Sumio Takashima

Castleman’s disease of the spleen: CT, MR imaging and angiographic findings

Since Castleman and Towne [Castleman and Towne, Hyperplasia of mediastinal lymph nodes, New Engl. J. Med. 250 (1954), 26-30] first described hyperplasia of the mediastinal lymph nodes in 1954, many cases of Castlemans disease have been reported. Lesions originating in the spleen arc extremely rare, and we here describe the imaging appearances for such a case, and discuss with a brief review of the literature.

Heterogeneity of hepatic parenchymal enhancement on computed tomography during arterial portography: quantitative analysis of correlation with severity of hepatic fibrosis.

Background/Aims: In patients with chronic liver disease, heterogeneous enhancement of liver parenchyma is often noted on computed tomography during arterial portography (CTAP). We investigated the factors contributing to the heterogeneous enhancement and its relationship with postoperative histopathological findings. Methodology: Eighty-seven patients who had undergone a right lobectomy for liver tumor after CTAP were evaluated. The heterogeneity of hepatic parenchymal enhancement on CTAP was assessed quantitatively using standard deviation of mean CT numbers for five ROIs (S.D.) set in the right hepatic lobe, and comparatively evaluated among three histological groups (liver cirrhosis (LC, n=41), chronic hepatitis (CH, n=33), and normal liver (Normal, n=13)). Severity of fibrosis and degree of splenomegaly (Sp) were taken up as factors contributory to the heterogeneity, and were assessed for correlation with the S.D. Results: The range (mean) of S.D. was LC, 3.07-17.64 (9.10); CH, 1.83-11.12 (6.77); and Normal, 2.06-8.89 (5.64) (Scheffes F-test: LC vs CH, P<0.0005; LC vs Normal, P<0.0002). The higher fibrosis group exhibited significantly greater S.D. values as compared with the lower fibrosis group (Scheffes F-test: P<0.00003). Coefficient of correlation between the S.D. and the Sp was 0.295 (P<0.005). Conclusion: There was a fair possibility of LC in patients with heterogeneous enhancement of liver parenchyma on CTAP. The severity of liver fibrosis and the degree of splenomegaly were considered to be factors contributing to the heterogeneous enhancement.

Clinical evaluation of intermittent arterial infusion chemotherapy with an implanted reservoir for hepatocellular carcinoma

SummaryA total of 45 patients with advanced hepato-cellular carcinoma were treated at Osaka City University Hospital by intermittent arterial infusion chemotherapy with an implanted reservoir. The treatment consisted of intermittent infusion of doxorubicin (5–20 mg/body), mitomycin C (4–10 mg/body) or degradable starch microspheres (600–1200 mg/body) plus doxorubicin (30 mg/body). In all, 26% of the patients received this treatment for disease recurrence following transcatheter arterial embolization (TAE). Among 43 evaluable patients, 4 showed a complete remission (CR) and 16 showed a partial response (PR) on computed tomograms and angiograms. For all 45 patients, the 1-year survival value was 41% and the 2-year value was 14%. Of the 20 patients who showed a CR or PR, 77% survived for 1 year and 29% survived for 2 years. Tumor regression showed a close relationship with the duration of survival. Intermittent arterial infusion with an implanted reservoir caused the least adverse reactions and seems to be appropriate for use in patients with advanced tumor extension or stenosis of the hepatic artery caused by repeated TAE.

Hepatocellular carcinoma associated with polyarteritis nodosa with symptoms appearing after intra-arterial chemotherapy

A 57-year-old man presented with pain in his right hypochondrium. There was no history of blood transfusions, prolonged fever, or pain of the muscles or joints. The patient reported that he had never taken methamphetamine and had not taken sulphonamides or penicillins for a long time. The physical examination revealed a hard elastic mass in the right hypochondrium. Laboratory tests (Table I) showed the presence of a chronic liver disorder, but hepatitis B surface antigen and antibody were not detected. Serum α-fetoprotein (AFP) was 14100 ng/ml. An ultrasound examination of the liver showed a large mass hypoechoic in parts and hyperechoic in other parts in the right lobe. Enhanced computed tomography (CT) revealed a large mass with a diameter of about 6 cm and a low density region in the anterior segment of the right lobe. There were multiple low density nodules throughout the right lobe and the medial segment of the left lobe, and a tumour thrombus in the portal vein and superior mesenteric vein. There wa...

A triple coaxial catheter system for subselective visceral artery catheterization and embolization: Preliminary clinical experience

We developed a triple coaxial catheter system (TCCS) which consists of a 6.1 Fr outer, a 4.1 Fr intermediate, and a 3.0 Fr inner catheter, all coated with a lubricant. The TCCS was used in seven patients with hepatic tumors, after several attempts to access a targeted vessel with conventional catheters and guidewires failed to reach the targeted vessel. No complications were encountered with the use of this system. TCCS may be a useful device for selective abdominal arteriography.

Whirl sign as CT finding in small-bowel volvulus

In three patients with ileus CT showed a whirl sign in which the bowel and mesenteric folds encircled the superior mesenteric vein in a whirl-like pattern. Two patients were confirmed surgically to have small-bowel volvulus arising from postoperative adhesions. The whirl sign is useful in decision-making about the need for surgery. A CT examination should be performed for patients with ileus of unknown cause.

Angioscopy of the Inferior Vena Cava: Preliminary Observations in Cases with Involvement by Neoplasm Work in Progress

Angioscopy of the inferior vena cava (IVC) was performed in 10 patients. Tumor thrombus extending into the IVC was suspected in six patients, and direct invasion of the IVC wall was suspected in four, based on computed tomographic and venographic findings. In each case, a fiberscope was directed to the area of interest in the IVC via a transfemoral 5-F catheter. Blood displacement by means of a saline infusion enabled angioscopic observation of the IVC wall. The neoplasms were seen clearly in all patients but one. The color and texture of the tumor thrombi surface made it easy to distinguish from the healthy IVC wall. In the four patients believed to have direct invasion of the wall, there were no angioscopic differences between the suggestive areas and adjacent areas of normal IVC wall. In these four cases, the absence of direct invasion was confirmed at surgery. Thus, angioscopy helps make an accurate nonoperative or preoperative diagnosis of tumor thrombi possible and may aid in the exclusion of direct invasion.

Transjugular Intrahepatic Portosystemic Shunt for Patients with Hepatocellular Carcinoma

Ten patients with hepatocellular carcinoma successfully underwent transjugular intrahepatic portosystemic shunt (TIPS) without technique-related complications. TIPS was indicated for massive ascites in six cases and ruptures of esophageal varices and hematemesis in four cases. Another two patients with massive ascites developed hepatocellular carcinoma between undergoing TIPS and follow-up observations after 12 and 30 months. In 10 of these 12 patients, the results of TIPS were satisfactory, having obtained good flow in the shunt and effective portal decompression. The gastrointestinal bleeding stopped in all four patients, and the uncontrollable ascites disappeared or decreased in six of the eight patients. Seven out of the 12 patients survived and were followed up for from 2 to 31 months after the TIPS procedure. After TIPS, five patients died due to tumor progression (three patients), hepatic failure (one patient) or acute hepatititis (one patient). In one other patient, the tumor ruptured one month after TIPS was performed. It is concluded that TIPS is a useful and safe treatment for portal hypertension, even in patients with hepatocellular carcinoma as long as it is not located in the puncture route. However, TIPS should be performed only in patients whose tumors have already been controlled by hepatic embolization and/or ethanol injection therapy. Careful follow-up observation is needed after the procedure on a long- term basis.