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To evaluate and compare the clinical outcomes between percutaneous gallbladder drainage (PGBD) and percutaneous gallbladder aspiration (PGBA) for acute cholecystitis after biliary stenting for malignant biliary obstruction. Twenty-six and 14 patients underwent PGBD and PGBA, respectively, for acute cholecystitis after biliary stenting for malignant obstruction. The technical success rate, clinical effectiveness, and safety were compared between the 2 groups. Technical success was achieved in all patients. Clinical effectiveness rate was significantly higher in the PGBD group than in the PGBA group [100% (26/26) vs. 57% (8/14), p

To review the chest computed tomography (CT) findings on the ultra-high-resolution CT (U-HRCT) in patients with the Novel coronavirus disease 2019 (COVID-19). In February 2020, six consecutive patients with COVID-19 pneumonia (median age, 69 years) underwent U-HR CT imaging. U-HR-CT has a larger matrix size of 1024 × 1024 thinner slice thickness of 0.25 mm and can demonstrate terminal bronchioles in the normal lungs; as a result, Reid’s secondary lobules and their abnormalities can be identified. The distribution and hallmarks (ground-glass opacity, consolidation with or without architectural distortion, linear opacity, crazy paving) of the lung opacities on U-HRCT were visually evaluated on a 1 K monitor by two experienced reviewers. The CT lung volume was measured, and the ratio of the measured lung volume to the predicted total lung capacity (predTLC) based on sex, age and height was calculated. All cases showed crazy paving pattern in U-HRCT. In these lesions, the secondary lobules were smaller than those in the un-affected lungs. CT lung volume decreased in two cases comparing predTLC. U-HRCT can evaluate not only the distribution and hallmarks of COVID-19 pneumonia but also visualize local lung volume loss.

A panel of Japanese experts on tumor ablation therapy gathered to reach a general consensus on topics surrounding ablation therapy. Questionnaires relating to ablation protocols for radiofrequency ablation (RFA) and cryoablation, as well as ancillary procedures required for safe and secure ablation therapy, were sent to seven institutions. Experts from these institutions discussed each topic based on the evidence and the questionnaire data, and a consensus was reached at an annual meeting of the Japan Image-guided Ablation Group in Maebashi, Japan, in October 2015. A consensus was reached on each of six topics, including “management of antiplatelet and anticoagulation drug therapy”; “pain control in the perioperative period”; “arterial embolization combined with ablation therapy”; “protection of non-target organs”; “RFA and cryoablation protocols”; and “ablative margins.” The consensus achieved here will serve as the framework for tumor ablation therapies in Japan.

To compare the clinical outcomes between radiofrequency ablation (RFA) and cryoablation for the treatment of clinical T1b (cT1b) renal cell carcinoma (RCC).The data of 46 patients [(39 men and 7 women, median age; 73 years, range 39-87 years)] were gathered from 3 institutions. RFA and cryoablation were performed on 23 patients each. The median number of ablation needle was 2 (range 1-4) and 4 (range 3-5, p 0.0001) in RFA and cryoablation, respectively. Technique efficacy defined as coverage of the tumor by ablative zone, adverse events, local tumor progression, and survival were compared between the RFA and cryoablation groups.The primary technique efficacy rate was significantly higher in the cryoablation group (96%, 22/23) than in the RFA group (65%, 15/23, P = 0.02). There was no significant difference in the secondary technique efficacy rate after additional RFA and cryoablation [21/23 (91%) vs. 23/23 (100%); P = 0.24]. The incidence of grade 3 or higher adverse events was similar between the 2 groups (P 0.99). There was no significant difference between local tumor progression rate after RFA and cryoablation [3/21 (14%) vs. 2/23 (9%); P = 0.66]. The 5-year overall survival rates were comparable between RFA and cryoablation (78 vs. 82%; P =0.82).Other than primary technique efficacy, the clinical outcomes between RFA and cryoablation were similar in patients with cT1b RCC.

In stereotactic body radiotherapy (SBRT) for centrally located non-small cell lung carcinoma (NSCLC), severe hemoptysis has been reported in several studies. We report here a rare case of hemoptysis after SBRT even though the lung tumor was peripherally located. A lung nodule of a 79-year-old man was accidentally found at the periphery of the left upper lobe. A computed tomography-guided biopsy of this nodule provided confirmation of the diagnosis of poorly differentiated adenocarcinoma. The clinical diagnosis was T1bN0M0, stage I primary lung cancer. The patient was treated with SBRT using helical tomotherapy at a dose of 60 Gy in 6 fractions (i.e., BED10 = 120). He obtained a complete response and did not experience recurrence. However, the patient suffered massive hemoptysis 4.5 years after SBRT. As hypervascularity of a left bronchial artery was observed at the left lung in accordance with SBRT field on bronchial arteriography, a bronchial artery embolization (BAE) procedure was performed. The patient has had no episodes of hemoptysis after BAE. Although SBRT for early stage NSCLC is usually safe and efficient, it is necessary to be careful for late-onset bronchial hemorrhage in SBRT, even for a peripheral tumor.

Cyanoacrylates are a group of fast-acting adhesives. They form low viscosity liquids in the monomer state and instantly polymerize to become adhesive upon contact with ionic substances. Since the 1950s, they have been used around the world for industrial and household purposes. N-butyl cyanoacrylate (NBCA) is a cyanoacrylate that is commonly used for medical care, and the closure of skin wounds with NBCA has been found to promote hemostasis. However, in Japan, the intravascular injection of NBCA is considered to be off-label use, except during the treatment of gastric varices under endoscopy. The use of NBCA in embolotherapy is considered when the target vessels cannot be cannulated superselectively, for vascular diseases that require long segments of the target vessel to be embolized, or for patients in a hypocoagulable state. NBCA-based embolotherapy can be used to treat vascular malformations, acute hemorrhaging, tumors, and venous disease. The complications associated with NBCA-based embolotherapy include tissue ischemia, hemorrhaging, systemic or local reactions, and catheter adhesion to blood vessels. NBCA is mixed with Lipiodol to make it radiopaque and to adjust its polymerization time. Since there are various technical aspects to performing NBCA-based embolotherapy safely, it should be carried out by, or with the assistance of, proficient interventional radiologists.

Complete esophageal obstruction developed after radiation and endoscopic submucosal dissection therapy for a cervical esophageal cancer in a 77-year-old woman. After failure to recanalize the esophageal obstruction by endoscopic and catheterization techniques, the esophageal obstruction was penetrated using a trocar stylet needle via a gastrostomy route. A covered stent was placed across the esophageal obstruction, letting her take water and liquid food until she died 2 months later. There was no complication related to the procedures except transient chest discomfort and pain that subsided with symptomatic treatment.