Hiroyoshi Isoda

Enhancement of thermoradiotherapy by glucose administration for superficial malignant tumours

The effect of hyperglycemia on the thermoradiotherapy of superficial malignant tumours was investigated. Glucose administration alone (500 ml of 10% glucose by intravenous drip infusion) reduced the tumour blood flow, when measured by laser Doppler flowmetry, to 66.1% of the baseline level at 30 minutes after the beginning of glucose infusion. Forty patients received glucose in tandem during the hyperthermia and radiotherapy (group A), and 38 patients received thermoradiotherapy alone (group B). The mean Tave (the average temperature of all intratumoural sensors) in group A was 43.4 +/- 1.1 degrees C while that in group B was 42.5 +/- 1.2 degrees C, i.e., glucose administrations significantly increased the tumour temperature (p < 0.01). In group A, complete tumour response (CR) was observed in 12 patients (30.0%), partial response (PR) in 25 patients (62.5%) and no response (NR) in three patients (7.5%). In group B, seven (18.4%), 20 (52.7%) and 11 (28.9%) patients showed CR, PR and NR, respectively. The tumour response rates were significantly different between two treatment groups (p < 0.05). The frequency of side effects of hyperthermia in groups A and B were 22.5 and 21.1%, respectively. This study suggests that hyperglycemia enhances the effectiveness of thermoradiotherapy.

MR findings of clear cell sarcoma: Two case reports

We report two patients with clear cell sarcomas arising from tendons in the ankle and knee. In the current cases, calcifications, fluid-fluid levels and the marked hypointense areas are not seen within the masses. In the differential diagnosis of the mass developing in the tendons and aponeuroses, when these signs are absent, the probability of clear cell sarcoma is higher.

Fibroma of the vulva

We describe a patient with fibroma of the vulva. The tumor had areas of marked hypointensity consistent with fibrosis on T1 and T2 weighted magnetic resonance (MR) images. The presence of abundant fibrous tissues on MR images enabled us to make a preoperative diagnosis of fibroma.

An unusual arterial supply of the kidney from the opposite renal artery

We describe an extremely rare case with a supplementary artery arising from an opposite renal artery without renal anomalies in position and in form. An unusual artery crossing the aorta can be suggested by contrast-enhanced computed tomography. A renal cell carcinoma is supplied by the branch of the opposite renal artery.

Multiple myeloma : Short T2 on MR imaging

We describe a rare case of multiple myeloma with marked hypointense areas on both T1- and T2-weighted images. Amyloid deposition and calcification were not found histologically. Hypointensity on T2-weighted images may be caused by distributed free radicals produced by significant macrophages.

Detection of an Increase in Ascorbate Radical in an Irradiated Experimental Tumour System Using ESR

We measured Asc.- (ascorbate radical) produced by the reaction of AscH- (ascorbic acid) with HO. or O2.- after irradiation in mouse. It is possible to measure Asc.- easily using ESR and a dialysis method in which Asc.- was collected at room temperature in the interstitial fluid through the dialysis membrane. After irradiation, Asc.- increased in both normal muscle and tumour tissues (SCC-VII) in proportion to the radiation dose. Asc.- increased after treatment with the agents H2O2 and FeCl2, while it decreased after treatment with SOD and catalase. These results suggest that the amount of HO. and O2.- produced is reflected in the Asc.- production. Also, the increase in Asc.- production when WR-2721 was administered prior to irradiation was less than for experiments in which irradiation only was performed. This method is useful for the following reasons. First, no special treatment, such as freezing of the sample, and no administration of noxious agents are necessary to measure Asc.-. Second, irradiation using a dose of only a few Gy shows an increase in production of Asc.-. Third, this method does not require removal of organs. Using this method, Asc.- can serve as an indicator of the amount of HO. and O2.- produced by irradiation in vivo.

Squamous cell carcinoma arising in a mature teratoma with metastasis to the urinary bladder

We describe a patient with squamous cell carcinoma arising in a mature teratoma. Magnetic resonance (MR) images revealed a solid lobulated mass attached to the ovarian cyst containing a fat-fluid level. The solid component with extension into pelvic fat showed as hypointensity on T2-weighted MR images with good enhancement. A metastatic tumor to the urinary bladder was also demonstrated.

Relevance of a New Impedance Matching, or Subtrap, Method for the Reduction of Pain During Hyperthermia

Capacitive heating is widely used in hyperthermic treatment of human malignancies. However, the pain on the body surface or thermoesthesia in the subcutaneous fatty layer may prevent an elevation of temperature in the tumors. Impedance matching is improved by a subtrap method entailing the application of two copper plates (10 x 850 x 0.06 mm) as a subtrap circuit to each of two capacitive electrodes. In a clinical trial the Tmax, Tave, Tmin for the subtrap method were all higher in comparison with those for the conventional technique (42.5 +/- 0.7 degrees C, 41.9 +/- 1.0 degrees C, 41.3 +/- 1.1 degrees C vs. 41.1 +/- 1.5 degrees C, 40.6 +/- 1.3 degrees C, 40.0 +/- 1.3 degrees C). Although the maximal radiofrequency (RF) power applied to patients was higher with the subtrap method (875 +/- 189 W vs. 763 +/- 200 W), the incidence of surface pain was reduced dramatically. It is concluded that the subtrap method substantially improves the RF capacitive heating of deep-seated tumors.

Dynamic computed tomography predicts tumor temperature and response to thermoradiotherapy in superficial and subsurface tumors.

Dynamic computed tomography (CT) was performed on patients undergoing thermoradiotherapy for superficial or subsurface tumors, and the correlation between tumor enhancement and tumor temperature during hyperthermia was evaluated. The authors further investigated whether tumor enhancement by dynamic CT is predictive of tumor response to thermoradiotherapy.

Dual radionuclide single-photon emission computed tomography in the prediction of further ischemic risk after acute myocardial infarction.

To evaluate whether the findings of dual single-photon emission computed tomography (SPECT) with technetium-99m pyrophosphate (Tc-99m PPi) and thallium-201 were predictive of further cardiac events in their hospital course, we studied 130 patients recovering from acute myocardial infarction (AMI). Fifty-four patients showed overlapping of Tc-99m PPi and thallium-201 in the same location (overlap positive group), and 76 patients had no overlap (overlap negative group). Of the 130 patients, 36 (28%) had a cardiac event. In patients in the overlap positive group, the incidence of subsequent events was significantly higher than in patients in the overlap negative group (44% versus 16%; p < 0.001). In the overlap positive group, the Tc-99m PPi uptake score and the number of overlap segments in patients with further events was significantly higher than those in patients without further events (10.2 ± 5.1 versus 6.4 ± 4.1, p < 0.005 and 5.2 ± 2.0 versus 3.3 ± 1.3, p < 0.001, respectively). These results suggest that patients who have a Tc-99m PPi and thallium-201 overlap negative scan can be candidates for early hospital discharge. In contrast, patients who have a greater number of overlap segments may require early catheterization and revascularization, so that simultaneous SPECT imaging Tc-99m PPi and thallium-201 might be useful for identifying patients with further ischemic risk after AMI in their hospital course.