WileyActa Medica Okayama0915-56353232020Efficacy and safety of scheduled early endoscopic ultrasonography]guided ethanol reinjection for patients with pancreatic neuroendocrine tumors: Prospective pilot study425430ENKazuyukiMatsumotoDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesHironariKatoDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesSeijiKawanoDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesHiroyasuFujiwaraDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesKenjiNishidaDepartment of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesRyoHaradaDepartment of Gastroenterology, Japanese Red Cross Okayama HospitalMasakuniFujii Department of Internal Medicine, Okayama Saiseikai General HospitalRyuichiYoshidaDepartment of Gastroenterological Surgery, Transplant and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesYuzoUmedaDepartment of Gastroenterological Surgery, Transplant and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesShiroHinotsuCenter for Innovative Clinical Medicine, Okayama University HospitalTakahitoYagi Department of Gastroenterological Surgery, Transplant and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesHiroyukiOkadaDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesEndoscopic ultrasonography (EUS)]guided ethanol injection was recently proposed for treatment of patients with small pancreatic neuroendocrine tumors (p]NET); however, tips on how to carry out safe and effective procedures are unclear. We launched a pilot study for scheduled early EUS]guided ethanol reinjection for small p]NET. Major eligibility criteria were presence of pathologically diagnosed grade (G) 1 or G2, tumor size ≤2 cm and being a poor or rejected candidate for surgery. For the treatment, we used a 25]gauge needle and pure ethanol. Contrast]enhanced computed tomography (CE]CT) was carried out on postoperative day 3, and if enhanced areas of the tumor were still apparent, an additional session was scheduled during the same hospitalization period. Primary endpoint was complete ablation rate at 1 month after treatment, and secondary endpoint was procedure]related adverse events. A total of five patients were treated. Median size of the tumor was 10 (range: 7–14) mm. Of the five patients, three underwent an additional session. Median volume of ethanol injection per session was 0.8 (range: 0.3–1.0) mL, and the total was 1.0 (0.9–1.8) mL. Complete ablation was achieved in four of the five tumors (80%) with no adverse events. During 1 year of follow up, none of the patients reported any procedure]related adverse events, and no recurrence of tumor. Scheduled early EUS]guided ethanol reinjection appears to be safe and effective for treating small p]NET (UMIN number: 000018834).No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7062016Acute Bowel Injury due to Cryoablation for Renal Cell Carcinoma: Correlated Radiologic and Pathologic Findings511514ENHideoGobaraDepartment of Radiology,Okayama University HospitalTakaoHirakiDepartment of Radiology,Okayama University HospitalToshihiroIguchiDepartment of Radiology,Okayama University HospitalHiroyasuFujiwaraDepartment of Radiology,Okayama University HospitalTakeshiNagasakaDepartment of Gastroenterological Surgery, Okayama University HospitalHiroyukiKishimotoDepartment of Gastroenterological Surgery, Okayama University HospitalTakehiroTanakaDepartment of Pathology, Okayama University HospitalSusumuKanazawaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceCase Report10.18926/AMO/54817An 87-year-old Japanese man underwent percutaneous cryoablation (PCA) therapy for his renal cell tumor. We displaced the colon from the tumor using hydrodissection. Computed tomography (CT) immediately after PCA was indicative of iceball extension to the colon wall, and a discontinuous enhancement of the colon wall was observed. We therefore performed an emergency surgery. On laparotomy, we observed a dark-purple area on the affected area of the colon, and the resected specimen showed focal, deep ulceration on the mucosal surface. Photomicrography revealed mucosal necrosis, submucosal hemorrhage, and necrotic foci in the muscularis propria, corresponding to the discontinuous colon wall enhancement on CT and the deep ulceration and dark-purple area on laparotomy. He recovered from surgery and was discharged without any complications.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7042016Single Center Prospective Phase II Trial of CT-guided Radiofrequency Ablation for Pulmonary Metastases from Colorectal Cancer (SCIRO-1401)317321ENJunSakuraiCenter for Innovative Clinical Medicine, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Okayama University HospitalTakaoHirakiDepartment of Radiology, Okayama University HospitalToshihiroIguchiDepartment of Radiology, Okayama University HospitalHiroyasuFujiwaraDepartment of Radiology, Okayama University HospitalHideoGobaraDepartment of Radiology, Okayama University HospitalToshiharuMitsuhashiCenter for Innovative Clinical Medicine, Okayama University HospitalTakeshiNagasakaDepartment of Gastroenterological Surgery Transplant and Surgical Oncology, Okayama University HospitalSusumu KanazawaSusumu KanazawaDepartment of Radiology, Okayama University HospitalClinical Study Protocols10.18926/AMO/54512The present single center prospective phase II clinical trial is designed to evaluate the efficacy and safety of percutaneous radiofrequency (RF) ablation for colorectal lung metastases. Patients who have colorectal lung metastases without extrapulmonary metastases are included in this study. The primary endpoint is 3-year overall survival (OS) after RF ablation. The secondary endpoints are the prevalence of adverse events within 4 weeks, local tumor progression rate, 1- and 5-year OS, cause-specific survival, and relapse-free survival. The recruitment of patients commenced in July 2014, and the enrolment of 45 patients is intended over the 3 years of study period.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7042016Safety of Percutaneous Cryoablation in Patients with Painful Bone and Soft Tissue Tumors: A Single Center Prospective Study (SCIRO-1502)303306ENToshihiroIguchiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesJunSakuraiCenter for Innovative Clinical Medicine, Okayama University HospitalTakaoHirakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHideoGobaraDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHiroyasuFujiwaraDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYusukeMatsuiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYoshihisaMasaokaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSusumuKanazawaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesClinical Study Protocols10.18926/AMO/54509This single center prospective study is being conducted to evaluate the safety of the cryoablation for patients with pathologically diagnosed painful bone and soft tissue tumors. Enrollment of 10 patients is planned over the 3-year recruitment period. Patients have related local pain after receiving medications or external radiation therapies will be included in this study. Cryoablation will be percutaneously performed under imaging guidance, and a temperature sensor will be used during treatment as necessary. The primary endpoint is prevalence of severe adverse events within 4 weeks after therapy. The secondary endpoint is effectiveness 4 weeks after the procedure.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7032016Computed Tomography-guided Radiofrequency Ablation for Subdiaphragm Hepatocellular Carcinoma: Safety and Efficacy of Inducing an Artificial Pneumothorax189195ENHiroyasuFujiwaraDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceYasuakiAraiDiagnostic Radiology Division, National Cancer Center HospitalHiroakiIshiiDiagnostic Radiology Division, National Cancer Center HospitalSusumuKanazawaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOriginal Article10.18926/AMO/54418We retrospectively evaluated the safety and efficacy of artificial pneumothorax induction to perform computed tomography (CT)-guided radiofrequency ablation (RFA) for sub-diaphragm hepatocellular carcinomas (HCCs). From June 2008 to October 2010 at our institution, 19 HCCs (16 patients) were treated using CT-guided RFA after artificial pneumothorax induction. A 23-G needle was inserted into the liver surface at a site of 2 connected pleurae without lung tissue. After a small amount of air was injected, the pleural space widened, creating a small pneumothorax. Additional air was insufflated via a newly inserted 18-G cannula to raise the lung away from the planned puncture line for RFA. The electrode was then advanced transthoracically. Ablation was performed using a cool-tip electrode with manual impedance control mode. The injected air was then aspirated as much as possible. Artificial pneumothorax was successfully induced in all cases. The average total volume of injected air in each case was 238ml. No artificial pneumothorax-related complication occurred; lung injury occurred in one case during RF electrode insertion. No local progression occurred during follow-up. Recurring HCCs were observed in eight patients. Artificial pneumothorax induction is safe and effective for CT-guided RFA of sub-diaphragm HCCs, which are difficult to locate on US.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6852014Prompt Resolution of Hypoglycemia by Hepatic Transarterial Embolization for Malignant Insulinoma with Multiple Liver Metastases307311ENShinichiroMuroJunichiroNasuRyoHaradaMinoruMatsubaraAsukaNakaraiHiromitsuKanzakiKouichiroTsutsumiHironariKatoTakehiroTanakaHiroyasuFujiwaraMasatoshiUnoHiroyukiOkadaKazuhideYamamotoCase Report10.18926/AMO/52900A 45-year-old female who presented with loss of consciousness and a cold sweat was found to have a pancreatic tumor and multiple liver metastases. Laboratory studies showed marked hypoglycemia and inappropriately elevated serum insulin, C-peptide, and serum tumor markers. Fine needle aspiration revealed Grade 3 small-cell type primary pancreatic neuroendocrine carcinoma. Consequently, the diagnosis of malignant insulinoma was made. Transarterial embolization (TAE) for hepatic metastases resulted in the reduction of tumor volume and prompt resolution of hypoglycemic attacks, whereas diazoxide and systemic chemotherapy had been ineffective for controlling blood glucose levels, and octreotide was unavailable due to the allergic effect. This case report highlights the potential usefulness of TAE for malignant insulinomas in the management of hypoglycemia.No potential conflict of interest relevant to this article was reported.