Association between shift work and the risk of death from biliary tract cancer in Japanese men

Background: There is increasing evidence suggesting that shift work involving night work may increase cancer risk. Methods: We examined the association between working rotating shifts and the risk of death from biliary tract cancer among Japanese men who participated in the Japan Collaborative Cohort Study. Of the 46, 395 men recruited, 22, 224 men aged 40-65 at baseline (1988-1990) who reported working full-time or were self-employed were included in the present analysis. The study subjects were followed through December 31, 2009. Information regarding occupation and lifestyle factors was collected using a self-administered questionnaire. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95 % confidence interval (CI) for the risk of death from biliary tract cancer in relation to shift work. Results: During a mean 17-year follow-up, we observed 94 biliary tract cancer deaths, including 23 deaths from gallbladder cancer and 71 deaths from extrahepatic bile duct cancer. Overall, shift work was associated with a statistically non-significant increase in the risk of biliary tract cancer, with an HR of 1.50 (95 % CI: 0.81-2.77), among rotating shift workers. When the analysis was limited to extrahepatic bile duct cancer, a significant association appeared, with a multivariable-adjusted HR of 1.93 (95 % CI: 1.00-3.72) for rotating shift workers. Conclusion: Our data indicate that shift work may be associated with increased risk of death from extrahepatic bile duct cancer in this cohort of Japanese men. The association with gallbladder cancer remains unclear because of the small number of deaths

Fatal myocardial infarction investigated using contrast‐enhanced postmortem computed tomography: A case report

Key Clinical Message Conventional autopsies are considered standard methods for clarifying cause of death. However, because of the increasing use of computed tomography, magnetic resonance imaging, and other diagnostic imaging techniques, autopsy imaging is now more frequently adopted to identify diseases with unknown causes and sudden deaths. A 84‐year‐old man was diagnosed with acute myocardial infarction using coronary angiography. After taking oral antiplatelet medication in the catheterization laboratory, the patient suddenly coughed violently, lost consciousness, and was diagnosed with cardiac arrest. Spontaneous circulation did not return after 50 min of cardiopulmonary resuscitation. To elucidate the cause of the cardiac arrest, we performed contrast‐enhanced postmortem computed tomography (PMCT), which revealed cardiac tamponade due to cardiac rupture of the inferior myocardium. Our findings reaffirm the effectiveness of contrast‐enhanced PMCT in the diagnosis of sudden death in the clinical setting

Pituitary Volumes and Functions in Children with Growth Hormone Deficiency: Volumetric Magnetic Resonance Findings

Purpose: The purpose of the study was to compare pituitary volumes calculated from magnetic resonance imaging (MRI) in patients with idiopathic growth hormone deficiency (GHD) without structural abnormalities in the pituitary gland with clinical and biochemical features.Methods: This study was designed as a retrospective review and the need for informed consent was waived. MRI of the head was performed for 39 male and 17 female patients ranging in age from 10 to 14 years. Pituitary volumes were calculated from sectional area and ellipsoid formula. Pituitary volumes were compared between boys and girls. Pituitary volumes were also compared with measurements of pituitary function, age, and standard deviation scores (SDS) for height.Results: Whole pituitary volumes in patients were 405.1 ± 150.6 mm3 for the male group and 348.6 ± 161.1 mm3 for the female group. No significant difference was identified between mean pituitary volumes of the female and male groups. A weak correlation was found between pituitary volume and height SDS for boys (Ï = 0.34, p = .03). For girls, a moderate correlation was identified between pituitary volume and FSH level (Ï = 0.67, p < .01).Conclusion: Pituitary volumes of GHD patients correlated with height SDS in boys and FSH levels in girls. Brain MRI can be used not only to rule out anatomical abnormalities of the pituitary gland in GHD patients, but also to assess pituitary functions in clinical settings

Magnetic resonance evaluation of multiple myeloma at 3.0 Tesla: how do bone marrow plasma cell percentage and selection of protocols affect lesion conspicuity?

PURPOSE: To compare various pulse sequences in terms of percent contrast and contrast-to-noise ratio (CNR) for detection of focal multiple myeloma lesions and to assess the dependence of lesion conspicuity on the bone marrow plasma cell percent (BMPC%). MATERIALS AND METHODS: Sagittal T1-weighted FSE, fat-suppressed T2-weighted FSE (FS- T2 FSE), fast STIR and iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) imaging of the lumbar spine were performed (n = 45). Bone marrow (BM)-focal myeloma lesion percent contrast and CNR were calculated. Spearman rank correlation coefficients were obtained between percent contrast, CNR and BMPC%. Percent contrasts and CNRs were compared among the three imaging sequences. RESULTS: BM-focal lesion percent contrasts, CNRs and BMPC% showed significant negative correlations in the three fat-suppression techniques. Percent contrast and CNRs were significantly higher for FS- T2 FSE than for STIR (P<0.01, P<0.05, respectively), but no significant differences were found among the three fat-suppression methods in the low tumor load BM group. CONCLUSION: The higher BMPC% was within BM, the less conspicuous the focal lesion was on fat-suppressed MRI. The most effective protocol for detecting focal lesions was FS- T2 FSE. In the high tumor load BM group, no significant differences in lesion conspicuity were identified among the three fat-suppression techniques

Incidentally found abdominal para-aortic and inferior mesenteric root lymph node metastases of prostatic adenocarcinoma in a surgical case with sigmoid colon cancer

We report a rare case of incidentally found metastatic adenocarcinoma in the abdominal para-aortic and inferior mesenteric root lymph nodes originating from the prostate, at the time of surgery in a patient with sigmoid colon cancer. A man in his mid-seventies was scheduled to undergo laparoscopic-assisted sigmoidectomy and regional lymph node dissection. At the beginning of laparoscopic surgery, a caterpillar-like swelling of abdominal para-aortic lymph nodes was found; the diagnosis using frozen sections was a metastatic adenocarcinoma showing cribriform and solid growth patterns different from typical colorectal cancer. The surgical procedure was changed to an abdominal sigmoidectomy with widely extended lymph node dissection, including inferior mesenteric root lymph nodes and sampling of abdominal para-aortic lymph nodes. The resected sigmoid colon cancer was a papillary/tubular adenocarcinoma invading the muscularis with no lymph node metastasis (pT2N0M0/pStage IIA). Additionally, the presence of a metastatic adenocarcinoma showing cribriform and solid growth patterns different from the primary sigmoid colon cancer was confirmed in the abdominal para-aortic and inferior mesenteric root lymph nodes. The metastatic adenocarcinoma cells were positive for prostate-specific antigen (PSA) and negative for CDX2, indicating that the tumor was from the prostate. A total of ten prostatic core needle biopsy specimens also contained a usual (acinar) adenocarcinoma, with a Gleason score of 4 + 5 = 9. Androgen blockade was performed; the serum PSA level was reduced to 0.06 nanograms per microliter in the subsequent five months. Regardless of radiologic images, examination of serum PSA level is recommended before surgery in male surgical colorectal cancer patients more than 60 years old

Migration to the pulmonary artery of nine metallic coils placed in the internal iliac vein for treatment of giant rectal varices

Transcatheter venous embolization with metallic coils is a safe and reliable method for the treatment of pelvic congestion syndrome and pelvic varicocele. While rare, coil migration to the pulmonary arteries is potentially fatal. We report the migration to the pulmonary artery of a cluster of nine metallic microcoils placed in the internal iliac vein to obliterate giant rectal varices. Our patient suffered no severe sequelae. To avoid coil migration to the pulmonary arteries, the coils chosen for placement must take into consideration the characteristics of the target vessels, particularly of larger veins