[A case of AFP-producing gastric cancer responding to the combination of systemic chemotherapy, transcatheter arterial embolization and hepatic infusion chemotherapy].

We report a case of a 64-year-old male with a-fetoprotein(AFP)-producing gastric cancer accompanied by large liver metastases and multiple lymph node metastases. The patient's serum AFP level was 42,307 ng/mL and a biopsy specimen showed AFP-positive tumor cells immunohistochemically. Systemic chemotherapy by tegafur gimeracil oteracil potassium(S-1)and local therapy for the hepatic metastases consisting of transcatheter arterial embolization (TAE)and infusion of epirubicin(EPI)to the hepatic arteries decreased the serum AFP level and reduced the gastric cancer and metastases. Due to the increase of AFP and lymph node metastases, we had to successively change the regimen to paclitaxel(PTX), a combination of cisplatin(CDDP)/irinotecan(CPT-11)and S-1. Continuous systemic chemotherapy in combination with various drugs for gastric cancer treatment followed by TAE and hepatic infusion chemotherapy for hepatic metastases proved effective. The patient survived for 3 years and 2 months.

Suitable blending method of lipiodol-cisplatin in transcatheter arterial embolization for hepatocellular carcinoma: evaluation of sustained release and accumulation nature.

BACKGROUND/AIMS: Recently, fine powder cisplatin (IA-call; Nipponkayaku, Japan) was released, but there is no detailed study on an appropriate blending method of lipiodol-cisplatin for transcatheter arterial chemoembolization. We evaluated the sustained release and accumulation nature of lipiodol-cisplatin for hepatocellular carcinoma. METHODOLOGY: We prepared three types of mixture: a suspension of lipiodol and cisplatin powder, an emulsion of cisplatin powder dissolved with contrast medium and lipiodol, and a suspension-emulsion that was a suspension of lipiodol and cisplatin powder emulsified with contrast medium. In a basic study, a cisplatin release test was performed. In a clinical evaluation, transcatheter arterial chemoembolization with 3 lipiodol-cisplatin mixtures that had sustained release was performed in 60 consecutive patients with hepatocellular carcinoma as a randomized controlled trial. The density ratio of the tumor and treated liver tissue was measured as the accumulation nature. RESULTS: The suspension-emulsion and emulsion with a 7:3 mixture of lipiodol and contrast medium, and the suspension had better sustained release. The accumulation nature of the suspension-emulsion and emulsion were higher than the suspension. CONCLUSIONS: The pattern efficiently accumulated on hepatocellular carcinoma was the suspension-emulsion and emulsion. We suggest that a suspension-emulsion may be created more easily and is more suitable for clinical use.

The relationship between cerebral T2 hyperintensity and fixation suppression of vestibulo-ocular reflex in elderly patients with dysequilibrium symptoms.

OBJECTIVES: To evaluate the relationship between cerebral T2 hyperintensity on MRI and visual suppression of vestibulo-ocular reflex (VOR) in elderly patients with dysequilibrium symptoms. METHODS: Eighty-nine elderly patients with no MRI abnormalities in the infratentorial region aged 60-89 years complaining dysequilibrium symptoms were studied. Cases with whom a definitive diagnosis of peripheral or central disease could be established were not included. T2 hyperintense lesions in the cerebrum: basal ganglia, subcortical white matter and periventricular white matter were evaluated. VOR in darkness and fixation-suppressed VOR using pseudo-sinusoidal rotation stimuli were recorded to calculate visual suppression rate. Correlation between visual suppression rate and semi-quantitative scores for severity of T2 hyperintensity in the cerebrum was investigated. RESULTS: Patients with T2 hyperintensity in the cerebrum exhibited significantly lower visual suppression rate than those without lesions in the cerebrum. Multiple regression analysis showed that visual suppression rate was significantly and negatively correlated with severity of lesions in the basal ganglia, but not with patient age, severity of subcortical white matter lesions, or that of periventricular white matter lesions. CONCLUSIONS: In elderly patients with dizziness with a non-specific history and otoneurological findings, fixation suppression of vestibular nystagmus was associated with T2 hyperintensities in the basal ganglia.

[Evaluation of the results of radiotherapy for carcinoma involving the external auditory canal or middle ear].

PURPOSE: To evaluate the results and significance of radiotherapy for carcinoma involving the external auditory canal or middle ear. MATERIALS AND METHODS: Six patients underwent radiotherapy. Five patients had squamous cell carcinoma and one had ceruminous adenocarcinoma. In addition to radiotherapy, two patients underwent complete resection, and the other patient underwent incomplete resection. Total radiation doses ranged from 30 to 88 Gy (2 Gy/fraction, 5 fractions/week). RESULTS: The post-treatment survival period ranged from 8 months to 7 years (mean, 3 years, 11 months). Two patients treated by radiotherapy alone (doses of more than 60 Gy) lived for more than five years. CONCLUSION: The prognosis of patients with advanced cancer involving the external auditory canal and middle ear is generally poor. Based on even this limited clinical experience, a tumor dose of at least 70 Gy should be delivered for local control of advanced cancer. To avoid complications, several plans such as application of the shrinking field technique are recommended.