Re: Percutaneous transcatheter embolization for hemorrhage from an empyema necessitatis of the thoracic wall.
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Publications and source records attributed to S Kanazawa.
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PURPOSE: Pigs were used to evaluate temporary segmental hepatic venous occlusion as a means of improving the selective delivery of therapeutic agents within the liver. MATERIALS AND METHODS: Hepatic angiography and scintigraphy were performed alone and in combination with hepatic venous occlusion. RESULTS: Arteriograms obtained during venous obstruction demonstrated a greater number of peripheral arterial branches in the occluded area compared with the nonoccluded areas. A prolonged hepatogram showing hepatofugal opacification of the portal branches was observed in the occluded area. Microscopically, mild congestion of the sinusoids and central veins was seen immediately after 60-minute occlusion, but these changes were not evident 2 hours after balloon deflation. Severe congestion and focal hemorrhage were found in the occluded segment of the liver 2 hours after 90-minute venous occlusion. When the right or left hepatic vein was occluded during hepatic arterial infusion of technetium-99m macroaggregated albumin, there was a significant (P < or = .05) increase in the amount of radioactivity measured in the obstructed segment and a significant (P < or = .05) decrease in that found in the nonoccluded regions. CONCLUSION: These results indicate that temporary segmental hepatic vein occlusion is safe for up to 60 minutes and may be clinically applicable as a means of improving the therapeutic index of agents within the liver when they are administered via concomitant hepatic arterial infusion.
Effects of protein kinase C (PKC) inhibitors (H7, staurosporine, calphostin C) on thermotolerance development were investigated in temperature sensitive tsAF8 cells derived from Syrian hamster BHK21 cells. Cells were pre-heated at 45 degrees C for 20 min, incubated at 34 degrees C with PKC inhibitors for varying lengths of time, i.e. 1.25-10.0 h, and then heated at 45 degrees C for 30 min. Increasing survival fractions after the second heat treatment was inhibited by the treatment with H7 (40-160 microM), with staurosporine (0.05-1.0 microM), and with calphostin C (0.8, 1.2 microM) in a concentration dependent manner. When the concentrations of these PKC inhibitors were low, the restraint of increasing survival fractions was temporary, since survival fractions increased 3-7.5 h after pre-heating. However, the survival fractions were almost constant by the treatment with 160 microM H7 and 1.0 microM staurosporine. Induction of HSP72 after heat stress was investigated in tsAF8 and BHK21 cells. Cells were heated at 45 degrees C for 20 min and incubated at 34 or 39.7 degrees C (tsAF8), at 37 degrees C (BHK21). Intensity of intracellular fluorescence from HSP72 was measured by flow cytometry. HSP72 was induced in BHK21 cells, but there was no definite induction of HSP72 in tsAF8 cells at either 39.7 or 34 degrees C. These results suggest that PKC is related with the thermotolerance development in tsAF8 cells; however, HSP72 is not involved in the thermotolerance development in tsAF8 cells.
It has been shown that hyperthermia can enhance the cytotoxicity of some chemotherapeutics. However, the most effective agent(s) at elevated temperatures have yet to be determined. A previous study suggests that the drug of choice at elevated temperatures may be different from that at the physiological temperature, and that the alkylating agents may be most effective at elevated temperatures. To further investigate these possibilities, the effect of chemotherapeutic agents were compared. These agents were cyclophosphamide, ifosfamide, melphalan, cis-diamminedichloroplatinum (II), 5-fluorouracil, mitomycin C and bleomycin. Three tumours (mammary carcinoma, osteosarcoma and squamous cell carcinoma) were used. They were transplanted into the feet of C3H/He mice. When tumours reached 65 mm(3), a test agent was injected intraperitoneally. Tumours were immediately heated at 41.5 degrees C for 30 min, and the tumour growth (TG) time was studied for each tumour. Using the TG times, the TG-50 (the time required for one-half of the total number of the treated tumours to reach the volume of 800 mm(3) from 65 mm(3)) was calculated. Subsequently, the tumour growth delay time (GDT) and the thermal enhancement ratio (TER) were obtained. The GDT was the difference between the TG-50 of treated tumours and that of non-treated control tumours. The TER was the ratio of the GDT of a group treated with an agent at 41.5 degrees C to that of a group treated with the agent at room temperature. Results showed that the top three effective agents tested at 41.5 degrees C were solely alkylating agents--CY, IFO and L-PAM--for each kind of tumour. A GDT of cisplatin was smaller than those of the alkylating agents. The smallest TER, 1.1, was observed for 5-fluorouracil, which was given for mammary carcinoma, and for mitomycin C, which was given for squamous cell carcinoma. It could be concluded that the alkylating agents at elevated temperatures might be the drugs of choice for many types of tumours. The possible mechanisms of thermal enhancement associated with these agents are discussed.
In contrast to cues to women's mate value (youth and physical attractiveness), many qualities that men display in lekking are socially and culturally specific. We predict that, for this reason, men avoid exposure to foreign cultures, but such xenophobia should cease once they are married (especially since the presence of their wives can function as a cross-culturally meaningful lekking device). Analyses of data from Europe and the United States confirm our predictions.
Uterine cirsoid aneurysm is uncommon. It is important to make a diagnosis of this disease preoperatively, because repeated curettages may induce life-threatening massive genital bleeding. We present a case of a 51-year-old woman with uterine cirsoid aneurysm in whom MRI and MRA were very useful for the preoperative diagnosis. The radiologic appearances on ultrasonography, CT, conventional SE MRI, MRA, dynamic MRI, and pelvic angiography are presented. Conventional SE T1-weighted and T2-weighted images demonstrated multiple flow voids in the uterus and bilateral adnexal regions. MRA demonstrated a cluster of distinct, tortuous, and coiled vascular channels in the pelvis. MRA could obtain images almost equal to angiography and was considered to be an excellent noninvasive imaging technique for the diagnosis of uterine cirsoid aneurysm.
PURPOSE: Our goal was to investigate the usefulness of dynamic MRI with the turbo-FLASH technique in estimating myometrial invasion by endometrial carcinoma. METHOD: Forty-six patients with endometrial carcinomas were evaluated with pathologic correlation. Dynamic MRI was performed with the rapid administration of Gd-DTPA using the turbo-FLASH technique. RESULTS: The inner muscle layer showed more rapid contrast enhancement effects than the outer muscle layer even after menopause. Contrast-to-noise ratio between the inner muscle layer and endometrial carcinoma was maximum at approximately 50 s after administration of Gd-DTPA. In postmenopausal women, the accuracy in estimating myometrial invasion with T2-weighted images, contrast-enhanced T1-weighted images, and dynamic MRI was 66.7, 77.8, and 92.6%, respectively. CONCLUSION: Dynamic MRI with the turbo-FLASH technique is considered to be a useful imaging method for the estimation of myometrial invasion by endometrial carcinoma, especially in postmenopausal patients.
For clinical islet cell transplantation, short-term storage of islet cells is likely to be necessary, and it is imperative that the islet cells be kept as viable as possible during the period. However, there are little data on which preservative solutions are most suitable for the storage of islet cells after isolations or before transplantation. To estimate islet cell viability and transplantation success rate in the present study, adenylylcyclase activity was measured with a rapid new fluorometric assay in rat islet cells prior to transplantation, because cAMP plays an essential role in determining islet beta-cell viability and responsiveness to various hormonal stimuli. Adenylylcyclase activity was measured in islet cells stored for different periods of time 0, 3, 16, 24, 48, 96 h) and in different preservative solutions. Approximately 1,000 islet cells from each preservation group using University of Wisconsin (UW) solution were transplanted to streptozotocin-induced diabetes mellitus (DM) rats. Transplant success was evaluated by measuring blood glucose levels. Preoperative adenylylcyclase activity was compared with posttransplant islet cell function. The adenylylcyclase activity of UW solution was significantly higher than that of Euro-Collins solution and lactate-Ringer's solution through the different preservation time periods. Preoperative adenylylcyclase activity correlated well with posttransplant islet cell function in a rat model of DM. We conclude that adenylylcyclase activity can be used as a marker to assess islet cell viability as well as differences in preservation media and may predict islet cell transplant success.
BACKGROUND/AIMS: We studied the effect of initial daily administration of interferon for the treatment of chronic hepatitis C, especially in patients with intermediate viral load. METHODOLOGY: Consecutive patients who met the inclusion criteria were randomly enrolled into two groups in this study. All patients analyzed could be treated with interferon-alpha for 6 months. Patients in group A were administered 6 million units of interferon-alpha subcutaneously daily initially for 2 weeks and then thrice weekly. Patients in group B were treated with the same dose of interferon-alpha thrice weekly from the first administration. We decided the criteria of complete remission as the absence of serum HCV-RNA at both points of the end of interferon treatment and 6 months later. RESULTS: Due to the relationship between the efficacy and serum viral load, we decided the criteria of the intermediate load as the quantitative value of serum HCV-RNA to be not lower than 10(5.0) and not higher than 10(6.5) copies/ml. Seventy-six and 78 patients, whose genotype and quantitative value of serum HCV-RNA could be measured before treatment, were analyzed in group A and B, respectively. The rate of complete remission in group A (40.8%) was higher than that in group B (25.6%), significantly (p = 0.046). In the intermediate viral load group, the rate of complete remission in group A (52.3%) was significantly higher than that in group B (29.3%) (p = 0.045). In the patients with genotype 1 b virus, the rate of complete remission had a tendency to be higher in group A (33.3%) than in group B (17.4%) (not significant). In the patients with genotype 2, the rate of complete remission was higher in group A (77.8%) than in group B (41.2%) (significant, p = 0.041). CONCLUSIONS: These results suggest that the initial daily interferon administration is necessary to gain a higher rate of serum HCV-RNA eradication in patients with intermediate viral load in chronic hepatitis C.
OBJECTIVE: To evaluate attenuation changes in the periportal regions of the liver during triphasic contrast CT. MATERIALS AND METHODS: The study group consisted of 93 patients, all of whom underwent triphasic contrast-enhanced CT with a helical scanner for survey of liver disease. The three phases included the arterial phase, portal venous phase, and equilibrium phase. Attenuation changes in the periportal area in each phase were evaluated in every patient. Factors surmised to be related with periportal low attenuation, including elevation of venous pressure, presence of ascites, cardiac enlargement, and lymphadenopathy of the porta hepatis and lesser omental region, were also evaluated. RESULTS: Periportal low attenuation was seen in 65 patients (69.8%) in the portal venous phase where the liver parenchyma showed the largest attenuation value. Among them, periportal low attenuation was continuously observed in every phase in 13 patients (13.9%), while it was confirmed only in the portal venous phase in 28 patients (30.1%), and in 24 patients (32.2%) in the portal venous phase plus either the arterial or equilibrium phase. None of the factors that were investigated could be related to the appearance of periportal low attenuation. CONCLUSION: Periportal low attenuation was a relatively common finding in the portal venous phase of triphasic contrast CT, whereas it was less usual in the arterial or equilibrium phase.
A case of Crohn's disease that underwent bowel resection two times at 3-year intervals due to life-threatening hemorrhage from ileum is presented. The bleeding sites were located in the ulcer lesions of ileum, in the oral side near to the ileum-colon transition. The first bleeding point was at the longitudinal ulcer of the terminal ileum and the secondary bleeding site was at the profound ulcer of ileum appearing in the oral side near to the ileo-colic anastomosis. This is the first case of Crohn's disease with recurrent life-threatening massive hemorrhage in the terminal region of ileum, for which operative bowel resections were necessary. This case suggests that we should search for the bleeding site in ileal lesions developed in the circumference of and especially the oral side near to the anastomosis due to prior resection, when intestinal massive bleeding occurs again after bowel resection, and that the careful follow-up and strict treatment with diet therapy and/or anti-inflammatory drugs are necessary for the protection of recurrence in patients with Crohn's disease.
The relationship between spontaneous apoptosis and overexpression of manganese superoxide dismutase (MnSOD) gene was examined in vivo. The mouse fibrosarcoma cells expressing high MnSOD activities due to transfection with the human MnSOD cDNA (SOD-H), or the fibrosarcoma cells transfected with the selectable marker alone (NEO), were transplanted into immune-deficient Fox Chase SCID C.B-17/Icr-scid Jcl mice. Apoptosis in tumors was visually quantified by the in situ end-labeling method. The number of apoptotic cells in the SOD-H tumors was significantly less than that in the NEO tumors. The tumor growth time of the SOD-H tumors to grow from 34 to 500 mm3 in one-half of the mice was slightly longer than that of the NEO tumors, but the difference was not statistically significant. These results suggest that overexpression of MnSOD gene is involved in the suppression of spontaneous apoptosis, without a resultant alteration in the tumor growth.
A 54-year-old male patient was admitted to Osaka University Medical School Hospital for interferon treatment for chronic hepatitis C and the daily administration of recombinant interferon-alpha 2a started at the dose of 9 megaunits per day. Fourteen days later, moderate right pleural effusion was detected by abdominal magnetic resonance imaging study. He had experienced no symptom to suggest pleural effusion or any pulmonary lesions during interferon treatment. The pleural fluid was serous, showing the character of slightly bloody, turbid and positive Rivalta test, and the levels of lactic dehydrogenase and adenosine deaminase were not elevated. His serum titer of anti-nuclear antibody increased to 80 in homogenous staining, but anti-DNA antibody and anti-liver kidney microsome-1 antibody remained negative. Other laboratory tests or physical findings could not satisfy the criteria of any autoimmune diseases, such as systemic lupus erythematosus. After discontinuation of interferon administration, his pleural effusion resolved gradually and disappeared completely by use of no specific drugs. This is the first case that pleural effusion developed during interferon administration without any other clinical signs indicating autoimmune diseases. The increase of serum titer of anti-nuclear antibody prompted us to elucidate that pleuritis might be induced by immunological activation of interferon.
In the field of radiology, new modalities have been developed and expanded. However, X-ray-based diagnostic imaging remains the main stream. Therefore, radiological technologists must provide dosimetry and other physical data related to radiation exposure. In this report, the basic information presented in our previous reports is supplemented with data regarding the relationships between exposure parameters and dose for inverter-type X-ray generators, which have been widely adopted in recent years. This report also describes the measurement of percentage depth dose. We also conducted a survey of medical facilities in Okayama prefecture to gather data concerning the radiographic parameters used for abdominal examinations, and calculated the patient dose from these data. We tabulated and calculated the patient dose for each hospital. The results showed a wide range of variation. The overall mean values were 0.337 cGy for the surface dose and 0.061 cGy for the dose at a depth of 9 cm.
A patient with hepatocellular carcinoma (HCC) and coexisting hepatic cavernous hemangiomas with arterioportal and arterio-hepatic vein shunts is reported. Antegrade and retrograde opacifications of portal vein radicles and filling of a branch of the right hepatic vein verging on cavernous hemangiomas were observed in the late arterial phase of hepatic arteriography in addition to HCC. Unenhanced CT scans performed eight days after the arterial infusion of Lipiodol showed clearly the location of the tumors and the shunting vessels. To the authors' knowledge, this is the first reported case of cavernous hemangioma with arterioportal and arterio-hepatic vein shunts accompanied by hepatocellular carcinoma.
BACKGROUND/AIMS: We studied the effect of initial daily administration of interferon for the treatment of chronic hepatitis C, to clarify a more effective treatment protocol for the eradication of the hepatitis C virus. METHODOLOGY: Consecutive patients who met the inclusion criteria were randomly enrolled in two groups in this study. One hundred and five patients were randomized and assigned to two groups. Patients, who enrolled in group A, were treated with 6 million units of natural interferon-alpha given subcutaneously daily for an initial two weeks and then thrice a week for 22 weeks. Patients, who were enrolled in group B, were treated with the same dose of interferon-alpha given for 26 weeks thrice a week from the first administration. RESULTS: In groups A and B, 58 and 47 patients were analyzed, respectively. At the end of treatment, 37 patients in group A (63.8%) had negative serum HCV-RNA test, compared with 26 in group B (55.3%), but at 6 months after discontinuation of interferon administration, 27 patients in group A (46.6%), compared with 8 in group B (21.3%). The rate of complete remission in group A (46.6%) was higher than that in group B (21.3%) (P<0.01). In patients with genotype 1b virus, the rate of complete remission was higher in group A (31.3%) than in group B (12.5%) (not significantly), and the relapse rate was lower in group A (9.4%) than in group B (37.5%), significantly (p<0.05). CONCLUSIONS: This study suggests that initial daily interferon administration is necessary to gain a higher rate of serum HCV-RNA eradication in patients with chronic hepatitis C.