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Purpose: To identify the countermeasures and current status of disaster power outages in the radiology departments of hospitals., Methods: A web-based questionnaire survey of 600 hospitals nationwide was conducted. The questionnaire survey covered 34 items, including availability of power in the radiology department in the event of a disaster and the impact of power outages on medical equipment in the radiology department., Results: In all, 242 facilities (40.3%) responded to our survey. During power outages, 55.8%-68.2% of facilities were able to use CT, digital radiography, and angiography systems with their private generators. In 28.1%-40.7% of facilities, medical information systems were not available in all laboratories. In addition, power outages caused equipment malfunctions in 81.4% of facilities' radiology departments., Conclusion: We have identified the power supplied by private generators to the radiology department's medical equipment and medical information systems. Many medical equipment have malfunctioned due to power outages. Therefore, drills should be conducted to simulate various situations caused by power outages.

Purpose: X-ray CT examinations are required not only in routine medical examinations but also in various situations such as emergency medical care. Although medical staff may be exposed to radiation when assisting patients, the distribution of air-absorbed doses in the CT examination room when using a special protective shield for CT has not been clarified. Here, we measured air-absorbed doses at several points simultaneously to clarify the distribution of these doses and the effect of a special protective shield for CT in reducing them., Method: A human phantom was imaged with an X-ray CT system. The absorbed dose in the air dose profile distribution was measured with an OSL dosimeter in the presence and absence of a special protective shield for CT., Results: The highest air absorbed doses of 4.27 mGy were at 0 cm in the horizontal direction, 120 cm in the vertical direction, and 50 cm in the body axis direction. The largest reduction in air absorbed dose following installation of the special protective shield for CT was 91.7%, obtained at 0 cm in the horizontal direction, 150 cm in the vertical direction, and 50 cm in the body axis direction., Conclusion: A 91.7% reduction in air-absorbed dose was o directly behind the special protective shield for CT. The reduction in air-absorbed dose was 65.8% at the location of a gap between the special protective shield for CT and gantry.

A 71-year-old man with a history of hoarseness and right upper extremity numbness was referred to our department for evaluation of an intrathoracic mass that was detected on chest radiography and a right kidney tumor observed on computed tomography (CT). Histopathological examination of percutaneous kidney biopsy and bronchoscopic lung biopsy specimens revealed renal clear cell carcinoma with multiple lung metastases. The patient showed a poor risk based on the International Metastatic renal cell carcinoma Database Consortium score, and nivolumab plus ipilimumab were initiated as first-line therapy. His symptoms gradually improved, following four courses of nivolumab plus ipilimumab treatment, and CT revealed shrinkage of all lesions. However, he developed diarrhea, rash, anemia, and elevated serum C-reactive protein levels (CRP) following this therapy. Diarrhea and rash were considered immune-related adverse events, and he was treated with oral prednisolone and topical corticosteroid. Nivolumab administration was discontinued because anemia worsened together with elevated serum CRP levels despite improvement in diarrhea. He subsequently developed constipation and abdominal bloating, following further treatment for 4 months. CT revealed intestinal tumor-induced intussusception, necessitating partial resection of the small intestinal tumor, which was histopathologically diagnosed as metastases. Both anemia and elevated CRP improved postoperatively. Currently, all metastatic lesions other than the resected intestine have continued to respond to treatment over 12 months after initiation of nivolumab plus ipilimumab therapy.

Purpose: Using a pediatric head phantom constructed in our department, we examined a method to reduce exposure by using organ-effective modulation (OEM; Toshiba Medical Systems Corporation, Tochigi) to tilt the gantry during pediatric head computed tomography (CT) scanning., Method: The radiation reduction and CT image standard deviation (SD) were measured at gantry angles at which the orbit was slightly irradiated, partially irradiated, and completely irradiated. The OEM incident surface dose reduction rate was measured using an automatic exposure control (AEC) phantom with a diameter of 6-18 cm., Results: The lens surface dose reduction rate using OEM was 21.2%. When the gantry was tilted and the orbit was completely out of the scanning range, the rate of reduction was 47.8%. OEM incident surface dose reduction rates were 27.4% for a phantom diameter of 18 cm, 22.0% for that of 16 cm, 17.8% for that of 14 cm, 17.2% for that of 12 cm, 8.4% for that of 10 cm, and 0% for that of 8 cm and 6 cm. OEM effectiveness decreased with decreasing phantom diameter. The use of OEM increased the rate of change of SD by 1.25´ when the gantry inclination was 0°, 1.27´ when the gantry inclination was 10°, and 1.27´ when the gantry inclination was 20°in the 12 o'clock position., Conclusion: The degree of reduction in exposure dose to the lens in pediatric head CT imaging was 47.8% by completely removing the lens from the irradiation range using gantry tilt and 21.2% by using OEM. The effect of OEM changed in proportion to tube current. The exposure reduction effect of the OEM decreases with decreasing head size, indicating its reduced effectiveness in head CT scans of smaller infants.

A 76-year-old woman presented with a left chest ulcer. Computed tomography (CT) showed a 9-cm-sized invasive mass with ulceration in the left breast, along with regional lymph node and distant metastases, and a 4-cm-sized tumor at the upper pole of the left kidney. Needle biopsy of the left breast tumor was performed, and she was diagnosed with breast cancer, cT4cN3M1, Stage IV. She underwent endocrine therapy and chemotherapy. After undergoing treatment for 2 years, CT showed no progression in the primary and metastatic lesions except for increasing renal mass. Primary kidney cancer was suspected, and she underwent laparoscopic nephrectomy. In the surgical specimen, a solid, brown-colored nodule was observed in the upper pole of the left kidney. The pathological diagnosis was clear cell renal cell carcinoma, including a metastatic lesion of breast cancer. She was diagnosed with tumor-to-tumor metastasis of breast cancer within renal cell carcinoma. Two years after the surgery, no recurrence of renal cell carcinoma has been observed, and she is undergoing secondary endocrine therapy against breast cancer.

We present a case of renal cell carcinoma growing into the renal pelvis with a fibrin cap in the ureter and bladder. A 66-year-old man presented to our hospital with anemia and gross hematuria. Computed tomography showed a large left renal tumor and space-occupying lesions in the left renal pelvis and ureter. Cystoscopy showed a 2 cm-restiform mass protruding from the left ureteral orifice. We performed open left nephroureterectomy, and there was a 3 cm white mass with a smooth surface in the bladder. Pathological examination of the resected mass revealed clear cell carcinoma with urinary collecting system invasion and fibrin cap in the ureter and bladder. As a result, it would have been difficult to make the diagnossis of renal cell carcinoma preoperatively if we had performed biopsy of the mass in the bladder or ureter. The patient was diagnosed as having lung metastases 5 months after surgery. Urinary collecting system invasion has been considered an independent prognostic factor in pT3 renal cell carcinoma.

Testicular nodules are occasionally palpable in patients with acute epididymitis. In these patients, we need to rule out testicular tumors. Advancement in imaging technology such as doppler ultrasound or magnetic resonance imaging (MRI) has enabled us to distinguish segmental testicular infarction from testicular tumor and refrain from orchiectomy. However, careful diagnosis is necessary and we should not hesitate to perform orchiectomy in case testicular tumor is not ruled out. Since segmental testicular infarction in the presence of epididymitis may occur, we should consider the disease in a case of hard testis in the presence of epididymitis. Herein we report a rare case of segmental testicular infarction after epididymitis, in which testicular tumor was difficult to rule out.

In 2014, Japanese Ministry of Health, Labour and Welfare published the guideline on the policy of the psychiatric hospitals. We executed a survey to the members of "The Japanese Society of Psychiatry and Neurology" about the impression of this guideline, especially about "The functional differentiation of psychiatric hospital beds". Nine questions were notified on the home page of the society. 862 answers (5.3% of the members) were corrected by website from 1st to 30th of May in 2015. Attribution of the answers : doctors working at the psychiatric hospitals (70.9%), the psychiatric clinics (20%), the others (9.1%). The questions which more than 80% of the answers agreed were "The reduction of the psychiatric beds should be stepwise under the rule of check & balance in the improvement of the psychiatric community treatment", "Improve the function of the recovery phase treatment" and "The adequate treat- ment for the patients of the severe and chronic phases". The questions more than 55% of the answers agreed were "The reduction of the chronic phase beds for the improvement of the function of the acute phase beds". The questions which opposites exceeded (almost 47%) were "The assessment of the psychiatric symptoms in the patients of the chronic phase should be done by the third party" and "The facility for social skill treatment should be placed in the community". We could know the mind of the members about the revolution of the psychiatric.

A 55-year-old man was referred to our hospital because of a tumor in his right kidney. A Fluorodeoxyglucose-positron emission tomography (PET)/computed tomography (CT) scan revealed strong abnormal uptake by the tumor in the right kidney and a nodule in the right lung. The patient was diagnosed with stage IV renal cell cancer, for which he underwent transperitoneal nephrectomy. Pathological diagnosis revealed the tumor to be a renal cell carcinoma (clear cell carcinoma, G2, pT3a, v (+), INF-β). Sunitinib was administered because of the occurrence of multiple lung metastases; however, the therapeutic effect was insufficient, and progressive disease was observed on a CT scan. Therefore, everolimus was immediately administered as a second-line therapeutic agent. After treatment, the lung metastases reduced in size, as observed on a CT scan, and partial response continued for 1 year after therapy. One metastatic lesion persisted in the right lung; therefore, he underwent right upper lobe resection after discontinuing everolimus administration. No viable tumor cells were observed on pathological diagnosis, and the patient achieved pathological complete response. 3 month after discontinuing everolimus administration, no metastatic lesions have been observed.

A 77-year-old female was indicated pelvic mass and hydronephrosis when her examination of advanced gastric cancer. Computed tomography revealed left ureteral dilatation and mass around the left ureter. Laparotomy biopsy was abandoned because of her low cardiac function. Thereafter, hemorrhagic stool was observed and colonoscopy revealed hemorrhagic mucosal protrusion at sigmoid colon. This lesion was diagnosed as squamous cell carcinoma by pathology of biopsy specimen. Colonic invasion of other organ carcinoma was suspected by colonoscopic findings. Retrograde pyelogram revealed a defect of left lower ureter. Positron emission tomography revealed the mass excluding sigmoid colon and high value (SUV max was 10.3) at the mass. Therefore, it was diagnosed invasive ureteral squamous cell carcinoma and she was treated with 2 cycles of combination chemotherapy consisting of gemcitabine (800 mg/m2: day 1 and 8) and nedaplatin (60 mg/m2: day 1). During the chemotherapy, only cytopenia (grade 4: CTCAE guidelines) was observed. About 4 months after 2 courses of chemotherapy, the tumor size was reduced by almost 100% (CR; RECIST guidelines). Thereafter, recurrence of pelvic mass was not observed.

A 67-year-old woman with a diabetic renal failure was scheduled for a living kidney transplantation. Heparin was first used during hemodialysis 5 days before operation. Thrombocytopenia was found immediately after induction of general anesthesia, and the diagnosis of HIT was wade based on clinical symptom and 4 T's scoring. The surgery was continued because of the progress of donor surgery. Argatoroban was administered based on APTT measurement as an anticoagulation therapy during and after the operation. Although deep vein thrombosis was found 13 days after the operation, the transplanted kidney was established successfully. It is necessary to take a great caution in HIT development after heparin use.

We report a case of drug-induced pneumomediastinum by bleomycin in testicular cancer, which is extremely rare ; to our knowledge, only 3 cases have been reported. A 28-year-old man presented with a left testicular mass. He underwent radical left inguinal orchiectomy that demonstrated a seminoma, pT3N0M0. Ten months after surgery, para-aortic lymph node metastasis appeared, and he received three cycles of bleomycin, etoposide and cisplatin (BEP) chemotherapy. On day 13 of the fourth course of BEP, he complained of snowball crepitation of the neck and computed tomography revealed subcutaneous emphysema, extensive mediastinal air, and intraspinal air accumulation without pneumothorax. The pneumomediastinum and subcutaneous emphysema tended to deteriorate until 15 days after the onset of pneumomediastinum, but fortunately he had no signs or symptoms of infection. These findings resolved spontaneously after 1 month.

We evaluated clinical outcomes of radical prostatectomy in 244 patients who had undergone radical prostatectomy as initial treatment from January 2000 to December 2011, and were followed up for more than 6 months. Biochemical recurrence after prostatectomy was defined as prostate-specific antigen (PSA) level of at least 0. 2 ng/ml. We evaluated potential risk factors for significant associations with biochemical recurrence. Median follow-up period after prostatectomy was 49 months (range, 6-144). Of the total, 192, 31, and 20 patients were at pathological stage pT2, pT3a, and pT3b, respectively. In 83 patients with the positive surgical margin, apexes were mostly in the positive area. Of the 68 patients with PSA recurrence, PSA non-relapse rate was 66.6% for 5 years. Multivariate analysis was performed for seminal vesicle invasion, PSA nadir, surgical margins, and Gleason score. Thirty-two patients with PSA recurrence underwent salvage radiotherapy, and the biochemical recurrence rate at 5 years was 73.8%. The group in which the PSA level before salvage radiotherapy was ＜0.5 ng/ml had a low rate of biochemical recurrence. We must consider the recurrence of poorly differentiated or non-confined cancer after radical prostatectomy. These results suggest that early use of salvage radiotherapy is effective for patients with biochemical recurrence after radical prostatectomy.

In Japan, the involuntary outpatient treatment system like the Community Treatment Order is defined only in the Medical Treatment and Supervision Act 2005. However, in our outreach approach activities in the community, our treatment may seem to be involuntary intervention for some patients, and, occasionally, we actually have to perform involuntary intervention in certain cases. Some patients do not even agree with our visit, and some agree with our visit but not with medication. Some patients do not take medication in spite of their agreement In this paper, I introduce some cases of our outreach approach activities and discuss the merit and demerit of involuntary intervention in community psychiatric care. The involuntary hospitalization system is being assessed, but involuntary intervention with an outreach approach has not been assessed or discussed well so far. We should discuss and try to develop rules for involuntary psychiatric intervention with an outreach approach.

Angiosarcoma is rare and highly malignant vascular neoplasm, and primary retroperitoneal angiosarcoma is extremely rare. Preoperative diagnosis is very difficult because there are no specific imaging features, and definitively effective treatment has not yet been established. We recently treated a patient with primary retroperitoneal angiosarcoma in which a prompt and exact diagnosis was difficult to obtain. One month after surgery, local recurrence appeared, but salvage immunotherapy using recombinant interleukin-2 (rIL-2) showed good efficacy, and the patient obtained complete response. Here we report this rare case of angiosarcoma. A 60-year-old woman with abdominal pain was diagnosed with a left retroperitoneal mass on CT scan. The tumor was about 9 cm in diameter and positioned above the left kidney. Further study using MRI, 131I-MIBG scintigraphy, and enhanced CT suggested chronic expanding hematoma and the patient underwent surgical resection. Histopathological diagnosis was primary retroperitoneal angiosarcoma based on positive staining for VIII factor, CD31, CD34, and p53. One month after surgery, FDG-PET revealed local recurrence adjacent to the psoas major. We initiated salvage immunotherapy using rIL-2. The patient was treated effectively and achieved complete response. She is alive and well 19 months after surgery and rIL-2 treatment.

We retrospectively reviewed 9 patients with squamous cell carcinoma of the penis who were treated with penis preservation between April 1988 and January 2008. Six patients had recurrence and 4 patients died of cancer. Patients treated with penis preservation had a significantly higher. Future studies are needed on a larger number of cases.

An 81-year-old male with hormone refractory prostate cancer, received chemotherapy of Docetaxel, Estramustine and dexamethasone as an outpatient. After 4 courses of chemotherapy, he was admitted to our hospital in December 2007 because of general fatigue, appetite loss and erythema of the back of hands and face. He was diagnosed with pellagra. Nicotinic acid was administered and the symptoms disappeared. An 80-year-old male with hormone refractory prostate cancer, received chemotherapy of Docetaxel, Estramustine and dexamethasone without admission. After 8 courses of the chemotherapy, appetite loss appeared. In January 2008, medical examinations revealed nails peeling off, facial erythema and erosion of the back of his hands. He was diagnosed with pellagra. Nicotinic acid was administered and the symptoms disappeared. Pellagra, a nicotinic acid deficiency disease, is rarely observed clinically nowadays. However, it may occur in the patients, undergoing chemotherapy without admission.

Theoretically, sciatic nerve block can be used alone or in combination with lumbar plexus block or femoral nerve block for anesthesia and/or analgesia of lower limb surgery. However, clinical use of sciatic nerve block was limited by technical difficulties in performing the block since techniques used relies only on surface anatomical landmarks. Recent advances in ultrasound technology allow direct visualization of nerves and other surrounding structures and have increased the interest in performing many kinds of peripheral nerve blocks including sciatic nerve block. Preliminary data suggest that ultrasound-guided technique can help perform the sciatic nerve block more reliably and safely. In this article we describe the anatomy of the sciatic nerve, sonographic features, and technique of three major approaches including subgluteal, anterior, and popliteal approaches. The use of this technique for postoperative analgesia is also discussed.

A 41-year-old man was referred to our hospital for a left renal mass detected by screening computed tomography for hypertension. He had undergone surgery for left pheochromocytoma at 16 years of age in 1981, and the last follow-up was in 1986. Although a 131I-metaiodebenzylguanidine (MIBG) scintigram did not show abnormal uptake, elevated levels of serum cathecholamines were demonstrated. The left renal mass positioned in the upper pole and inside of the kidney had invaded the pancreas, colon and spleen. Surgical resection was done under a diagnosis of recurrent pheochromocytoma, and the tumor was removed with other organs, including normal left adrenal gland that was confirmed histologically. Histologically and immunohistochemically, the resectioned tumor was invasive malignant paraganglioma and diagnosed as the local recurrence or metastasis of previously resectioned retroperitoneal paraganglioma, which was believed to have grown slowly.

A 66-year-old man visited our hospital complaining of a high prostate-specific antigen (PSA) (6.9 ng/ml) and dysuria. Prostatic needle biopsies revealed no malignancy in January 1998 and February 1999 (PSA 8.0 ng/ml). Transurethral resection of prostate (TURP) was performed in March 1999. Although none of the TURP specimen showed any malignancy, the PSA level remained high (3.7 ng/ml 1 year after the TURP), and gradually increased. About 3 years later, re-biopsy was done (PSA 13.2 ng/ml) and pathological finding was moderately differentiated adenocarcinoma (Gleason score 3 + 3 = 6). After 9-month MAB, radical prostatectomy (RP) was performed in January 2003 (PSA 4.2 ng/ml). Though the RP specimen showed moderately differentiated adenocarcinoma with negative capsule penetration and negative surgical margins, PSA decreased to 2.5 ng/ml and gradually increased. Computed tomography (CT), magnetic resonance imaging (MRI), and bone scintigraphy showed neither distant metastasis nor local recurrence. Review of the RP specimen revealed ductal carcinoma with positive capsular penetration and suspicion of positive surgical margins. Although the patient was treated with maximum androgen blockade, diethylstilbestrol diphosphate, and tegafururacil, PSA gradually increased and was kept at a high level (5-6 ng/ml). In December 2005, the patient complained of anal pain and MRI showed a 4.8 x 2.3 cm tumor in the prostatic bed. Needle biopsy of the tumor revealed ductal carcinoma (PSA 6.39 ng/ml). In January 2006 (PSA 11.9 ng/ml), we initiated a treatment with 66 Gy of intensity modulated radiation therapy. In November 2006, PSA decreased to 0.279 ng/ml, and the tumor reduced (3.8 x 1.0 cm) on MRI.

A 13-year-old boy with [SLL] single left ventricle first underwent ventricular septation using a dacron patch at 3 years of age. Eight years after the first surgery, he presented with general fatigue on exertion as the chief complaint. Right-sided atrioventricular valve regurgitation, and dilatation of the right heart were diagnosed. Eleven years after surgery, right heart failure was uncontrollable by medicine, and 2nd surgery was performed. At operation, the right-sided heart valve leaflet was tightly adherent to the dacron septation patch, and valve plasty was judged impossible. We repaired the right-sided atrioventricular valve using an autologous pericardial valve leaflet and sub-valvular tissue. The postoperative course was uneventful, and he has been free from any complication for 33 months.

We report a case of a 28-year-old female who underwent an extracardiac Fontan procedure. The subject was diagnosed as an atrioventricular septal defect (Rastelli classification: type C), a double outlet right ventricle, pulmonary artery stenosis, a hypoplasty of left ventricle, total anomalous venous return (Darling: Ib + IIb), and atrial flutter. She underwent a Blalock shunt and an aorto-pulmonary shunt at the ages of 3 and 9 years, respectively. Under a total CPB, an extracardiac total cavo-pulmonary connection (TCPC), using a 26 mm Hemashield graft, was completed. The postoperative course was uneventful. The complicated atrial anatomy and atrial arrhythmia indicated TCPC in this adult patient.

A two-year-old girl with supravalvular mitral ring successfully underwent the excision of the ring. The preoperative echocardiogram showed supravalvular mitral ring and almost normal mitral leaflets. We paid attention not to injury mitral valve at the excision of the ring because supravalvular mitral ring adhered to the mitral valve.

A late phase II clinical study of RP56976 (docetaxel) in patients with advanced or recurrent gastric cancer was performed to evaluate the anti-tumor activity and clinical toxicity as a multicenter cooperative trial. Docetaxel was administered intravenously at a dose of 60 mg/m2 every 3-4 weeks. Of 72 patients enrolled, 63 patients were eligible and 59 patients were evaluable for response. The anti-tumor effects obtained complete response (CR) in one patient partial response (PR) in 13, minor response (MR) in 3, no change (NC) in 20, and progressing disease (PD) in 22 patients. The overall response rate in 59 patients was 23.7% (14/59). For 14 CR or PR cases, a response appeared 10 to 107 days (median 33.5 days) and 1 to 8 (median 2) times of dosing after the initial administration. The response rate was 9.5% in the primary tumor, 31.3% livers, 50.0% abdominal tumor, and 24.1% lymph nodes, respectively. The major adverse reactions were gastrointestinal symptoms including nausea/vomiting, anorexia, fatigue, alopecia and fever. Leukocytopenia and neutrocytopenia were also observed with a high incidence, but they recovered after 8 days from the nadir. The results show that docetaxel is an effective anti-tumor agent for advanced or recurrent gastric cancer. It is necessary to conduct another clinical trial by concomitant administration with other anti-tumor agents.

A late phase II clinical study of RP56976 (docetaxel) was conducted in patients with advanced/recurrent gastric cancer as a multicenter cooperative trial. Docetaxel was administered intravenously at a dose of 60 mg/m2 every 3-4 weeks. Of the 76 patients enrolled, 66 patients were eligible and 59 patients were evaluable for response. One patient showed complete response (CR), 13 patients partial response (PR), 1 patient minor response (MR), 19 patients no change (NC) and 25 patients had progressive disease (PD). The overall response rate in 59 evaluable patients was 23.7% (95% CI = 13.6-36.6%). The primary tumor showed a 4.3% (1/23) response, while the metastatic lesions in the abdomen, pelvic mass, lung, liver, and lymph nodes showed response rates of 62.5% (5/8), 33.3% (1/3), 33.3% (1/3), 14.8% (4/27), and 13.9% (5/26), respectively. About hematological toxicity, severe (Grade 3 or more) leukopenia was observed in 36 patients (56.3%) and neutropenia in 52 patients (81.3%). Other major toxicity (Grade 3 or more) included nausea/vomiting in 11 patients (17.2%), anorexia in 9 patients (14.1%), fatigue in 5 patients (7.8%), and alopecia in 7 patients (10.9%), all which were tolerable. The results show that docetaxel is an effective anticancer agent for advanced/recurrent gastric cancer.

An early phase II clinical study of S-1 in patients with advanced or recurrent breast cancer was undertaken by a cooperative study group (Breast Cancer Working Group) of 14 institutes in Japan. S-1 was administered twice daily at 75 or 50 mg (dose FT)/body for 28 consecutive days with 14 days rest (one course). Twenty-eight patients were enrolled, 27 were eligible for the study, and 25 were evaluable for efficacy. Four complete responses and seven partial responses were obtained, and the response rate was 40.7% (11/27) [ninety percent confidence interval for this response was 26.7-56.4%]. The major adverse reactions observed were myelosuppression represented by leukopenia 44.4% (12/27), neutropenia 40.7% (11/27), RBC decreased 37.0% (10/27), hemoglobin decreased 29.6% (8/27), anorexia 55.6% (15/27), nausea/vomiting 48.1% (13/27), and fatigue 33.3% (13/27). The results suggested that the efficacy and safety of S-1 were effective against advanced or recurrent breast cancer. The objective of study judged should be investigated in a late phase II clinical study.

The inhibitory effects of GG032X tablets, a new dosage form (fast dispersing tablet) of ondansetron, 5-HT2 receptor antagonist, on nausea and emesis induced by cisplatin (CDDP), were investigated along with safety and usefulness. Subjects were chemotherapy patients starting CDDP administration for the first time, who were receiving a high single dose of CDDP (50 mg/m2 or more and intravenous drip infusion of less than 4 hours), or lower multiple doses of CDDP (a single dose of 10 mg/m2 or more, administered intravenously for 3-5 consecutive days). GG032X tablets were administered orally 1-2 hours before CDDP administration. In lower multiple doses of CDDP, GG032X tablets and CDDP were administered, as much as possible, at the same respective time when they were administered on the first day. Efficacy of GG032X tablets was evaluated in terms of inhibitory effect on nausea and emesis 24 hours after administration of a high single dose of CDDP, and of the inhibitory effect on nausea and emesis during the study period (3-5 days) in lower multiple doses of CDDP. Efficacy, safety and usefulness were evaluated in accordance with the evaluation criteria used in the clinical study of already-approved ondanstron tablets. In a high single dose of CDDP, the cases judged "effective" or better in the investigation of the inhibitory effect of the drug on nausea and emesis, accounted for 52.9% (63/119 cases). As for the overall safety rating, the cases judged as "safe" accounted for 87.0% (107/123 cases), and as a "minor safety problem" accounted for 13.0% (16/123 cases). As for the usefulness rating, the cases judged "useful" or better accounted for 52.1% (62/119 cases). Major adverse effects included headache, fever, atrial fibrillation and increases in total bilirubin, GOT and GPT values. None of these was serious, and the patients recovered without any treatment or by nosotropic therapy. Meanwhile, in lower multiple doses of CDDP, the inhibitory effect judged "effective" or better accounted for 70.6% (12/17 cases). As for the overall safety rating, all cases were judged "safe". In terms of usefulness, those cases judged "useful" or better accounted for 70.6% (12/17 cases). No adverse effect was observed. Study results of these two groups were almost the same as those for already-approved ondansetron tablets. According to the results of questionnaires for the patients who participated in the study and took GG032X tablets, the drug was found to be easy to take and had favorable results. Based on the above results, GG032X tablets were evaluated as having the same inhibitory effect as the already-approved ondansetron tablets against CDDP-induced nausea and emesis, and were considered safe and clinically useful.

Cyclophosphamide is one of the alkylating agents and is a masked from compound. Combination chemotherapy with CMF or CAF has been commonly used as a first-line chemotherapy for recurrent and advanced breast cancer. The clinical efficacy of CMF chemotherapy (CPA + MTX + 5-FU) was evaluated on advanced and recurrent breast cancer. It is considered to be one of the most useful treatments. CAF chemotherapy (CPA + ADM + 5-FU) is also thought to be effective against breast cancers.

A multicentral cooperative study was conducted to evaluate the clinical efficacy and toxicity of l-Leucovorin (l-LV) and 5-fluorouracil (5-FU) in advanced colorectal cancer. The administration schedule was a two-hour intravenous infusion of l-LV (250 mg/m2) and an intravenous bolus injection of 5-FU (600 mg/m2), given one hour after the beginning of the l-LV infusion. Sixty-four patients were treated weekly for six weeks followed by two-weeks rest, and then evaluated for response. Complete response and partial response were obtained in 21 patients (32.8%). The median survival time was 12.8 months. The most prominent side effects were anorexia (57.8%), nausea and vomiting (56.3%), diarrhea (48.4%) and myelosuppression such as leucopenia (54.7%), thrombocytopenia (18.8%) and decreased hemoglobin (40.6%). These side effects, however, were within permissible levels. Severe toxicity was prevented by discontinuance of the treatment. From the present study, l-LV and 5-FU combination therapy seems to be a very promising and useful treatment for patients with advanced colorectal carcinoma.

Expression of EGF, EGFR, TGF alpha, and PCNA in resected gastric carcinomas (15 cases of superspreading type and 25 cases of penetrating type) was immunohistochemically studied to understand biological features of these two types of gastric carcinomas. EGF, EGFR, and TGF alpha positive cases were preferentially found in the penetrating type rather than in the superspreading type (p < 0.05). Incidence of PCNA high expression cases in the penetrating type was significantly higher than that in superspreading type. Nineteen cases (76%) of the penetrating type and 1 case of the superspreading type (6.7%) were diffusely PCNA (+), and the incidence of in the former type was significantly higher than that of the latter type (p < 0.001). One case of the superspreading type and 13 cases of the penetrating type were either EGF (+) or TGF alpha (+), and EGFR (+), and the incidence in the latter type was significantly higher than that in the former type (p < 0.05), suggesting that growth and invasion of carcinoma cells, especially in the penetrating type, may depend on "autocrine mechanism". Incidence of the growth factors (+) and PCNA (+) cells in classical type of signet ring cells was lower than that in other types of singnet ring cells.

Outpatients with advanced and recurrent breast cancer were treated by a combination therapy of the following drugs: doxifluridine (5'-DFUR) orally administered at a dose of 1200 mg/day; cyclophosphamide (CPA) orally given at dose of 100 mg/day; and tamoxifen (TAM) orally given at dose of 20 mg daily. 5'-DFUR and CPA were administered on consecutive days 1-14, then discontinued for 14 days. The response rate was 44.8% including five CR and eight PR out of 29 complete cases. As for response cases in terms of the subject lesions, corresponding cases were chiefly found in soft tissue and the lung. As for the response rate with or without pretreatment, cases previously treated showed a higher response rate such as 42.9% indicating that the present therapy was effective in pretreatment cases. The main side effect was leukopenia, but not so severe. Few cases with diarrhea were found. Based on the above findings, the present treatment is conceivably a highly useful therapy, on an outpatient basis, for advanced and recurrent breast cancer, especially metastatic lesions of soft tissue and the lung.

To establish effective mass screening projects for breast cancer, our study group (Tominaga group) was co-sponsored by the Ministry of Welfare. From 1968 to 1986, 643,513 women at the initial screening and 719,189 women at the subsequent screening were examined by physical examination. Abnormalities were found in 24,864 (3.9%) and 23,880 (3.3%) of these women, respectively. Cancer was detected in 833 women (detection rate 0.13%) and 428 women (0.06%), respectively. To establish the criteria for assessing the life-prolonging effect of mass screening for breast cancer, clinical stage and prognosis of breast cancer detected by mass screening were compared with those for matched patients in outpatients clinics. Early stages were significantly more common in the patients detected by mass screening. The 5-year survival rate was significantly higher in the patients detected by mass screening (91.7% vs. 85.6%; P less than 0.01), but the difference with the other group was not significant (80.5% vs. 78.1%). Women who had conducted breast self-examination (BSE) showed a higher survival rate than those who had not. We were not able to confirm the general belief that interval cancer is more aggressive in nature and shows a poorer prognosis than the cancer detected through periodic screening.

A phase I study of YM-881 (zinostatin stimalamer), neocarzinostatin combined with butylesterified styrene maleate, suspended in iodized poppy oil ethyl ester, was conducted in patients with hepatocellular carcinoma by giving single intra-arterial infusions via catheters inserted by Seldinger's method. Four dose levels, 2, 4, 6, and 8 mg, were tested. Major adverse reactions were fever, anorexia, nausea, vomiting, and abnormal hepatic function. Both the incidence and severity of adverse reactions tended to increase with the 8 mg dose. Tumor regression of 50% or more occurred in one receiving 2 mg and one receiving 4 mg. The results of the study suggest that doses of 6 mg or less may be appropriate for the phase II studies.

A phase II study of YM 881 (zinostatin stimalamer) to determine the response and safety was conducted in patients with hepatocellular carcinoma by injecting a suspension of the drug into the hepatic artery. Repeated doses of 4 to 6 mg of the drug were given every 4 weeks so that the tumor tissues were filled with the suspension. Of the 195 registered patients, 15 were ineligible for the study, 8 dropped out, and data were missing for 5. A total of 167 patients completed the study. Response was assessed in the 167 patients who completed the study. CR was found in one, PR in 59, MR in 25, NC in 67, and PD in 15, with a response rate of 35.9. The safety of the drug was assessed in 177, excluding ineligible patients and 3 who dropped out because of the concurrent use of other drugs. Adverse reactions were found in 93.2% of the patients, and abnormal values in clinical laboratory tests in 60.5%. Major unwanted symptoms included fever, nausea, vomiting, and anorexia. Major abnormal changes in laboratory tests were elevated total bilirubin and LDH and abnormal hepatic function. About half the patients had malaise and pain related to the intra-arterial infusion therapy. The one year survival rate was 56.9%, and the duration of survival of 50% of the patients was 407 days.

We have reviewed the clinical usefulness of tumor markers in gynecologic malignancy. In cervical squamous cell carcinoma. SCC and CEA showed increase in frequency of elevated cases according to the clinical stages (FIGO), and the frequency was significantly higher in recurrent cases than in patients with no evidence of disease. In endometrial carcinoma, presently, no specific tumor marker has been found. The diagnostic efficiency of CA 125, CA 19-9 and TPA were 25.2, 23.8 and 32.6, respectively. Further investigation must be necessary to establish markers sensitive enough. In primary ovarian malignancy, combination assay might be much more useful than single assay. The most effective combinations were TPA/CA 125/Ferritin in serous cystadenocarcinoma, and CEA/CA 19-9/TPA in mucinous cystadenocarcinoma. In the monitoring of the disease, it seems to be essential to select suitable combination of markers in each case. In addition, recently, multivariate analysis systems, such as CAMPAS (computer-aided multivariate and pattern analysis system), have become available.

In advanced cancers the focus is frequently located widely in the intraabdominal organs below the diaphragm both in cases of postoperative recurrence and in unresectable cases. We have attempted subselective intraaortic injection therapy with carcinostatic agents for such cases. However, since the patients have advanced cancers, complete remission cannot be obtained and chances of rehabilitation are only for a definite period. Correct evaluation of the carcinostatic effect is difficult because the of complex nature of lesions. Hence, comparison by measurement of other than carcinostatic effect was attempted, and the period of survival was examined. Furthermore, it was believed useful in evaluating intraarterial infusion chemotherapy in cancer bearing patients to examine not only the survival for a long period but also the improvement in "quality of life" (QOL) based on factors other than direct effects, such as hospitalization period and at-home period.

Enhancement of the antitumor effects of adriamycin (ADR) by concomitant use of degradable starch microspheres (DSM) and pharmacokinetics of ADR in combination with DSM was investigated. An intra-arterial chemotherapy model of the nude rats transplanted of human gastric cancer xenografts (H-154) in the hind-limbs was used for this study. Drug was administered through a catheter inserted into the carotid artery with the tip in the common iliac artery. In the pharmacological study, increase of regional uptake of ADR and decrease of systemic distribution of ADR were recognized in some degree. DSM 30 mg/kg, which caused temporary arrest of blood flow in the tumor, had an only weak effect on tumor growth. ADR 3 mg/kg mixed with DSM 30 mg/kg was more effective than ADR 3 mg/kg solution. Furthermore, mixture of ADR 2 mg/kg and DSM 30 mg/kg had a greater effect on tumor growth than ADR 2 mg/kg following DSM 30 mg/kg. It seems that embolization by DSM, retention of ADR in regional tissues and cytotoxic effect of ADR have contributed to such a strong effect of ADR mixed with DSM.

5-Fluorouracil levels in Yoshida sarcoma implanted subcutaneously and some organs of rats were measured following intraarterial or intravenous administration of 5-FU at various infusion time and doses, and the relationship between 5-FU level in tumors and antitumor effect was examined. The antitumor effect following intraarterial infusion of 5-FU was superior to its systemic administration. With intraarterial infusion, higher levels of 5-FU in tumors could be expected during infusion and immediately after injection. One-shot intraarterial injection of 5-FU was much more effective than continuous infusion of 5-FU from view points of the antitumor effect. This reason might be attributed to that, 5-FU level in the tumor after one shot intraarterial injection was maintained higher for many longer period than its level during continuous infusion. 5-FU levels in the liver following and during intraaortic infusion of 5-FU showed interesting change, i.e. if 5-FU levels flowing into the liver was low, 5-FU in the liver was not detected at all, however, if high level of 5-FU was flown into, the liver 5-FU was measured even 24 hours after injection. It was supposed that the low level of 5-FU was degraded by the liver easily, but the high level of 5-FU flown into the liver could not be metabolized. From these experiments it may be concluded that infusion time of intraarterial administration of 5-FU must be as short as possible within tolerable toxicity, and infusion doses must be as high as possible that could be degraded by the liver for reduction of toxicity.

Degradable starch microspheres (DSM) have a mean diameter of 45 micron and temporarily obstruct blood flow at the arteriolar (micro-circulatory) level. A new approach was attempted to improve the anticancer effect on non-resectable liver cancer with simultaneous administration of DSM and MMC (mitomycin C) or ADR (adriamycin) into hepatic artery. Three patients with primary liver cancer were treated with DSM (600-1200 mg) and ADR (20-60 mg), and five with metastatic liver cancer were treated with DSM and MMC (10-20 mg). The treatment was repeated two to ten times. Partial or minor responses were observed in 1 out of 3 cases of primary liver cancer and 3 out of 5 metastatic cases. Side effects of DSM were temporary and mild epigastric or chest pain, vomiting, fever, slight dyspnea, etc. A temporary change in the liver functional data (GOT, GPT) was noted in 3 patients. Selective intra-hepatic arterial chemo-embolization therapy with DSM would appear to be beneficial for the treatment of liver cancers with appropriate indications. Cases in which DSM and anticancer drugs were effected were presented in detail.

TNM classification, tumor size, lymph node metastasis, histological type of primary tumor, ER status and biological tumor markers have been recognized as prognostic factors in breast cancer. The 673 breast cancer patients undergoing radical mastectomy at this department were analyzed for TNM classification influencing on the postoperative prognosis. Five-and ten- year survival rates were 93% and 89% in stage I, 83.9% and 75.5% in stage II, 67.3% and 60% in stage III. The most common histological type, namely, invasive ductal carcinoma, of primary breast cancer was classified into three types by Japan Mammary Cancer Society. The first type was papillotubular carcinoma, the second solid-tubular carcinoma, and the third scirrhous carcinoma. The prognosis of papillotubular carcinoma was best. Many investigators reported that the prognosis of ER positive breast cancer was good. But in the latest report, the opposite result is obtained. More study is necessary to evaluate the prognostic value of ER. The most common biological tumor markers were CEA, LDH and ALP. The CEA was the best prognosis-factor in biological tumor markers.

5-Fluorouracil (5-FU) is one of the most popular anticancer drugs, especially in treatment of for adenocarcinoma; however, an optimal therapeutic schedule of 5-FU is not determined even now. An animal model for continuous intraarterial infusion in rats was constructed using retrograde cannulation to aorta via right femoral artery in order to study the intraarterial and systemic effects of 5-FU on Yoshida sarcoma implanted in left fore limb and hind limb subcutaneously. By implanting Yoshida sarcoma in fore and hind limb and cannulating and infusing aorta, the regional and systemic antitumor effects could be compared in the same animal. Antitumor effect and toxicity after intraarterial 5-FU administration was studied at various infusion time and doses. The results revealed that intraarterial infusion of 5-FU was more effective than its systemic administration from view points of the antitumor effect. The antitumor effect after one shot intraarterial injection of 5-FU was ar superior to that after continuous infusion of 5-FU. However, toxicity after one shot injection was much more severe than continuous infusion. Consequently, the desirable administration schedule of 5-FU appears to be an intraarterial infusion as short time as possible within tolerable toxicity.

The clinical usefulness of tumor markers was discussed in gastrointestinal cancer. SCC antigen (subfraction of TA-4) was useful marker in esophageal squamous cell cancer, but was not so helpful in cancer treatment. CEA and CA19-9 were also available as tumor markers of gastric and colorectal cancers, but extremely increased levels were found in only advanced but in early cancer. There was no significant correlation between CEA and CA19-9 so the combination assay of a few kinds of tumor markers, especially CEA and CA19-9 were helpful in cancer treatment.