Spontaneous infrarenal abdominal aortic dissection (SIAAD) is a rare entity with various clinical presentations. We recently encountered the even rarer condition of a female patient suffering from chronic SIAAD with multiple intimal flaps and prominent lumbar artery collaterals; this all caused stenotic changes of the infrarenal abdominal aorta and produced progressive lower extremity pain and claudication in both her legs. This patient's condition was successfully managed by primary stent placement followed by balloon angioplasty.
Angioplasty, Balloon ; Aorta, Abdominal ; Arteries ; Female ; Humans ; Leg ; Lower Extremity ; Stents*

The Neurosensory retinal detachment contributes to the visual loss in the idiopathaic macular holes. Vitrectomy can be performed to reattach the retina by removing anterior-posterior and tangential traction between cortical vitreous and macular surface. Also bioadhesives, like autologous serum or platelets aggregates are used to flatten of surrounding rim detachment of macular holes. Among 22 eyes that underwent vitrectomy for the treatment of macular holes, anatomic success was achieved in 12 eyes (59.1%), and visual improvement in 10 eyes (45.5%). The time interval between diagnosis and operation was well-correlated to the functional success rate, while the type of surgical procedures was not. Postoperative complications included 2 cases of cataract, and 1 case of retinal detachment.
Cataract ; Diagnosis ; Postoperative Complications ; Retina ; Retinal Detachment ; Retinal Perforations* ; Traction ; Vitrectomy*

Although cervical epidural abscess is rare, it should be strongly suspected in any patient with unexplainable neck pain and fever, especially when the patient has a predisposing factor for this infectious process. The authors report a case of cervical epidural abscess in a 39-yr-old man with an aorto-duodenal fistula, which complicated the interposition of artificial graft for abdominal aortic aneurysm rupture, which had undertaken 40 months before. Timely detection and intervention rendered him a full neurological recovery. This extremely rare case is presented with a literature review.
Adult ; Aneurysm, Dissecting/complications ; Aneurysm, Dissecting/surgery ; Aortic Aneurysm, Abdominal/complications ; Aortic Aneurysm, Abdominal/surgery ; Aortic Diseases/complications* ; Aortic Rupture/complications ; Aortic Rupture/surgery ; Blood Vessel Prosthesis Implantation ; Cervical Vertebrae* ; Duodenal Diseases/complications* ; Duodenal Ulcer/complications ; Enterococcus ; Epidural Abscess/etiology* ; Epidural Abscess/microbiology ; Epidural Abscess/surgery ; Fistula/complications* ; Gram-Positive Bacterial Infections/complications ; Human ; Male ; Peptic Ulcer Perforation/complications ; Salmonella Infections/complications ; Staphylococcal Infections/complications

Gastrointestinal (GI) fistulae are defined as an abnormal communication between the gastrointestinal tract and the skin and/or the epithelial surface of an adjacent viscus. GI fistulae are the most feared complications caused by a variety of medical conditions including abdominal surgery, inflammatory bowel disease, abscess, radiation, or trauma. The management of GI fistulae is complex and requires a detailed, stepwise approach to achieve successful closure. The ultimate goal of management is to re-establish the continuity of the GI tract, while limiting the morbidity and mortality. Interventional radiology can play an important role in the diagnosis and treatment of GI fistulae. In this article, we review the clinical and radiologic features and interventional treatment of GI fistulae.

Purpose: The relationship between microsatellite instability (MSI) and tumor response after neoadjuvant chemoradiotherapy (nCRT) in rectal cancer remains unclear. The present study aimed to evaluate the association between MSI and tumor response to nCRT in rectal cancer treatment. Methods: Patients with rectal cancer from 2 tertiary hospitals who underwent nCRT, followed by radical surgery, were included. The microsatellite status was determined using a PCR-based Bethesda panel. Tumors with a Dworak’s tumor regression grade of 3 or 4 were considered to have a good response. Predictive factors for a good response to nCRT were analyzed. Results: Of the 1,401 patients included, 910 (65.0%) had MSI results and 1.5% (14 of 910) showed MSI-H. Among all the patients, 519 (37.0%) showed a good response to nCRT. A univariate analysis showed that MSI-H tended to be negatively associated with a good response to nCRT, but no statistical significance was observed (7.1% vs. 24.1%, P = 0.208).Multivariate analysis showed that well-differentiated tumors were the only predictive factor for good response to nCRT (odds ratio [OR], 2.241; 95% confidence interval [CI], 1.492–3.364; P < 0.001). MSI status tended to be associated with the response to nCRT (OR, 0.215; 95% CI, 0.027–1.681; P = 0.143). Conclusion MSI-H was not associated with response to nCRT in patients with rectal cancer.

Heart failure is a major clinical problem in developed countries with about half of heart failure patients exhibiting decreased left ventricular systolic function. The correct identification and prompt treatment of some specific etiologies can reverse heart failure, and recognition of myocardial recovery may avoid long-term therapy. However, the echocardiographic patterns of patients with a variety of etiologies of heart failure are similar, so the selective use of other imaging techniques is necessary for identification of specific etiologies. The role of repeat imaging in monitoring the therapeutic response is controversial, as is the cessation of medical therapy in patients demonstrating recovery.
Cardiomyopathies ; Developed Countries ; Echocardiography ; Heart Failure ; Humans

We have developed two novel cell co-culture system, without any on cell type combination limitation, utilizing a polymer surface which is temperature-sensitive with respect to its cell adhesion characteristics. One system involves a patterned co-culture of primary hepatocytes with endothelial cells utilizing patterned masked of the electron-beam cured, temperature-responsive polymer, poly (N-isopropylacrylamide) (PIPAAm) by masked electron beam irradiation. Hepatocytes were cultured to confluency at 37 degrees C on these surfaces. When the culture temperature was reduced below 32 degrees C, cells detached from the PIPAAm-grafted areas without any need for trypsin. Endothelial cells were then seeded onto the same surfaces at 37 degrees C. These subsequently seeded endothelial cells adhered only to the now-exposed PIPAAm-grafted domains and could be co-cultured with the hepatocytes initially seeded at 37 degrees C in well-ordered patterns. The other system involves a double layered co-culture obtained by overlaying endothelial cell sheets of the designed shape onto hepatocyte monolayers. The endothelial cells adhered and proliferated on the PIPAAm-grafted surface, as on polystyrene tissue culture dishes at 37 degrees C. By reducing the temperature, confluent monolayers of cells detached from the PIPAAm surfaces without trypsin. Because the recovered cells maintaed intact cell-cell junctions together with deposited extracellular matrix, the harvested endothelial cell sheets, with designed shapes, were transferable and readily adhered to hepatocyte monolayers. Stable double layered cell sheets could be co-cultivated. These two co-culture methods enabled long-term co-culture of primary hepatocytes with endothelial cells. Hepatocytes so co-cultured with endothelial cells maintained their differentiated functions, such as albumin synthesis for unexpectedly long periods. These novel two co-culture systems offer promising techniques for basic biologic researches upon intercellular communications, and for the clinical applications of tissue engineered constructs.
Acrylic Resins/chemistry* ; Animal ; Coculture ; Cytological Techniques* ; Endothelium/cytology* ; Human ; Surface Properties ; Temperature*

Gastrointestinal (GI) fistulas are frequently very serious complications that are associated with high morbidity and mortality. GI fistulas can cause a wide array of pathophysiological effects by allowing abnormal diversion of the GI contents, including digestive fluid, water, electrolytes, and nutrients, from either one intestine to another or from the intestine to the skin. As an alternative to surgery, recent technical advances in interventional radiology and percutaneous techniques have been shown as advantageous to lower the morbidity and mortality rate, and allow for superior accessibility to the fistulous tracts via the use of fistulography. In addition, new interventional management techniques continue to emerge. We describe the clinical and imaging features of GI fistulas and outline the interventional management of GI fistulas.
Drainage ; Gastric Fistula/diagnosis/radiography/*therapy ; Humans ; Intestinal Fistula/diagnosis/radiography/*therapy ; Punctures ; *Radiography, Interventional

BACKGROUND: Right ventricular (RV) dysfunction in ischemic cardiomyopathy (ICM) is associated with poor prognosis, but RV assessment by conventional echocardiography remains difficult. We sought to validate RV global longitudinal strain (RVGLS) and global longitudinal strain rate (RVGLSR) against cardiac magnetic resonance (CMR) and outcome in ICM. METHODS: In 57 patients (43 men, 64 +/- 12 years) with ICM who underwent conventional and strain echocardiography and CMR, RVGLS and RVGLSR were measured off-line. RV dysfunction was determined by CMR [RV ejection fraction (RVEF) < 50%]. Patients were followed over 15 +/- 9 months for a composite of death and hospitalization for worsening heart failure. RESULTS: RVGLS showed significant correlations with CMR RVEF (r = -0.797, p < 0.01), RV fractional area change (RVFAC, r = -0.530, p < 0.01), and tricuspid annular plane systolic excursion (TAPSE, r = -0.547, p < 0.01). RVGLSR showed significant correlations between CMR RVEF (r = -0.668, p < 0.01), RVFAC (r = -0.394, p < 0.01), and TAPSE (r = -0.435, p < 0.01). RVGLS and RVGLSR showed significant correlations with pulmonary vascular resistance (r = 0.527 and r = 0.500, p < 0.01, respectively). The best cutoff value of RVGLS for detection of RV dysfunction was -15.4% [areas under the curve (AUC) = 0.955, p < 0.01] with a sensitivity of 81% and specificity 95%. The best cutoff value for RVGLSR was -0.94 s-1 (AUC = 0.871, p < 0.01), sensitivity 72%, specificity 86%. During follow-up, there were 12 adverse events. In Cox-proportional hazard regression analysis, impaired RVGLS [hazard ratio (HR) = 5.46, p = 0.030] and impaired RVGLSR (HR = 3.95, p = 0.044) were associated with adverse clinical outcome. CONCLUSION: Compared with conventional echocardiographic parameters, RVGLS and RVGLSR correlate better with CMR RVEF and outcome.
Cardiomyopathies ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Heart Ventricles ; Hospitalization ; Humans ; Male ; Prognosis ; Sensitivity and Specificity ; Vascular Resistance ; Ventricular Dysfunction, Right*