[Dose finding of epirubicin in transcatheter hepatic chemoembolization].
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Biomedical subjects
Publications and source records attributed to I Tsukaguchi.
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Axial three-dimensional volume scans obtained by magnetic resonance (MR) imaging were used to evaluate meniscal lesions of the knee in 28 knees of 26 cases. Axial 0.7 mm thin-sliced images with volume scan outlined the overall meniscal appearance for the first time. Axial volume scan was essential to the diagnosis of discoid lateral meniscus because only it could depict the characteristic elongated appearance of discoid lateral meniscus. Radial meniscal tears were depicted only by this technique: conventional sagittal and coronal views could not detect this type of meniscal tear. Volume scan could detect the precise extent of lesions with horizontal meniscal tears and meniscal degeneration. These MR findings obtained by axial volume scans were confirmed by arthroscopy in all cases. We concluded that volume scans were extremely useful in the evaluation of meniscal lesions because they offered axial views that provided much information on menisci located horizontally in the knee.
We retrospectively reviewed the MR examinations of 10 patients (17 knees) with surgically documented discoid lateral meniscus of the knee joint. As MRI of the knee is being used more often, the criteria for diagnosis of this entity with MRI need to be established. We tried to define MRI criteria for the detection of discoid menisci by performing numerical measurements of MR images on a display screen. The transverse diameter of the midbody of a discoid lateral meniscus averaged 21.9 mm (normal control: 8.6 mm), and its proportion to the transverse width of the tibia averaged 29.4% (normal control: 12.0%). The measurable difference in height between the discoid and the medial meniscus was negligible. The number of sagittal sections on which the anterior and posterior horns connected varied from two to five in cases of discoid lateral meniscus, and from zero to two in normal controls. Among these parameters, the transverse diameter and its proportion of the transverse width of the tibia proved to be the most reliable. We concluded that a discoid meniscus is indicated if a transverse diameter of a lateral meniscus exceeds 15 mm (proportion to the tibia: 20%).
An axial 3D volume scan with MRI was applied to the evaluation of discoid lateral meniscus of the knee. By 0.7 mm-thick thin-sliced and gapless images with volume scan, characteristically elongated appearance of discoid lateral meniscus was clearly depicted. These MR findings completely accorded with those on arthroscopy. Our conclusion is that an axial 3D volume scan was essential to the diagnosis of discoid lateral meniscus.
Two cases of pseudohypoparathyroidism were examined with a superconductive 1.5 T MR imaging system. High signal intensities were seen in both putamina, pulvinars and dentate nuclei on T1-weighted images.
A 51-year-old woman manifested with complaints of an abdominal mass 5 years after colectomy. In comparison with the cases previously reported, this desmoid had lower CT value (20-30 HU), and more vascularity with neovascularization on angiography. These findings seem to reflect the characteristic of much cellularity and malignancy of the desmoid.
Since 1983 we have performed transcatheter oily chemoembolization (TOCE) using adriamycin (40-100 mg), Lipiodol (5-20 ml) and Gelfoam in the treatment of 100 cases with unresectable hepatocellular carcinoma. Adriamycin was dissolved in a fluid equal in specific gravity to Lipiodol and the adriamycin solution was mixed with 3 volumes of Lipiodol, making an adriamycin-in-oil emulsion (AOE). After TOCE, the blood concentration of adriamycin was obviously lower than that after one-shot injection because of the slow release of adriamycin from the AOE. Also, in cases of hepatic resection after TOCE, there was a clear difference in the adriamycin concentration between the tumor and the normal hepatic tissue. The cumulative survival rates for the 100 patients treated by TOCE were: 6 months 81.9%, 1 year 53.8% and 2 years 36.5%. Thus, improvement was found in comparison with the cumulative survival rates for 104 patients who underwent hepatic embolization without Lipiodol, which were 6 months 67.4%, 1 year 45.2% and 2 years 16.3%. AOE retained in the tumor as microemboli brings about the slow-releasing effect of adriamycin. Furthermore, by adding the effect of Gelfoam embolization, TOCE has a strong antitumor effect.
Chemoembolization is a technique by which the blood flow in the artery feeding a tumor is arrested and, at the same time, an antitumor agent is delivered in a high concentration to the target site in anticipation of a synergistic antitumor effect. Usually, this is a transcatheter technique. The embolic materials used to arrest the blood flow include gelatin sponge, Lipiodol, microcapsule, albumin microsphere, degradable starch microsphere and the like. Since the gelatin sponge and Lipiodol are available on the market, transcatheter oily chemoembolization (TOCE) using these two materials was performed in cases of hepatic tumor. In many cases of TOCE, adriamycin was used as an adriamycin solution Lipiodol mixture (adriamycin-in-oil emulsion). The cumulative survival rates for 100 patients with unresectable hepatoma treated by TOCE were 53.8% for one year and 36.5% for two years. Thus, improvement was observed in comparison with the cumulative survival rates of 104 patients who underwent hepatic embolization without Lipiodol (1 year, 45.2%, 2 years, 16.3%). Adriamycin-in-oil emulsion retained in the tumor as microemboli brings about the slow-releasing effect of adriamycin. The effect was demonstrated in the blood and tissue concentrations of adriamycin following TOCE.
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A case of adrenal myelolipoma which was diagnosed preoperatively based on the combined examinations of computed tomography and angiography is presented. Computed tomography revealed a large suprarenal fatty tumor with increased density areas secondary to hemorrhage. Angiography demonstrated that the tumor originated from the adrenal gland.
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We report a case of a free supernumerary kidney, which was asymptomatic. Excretory urography and angiography showed 3 separate kidneys.
Four cases of hepatoma seen on follow-up angiograms of patients with liver cirrhosis are described. Hepatic angiography is the most useful method of detecting a hepatoma complicating liver cirrhosis, and it should be repeated following any minimal change in the serum alpha-fetoprotein level or when the radionuclide image suggests hepatoma, since a small hepatoma may be resectable.
Two cases of benign duodenocolic fistula resulting from duodenal diverticula are presented. In both cases, the diverticula were located on the outer border of the second portion of the duodenum. The upper gastrointestinal study is the easiest and most useful examination for diagnosis. Hypotonic duodenography and the barium enema complement the upper series and serve to differentiate benign from malignant fistulas.
Lymph node metastasis was evaluated angiographically in 151 patients with gastric cancer. In 20% of the patients with nodal metastases, abnormally staining masses were demonstrated by angiography. Superselective angiography is useful in confirming the presence of lymph node involvement.