[PURPOSE]: An attempt was made to evaluate the ability of magnetic resonance (MR) imaging to diagnose stage IIIa endometrial carcinoma. [MATERIALS AND METHODS]: Thirty-three patients with endometrial carcinoma underwent MR imaging and surgery. Surgical staging was classified as I in 21 patients, II in 3 patients and III in 9 patients. The MR images of each patient were retrospectively reviewed by three radiologists. Only the clinical diagnosis of endometrial carcinoma was previously notified. Segmental disruption of the full thickness of the myometrium was considered serosal invasion. Intraperitoneal metastasis was diagnosed according to three criteria (intraperitoneal solid mass of isointensity compared with endometrial lesion, cystic mass excluding benign ovarian cysts, ascites). These evaluations were compared with the surgical findings and analyzed by the kappa statistic. [RESULTS]: The rates of sensitivity and positive predictive value (PPV) for serosal invasion were 33% and 6%, respectively. False positive evaluation frequently occurred when thickness of the intact myometrium was less than 5mm. The rates of sensitivity and PPV for intraperitoneal metastasis were 86% and 72%, respectively. The reason for false negative evaluation was small foci of intraperitoneal metastasis. Overall, sensitivity and PPV for stage IIIa were 86% and 69%, respectively. [CONCLUSION]: MRI was useful in detecting intraperitoneal metastasis of endometrial carcinoma with the exception of diagnosing serosal invasion. It is difficult to detect small foci of peritoneal metastasis. It is necessary to differentiate adnexal metastasis from benign adnexal masses.

Adenocarcinoma↗

PubMed1996

Pancreas transplantation using non-suture cuff technique in the neck.

To get a successful pancreas transplantation in a rat model, we performed heterotopic pancreas transplantation with non-suture cuff technique to neck vessels. As the graft was placed in the neck, we could avoid the clamping of systemic circulation which is essential but detriment to the rat during vascular anastomosis in intraabdominal grafting. The diameter of the portal vein was enlarged to prevent outflow block after transplantation. The cuff was fixed by fat clay during anastomosis to perform vascular anastomosis easily. As a result the success rates was 16/20, 80%. 16 rats survived more than 30 days and maintained serum glucose level within 200 mg/dl throughout the experiment. The heterotopic pancreas transplantation using non-suture cuff technique to the neck vessels is safe, reliable and recommended as the experimental model using the rat.

Animals↗

PubMed1996

[Phase I study of bicalutamide (Casodex), a nonsteroidal antiandrogen in patients with prostatic cancer].

A phase I study (open trial) of bicalutamide (Casodex), a non-steroidal antiandrogen, was conducted on 16 patients with prostatic cancer (stage C to D). The patients were given 10, 30, 50, 80 or 100 mg of bicalutamide orally daily for 12 weeks. Adverse reactions were observed in 8 out of 16 patients, but almost all were mild. Breast pain, gynecomastia and hot flushes were observed in 6 patients. Adverse reactions regarding liver function tests were observed in 3 patients. These were increased glutamic-oxalacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT), alkaliphosphatase (AL-P) or gamma guanosine 5'-triphosphate (gamma-GTP). However, during or after the treatment period the elevated values were reversed to the pretreatment level. In terms of efficacy, anti-tumor effect was observed in 1 or 2 patients at each dose. Serum concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone and estradiol increased during treatment. Plasma concentrations of the R (-) enantiomer, which has antiandrogenic activity, reached the steady state 6-8 weeks after the initiation of treatment; its apparent plasma elimination half-life observed following repeated administration was 8.4 +/- 1.1 days. In conclusion, bicalutamide (10-100 mg od) is considered to be tolerated well enough to be administered to patients with prostatic cancer and has shown evidence of anti-tumor effect.

Administration, Oral↗

PubMed1996

[Clinical early phase II study of bicalutamide (Casodex) in patients with prostatic cancer].

To investigate the efficacy and safety of bicalutamide (Casodex) with its clinically recommended dose, the randomized early phase II study was performed in 124 patients with prostatic cancer (stage C, D). The patients were given 50, 80 or 100 mg of bicalutamide orally once a day in fixed doses for 12 weeks; 122 patients were eligible for evaluation. The overall response rate was 50.0% (20/40), 61.0% (25/41) and 53.7% (22/41) in the 50 mg, 80 mg and 100 mg groups, respectively. The response rate in prostate lesion, bone and lymph node metastases was slightly higher in the 80 mg group than in the 50 mg and 100 mg groups. The proportion of patients showing a response with regard to serum PSA (CR and PR) was 84.2, 92.7 and 97.6% in the 50, 80 and 100 mg groups, respectively. The incidence of adverse reactions was 65.0, 61.0 and 61.0% in the 50, 80 and 100 mg groups, respectively, and there was no significant difference in overall safety rating in the three groups. Frequent adverse reactions were gynecomastia and breast pain. Only one patient in the 80 mg group was withdrawn due to shortness of breath. Serum concentrations of LH, testosterone and estradiol increased significantly after treatment. Bicalutamide was concluded to be effective and well tolerated in patients with prostatic cancer, and its recommended dose was 80 mg once daily.

Administration, Oral↗

PubMed1996

[Constrictive pericarditis with dissecting aortic aneurysm (DeBakey type II)].

We experienced a case of constrictive pericarditis with dissecting aortic aneurysm (DeBakey type II). The patient complained of orthopnea and leg edema. The cause of constrictive pericarditis was pericardial effusion due to dissecting aortic aneurysm. Ascending aortic replacement with graft and decortication of thickened pericardium were performed. We confirmed the decrease of CVP and PAP intraoperatively. Postoperative course was uneventful.

Aged↗

PubMed1996

[Case of intralobar pulmonary sequestration with increased serum sialyl Lewis X-i (SLX)].

A 37-year-old male whose chief complaint was fever and back pain was admitted to our hospital because of a mass shadow in the left lower P3ng field found in X-ray examination. The level of serum SLX on admission increased to 1,338 U/ml. He was diagnosed intralobar pulmonary sequestration by angiography. The left lower lobe was resected 2 months after second admission. His general condition was steady, and he was discharged 18 days after the operation because the level of serum SLX decreased to 49.9 U/ml.

Adult↗

PubMed1996

[Clinical evaluation of 99mTc-HMPAO labeled leukocyte imaging in ulcerative colitis].

Inflammatory imaging using 99mTc-HMPAO-labeled mixed leukocytes was assessed for use in treating 11 cases diagnosed as ulcerative colitis: 10 cases with total colitis and 1 with left-sided colitis. They consisted of 8 patients with relapse-remitting type and 3 with chronic continuous type. Radionuclide abdominal images were obtained at 1 hr, 4 hr and 24 hr after intravenous injection of 200 MBq prepared 99mTc leukocytes. Obvious colonic activity noted at 4 hr served as the basis for positive comparative criterion in the present study. The diagnostic efficacy of radionuclide imaging was compared with endoscopic findings (based on Matts' classification) and the clinical manifestations as reference. The sensitivity and specificity of this imaging were 83.3% and 85.7%, respectively, these values being consistent with endoscopic findings and clinical manifestations at sites of disease activity. All of positive images changed to negative after treatment by leukocyte apheresis or glucocorticoid. Based on these results, 99mTc leukocyte imaging can be used to accurately evaluate severity and treatment response in ulcerative colitis. Leukocytes may be closely related to the pathogenesis of ulcerative colitis.

Adolescent↗

PubMed1996

[Bacterial translocation induces remnant liver injury after subtotal (90%) hepatectomy in rats--the effect of decontamination of gram-negative rods in digestive tract by oral polymyxin B treatment].

To clarify the relationship of bacterial translocation (BT) to remnant liver injury after subtotal (90%) hepatectomy, we compared orally polymyxin B treated rats (PL-B (+)), of which gram-negative rods (GNR) in digestive tract decreased, with control rats (PL-B (-)). The increase in intestinal permeability assessed by lactulose/mannitol ratio in urine, the increase in GNR positive in tissue culture including mesenteric lymphnode, liver, spleen, portal blood, and kidney, and the elevation of serum endotoxin levels showed BT after subtotal hepatectomy in PL-B (-) group. Liver injury was also observed by increased serum GPT levels and massive coagulative necrosis of hepatocytes with bleeding in the remnant liver. In PL-B (+) group rats, BT and liver injury decreased and hepatocyte DNA synthesis increased, while intestinal permeability was the same as PL-B (-) group. It is suggested that BT is the cause of remnant liver injury after subtotal hepatectomy, and oral PL-B treatment is effective in preventing liver injury.

Administration, Oral↗

PubMed1996

Predicting risk of embolization during anticoagulation for left atrial thrombus by transesophageal echocardiography: a case report.

A 75-year-old woman was admitted with transient left hemiparesis accompanied by diminished level of consciousness in September 1994. Holter electrocardiography showed transient atrial fibrillation, and transesophageal echocardiography (TEE) revealed an atrial septal aneurysm, spontaneous echo contrast, and a thrombus in the left atrial appendage. The patient received anticoagulant treatment with warfarin, and follow-up TEE showed thrombus resolution. However, after the warfarin was discontinued, symptoms recurred in October 1995 and TEE showed a club-like left atrial thrombus (21 x 40 mm) originating in the left atrial appendage and extending to the center of the left atrium. Follow-up TEE after warfarin therapy showed resolution at the neck of the thrombus but the head threatened detachment. The thrombus was subsequently excised surgically. Follow-up TEE was critical for detecting the risk of significant embolization during anticoagulant therapy.

Aged↗

PubMed1996

[A case of right postpneumonectomy empyema treated by open window thoracostomy, thoracoplasty, pedicled omental flap and musculocutaneous flaps].

A case of right postpneumonectomy empyema treated by open window thoracostomy, thoracoplasty, pedicled omental flap and musculocutaneous flaps is reported. After open window thoracostomy, pedicled omental flap and musculocutaneous flaps transplantation utilizing techniques used in plastic surgery were performed, and right postneumonctomy empyema was successfully treated. In this study, open window thoracostomy was effective against depuration of the empyema cavity and omental and musculocutaneous flaps against the infection control and plombage of the cavity. Furthermore, to maximize the effect of musculocutaneous flaps and to use them effectively, it is thought that techniques utilized in plastic surgery are effective and necessary.

Adenocarcinoma↗

PubMed1996

[Evaluation of concomitant use of cyclosporin and percutaneous isolated liver perfusion under complete venous isolation and charcoal hemoperfusion].

It is difficult to administer an effective dose of cyclosporin A (CsA), a potent inhibitor of P-glycoprotein, to prevent multiple drug resistance due to its side effect. We herein evaluated the efficacy of concomitant use of this agent and complete hepatic venous isolation and charcoal hemoperfusion (HVI.CHP). Dogs were divided into two groups; group I (n = 4), intraarterial infusion of only adriamycin (ADM) and group II (n = 4), intraarterial infusion of CsA and ADM. In both groups, ADM was intraarterially administered for 10 minutes under HVI.CHP. In addition, in group II, CsA infusion (0.3 mg/min.kg) was initiated 20 min prior to the start of ADM infusion and maintained for 30 min. The AUC (micrograms.min/ml) of ADM were 21.2 +/- 8.6 (mean +/- SD) and 28.4 +/- 10.3 in groups I and II, respectively, at prefilter (hepatic venous level) and 8.1 +/- 4.6 and 4.8 +/- 3.8, respectively, at postfilter, showing an effective drug elimination in both groups. The Cmax (micrograms/ml) were 14.1 +/- 2.2 at prefilter, 2.4 +/- 0.5 at postfilter, and 3.4 +/- 1.2 in systemic level. These results indicated that HVI.CHP allowed the high-dose CsA infusion required for P-gp inhibition in the liver and could reduce extraregional CsA leakage.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

PubMed1996

[The effect of high-dose intraarterial chemotherapy with percutaneous hepatic venous isolation and charcoal hemoperfusion (HVI.CHP) for unresectable multiple hepatocellular carcinoma--comparison with other therapeutic modalities].

We evaluated the therapeutic effect of HVI.CHP in 11 patients with Stage III and IVA multiple hepatocellular carcinoma (group H) in comparison with conventional intraarterial chemotherapy (group S, 12 patients) and transarterial embolization (TAE; group T, 15 patients). The patients in each group had the same background as group H in terms of liver function tests. The Vp3 positive rates in group H (37%) and group S (47%) were significantly higher than group T (0%). One-year survival rates of groups H, S and T were 63. 6%, 8.3% and 46.7%, respectively, and 2-year survival rates were 63.6%, 0% and 20%, respectively. A significant difference was seen between the survival curves of groups H and S (p < 0.01), whereas no significant differences were detected between those of groups H and T. The survival rates for stage IVA patients in groups H, S and T were 55.6%, 10% and 40%, respectively, for 1 year and 55.6%, 0% and 10%, respectively, for 2 years. The difference of survival curves between Stage IVA patients of each group was analogous to those between overall patients of each group. Although 4 patients with Vp3 were included in group H but none in group T, the survival rates of group H were rather higher than in group T at 2 years. These data suggest that HVI.CHP could be the treatment of choice for unresectable multiple hepatocellular carcinoma.

Antineoplastic Combined Chemotherapy Protocols↗