Computed Tomography of the Abdomen with Fat Density Oral Contrast Medium

A 12.5% corn oil-emulsion (COE) was tested as an oral contrast agent for abdominal computed tomography (CT) examinations in 100 patients. The results were compared with those obtained from another group of patients who received a conventional, high-density, oral contrast agent (2–3% iodinated solution). There was no statistically significant difference in the subjects' tolerance to the two agents (P > 0.05). There was, however, a significant improvement in image quality with COE (P > 0.005). Gastrointestinal tract discrimination, and mucosal and mural visualisation was of higher quality with fat density oral contrast medium than with the high-density contrast agent. These data suggest that COE should be considered for routine use as an alternative to conventional high density oral contrast agents in upper abdominal CT.     

A Comparison of Different Doses of Non-Ionic Contrast Media in I.V. Urography

This study attempts to find out what is the appropriate dose of non-ionic contrast media to provide an acceptable study at the lowest possible cost. 139 adults with normal renal function were studied. Four different dose regimes were employed and a standardised set of I.V.U. films were obtained. These were reviewed by two independent assessors who were unaware of the dose regime used. Each I.V.U. was scored on a modified Fry regime. This survey showed a clear relationship between quality and dosage.     

多层螺旋CT泌尿系成像在尿路上皮癌患者随访中的临床价值

目的评价多层螺旋CT泌尿系成像（multi-slice spiral computed tomography urography,MSCTU）在尿路上皮癌患者随访中的临床价值。方法2006年1月～2010年7月我科共行2800例MSCTU检查,其中413名尿路上皮癌患者术后随访共行466例MSCTU检查,包括平扫、肾实质期和排泄期三期扫描。顺序注射造影剂100ml（370mgI／ml）和100ml生理盐水,注射速度均为4．5ml／s。对MSCTU轴位及三维后处理图像进行前瞻性诊断,以评价是否有肿瘤复发。分析诊断的敏感性、特异性、准确性、阳性和阴性预测值。参考标准为病理学结果和随访临床资料。结果对尿路上皮癌患者的术后随访中,MSCTU诊断肿瘤复发的敏感性、特异性、准确性、阳性和阴性预测值分别为92．0％、99．0％、97．1％、97．2％和97．1％。结论MSCTU对随访尿路上皮癌患者肿瘤复发具有重要的临床价值。     

Audit of patients with mesothelioma treated with pemetrexed in a single institution in Western Australia

Malignant pleural mesothelioma (MPM) is a devastating malignancy that until recently has had no effective treatment. Pemetrexed in combination with cisplatin entered routine clinical practice following reports of efficacy in 2003. We performed a retrospective analysis of all patients with malignant mesothelioma at a single institution treated with pemetrexed in any combination or as monotherapy between 2004 and 2007. During this period, 62 patients received pemetrexed-based chemotherapy for MPM, most of whom were male (87%), treated in the palliative setting (84%) and received pemetrexed in combination with a platinum agent (95%). Pemetrexed was found to be well tolerated and produced clinical benefit and response rates similar to other published studies for its use in MPM in the phase IV or community practice settings. Patients with progressive disease as their best radiological response had very poor outcomes, while patients with stable disease had similar outcomes to those with responses. We confirmed that survival after commencement of pemetrexed-based chemotherapy remains under one year in this group of patients, somewhat less than the survival reported in phase III trials that currently inform clinical decision making. Further research is required to identify those patients who might benefit from pemetrexed based on molecular predictive markers.     

Contrast Agents — State of the Art

The osrnolality and chemotoxicity aspects of contrast agents are reviewed. The next stop in contrast agent development, non-ionic dimers, is indicated. A mechanism for chemotoxicity is suggested involving the iodine atoms. The mechanisms possibly involved in major adverse reactions are outlined and it is suggested that new contrast agents should be safer. The cost implications are discussed. Nephrotoxicity is briefly examined and it is shown that dehydration for intravenous urography. which is a risk factor for renal injury, is ineffective and unnecessary. Finally, a rarely discussed form of toxicity. namely contrast enhanced tissue radiation injury, is discussed.     

Comparison of Blood-Brain Barrier Disruption in the Rabbit Following Intracarotid Iopamidol and Methylglueamine Iothalamate

This paper compares the effect of intracarotid injections of non-ionic iopatnidol, and ionic methylglucamine iothaiamate (Conray 280), a commonly used angiographic agent. Both compounds were injected at a concentration of 280mgl/ml in rabbits. A series of studies was also performed in which the intracarotid injection was physiological saline. Control studies received no intracarotid injection. Disruption of the blood-brain barrier (BBB) was assessed both qualitatively by Evans' Blue staining and quantitatively by comparing the uptake of 99m-pertechnetate in the injected hemisphere with that of the non-injected control hemisphere. These differences were expressed as a ratio of cpm/ml blood to cpm/gm brain tissue. It was found that Evans' Blue staining, although variable, occurred in every study with methylglucamine iothaiamate whereas slight staining occurred in only one of the iopamidol studies. No staining was seen in studies with physiological saline or control studies. Mean quantitative results for each series of studies were compared by Student's t-test. It was found that methylglucamine iothaiamate caused significantly more BBB breakdown than iopamidol (p < 0.01).     

非小细胞肺癌脑转移不同治疗的疗效分析

目的比较不同治疗方法在非小细胞肺癌脑转移中的作用。方法回顾性分析56例非小细胞肺癌脑转移患者,7例接受开颅手术治疗,13例接受开颅手术 术后放疗,22例接受全脑放疗(WBRT),9例接受立体定向放射治疗(SRT),5例接受全脑放疗 立体定向放疗,全部病例定期随访直至死亡。结果总的1年生存率为39.2%,中位生存期是220天。单纯开颅手术组1年生存率为71.4%,中位生存期517天;开颅手术 术后放疗组1年生存率76.9%,中位生存期533天;全脑放疗组1年生存率4.5%,中位生存期78天;立体定向放疗组1年生存率44.4%,中位生存期187天;全脑放疗 立体定向放疗组1年生存期62.0%,中位生存期509天;年龄大于60岁组1年生存率为26.7%,年龄小于60岁组1年生存率53.8%。结论对于一般情况较好,能耐受手术的单发脑转移患者,开颅手术 术后放疗是一种较好的治疗手段。无开颅手术条件的脑转移患者,选择SRT或SRT联合WBRT较单纯WBRT治疗可能更有效。     

造影剂对食管癌调强放疗计划的影响

目的探讨增强造影剂对食管癌调强放疗计划的影响。方法对10例食管癌进行CT平扫与增强造影,分别设计调强放疗计划,比较2个计划靶区剂量分布和危及器官的剂量体积受量。结果增强影像计划的靶区最大剂量、最小剂量、平均剂量及中位剂量,较平扫影像计划的平均高30 cGy,适形度指数和均匀性指数的比较无差异,增强影像计划的双肺平均剂量、心脏平均剂量受量高。2种计划的双肺V20、V30和脊髓最大剂量比较无差异。结论造影剂对食管癌调强放疗剂量有影响,但影响较小,可以直接在增强影像上设计放疗计划。     

Plicamycin and pamidronate in symptomatic tumor-related hypercalcemia: a prospective randomized crossover trial.

We have conducted a randomized crossover comparative trial of a single-dose course of disodium (3-amino-1-hydroxypropylidene) bisphosphonate pentahydrate (pamidronate) and plicamycin in 48 patients with a first occurrence of tumor-related hypercalcemia. All patients had hypercalcaemia-associated symptoms and serum-calcium levels (corrected for total protein) greater than or equal to 2.80 mmol/l. Pamidronate and plicamycin were given concurrently with rehydration immediately after diagnosis of hypercalcaemia was made. Both agents lowered serum calcium levels significantly within 1 week, with 88% of the evaluable patients in the pamidronate group and 45% of those in the plicamycin group achieving normocalcemia (p less than 0.01). In the patients who received pamidronate, the duration of normocalcemia was longer (p less than 0.05) and there was a significant decrease in serum creatinine (p less than 0.05). Vomiting occurred in 8 of 22 evaluable patients (36%) who received plicamycin, but in none of 25 evaluable patients who received pamidronate (P less than 0.01). Phlebitis occurred at the infusion site in more of the pamidronate-treated patients (P less than 0.05). Hypocalcemia, which occurred in 8 of 25 evaluable patients (32%) in the pamidronate group and in 1 of 22 of those (5%) in the plicamycin group, was either clinically asymptomatic or mild, except in one pamidronate-treated patient. Overall, pamidronate was found to be more effective and better tolerated than plicamycin, thereby confirming results of previous studies that showed pamidronate to be an effective, simple, and safe agent for the relief of the morbidity associated with tumor-related hypercalcemia.     

Potent effects of adjuvant chemotherapy using 5-fluorouracil + leucovorin on DNA aneuploid colorectal cancer

Background The relationship between DNA ploidy of colorectal cancer cells and sensitivity to adjuvant chemotherapy, using 5-fluorouracil+leucovorin was investigated. Methods Seventy-five patients with Duke's B or C colorectal cancer, who underwent potentially curative resection, were randomly allocated to 2 groups. Thirty-eight patients received adjuvant chemotherapy using 5-fluorouracil+leucovorin (chemotherapy group), and 37 patients received no adjuvant chemotherapies (no-chemotherapy group). Tumor cell ploidy of all patients was analyzed using paraffin-embedded samples. Results There was no statistically significant difference in overall survival between patients who received chemotherapy and those who did not. Among the patients with diploid tumors (n=39), there was no significant difference in survival between the chemotherapy group (n=20, 5-year survival rate of 34.3%) and the no-chemotherapy group (n=19, 5-year survival rate of 27.1%). By contrast, among the aptients with aneuploid tumors (n=36), the survival rate was significantly better in the chemotherapy group (n=18, 5-year survival rate of 77.8%), than in the no-chemotherapy group (n=18, 5-year survival rate of 43.7%) (P=0.023). Conclusion These results suggest that aneuploid tumors are more sensitive to adjuvant chemotherapy, using 5-fluorouracil+leucovorin, than are diploid tumors.     

Long-term survival and prognostic factors in patients with metastatic gastric cancers treated with chemotherapy in the Japan Clinical Oncology Group (JCOG) study

BACKGROUND: The long-term survival of patients after chemotherapy for advanced gastric cancer remains unclear. The aim of this analysis was to investigate prognostic factors for patients with metastatic gastric cancer treated by chemotherapy, and to identify the characteristics of long-term survivors. METHODS: Six hundred and forty three patients were enrolled in four phase II studies and one phase III study by the Japan Clinical Oncology Group between January 1985 and April 1997. By adjusting patients' eligibility between the five studies, 497 patients (77%) were selected for the analysis. Univariate and multivariate analyses were performed using log-rank tests and Cox's proportional hazard model, respectively. RESULTS: Of the 497 patients analyzed, 39 (8%) and 11 (2%) patients have survived longer than 2 and 5 years, respectively. By multivariate analysis, better performance status, a small number of metastatic sites and macroscopically non-scirrhous type tumors were significantly associated with better prognosis. Characteristics of the 11 5-year survivors revealed eight with para-aortic node metastases alone. Eight of these patients received gastrectomy; four underwent it before chemotherapy, and the other four patients received it after achieving downstaging with successful chemotherapy. CONCLUSIONS: These results demonstrated that better performance status, a small number of metastatic sites and macroscopically non-scirrhous type tumors are independent favorable factors for survival. There were a few 5-year survivors with unresectable gastric cancers, most of whom had only abdominal lymph node metastases and received gastrectomy before or after chemotherapy.     

Contrast enhanced susceptibility weighted imaging (CE-SWI) of the mouse brain using ultrasmall superparamagnetic ironoxide particles (USPIO)

Susceptibility weighted imaging (SWI) has been introduced as a novel approach to visualize the venous vasculature in the human brain. With SWI, small veins in the brain are depicted based on the susceptibility difference between deoxyhaemoglobin in the veins and surrounding tissue, which is further enhanced by the use of MR phase information. In this study we applied SWI in the mouse brain using an exogenous iron-based blood-pool contrast agent, with the aims of further enhancing the susceptibility effect and allowing the visualization of individual veins and arteries. Contrast enhanced (CE-) SWI of the brain was performed on healthy mice and mice carrying intracerebral glioma xenografts. This study demonstrates that detailed vascular information in the mouse brain can be obtained by using CE-SWI and is substantially enhanced compared to native SWI (i.e. without contrast agent). CE-SWI images of tumour-bearing mice were directly compared to histology, confirming that CE-SWI depicts the vessels supplying and draining the tumour. We propose that CE-SWI is a very promising tool for the characterization of tumour vasculature.     

Ionic and Non-Ionic Contrast Media: Current Practice in the Major Hospitals of Australia and New Zealand

Major hospitals in Australia and New Zealand were surveyed to estimate the extent of conversion to nonionic and/or low-osmolar media. The results indicate that conventional ionic media now comprise only approximately one-third of the total usage.     

A Comparative Trial of Two Urographic Contrast Media — Conray 420 and Urografin 370

A double blind randomised trial of two urographic contrast media was performed on two hundred patients with normal renal function and no significant urological abnormality. One hundred patients were given Conray 420 (sodium iothalamate), and one hundred received Urografin 370 (mainly methylglucamine diatrizoate with a small amount of sodium diatrizoate). The same amount of iodine, 300 mg per kg B.W., was given to each patient. The only significant urographic difference was an inferior demonstration of the pelvicalyceal system with Urografin 370. No serious reactions were encountered but of the minor side effects, pain at the injection site, pain in the proximal part of the arm, and a metallic taste were significantly more frequent with Conray 420. There was no relationship between individual side effects and the presence or absence of anxiety. No significant change in blood pressure or pulse occurred with either contrast medium.     

超声造影联合免疫组织化学诊断小肝细胞癌微血管侵犯：两个医院的回顾性研究

目的 探讨超声造影（contrast enhanced ultrasound,CEUS）联合免疫组织化学（immunohistochemistry,IHC）在术前诊断小肝细胞癌（hepatocellular carcinoma,HCC）微血管侵犯（microvascular invasion,MVI）中的价值。方法 回顾性收集日本横滨市立大学附属市民综合医疗中心和西安交通大学第一附属医院142例HCC患者的资料,包括177个新发的、最大直径不超过3 cm的HCC病灶。根据手术切除标本的病理学诊断分为MVI（+）组（n=37）和MVI（-）组（n=140）。在术前CEUS动脉期（arterial phase,AP）和血管后期（post-vascular phase,PVP）图像上分别观察病灶周边有无高灌注、低灌注;采用IHC检测热休克蛋白70(heat shock protein,HSP70)、磷脂酰肌醇蛋白聚糖3(glypican 3,GPC3)在术前穿刺活检标本中的表达。结果 CEUS指标（AP、PVP）和IHC指标（GPC3、HSP70）单独诊断MVI时,PVP的诊断效率最高,准确...     

101例大肠癌术后肝转移治疗分析

目的比较大肠癌肝转移患者不同治疗方法的疗效。材料与方法将１０１例原发灶得到控制，无肝外播散的大肠癌肝转移患者按治疗方法不同分为３组，其中手术切除＋肝动脉化疗组４０例，动脉插管化疗＋放疗组３４例，静脉化疗组２７例。结果手术切除＋动脉化疗组１，３，５年生存率分别为６７．５％，５０．０％，２７．５％，明显高于其他两治疗组，Ｐ值均小于０．０５。动脉化疗＋放疗组的治疗有效率１，３年生存率分别高于静脉化疗组，Ｐ值均小于０．０５。结论对原发灶得到控制，无肝外播散的大肠癌肝转移患者应争取切除孤立或仅局限于一叶的多发病灶；对不可切除的病例选用动脉化疗辅助放疗不失为一重要的治疗手段。     

首发单纯骨转移乳腺癌患者的临床病理特征及预后分析

  目的  探讨乳腺癌首发单纯骨转移（bone-only metastasis, BOM）患者的临床病理学特征及预后特点。  方法  回顾性分析2009年1月至2016年12月967例于天津医科大学肿瘤医院治疗的转移性乳腺癌患者的临床病理资料。分为180例BOM组与787例非BOM组, 对BOM组患者的预后因素行单因素分析和Cox回归模型多因素分析, 并根据激素受体（hormone receptor, HR）状态、转移数目及治疗方式行亚组分析。  结果  BOM组与非BOM组患者的中位无进展生存（progression-free survival, PFS）时间分别为19.4个月与10.0个月, BOM组中位总生存（overall survival, OS）时间为45.6个月。BOM组与非BOM组HR阳性患者分别占81.7%（147/180）与64.7%（509/787）（P < 0.001）。Cox回归模型多因素分析显示HR状态、转移位置、转移数目和治疗方式是BOM患者预后的独立影响因素。BOM组的HR阳性患者内分泌治疗（P=0.004）或联合治疗（P < 0.001）较单独化疗的预后更佳。影响BOM组HR阳性患者预后的主要因素为骨转移数目和内分泌治疗。单部位骨转移患者行内分泌治疗（P=0.004）或联合治疗（P= 0.002）较单独化疗的预后更佳, 多部位骨转移患者行联合治疗较单独化疗（P < 0.001）或内分泌治疗（P=0.04）的预后更佳。  结论  对于HR阳性BOM尤其是单部位骨转移患者, 单纯内分泌治疗可获得较为满意的疗效, 而对于多部位BOM则应考虑行联合治疗。      

Health-related quality-of-life outcomes following IMRT versus conventional radiotherapy for oropharyngeal squamous cell carcinoma

PURPOSE: To compare health-related quality-of-life (HRQOL) outcomes of patients with oropharyngeal squamous cell carcinoma treated using intensity-modulated radiotherapy (IMRT) vs. conventional radiotherapy (CRT). PATIENTS AND METHODS: Patients with oropharyngeal squamous cell carcinoma were extracted from the database of an ongoing longitudinal Outcome Assessment Project. Eligible criteria included (1) treated with definitive radiation, and (2) provided 12-month posttreatment HRQOL data. Excluded were 7 patients who received IMRT before October 1, 2002, during this institution's developmental phase of the IMRT technique. The HRQOL outcomes of patients treated with IMRT were compared with those of patients who received CRT. RESULTS: Twenty-six patients treated using IMRT and 27 patients treated using CRT were included. Patients in the IMRT group were older and had more advanced-stage diseases and more patients received concurrent chemotherapy. However, the IMRT group had higher mean Head and Neck Cancer Inventory scores (which represent better outcomes) for each of the four head-and-neck cancer-specific domains, including eating, speech, aesthetics, and social disruption, at 12 months after treatment. A significantly greater percentage of patients in the CRT group had restricted diets compared with those in the IMRT group (48.0% vs. 16.0%, p = 0.032). At 3 months after treatment, both groups had significant decreases from pretreatment eating scores. However, the IMRT group had a significant improvement during the first year, but the CRT group had only small improvement. CONCLUSIONS: Proper delivery of IMRT can improve HRQOL for patients with oropharyngeal cancer compared with CRT.     

Investigation of acute lower gastrointestinal bleeding with 16‐ and 64‐slice multidetector CT†

We evaluated the usefulness of 16‐ and 64‐slice multidetector CT (MDCT) in the detection of a bleeding site in acute lower gastrointestinal tract (GIT) haemorrhage by conducting a retrospective study of cases of presumed acute lower GIT haemorrhage imaged with CT in two teaching hospitals in an 11‐month period. The patients underwent contrast enhanced CT using either a 16 or 64 MDCT. No oral contrast was used. One hundred milliliters of non‐ionic intravenous contrast agent was injected at 4.5 mL/s, followed by a 60 mL saline flush at 4 mL/s through a dual head injector. Images were acquired in arterial phase with or without non‐contrast and portal phase imaging with 16 × 1.5 mm or 64 × 0.625 mm collimation. Active bleeding was diagnosed by the presence of iodinated contrast extravasation into the bowel lumen on arterial phase images with attenuation greater than and distinct from the normal mucosal enhancement or focal pooling of increased attenuation contrast material within a bowel segment on portal‐venous images. Further management and final diagnosis was recorded. Fourteen patients and 15 studies were reviewed. CT detected and localized a presumed bleeding site or potential causative pathology in 12 (80%) of the patients. Seven of these were supported by other investigations or surgery, while five were not demonstrated by other modalities. Eight patients had mesenteric angiography, of which only four corroborated the site of bleeding. CT did not detect the bleeding site in three patients, of which two required further investigation and definitive treatment. We propose that MDCT serves a useful role as the initial rapid investigation to triage patients presenting with lower GIT bleeding for further investigation and management.     

化疗前应用重组人粒细胞集落刺激因子预防白细胞减少

 【摘要】　目的　观察重组人粒细胞集落刺激因子（rhG-CSF）预防化疗后中性粒细胞减少症的有效性和安全性。方法　采用随机对照方法，初治恶性肿瘤患者接受1个周期的化疗，其中治疗组化疗前24 h给予rhG-CSF 150 μg皮下注射1次，对照组不给予rhG-CSF。结果　入组52例肿瘤患者，分为治疗组和对照组各26例，WBC＜4.0×109／L的发生率分别为19.23 %和53.85 %（P＜0.05），白细胞减少发生率Ⅰ度分别为7.69 %和19.23 %，Ⅱ度7.69 %和15.39 %，Ⅲ度3.85 %和1.54 %，Ⅳ度0和7.69 %； 持续时间分别为1.27 d和4.04 d（P＜0.05）；抗生素使用率分别为7.69 %和26.92 %（P＜0.05）；发热性中性粒细胞减少发生率分别为3.85 %和26.92 %（P＜0.05）。rhG-CSF的毒副作用主要为骨骼肌肉疼痛、乏力、头晕等。结论　化疗前应用rhG-CSF能有效控制肿瘤化疗后白细胞减少的发生，降低肿瘤化疗后白细胞减少的程度。