Right Pleural Effusion in Fitz-Hugh-Curtis Syndrome

Right pleural effusion was diagnosed in a 36-year-old woman with right upper quadrant pain and fever. Enhanced pelvic computed tomography performed because of irregular genital bleeding revealed the pelvic inflammatory disease. Upon further questioning, the patient confirmed that she had recently undergone therapy for Chlamydia trachomatis infection. Therefore she was given an injection of tetracycline because we suspected Fitz-Hugh-Curtis syndrome (FHCS), a pelvic inflammatory disease characterized by perihepatitis associated with chlamydial infection. A remarkable clinical response to antibiotics was noted. The right upper quadrant pain was due to perihepatitis, and the final diagnosis was FHCS. Right pleural effusion may be caused by inflammation of the diaphragm associated with perihepatitis. Once chlamydial infection reaches the subphrenic liver, conditions in the closed space between the liver and diaphragm due to inflammatory adhesion may be conductive to chlamydial proliferation. The possibility of FHCS should be considered in patients and carefully distinguished from other abdominal diseases

Computed tomography findings of intersigmoid hernia

Purpose: To evaluate the computed tomography findings of intersigmoid hernias. Material and methods: Between April 2010 and March 2018, 7 patients who were surgically diagnosed with intersigmoid hernia in 3 institutions were enrolled in this study. Two radiologists evaluated imaging findings for the herniated small bowel, the distance between the occlusion point and bifurcation of the left common iliac artery, and the anatomic relationship with adjacent organs. Results: All patients were male, and their mean age (standard deviation, range) was 61.0 (13.5, 36-85) years. The mean size of the bowel loops was 5.2 (1.3, 4.0-8.3) cm in the caudal direction, 3.6 (0.8, 2.5-5.1) cm in the lateral, and 3.4 (0.6, 2.5-4.7) cm in the anterior-posterior direction. The volume was 37.9 (27.8, 15.6-103.0) cm3 approximated by an ellipse, and 24.0 (17.7, 9.9-65.6) cm3 approximated by a truncated cone. The obstruction point was located 3.6 (0.6, 2.8-4.7) cm inferior to the bifurcation of the left common iliac artery. In all cases, the small bowel ran under the point at which the inferior mesenteric vessels bifurcated to the superior rectal vessels and the sigmoid vessels and formed a sac-like appearance between the left psoas muscle and the sigmoid colon. The ureter ran dorsal to the point of the bowel stenosis, and the left gonadal vein ran outside the small bowel loops. Conclusions: All cases showed common imaging findings, which may be characteristic of men's intersigmoid hernia. In addition, the fossa's position was lower, and the size was larger than in the previous study, which may be a risk factor

C-arm Cone-beam CT-guided Needle Biopsies through the Erector Spinal Muscle for Posterior Thoracic Pulmonary Lesions

This study investigated retrospectively the diagnostic yield and complication rate of transthoracic needle biopsies for posterior thoracic pulmonary lesions using C-arm cone-beam computed tomography （CBCT）. The risk factors for pulmonary hemorrhage were evaluated. Our study included 113 patients with 113 posterior pulmonary lesions （mean longest diameter: 30.6mm, and mean depth: 4.7mm） through the erector spinal muscles using a 19/20-gauge coaxial system. The diagnostic performances of procedures for malignant lesions and the incidence of complications after biopsies were also assessed. The patient-related and procedure-related variables were investigated. Risk factors for pulmonary hemorrhage were analyzed with a multivariate logistic regression analysis. Findings revealed 99 malignant, 13 benign, and one intermediate lesion. Sensitivity, specificity, and diagnostic accuracy rates were 100％ （99/99）, 92.3％ （12/13）, and 99.1％ （111/112）, respectively. Air embolization, hemothorax, hemoptysis, pneumothorax, and pulmonary hemorrhage, occurred in 0, 2, 12, 48, and 70 procedures. The averaged spinous process-pleura depth and the traversed lung parenchyma depth achieved by the introducer needles were 54.2mm and 27.4mm, respectively. The needle position at the pleural puncture site within the intercostal space was in middle （31％） and inferior （69％） areas. The incidence of pulmonary hemorrhage was significantly higher in smaller lesions （p＝0.001）. Manual evacuation was performed in five procedures for patients with pneumothorax. The chest tube placement （trocar＞8 Fr） was performed in two procedures in patients with hemothorax and pneumothorax. In conclusion, the biopsy method with a posterior intercostal approach for posterior thoracic pulmonary lesions yielded high diagnostic accuracy and few major complications

Diagnostic Ability of Diffusion-weighted Magnetic Resonance Imaging to Discriminate Ampullary eoplasms: A Preliminary Study of 15 Cases

We assessed the diagnostic capability of diffusion-weighted magnetic resonance imaging (DWI) to predict the histological diagnosis of ampullary lesions to resolve the diagnostic uncertainty of endoscopic biopsy for ampullary neoplasms. From January 2009 to August 2011, we performed DWI using b values of 0 and 1000s/mm2 for 15 patients with a histological diagnosis of ampullary lesion (adenocarcinoma, n = 8; adenoma, n = 4; hyperplasia, n = 3). We compared the signal intensities (determined by comparing signal intensities of ampullary lesions and rating them as markedly hyperintense, hyperintense, or hypo-to-isointense relative to the duodenal wall) and the apparent diffusion coefficient (ADC, × 10-3 mm2/s) values of the ampullary lesions on DWI among the three groups based on the histological diagnosis. Values are expressed as median (range). The cancer-group lesions showed a significantly higher signal intensity than either adenoma or hyperplasia (markedly hyperintense/hyperintense/hypo-to-isointense; adenocarcinoma, 7/1/0; adenoma, 0/4/0; hyperplasia, 0/0/3; P < 0.005). The ADC values were significantly lower in adenocarcinoma at 1.46 (0.83-1.63) than in either adenoma at 2.14 (1.92-2.37) or hyperplasia at 2.06 (1.88-2.53) (P < 0.005). In addition, the ADC values in the malignant group (adenocarcinoma) were significantly lower than those in the benign groups (adenoma and hyperplasia) (P < 0.001). The findings suggested that DWI could contribute significantly to accurate preprocedural diagnosis of ampullary lesions

Conceptual design of a wide-field near UV transient survey in a 6U CubeSat

A conceptual design of a wide-field near UV transient survey in a 6U CubeSat is presented. Ultraviolet is one of the frontier in the transient astronomy. To open up the discovery region, we are developing a 6U CubeSat for transient exploration. The possible targets will be supernova shock-breakouts, tidal disruption events, and the blue emission from NS-NS mergers in very early phase. If we only focused on nearby/bright sources, the required detection limit is around 20 mag (AB). To avoid the background and optical light, we chose a waveband of 230-280 nm. As an imaging detector, we employ a delta-doped back-illuminated CMOS. In addition to delta doping, the multi-layer coating directly deposited on the detector enables both a high in-band UV QE and the ultra-low optical rejection ratio. Taking into account these specifications, even an 8 cm telescope can achieve the detection limit of 20 magAB. The expected FoV is larger than 60 deg^2

Alternative Starting Position for CT Coronary Angiography

We examined whether the superior margin of the left main bronchus is the best landmark for the starting position of computed tomography coronary angiography（CTCA）. We retrospectively evaluated 693 consecutive CTCAs. From the scout scanogram, the superior margin of the left main bronchus was noted. The relationships among and distance between the superior margin of the left main bronchus and the left coronary system were analyzed. The superior margin of the left main bronchus extended caudally to the superior margin of the left coronary system in 13 patients（1.9％）. The addition of 1cm to the superior margin of the left main bronchus kept it caudal to the superior margin of the left coronary system in only one patient（0.1％）. On the scout scanogram, 1cm above the superior margin of the left main bronchus is the most appropriate starting position for CTCA

Assessment of Hepatocellular Carcinoma Ablation Margins Using Fused Pre-ablation Hepatobiliary Phase and Post-ablation Unenhanced T1-weighted Images

This study retrospectively investigated the value of fusing a pre-ablation hepatobiliary phase（HBP）series and post-ablation unenhanced T1-weighted images（T1WIs）to evaluate the treatment effectiveness of radiofrequency ablation for hepatocellular carcinoma（HCC）. Predictors of local tumor progression（LTP）were also identified. Our study comprised 47 patients with 88 HCCs（＞2 years follow up）who underwent pre-ablation gadoxetate disodium-enhanced magnetic resonance imaging and post-ablation T1-weighted imaging. For the new assessment, pre-ablation HBP series and post-ablation T1WIs were fused using a rigid registration and manual correlation, and the ablation margin appearance was classified as ablation margin（＋）, ablation margin zero, ablation margin（−）, or indeterminate（index tumor was invisible）based on the post-ablation T1WIs and fusion images. The minimal ablation margin was measured and clinical factors were investigated to identify other risk factors for LTP, which was observed in 14 tumors. The mean minimal ablation margin was 1.9mm, excluding 5 indeterminate nodules without LTP, and 8 ablation margin-zero HCCs with LTP, with multivariate logistic regression analysis showing that the likelihood of ablation margin＋was inversely proportional to tumor size. The independent risk factors for LTP were not identified, but the cumulative LTP rates（0％ at 1, 2, and 3 years）in 41 ablation margin＋ nodules were significantly lower（P＝0.005）than those（8.8％, 17.6％, and 17.6％ at 1, 2, and 3 years, respectively）in 34 ablation margin-zero nodules. In conclusion, fusion images might show an early therapeutic response of the ablated tumors in the majority of HCC cases

PETREL: Platform for Extra and Terrestrial Remote Examination with LCTF

A small satellite ”PETREL” for UV astronomy and remote sensing with ”tunable” multi-spectral cameras conducted by an academia-industrial collaboration is presented. This project was originally proposed by an astronomer who desired a satellite for exploration of explosive objects in ultraviolet. To avoid the earthshine the astronomical observations are scheduled only in the nighttime. To utilize the daytime more electively we conceived a plan of ”satellite sharing” with the industrial collaborators, that can also reduce the developing cost drastically. The daytime mission is spectroscopy that is one of the potential fields in terms of data business, because that can provide chemical and biological information on the surface of the earth. We employ multi-spectral cameras making use of liquid crystal tunable filters (LCTFs) that enable adaptive observations at the optimized wave-bands for each targets. In 2020, this remote-sensing project and ultraviolet astronomy mission were accepted as a small satellite project of JAXA’s Innovative Satellite Technology Demonstration program and as an ISAS/JAXA’s small-scale program, respectively. This satellit

Changes in Atrial Size Following PVI: Comparison of the Right and Left Atria

Background: Pulmonary vein isolation (PVI) is expected to cure atrial fibrillation (AF) and to improve atrial remodeling. However, the effects of PVI on the right atrial (RA) size have not been fully examined. We studied the effects of PVI on RA size in comparison that with the effects on LA size. Method: We studied 17 patients with drug-refractory AF (11 paroxysmal, 6 persistent). Two-dimensional echocardiography was performed at baseline and at follow-up to measure and compare RA and LA size.Results: Despite a short duration of AF in 7 patients after the PVI, all cases were maintained in sinus rhythm during the follow-up. LA and RA size were both reduced after the PVI compared with baseline measurements (LA 25.5 ± 2.9cm2 vs. 23.2 ± 3.6cm2, P < 0.05, RA 21.2 ± 2.9cm2 vs. 18.1 ± 3.0cm2, P < 0.01). The reduction ratio was more prominent in RA size (14.9%) than in LA size (8.7%)(P < 0.05). Conclusion: Atrial size was reduced following PVI for both the LA and RA, although the rate of reduction was more prominent in the RA

Conceptual design of a wide-field near UV transient survey in a 6U CubeSat

A conceptual design of a wide-field near UV transient survey in a 6U CubeSat is presented. Ultraviolet is one of the frontier in the transient astronomy. To open up the discovery region, we are developing a 6U CubeSat for transient exploration. The possible targets will be supernova shock-breakouts, tidal disruption events, and the blue emission from NS-NS mergers in very early phase. If we only focused on nearby/bright sources, the required detection limit is around 20 mag (AB). To avoid the background and optical light, we chose a waveband of 230-280 nm. As an imaging detector, we employ a delta-doped back-illuminated CMOS. In addition to delta doping, the multi-layer coating directly deposited on the detector enables both a high in-band UV QE and the ultra-low optical rejection ratio. Taking into account these specifications, even an 8 cm telescope can achieve the detection limit of 20 magAB. The expected FoV is larger than 60 deg^2