S Wada

OBJECTIVE: We report the first study on the value of color Doppler ultrasonography (CDUS) in assessing arterial invasion of pancreatic cancer. METHODS: The relationships between tumors and surrounding major splanchnic arteries (celiac, superior mesenteric, common hepatic, splenic, and gastroduodenal arteries) were preoperatively evaluated with CDUS in 33 consecutive patients with pancreatic cancer. When a tumor partially or completely surrounded the artery, the invasion was diagnosed as positive. Imaging results were then compared with angiographic, surgical, and histopathological findings. RESULTS: In 22 nonsurgical patients, the correspondence rate of CDUS with angiography for the presence of invasion, absence of invasion, and overall was 78%, 95%, and 88%, respectively. In 11 surgical patients, a sensitivity of 60%, specificity of 93%, and accuracy of 87% for detection of arterial invasion were obtained in comparing CDUS with surgical and histopathological findings. There was no significant difference between the accuracy of CDUS and that of CT, or that of angiography. However, the accuracy of CDUS was higher than that of CT (72%) and equal to that of angiography (91%). CONCLUSION: Color Doppler ultrasonography is useful for detecting arterial invasion in pancreatic cancer. It may make angiography unnecessary, especially with advanced tumors, if thorough evaluation for the large artery invasion is performed initially.

BACKGROUND AND OBJECTIVES: LDL apheresis is used to treat patients with familial hypercholesterolaemia, and low-volume plasmapheresis for plasma donation may similarly lower cholesterol levels in some donors. This study was designed to assess the effect of plasmapheresis on total, LDL and HDL cholesterol levels in a plasma donor population. MATERIALS AND METHODS: This was a prospective, unblinded longitudinal cohort study in which a blood sample was obtained for analysis before each donation. Data from 663 donors were analysed using a multivariable repeated measures regression model with a general estimating equations approach with changes in cholesterol as the primary outcome measure. RESULTS: The model predicted a significant decrease in total and LDL cholesterol for both genders and all baseline cholesterol levels (P < 0.01). The greatest total cholesterol decreases (women, -46.8 mg/dL; men, -32.2 mg/dL) were associated with high baseline levels and 2-4 days between donations. Small but statistically significant increases (P ≤ 0.01) in HDL cholesterol were predicted for donors with low baseline levels. CONCLUSIONS: These results suggest that, in donors with elevated baseline cholesterol levels, total and LDL cholesterol levels may decrease during routine voluntary plasmapheresis.

BACKGROUND AND OBJECTIVES: Donor plasmapheresis involves the removal of a weight-adjusted volume of plasma and the return of cellular components to the donor. Although plasma volume generally returns to normal, some residual effect on vital signs may be possible. This analysis was performed to determine the possible effects of plasmapheresis on blood pressure. MATERIALS AND METHODS: A 16-week study was conducted to evaluate the effects of plasma donations on cholesterol levels in healthy donors. From this study, the vital signs obtained prior to donation were analysed using statistical and dynamic analytical predictive models. RESULTS: Preliminary analyses revealed a change in systolic and diastolic blood pressure from the corresponding baseline values (Pearson Coefficient -0.44 and -0.47, respectively). Statistical models predicted a marked decrease in systolic and diastolic blood pressure following multiple donations in donors with baseline pressure in the Stage 2 hypertension range with less pronounced decreases predicted in Stage 1 donors. Little or no change in blood pressure was predicted in donors with baseline normal blood pressure or prehypertension. Dynamic models including time between donations supported these results and predicted a recovery period of about 14 days without donation in donors with Stage 2 baseline levels. CONCLUSIONS: Results suggest that systolic and diastolic blood pressure may be decreased following plasmapheresis used for plasma donations at intervals of <14 days in donors with high baseline blood pressure levels.

This case report deals with transverse sinus thrombosis accompanied by intracerebellar hemorrhage. A 33-year-old woman had sudden onset of headache, vomiting, and disturbance of consciousness. Computed Tomography (CT) scan showed left intracerebellar hematoma, while vertebral angiography revealed no visualization of the transverse sinus and cerebellar cortical veins on the left side. Evacuation of the intracerebellar hematoma along with decompression of the posterior fossa was carried out. Findings of the histopathological examination of the operation specimen showed the cortical veins to be filled with fresh thrombus and softened cerebellar parenchyma mixed with many small clots. Until now, cases such as hemorrhagic infarction in the cerebellum, due to transverse sinus thrombosis have not yet been reported. It is considered that there is much more collateral circulation in the infratentorial region rather than in the supratentorial region. This indicates that cerebellum hemorrhagic infarction rarely occurs due to transverse sinus thrombosis. In our case, the inflammation of the cortical veins (thrombophlebitis) was thought to have disturbed the collateral circulation in the cerebellum.