[A case of Behçet's disease with chronic and repeated sudden hearing loss: successful treatment with intravenous cyclophosphamide pulse therapy].

A 54 year-old man who had been diagnosed as Behcet's disease since 1985 was admitted due to sypmtoms of fever, bilateral chronic hearing loss and repeated sudden left deafness after a partial laparoscopic gastrectomy for IIa type of early gastric cancer. Pure-tone audiometry, Bekesy audiometry, speech audiogram and auditory brain stem response revealed sensorineural hearing loss. The findings of magnetic resonance imaging, magnetic resonance angiography, single photon emission computed tomography and positron emission tomography ruled out a central nervous system disorder. The presence of an elevated C-reactive protein level, von Willebrand factor and plasmin alpha 2-plasmin inhibitor complex suggested vasculitis to be involved in the development of hearing loss. Although pulse-dose methylprednisolone therapy effectively arrested the acute progression of hearing loss, repeated audiograms showed that a modest dosage of oral prednisolone failed to maintain such improvement. However, after performing high-dose cyclophosphamide (CY) therapy, a significant improvement in the hearing loss (more than 10 dB) was observed. As a result, CY is thus considered to be a potentially important treatment for sensorioneural hearing loss.

[Arterial infusion chemotherapy for liver metastases from colorectal cancer--therapeutic effects of different protocols].

The therapeutic effects of different protocols for arterial infusion chemotherapy were compared in patients with multiple liver metastases from colorectal cancer. A total of 49 patients with colorectal multiple liver metastases treated in our hospital since 1988 were the subjects. In order to compare the therapeutic effects on the regression of cancer and the survival rate, the subjects were assigned into Groups A-D, which were treated using different protocols. Group A received ADR, EPI, CDDP or 5-FU alone at first. If this drug was not effective, it was replaced with another of those mentioned here, and so on. Group B received CDDP 50 mg on day 1, 5-FU 500 mg/day from day 2 to day 7 and 5-FU 500 mg/day for 2 weeks thereafter (FP treatment). Group C received CDDP 50 mg at the time of reservoir insertion and 5-FU 1,000 mg for 5 hours thereafter (WHF treatment). Group D received 5-FU 1,000 mg for 24 hours on day 1, day 3, and day 5 of every week with combination of CDDP 5-10 mg/day from day 1 to day 5 and none on day 6 and day 7 (intermittent F + low-dose P treatment) for 3 weeks. The response rate was 33% for Group A (n = 18), 46% for Group B (n = 13), 25% for Group C (n = 8) and 80% for Group D (n = 10), showing significant differences between Group D and other groups. The 1-year survival rate was 50% for Group A, 46% for Group B, 29% for Group C and 89% for Group D. Significant differences in survival rate were found between Group B and D, and Group C and D.

[Efficacy of intra-arterial chemotherapy on life prolongation in patients with hepatic metastasis from colorectal cancer].

The efficacy of intra-arterial chemotherapy for life prolongation was investigated in patients with hepatic metastasis from colorectal cancer who visited our hospital from Jan. 1989-Mar. 1999, but without any other remote metastasis when the presence of their hepatic metastasis was detected. The subjects were assigned to 4 groups; group A (n = 8) was only treated by hepatectomy, group B (n = 27) by intra-arterial chemotherapy combined with hepatectomy, group C (n = 42) with intra-arterial chemotherapy alone, and group D (n = 23) by systemic chemotherapy through intra-venous or oral administration. The survival rates of these groups were determined, and the recurrence risk after hepatectomy was compared between group A and B. Further, the survival rate of the patients treated by intra-arterial chemotherapy was compared between the cases of PD and not-PD (including CR, PR, and NC). The median survival in cases of H1 and H2 was 405 days for group A, 1,018 days for group B and 245 days for group C, showing that group B had a significantly more favorable prognosis than either group A or group C. There were also significant differences in the median survival of H3 cases between group C (422 days) and group D (113 days). One-year cumulative recurrence risks in the residual livers of group A and group B were 79% and 28%, respectively. Thus, significant differences in the recurrence risk were found in the two groups. Meanwhile, the median survival of PD and non-PD cases was 240 and 588 days, respectively. These results suggested that local control by intra-arterial chemotherapy is useful for life prolongation.

A case of gross hematuria arising during embolization for renal arteriovenous malformation.

A cirsoid type of arteriovenous malformation was treated successfully by superselective embolization using a platinum micro coil and absorbable gelatin sponge. During the procedure, as soon as the arteriovenous shunt had disappeared, an arteriopelvic shunt appeared. The pyelogram showed that the high pressure arterial blood flow drained directly into the pelvic cavity. Massive gross hematuria occurred immediately accompanied by a sudden blood pressure drop to 60 mm Hg, necessitating blood transfusion. Fortunately this complication was managed successfully. To our knowledge, there are only a few reported cases that make reference to gross hematuria occurring on embolization. We discuss the possible causes of this complication and the mechanism of occurrence of gross hematuria in renal arteriovenous malformation.

[Clinico-pathological study of autopsy cases of nonresected gastric cancer in the young and old].

To elucidate the difference between the natural history of gastric cancer in young and old patients, this study was carried out. Fifty-four cases were studied, representing the autopsy findings of gastric cancer patients who did not undergo operation. The characteristics of the gastric cancer in the young patients were as follows: had infiltrative macroscopical types, had histologically diffuse types, had deeper and wider infiltration, showed a severer invasion into the vessels, and, showed marked lymphatic disseminated, and distant metastasis. The elderly, in comparison, showed various types of gastric cancers. The extension of the cancer in the old group was significantly, less than in the young, even in the same diffuse type. The period from the onset to death was almost same in both groups. The age of the host seems one of the important factors influencing the natural history of gastric cancer.