Crossed cerebellar hypoperfusion in unilateral major cerebral artery occlusive disorders.

We evaluated regional blood flow and oxygen metabolism in the cerebral and cerebellar cortices of 15 patients with unilateral major cerebral artery occlusive disorders with PET. These patients showed a cortical blood flow asymmetry in middle cerebral artery distribution. Only subcortical abnormalities were detected on computed tomography. Nine patients showed crossed cerebellar hypoperfusion, a reduction in contralateral cerebellar blood flow, while six did not. No difference in the degree of cerebral blood flow asymmetry existed between the two patient groups. However, oxygen metabolism asymmetry was more pronounced and was more closely matched to blood flow asymmetry in patients with crossed cerebellar hypoperfusion. These findings suggest that a major cause of cerebral cortical blood flow reduction is reduced metabolic demand in patients with crossed cerebellar hypoperfusion. Crossed cerebellar hypoperfusion may have clinical significance as a reflection of the cerebral metabolic state on blood flow images.

[Successful management of massive hemoptysis, following pulmonary mycosis by bronchial artery embolization in a patient with acute lymphoblastic leukemia].

In June 1987, a 20-year-old man was diagnosed as T-cell acute lymphoblastic leukemia. In August, at a nadir period of the remission induction chemotherapy, he complained of high fever and dry cough. A chest roentgenogram also showed a nodular area of increased density in the left upper lobe. Since his clinical state deteriorated progressively despite the administration of broad-spectrum antibiotics, amphotericin B was administered intravenously (with an initial dose of 5 mg/day, increased up to 25 mg/day). Concomitant with bone marrow recovery and continued antifungal therapy, he became soon afebrile and improved over the next 2 months. The infiltrates also began to resolve. Then he abruptly coughed up about 800 ml of blood and suffered from acute respiratory failure. Bronchial arteriographic studies demonstrated active extravasation of contrast medium in the region of the cavity. After therapeutic embolization with Gelfoam, the extravasation was no longer observed. Active bleeding abruptly ceased and had not recurred until the left upper lobectomy which was performed 10 days after the embolization. This case typically demonstrates the value of bronchial arterial embolization in treating massive hemoptysis.

A case of aleukemic monocytic leukemia cutis treated with total body electron therapy.

A 39-year-old man with aleukemic monocytic leukemia cutis was treated with total skin electron therapy. The patient was irradiated twice a week for five weeks using three overlapping beams (SSD 145 cm) in a four-field technique with 4 MeV electrons. After delivery of 20 Gy, the nodular lesions disappeared. The patient tolerated the treatment well and showed no serious side effects.

Computed tomography of bronchiolitis obliterans.

A case of bronchiolitis obliterans was studied by high resolution CT. The morphologic changes of the lesions are described.

[Radiation therapy of metastatic sites in hepatoma].

Ten patients with hepatoma who had received radiotherapy for their metastatic sites have been reviewed. In 13 lesions of bone metastasis in 7 patients complete pain relief from 5 lesions (38%) was achieved, while partial relief (54%) was obtained in other lesions. Of 3 patients with a brain metastasis, one attained complete symptomatic improvement with a 65% tumor reduction, and one of the remaining two gained a symptomatic palliation. In a patient with two pulmonary metastases, intraarterial chemotherapy showed a more remarkable effect when treatment was combined with radiotherapy than intraarterial chemotherapy alone. It may be concluded that radiation therapy is effected modality for palliating metastatic lesions of hepatoma.

Oxygen-assisted breath-holding in computed tomography.

To achieve prolonged breath-holding, oxygen was administered just before dynamic CT and high resolution lung CT. Oxygen administration has proved to be a supportive means to improve the quality of CT studies.