Preoperative intraarterial infusion chemotherapy for advanced gastric cancer--a retrospective review of four cases

For the purpose of improving operability and curability, we performed intraarterial infusion chemotherapy on four patients with advanced gastric cancer diagnosed pathologically as papillary adenocarcinoma or poorly differentiated adenocarcinoma. Anti-cancer drugs including cis-diamminedichloroplatinum (II), epirubicin, and mitomycin C were administered through catheters whose tips were placed at various sites, as follows: celiac artery, common hepatic artery, right and left gastric artery, accessory left gastric artery, gastroduodenal artery, and right gastroepiploic artery. The therapeutic effect was evaluated by computed tomography (CT) and double contrast X-ray examination of the stomach. A partial response was obtained in one patient, there was no change in two patients, and the fourth patient showed no change and died eight months later. One patient had no recurrence, and recurrence was found in two. The major toxicity was bone marrow suppression, and other side effects such as appetite loss, nausea, and vomiting were all transient. A deep gastric ulcer was found in one patient, but it was cured by intravenous administration of H2 blocker. Although the four patients showed varying responses, intraarterial chemotherapy may prove to be an assistant therapy that enhances the therapeutic effect.     

Significance of mesenteric lymphadenopathy after pancreaticoduodenectomy for periampullary carcinomas: evaluation with serial MDCT studies

OBJECTIVE: To evaluate the significance of mesenteric lymphadenopathy arising after pancreaticoduodenectomy (PD) for periampullary carcinomas. MATERIALS AND METHODS: Serial multidetector CT (MDCT) studies in 44 patients after PD for periampullary carcinomas (Group A) were retrospectively reviewed, the incidence and interval changes of mesenteric lymphadenopathy were evaluated, and comparisons were made with 21 patients who underwent PD for benign diseases (Group B). RESULTS: In Group A, mesenteric lymphadenopathy was seen in 31 of 44 (70.5%) patients. The short axis diameter of the largest lymph node ranged from 6.2 to 11.5mm (mean+/-S.D.: 8.6+/-1.4mm), and the short-axis-to-long-axis (S/L) ratio ranged from 0.46 to 0.99 (mean+/-S.D.: 0.69+/-0.12). Six of the 31 (19.4%) mesenteric lymphadenopathy cases showed interval increases in size on follow-up studies, and three cases showed new development of mesenteric lymphadenopathy: all of these nine cases had concurrent recurrence in the mesenteric root. In Group B, 11 (52.4%) had mesenteric lymphadenopathy. The short axis diameter of the largest lymph node ranged from 5.6 to 10.9mm (mean+/-S.D.: 8.0+/-1.9mm) and the S/L ratio ranged from 0.48 to 0.93 (mean+/-S.D.: 0.67+/-0.12). Differences in the incidence, short axis diameter and S/L ratio were not significant between Groups A and B (p=0.154, 0.271 and 0.654, respectively). CONCLUSION: Mesenetric lymphadenopathy after PD less likely reflects recurrence. Lymph node metastasis may be suggested only when coexisting recurrent mass is found in the proximal mesenteric root.     

Increased frequency of CD4+T cells expressing fractalkine receptor CX3CR1 in patients with HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP), but its AIDS susceptible polymorphisms are not associated with the disease

To investigate whether fractalkine receptor CX3CR1 polymorphisms that have been associated with rapid progression to AIDS among HIV-1 positive individuals also affects the risk of human T cell lymphotropic virus type 1 (HTLV-1) associated myelopathy/tropical spastic paraparesis (HAM/TSP), we compared the allele frequencies of V249I and T280M between 233 HAM/TSP patients and 213 HTLV-1 seropositive asymptomatic carriers (HCs). Although the frequency and absolute number of peripheral blood CX3CR1+CD4+T cells were significantly increased in HAM/TSP patients compared to HCs and uninfected controls independent of HTLV-1 trans-activator protein Tax, we could not observe any association between the two polymorphisms and the risk of HAM/TSP in our cohort.     

Interobserver agreement on the diagnosis of bowel ischemia: assessment using dynamic computed tomography of small bowel obstruction

Purpose  

The aim of this study was to evaluate the accuracy and interobserver variability of dynamic computed tomography (CT) for diagnosis of small bowel obstruction.     

Recanalization of Splenic Artery Aneurysm After Transcatheter Arterial Embolization Using N-Butyl Cyanoacrylate

A 65-year-old woman who had been diagnosed as having microscopic polyangiitis developed sudden abdominal pain and entered a state of shock. Abdominal CT showed massive hemoperitoneum, and emergent angiography revealed a ruptured splenic artery aneurysm. After direct catheterization attempts failed due to tortuous vessels and angiospasm, transcatheter arterial embolization using an n-butyl cyanoacrylate (NBCA)-lipiodol mixture was successfully performed. Fifty days later, the patient developed sudden abdominal pain again. Repeated angiography demonstrated recanalization of the splenic artery and splenic artery aneurysm. This time, the recanalized aneurysm was embolized using metallic coils with the isolation method. Physicians should keep in mind that recanalization can occur after transcatheter arterial embolization using N-butyl cyanoacrylate, which has been used as a permanent embolic agent.     

Joint Gap in Mid-Flexion Is Not a Predictor of Postoperative Flexion Angle After Total Knee Arthroplasty

Background

Postoperative knee flexion angle is one of the most important outcomes of total knee arthroplasty (TKA). Intraoperative ligament balancing may affect the postoperative range of motion of the knee. However, the relationship between intraoperative ligament balancing and postoperative flexion angle was still controversial. The purpose of this study was to determine whether intraoperative joint gap affects postoperative knee flexion angle or not.

MELAS presenting as migraine complicated by stroke: case report

A case of MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes) which presented as migraine complicated by stroke is reported. Strokes associated with migraine have often been reported, but the mechanism remains unclear and may include a variety of pathologies. MELAS also presents with migrainous headache, vomiting, and stroke-like symptoms. Magnetic resonance imaging demonstrates characteristic findings. MELAS should be considered in the differential diagnosis of infarct-like lesions with migrainous headaches in young adults, especially if the symptoms fluctuate and are accompanied by a homonymous hemianopia. Received: 23 September 1996 Accepted: 19 February 1997     

Thallium-201 myocardial SPECT findings at rest in sarcoidosis

In 41 patients with sarcoidosis (diagnosed according to criteria recommended by the Committee on Diffuse Pulmonary Disease, Ministry of Health and Welfare, Japan 1988), thallium-201 (²⁰¹Tl) myocardial SPECT was performed to investigate: (1) the ability of²⁰¹Tl SPECT to detect cardiac involvement of sarcoidosis with images recorded at rest and 2 hours later, and (2) the relationships between²⁰¹Tl myocardial SPECT findings and the activity of sarcoidosis or endomyocardial biopsy findings. As to the abnormal findings in²⁰¹Tl myocardial SPECT, (1) a low density area was seen in 13 of 41 cases (31.7%) and non-uniform uptake was found in 17 cases (41.5%), (2) the mean washout ratio (n=39) was 16.5±7.4%, which is significantly (p < 0.05) lower than that found in normal subjects, 23.9±7.5 % (n=10). Of the 19 patients judged visually to be normal, 5 patients had a reduced mean washout ratio less than 12%. Thus, the incidence of abnormal findings including all types of abnormality, on²⁰¹Tl myocardial SPECT in sarcoidosis was 63.4% (26/41 cases). In studying the relationship between²⁰¹Tl myocardial SPECT findings and the activity of sarcoidosis (as measured by the serum ACE (angiotensin converting enzyme) or lysozyme level, or the presence of more than 30% symphocyte fraction in BALF (broncho-alveolar lavage fluid)), 20 (80%) of 25 cases with²⁰¹Tl abnormality were judged to be active sarcoidosis, while only 6 (37.5%) of 16 cases with normal findings on²⁰¹Tl SPECT were judged to be active. This suggests that there is a significant (p < 0.01) relationship between the presence or absence of an abnormal finding on²⁰¹Tl myocardial SPECT and the activity of sarcoidosis. Among 13 patients examined by endomyocardial biopsy, 10 patients had abnormal findings on²⁰¹Tl myocardial SPECT and 7 of these 10 patients had no histological evidence of cardiac sarcoidosis. In all of these 7 patients, however, sarcoidosis was judged to be active. This suggest that endomyocardial biopsy is of limited value in the diagnosis of cardiac sarcoidosis.     

Sevoflurane anaesthesia causes a transient decrease in aquaporin-2 and impairment of urine concentration

Sevoflurane anaesthesia is occasionally associated with polyuria, but the exact mechanism of this phenomenon has not been clarified. Aquaporin-2 (AQP2) is an arginine vasopressin (AVP)-regulated water channel protein localized to the apical region of renal collecting duct cells and is involved in the regulation of water permeability. To elucidate the effect of sevoflurane anaesthesia on urine concentration and AQP2, we have compared serum and urinary concentrations of AVP, AQP2 and osmolar changes during sevoflurane and propofol anaesthesia. General anaesthesia was induced with sevoflurane or propofol in 30 patients for a variety of major surgical procedures. Blood and urine samples were obtained from patients at baseline, and 90 and 180 min after induction of anaesthesia. AVP and AQP2 concentrations were measured by radioimmunoassay. In both groups, plasma and urinary concentrations of AVP increased similarly during anaesthesia although plasma osmolality remained unchanged. Although urinary AQP2 excretion in the propofol group increased together with changes in plasma and urinary AVP, urinary AQP2 was significantly lower at 90 min in the sevoflurane group. Urine osmolality in the sevoflurane group also showed a transient but significant decrease in parallel with suppression of AQP2. Our data suggest that sevoflurane anaesthesia transiently produced an impaired AQP2 response to an increase in intrinsic AVP.