a-novel-method-super-selective-adrenal-venous-sampling

A Novel Method: Super-selective Adrenal Venous Sampling

Primary aldosteronism (PA) and subclinical Cushing&#39;s syndrome (SCS) are conditions in which the adrenal glands autonomously produce excessive amounts ...

Nerima Hikarigaoka Hospital

The aim of this study was to verify the feasibility of using a J-tipped guidewire as a target for puncture of the subclavian artery in the placement of a reservoir port and catheter system (RPCS). Twenty-five patients with various hepatic malignancies underwent percutaneous implantation of an RPCS through the left subclavian artery for regional chemotherapy. To successfully puncture the left subclavian artery, a J-tipped guidewire was used as a target with fluoroscopic guidance. Technical success and complication rates, and numbers of puncture failures, were retrospectively analyzed. Implantation of the RPCS was successful in all patients. Eight (32%) patients had minor complications and no patient had major complications. The number of puncture failures per patient was 0 to 1 (mean=0.32). The J-tipped guidewire is a safe and appropriate target for puncture of the subclavian artery in the placement of an RPCS.

J-tipped guidewire as a target for puncture of the subclavian artery in the placement of a reservoir port and catheter system.

Arteriobiliary fistula is a rare complication of hepatic intra-arterial chemotherapy. We report successful coil embolization of an arteriobiliary fistula. An 80-year-old woman underwent percutaneous placement of an indwelling catheter into the replaced right hepatic artery for intra-arterial chemotherapy of liver metastases. Coil embolization of the left hepatic artery was not performed. The patient complained of abdominal pain during intra-arterial chemotherapy. Angiography revealed a fistula between the replaced right hepatic artery and the common bile duct. The fistula was successfully treated by coil embolization via the indwelling catheter, and the indwelling catheter was removed. Although such complications usually herald the termination of intra-arterial chemotherapy, the patient underwent percutaneous implantation of a new catheter-port system, and intra-arterial chemotherapy was restarted.

Coil embolization of an arteriobiliary fistula caused by hepatic intra-arterial chemotherapy.

A case of cerebral lipiodol embolism after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma is presented. A 76-year-old man underwent TACE for advanced hepatocellular carcinoma. Immediately after chemoembolization, his level of consciousness deteriorated. Computed tomography revealed deposition of iodized oil in the cerebral cortex, basal ganglia, and thalami. Magnetic resonance imaging showed restricted diffusion within the thalami and basal ganglia. The patient's level of consciousness gradually improved, and all neurologic symptoms disappeared over 6 weeks.

Cerebral lipiodol embolism after transcatheter arterial chemoembolization of hepatocellular carcinoma.

The purpose of this study was to describe MRI findings in 11 patients with mucinous adenocarcinomas arising from fistula in ano.

Mucinous adenocarcinoma arising from fistula in ano: MRI findings.

A 21-year-old woman with a history of bacterial endocarditis and ventricular septum defect repair was referred for evaluation of a mass in the right mid-lung field. A contrast-enhanced computed tomography scan of the chest showed an aneurysm of the right lateral pulmonary artery. The aneurysm was considered to be mycotic in origin. The aneurysm was treated by coil embolization using 19 detachable coils measuring 425 cm in overall length.

Mycotic pulmonary artery aneurysm diagnosed 18 years after bacterial endocarditis.

[Adrenal venous sampling].

Retropharyngeal abscess-like lesions are occasionally seen in computed tomography (CT) imaging of patients with Kawasaki disease (KD) and these patients often undergo unnecessary surgery. We could distinguish the lesions from true abscesses by measuring their Hounsfield unit values (HUs).

Hounsfield unit values of retropharyngeal abscess-like lesions seen in Kawasaki disease.

A 38-year-old male with no past history of illnesses visited the out-patient clinic of Nerima Hikarigaoka Hospital complaining of dizziness and persistent anal bleeding. There was a significant anemia on a blood test and colonoscopy showed a thrombus in a markedly swollen internal hemorrhoid. Contrast-enhanced computed tomography (CT) showed a poorly demarcated area with early face enhancement on the right side of the rectum and anal canal. Based on these findings, an arterio-venous malformation (AVM) of the rectum was suspected. Abdominal angiography showed abnormal vessels receiving a blood supply from the bilateral superior rectal arteries. We suspected that the AVM in the rectum was the cause of the hemorrhage from the internal hemorrhoid, and therefore performed embolization of the AVM. Thereafter, the hemorrhage from the internal hemorrhoid stopped completely and the anemia improved to the normal level, without the need for treatment for the internal hemorrhoid. Colonoscopy performed 6 months after embolization showed shrinkage of the internal hemorrhoid. To the best of our knowledge, there are no reports stating a relationship between rectal AVM and internal hemorrhoids. However, we consider that contrast-enhanced CT can be used to detect vessel abnormalities related to severe bleeding of the internal hermorrhoids in patients with internal hemorrhoids and severe anemia.

Rectal arterio-venous malformation (AVM) with bleeding of an internal hemorrhoid.

We report a case of non-familial juvenile primary aldosteronism (PA). Super-selective adrenal venous sampling identified less aldosterone production in the right inferior adrenal segment than others. Bilateral adrenalectomy sparing the segment normalized blood pressure and improved PA. Both adrenals had similar histologies, consisting of a normal adrenal cortex and aldosterone synthase-positive hyperplasia/adenoma. An aldosterone-driving KCNJ5 mutation was detected in the lesions, but not in the histologically normal cortex. After taking into account that the two adrenal glands displayed a similar histological profile, as well as the fact that hyperplastic lesions in both glands exhibited a common KCNJ5 mutation, we conclude that the specific mutation may have occurred at an adrenal precursor mesodermal cell, at an early stage of development; its daughter cells were mixed with non-mutant cells and dispersed into both adrenal glands, resulting into a form of the condition known as genetic mosaicism.

Somatic KCNJ5 mutation occurring early in adrenal development may cause a novel form of juvenile primary aldosteronism.

A stress reaction involving increased adrenal hormone release occurs when starting adrenal venous sampling (AVS). The purpose of the present study was to investigate the effect of single shot venography on adrenal hormone production during AVS.

Article	Year
J-tipped guidewire as a target for puncture of the subclavian artery in the placement of a reservoir port and catheter system. European radiology\| PubMed ID: 14605841	2004
Coil embolization of an arteriobiliary fistula caused by hepatic intra-arterial chemotherapy. Cardiovascular and interventional radiology\| PubMed ID: 16010508	2005
Cerebral lipiodol embolism after transcatheter arterial chemoembolization of hepatocellular carcinoma. Journal of computer assisted tomography\| PubMed ID: 16163042	2005
Mucinous adenocarcinoma arising from fistula in ano: MRI findings. AJR. American journal of roentgenology\| PubMed ID: 16861558	2006
Mycotic pulmonary artery aneurysm diagnosed 18 years after bacterial endocarditis. Clinical imaging\| PubMed ID: 17320781	2007
[Adrenal venous sampling]. Nihon rinsho. Japanese journal of clinical medicine\| PubMed ID: 21830595	2011
Hounsfield unit values of retropharyngeal abscess-like lesions seen in Kawasaki disease. Acta oto-laryngologica\| PubMed ID: 24512428	2014
Rectal arterio-venous malformation (AVM) with bleeding of an internal hemorrhoid. Clinical journal of gastroenterology\| PubMed ID: 26879656	2016
Somatic KCNJ5 mutation occurring early in adrenal development may cause a novel form of juvenile primary aldosteronism. Molecular and cellular endocrinology\| PubMed ID: 27514282	2017
Adrenal hormones before and after venography during adrenal venous sampling: a self-controlled study. Japanese journal of radiology\| PubMed ID: 28074381	2017

Kohzoh Makita

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