Diagnostic imaging modalities have evolved significantly with the development of iodine-containing X-ray contrast media and gadolinium-based MRI contrast agents. Gadolinium-containing contrast media are widely employed as a contrast agent for MRI and have been generally considered to be safe. Nephrogenic systemic fibrosis has been reported as a severe progressive disorder related to the administration of gadolinium-chelate agents in patients with renal insufficiency, since 2006. NSF causes fibrosis of the skin and connective tissue throughout the body. The exact pathophysiolosy of NSF remains uncertain and no clearly effective therapies exist for NSF so far. Since 2007, the FDA has asked manufactures to include a boxed warning on the product labeling of all gadolinium-based MR contrast agents. In this article, we introduce the nephrogenic systemic fibrosis in addition to iodine-containing contrast induced nephropathy.

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Purpose: We investigated whether reorganization in the department of surgery, Nihon University School of Medicine was effective from the perspective of the division of breast and endocrine surgery. Material and methods: We compared the average number of operative cases, the average breast conservation rate, the average number of operative cases, the average number of breast conserving rate, the average number of out patients, the average number of first examination patients, the annual average introduction rate, the average number of inpatients, the average total number of out patients, the average total number of inpatients, the average income per patient in the outpatient department, the average income per patient in the inpatient department, and the total amount of medical care emergence for only breast and endocrine diseases between the period four years before reorganization and four years after reorganization. Results: The postreorganization group increased significantly compared with the pre-reorganization group regarding the average number of operative cases, the average rate of breast conservation the average number of out patients, the average number of first examinations, the average total number of out patients per year, the average income per patient in the outpatient department, and the total amount of medical care emergence. Conclusion: These results suggested that reorganization of the department of surgery was effective to obtain new patients with breast and endocrine diseases.

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The use of MDCT angiography has increased for the evaluation after PCI or CABG. This study sought to evaluate the diagnostic accuracy of CABG graft patency. Subjects and methods: The subjects were 32 post-CABG patients who had undergone CT and CAG at the same time for graft evaluation [anastomotic sites, 110]. The findings were rated by using 2 levels, satisfactory patency and obstruction, and were compared against the imaging of CAG. Results: According to CT, patency was rated as satisfactory in 90 and obstructed in 20. CAG was rated as satisfactory patency in 96 and obstructed in 14. The sensitivity, specificity, and positive and negative predictive values were 100%, 93.6%, 70.0% and 100%, respectively. Conclusion: The evaluation of bypass graft after CABG by MDCT is simple and effective because of its high negative predictive value. However, it is associated with a high false positive rate in low flow ITA. It must be used carefully in the evaluation of low flow ITA.

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A 74-year-old woman who had a history of B-II gastrectomy at the age of 32 was admitted to our hospital with severe vomiting. Abdominal CT and gastrograffin enema examination were consistent with ultrasonography and showed complete obstruction due to intussusception, which was compatible with a submucosal tumor at the jejunum on the anal side of the anastomosis in gastric fiberscopy. She underwent laparotomy, which showed retrograde intussusception caused by a submucosal tumor. The histological findings were consistent with lipoma.

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We report a case of carcinoid tumor of the breast. A 50-year-old woman was admitted to our hospital because she had a palpable tumor of 2.0 cm in diameter in her right breast. The tumor was located at the upper-outer quadrant of her right breast. Mammography showed a focal asymmetric density (FAD) in the middle of her right breast. Ultrasonography demonstrated a heterogeneous and low-echoic mass with an ill-defined margin. The cytologic diagnosis was class IIIa by fine-needle aspiration cytology. We could not rule out a malignant tumor. The patient underwent tumorectomy for diagnosis. The histlogical features of the tumor were consistent with a carcinoid-like apperance. Immunohistochemical study was performed. The diagnosis of the tumor was carcinoid tumor of the breast. The patient underwent additional ipsilateral axillary lymph node dissection.

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We report a case of a 77-year-old woman who underwent mastectomy for breast cancer 2 years ago. She was admitted with abdominal pain. Abdominal X-ray and computed tomography showed a free air space, suggesting a perforation that necessitated emergency surgery. During the operation, one site of perforation was localized on the small intestine near by two tumors. We resected each area of the small intestine including the tumors. The two intestinal tumors were diagnosed as metastatic intestinal tumor from breast cancer based on pathological findings. Ninety-one days after the operation, the patient died because of dissemination of the carcinomatosis. It is important to pay attention to metastatic intestinal tumor in patients who have had breast cancer.

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This was a case of a 60-year-old man who was negative for hepatitis-B and -C and exhibited alcoholic cirrhosis syndromes. He was transported due to solitary rapture of gastric varices. Initially, the bleeding was prevented by an emergency endoscopy and his life was saved. We decided that balloon-occluded retrograde transvenous obliteration (B-RTO) was effective because stomach-renal shunt was described by MRA. The state of liver cirrhosis was Child-Pugh B, and liver damage was B in the cirrhosis classification and the hepatocellular carcinoma was complicated (liver S4 frequent occurrence and Stage 2). We allowed the patient to eat early on and treated him with branched-chain amino acids (BCAA) and zinc to stabilize the liver spare function after stopping bleeding. We then selected transcatheter arterial chemo-embolization (TACE) to treat the HCC after we cured the gastric varices by B-RTO. Since the initial treatment was performed and more than one year has been passed, gastric varices continued to disappear, the liver cirrhosis remains stable, and the HCC has been completely responsive.

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Herein, we report a 6-year-old girl who developed Posterior Reversible Encephalopathy Syndrome (PRES) after stem cell transplantation (SCT) for severe aplastic anemia. She had received Cyclosporine A (CsA) for prophylaxis of graft versus host disease (GVHD). On day 22 after transplantation, she experienced generalized seizure and consciousness disturbance. Prior to the onset, she exhibited hypertension, oliguria and headache. Brain MRI showed abnormal, bilateral high-intensity areas in the parieto-occipital white matter lesions on T2-weighted images and fluid-attenuated inversion recovery (FLAIR) images. We diagnosed her as PRES. CsA was immediately withdrawn, and her condition improved. Thereafter, She developed grade III acute GVHD, which was treated with tacrolimus with no adverse effects. This case suggests that if symptoms, such as headache and hypertension, appear with the use of CsA, it is important to examine head MRI at an early stage and to consider the possible presence of PRES.

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