[Percutaneous microwave coagulation therapy and endoscopic microwave coagulo-necrotic therapy for small hepatocellular carcinoma]

Recently, microwave coagulation has been in the spotlight for its local application on tumor necrosis with sufficient effects. We introduce here percutaneous microwave coagulation therapy (PMCT) and endoscopic microwave coagulo-necrotic therapy (endo. MCN) for small hepatocellular carcinoma.

[Percutaneous ethanol injection therapy for small hepatocellular carcinoma]

Surgical resection is rarely indicated for hepatocellular carcinoma, because of its multiple lesions and often associated complication of liver cirrhosis. In 70-90% of patients who undergo radical operation, cancer will recur within 5 years after the surgery. Therefore, medical therapy plays an important role in the treatment for small hepatocellular carcinoma. Percutaneous ethanol injection therapy is thought to be the first choice, because of its excellent local control, preservation of liver function, and possibility of repeated use when necessary. We confirmed good long-term results of this therapy.

[Endoscopic treatment of early gastric cancer with heat probe method]

The heat probe method, which was developed as an instrument for hemostasis, has a strong coagulating effect and can be applied to the treatment of early gastric cancer. Intramucosal, differentiated adenocarcinomas of the protruded type with less than 20 mm diameter were most effectively treated with the endoscopic heat probe method. As compared with laser or microwave, heat probe treatment is inexpensive and portable, and it can be used in patients who are not candidates for surgery or who refuse surgery.

Protective effect of teprenone on blood flow and incidence of histologic lesions in rat gastric mucosa after hemorrhage and retransfusion

BACKGROUND

The effects of teprenone (6,10,14,18-tetramethyl-5,9,13, 17-nonadecatetraen-2-one) on changes in gastric mucosal blood flow, adenosine triphosphate (ATP) content, and incidence of histologic lesions were evaluated in rat gastric mucosa after hemorrhage and retransfusion.

METHODS

Teprenone (100 mg/kg) was administered orally once a day for 3 consecutive days. On the 3rd day hemorrhage was induced, withdrawn blood (retransfusion) was returned, and the above variables were determined.

RESULTS

Teprenone significantly inhibited the decreases in blood flow and index of mucosal oxygen saturation (ISO2) during hemorrhage in the corpus and antral mucosa. However, no effect of teprenone was observed on systemic blood pressure and ATP levels after hemorrhage and retransfusion. Teprenone significantly (p < 0.05) decreased both the incidence of ischemic lesions and the increase in the severity of lesions after retransfusion in both mucosal regions.

CONCLUSION

From these results, it is concluded that the protective effect of teprenone on blood flow was partly responsible for its inhibitory effect on the incidence of lesions in the rat stomach in this hypovolemic shock model, although the former effect might be not a direct effect on systemic vascular tone.

[The fellow eye in patients with retinal detachment associated with atopic dermatitis]

The fellow eyes of 13 cases of retinal detachment associated with atopic dermatitis were examined by binocular ophthalmoscope combined with scleral indentation. Breaks in the retina or pars plana were detected in 8 cases (62%); 2 of these eyes had asymptomatic retinal detachment. The most common location of these breaks was at the vitreous base symmetrical to the affected, symptomatic eye. Meticulous ophthalmoscopic examination is recommended for both eyes in patients with retinal detachment associated with atopic dermatitis.

Trigeminal neuralgia: association with tentorial meningioma and persistent primitive trigeminal artery

A rare case of trigeminal neuralgia caused by tentorial meningioma associated with a persistent primitive trigeminal artery (PTA) is reported. This case involved a 59-year-old female patient with a more than 6 month history of left trigeminal neuralgia. A left cerebello-pontine angle (CP angle) meningioma was found associated with a right PTA connecting the proximal portion of the cavernous internal carotid artery with the basilar artery, supplying the bilateral superior cerebellar arteries. The tumor was totally removed via the suboccipital approach, which relieved the pain completely. Since the combination of a CP angle meningioma and a PTA is quite rare in patients with trigeminal neuralgia, we have presented this case here.

Intraorbital malignant lymphoma presenting with tumor stain on angiography--case report

A 58-year-old male presented with a 1 month history of left retro-orbital pain and diplopia. Computed tomography demonstrated an isodense intraorbital tumor with slight homogeneous enhancement. Magnetic resonance imaging showed the tumor was isointensity on T1-weighted imaging, slightly high intensity on T2-weighted imaging, and slightly enhanced by gadolinium-diethylenetriaminepenta-acetic acid. Left external carotid angiography showed a tumor stain fed from the branches of the left internal maxillary artery. The tumor was partially removed. The histological diagnosis was malignant lymphoma. Tumor staining is rare in intraorbital malignant lymphoma and is not adequate for differential diagnosis of intraorbital tumors, so biopsy is essential.

Pulmonary metastasis of renal cell carcinoma resected sixteen years after nephrectomy

A 50-year-old man underwent a left nephrectomy for renal cell carcinoma of the clear cell type in February, 1978. He was examined using computed tomography in September, 1993, and was found to have a small coin lesion in his right lung. A fine needle aspiration biopsy failed to disclose any tumor cells. He underwent a video-assisted thoracoscopic biopsy of the right lung in February, 1994, 16 years after his nephrectomy. The resected specimen contained a coin lesion measuring approximately 1 cm in diameter, and the lesion was microscopically diagnosed as a renal cell carcinoma of the clear cell type metastatic to the lung. The patient is doing well with no signs of re-recurrence six months after the resection of the metastatic lesion. To our knowledge, the time interval between his nephrectomy and resection of the metastatic lesion is the longest ever reported in Japan.

A case of an intra-atrial tumor thrombus from hepatocellular carcinoma (HCC), first indicated by 67Ga-citrate scintigraphy

We encountered a very rare case of an intra-atrial tumor thrombus from hepatocellular carcinoma (HCC). Conventional XCT and US gave evidence of HCC. In nuclear medicine studies performed incidentally, the first study with 99mTc-phytate liver scintigraphy showed 2 SOLs and evidence of chronic liver disease, and the second study with 67Ga-citrate scintigraphy demonstrated 2 hot lesions within the liver parenchyma, and also another unexpected hot area just above the left lobe of the liver, seemingly beyond the diaphragm. When echocardiography was performed, in addition to ECG, because the patient began to complain of dyspnea, an oblong mass lesion was detected within the right atrium. Reexamination with XCT and angiography clearly proved the existence of an intraatrial tumor thrombus. These results indicate the need for routine examination by echocardiography for HCC patients complaining of dyspnea.

[Visual acuity and central retinal sensitivity following removal of epimacular membrane]

We evaluated visual acuity and central retinal sensitivity after removal of the epimacular membrane to explore whether and how the visual outcome differs between idiopathic disease (seven cases) and secondary disease following rhegmatogenous retinal detachment surgery (seven cases). A 12-month follow-up study revealed that both the idiopathic and the secondary group showed a marked improvement in visual acuity during the initial six months, followed by a slight decrease. As regards the central retinal sensitivity as assessed by an Octopus automated perimeter, the idiopathic group remained unchanged, but the secondary group showed a gradual improvement. In addition, postoperative visual acuity in the secondary group appeared to correlate with the preoperative central retinal sensitivity. Preoperative assessment of preoperative retinal sensitivity may provide a means of predicting postoperative visual outcome.

Radioimmunodetection of cancer of gastrointestinal tract and liver metastasis with I-131 anti-CEA and I-131 anti-CA19-9 monoclonal antibody cocktail (IMACIS-1)

We evaluated the intravenous infusion of a cocktail of I-131 anti-CEA and anti-CA19-9 monoclonal antibody F(ab')2 (IMACIS-1) in patients with gastrointestinal neoplasm and liver metastases in order to assess its efficacy in detecting the presence of cancer. Seven patients with primary or recurrent gastrointestinal cancer in whom liver metastases were also detected were studied. Accumulation of radioactivity in the primary tumor was seen in only one patient. Visualization of the liver metastases was achieved in all patients. Thus detection of liver metastasis was better than in primary or recurrent tumors. While tumor visualization was most often seen in the 3 day image, optimal visualization of the tumor was seen at 5-7 days. There was no correlation between the serum concentration of CEA or CA19-9 and the visualization of tumors. Serum kinetics of I-131 IMACIS-1 showed biexponential components with a 1st phase T1/2 of 5.0 hours and 2nd phase T1/2 of 34.7 hours. The mean whole body (I-131) half-life determined from the whole-body scans was 1.95 days. The mean urinary excretion of I-131 in 7 days was 85%. This value agreed closely with total radioactivity retention detected by scanning. This series of studies demonstrated the potential utility of a cocktail of antibodies consisting of an anti-CEA and an anti-CA19-9 monoclonal F(ab')2.

[Acute erythroblastic leukemia presenting as FAB M6 with surface marker positive for megakaryocytic and erythroid: report of a case]

A fifty five-year-old male presenting as FAB M6 had blasts that were positive both for erythroblastic and megakaryocytic surface makers, i.e., carbonic anhydrase I, CD36 and CD41. HLA-DR and cD71 were also positive. In a very small portion, CD33 and glycophorin A were also positive. By Giemsa staining, these blasts were relatively large and had basophilic cytoplasm. By electroscopic study, PPO was negative and showed ferritin particles, theta granules and iron containing mitochondria in cytoplasm. Chromosome analysis revealed major karyotypic abnormality (MAKA). After initial treatment with blood transfusion, prednisolone and exymetholone, CD41b increased in positive ratio. Trial of remission induction with BHAC-DMP failed and patient died in 5 months.

[A case of macrocystic cervical neurinoma diagnosed by MRI with Gd-DTPA]

The authors report a rare case of a large cystic cervical neurinoma. A 45-year-old female was admitted to our clinic because of motor weakness of the right upper extremity, numbness of the right fingers and right posterior cervical pain. Metrizamide CT myelography demonstrated the outline of a low density mass. MRI showed a mass revealing low signal intensity on T1-weighted image, high signal intensity on T2-weighted image and marginal enhancement on contrast image with Gd-DTPA. The mass which was diagnosed as cystic tumor, was located in the intradural extramedullary space between C4 to C5 segments. After C4 through C5 laminectomy, the tumor was found to originate from the C5 anterior motor root. The tumor consisted mostly of a cystic part with a very thin solid compartment beneath the capsule. Postoperative course of the patient was uneventful. Although spinal neurinoma is one of the most common spinal tumors, an almost completely degenerated large cystic spinal neurinoma is extremely rare. MRI with Gd-DTPA was useful for the diagnosis of the cystic neurinoma by clearly enhancing the margin of the tumor.

[Clinical usefulness of 111In transferrin scintigraphy in colorectal cancer]

As assessment was made regarding the clinical value of 111In transferrin in scintigraphy on 28 lesions in 26 cases of colorectal cancer. The positive rate of colorectal cancer was high: 21 lesions out of the 28 (75%) were found to be positive. As for the location of cancer, there was a tendency for the positive rate to be high in the ascending and transverse colon. There was no obvious trend regarding Borrmann's classification, histological type, or macroscopic depth of invasion. There was a trend for cases in which the maximum diameter of the tumor was large and depth of invasion was in progress to be positive. Ten cases in which a specimen was resected were all shown to be positive by scintigraphy. Radioactivity in the tumorous regions was 4.41 +/- 2.96 times that of the non-tumorous regions. Moreover, tumorous tissue was strongly stained by the immuno-histological staining with anti-Tf.receptor antibody. From the above findings, it was considered that 111In transferrin is clinically useful in scintigraphy, since it is evident that it accumulates in the tissue of colorectal cancer.

[A case of achalasia evaluated with esophageal scintigraphy in terms of efficacy with endoscopic pneumatic dilatation]

The therapeutic effects on pneumatic dilatation were evaluated quantitatively by radionuclide transit study using 99mTc-Sn colloid in an achalasia patient. After dilatation, transit time (T3/4) with distilled water has improved from 13.5 seconds to 5.5 seconds. Radionuclide transit study using 99mTc-Sn colloid was a preferable method to evaluate the efficacy of the treatment quantitatively in an achalasia.

[A case of gastric carcinoma with peritonitis carcinomatosa responding remarkably to etoposide, adriamycin and cisplatin (EAP) therapy]

The patient was a 62-year-old male who had Borrmann 4 type gastric cancer. He presented massive ascites due to peritonitis carcinomatosa and the cytology of ascites was class V. He was treated with 3 courses of EAP (etoposide, adriamycin, cisplatin) therapy. Computed tomography showed ascites nearly disappeared. Remarkable improvement was observed by barium meal study and endoscopic examination, and partial remission (PR) was achieved. As for toxicity bone marrow suppression, alopecia and elevation of BUN were observed.