The purpose of this retrospective study was to better understand the outcome of gamma knife radiosurgery in patients with idiopathic trigeminal neuralgia. Between April 2003 and August 2009, 35 patients with idiopathic trigeminal neuralgia in whom medication with carbamazepin was not effective were treated with gamma knife raidosurgery for the first time at Aizawa Hospital. Of these 35 patients, 12 were men and 23 were women. The median age was 69.8 years (range 46-86 years). Pain was predominantly distributed in the V2 and V3 divisions. Under local anesthesia, all radiosurgical procedures were performed with the aid of Gamma Unit Model B, and stereotactic MR imaging (heavy T2 and time-of-flight) was performed to identify the trigeminal nerve. A single 4-mm isocenter was used in all patients, and the target was placed between the root entry zone and retrogasserian region. The central radiation dose was 80 Gy or 85 Gy. The median follow-up period was 45.6 months (range 13-90 months). Complete pain relief with or without medication was achieved in 75.8% at 1 year, 68% at 2 years, 64.7% at 3 years, 57.1% at 4 years, and 55.6% at 5 years. Pain relief was not achieved at all in a patient whose trigeminal nerve was difficult to identify. One patient, who was treated with a central dose of 85 Gy, complained of bothersome facial numbness. Although the long-term results of pain relief remain unknown and gamma knife radiosurgery should be performed in carefully selected patients, the results of this study suggest that gamma knife radiosurgery is a safe and effective treatment for idiopathic refractory trigeminal neuralgia.
We report two cases of gastric tube carcinoma (GTC) treated with endoscopic submucosal dissection (ESD) after esophagectomy. Case 1 was a 47-year-old woman who had received esophagectomy with reconstruction of the gastric tube (GT) for esophageal squamous cell carcinoma. Sixty-seven months later, endoscopy showed a carcinoma in the lower part of the GT. The removed tumor showed a 0-IIc lesion, 10mm in diameter, diagnosed as a signet ring cell carcinoma limited to the mucosa. Case 2 was an 83-year-old woman who simultaneously underwent lower esophagectomy for basaloid-squamous cell carcinoma of the esophagus and colectomy for ascending colon carcinoma. Sixty-one months later, endoscopy showed a carcinoma in the middle part of the GT. The tumor removed by ESD showed a 0-IIa+IIc lesion, 50mm in diameter, diagnosed as a moderately differentiated tubular adenocarcinoma limited to the mucosa. The clinicopathologic features of 48 Japanese cases, including Cases 1 and 2, with GTC were reviewed. An extended indication of endoscopic resection for gastric carcinoma was present in 12 (25%) including Cases 1 and 2. In conclusion, ESD may be safe for GTC ; however, further investigations may be necessary to confirm the safety and curative potential of ESD for GTC.
We experienced a case of minimal thyroid carcinoma diagnosed by a solitary pulmonary nodule. A 70-year-old woman visited a medical practitioner because of a cough, and was referred to our hospital due to an abnormality on the chest X-ray. Chest computed tomography (CT) showed a small nodule in the right upper lobe (S3). Because the nodule was diagnosed as adenocarcinoma by aspiration biopsy cytology during surgery, a right upper and middle lobe lobectomy was perfomed. The nodule in the right lung was diagnosed as metastasis from a thyroid carcinoma by histopathology, and subtotal thyroidectomy and neck dissection (D2a) were therefore perfomed two months later. There was micropapillary carcinoma of 8mm, 5mm and 3mm in the thyroid gland, but there was no cervical lymph node metastasis. There has been no recurrence so far.
Endovascular treatment of calcified and occluded lesions remains a challenge. Dense calcifications in occlusive lesions hinder the advancement of guidewires, angioplasty balloon catheters, and stenting. We present a technique of piercing calcifications in a patient with chronic total occlusion (CTO) of the superficial femoral artery (SFA) using a Brockenbrough needle. The case was a 79-year-old man with resting pain in the left leg for a month. The ankle-brachial index in his left lower limb was 0.45. Duplex scanning and angiography revealed complete occlusion of the proximal left SFA. Endovascular treatment for the recanalization of the SFA-CTO was carried out using the bidirectional approach. Only the coronary CTO wire was able to cross the lesion, with the balloon catheters failing to cross. To widen the crossing site, a Brockenbrough needle was applied to penetrate the lesion. The needle successfully passed the lesion, and balloon passage was possible. Following predilatation, we deployed two Nitinol self-expandable stents. We confirmed the patency of this lesion with duplex sonography and angiogram 18 months later.