Mesenteric phlebosclerosis associated with long-term oral intake of geniposide, an ingredient of herbal medicine.

BACKGROUND: Idiopathic mesenteric phlebosclerosis (IMP) is a rare disease, characterised by thickening of the wall of the right hemicolon with calcification of mesenteric veins. However, the aetiology remains unknown. AIM: To investigate the possible association of herbal medicines with IMP. METHOD: The clinical data of four of our own patients were collected. Furthermore, we searched for previous reports about similar patients with detailed descriptions of herbal prescriptions that they had taken. We compared herbal ingredients to identify the toxic agent as a possible aetiological factor. RESULTS: Clinical data on a total of 25 patients were summarised. Mean age was 61.8 years and there was female predominance (6 men and 19 women). The used Kampo prescription, the number of cases, and the mean duration of use were as follows: kamisyoyosan in 12 cases for 12.8 years, inshin-iseihaito in 5 cases for 13.4 years, orengedokuto in 4 cases for 14.3 years, inchinkoto in 1 case for 20 years, kamikihitou in 1 case for 19 years, seijobofuto in 1 case for 10 years and gorinsan in 1 case for an unknown duration. Only one ingredient, sansisi, was common to the herbal medicines of all 25 patients. This crude drug called geniposide in English is a major constituent of the Gardenia fruits. CONCLUSION: The long-term use of geniposide in herbal medicines appears to be associated with mesenteric phlebosclerosis.

Simulation model based on non-newtonian fluid mechanics applied to the evaluation of the embolic effect of emulsions of iodized oil and anticancer drug.

PURPOSE: To verify the difference in embolic effect between oil-in-water (O-W) and water-in-oil (W-O) emulsions composed of iodized oil and an anticancer drug, epirubicin, using a simulation model based on non-Newtonian fluid mechanics. METHODS: Flow curves of pure iodized oil and two types of O-W and W-O emulsions immediately and 1 hr after preparation were examined with a viscometer. Using the yield stress data obtained, we simulated the stagnation of each fluid with steady flow in a rigid tube. RESULTS: The W-O emulsions were observed to stagnate in the thin tube at a low pressure gradient. However, the embolic effect of the W-O emulsions decreased 1 hr after preparation. The O-W emulsions were stable and did not stagnate under the conditions in which the W-O emulsions stagnated. CONCLUSION: The simulation model showed that the embolic effect of the W-O emulsions was superior to that of the O-W emulsions.

Strategy for pancreatic endocrine tumors.

BACKGROUND/AIMS: The endocrine tumors of the pancreas are rare diseases and there is no established standard therapy for the liver metastasis of pancreatic endocrine tumors. In this study, the therapy for the pancreatic endocrine tumors was evaluated. METHODOLOGY: The endocrine pancreas tumors of 13 patients had been surgically treated. All primary tumors were completely resected. The liver metastasis was recognized in 4 patients. Partial resection of the liver was performed in 2 patients. Lipiodol-transcatheter arterial embolization was performed for synchronous unresectable liver metastases in the other 2 patients. RESULTS: The patients with no liver metastases survived without recurrence (max: 18.8 yr; mean follow-up: 9.2 yr). The patient with resected synchronous solitary liver metastasis died of recurrent multiple liver metastases 5 months after surgery. The other patient with the metachronous liver metastasis completely resected survived 13.9 years. In the 2 patients with unresectable numerous liver metastases, after lipiodol-transcatheter arterial embolization, tumor necrosis rate was more than 90% in both cases and serum gastrin level was normalized. CONCLUSIONS: Complete resection of liver metastasis is favorable, whereas lipiodol-transcatheter arterial embolization is effective for unresectable liver metastases from pancreatic endocrine tumors as palliation. Complete resection of the primary site is recommended even in the cases with unresectable numerous liver metastases.

Prognostic factors in resected hepatocellular carcinomas and therapeutic value of transcatheter arterial embolization for recurrences.

The authors summarize the results of patients who had hepatectomy for hepatocellular carcinoma (HCC) over a 16-year period. Survival rates for 52 patients with HCC classified according to the Liver Cancer Study Group of Japan were calculated according to various clinicopathological variables. A univariable analysis revealed that alpha-fetoprotein > or =2000 ng/ml, portal involvement, tumor size > or =3.1 cm, and noncurative resection were associated with unfavorable outcomes, while neither the number of tumors nor underlying cirrhosis was associated with such outcomes. Furthermore, some of the patients with recurrence survived long after transcatheter arterial embolization (TAE) for recurrent tumors. Early detection as well as TAE for recurrent HCCs is necessary to improve long-term survival.

[Intracranial aneurysms in autosomal dominant polycystic kidney disease detected by MR angiography: screening and treatment].

The association of intracranial aneurysm with ADPKD is well-known, and patients with ADPKD are at increased risk of subarachnoid hemorrhage from rupture of intracranial aneurysms. We prospectively performed three-dimensional time-of-flight magnetic resonance angiography (MRA) in 30 nonselective adult patients with ADPKD. Sixteen were women and 14 were men with a mean age of 51 yr (range 24 to 79 yr). The diagnosis of ADPKD was made on the basis of abdominal ultrasound or computed tomographic studies. Three patients were on maintenance hemodialysis, 8 patients were nondialysed patients with chronic renal failure (serum creatinine > or = mg/dl) and 25 patients had hypertension (BP > or = 140/90 mmHg). None of these patients have a previous diagnosis of intracranial aneurysm. Unruptured intracranial aneurysms were suspected in 5 patients by MRA, and 8 aneurysms were confirmed in 4 (13.3%) of 30 patients by conventional arteriography. These aneurysms were 3 approximately 10 mm in diameter and 3 aneurysms (3 approximately 4 mm in diameter) were newly detected by cerebral arteriography. After informed consent was obtained, neck clipping of the intracranial aneurysms were performed successfully in all the patients. These results suggest that the prevalence of intracranial aneurysms is about 13% in ADPKD, and that MRA is useful in screening for occult intracranial aneurysms in patients with ADPKD.

Histological influence on contrast-enhanced CT of pancreatic ductal adenocarcinoma.

PURPOSE: The purpose of our study was to examine the influence of the histology of pancreatic ductal adenocarcinoma on its appearance with contrast-enhanced CT. METHOD: Early-phase and late-phase dynamic CT images were obtained in 34 patients who underwent pancreaticoduodenostomy. The attenuating areas of the tumors (n = 58) on early- and late-phase images were classified as hyperattenuated, isoattenuated, hypoattenuated, or unenhanced. The histologic findings of these lesions were compared to the CT appearances. RESULTS: The isoattenuated areas on both early- and late-phase images histologically showed increasing cellularity of tumor cells (n = 1) or coexisting acinar tissues and tumor cells (n = 2) within the tumor. Hypoattenuated areas on early-phase images and isoattenuated or hyperattenuated areas on late-phase images (n = 27) showed dense fibrosis except in one tumor with an abscess. Hypoattenuated areas on early- and late-phase images and unenhanced areas (n = 28) showed mucin and/or necrosis within the tumor. CONCLUSION: The contrast-enhanced CT appearance of pancreatic ductal adenocarcinoma is influenced by the histologic features associated with tumor cells.

Fatty infiltration of the liver distal to a metastatic liver tumor.

We report a case of focal fatty infiltration of the liver parenchyma adjacent to a metastatic liver tumor from an islet cell tumor. The decreased portal flow by the tumor and insulin produced by the tumor cells might be causes of focal fatty infiltration.

Dynamic MRI using a surface coil in chronic cholecystitis and gallbladder carcinoma: radiologic and histopathologic correlation.

PURPOSE: The purpose of this study was to determine whether dynamic MRI could differentiate gallbladder carcinoma from chronic cholecystitis. METHOD: The dynamic MR findings of 50 patients with pathologically proven chronic cholecystitis and 13 with gallbladder carcinomas were correlated with the pathological findings. RESULTS: In chronic cholecystitis with thickened wall, mucosa and muscle were shown in early images as smoothly delineated enhancement except in one case, and the subserosa with fibrosis was enhanced in late or delayed images. Unenhanced foci in the wall correlated with Rokitansky-Aschoff sinuses or mural stones. In carcinomas, all tumors showed irregularly delineated enhancement in early images. In late or delayed images, noncancerous portions were also enhanced. The outer margin of early enhancement correlated with the extension of the tumor. CONCLUSION: Dynamic MRI is useful for the differentiation of chronic cholecystitis from carcinoma and for the evaluation of its local extension.

[A case of gastric cancer responding well to MTX/5-FU (methotrexate/5-fluorouracil) and PMUE (CDDP, MMC, UFT, etoposide) therapies upon lymphnode recurrence].

We encountered a case of non-curatively resected gastric cancer (p1, n4) who responded well to sequential MTX/5-FU therapy and PMUE therapy. A 63-year-old man was admitted to our hospital with complaints of nausea and vomiting. Upper gastrointestinal examination and CT scan revealed Borrmann type 3 gastric cancer with pyloric stenosis and multiple paraaortic lymphnodal metastasis. The patient underwent palliative gastrectomy for extensive gastric cancer (H0, P1, N4, T3, Stage IV b). Histological examination of the resected stomach revealed poorly differentiated adenocarcinoma with paraaortic lymphnodes metastasis (n4) and peritoneal dissemination (p1). Chemotherapy with sequential MTX/5-FU was given 13 times. Ten months after the operation, abdominal pain and back pain required analgesic treatment. Abdominal CT scan revealed increased size of paraaortic lymphnodes, suggesting recurrence. Sequential MTX/5-FU therapy was switched by PMUE therapy. Lymphnode size became smaller and habitual analgesics could be discontinued. Since then he was given MTX/5-FU and PMUE therapies alternately on an ambulant basis. The patient resumed his daily activities at 2 years and 8 months after the operation.

The protective effect of portoarterial shunts after experimental hepatic artery embolization in rats with liver cirrhosis.

PURPOSE: The role of the portal system after hepatic artery embolization (HAE) was examined. METHODS: Using a Wistar strain rat model of liver cirrhosis, the route and occurrence of portoarterial (PA) shunts before and after HAE by scanning electron microscopic (SEM) and histologic methods were evaluated. HAE was performed with iodized oil and gelatin sponge particles. RESULTS: In the SEM study, PA shunts did not develop in normal rats regardless of whether they did (n = 10) or did not have HAE (n = 5). The cirrhotic rat model showed PA shunts in both HAE (n = 5) and non-HAE (n = 5) animals. PA shunts were established via the peribiliary plexus and direct arterioportal anastomosis. In the histologic study, the occurrence of PA shunts in liver cirrhosis was significantly increased by HAE (HAE = 6, non-HAE = 6, p < 0.01). CONCLUSION: The development of PA shunts, which help perfuse liver parenchyma, may explain why HAE can be safely performed in patients with liver cirrhosis.

[A case of poorly differentiated hepatic cell carcinoma which showed 90% decrease in size after chemotherapy with intraarterial infusion of mitomycin C and oral administration of tegafur].

The patient was a 77-year-old man, admitted complaining of abdominal fullness and appetite loss. By ultrasonography and CT an 8 x 5 cm mass was discovered in S1 of the liver. Needle biopsy specimen from the lesion revealed poorly differentiated hepatic cell carcinoma. Because of his advanced age and the size of the tumor, surgical therapy was not used. Chemotherapy with intraarterial injection of mitomycin C 2 mg once a week and 800 mg of tegafur PO daily was given for 5 weeks until bone marrow suppression developed. After recovery of hematological data, tegafur 800 mg PO daily every other week was administered for a year. In the course of these therapies, the hepatic tumor became smaller, and the ultimate decrease rate was over 90% (PR). Thus far it seems that chemotherapy with tegafur might be tried in hepatic cell carcinoma cases in which surgery is not indicated.

Subsegmental transcatheter arterial embolization for small hepatocellular carcinomas: local therapeutic effect and 5-year survival rate.

The local therapeutic effects and 5-year survival rates obtained following subsegmental transcatheter arterial embolization (TAE) therapy for small hepatocellular carcinomas (HCCs) were retrospectively analyzed. A total of 124 nodular-type HCC lesions measuring less than 4 cm in diameter in 100 patients with liver cirrhosis were subjected to the analysis. All lesions became opaque on digital subtraction angiography. Complete necrosis was seen in 64% of 11 resected lesions. Among the remaining 113 lesions, the 1- and 5-year local recurrence rates following one performance of TAE were 18% and 33%, respectively. The 1- and 5-year survival rates were 100% and 53%, respectively. No significant side effect was observed after TAE therapy. Subsegmental TAE therapy significantly improved the long-term survival rates of patients with small HCCs associated with liver cirrhosis as compared with those treated by conventional TAE therapy.

Small hepatocellular carcinoma: treatment with subsegmental transcatheter arterial embolization.

The effectiveness of subsegmental transcatheter arterial embolization (TAE) therapy for small hepatocellular carcinomas (HCCs) was retrospectively analyzed. TAE was performed in 100 patients with liver cirrhosis. There was a total of 124 nodular-type HCCs less than 4 cm in diameter. TAE was performed by injecting a mixture of iodized oil and anticancer drugs followed by gelatin sponge particles or a mixture of iodized oil and absolute ethanol into the more distal branches of the subsegmental artery. Complete necrosis was seen at histologic examination in seven of 11 resected lesions. Among the remaining 113 lesions in 90 patients followed up without surgery, the 1-and 4-year local recurrence rates after TAE were 18% and 33%, respectively. The 1- and 4-year survival rates for 82 patients with Child class A or B disease were 100% and 67%, respectively. No substantial deterioration of liver function was observed. Subsegmental TAE improved the prognosis of the patients with liver cirrhosis associated with small HCCs.

Differentiation of hepatocellular carcinomas from hyperplastic nodules induced in rat liver with ferrite-enhanced MR imaging.

The potential of superparamagnetic ferrite particles in magnetic resonance (MR) imaging to help differentiate between hyperplastic nodular lesions in the liver and hepatocellular carcinomas was evaluated with chemically induced liver tumors in cirrhotic rats. Ferrite particles decreased the signal intensity of hyperplastic nodules but not that of hepatocellular carcinomas, and stainable iron was found in the former but not in the latter with Prussian blue iron stain. T1-weighted spin-echo images made little contribution to the differentiation between these two lesions, while T2-weighted spin-echo images were effective for this purpose, since ferrite particles cause T2 shortening. Ferrite-enhanced MR imaging may be useful in differentiating these two lesion types according to their signal intensity changes on images, because Kupffer cells are present in hyperplastic nodular lesions but rarely in hepatocellular carcinomas.

Scanning electron microscopy of intrahepatic microvasculature casts following experimental hepatic artery embolization.

The initial site of occlusion of the intrahepatic microvasculature in rats following hepatic artery embolization was studied by scanning electron microscopy of microvasculature casts. The rats were divided into four groups: embolization with gelatin powder (n = 3), polyvinyl alcohol (n = 3, 125-150 microns), gelatin sponge (n = 3, 212-250 microns), and ionized oil. Not only the hepatic arteries but also vessels in the peribiliary plexus were occluded. However, the size of the hepatic arteries and vessels of the peribiliary plexus occluded correlated with the size of the embolic material, except in the case of the gelatin powder which occluded vessels smaller than the particle size.

MR imaging of spinal neurinomas with pathological correlation.

Eight patients with nine spinal neurinomas were examined with magnetic resonance (MR) imaging. We attempted to correlate MR images with the gross and microscopic characteristics of the tumors. On T1-weighted images (T1WIs) all tumors were iso- to slightly hyperintense to CSF, although two comprised hyperintense areas. On the T2-weighted pulse images (T2WIs), available for seven tumors, two tumors were markedly and two relatively hyperintense to CSF. Three tumors exhibited mixed signal intensity. On macroscopic examination, the markedly hyperintense areas on T2WIs corresponded to the cystic portions and relatively hyperintense areas to the solid portions. Areas that were hypointense on T2WIs and isointense or markedly hyperintense on T1WIs corresponded to hemorrhage. On microscopic examination it was impossible to establish a correlation between Antoni A and Antoni B tissue types and features recognized on T1WIs and T2WIs. Gadolinium-diethylenetriamine pentaacetic acid enhanced T1WIs were performed in four patients with five tumors. All tumors enhanced, demonstrating the tumor contours and the cystic degeneration within.