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Objectives: To evaluate whether a pharmacokinetic analysis is useful for both predicting and monitoring the response to chemoradiotherapy (CRT) in oral cancer.Methods: Patients with oral squamous cell carcinoma treated with preoperative CRT and surgery were enrolled. They underwent dynamic contrast-enhanced MRI before (n = 23), and after CRT (n = 20). We estimated four parameters: arrival time of contrast medium (TA), exchange rate constant from the extracellular extravascular space (EES) to plasma (k(ep)), elimination of contrast medium from the central compartment (k(el)) and an amplitude scaling constant (AH) using the Brix model. The histological evaluation of the effects of CRT was performed according to Ohboshi and Shimosato's classification. We analysed the correlation between the parameters and the histological evaluation.Results: The pre-CRT AH between the responders and non-responders was significantly different (P = 0.046), however, the three parameters (TA, K(ep), K(el)) were not significantly different among the groups (P = 0.76, P = 0.60, P = 0.09). As AH decreased, the tumour response improved. The change in the AH between the pre- and post-CRT of responders was significantly higher than that of non-responders (P = 0.043).Conclusion: The AH, which is affected by the ratio of the EES, was an important parameter for predicting and monitoring the tumour response to CRT. [ABSTRACT FROM AUTHOR]

Purpose: Small-cell esophageal carcinoma (SCEC) is a rare disease for which standard therapy has not yet been established. We report the results of three cases of limited-stage SCEC treated with combination therapy using carboplatin (CBDCA) and etoposide (VP-16) and radiotherapy.Materials and Methods: The clinical stage according to the Japanese Classification of Esophageal Cancer 7th ed. was stage III in 2 cases and stage IVa in 1. These patients with limited-stage SCEC were treated at our institution with four cycles of CBDCA and VP-16, either concurrent with radiotherapy for the second two cycles (n = 2) or followed by radiotherapy after the last cycle (n = 1).Results: A complete response (CR) was obtained for all three patients, resulting in a response rate of 100%. Two patients are alive at 16.4 and 22.5 months after initial treatment. One patient died with myeloid leukemia at 43.5 months after initial treatment. None of the patients had loco-regional recurrence. Brain metastasis was detected in one patient at 7 months after initial therapy and was treated with stereotactic radiotherapy combined with whole brain irradiation.Conclusion: CBDCA and VP-16 in combination with radiotherapy should be considered an important treatment option for SCEC. [ABSTRACT FROM AUTHOR]

The report presented here describes a case of spontaneous pneumothorax observed after stereotactic radiotherapy (SRT) for non-small-cell lung cancer (NSCLC). An 84-year-old man with a Stage IIB, T3N0M0 NSCLC in the right upper lobe and a Stage IA NSCLC in the right lower lobe of the lung was treated with SRT for both tumors. He received SRT with a total dose of 60.0 Gy in 10 fractions delivered to the right upper lobe, and 48.0 Gy in 4 fractions delivered to the right lower lobe. Two months after completion of the treatment, he developed spontaneous pneumothorax. He was asymptomatic and recovered with conservative management. Spontaneous pneumothorax has occasionally been reported to occur following thoracic radiotherapy for malignancy. Almost all of the reported cases are patients who had received mantle irradiation for Hodgkin's disease. We have been unable to fi nd any reports of spontaneous pneumothorax after SRT, which has recently been used for treating patients with early-stage NSCLC. Because a case of spontaneous pneumothorax after SRT was observed in our institution, its clinical course is described here along with a discussion of possible causes of spontaneous pneumothorax. [ABSTRACT FROM AUTHOR]

We report two cases of autoimmune pancreatitis (AIP) in which fluorine-18 fluorodeoxyglucose (FDG) showed moderate accumulation in the pancreas, as well as in bilateral submandibular glands and in multifocal lymph nodes. FDG positron emission tomography (PET)/computed tomography (CT) is a useful diagnostic tool to assess the extrapancreatic lesions of AIP, which is a recently proposed new clinicopathological entity named immunoglobulin G4 (IgG4)-related systemic disease. Recognition of the FDG-PET/CT findings of IgG4-related sclerosing disease is crucial to avoid unnecessary surgery or other intervention because of similarities to malignant lymphoma or malignant tumor with multiple lymph node metastases. [ABSTRACT FROM AUTHOR]

We present a case of gluteal muscular and sciatic nerve metastases from urinary bladder carcinoma. T2-weighted magnetic resonance images demonstrated diffuse swelling and an increase in the signal of the right gluteus maximus muscle without destruction of the original arrangement of muscular fibers. Further, remarkable thickening of the right sciatic nerve showing a relatively hypointense signal was detected. Postcontrast T1-weighted images showed strong enhancement of these structures. Fine-needle aspiration biopsy with ultrasonographic guidance confirmed metastatic carcinoma cells in the right gluteal muscle and the sciatic nerve. These radiologic findings may represent a rare pattern of metastasis from urinary bladder carcinoma. [ABSTRACT FROM AUTHOR]

Background: The normal and pathologic anatomies of the peripancreatic arteries were demonstrated using thin-section multislice computed tomography (CT).Methods: Triple-phase dynamic CT was performed in 304 consecutive patients without pancreatic pathology and in 22 patients with pancreatic carcinoma. CT angiographies images (2.5-mm collimation, multihelical pitch 3, HQ mode) and a 1.25-mm reconstruction interval were obtained with a GE Lightspeed Qx/i at 25, 40, and 80 s after bolus injection of 130-150 mL of iodinated contrast medium at a rate of 3-5 mL/s. The images were assessed mainly by the manual cine paging method.Results: The anterior and posterior arcades and the dorsal pancreatic artery were frequently visualized. However, small-caliber arteries smaller than 1.5 mm in diameter, such as the pancreaticomagna, caudal pancreatic, and transverse pancreatic arteries, were infrequently visualized. In some cases, the peripancreatic arteries were very useful for differentiating the origin of tumors.Conclusion: Multislice helical CT enables the recognition of small peripancreatic arteries, and evaluation of these arteries should be considered when assessing tumors in the pancreaticoduodenal region. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relationship between the incidence of radiation-induced malformations and the extent of p53-dependent apoptosis. Materials and methods: Wild-type p53 ( / ) and heterozygous p53 ( / ) mice were exposed to X-rays at the mid-gestational period. The incidence of anomalies and prenatal deaths, the extent of apoptosis, and the levels of p53 protein were assessed. Results: After X-irradiation with 2 Gy, the incidence of malformation (corrected for control levels) was 0 and 30%, respectively, for p53 ( / ) and p53 ( / ). After irradiation of p53 ( / ) foetuses with 3 Gy, the frequency ( F ) of apoptotic cells rapidly peaked at 80% at 4 h and fell close to the control level at 48 h. The relationship between F 4 h after irradiation and dose ( D ) (1-3 Gy) is accurately expressed by a single-hit equation, F 1 exp\[ ( a bD )], where the radiation-induced apoptosis rate, b , is 0.47 for the wild type and 0.22 for the heterozygous mice. The X-irradiated foetuses showed no increase in the levels of p53 protein. Conclusion: The higher susceptibility of irradiated p53 ( / ) foetuses to malformation is related to a twofold lower rate of apoptosis; competent removal by apoptosis of damaged cells from irradiated tissues is impaired dramatically if one of two wild-type p53 alleles is lost. The frequency of apoptotic cells in the wild type reached a maximum 4 h after foetal irradiation with no measurable increase in the level of p53 protein,indicating that radiation-induced p53-mediated foetal apoptosis depends on non-transcriptional events. [ABSTRACT FROM AUTHOR]

Epigallocatechin gallate (EGCG) is a major water-soluble component of green tea. The antimutagenic activity of EGCG against benzo[a]pyrene (B[a]P)-induced mutations was assessed by using transgenic mice carrying the rpsL gene as a monitor of mutations. Seven-week-old male mice were given drinking water containing EGCG for 3 weeks. On day 7, mice were treated with a single i.p. injection of B[a]P (500 mg/kg body wt). Two weeks after the injection, the mutations in the rpsL gene were analyzed. B[a]P treatment resulted in an 4-fold increase of mutation frequency at the rpsL gene in the lung. An 60% reduction in the B[a]P-induced mutations in the lung was observed when mice were given EGCG at concentrations >0.005%. B[a]P-induced mutations mainly occurred at G:C base-pairs in the several specific nucleotide sequences of the rpsL gene. These were AGG, CGG, CGT, TGG, TGC and GGT: all of them contained a guanine residue. Mutations seen similarly in the human Ki-ras codon 12 or p53 codons 157, 248, and 273 of lung tumor were also found in the rpsL gene, and the mutations were suppressed by the EGCG treatment. In conclusion, the antimutagenic effects of EGCG for B[a]P-induced mutagenesis in vivo suggest that drinking green tea may reduce the tumor-initiating potency of B[a]P in the lung. [ABSTRACT FROM PUBLISHER]

Purpose: To assess the efficacy of Doppler ultrasonography (US) as a noninvasive method for monitoring patency of the transjugular intrahepatic portosystemic shunt (TIPS).Methods: Twenty-nine patients who had received TIPS for bleeding esophagogastric varices and/or refractory ascites with portal hypertension underwent Doppler US studies within 2 weeks after TIPS. Further studies were performed in 15 of them at 6 months, in 9 at 1 year, and in 4 at 2 years for a total of 57 US studies. The US findings were compared with the angiographic findings obtained at the same time.Results: In 45 of the 57 studies, shunt patency was found by Doppler US, correlating to 44 patencies and one occlusion on angiography. Doppler signal in the shunt could not be detected in 12 studies resulting in the diagnosis of shunt occlusion. This correlated with angiographic occlusion in 8 studies and patency in the remaining 4. All angiographically patent shunts that were occluded by Doppler US had various degrees of stenosis. A number of technical factors were found to be responsible for Doppler US false-positive or false-negative diagnoses, some related to the type of stent used. The Doppler US sensitivity was therefore 92%, the specificity 89%.Conclusion: Doppler US is a reliable noninvasive method to evaluate patency of TIPS. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical feasibility of balloon-occluded retrograde transvenous obliteration (BORTO) for gastric varices.Methods: BORTO was performed in 14 patients with gastric varices due to liver cirrhosis. The gastric varices were confirmed by endoscopy, and their feeding and draining veins were identified by contrast-enhanced computed tomography (CT) and angiography. A 6 Fr Simmons-shaped balloon catheter was inserted into the gastrorenal shunt. The balloon was inflated, and 5% ethanolamine oleate iopamidol was infused slowly through the catheter. Patients were followed up with endoscopy and enhanced CT at 1 week, 1, 3, and 6 months after the procedure and every 6 months thereafter.Results: The gastric varices completely disappeared in 12 of 14 patients and was partially resolved in the remaining 2 patients. Neither a recurrence nor an aggravation of gastric varices were found. No major complications were experienced.Conclusion: BORTO is a safe and effective treatment for gastric varices. [ABSTRACT FROM AUTHOR]

Purpose: To determine the optimal needle path for computed tomography (CT)-guided biopsy of small lesions just beneath the pleura.Methods: A biopsy of 61 subpleural lesions measuring less than 2.5 cm was done prospectively with regard to the approach and the results. One of two needle paths was randomly chosen: a nearly right angle path (n = 30) or an "oblique path" in which the needle was sharply inclined within the slice, using a course nearly parallel to the pleura (n = 32). One lesion was sampled twice. The procedures were considered successful when diagnostic samples were obtained.Results: The success rate of the oblique path was 81.2% and that of the near 90 degrees path was 43.3% (p < 0.05).Conclusion: For percutaneous biopsy of small subpleural lesions under CT guidance, the oblique path is better than the perpendicular path. [ABSTRACT FROM AUTHOR]

A 51-year-old man with posthepatitis cirrhosis underwent a transjugular intrahepatic portosystemic shunt (TIPS) for bleeding of recurrent esophageal varices. The patient had a coexisting, spontaneous, splenorenal shunt. He subsequently developed hepatic encephalopathy, presumably due to excessive portosystemic shunting. Since medical management resulted in no significant improvement, the splenorenal shunt was embolized from the jugular vein approach via renal vein access during temporary balloon occlusion. Within a few days, the patient's hepatic encephalopathy resolved. Twelve months later the patient showed no recurrence of encephalopathy and had maintained a patent TIPS. [ABSTRACT FROM AUTHOR]