Late stent thrombosis (LST) which is a life threatening complication has emerged as a serious problem of drug-eluting stents (DES). Several studies have suggested that incomplete neointimal coverage of stent struts contributes to LST. Progressive atherosclerosis within the neointima is an another possible cause of LST, but this phenomenon has seldom been reported in DES. We present a case of LST following DES implantation after a period of 28 months due to ruptured atheromatous plaque, despite complete neointimal coverage of stent struts proven by optical coherence tomography.
*Angioplasty, Balloon, Coronary ; Coronary Angiography ; *Drug-Eluting Stents ; Humans ; Male ; Middle Aged ; Neointima/*pathology/ultrasonography ; Thrombosis/pathology/ultrasonography ; Tomography, Optical Coherence/*methods ; Ultrasonography, Interventional/*methods

Child ; Female ; Fibrosis ; Heart Ventricles ; Humans ; Hypereosinophilic Syndrome ; diagnostic imaging ; surgery ; Myocardium ; pathology ; Thrombosis ; surgery ; Ultrasonography

Yolk sac tumor (YST) is a rare germ cell neoplasm of childhood that usually arises from the testis or ovary. The rare cases of YST in various extragonadal locations have been reported, but the primary intrarenal YST is even more uncommon. Here, we report a case of a primary intrarenal YST with tumor thrombus of the inferior vena cava and left renal vein in a 2-year-old boy, with an emphasis on the CT features. To our knowledge, this is the first reported case of an intrarenal YST with intravascular involvement.
Child, Preschool ; Humans ; Male ; Neoplasms, Germ Cell and Embryonal/*diagnosis/pathology/ultrasonography ; Renal Veins/pathology/*radiography ; Thrombosis/pathology/radiography ; *Tomography, X-Ray Computed ; Vena Cava, Inferior/pathology/*radiography

The term “vulnerable plaque” denotes the plaque characteristics that are susceptible to coronary thrombosis. Previous post-mortem studies proposed 3 major mechanisms of coronary thrombosis: plaque rupture, plaque erosion, and calcified nodules. Of those, characteristics of rupture-prone plaque have been extensively studied. Pathology studies have identified the features of rupture-prone plaque including thin fibrous cap, large necrotic core, expansive vessel remodeling, inflammation, and neovascularization. Intravascular imaging modalities have emerged as adjunctive tools of angiography to identify vulnerable plaques. Multiple devices have been introduced to catheterization laboratories to date, including intravascular ultrasound (IVUS), virtual-histology IVUS, optical coherence tomography (OCT), coronary angioscopy, and near-infrared spectroscopy. With the use of these modalities, our understanding of vulnerable plaque has rapidly grown over the past several decades. One of the goals of intravascular imaging is to better predict and prevent future coronary events, for which prospective observational data is still lacking. OCT delineates microstructures of plaques, whereas IVUS visualizes macroscopic vascular structures. Specifically, plaque erosion, which has been underestimated in clinical practice, is gaining an interest due to the potential of OCT to make an in vivo diagnosis. Another potential future avenue for intravascular imaging is its use to guide treatment. Feasibility of tailored therapy for acute coronary syndromes (ACS) guided by OCT is under investigation. If it is proven to be effective, it may potentially lead to major shift in the management of millions of patients with ACS every year.
Acute Coronary Syndrome ; Angiography ; Angioscopy ; Catheterization ; Catheters ; Coronary Thrombosis ; Diagnosis ; Humans ; Inflammation ; Pathology ; Plaque, Atherosclerotic ; Prospective Studies ; Rupture ; Spectroscopy, Near-Infrared ; Tomography, Optical Coherence ; Ultrasonography ; Ultrasonography, Interventional

INTRODUCTIONGas is rarely found within the viscera outside the lumen of the gastrointestinal tract. Emphysematous gastritis is a rare form of infection of the stomach wall by gas producing organisms.

CLINICAL PICTUREA 45-year-old Chinese lady underwent hepatectomy for hepatocellular carcinoma. Postoperatively, she turned septic and encephalopathic with worsening liver function. Computed tomography scan revealed a thickened, oedematous stomach wall with air pockets within.

TREATMENTThe patient was started on a course of broad spectrum antibiotics.

OUTCOMEShe responded and was discharged well.

CONCLUSIONEmphysematous gastritis is a rare condition with high mortality. There is however, still no preferable approach of treatment despite therapeutic advances.

Anti-Bacterial Agents ; therapeutic use ; Emphysema ; diagnostic imaging ; Female ; Gastritis ; drug therapy ; pathology ; Humans ; Middle Aged ; Portal Vein ; Radiography ; Thienamycins ; therapeutic use ; Ultrasonography ; Venous Thrombosis ; diagnostic imaging

Pseudoaneurysm arising from the superficial temporal artery (STA) is very rare and is most commonly caused by blunt trauma. Most pseudoaneurysms of the STA usually present as a painless pulsating mass, with concomitant symptoms according to location, and their size may rapidly increase. The treatment of choice is ligation and resection. We present a case of pseudoaneurysm arising from STA after a penetrating injury caused by broken glass. We describe the history, findings of physical examination, Doppler sonography, angiography, histopathology, and the outcome of treatment. We also include a brief review of this condition.
Aneurysm, False/surgery ; Aneurysm, False/etiology* ; Aneurysm, False/diagnosis ; Angiography, Digital Subtraction ; Case Report ; Human ; Male ; Middle Age ; Temporal Arteries/surgery ; Temporal Arteries/pathology ; Temporal Arteries/injuries* ; Thrombosis/etiology ; Ultrasonography, Doppler ; Wounds, Penetrating/surgery ; Wounds, Penetrating/complications*

We investigated tissue responses to endoskeleton stent grafts for saccular abdominal aortic aneurysms (AAAs) in canines. Saccular AAAs were made with Dacron patch in 8 dogs, and were excluded by endoskeleton stent grafts composed of nitinol stent and expanded polytetrafluoroethylene graft. Animals were sacrificed at 2 months (Group 1; n = 3) or 6 months (Group 2; n = 5) after the placement, respectively. The aortas embedding stent grafts were excised en bloc for gross inspection and sliced at 5 to 8 mm intervals for histopathologic evaluation. Stent grafts were patent in all except a dog showing a thrombotic occlusion in Group 2. In the 7 dogs with patent lumen, the graft overhanging the saccular aneurysm was covered by thick or thin thrombi with no endothelial layer, and the graft over the aortic wall was completely covered by neointima with an endothelial layer. Transgraft cell migration was less active at an aneurysm than at adjacent normal aorta. In conclusion, endoskeleton stent grafts over saccular aneurysms show no endothelial coverage and poor transgraft cell migration in a canine model.
Alloys/chemistry ; Angiography ; Animals ; Aortic Aneurysm, Abdominal/*pathology/surgery/ultrasonography ; Cell Movement ; Disease Models, Animal ; Dogs ; Endothelial Cells/cytology ; Neointima/etiology ; Polytetrafluoroethylene/chemistry ; *Stents ; Thrombosis/etiology ; Tomography, X-Ray Computed

BACKGROUNDFew reports have evaluated the efficacy of re-operation for relapse after initial surgery for hepatocellular carcinoma (HCC) with bile duct thrombosis (BDT). The aim of this study was to investigate the efficacy of initial surgery and subsequent re-operation for HCC with BDT, and their effects on prognosis.

METHODSThe clinical data of 880 patients with HCC, including 28 patients with BDT, who underwent radical hepatectomy between 1998 and 2008 in our hospital, were reviewed. The effects of BDT and re-operation on prognosis were retrospectively analyzed.

RESULTSThe 1-, 3- and 5-year survival rates were 89.3%, 46.4% and 21.4%, respectively, in 28 patients with BDT versus 91.4%, 52.9% and 20.9% in 852 patients without BDT (P>0.05). Six patients with BDT underwent re-operation after disease relapse, and their survival time was significantly longer than those who did not undergo re-operation (P<0.05). Multivariate analysis indicated that portal vein invasion and tumor size were independently associated with tumor relapse and prognosis (P<0.05). Univariate analysis and multivariate analyses showed that obstructive jaundice was not significantly correlated with tumor relapse or prognosis (P>0.05).

CONCLUSIONSHepatectomy plus BDT removal is an effective treatment option for HCC with BDT. Obstructive jaundice is not a contraindication for surgery. Re-operation after relapse can provide good outcomes if the cases are appropriately selected.

Adult ; Bile Ducts ; pathology ; Carcinoma, Hepatocellular ; diagnostic imaging ; surgery ; Female ; Hepatectomy ; Humans ; Liver Neoplasms ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography ; Thrombosis ; surgery ; Treatment Outcome ; Ultrasonography

BACKGROUND AND OBJECTIVES: Intracardiac pathology results in 15 - 20% of ischemic stroke, but transthoracic echocardiography (TTE) has a number of limitations because of suboptimal precordial windows or ultrasound interference with prosthetic materials. Transesophageal echocardiography (TEE) provides superior resolution of basal structures such as the left atrium, left atrial appendage, mitral valvular apparatus, atrial septum, and aorta. The purpose of this study was to describe the various TEE findings which were sources of cerebral emboli. MATERIALS AND METHOD: The study population was comprised of 122 patients (mean age:54.5, male 83, female 39) who were admitted to Severance Hospital because of ischemic stroke from 1991 to 1997. All patients underwent TEE with agitated saline contrast administration. Patients without a definitive cardiac source of embolism underwent Holtor monitoring, internal carotid and cerebral angiography, as well as transcranial Doppler. RESULTS: 1) The number of patients diagnosed as cardioembolic stroke was 55 (45.1%). Atrial fibrillation was noted in 31 patients of cardioembolic stroke and it was the most frequent finding. Among these patients, 16 did not have any other cardiac problem. 2) We were able to find the possible source of embolism in 49 (40.2%) patients with TEE. Among these patients, 12 did not have dysrhythmia or any known previous heart problem. We found spontaneous echo contrast in the left atrium and left atrial appendage in 33 cases. There were 8 patients who had intracardiac thrombus. Among these patients, 6 patients had thrombi in the left atrial appendage, 1 in left atrium and 1 in left ventricular apex. We found patent foramen ovale in 3 cases and atrial aneurysm in 1 case. We found atheromatous plaque and/or thrombi of the aorta in 16 cases, while there were 4 cases where lesions located in the ascending aorta and aortic arch and which were considered as the source of embolism. Small thrombi in the left atrial appendage and left atrium were only detectable with TEE. CONCLUSIONS: We described TEE findings in ischemic stroke patients. And we assert TEE is a useful diagnostic tool in detecting the source of cardioembolic stroke and it may be used as a primary diagnostic tool in patients who are being evaluated for ischemic stroke.
Aneurysm ; Aorta ; Aorta, Thoracic ; Atrial Appendage ; Atrial Fibrillation ; Atrial Septum ; Cerebral Angiography ; Dihydroergotamine ; Echocardiography ; Echocardiography, Transesophageal* ; Embolism ; Female ; Foramen Ovale, Patent ; Heart ; Heart Atria ; Humans ; Intracranial Embolism ; Male ; Pathology ; Stroke* ; Thrombosis ; Ultrasonography

A 53-year-old woman was admitted with epigastric discomfort and weakness. Laboratory examination at admission showed mild anemia and proteinuria. Esophagogastroduodenoscopy revealed marked mucosal atrophy, diffuse nodularity and granular appearance with mucosal friability. Biopsy was performed on the antrum and body of the stomach. On the next day, the patient began to complain of severe dyspnea, and hypoxia was present on pulse oximetry. Therefore, emergency echocardiography was conducted and it showed restrictive cardiomyopathy along with thrombus in the left atrium. With time, heart failure was aggravated despite intensive management. The result of gastric biopsy revealed amyloid deposits which stained positively with Congo red. On immunohistochemistry study, kappa and lambda chain were present. In addition, kappa chain was significantly elevated in urine and serum on electrophoresis. Although the patient was finally diagnosed as having primary gastric amyloidosis with restrictive cardiomyopathy, her general condition rapidly deteriorated and died at 12th hospital day. When obscure gastric lesion is encountered, performing gastric biopsy is strongly recommended since it be primary gastric amyloidosis. Herein, we present an unusual case of primary gastric amyloidosis.
Amyloidosis/complications/*diagnosis/pathology ; Endoscopy, Digestive System ; Female ; Heart Atria/diagnostic imaging ; Heart Failure/complications/*diagnosis ; Humans ; Immunoglobulin kappa-Chains/blood/urine ; Immunoglobulin lambda-Chains/blood/urine ; Immunohistochemistry ; Magnetic Resonance Imaging ; Middle Aged ; Stomach Diseases/complications/*diagnosis/pathology ; Thrombosis/diagnosis/diagnostic imaging ; Tomography, X-Ray Computed ; Ultrasonography