Measurement of the time course of DNA/RNA hybridization and RNA detection using fluorescence polarization analysis

Using fluorescence polarization analysis, the time courses of hybridization between probe oligo-DNAs and target RNAs were measured. The RNAs were amplified using the DNA templates of Shiga toxin genes by NASBA (Nucleic Acid Sequence Based Amplification). Two DNA probes were designed for detecting the genes and they rapidly and specifically hybridized with their target RNA sequences. NASBA could be sufficiently used for the combination and DNA/RNA hybridization could be detected in the fluorescence polarization.

Rapid and simple detection of PCR product DNA: a comparison between Southern hybridization and fluorescence polarization analysis

The essential aim of this study was to compare two different methods, Southern hybridization and fluorescence polarization (FP) assay. They both detect specific hybridization and were examined using common asymmetric PCR products and probes. FP assay clearly showed the hybridization of probe DNAs with the asymmetric PCR products of their target genes. Southern blot patterns presented excellent consistency with the results of FP assay. In both methods, two types of Shiga toxin (vero toxin) genes held in enterohaemorrhagic Escherichia coli (EHEC) were used as target genes. For detection of the two genes, stx1 and stx2, two respective DNA probes were synthesized. Both in FP assay and in Southern hybridization, the probe for stx1 hybridized only with the product of stx1 and vice versa. The results of the DNA detection using different methods were completely in agreement. Moreover, FP assay makes it possible to detect the hybridization rapidly. In our high NaCl concentration condition, hybridization between the probes and the asymmetric PCR products could be monitored within about 15min.

Summary of entire Japanese thorotrast follow-up study: updated 1998

Updated data from two series in a cancer mortality study for a total of 412 Japanese Thorotrast patients were combined. The rate ratio for all deaths of Thorotrast patients, compared to controls, started to increase after a latent period of 20 years after injection of Thorotrast. Rate ratios for liver cancer, liver cirrhosis, leukemia and lung cancer were 35.9, 6.9, 12.5 and 2.0 times higher, respectively, than those for controls.

Cancer mortality of thorotrast patients in Japan: the second series updated 1998

The 150 male patients exposed to Thorotrast who were confirmed by a 1975-1978 national survey with diagnostic X rays of 50,860 war-wounded soldiers were followed up between 1979 and 1998 (Aichi series or second series). Age-adjusted rate ratios of deaths from all causes were 3.0 times higher in Thorotrast patients compared to controls; this was statistically significant. Rate ratios for liver cancer, liver cirrhosis and leukemia were 35.0, 7.5 and 18.2, respectively.

Type II citrullinemia associated with neutropenia

A 37-year-old Japanese man was admitted with delirium and hyperammonemia. He was diagnosed as having type II citrullinemia because of an elevated citrulline level on amino acid analysis and very low hepatic argininosuccinate synthetase activity. He also showed a low neutrophil count and a low serum level of granulocyte colony-stimulating factor. Reduced production of this cytokine and/or impairment of its feedback regulation by the neutrophil count may have played a role in the neutropenia of this patient.

Endoscopic MRI using 3D-spoiled GRASS (SPGR) sequence for local staging of rectal carcinoma

OBJECTIVE

Magnetic resonance imaging was performed with an MR endoscope to evaluate the depth of invasion of rectal carcinomas.

MATERIALS AND METHODS

Twenty-two patients with rectal carcinomas were studied prior to surgery with MRI using a 3D-fast spoiled GRASS (SPGR) sequence, a nonmagnetic endoscope and an antenna probe.

RESULTS

The MR images on 3D-fast SPGR sequence showed that the normal bowel mucosa had a high signal intensity, the submucosal layer had a low signal intensity, and the muscularis propria had moderate signal intensity. Small tumors had moderate signal intensity similar to the muscularis propria. Advanced tumors with considerable volume revealed heterogeneous findings with intermediate and low signal intensities. The depth of wall invasion by rectal carcinoma was correctly staged with endoscopic MRI in 16 of 22 patients.

CONCLUSION

This technique may be useful for the accurate staging of the depth of invasion by rectal carcinomas.

[Early diagnosis of breast cancer]

Despite the increasing incidence of breast cancer in recent years, early detection of breast cancer improves the curative rate and quality of life (QOL). Advances in diagnostic imaging are making early detection increasingly common. Although mammography (MMG) is the most popular examination method and yields excellent image description, diagnosis is influenced by imaging technique and ability to read the images. A clear image can be achieved if the MMG image acquired at 28 Kv using an M0 filter is energy subtracted at 32 Kv using an Rh filter. Ultrasonography can be excellent for qualitative diagnosis of a tumor, but changes in blood flow volume, as demonstrated by Doppler imaging, makes early detection difficult. Breast scintigraphy by 201TlCl can clearly demonstrate palpable breast cancer and also lymph node metastasis, but poor spatial resolution remains a problem. High resolution CT is effective for detection of lymph node metastasis. MRI offers excellent qualitative diagnosis of tumors, but detection of ultra-small lesions is difficult even using contrast medium. The detection rate and proportion of early breast cancer detected on the whole will rise if MMG is introduced into the present mass screening for breast cancer, but its implementation requires improved facilities, imaging capability, and experience in image reading.

Hepatic arterial infusion chemotherapy for liver metastases from breast cancer

Between 1985 and 1992, 56 patients with unresectable liver metastases from breast cancer were treated by repeated hepatic arterial infusion chemotherapy employing an implantable port system. 5-Fluorouracil (5-FU) at 330 mg/m2 per week. Adriamycin (ADR) at 20 mg/m2 every 4 weeks, and mitomycin C (MMC) at 2.7 mg/m2 every 2 weeks were given to 42 patients. The remaining 14 patients received 5-FU at 330 mg/m2 per week and epirubicin (EPIR) at 20 mg/m2 every 2 weeks. As a rule, the treatment was performed on an outpatient basis. The side effects and complications observed included myelosuppression (41%), hepatic arterial occlusion (23%), and gastric mucositis (20%), but no major toxicity was encountered. The response rate (CR+PR) of the evaluated patients as determined from CT scans was 81%. The overall median survival period was 12.5 months. Only 14% of the patients died due to regrowth of liver metastases, and in 70% of the total cases, death due to liver metastases was avoided by this treatment. Thus, repeated hepatic arterial infusion chemotherapy for liver metastases from breast cancer might be capable of prolonging the survival of patients via avoidance of death due to the liver metastases.

[Changes in arterial blood flow patterns by patients' posture during hepatic arterial infusion chemotherapy assessed by 99mTc-MAA perfusion scintigraphy]

Hepatic arterial perfusion scintigraphy (HAPS) with 99mTc-macroaggregated albumin (MAA) was performed to reveal the effect of patients' posture for the arterial blood flow patterns in hepatic arterial infusion (HAI) chemotherapy. 20 patients of liver metastases with the percutaneously implanted catheter into the hepatic artery underwent HAPS following administration of 99mTc-MAA at the supine and the upright position under one week interval. 10 ml of the saline with radionuclide was injected at a rate of 1 ml per minute. Acquired two images at the different position of each patient were compared and grouped into three classes; similar, slightly different and different. Of 20 patients, 6 (30%) were judged as similar, 8 (40%) as slightly different, and 6 (30%) as different. These results suggest that the drug distribution can change by patients' posture in case of the slow rate HAI performed with continuous infusion pump.

[Transurethral microwave thermotherapy for benign prostatic hyperplasia]

Transurethral microwave thermotherapy (TUMT) of prostate was administered to 10 patients with bladder outlet obstruction due to benign prostatic hyperplasia. The mean age of the patients was 74.4 years (range 63 to 85). The Prostatron device, which provides microwave heating of the prostate and conductive cooling of the urethra was used, and the prostate was heated with a calculated intraprostatic temperature of 45.5 degrees C for 55 minutes. No anesthesia was required for most of the patients. The clinical effects were evaluated at 4-6 weeks and 3 months after treatment. The symptomatic scores improved in the majority of patients. There was no significant change in prostate volume. The maximum flow rate and average flow rate were increased at 6 weeks and 3 months, but there was no significant change. The only side effects were transient hematuria and short-term obstruction secondary to urethral edema. In comparing TUMT with the transurethral resection of prostate (TUR-P), the maximum flow rate after TUMT was lower than that after TUR-P and the improvement of residual urine after TUMT was lower than that after TUR-P.

[Pharmacokinetics in arterial infusion chemotherapy]

The pharmacokinetics of arterial infusion chemotherapy was introduced. The pharmacokinetic rationales were based on the theories of "first pass effect" and "increased local concentration without first pass effect" advocated by Dr. Collins. These theories can offer much information to select the drug and to determine the administration schedule. However, for most of the drugs, the clinical pharmacokinetic studies are poor, and the optimal dose in bolus intraarterial infusion and the administration schedule is uncertain in terms of the dosage and hours. There are also some differences between pharmacokinetic understanding and clinical effect. Thus, further pharmacokinetic investigations and clinical studies are required to establish effective regimens for arterial infusion chemotherapy.

[Intermittent hepatic arterial infusion of high-dose 5-FU for liver metastases from colorectal cancer]

A phase II study of weekly intermittent hepatic arterial infusion of high dose 5-FU for liver metastases from colorectal cancer was carried out. Thirty-two patients with unresectable liver metastases from colorectal cancer were entered in this study. Nausea (< or = grade 2) was observed in 31% of the cases, mild elevation of rGTP in 13%, biloma in 9%, and hepatic arterial occlusion in 22%. However, no major toxicity occurred. The response rate evaluated by CT-scans was 75% (4 CR + 20 PR/32), and the overall median survival was 22 months. Significant differences of median survival were observed in the extra-hepatic lesions [extrahepatic lesions: (-) 16 months vs (+) 22 months]. This regimen showed high activity without major toxicity and the reduction of pts' QOLs caused by pumps. It confirmed by a study involving a large number of cases, this regimen will become a standard regimen for unresectable liver metastases from colorectal cancer.

[CT appearance of thorotrast-related and non-thorotrast-related peripheral cholangiocarcinoma]

To assess the differences in CT findings among patients with peripheral cholangiocarcinoma with and without a history of Thorotrast administration, CT studies from 13 Thorotrast patients and eight non-Thorotrast patients were reviewed. Diagnostic and prognostic differences were evaluated between the two groups. Despite periodic imaging surveillance, eight of the 13 (62%) lesions discovered by CT were larger than 6 cm. The prognosis for Thorotrast patients was unfavourable due to difficulties in early detection and complications from associated hepatic fibrosis. The main problem with early detection was that a background of uneven Thorotrast deposits visualized in the liver disguised the tumor as Thorotrast granulations. Although non-Thorotrast patients were not monitored regularly, they had a better chance of undergoing curative resection for the following three reasons: 1) it was easy to detect the tumor (detection rate, 100%); 2) this group rarely had associated liver cirrhosis in noncancerous areas, and 3) non-Thorotrast patients were younger than Thorotrast patients. Early detection of cancer by CA19-9 assay and imaging in asymptomatic subjects without any history of liver disease could be important steps toward the early and radical resection of cancer to achieve a better prognosis.

pH mapping in living tissues: an application of in vivo 31P NMR chemical shift imaging

Chemical shifts were extracted from in vivo 3-dimensional 31P NMR CSI data and pH images were constructed. The images could spatially resolve tissue pH ranging from 5.8 to 7.2 (with uncertainty of 0.11-0.17 pH unit) in an ischemia-reperfusion model of diabetic rat calf muscles.

Detection of locally recurrent colorectal cancer with radiolabeled monoclonal antibody H-15

H-15 (HT-29-15) is an IgG1 mouse monoclonal antibody (mAb) to a cell surface antigen (molecular mass, 200,000 daltons) present on virtually all colorectal cancers and also in normal pancreatic ducts and bile ducts, but not in other normal tissues. The biological distribution and imaging characteristics of iodine-131 (131I)-labeled mAb H-15 were studied in 5 primary colorectal cancer patients and 9 patients with local recurrence of colorectal cancer. H-15 mAb labeled with 0.5-10 mCi of 131I was administered 7 to 8 days before surgery at 4 dose levels, ranging from 0.2 to 6 mg. Selective mAb H-15 localization to tumor tissues was demonstrated in 6 of 12 patients with antigen-positive tumors: in two patients, recurrent tumors were negative to H-15 mAb, although the primary tumors were positive. In six patients with positive radioimaging, tumor:normal tissue ratios ranged from 2.05 to 5.35 and tumor:serum ratios from 1.18 to 2.73. The clarity of images seems to correlate well with the latter ratios. Technetium-99 (99mTc)-albumin blood pool studies in selected cases showed that local recurrence of colorectal cancers was hypovascular, emphasizing the selective localization of mAb H-15 despite poor blood flow distribution in the tumors. The results altogether demonstrated that radioimmunodetection with 131I mAb H-15 is valuable for differentiating recurrent colorectal cancer from granuloma formation after surgery.

Chemical assessment of phospholipid and phosphoenergetic metabolites in regenerating rat liver measured by in vivo and in vitro 31P-NMR

For the assessment of 31P-NMR spectroscopic data, phospholipid precursors (phosphorylethanolamine (PE) and phosphocholine) and catabolites (glycerophosphorylethanolamine (GPE) and glycerophosphorylcholine (GPC)), as well as adenosine phosphates were chemically determined in regenerating rat liver. The data were compared with those obtained by in vivo and in vitro 31P-NMR spectroscopies. Chemical assay revealed a significant increase of PE and a decrease of GPE, GPC and ATP in hepatectomy group compared to sham operation group. The values obtained by in vitro NMR were in good agreements with those of chemical assay, but significant differences between the two groups were observed only in PE and inorganic phosphate (Pi). Noticeable increase in PME was not detected by in vivo 31P-NMR spectroscopy, although the increase of PE was about 2.5-times that of the control and its constitution ratio to the whole phosphomonoester (PME) was less than 15%. On the other hand, in vivo NMR showed a large phosphodiester (PDE) peak occupying approx. 40% of the total phosphorus signal, while the contribution of its constituents, GPE and GPC was about 5% found by both chemical assay and in vitro NMR. The PDE peak in in vivo NMR seemed to reflect the membrane phospholipid itself rather than its catabolites. A slight decrease of phosphoenergetic level in regenerating rat-liver was commonly suggested by all three analytical methods.

Clinical evaluation of assistant diagnostic system for mammograms using the auto-analyzing method

Clinical usefulness of a newly developed auto-analyzing system of mammograms to search the abnormal dense areas such as cancer lesions was studied. 345 breasts including 86 cancers, 52 mastopathies, 18 fibroadenomas, 13 cysts, 4 lipomas and 172 normals were analyzed and compared with final diagnosis. 84 of 86 cancer lesions were correctly pointed out (sensitivity: 97.9%). Based on the gradient of the density, the ranking of the cancer or calcified lesions among suspected regions in a mammogram was decided. 55 lesions of them (64.0%) were ordered at the first rank and 83 (96.5%) were in the upper three ranks. 68 of 74 breasts with calcifications were correctly diagnosed and 48 of them were ranked in the upper three ranks. Although further improvement of the system is needed, this system will be a useful assistance for screening the breast cancer in the analyses of mammograms.

Management of patients with unresectable liver metastases from colorectal and gastric cancer employing an implantable port system

Between 1985 and 1990, 50 patients with unresectable liver metastases from colorectal cancer and 34 subjects with metastases from gastric cancer were treated by repeated hepatic arterial infusion chemotherapy employing an implantable prot system. A catheter was inserted into the hepatic artery via the left subclavian artery and was connected to the implantable injection port in each patient. 5-Fluorouracil (5-FU) at 330 mg/m2 per week (167 mg/m2 daily given continuously over the initial 3 months for colorectal cancer), Adriamycin (ADR) at 20 mg/m2 every 4 weeks and mitomycin C (MMC) at 2.7 mg/m2 every 2 weeks were given to all 34 patients with gastric cancer and to 31 of the colorectal cancer patients. The remaining 19 patients with colorectal cancer received 5-FU at 1,000 mg/m2 every week. As a rule the treatment was performed on an outpatient basis. The side effects and complications observed included myelosuppression (23%), hepatic arterial occlusion (21%), and gastroduodenal mucositis (12%), although no major toxicity was encountered. The response rate (CR+PR) among the evaluated patients as determined using CT scans was 67% for colorectal cancer and 73% for gastric cancer. The overall median survival was 12 months and 15 months, respectively. Good local control of liver metastases from the colorectal and gastric cancers was achieved by repeated hepatic arterial infusion chemotherapy employing an implantable port system without the need for hospitalization and without producing major toxicity. Thus, the implantable port system is very useful for the management of patients with unresectable liver metastases.

[Outpatient cancer chemotherapy employing implantable systems]

Outpatient cancer chemotherapy (OCC) employing implantable systems was introduced and the objects, conditions and problems of OCC were discussed based on experiences in 324 cases. The aims of OCC are improved QOL and the continuation of chemotherapy. Our requirements are safety, effectiveness, easy management and non-disturbance of activity. Implantable systems are very useful for OCC, especially continuous infusion combined with ambulatory pumps. However, the improvement of ambulatory pumps and the establishment of methods to evaluate OCC are required to further develop OCC.

[Mass screening of breast cancer with imaging diagnosis]

Westernization of our life-style and diet has caused a higher incidence of breast cancer in Japan. Although mass screenings such as anamnesis, visual and palpable examinations are provided by local government in Japan, no curable cancer in the early stage can be detected without the use of imaging diagnosis. Furthermore, the image can be saved as a record. Mammography yields images that are best suited for breast cancer examination in terms of sensitivity, specificity and accuracy. However, the large volume of information collected from the images makes diagnosis extremely difficult. In order to ease the burden on the diagnosing physician and to reduce the examination cost, CRT diagnosis by digital images and image selection by an automatic diagnosis supporting system with neuro-computer must replace the present filming method. On the other hand, 100% accuracy can not be achieved by either mammography or ultrasonic examination due to the limitation in depicting images on a display monitor. The accuracy rates of mammography and ultrasonic examination are 91.5% and 87.5% in our hospital. Imaging diagnosis, however, must be efficiently applied in addition to the visual and palpable examinations in promoting mass screening for breast cancer.

[Technique and problems of total parathyroidectomy with autotransplantation in secondary hyperparathyroidism]

Between 1982 and 1990, 20 patients with chronic renal failure underwent total para-thyroidectomies and autotransplantations as treatment for secondary hyperparathyroidism. Fourteen cases were cured of their symptoms and their serum PTH levels was restored to normal. Recurrent hyperparathyroidism developed in 6 cases. In 3 of the 6 cases, excision of parathyroid tissue from the forearm could easily be performed under local anesthesia. Of the other cases, 2 had five and one had six glands. Several localizing methods should be performed before operation, in order to overlook the parathyroid glands in different anatomic positions.

[Five-hour hepatic arterial infusion of high-dose 5-FU on weekly schedule for liver metastases from colorectal cancer]

The study of 5-hour hepatic arterial infusion of high-dose 5-FU on a weekly schedule (weekly high-dose 5-FU HAI: WHF) was conducted to reveal a new pump-free regimen to avoid the reduction of QOL due to continuous infusion pumps. By the phase I study, the recommended dose was determined to be 1.000 mg/m2/5 hrs qw. Thus far, 20 cases entered the phase II study of this regimen, and 1 CR and 10 PRs were observed in 15 evaluated cases without major toxicity. This regimen is highly effective for liver metastases from colorectal cancer without reduction of QOL in patients by pumps. A study of this regimen involving a large number of cases is required.

[Hepatic arterial infusion of high dose 5-FU in weekly schedule for liver metastases from colorectal cancer employing a newly developed pump "Koken Infusor"]

Seventeen patients with unresectable liver metastases from colorectal cancer were treated with 5 hour infusion of 1,000 mg/m2 of 5-FU in weekly schedule, employing a newly developed portable pump "Koken-Infusor". This pump is operated by batteries. It is small, light and easy to use. And five hundred cycles of treatments were performed, but the pump induced no major complications. The response evaluated by a CT-scan was 73% (11/15) without major toxicities. In conclusion "Koken-Infusor" is very useful for this treatment, especially for out patients. It appears that this therapy is one of the effective treatments for liver metastases from colorectal cancer.

Observation of rat hind limb skeletal muscle during arterial occlusion and reperfusion by 31P MRS and 1H MRI

31P NMR spectra and 1H MR T1- and T2-weighted spin-echo images were concurrently observed in rat hind limb during arterial occlusion and following reperfusion. With arterial occlusion, phosphocreatine level decreased and inorganic phosphate (Pi) level increased in 31P NMR spectra. Intracellular pH's dropped as a function of time. Beta-ATP started to decrease in three hours. In six hours after the occlusion, any peaks other than Pi were scarcely detected. The signal intensities in the 1H MR images increased homogeneously in both T1- and T2-weighted conditions, but the changes were more profound with T2-weighted images. After the release of the arterial occlusion, the 31P NMR spectra recovered to the preischemic state in several hours. The 1H MR images during reperfusion showed characteristic heterogenous pattern. The signal intensities in the anterior tibial muscle and the gastrocnemius muscle remained high in T1-weighted condition and the intensities further increased in T2-weighted condition, while those in other parts returned to the preischemic level. These changes were found to be irreversible even 12 hr after the release. The high signal intensities suggested the increase of water in the extracellular compartment induced by so-called reperfusion injury. Multinuclear analysis using in vivo NMR was valuable to consecutively detect time-dependent and location-specific response in skeletal muscle during ischemia and reperfusion.

[Ca++ antagonist and acute brain ischemia: effects of nilvadipine and nicardipine on middle cerebral artery occlusion in rats]

Effects of calcium antagonists, Nicardipine and Nilvadipine, on neurologic deficits and size of infarct were studied in the rat middle cerebral artery (MCA) occlusion model. Each drug was administered immediately after induction of ischemia, and neurologic grade was evaluated 1 to 24 hours after MCA occlusion. At 24 hours post-occlusion, size of the infarct was compared with that of the control group. In addition, evolution of cerebral infarction was studied at 6 hours and 12 hours post-occlusion by magnetic resonance imaging (MRI). In the Nilvadipine-treated group, neurologic deficits improved more rapidly and the size of infarct was significantly smaller than in the Nicardipine-treated group. MRI showed a progressive extension of cortical infarct in the untreated rat, whereas the infarct size remained unchanged in the Nilvadipine-treated rat. These results suggest the potential therapeutic usefulness of calcium antagonist for acute cerebral ischemia.

Comparisons of interval breast cancers with other breast cancers detected through mass screening and in outpatient clinics in Japan

In a nation-wide collaborative study on mass screening for breast cancer, we collected 152 cases of interval breast cancer diagnosed at 35 hospitals or clinics distributed throughout Japan. The definition of interval breast cancer used in the present study is "breast cancer cases which were diagnosed as having 'no malignant findings' in a previous screening for breast cancer but subsequently diagnosed as 'breast cancer' at a hospital or medical clinic within two years of the previous screening." The clinical stages and prognoses of these interval cancer were analyzed and compared with those of other breast cancers detected through mass screening and in outpatient clinics. In the clinical staging of interval breast cancer, Tis (non infiltrating cancer) accounted for only 2.1%, compared to 8.0% in cases detected through mass screening. At stage I 43.4% were interval breast cancers compared to 32.9% breast cancers detected through mass screening and 25.4% diagnosed in outpatient clinics. The stage differences between interval breast cancers and breast cancers detected through mass screening were not statistically significant. Five-year survival rates were 85.6% for interval breast cancers, 91.7% for breast cancers detected through mass screening and 84.7% for breast cancers diagnosed in outpatient clinics. Ten-year survival rates were 75.9, 80.5 and 78.1%, respectively, suggesting the interval breast cancer cases to show a similar prognosis to that of breast cancer cases diagnosed in outpatient clinics. The differences in five- and 10-year survival rates among the three groups were not statistically significant. From the present study we were not able to confirm the general belief of interval cancer being more aggressive in nature and showing a poorer prognosis than cancer detected through periodic screening. The reasons for this are discussed.

[Progress of imaging diagnosis for the cancer therapy--breast cancer]

As two main modalities for the breast cancer, ultrasonography (US) and mammography (MMG) were discussed about the efficacy and limitation of qualitative diagnosis. The accuracy rate of US and MMG for the breast cancer were 90.0% and 92.7% at the Aichi Cancer Center Hospital during these 2 years (1986-1988). The number of patients with the breast cancer is increasing recently in Japan. This cancer, however, is one of the curable cancer at the early stage. Therefore, it is very important thing to detect a small malignant mass less than 1cm in a diameter by using these modalities. In addition, the establishment of the mass screening system for breast cancer is desired. In order to make a precise diagnosis, it is necessary to add some devices on the ordinary modalities. For examples, mechanical improvement of the Moribuden tube with 0.1mm focus, operation of ductgraphy and cystography by double contrast method in MMG and application of 10MHz transducer in US. Furthermore, needle biopsy under US or X-ray is expected positively to make a fast diagnosis. On the other hand, DMR (Digital Mammo-Radiography) system has a bright prospect for the mass screening of the breast cancer in the respect of efficacy, cost and radiation hazard. DMR system has many advantages as follows, 1. The system is capable of bringing out clearly very minor differences of contrast. 2. Tumor shadows can be easily displayed. 3. The lateral projection only is sufficient (allowing examination of the chest wall also). 4. The X-ray dose is small: 0.03-0.05mSv. 5. The equipment is inexpensive to use. 6. Patient positioning is simple, and examinations take little time. 7. Long operator training programs are unnecessary. 8. The system uses digital signals, and so automatic diagnosis is possible. 9. Theoretically, at least, tumors as small as 0.2 mm in diameter can be detected.

[Requirements for the randomized trial of i.a. vs. i.v. administration to reveal the impact of hepatic arterial infusion on survival in the treatment of liver metastases]

In spite of its high response rate, the impact of hepatic arterial infusion (HAI) chemotherapy on survival is still uncertain in the treatment of liver metastases. There were no significant differences in survival between i.a. and i.v. in western randomized trials for liver metastases from colorectal cancer in the 1980s. The requirements for randomized trials between i.v. and i.a. administration for liver metastases to reveal the impact of HAI on survival are as follows. 1) Investigators have standardized the technical level for HAI. 2) The natural history of the disease is not so long for continuing HAI over living period. 3) The cases have no extra-hepatic lesions. 4) The number of patients suffices for the evaluation. Therefore, the patients with liver metastases from gastric cancer and without extra-hepatic lesions are better materials for the randomized trial of i.a. vs i.v. in Japan, and the multiinstitutional trial with standard technical level is recommended.

[Diagnostic imaging for breast cancer]

With the westernization of the Japanese diet and way of life, the mortality due to breast cancer continues gradually to increase. This disease, however, is a type of cancer that can be well controlled by primary preventive measures and early detection. Numerous techniques of diagnostic imaging for breast cancer have been established, but the most common are mammography and ultrasonography. For X-ray mammography, a low tube voltage is necessary so that small differences in X-ray absorption by the various tissues within the breast may be detected, but when the surface dose is increased, it is a source of anxiety because of the possible development of secondary carcinoma. Ultrasonography of the breast, however, is free from the dangers of radiation exposure, and may be conducted in conjunction with palpation, thus representing a highly reliable approach. The diagnostic reliability of mammography and ultrasonography was investigated in 251 cases in which breast cancer was confirmed by these methods in a total of 752 outpatients who visited the Department of Breast Surgery of the Aichi Cancer Center Hospital in Nagoya, Japan. As a diagnostic procedure for breast cancer, mammography was shown to have a sensitivity of 89.2%, a specificity of 92.6%, and an accuracy rate of 91.5%, the respective values for the ultrasound technique being 84.9%, 88.9%, and 87.5%. These results are superior even to those of surgeons with 30 years of experience specializing in the breast (86.9%, 85.3%, and 85.8%), especially when tumors cannot be palpated.(ABSTRACT TRUNCATED AT 250 WORDS)

[A 5-FU, ADR, MMC combined hepatic arterial infusion therapy in non-resectable liver metastases from colon and gastric cancer]

Fifty-seven patients with non-resectable liver metastases (31 from colon cancer, 26 from gastric cancer) received 5-FU, ADR, MMC combined hepatic arterial infusion therapy. (FAMia: 5-FU 334 mg/m2 qw, ADR 20 mg/m2 q4w, MMC 2.7 mg/m2 q2w; in colon cancer, 5-FU 167 mg/m2/day continuously for 3 months and then 334 mg/m2 qw). Myelo-suppression, hepatic arterial occlusion, gastroduodenal toxicity and elevation of biliary enzyme were observed at 29%, 39%, 32% and 13% in colon cancer, respectively, and at 35%, 8%, 0% and 0% in gastric cancer, respectively. Response rates evaluated by CT-scan were 63% (1 CR + 18 PR/30) in colon cancer and 79% (4 CR + 15 PR/24) in gastric cancer. Overall median survival was 352 days in colon cancer and 449 days in gastric cancer. Concerning background factors, the response rate in the well-differentiated type of colon cancer was significantly higher than in the moderately differentiated type, and significantly low in poorly differentiated medullary type gastric cancer. The existence of extra-hepatic lesions was the most important factor in survival in both cancers. [colon cancer: (-) 740 days vs (+) 267 days; gastric cancer: (-) 517 days vs (+) 245 days]. In conclusion, this therapy yields favorable direct effects on liver metastases from colon and gastric cancer without major side-effects and complications, but effective therapy of extrahepatic lesions is required for longer survival. Now, to release colon cancer patients from restrictions of continuous infusion pumps, a phase I study of weekly high dose 5-FU HAI therapy is under way.

[On the assessment of the diagnostic accuracy of imaging diagnosis by ROC and BVC analyses--in reference to X-ray CT and ultrasound examination of liver disease]

To achieve an effective assessment of diagnostic accuracies of currently used imaging methods on liver diseases, X-ray CT (CT) and realtime ultrasound (US), ROC analysis and a new analysis method, "the bias to variance characteristics (BVC)" were applied in parallel. The survey has been carried out to assess an image interpretation accuracy on cases with established diagnosis collected on the multi-institutional basis. The images, CT and US of liver diseases including localized and diffuse lesions were selected for image reading sessions and the interpretative difficulties were geared to an appropriate grade so that it does fit to the basic requirement of ROC analysis. Consequently, 91 cases were selected from a total of 258 cases which were collected from 16 institutions. Two image reading sessions were scheduled and a total of 28 radiologists and sonologists undertook the first session. The final analysis covered 8 radiologists for CT and 9 sonologists who carried out both sessions. The image interpretation results were fed to the computer and analyses were made accordingly. Analysis of the first image reading session gave true positive ratios (TPR) of CT and US as 92.5% and 97.4%, and true negative ratios (TNR) of 50.5% and 46.8%, respectively. The second reading session, in which both CT and US images were interpreted simultaneously, gave the similar values of TPRs, 96-97% and TNRs, 44-47%. The ROC analysis of existence of liver mass and diagnosis of malignancy resulted in the higher values in US compared to CT in the first separate reading, however, the 2nd session gave almost identical values in each modality. The diagnostic accuracy for the benign tumors, mostly consisted of hemangioma, CT reading gave higher accuracy rates compared to the US. The entirely new interpretations scheme, arbitrarily named as BVC was carried ou on matrix data obtained in the same experiment. The scatterograms plotted according to the BV values, the mean and the standard deviation inherent to individual cases have demonstrated marked variations among individual cases most likely reflecting the interpretative difficulty of respective images, thus indicating the method to be well in adjunct to the ROC analysis.

[Non vascular interventional radiology--general]

Since last about 20 years, invasive diagnostic procedures have gradually changed the conception to interventional radiology (IVR). Non vascular IVR has been developing steadily by suitable instruments and excellent techniques as well as vascular IVR. The fields of non-vascular IVR is becoming wider and wider in various regions in the body. Non-vascular IVR contains many kinds of drainage and forming inner fistula in the biliary and urinary tracts, for example, occlusive jaundice or hydronephrosis. Drainage for abscess in the thoracic or abdominal cavity is a good indication except peri-pancreatic abscess. In addition, IVR means time saving and cost saving in the aspiration biopsy for malignant neoplasms this is fast decision for reasonable therapies. In the earlier period, aspiration biopsy was considered as dangerous method because of bleeding and dissemination of malignant seeds along the route of aspiration needles. By using fluoroscopic image amplifier and ultrasonic unit, non-vascular IVR has many indications that radiologist's specialty demonstrated. Therefore, radiologist should have heavy responsibility based on understanding of right knowledge and good management for non-vascular IVR.

Roentgenologic appearance of a thorotrast-induced small cholangiocarcinoma in a case of thorotrastosis. An autopsy case of massive gastrointestinal bleeding of esophageal varices

A small cholangiocarcinoma was detected at autopsy in a patient with thorotrastosis who died from the rupture of esophageal varices at the esophagogastric junction. Prior to the advent of recent diagnostic imaging technique, a correct antemortem diagnosis could only be obtained from tumor markers. However, the tendency for the opacity of the liver to decrease slowly with time and develop uneven trabeculation suggests that small tumors may be difficult to detect against such a non-homogeneous background.

[5-FU/ADR/MMC combined hepatic infusion in liver metastases from gastric cancer]

Twenty patients with liver metastases from gastric cancer judged non-resectable and the factors limiting their survival were treated with 5-fluorouracil (5-FU), adriamycin (ADR) and mitomycin C (MMC) combined hepatic arterial infusion chemotherapy. The catheter was placed into the hepatic artery, via the left subclavian artery in every case, and 5-FU 334 mg/m2 qw, ADR 20 mg/m2 q4w, MMC 2.7 mg/m2 q2w was administered bolusly. Myelo-suppression (WBC less than 2,000 or platelet less than 50,000) occurred in 25% of the patients, but this therapy was tolerable in all patients without major complication. The response rate in evaluable cases by CT-scan was 76.5% (4CR + 9PR/17), and 50% survival was 407 days. A significant correlation between the existence of extra-hepatic lesions and 50% survival (extra-hepatic lesions (-): 196 days vs (+): 464 days) was noted. The comparison between responder and non-responder in terms of 50% survival and the cause of death showed the importance of control of liver metastases for improved survival.

[Digital mammo-radiography (DMR) in mass screening for breast cancer]

There are still many problems to be overcome in the development of mammographic apparatus suitable for mass screening purposes, but a certain number of these have been solved in the system discussed in the present paper. The equipment employs the technique of displaying I.I. images on a monitor by means of an image processor. This possesses the advantages of both film mammography and xeromammography, and the X-ray dose involved is small. The following advantages over film mammography are offered: The system is capable of clearly bringing out very minor differences of contrast. Tumor shadows can be easily displayed. The X-ray dose is small: 0.03-0.05 R. The equipment is inexpensive to use. Patient positioning is simple, and examinations take little time. Long operator training programs are unnecessary. The system uses digital signals, and so automatic diagnosis is possible. Theoretically, at least, tumors as small as 0.2 mm in diameter can be detected. The future goal is discovering unpalpable breast cancers. DMR is useful because of low dose, low cost and high safety. In our study as screening for breast cancer, DMR system shows high sensitivity (87.1%), specificity (78.7%) in 391 cases of out patients.

[Changes in CT findings in patients with liver metastases of breast cancer during effective intra-arterial infusion]

A study was done of the changes occurring in the CT findings of 12 cases in which liver metastases were found after radical mastectomy for breast cancer, as a result of intermittent low-dose hepatic arterial infusion chemotherapy using a reservoir, achieving PR. In four cases (33.3%) only shrinkage of the metastatic lesions was seen; in 3 others (25.0%), this was accompanied by irregularities in the margins of the liver surface; in the other 5 (41.7%), a high proportion of total, widespread compensatory deformity of the liver was observed. A tendency was noted for these changes to be more pronounced in cases in which the metastatic lesions occupied a large proportion of the liver. Hepatic degeneration appeared with a high frequency in cases where liver metastasis followed breast cancer, and it is considered that considerable care is necessary in evaluating the efficacy of treatment.

Increased risk of death in thorotrast-exposed patients during the late follow-up period

To evaluate the effects of continuous low-level ionizing radiation on humans, the follow-up data (1980-85) on Japanese thorotrast-exposed patients were analyzed. The patients were 241 war-wounded military personnel registered with and cared for by the Ministry of Health and Welfare since 1979. During this period, a total of 1144 person-years, 94 patients died. Compared with the expected number of deaths calculated from age- and cause-specific death rates in Japan during the same period, the thorotrast-exposed patients were at three times greater risk of death from all causes (P less than 0.001), had 47 times the risk of liver cancer (P less than 0.001), 12 times the risk of leukemia (P less than 0.05), and 20 times the risk of liver cirrhosis (P less than 0.001). Age at time of thorotrast injection, drinking and smoking habits had little effect on these statistics. Analyses of 30 autopsied patients with liver cancer showed statistically significantly increases in hemangiosarcoma and cholangiocarcinoma. The thorotrast-exposed patients' estimated risk of liver cancer by histological type was 21 times that of the general population for hepatocellular carcinoma, 303 times that for cholangiocarcinoma and 3129 times that for hemangiosarcoma.

[The effect and CT imaging of FAM hepatic infusion chemotherapy in patients with liver metastasis from colorectal carcinoma]

A study of FAM (5-FU, ADM, MMC) hepatic infusion chemotherapy via the left subclavian artery was performed in 40 patients with liver metastasis from colorectal carcinoma. The response rate was 61.1% (1 CR and 21 PR among 36 evaluable cases), and the 50% survival period was 11.6 months. CT imaging in the 22 responders was discussed. The CT scan images showed no remarkable changes except for tumor size in 10 cases (45.5%), a decrease of marginal density in 4 cases (18.2%), an increase of calcification in 2 cases (9.1%), dimpling sign in 3 cases (13.6%) and fatty liver degeneration and abscess formation in the hepatic duct in 1 case (4.5%). These findings on CT scan were important for evaluating the effects and side effects in patients receiving hepatic infusion chemotherapy, and provided useful information for follow-up.

[A study of hepatic arterial occlusion by infusion chemotherapy via the left subclavian artery]

Hepatic arterial infusion chemotherapy via the left subclavian artery was performed in 112 patients with primary or metastatic liver tumors, and those cases showing hepatic arterial occlusion were discussed. Hepatic arterial occlusion occurred in 22.3% of cases, and the rates of occurrence in males and females showed no significant difference. Therefore, when the catheter was placed and replaced in the RHA or LHA, the occurrences of arterial occlusion seemed to be relatively high, i.e., 45.5% and 50.0%. The diameter of the hepatic artery, which was measured in 25 patients with hepatic arterial occlusion (occlusion group) and 17 patients in a control group (catheter placed in position for over 150 days) on angiographs was 5.2 +/- 1.42 mm (mean +/- S.D) in the occlusion group and 6.1 +/- 1.77 mm in the control group, but the difference was not significant (p less than 0.05). Clinical symptoms and flow scintigraphy were useful for the diagnosis of hepatic arterial occlusion. However, recently, a frequent check of drug delivery has been necessary.

[Preliminary results of a phase II study of 5-FU, adriamycin, and mitomycin C (FAM) in combined hepatic infusion in patients with non-resectable metastatic liver cancer]

Sixty-eight patients in which non-resectable liver metastases were the predicted limiting factor of their survival were treated with 5-FU, ADM, MMC combined hepatic infusion chemotherapy using the following regimen: 5-FU 334 mg/m2/w shot, ADM 20 mg/m2/4 shot, MMC 2.7 mg/m2/2w shot. In the case of colorectal cancer, 5-FU 167 mg/m2/day continuously for over 3 months, then 334 mg/m2/w shot was used. In every case, the catheter was placed into the hepatic artery via the left subclavian artery and an implantable portal system was used for shot infusion and a portable pump for continuous infusion. The results were as follows: Except for one drop-out case, 67 patients were able to receive this therapy. Bone marrow suppression occurred in 32.8% of patients, gastroduodenal trouble in 31.3%, and hepatic arterial occlusion in 19.4%. Response rates and 50% survival times were 65.6%, 324 days for colorectal cancer, 80.0%, 393 days for breast cancer, and 87.5%, 342 days for gastric cancer. These are preliminary results. However, we conclude that it is appropriate to go on with this study, although discussion of this regimen involving more cases is required.