Biomedical subjects

S Murayama

Publications and source records attributed to S Murayama.

At least 289 records · Page 16Linked to original sources

PubMedDate not supplied

Bronchogenic carcinoma invasion of the chest wall: evaluation with dynamic cine MRI during breathing.

PURPOSE: Our goal was to assess the utility of breathing dynamic cine MR (BDCMR) in the evaluation of tumor invasion to the chest wall in bronchogenic carcinomas. METHOD: BDCMR imaging was performed preoperatively in 25 patients with bronchogenic carcinomas adjacent to the chest wall. Twelve sequential images were obtained in the same coronal and/or sagittal planes during one respiratory cycle with fast spoiled GRASS sequence, and analysis with cine-loop display was performed. RESULTS: In all 14 cases in which free movement of tumor along the parietal pleura on BDCMR was demonstrated, no chest wall invasion was evident at thoracotomy. However, of 11 patients with fixation of the tumor on BDCMR, 5 had benign pleural adhesions, 5 had chest wall invasion at thoracotomy, and 1 with an apical tumor had no benign pleural adhesion or chest wall invasion. CONCLUSION: Although BDCMR cannot distinguish benign pleural adhesions from chest wall invasion by tumor, this method accurately estimated the free movement of lung tumors with no invasion of chest wall from bronchogenic carcinomas prior to surgery.

Aged↗

PubMedDate not supplied

"Crazy paving appearance" on high resolution CT in various diseases.

PURPOSE: The purpose of this work was to demonstrate the variety of causes of crazy-paving appearance (CPA) on high resolution CT (HRCT). METHOD: To identify cases exhibiting CPA (ground-glass opacity with superimposed interlobular septal thickening and intralobular interstitial thickening) on HRCT, we prospectively searched for them over a period of 29 months. RESULTS: We identified 10 cases of CPA on HRCT, including 4 Pneumocystis carinii pneumonia, 1 alveolar proteinosis, 1 usual interstitial pneumonia, 1 pulmonary hemorrhage, 1 acute radiation pneumonitis, 1 adult respiratory distress syndrome, and 1 drug-induced pneumonitis. CONCLUSION: CPA can result from a variety of diseases. When we encounter CPA on HRCT, clinical information is necessary for differentiation of these entities.

Adolescent↗

PubMedDate not supplied

Radiation therapy following mastectomy for axillary node-positive breast cancer: indication of chest wall irradiation.

This retrospective study was conducted to determine the indication of chest wall irradiation following mastectomy in axillary node-positive breast cancer patients. Between 1982 and 1993, 103 women with axillary node-positive breast cancer received postoperative radiation therapy following mastectomy using the hockey-stick field, which included the ipsilateral supraclavicular fossa and internal mammary nodes, without the chest wall. Ages ranged from 33 to 73 years (median: 47). Thirty-five patients underwent modified radical mastectomy, 48 radical mastectomy, and 20 extended radical mastectomy. Twenty-two patients had 1-3 positive axillary nodes, and 81 had 4 or more positive axillary nodes. The total doses ranged from 42 to 64 Gy (median 54 Gy) with a daily fraction size of 2 Gy. Adjuvant chemotherapy was given to 75 patients, and hormone therapy was administered to 78 patients. The median follow-up time was 121 months (range, 68-191 months) for the 57 surviving patients. The actuarial overall survival rate and the chest wall control rate at 10 years for all patients were 55% and 85%, respectively. Of the 103 patients, 14 developed chest wall recurrence. In the analysis, status of vascular invasion alone had a significant impact on chest wall control. In patients with definite vascular invasion, 2 of 5 (40%) patients with 1 to 3 positive axillary nodes, and 10 of 31 (32%) with 4 or more positive axillary nodes developed chest wall recurrence. In contrast, no patients without definite vascular invasion developed chest wall recurrence. Factors such as age, menopausal status, pathology, tumor location, extent of resection, estrogen receptor status, total dose, chemotherapy, and hormone therapy did not influence the development of chest wall recurrence. Among node-positive breast cancer patients following mastectomy, those with definite vascular invasion should be delivered chest wall irradiation regardless of the number of positive axillary nodes. In contrast, those without definite vascular invasion need not be administered chest wall irradiation.

Adult↗

PubMedDate not supplied

Postoperative radiotherapy for squamous cell carcinoma of the maxillary sinus: analysis of local control and late complications.

This retrospective study was conducted to analyze the local control and late complications in patients with squamous cell carcinoma of the maxillary sinus treated with postoperative radiation therapy following surgery. Between 1979 and 1998, 41 patients with squamous cell carcinoma of the maxillary sinus were treated with postoperative irradiation following partial or total maxillectomy. Tumor classification according to the TNM classification of the International Union Against Cancer (1997) was T2 in 6 patients, T3 in 21 patients, and T4 in 14 patients. Fourteen patients had negative surgical margins, 23 had microscopically positive margins, and 4 had grossly positive margins. Sixteen patients received preoperative intraarterial chemotherapy. The total dose to the primary tumor bed was 40-70 Gy (median: 54 Gy) with a fraction size of 2 Gy. The median follow-up time of the surviving patients was 93 months (range: 25-179 months). Local recurrence was observed in 17 patients (41%), and the 5-year actuarial overall survival and local control rates were 48% and 55%, respectively. In the univariate analysis, surgical margin status and total dose each had a statistically significant impact on local recurrence. For the patients with negative surgical margins, 8 of 9 (89%) patients achieved local control with a dose of 50-54 Gy, while 7 of 10 (70%) patients with microscopically positive margins achieved local control with a dose of 60-64 Gy. There were 11 late complications found in 9 patients; bone necrosis in 2, soft tissue necrosis in 2, trisumus: 2, cellulitis in 1, retinopathy in 1, and vision impairment in 3 patients. A total dose of 60 Gy or more was administered in all patients who suffered late complications except for 2 patients with vision impairment. These results indicated that an optimal dose of postoperative irradiation according to the surgical margin status was necessary to achieve local control for squamous cell carcinoma of the maxillary sinus following surgery. For patients with negative surgical margins, a total dose of 50-54 Gy in conventional fractionation was appropriate to achieve local control as well as to reduce late complications. On the other hand, a dose of 60 Gy or more was required for the patients with microscopic positive margins.

Adult↗

PubMedDate not supplied

[A clinico-pathological study of so-called "acute multiple sclerosis" mimicking a brain tumor on the MRI findings].

We are reporting an autopsy case of so-called "acute multiple sclerosis" that was difficult to differentiate from a brain tumor on MRI findings. This case was a 69-year-old man, whose initial symptoms consisted of headache and unsteadiness in walking. Neurological findings included mild ataxia of the left upper extremity and positive Romberg sign. T 2-weighted MRI showed high intensity areas in the posterior limb of the right internal capsule and white matter near the posterior horn of the right lateral ventricle. Although the headache improved, the unsteadiness was exacerbated and the patient became unable to keep standing. Psychiatric symptoms and left hemiparesis were added to the clinical picture. The following MRI proved expansion of the previous lesions and the diffusely enhanced lesion spreading into the contralateral side through the corpus callosum. Stereotaxic biopsy showed the perivascular accumulation of small lymphocytes and a large number of bizarre astrocytes. Primary brain malignant lymphoma was diagnosed and radiation therapy was carried out. However, he developed perforation of the intestinal tract and died. Autopsy findings revealed scattered and disseminated small lesions in the cerebral white matter and the corpus callosum. There were a large number of lipid-laden macrophages, no stainable myelin and preserved axis cylinders in those lesions. Thus, those were interpreted as demyelinting lesions. They were scattered and multiple. This case was radiologically characterised by the diffusely enhanced, expanding butterfly-shaped lesion in bilateral cerebral hemisphere through the corpus callosum, and pathologically proven to be acute demyelination associated with severe perivascular infiltration of inflammatory cells. Multiple sclerosis may mimic neoplastic processes as trans-callosal hyperplastic neuroimage on neuroimaging like the present case.

Acute Disease↗

PubMedDate not supplied

Brain involvement in Hodgkin's disease: case reports and review of the literature.

Hodgkin's disease involving in the central nervous system is extremely rare. It usually spreads contiguously, as visceral involvement is generally thought to occur secondary to involved adjacent lymph nodes. We report three such cases found in our institution in the last two decades. Based upon our limited experience together with reported data, whole brain irradiation combined with systemic chemotherapy remains the treatment of choice for these lesions.

Adolescent↗

PubMedDate not supplied

Polymyositis as a paraneoplastic manifestation of hepatocellular carcinoma.

A case of hepatocellular carcinoma associated with polymyositis is reported. A 70-year-old man noticed muscular weakness mainly in the proximal limb muscles. The clinical course, a raised level of serum creatine kinase and electromyographic findings suggested polymyositis, and the pathological findings on muscle biopsy were compatible with this diagnosis. Computed tomography of the upper abdomen revealed a mass lesion in segment VII and VIII of the liver, which was diagnosed pathologically as hepatocellular carcinoma. The patient underwent systematic resection of segment VII and the dorsal part of segment VIII of the liver. After surgery, the weakness improved and the serum creatine kinase level normalized without medical treatment for the polymyositis. The relief of neurological symptoms and signs after complete resection of the tumor strongly suggests paraneoplastic polymyositis, which has been described only rarely in association with hepatocellular carcinoma.

Aged↗

PubMedDate not supplied

High-resolution CT characteristics of poorly differentiated adenocarcinoma of the peripheral lung: comparison with well differentiated adenocarcinoma.

OBJECTIVE: The purpose of this study was to elucidate the characteristic high-resolution CT (HRCT) findings of poorly differentiated adenocarcinoma (PDA) in comparison with those of well differentiated adenocarcinoma (WDA). MATERIALS AND METHODS: We investigated the HRCT features of surgically resected PDAs (n=21) and WDAs (n=31). We analyzed the margin, CT attenuation, and internal architecture of the tumor and findings in the surrounding lung field, comparing them with the corresponding pathologic findings. RESULTS: Smoothness of the greater part (full-1/2 round) of the tumor and solid appearance were more prevalent in PDAs than WDAs (81% vs. 32%, 100% vs. 35%) [p<0.01]. Air-bronchogram was prevalent in WDAs (58%), but was never seen in PDAs [p<0.01]. Ground-glass opacity in PDAs pathologically corresponded to inflammation and edema in the alveolar space. CONCLUSIONS: Smoothness of the tumor margin and solid appearance without air-bronchogram were more commonly found in PDA than in WDA. HRCT may predict the histological differentiation of adenocarcinoma in selected cases in which differentiation is inconclusive by sputum cytology and transbronchial or CT-guided biopsy.

Adenocarcinoma↗

PubMedDate not supplied

[A case of mononeuritis multiplex associated with type I (monoclonal) IgG kappa cryogloblinemia].

We here reported a fifty-three year-old woman with mononeuritis multiplex, associated with type I cryoglobulinema induced IgG kappa MGUS (monoclonal gammopathy of undetermined significance). She first experienced numbness in the extremities, that showed stepwise deterioration for several weeks. The nerve conduction study revealed axonal neuropathy, and laboratory examination detected type I cryoglobulinema. The sural nerve biopsy demonstrated with severe axonal degeneration with focal accentuation, lacking any inflammatory response. Single cryofiltration definitely stopped the progression of the symptoms. The prompt clinical response to the removal of cryoglobulin, without the administration of anti-inflammatory drugs, confirmed the direct etiological correlation between type-1 cryoglobulin and the neuropathy, and may favor ischemic, rather than inflammatory nature of this rare type of neuropathy.

Cryoglobulinemia↗

PubMedDate not supplied

Wide anulus rent appearance on axial MR imaging: a sign of postdiskectomy recurrent disk herniation.

A band of high intensity extending from a hyperintense nucleus pulposus at the center of a lumbar disk toward the thecal sac is occasionally encountered on axial MR images with a long TR technique. A retrospective review of 195 patients who previously underwent surgery of the lumbar spine revealed eight instances of this wide anulus rent appearance. Four were confirmed to have recurrent disk herniation at re-operation, and the other four were clinically strongly suggestive. Wide anulus rent appearance is a useful sign of a postdiskectomy recurrent disk herniation.

Adult↗

PubMedDate not supplied

MR imaging of malignant uveal melanoma: role of pulse sequence and contrast agent.

To determine the most sensitive pulse sequence and to clarify the role of each pulse sequence in the MR diagnosis of uveal malignant melanoma, noncontrast T1- and T2-weighted, and postcontrast T1-weighted, spin-echo images were compared blindly and independently by two experienced observers. Thirty uveal malignant melanomas, preselected by ophthalmoscopy and sonography for size greater than 2 mm, were examined with a 1.5-T superconducting MR unit with an orbital surface coil. Fifteen tumor studies were done after the patient was injected with gadopentetate dimeglumine. Postcontrast T1-weighted images were the most sensitive in detecting melanomas, demonstrating tumors 2 mm in height accurately on axial planes and 1.6 mm in height on combined orthogonal planes. The contrast-to-noise ratio between melanoma and vitreous fluid was greatest on postcontrast T1-weighted images (average, 72.1), followed by noncontrast T1-weighted images (average, 32.9), and then by T2-weighted images (average, -21.2). Postcontrast T1-weighted images also proved useful in differentiating melanomas from subretinal fluid collections when combined with noncontrast images. We conclude that postcontrast T1-weighted images are most helpful in detecting small uveal melanomas and in differentiating melanomas from subretinal fluid collections.

Contrast Media↗

PubMedDate not supplied

The diagnosis of herniated intervertebral disks with MR imaging: a comparison of gradient-refocused-echo and spin-echo pulse sequences.

Axial MR images of 65 lumbar disks with herniated nucleus pulposus imaged by gradient-refocused-echo (GRE) and spin-echo (SE) MR pulse sequences of 200-400/15 with a flip angle of 15-30 degrees was selected as optimal because of its high signal-to-noise ratio and good contrast between CSF, nucleus pulposus, and bone. The GRE technique was confirmed to be more sensitive in detecting prolapsed disks than the SE technique, but was less sensitive in demonstrating extruded disks. The combination of axial GRE and SE resulted in high detectability of herniated nucleus pulposus on axial MR images. Our results suggest that the GRE technique is an important adjunct to SE imaging in studying herniated nucleus pulposus.

Humans↗

PubMedDate not supplied

Degeneration of posterior column nucleus, inferior olivary nucleus and cerebellar cortex: system degeneration of paraneoplastic disease?

Degeneration of the posterior column nucleus, inferior olive, and cerebellar cortex is reported in a cancer patient. A 70-year-old man developed an ataxic gait and rapidly progressive disturbance of deep sensation over six months, followed by an abasic state. Early well-differentiated tubular adenocarcinoma was detected and total gastrectomy was performed. He died due to pulmonary tuberculosis about two years and nine months after the operation. Degeneration of the posterior column nuclei was found, explaining the disturbance of deep sensation noted in the clinical course, although there were few changes in the peripheral nerves, dorsal root ganglia, and spinal cord. Degeneration of the inferior olive and cerebellar corte was also found. Metastatic small cell carcinoma was present in the right pulmonary hilar and paratracheal lymph nodes at autopsy without any detectable primary focus. There was neither recurrence nor metastasis of the gastric carcinoma. This is the first case report of this type of central nervous system degeneration in a cancer patient, and its pathogenesis and etiology remain obscure. We discuss whether system degeneration or paraneoplastic degeneration was the etiology.

Adenocarcinoma↗

PubMedDate not supplied

Pyelovenous backflow in left renal vein hypertension: case report.

Retrograde pyelography for a patient with left renal vein hypertension due to "nutcracker phenomenon" revealed pyelovenous backflow. This is considered to be the first actual demonstration of renal bleeding during the nutcracker phenomenon.

Constriction, Pathologic↗

PubMedDate not supplied

Incremental dynamic CT for small hepatic tumours using high-speed, high-resolution CT apparatus.

Incremental dynamic CT with a high-speed, high-resolution CT apparatus was utilized in four patients with small hepatic tumors. These tumors were imaged as minute, high-density regions, but were difficult to detect because they resembled transverse sections of the portal vein or were located immediately beneath the surface of the liver. Nevertheless, incremental dynamic CT with high-speed CT apparatus, with careful scrutiny and evaluation, can be applied as a means of screening for small hepatic tumors.

Aged↗

PubMedDate not supplied

Malignant pleurisy and intrathoracic dissemination in carcinoma of the lung: diagnostic, therapeutic and prognostic implications.

Of T4 disease of lung cancer, malignant pleurisy and intrathoracic dissemination are the greatest factor preventing a cure, despite the best efforts of surgery and various adjuvant therapy modalities. Preoperative evaluation of this disease is of first importance using conventional radiology and computed tomography. Of the 43 patients who were intraoperatively diagnosed to be the disease, 8 (18%) appeared on the conventional radiology as small amounts of pleural effusion, and 9 (21%) with a interlobar pleural thickening. Based on CT findings, 16 (67%) had one or more of some disseminated nodules, interlobar pleural thickening and broad pleural indentation. In patients with T4 disease, the 5-year survival rate was 14% in patients with malignant pleurisy and/or intrathoracic dissemination, compared with the 18% in those with direct invasion to great vessels, with no significant difference. According to intrapleural instillation as postoperative adjuvant therapy, the 5-year survival rate was 25% in the patients given interleukin-2, compared with 38 months of survival time for patients prescribed doxorubicin and 33 months for those underwent exploratory thoracotomy. A more favorable prognosis of patients whose malignant pleurisy and/or intrathoracic dissemination are first found at thoracotomy can be expected when postoperative intrapleural instillation of interleukin-2 is prescribed following the resection of the intrathoracic tumors.

Adenocarcinoma↗

PubMedDate not supplied

Modified Inoue applicator for endometrial brachytherapy.

The Inoue applicator (3 channels) for endometrial cancer with a microSelectron-HDR was modified to enable both intrauterine and vaginal treatments to be done at the same time. The applicator is described together with a case report.

Adenocarcinoma↗

PubMedDate not supplied

Modified ovoid applicator for intracavitary radiation therapy with a Selectron-MDR or microSelectron-HDR.

A modified ovoid applicator for intracavitary radiotherapy was developed for Japanese and other Asian women. It has more variations of smaller sized ovoids than the original rigid standard applicator of the Selectron-MDR and microSelectron-HDR. In addition, application of the ovoid pair and tandem flange is easy due to the flat surface of the inner aspect of the ovoid pairs, which prevents slippage of the ovoids and flange. The applicator is described together with source loading and dose distribution.

Asia↗