Arterial dynamic appearance of common bile duct carcinoma by helical CT on angiography (angio-HCT): four operated cases.

We present four cases of common bile duct carcinoma in which both angiographic helical CT (angio-HCT) and pancreatoduodenectomy were done in the 3 years since 1995. Angio-HCT was performed with direct infusion of the contrast medium through the gastroduodenal artery inserted on angiography. Angio-HCT displayed the tumors as lower density areas in contrast to the strong enhancement of the circumferential nontumorous areas, including the pancreas and duodenum.

Quantitative analysis of nonuniform distributions in lung perfusion scintigraphy.

UNLABELLED: Nonuniform distributions of lung perfusion scintiscans obtained by SPECT were quantified to supplement qualitative lung scintiscans. A total of 126 lung perfusion scintigraphy examinations were performed between February and December 1996 on a subject population of 102 patients, including 8 control subjects. All of the subjects were broadly classified according to whether they had pulmonary disease or nonpulmonary disease. The latter group was subdivided into a group with cardiac disease and other diseases. The grade of breathlessness was classified according to whether oxygen inhalation was required, the clinical severity of the breathlessness and patient's performance status. Blood gas analysis was performed in 21 cases, and pulmonary function testing was performed in 26 cases. METHODS: With the subjects resting in the supine position, 185 MBq 99mTc-macroaggregate albumin was infused. From reconstructed SPECT images, the volume of lung as a whole calculated at 10% of threshold was assumed to be the functional lung volume, and the functional volume rates were calculated in 10% threshold widths from 10% to 100% of thresholds. Assuming the total absolute difference in functional volume rate between each subject and the control to be the distribution index of the lung as a whole (D index), we quantified the degree of nonuniform distribution in each subject. RESULTS: The D index of all subjects ranged from 2.7 to 72.2. The mean D index in pulmonary disease was significantly higher than in nonpulmonary disease (p < 0.0005) and cardiac disease (p < 0.005). It was significantly positively correlated with the grade of breathlessness, significantly negatively correlated with the oxygenation index and significantly positively correlated with measured vital capacity and forced expiratory volume in 1 sec as percentages of their predicted values. CONCLUSION: The D index is a useful indicator for quantifying nonuniform distributions on lung scintiscans. If it is used as a supplement to qualitative interpretation of scintiscans, pulmonary perfusion scintigraphy will become a more useful technique for clinical evaluation of treatment and assessment of breathlessness and respiratory failure than the usual one.

Impact of tumor extent and location on treatment outcome in patients with stage III non-small cell lung cancer treated with radiation therapy.

The results of treatment of 141 patients with stage III non-small cell lung cancer (NSCLC) who received definitive radiation therapy at Gunma University Hospital between 1976 and 1989 were retrospectively analyzed. Radiation was given with standard fractionation for a planned prophylactic dose of 40 Gy over 4 weeks and a definitive dose of 60 Gy over 6 weeks or more. The two- and five-year survival rates were 27% and 12% for stage IIIA, and 18% and 8% for stage IIIB, respectively (P = 0.052). By univariate analysis, a primary tumor less than 5 cm in diameter was also an important predictor of survival (P = 0.008). As for tumor location, the patients with primary tumors in the upper lobes or the superior segment of the lower lobes of the lung lived longer than those with primary tumors at any other site (P = 0.032). Patients with epidermoid carcinoma had a higher survival rate at 5 years than those with other histologic types (14% vs 3%, P = 0.074). Multivariate analysis showed that among tumor characteristics, the site of the primary tumor, the pattern of tumor spread and N stage were significantly associated with overall survival. Among the patients with stage III NSCLC, those with stage IIIA epidermoid carcinoma in the upper lobe or the superior segment of the lower lobe of the lung were considered to be the most favorable candidates for definitive radiation therapy.

Useful interventional thrombolytic and anticoagulant therapy for thrombosis due to embolization (TAE) in Budd-Chiari syndrome.

Transarterial embolization given for hepatoma in a patient with Budd-Chiari syndrome resulted in hepatic infarction and inferior vena cava thrombosis. Transarterial membranotomy and repeated infusion of thrombolytic agents and anticoagulants directly in the thrombus brought about improvement of the circulation surrounding the liver and IVC, and recovery from hepatic failure.

[Split-course radiation therapy in non-small cell lung cancer].

Split-course radiation therapy (Sp-RT) is based on theoretical differences between the kinetics of normal and malignant cells. A rest interval halfway through the course of treatment permits the normal tissues to recover, while the tumor shows vary little repopulation. Indeed, it shows mostly regression, resulting in shrinkage of the radiation field. From 1976 through 1985, 185 patients with localized but inoperable or unresectable (stage I-III) non-small cell carcinoma of the lung completed high-dose definitive RT delivered by continuous-course or split-course irradiation. Forty-seven patients who had large tumors or atelectases of the lung showing slow radioresponsiveness received Sp-RT over 60 Gy at 2 Gy per fraction. Rest periods were two or three weeks long in the interrupted schedules. The 5-year survival rate was 16% in the Sp-RT group and 13% in the continuous RT group. In the 33 patients that had differentiated epidermoid carcinoma with slow responsiveness to irradiation, the radiation fields could be shrunk by Sp-RT to the same extent as in the continuous group. Sp-RT was considered to be useful in the treatment of well-differentiated epidermoid carcinoma of the lung.

[Clinical evaluation of lung scintigraphy with 99mTc-technegas].

The aim of this study is to evaluate the safety and clinical usefulness of lung scintigraphy using 99mTc-technegas produced by the evaporation of pertechnetate elution at 2500 degrees C. Lung images were recorded by the gamma camera-computer system after a few deep inspirations of 99mTc-technegas. One healthy volunteer and 32 patients including 10 with lung cancer, 8 with chronic obstructive lung disease, 5 with pulmonary embolism, 2 with interstitial pneumonia, 2 with bronchiectasis and 12 with other various disease were studied. Delayed images were taken at more than 1 hour later in one healthy and 13 patients to investigate the interval changes of the intrapulmonary distribution of 99mTc-technegas. Obvious differences of radioactive distribution between early and delayed image were observed in only 2/14 cases. Penetration index (P.I.) averaged 0.81 +/- 0.11 for early images and 0.85 +/- 0.12 for delayed image. There was no significant difference between P.I. for early and delayed images. More than 97 MBq of 99mTc-macroaggregated albumin (99mTc-MAA) were required to obtain the adequate perfusion images after the acquisition of lung images with about 37 MBq of 99mTc-technegas. Bronchial deposits of 99mTc-technegas were shown in 12/33 cases and pathological defects in 26/32 patients (81.3%). Twenty three of 33 cases also had a perfusion scintigraphy with 99mTc-MAA. Ventilation perfusion mismatches were presented in 5/5 patients with pulmonary embolism and 1/10 patients with lung cancer. The safety was confirmed in all cases and clinical usefulness in 30/32 patients (94%). In conclusion, the safety and clinical usefulness of lung scintigraphy with 99mTc-technegas were proven in this study.

[Therapeutic cranial irradiation in patients with metastatic brain tumors from pulmonary carcinoma].

Fifty-three patients with intracranial metastases from pulmonary carcinoma were treated with cranial irradiation between 1976 and 1983. There was improvement in neurologic symptoms in 80%, and the one and two-year survival rates for the entire group of patients were 21% and 4%. Those or patients without metastasis tumor in other organs were 38% and 9%, respectively. It was suggested that the total dose should be in excess of 40 Gy. Histologically, adenocarcinoma and epidermoid carcinoma showed better prognosis than other types of cancer.

[Evaluation of multi-disciplinary treatment combined with intra-arterial chemotherapy for carcinoma of the meso-pharynx].

Forty-seven cases of carcinoma of the mesopharynx , treated from 1973 to 1981 at Gunma Cancer Center, were evaluated. The following results were obtained, According to histopathologic diagnosis, 37 were well-differentiated squamous cell carcinoma and other cases were poorly differentiated squamous cell carcinoma. Classification of the site of the disease showed the most frequent site was lateral wall type (31 cases, 65.9 per cent) followed by anterior wall (9 cases), superior wall (5 cases), and posterior wall types (2 cases). According to TN classification, there were 1 case in T1, 14 cases in T2, 24 cases in T3, and 7 cases in T4, N distribution revealed 27 cases N0, 20 cases N1, N2 and N3. The most common treatment was intraarterial chemotherapy using 5-FU combined with external irradiation (15 cases, 31.9 per cent), external irradiation alone (14 cases, 29.7 per cent), external irradiation with Radium (8 cases, 17.0 per cent), and combined with cryosurgery 5 cases, 10.6 per cent). The five-year cumulative survival rate was 35.3 per cent. The lesion of mesopharyngeal carcinoma takes various forms, so the treatment policy cannot be a standard one. Thus multi-disciplinary treatment should be applied for this disease.