Haruki Nakatsuka

A comparison of transcatheter arterial embolization with one shot therapy for the patients with hepatic cell carcinoma

SummaryIt has been confirmed gradually that transcatheter arterial embolization is the most effective, conservative therapy for the treatment of unresectable hepatic cell carcinoma (hepatoma). Embolization or one shot therapy was carried out in a clinical trial involving 41 patients with unresectable hepatoma visiting our department. Embolization group (emboli G): 19 cases. 1 to 6 embolizations in each case. One shot group (one shot G): 22 cases. Medications: Mitomycin C 10–40 mg and others.Disappearance rate of icterus after treatment was 50% (emboli G) and 25% (one shot G). Decrease in size of hepatomegaly or tumor was seen in 84% (emboli G) and 32% (one shot G) which was statistically significant (< 1 %). Serum AFP titer after embolization decreased in all cases but in only 5 of 12 cases (ca 41 %) after one shot (< 1 %). Effective cases measured by Karnofsky’s method were 18 out of 19 cases (95%) in emboli G, but in one shot G only 10 out of 22 cases (ca 45%)(< 0.1%). Survival rate after each therapy was 67% (emboli G) and 38% (one shot G) after 6 months, and 59% (emboli G) and 19% (one shot G) at 1 year respectively.One study showed that transcatheter arterial embolization therapy was much more effective than one shot therapy.

Protein-losing enteropathy and pancreatic involvement in a case of connective tissue disease

SummaryA patient with connective tissue disease presenting with both protein-losing enteropathy and pancreatic involvement is reported. A 52-year-old female was admitted because of mild epigastralgia, anasarca and ascites. Serum albumin, transferrin and zinc, showed low levels. An Upper G.I. series and endoscopy showed thickened folds of the duodenum and the jejunum. Biopsy specimens revealed lymphangiectasia in edematous villi.99mTc-labeled human serum albumin scintigram showed abnormal radioactivity in the small intestine 90 minutes after intravenous injection, indicating protein-losing enteropathy. Hypoalbuminemia was ameliorated by glucocorticoid therapy, but recurred twice when glucocorticoid treatment was tapered. Hypoalbuminemia has not occurred since intestinal lymphangiectasia was improved with glucocorticoid treatment. Levels of elastase 1 and lipase were high in serum and ascites on admission. Endoscopic retrograde pancreatogrm showed no abnormalities. Serum pancreatic enzymes were also ameliorated by glucocorticoid therapy, but slightly high levels continued for about one year and a half. This case might have been diagnosed as systemic lupus erythematosus although mixed connective tissue disease was also suspected. There are few reports of protein-losing enteropathy and pancreatic involvement associated with connective tissue diseases. Protein-losing enteropathy and pancreatic involvement were ameliorated with glucocorticoid treatment, suggesting participation of immunological mechanisms.

Clinical evaluation of intermittent arterial infusion chemotherapy with an implanted reservoir for hepatocellular carcinoma

SummaryA total of 45 patients with advanced hepato-cellular carcinoma were treated at Osaka City University Hospital by intermittent arterial infusion chemotherapy with an implanted reservoir. The treatment consisted of intermittent infusion of doxorubicin (5–20 mg/body), mitomycin C (4–10 mg/body) or degradable starch microspheres (600–1200 mg/body) plus doxorubicin (30 mg/body). In all, 26% of the patients received this treatment for disease recurrence following transcatheter arterial embolization (TAE). Among 43 evaluable patients, 4 showed a complete remission (CR) and 16 showed a partial response (PR) on computed tomograms and angiograms. For all 45 patients, the 1-year survival value was 41% and the 2-year value was 14%. Of the 20 patients who showed a CR or PR, 77% survived for 1 year and 29% survived for 2 years. Tumor regression showed a close relationship with the duration of survival. Intermittent arterial infusion with an implanted reservoir caused the least adverse reactions and seems to be appropriate for use in patients with advanced tumor extension or stenosis of the hepatic artery caused by repeated TAE.

Changes in serum enzyme activity after transcatheter arterial embolization for hepatic neoplasm

We assayed serum levels of certain enzymes and tumor markers in patients after transcatheter arterial embolization (TAE) to evaluate the effectiveness of this treatment. Twenty patients had hepatocellular carcinoma and two patients had metastases to the liver from colon cancer. Assays were first done immediately after TAE and were continued for the next 12 days. Glutamic oxaloacetic transaminase (GOT; EC 2.6.1.1, L-aspartate:2-oxoglutarate aminotransferase), glutamic pyruvic transaminase (GPT; EC 2.6.1.2, L-alanine:2-oxoglutarate aminotransferase), and lactate dehydrogenase (EC 1.1.1.27; (S)-lactate:NAD+ oxidoreductase) peaked 24 to 48 h after TAE and returned to the base lines in 7 to 10 days. Mitochondrial GOT (mGOT) and glutamate dehydrogenase (GLDH; EC 1.4.1.2, L-glutamate:NAD+ oxidoreductase) also peaked at the same time after TAE. alpha-Fetoprotein peaked 2 h after TAE and decreased to half of the baseline on day 7. Carcinoembryonic antigen peaked at 24 h and fell at 48 h only in the patients with colon cancer. The total amount of cytosolic GOT, GPT, mGOT, and GLDH released was correlated to the volume of the necrotic mass estimated by computed tomography scans. The correlation coefficients for mGOT and GLDH were r = 0.919 and r = 0.939 (both p less than 0.001), respectively. Assays of mGOT and GLDH may be useful to estimate the volume of the necrotic mass of a hepatoma or metastatic carcinoma in the liver.

Tumor regression and growth rate of tumor after transcatheter arterial embolization for patients with hepatocellular carcinoma.

肝細胞癌44例のTAE効果を肝癌化学療法判定基準(案)に従って判定した.奏功度ではcomplete response (CR)2例,partial response (PR) 20例,minor response (MR) 11例,no change (NC) 9例およびprogressive disease (PD)2例であり,奏功率は50% (44例中22例)であった.奏功期間はCR 13～31ヵ月,PR 2～22ヵ月(8.7±5.1ヵ月),MR 2～12ヵ月(5.0±2.7ヵ月)であった.縮小率は径3～4cmの腫瘍で最も大きく,4cm以上では腫瘍の増大に伴い漸減傾向を示し,8cm以上では縮小効果は極めて不良であった.また2～3cmの腫瘍では,縮小効果は比較的不良であった.25%以上の腫瘍縮小を示したPRおよびMR 9例のうち,doubling time (DT)が120日以下であった3例はいずれも1年2ヵ月以内に死亡した.しかし,DTが120日以上であった6例では5例が1年8ヵ月以上生存し,DTと予後との間に関連性が認められた.

An autopsy case of hepatocellular carcinoma survived for five years and eight months after embolization therapy.

症例は55歳の男性,肝右葉に径8×7.5cmの肝癌が認められ,多数の娘結節を伴っていた.右肝動脈より動脈塞栓術(TAE)を施行したところ,AFPの減少と腫瘍血管の明らかな消失が認められた.右肝動脈はTAE 4回施行後に閉塞を来たし,左葉側の動脈および右下横隔膜動脈が新たに腫瘍の栄養動脈となった.右下横隔膜動脈に対するTAEが著効を示し,AFP値は78,800ng/mlから17.1ng/mlに著減した.しかし,その後腫瘍は肝右葉から右副腎,右腎に連続性に浸潤発育し,初回TAE施行より5年8カ月で腫瘍死に至った.本例における長期生存の理由として,以下のことが重要であると考えられた.1. TAE施行中に生じた側副動脈路のうち,右下横隔膜動脈に対するTAEが著効を示した.2. 血管造影所見において,腫瘍が結節型で60%以下の占拠率を有し,主要門脈枝に閉塞が認められなかった.3. Edmondson II型の高分化型肝癌であった.4. 肝硬変の重症度がchild分類のA群であった.