The effects of preanesthetic oral clonidine on total requirement of propofol for general anesthesia

STUDY OBJECTIVE

To investigate the effects of preanesthetic oral clonidine on total propofol requirement for uniform minor surgery (breast conservative surgery: breast cancer removal with axillary lymph node dissection), and to compare the action of clonidine with that of preanesthetic oral diazepam, a commonly used benzodiazepine.

DESIGN

Randomized double-blinded study.

SETTING

Operating room ASA physical status I and II room and recovery room of the cancer center.

PATIENTS

80 breast cancer patients scheduled for surgery.

INTERVENTIONS

Patients were randomized to one of four treatment groups (placebo, clonidine 75 micrograms, or 150 micrograms of clonidine, or 10 mg of diazepam were orally administered 60 min before induction of anesthesia); n = 20 per group. After evaluating the sedation and anxiety levels of patients using a visual analog scale, anesthesia was induced with propofol (1.5 mg/kg), and maintained with oxygen (O2): nitrous oxide (N2O) (30:70) with a continuous infusion of propofol. The propofol infusion was started at 10 mg/kg/h for 10 minutes, then decreased to 8 mg/kg/h, and 6 mg/kg/h thereafter, and the rate of infusion was adjusted to obtain adequate anesthesia (maintaining hemodynamic parameters within 20% of that prior to premedication). Fentanyl 0.2 mg (each 0.1 mg was given for intubation and axillary lymph node dissection, respectively) was administered.

MEASUREMENTS AND MAIN RESULTS

Preanesthetic oral clonidine (150 micrograms) and diazepam (10 mg) induced anxiolysis without sedation. The total requirement (the mean infusion rates) of propofol in placebo, clonidine 75 micrograms, clonidine 150 micrograms, and 10 mg of diazepam groups were 841 +/- 70 (9.0 +/- 0.3), 720 +/- 63 (7.1 +/- 0.4), 491 +/- 39 (5.6 +/- 0.2), and 829 +/- 77 mg (7.9 +/- 0.4 mg/kg/h), respectively. The cost of propofol in these groups was $51.0 +/- 3.8, $45.5 +/- 3.2, $33.5 +/- 2.3, and $50.5 +/- 4.4, respectively.

CONCLUSIONS

Preanesthetic oral clonidine (150 micrograms) but not diazepam (10 mg) reduced the total requirement of propofol while stabilizing hemodynamic parameters. In addition, 150 micrograms of oral clonidine attenuates the hemodynamic responses associated with tracheal intubation.

Extrahepatic biliary cystadenocarcinoma arising from the left hepatic duct

A 54-year-old man, who had no clinical symptoms, underwent a routine health checkup at our hospital. Abdominal ultrasonography disclosed a well demarcated tumor containing a solid portion occupying the dilated left hepatic duct and a cystic portion expanding into the parenchyma of the left hepatic lobe, with mild dilatation of the intrahepatic bile ducts. These findings were later confirmed by computed tomography (CT) and magnetic resonance imaging. Endoscopic retrograde cholangiography revealed a complete defect at the level of the left hepatic duct, while drip infusion cholangiographic-CT (DIC-CT) disclosed a defect of the left hepatic duct only, with the distal portions of the left intrahepatic ducts being visualized on the image. Hepatic angiography revealed light stains in the solid portion in the parenchymal phase. At left lobectomy, a multiloculated polyp-like tumor was found arising from the left hepatic duct and expanding into the parenchyma of the left hepatic lobe. Microscopically, all the lining cells in the cysts and the tumor cells in the solid portion showed the features of papillary adenocarcinoma. In this patient with extrahepatic biliary cystadenocarcinoma, DIC-CT was useful in identifying the site of origin of the tumor, and hepatic angiography was also useful in differentiating this rare malignant tumor from benign cystadenoma.

Effects of ADP and low ATP on the Ca(2+)-sensitive transient contraction upon photolysis of caged ATP in rat muscle fibres: a study on the Bremel-Weber type cooperation

Caged ATP was photolysed in rat psoas fibres under various conditions to examine whether ADP plays a special role in the 'Bremel-Weber type cooperation', viz. the Ca(2+)-like action of the rigor cross-bridges. Various concentrations of ATP (0.25-1.6 mM) were photoreleased in the presence of various concentrations of ADP (0-0.4 mM) at approximately 8 or 20 degrees C. The Ca2+ concentration was set at around 0.2 microM in order that the ATP-induced contraction was significant but short. Both lower [ATP] and higher [ADP] resulted in a slower detachment of the rigor cross-bridges and a larger contraction after the detachment. ADP did not seem to affect the relationship between the rate of detachment and the size of the Ca(2+)-sensitive component of the subsequent contraction. It is concluded that there is little evidence that the ADP-bound rigor cross-bridges are more potent than the nucleotide-free ones in the Bremel-Weber type cooperation that is seen in the ATP-induced transient contraction. The mechanism by which the ADP-specific, Ca(2+)-independent contraction occurs immediately after the release of ATP remains to be clarified.

Liquid refractometry by the rainbow method

A new method for measuring the refractive index of liquid, proposed in a previous paper [Appl. Opt. 36, 5552-5556 (1997)], has been developed. The minimum deviation of a laser beam deflected by a liquid-filled cylindrical cell was calculated by use of geometric optics. These theoretical results were compared with experimental results, with excellent agreement. As a result, the unknown refractive index of a liquid could be obtained by use of a computer calculation to give a best fit. The computer calculation showed that the sensitivity of the refractometer increases with the cell-wall thickness until total reflection takes place. A small refractive-index difference can be detected within a precision of 1 x 10(-6) by use of a metal-oxide semiconductor linear image sensor. We show how to calibrate the refractometer with pure water at 3.98 degrees C.

5 Gy irradiation does not alter the expression level of WT1 (Wilms tumor gene) in K562 and ML1

Recently, Wilm's Tumor gene (WT1) has been identified as a predisposing indicator for the activity of leukemia. To know the influence of irradiation on the expression level of WT1, we examined changes in WT1 expression after 5 Gy of irradiation of the K562 and ML1 cell lines (lymphoblastic cell lines). 48 hours after irradiation we could not find any alteration in the expression of WT1 at the mRNA and protein levels. Therefore, our results indicate that 5 Gy of irradiation does not induce differentiation of the leukemia cells.

Primary cardiac leiomyosarcoma growing rapidly and causing right ventricular outflow obstruction

Leiomyosarcomas are extremely rare primary cardiac tumors. We report a rapidly growing primary leiomyosarcoma of the right ventricle, which obstructed the right ventricular outflow tract within one month after symptom onset in a 68-year-old man. Two-dimensional echocardiography was useful in diagnosing the extent and progression of the tumor. The tumor was surgically resected on an emergency basis, and the right ventricle and pulmonary artery were successfully reconstructed. Recurrence of the tumor on the right ventricle was observed, and the patient was overcome by sudden dyspnea and died three months after surgery.

High dose rate versus low dose rate interstitial radiotherapy for carcinoma of the floor of mouth

PURPOSE

Patients with cancer of the floor of mouth are treated with radiation because of functional and cosmetic reasons. We evaluate the treatment results of high dose rate (HDR) and low dose rate (LDR) interstitial radiation for cancer of the floor of mouth.

METHODS AND MATERIALS

From January 1980 through March 1996, 41 patients with cancer of the floor of mouth were treated with LDR interstitial radiation using 198Au grains, and from April 1992 through March 1996 16 patients with HDR interstitial radiation. There were 26 T1 tumors, 30 T2 tumors, and 1 T3 tumor. For 21 patients treated with interstitial radiation alone, a total radiation dose of interstitial therapy was 60 Gy/10 fractions/6-7 days in HDR and 85 Gy within 1 week in LDR. For 36 patients treated with a combination therapy, a total dose of 30 to 40 Gy of external radiation and a total dose of 48 Gy/8 fractions/5-6 days in HDR or 65 Gy within 1 week in LDR were delivered.

RESULTS

Two- and 5-year local control rates of patients treated with HDR interstitial radiation were 94% and 94%, and those with LDR were 75% and 69%, respectively. Local control rate of patients treated with HDR brachytherapy was slightly higher than that with 198Au grains (p = 0.113). For late complication, bone exposure or ulcer occurred in 6 of 16 (38%) patients treated with HDR and 13 of 41 (32%) patients treated with LDR.

CONCLUSION

HDR fractionated interstitial brachytherapy can be an alternative to LDR brachytherapy for cancer of the floor of mouth and eliminate radiation exposure for the medical staff.

Tongue cancer treated with brachytherapy: is thickness of tongue cancer a prognostic factor for regional control?

BACKGROUND

We aimed to investigate the predisposing factor for lymph node metastasis and examine the influence of thickness for lymph node recurrence in oral tongue cancer.

METHODS

We analysed 254 patients with early oral tongue cancer (T1-2N0) who were treated with brachytherapy from 1967 through 1985.

RESULTS

T category (p = 0.005), and thickness (p = 0.04) were identified as a significant predisposing factors for neck failure. 50%, 40% and 30% were the incidences of lymph node metastasis for patients with thickness of tumor more than 11 mm, 6-10 mm and 5 mm or less. Furthermore, T category (largest diameter of lesion) correlates strongly to thickness of tumor.

CONCLUSIONS

Although it is not an independent factor, thickness is a significant predisposing factor for lymph node metastasis.

Craniofacial fibrous dysplasia with rapidly increasing proptosis due to a mucocele behind the globe

A 16-year-old male with fibrous dysplasia, in which rapidly increasing proptosis of the left eye was induced by a mucocele behind the globe, is reported. The mucocele was removed and the expanded bone was completely recontoured back to normal dimensions with the aid of an acrylic skull replica fabricated preoperatively by laser lithography on the basis of computed tomographic data. The result was satisfactory and no recurrence of bony swelling or proptosis has been detected for 2 years and 9 months.

Angiogenesis in hepatocellular carcinoma as evaluated by CD34 immunohistochemistry

To clarify the relationship between angiogenesis and hepatocarcinogenesis on progression of hepatocellular carcinoma (HCC), we quantitatively evaluated angiogenesis by CD34 immunohistochemistry in liver cirrhosis (LC), adenomatous hyperplasia (AH), and HCC, and proliferative activity estimated by Ki-67 immunohistochemistry. Angiogenesis was evaluated by CD34 immunohistochemistry using monoclonal antibody HPCA-2, and tumor proliferative activity was evaluated using monoclonal antibody MIB-1. We used an image analysis system to assess the microvessel density as the area percentage of the endothelial area. Angiogenesis was generally observed in HCC and there was no significant difference among all clinical stages and histological grades of HCC. On the other hand, the staining of CD34 was partly observed in sinusoids of AH, although no positive staining was seen in any sinusoids of LC. The proliferative activity was significantly correlated with the clinical stage and histological grade of HCC. Our results indicate that the quantitation of angiogenesis does not provide significant prognostic information in HCC, but that it may have diagnostic value in distinguishing HCC from non-HCC. Meanwhile, AH, which is not morphologically diagnosed as cancer, shows positive staining for CD34, suggesting that some portion of AH contains cancerous characteristics.

Suppressive effect of globin digest on postprandial hyperlipidemia in male volunteers

We have reported previously that various edible protein digests inhibit dietary hyperlipidemia in mice, rats, pigs and dogs. Of the various digests tested, globin digest had the most potent inhibitory activity, and a tetrapeptide extracted from globin digest, Val-Val-Tyr-Pro, had activity 7000-fold greater than that of the parent digest. In this clinical study, we investigated the influence of globin digest on serum chylomicron triglyceride concentrations as an indicator of the effect of globin digest on fat absorption and catabolism in humans. Parallel and crossover trials were conducted in which men consumed a control high fat diet (25 g fat, 7.6 g carbohydrate, 1.9 g protein and 0.7 g sodium chloride) or the same diet supplemented with globin digest. The supplemented dosages were 1 and 4 g globin digest. In the parallel trial, 22 men were divided into three groups: control, globin digest 1 g and globin digest 4 g. The increases in chylomicron triglyceride concentrations at 1 h after ingestion of 1 or 4 g globin digest were significantly lower (P < 0.05) compared with the control group. The crossover trial involved six subjects who consumed the control high fat diet and the same diet supplemented with 4 g globin digest. Serum chylomicron triglyceride levels increased in both groups at 1 and 2 h after ingestion, but when subjects consumed 4 g globin digest the increases were suppressed to 75 (P < 0.05) and 42% (P < 0.05) of the increases in controls at the corresponding times, respectively. The areas under the curves of chylomicron and serum total triglyceride concentrations during the 4 h after ingestion of 4 g globin digest were 46 (P < 0.05) and 34% (P < 0.05) lower, respectively, than when the men consumed the high fat control diet. In these trials, globin digest reduced the increase in serum chylomicron triglyceride concentrations as a result of the ingestion of a high fat diet. This hypotriglyceridemic effect of globin digest may be valuable for preventing obesity and in lowering the incidence of cardiovascular diseases.

Overexpression of GML promotes radiation-induced cell cycle arrest and apoptosis

Expression of the GML gene is regulated in a p53-dependent manner and is correlated with the sensitivity of esophageal cancer cells to anti-cancer drugs. To clarify the effect of GML expression on the sensitivity of cancer cells to ionizing radiation treatment, we established cell lines derived from p53-mutant human osteosarcoma HOS and esophageal carcinoma TE10 lines in which GML expression can be induced using the tetracycline-regulable system. Colony formation assay showed that the growth of cells expressing GML are inhibited in response to ionizing radiation, whereas cells not expressing GML were resistant to irradiation. Further investigation demonstrated that GML expression enhances G2/M arrest and apoptosis induced by gamma-irradiation. These results suggest that GML sensitizes cancer cells to ionizing radiation.

Age as a prognostic factor for late local recurrence of early tongue cancer treated with brachytherapy

BACKGROUND

We aimed to examine predisposing factors on late local recurrence of early oral tongue cancer (T1-2N0).

METHODS

We analysed 152 patients with no evidence of disease 2 years after interstitial radiation therapy without external radiation.

RESULTS

Multivariate analysis showed age to be the only significant prognostic factor for late local control (p = 0.03). We then examined the influence of age by comparing the results between 36 older patients (age more than, or equal to, 65) and 116 other control patients (age less than 65). Aged patients showed poor local control rates of 62% at 10 years after treatment, whereas the corresponding figures for control patients were 90% (p = 0.003). The cause specific survival rate at 10 years was also lower in elderly patients (75%) than in control patients (93%, p = 0.02).

CONCLUSIONS

Age is a predisposing factor for late local recurrence in patients free from disease 2 years after treatment.

The effect of imidazoline receptors and alpha2-adrenoceptors on the anesthetic requirement (MAC) for halothane in rats

BACKGROUND

Recent evidences have documented that several pharmacologic actions of alpha2-adrenoceptor agonists are mediated via activation of not only alpha2-adrenoceptors, but also by imidazoline receptors, which are nonadrenergic receptors in the central nervous system. However, the effect of imidazoline receptors on the anesthesia is not well known, and it is important to clarify the effects of both receptors on anesthesia.

METHODS

Seventy-two rats were anesthetized with halothane, and the anesthetic requirement for halothane was evaluated as minimum alveolar concentration (MAC). The MAC for halothane was determined in the presence of dexmedetomidine (0, 10, 20, and 30 microg/kg, intraperitoneally [IP]), a selective alpha2-adrenoceptor agonist with weak affinity for imidazoline receptors. Then, the authors evaluated the inhibitory effect of rauwolscine (20 mg/kg, IP), an alpha2-adrenoceptor antagonist with little affinity for imidazoline receptors, on the MAC-reducing action of dexmedetomidine (30 microg/kg). Further, the effect of rilmenidine (20, 50, 100, 1000 microg/kg, IP), a selective imidazoline receptor agonist, on the MAC for halothane was also investigated.

RESULTS

Dexmedetomidine decreased the MAC for halothane dose-dependently, and this MAC-reducing action of dexmedetomidine was completely blocked by rauwolscine. Rilmenidine alone did not change the MAC for halothane.

CONCLUSIONS

The present data indicate that the anesthetic sparing action of dexmedetomidine is most likely mediated through alpha2- adrenoceptors, and the stimulation of imidazoline receptors exerts little effect on the anesthetic requirement for halothane.

Assessment of left atrial operative mean stiffness using simultaneous recordings of left ventricular pressure and M-mode echocardiography of the left atrium and mitral valve

Left atrial (LA) operative mean stiffness was measured using simultaneous recordings of the left ventricular (LV) pressure and M-mode echocardiography of the LA and mitral valve. The LA operative passive mean stiffness value was obtained during LV systole using LV pressure at the mitral valve opening and the pre-atrial contraction where the LV and LA pressure curves cross each other. Before the LA stiffness measurement, the LA volume calculated by biplane left atriography was compared with the dimension of the LA M-mode echocardiogram at three points (maximum volume, pre-atrial contraction and minimum volume) in another 23 patients (5 normal subjects, 4 patients with angina pectoris, 14 patients with myocardial infarction), and the regression equation was obtained by power fitting (y = ax3+ b). Using this equation, the LA volumes were calculated and used for the measurement of LA operative mean stiffness. Eleven normal subjects (C group), 14 patients with myocardial infarction (ejection fraction: EF > or = 55%; NF group), and 12 patients with myocardial infarction (EF < 55%; F group) were studied. The measured operative mean stiffness values based on the LA dimension and LV pressure [K(D)] were 0.69 +/- 0.40, 1.0 +/- 0.37, and 2.0 +/- 0.61 mmHg/mm, respectively (p < 0.01 in C vs F). The mean stiffness values calculated with LA volume [K(V)] were 0.48 +/- 0.23, 0.42 +/- 0.19, and 0.66 +/- 0.25 mmHg/ml, respectively (p < 0.05 in NF vs F). In F group, both the K(D) and K(V) values were high. The K(D) value can thus be used clinically as an easily obtained index of the LA operative mean stiffness. The high LA operative mean stiffness in F group appeared to be related to the increased LA pressure at the mitral valve opening. This method of measurement of the LA operative mean stiffness can be easily applied and used as a routine measurement providing additional information regarding left ventricular function.

Efficacy of a belly board device with CT-simulation in reducing small bowel volume within pelvic irradiation fields

PURPOSE/OBJECTIVE

Acute and chronic small bowel toxicity associated with pelvic irradiation limits dose escalation for both chemotherapy and radiotherapy for rectal cancer. Various surgical and technical maneuvers including compression and belly board devices (BBD) have been used to reduce small bowel volume in treatment fields. However, quantitative dose volume advantages of such methods have not been reported. In this study, the efficacy of BBD with CT-simulation is presented with dose-volume histogram (DVH) analyses for rectal cancer.

METHODS AND MATERIALS

Twelve consecutive patients referred to our department with rectal cancer were included in this study. Patients were given oral contrast 1.5 h prior to scanning and instructed not to empty their bladder during the procedure. The initial CT scan without BBD was taken in the prone position with an immobilization cast. A second CT study was performed with a commercially available BBD consisting of an 18-cm thick hard sponge with an adjustable opening (maximum 42 x 42 cm2). All patients were positioned prone over the BBD so that the opening was above the treatment volume and usually extended from the diaphragm to the bottom of the fourth lumbar spine. Image fusion between both sets of CT scans (with and without BBD) was performed using common bony landmarks to maintain the same target volume. The critical structures including small bowel and bladder were delineated on each slice for DVH analysis. On each study, a three-field optimized plan with conformal blocks in beams-eye-view was generated for volumetric analysis. The DVHs with and without BBD were evaluated for each patient.

RESULTS

The median age and body weight of 12 patients (4 females and 8 males) were 57.5 years and 82.7 kg, respectively. The changes in posterior-anterior (PA) and lateral separation with and without BBD at central axis slices were analyzed. The changes in lateral separation were minimal (<0.8 cm); however, the PA separation was reduced by 11.3 +/- 3.3% when BBD was used. The reduction in PA separation was directly related to the reduction in small bowel volume. The small bowel volume was significantly reduced with a median reduction of 70% (range 10-100%) compared to the small bowel volume without BBD. The small bowel volume reduction did not correlate either with body weight, age, gender, or sequence of radiation treatment with surgery (pre-op vs. post-op). The DVH analysis of small bowel with BBD showed significant volume reduction at each dose level. For 50% patients, the DVH analysis demonstrated an increase in bladder volume with BBD. All patients treated with the BBD completed their treatment without any break and without significant acute gastrointestinal or genitourinary toxicity.

CONCLUSIONS

For rectal cancers, small bowel is the dose-limiting structure for acute and chronic toxicity. The use of the BBD should improve the tolerance of aggressive combined modality treatment by reducing the small bowel volume within the pelvis compared to the prone position alone. The BBD provides an easy, economical, comfortable, and noninvasive technique to displace small bowel from pelvic treatment fields. The small bowel volume is dramatically reduced at each dose level. The volume reduction does not correlate with gender, age, weight, pelvic separation, and sequence of radiation treatment vs. surgery.

Using minimum deviation of a secondary rainbow and its application to water analysis in a high-precision, refractive-index comparator for liquids

A new method for measuring the refractive-index difference of a liquid has been developed. The liquid to be measured is contained in a 60-mm-diameter, cylindrical glass cell, and a He-Ne laser light is passed into the cell so that the laser light incidence fulfills the condition of minimum deviation. In this condition, the beam emerging from the cell has a fine interference fringe. The position of the interference fringe is read out as a marker to measure the deflection of the laser light. Directly reading the peak shift of the interference fringe makes it easy to obtain the refractive index difference of the liquid with a fairly high precision of at least 6 x 10(-6). Further high precision is potentially expected to be realized by use of an improved data analysis treatment of the overall interference fringe pattern.

Visual evoked potential and electroencephalogram of healthy females during the menstrual cycle

Flash visual evoked potential (VEP) and electroencephalogram (EEG) changes during the menstrual cycle were studied using healthy females having regular menstruation, with 21 at the follicular phase (FP) and 23 at the luteal phase (LP). The following results were obtained. (1) The waveforms of Group Mean VEPs of both groups had approximately similar triphasic contours, consisting of 16 components of P 1-N 8 up to 500 msec of latency. (2) Latencies tended to be longer in LP. (3) Interpeak amplitudes tended to be larger in LP, and one VEP interpeak amplitude (P 5-N 7) of long latency component was significantly larger at LP after eliminating the effect of body height by ANCOVA for 2 CH. (4) Quantitative analysis of EEGs between FP and LP resulted in a tendency for increased alpha, and decreased beta power % at LP. Since estrogen increases the VEP amplitude, and decreases the VEP latency and the alpha activity of EEGs, the large VEP amplitude, the tendency for prolonged VEP latency, and the tendency for increased alpha power % at LP observed in this study indicate that the VEP amplitude at LP reflects the effect of estrogen, and that the VEP latency and EEGs at LP reflect the effect of progesterone.

Interactions between neuronal histamine and halothane anesthesia in rats

Using an in vivo microdialysis method, we measured the release of histamine in the anterior hypothalamic area (AHy) of rats under several concentrations of halothane anesthesia (1, 0.5, and 0.2%). The release of histamine increased to 341 and 325% at halothane concentrations of 0.5 and 0.2%, compared with the basal level at anesthesia induced by 1% halothane. alpha-Fluoromethylhistidine (100 mg/kg i.v.), a specific and irreversible inhibitor of histidine decarboxylase, reduced the histamine release to <35% of the basal value at 1% halothane anesthesia in the AHy, and also decreased the anesthetic requirement for halothane, evaluated as the minimum alveolar concentration (MAC), by 26%. Furthermore, pyrilamine (20 mg/kg i.v.), a brain-penetrating H1 antagonist, and zolantidine (20 mg/kg i.v.), a brain-penetrating H2 antagonist, reduced the MAC for halothane by 28.5 and 16%, respectively. Although thioperamide (5 mg/kg i.v.), an antagonist of presynaptic H3 autoreceptor, induced an approximate twofold increase in the level of histamine release in conscious freely moving rats, the same dose of thioperamide had little effect on the release of histamine under 1% halothane anesthesia in the AHy. Furthermore, thioperamide did not change the anesthetic requirement (MAC) for halothane. The present findings indicate that halothane anesthesia inhibits the release of neuronal histamine and that histaminergic neuron activities change the anesthetic requirement (MAC) for halothane through H1 as well as H2 receptors.

Comparison of the long-term results of brachytherapy for T1-2N0 oral tongue cancer treated with Ir-192 and Ra-226

BACKGROUND

The authors report the compatibility of iridium-192 (Ir-192) to Radium-226 (Ra-226) based on the clinical results of three-decades.

METHODS

From 1967 through 1985, 119 patients with early oral tongue cancer (T1-2N0) were treated with conventional Ra-226 needles and 135 patients with Ir-192 hair pins.

RESULTS

Local control rates at 10 years for T1 and T2 tongue cancer were 79% and 61% for patients treated with Ra-226, 83% and 68% with Ir-192. The 10-year cause-specific survival rates for the T1 and T2 patients with Ra-226 were 76% and 63%, and those with Ir-192 were 77% and 68%, respectively.

CONCLUSIONS

Ir-192 showed good possibilities as a substitute for Ra-226 in brachytherapy for early oral tongue cancer.

Factor VIII Ise (R2159C) in a patient with mild hemophilia A, an abnormal factor VIII with retention of function but modification of C2 epitopes

We found a patient with mild hemophilia A who had no detectable factor VIII antigen (FVIII:Ag), as shown by two-site ELISA using inhibitor alloantibodies (TK). We then analyzed A2, A2/B, and C2 antigen of the patient's DDAVP-induced FVIII using several anti-FVIII monoclonal antibodies. Factor VIII activity (FVIII:C) was increased from 12 to 42 U/dl by the administration of DDAVP. The DDAVP-induced increases in the A2 and A2/B antigens were 40 and 36 U/dl, respectively. However, the increase in the C2 antigen was only 7.5 U/dl. SSCP analysis and subsequent sequencing demonstrated an Arg to Cys transition at codon 2159. The anti-FVIII:C titer of monoclonal antibody, NMC-VIII/5 which recognized the C2 domain, against normal plasma was 450 Bethesda U/mg of IgG. However, the titer against DDAVP-treated patient's plasma was only 15 Bethesda U/mg. We also tested DDAVP-induced increase in the FVIII:Ag in another mild hemophilia A patient with the same mutation at Arg2159. Increase in his C2 antigen levels was only 19% of those in the A2 and A2/B antigen. We designate this abnormal FVIII as FVIII Ise. Our results show that a missense mutation at Arg2159 to Cys modifies the antigenicity of the C2 domain.

Effects of Albunex infusion on left ventricular inflow velocity in dogs

This study examined the effects of Albunex (sonicated 5% human serum albumin) infusion on left ventricular inflow velocity by Doppler echocardiography. Left ventricular pressure and left ventricular inflow velocity were recorded simultaneously under eight different conditions in dogs: 1) baseline 1 (control), 2) Albunex 0.2 ml/kg, 3) baseline 2, 4) Albunex 0.5 ml/kg, infusion of dextran 100 ml, 5) baseline 3, 6) Albunex 0.2 ml/kg, 7) baseline 4, and 8) Albunex 0.5 ml/kg. In the normal state (no dextran), Albunex (0.2 ml/kg) caused no hemodynamic changes or inflow velocity changes. In contrast, infusion of Albunex (0.5 ml/kg) caused time velocity integrals of early filling to increase from the baseline (5.51 +/- 1.13 vs 7.19 +/- 1.14 cm, p < 0.05). After dextran infusion (100 ml), Albunex (0.2 ml/kg) caused peak early filling velocity to increase (62.4 +/- 6.9 vs 67.3 +/- 9.4 cm/sec, p < 0.05), and infusion of Albunex (0.5 ml/kg) also caused peak early filling velocity to increase from baseline (64.6 +/- 8.5 vs 73.7 +/- 14.5 cm/sec, p < 0.05). Infusion of Albunex (0.5 ml/kg) after dextran infusion caused increases in left ventricular pressure at the mitral valve opening (12.7 +/- 3.1 vs 15.2 +/- 3.3 mmHg, p < 0.05) and in left atrial driving force (13.5 +/- 3.6 vs 16.7 +/- 5.9 mmHg, p < 0.05). Clinicians should be cautious about using Albunex at doses of greater than 0.2 ml/kg when evaluating the pressure gradient of the left ventricle in patients with elevated left ventricular diastolic pressure. In patients with normal hemodynamics, Albunex infusion at doses of less than 0.2 ml/kg apparently did not affect the velocity measurement.

Initial clinical assessment of CT-MRI image fusion software in localization of the prostate for 3D conformal radiation therapy

PURPOSE

To assess the utility of image fusion software and compare MRI prostate localization with CT localization in patients undergoing 3D conformal radiation therapy of prostate cancer.

MATERIALS AND METHODS

After a phantom study was performed to ensure the accuracy of image fusion procedure, 22 prostate cancer patients had CT and MRI studies before the start of radiotherapy. Immobilization casts used during radiation treatment were also used for both imaging studies. After the clinical target volume (CTV) (prostate or prostate + seminal vesicles) was defined on CT, slices from the MRI study were reconstructed to precisely match the CT slices by identifying three common bony landmarks on each study. The CTV was separately defined on the matched MRI slices. Data related to the size and location of the prostate were compared between CT and MRI. The spatial relationship between the tip of urethrogram cone on CT and prostate apex seen on MRI was also estimated.

RESULTS

The phantom study showed the registration discrepancies between CT and MRI smaller than 1.0 mm in any pair in comparison. The patient study showed a mean image registration error of 0.9 (+/- 0.6) mm. The average prostate volume was 63.0 (+/- 25.8) cm3 and 50.9 (+/- 22.9) cm3 determined by CT and MRI, respectively. The difference in prostate location with the two studies usually differed at the base and at the apex of the prostate. On the transverse MRI, the prostate apex was situated 7.1 (+/- 4.5) mm dorsal and 15.1 (+/- 4.0) mm cephalad to the tip of urethrogram cone.

CONCLUSIONS

CT-MRI image fusion study made it possible to compare the two modalities directly. MRI localization of the prostate is more accurate than CT, and indicates the distance from cone to apex is 15 mm. CT-MRI image fusion technique provides valuable supplements to CT technology for more precise targeting of the prostate cancer.