[Clinical effectiveness of intra-arterial chemotherapy combined with degradable starch microspheres (DSM) for liver metastases and prediction of effectiveness by diagnostic imaging].

The aim of this study was to evaluate the clinical effectiveness of intra-arterial chemotherapy combined with degradable starch microspheres (DSM) for liver metastases and the possibility of predicting the effectiveness of the chemotherapy by pretreatment diagnostic imaging. The subjects were 67 patients with metastatic liver cancer, treated with Seldinger method via the left brachial artery, and tumor selective hepatic injection using a micro-catheter. The early response rate was 38.7% for colorectal cancer, 42.8% for gastric cancer, 16.7% for bile tract cancer and 80% for uterine cancer. The relationship between effectiveness and the tumor occupation rate in the liver estimated from pretreatment CT images was not significant, but the degree of tumor stain in the early phase of contrast enhancement CT correlated well with early responsiveness of the liver metastases for this treatment. This suggests the possibility of pretreatment prediction of the effectiveness of intra-arterial chemotherapy combined with DSM for metastatic liver tumors.

Usefulness of cerebral blood flow (CBF) measurements to predict the functional outcome for rehabilitation in patients with cerebrovascular disease (CVD).

PURPOSE: The objectives of this study were to (1) elucidate the relationship between the mean CBF in the whole brain (Av.mCBF) before rehabilitation of CVD patients and the BI score before and after rehabilitation, (2) determine whether the efficacy of rehabilitation can be predicted by measurement of the Av.mCBF, and (3) investigate what part of the brain was most important to improving the BI score. MATERIALS AND METHODS: The Av.mCBFs in 160 patients with CVD were calculated by Patlak plots with 99mTc-HMPAO before rehabilitation, and we determined the BI score before and after rehabilitation. Based on the BI scores before and after rehabilitation, patients were divided into four groups: Group A, BI = 100; Group B, 80 < or = BI < or = 99; Group C, 60 < or = BI < or = 79; Group D, 0 < or = BI < or = 59. We evaluated the relationship between the Av.mCBF and BI score before and after rehabilitation. RESULTS: The Av.mCBF before rehabilitation showed a tendency to be more correlated with the BI score after rehabilitation (r = 0.414, p < 0.0001) than before rehabilitation (r = 0.272, p = 0.0006). After rehabilitation, there was a tendency for the Av.mCBF value to increase in direct proportion to the BI score of the group: it was highest in Group A and lowest in Group D. The strongest correlation was found between the frontal lobe regional CBF before rehabilitation and the BI score after rehabilitation (r = 0.343, p < 0.0001). CONCLUSIONS: Measurement of the Av.mCBF before rehabilitation of CVD patients will permit prediction of the efficacy of rehabilitation. Also the regional CBF of the frontal lobe is most important for improving the BI score.

Accuracy of the bronchoscopic DNA content analysis of non-small-cell lung carcinoma.

To assess the accuracy of the bronchoscopic DNA content analysis, samples of non-small-cell lung carcinomas (NSCLC) were investigated by means of flow cytometry. Samples were dissociated using the detergent Triton X-100. In 58 NSCLC cases, 39 (67%) had DNA aneuploid tumors. We compared the DNA indices of bronchoscopic brushing samples with 21 corresponding surgical samples. In 16 (76%) cases, DNA ploidy of both bronchoscopic and surgical samples were in concordance. In 3 (14%) cases, both bronchoscopic and surgical sample showed DNA aneuploidy, but the number of the DNA aneuploid stem cell lines was different. The cause of these differences was ascribed to the intratumor DNA heterogeneity. In 2 (10%) cases, the bronchoscopic sample showed DNA diploidy, but the surgical sample showed DNA aneuploidy. In these cases, tumor cells obtained by bronchoscopic brushing were so few that the small DNA aneuploid peak was undetectable in the DNA histogram. But the tumor DNA ploidy was evaluated correctly in 90% of 21 cases using bronchoscopic samples. Consequently, despite some drawbacks, the DNA ploidy diagnosis using bronchoscopic samples in this relatively small study, was almost as reliable as surgical samples.

[A case of middle lobar bulla associated with severe bronchial asthma].

We experienced a case of middle lobar bulla associated with severe bronchial asthma. Bulla occurs favoritely at apical area and S6, and middle lobar bulla which is very rare has been reported to cause higher ventilatory disorder compared with superior lobar bulla, when it becomes giant. The pathogenesis of the present middle lobar bulla remains unknown, but steroid administration to bronchial asthma may possibly have influenced pleura and/or lung parenchyma. We would like to make its further observation, paying attention to its possible recurrence and its occurrence at other sites.

[A case of intrathoracic chest wall type lipoma].

Intrathoracic lipoma is a comparatively rare disease. We have recently experienced a case of intrathoracic chest wall type lipoma associated with Charcot-Marie-Tooth disease. The case was a 16-year-old man, in whom preoperative examination of his foot-drop due to Charcot-Marie-Tooth disease pointed out an abnormal chest shadow. Image diagnosis led to intrathoracic chest wall type lipoma. The tumor was easily resectable and was lipoma pathohistologically as well. The literature presented us with 22 cases of such lipoma, which appeared to be predominant for age not more than 10 and age 41-60 and to occur favorably in postero-superior chest wall. Preoperative diagnosis of the present disease became possible to a certain extent by means of CT, MRI. However, in view of imperfect differentiation between lipoma and liposarcoma, surgical resection should be considered, if possibly. No case of intrathoracic lipoma associated with Charcot-Marie-Tooth disease had been reported in the literature, and the causal relationship there between also remains unknown, but to be further examined.

[A case report of congenital bronchial atresia--a review of 43 cases in Japan].

Our case is a 20 years old man. An abnormal mass shadow and emphysematous lesion were found in the left S3 segment on a chest roentgenogram. A bronchogram revealed a left B3 defect. A complete obstruction of the left B3 bronchi covered with normal mucosa was found with a bronchoscopy. Since the patients suffered repeated respiratory infection, a left S3 segmentectomy was performed. Histological examination showed emphysematous change and the normally developed bronchi containing ciliated epithelium and cartilage. We found that, including this case, there are altogether 44 cases of congenital bronchial atresia in Japan. The literature of those cases was reviewed and discussed.

[Anterolateral approach to giant cell tumor in T4 vertebral body].

A case of giant cell tumor involving the Th4 vertebral body is reported. A 27-year-old man, who had a 2 month history of back pain and paraparesis, was admitted to our department in August, 1986. On the first admission, he manifested severe paraparesis and sensory disturbance below the Th5 dermatome level. Neuroradiological examination demonstrated an epidural tumor involving the Th4 vertebral body and compressing the spinal cord. Emergency laminectomy for decompression and biopsy was performed. The surgical specimen was a giant-cell tumor. 6 weeks after the first operation, total removal of the tumor and anterior fusion of the Th 3-5 with iliac bone graft was performed through the anterolateral transthoracic approach. Postoperative course was uneventful. A curative resection and immediate stabilization was thus able to be undertaken through the anterolateral transthoracic approach, when the epidural tumor was confined to the thoracic vertebral body.

[Clinical study of multiple primary cancers including lung cancer].

Out of a total of 506 lung cancers treated between 1977 to 1988, a total of 27 (5.3%) multiple primary cancers were uncovered. The patients consisted of 20 males and 7 females and their average age was 67 (48-81) years. The frequency seen in the histological type of patient with multiple primary cancers was the same as that seen in their background lung cancers. Twenty-one (78%) patients were smokers. Thirteen patients (45%) had a family history of cancer. Two cases had 3 family members who had a cancer history. The tumor DNA contents of 2 cases with multiple primary cancers were analyzed. In both cases, the DNA indices were found to differ between the first and the second cancer. Thus, it may be possible to identify multiple primary cancers by determining the tumoral DNA content.

[Prognostic significance of the nuclear DNA content of a small adenocarcinoma of the lung].

DNA ploidy has been determined by flow cytometry in 28 surgical specimens from patients with adenocarcinoma of the lung (tumor diameter, 3.0 cm or less), and the relationship between DNA ploidy and the clinical stage and survival also has been investigated. The cases were classified according to the DNA index (DI) into group A (DI 1.00 to 1.50), group B (DI 1.51 to 2.00) and group C (DI greater than 2.01). A close relationship was observed between the DI and the survival rates but not between the DI and the clinical stage. Tumor ploidy is considered to be one of the prognostic factors and may be useful in selecting adjuvant therapy.