Kisaku Yoshida

Postoperative prophylactic lipiodolization reduces the intrahepatic recurrence of hepatocellular carcinoma

BACKGROUND To determine a feasible postoperative adjuvant chemotherapy for patients with hepatocellular carcinoma, orally-administered chemotherapy (OC) and prophylactic lipiodolization (selective regional cancer chemotherapy using lipid contrast medium plus an anticancer drug) (PL) were compared prospectively. PATIENTS AND METHODS Forty-eight patients who had undergone hepatic resection from 1989 to 1992 were divided into three groups: the control group (n = 19), given no chemotherapy; the OC group (n = 12), given 300 to 400 mg/d of 5-FU derivatives (either 1-hexylcarbamoyl-5-fluorouracil or uracil and tegafur, mean total dosage: 188 g, mean administrative duration: 18 months); and the PL group (n = 17), who underwent prophylactic lipiodolization 1.8 times on average using a 44-mg mean dose of epirubicin per treatment. RESULTS No statistical differences were found either in the 25 variables studied as a background analysis, or among the survival curves of the 3 groups. Recurrence was found in 23 remnant livers of the 48 patients. The 3-year, disease-free survival rate was 15%, 50%, and 86% in the control, OC, and PL groups, respectively. The disease-free survival curve of the PL group was significantly higher compared to either the control (P = 0.001) or the OC group (P = 0.025). CONCLUSIONS Prophylactic lipiodolization was found to be an effective treatment for patients with hepatocellular carcinoma for reducing intrahepatic recurrence after resection.

Laparoscopic splenectomy may be a superior supportive intervention for cirrhotic patients with hypersplenism.

Background and Aims:  To evaluate and compare laparoscopic splenectomy and partial splenic embolization as supportive intervention for cirrhotic patients with hypersplenism to overcome peripheral cytopenia before the initiation of and during interferon therapy or anticancer therapy for hepatocellular carcinoma.

Contrast-enhanced MRI in spinal arteriovenous malformations and fistulae before and after embolisation therapy

Abstract MRI was performed in six cases of spinal arteriovenous malformation (AVM) and arteriovenous fistula (AVF) before and after embolisation. Intramedullary and perimedullary AVMs showed marked vascular enhancement after embolisation. This was thought to reflect feeding vessel occlusion and correlated well with a favourable clinical outcome. In dural AVFs, contrast-enhanced studies were essential for the diagnosis, unenhanced images being nonspecific. After embolisation, enhancement of the spinal cord was reduced, although one case with a poor outcome showed persistent enhancement.

Partial splenic embolization facilitates completion of interferon therapy in patients with chronic HCV infection and hypersplenism.

events of the systemic circulation when we employ RFA for an adrenal tumor. Monitoring of the adrenal hormones should also be considered. Although considerable care is also required to avoid severe adverse events such as infarction5 or tumor rupture6 during the procedure, our experience suggests that percutaneous RFA is a useful approach for the control of metastatic HCC and prevention of localized tumor growth in the adrenal gland.

Magnetic resonance imaging compared with computed tomography and angiography in Moyamoya disease

Magnetic resonance (MR) imaging performed in 13 patients with moyamoya disease was reviewed and compared with computed tomography (CT) and angiography. The MR findings consisted of occlusion of arteries, collateral vessels and parenchymal changes. Narrowing or occlusion of the middle cerebral artery and the supraclinoid portion of the internal carotid artery were seen in all hemispheres but one. Collateral vessels, cerebral infarcts and atrophy with dilatation of the ventricles were observed on MR imaging. In general, the MR findings correlated well with angiography regarding occlusive changes and moyamoya vessels but was less sensitive in a few cases. Because of its higher sensitivity in detecting occlusive changes and collateral vessels, MR imaging was superior to CT in the diagnosis of this disease.

New method of catheter-port system implantation in hepatic arterial infusion chemotherapy

BACKGROUND This report describes a novel method of implantation of the catheter-port system in hepatic arterial infusion chemotherapy, which is the inferior epigastric arterial approach. METHODS Using this method, the length of incision is about 3 cm in lower abdomen. The inferior epigastric artery is exposed above the inguinal ligament. The half of the artery is cut, and a vascular sheath is inserted into the external iliac artery along a guide wire. A catheter is inserted into the hepatic artery through the vascular sheath. Coil occlusion of nontarget artery is performed by the technique of interventional radiology. Then the vascular sheath is removed and the catheter is fixed to the inferior epigastric artery. A port is connected to the catheter and placed above the incision in the lower abdomen. CONCLUSIONS Using this method, the hip joint can be moved freely and port-related complications are few, which contributes to a good quality of life of patients during the therapy. The inferior epigastric arterial approach may give a benefit to those who are treated with hepatic arterial infusion chemotherapy.

Successful Treatment of Massive Hemorrhage after Percutaneous Renal Biopsy with Transcatheter Arterial Embolization

We report a case with life-threatening renal hemorrhage after percutaneous renal biopsy that was successfully treated with percutaneous transcatheter arterial embolization (TAE) with a good preservation of renal function

Case report : Primary splenic non-Hodgkin's B cell lymphoma in a patient with chronic hepatitis C

A case of primary splenic lymphoma in a patient with chronic hepatitis C is reported. A 69‐year‐old man with chronic hepatitis C was admitted to Fukuoka City Hospital for evaluation of an enlarging splenic tumour. In the spleen, ultrasonographic examination revealed a hypoechoic tumour and computed tomography demonstrated a non‐enhancing low density area measuring 7 cm in diameter; coeliac angiography revealed a hypovascular tumour. Gallium scintigraphy showed uptake of the radioisotope in the splenic tumour. A splenectomy was performed and the morphological and immunohistochemical findings of this tumour were compatible with those of non‐Hodgins B cell lymphoma. Recently, cases of malignant B cell lymphoma associated with hepatitis C virus infection have been reported. Lymphotropism of hepatitis C virus may play a pathological role in the development of non‐Hodgkins lymphoma. We emphasize the importance of considering lymphoma in the differential diagnosis of extrahepatic disorders during the course of chronic hepatitis C virus infections.

Ultrasonic and CT findings in penicillin-induced nonpseudomembranous colitis

The findings of ultrasonography (US) and computed tomography (CT) of the abdomen in two cases of nonpseudomembranous colitis (NPMC) induced by penicillin are described. Both imaging methods revealed diffuse thickening of the colon in patients who were endoscopically diagnosed as suffering from this disease. The clinical and radiographic features of this entity are presented along with a brief review of pertinent literature.

Magnetic resonance imaging in a juvenile type of distal and segmental muscular atrophy of the upper extremities

Eight patients with a juvenile type of distal and segmental muscular atrophy of the upper extremities (DSMA), a type of cervical flexion myelophathy, were evaluated using MR imaging. In the neutral position there was no spinal cord compression, but in flexion the spinal cord was displaced anteriorly and was compressed by the posterior surfaces or margins of the vertebrae and/or any herniated disks in all cases. In flexion, compression of the cord was exaggerated in seven patients by the anterior displacement of the posterior margin of the thecal sac, which was accompanied by dilated posterior internal vertebral veins. In patients suspected of having DSMA, MR images made in flexion are regarded essential for verifying the diagnosis.