[Tumor hemodynamics in hepatic nodules associated with liver cirrhosis: relationship between cancer progression and tumor hemodynamic change]

Tumor hemodynamics including arterial vascularity (AV) and portal perfusion (PP) were evaluated in histologically confirmed 55 hepatic nodules associated with cirrhosis using ultrasonographic (US) angiography during intraarterial carbon dioxide microbubbles injection and CT during arterial portography. Tumor hemodynamic patterns were classified into 6 types as follows: Type I (n = 10): PP (+), AV (hypo); Type I' (n = 2): PP (+), AV (iso); Type II (n = 5): PP (-), AV (hypo); Type III (n = 8): PP (-), AV (iso); Type IV (n = 25): PP (-), AV (hyper), Type V (n = 5): PP (partially +), AV (vascular spot in hypovascular). Eight nodules of Type I were diagnosed as benign nodules histologically including adenomatous hyperplasia (AH) (n = 6) and regenerative nodule (n = 2). Hundred percent (5/5) of Type II and 88% (7/8) of Type III nodules were well-differentiated HCC, in contrast to 8% (2/25) of Type IV nodules, typical HCCs. Fatty metamorphosis was observed in 75% (6/8) of Type III nodules, in contrast to 16% (4/25) of typical (classical) HCC nodules (Type IV). We concluded that at the malignant transformation from AH to HCC, reduction of portal blood flow in the nodule precedes the initiation of the increase of the arterial tumor vessel. Moreover, early stage HCC could exhibit hypovascular (Type I, II), isovascular (Type III), or vascular spot in hypovascular pattern (Type V) compared with a typical HCC (Type IV). It was also suggested that the more mature as a neoplasms the HCC becomes, the more the arterial tumor vessel in the nodule increases and fatty metamorphosis of well-differentiated HCC is highly related with tumor hemodynamic condition, i.e., hypoperfusion state from both arterial and portal vessel.

Prognosticating study for cervical myelopathy using evoked spinal cord potentials

One hundred twenty-three cases of cervical spondylotic and ossification of the posterior longitudinal ligament (OPLL) myelopathy cases with long tract signs subjected to surgical treatment were studied to identify the most important factors having an influence on postoperative outcome using evoked spinal cord potentials (ESCP). Disappearance and positive wave changes of these potentials at the level of responsible lesions and slow conduction velocity under 40 m indicated an unsatisfactory outcome. Localized-lesion cases diagnosed by ESCPs had excellent results, significantly more so than extensive-lesion cases, regardless of operative methods. In 123 cases, 76% were found to have localized lesions, while the other 24% showed extensive lesions. Concerning the difference between CSM and OPLL, 54% of OPLL and only 14% of CSM demonstrated extensive lesions.

Partial trisomy 22 with Dandy-Walker malformation

Partial trisomy 22 usually occurs through a 3:1 meiotic segregation of the parental 11q;22q translocation carrier, which is the most common balanced translocation in man. Common neurologic findings are delayed psychomotor development and muscular hypotonia. There have been a few neuroradiologic and neuropathologic studies, which include ventricular dilatation, arrhinencephaly, and aplasia or hypoplasia of the cerebellar vermis, corpus callosum and pons. We here add one patient with partial trisomy 22 who had, in addition to the usual features, Dandy-Walker malformation, which, to our knowledge, is a previously undescribed feature.

Focal fatty infiltration of the liver in acute alcoholic liver injury: hot spots with radiocolloid SPECT scan

We present herein a case of focal fatty infiltration of the liver, in which extremely unusual findings were exhibited on single-photon emission computed tomography (SPECT) of the radiocolloid liver scan. Liver scan was performed on a 46-yr-old patient with a clinical picture of acute alcoholic hepatitis. Multiple hot spots were demonstrated by SPECT scan, and these lesions corresponded to focal fatty infiltration, which were proven by computed tomography (CT). These hot spots disappeared rapidly in accordance with the improvement in fatty change on CT, and with the improvement in the clinical picture. The hot spots in this case were believed to represent the nonuniform intrahepatic shuntings, which presumably caused the development of focal fatty infiltration as well. SPECT may be useful in detecting and monitoring the alteration of hepatic circulation in alcoholic patients with focal fatty infiltration of the liver when planar colloid liver scan shows a mottled pattern.

Distinction between hemangioma of the liver and hepatocellular carcinoma: value of labeled RBC-SPECT scanning

The role of adding single-photon emission CT (SPECT) to 99mTc-labeled RBC imaging of the liver was evaluated by specifically focusing on the differentiation between hepatic hemangioma and hepatocellular carcinoma. Planar RBC imaging followed by blood-pool SPECT scanning was performed in 77 patients with a total of 108 hemangiomas and in 29 patients with a total of 46 hepatocellular carcinomas. All lesions were smaller than 5 cm in diameter. Thirty-six (33%) of 108 hemangiomas were detected by planar delayed RBC imaging, whereas 63 (58%) were detected by the delayed RBC-SPECT scan. The smallest hemangioma shown by delayed RBC-SPECT scanning was 1.4 cm in diameter, compared with 1.7 cm by planar RBC scanning. When confined to nodules larger than 1.4 cm in diameter, 42% of hemangiomas (36/85) were detected by planar delayed RBC imaging, whereas 74% (63/85) were detected by delayed RBC-SPECT. Increase in sensitivity was noted in nodules 2.1-4.0 cm in diameter. No hepatocellular carcinomas were shown by delayed RBC planar or SPECT scans. We concluded that with the addition of SPECT, the sensitivity of delayed RBC scans in the detection of small hemangiomas is considerably improved. Delayed RBC-SPECT scanning can be used to distinguish hemangioma from hepatocellular carcinoma.

[Ultrasonic determination of the common carotid and brachial artery blood flow in patients with acute hepatic failure--with special reference to a decrease in common carotid artery blood flow and its relationship with brain edema]

A study was conducted to elucidate characteristics of circulatory parameters in patients with acute hepatic failure (AHF) employing Swan-Ganz catheter method and, in particular, ultrasonic quantitative flow measurement (QFM) system. The following results were obtained: 1) In five AHF patients who received Swan-Ganz catheter examinations, significant increases of cardiac index as well as decreased systemic vessel resistance were observed. 2) QFM in 11 patients with AHF revealed a significant increase of brachial artery blood flow (Br.F.), whereas common carotid blood flow (Ca.F.) was found to be significantly decreased. Thus, ratio of Ca.F./Br.F. showed a marked reduction as compared with that of control patients. 3) Vessel resistances measured by QFM were found to be significantly reduced in brachial artery, whereas markedly elevated in common carotid artery. 4) Those changes of circulatory parameters as described above were found to restore toward normal in parallel with the improvement of clinical features. 5) Vessel resistances of common carotid artery (Ca.R.) of AHF patients showed a significant negative correlation with CT values in the white matter of the brain, being regarded to well represent the degree of brain edema. In addition, in a case of AHF in whom intracranial pressure (ICP) was directly measured, time course of changes in Ca.F. was found to be in "mirror image" with that of ICP. Thus, it is strongly suggested that the increase of Ca.R. may well be induced, at least in part, by the elevated ICP in AHF patients.

14C-labeling of bromobutide, 2-bromo-3,3-dimethyl-N-(alpha, alpha-dimethylbenzyl)butyramide

Bromobutide, a novel herbicide, was labeled with carbon-14 independently at the carbonyl group and the phenyl ring for use in metabolic studies. 14C-Carbonation of neopentylmagnesium chloride (3) gave 3,3-dimethyl[1-14C]butyric acid (4a) quantitatively. Chlorination of 4a with thionyl chloride followed by alpha-bromination with bromine yielded 2-bromo-3,3-dimethyl[1-14C]-butyryl halide (5a), which was subsequently condensed with alpha, alpha-dimethylbenzylamine (6a) to afford [carbonyl-14C]bromobutide (1a). The overall yield of 1a was 76% from barium [14C]-carbonate (2). Similarly, condensation of alpha, alpha-dimethyl[phenyl-14C]benzylamine (6b), which was prepared from alpha-methyl[phenyl-U-14C]styrene (7) in three steps, with 2-bromo-3,3-dimethylbutyryl halide (5b) gave [phenyl-14C]bromobutide (1b) in 67% yield after purification. The specific activities of 1a and 1b were 1.38 and 0.781 GBq/mmol (37.2 and 21.1 mCi/mmol), respectively.

Concept of the clinical stages of acute hepatic failure

Serial medical diagnostic imagings were performed on 15 patients with acute hepatic failure to compare liver size and clinical picture. In patients showing hepatatrophy at the onset of coma, the interval between the onsets of disease and coma was long, ascites and edema supervened, high total bilirubin and low glutamic pyrubic transaminase levels tended to be found, and prothrombin time did not respond to treatment. All of these patients died. Based on liver size changes in patients who survived acute hepatic failure, acute hepatic failure was assumed to be classified into swelling, reduction, and recovery stages. The shorter the interval between the onsets of disease and coma, the earlier coma and prolonged prothrombin time occurred before hepatatrophy. In acute hepatic failure, signs of hepatic failure develop with various histological pictures and it is very important to institute the treatment before the liver is atrophied.

Small hepatocellular carcinomas in chronic liver disease: detection with SPECT

Single-photon emission computed tomography (SPECT) performed using a rotating gamma camera was compared with alpha 1-fetoprotein (AFP) assay, conventional liver scintigraphy, ultrasound (US) imaging, computed tomography (CT), and selective celiac angiography in 40 patients with a total of 50 small hepatocellular carcinomas (HCCs; less than 5 cm). The detection rates of US and CT were determined on an initial screening study and on a second, more precisely focused study. The detection rate of small HCCs by the various modalities was as follows: AFP, 13%; liver scintigraphy, 36%; SPECT, 72%; initial screening US, 80%; second, more precise US studies, 94%; initial screening CT, 64%; second, more precise CT study, 82%; angiography, 88%. Although SPECT was inferior to the initial screening US examination in detecting HCCs less than 2 cm in size, its sensitivity was identical to that of the initial screening US study for detecting HCCs of 2-5 cm. The combination of SPECT and US was an excellent method for the early detection of HCCs, yielding a detection rate of 94%.

[A study of cases of early gastric cancer with hematemesis and/or melena]

In this hospital, gastric cancers showed a slightly lower incidence (9.3%) of hematemesis and/or melena than gastric ulcers (13.9%), and no distinct difference in such incidence between early gastric cancers and advanced gastric cancers was observed. A study of the literature on early gastric cancers presenting such symptoms revealed that male patients showed an extremely high incidence of these symptoms, as did those with depressed lesions, including types II c + III, and lesions occurring in the MC-C regions dominated by the left gastric artery.