Purpose: To determine the correlation of the rate of change of each future remnant liver (FRL) before and after portal vein embolization (PVE), by CT volumetry and Tc-99m galactosyl human serum albumin scintigraphy (GSA scintigraphy). Material and methods: From December 2007 to July 2012, ten patients underwent PVE before hepatic resection. CT volumetry and GSA scintigraphy were performed before and after PVE. The FRL was divided at Cantlie's line for CT volumetry, and volume change rates before and after PVE were calculated. The maximum removal rate (Rmax) was calculated using a radiopharmacokinetic model in GSA scintigraphy. The FRL Rmax change rates before and after PVE were calculated. The correlation between the volume change rates and the Rmax change rates was analyzed. Results: The FRL volume change rate was 1.28 ± 0.26 (mean ± SD); the FRL hypertrophied in all patients significantly (p = 0.005). The FRL Rmax change rate was 1.66 ± 0.75; excluding one patient, there was significant FRL Rmax increase (p = 0.022). Although both increased significantly, no correlation between the volume change rate and the Rmax change rate was observed. Conclusion: No correlation was observed between the FRL volume rate and the Rmax rate.
This animal study investigated the feasibility of creating a bypass between two hollow organs, using a modified gun-sight approach with a pull-through string and pull-through tow wire. Ten procedures (femoral arteriovenous shunt, n = 4; portacaval shunt, n = 4; cholangiogastrostomy, n = 2) were performed in six adult swine. Snares were inserted into the two hollow organs through the sheath and deployed at the site of bypass creation. When snares overlapped on fluoroscopy, a needle was inserted to pass through both snares. The string was inserted through the needle, with only the needle then withdrawn. The snare furthest from the skin was closed to capture the string and was then withdrawn. The other snare was withdrawn without closing. The string thus served as a pull-through string penetrating both hollow organs. This string was then attached to a pull-through tow wire, withdrawn, and exchanged for the pull-through tow wire. By withdrawing the pull-through tow wire, the delivery sheath connected to the pull-through tow wire was towed through the site of the bypass, and the stent was placed. In all cases, bypass creation was achieved. Percutaneous bypass creation using a modified gun-sight approach with a pull-through string and pull-through tow wire is feasible between two hollow organs.
It remains unknown whether a regimen of a combination of high- and low-intensity resistance training increases muscle size and maximal voluntary isometric contraction (MVC) simultaneously. This study aimed to clarify the effect of the combination of high- and low-intensity resistance training on muscle size and neuromuscular function in the elbow flexors. Sixteen male adults participated in a 9-week isometric training regimen in elbow joint flexion of each arm. We randomly assigned two different training regimens to left and right arms: one aiming to strengthen maximal strength (ST) and the other aiming to develop muscle size as well as maximal strength, which consists of one contraction to volitional failure with 50% of MVC added to ST (COMB). Following the 3-week training to volitional failure as familiarization, the participants conducted the 6-week ST and COMB training in each arm. Before the intervention, and at the third (Mid) and ninth (Post) weeks, MVC and muscle thickness in the anterior part of the upper arm (ultrasound) were measured. Muscle cross-sectional area (mCSA) was derived from the obtained muscle thickness. From Mid to Post, the relative change in MVC was similar in both arms. The COMB regimen increased muscle size, but no significant change was found in ST. Following the 3-week isometric training to volitional failure, the 6-week training regimen for developing maximal voluntary and muscle hypertrophy increased MVC, with increasing mCSA, and the training-induced change in MVC was similar to that for developing maximal voluntary strength alone.
Massive hemobilia caused by hepatic artery pseudoaneurysm is an uncommon but potentially fatal complication that can occur after biliary intervention. Previous intervention or surgery, atherosclerotic disease, inflammation and even anatomic variants may make the pseudoaneurysm inaccessible to transcatheter approach, therefore it is not always feasible. The present report describes a case of successful embolization of a hepatic artery pseudoaneurysm with N-butyl cyanoacrylate via direct puncture as an alternative approach. The case presentation is followed by the technical points and the properties of N-butyl cyanoacrylate that are particularly advantageous for use in direct puncture procedures.
Summary Previous studies have investigated the relationship between ultrasound‐measured muscle thickness (MT) and individual muscle cross‐sectional area (CSA); however, the forearm muscle had not yet been studied. The purpose of this study was to examine the relationship between forearm MT by ultrasound and the muscle CSA of the forearm obtained by magnetic resonance imaging (MRI). Ten young and middle‐aged adults had both ultrasound and MRI measurements at 30% the distance from the styloid process of the ulna to the head of the radius. Handgrip strength (HGS) was also measured. Strong correlations ( P <0·001) were observed between MRI‐measured muscle CSA (total and flexor and extensor components) and MT‐ulna (ranged r = 0·937–0·946) and MT‐radius (ranged r = 0·884–0·891). HGS was also correlated ( P <0·001) with forearm MT (MT‐ulna, r = 0·877; MT‐radius, r = 0·852) and MRI‐measured muscle CSA (flexor CSA, r = 0·910; extensor CSA, r = 0·923). Our results suggest that forearm MT is closely associated with MRI‐measured forearm muscle CSA in young and middle‐aged adults and suggest that ultrasound‐measured forearm muscle thickness may be a useful variable for evaluating muscle CSA and function in the forearm.
