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Van Linh Ho,1 Nhu Hien Pham,2 Thanh Xuan Nguyen,2 An Phong Tran,1 Nhu Thanh Dang,3 Nhu Hiep Pham1 1Digestive Surgery Department, Hue Central Hospital, Hue City, Vietnam; 2Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue City, Vietnam; 3Surgery Department, Hue University of Medicine and Pharmacy, Hue City, VietnamCorrespondence: Thanh Xuan NguyenDepartment of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, 16 Le Loi Street, Hue City, VietnamTel +84945313999Email thanhxuanbvh@hotmail.comObjective: This study aims to explore the short-term results of hepatectomy with Takasaki’s technique using Sonastar ultrasonic aspiration system.Materials and Methods: We retrospectively examined data of 58 patients who underwent hepatectomy with Takasaki’s technique using Sonastar ultrasonic aspiration system at Hue Central Hospital from 01/2018 to 02/2021.Results: The mean age was 60.7 ± 10.5 years (25– 80) and the male/female ratio was 6:1. Patients with solitary tumor accounted for 79%; 68.4% had tumor size greater than 5 cm. Pringle maneuver was used in 57.9%, while selective right or left Glissonean pedicle occlusion was used in 69.0% and 32.8%, respectively. Final transection surface reinforcement was achieved by Surgicel and BioGlue in 78.9% and 21.5% of cases, respectively. Major liver resection accounted for 73.7%. The mean parenchymal transection time was 50 (45– 110) minutes, while mean total operative time was 125 (90– 280) minutes. Mean operative blood loss was 250 (150– 650) mL. Mean post-operative hospital stay was 8 days (7– 23). Post-operative complication rate was 15.9% and mortality rate was 1.7%.Conclusion: Hepatectomy using Takasaki technique with Sonastar ultrasonic aspiration system is safe, effective, allowing an anatomical resection with sufficient safety margin and resulting in low complication rates (liver failure, biliary leakage) and good survival outcomes.Keywords: liver tumor, SonaStar, Takasaki’s technique

Malakoplakia is a rare, granulomatous disease that affects a wide variety of organs and can have a clinical and radiographic presentation resembling that of malignancy. The genitourinary tract is the most commonly involved site. There are scant reported cases presenting as a locally advanced renal mass and even rarer, diagnosed by fine-needle aspiration (FNA) cytology. We report clinical, imaging, cytologic, and histological findings of an interesting case of malakoplakia initially diagnosed by FNA cytology. We also briefly review the literature and emphasize the importance of recognizing this entity when encountered in an aspirate material, which can help mitigate the diagnostic confusion of malakoplakia for clinicians.

Sirtuin-3 (Sirt3) is an essential metabolic regulatory enzyme that plays an important role in mitochondrial metabolism, but its role in bone marrow and skeletal homeostasis remains largely unknown. In this study, we hypothesize that increased expression of Sirt3 plays a role in skeletal aging. Using mice that overexpress Sirt3 [i.e., Sirt3 transgenic (Sirt3Tg)], we show that Sirt3 is a positive regulator of adipogenesis and osteoclastogenesis and a negative regulator of skeletal homeostasis. Sirt3Tg mice exhibited more adipocytes in the tibia compared with control mice. Bone marrow stromal cells (BMSCs) from Sirt3Tg mice displayed an enhanced ability to differentiate into adipocytes compared with control BMSCs. We found a 2.5-fold increase in the number of osteoclasts on the bone surface in Sirt3Tg mice compared with control mice (P < 0.03), and increased osteoclastogenesis in vitro. Importantly, Sirt3 activates the mechanistic target of rapamycin (mTOR) pathway to regulate osteoclastogenesis. Sirt3Tg male mice exhibited a significant reduction in cortical thickness at the tibiofibular junction (P < 0.05). In summary, Sirt3 activity in bone marrow cells is associated with increased adipogenesis, increased osteoclastogenesis through activation of mTOR signaling, and reduced bone mass. Interestingly, Sirt3 expression in bone marrow cells increases during aging, suggesting that Sirt3 promotes age-related adipogenesis and osteoclastogenesis associated with bone loss. These findings identify Sirt3 as an important regulator of adipogenesis and skeletal homeostasis in vivo and identify Sirt3 as a potential target for the treatment of osteoporosis.

Objectives: Studies suggest that rheumatoid arthritis (RA)-related autoimmunity is initiated at a mucosal site. However, the factors associated with the mucosal generation of this autoimmunity are unknown, especially in individuals who are at-risk for future RA. Therefore, we tested anti-cyclic citrullinated peptide (anti-CCP) antibodies in the sputum of RA-free first-degree relatives (FDRs) of RA patients and patients with classifiable RA. Methods: We evaluated induced sputum and serum from 67 FDRs and 20 RA subjects for anti-CCP-IgA and anti-CCP-IgG, with cut-off levels for positivity determined in a control population. Sputum was also evaluated for cell counts, neutrophil extracellular traps (NETs) using sandwich ELISAs for protein/nucleic acid complexes, and total citrulline. Results: Sputum anti-CCP-IgA and/or anti-CCP-IgG was positive in 17/67 (25%) FDRs and 14/20 (70%) RA subjects, including a portion of FDRs who were serum anti-CCP negative. In FDRs, elevations of sputum anti-CCP-IgA and anti-CCP-IgG were associated with elevated sputum cell counts and levels of NET complexes. Anti-CCP-IgA was associated with ever-smoking and elevated sputum citrulline levels. Conclusions: Anti-CCP is elevated in the sputum of FDRs, including seronegative FDRs, suggesting the lung may be one site of anti-CCP generation in this population. The association of anti-CCP with elevated cell counts and NET levels in FDRs supports a hypothesis that local airway inflammation and NET formation may drive anti-CCP production in the lung and may promote the early stages of RA development. Longitudinal studies are needed to follow the evolution of these processes relative to the development of systemic autoimmunity and articular RA. This article is protected by copyright. All rights reserved.

Aim: To evaluated the feasibility and initial outcomes application of laparoscopic rectocolectomy with specimen retrieval through natural orifices specimen extraction (N.O.S.E). Material and Method: Prospective, retrospective study in 20 patients were diagnosted sigmoid and rectal cancer and underwent laparoscopic anterior resection, low anterior resection with specimen retrieval through natural orifices specimen extraction (N.O.S.E) at Hue Central Hospital from 2011 to 2013. Results: All cases were successfully performed by laparoscopy. There was no complications during and after operation. Patients felt less pain, had early bowel movement and early discharge from hospital. Conclusions:Our initial experiences showed that laparoscopic surgery with specimen retrieval through natural orifices is feasible. It has full advantages of laparoscopic colectomy otherwise, it prevents an abdominal incision for specimen retrieval. Patient has less pain and short hospitalization. There will be a need for a larger cases study with longer follow-up time to further evaluate the outcome of this method, espencially in oncology. Keywords: colorectal laparoscopic surgery, specimen retrieval transanal.

Objective: To research the indications, methods and access the outcomes of thoracoscopic esophagectomy for intrathoracic esophageal cancer. Methods: From 2009 to 2011, 71 patients of intrathoracic esophageal cancer underwent thoracoscopic esophagectomy at Digestif Surgery Department of Hue Central Hospital. Upper third: 13 cases, middle third: 41 cases and lower third: 17 cases. T3,N1 was found with the highest percentage. Results: Ratio male/female is 69/2, mean age: 63, no case of open conversion, 2 cases broncheal rupture, 6 cases anastomotic leak, 12 cases pneumonia (1 case to be death). Conclusion: Thoracoscopic esophagectomy for esophageal cancer is a a feasible and safe procedure with perioperative complication are acceptable. However, let is a long-term research to evaluate the oncology effection.

We report PET/CT appearance of bilateral ovarian metastases in a 63-year-old female patient with newly diagnosed poorly differentiated adenocarcinoma of the stomach. She was also found to have peritoneal metastasis on an outside CT study. Staging PET/CT demonstrates not only the hypermetabolic gastric primary tumor and peritoneal disease but also bilateral enlarged, moderately active ovaries. The patient subsequently underwent biopsies of bilateral ovaries which revealed metastatic disease from primary gastric carcinoma. It is important to consider this form of neoplasm in the differential diagnosis because the treatment and prognosis will be different from a dyssynchronous primary tumor.

We report 2 separate cases with significant head motion causing apparent hypometabolic and hypermetabolic cerebral activity on FDG PET/CT. Case 1 is a 57-year-old man with facial numbness status post chemotherapy for mantle cell lymphoma. Restaging attenuation-corrected PET showed increased left frontal region activity, whereas nonattenuation-corrected PET demonstrated evidence of patient motion with normal physiologic left frontal cortical activity. Case 2 is a 78-year-old man with history of malignant melanoma. Attenuation-corrected PET/CT demonstrated diffusely decreased activity in the left cerebral hemisphere, whereas nonattenuation-corrected PET showed significant head motion with intact cortical activity.

We report the PET/CT appearance of metastasis from primary renal cancer to the thyroid in a 52-year-old man with a history of right renal cell carcinoma, status postright nephrectomy, recently presented biopsied-proven metastatic lesion in his left thyroid lobe. Restaging PET/CT study demonstrates a 1.4 × 0.9 cm hypodense, moderately active lesion in the left thyroid lobe with a maximum SUV of 2.8. No other abnormal hypermetabolic lesion is seen in the right renal surgical bed or the remaining body. The patient has subsequently treated with Sutent (Sunitinib).

We report the PET-CT appearance of Zoledronate-related osteonecrosis of the mandible in a 54-year-old woman with right breast cancer with osseous and pulmonary metastases. Her treatment included surgery, chemotherapy and Zoledronate, and external beam radiation treatment. During the course of treatment, the patient developed osteonecrosis of the jaw secondary to Zoledronate, which was biopsy-proven, for which Zoledronate was discontinued shortly after. Hybrid PET-CT was performed approximately 1 year after the discontinuation of Zoledronate. PET-CT images demonstrated diffuse, intense hypermetabolism in the mandible, consistent with documented osteonecrosis.

We report FDG PET/CT appearance of malignant transformation of retroperitoneal inflammatory pseudotumor to pleomorphic sarcoma in a 78-year-old woman. The patient was diagnosed with left retroperitoneal pseudotumor in 2007. She subsequently suffered from recurrent disease and chronic osteomyelitis in the L5 vertebral body in July 2008, status post surgical excision. In November 2009, after the patient developed left groin pain, MRI study of lumbosacral spine and whole-body PET/CT study demonstrated 2 hypermetabolic soft-tissue masses originating from the L5 surgical bed. These masses were subsequently resected and were consistent with pleomorphic sarcoma. Malignant transformation of retroperitoneal pseudotumor to pleomorphic sarcoma is extremely rare.

We report the positron emission tomography/computed tomography appearance of solitary sternal metastasis from primary ovarian carcinoma in a 65-year-old woman who underwent surgery followed by chemoradiation treatment 3 years earlier. Restaging positron emission tomography/computed tomography study demonstrates an intensely active destructive lesion involving the entire sternum (maximum standard uptake value: 4.7) with a photopenic soft tissue mass component in the center of the sternum protruding anteriorly suggestive of necrosis. This sternal lesion was subsequently biopsied and pathology revealed metastatic disease from the primary ovarian tumor for which the patient had received chemoradiation therapy. Bone involvement in ovarian cancer is relatively rare and even rarer in the sternum.

We report the F-18 fluorodeoxyglucose positron emission tomography/computed tomography appearance of a biopsy-proven primary epidural non-Hodgkin lymphoma involving the lower cervical and upper thoracic spine with a small hypermetabolic right middle lobe nodule in a 33-year-old man. The HIV-positive patient presented with mid- to low back pain for several days, which progressed to lower extremity weakness and urinary retention. Primary spinal epidural non-Hodgkin lymphoma is a rare form of malignancy, constituting approximately 0.1% to 3.3% of all lymphomas. In our case, the primary tumor appears as an intensely hypermetabolic soft-tissue mass involving the posterior epidural space from C6 through T9 levels.

We report the PET-CT appearance of a metastasis from a primary colon cancer to the right kidney in an 84-year-old woman with a history of moderately differentiated adenocarcinoma of the cecum. The patient underwent right hemicolectomy and chemotherapy. Restaging PET-CT study, 4 months after her last chemotherapy, demonstrates a hypermetabolic soft-tissue mass in the inferior pole of the right kidney. The patient subsequently had a right partial nephrectomy. The pathology was consistent with metastatic colonic adenocarcinoma. Renal metastasis from primary colon cancer is very rare.

We introduce the first implantable drug delivery system based on MEMS (Micro-Electro-Mechanical-Systems) technology specifically designed as a platform for treatment in ambulatory emergency care. The device is named IRD(3) (implantable rapid drug delivery device) and allows rapid delivery of drugs. Vasopressin was used as a model drug for in vitro tests as it is a commonly used drug for cardiac resuscitation. Experimental results reveal that the IRD(3) provides an effective method for rapid delivery without significant drug degradation. Several medical uses and delivery modalities for IRD(3) are proposed.

We report the PET-CT appearance of a newly diagnosed, biopsy proven squamous cell carcinoma of the right kidney in a 61-year-old man who presented with hematuria. This is a rare tumor, with few cases reported in the literature. The patient subsequently underwent right nephrectomy shortly after the initial staging PET-CT study.

We report the PET-CT appearance of bilateral ovarian metastases in a 51-year-old woman with a history of right breast carcinoma with osseous metastasis diagnosed 14 years earlier. The colon and stomach are the most common primary tumor sites in ovarian metastasis, followed by the breast, lung, and contralateral ovary. It is important to consider this form of neoplasm in the differential diagnosis because the treatment and prognosis will be different from a dyssynchronous primary tumor.

We report the PET-CT appearance of sclerotic bone mimicking active bone metastasis in a 57-year-old woman with right breast cancer and bone and hepatic metastases. Hybrid PET-CT was performed 1 month after completion of surgery and chemoradiation treatment. PET-CT demonstrated hypermetabolic foci in the right pulmonary hilum and liver. Increased hypermetabolic activity in L1 and L3 vertebral bodies was also seen corresponding to sclerotic vertebral bodies on CT study. The activity in L1 and L3 vertebral bodies was not visualized on nonattenuation-corrected images, consistent with an attenuation correction artifact resulting from extensive sclerosis in these regions.

We report the PET-CT appearance of actinomycosis in a 76-year-old man with a history of squamous cell carcinoma of the esophagus. The patient was initially treated with neoadjuvant chemoradiation therapy followed by esophagectomy and gastric pull-up. Hybrid PET-CT was performed 20 months after completion of treatment using a Siemens Biograph scanner 45 minutes after intravenous administration of 15 mCi of F-18 FDG. PET-CT demonstrated intense hypermetabolism to the left of the anastomosis, corresponding to a soft tissue mass on CT. The patient underwent biopsy of the mass 10 days after PET-CT examination that confirmed actinomycosis with no evidence of recurrent disease.

We report the F-18 fluorodeozyglucose positron emission tomography computed tomography appearance of a biopsy-proven primary gastric sarcoma in a 24-year-old man who presented with early satiety, dyspepsia, and weight loss. Gastric sarcoma is a rare form of malignancy constituting approximately 0.3% to 8% of malignant soft tissue tumors of the stomach. The tumor appears as an ill-defined heterogeneous mass protruding off the lesser curvature of the stomach on computed tomography with central photopenia and peripheral intense uptake on positron emission tomography images.

We report the F-18 FDG PET-CT appearance of recurrent gliosarcoma (GS) with extracranial extension in a 47-year-old man who underwent surgical resection of a right frontal GS 5 months earlier. F-18 FDG PET demonstrated moderate uptake in the recurrent disease. GS is a very rare, biphasic primary neoplasm of the central nervous system, composed of glioblastoma multiforme mixed with a sarcomatous component. It occurs in adults of middle age and carries a poor prognosis. The median survival reported is less than a year. The results suggest that F-18 FDG PET imaging may be useful in detecting recurrent GS.

We report the PET-CT appearance of recurrent Wilms tumor in the surgical bed with multiple metastatic sites in a 30-year-old man. He was initially diagnosed with Wilms tumor in the right kidney with involvement of the right adrenal gland and right renal vein into the inferior vena cava, for which he underwent a right nephrectomy, right adrenalectomy, and retroperitoneal lymph node dissection. Three months later, a restaging PET-CT study demonstrated multiple hypermetabolic lesions in the surgical bed region, the left adrenal gland, liver, thoracolumbar spine, retroperitoneal lymph nodes, and peritoneum.

A normal cisterna chyli is a structure that may simulate retrocrural adenopathy on unenhanced CT. Our case report is significant because it highlights two cases in which patients with prior primary malignancies (medullary thyroid carcinoma, esophageal carcinoma) underwent PET-CT for re-staging, and in each case, a prominent right retrocrural structure is seen representing either a cisterna chyli or retrocrural metastasis. The physiologic activity of the structure on PET-CT is considered and cross-sectional abdominal images are examined in full as well. In both cases, the structure has a low attenuation on CT and a low SUVmax on PET-CT, consistent with a benign process. These cases demonstrate that with the combined use of CT attenuation and PET SUVmax as guiding parameters, a cisterna chyli should be more readily distinguishable from retrocrural adenopathy, and thus can help to avoid unnecessary invasive management of the patient.