R. Saito

Balloon-occluded arterial infusion therapy in the treatment of primary and recurrent gynecologic malignancies

Balloon-occuluded arterial infusion (BOAI) of bilateral internal iliac arteries produces high drug concentration as well as increased arterial flow of pelvic organs. Twenty-seven patients with primary and locally recurrent gynecologic malignancies were treated with BOAI of cisplatinum. Six of 10 patients with primary advanced uterine cancer and 5 of 11 patients with recurrent cancer showed clinical response. In 6 patients, BOAI was performed as an adjuvant therapy to radiation or other chemotherapy. Toxicity was similar to that seen with systemic treatment using cisplatinum, but its frequency and degree were less severe.

Hybrid digital subtraction angiography: Initial clinical experience

Hybrid digital subtraction angiography was performed after modification of a DSA system. Alternate high voltage (110-120 kV) and low voltage (65-70 kV) were obtained within short time intervals of 60-70 ms with a high voltage switching generator. Experimental phantom studies revealed the exposure dose per single image of hybrid subtraction was approximately 30% of that of conventional DSA. The SNR of hybrid subtraction was improved by increasing the exposure dose and application of postprocessing programs. Clinical application of intraarterial and intravenous DSA revealed that soft tissue artifacts were removed surprisingly well, but image quality decreased because of lowered SNR. Frame integration and matched filtering improved image quality of hybrid subtraction.

Duodenal Adenoma Removed by Endoscopic Polypectomy

Abstract: We report two duodenal adenoma cases treated by endoscopic polypectomy. Case 1, a 59‐year‐old male, visited our hospital for further examination of a duodenal polyp found elsewhere. X‐ray examination revealed a semi‐pedunculated polyp with an irregular surface in the second portion of the posterior wall of the duodenum. Case 2, a 68‐year‐old male, was admitted to our hospital for endoscopic polypectomy of a duodenal polyp. Upper GI series demonstrated a semi‐pedunculated round polyp with a shallow central depression. Endoscopic polypectomy was performed for both lesions and the polyps were successfully removed. The resected polyps were 11 × 10 mm and 13 × 12 mm in size, respectively. The polyps were histologically diagnosed as tubulovillous and tubular adenomas, respectively, with no evidence of malignancy. Endoscopic polypectomy provides histological confirmation of adenoma of the gastrointestinal tract, and it is frequently applicable to the duodenum.

Differential diagnosis of gastric adenoma and type IIA early gastric cancer

The endoscopic and radiographic findings of 45 gastric adenomas in 39 patients were followed for 6 months to 13 years and compared with type IIa early gastric cancer observed in 9 patients. Difficulties in the differential diagnosis of these disorders were evaluated. The following features were suggestive of gastric adenomas: clustered lesion; protuberance with gentle slope; smooth surface; and relatively young patients. Discrimination of adenoma from type IIa early gastric cancer is often difficult by visual observation alone; biopsy was essential in most patients. A group III adenoma verified on biopsy should be followed closely because the lesion may harbor a cancer (so-called carcinoma-in-adenoma) or a cancer may later develop.

Gastrointestinal Complications Following Transcatheter Arterial Embolization through Subsegmental Catheterization for Hepatic Malignancies

Abstract: We assessed gastrointestinal complications after transcatheter arterial embolization (TAE) performed over the three‐year period from 1991–1994. Gastric erosion, gastroduodenal ulcer and hemorrhagic gastritis were investigated in a series of 273 cases (408 TAEs) with hepatic malignancies. Gastric erosions were found in 60 cases (7.6%), gastroduodenal ulcer in 24 cases (5.9%) and hemorrhagic gastritis in six cases (1.5%). Gastroduodenal complications occurred in a total of 60 cases (61 instances) (15.0%). Neither the formerly occurring geographic ulcers in the gastric antrum nor fatal hemorrhagic gastritis/ ulcers were encountered in the present study. This relative mildness of complications is probably attributable to superselective catheterization into the proximal hepatic artery. Such complications are due not only to ischemic changes resulting from backflow of embolic materials into the gastroduodenal artery, but also to transient liver damage caused by TAE.