Duodenal ulcer bleeding from a branch of the middle colic artery: A case report

RATIONALE

Duodenal ulcer bleeding is a potentially life-threatening condition commonly caused by the erosion of the duodenal arteries.

PATIENT CONCERNS

A 55-year-old male was referred to our hospital with abdominal pain for the past 3 days. Contrast-enhanced computed tomography of the abdomen revealed wall thickening in the descending part of the duodenum and a cystic lesion (27 × 19 mm) contiguous with the duodenum, with an accumulation of fluid. An esophagogastroduodenoscopy showed the significantly stenotic duodenum, which prevented passage of the endoscope and evaluation of the main lesion. Based on these findings, duodenal ulcer perforation and concomitant abscess formation were suspected. Two days after admission, he had massive hematochezia with bloody drainage from the nasogastric tube.

DIAGNOSES

Emergency angiography revealed duodenal ulcer bleeding from the gastroduodenal artery and the branch artery of the inferior pancreaticoduodenal artery and middle colic artery (MCA).

INTERVENTIONS

The patient was treated with transcatheter arterial embolization (TAE) of the gastroduodenal artery, the branch vessel of the inferior pancreaticoduodenal artery, and the main trunk of the MCA.

OUTCOMES

Hemostasis was achieved with TAE. The patient recovered uneventfully and undergone a gastro-jejunal bypass surgery for the duodenal stenosis 2 weeks after TAE. He was discharged without any abnormal complaints on postoperative day 12.

LESSONS

We have experienced a rare case of duodenal ulcer bleeding from a branch of the MCA. In patients with refractory upper gastrointestinal bleeding, careful evaluation of bleeding sites is recommended considering unexpected culprit vessels.

Diagnosis of intracranial hemorrhagic lesions: comparison between 3D-SWAN (3D T2*-weighted imaging with multi-echo acquisition) and 2D-T2*-weighted imaging

BACKGROUND

3D-susceptibility-weighted angiography (SWAN) can produce high-resolution images that yield excellent susceptibility-weighted contrast at a relatively short acquisition time.

PURPOSE

To compare SWAN- and 2D-T2*-weighted gradient-echo images (T2*-WI) for their sensitivity in the depiction of cerebral hemorrhagic lesions.

MATERIAL AND METHODS

We subjected 75 patients with suspected cerebral hemorrhagic lesions to SWAN and T2*-WI at 3T. We first measured the contrast-to-noise ratio (CNR) using an agar phantom that contained different concentrations of superparamagnetic iron oxide (SPIO). The acquisition time for SWAN and T2*-WI was similar (182 vs. 196 s). Neuroradiologists compared the two imaging methods for lesion detectability and conspicuity.

RESULTS

The CNR of the phantom was higher on SWAN images. Of the 75 patients, 50 were found to have a total of 278 cerebral hemorrhagic lesions (microbleeds, n = 229 [82.4%]; intracerebral hemorrhage, n = 18 [6.5%]; superficial siderosis, n = 13 [4.7%]; axonal injuries, n = 8 [2.9%]; subarachnoid hemorrhage [SAH] or brain contusion, n = 3 each [1.0%]; subdural hematoma, n = 2 [0.7%]; cavernous hemangioma or dural arterteriovenous fistula, n = 1 each [0.4%]). In none of the lesions was the SWAN sequence inferior to T2*-WI with respect to lesion detectability and conspicuity. In fact, SWAN yielded better lesion conspicuity in patients with superficial siderosis and SAH: it detected significantly more lesions than T2*-WI (P < 0.01) and it was particularly useful for the detection of microbleeds and lesions near the skull base.

CONCLUSION

SWAN is equal or superior to standard T2*-WI for the diagnosis of various cerebral hemorrhagic lesions. Because its acquisition time is reasonable it may replace T2*-WI.

Differential interference contrast microscope with differential detection for optimizing image contrast

A laser scanning differential interference contrast microscope using a differential detection method is proposed. This microscope permits observers to control the differential image contrast with a simple operation. Utilizing this function, the observers are capable of obtaining the optimized differential image whose contrast is most favorable for observation. A simple theoretical analysis and experimental considerations are described.

[The clinical evaluation of hepatic arterial infusion chemotherapy in patients with liver metastases from colorectal cancer employing an implanted port system]

Between 1986 and 1994, 66 patients with unresectable liver metastases from colorectal cancer were treated by repeated hepatic arterial infusion chemotherapy employing an implantable port system. In this study, 44 patients who received intermittent hepatic arterial infusion of high dose 5-FU (1000mg/m2) were analysed according to a response rate, survival rates, developments of extrahepatic lesions, periods of hepatic arterial infusion, and the rates at home. Two cases (4.5%) achieved a complete response (CR) and 27 cases (61.4%) a partial response (PR). The overall one-year and two-year survival rates were 56.7% and 37.8% respectively. The 50% survival time for all patients was 17.2 months. During the course of observation, extrahepatic lesions developed in 16 of the 39 patients (41.0%) and many responders died due to deterioration of extrahepatic lesions. The over all rates at home were more than 85%. Hepatic arterial infusion of the 5-FU at 1000mg/m2 every week showed a high response rate in colorectal cancer patients with hepatic metastases, and the responders showed a low rate of death due to the hepatic metastases. However, in many patients the prognosis-determining-factor was extrahepatic lesions. Thus, countermeasures were necessary for extrahepatic lesions.

[MR evaluation of wallerian degeneration of the pyramidal tract]

This study is based on 135 magnetic resonance (MR) exams of 110 patients with wallerian degeneration of the pyramidal tract shown on MR images acquired on a mid field imaging scanner. The MR findings of wallerian degeneration were abnormal signal band along the course of the pyramidal tract and ipsilateral brain stem shrinkage. In all 110 cases an abnormal signal band was seen on T2-weighted spin-echo images, that is, a hypointense band in four exams between 30 days and 116 days after onset of symptoms, and hyperintense bands in 122 exams. The hyperintense signal on T2-weighted images was shown in most cases after 200 days from the onset. In one case a signal of the pyramidal tract showed a hyperintense band at 7 days, hypointense at 30 days, and hyperintense again at 123 days after onset. Sequential MR exams of another case showed gradual narrowing of the hyperintense signal band and progression of the ipsilateral brainstem shrinkage. The narrowing of the pyramidal tract and the ipsilateral brain stem shrinkage tended to be shown after 6 months from onset.(ABSTRACT TRUNCATED AT 250 WORDS)

Laser computed-tomography microscope

The computed tomography (CT) technique is implemented in an optical transmission microscope with a laser as a light source. A rotational Pechan prism is used in the illumination optics of the microscope for projecting a thick 3-D sample onto a 2-D array detector in different directions. A minicomputer is employed for 3-D reconstruction from the observed image data. Energy throughput efficiency and signal-to-noise ratio in the developed CT microscope are higher than those of our previously developed CT microscope [J. Opt. Soc. Am. A 4, 292 (1987)]. Instrumentation of this microscope is described and some experimental results are shown with biological samples.