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PURPOSE To evaluate the efficacy and safety of intra-arterial infusion of temporary embolic material with/without radiographic monitoring via a needle placed into the radial artery to occlude abnormal neovessels for trapeziometacarpal osteoarthritis. MATERIALS AND METHODS Thirty-one patients having Eaton stage II or III osteoarthritis, with a symptom duration longer than 6 months, resistant to conservative therapy for at least 3 months were prospectively enrolled. All procedures were performed by infusing imipenem/cilastatin sodium through a 24-gauge needle that was percutaneously inserted into the radial artery. Seven patients underwent the procedure with fluoroscopy, and 21 patients underwent the procedure without fluoroscopy. The mean Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, numerical rating scale (NRS), and Patient Global Impression of Change (PGIC) scale were evaluated before and at 2, 6, and 24 months after the first procedure. RESULTS Technical success was 100%. The mean procedure time (from the beginning of local anesthesia to the removal of needle) was 2.9 minutes ± 1.6. The QuickDASH score improved from the baseline to 2, 6, and 24 months (49.2 ± 11.2 vs 22.1 ± 11.2, 20.9 ± 16.6, and 19.5 ± 16.1, respectively, all P

Frozen shoulder (FS) is speculated to have an inflammatory etiology. On angiography, abnormal angiogenesis is observed around the affected shoulder, suggesting a possible source of inflammation and pain. The effectiveness and safety of transarterial embolization (TAE) targeting abnormally proliferating blood vessels have been reported. This study investigated changes in chronic inflammatory and hypoxic status before and after TAE in FS by [Fifteen patients with unilateral FS, persistent for more than 6 months, who were refractory to conservative treatments, underwent TAE using the temporary embolic agent imipenem/cilastatin. Patients underwent PET/CT with FDG (as a biomarker of inflammation) before and 8 weeks after TAE. Regional uptake was evaluated by the maximum standardized uptake value (SUVmax). The lesion-side to (contralateral-) normal-side uptake ratio (L/C ratio) was also calculated. Pain and functional scales, range-of-motion, and laboratory tests, including WBC, CRP, IL-6, VEGF, and TNFα were evaluated.On FDG-PET, the average SUVmax of the lesion-side was significantly greater than that of the normal-side (SUVmax before TAE: 3.11 ± 1.25 vs. 1.95 ± 1.15, p = 0.0001; 8-weeks post-TAE: 2.36 ± 0.74 vs. 1.78 ± 0.69, p = 0.0002). The mean L/C ratios before TAE (1.71 ± 0.60) decreased after TAE (1.37 ± 0.29, p = 0.011). The decrease of FDG uptake (-21.1 ± 12.2%) showed a significant correlation with the change in the pain scale score (r = -0.56, p = 0.039) and extension score (r = -0.59, p = 0.026).Chronic inflammation in FS, as demonstrated by FDG uptake, was decreased after TAE. Thus, chronic inflammation is likely to be an underlying mechanism that should be targeted for symptomatic improvement of frozen shoulder.

A 68-year-old man was seen at the medical center because of jaundice and bilirubiuria in February 1992. CT and ultrasonography (US) demonstrated a mass in the head of the pancreas. Although US-guided PTCD was performed, biliary decompression was poor. Pancreaticoduodenectomy was done, because total bilirubin level was less than 5.0mg/dl after three times plasmaphoresis using fresh frozen plasma. The postoperative course was uneventful. A case of pancreas head cancer, resected safely by plasmaphresis for obstructive jaundice, is described here.