Intravenous thrombolysis for patients with reverse magnetic resonance angiography and diffusion-weighted imaging mismatch: SAMURAI and NCVC rt-PA Registries.

BACKGROUND AND PURPOSE: The characteristics of reverse magnetic resonance angiography and diffusion-weighted imaging (MRA-DWI) mismatch (RMM), defined as a large DWI lesion in the absence of major artery occlusion (MAO), remain unknown, especially in patients treated with intravenous recombinant tissue plasminogen activator (rt-PA). METHODS: Patients with stroke in the middle cerebral artery territory were included. Early ischaemic changes (EIC) were assessed with the Alberta Stroke Program Early CT Score on DWI (DWI-ASPECTS). All patients were divided into four groups based on the presence of MAO and a DWI-ASPECTS cut-off value of <7. RMM was defined as DWI-ASPECTS <7 without MAO. Clinical characteristics, symptomatic intracerebral hemorrhage (sICH) and favorable functional outcome (modified Rankin Scale score 0-2) at 90 days were compared amongst the four groups. RESULTS: Of the 486 patients enrolled (167 women, median age 74 years, median initial National Institutes of Health Stroke Scale score 13), reverse MRA-DWI mismatch was observed in 24 (5%). Of the clinical characteristics, cardioembolism was the only factor that was independently associated with RMM [odds ratio (OR) 5.49, 95% confidence interval (CI) 1.25-24.1]. Multivariable analyses revealed that patients with RMM more commonly had sICH than those with DWI-ASPECTS ≥ 7 irrespective of the presence (OR 5.44, 95% CI 1.13-26.1) or absence (13.1, 2.07-83.3) of MAO, and they had a more favorable functional outcome than those with DWI-ASPECTS < 7 plus MAO (7.45, 2.39-23.2). CONCLUSION: RMM was observed in 5% of patients treated with rt-PA and associated with cardioembolism. Patients with RMM may benefit from thrombolysis compared with those with EIC with MAO, although increment in the rate of sICH is a concern.

Outcomes of 116 patients with hepatocellular carcinoma.

We studied the outcomes of 116 patients with hepatocellular carcinoma (HCC) diagnosed in our hospital between January 1980 and August 1992. The patients were divided into groups according to the principal treatment procedure. The 3-year survival rates in the patients treated by percutaneous ultrasonically guided ethanol injection (PEI), operation (hepatic resection), and transcatheter hepatic arterial embolization (TAE) were 90.9%, 53.6%, and 29.0%, respectively. None of the patients treated by one-shot injection of an anticancer agent into the hepatic artery and chemotherapy survived for more than 2 years. The outcomes of the patients treated by PEI and hepatic resection were significantly better than those of the patients treated by the other procedures. There was no significant difference when the patients were stratified according to the year of detection. The 3-year survival rate was 57.3% for 19 patients in whom HCCs were detected during clinical follow-up for chronic liver disease and 17.3% for the other 97 patients. We concluded that hepatic resection in patients with good liver function and PEI for early HCC yielded significantly better survival rates than the other procedures. Moreover, for early detection and treatment of HCC, we recommend clinical follow-up of patients with chronic liver disease.

[A case of huge duodenal leiomyosarcoma].

A case of duodenal leiomyosarcoma with large central necrosis was reported. Tumor was 15 X 10 X 10 cm in size. Ultrasonography showed a cystic tumor with thick wall in the right upper abdomen. CT scan revealed a gas formation in the central cystic cavity of the tumor. The gas formation was probably caused by bacterial infection. The diagnosis was confirmed histologically.

[Relationship between endoscopic features and prognosis of pm-gastric cancer--with special reference to the depressive type of pm-cancer].

In this report, operated advanced gastric cancer was analysed based on 96 cases of carcinoma of the proper muscle layer (pm-cancer) experienced between 1961 and 1982 at the Third Department of Internal Medicine, Tohoku University School of Medicine, and its associated hospital. Patterns of macroscopic findings in pm-cancer were classified into three types: (1) early type, (2) early-like cancer type, and (3) Borrmann's variety type. The degree of lymph node metastasis ascended in types (1), (2) and (3) in that order, and the five-year survival rate descended in the same order.

Diagnosis of submucosal tumors by injecting a water soluble contrast medium: judgement of tumor developing pattern and endoscopic lumpectomy.

With the remarkable increases in the number of cases of endoscopical removal of submucosal tumors spurred by the application of high-frequency current, it has become more and more important to apply beforehand some reliable methods like ours to differentiate between tumors and other tumescent lesions due to extra-gastric pressure similar in configuration to tumors and also to confirm the development patterns of tumors either intra-gastric or extra-gastric. Such preparatory arrangements seem indispensable to minimize the risk of perforation incidental to the endoscopical treatment of tumors. To cope with another danger of major bleeding following tumor resection, securing on hand an effective hemostatic is indispensable as well. In our care of the patients after their undergoing endoscopical lumpectomies, we usually subject them to quiet rest and fasting for two or three days; then when they are to resume a regular diet, we endoscopically examine them before and after each meal to confirm the presence or absence of bleeding. In 12 subjects of this series treated with our routine and finally with lumpectomies for gastric submucosal tumors, no serious adverse reactions developed.

[Chemotherapy of gastric and rectal cancers incorporating non-radical irradiation during remission induction. 1].

For the remission induction therapy of advanced gastric and rectal cancer, 25 cases were treated by non-radical irradiation (total doses: 3000-6000 rad) combined with tegafur, which minimized the tumor mass. For the reduction of tumor mass, a modified method of FAMT was employed and for the maintenance therapy of long-term chemotherapy a modified method of FAMT, MFE, MF or tegarfur alone were performed. Prolongation in survival was obtained with this combination therapy: Of 25 cases, 11 cases survived longer than one year and 6 cases longer then two years. One case of survived rectal cancer obtained disease-free for about 8 years with this treatment. But the observation period was too short to calculate one-year and two-year survival rates of all cases. The indications for application of this combination therapy were as follows; (1) Locally operable cases with myocardial infarct, heart insufficiency, poor risk or refusal of operation, (2) Very aged patients, (3) Locally inoperable cases without clinical metastasis, and (4) Primary lesion of gastric cancer with small metastasis controllable by tegafur. It was concluded that over 3000 rad of irradiation combined with tegafur was necessary to obtain the sufficient radiation effect. As for side effects, loss of appetite , leukopenia and a few case of gastric bleeding by radiation were noted. From the result this treatment modality appears to be valuable in the management of gastric and rectal cancer.