized reporting to allow for pooling of results of larger patient cohorts in the future.
SPRINGER, 2015年02月, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 38 (1), 79 - 87, 英語[査読有り]
研究論文(学術雑誌)
A 68-year-old man with cholangiocarcinoma underwent percutaneous transhepatic portal embolization to expand the indication for hepatic resection. Selective right posterior portography revealed an intrahepatic portosystemic venous shunt (IPSVS) connecting the segment VII branch to the right hepatic venous branch. An infusion of 50 % glucose solution was given to occlude the shunt. This is novel management for IPSVSs when they are numerous, small, or torturous, and makes the subsequent procedures simpler, shorter, and less expensive.
SPRINGER, 2014年12月, SURGERY TODAY, 44 (12), 2366 - 2368, 英語[査読有り]
研究論文(学術雑誌)
Endovascular treatment for arteriocaval fistula (ACF) has become the preferred alternative to open repair. However, endoleaks sometimes occur and maintain the ACF. A 64-year-old man presented with persistent fistula after placement of a bifurcated stent-graft for ACF complicating an aortoiliac aneurysm that was maintained by endoleaks from the inferior mesenteric and lumbar arteries. Transarterial embolization of the aneurysm sac and inferior mesenteric artery successfully resolved the problem without any complications observed over 16 months of follow-up. A literature review and discussion of the management options for this entity are presented. A combination of inflow and outflow control is important to obtain better long-term outcomes.
2014年11月, Journal of vascular and interventional radiology : JVIR, 25 (11), 1809 - 15, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
Ectopic variceal hemorrhage caused by sinistral portal hypertension after splenic vein ligation during a pyloric-preserving pancreatoduodenectomy is a rare entity. We report the case of a 58-year-old man with symptoms of refractory melena. The varices could not be treated endoscopically and surgery was considered unsuitable due to severe adhesions and altered anatomy. Following clinical failure of partial splenic embolization, an alternative obliteration method by a retrograde trans-portal-venous approach was successfully performed and resolved the problem. It seems to be an effective method for ectopic variceal bleeding, especially when other interventions are unavailable or highly risky.
2014年08月, Japanese journal of radiology, 32 (8), 487 - 90, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
PURPOSE: This study was designed to analyze the outcomes of endovascular treatment for internal iliac artery aneurysm (IIAA) at mid-term follow-up. METHODS: We retrospectively analyzed 33 patients (28 males, mean age 77.4 years) who underwent endovascular treatment of 35 IIAAs (mean diameter 39.8 mm) from 2002 to 2012. We attempted to completely and selectively embolize all distal branches with permanent embolic materials, followed by proximal controls either by stent-graft placement (type 1) or coil embolization (type 2). RESULTS: Procedural success rate was 97.1% (n = 34). Complete permanent distal branches embolization was achieved in 27 (79.4%), type 1 in 24 (70.6%), and type 2 in 10 (29.4%) cases. During mean follow-up period of 29.1 months (range, 1.2-92.8), no IIAA-related mortality and stent/stent-graft related complications occurred. Pelvic ischemia occurred and resolved in 8 (25%) patients. Among 32 cases followed by CT, the aneurysm diameter was stable in 18 (56.3%), shrank in 11 (34.4%), and enlarged in 3 (9.4%) cases. In 22 assessed by contrast-enhanced CT, secondary endoleak occurred in 3 (13.6%) cases and 2 required secondary interventions (2/32, 6.3%). Type 1 procedure tends to have better mid-term outcomes. Incomplete permanent distal branches embolization was associated with enlargement and secondary intervention (p = 0.007 and p = 0.042, respectively). The secondary intervention-free rate at 3 years in the complete and incomplete distal embolization group was 100 and 83.3%, respectively (p = 0.128). CONCLUSIONS: Endovascular treatment for IIAA is feasible and safe. Complete permanent distal branches embolization is important to achieve satisfactory mid-term outcomes.
2014年04月, Cardiovascular and interventional radiology, 37 (2), 348 - 54, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
Seven patients with superior mesenteric artery embolism were treated by aspiration with the use of a 6-F angled guiding sheath and a 6-F guiding catheter through an 8-F short sheath by direct advancement using a telescopic and "biting-off" technique. Aspiration of the trunk took between 30 and 60 minutes (median, 44.0 min), and total procedure time ranged from 34 to 94 minutes (median, 60 min). Five of six trunk lesions and six of nine branch lesions were successfully aspirated. One dissection was observed. Six patients underwent bowel resection. Two patients died and the remaining five survived for a median of 868.2 days without complications.
2014年04月, Journal of vascular and interventional radiology : JVIR, 25 (4), 635 - 9, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
Hemomediastinum and hemothorax due to spontaneous internal mammary artery (IMA) rupture is extremely rare, and can be a life-threatening condition. We herein present, to the best of our knowledge, the first case of spontaneous IMA rupture complicating myelodysplastic syndrome, and the first case that was successfully treated by emergency trans-arterial embolization using n-butyl cyanoacrylate.
2014年03月, Surgery today, 44 (3), 564 - 7, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
PURPOSE: To evaluate the efficacy of intraarterial infusion of CO2-saturated solution in rabbit VX2 thigh tumors. MATERIALS AND METHODS: Fourteen Japanese white rabbits had VX2 tumors implanted in the right femoral muscle 3 weeks before intraarterial infusion. Rabbits were divided into control and CO2 groups (n = 7 each). Fifty milliliters of solution (saline solution and CO2-saturated solution for the control and CO2 groups, respectively) was administered via a 24-gauge catheter in the ipsilateral iliac artery close to the feeding artery of the VX2 tumor. All rabbits were killed for tumor harvest on day 3 after the procedure. Tumor volume was evaluated with in vivo direct caliper measurement and contrast-enhanced computed tomography (CT). Tumor apoptotic changes were examined by DNA fragmentation assay and immunoblot analysis. The tumor growth ratio and apoptotic cell rate were analyzed. RESULTS: Body weight was equally increased in both groups, but the mean tumor growth ratio was significantly decreased in the CO2 group compared with the control group (-9.5% ± 7.9 vs 27.2% ± 6.6 and 4.1% ± 4.4 vs 35.7% ± 4.5 measured by calipers and contrast-enhanced CT, respectively; P < .01). Apoptotic activity in the CO2 group was higher than in the control group (number of apoptotic cells per area, 215.0 ± 58.7 vs 21.8 ± 5.4; adjusted relative density of cleaved caspase-3, 0.23 ± 0.07 vs 0.04 ± 0.01; P < .01). CONCLUSIONS: Intraarterial infusion of CO2-saturated solution inhibits rabbit VX2 thigh tumor growth by activation of apoptotic cell death through cleaved caspase-3 upregulation.
2014年03月, Journal of vascular and interventional radiology : JVIR, 25 (3), 469 - 76, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
Stent graft placement for ureteroarterial fistula is the preferred treatment. However, some pitfalls may occur during the procedure. Chronic inflammation process will induce longer adhesion area between artery and ureter, which results in unusual fistula site and rigid iliac arteries. This further leads to difficulty in advancing the endograft delivery system, even when access route is large enough. Multiple attempts to pass the iliac artery may result in "incidental" mechanical provocative angiography with subsequent massive bleeding. These suggested us not only to be careful and prepared but also to consider that angiography after inserting the delivery system could give additional information on the exact fistula site.
2014年02月, Vascular and endovascular surgery, 48 (2), 159 - 61, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
Acute spontaneous and isolated dissection of the iliofemoral artery is an extremely rare entity. Conservative, surgical, and endovascular treatment have been used to treat such cases. To the best of our knowledge we report the first case of using hybrid management to successfully treat isolated external iliac artery dissection extending to the superficial femoral artery. This method could potentially overcome the limitations of endovascular techniques and minimize use of extensive open surgery.
2014年02月, Annals of vascular surgery, 28 (2), 490.e13-6 - 6, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
Thoracic endovascular aortic repair for blunt thoracic aortic injury in young adults with small aortic diameter often encounters high difficulty. We report, to our knowledge, the first case of successful treatment using combination of iliac leg and abdominal aortic cuff stent-graft.
2014年, Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, 20 Suppl (Suppl), 825 - 8, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
OBJECTIVE. The purpose of this study was to assess the therapeutic effect of lymphangiography for refractory postoperative chylothorax and chylous ascites and analyze the relation between the clinical outcomes and radiologic findings or response to the preceding medical treatment. MATERIALS AND METHODS. Between January 2004 and June 2012, 14 patients underwent lymphangiography. All patients had been unresponsive to at least two medical treatments for 3-62 days (median, 13.5 days) before lymphangiography. Leaks were classified as major, minor, and undetectable on the basis of radiologic findings including CT and conventional radiography after lymphangiography. The clinical outcomes were correlated with the radiologic findings or the changes of the daily chylous output after the preceding medical treatments. RESULTS. The leaks were healed in nine of 14 patients (64.3%) by 3-29 days (median, 8 days) after lymphangiography. Healing was achieved for two of seven major leaks, and all of the minor leaks (n = 4) and undetectable leaks (n = 3) after lymphangiography. The remaining five major leaks were not healed after a median follow-up of 15 days. The daily output decreased more than half after medical treatment in seven of the 14 patients, and the leak was healed in six of these patients (85.7%) by 5-18 days (median, 10 days). CONCLUSION. Lymphangiography might be useful for the treatment of refractory postoperative chylothorax and chylous ascites.
AMER ROENTGEN RAY SOC, 2013年09月, AMERICAN JOURNAL OF ROENTGENOLOGY, 201 (3), 659 - 666, 英語[査読有り]
研究論文(学術雑誌)
研究論文(その他学術会議資料等)
PURPOSE: To evaluate the safety, efficacy, and long-term results of endovascular stent graft placement for ureteroarterial fistula (UAF). METHODS: We retrospectively analyzed stent graft placement for UAF performed at our institution from 2004 to 2012. Fistula location was assessed by contrast-enhanced computed tomography (CT) and angiography, and freedom from hematuria recurrence and mortality rates were estimated. RESULTS: Stent graft placement for 11 UAFs was performed (4 men, mean age 72.8 ± 11.6 years). Some risk factors were present, including long-term ureteral stenting in 10 (91%), pelvic surgery in 8 (73%), and pelvic radiation in 5 (45%). Contrast-enhanced CT and/or angiography revealed fistula or encasement of the artery in 6 cases (55%). In the remaining 5 (45%), angiography revealed no abnormality, and the suspected fistula site was at the crossing area between urinary tract and artery. All procedures were successful. However, one patient died of urosepsis 37 days after the procedure. At a mean follow-up of 548 (range 35-1,386) days, 4 patients (36%) had recurrent hematuria, and two of them underwent additional treatment with secondary stent graft placement and surgical reconstruction. The hematuria recurrence-free rates at 1 and 2 years were 76.2 and 40.6%, respectively. The freedom from UAF-related and overall mortality rates at 2 years were 85.7 and 54.9%, respectively. CONCLUSION: Endovascular stent graft placement for UAF is a safe and effective method to manage acute events. However, the hematuria recurrence rate remains high. A further study of long-term results in larger number of patients is necessary.
2013年08月, Cardiovascular and interventional radiology, 36 (4), 950 - 6, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
Aim. We reviewed the importance of six angiosomes concept in the foot area through arterial-arterial connections. Methods. We retrospectively analyzed 145 limbs from 111 critical limb ischemia (CLI) patients to investigate whether the wound location corresponded with the occlusion of the feeding artery. We also analyzed 57 limbs that underwent endovascular therapy (EVT). Regardless of which target vessel underwent EVT in the calf area, it was considered "direct" if the feeding artery flow in the foot area was achieved and "indirect" if not achieved. The wound healing rate was compared between the direct group and the indirect group relative to the six angiosomes of the foot. Further, we analyzed the absolute difference of the skin perfusion pressure (SPP) values measured before and after EVT. Results. A concordance rate of 82.1% (119/145 limbs) was observed between the wound location and the site of vessel occlusion. The wound healing rate of the six angiosomes-direct group was significantly higher than that of the six angiosomes-indirect group (96.6% vs. 72.7% P=0.03). The SPP values were significantly higher in the six angiosomes-direct group than those in the six angiosomes-indirect group (20.3±18.1 mmHg vs. 5±14.5 mmHg P=0.039). Conclusion. In the case of the patency of the arterial-arterial connections, even if one undergoes EVT for any of the three vessels in the lower leg, wound healing is likely to be achieved, if we can achieve six angiosome-direct flow.
2013年08月, International Angiology, 32 (4), 375 - 385, 英語[査読有り]
研究論文(学術雑誌)
A 70-year-old male presented with intermittent macroscopic hematuria. There was no history of previous trauma or pelvic operation. At first, we were unable to clarify the origin of the hematuria, but 3Dcomputed tomography revealed an arteriovenous malformation (AVM) consisting of multiple feeding vessels arising from the bilateral, especially right, internal iliac artery. Treatment with transcatheter arterial embolization (TAE) with a combination of lipiodol and N-butyl-2-cyanoacrylate twice was effective. He needs to be followed up carefully for recurrence of AVM.
2013年07月, Acta Urologica Japonica, 59 (7), 439 - 442, 中国語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
[査読有り]
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
Thoracic endovascular aortic repair for a descending thoracic aortic aneurysm is an excellent alternative to open surgery, especially in patients with a number of comorbidities. It may cause fatal complications, including aortoesophageal stula, but these are very rare. Here, we report the case of secondary aortoesophageal stula four months after the procedure for a huge descending thoracic aortic aneurysm, which presented with new-onset high-grade fever accompanied by elevated inammatory markers.
2013年01月, Diagnostic and Interventional Radiology, 19 (1), 81 - 84, 英語[査読有り]
研究論文(学術雑誌)
要 旨:潰瘍・壊死を合併した重症虚血肢の救済においては,血行再建術は治療の第1段階であり,その後に創傷ケアや適切な装具の作成・リハビリテーションなどの集学的治療が不可欠である。2003年以降にバイパス術が施行されたFontaine IV度の93例100肢を対象とし,バイパス術と術後の創傷ケア,とくに切断部位による歩行機能への影響について検討を加えた。血行再建術の末梢吻合部は,膝上28肢,膝下20肢,下腿3分岐以下52肢で,2年での一次/二次開存率は膝上85.2/93.7%,膝下73.8/73.8%,下腿71.8/78.3%であった。バイパス術後に小切断なしが39肢,趾の断端形成術を要したものは31肢,踵部部分切除1肢で,生存例では術後全例に歩行機能の低下は認められなかった。中足骨レベルでの切断は20肢で,術前歩行可能であった17例のうち15例が,退院時も自力歩行可能であった(歩行維持率88.2%)。一方ショパール離断1肢,下腿切断5肢,大腿切断3肢中,術後に歩行可能な症例はなかった。救肢率は1年/5年で90.3/85.0%と良好であったが,生存率は85.0/55.9%と低値であった。重症虚血肢の症例に関しては,救肢可能であってもその生命予後が不良な例も多く,血行再建術および創傷ケアによって歩行機能を維持することが重要と考えられた。
Japanese College of Angiology, 2012年11月, 脈管学, 52 (November), 343 - 348, 日本語[査読有り]
研究論文(学術雑誌)
[招待有り]
研究論文(その他学術会議資料等)
[査読有り]
研究論文(学術雑誌)
Isolated iliac vein injury caused by blunt pelvic trauma is a rare condition that is difficult to diagnose and often fatal. We report a case of a 52-year-old female who presented with life-threatening isolated iliac vein injury caused by blunt pelvic trauma that was successfully managed with endovascular uncovered stent placement. Although further studies are warranted to clarify the hemostatic mechanism, uncovered stent placement can be considered as an alternative treatment option to covered stent placement for life-threatening iliac vein injury when a covered stent is not rapidly available.
SPRINGER, 2012年10月, JAPANESE JOURNAL OF RADIOLOGY, 30 (8), 680 - 683, 英語[査読有り]
研究論文(学術雑誌)
Blunt traumatic abdominal aortic dissection is extremely rare and potentially deadly. We present the case of a 62-year-old man involved in a frontal car crash. After emergency undergoing laparotomy for bowel injuries, he was referred to our hospital due to acute ischemia of bilateral lower extremities on day 3 after the trauma. Computed tomography and aortography showed an aortobiiliac dissection with complete occlusion. This injury was successfully treated by endovascular treatment with "kissing"-technique stent placement, which appears to be a safe, effective, and minimally invasive treatment.
2012年10月, Cardiovascular and interventional radiology, 35 (5), 1216 - 20, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
重症下肢虚血では下腿3分枝のangiosomeが足部で変動し,arterial-arterial connectionを介して末梢が栄養されることが多く認められる.我々は創部と血管造影の所見を比較し,足部のangiosomeについてその相関関係を検討するとともに,血管内治療施行部位と潰瘍の治癒率についてもその相関関係を検討した.結果,潰瘍形成部位と足部の血管閉塞部位は82.1%と高率に一致していた.また,EVT後血管開存部位と潰瘍治癒率を検討した結果,下腿ではdirect群で91.7%,indirect群で81.5%と両群に有意差を認めなかったが,足部ではdirect群で96.6%,indirect群で72.7%とdirect群において有意に治癒率が高いとの結果であった.すなわち,足部において,潰瘍形成部位のangiosome支配血管は閉塞していることが多く,EVTによりその血管を開存させることができれば潰瘍の治癒および大切断の回避が望めることが示唆された.
日本下肢救済・足病学会, 2012年09月, 日本下肢救済・足病学会誌, 4 (3号), 163 - 168, 日本語[査読有り]
研究論文(学術雑誌)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
OBJECTIVE: Creating an experimental model of a type B aortic dissection with a minimally invasive endovascular procedure in swine to help future evaluation of therapies for aortic dissection. METHODS: Aortic dissection was created in 14 swine using endovascular procedures only. Under fluoroscopy, a modified 10F outer catheter with a 14 G stiffening inner metallic cannula was forced via the femoral artery into the aortic vessel wall to create an initial dissection. A .035-inch guidewire and a 4F straight catheter were advanced into the dissected space, and the dissection was extended in a retrograde direction using a technique including loop formation of the guidewire, which was placed carefully against the transmural penetration and extended as far as possible in the descending thoracic aorta up to the point where loop formation of the guidewire reached smoothly. An 8F introducer sheath was advanced with a Brockenbrough needle into the dissected space, and a proximal fenestration was created by puncturing the intima. If required, balloon dilatation was performed to enlarge the proximal and distal tears. Aortography and contrast-enhanced cone beam computed tomography (CBCT) were performed in addition to a detailed histologic evaluation of the dissected portion. RESULTS: Aortic dissection was successfully created in 11 of the 14 swine (78.6%). Among the 11 dissections, nine were located in the thoracoabdominal aorta and two in the abdominal aorta. The initial aortic diameter at the middle portion of the created dissection ranged from 7.4 to 16.8 mm (mean ± standard deviation, 10.9 ± 2.9), while after dissection, it ranged from 7.8 to 19.3 mm (12.9 ± 3.8 mm). The dissected length ranged from 4.4 to 17.7 cm (10.7 ± 4.6 cm). Aortography and CBCT revealed seven dissections (63.6%) with a smooth and patent false lumen. Histologic evaluation revealed that the outer one-third of the media was separated from the inner two-thirds. In the remaining four dissections (36.4%), imaging procedures revealed the formation of a rough and patent false lumen beside the true lumen, and histologic evaluation revealed greater separation of the outer media. Five animals were chronic dissection models. Three (60%) of these survived for more than 14 days without any symptoms. Moreover, completely patent true and false lumens without thrombus formation were observed in these three animals. The aortic diameter at the dissected portion tended to be dilated compared with the initial diameter. CONCLUSIONS: This new technique of creating an experimental aortic dissection model in swine is promising and should contribute to the development of future therapies for aortic dissection.
2012年05月, Journal of vascular surgery, 55 (5), 1410 - 8, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
[査読有り]
研究論文(学術雑誌)
研究論文(その他学術会議資料等)
PURPOSE: To evaluate the safety, efficacy, and mid-term outcomes of endovascular tubular stent-graft placement for repair of isolated iliac artery aneurysms (IAAs). MATERIALS AND METHODS: Between January 2002 and March 2010, 20 patients (7 women and 13 men; mean age 74 years) underwent endovascular repair of 22 isolated IAAs. Two patients underwent endovascular repair for bilateral aneurysms. Ten para-anastomotic aneurysms (45%) developed after open abdominal aortic aneurysm (AAA) repair with an aorto-iliac graft, and 12 were true aneurysms (55%). Eleven straight and 11 tapered stent-grafts were placed. Contrast-enhanced computed tomography (CT) was performed to detect complications and evaluate aneurysmal shrinkage at week 1, 3, 6, and 12 months and once every year thereafter. Non-contrast-enhanced CT was performed in seven patients with chronic kidney disease. RESULTS: All procedures were successful, without serious complications, during the mean (range) follow-up period of 746 days (47-2651). Type II endoleak not requiring treatment was noted in one patient. The mean (SD) diameters of the true and para-anastomotic aneurysms significantly (p < 0.05) decreased from 42.0 (9.3) to 36.9 (13.6) mm and from 40.1 (13.0) to 33.6 (15.8) mm, respectively; the mean (SD) shrinkage rates were 15.1% (20.2%) and 18.9% (22.4%), respectively. The primary patency rate was 100%, and no secondary interventions were required. Four patients (21%) developed transient buttock claudication, and one patient (5%) developed colorectal ischaemia, which was treated conservatively. CONCLUSION: Endovascular tubular stent-graft placement for the repair of isolated IAAs is safe and efficacious. Tapered stent-grafts of various sizes are required for accurate placement.
2012年02月, Cardiovascular and interventional radiology, 35 (1), 59 - 64, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
PURPOSE: This study was designed to evaluate the safety of selective transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) in a swine model in terms of histological changes in the pancreas. METHODS: Three groups of two female swine (58-64 kg) per group underwent TAE of the dorsal pancreatic artery, under anesthesia, with 1:1, 1:4, and 1:9 mixtures of NBCA and iodized oil. Blood parameters were evaluated at days 1, 4, and 10 after TAE, after which the animals were sacrificed and pancreatic tissues were examined under light microscopy. RESULTS: All of the animals were asymptomatic and survived for 10 days. Cone beam computed tomographic angiography revealed occlusion of the dorsal pancreatic artery and no enhancement in the embolized area. The white blood cell count and C-reactive protein level were elevated slightly on day 1 after TAE (mean ± SD: 252.7 ± 27.8 × 10(2)/μl and 0.15 ± 0.07 mg/l, respectively), but they normalized or remained near the upper normal limit thereafter. The serum amylase and lipase levels also were elevated on day 1 (8831.7 ± 2169.2 U/l and 130 ± 53.4 U/l, respectively) but normalized thereafter. Histologically, necrosis and fibrosis were noted only in the embolized segment, and necrosis and acute inflammatory reactions were absent in the nonembolized segment. The border between both segments was well defined. Lymphocytic infiltration and foreign body reaction were noted around the embolized vessels. CONCLUSIONS: Selective TAE with NBCA in the pancreas caused localized ischemic necrosis without clinically significant pancreatitis; therefore, this procedure is tolerable in swine.
2012年02月, Cardiovascular and interventional radiology, 35 (1), 161 - 7, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
[招待有り]
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
A 70-year-old woman, with history of asymptomatic isolated superior mesenteric artery (SMA) dissection was admitted for acute abdominal pain. Computed tomography showed ruptured isolated SMA dissection. Endovascular treatment was chosen over surgical repair because of prior abdominal surgeries. Because an angulated SMA trunk and compressed true lumen by the dilated false lumen prevented the insertion of a guidewire into the SMA via the transfemoral artery, transmesenteric approach under laparotomy was selected. After creating a pull-through condition from the SMA to the left brachial artery, a successful stent graft placement with adequate hemostasis was achieved. The aneurysm shrunk remarkably, with no complication at follow-up.
2011年12月, Journal of vascular surgery, 54 (6), 1808 - 11, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
A 57-year-old woman with a history of diabetes mellitus underwent simultaneous pancreas-kidney transplantation. The pancreaticoduodenal graft was implanted in the right iliac fossa. The donor's portal vein was anastomosed to the recipient's inferior vena cava (IVC). Seven days after the surgery, a thrombus was detected in the graft veins. Percutaneous thrombolysis was immediately performed; however, venous congestion was still present. We therefore attempted selective embolectomy using a Fogarty Thru-Lumen Catheter. Thrombi were directed from the graft veins toward the IVC and captured in the IVC filter with complete elimination of the thrombus without any major complications. We present our technique for the successful treatment of pancreas graft thrombosis within a short time period by percutaneous selective embolectomy using a Fogarty Thru-Lumen Catheter.
2011年06月, Cardiovascular and interventional radiology, 34 (3), 650 - 3, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
[査読有り]
研究論文(学術雑誌)
研究論文(その他学術会議資料等)
PURPOSE: To evaluate the clinical effectiveness and safety of transcatheter arterial embolization with n-butyl cyanoacrylate (NBCA) for pseudoaneurysms complicating pancreatitis or pancreatectomy. MATERIALS AND METHODS: Twelve procedures were performed in nine patients (seven men and two women; mean age, 60.6 years) for pseudoaneurysms that occurred secondary to pancreatitis or as a consequence of pancreatic juice leakage at the site of pancreatectomy. For embolization, NBCA was mixed with iodized oil at a ratio of 1:1-1:4; in one patient with failed selective catheterization of the target vessel, the mixture ratio was 1:9. Technical and clinical success rates, recurrent bleeding, procedural complications, serum amylase level, and clinical outcome were determined for each procedure. RESULTS: Embolization was technically successful in all procedures, with no recurrent bleeding documented from the initially treated territory. In three procedures, we encountered additional bleeding vessels at 11, 33, and 49 days after the procedures, which were successfully managed by a second embolization in each case. There were no major complications related to the procedures. As minor complications, in two procedures, the embolized material overflowed beyond the target vessels; however, no clinically significant ischemic events were observed in the embolized territories. Serum amylase did not increase compared with initial levels after any of the procedures. Seven patients were discharged after clinical improvement. Two patients died 2 and 3 weeks after the embolization as a result of multiple organ failure not associated with the procedure. CONCLUSIONS: In this limited series, NBCA embolization was found to be feasible and effective for pseudoaneurysms as a complication of pancreatitis or pancreatectomy.
2011年03月, Journal of vascular and interventional radiology : JVIR, 22 (3), 302 - 8, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
[査読有り]
研究論文(学術雑誌)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
[査読有り]
研究論文(学術雑誌)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
研究論文(その他学術会議資料等)
[査読有り]
研究論文(学術雑誌)
We report a case of hemangioma with an atypical vascular enhancement pattern. The hemangioma showed peripheral rim enhancement at the arterial phase during dynamic magnetic resonance imaging, and the peripheral enhanced zone was still apparent during the delayed phase, as shown on double-phase computed tomography hepatic arteriography. The rim enhancement pattern of this case, mimicking that of hepatocellular carcinoma, may be due to the surrounding liver parenchymal fibrotic change caused by an active hepatitis C viral infection.
SPRINGER, 2009年04月, JAPANESE JOURNAL OF RADIOLOGY, 27 (3), 156 - 160, 英語[査読有り]
研究論文(学術雑誌)
We report a case of hemangioma with an atypical vascular enhancement pattern. The hemangioma showed peripheral rim enhancement at the arterial phase during dynamic magnetic resonance imaging, and the peripheral enhanced zone was still apparent during the delayed phase, as shown on double-phase computed tomography hepatic arteriography. The rim enhancement pattern of this case, mimicking that of hepatocellular carcinoma, may be due to the surrounding liver parenchymal fibrotic change caused by an active hepatitis C viral infection.
2009年04月, Japanese journal of radiology, 27 (3), 156 - 60, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
研究論文(その他学術会議資料等)
Aim: The significance of dihydropyrimidine dehydrogenase (DPD) and thymidylate synthase (TS) gene expressions for the post-surgical prognosis of hepatocellular carcinoma (HCC) has not yet been determined. In the present study, we clarified the significance of DPD and TS gene expressions for the prognosis of HCC. Methods: Seventy-four patients, who underwent curative hepatic resection for primary HCC, were evaluated. The DPD and TS mRNA levels of the resected HCC specimens were evaluated using a microdissection technique and quantative real-time RT-PCR. The patients were categorized into high and low groups for each mRNA based on the median value. Various clinicopathological factors, including prognosis, and proliferation index using Ki-67 staining were evaluated in association with the DPD and TS mRNA expression levels. Results: The low DPD mRNA expression was related to younger age, advanced clinical stage, undifferentiated histology, and microscopic intrahepatic metastasis. The overall and recurrence-free survival were significantly lower in the low DPD group than in the high DPD group (P < 0.05). Furthermore, the proliferation index in the low DPD group was significantly higher than that in the high DPD group (P < 0.01). On the other hand, the high TS group showed a tendency of better prognosis than the low TS group, although it was not statistically significant. Conclusions: The low DPD mRNA expression is a significant poor prognostic factor. after curative resection of HCC. © 2009 The Japan Society of Hepatology.
2009年, Hepatology Research, 39 (3), 274 - 281, 英語[査読有り]
研究論文(学術雑誌)
The purpose of this study was to prospectively evaluate the efficacy of high-spatial-resolution dynamic MRI using sensitivity encoding (SENSE) in detection of hypervascular hepatocellular carcinoma (HCC). Thirty-five patients were included in this prospectively planned study, and 25 patients with 31 HCCs were assigned into three groups and underwent the following sequences: group A (n = 11): three-dimensional fast-gradient-echo (3D-FGE) high-spatial-resolution dynamic MRI (HR-MRI) with SENSE; group B (n = 10): 3D-FGE low-spatial-resolution dynamic MRI (LR-MRI) with SENSE; and group C (n = 14): 3D-FGE/LR-MRI without SENSE. For the quantitative analysis, the lesion-to-liver contrast-to-noise ratio (CNR) between the liver and HCCs was measured. For the qualitative analysis, overall image quality for each group was evaluated with a five-point scale analysis. The sensitivities for detection of HCCs were evaluated. The overall image quality in group A was significantly greater than both groups B and C (P < 0.01). The sensitivity of lesion detection on HAP was not significantly higher in group A (100%) than group C (69.2%; P > 0.05). In our pilot study on a small number of patients, image quality in HR-MRI with SENSE was superior to LR-MRI. A high detection rate was seen with HR-MRI with SENSE in the patients with hypervascular HCCs.
SPRINGER, 2008年10月, EUROPEAN RADIOLOGY, 18 (10), 2206 - 2212, 英語[査読有り]
研究論文(学術雑誌)
OBJECTIVE: The objective of our study was to retrospectively assess the safety and efficacy of endovascular treatment for branch stenosis or obstruction after branched graft replacement in patients with thoracoabdominal aortic aneurysm or aortic arch aneurysm. MATERIALS AND METHODS: Seven patients (all men; median age, 62 years; age range, 19-79 years) who had undergone aortic surgery using branched grafts between March 2004 and January 2007 were treated. Diagnosis was established on dynamic contrast-enhanced CT or angiography. A self- or balloon-expandable stent was placed after predilatation with a balloon catheter and, if necessary, thrombolysis was also performed. Stent patency was assessed on thin-slice axial images obtained during the arterial phase on dynamic contrast-enhanced CT. RESULTS: Seven lesions (one celiac artery, two left subclavian arteries, and four renal arteries) were treated. The time between the surgery and treatment was 0-3 days for patients with abdominal lesions and 20-41 days for those with thoracic lesions. Stent placement was successful in five of the seven patients. In one patient, insertion of the stent delivery system was unsuccessful; in the other patient, the stent was not completely expanded. The clinical symptoms and abnormal laboratory data improved in all patients with successful procedures. No restenosis was observed on imaging follow-up, with a median patency of 104 days (range, 5-1,218 days) during clinical follow-up (range, 37-1,218 days; median, 135 days). CONCLUSION: Endovascular repair can be an alternative treatment for visceral vessel complications of branched grafts, especially in obstructed but peripherally patent branches.
2008年10月, AJR. American journal of roentgenology, 191 (4), 1175 - 81, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
Background. Blunt trauma-induced aortic injury traditionally has been treated with early open surgical repair. However, recently endovascular stent-graft technology is considered a less-invasive therapeutic alternative, and flexible stent-grafts, such as the Matsui-Kitamura stent-graft (MKSG), are being used widely. We report our experience with the curved MKSG in treating thoracic aortic injuries. Methods. Nine patients with traumatic thoracic aortic injury underwent endovascular surgery (8, emergency; 1, elective) with curved MKSG. The study variables were Injury Severity Score, endovascular surgery duration, aortic and stent-graft diameter, stay in the intensive care unit, follow-up period, and mortality. An MKSG was constructed using the Matsui-Kitamura stent and a polyester fabric graft. The stent-graft was placed using the transfemoral approach and the wire-tug technique. Results. The mean Injury Severity Score was 42.3; 5 patients required 6 emergency procedures before the endovascular procedure (pneumothorax or hemothorax drainage, 5; transarterial embolization, 1). In 8 patients (88.9%), we achieved complete pseudoaneurysm exclusion or hemostasis in the injured portion. There were no postoperative complications; blood loss was minimal, and the intensive care unit stay was 13.4 days. The overall hospital mortality was 22.2% (n = 2; causes of death were unrelated to MKSG placement). Neither intervention-related mortality during follow-up (mean, 237.7 days) nor late endovascular graft-related complications (endoleak or graft migration) were noted. Conclusions. Although this study is limited by a small sample size and short follow-up period, no collapse or stent-graft fractures were noted. Thus, MKSG placement for traumatic thoracic aortic injury appears a safe and effective therapy.
ELSEVIER SCIENCE INC, 2008年09月, ANNALS OF THORACIC SURGERY, 86 (3), 780 - 786, 英語[査読有り]
研究論文(学術雑誌)
BACKGROUND AND PURPOSE: CT and MR angiographies have been reported to visualize the artery of Adamkiewicz (AKA) noninvasively to prevent spinal cord ischemia in surgery of thoracic descending aortic aneurysms. The purpose of this work was to compare the usefulness of CT angiography (CTA) with intra-arterial contrast injection (ACTA) with that of conventional CTA with intravenous contrast injection (IVCTA). MATERIALS AND METHODS: We enrolled 32 consecutive patients with thoracic or thoracoabdominal aortic aneurysms who were scheduled for surgical repair or endovascular stent-graft treatment. All of the CTA images were obtained using a 16-detector row CT scanner and 100 mL of contrast material (370 mg/mL) injected at a rate of 5 mL/s. Contrast was injected via the antecubital veins of 15 patients and via a pig-tail catheter placed at the proximal portion of the descending aorta in 17 patients who underwent IVCTA and IACTA, respectively. Two datasets were reconstructed from 2 consecutive scans. The AKA was identified as a characteristic hairpin curved vessel in the anterior midsagittal surface of the spine and by the absence of further enhancement in the second rather than in the first phase. Continuity between the AKA and aorta was confirmed when the vessel could be traced continuously by paging the oblique coronal multiplanar reconstruction or original axial images. RESULTS: Intra-arterial contrast injection was significantly more sensitive in identifying the AKA than IVCTA: 16 (94.1 %) of 17 versus 9 (60.0%) of 15 (P =.033). Continuity between the AKA and aorta through intercostal or lumbar artery was confirmed in 14 (87.5%) of 16 and 5 (55.6%) of 9 of the IACTA and IVCTA groups, respectively. CONCLUSION: Intra-arterial contrast injection detected the AKA at a high rate and verified continuity from the aorta to the AKA.
AMER SOC NEURORADIOLOGY, 2008年02月, AMERICAN JOURNAL OF NEURORADIOLOGY, 29 (2), 314 - 318, 英語[査読有り]
研究論文(学術雑誌)
For these recent years, safety and effectiveness of endovascular treatment for pulmonary thromboembolism and deep vein thrombosis have been reported by several investigators. The treatment is based on a single or a combination of several interventional techniques, including catheter-directed thrombolysis, fragmentation, rheolytic thrombolysis, aspiration thrombectomy, and balloon angioplasty. Prompt effect and less invasiveness are recognized as the biggest advantages compared to the traditional treatment.
2008年, Japanese Journal of Clinical Radiology, 53 (8), 977 - 986研究論文(学術雑誌)
AIM: To evaluate the diagnostic accuracy of the combination of computed tomography (CT) during arterial portography (CTAP) and doubte-phase CT hepatic arteriography (CTHA) with multidetector-row CT (MDCT) for the evaluation of hepatocellular carcinomas (HCCs) in patients with cirrhosis. MATERIALS AND METHODS: The combination of CTAP and doubte-phase CTHA was performed on 46 patients with 54 nodular HCCs. Three readers reviewed the images obtained with CTAP atone, first-phase CTHA atone, doubte-phase CTHA, and the combination of CTAP and double-phase CTHA. The review of the images was conducted on a segment-by-segment basis, with 368 hepatic segments, including 50 segments with 54 HCCs, reviewed for detection of HCCs with the aid of a five-point confidence scale. Diagnostic accuracy was evaluated by comparing the receiver-operating characteristic (ROC) analysis results. RESULTS: The sensitivity for detecting HCCs was significantly higher with either double-phase CTHA or the combination of CTAP and doubte-phase CTHA than with first-phase CTHA alone (90 and 93 versus 85%, respectively, p < 0.01). The specificity for detecting HCCs was significantly higher with the combination of CTAP and double-phase CTHA than with CTAP alone (97 and 94%, respectively, p < 0.01). The positive predictive values for detecting HCCs were significantly higher with doubte-phase CTHA than with first-phase CTHA alone (86 and 82%, respectively, p < 0.05). The area under the ROC curve (Az) values were significantly higher with the combination of CTAP and double-phase CTHA (0.983) than with first-phase CTHA alone (0.959; p < 0.05). CONCLUSION: The combination of CTAP and double-phase CTHA with MDCT significantly enhances the detection of HCC. (c) 2007 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
W B SAUNDERS CO LTD, 2007年12月, CLINICAL RADIOLOGY, 62 (12), 1189 - 1197, 英語[査読有り]
研究論文(学術雑誌)
The case of a 51-year-old man with hepatitis C virus (HCV)-related hepatocellular carcinoma metastasizing to the peritoneal cavity and mimicking a sarcomatous tumor is presented. A 12 x 12 cm mass, disclosed by computed tomography (CT), in the peritoneal cavity was predominantly isodense to muscle but had hypodense areas that suggested necrosis. T1-weighted magnetic resonance imaging (MRI) showed a large mass, slightly hyperintense to muscle, with local hyperintense areas of suspected hemorrhagic necrosis.T2-weighted MRI of the same region revealed a markedly non-homogeneous and hyperintense mass with inner high signals and peripheral brush-like linear striations. From such imaging studies, sarcomatous tumors, such as fibrosarcoma, leiomyosarcoma, and gastrointestinal stromal tumors, can be distinguished. Pathological findings at autopsy revealed necrotic tissue with a small portion of moderately differentiated HCC. Further studies may provide insights into the metastatic modes of HCC.
BLACKWELL PUBLISHING, 2007年10月, HEPATOLOGY RESEARCH, 37 (10), 885 - 889, 英語[査読有り]
研究論文(学術雑誌)
Purpose: To investigate variations in the features of gastrorenal shunts and collateral veins shown by balloon-occluded retrograde venography (B-RTV) and by superior mesenteric and celiac arteriography. Methods: A retrospective analysis was performed of the variation in these features on B-RTV and arteriography images obtained from 130 patients who have undergone these studies prior to balloon-occluded retrograde transvenous obliteration at our hospital since 1993. Results: At least one gastrorenal shunt was revealed in 97% (126/130) of cases. Types of gastrorenal shunts observed were as follows: only one main gastrorenal shunt, 94% (118/126) of cases; two main gastrorenal shunts with a ring-like appearance, 3% (4/126); and some gastrorenal shunts to the left renal vein, 3% (4/126). Collateral veins detected were as follows: left inferior phrenic vein, 75% (95/126) of cases; pericardiacophrenic vein, 40% (50/126); gonadal vein, 13% (16/126); retroperitoneal veins, 65% (82/126). Conclusion: It is very important to know the exact configuration of any gastrorenal shunts in order to guide advancement of the balloon catheter into the shunt and to avoid unexpected injection of the sclerosing agent.
SPRINGER, 2007年06月, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 30 (3), 410 - 414, 英語[査読有り]
研究論文(学術雑誌)
A 72-year-old man who had undergone a total gastrectomy with a Roux-en-Y esophagojejunostomy for gastric cancer 6 years earlier presented to our hospital with massive hematemesis and melena. Endoscopic examination indicated esophageal varices with cherry-red spots and hemorrhage arising from beyond the anastomosis. Abdominal contrast-enhanced computed tomography and angiography revealed a dilated vein in the elevated jejunal limb supplying the varices. Percutaneous trans-hepatic obliteration (PTO) of the varices through the jejunal vein was performed using microcoils, ethanolamine oleate, and gelatin sponge cubes. Ten days after the procedure, endoscopic examination revealed reduction and thrombosis of the varices. We consider PTO to be an effective alternative method for treating ruptured esophagojejunal varices after total gastrectomy.
SPRINGER, 2006年12月, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 29 (6), 1152 - 1155, 英語[査読有り]
研究論文(学術雑誌)
A 60-year-old woman with massive hemorrhage from duodenal varices was transferred to our hospital for the purpose of transcatheter intervention. Although digital subtraction arterial portography could not depict the entire pathway of collateral circulation, the efferent route of the duodenal varices was clearly demonstrated on subsequent CT during arterial portography. Balloon-occluded retrograde transvenous obliteration (B-RTO) of the varices was performed via the efferent vein and achieved complete thrombosis of the varices.
SPRINGER, 2006年12月, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 29 (6), 1148 - 1151, 英語[査読有り]
研究論文(学術雑誌)
A 60-year-old woman with massive hemorrhage from duodenal varices was transferred to our hospital for the purpose of transcatheter intervention. Although digital subtraction arterial portography could not depict the entire pathway of collateral circulation, the efferent route of the duodenal varices was clearly demonstrated on subsequent CT during arterial portography. Balloon-occluded retrograde transvenous obliteration (B-RTO) of the varices was performed via the efferent vein and achieved complete thrombosis of the varices.
SPRINGER, 2006年12月, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 29 (6), 1148 - 1151, 英語[査読有り]
研究論文(学術雑誌)
A 69-year-old hypertensive man who had 7 pseudoaneurysms caused by penetrating atherosclerotic ulcers underwent 2-staged endovascular grafting in the thoracic and thoracoabdominal aorta and a conventional graft replacement of the abdominal aorta. He had an uneventful postoperative course follow-up computed tomography demonstrated that all aneurysmal lesions treated by endovascular grafting completely disappeared. He has been free from any aortic events 20 months after the last surgery. © 2007 Sage Publications.
2006年12月, Vascular and Endovascular Surgery, 40 (6), 495 - 498, 英語[査読有り]
研究論文(学術雑誌)
We describe a rare case of HCV-related recurrent multiple hepatocellular carcinoma (HCC) metastasizing to the skull base involving multiple cranial nerves in a 50-year-old woman. The patient presented with symptoms of ptosis, fixation of the right eyeball, and left abducens palsy indicating disturbances of the right oculomotor and trochlear nerves and bilateral abducens nerves. Brain contrast-enhanced computed tomography (CT) revealed an ill-defined mass with abnormal enhancement around the sella turcica. Brain magnetic resonance imaging (MRI) disclosed that the mass involved the clivus, cavernous sinus, and petrous apex. On contrast-enhanced MRI with gadolinium-chelated. contrast medium, the mass showed inhomogeneous intermediate enhancement. The diagnosis of metastatic HCC to the skull base was made on the basis of neurological findings and imaging studies including CT and MRI, without histological examinations. Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area. (C) 2006 The WJG Press. All rights reserved.
W J G PRESS, 2006年11月, WORLD JOURNAL OF GASTROENTEROLOGY, 12 (41), 6727 - 6729, 英語[査読有り]
研究論文(学術雑誌)
We report a case of lower limb ischemia secondary to type B aortic dissection, which was successfully treated with endovascular aortic fenestration and stent placement. In this case, we were not able to restore adequate flow to the ischemic limb by means of aortic balloon fenestration alone, so additional stent placement was required to buttress the true lumen and fenestra. There was no recurrence of lower limb ischemia complications during the follow-up period. Aortic balloon fenestration with stent placement seems to be a safe and effective technique to salvage an ischemic lower limb complicated by acute aortic dissection.
2006年04月, Radiation medicine, 24 (3), 233 - 7, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
Splenic pseudoaneurysms following chronic pancreatitis can rarely become a source of life-threatening bleeding by rupturing into various regions or components, including pseudocysts, the abdominal cavity, the gastrointestinal tract, and the pancreatic duct. In such cases, prompt diagnosis and therapy are warranted. We report herein the case of a 52-year-old man in whom a splenic pseudoaneurysm ruptured into the colon via a fistula with an abscess cavity, causing massive bleeding, which was successfully managed by trans-catheter arterial embolization (TAE).
SPRINGER, 2006年02月, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 29 (1), 133 - 136, 英語[査読有り]
The purpose of this paper is to describe our experience with endovascular obliteration of duodenal varices in patients with liver cirrhosis and portal hypertension. Balloon-occluded transvenous retrograde and percutaneous transhepatic anterograde embolizations were performed for duodenal varices in five patients with liver cirrhosis, portal hypertension, and decreased liver function. All patients had undergone previous endoscopic treatments that failed to stop bleeding and were poor surgical candidates. Temporary balloon occlusion catheters were used to achieve accumulation of an ethanolamine oleate-iopamidol mixture inside the varices. Elimination of the varices was successful in all patients. Retrograde transvenous obliteration via efferent veins to the inferior vena cava was enough to achieve adequate sclerosant accumulation in three patients. A combined anterograde-retrograde embolization was used in one patient with balloon occlusion of afferent and efferent veins. Transhepatic embolization through the afferent vein was performed in one patient under balloon occlusion of both efferent and afferent veins. There was complete variceal thrombosis and no bleeding was observed at follow-up. No major complications were recorded. Endovascular obliteration of duodenal varices is a feasible and safe alternative procedure for managing patients with portal hypertension and hemorrhage from this source.
SPRINGER, 2006年01月, EUROPEAN RADIOLOGY, 16 (1), 73 - 79, 英語[査読有り]
研究論文(学術雑誌)
PURPOSE: To study the vascular histologic response after placement of oversized self-expanding stents in the porcine venous system. MATERIALS AND METHODS: Twenty-four oversized stents (range of oversizing, 119.5%-216.0%) were deployed in jugular and iliac veins of six miniature pigs divided into two groups with follow-up times of 1 and 3 months. Necropsy with histologic evaluation of each stent was performed, and the areas of neointimal proliferation were calculated with slices obtained during follow-up from each stent at 5 ram from the proximal and distal edges and at the midpoint. RESULTS: Neointimal proliferation was observed inside the stent lumen. All segments were patent in both groups. However, one jugular stent in the 1-month group and one jugular stent in the 3-month group had migrated at follow-up and were excluded from analysis. There were no significant differences in neointimal growth between the stent edges (proximal and distal) and middle segments of the stents at follow-up in the 1-month group (P = .970) or in the 3-month group (P =.694). Simple linear regression showed strong positive correlation between stent oversizing and neointimal proliferation in the 1-month model (r = 0.791; P <.001) and the 3-month model (r = 0.718; P <.001). There were no significant differences between 1-month and 3-month groups in the degree of neointimal proliferation (P=.072). Also, branched vessels showed no neointimal proliferation at their intersections with the stent-implanted segments. CONCLUSION: Stent oversizing showed a strong positive correlation with neointimal growth in each follow-up model in this study.
LIPPINCOTT WILLIAMS & WILKINS, 2006年01月, JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, 17 (1), 113 - 119, 英語[査読有り]
研究論文(学術雑誌)
The efficacy of a "downgrading" method for treatment of gastric varices (GVs) was evaluated in 15 patients who had undergone balloon-occluded retrograde transvenous obliteration (B-RTO) of GVs with multiple collateral veins. Downgrading in this study was meant to transform high-grade GVs into GVs with a low-grade architecture more amenable to treatment. Success was defined as gastrorenal shunt occlusion at the proximal site with a 6-F balloon catheter advanced over a microcatheter and without opacification of large collateral vessels. Thirteen of 15 patients with grade 3/4 GVs had their GVs successfully downgraded. The procedure is thought to be safe and effective in the initial B-RTO procedure.
LIPPINCOTT WILLIAMS & WILKINS, 2005年10月, JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, 16 (10), 1379 - 1383, 英語[査読有り]
研究論文(学術雑誌)
Four patients who underwent secondary elephant trunk fixation by endovascular stent grafting are presented and the advantage of this method to treat multiple/extensive thoracic aortic aneurysm is discussed. In two of them, the elephant trunk installation has been performed at another hospital for extensive aortic aneurysm. In two other patients, the aortic arch replacement and the elephant trunk installation were performed through median sternotomy, initially for multiple aortic lesions, including both arch and descending aorta. No neurological deficit, stroke nor spinal cord injury was encountered during the follow-up period (24-40 months). The diameter of the aneurysms decreased markedly in three patients. In one patient, the aneurysm expanded gradually and type II endoleak was treated by coil embolization. In one patient, who showed marked shrinkage of the aneurysm, the stent graft kinked mildly. Based on the tow mortality rate of well-established aortic arch surgery, concomitant elephant trunk installation which was followed by the secondary fixation with endovascular stent grafting might be useful to treat muttiple/extensive thoracic aneurysm from distal arch to descending aorta. (c) 2005 Elsevier B.V. All rights reserved.
ELSEVIER SCIENCE BV, 2005年08月, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 28 (2), 335 - 336, 英語[査読有り]
研究論文(学術雑誌)
PURPOSE: To present an in vivo evaluation of the effects of stent oversizing on in-stent stenosis and on actual lumen size in normal veins. METHODS: Twelve self-expanding stents were implanted in the common iliac veins of 6 minipigs, which were divided in 2 groups for follow-up at 1 and 3 months, respectively. Oversizing ranged from 119.5% to 216% of the original vessel diameter. Intravascular ultrasound (IVUS) was used to measure vessel areas at the stent edges and midpoint. In-stent stenosis and decrease in actual lumen size were evaluated with IVUS immediately after implantation and during follow-up. RESULTS: There was a very strong positive linear regression between stent oversizing and in-stent stenosis in the 1-month model (r=0.947, p=0.004), in the 3-month model (r=0.931, p=0.007), and in the sum of these 2 groups (r=0.83, p<0.001). Regarding the change in actual lumen size, we found a strong negative linear regression with stent oversizing in the 1-month (r=-0.754, p=0.083) and the 3-month (r=-0.562, p=0.246) groups, but these did not attain statistical significance. However, a strong correlation between stent oversizing and a decrease in lumen size in all samples proved to be statistically significant (r=0.619, p=0.032). CONCLUSIONS: Stent oversizing was strongly correlated with increased in-stent stenosis and decreased actual lumen size at follow-up in normal non-stenotic porcine veins.
2005年08月, Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 12 (4), 495 - 502, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
PURPOSE: To report our experience with the Wallstent for the relief of congestive symptoms in patients with malignant inferior vena cava (IVC) obstructions. MATERIALS AND METHODS: We treated five patients with malignant obstructions of the IVC with a total of seven self-expandable stents. All obstructions were due to extrinsic compression; the procedures were indicated to relieve congestive symptoms in patients unresponsive to other therapies or in whom other treatments were contraindicated. Patients were evaluated for decrease in ascites and edema, weight loss, and patency, where available. RESULTS: All procedures were straightforward and obstructions could be successfully canalized. Inferior venacavograms obtained immediately after the procedure showed complete revascularization and disappearance of collateral circulation. Follow-up was carried out until death in four patients and until discharge in one. Of the five patients, four showed clinical improvement and one had no improvement. There was no recurrence of congestive symptoms. Except for one patient with partial migration of a stent, there were no important complications related to the procedure. CONCLUSION: Wallstents could be placed without complications in the IVC and were effective to ameliorate congestive symptoms in patients with malignant IVC obstructions.
2005年08月, Radiation medicine, 23 (5), 380 - 5, 英語, 国内誌[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
Injury to lumbar arteries is a relatively uncommon finding. Nevertheless, once damaged, they can become a significant source of hemorrhage, especially because such injuries can be easily overlooked. Also, their exposure is difficult during surgery.(1) These lesions have been more often reported in association with blunt(1-5) and penetrating trauma (6.7) and as a complication of spinal surgery and other interventions. (8-14) There are no reports of lumbar arterial damage associated with self-inflicted penetrating trauma. The so-called hara-kiri was an ancient Japanese form of suicide. It is exceptionally rare nowadays, representing only an insignificant fraction of total suicides in Japan.(15,16) This unusual method involves disembowelment by slashing the abdomen from side to side. Because of the nature of the offensive mechanism, multiple abdominal organs can be severely wounded. In fact, most of them necessitate surgical repair.(17) We describe the management of a patient who failed to conclude hara-kiri. In this case, he was not able to shift the blade further, which allowed prompt emergency treatment without much damage. Surgical evaluation and repair were warranted, but uncontrollable intraoperative hemorrhage demanded an interventional radiologic approach.
LIPPINCOTT WILLIAMS & WILKINS, 2005年02月, JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 58 (2), 384 - 387, 英語[査読有り]
研究論文(学術雑誌)
Purpose: The purpose of this study was to investigate the effect and usefulness of gadolinium-chelated contrast medium in phase-contrast magnetic resonance (MR) portography. Methods: Twenty-six patients (21 men, 5 women aged 34 to 79 years, mean 62 years) underwent respiratory-triggered 3-dimensional phase-contrast portography before and after administration of gadolinium in a 1.5T MR unit. Coronal maximum intensity projection (MIP) images of the portal vein were reconstructed and compared to conventional arterial portograms regarding visualization. Signal-to-noise ratio (SNR) and portal vein-to-liver contrast-to-noise ratios (CNR) of main, right, right anterior, right posterior, left portal veins, and umbilical portion were measured on both non-enhanced and gadolinium-enhanced images and compared. Results: Portal veins and branches were more clearly visualized on the gadolinium-enhanced than on the non-enhanced images. Compared to arterial portography, gadolinium-enhanced portography showed similar performances in visualization, except in the right posterior branch and left portal vein. No severe image degradation from respiration was experienced. SNR was significantly higher on the gadolinium-enhanced than on non-enhanced images except in the right anterior branch. CNR was significantly higher on the gadolinium-enhanced than on the non-enhanced images at all measured locations. Conclusions: Administration of gadolinium improves the SNR and CNR of phase-contrast portography and visualization of the portal vein. The phase-contrast technique with gadolinium enhancement can be used to evaluate the portal vein as a supplemental technique.
2005年, Magnetic Resonance in Medical Sciences, 4 (4), 165 - 174, 英語[査読有り]
研究論文(学術雑誌)
PURPOSE: It is proposed that local elastase inhibition could suppress the extracellular matrix (ECM) degradation and subsequent smooth muscle cell migration and limit subsequent in-stent restenosis. This study evaluated the effect of stent-based controlled elastase inhibition on restenosis after stent implantation in a rabbit model. MATERIALS AND METHODS: Biodegradable microspheres containing the potent elastase inhibitor a-l-antitrypsin (AAT) were prepared. Daily release of AAT from the microspheres was confirmed in vitro. The microspheres were loaded into stents with an abluminal polymer reservoir. Implantation of the stent with AAT microspheres and blank microspheres (control) was performed in the abdominal aortae of six rabbits in each group. After stent deployment, all stents were overdilated to 125% diameter. Stent-implanted arteries were harvested after 7 days (n = 3 each) or 28 days (n = 3 each). To assess the effect of local delivery of AAT, elastase activity and elastin content of the stent-implanted aortae were analyzed. As an endpoint, intima-to-media (I/M) ratio was determined in the 7-day and 28-day specimens. RESULTS: Significant inhibition of elastase was confirmed in treated vessels versus controls at 7 days after stent implantation (P < .05). This reduction in elastase activity was sufficient to afford early and late reduction of in-stent neointima. Plaque progression in the 28-day specimens decreased to 67% with elastase inhibition relative to controls (P < .05). CONCLUSION: Stent-based controlled release of elastase inhibitor may significantly reduce ECM degradation and might limit in-stent restenosis.
LIPPINCOTT WILLIAMS & WILKINS, 2004年11月, JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, 15 (11), 1287 - 1293, 英語[査読有り]
研究論文(学術雑誌)
A 44-year-old man with abdominal pain was diagnosed as having a spontaneous isolated dissection of the superior mesenteric artery. The patient was successfully treated with endoaneurysmorrhaphy 5 months after the onset and has been symptom free 15 months after surgery. In view of the excellent surgical outcome in the literatures, surgical intervention for this rare pathology should be considered.
2004年09月, Vascular and Endovascular Surgery, 38 (5), 469 - 472, 英語[査読有り]
研究論文(学術雑誌)
A patient with portosystemic encephalopathy, hyperammonemia, and a spontaneous splenorenal shunt was admitted to the authors' institution after a failed attempt at transvenous retrograde shunt obliteration. As an alternative approach, the authors separated splenic and portal flows by embolizing only the proximal splenic vein while leaving the shunt intact. Thus, the splenic flow could escape into the systemic circulation and an extreme increase in portal pressure was avoided. The procedure could provide rapid decreases in blood ammonia levels and a fast resolution of symptoms, but repeated interventions were required.
LIPPINCOTT WILLIAMS & WILKINS, 2004年08月, JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, 15 (8), 875 - 879, 英語[査読有り]
研究論文(学術雑誌)
OBJECTIVE. The aim of our study was to determine the utility of time-resolved contrast-enhanced MR angiography combined with sensitivity encoding (SENSE) for patients with pulmonary embolism. SUBJECTS AND METHODS. Forty-eight consecutive patients (26 men and 22 women; age range, 27-73 years; mean age, 55 years) with suspected pulmonary embolism underwent chest radiography, contrast-enhanced MDCT, MR angiography with SENSE, ventilation-perfusion scintigraphy, and pulmonary angiography. MR angiography with SENSE was performed using IV administration of gadolinium contrast medium with a 3D turbo field-echo pulse sequence (TR/TE, 4.0/1.2; flip angle, 30degrees) on a 1.5-T scanner. Capabilities of diagnosing pulmonary embolism using MR angiography (data set A), contrast-enhanced MD (data set B), contrast-enhanced MDCT with MR angiography (data set C), ventilation-perfusion scintigraphy (data set D), and contrast-enhanced MDCT with ventilation-perfusion scintigraphy (data set E) were determined by receiver operating characteristic analysis, using the results of pulmonary angiography as the reference standard. The diagnostic capability of each data set was analyzed on a per-vascular zone and a per-patient basis with the McNemar test. RESULTS. Sensitivity and specificity of data set A were 83% and 97%, respectively, on a per-vascular zone basis and 92% and 94%, respectively, on a per-patient basis. Specificity and accuracy of data set A were significantly higher than those of data set D on a per-patient basis (p < 0.05). CONCLUSION. Time-resolved MR angiography with SENSE is effective for the diagnosis of pulmonary embolism.
AMER ROENTGEN RAY SOC, 2004年07月, AMERICAN JOURNAL OF ROENTGENOLOGY, 183 (1), 91 - 98, 英語[査読有り]
研究論文(学術雑誌)
A 70-year-old woman presented to our outpatient clinic with a large idiopathic renal arteriovenous fistula (AVF). Transcatheter arterial embolization (TAE) using interlocking detachable coils (IDC) as an anchor was planned. However, because of markedly rapid blood flow and excessive coil flexibility, detaching an IDC carried a high risk of migration. Therefore, we first coiled multiple loops of a microcatheter and then loaded it with an IDC. In this way, the coil was well fitted to the arterial wall and could be detached by withdrawing the microcatheter during balloon occlusion ("pre-framing technique"). Complete occlusion of the afferent artery was achieved by additional coiling and absolute ethanol. This technique contributed to a safe embolization of a high-flow AVF, avoiding migration of the IDC.
SPRINGER, 2004年07月, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 27 (4), 374 - 376, 英語[査読有り]
研究論文(学術雑誌)
Purpose: The purpose of this study was to assess the quantitative effects of contrast material concentration on hepatic parenchymal and vascular enhancement in multiphasic computed tomography (CT), using multi-detector row helical CT. Materials and Methods: We designed a prospective randomized study to test two different concentrations of contrast material on five phasic scans of the liver. One hundred patients were randomly assigned to two groups: an iodine concentration of 300 mg/mL in group A and 370 mg/mL in group B. All patients received a fixed volume of 100 mL at a 4 mL/sec injection rate. Enhancement values for the hepatic parenchyma and aorta at three levels (upper, middle, and lower level of the liver), and values for portal and hepatic veins were statistically compared between the two groups. Results: Hepatic parenchymal enhancement values at all levels of the liver in portal phase (PP) and equilibrium phase (EP) were significantly higher in group B than in group A (p< 0.01). Aortic enhancement values at two levels of the liver (middle and lower) in early hepatic arterial phase (EAP) were significantly higher in group B than in group A (p< 0.05), however, there was no significant difference between groups A and B in aortic enhancement during the delayed hepatic arterial phase (DAP). Portal and hepatic venous enhancement values in PP and EP were significantly higher in group B than in group A (p< 0.01). Conclusion: On multiphasic dynamic CT, the use of a higher iodine concentration of contrast material results in higher hepatic parenchymal enhancement and aortic enhancement, as well as higher portal and hepatic venous enhancement.
2004年07月, Radiation Medicine - Medical Imaging and Radiation Oncology, 22 (4), 239 - 245, 英語[査読有り]
研究論文(学術雑誌)
Purpose: To evaluate the efficacy and safety of transcatheter arterial embolization with gelatin sponge immersed in an anti-cancer agent (GIA-TAE) alone or combined with radiation therapy, in hepatocellular carcinoma with portal vein tumor thrombus (PVTT) or hepatic vein tumor thrombus (HVTT) complicated by marked arterioportal or arteriovenous shunts. Materials and Methods: GIA-TAE was performed in 15 patients with PVTT and arterioportal shunts to the main portal trunk or first-order branch, and five with HVTT and arteriovenous shunts, adding radiation therapy in suitable cases. Primary efficacy, hemodynamic changes, Child-Pugh score, and survival rates were evaluated. Results: GIA-TAE with or without radiation therapy was effective for tumor thrombus in 11 patients with PVTT and in four with HVTT. Treatment was effective for the main tumor in eight patients with PVTT and three with HVTT. Shunts disappeared in seven of 13 patients available for follow-up. Child-Pugh scores before and after the treatment were not significantly different. Median survival times of PVTT and HVTT groups were 8.7 and 12.2 months, respectively. One-year survival rates for both groups were about 15.6% and 50.0%, respectively. Conclusion: TAE with GIA alone or combined with radiation therapy is effective and safe for severe arteriovenous shunts with PVTT or HVTT, and also favors patient survival.
2004年05月, Radiation Medicine - Medical Imaging and Radiation Oncology, 22 (3), 155 - 162, 英語[査読有り]
研究論文(学術雑誌)
研究論文(学術雑誌)
研究論文(国際会議プロシーディングス)
研究論文(国際会議プロシーディングス)
研究論文(国際会議プロシーディングス)
研究論文(国際会議プロシーディングス)
PURPOSE: To evaluate effect of controlled stent-based release of an NO donor to limit in-stent restenosis in rabbits. MATERIALS AND METHODS: Bioerodable microspheres containing NO donor or biodegradable polymer (polylactide-co-glycolide-polyethylene glycol) were prepared and loaded in channeled stents. Daily concentrations of NO release from NO-containing microspheres were assayed in vitro. NO- and polymer-containing (control) microsphere-loaded stents were deployed in aortas of New Zealand white rabbits (n = 8). Aortas with stents were harvested at 7 (n = 5) and 28 days (n = 3) and evaluated for cyclic guanosine monophosphate (cGMP) levels (7 days), number of proliferating cell nuclear antigen-positive cells (7 days), and intima-to-media ratio (7 and 28 days), with statistical significance evaluated by using one-way analysis of variance. RESULTS: NO-containing microspheres released NO with an initial bolus in the 1 st week, followed by sustained release for the remaining 3 weeks. Significant increase in cGMP levels and decrease in proliferating cell nuclear antigen-positive cells were found at 7 days for the NO-treated relative to controls (P < .05). Intima-to-group media ratio in the NO-treated group was reduced by 46% and 32% relative to controls at 7 and 28 days; respectively (mean, 0.14 +/- 0:01 [standard error] vs 0,26 +/- 0.02 at 7 days P < .01; 1.34 +/- 0.05 vs 1.98 +/- 0.08 at 28 days P < .01). CONCLUSION: Stent-based controlled release of NO donor significantly reduces in-stent restenosis and is associated with increase in vascular cGMP and suppression of proliferation. ((C))RSNA, 2003.
RADIOLOGICAL SOC NORTH AMERICA, 2004年02月, RADIOLOGY, 230 (2), 377 - 382, 英語[査読有り]
研究論文(学術雑誌)
PURPOSE: To report the use of the self-expanding Wallstent as an alternative to prophylactic inferior vena cava (IVC) filter placement before embolization of renal carcinomas with tumor thrombus. CASE REPORTS: Two patients, a 71-year-old man and an 88-year-old woman, were diagnosed with extensive tumor infiltration of the IVC secondary to renal cell carcinomas. Prophylactic placement of an IVC filter before transcatheter embolization was unsuccessful in both cases; a reduced space for deployment would have left part of the filter inside the right atrium. Instead, a Wallstent was used to constrain the tumor thrombus against the vessel wall and, at the same time, protect the patency of the contralateral kidney. Adequate patencies were confirmed 9 months after stenting in the first patient and after 19 days in the second patient. There were no clinical manifestations of pulmonary embolism. CONCLUSIONS: Wallstent implantation is an alternative prophylactic measure before transarterial embolization of renal carcinomas if IVC filters cannot be placed.
2004年02月, Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 11 (1), 84 - 8, 英語, 国際誌[査読有り]
研究論文(学術雑誌)
We report two cases of gastric varices complicated by massive ascites that disappeared after balloon-occluded retrograde transvenous obliteration (B-RTO). The first patient had progressive gastric varices that continued to enlarge even after three episodes of esophagogastric variceal bleeding, and the second patient was admitted to our hospital because of the bleeding from gastric varices. After B-RTO procedures in both patients, significant improvement of the ascites, hepatic function reserve, and hypoalbuminemia was observed. Although further experience is needed, our experience points to the likelihood of the amelioration of ascites after B-RTO.
SPRINGER-VERLAG, 2004年01月, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 27 (1), 64 - 67, 英語[査読有り]
研究論文(学術雑誌)
研究論文(国際会議プロシーディングス)
研究論文(国際会議プロシーディングス)
Purpose: We conducted a prospective trial of combined transarterial chemoembolization (TACE) and three-dimensional conformal radiotherapy (3D-CRT) for portal vein tumor thrombus (PVTT) in unresectable hepatocellular carcinoma (HCC). The aim of the present study was to investigate the efficacy and toxicity of this trial regime. Methods and Materials: Patients with unresectable HCC complicated with tumor thrombus in the first branch of portal vein were selected as eligible for this study. TACE was performed using Lipiodol, epirubicin hydrochloride, and mitomycin, followed by gelatin sponge cubes. The 3D-CRT was performed targeting the clinical target volume (CTV) defined as PVTT only to a total dose of 60 Gy using 10-MV accelerator. Results: A total of 19 patients were enrolled in this study. Survival rates at 1 and 2 years were 40.6% and 10.2%, respectively. The median survival time was 7.0 months. An objective response was observed in 11 of 19 cases (57.9%). Recanalization of the first portal branches was not observed; however, the protrusion of PVTT into the main portal trunk decreased in all cases. Growth of intrahepatic metastasis outside the 3D-CRT field was observed in 12 cases (63%). Deterioration of the Child-Pugh Score was observed in 5 of 6 cases with the percent volume of the total liver receiving a dose exceeding 30 Gy (V-30) greater than or equal to40%, vs. 2 of 13 cases with a V-30 <40% (p < 0.01). Conclusion: This combined therapy was feasible. Our results indicate that V-30 was a predictive test for deterioration of liver function. Further investigation of treatment modalities is needed to prevent the growth of intrahepatic metastasis. (C) 2003 Elsevier Inc.
ELSEVIER SCIENCE INC, 2003年09月, INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 57 (1), 113 - 119, 英語[査読有り]
研究論文(学術雑誌)
Purpose: Penetrating atherosclerotic ulcer (PAU) is an ulceration of an atherosclerotic plaque penetrating through the intima, which may lead to intramural hematoma, aneurysm formation, or rupture. This disease is predominantly found in the thoracic aorta and is uncommon in the infrarenal aorta. The effectiveness of endovascular repair of PAU in the infrarenal aorta was retrospectively investigated. Methods. From 1999 to 2002, PAU was diagnosed with computed tomography and magnetic resonance imaging in the abdominal aorta in four patients. All patients were men; their average age was 78 years. All four patients had hypertension, and two patients had concomitant coronary artery disease. Three patients had abdominal pain or lumbago. Results. All patients underwent endovascular grafting with a Gianturco, Z-stent covered with thin-wall woven Dacron graft. Indications for endovascular intervention were aneurysm formation with or without intramural hematoma in two patients and contained rupture with extraaortic hematoma in two patients. The postoperative course was uneventful in all cases, and no endoleak or aneurysm expansion was recognized during follow-up (4-32 months; average, 14 months). Conclusions: Infrarenal aortic lesions caused by PAU were generally localized, and endovascular grafting appears to be a feasible alternative to surgical repair.
MOSBY, INC, 2003年08月, JOURNAL OF VASCULAR SURGERY, 38 (2), 383 - 388, 英語[査読有り]
Our objective was to identify the factors adversely affecting long-term patency after percutaneous transluminal angioplasty (PTA) for hemodialysis Brescia-Cimino arteriovenous fistulas. Between November 1995 and March 2000, 91 PTA procedures were performed on 50 patients with 57 Brescia-Cimino fistulas. A retrospective study based on the chart review was performed. The initial technical success rate for all procedures and the primary and secondary patency rates for all fistulas were calculated. Regarding fistulas successfully maintained by the primary PTA, the primary and secondary patency rates were compared using the Kaplan-Meier method between two patient groups. They were classified on the basis of several factors, including age (older, over 70 years, and younger group), age of the fistulas (older, over 6 months, and younger group), with or without diabetes mellitus (DM), solitary or multiple lesions, long or short segment lesion, stenosis or occlusion, and with or without arterial and/or anastomotic lesions. Initial technical success rates for all procedures and fistulas were 91.2 and 89.5%, respectively. Cumulative primary and secondary patency rates at 1 year were 47.3 and 67.3%, respectively. In the comparative study, the secondary patency rate for the older group was lower than that of the younger group with statistical significance ( p =0.029). The higher age is the only factor that reduces the long-term patency rate after PTA.
SPRINGER-VERLAG, 2003年07月, EUROPEAN RADIOLOGY, 13 (7), 1615 - 1619, 英語[査読有り]
研究論文(学術雑誌)
研究論文(国際会議プロシーディングス)
研究論文(国際会議プロシーディングス)
研究論文(国際会議プロシーディングス)
研究論文(国際会議プロシーディングス)
Purpose: The purpose of this study was to compare the efficacy, complications, and costs associated with low-dose (:52 mg/h) alteplase (tissue plasminogen activator [t-PA]) versus urokinase for the catheter-directed treatment of acute peripheral arterial occlusive disease (PAO) and deep vein thrombosis (DVT). Materials and methods. A retrospective review was performed during sequential time periods on two groups with involved extremities treated with either t-PA with subtherapeutic heparin (TPA group) or urokinase with full heparin (UK group) at a single center. Treatment group characteristics, success rates, complications, dosages, infusion time, and costs were compared. Results. Eighty-nine patients with 93 involved limbs underwent treatment (54 with DVT, 39 with PAO). The treatment groups were statistically identical (TPA: 45 limbs; 24 with DVT, 53.3%; 21 with PAO, 46.7%; UK: 48 limbs; 30 with DVT, 62.5%; 18 with PAO, 37.5%). The overall average hourly infused dose, total dose, infusion time, success rates, and cost of thrombolytic agent were as follows (+/- standard deviation): TPA, 0.86 +/- 0.50 mg/h, 21.2 +/- 15.1 mg, 24.6 +/- 11.2 hours, 89.4%, $466 +/- $331; and UK, 13.5 +/- 5.6 (10(4)) U/h, 4.485 +/- 2.394 million U, 33.3 +/- 13.3 hours, 85.7%, $6871 +/- $3667, respectively. Major and minor complication rates were: TPA, 2.2% and 8.9%; and UK, 2.1% and 10.4%, respectively. No statistical differences in success rates or complications were observed; however, t-PA was significantly (P < .05) less expensive and faster than urokinase. Conclusion: Low-dose t-PA combined with subtherapeutic heparin is equally efficacious and safe compared with urokinase. Infusions with t-PA were significantly shorter and less expensive than those with urokinase.
MOSBY, INC, 2003年03月, JOURNAL OF VASCULAR SURGERY, 37 (3), 512 - 517, 英語[査読有り]
研究論文(学術雑誌)
Background-Advances in imaging techniques have increased the recognition of aortic intramural hematomas (IMHs)and penetrating atherosclerotic ulcers (PAUs); however, distinction between IMH and PAU remains unclear. We intended to clarify differences between IMH coexisting with PAU and IMH not associated with PAU by comparisons of clinical features, imaging findings, and patient outcome to derive the optimal therapeutic approach. Methods and Results-We performed a retrospective analysis of 65 symptomatic patients with aortic IMH. There were 34 patients with IMH associated with PAU (group 1) and 31 patients with IMH unaccompanied by PAU (group 2). Involvement of the ascending aorta (type A) was more frequent in group 2 (8 of 31, 26%), whereas most of the patients in group 1 had exclusive involvement of the descending aorta (type B) (31 of 34, 91%). Patients were subdivided into 2 categories, those with clinical progression and those with stable disease. Forty-eight percent of patients in group 1 and 8% in group 2 were in the progressive category (P=0.002). Clinical and radiological findings were compared between those group 1 patients who had a progressive disease course (n=12) and those who were stable (n=13). Sustained or recurrent pain (P<0.0001), increasing pleural effusion (P=0.0003), and both the maximum diameter (P=0.004) and maximum depth (P=0.003) of the PAU were reliable predictors of disease progression. Conclusions-This study suggests a difference in disease behavior that argues for the prognostic importance of making a clear distinction between IMH caused by PAU and IMH not associated with PAU. IMH with PAU was significantly associated with a progressive disease course, whereas IMH without PAU typically had a stable course, especially when limited to the descending thoracic aorta.
LIPPINCOTT WILLIAMS & WILKINS, 2002年07月, CIRCULATION, 106 (3), 342 - 348, 英語[査読有り]
研究論文(学術雑誌)
The objective of this work was to develop a platform to evaluate and deliver putative therapeutic agents for in-stent restenosis. Arterial stenting is applied in more than 60% of balloon angioplasties for treating cardiovascular disease. However, stented arteries encounter accelerated rates of restenosis. No prior platform has allowed evaluation or local management of in-stent restenosis without perturbing the very system being examined. A stainless steel, balloon-expandable stent was modified to serve as an ablumenal drug delivery platform. Several combinations of bioerodible polymer microspheres and gels were evaluated for channel retention under in vitro flow and in vivo conditions. A stent-anchored hybrid system prevented material embolization under all conditions. Unlike prior platforms, these stents do not alter local inflammation or in-stent plaque formation relative to conventional Palmaz-Schatz stents after in vivo deployment. The system also proved sensitive enough to detect plaque reduction with an antirestenotic agent. We conclude that a platform to evaluate and deliver therapeutic agents for in-stent restenosis has been achieved.
MARY ANN LIEBERT INC PUBL, 2002年06月, TISSUE ENGINEERING, 8 (3), 395 - 407, 英語[査読有り]
研究論文(学術雑誌)
Background: Patients suffering from hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) generally have a poor prognosis. We therefore conducted a prospective pilot trial of combined transcatheter arterial chemoembolization (TACE) and local radiotherapy (RT) for PVTT in unresectable HCC. The aim of the study was to investigate the efficacy and toxicity of this preliminary trial regime and to explore RT guidelines for cirrhosis. Methods: Eight patients with unresectable HCC accompanied by first branch PVTT were entered into the study from February 1998 to December 1999. TACE was performed using Lipiodol, epirubicin hydrochloride and mytomycin followed by gelatin sponge cubes. RT was started 10-14 days following TACE. A total delivered dose of 60 Gy was given as daily 2 Gy fractions, with the clinical target volume defined as PVTT only. We observed a relationship between deterioration of liver function and the percent volume of the total liver receiving a dose exceeding 30 Gy (V-30). Results: An objective response was observed in three of the eight patients. However, on follow-up angiograms the protrusion of PVTT into the main portal trunk was decreased in all cases. Deterioration of liver function was observed in all patients with V-30 > 40%. Conclusion: It is possible that this combined therapy prevents PVTT from spreading to the main trunk and that indicates a further benefit of TACE. Our results indicate that V,, constitutes a predictive test for the development of liver failure. More detailed evaluations of liver function and determination of the safe irradiation volume are necessary.
OXFORD UNIV PRESS, 2001年04月, JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 31 (4), 147 - 152, 英語[査読有り]
研究論文(学術雑誌)
The aim of this study was to assess the efficacy and safety of thin membranes of polychlorovinylidene (PCV) or polyurethane (PU) as covering materials for Gianturco stents in the treatment of severe tracheal stricture caused by intraluminal tumor. Manufactured Gianturco stents covered with PCV or PU membrane were used to treat six malignant and one benign tracheal stricture. The initial results, complications, clinical follow-up, bronchoscopic findings, and three autopsy microscopic examinations were reviewed. Informed consent was obtained after the nature of the treatment had been fully explained before every procedure. The stents successfully dilated the tracheal strictures, providing immediate relief of respiratory symptoms in all patients with no major complications. During the follow-up period, the covering materials prevented tumor ingrowth until death or intraluminal granuloma formation. Autopsies proved that no histological change occurs in the tracheal mucosa in response to the presence of PCV or PU however, ulcer formation occurred in one patient and penetration of the stent struts into the tracheal wall in two. Bloody sputum with ulcer formation, minimal granuloma formation at the distal end of the stent, and abnormal bacterial load in the sputum were long-term complications. The Gianturco stent covered with PCV or PU membrane is a useful option as a palliative treatment for malignant and an emergent salvage for benign tracheal stricture, because both materials are thinner and less voluminous than the others. However, the indications for its use are limited to patients with poor prognoses, because hemoptysis, granuloma formation, and bacterial propagation remain problematic.
2001年, European Radiology, 11 (10), 1933 - 1938, 英語[査読有り]
研究論文(学術雑誌)
[査読有り]
研究論文(学術雑誌)
We report a case of a 50-year-old woman with histologically proven cystic hamartoma of the renal pelvis, focusing on the imaging findings and pathologic features. A large multicystic tumor with solid components in the left kidney was enhanced on both contrast-enhanced CT and gadolinium-enhanced MR images. Angiographic images showed irregular tumor vessels with moderate tumor stain.
2000年, Radiation Medicine - Medical Imaging and Radiation Oncology, 18 (2), 139 - 142, 英語[査読有り]
研究論文(学術雑誌)
Several types of self-expanding metallic stents (SEMS) were placed in two patients suffering from severe malignant stricture at the site of a mechanically stapled esophagojejunostomy used for the treatment of recurrent gastric cancer. Following modified Gianturco stent placement with limited success in one of the patients, an additional Ultraflex stent (Boston Scientific Co., Boston, USA) failed to expand satisfactorily at the outlet of the second stent. In the other patient, since the proximal end of an additional covered Ultraflex stent (Boston Scientific Co.) inserted through the first one failed to expand satisfactorily at the level of severe stenosis because of the extreme rigidity caused by the mechanical staples, a spiral Z- stent was inserted to dilate it. The cases reported here raise some problems associated with the treatment of severely malignant stricture accompanied by extreme rigidity following mechanically stapled esophagojejunostomy with SEMS.
2000年, Radiation Medicine - Medical Imaging and Radiation Oncology, 18 (2), 133 - 137, 英語[査読有り]
研究論文(学術雑誌)
A 55-year-old male was admitted to our hospital because of arthralgia, rash, and painful tumor in the legs. On admission, skin lesions involving dark erythematous macules and a tender mass of 3 by 5 cm were present. Laboratory findings included hemoglobin of 11.2 g/dl, white blood cell count of 6200/μl, erythrocyte sedimentation rate (ESR) of 88 mm/hour, and normal results of renal function tests. Hepatitis B surface antigen, anti-nuculear antibody (ANA), and perinuclear pattern antineutrophil cytoplasmic autoantibody (ANCA) were negative. A T 1-weighted magnetic resonance image (MRI) showed iso-intensity areas that increased in intensity on T 2-weighted images of the M. gastrocnemius. The angiographic appearance of tumor staining with some degree of luminal irregularity in the posterior tibial artery suggested a diagnosis of soft tissue neoplasm. Biopsy specimens of the right leg lesion were consistent with necrotizing arteritis of both small and medium-sized vessels. Treatment with prednisolone and cyclophosphamide resulted in the disappearance of the skin lesions and the improvement of laboratory data. At first, classical polyarteritis nodosa was considered histologically. However, lesions were limited to skin, muscles, and joints, and there has been no evidence of systemic disease for 1.5 years consequently, cutaneous form of polyarteritis nodosa was diagnosed. Reports of soft tissue tumors on the legs of patients with polyarteritis nodosa are quite rare. The interesting radiographic findings of cutaneous polyarteritis nodosa were reported.
2000年, Ryumachi, 40 (1), 16 - 20, 日本語[査読有り]
研究論文(学術雑誌)
Purpose: To evaluate the incidence and causes of complications associated with balloon-occluded arterial infusion chemotherapy (BOAI) for pelvic malignancies. Methods: In 34 courses of BOAI in 22 patients with pelvic malignancies, we analyzed the incidence of complications as well as the effect of the dose of the anticancer drugs, the infusion site, and the number of BOAI administrations on these complications. Complications were divided into two categories: cystitis-like symptoms and neurological complications such as pain, numbness, and paresthesia of the lower extremities and the hip. Results: Eleven patients (50%) suffered from complications, seven (31.8%) from neurological complications and four (18.2%) from cystitis-like symptoms. The complications appeared in 14 courses (42.4%) of BOAI, neurological complications in 10 (30.3%) and cystitis-like symptoms in four (12.1%). A high dose of anti-cancer drugs and infusion from the anterior division tended to induce neurological complications more frequently however, the cystiris-like symptoms were not related to any factors. Conclusion: Our results indicate that a smaller dose of anticancer drugs should be infused from the bilateral internal iliac arteries for safer pelvic BOAI.
1999年11月, CardioVascular and Interventional Radiology, 22 (6), 481 - 485, 英語[査読有り]
研究論文(学術雑誌)
Three patients with recurrence of brain metastases from small cell lung cancer were treated with whole brain reirradiation therapy. A total dose of 20 Gy was administered to two patients with hyperfractionation (20 fractions) and to one with conventional fractionation (10 fractions). Two cases achieved PR and the other NC. Survival after reirradiation was four months for all patients. Two patients died of progressive brain metastases and one patient of liver metastases. No radiation injury was observed during follow-up. Whole brain reirradiation at a dose of 20 Gy in 10 or 20 fractions was therefore considered useful and safe for brain recurrence of small cell lung cancer.
1998年, Radiation Medicine - Medical Imaging and Radiation Oncology, 16 (2), 153 - 156, 英語[査読有り]
研究論文(学術雑誌)
We evaluated the usefulness of power Doppler imaging in the differential diagnosis between hepatocellular carcinoma and metastatic adenocarcinoma. Forty-seven patients with hepatocellular carcinoma and 18 patients with metastatic adenocarcinoma were evaluated using power Doppler imaging. The colour signals of hepatic turnouts were graded as follows: 1, colour signals only in the marginal area 2, small dot or dotted line colour signals within the tumours 3, continuous solid line colour signals within the tumours. The grade 3 colour signals were classified in the following three patterns winding line pattern, stretched line pattern and mixed pattern. The colour signals of hepatocellular carcinoma were grade 1 in seven patients, grade 2 in 11 and grade 3 in 29. The colour signals of metastatic adenocarcinoma were grade 1 in three patients and grade 3 in 15. Of the 29 hepatocellular carcinoma patients with a grade 3 signal, 26 patients had winding line patterns and three had mixed patterns. Of the 15 metastatic adenocarcinoma patients with a grade 3 signal, 12 patients had stretched line patterns and three had mixed patterns. In conclusion, power Doppler imaging is useful in the differential diagnosis between hepatocellular carcinoma and metastatic adenocarcinoma to evaluate the colour signal pattern within the tumour.
Blackwell Publishing, 1998年, Journal of Gastroenterology and Hepatology (Australia), 13 (11), 1152 - 1160, 英語[査読有り]
研究論文(学術雑誌)
Background: A study to determine the usefulness of magnetic resonance imaging (MRI) of the liver in patients with type Ia glycogen storage disease was performed. Methods: T1-weighted images and T2-weighted images were obtained with spin echo technique in 4 patients with type Ia glycogen storage disease. TheT2 values for the liver parenchyma of these 4 patients, and for the complicating liver tumors in 2 of these patients, were measured. One patient underwent hepatic angiography. For each patient with liver tumors, the number, size, and MRI findings of the tumors and their signal intensity were compared to that for the liver parenchyma on both T1-weighted and T2-weighted images. Results: There was a slight reduction of T2 relaxation time in the liver parenchyma. Complicating liver tumors were depicted as high-intensity areas on T2-weighted images. The mean T2 value for diseased liver parenchyma was 34.5 milliseconds, and for liver tumors, 41.5 milliseconds. The former was less than the value for normal liver parenchyma. Reduction of T2 relaxation time for diseased liver parenchyma was probably due to the regulation of proton movement by macromolecular glycogen granules. All complicating liver tumors were depicted as high-intensity areas, compared to the diseased liver parenchyma. Conclusion: These findings suggest that MRI can be useful for the observation of type Ia glycogen storage disease and complicatins liver tumors. © JSCO/CLJ 1997.
Springer Japan, 1997年, International Journal of Clinical Oncology, 2 (1), 1 - 5, 英語[査読有り]
研究論文(学術雑誌)
We report a case of 64-year-old man with chronic hemorrhagic empyema. T1 and T2-weighted MR images showed variably hyperintense areas in the tumor that reflected the presence of fresh and old hematoma. Gd-DTPA-enhanced MRI revealed capillary bleeding in the periphery of the mass.
1996年, Radiation Medicine - Medical Imaging and Radiation Oncology, 14 (4), 201 - 203, 英語[査読有り]
研究論文(学術雑誌)
We evaluated re-diagnostic ability of dynamic MRI as compared with T2 weighted image in the diagnosis of primary therapeutic effect and tumor recurrence after transcatheter arterial embolization (TAE) for hepatocellular carcinoma. Thirty-four nodules in 30 patients with hepatocellular carcinoma were estimated based on operative and angiographic findings. According to the time when dynamic MRI was taken, nodules were classified as a short-term observation group consisting of 15 nodules obtained within a month after TAE, or as a long-term observation group consisting of 19 nodules obtained over a month after TAE. In the short-term observation group, sensitivity, specificity, accuracy was 89%, 100%, 93% on dynamic MRI and 78%, 67%, 73% on T2WI, respectively. In the long-term observation group, these were 94%, 100%, 95% on dynamic MRI and 100% 33%, 89% on T2WI and 94%, 67%, 89% on Lipiodol-CT respectively. In both groups, dynamic MRI was superior in accuracy. Conclusively, we consider that dynamic MRI is a most accurate diagnostic method that should be added to routine MRI after TAE. Especially in the case diagnosed positive on T2WI, the usefulness of dynamic MRI should be emphasized to determine the schedule of the therapy, because the cases that were false positive on T2WI were accurately diagnosed on dynamic MRI.
1994年, Japanese Journal of Cancer and Chemotherapy, 21 (8), 1235 - 1240, 日本語[査読有り]
研究論文(学術雑誌)
A case of mucoepidermoid carcinoma of the lung which showed a poor course was reported, and the literature was reviewed. The patient was a 66-year-old male. A mass shadow on the right lower lung field was seen on the chest X-ray. © 1993, The Japan Lung Cancer Society. All rights reserved.
1993年, Japanese Journal of Lung Cancer, 33 (2), 247 - 253, 英語[査読有り]
研究論文(学術雑誌)
外傷性・医原性血管損傷に対するバイアバーンステントグラフト留置後の抗血栓療法には定まった見解はなく、治療担当医の判断に委ねられている。浅大腿動脈の閉塞性疾患に対するバイアバーン留置後の抗血栓療法に準じた治療が行われることが多いが、治療血管の部位や再出血のリスクなどを鑑みて調整する必要がある。腹部分枝では、血管の蛇行や血管周囲の炎症や感染など、グラフト閉塞の原因となり得る因子がある一方で、必ずしも長期開存が求められない場合もある。腸骨動脈では、グラフト閉塞の可能性は基本的に低いと思われるため、場合によっては抗血栓療法を行わないのも一つの選択肢である。反対に、鎖骨下動脈では確実な開存性を担保したい場合が多く、抗血栓療法は必須と考える。外傷性・医原性出血に対するバイアバーンステントグラフトの長期成績はいまだ不明であり、さらなるエビデンスの構築が望まれる。(著者抄録)
(一社)日本血管内治療学会, 2021年, 日本血管内治療学会誌, 22 (1), 50 - 53, 日本語膵十二指腸動脈瘤(PDAA)は瘤径に関係なく破裂する可能性が示唆されており,発見次第治療を考慮する必要がある.また,解剖学的に複雑な位置に存在するため,低侵襲治療である血管内治療による塞栓術(TAE)が選択される機会が増加している.しかしながら,主要血管を閉塞させる可能性があるなどの解剖学的な理由でTAEだけでは治療を完遂することが難しい症例がある.今回TAEと従来の外科手術を組み合わせたハイブリッド治療を行った2症例を経験したので報告する.1例目のPDAAに対しては,TAEと外科的瘤切除を2期的に分割して手術治療を行い,2例目のPDAAに対しては,TAEと外科的バイパス術を同時に施行し,2例共に良好な経過を辿った.ハイブリッド治療は膵十二指腸動脈瘤に対して非常に有用な選択肢であると思われた.しかしながら,本治療の長期成績についての報告は少なく,注意深いフォローアップが必要である.(著者抄録)
(NPO)日本血管外科学会, 2021年02月, 日本血管外科学会雑誌, 30 (1), 7 - 12, 日本語<文献概要>Point 1.肝細胞癌の診断において画像診断はきわめて重要な位置を占め,ダイナミックCT・MRIによる血流評価はその基本である.2.肝細胞特異性造影剤(Gd-EOB-DTPA)の臨床導入は,肝細胞癌の診断体系を変化させるほどのインパクトを与えている.
(株)学研メディカル秀潤社, 2019年04月, 画像診断, 39 (6), 623 - 631, 日本語[招待有り]
記事・総説・解説・論説等(学術雑誌)
記事・総説・解説・論説等(学術雑誌)
記事・総説・解説・論説等(学術雑誌)
1999年10月〜2016年12月に弓部全置換術を施行した350例を、術前MRIのFLAIR像を用いて大脳白質病変(WMC)をFazekasスケールにより3群(Mild 100例、Moderate 158例、Severe 101例)に分け、早期・長期成績に及ぼす影響について検討した。全体の30日死亡率と院内死亡率はそれぞれ1.4%、2.8%であり、Severe群は1年死亡の有意な危険因子であった。恒久的脳障害(PND)と一過性脳障害(TND)はそれぞれ2.2%、7.8%で生じ、いずれもWMC重症度と有意に相関した。多変量解析では、PND発生の有意な危険因子としてatherothrombotic aorta、Severe WMC、人工心肺時間が挙げられ、TND発生の有意な危険因子としてatherothrombotic aorta、Severe WMC、頸動脈狭窄があげられた。平均観察期間4.8年で97例の遠隔死亡を認め、5年生存率はWMCの重症度と相関して有意に減少し、心大血管・脳血管関連死亡回避率もWMCの重症度と相関して有意に低下した。
(NPO)日本心臓血管外科学会, 2018年07月, 日本心臓血管外科学会雑誌, 47 (4), vii - xii, 日本語[査読有り]
記事・総説・解説・論説等(学術雑誌)
Acute occlusion of abdominal aortic aneurysm (AAA) is a rare complication and is usually treated with surgical reconstruction. We present a case of acute AAA occlusion that was successfully treated by endovascular aneurysm repair (EVAR) with Fogarty balloon thrombectomy. A 77-year-old man with a history of acute myocardial ischemia presented with limb weakness and coldness. Contrast-enhanced computed tomography showed a 42-mm-diameter infrarenal AAA that was completely thrombosed in the distal portion. The proximal neck of the aneurysm was patent, and its shape was suitable for EVAR. Therefore, we performed balloon thrombectomy of the aortoiliac thrombus that was followed by EVAR. EVAR can be a less invasive alternative than traditional treatment for acute occlusion of AAA.
Springer New York LLC, 2018年01月, Cardiovascular and interventional radiology, 41 (1), 182 - 185, 英語, 国際誌[査読有り]
近年のがん診療の向上に伴い、骨転移を有する"がんサバイバー"が増加している。骨転移や脊椎転移は、骨関連事象と呼ばれる病的骨折や脊髄麻痺症状をきたし、がん患者のADLやQOLを大きく障害する。がん集学的治療の最終目標は、予後の延長とQOLの維持向上であり、骨関連事象の予防と制御は、がん集学的治療において大変重要である。このため、骨転移を専門に扱うCancer Board(以下、CB)を開設する施設が増えている。当院では、2013年より骨転移CBを設置し活動しているが、院内では骨転移診療が認知されるようになり、手術数の増加と緊急手術の減少など、一定の効果を上げている。しかしながら、院外からの紹介患者が緊急手術となるケースは増加しており、兵庫県内の基幹病院でも骨転移CBを設置している施設は限られていることから、我々は出張型の骨転移CBの活動を開始している。本稿では、当院での骨転移CBを紹介するとともに、出張型骨転移CBの活動についても触れたい。(著者抄録)
(株)全日本病院出版会, 2017年09月, 整形外科最小侵襲手術ジャーナル, (84), 79 - 83, 日本語[査読有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
速報,短報,研究ノート等(学術雑誌)
記事・総説・解説・論説等(商業誌、新聞、ウェブメディア)
[招待有り]
記事・総説・解説・論説等(商業誌、新聞、ウェブメディア)
<Point>右下腹部痛ではまず虫垂炎を鑑別する.そのためには画像検査で虫垂を正確に同定する必要がある.造影CTは,単純CTで虫垂の同定ができない時や診断に悩む時に施行するとよい.施設によっては単純CTを撮らずに,最初から造影CTを施行することもある.虫垂炎と回盲部憩室炎はともに回盲部に炎症を生じ,ときに鑑別に悩むが,画像診断で最も重要な点は,虫垂の同定にある.(著者抄録)
(株)医学書院, 2017年04月, Medicina, 54 (5), 718 - 722, 日本語[招待有り]
記事・総説・解説・論説等(商業誌、新聞、ウェブメディア)
骨転移は,がん患者のがん集学的治療の最終目標であるQOLを大きく障害する.とりわけ脊椎転移は麻痺症状を来すため,脊椎転移の制御はQOLの維持には重要である.骨転移の早期発見,早期治療を目標とした集学的診療を実践するために,全国で骨転移に特化したcancer board(CB)が各施設で開設されている.当施設でも2013年から開設し,現在353名が登録されている.本稿では,当施設での骨転移CBを紹介するとともに,脊椎転移の診断,集学的治療の迅速化など骨転移CBが脊椎転移診療に与えた効果を中心に述べる.(著者抄録)
(株)医学書院, 2016年07月, 臨床整形外科, 51 (7), 601 - 605, 日本語[招待有り]
記事・総説・解説・論説等(学術雑誌)
[査読有り][招待有り]
記事・総説・解説・論説等(学術雑誌)
[査読有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(商業誌、新聞、ウェブメディア)
[招待有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(学術雑誌)
日本における下腿切断の原因は近年著しく変化し、糖尿病性足病変に起因した切断が増加している。糖尿病性足病変とは、糖尿病性神経障害、血管障害に感染が加わった複合性病変で、特に糖尿病を合併した重症下肢虚血は大切断の大きな原因となる。この糖尿病性足病変に対しては、神経障害による麻痺や足の変形、血管障害による虚血症状、骨髄炎による感染の拡大などさまざまな問題に対するアプローチが必要になってくる。病態も軽症から重症までさまざまで、単診療科だけではなく、多診療科・多職種にまたがった集学的治療が不可欠になってくる。さらに最適なチーム医療を構築する場合、重症度に応じてフットマネージメントを一次〜三次医療に分類する方が有用である。また、患者が単一の医療機関へのみ集中するのではなく、複数の施設間での円滑な地域連携により、迅速で最適な医療が施行されるべきである。本稿では、糖尿病足病変を中心とした救肢のためのチーム医療の現状を総括し、今後の問題点について展望する。(著者抄録)
日本下肢救済・足病学会, 2014年03月, 日本下肢救済・足病学会誌, 6 (1), 3 - 8, 日本語[招待有り]
記事・総説・解説・論説等(学術雑誌)
[招待有り]
記事・総説・解説・論説等(学術雑誌)
60歳代男。飲酒後に気分不良と大量下血を来たし救急搬送された。上部消化管内視鏡で十二指腸傍乳頭憩室から活動性動脈性出血を認め、憩室内部には凝血塊が充満しており、腹部造影CTで同憩室内に造影剤の貯留を認め、後上膵十二指腸動脈(PSPDA)の関与が疑われた。血管造影を行うも出血点を同定できず、PSPDA右枝にマイクロカテーテルを挿入し超選択的CTAを行ったところ、十二指腸傍乳頭憩室内の血管外漏出を認め、同血管に対しN-butyl-2-cyanoacrylate(NBCA)を用いた経カテーテル的動脈塞栓術を行った。しかし、翌日に再出血を認め、血管造影でPSPDA左枝末梢領域に多数の微細な分枝が関与する血管外漏出像を認めた。広範囲に塞栓する必要があると考え、後下膵十二指腸動脈(PIPDA)側をコイル塞栓した後、NBCAでPSPDA側よりカテーテル的塞栓術を行う計画を立てた。術中、4mm径のマイクロコイルがPIPDA側よりPSPDA側にかけてelongationしたため、3mm径のマイクロコイルをPSPDA側に追加してisolationを行った。術後再出血は認めず、第13病日に退院した。治療後2ヵ月に急性膵炎を生じたが、保存的治療で軽快した。
(一社)日本インターベンショナルラジオロジー学会, 2011年02月, IVR: Interventional Radiology, 26 (1), 64 - 68, 日本語急性動脈性出血に対してN-butyl-2-cyanoacrylate(NBCA)を用いた止血術を施行し、その有用性、安全性について検討した。急性動脈性出血に対するNBCAを用いた経カテーテル的塞栓術(TAE)を行った37例を対象とした。手技的成功率は100%であった。10例で金属コイルによる塞栓を併用した。再出血は2例で認めた。TAEに伴う合併症としての虚血性障害は初期に経験した下部消化管出血の1例で認めた。在院中の死亡は9例に認め、7例が多臓器不全であったが、TAEを施行した部位の出血はコントロールされており、原疾患の増悪が原因と考えられた。腹腔鏡下胆摘術後出血の1例ではTAEによる止血効果は良好であったが出血性ショックから回復できず、TAE当日に死亡した。もう1例はTAE後の再出血に対する消化管切除後合併症による死亡であった。
金原出版(株), 2011年02月, 臨床放射線, 56 (2), 197 - 204, 日本語【目的】日本人の腹部大動脈瘤ステントグラフト内挿術(EVAR)の適応と限界についてZenith AAAステントグラフトの適応基準に従い検討した。【方法】2006年1月から2007年12月の間、当科で評価した腹部大動脈瘤(AAA)125人のうち、CT評価可能であった106人(男性88人、平均年齢73歳)を対象とした。マルチスライスCTスキャンを用い、以下について計測、解析を行った。1)腹部大動脈瘤最大短径、2)Proximal neck外径、長、3)総腸骨動脈外径、長、4)Proximal neckの腎動脈上方大動脈に対する角度、大動脈瘤長軸に対する角度、5)外腸骨動脈径、6)低位腎動脈から大動脈分岐部までの腹部大動脈長。【結果】EVAR可能症例27例(25.5%)、除外症例79例(74.5%)であった。男女別EVAR適応率は男性29.5%(26/88例)、女性5.6%(1/18例)であり、女性でよりEVAR除外例が多かった(P=0.04)。おもな除外理由は、short proximal neck 32例(40.5%)、腸骨動脈狭小24例(30.4%)、腎動脈下proximal neck高度屈曲23例(29.1%)であった。【結論】文献上、欧米人のEVAR適応率は48〜66%と報告されているが、日本人においてZenith AAAステントグラフトの適応基準を順守すると、short proximal neck、腸骨動脈狭小、proximal neck高度屈曲等の問題から、とくに女性においてEVARの適応は限界があると言わざるを得ない。(著者抄録)
(NPO)日本血管外科学会, 2009年10月, 日本血管外科学会雑誌, 18 (6), 595 - 602, 日本語51歳女.心窩部痛と嘔吐を主訴に受診した.心窩部に手拳大の腫瘤を触知し,入院となった.腹部超音波と造影CTで十二指腸狭窄を認めた.経過観察したところCT上腫瘤はやや縮小し,十二指腸狭窄も改善した.画像所見と臨床経過から血腫が疑われたが,診断確定のため腹腔鏡検査を行った.その結果,膵前面に後腹膜に覆われた手拳大の腫瘤が十二指腸を左に圧排するように存在し,ウインスロー孔とダグラス窩に凝血塊が認められた.後腹膜血腫と診断し,引き続き腹部血管造影を行ったところ上腸間膜動脈造影で後上膵十二指腸動脈の膵アーケードのすぐ頭側に近接して動脈瘤が認められ,選択的造影で背側膵動脈分岐の動脈瘤であることが確認された.これらの所見から同動脈瘤の破裂による後腹膜腔血腫と診断した.治療は動脈瘤のすぐ近位までカテーテルを挿入しコイル3本で経皮的動脈塞栓術を行った.3ヵ月後に腹部造影MRIを施行したところ動脈瘤への造影剤貯留はほとんど認められず,現在経過観察中である
(株)永井書店, 2005年11月, 綜合臨床, 54 (11), 2985 - 2987, 日本語高齢者を対象とした音読・計算による学習療法の効果を,コミュニケーションの要因から検討することを目的に,最もコミュニケーションが少ない,サポーター1人に対し5名の対象者の割合で学習課題を遂行するだけのグループ10名(I群),対象者とサポーターが1対1の最もコミュニケーションの多い群15名(III群),およびコミュニケーションの量と質をI群とIII群の中間とした群16名(II群)の3群に分け,1回15分程の音読・計算課題を週3回,6ヵ月間にわたり実施し,FAB(Frontal Assessment Battery at bedside)による前頭葉機能の測定,MMSE(Mini-Mental State)による認知機能の測定,日常生活活動評定尺度による評価などを行い,対照群14名(平均年齢84.7歳)と比較,検討した.その結果,学習療法実施群は対照群と比較して,FAB,MMSEともに有意に高得点であった.また,コミュニケーションの形態の違いによる比較では,FAB,MMSEともに,サポーター1人に対し対象者2名の割合で実施し,限定したコミュニケーションをとったII群において,最も変化が大きく,効果があることが分かった
日本老年行動科学会, 2005年09月, 高齢者のケアと行動科学, 10 (2), 53 - 56, 日本語速報,短報,研究ノート等(学術雑誌)
記事・総説・解説・論説等(学術雑誌)
簡単な計算や音読といった課題を遂行することが前頭前野を活性化するということが示されている.そこで,痴呆性高齢者がこうした課題を継続的に遂行すれば,彼らの前頭前野が活性化され,その結果として認知機能の低下を防止することができるか検討した.Frontal Assessment Battery at the bedsideにおいては,学習群では介入前から1年後にかけて得点が有意に上昇したが,対照群では有意な差はみられなかった.下位項目ことに分析すると,概念化,行動プログラミング,反応選択の項目で有意な差があり,GO/NO-GOでは有意に上昇したが,対照群では,GO/NO-GOでのみ得点に有意な減少の傾向がみられた,Mini-Mental State Examinationについては,学習群では介入前から1年後にかけては有意な変化はなかったが,対照群では1年後にかけて有意な得点の減少がみられた
(株)ワールドプランニング, 2004年03月, 老年精神医学雑誌, 15 (3), 319 - 325, 日本語研究発表ペーパー・要旨(国際会議)
percutaneous isolated hepatic pertusion(PIHP)の方法と高度進行多発肝細胞癌79例に対する治療成績を述べる.対象例の主腫瘍径は6.9±4.8cm,血管侵襲はVp3以上が18例,Vv2以上が10例であった.全例UICC Stage IV(IV-A 66例,IV-B 13例)で担癌腫瘍量の高度例が大半を占めた.奏効率は評価不能1例を除きCR 19例,PR 32例,SD 19例,PD 8例でPR以上は64.5%と高率に腫瘍の縮小が得られた.5年生存率は79例全例では17.1%,Stage別ではIV-Bは0%と不良であったが,IV-Aでは20.3%であり高度に進展した末期肝細胞癌でもPIHPによって良好な局所制御が得られれば中〜長期生存が可能になると考えられた
(株)南江堂, 2003年10月, 外科, 65巻, 10号, pp. 1158-1167 (10), 1158 - 1167, 日本語記事・総説・解説・論説等(学術雑誌)
研究発表ペーパー・要旨(国際会議)
68歳男.慢性肝炎で加療していた.突然の激しい腹痛を自覚し,腹部CTにて肝S7の腫瘤及び周囲の腹水貯留を認め緊急入院となった.保存的治療より開始したが,6時間後に施行した腹部CTで総胆管内の貯留物の増加を認めたため止血を目的としたTAEを選択した.TAE後のCTではS7背側に一部集積の不良部位を認め下横隔動脈等の肝外枝の関与が疑われたが,腹水の増悪もなく症状も軽快傾向であった.総ビリルビン値の著明な上昇を認めたため,総胆管内に貯留した凝血塊による閉塞性黄疸を考え,減黄を目的として内視鏡的胆管ドレナージを施行した.徐々に総ビリルビン値の減少を認め,2ヵ月後に右下横隔動脈よりTAEを追加し,外来で観察となった.以後,肝内再発に対し追加TAEを施行し12ヵ月後に多発再発,骨転移等により死亡する迄,胆道出血,腹腔内破裂いずれも再燃は認めなかった
金原出版(株), 2002年11月, 臨床放射線, 47 (12), 1745 - 1748, 日本語B-RTOを施行した胃静脈瘤145例について検討した.B-RTOは長期にも再発が少なく,胃静脈瘤に対する優れた治療効果を示した.また,副次的な結果として肝予備能の改善した例が多くみられ,術後の血流動態の変化が予備能向上に寄与していると考えられた
(一社)神緑会, 2002年08月, 神緑会学術誌, 18, 106 - 108, 日本語大動脈疾患に対するステント・グラフト内挿術は,各種デバイスの進歩と共にvascular interventional radiologyの代表的治療法として確立しつつある.ここ数年,世界各国から良好な治療成績が報告されている.しかし,ステント・グラフト自体の生体内での長期的耐久性や長期成績の問題など,未知の部分も多数残されている.一方,multi detector CTをはじめとする先端画像の進歩により,大動脈をはじめとする血管系疾患の非侵襲的画像診断法の質も飛躍的に改善されつつある.ステント・グラフト内挿術の現況と先端画像の応用について述べた
(株)最新医学社, 2002年03月, 最新医学, 57 (3), 442 - 448, 日本語研究発表ペーパー・要旨(国際会議)
研究発表ペーパー・要旨(国際会議)
66歳男.右側腹部痛を主訴としC型肝炎,肝細胞癌(HCC),下大静脈腫瘍塞栓を指摘された.血液生化学所見では軽度肝機能障害を認め,腫瘍マーカーではAFP,PIVKA-IIの上昇を認めた.腹部CT所見では肝右葉から内側区域に巨大な塊状型HCCを認め,門脈右枝,右肝静脈から下大静脈に腫瘍塞栓を認めた.以上より,下大静脈腫瘍塞栓合併進行HCCと診断した.腫瘍塞栓による肺塞栓の予防目的に,右房合流部にtemporary IVC filter留置を行い,右肝動脈よりTAEを施行した.TAE1週間後のfilter交換時に腫瘍塞栓が遊離し,一部が抜去したfilterに捕捉されたが,組織はghost cellであった.1ヵ月後のCT所見では腫瘍の著明な縮小,下大静脈腫瘍塞栓の消失が得られた.13ヵ月経過した現在,肺塞栓・肺転移はみられず経過良好である
(株)癌と化学療法社, 2001年10月, 癌と化学療法, 28 (11), 1708 - 1711, 日本語方法はJ型の5Fr親カテーテルの先端より7〜13mmのカーブ外縁部に,約7mm長の細長い側孔を自作し,このカテーテルを腹腔動脈に挿入後側孔からマイクロカテーテルを出して選択的挿入をするというものである.平成8年7月〜平成11年9月に従来のcoaxial法で挿入困難であったHCCのTAE例など肝腫瘍6例,副腎腫瘍2例,計8例延べ23回に本法を行い成功した.本法は親カテーテルの先端部が腹腔動脈内に十分挿入された状態で行うのでその安定性に優れ,腹腔動脈付近からの殆どの分岐状態に対応できると考えられた
(地独)神戸市民病院機構, 2001年03月, 神戸市立病院紀要, (39), 55 - 59, 日本語研究発表ペーパー・要旨(国際会議)
速報,短報,研究ノート等(学術雑誌)
50歳男,好中球減少性腸炎例.本症は致死率が高い重篤な疾患であり,臨床所見ならびに画像による早期の診断と手術適応の決定が重要である.特にCTは穿孔や膿瘍形成を的確に診断できる有用なmodalityと考えられる.又,保存的治療が選択された場合には,腹部超音波が腸管壁肥厚の経過観察において有用と考えられる
金原出版(株), 2000年05月, 臨床放射線, 45 (5), 640 - 643, 日本語55歳男.平成9年9月,発熱,関節痛及び下肢後面の皮疹と有痛性腫瘤に気付き10月受診.両下腿背部の皮膚に暗赤色皮疹あり.ESR88mm/h,WBC6,200/μl,PLT22万/μl,肝腎機能に異常なく,HBs抗原陰性,ANA陰性,P-ANCA陰性.下腿の腫瘤は径3×5cmでMRIではT2WIで高信号,T1WIで等信号の所見.下肢血管造影での血管のencasementや境界不明瞭なtumor stain像から腫瘍性病変が疑われ11月28日腫瘤摘出.病理的に間質の中型から小型の動脈壁にfibrinoid変性及び炎症性細胞浸潤を伴う壊死性血管炎の像を認め,結節性多発動脈炎(PN)と診断した.PSL,cyclophosphamideを投与し症状ならびに検査成績の改善を認めた.病変は皮膚,関節,筋肉に限局しており,PSL10mgまで減量し発症後約1年半経過観察中であるが,他臓器病変見られず皮膚型PNと診断した
(一社)日本リウマチ学会, 2000年04月, リウマチ, 40 (1), 16 - 20, 日本語1998年4月〜10月の治療計画は151例で,RT markerを用いたのが147例あり,このうちAxial法123例,Scout法24例であった.Isocenterの位置修正がAxial法で13例,Scout法で2例,平均6.1mmであった.照射野形の修正がAxial法で16例,Scout法5例であり,再計画が必要であったのが両方法とも各1例であった.臨床上特に問題となる誤差ではないが,本法の精度にはCT撮影時と治療時の体位再現性が大きな比重を占める.このため,固定具を有効に使用すること,再現性に問題が予測される症例に関しては,治療担当者がCT撮影の段階から関与することで精度上昇が得られると考える.また,患者動線,ハード面における再検討も必要と思われる
(地独)神戸市民病院機構, 2000年03月, 神戸市立病院紀要, (38), 41 - 45, 英語速報,短報,研究ノート等(学術雑誌)
68歳男,甲状腺癌術後再発によるSVC症候群に対して食道用Wallstentを留置し,症状の改善に有効であった症例を経験した.SVC症候群に対する食道用Wallstent留置は手技も容易で低侵襲に施行でき,特に血栓形成を合併した狭窄に対してQOL改善に有効と思われた
(一社)日本インターベンショナルラジオロジー学会, 2000年01月, IVR: Interventional Radiology, 15 (1), 88 - 92, 日本語67歳男,慢性C型肝炎の経過観察中,CTで肝内に腫瘤を発見され入院した.各種画像所見で乏血管性で門脈血流にも乏しく,delayed enhancementがみられ,間質成分に富む腫瘤性病変,特に肝内胆管癌,転移性肝癌,炎症性偽腫瘍等が疑われ,悪性腫瘍の可能性も否定できず手術した.組織学的に肝内胆管腺腫と診断,非腫瘍部は慢性C型肝炎による乙'型肝硬変と診断された
(株)学研メディカル秀潤社, 1999年10月, 画像診断, 19 (11), 1309 - 1313, 日本語子宮頸管癌からの腟出血により入院した70歳女で,術前BOAI(一時的動脈閉塞下抗癌剤動注療法)を2回行った.腫瘍は縮小したが,排尿時痛,頻尿,及び潜血を含む膀胱炎様愁訴が出現した.術中,縮小した頸管癌及び膀胱の壊死が認められ,根治的子宮摘出,膀胱部分切除,及び小腸による膀胱形成術を行った.膀胱壁に腫瘍侵襲がない出血性壊死を病理学的に認めた.術後32日に膀胱の進行性壊死による縫合不全の為,尿管皮膚瘻造設を行った.腫瘍再発なしに外来で追跡している
(一社)日本インターベンショナルラジオロジー学会, 1999年04月, IVR: Interventional Radiology, 14 (2), 208 - 212, 日本語47歳男.気管原発腺様嚢胞癌に対する気管分岐部切除術・気管形成術後の吻合部狭窄にて来院し,金属ステント(Z-stent)による拡張術を施行した.その約1年6ヵ月後,異物性肉芽による金属ステント内腔の再狭窄をきたした.Nd-YAG laserを照射したが,無効であったため,ポリウレタンを部分的に外張りした両端フレアー型金属ステント(Z-stent)を作製・留置し,救命しえた
(NPO)日本呼吸器内視鏡学会, 1999年01月, 気管支学, 21 (1), 66 - 71, 日本語1)62歳男,胃癌全摘後局所再発による吻合部狭窄例に対し,ポリウレタンによる自作covered Ultraflex stentを挿入し有用であった. 2)拡張力に乏しいUltraflex stentは,stent-in-stentに際し正円形の良好な内腔を確保できない場合がある.これが食物残渣滞留による再閉窄の原因となるため,注意を要する. 3)この対策としてZ-stentによる拡張が有用であった
(地独)神戸市民病院機構, 1998年03月, 神戸市立病院紀要, (36), 115 - 121, 日本語86歳女.甲状腺癌の気管浸潤による高度気管狭窄に対し,Dumon tube留置が奏効せず,自作EMSにより気道確保し,QOLの向上を認めた.ポリ塩化ビニリデンは生体刺激性に乏しく,EMSに対する軽量のカバー素材として期待できる.YAG-laserや放射線治療併用により脆弱化した組織にEMSを留置する場合,広範な組織の剥脱や穿孔をきたす恐れがある
(一社)日本インターベンショナルラジオロジー学会, 1998年01月, IVR: Interventional Radiology, 13 (1), 80 - 86, 日本語悪性腫瘍を原因とする高度気管狭窄症例4例に対し,自作Expandable metallic stent(EMS)を留置し,劇的な症状の改善を得た.4例中2例には病理解剖が施行された.cover素材として用いたポリ塩化ビニリデンの安全性が確認された.合併症として気管穿孔や潰瘍形成を認めたが,直接死因とはならなかった
(地独)神戸市民病院機構, 1997年03月, 神戸市立病院紀要, (35), 85 - 91, 日本語1)分子サイズが異なる2種類の造影剤の組織濃染度をdynamic CTにより分析し,両造影剤の有用性と問題点を探り,併用による有用性の有無を検討した。2) IPは分子サイズが小さく透過性が高いため,微細な血洞や血液腔を含めた腫瘍血管の多寡を高い濃染度として表現し,富血管性腫瘍の拾い上げおよび質的診断に有用であった。3) IPは,腫瘍血管近傍の壊死巣にも拡散するため,ある時相の画像のみの評価では壊死範囲の的確な診断は困難で,腫瘍濃染各部位での時間-濃度曲線の詳細な分析が必要である。4) IESは,壊死巣では全く濃染を示さず,壊死範囲の診断に有用である。5)平均分子量60,000のIESでは,微細な脈管腔などを表現し得ず,今後至適分子量の検討が必要である。6)乏血管性部のviabilityの診断には,IPには限界があり,IESなどの血管内貯留型造影剤併用による血管透過性の把握が有用である
産業開発機構(株), 1994年08月, 映像情報Medical, 26 (16), 919 - 925, 日本語対象は肝細胞癌30例34結節で,治療効果判定を目的とした短期観察例15結節と,再発診断を目的とした長期観察例19結節に分けて行った。短期観察例ではdynamic MRIのsensitivity, specificity, accuracyはそれぞれ89, 100, 93%で,T2強調画像は78, 67, 73%であった。長期観察例では,同様にdynamic MRIはそれぞれ94, 100, 95%,T2強調画像は100, 33, 89%,Lipiodol-CTは94, 67, 89%であり,両者とも正診率でdynamic MRIが優れていた。特にT2強調画像で偽陽性となった例はいずれもdynamic MRIで正診され,以後の治療方針を決定する意味でもdynamic MRIの有用性が強調された
(株)癌と化学療法社, 1994年07月, 癌と化学療法, 21 (8), 1235 - 1240, 日本語1) Iopamidol (IP)は分子サイズが小さく透過性が高いことから,微細な血洞や血液腔を含めた腫瘍血管の多寡を高い濃染度として表現し,富血管性腫瘍の拾い上げおよび質的診断に有用であった。2) IPは腫瘍血管近傍の壊死巣にも拡散し濃染がみられるため,ある時相の画像のみの評価では壊死範囲の的確な診断は困難で,腫瘍濃染各部位での時間-濃度曲線の詳細な分析が必要である。3) 6-ヨード化エチル澱粉(IES)は壊死巣では全く濃染を示さず,壊死範囲の的確な診断に有用である。4)平均分子量60,000のIESでは微細な脈管腔などを表現し得なかった。5)乏血管性部のviabilityの診断は,IPには限界があり,IESなどの血管内貯留型造影剤併用による血管透過性の把握が有用である
神戸大学医学部, 1994年03月, 神戸大学医学部紀要, 54 (2〜4), 191 - 200, 日本語透析用ダイアライザーを応用した血管透過性実験ファントームを考察した。このファントームに物理化学的性状の異なるヨード造影剤IotrolanとIopamidolを用いてdynamic CTとDSAを行い,ファントームとしての可能性及び両造影剤における画像やT-D curveの差異につき検討した。1)透析用ダイアライザーは血管透過性ファントームとして応用できる。2)非イオン性ダイマー型造影剤Iotrolanを臨床的にdynamic CTに用いる場合,T-D curveは従来の非イオン性モノマー型と比べ,narrow peakとなるため留意すべきである。3) IotrolanをIA-DSAや血管造影に用いる場合,特に細いカテーテルを使用すると,その粘稠度のため流入遅延を生じる可能性があり,撮像タイミングに留意する必要がある。4) Iotrolanは毛細血管からの透過が遅れるため,特に拡大撮影による微細血管の描出に有利である
(公社)日本医学放射線学会, 1994年01月, 日本医学放射線学会雑誌, 54 (1), 32 - 39, 日本語66歳男,右下肺野に腫瘤影を認めたが,縦隔・肺門リンパ節転移がみられたため,手術不能と考えて放射線治療を行った。しかし,4ヵ月後に腫瘍死した。本邦における臨床的に悪性度の高い粘表皮癌の報告は自験例を含めて13例みられるが,胸部X線写真や気管支鏡所見では多彩な像を示す傾向がみられた
(NPO)日本肺癌学会, 1993年04月, 肺癌, 33 (2), 247 - 253, 日本語分子サイズの異なる2種類の造影剤の循環動態の差異に着目し,各々によるdynamic CT上の組織濃染度を分析して,これらの有用性と問題点を検討した。ヨード含有率を30mgI/mlに調整したIopamidol(分子量777.9,分子サイズ13A^^。,以下IP)および6-ヨード化エチル澱粉(平均分子量約60,000,分子サイズ200A,以下IES)を用い,家兎大腿部Vx2腫瘍のdynamic CTを施行した。得られた画像から,任意の関心領域での両造影剤UI手よる時間-濃度曲線並びに両造影剤による時間-濃度曲線の差にあたる時間-透過曲線を作製し,両曲線下面積を算定した。病理組織標本から,各関心領域に相当する部位の脈管腔面積と腫瘍面積を計測し,曲線下面積との相関性について検討した。この結果,脈管腔面積および腫瘍面積とIPによる曲線下面積との間に良好な相闘を認めたが(平均2乗誤差:0.763,0.685),これらとIESによる曲線下面積との問には明らかな相関を認めず,時間-透過曲線下面積との間に相関性を認めた(平均2乗誤差:0.814,0.546)。特に,腫瘍内の乏血管性領域では, IESで全く濃染を認めなかったのに対し,IPでは軽度の濃染を認め,時間-透過曲線下面積は,富血管性領域のそれと同等であった。以上から, IPは微細な血洞や血液腔を良好に反映し,富血管性部の診断に有用であるが,壊死部にも拡散して濃染像を示すため,質的診断には注意を要すると恩われた。一方,IESは微細な血洞や血液腔の診断には適さないが,壊死部の適確な診断に有用であり,特に乏血管性部の診断には, IESなどの高分子型造影剤の併用による腫瘍血管の透過性の把握が必要であると思われた。
神戸大学, 1994年03月, 神戸大学医学部紀要, 54 (2), 99 - 108, 日本語教科書・概説・概論
学術書
教科書・概説・概論
教科書・概説・概論
教科書・概説・概論
学術書
学術書
学術書
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
[招待有り]
口頭発表(招待・特別)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
その他
口頭発表(一般)
ポスター発表
シンポジウム・ワークショップパネル(公募)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
ポスター発表
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
公開講演,セミナー,チュートリアル,講習,講義等
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
シンポジウム・ワークショップパネル(公募)
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
口頭発表(一般)
ポスター発表
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
シンポジウム・ワークショップパネル(公募)
口頭発表(一般)
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
口頭発表(一般)
[招待有り]
口頭発表(招待・特別)
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
シンポジウム・ワークショップパネル(公募)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
[招待有り]
シンポジウム・ワークショップパネル(指名)
[招待有り]
口頭発表(招待・特別)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
ポスター発表
ポスター発表
口頭発表(一般)
口頭発表(一般)
ポスター発表
口頭発表(招待・特別)
ポスター発表
口頭発表(招待・特別)
口頭発表(一般)
シンポジウム・ワークショップパネル(公募)
シンポジウム・ワークショップパネル(公募)
口頭発表(一般)
口頭発表(招待・特別)
シンポジウム・ワークショップパネル(公募)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
シンポジウム・ワークショップパネル(公募)
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
シンポジウム・ワークショップパネル(公募)
シンポジウム・ワークショップパネル(公募)
シンポジウム・ワークショップパネル(公募)
ポスター発表
口頭発表(一般)
ポスター発表
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
その他
ポスター発表
ポスター発表
ポスター発表
ポスター発表
口頭発表(一般)
ポスター発表
ポスター発表
ポスター発表
口頭発表(一般)
口頭発表(一般)
口頭発表(一般)
ポスター発表
ポスター発表
ポスター発表
口頭発表(一般)
口頭発表(一般)
その他
ポスター発表
口頭発表(一般)
口頭発表(一般)