To assess the ability of multi-detector row helical computed tomography (CT) to depict the artery of Adamkiewicz. Seventy patients with vascular diseases underwent multi-detector row helical CT of the entire aorta and iliac arteries. The artery of Adamkiewicz was examined on multiplanar and curved planar reformation images and on cine-mode displays. The visualization of the artery of Adamkiewicz, as well as its branching level and side of origin, was investigated. In 63 (90%) of the 70 patients, at least a single artery of Adamkiewicz was clearly visualized from the intervertebral foramen to the hairpin-shaped union with the anterior spinal artery. Two arteries of Adamkiewicz were identified in 15 (24%) of 63 patients. Fifty-five arteries of Adamkiewicz (71%) originated from the left side. Seventy-two (92%) originated between T8 and L1. Neither the intercostal vein nor the posterior spinal vein were visualized in 57 of 63 patients. Continuity of the entire length, starting from the stem of the intercostal or lumbar artery and proceeding to the artery of Adamkiewicz and finally to the anterior spinal artery, was traceable on cine-mode displays or on curved planar reformation images in 20 of 63 patients. Multi-detector row helical CT depicts the artery of Adamkiewicz in a high percentage of patients.

This paper is part of the international consensus guidelines on chronic pancreatitis, presenting for interventional endoscopy. An international working group with experts on interventional endoscopy evaluated 26 statements generated from evidence on 9 clinically relevant questions. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to evaluate the level of evidence. To determine the level of agreement, a nine-point Likert scale was used for voting on the statements. Strong consensus was obtained for 15 statements relating to nine questions including the recommendation that endoscopic intervention should be offered to patients with persistent severe pain but not to those without pain. Endoscopic decompression of the pancreatic duct could be used for immediate pain relief, and then offered surgery if this fails or needs repeated endoscopy. Endoscopic drainage is preferred for portal-splenic vein thrombosis and pancreatic fistula. A plastic stent should be placed and replaced 2-3 months later after insertion. Endoscopic extraction is indicated for stone fragments remaining after ESWL. Interventional treatment should be performed for symptomatic/complicated pancreatic pseudocysts. Endoscopic treatment is recommended for bile duct obstruction and afterwards surgery if this fails or needs repeated endoscopy. Surgery may be offered if there is significant calcification and/or mass of the pancreatic head. Percutaneous endovascular treatment is preferred for hemosuccus pancreaticus. Surgical treatment is recommended for duodenal stenosis due to chronic pancreatitis. This international expert consensus guideline provides evidenced-based statements concerning indications and key aspects for interventional endoscopy in the management of patients with chronic pancreatitis.

Approximately 10% of cases of hypertension in Japan are caused by primary aldosteronism (PA), amounting to about 4 million patients in total. Primary aldosteronism due to unilateral aldosterone hypersecretion is potentially curable by adrenalectomy. The clinical benefits of identifying and treating PA have been reported internationally, but its cost-effectiveness is unclear. We examined whether diagnosing and treating hidden PA in hypertensive population was cost-effective compared with suboptimal treatment. Our hypothetical patient was a 50-year-old man diagnosed with stage I–III hypertension. We established a Markov decision model based on plausible clinical pathways and prognoses of PA. We applied cost-effectiveness analysis comparing a comprehensive diagnostic strategy for PA (measurement of plasma aldosterone/renin ratio, 2 loading tests, imaging, and selective adrenal venous sampling) with a suboptimal strategy to manage hypertension by medication unless the typical signs of PA or other complication were manifest. Outcome measures were expected costs, expected effectiveness, and incremental cost-effectiveness ratio. The robustness of the findings was established by one-way and scenario sensitivity analyses. The comprehensive PA diagnostic strategy increased the expected costs by 64 004 JPY and expected life-years by 0.013 compared with standard treatment. The incremental cost-effectiveness ratio for the diagnosis of PA was 4 923 385 JPY per year. Our findings were sensitive to the outcomes of screening and treatment, and the costs of continuous or periodic medication for hypertension and the treatment of stroke and its complications.