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動脈内にリザーバーカテを留置し，化学療法を行う治療の長期的な予後と合併症についての報告は少ない．（対象と方法）動注化学療法を行った消化器癌症例45例．内訳はHCC10例，大腸癌からの転移性肝癌15例，胃癌，大腸癌による腹膜播種20例である．肝癌症例には肝動脈に，腹膜播種症例には大動脈内にリザーバーカテを留置し，low dose CDDP，5FU，アイソボリンを用いた化学療法を主に外来で行った．肝動脈に留置したカテは頚部から4例，そけい部から17例，開腹時４例挿入した．予後および合併症について比較検討した．（成績）肝癌症例および腹膜播種症例の1年生存率はそれぞれ64％，32％で２年生存率は36％，15％であった．合併症は11例にみられ，うち6例（TIA，皮膚色素沈着，腸管の潰瘍，肝障害）がカテ挿入後1カ月以内に，5例（肝動脈閉塞，肝動脈瘤，敗血症，カテの閉塞，創感染）が6カ月以降の晩期にみられた．カテの挿入経路別では頚部からの1例にTIA がみられた他は特徴的なものはみられなかった．（結語）肝動脈内にリザーバーカテを長期留置し化学療法を行うと，動脈の閉塞や動脈瘤がみられやすいと思われる．また頚部よりカテを挿入するとTIA の引き金となりやすい．その対策として現在当科では，カテをあまり奥にまで留置しないことやそけい部からのアプローチを選択している．

MDR1遺伝子を高いレベルで発現する2種類の腎癌細胞を使い, cepを含む5種類のMDR克服剤のVBLに対する感受性増強効果を比較した。さらにcepの各種抗癌剤に対する感受性増強の有無とその程度を検討した。これらをもとにVBL, ADRまたはepi-ADRにcepを併用した動脈内注入化学療法を6症例の腎癌転移巣に対し行い, 骨転移の2症例で著しい治療効果がえられた。このようなP糖蛋白を標的とした化学療法は, 特にBRM療法に比較的抵抗性の骨転移病巣などに対しては, 有効な治療法になりえると考えられた, We analyzed the sensitizing activity of five agents, which have been assumed to be MDR-overcoming drugs, in two human renal cell carcinoma cell lines expressing the MDR1 gene at high levels. In addition, we studied the sensitizing activity of cepharanthin, an MDR-overcoming agents, to vinblastine, adriamycin, epirubicin, cisplatin, mitomycin C and etoposide. Based on the results, we treated 6 patients with metastatic renal cell carcinomas (4: bones, 2: contralateral kidneys) by intraarterial injection of vinblastine and adriamycin (or epirubicin) in combination with cepharanthin. Two of the 4 bone metastasis cases responded markedly to the treatment. Renal tubular impairment was observed in one patient who was treated for the contralateral kidney metastasis.

Bilateral sciatic nerve paralysis developed in two patients with invasive bladder cancer following intraarterial infusion of cisplatin (CDDP) and 4'-0-tetrahydropyranyladriamycin (THP) as preoperative adjuvant chemotherapy. Balloon catheters were selectively inserted into both internal iliac arteries, and CDDP 100 mg/m2 and THP 40 mg/m2 were administered under balloon occlusion. Pain of lower extremities developed soon after infusion and was gradually followed by paralysis. One patient recovered from paralysis partially after 4 months, but the other patient didn't recover. The use of balloon catheters resulted in an excessive concentration of chemotherapeutic agents with the adverse action on the sciatic nerves.

Nine patients were operated on endovascular surgery and grouped as follows. Group I ( 3 cases of facial hemangioma):Feeding arteries of the hemangioma were embolized with microparticles (polyvinyl alcohol foam.Gelfoam or microfibrillar collagen) or ethanol liquid. Endovascular surgery seems to be the best treatment leaving the minimal damage both in functional and cosmetic standpoints of view. Group II (4 cases of malignant tumor) : Supersel∝live intraarterial infusion of LAK cells(lymphokine activated killer cells) ,MCNU,and CDDP was performed via the feeding arteries of tumors in four cases. Infusion should be performed as close as possible to the tumor in order to give higher concentration of drugs into the tumor and minimize local and systemic side effects by excessive extratumoral path. Group III(2 caces of intracavernous vascular lesion) : lntracavernous giant aneurysm was treated by proximal occlusion with detachable balloons without making bypass. Balloon occlusion test is essential to make sure of the pnresence of sufficient collaterals before the treatment. Cavernous dural arteriovenous malformation was successfully treated by staged embolization via transarterial route with gelfoam and microfibrillar collagen, and transvenous route with metal coils. Rescent advances of microcatheter and embolic agents have made dramatic progress in endovascular surgery. Endvascular surgery is considered to be the measure of choice primarily in the treatment of craniofacial vascular lesions., 論文