Effects of a self-management program on antiemetic-induced constipation during chemotherapy among breast cancer patients: a randomized controlled clinical trial.

Research on patient-reported outcomes indicates that constipation is a common adverse effect of chemotherapy, and the use of 5-hydroxytryptamine (serotonin; 5HT3) receptor antagonists aggravates this condition. As cancer patients take multiple drugs as a part of their clinical management, a non-pharmacological self-management (SM) of constipation would be recommended. We aimed to evaluate the effectiveness of a SM program on antiemetic-induced constipation in cancer patients. Thirty patients with breast cancer, receiving 5HT3 receptor antagonists to prevent emesis during chemotherapy were randomly assigned to the intervention or control group. The SM program consisted of abdominal massage, abdominal muscle stretching, and education on proper defecation position. The intervention group started the program before the first chemotherapy cycle, whereas patients in the wait-list control group received the program on the day before their second chemotherapy cycle. The primary outcome was constipation severity, assessed by the constipation assessment scale (CAS, sum of eight components). The secondary outcome included each CAS component (0-2 points) and mood states. A self-reported assessment of satisfaction with the program was performed. The program produced a statistically and clinically significant alleviation of constipation severity (mean difference in CAS, -3.00; P = 0.02), decrease in the likelihood of a small volume of stool (P = 0.03), and decrease in depression and dejection (P = 0.02). With regards to program satisfaction, 43.6 and 26.4 % patients rated the program as excellent and good, respectively. Our SM program is effective for mitigating the symptoms of antiemetic-induced constipation during chemotherapy

Prevalence of Femoroacetabular Impingement Features in Japanese Young Adults without Symptoms: Hip Joint Morphology Using Radial Reformation from Computed Tomography

Purpose: To determine the prevalence of femoroacetabular impingement (FAI) morphology in asymptomatic Japanese young adults using multi-detector computed tomography (MDCT) scan. Materials and Methods: A total of 170 subjects (85 men; age, 19–39 years) without hip-related problems were included. Radial slices of 2-mm thickness at 30° intervals were reconstructed perpendicular to the central axis of the femoral head and neck for both hips. Alpha (α) angles, acetabular (AC) depths, and lateral centre-edge (LCE) angles were measured; maximum value of measured α angles was defined as max α angle, and minimum value of measured AC depths was defined as min AC depth. Max α angle > 55° was considered positive for cam-type FAI feature and min AC depth 40° was considered positive for pincer-type FAI feature. Differences among planes, right-left correlations, and sex differences in FAI abnormalities were assessed. Results: The α angles at 1- and 2-o’clock positions in men and at 2-o’clock position in women were significantly greater than those at other positions. AC depths at 2-o’clock position were smallest in men and women. Max α angles and min AC depths and LCE angles showed strong right-left correlations. Max α angles and the numbers of hips with cam features were significantly higher in men than in women. The prevalence of pincer features was similar between men and women. Conclusion: The prevalence of cam type deformity is higher in men. Our results in Japanese populations were similar to those reported previously for Caucasians

Accelerated Splenic Enlargement after Splenic Trauma: Influence of Splenic Arterial Embolization

Splenic injury is common in blunt trauma. As post-injury splenic volume changes are unclear, the aim of this study was to elucidate such changes. This retrospective study included 18 patients (14 males, median age 24.5 years) with a splenic injury treated between January 2009 and December 2016. All underwent computed tomography (CT) during admission to our hospital and at the last follow-up visit. The splenic volumes on the first and last enhanced delayed-phase CT scans were compared. The fluid response, transfusion, injury severity score, trauma grade, and extent of splenic artery embolization (SAE) were obtained from medical records. The volume change was assessed with a Mann-Whitney U-test. The volume change in patients treated conservatively was also evaluated to study the natural course after injury. On the first and last scans, the median splenic volume was 105.8 (interquartile range [IQR] 65.4–139.7) and 123.6 (IQR 102.0–225.0) cm3, respectively. The volume increased by 67 (-0.4 ± 120.0) %. SAE was the only factor significantly related to the volume change (p < 0.05). The median follow-up period was 13 (IQR 6–20) days. In conservatively treated patients, the splenic volume change was correlated with the interval between the first and last CT studies. Our findings suggest that the volume of the injured spleen increases in the natural course after trauma. SAE resulted in a decrease in the splenic volume

Predicting Blood Flow from the Superior Mesenteric Artery to the Celiac Arterial Region on CT Angiography in Patients with Median Arcuate Ligament Syndrome

Purpose: This study aimed to assess whether computed tomography (CT) findings can be used to predict blood flow from the superior mesenteric artery (SMA) to the celiac artery (CA) region in patients with median arcuate ligament syndrome (MALS). Materials and methods: Two radiologists who reviewed 1,290 conventional SMA angiograms and CT scans identified 36 patients with MALS. MALS was classified by their blood flow angiography findings as type A (CA region not or barely visualized) and type B (CA region clearly visualized). The association between patient age, sex, post-stenotic dilatation ratio of the celiac axis, maximum diameter of the pancreaticoduodenal arcade (PDA), and MALS classification based on SMA angiography was assessed. Results: Of 36 MALS patients, 17 had MALS type A and 19 had MALS type B. The mean of the maximum diameter of the PDA in MALS type A was 1.6 ± 0.9 mm (SD) and 4.3 ± 1.3 mm in MALS type B. The poststenotic dilatation ratio of the celiac axis was 2.4 ± 1.2 in MALS type A and 2.2 ± 1.4 in MALS type B. Only maximum diameter of the PDA was a predictor of MALS type B (odds ratio, 15.7; 95% confidence interval, 2.3–108.1). Conclusion: The maximum diameter of the PDA on CT angiography can be used to predict the blood flow from the SMA to the CA region in patients with MALS

急性期中大脳動脈梗塞における頭部CTのthin-slice逐次近似画像再構成法を用いた診断能 : 他施設研究

内容の要約広島大学(Hiroshima University)博士(医学)Doctor of Philosophy in Medical Sciencedoctora

Cranio-caudal puncture with computed tomography-guided drainage of a deep pelvic abscess

Purpose: Computed tomography (CT)-guided percutaneous drainage has been used to address pelvic abscesses because it is safe and minimally invasive. However, CT-guided drainage has the limitation that the puncture route should be on the same axial slice. A technique for puncturing in the cranio-caudal direction under CT fluoroscopy is needed. Case report: An 82-year-old man with an abscess due to rectal cancer was scheduled for CT-guided drainage to improve his general condition before radical surgery. Drainage was performed via a perineal approach to localize the drainage tract in the resection area to avoid dissemination of cancer cells. To perform a puncture in the cranio-caudal direction we controlled the needle like a joystick and advanced it under CT fluoroscopy while moving the CT gantry cranially to follow the needle tip throughout the puncture. Our unique technique yielded successful CT-guided puncture in the cranio-caudal direction. Conclusions: Our unique technique overcomes the limitations of CT-guided cranio-caudal puncture and may allow the drainage of abscesses whose treatment was heretofore difficult