[Purpose] Blunt splenic trauma is primarily treated conservatively. Delayed hemorrhage is sporadically reported as a complication. We present our experience of blunt splenic trauma and discuss the management of associated pseudo aneurysms.
[Methods] Nineteen pediatric cases of blunt splenic trauma managed at our facility from 2005 to 2018 were examined. Age at the time of trauma; disease type; presence or absence of extravascular leakage, pseudoaneurysms, and multiple trauma; treatment; and outcomes were retrospectively collected from the medical records.
[Results] The median age at the time of trauma was 8.0 (4–14) years. Overall, two, three, one, and 13 patients had type I, II, IIIa, and IIIb disease, respectively. Multiple trauma and extravascular leakage were observed in four patients (21.1%). Six patients (31.6%) developed pseudoaneurysms. The treatments included nonoperative management (NOM) (14 patients [74%]), transarterial embolization (TAE) (four patients [21%]), and surgery (one patient [5%]). Regarding complications, one patient with pseudoaneurysm who underwent NOM developed delayed hemorrhage.
[Conclusion] The incidence of pseudoaneurysm due to splenic trauma is higher than that previously reported. We also observed delayed hemorrhage as a complication. We, therefore, emphasized the risk of rupture during conservative treatment and decided to perform TAE in principle for pseudoaneurysm at our hospital.

Purpose: Bevacizumab and gemcitabine are key drugs for treating platinum-resistant recurrent ovarian cancer (PROC) patients. We retrospectively investigated its efficacy and safety of the combination chemotherapy in PROC patients.
Methods: Twenty-one patients who were diagnosed with PROC at our hospital that had received a course of multidrug therapy with gemcitabine and bevacizumab between March 2016–March 2018 were analyzed. Therapeutic effects were evaluated in accordance with the RECIST guidelines (version 1.1).
Results: Five patients had a complete response (CR), 5 had a partial response (PR), 8 had stable disease (SD), and 2 had progressive disease (PD). The response rate (CR + PR) was 50%, and the disease-control rate was 90%. The median progression-free survival (PFS) was 6 months (5–11 months), and the median overall survival (OS) was 11 months (11–23 months). Grade 3/4 hematological toxicities included neutropenia (Grade 3: 4 patients and Grade 4: 4 patients), anemia (Grade 3: 4 patients and Grade 4: 1 patient) and thrombocytopenia (Grade 3: 2 patients). No febrile neutropenia occurred. Grade 3 non-hematological toxicities included thromboembolism (2 patients), hypertension (2 patients), and interstitial pneumonia (1 patient). No Grade ≥3 proteinuria or digestive tract perforation occurred.
Conclusions: The combination chemotherapy with gemcitabine and bevacizumab was feasible, effective and safe in PROC patients.

Objectives: Self-expandable metallic stent (SEMS) therapy for malignant colorectal strictures has been covered by the national insurance in Japan since 2012. There has been a gradual increase in the use of bridge to surgery (BTS), in which a stent is inserted for obstructive colorectal cancer to avoid emergency surgery, following which elective surgery is performed. SEMS reportedly reduces the rate of postoperative complications compared to emergency surgery. Malnutrition is also known to be a risk factor for postoperative complications, however, few reports have assessed nutritional status with respect to obstructive colorectal cancer. Therefore, we retrospectively investigated changes in nutritional status and colorectal cancer treatment outcomes in BTS patients following SEMS placement for obstructive colorectal cancer.
Methods: Subjects included 33 BTS patients who underwent nutritional assessment before and after SEMS placement for obstructive colorectal cancer at Kawasaki Municipal Tama Hospital between January 2012 and December 2018. The indicators of nutritional status were prealbumin (PA) and the prognostic nutritional index (PNI). In addition to nutritional status, patient background, SEMS outcome, and postoperative results of BTS were examined. Regarding the postoperative results of BTS, nutritional status was compared with and without postoperative complications.
Results: In the group with postoperative complications, before SEMS placement and after SEMS placement PA didn’t differ significantly (P=0.603); and after SEMS placement PNI was significantly lower than before SEMS placement PNI (P=0.014). On the contrary, in the group without postoperative complications, PA after SEMS placement was significantly higher than that before SEMS placement (P=0.008); and PNI didn’t increased after SEMS placement (P=0.205).
Conclusions: In BTS patients with SEMS for obstructive colorectal cancer, PA may be a useful indicator of postoperative complications. PA and PNI demonstrated different manifestations related to SEMS as a BTS use for obstructive colorectal cancer, and improvement of PA may be useful as a predictor of postoperative course.

[Background/Objective] To evaluate the efficacy and safety of transcatheter arterial embolization (TAE) around the pancreatic head, and identify the factors associated with clinical failure.
[Methods] We evaluated 41 patients (27 men, median age 67 years) who underwent TAE for arterial bleeding around the pancreatic head from April 2005 to May 2019 at St. Marianna University Hospital. Clinical success, technical success, rebleeding, complications (assessed using the Society of Interventional Radiology classification 2013), and laboratory data were evaluated. Univariate and multivariate analysis were performed to identify the factors associated with clinical failure.
[Results] The clinical and technical success rates were 70.7% (29/41) and 90.2% (37/41), respectively. A grade 4 complication (duodenal necrosis) occurred in a patient who was treated with N-butyl cyanoacrylate embolization. Compared with the clinical success group, the clinical failure group had a lower hemoglobin (P=0.0315), fibrinogen (P=0.0119), and platelet count (P=0.0103), and a longer prothrombin time-international normalized ratio (P=0.0036). In univariate analysis, the significant predictors of clinical failure were coagulopathy (odds ratio (OR) 14.4, 95% confidence interval (CI) 2.84–73.01), use of N-butyl cyanoacrylate (OR 5.25, 95% CI 1.23–22.39), and level of embolization (gastroduodenal artery) (OR 7.08, 95% CI 1.31–38.3). Multivariate analysis revealed coagulopathy as the significant predictor (OR 8.11, 95% CI 1.34–49.2).
[Conclusion] TAE is effective for managing bleeding around the pancreatic head. Although TAE is relatively safe, caution is required to avoid disastrous complications.

Background: Increased coagulation factor VIII (FVIII:C) activity is potentially associated with the pathogenesis of glucocorticoid (GC)-induced coagulopathy. However, the mechanism underlying the increase in FVIII:C activity remains unclear.
Objectives: We analyzed the changes in coagulation parameters, including FVIII and von Willebrand factor (VWF), in pediatric patients with immune thrombocytopenic purpura (ITP) treated with GC. The influence of GC treatment on mRNA expression of the FVIII (F8) and VWF (VWF) genes was examined in human liver sinusoidal endothelial cells (HLSEC/ciJ) and umbilical vein endothelial cells (EA. hy926).
Methods: Activated partial thromboplastin time (APTT) and levels of FVIII:C, FVIII antigen (FVIII:Ag), and VWF antigen (VWF:Ag) were compared before and after GC treatment in patients with ITP. Changes in F8 and VWF mRNA levels in HLSEC/ciJ and EA. hy926 cells before and after dexamethasone (DEX) treatment were quantified by reverse transcription polymerase chain reaction. Changes in FVIII protein levels were also evaluated in the lysates of DEX-treated HLSEC/ciJ cells.
Results: Values of APTT significantly decreased after GC treatment in ITP patients; significant increases in FVIII:C and FVIII:Ag levels were observed (p<0.05). Notably, no significant increase in VWF:Ag level was observed. F8 and VWF mRNA expressions in HLSEC/ciJ cells increased following DEX treatment (1 and 100 μM) (p<0.05), with the most significant increase seen in F8 mRNA levels (100 μM DEX; p<0.01). These increases were nullified by pretreatment with the GC receptor (GR) antagonist RU486. Additionally, VWF mRNA, but not F8 mRNA, expression increased after treating EA. hy926 cells with 1 μM DEX (p<0.05). No significant increase in FVIII protein level was observed in HLSEC/ciJ cells after treatment with 100 μM DEX.
Conclusions: Direct enhancement of mRNA levels of endogenous FVIII by GC via GR activation is, at least in part, a mechanism underlying the increase in FVIII levels during GC treatment.

Advanced osteoarthritis (OA) of the ankle is often accompanied by arthritic changes in the subtalar joint, and when arthrodesis is performed for ankle OA, the subtalar joint symptoms remain or even worsen. If the degree of subtalar cartilage degeneration can be quantified, prognosis can be predicted. T1ρ mapping has proven useful for identification of early cartilage degeneration. We hypothesized that T1ρ values of subtalar joint cartilage are higher (i.e., cartilage degeneration is greater) in patients with ankle OA without plain radiographic evidence of subtalar joint space narrowing and osteophytes than in healthy individuals. The T1ρ value of full thickness subtalar joint cartilage was measured on sagittal MR images obtained from 12 patients with ankle OA (3 with Takakura stage 3a disease and 9 with Takakura stage 3b disease) and from 12 healthy individuals. Imaging was performed with a 3.0 T MRI scanner, and PRIDE was used to construct T1ρ maps. A region of interest was set on the water-selective excitation image, which was projected onto the corresponding slice of the T1ρ mapping image to calculate the T1ρ value. The T1ρ value of the subtalar cartilage in patients with ankle OA (41.8 [39.8, 44.4] ms) did not differ significantly from that in healthy individuals (45.0 [37.0, 50.2] ms) (p=0.219 by Mann-Whitney U test). Our findings suggest that the T1ρ value of subtalar articular cartilage in patients with stage 3a or 3b ankle OA for whom conventional imaging reveals no OA changes does not differ significantly from that of healthy individuals.