Extracorporeal shock wave lithotripsy--difficulties in ESWL

At Kanbara Hospital, 187 patients with urolithiasis have been treated by extracorporeal shock-wave lithotripsy (ESWL) since the first ESWL treatment in December, 1986. Some cases in which ESWL could not be performed easily were experienced. These difficulties were analyzed retrospectively and some problems in the ESWL treatment are discussed.     

Patient absorbed dose in coronary angiography determined by the flat panel digital detector X-ray system

The INNOVA 2000, an all-digital cardiovascular X-ray system with flat panel detector, is equipped with a monitoring function that makes it possible to track a patient's absorbed dose by displaying the real-time presumed absorbed dose. We verified this dose monitoring system and evaluated how it is affected by various parameters. We also compared the INNOVA 2000 to a conventional machine, the Advantx LC. The average absorbed dose of the INNOVA 2000 was 1,066 mGy, while that of the Advantx LC was calculated to be 2,028 mGy. Dose reduction with the INNOVA 2000 was 76% at Low mode and 52% even at Normal mode. The INNOVA provides an advantage in lowering absorbed dose, even considering that it has a rectangular image intensifier (I.I.) versus the Advantx LC's round I.I. This comparison was made by cine and digital angiography.     

Radiation therapy for intrahepatic recurrence after hepatectomy for hepatocellular carcinoma

Background. The intrahepatic recurrence rate after curative hepatectomy for hepatocellular carcinoma (HCC) is high, and management of recurrence is thus important for long-term survival. The use of radiation therapy has been relatively uncommon in the treatment of recurrent HCC.Methods. Eight patients underwent radiation therapy for recurrent HCC 12–98 months after hepatectomy. Five of them were treated with protons (250MeV; 68.8–84.5Gy), and three were treated with X-rays (6MV; 60 or 70Gy). One patient received radiation therapy twice for another lesion with a 79-month interval. The target tumors were 1.2–4.5cm. All patients also underwent transcatheter arterial embolization or other regional therapy.Results. Although transient ascites was found in three patients after radiation therapy, no patient died as a result of the irradiation. Seven patients died 9 months to 4 years (median 1 year 6 months) after radiation therapy. Re-recurrence was observed in the irradiated liver in two patients (local control 78%). Four patients died of lung metastasis after radiation therapy. The median survival time was 3 years 3 months (range 1 year 1 month to 8 years 6 months) after recurrence.Conclusion. Multimodality therapy is necessary for the management of recurrence. Radiation therapy could be beneficial when other therapies present some difficulty regarding application or are performed incompletely. It must be emphasized that radiation therapy should be considered in addition to other regional therapies for the treatment of recurrent or re-recurrent HCC, and that radiation therapy can be repeated in selected patients.     

Evaluation of an automatic fogging disinfection unit

A new fogging disinfection method was evaluated as a means of disinfecting ward rooms and operating theaters. A temporary room was established where the disinfection effect of fogging was examined. Based on the results, an automatic fogging disinfection unit was developed. This unit was then used in the disinfection of operating theaters, where its safety and effectiveness were examined. To evaluate the results of disinfection, bacterial culture tests were performed on the floor, walls and other areas of the operating theater, and the number of colony forming units was used as an index of effectiveness. Benzalkonium chloride, alkyldiaminoethylglycine, sodium hypochlorite, glutaral and acidic electrolytic water were used for the operating theaters. The average disinfection effect was 90% or better for all disinfectants, except acidic electrolytic water. The newly developed automatic fogging disinfection unit enables safe and effective disinfection, and may be suitable for disinfecting ward rooms and operating theaters.     

麻黄对脂肪细胞脂质代谢影响的实验研究

目的：研究麻黄对脂肪细胞脂质代谢的影响。方法：用正常大鼠附睾处脂肪细胞,分别观察麻黄对由１４Ｃ标记的葡萄糖转化的脂肪合成及由去甲肾上腺素（ＮＥ）促进的脂肪分解的作用。结果：麻黄可促进由葡萄糖转化的脂肪合成,并且这种作用与基质溶液的ｐＨ值有关;麻黄尚可抑制由ＮＥ促进的脂肪分解作用。结论：麻黄具有促进脂肪细胞脂肪合成的作用,该作用不是由麻黄碱所致,其作用机制与胰岛素有类同之处。     

Optimal timing of contrast enhancement in coronary CT angiography using the Bolus-tracking method

Negative product value for coronary artery disease is 98% to 99%. Therefore, the number of unnecessary cardiac catheterization procedures is reduced as the usefulness of CT systems for examination of the coronary arteries improves. In the bolus-tracking method, in which an ROI is placed in the ascending aorta to trigger scanning, scanning may not be performed at the optimal time of contrast enhancement depending on the patient. In addition to identifying the causes of this problem, we have developed a new method in which ROIs are placed in the right ventricle and left atrium to trigger scanning when the concentrations of contrast medium in the right ventricle and left atrium become equal. The two methods were then compared and evaluated. In the scan method, in which an ROI is placed in the ascending aorta, the reason for non-optimal scan timing is considered to be that the time required for contrast medium injected via an antecubital vein to reach the heart varies depending on the individual patient(approximately 3 times the variation of our method)followed by a delay of approximately 5 seconds between the scan trigger time and the actual scan start time. In the scan method in which scanning is triggered when the concentrations of contrast medium in the right ventricle and left atrium become equal, scanning can be performed at the time of peak enhancement regardless of differences in the time required for the injected contrast medium to reach the target region or differences in the injection rate, demonstrating the usefulness of this method.     

Dose escalation study of nedaplatin with 5-fluorouracil in combination with alternating radiotherapy in patients with head and neck cancer

BACKGROUND: This study, with a large number of patients, confirms that after administration of 5-fluorouracil (5FU), a higher dose of nedaplatin (NDP) can be safely administered rather than a single therapy of NDP, as demonstrated in a phase I study. METHODS: The subjects were 52 patients with stage II-IV (M0) head and neck cancer other than nasopharyngeal cancer. Alternating chemoradiotherapy was performed using the following method. Initially, chemotherapy was administered. For chemotherapy, 5FU at 700 mg/m2/24 h was intravenously administered for 5 days (days 1-5), and NDP was administered on day 6. We established three dose groups: level 1, 120 mg/m2; level 2, 140 mg/m2; and level 3, 150 mg/m2 (n = 13 or more per group). RESULTS: The maximum acceptable dose of NDP (150 mg/m2) was confirmed. The 5-year overall survival rates were 77% (95% CI: 66-90%) in all subjects and 75% (95% CI: 61-92%) in the stage III/IV patients. The 5-year progression-free survival rates were 73% (95% CI: 62-87%) in all subjects and 72% (95% CI: 57-89%) in the stage III/IV patients. CONCLUSIONS: After administration of 5FU, a higher dose of NDP can be safely administered. This alternating chemoradiotherapy showed potent antitumor effects. The efficacy of chemotherapy with NDP and 5FU should be compared to that of chemotherapy with CDDP and 5FU.