F-fluorodeoxyglucose-positron emission tomography (FDG-PET) has repidly entered into widespread use throughout Japan. Over 200 PET centers are currently in use. FDG-PET can be used to detect many malignant tumors and has become the gold standard for oncologic imaging. However, many false-negative cases have been reported. Many new radiopharmaceuticals have been developed as post-FDG agents. One of these radiopharmaceuticals, 11 C-acetate (AC), has been used to detect tumors for which FDG gives poor results. The usefulness of AC-PET remains to be established, but many reports have suggested its utility for tumors, such as prostate cancer, lung cancer, hepatocellular carcinoma, brain glioma. etc.
A 70-year-old man with portal hypertension, likely due to extrahepatic portal vein occlusion, was followed up by a family doctor. Esophagogastric varices were diagnosed by endoscopic examination and he was referred to our hospital for treatment of the varices. Although the esophageal varices decreased in volume after repeated courses of endoscopic injection sclerotherapy, massive hematemesis occurred from ruptured gastric varices. Endoscopic hemostasis was resistant for the gastric varices located in the cardia and fornix of the stomach. The dilated left gastric vein was primarily responsible for gastric varices. Percutaneous transhepatic transcatheter variceal embolization via the portal vein was considered to be difficult because of the marked tortuosity and stenosis of the portal trunk with cavernous transformation. The transileocolic obliteration (TIO) method was selected and conducted. After the procedures, a marked hemostatic effect was achieved. TIO is an effective and useful treatment for hemostasis of gastric varices, especially in patients with marked abnormalities of the portal trunk.
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