Koh Tokunaga

Limitation of transcatheter arterial chemoembolization using iodized oil for small hepatocellular carcinoma. A study in resected cases

The radiologic and histologic findings are presented of the resection of 14 small hepatocellular carcinomas (HCC), less than 2 cm in maximum diameter, after transcatheter arterial chemoembolization (TCE) using iodized oil. The effect of TCE on small HCC depended on the morphologic type of the tumors. When no extracapsular invasion of tumor cells occurred, TCE was extremely effective against encapsulated tumors. However, in nine of the 14 resected specimens, viable tumor cells remained in or around the tumor. The authors suggest that small HCC are not always curable with TCE alone and that a multi‐disciplinary approach is necessary for patients with small HCC.

Intrahepatic cholangiocarcinoma with marked hypervascularity

Abstract Two rare cases of small intrahepatic cholangiocarcinoma with marked hypervascularity are reported. Dynamic computed tomographic and magnetic resonance images of the two cases revealed strong enhancement of the whole tumor on the early phase and prolonged enhancement on the late and delayed phases. In both cases, the tumors turned out to be well-differentiated tubular cholangiocarcinoma that contained a large number of tumor cells and few interstitial fibrous tissues. These results suggest that some intrahepatic cholangiocarcinoma should be differentiated from other hypervascular hepatic tumors, especially hepatocelluar carcinoma, and that prolonged enhancement of the tumor on late and delayed phases of dynamic images could be of diagnostic value.

Endogenous platelet-activating factor and anti-platelet-activating factor in patients with renovascular hypertension

Renovascular hypertension is relieved by percutaneous transluminal renal angioplasty. In four patients with renovascular hypertension, platelet-activating factor (PAF) was found to be released into the ipsilateral renal venous blood after percutaneous transluminal renal angioplasty, but was not found in the contralateral renal venous blood following this procedure. Anti-platelet-activating factor with a lipid-like property was also found, and its polarity was slightly lower than that of PAF judging by its behavior on thin layer chromatography. Anti-platelet-activating factor completely blocked the aggregation of rabbit platelets induced by PAF, ADP or arachidonic acid. These results indicate that PAF and anti-platelet-activating factor are released into renal venous blood following percutaneous transluminal renal angioplasty in patients with renovascular hypertension.

Adrenal venous sampling analysis of primary aldosteronism: value of ACTH stimulation in the differentiation of adenoma and hyperplasia

Adrenal venous blood samples drawn before and after stimulation with adrenocorticotropic hormone (ACTH) were analysed in 32 consecutive patients with primary aldosteronism. Twenty-six patients had aldosterone-producing adenomas and six patients had bilateral hyperplasia.The ratio of higher to lower levels of aldosterone in the right and left adrenals (aldosterone ratio), aldosterone to cortisol ratio (A/C ratio), and the ratio of higher to lower levels of A/C ratio in the right and left adrenals (ratio of A/C ratios) were calculated. We used both aldosterone ratio and ratio of A/C ratios as a means of diagnosis, a ratio of 3.0 or more for unilateral adenoma, and less than 3.0 for bilateral hyperplasia. With ACTH stimulation, correct characterization of lesions increased from 91% (29 of 32) to 97% (31 of 32) by aldosterone ratio and from 84% (27 of 32) to 97% (30 of 31) by ratio of A/C ratios. Correct diagnosis of bilateral hyperplasia increased markedly from 67% (4 of 6) to 100% and 50% (3 of 6) to 83% (5 of 6) with use of each criterion.In patients with adenoma, aldosterone ratio rose in 54% (14 of 26) from the pre-stimulation levels. Before stimulation, it ranged from 1.5 to 115.9 (mean 34.8), and afterwards, from 2.1 to 1097.9 (mean 95.5). In contrast, in all patients with bilateral hyperplasia aldosterone ratio fell to less than 3.0 following stimulation with ACTH. With ACTH stimulation, aldosterone ratio increased in patients with adenoma and decreased in patients with hyperplasia.Measurement of A/C ratio is used to ensure correct access to the adrenal veins, but it was useful in only one case and aldosterone ration was a more reliable diagnostic parameter than ratio of A/C ratios in both pre-and post-ACTH stimulations.Assay of aldosterone levels and calculation of aldosterone ratios before and after ACTH stimulation were valuable in locating small adenomas in the right and left adrenal and especially in differentiating bilateral hyperplasia from adenoma.

Fine-needle aspiration biopsy via percutaneous transhepatic catheterization: technique and clinical results.

Under fluoroscopy, we performed fineneedle aspiration biopsy of the pancreas and bile duct via percutaneous transhepatic catheterization in 24 patients with obstructive jaundice. The sensitivity, specificity, and overall accuracy of our technique were 67, 100, and 71%, respectively. This method of biopsy avoids malignant seeding of the tract and does not burden patients psychologically.

Transcatheter arterial embolization for metastatic liver tumors: A study in resected cases

We evaluated histologically the effect of transcatheter arterial embolization (TAE) in five metastatic liver tumors from gastrointestinal cancer, which were resected at surgery or removed at autopsy after TAE. TAE was carried out with cubes of gelatin sponge; in 2 cases, iodized oil was used as peripheral embolic material. Histological examination revealed three tumors to be completely necrotized. Approximately 80% of the remaining two tumors were necrotic. Our data suggest that TAE holds promised in the treatment of metastatic liver tumor from gastrointestinal cancer.

Computed Tomographic Arteriography of the Liver Using Balloon Occlusion

The article describes a new method for computed tomographic arteriography (CTA) of hepatocellular carcinoma (HCC) using a balloon occlusion catheter in 8 patients. Our dynamic study indicated that: 1) a bolus injection of contrast medium with our method of CTA (CTA-B) produced an attenuation difference between liver and tumor which was about double that obtained with standard methods for CTA, and 2) marked tumor-liver attenuation differences (above 20 HU) persisted for more than 60 s in CTA-B and for not more than 20 s with conventional methods for CTA. The results show that CTA-B is superior to standard methods in enabling multiple scans of the liver during greater and prolonged differential tumor enhancement after administration of a bolus of contrast medium. In conjunction with table incrementation, CTA-B allows scanning of the entire liver at the time of maximal contrast enhancement with two to three injections of contrast medium. Two patients complained of abdominal pain during balloon inflation. No other complications were observed.

Staging of Bladder Carcinoma by Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) of bladder carcinoma was performed in 10 patients who subsequently underwent operations for tumor staging. MRI was performed with a 0.1 T resistive magnetic resonance unit. Images were obtained in the transverse, coronal and sagittal directions with different repetition and echo times. Simultaneously, computed tomography (CT) was performed in 9 of the 10 patients. The accuracy of MRI and CT staging was then evaluated by comparison with the staging from pathologic diagnosis. All of the tumors, which were 2.3-6.3 cm in diameter, were readily depicted by both imaging techniques. The overall accuracy of MRI staging for the 10 patients in whom staging had been pathologically confirmed was 90%, while the accuracy of CT staging for the 9 patients was 55%. Although no statistically significant differences in accuracy between CT and MRI staging can be established on the basis of the above results because of the small number of patients included in this study, MRI appears to be a very useful modality for staging bladder carcinoma.

A Close Correlation of Fasting Insulin Levels to Blood Pressure in Obese Children

Many epidemiologic studies suggest that obesity is an important factor in the development of hypertension (1,2). However, the mechanism linkage of obesity to hypertension has not been fully elucidated (3,4). Especially in adult obese subjects, they have various degrees of arteriosclerosis in each case because the severity of metabolic disorders and the duration of obesity were different in each case, and it may be related with hypertension or cardiac function in obesity (5). However, it is difficult to estimate the effect of arteriosclerosis on blood pressure quantitatively. Therefore, we studied the relationship between blood pressure and obesity in school children in order to exclude the effects of aging and arteriosclerotic factors and clarify the direct effect of obesity on blood pressure in this population.

The New Editorial Board: 1991-1996

The New Editorial Board: 1991-1996 Cardiology was first published in 1937; the original editors were Drs. Bruno Kirsch of Cologne and W. Löffler of Zurich. The journal was originally named Cardiologia International Archives of Cardiology. In 1970, the name of the journal was changed to Cardiology. The Editorial Board at the time the journal was founded consisted of 24 distinguished cardiologists from Europe, North and South America, and Asia. The United States had 5 members including Paul D. White and Frank N. Wilson; Switzerland had 3 members, the UK and Czechoslovakia 2. The remaining 14 members came from the Netherlands, Portugal, Rumania, France, Germany, Sweden, Denmark, Austria, Mexico, and Japan. The 3 eastern European members are of even greater interest given current political changes in that region. More than half the articles in the first two volumes were in German, a quarter were in French, 15% were in Italian, and only 5% were in English. By 1960, the majority of the articles were in English, although French and German manuscripts were still being published. In 1970, when the journal took its present name, English became the sole language of the publication. Contributions in those first two volumes (1937-1938) came from the Netherlands, Italy, Germany, Denmark, France, Switzerland, and the USA. Each article ended with summaries in French, German, English, and Italian. There were no editorials and only occasional book reviews. Slightly more than one-third of the articles dealt with laboratory investigations in animals. Most studies were observational rather than experimental. It is interesting to review the topics covered in the first two volumes of Cardiologia. A number of animal studies were published including one of particular merit on the circulatory effects of intravenous epinephrine and adrenal cortical hormones. Clinical studies of note included work dealing with ventricular premature beats recorded by electrocardiography, congenital heart block, pathological observations on the etiology of atherosclerosis, and the application of cardiac output determinations to clinical problems. Thus, many of the topics which interest us today were already being considered in 1937 and 1938. Modern cardiology was already prefigured at that time. The new Editor and Editorial Board are honored to be part of a scholarly enterprise that is more than 50 years old. On behalf of the publisher and the members of the new Board, I would like to take a few minutes of 2 The New Editorial Board: 1991-1996