Yoshihiro Asanuma

Role of positron emission tomography with 2-deoxy-2-[18F]fluoro-D-glucose in evaluating the effects of arterial infusion chemotherapy and radiotherapy on pancreatic cancer

BackgroundThis study evaluated the usefulness of positron emission tomography with 2-deoxy-2-[18F]fluoro-d-glucose (FDG-PET) in monitoring the response to continuous arterial infusion chemotherapy (CAI) combined with external radiation therapy (ERT) for unresectable pancreatic carcinomas.MethodsTen patients with unresectable pancreatic cancer were enrolled in this study. Computed tomography (CT) and FDG-PET were done before and after CAI (5-fluorouracil [FU], 500 mg/body per day) combined with ERT (50.4 Gy total dose). Tumor regression was evaluated by standardized uptake value (SUV) with FDG-PET, tumor size on CT, and changes in blood levels of carbohydrate antigen (CA) 19-9. The three methods of evaluation were compared.ResultsThe ten patients were classified in three categories. In category I, tumor changes evident on CT and FDG-PET were consistent. In category II, CT could not accurately detect the area of the tumor. However, tumor uptake on FDG-PET decreased markedly after the treatment in category II patients. In category III, both CT and FDG-PET detected the tumor, as in category I. Although there was no definite change in tumor size on CT, FDG-PET uptake was markedly reduced immediately after the treatment. Reduction in tumor size did not appear on CT until 2 months later.ConclusionsFDG-PET aids in analysis of the effectiveness of chemotherapy and/or radiotherapy.

Outcomes and Indications of Segmental Pancreatectomy

Background/Aim: To preserve pancreatic function, segmental pancreatectomy has been proposed for benign or low-malignancy tumors in the pancreatic body. Indications for the procedure, however, are still controversial. Methods: In this study, we investigated the advantages and disadvantages of segmental pancreatectomy compared with distal pancreatectomy and subsequently determined indications for segmental pancreatectomy. Results: The distal pancreatectomy patients had shorter operation times, lower incidence of operative complications, and shorter hospital stays compared to segmental pancreatectomy patients. Endocrine function in distal pancreatectomy patients deteriorated compared to that of segmental pancreatectomy patients. The postoperative 75-gram oral glucose tolerance test showed a diabetic pattern in 3 of 7 distal pancreatectomy patients, whereas none of the segmental pancreatectomy patients became diabetic after surgery. The relation between the length of the removed pancreas and plasma glucose at 2 h after the 75-gram glucose intake showed a significant correlation. Conclusion: According to our results, if the length of removed pancreas is longer than 12 cm, the patients will have a risk of acquiring diabetes. In those cases, the segmental pancreatectomy should be considered.

Jejunal Varix with Extrahepatic Portal Obstruction Treated by Embolization Using Interventional Radiology : Report of a Case

Abstract.We report a case of relapsing jejunal varix with extrahepatic portal obstruction, which was successfully treated by embolization using interventional radiology. A 79-year-old woman suffered repeated episodes of tarry stools 2 years after undergoing jejunal resection for a jejunal varix. The bleeding point was inferred to be in the small intestine, and abdominal angiography revealed extrahepatic portal obstruction and the development of a jejunal varix around the hepaticojejunostomy. Because surgical obliteration of the varices or a shunt operation for portal decompression may have been very invasive due to severe adhesions, the jejunal varix was embolized with anhydrous ethanol and interlocking detachable coils. There were no changes in liver enzymes, the clearance rate of indocyanine green, or portal pressure, and there has been no sign of rebleeding for 13 months. Our experience shows that hemostasis can last, as long as the embolization can be done without aggravating portal hypertension. In conclusion, embolization using interventional radiology is a safe and useful method of treating intestinal varices.

An appraisal of segmental pancreatectomy for benign tumors of the pancreatic body : a report of two cases

To preserve pancreatic and splenic function, segmental pancreatectomy with pancreatojejunostomy was performed on two patients with benign pancreatic tumors, and a 3-year follow-up study was conducted. The pancreatic endocrine functions assessed by 75 g oral glucose tolerance test were normal 3 years after surgery, and the exocrine functions returned to within the normal range 1 month after surgery according to a pancreatic function diagnostant (PFD) test. The platelet count increased transiently to 48.9×104/mm3, and 70.5×104/mm3, in the two patients, respectively, but returned to the preoperative value 1 month postoperatively. The operative times were 7 h 51 min and 5 h 3 min, which included the time taken for intraoperative ultrasonography and frozen section diagnosis, and the blood losses were 183 ml and 212 ml. The postoperative hospitalization period averaged 39 days and no complications developed in either patient. The method of performing segmental pancreatectomy, initially reported by Letton and Wilson for cases of pancreatic trauma, was evaluated and successfully applied to benign pancreatic tumors.

Positron emission tomography with 2-deoxy-2-[18F] fluoro-D-glucose for diagnosis of intraductal papillary mucinous tumor of the pancreas with parenchymal invasion

We used positron emission tomography with 2-deoxy-2-[18F]fluoro-d-glucose (FDG-PET) in the diagnosis of two cases of malignant intraductal papillary mucinous tumor (IPMT) of the pancreas. A 56-year-old man and a 72-year-old man, both with tumors in the pancreatic head, were referred to Akita University Medical Center. Computed tomography revealed tumors with multiple cystic components in both patients. FDG-PET images showed markedly high FDG uptake in the area corresponding to a solid component found in one patient and diffuse faint uptake, higher than that of the surrounding tissue, in the other patient, who had no solid component. Histological examination of the resected specimens after pancreatectomy showed invasive carcinoma involving the pancreatic parenchyma in both patients. Although our experience is limited and preliminary, FDG-PET seems to be useful for the detection of malignancy in IPMT, especially in patients not showing any solid component on conventional diagnostic images such as computed tomography.

Resection of metastatic thyroid carcinomas to the liver and the kidney: Report of a case

Differentiated thyroid cancer is considered to have a quite favorable prognosis. However, some patients die as a result of distant metastasis, which mainly consists of pulmonary, mediastinal, or osteal metastases. The biological features of the tumor, such as a slow growth gradient, indicate the possibility of achieving comparatively satisfactory results in the treatment of such distant metastases. A complete surgical excision of the distant metastases in differentiated thyroid carcinoma has been reported to offer the best chance for prolonged survival. A case of unusual metastasis sites on the caudate lobe of the liver and right kidney occurring in a 72-year-old woman is herein presented. The location of the surgically treated distant metastases of the papillary thyroid carcinoma make this case unique.

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.

Difference in hepatic tissue oxygenation between total vascular exclusion and inflow occlusion of the liver and the possible role of hepatic venous blood under liver ischemia

The difference between total vascular exclusion (TVE) and inflow occlusion (IO) of the liver was assessed by the extent of DNA injury in rats and by hepatic tissue oxygen saturation (SahtO2) in pigs. Moreover, the role of hepatic venous blood under liver ischemia was discussed. Seventy percent of the rat livers were exposed to complete IO (hepatic artery + portal vein) or to TVE (IO + hepatic vein) for 30 or 60 min. DNA strand breaks following blood flow interception were measured using the in situ nick translation technique as an indicator of liver damage. IO/TVE were performed on pigs as well under portosystemic bypass, and the oxygen saturation of the hepatic venous blood (SahvO2) was altered by changing the fraction of inspiratory oxygen or by oxygenating the inferior caval blood using an extracorporeal membrane oxygenator. The changes in SahtO2 were measured sequentially using near-infrared spectroscopy. The results were as follows: (1) DNA injury occurred more severely under TVE than under IO of the rat liver at the end of ischemia, as well as 30 min after revascularization. (2) SahtO2 during TVE was significantly lower than that during IO. (3) The increase in SahvO2 by oxygenation of the inferior caval blood resulted in the elevation of SahtO2 under IO. In conclusion, TVE could cause greater damage to the liver than IO due to the lack of the hepatic venous blood. Hepatic venous blood might play an important role in hepatic tissue oxygenation in the case of hepatic blood flow interception.

Exchange blood transfusion and on-line plasma exchange for sepsis in infants.

During the last 6 years, 19 infants with sepsis have been treated with exchange blood transfusions 47 times, and 13 patients survived. However, this procedure is compromised by antibody formation against WBCs and platelets. Accordingly, a miniature system for on-line plasma exchange (PE) between septic infant and healthy parent has been developed and evaluated using a canine model. Escherichia coli, at a dose of 5 X 10(9) CFU/ml/kg, was injected intravenously into 17 puppies that were divided into 3 groups; untreated; sham treated; and PE in which 80 ml/kg of plasma in each septic puppy was replaced during 2 hr with fresh plasma simultaneously obtained from healthy adult dogs. Four of 5 puppies survived in the PE group, while all other puppies died within 24 hr. In the PE group, viable cell counts of E. coli and endotoxin decreased significantly, and opsonic activity improved. This system is effective and applicable for treatment of sepsis in infants.

Prostaglandin E1 Continuous Hepatic Arterial Infusion in the Treatment of Postoperative Acute Liver Failure

Aim: In the treatment of severe liver damage, it is of greater advantage to administer prostaglandin E1 (PGE1) directly to the liver compared with systemic intravenous infusion, because of its high inactivation rate in the lungs. In comparison with intraportal infusion, hepatic arterial infusion is more advantageous because of its easier and safer accessibility. This study was designed to prove the superiority of hepatic arterial infusion to intravenous infusion. Methods: Changes in hepatic hemodynamics and oxygen delivery accompanying PGE1 infusion using both methods were investigated in pigs. In addition, continuous hepatic arterial infusion was applied in 3 cases of postoperative acute liver failure, for patients in whom other conventional treatments like plasma exchange failed to improve the functioning of the liver. Results: Hepatic arterial flow increased significantly accompanying hepatic arterial infusion of PGE1 at a rate of 0.1 μg/kg/min compared with intravenous infusion at the same rate in pigs. Such an increase resulted in elevation of total hepatic blood flow and oxygen delivery to the liver. Correspondingly, bile flow significantly increased accompanying hepatic arterial infusion of PGE1. Continuous hepatic arterial infusion was applied in 3 cases of postoperative acute liver failure. The infusion was continued for 7–9 days at a rate of 0.01 μg/kg/min without any complications through heparin-coated catheters inserted via the femoral artery. Significant increase in bile flow was observed in 2 cases in whom bile was collected, serum total bilirubin began to decrease in all these 3 cases, and the patients recovered from acute liver failure. Conclusion: Hepatic arterial infusion of PGE1 is very useful and effective in the treatment of acute liver failure.