Hozumi Fukuda

The relation between an esophageal cancer and associated cancers in adjacent organs

Background. The relation between esophageal cancers and head and neck tumors was studied in order to improve the treatment results in patients with multiple cancers.

CT and MR appearances of splenic hamartoma.

The MR and CT appearances of two cases of splenic hamartoma are presented. Computed tomography showed a well demarcated low-density mass without calcification. Dense spreading enhancement was seen in one case on dynamic CT, and prolonged enhancement was noted in both. The masses were demonstrated as areas of isointensity on T1-weighted MR images and of high intensity on T2-weighted images. On gadolinium-enhanced T1-weighted images they were shown as areas of high intensity. Prolonged enhancement on postcontrast CT and MR imaging was a useful finding in differentiation of splenic hamartoma from malignant lesions of the spleen, especially from nodular lesions of malignant lymphoma.

FACTORS AFFECTING MANDIBULAR COMPLICATIONS IN LOW DOSE RATE BRACHYTHERAPY FOR ORAL TONGUE CARCINOMA WITH SPECIAL REFERENCE TO SPACER

PURPOSE To evaluate the efficacy of a spacer in the prevention of mandibular complications in low dose rate (LDR) brachytherapy (BRT) for oral tongue carcinoma. METHODS AND MATERIALS A retrospective analysis was conducted using 103 patients with T1 or T2 tongue carcinoma treated by a single plane implantation of iridium (192Ir) pins between 1979-1994. Of these patients, 60 were treated by BRT alone, and the rest were combined with external irradiation (Ext) and/or chemotherapy (CHT). Forty-eight and 55 patients were given BRT with and without a spacer, respectively. Spacers were individually made of acrylic resin according to a prosthetic technique so as to obtain the thickness of 7-10 mm at the lingual part of the implanted side. Variables, including a spacer, which may be associated with the development of osteoradionecrosis (ORN) of the mandible, were analyzed by the Cox proportional hazards regression analysis. RESULTS Our spacer reduced about 50% of the absorbed dose at the lingual side surface of the lower gingiva (LSG) to that in the absence of a spacer. Absolute incidence of ORN was 2.1% (1 of 48) and 40.0% (22 of 55), with and without a spacer, respectively, and the difference was statistically significant by univariate analysis (p = 0.0004). It was revealed by the Cox analysis that the spacer (p = 0.0247), combined CHT (p = 0.0295), and combined Ext (p = 0.0279) were significant independent factors associated with the development of ORN. The spacer was shown to be a significant factor by univariate analysis (p = 0.0037), but not by multivariate analysis when analysis was restricted to the patients who did not receive CHT. The absorbed dose, dose rate, and biological effective dose (BED) reflecting early or late response were estimated at the LSG, and prognosticators associated with the incidence of ORN were also determined by the Cox analysis. Particularly, BED for late response by BRT, the total absorbed dose, and any BED by Ext plus BRT were highly significant factors in the whole population. Essentially similar results were obtained in the patients without receiving CHT. CONCLUSIONS It was clarified that our spacer effectively prevents mandibular complications in LDR BRT by 192Ir for oral tongue carcinoma. Furthermore, introduction of a spacer provided novel information concerning the development of ORN, where BED particularly for late response given by BRT, the total absorbed dose, and any BED by Ext plus BRT could be good prognostic factors only when estimated at the LSG.

Air Embolism and Needle Track Implantation Complicating CT-Guided Percutaneous Thoracic Biopsy: Single-Institution Experience

OBJECTIVE The objective of our study was to present the details and incidence of air embolism and needle track implantation in patients who underwent percutaneous CT-guided thoracic biopsy. MATERIALS AND METHODS We retrospectively reviewed 1,400 percutaneous CT-guided thoracic biopsies during the period from August 1993 to August 2008. A case with air embolism was considered to be a patient with hypotension during or after biopsy and with an air embolism confirmed on CT. A needle track implantation was considered to be a mass in the needle track on the postbiopsy follow-up CT. RESULTS There were three (0.21%) cases of air embolism. Air embolisms were confirmed in the left ventricle, coronary artery, ascending aorta, and pulmonary vein. The pulmonary venous wall was pathologically identified in one case. Although there were no fatalities, two patients needed resuscitation. Left hemiplegia occurred in one case, but it gradually disappeared. There were four (0.56%) cases of needle track implantation in 713 pathologically proven malignant thoracic biopsy cases with follow-up CT scans. Two were primary lung cancer and the others were lung metastasis (renal cell carcinoma and osteosarcoma). Implantation was found 4-7 months (mean, 5.6 months) after the biopsy, and size was 2.5-5.6 cm (mean, 3.5 cm). CONCLUSION The incidence of air embolism with clinical symptoms and needle track implantation complicating percutaneous thoracic biopsy is more frequent than the previously reported rate.

Metastases to pelvic lymph nodes from carcinoma in the pelvic cavity: diagnosis using thin-section CT.

OBJECTIVE To assess the accuracy of thin-section computed tomography (CT) in the diagnosis of pelvic lymph nodes affected by metastatic cancer. METHODS Incremental CT was performed by obtaining 3 mm sections with 3 mm intervals in 34 patients who had carcinoma in the pelvis, pre-operatively and prospectively. CT diagnoses were made before surgery using the cine mode with a manual trackball. Lymph nodes with a maximum short axis diameter of greater than 5 mm were considered enlarged. RESULTS The accuracy, sensitivity, specificity, positive and negative predictive values of CT diagnoses were 79.7%, 54.5%, 84.9%, 42.9% and 90.0% on a hemipelvis basis; and 79.4%, 85.7%, 77.8%, 50.0% and 95.5% on a patient basis, respectively. There was only one false-negative case on a patient basis analysis. CONCLUSION Because of a fairly high negative predictive value, negative thin-section CT can be considered an alternative to surgical lymphadenectomy. This is clinically important as unnecessary staging operations and extended surgery are avoided.

Spatial Relationship Between the Hepatic Artery and Portal Vein Based on the Fusion Image of CT Angiography and CT Arterial Portography: The Left Hemiliver

OBJECTIVE The objective of our study was to clarify the hepatic artery anatomy of the left hemiliver using the fusion image of CT angiography (CTA) and CT arterial portography. MATERIALS AND METHODS CTA and CT arterial portography were performed on a 64-MDCT scanner in 144 patients. All images were transferred to a workstation for 3D analysis using the multiimage fusion mode. We classified the left hepatic artery (LHA) and middle hepatic artery (MHA) as type L when only the LHA was present, type MB when a medial branch from the LHA was present, type LM when both the LHA and MHA were present, and type M when only the MHA was present. The hepatic artery was classified into infraportal and supraportal groups on the basis of its relationship with the laterosuperior branch of the left portal vein. We also classified the branching pattern of the arteries to each segment. Pattern 1 was defined as when the LHA divided into the laterosuperior segment artery (A2), which then divided into the lateroinferior segment artery (A3) and medial segment artery (A4). Pattern 2 was defined as when the LHA divided into A3, which then divided into A2 and A4. Pattern 3 was defined as when the LHA divided into A4, which then divided into A2 and A3. Pattern 4 was defined as when the LHA divided into A2, A3, and A4 simultaneously. RESULTS The prevalence of each type was as follows: type L (n = 37, 25.7%), type MB (n = 44, 30.6%), type LM (n = 53, 36.8%), and type M (n = 6, 4.2%). The number of cases classified as infraportal was 54 (37.5%) and supraportal, 73 (50.7%). The cases classified by branching pattern were as follows: pattern 1, 26 cases (18.0%); pattern 2, eight (5.6%); pattern 3, 93 (64.5%); and pattern 4, 13 (9.0 %). CONCLUSION Three-dimensional fusion images based on CTA and CT arterial portography can show the various anatomic patterns of the left hemiliver hepatic artery in relation to the left portal vein.

INDUCTION OF SISTER CHROMATID EXCHANGE IN THE PRESENCE OF GADOLINIUM-DTPA AND ITS REDUCTION BY DIMETHYL SULFOXIDE

RATIONALE AND OBJECTIVES The authors investigate the frequency of sister chromatid exchange (SCE) after the addition of gadolinium (Gd)-DTPA to venous blood samples. METHODS Venous blood was obtained from nonsmokers. Samples were incubated with Gd-DTPA alone or in combination with mitomycin C, cytarabine, and dimethyl sulfoxide (DMSO), and then evaluated for SCEs. RESULTS The frequency of SCE increased with the concentration of Gd-DTPA and as each chemotherapeutic agent was added. Sister chromatid exchange frequencies were lower when the blood was treated with a combination of Gd-DTPA and DMSO compared with Gd-DTPA alone. DISCUSSION The increase in frequency of SCE seen after the addition of Gd-DTPA was decreased by the addition of DMSO, indicating the production of hydroxyl radicals. The effect likely is dissociation-related.

Percutaneous transluminal angioplasty for venous stenosis of hemodialysis fistula: Indication and prognosis

BackgroundPercutaneous transluminal angioplasty is an acceptable procedure for insufficient hemodialysis fistula flow, but the factors affecting the patency after angioplasty remain to be clarified.MethodsPercutaneous transluminal angioplasty was performed 29 times in 24 patients undergoing hemodialysis who had insufficient blood flow arising from stenosis in the venous limb of the arterio-venous fistula. We retrospectively investigated factors affecting patency of stenotic lesions after the angioplastic procedure.ResultsCumulative patency rate after angioplasty in all patients, by using Kaplan-Meiers plot, amounted to 58% at 1 year and 54% at 2 years. Analysis by the Cox proportional hazard model showed that length of the stenotic lesions was the only significant factor for patency. The 1-year patency rate after percutaneous transluminal angioplasty was identified as 81% when original stenosis length had been less than 1 cm, 42% when stenosis length had been between 1 and 2 cm, and 16% when stenosis length had exceeded 2 cm.ConclusionShort venous stenotic lesions in hemodialysis fistulas can be treated successfully with percutaneous transluminal angioplasty.