Dual Microcatheter Retrograde Transvenous Obliteration of Gastric Varices: Coil Embolization as a Substitute for Balloon Occlusion

Dual microcatheter retrograde transvenous obliteration (DMRTO) of gastric varices enables dual microcatheters to be advanced to the gastric varices themselves or to a site adjacent to the varices. The sclerosing agent is infused through the first microcatheter following coil embolization of the outflow vessels through the second microcatheter, which is placed several centimeters back from the varices. We present two cases of gastric varices in whom balloon-occluded retrograde transvenous obliteration failed, because of angulated gastrosubphrenic shunt in case 1 and a tortuous and elongated gastrorenal shunt in case 2. DMRTO successfully achieved eradication of the gastric varices in both cases

Uterine adenomyosis with extensive glandular proliferation: case series of a rare imaging variant

PURPOSEWe aimed to investigate the clinical and magnetic resonance imaging (MRI) characteristics of uterine adenomyosis, in which there is an extensive area of high signal intensity in the myometrium on T2-weighted MRI.METHODSThis retrospective radiographic study reviewed a case series of six patients (mean age, 36 years) with adenomyosis. These patients were selected because, unlike in classical adenomyosis, T2-weighted images showed a larger area of high signal intensity than that of low signal intensity in the myometrium. The morphology of the myometrial lesions, patterns of contrast enhancement (n=4), intramyometrial hemorrhaging, diffusion restriction (n=5), endometrial lesions, and imaging findings after treatment (n=3) were evaluated on MRI.RESULTSThe patients’ clinical symptoms included vaginal bleeding and severe anemia. Four were administered hormonal therapy, one underwent hysterectomy, and one underwent enucleation. On T2-weighted images, all showed endometrial thickening and a high signal intensity area in the myometrium that was divided up by a mesh of low signal intensity bands, with an appearance reminiscent of a fish caught in a net. Other findings included gradual centripetal enhancement with contrast defects in multicystic areas (4/4), an intramyometrial hemorrhage (1/6), and increased diffusion (5/5). Following hormonal therapy, the uteruses decreased in size and were similar to those of classical adenomyosis on MRI (3/3). The lesions were diagnosed as adenomyosis with a proliferation of adenomyotic glandular tissue and a proliferative endometrial polyp.CONCLUSIONThis case series suggests that there is a subgroup of uterine adenomyosis that shows a characteristic “fish-in-a-net” appearance on T2-weighted images

Usefulness of Microcatheters Inserted Overnight for Additional Injection of Sclerosant after Initial Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices

In patients with large gastric varices, dose limitation of the sclerosant can cause difficulties in achieving complete thrombosis of varices during a single balloon-occluded retrograde transvenous obliteration (BRTO) procedure. For patients with incomplete variceal thrombosis after the first BRTO, additional sclerosant must be injected in a second BRTO. We report a successful case of BRTO for large gastric varices in whom additional sclerosant was injected through a microcatheter that remained inserted overnight. To achieve complete variceal thrombosis in a patient with incomplete thrombosis of large gastric varices after a first BRTO, a retained microcatheter can be used to inject additional sclerosant in a second BRTO the next day

Development and Operation of the Handbooks for Novice Teachers and Mentors (I) : Towards Constructing Foundation and Basis of Teachers as Continuous Learners

In this study, we developed Handbook for improving the practical teaching competencies for novice teachers and Handbook for supporting Novices for mentors and actually got them used by those teachers. We interviewed three pairs of novice and mentor, obtained feedbacks on their contents & usability and analyzed them. As a result of this research, we reached following three conclusions: 1) Handbook for novice teachers helped in organization and accumulation of the documents of novice teachers training; 2) Handbook for mentors are contributory for mentors to support and to advise novices by offering useful knowledge and so on; 3) Standard can be an index of lesson observation and analyzation for novices as well as a tool promoting their reflections. Furthermore, it also works as a medium connecting novices and mentors. We plan to keep on considering the valid ways to utilize these Handbooks.本研究は，平成25-26年度独立行政法人教員研修センター委嘱事業「教員研修モデルカリキュラム開発プログラム」の成果の一部である。なお，本稿は広島大学（2015）の一部を加筆・修正するとともに，平成27年度日本教育大学協会研究集会（10月10日開催）で発表した内容を加え執筆したものである

Magnetized Fast Isochoric Laser Heating for Efficient Creation of Ultra-High-Energy-Density States

The quest for the inertial confinement fusion (ICF) ignition is a grand challenge, as exemplified by extraordinary large laser facilities. Fast isochoric heating of a pre-compressed plasma core with a high-intensity short-pulse laser is an attractive and alternative approach to create ultra-high-energy-density states like those found in ICF ignition sparks. This avoids the ignition quench caused by the hot spark mixing with the surrounding cold fuel, which is the crucial problem of the currently pursued ignition scheme. High-intensity lasers efficiently produce relativistic electron beams (REB). A part of the REB kinetic energy is deposited in the core, and then the heated region becomes the hot spark to trigger the ignition. However, only a small portion of the REB collides with the core because of its large divergence. Here we have demonstrated enhanced laser-to-core energy coupling with the magnetized fast isochoric heating. The method employs a kilo-tesla-level magnetic field that is applied to the transport region from the REB generation point to the core which results in guiding the REB along the magnetic field lines to the core. 7.7 $\pm$ 1.3 % of the maximum coupling was achieved even with a relatively small radial area density core ($\rho R$ $\sim$ 0.1 g/cm$^2$). The guided REB transport was clearly visualized in a pre-compressed core by using Cu-$K_\alpha$ imaging technique. A simplified model coupled with the comprehensive diagnostics yields 6.2\% of the coupling that agrees fairly with the measured coupling. This model also reveals that an ignition-scale areal density core ($\rho R$ $\sim$ 0.4 g/cm$^2$) leads to much higher laser-to-core coupling ($>$ 15%), this is much higher than that achieved by the current scheme