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Purpose: Volumetric modulated arc therapy (VMAT) can acquire projection images during rotational irradiation, and cone-beam computed tomography (CBCT) images during VMAT delivery can be reconstructed. The poor quality of CBCT images prevents accurate recognition of organ position during the treatment. The purpose of this study was to improve the image quality of CBCT during the treatment by cycle generative adversarial network (CycleGAN)., Method: Twenty patients with clinically localized prostate cancer were treated with VMAT, and projection images for intra-treatment CBCT (iCBCT) were acquired. Synthesis of PCT (SynPCT) with improved image quality by CycleGAN requires only unpaired and unaligned iCBCT and planning CT (PCT) images for training. We performed visual and quantitative evaluation to compare iCBCT, SynPCT and PCT deformable image registration (DIR) to confirm the clinical usefulness., Result: We demonstrated suitable CycleGAN networks and hyperparameters for SynPCT. The image quality of SynPCT improved visually and quantitatively while preserving anatomical structures of the original iCBCT. The undesirable deformation of PCT was reduced when SynPCT was used as its reference instead of iCBCT., Conclusion: We have performed image synthesis with preservation of organ position by CycleGAN for iCBCT and confirmed the clinical usefulness.

A 68-year-old female patient presented with advanced gastric cancer and multiple hepatic tumors. Upper GI endoscopy showed a type 3 lesion in the posterior wall of the gastric body. Abdominal computed tomography revealed multiple liver metastases, and staging laparoscopy identified peritoneal dissemination. She was diagnosed with clinical Stage Ⅳ gastric cancer(cT3N2M1H1). She received 3 courses of combined chemotherapy containing S-1 and cisplatin. The therapeutic response was PR. We performed total gastrectomy with D2 lymph node dissection and splenectomy. Histopathological examination revealed no residual cancer cells, indicating pCR. She continued S-1 adjuvant chemotherapy and has remained free from recurrence for 18 months.

A 60s-year-old Japanese male underwent curative resection for an advanced adenocarcinoma of the esophagogastric junction(Stage III C), followed by adjuvant chemotherapy.Twenty -one months later, he was admitted to our hospital with a complaint of marked decline in activities of daily living(ADL).The patient was diagnosed with pancytopenia, disseminated intravascular coagulation(DIC), multiple lymph node and bone metastases, and bone marrow carcinomatosis.After completing a sufficient informed consent process, he received chemotherapy along with blood transfusion, and then DIC, pancytopenia, and ADL of the patient improved.However, the lack of response of pancytopenia and DIC to transfusion relapsed and his ADL worsened after the second course of chemotherapy.It was difficult to administer additional chemotherapy in the patient and he died 24 months after surgery.There is no established treatment for disseminated carcinomatosis of the bone marrow, and the prognosis of these patients without treatment is reported to be only one month.Our case with prolonged survival following chemotherapy and blood transfusion may support the clinical usefulness of chemotherapy for bone marrow carcinomatosis from esophagogastric junctional carcinoma.

We report a case of bile duct cancer with a positive surgical margin obtaining long-term survival after S-1 monotherapy. A 79-year-old male with fever and liver dysfunction was admitted to our hospital. After a series of examinations he was diagnosed as hilar cholangiocarcinoma, which was treated with bile duct resection and biliary reconstruction for adhesion and pulmonary dysfunction of tuberculosis. Histopathological findings revealed that both surgical margins of the bile duct were positive. After operation, the patient received S-1 oral monotherapy(100mg/day for 28 days, followed by 14 days of rest)for 3 years. The patient has been alive for 5 years without recurrence.

Background: The aim was to evaluate the adjuvant chemotherapy using gemcitabine (GEM) for resected pancreatic cancer., Methods: We investigated 69 patients who had undergone curative operations for pancreatic cancer. They were classified into two groups of patients using GEM (group A: 37) and patients with surgery alone (group B: 32) between 2009 and 1998. Outcomes, including disease-free survival (DFS), median survival time (MST), and adverse events were reported retrospectively. Patients assigned to the gemcitabine group received GEM at a dose of 800 mg/m² on days 1, 8 and 15, every 4 weeks for 5 cycles., Results: DFS and MST did not differ significantly between group A and group B (DFS; group A: 10. 4 vs group B 8. 0 months, MST; group A: 21. 7 vs group B 16. 3 months). The estimated overall survival rates at 3 and 5 years were 40% and 25. 7%, respectively, in group A, and 12. 9% and 12. 9% in group B. Grade 3 or 4 toxicity revealed 8.1%with leucopenia, 2. 7% with thrombocytopenia, and 2. 7% with nausea., Results: Adjuvant chemotherapy using gemcitabine for resected pancreatic cancer contributes to prolonged DFS, MST, and estimated overall survival.

We have experienced and report here a case of postoperative recurrence of colon cancer with metastases in the liver and the periaortic lymph nodes, where we attained CR through combination therapy with bevacizumab+mFOLFOX6. The patient was a male aged 65. He had already had cecal cancer, metastasis in the para-aortic lymph nodes, and multiple hepatic metastases. The surgery involved right colon resection+partial hepatectomy as well as dissection of the para-aortic and the superior mesenteric lymph nodes. The postoperative stage was SSN3H1P0M1 (#216)-pStage IV. S-1+CPT-11 was chosen as an adjuvant therapy. The para-aortic lymph nodes at the level of renal hilus were found enlarged after 17 courses of the therapy. Hence bevacizumab+mFOLFOX6 was chosen for the first-line treatment. After 14 courses of the therapy, CR was proved on the RECIST standard. On continued chemotherapy, CR has been maintained at present, 2 years and 11 months after the surgery or 10 months after confirmation of CR.

We report here two patients with chronic disseminated intravascular coagulation (chronic DIC) secondary to aortic aneurysm, who were successfully treated with continuous subcutaneous infusion of heparin. The patients were 69- and 89-year-old males, who were admitted to our hospital because of thrombocytopenia and marked bleeding tendency. The underlying conditions were aortic dissection and aortic aneurysm, respectively. Coagulation test demonstrated that these patients had DIC, and a diagnosis of chronic DIC secondary to aortic aneurysm was made. Anti-coagulation treatment with oral camostat mesylate and daily subcutaneous infusion of heparin calcium was started. However, the treatment was insufficient to control chronic DIC, and these patients developed recurrent severe subcutaneous hemorrhages. Therefore, we attempted continuous subcutaneous infusion of heparin using a mobile infusion pump. This delivery of heparin markedly improved the coagulopathy, and the hemorrhagic episode disappeared with good compliance in the use of infusion equipment in these patients. Continuous subcutaneous infusion of heparin using a mobile infusion pump is effective and useful for long term treatment of chronic DIC by the outpatient department.

A 77-year-old man with advanced esophageal carcinoma and lymph node swelling of abdomen and mediastinum, underwent neoadjuvant chemotherapy (NAC) with 5-FU/CDDP. Adverse reactions were general fatigue and nausea of grade 3 and stomatitis of grade 2. Primary tumor and lymph node swelling revealed remarkable effectiveness after 1 course of NAC, so 2 courses of NAC were given. The esophageal carcinoma was not found by endoscopy, and a biopsy specimen revealed inflammatory granulation. Lymph node on CT examination disappeared in the abdomen and reduced in the mediastinum. Because of retention of lymph node swelling, radical resection of the esophageal carcinoma was performed. Pathologic examination of the resected specimen revealed no malignant cells in the esophagus, and 3 lymph node metastases (pStage III). He had no recurrence in 15 months after the operation. Because NAC was markedly effective for primary tumor and lymph node of esophageal carcinoma, a radical operation was performed.

A 78-year-old man was admitted to our hospital complaining of dysphagea on April 8, 2005. Upper gastrointestinal endoscopic examination showed type 2 esophageal cancer in the lower thoracic area and type 3 gastric cancer in the upper body. Computed tomography showed No. 3 lymph node swelling, but no distant metastasis. Surgery was contraindicated because of many complications, so the patient was given combined chemotherapy with TS-1 and low-dose cisplatin. Chemotherapy was started on April 18. After 2 courses of chemotherapy the esophageal lesion showed a complete response, and after 5 courses the gastric lesion evidenced a complete response.

Objectives: Recently, a combined 0.014 pressure/temperature sensor-mounted guide wire has been developed to simultaneously measure fractional flow reserve and coronary flow reserve (CFR) by thermodilution (CFR-thermo). The accuracy of CFR-thermo was compared with CFR obtained by flow rate (CFR-flow) in experimental models., Methods: Using an experimental model made from a straight-rigid tube (4 mm diameter) filled with 36 degrees C water, CFR-thermo and CFR-flow were measured under different conditions of sensor position and injected water temperature (0-40 degrees C). A side branch (2 mm diameter) was then placed at 4, 6, 8 and 10 cm from the injected site just proximal to the stenosis. The degree of stenosis ranged from 0 to 75% (0%, 25%, 50%, 75%). CFR-thermo and CFR-flow were calculated from the inverse ratio of the mean transit time and the flow ratio during high flow to low flow rates., Results: Under the conditions without the side branch, there were good correlations between CFR-thermo and CFR-flow if the temperature of the injected water was under 28 degrees C and the sensor was not placed within 4 cm from the injection site. With the side branch, CFR-thermo was smaller than CFR-flow although there were good correlations between CFR-thermo and CFR-flow. The value of CFR-thermo increased with more distal positions of the side branch to the injected site., Conclusions: Temperature of the injected water, and the position of the sensor, the side branch and the stenotic lesion may influence measurements of CFR-thermo. These effects should be considered when CFR is measured by the thermodilution method.

A 59-year-old women was referred to our hospital due to severe dyspnea and shock status 12 days after intracranial hematoma evacuation for the hypertensive right putaminal hemorrhage. Transthoracic echocardiography revealed right ventricular dilatation and floating structures in the right atrium. Transesophageal echocardiography demonstrated a large, snake-like structure crossing her foramen ovale of the interatrial septum, and impending paradoxical embolism was diagnosed. She did not receive any anticoagulation and surgery due to recent cerebral hemorrhage. Follow-up TEE showed complete disappearance of the thrombus in the atrium two weeks after the onset. Phlebogram of deep vein demonstrated several thrombus in her leg. She underwent placement of inferior vena cava filter and was discharged from our hospital without any symptom of paradoxical embolism.

The color Doppler echocardiographic technique has been developed for automated cardiac flow measurement (ACM). This study evaluated the effect of imaging parameters on stroke volume measurement. Cardiac output derived from the ACM method was compared with that obtained from pulsed wave Doppler in 36 patients (26 men and 10 women, mean age 54 +/- 8 years) in whom clear two-dimensional and color Doppler images of the left ventricular outflow tract were obtained. The effects of frame rate, color gain and moving target indicator (MTI) filter on cardiac output were evaluated in 13 patients (8 men and 5 women, mean age 49 +/- 6 years). Using ACM at a frame rate of 30 Hz, optimal color gain setting and high-frequency MTI filter (cutoff frequency: 915 Hz), there was an excellent correlation in cardiac output between the ACM and pulsed wave Doppler methods (stroke volume: r = 0.91, SEE = 0.32 l/min). Using ACM at a frame rate of 30, 22 and 15 Hz, the differences in stroke volume were 4.4%, 5.2% and 8.6%, respectively. When color gain was reduced, left ventricular stroke volume reduction was 12.1% (-2 dB), 18.9% (-4 dB). In contrast, there was no significant change in stroke volume measurement when color gain was increased. There was a significant decrease in stroke volume using the low-frequency MTI filter [cutoff frequency: 467 Hz (-35.6%)] and medium-frequency MTI filter [cutoff frequency: 703 Hz (-13.4%)]. Color Doppler imaging parameters are extremely important for automated assessment of cardiac output.

Recognition of the involved lesions is extremely important in mitral valve repair for infective endocarditis. Transesophageal echocardiography (TEE) is more sensitive for the detection of lesions than transthoracic echocardiography, but localization of the lesions is sometimes difficult by TEE. Three-dimensional (3D) TEE provides images of the mitral valve similar to the view from the left atrium. This study evaluated the value of 3D echocardiography for the diagnosis of involved lesions in 12 patients who underwent surgery for mitral regurgitation due to infective endocarditis. The location of the lesion in the mitral valve was classified as the medial, central and lateral portions of the anterior leaflet, and the medial, middle and lateral scallops of the posterior leaflet, respectively. In all patients, the involved sites were confirmed at operation. The sensitivities of 3D TEE for detecting the lesions at the medial, central and lateral portions of the anterior leaflet, and the medial, middle and lateral scallops of the posterior leaflet were 100%, 78% and 67%, and 100%, 100% and 100%, respectively. The specificities were 90%, 100% and 78%, and 100%, 100% and 100%, respectively. The lesions diagnosed by 3D TEE coincided with lesions confirmed at operation in 23 (92%) of 25 lesions. 3D TEE is useful for the assessment of the involved lesion of the mitral valve in patients with infective endocarditis.

Abnormal coronary flow pattern and coronary vasodilator reserve have been identified in patients with hypertrophic cardiomyopathy (HCM) using invasive techniques. The characteristics of coronary flow velocity and coronary flow reserve were evaluated by noninvasive-recording of coronary flow velocity in the distal portion of the left anterior descending coronary artery in 7 patients with HCM and 7 normal subjects using transthoracic color Doppler echocardiography. Coronary flow velocity was measured at rest and during intravenous infusion of adenosine triphosphate (0.15 mg/kg/min). Diastolic peak velocity, diastolic mean velocity, the time from the beginning of diastole to peak velocity (TVP) and velocity half time from peak velocity was measured in each group. Coronary flow reserve was obtained as the ratio of hyperemic mean velocity to resting mean velocity. TVP was significantly prolonged in the patients with HCM compared with the normal subjects (159 +/- 38 vs 103 +/- 54 msec, p < 0.05). Velocity half time was significantly shorter in the patients with HCM compared with the normal subjects (304 +/- 138 vs 451 +/- 109 msec, p < 0.05). Although diastolic mean velocity during hyperemia was not different between the 2 groups (62 +/- 8 vs 70 +/- 19 cm/sec), diastolic mean velocity at rest was significantly higher in the patients with HCM than in the normal subjects (39 +/- 6 vs 26 +/- 7 cm/sec, p < 0.01). Therefore, coronary flow reserve was significantly lower in the patients with HCM than in the normal subjects (1.6 +/- 0.4 vs 2.7 +/- 0.4, p < 0.001). There was a good correlation between diastolic mean velocity and the ratio of interventricular septal to posterior left ventricular wall thickness (y = 0.024x + 0.46, r = 0.75). Transthoracic assessment of coronary flow velocity using color Doppler echocardiography reveals that coronary flow reserve is reduced in patients with HCM because of increased baseline resting diastolic mean velocity.

Recently, automated cardiac flow measurement (ACM) has been developed for measuring the volume flow rate of blood flow through the left ventricular outflow tract. Measurements of left ventricular cardiac output by the ACM method were compared with those by the thermal dilution method with a Swan-Ganz catheter in 27 patients (16 men and 11 women; aged 44 +/- 3 years) in whom clear two-dimensional and color Doppler images of the left ventricular outflow tract were obtained. The total time required for left ventricular stroke volume calculation by both ACM and pulsed Doppler methods was measured in 10 patients (six men and four women; aged 41 +/- 2 years). There was an excellent correlation in the measurements of cardiac output between the ACM and thermal dilution methods (y = 0.77x + 0.77, r = 0.84, SEE = 0.4 l/min). The total time required for left ventricular stroke volume calculation by the ACM method was significantly shorter than that by the pulsed Doppler method (92 +/- 10 vs 177 +/- 30 sec, p < 0.01). The ACM method is simple, quick, and accurate for the automated assessment of cardiac output.

The usefulness of three-dimensional echocardiography using intravascular ultrasound (3D-IVUS) for the measurement of plaque volume was evaluated by comparing plaque volume derived from 3D-IVUS with that directly measured in 10 autopsied iliac or femoral plaque models (5-15 mm long). Using IVUS (3.5 F, 30 MHz), sequential cross-sectional images for three-dimensional datasets were acquired with a motorized catheter pullback device connected to the three-dimensional reconstruction system. Three-dimensional reconstruction was performed from the sum of the two-dimensional cross-sectional views. Plaque volumes were calculated using a summation of disks algorithm based on the reconstructed multiple short-axis cross-sections from the three-dimensional data. Three-dimensional IVUS demonstrated a good correlation with direct measurement of plaque volume (y = 0.71x + 0.001, r = 0.80, SEE = 0.003 ml), so is useful for the measurement of plaque volumes in the experimental models.

Noninvasive assessment of the distal left anterior descending coronary artery and intramyocardial blood flow were attempted in 50 consecutive patients (28 males and 22 females, mean age [+/-SD] 58 +/- 12 years) using a 7.5 MHz transducer (Doppler frequency: 5 MHz) and a SSA-380A ultrasound digital system with special optimal settings for the color Doppler examination. Modified apical acoustic windows were used to visualize the blood flow in the distal left anterior descending coronary artery and the intramyocardial artery. By selecting a sample volume (2 mm wide) on the color trace of these blood flows, Doppler spectral tracing of the distal left anterior descending coronary artery and intramyocardial blood flows could be recorded using pulsed-wave Doppler system. Blood flow in the distal left anterior descending coronary artery was detected in 43 (86%, Vmax = 22 +/- 8.7 cm/sec, Vmean = 16 +/- 5.1 cm/sec) of 50 patients, and intramyocardial blood flow in 40 (80%, Vmax = 26 +/- 11.0 cm/sec, Vmean = 19 +/- 8.5 cm/sec) of 50 patients. Distal left anterior descending coronary artery and the intramyocardial blood flows can be imaged by transthoracic digital color Doppler echocardiography in the clinical setting.

The role of bacteria isolated from patients with urinary tract infection (UTI) was studied with a view to the possibility that such bacteria are an etiological factor in the development of bladder cancer. The bacterial strains of Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Serratia marcescens, Staphylococcus epidermidis and Enterococcus faecalis, isolated from patients with UTI at the Kyushu University Hospital, were tested for their nitrate-reducing activity after 1 hr of incubation with sodium nitrate (3.57 mM) in a growth medium (pH 7.2) at 37 degrees C. Of 35 strains tested, 27 strains (77%) showed the ability to reduce nitrate to nitrite with yields ranging from 2 to 310 microM NO2-/hr/10(7) bacterial cells, but in 8 strains (23%) including all the 7 strains of E. faecalis no elevated activity (0.0-0.3 microM) could be detected. Various kinetic profiles were observed for the nitrate-reducing bacteria, at various rate ranging from rapidly to slowly, during 5 hr of incubation. The effect of nitrate-reducing bacteria on mutagen formation in the human urine was examined. The mutagenic activity of smokers' or non-smokers' urine incubated with or without bacteria for 72 hr at 37 degrees C was assayed by the Ames Salmonella/microsome test (using TA100 or TA98 with S9-mix). The mutagenic activity increased in urine incubated with the nitrate-reducing S. marcescens or P. aeruginosa, compared to controls which were incubated without bacteria. Potent mutagenic activity could be induced when the urine concentrate prepared from smokers' urine with an XAD-2 resin column was incubated with sodium nitrite (40 mM) at pH 3 for 4 hrs. The potent mutagenic activity observed here seems to be due to the class of direct-acting mutagen(s), because no metabolic activation was required. The mutagen formation at an optimal pH 4 proceeded rapidly during 4 hrs of incubation, but decreased thereafter. It was noted that even at a physiological pH 6 of human urine, a lower but significant level of mutagenic activity could still be detected. The mutagenic activity of individual urine concentrate from 14 male smokers and from 6 male non-smokers was assayed after 30 min of incubation with or without sodium nitrite (40 mM) at pH 6. Mutagenic activity increased in most of these urine concentrates incubated with sodium nitrite. The levels were variable between individuals with a 1.3- to 53-fold increase compared with the controls incubated without sodium nitrite.(ABSTRACT TRUNCATED AT 400 WORDS)

The incidence of bacteriuria in patients with benign prostatic hypertrophy was studied at 8 National Hospitals. Among 1,542 patients, urinary infection was the reason of visit in 63 patients (4.1%). After open and transurethral prostatectomy, one-third of patients developed bacteriuria (30 of 59 subcapsular enucleations, and 252 of 776 transurethral resections). When a catheter is placed without prophylactic antimicrobial, all patients developed bacteriuria within 10 days, and within 30 days even if they received antimicrobials. The incidence of bacteriuria increased with age.

We investigated the effects of intramyocardial acidosis on cardiac function during hypoxia in mongrel dogs (n = 50). Intramyocardial pH in subendocardium of left ventricle was measured continuously using a pH electrode. During hypoxia (PaO2 = 20 mmHg) caused by inhalation of low oxygen fraction, intramyocardial pH decreased significantly following initial enhancement. Intramyocardial pH correlated significantly with arterial pH, base excess, lactic acid (LA) levels, coronary venous PcO2, and coronary venous-arterial PcO2 difference. There were significant correlations between intramyocardial pH with maximum rate of rise of left ventricular pressure (LV dp/dt max), left ventricular end-diastolic pressure (LVEDP), LVEDP/LVP and the time constant of exponential isovolumic left ventricular pressure fall. High arterial LA levels tended to cease myocardial LA uptake and production, turning LA balance into zero. LV dp/dt max was low in such a condition. Myocardial LA production decreased intramyocardial pH, but LV dp/dt max was maintained at high levels of LA production. These observations suggest that myocardial LA production maintains left ventricular function with the increase of ATP by acceleration of anaerobic glycolysis. In conclusion, during hypoxia, intramyocardial acidosis was caused by the increase of arterial LA level, myocardial anaerobic glycolysis and ATP breakdown, and it worsened left ventricular contractile function and relaxation. Arterial LA levels can play a major part in intramyocardial acidosis, but the increase in myocardial LA production might be beneficial to left ventricular contractile function.

A mass screening for prostatic cancer was conducted in Hisayama town, Fukuoka Prefecture, Japan from 1988 to 1989. As the primary screening questionnaire survey about urination and measurement of serum prostate specific antigen (PSA) were performed in 789 of the 1025 male residents over 50 years old (77.0%). For the second screening with digital rectal examination and transrectal ultrasonography, 184 subjects (23.3%) were picked up. Prostatic cancer was suspected in 33 (4.2%) of the 134 subjects who actually underwent the second screening examination. Prostatic biopsy and other examinations such as measurement of prostatic acid phosphatase and gamma-seminoprotein, urinalysis and radiographic examination were performed in 26 as the third screening, and prostatic cancer was detected in 5 (0.63%); 3 in stage B and 2 in stage C. Four of the 5 subjects with prostatic cancer had complained no urinary symptoms on questionnaire. Serum PSA was useful for detecting early stage prostatic cancer.