Masaaki Shindo

CT of Retropharyngeal Lymph Node Metastasis from Maxillary Carcinoma

CT findings for retropharyngeal lymph node metastasis in 25 patients with histologically proven carcinoma of the maxillary sinus and with no prior treatment were evaluated retrospectively. Four lateral retropharyngeal node metastses (16%, 4/25) could be identified by CT. All retropharyngeal metastatic nodes were located between the ipsilateral internal carotid artery and the longus colli muscle at the level of the first cervical vertebral body. The metastatic nodes ranged from 8 mm to 35 mm in size at the long axis. The risk of retropharyngeal node metastasis depends on the degree of carcinoma involvement to the posterior nasal cavity, the posterior ethmoid sinuses, the sphenoid sinuses, the palate (soft and hard) and the nasopharynx. This study indicates that CT is useful for detecting these lymph node metastases.

A resected case of giant leiomyosarcoma of the pancreas.

Leiomyosarcoma of the pancreas is very rare. We report a case of giant leiomyosarcoma of the pancreas treated by distal pancreatectomy. A 53-year-old female was admitted with an large abdominal mass. Computed tomography, magnetic resonance imaging, and ultrasonography revealed a huge tumor adjacent to the pancreas. However, we could not identify the primary organ with these imagings. Angiographic findings strongly suggested that the tumor originated from the pancreas, as main feeding arteries arose from the great pancreatic artery. Fourteen days after transcatheteric arterial embolization, we performed a distral pancreatectomy with splenectomy; the patients postoperative course was uneventful. Histologically, we confirmed the diagnosis as a leiomyosarcoma originating from the pancreas.

Computed tomography of the paranasal sinuses and their adjacent structures

Forty-five computed tomographic examinations were performed on 34 patients with diseases of the paranasal sinuses and their adjacent structures. Coronal sections were obtained in addition to transverse axial tomographic sections. Evaluation was made whether CT could provide more informations compared with plain roentgenography and whether there were additional informations on coronal sections. CT showed soft tissue abnormality and its extension to better advantage. Especially, involvement of the orbits, pterygoid fossa, nasopharynx, skull base and brain were shown well. Coronal sections were useful in evaluation of superior and inferior extension of the tumors such as involvement of the superior and inferior orbital walls and skull base as well as intracranial extension. Since CT has the ability to better define the total extent of the lesion, this technique should be added to the conventional roentgenologic techniques preferably with the use of coronal sections.

Three-dimensional computed tomography in the head and neck diseases with bony abnormalities

The purpose of this study was to define the role of three-dimensional (3D) computed tomography (CT) in the head and neck diseases with bony abnormalities. Thirty-two patients were examined with a low dose radiation technique. Three-dimensional CT clearly delineated bony lesions in 27 of 32 patients. Three-dimensional CT could not demonstrate subtle bony erosions infiltrated by tumor, a temporal bone fracture, and a blow-out fracture, although two-dimensional (2D) images obtained before the 3D reconstructions clearly depicted those lesions. These two kinds of CT technique were thought to be complimentary.

Metrizamide spinal computed tomography following myelography

Abstract Spinal computed tomography was performed following metrizamide myelography in five cases of spinal lesions. A metrizamide computed tomogram with myelogram revealed the extent of spinal tumors and disk herniation more precisely than a myelogram alone. In addition, syrinx of syringomyelia was demonstrated by sequential metrizamide computed tomography. This technique will play an essential role in the diagnosis of various spinal lesions.

Temporary Interruption of the Left Renal Vein as an Adjunct to Resection of Interaortocaval Pheochromocytoma

Although the left kidney has a number of venous collaterals, the collateral venous drainage is not always sufficient to allow permanent ligation of the venous trunk. Interruption and reanastomosis of the left renal vein were performed as an adjunct to dissection of extra-adrenal pheochromocytoma arising in the interaortocaval space. Reconstruction of the interrupted vein is a simple and reasonably acceptable technique to preserve the ipsilateral renal function. This maneuver, though practiced infrequently, facilitates the juxtarenal surgeries exposure of which is seriously hampered by the anatomical disposition of the left renal vein.

Arterial chemoembolization with microencapsulated anticancer drugs as a treatment for malignant tumors.

Seven hundred and fifty nine patients with malignant tumors were treated by intra-arterial infusion with microencapsulated anticancer drugs from 1978 to 1986. Mean age of the patients was 60.3 yrs(13-88). Fifty seven percents of patients had stage 4 tumor and 41%were grade 3-4 in performans status. The target organs subjected to the treatment were liver(310), kidney(177), bladder(100), prostate(41), lung(39), pelvic organs(13), bone(4)and the others (75). Median doses of drugs in microcapsules were 20 mg for MMC, 40 mg for PEP and 60 mg for CDDP. Of 455 measurable tumors, 113(25%)showed a substantial reduction of greater than 50%. In 508 evaluable patients, side effects frequently recognized were fever(57%)and local pain(50%)shortly after the treatment. However, these side effects were generally mild and temporary. Gluteal skin ulcer occured in 33 patients(21%)who underwent hypogastric arterial infusion, but improved within a few months. Only one patient died of treatment-related cause. These results suggested that microcapsule therapy can be successfully applied to a variety of tumors with low morbidity and low mortality, and also can be combined with other treatments in multidisciplinary therapy.