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Meningioma is a central nervous system tumor originated from arachnoid cells. 2D cell culture is widely used as a platform for tumor research as it enables us to culture cells in in vitro and a controlled environment. However, in 2D culture condition, 3D architecture of in vivo tumor mass is lost and phenotypic change may occur. Due to the drawbacks of 2D cell culture, organoid culture is seen as an alternative platform for disease modeling, drug testing and personalized medicine. The objective of this study was to establishing protocol for culturing cells from patient meningioma tissue in in vitro 3D environment. Eight meningiomas were collected for the 3D organoid culture. Cells of 5 meningioma tissues survived and proliferated. Under 3D culture condition, cell aggregates were formed and cytoplasmic processes linking the cell aggregates could be observed. In H&E staining, ovaloid cells and spindle cells were observed. Resembling cultured organoids observed under the light microscope, cell aggregates were also observed in the H&E staining. Epithelial Membrane Antigen (EMA) staining was positive. In 4 (80%) cultured organoids, low Ki67 index (≤6%) were measured. In one cultured organoid, a high Ki67 index (12.8%) was seen. The result of this study revealed the feasibility of culturing meningioma cells in in vitro 3D culture condition. Organoid technology showed its potential as an alternative platform for meningioma research.

Background and Aim: CO2 has been reported to be absorbed from the bowel more rapidly than air, resulting in a discomfort reduction after colonoscopy. Its role in deeply sedated patients is limited. This study was designed to investigate the efficacy and safety of CO2 insufflation during colonoscopy in patients deeply sedated with propofol. Methods: A total of 125 continuous patients were randomly assigned to receive either CO2 (n = 63) or air (n = 62) insufflation during propofol-sedated colonoscopy. Postcolonoscopy abdominal pain, distention, and satisfaction were assessed at 1, 3, and 24 h after the procedure, and the proportions of pain-free and distention-free patients were compared. Residual bowel gas in the colon and small bowel was evaluated at 1 h after colonoscopy. End-tidal CO2 and O2 saturation was measured for safety analysis. Results: There was a significant difference between the two groups regarding the postcolonoscopy abdominal pain, distention, and subjective satisfaction at 1 h (P

Objective We wanted to report on our experience with modified radiology-guided percutaneous gastrostomy (MRPG) without endoscopic or nasogastric access for treating patients with complete obstruction of the upper digestive tract. Materials and methods Fourteen oncology patients (13 had hypopharyngeal cancer and 1 had upper esophageal cancer) with complete obstruction of the upper digestive tract were recruited. Conventional percutaneous endoscopic gastrostomy (PEG) and radiologic (fluoroscopy-guided) percutaneous gastrostomy (RPG) were not feasible in all the patients. An MRPG technique (with a combination of ultrasound, an air enema and fluoroscopic guidance) was performed in these patients. Results We achieved successfully percutaneous gastrostomy using the modified technique in all patients without any major or minor complications after the procedure. Conclusion A modified radiology-guided percutaneous gastrostomy technique can be safely performed in patients who failed to receive conventional PEG or RPG due to the absence of nasogastric access in the completely obstructed upper digestive tract.

CO2 has been reported to be absorbed from the bowel more rapidly than air, resulting in a discomfort reduction after colonoscopy. Its role in deeply sedated patients is limited. This study was designed to investigate the efficacy and safety of CO2 insufflation during colonoscopy in patients deeply sedated with propofol.A total of 125 continuous patients were randomly assigned to receive either CO2 (n = 63) or air (n = 62) insufflation during propofol-sedated colonoscopy. Postcolonoscopy abdominal pain, distention, and satisfaction were assessed at 1, 3, and 24 h after the procedure, and the proportions of pain-free and distention-free patients were compared. Residual bowel gas in the colon and small bowel was evaluated at 1 h after colonoscopy. End-tidal CO2 and O2 saturation was measured for safety analysis.There was a significant difference between the two groups regarding the postcolonoscopy abdominal pain, distention, and subjective satisfaction at 1 h (P 0.001) and 3 h (P 0.01) after the procedure. Patients' pain and distention at 1 and 3 h after the procedure were significantly lower in the CO2 group (P 0.01). Residual bowel gas in the colon and small bowel was significantly less in the CO2 group (P 0.001). There was no significant difference in end-tidal CO2 levels between two groups before, during, and after the procedure.Compared with air, CO2 insufflation during colonoscopy reduced postcolonoscopy abdominal discomfort and improved patients' satisfaction. It was safe to use CO2 insufflation in deeply sedated colonoscopy.

The real-time images of computed tomography (CT)-fluoroscopy provide an excellent means of guidance for percutaneous interventions. We describe the performance of T-fastener gastropexy and percutaneous gastrostomy under CT-fluoroscopic guidance in a 59-year-old woman who had received total pharyngolaryngectomy for hypopharyngeal cancer and partial gastrectomy with Billroth II anastomosis for bleeding gastric ulcer 10 years before this operation. The previous gastric operation altered the gastrointestinal anatomy and made conventional fluoroscopic-guided percutaneous gastrostomy extremely difficult and risky. The T-fastener gastropexy and percutaneous gastrostomy were accomplished smoothly in a single session using CT-fluoroscopic guidance. This modified method of percutaneous gastrostomy may be useful in patients with anatomic distortion due to previous gastric surgery.

Angiomyolipomas are benign mesenchymal tumors, but those that arise from the small intestine are exceedingly rare. We report on a 48-year-old woman who had an ileal angiomyolipoma, who presented clinically with vague abdominal pain and bloody stool. Small-bowel intussusception was shown on an abdominal computed tomography (CT) scan. We discuss the clinical manifestations and clinicopathological and immunohistochemical findings of this benign tumor which appeared in this rare location.

Combined hepatocellular-cholangiocarcinoma (HCC-CC) is a rare primary liver tumour. We report a carrier of both HBV and HCV presenting with intermittent abdominal pain, fever, chillness and elevated a-fetoprotein (AFP) of 1197 ng/ml. Computed tomography showed an irregular hypodense mass in the left lateral segment of the liver with vague contrast enhancement and multiple regional lymphadenopathy. Hepatic angiogram showed that the mass was hypovascular and the left portal vein was occluded with a tapered end. Percutaneous ultrasound-guided core needle biopsy of the liver yielded HCC-CC. We suggest that HCC-CC should be considered in hypovascular liver tumours with striking elevation of serum AFP and multiple regional lymphadenopathy.

Purpose: To report on fluoroscopically guided percutaneous gastrostomy (FPG) using a modified gastropexy technique with the insertion of a large‐bore balloon‐retained gastrostomy catheter in patients with head and neck tumors. Material and Methods: Thirty‐four patients with head and neck tumors underwent a modified gastropexy with two T‐fasteners followed by the insertion of a 14‐F balloon‐retained catheter through a peel‐away introducer. The success rate and the complications of the procedures were evaluated at 14 days, 30 days, and 60 days. The complications were classified as: major complications that necessitated intensive and/or surgical treatment; minor complications that could be treated conservatively; and tube‐related complications manageable by tube exchange. Results: FPG was technically successful in all cases. There were no major complications, two minor complications where superficial stoma infection was controlled by antibiotics, three minor tube‐related complications, all three easily managed by catheter replacement via the original tract. Conclusion: FPG with insertion of a large‐bore balloon‐retained catheter using a modified gastropexy technique is a safe and effective method that creates a feeding access for patients with head and neck tumors and esophageal obstruction. Minor complications can be managed conservatively. FPG may be a good alternative to surgical or percutaneous endoscopic gastrostomy.

Sonography is rarely used to evaluate the breasts in patients who have undergone liquid silicone injections for breast augmentation because strong acoustic shadowing from the resulting silicone granulomas hampers the examination. We report on 2 patients who underwent silicone injection 18 and 20 years earlier and in whom breast cancers (1 invasive ductal carcinoma and 1 carcinosarcoma) were diagnosed by sonographically guided core-needle biopsy. On sonograms, both cancers had a peripheral hypoechoic rim surrounding an echogenic center. The echogenic center corresponded histologically to a silicone granuloma in 1 patient and to a large area of necrosis in the other; the hypoechoic rims corresponded to areas of cancer in both patients.

We report a case of a fistula between a subphrenic abscess and a perforated duodenal ulcer diagnosed by sonography and confirmed by CT. The sonographic findings included a subphrenic fluid collection connected to the anterior aspect of the superior duodenum by a nonpulsatile, anechoic tubular lesion. Manual compression of the upper epigastrium resulted in movement of echogenic debris from the antrum and superior duodenum through the fistulous tract into the abscess.

18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) has proved to be valuable in the diagnosis and management of a variety of malignancies, but is still limited in providing detailed anatomical information. According to the literature, an adrenal incidentaloma with high FDG uptake usually indicates malignancy and requires further investigation. However, accurate localization of the adrenal gland in FDG-PET is difficult without the presence of surrounding well-visualized organs, such as the kidney or liver. If these organs have a congenital anomaly or are altered due to a previous operation, misdiagnosis can occur. We present a case with right partial duplex kidney accompanied by abnormal urine retention in the upper pole, which was misinterpreted as an adrenal incidentaloma in FDG-PET. A subsequent CT scan revealed a normal right adrenal gland, but a right partial duplex kidney. Fusion of the PET and CT images showed that the right adrenal lesion seen in the PET image corresponded to the upper pole of the duplex kidney.

Ultrasound is an effective means of detecting renal stones in patients with hydronephrosis. The filled urinary bladder in a normal person under hydration frequently results in the sonographic appearance of minimal or moderate hydronephrosis. For optimal visualization of stones and associated acoustic shadows, six patients with radiographically opaque renal stones were evaluated with fluid-loaded renal ultrasonography, which was compared to conventional renal sonogram in basal state. Although ultrasound in basal state can be used for detection of intrarenal lithiasis, fluid-challenged renal sonogram appears more accurate for the determination of contour, location, size, and number of small stones. In one case, this fluid-loaded ultrasound well demonstrated the tramline appearance of an isolated renal artery, which mimics stone before fluid challenge.

Summary The first case of gas-containing liver abscesses converting from total gas content to gas and fluid content is reported, and the clinical significance of such a conversion is emphasised. A 58-year-old diabetic woman suffered from fever and chill due to totally gas-containing liver abscesses shown by computerised tomography (CT). The patient did not recover despite ultrasound-guided aspiration of the abscess. CT carried out 2 weeks later revealed that the initial totally gas-containing liver abscesses converted to ones with gas and fluid content. The patient recovered after CT-guided drainage of the abscesses.

Hepatic lymphangioma is an extremely rare benign neoplasm that is usually associated with lymphangiomas of other viscera. We report a patient with huge, solitary hepatic lymphangioma involving only the liver. The clinical features and computed tomography findings of this case are described.

We report a case of thoracic sclerosing haemangioma with concomitant pulmonary and mediastinal involvement in a 19-year-old girl who presented with haemoptysis and dyspnoea. CT showed a large oval mass in the left lower lobe and another larger dumbbell-shaped mass in the posterior mediastinum. Both masses were well-defined and harboured punctate calcifications. They exhibited inhomogeneous contrast enhancement and contained some cystic areas. In addition, an air meniscus sign was present around the pulmonary lesion.

Kimura's disease is a rare chronic inflammatory disorder with a high rate of recurrence. The clinical and imaging features of Kimura's disease have been documented in the literature, but the relationship between these features and disease recurrence is still unclear. We conclude that disease duration of greater than 5 years, bilateral involvement, a lesion diameter of greater than 3 cm, a blood eosinophil count greater than 20%, and ill-defined lesions are predictive factors for the recurrence of Kimura's disease.

Background/Purpose To review the complications, mortality rate and nutritional status of patients with head and neck cancer after fluoroscopically guided percutaneous gastrostomy (FPG). Methods We retrospectively recruited 110 patients who had undergone FPG using 14-French balloon-retained catheters. The mortality rate, procedural and catheter-related complications, and Eastern Cooperative Oncology Group performance status were reviewed. Peritonitis, abscess, septicemia and bleeding were defined as major complications. Tube-related problems, including dislodgment, obstruction, leakage, vomiting and infection, were classified as minor complications. Results Patients were stratified according to Eastern Cooperative Oncology Group performance status as follows: grade 0 ( n =6); grade 1 ( n =22); grade 2 ( n =44); grade 3 ( n =29); and grade 4 ( n =7). The respective complication rates were 21%, 24%, 26%, and 29% for grades 1–4; however, there were no significant intergrade differences. The rates of major and minor complications were 1.9% and 20.0%, respectively. A total of 47 (43.5%) patients succumbed due to cancer deterioration; however, there was no gastrostomy-induced mortality. The catheter-occlusion rate of 3.7% in this cohort was significantly lower than that reported in other pigtail-retained gastrostomy studies. Conclusion FPG is a safe method with low mortality and complication rate for constructing long-term enteral access in patients with head and neck cancer and esophageal abnormalities, who have no endoscopic access to the stomach.

This study investigates adoption/use behavior within the context of Hong Kong Internet Banking services. A research framework based on the extended Technology Acceptance Model (TAM2) and Social Cognitive Theory is developed to identify factors that would influence the adoption and continue use of Internet Banking. Structural Equation Modeling (SEM) is employed to examine the entire pattern of inter-correlations among the eight proposed constructs, and to test related propositions empirically. A survey involving a total of 499 university students is conducted and confirmatory factor analysis used to determine the measurement efficacies. The results reveal that both subjective norm and computer self-efficacy indirectly play significant roles in influencing the intention to adopt Internet Banking. Perceived ease of use has a significant indirect effect on intention to adopt/use through perceived usefulness, while its direct effect on intention to adopt is not significant.

AIM: To evaluate the clinical outcome and cost-effectiveness of transcatheter arterial ethanol-lipiodol embolotherapy on hepatocellular carcinoma (HCC). METHODS: One hundred patients with HCC who were treated only by lobar or segmental transarterial embolization (TAE) with ethanol-lipiodol mixture were enrolled in this study. The 1st- and 2nd-year survival rates were analyzed to evaluate the feasibility of its method. These outcomes of our patients were individually correlated to the Child-Pugh classification and the computed tomographic features of HCC. RESULTS: The overall 1st- and 2nd-year survival rates were 72% and 46%, respectively. The patients were classified into three groups according to their liver function status: 68 patients as Child-Pugh class A, 26 as Child B, and 6 as Child C. Child A had better survival rate than the Child B and/or C. The 1st-year survival rates of patients with Child A-C were 84%, 50%, and 33.3% respectively and the 2nd-year survival rates were 55.5%, 28.5%, and 33.3%, respectively. According to the computed tomographic features, solitary HCC with maximum diameter less than 5 cm had the best outcome with the 1st-year survival rate of 100% and the 2nd-year survival rate of 71.4%, while solitary HCC with maximum diameter over 5 cm and multiple HCC had the 1st-year survival rates of 75% and 63.7%, respectively, and the 2nd-year survival rates of 33.3% and 44.4%, respectively. Only one patient was complicated with abscess formation and was cured with antibiotic therapy. No mortality resulted from the procedures performed. CONCLUSION: TAE with ethanol-lipiodol mixture is an economic, safe and feasible method for treating HCC, especially for the patients with smaller solitary HCC or with liver function status of Child-Pugh class A.

Angiomyolipoma of the liver or kidney is one of the clinical manifestations of tuberous sclerosis complex. However, concurrence of angiomyolipoma in both liver and kidney associated with tuberous sclerosis complex is a rare entity. Renal angiomyolipomas with large aneurysms confer a higher probability of rupture as compared to small aneurysms. Herein, we document a case of tuberous sclerosis coexisting with hepatic and renal angiomyolipoma in a 37 year-old woman who presented with an acute abdomen due to ruptured tumor. Computed tomography of the abdomen revealed multiple tumors over the bilateral kidneys and liver. A right nephrectomy was performed. During surgery, a liver biopsy was performed from which a preliminary diagnosis of necrosis was established. However, immunoreactivity staining using monoclonal antibody HMB-45 (Human Melanoma, Black) led to the final diagnosis of angiomyolipoma. We emphasized that pathologists and clinicians should be aware that cases of tuberous sclerosis complex may be associated with renal and hepatic angiomyolipoma. To avoid an inappropriate diagnosis, before diagnosing liver necrosis, immunohistochemical staining for HMB-45 is recommended.

BACKGROUND AND PURPOSE: An accurate diagnosis of a parotid gland mass is essential for adequate management. We determined the clinical efficacy of USCNB in diagnosing parotid gland masses by using cutting needles of different bores. METHODS: We reviewed records for 40 benign and 13 malignant parotid lesions. USCNB was performed by using 14–20-gauge needles (mean, 16.6 gauge) with one to five (mean, 2.43) passes and a 15-mm throw or specimen notch. Final diagnoses were established on the basis of surgicopathologic results in 31 cases, and on the basis of histopathologic analysis of biopsy specimens, clinical data, and/or imaging studies in 22, with a follow-up of 12.2–77.5 months (mean, 33.6 months). RESULTS: Compared with surgicopathology, USCNB had a sensitivity of 83%, a specificity of 100%, and an accuracy of 97% in providing specific tissue diagnoses and in differentiating malignant from benign masses. Its positive and negative predictive values were100% and 96%, respectively, in diagnosing malignancy. One patient (2%) had a local hematoma without sequela after surgical removal of a Warthin tumor. Core biopsy results were completely concordant with surgical findings in 30 (97%) of 31 cases. CONCLUSION: USCNB is a safe and efficient diagnostic procedure with an accuracy of 97% in the pathologic diagnosis of parotid masses. It can be performed in an outpatient clinic and enables specific tissue diagnosis to obviate intraoperative frozen biopsy and unnecessary surgery. An 18-gauge needle is sufficient for accurate and specific tissue diagnosis of parotid masses.

Stem cell markers are upregulated in various cancers and have potential as prognostic indicators. The objective of this study was to determine the expression of three stem cell markers, aldehyde dehydrogenase 1 (ALDH-1), B cell-specific Moloney murine leukemia virus integration site 1 (Bmi-1), and Nanog, in esophageal squamous cell carcinoma (ESCC) tissues. Immunohistochemistry was used to measure the expression of ALDH-1, Bmi-1, and Nanog in ESCC tissues from 41 patients who received pre-operative chemoradiation. We evaluated the relationship between expression of these markers, and clinicopathological features, tumor regression grade (TRG), and 5-year overall survival (OS). There were no significant associations of ALDH-1 or Bmi-1 expression with age, gender, clinical stage, and treatments (p>0.05). However, patients with Nanog-positive tumors were significantly older than those whose tumors were Nanog-negative (p = 0.033). TRG after treatment was significantly associated with expression of ALDH-1 (p = 0.001), Bmi-1 (p = 0.004), and Nanog (p

Results: Between December 2005 and April 2009, 112 eligible patients were enrolled. The median age was 55 (range, 25-88) years with the majority being males (81%). The predominant primary site and T and N staging were oropharynx 74%, T2 36% and N2 75% (N2b 38%). The median pre-treatment nodal size of the dominant node was 30mm (range, 11-90mm). Residual CT/MRI nodal abnormalities were present in 41 of the 103 (40%) patients with a neck negative PET (median size 15mm, range 10-40mm). All PET negative patients were observed and, with a median follow-up of 24 months (range, 9-60), the 2-year isolated regional failure rate for this group was 0% (95% CI 0-3.5%). of the 9 PET neck positive patients, 8 underwent a post-RT neck dissection with 3 subsequently experiencing an isolated regional failure. The 2-year isolated regional failure rate for the entire cohort was 2.5% (95% CI 0.6 -10.0%) with a neck dissection rate of 7%.

Choledochal cysts are congenital anomalies of the biliary ducts, characterized by cystic dilatation of the ducts. Prenatal diagnosis of this anomaly using ultrasonography (US) has been well documented. Magnetic resonance imaging (MRI) has recently become an important complement to US in prenatal diagnosis of fetal anomalies. We herein report a patient in whom at 24 wk’ gestation US suggested a right upper quadrant abdominal cyst and in whom at 26 wk’ gestation MRI more clearly delineated the cyst and its surrounding structures and suggested a choledochal cyst, which was confirmed at postnatal surgery and histopathology.

Background/Purpose Percutaneous cryotherapy has become a minimally invasive treatment option for unresectable lung malignancies. We report the experience and outcomes with percutaneous computed tomography (CT)-guided cryotherapy of primary lung malignancies, as well as recurrence and metastases, in patients ineligible for surgery. Methods The procedure was performed after administration of local anesthesia on 23 tumors in 19 patients (10 male and 9 female patients; mean age, 58.7 years). None of the patients were surgical candidates and underwent CT-guided percutaneous cryotherapy for treatment of the malignant mass in the lung. Visualization of low-attenuation ice ball formation was performed using CT scanning after each cycle of freezing and thawing therapy. Subsequent CT scans were scheduled at 3-month intervals post-procedure to assess tumor control. Results No lethal complication, major bleeding or bronchial damage was observed in any of the 23-cryotherapy sessions performed. Three patients developed pneumothorax and one patient required chest tube insertion. Thirteen tumors (56.5%) regressed, including two complete responses, five tumors (21.7%) were stationary and the remaining five tumors (21.7%) were found to be progressing at the 3-month follow-ups. No recurrence was found in the 11 regressed tumors for 6 months, and there was also no recunence in the two tumors that completely responded up to 12 months later with a satisfactory procedure. Conclusion Percutaneous cryotherapy for primary lung cancer, recurrence and metastatic lung tumors is feasible and safe for local control.