Problems with topical therapies for extensive squamous cell carcinoma of the buttocks]

In patients in whom cancer originating from a bed-sore has advanced to a stage where radical treatment is impossible, topical treatment with ointment, or systemic anti-cancer chemotherapy, is usually applied. We recently attempted treatment of extensive squamous cell carcinoma of the buttocks, for which radical treatment was impossible, by chemotherapy using a reservoir for intraarterial injection. This therapy involved intraarterial injection of bleomycin and 5-FU, together with topical treatment with 5-FU ointment. We describe the problems encountered with this therapy, e.g., measures against fever after intraarterial injection, management of the affected area, evacuation, possibility and limits of radiation therapy, and assessment of its efficacy.     

High-dose-rate intraluminal brachytherapy for esophageal cancer: 10 years experience in Hyogo College of Medicine.

From May 1980 through December 1989, 148 patients with thoracic esophageal cancer were treated with high-dose-rate intraluminal brachytherapy (HDRIBT) following external radiotherapy (ERT). The standard treatment protocol was 60 Gy/6 weeks of ERT and 12 Gy/1 week of HDRIBT. The patients were divided into two groups according to disease stage. Sixty-six patients had limited disease (LD), and 82 patients had extensive disease (ED). The 2-year survival rate was 37% in LD group, and 7% in ED group. The 5-year survival rate of LD group was 18%. The 1- and 2-year actuarial local control rate was 66% and 64% in LD group, and 49% and 45% in ED group, respectively. In the total patients, ulceration, stricture, and fistula were found in 42 (28%), 15 (10%) and 6 (4%) patients, respectively; however, major complication defined as one resulting in a second hospitalization or requiring surgical intervention was 3 of the 42 patients with ulceration, 1 of the 15 patients with stricture, and all of the six patients with fistula. As to cause of death, local failure, local failure with distant metastasis, distant metastasis, intercurrent disease, and unknown reason was 14, 6, 15, 16 and 0 in LD group, and 13, 24, 30, 9 and 1 in ED group, respectively. The technique and method of combined treatment are described in detail.     

Mediastinal ganglioneuroma with the secretive activity of catecholamines, visualized by 131-I-MIBG scintigraphy

A 6-year-old girl with mediastinal ganglioneuroma was reported. Preoperative examinations revealed that the tumor had both secretive activity of catecholamine and uptake of 131-I-MIBG. Clinical symptom was only supraventricular premature beat on ECG. The tumor, which was located at the left upper mediastinum, was well encapsulated. Total surgical removal was accomplished. Subsequently serum and urine levels of catecholamine were normalized. Detailed histological examination of the tumor revealed benign ganglioneuroma. No blastic change was recognized. We postulate that secretive activity of catecholamine and uptake of 131-I-MIBG cannot suggest malignancy necessarily.     

Enhanced neutrophil functions in a patient with colony-stimulating activity-producing lung cancer.

We studied neutrophil functions in a patient with colony-stimulating activity (CSA)-producing lung cancer. A 59-year-old man had an abnormal chest X-ray and leucocytosis, predominantly with neutrophils. Pneumonectomy was performed, and the histological diagnosis of the tumour was large-cell carcinoma of the lung. The tumour induced marked granulocytosis in tumour-transplanted nude mice, and the conditioned media of the tumour contained very strong human-active CSA. Superoxide release and membrane depolarization in neutrophils stimulated by the chemotactic peptide, N-formyl-methionyl-leucyl-phenylalanine, were markedly enhanced in the patient. These findings suggest that CSA produced by the tumour primed neutrophil functions in vivo in the patient.     

Recurrence and survival rates in British and Japanese women with breast cancer

The biology of breast cancer in Japan appears to be changing in that, while post-menopausal Japanese patients have a better prognosis than comparable British women, no differences in recurrence or survival rates can now be found in pre-menopausal patients.     

Bilateral multilocular cystic renal cell carcinoma]

A case of bilateral renal cell carcinoma with multilocular cysts is described. A 42-year-old female was admitted to our hospital for the purpose of further examination or right renal cystic mass discovered incidentally by ultrasonography. After she was examined by CT-scan and angiography, right nephrectomy was performed under the diagnosis of right renal cancer. Histological diagnosis was multilocular cystic renal cell carcinoma. One year later a small cystic legion was found in the left kidney. Under the diagnosis of left renal cancer, left partial nephrectomy was performed. Histological diagnosis was multilocular cystic renal cell carcinoma same as the right kidney. Multilocular renal cyst is classified into several classes by its style of development. This case of bilateral renal cell carcinoma which grew to be multilocular cysts is the first case in Japan as far as we can search.     

Successful pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension associated with anticardiolipin antibodies: Report of a case

Chronic pulmonary thromboembolism with pulmonary hypertension is a rare but most unique syndrome in the broad spectrum of pulmonary embolism. This report describes a successful pulmonary thromboendarterectomy performed for a totally occluded right pulmonary artery on a 43 year old man who presented with positive cardiolipin antibodies. The surgery was performed through a median sternotomy with cadiopulmonary bypass and intermittent periods of deep hypothermic circulatory arrest. We are convinced that this method allows for complete removal of the thrombotic obstruction and should be the procedure of choice for patients with very proximal obstruction of a pulmonary artery.     

Magnetic resonance imaging in scaphoid fractures.

The use of a 1.5 tesla superconducting M.R. imager and surface coil was found to enhance the ability of M.R.I. to depict the fine anatomy of the wrist. Five healthy volunteers and 28 patients with scaphoid fractures underwent M.R.I., which made possible a definitive diagnosis of scaphoid fractures at an early stage. A fresh fracture was identified by decreased or iso signal intensity on the T1-weighted image and increased signal intensity on the T2-weighted image. This increase continued until bony union was apparent on radiographs. On the T2-weighted image, high signal intensity was characteristic of fresh fractures and suggested that bony union was possible. When bony union was complete, the intensity of the signal for the scaphoid on both T1- and T2-weighted images returned to normal. M.R.I. should thus prove useful in the diagnosis of scaphoid fractures.