Radiotherapy for patients with localized hormone‐refractory prostate cancer: results of the Patterns of Care Study in Japan

OBJECTIVE

To evaluate the clinical results of radiotherapy (RT) for patients with regionally localized hormone‐refractory prostate carcinoma (HRPC).

PATIENTS AND METHODS

As part of a Patterns of Care Study in Japan, a nationwide survey was conducted of RT for patients with prostate adenocarcinoma. We reviewed the detailed information of 140 patients with regionally localized HRPC who received RT between 1996 and 1998, and between 1999 and 2001, in 117 randomly selected institutes in Japan. The median (range) age of the patients was 74 (51–94) years, and their tumours were defined as well (14), moderately (51) or poorly (54) differentiated, or of unknown differentiation (21). The median (range) interval between hormonal therapy (HT) and RT was 32.5 (1.1–168.4) months. Ninety‐five patients had T3‐4 tumours and 28 had regional lymph node metastases before treatment. The median (range) prostate‐specific antigen levels before the initial HT and before RT were 35.0 (1.5–276) and 10.0 (0.06–760.3) ng/mL, respectively. External beam RT was administered, with a median total dose of 66 Gy; 70 patients (50%) received pelvic irradiation.

RESULTS

At a median follow‐up of 20.7 months, the 5‐year overall and clinical progression‐free survival rates (95% confidence interval) were 48.1 (36–60)% and 36.7 (26–47)%, respectively. Although there were distant metastases in 46 patients, only six had local progression. There was late morbidity of grade ≥3 in six patients.

CONCLUSION

To the best of our knowledge, this study comprises the largest series of regionally localized HRPC treated with RT reported to date. RT might have a limited role for HRPC, because in most patients RT failed, with distant metastasis.     

Three-dimensional analysis of morphological aspects of the human saccular macula.

The 3-dimensional shape of the human saccular macula and its orientation in the skull were quantitated in this study. The semicircular canals and saccular maculae were reconstructed 3-dimensionally on a computer from 3 human temporal bones. The 380 to 522 triangles in the entire area of the saccular macula were made by drawing lines between 2 adjacent points every 100-pm width of the saccular macula in each section. The angles between each triangle and each estimated standard axis in the skull obtained were calculated. This information will provide standard data regarding the 3-dimensional morphological aspects of the saccular macula for further investigations of the function of the sacculus. It was determined that the 3-dimensional shape of the saccular macula was not a plane, but was a curved surface like that of an ellipsoid. It is thought that this shape is necessary in order for the saccular macula to detect wide-range linear acceleration.     

Fractional anisotropy values of calf muscles in normative state after exercise: preliminary results

PURPOSE: We measured fractional anisotropy (FA) of calf muscles from diffusion tensor (DT) images from simultaneous scanning of bilateral calves and determined changes in values after unilateral exercise loading. METHOD: We obtained DT images of both calves of 10 healthy male volunteers and measured FA of the anterior tibialis, gastrocnemius, and soleus muscles. Two of the ten were subjected to loaded exercise in their right calves; we recorded FA values immediately after exercise and 24 hours, 72 hours, and 1 week later. RESULTS: At rest, the mean FA values of the 20 calves were 0.63+/-0.02 in the anterior tibialis, 0.56+/-0.05 in the gastrocnemius, and 0.57+/-0.04 in the soleus muscles. The differences were statistically significant (P<0.001) by analysis of variance (ANOVA), and differences between anterior tibialis and gastrocnemius (corrected P<0.01) and anterior tibialis and soleus (corrected P<0.01) muscles were significant by Bonferroni post hoc test. The FA values of the exercise-loaded soleus and gastrocnemius muscles of the 2 volunteers decreased just after exercise but gradually recovered to the baseline after one week. CONCLUSION: Our method may be useful for assessing minimal muscle damage related to muscle fatigue.     

A case of endocrine carcinoma of the sigmoid colon]

We report a case of endocrine carcinoma of the sigmoid colon. A 71-year-old man was admitted to our hospital because of constipation and bloody stool. Colonoscopy showed a mass lesion with irregular ulceration in the sigmoid colon. He was given a diagnosis of the poorly differentiated adenocarcinoma of the colon, and underwent sigmoidectomy with dissection of the lymph nodes. Histological and immunohistochemical examinations of the resected specimen revealed endocrine carcinoma. Endocrine carcinoma of the colon is rare, and the prognosis is very poor. We discuss this case with references.     

Giant cell arteritis associated with rheumatoid arthritis monitored by magnetic resonance angiography.

A 57-year-old Japanese woman with well controlled rheumatoid arthritis visited our hospital with a severe bitemporal headache and marked fatigue. Based on the classification criteria by the American College of Rheumatology, she was diagnosed as having giant cell arteritis. Magnetic resonance (MR) angiography was performed, from which stenotic changes in the bilateral superficial temporal arteries were strongly suspected. Corticosteroid therapy was quickly started. The patient followed an uneventful course with no complications. Therapeutic effect was confirmed by MR angiographic findings obtained 4 weeks after the initiation of therapy.     

Oral and facial representation in the trigeminal principal and rostral spinal nuclei of the cat

Transganglionic transport of horseradish peroxidase (HRP) was used to study the patterns of termination of somatic afferent fibers innervating oral and facial structures within the principal nucleus (Vp), nucleus oralis (Vo), and nucleus interpolaris (Vi). The primary trigeminal afferent fibers that innervate the oral cavity supplied by the pterygopalatine, superior alveolar, lingual, buccal, and inferior alveolar branches, as well as the facial skin supplied by the frontal, corneal, zygomatic, infraorbital, auriculotemporal, mylohyoid, and mental branches, were traced in this experiment. The results show that trigeminal afferent nerves that innervate the oral cavity project mainly to the principal nucleus, the rostrodorsomedial part (Vo.r) and dorsomedial division (Vo.dm) of pars oralis, and the dorsomedial region of pars interpolaris, while an extensive overlap of projections is found in the Vo.r, Vo.dm, and rostral Vi. The central processes of fibers innervating the anterior face (i.e., mental, infraorbital, and frontal nerves) terminate in the ventral division of principalis (Vpv), caudal region pars oralis (Vo.c), and ventrolateral Vi, with the largest numbers of terminals being found in the Vpv and Vi. In contrast, the central projection patterns of the corneal, zygomatic, mylohyoid, and auriculotemporal afferents are different from those of other afferent nerves examined, and present a discrete projection to the trigeminal sensory nuclear complex (TSNC). The corneal, mylohyoid, and auriculotemporal afferents mainly project to the restricted regions of principalis and caudal Vi, while zygomatic afferent nerve fibers project to the caudal third of pars interpolaris. The typical somatotopic organization with the face of the mouth open inverted is represented in the rostrocaudal midlevels of the Vpv and caudal pars interpolaris. The Vpd receives topographical projection from primary afferent nerves that innervate the oral structure only, while this projection was organized in a complicated manner. The relationship between the functional segregation and the cytoarchitectonic differentiation of the TSNC is discussed, particularly with respect to this somatotopic organization, combined with the characteristics of projecting cells in the TSNC.     

Clinical studies of cefpodoxime proxetil in pediatric field

Clinical studies of cefpodoxime proxetil (CPDX-PR), a new cephem antibiotic, were carried out in 60 patients in the pediatric field. The overall efficacy rate on 54 patients with various infections was 98.1%, and few side effects, all of them very mild, were developed in 6 of 60 patients (10%). It was concluded that CPDX-PR was one of the most useful antibiotics in the pediatric field because of the high efficacy rate and the safety.