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Fifty-seven patients with hypopharyngeal cancer treated by irradiation at Kyushu University Hospital between 1985 and 1992 were analyzed retrospectively. They included 53 men and 4 women, and their ages ranged from 39 to 83 years (mean, 63 years). Two patients had stage I, 7 had stage II, 13 had stage III, and 35 had stage IV disease according to the UICC (1997) classification. Initially, they were irradiated in the conventional way with a dose of 30 Gy, and 17 patients with good response were irradiated to curative dose (more than 60 Gy), and 32 patients with poor response were operated immediately. Medically inoperable or unresectable patients were treated in a semiradical way (n = 8). The 5-year overall and cause-specific survival rates were 46% and 51%, respectively. Five-year cause-specific survival rates were 88% for stages I and II (n = 9), 67% for stage III(n = 13), and 35% for stage IV (n = 35). Five-year cause-specific survival according to treatment method was 58% for surgery and 51% for curative radiotherapy. There was no statistically significant difference between the two rates. These results suggest that initial radiation response is an important factor in deciding on the following treatment method. Curative radiotherapy for hypopharyngeal cancer according to initial radiation response is a desirable treatment strategy.

Purpose: To evaluate the usefulness of multi-detector helical CT (MDHCT) with contrast medium in the diagnosis of deep vein thrombosis (DVT)., Materials and Methods: The bilateral veins of the dorsal pedis in 45 patients (12 men, 33 women; average age, 64 years) under clinical suspicion of DVT were first punctured using 22-G needles. Then CT scanning from the level of the foot to the inferior vena cava was started 20 sec after the initial injection of 200 mL of dilute contrast medium (50 mL nonionic iodinated contrast medium of 300 mgI/mL and 150 mL saline) at a rate of 5 mL/sec., Results: Two patients were excluded because of unsuccessful venous puncture. The average scanning time in 43 patients was 38.5 +/- 7.9 seconds. Images of veins from the foot to the inferior vena cava were clearly demonstrated in each case. MDHCT showed DVT in 32 cases and patent deep vein in 11 cases. Simultaneous venography of the lower extremity in 18 patients clearly visualized DVT at the same level detected by contrast MDHCT., Conclusion: MDHCT for the diangosis of DVT has the advantages of wider scanning range, shorter scanning time, and finer Z-axis resolution than the other diagnostic modalities.

The purpose in this study was to compare the ratio of visualization of upper abdominal arteries using MDHCT between the super-high-flow injection method (Group A) and the conventional injection method (Group B). The subjects ects were 200 patients who were randomly divided into Group A (100 patients) and Group B (100 patients). In Group A, visualization of the large arteries, including the CE, SMA, HA and LGA, was possible at a rate exceeding 96%, and that of the small arteries, including the DPA, SPDA, RGA and Cyst A, was more than 79%. Visualization of upper abdominal arteries was markedly improved by the super high flow injection technique.

We evaluated the therapeutic effect of TAE in 9 nodules with hepatocellular carcinoma (HCC) using color Doppler flow imaging with an intravenous ultrasound contrast agent. The intratumoral color signal enhancement that was detected in 7 nodules resulted in complete disappearance after TAE. The other 2 nodules without color signal enhancement showed well-differentiated HCC with fatty degeneration on histological study. The intratumoral enhancement noted in dynamic MRI in 7 of the 9 nodules resulted in complete disappearance after TAE. Color Doppler flow imaging with an intravenous contrast agent is a promising method for assessing the therapeutic effect of TAE.

The long-term results of transjugular intrahepatic portosystemic shunt(TIPS) were analyzed in 48 patients between February 1992 and December 1998, for treatment of esophageal varices and ascites caused by portal hypertension. The procedure was successful in 42 patients. Portal vein pressure was reduced from 29 mmHg +/- 7.9 to 19 mmHg +/- 7.3 immediately after TIPS and to 17 mmHg +/- 6.5 one year later. Varices were controlled in 82% (23/28) of patients after one year and in 78% (7/9) of patients after five years. Ascites disappeared or decreased in 79% (11/14) after one year. Primary shunt patency was 12%, with a secondary patency rate of 79% after five years. The overall incidence of new or worsened encephalopathy was 31% (13/42). Long-term follow-up showed one-, three-, and five-year survival rates of 82%, 68%, and 59%, respectively. TIPS is an effective means of lowering portal hypertension, and it controls varices and ascites with little risk of hepatic encephalopathy.

TIPS (transjugular intrahepatic portosystemic shunt) is an efficacious treatment for esophagogastric varices, ascites and hypertensive gastrointestinal vasculopathy associated with portal hypertension. The main complication after the procedure is hepatic encephalopathy. We tried to elucidate the correlation between hepatic encephalopathy and changes in portal hemodynamics after TIPS, based on observation by Doppler ultrasonography. We carried out Doppler ultrasonography in 28 cases of TIPS to assess hepatopetal and hepatofugal blood flow in the right and left portal branches. Hepatic encephalopathy occurred after TIPS in 9 cases out of 28 (32%), and new onset of disease was observed in 6 of 9. Doppler ultrasonography revealed hepatofugal blood flow in both right and left portal branches in 6 cases, 5 of which showed encephalopathy. Hepatopetal blood flow of the right and left portal branches was observed in 17 of 28 cases after TIPS. Hepatic encephalopathy occurred in only 2 of 17 cases. The changes in portal vein hemodynamics after TIPS were investigated by color Doppler ultrasonography, which were considered to be very useful for prediction of hepatic encephalopathy and indication of medical treatment to prevent the occurrence of this disease.

Malignant esophageal stenoses develop esophagorespiratory fistulae or perforations so frequently that esophageal stents must be required. We devised a covered stent with a thin Gore-Tex sheet and a nitinol stent system, Ultraflex, without increasing the size of the introducer assembly. Nine patients with malignant esophageal stenoses, including seven patients with perforation or fistulation, were carefully treated with the covered stent. All stent deployments were successfully carried out under fluoroscopic guidance. The average time required for full self-expansion was two weeks. The average grade of dysphagia improved from 3.7 to 1.2. Clinical symptoms due to esophagorespiratory fistulae were improved in three of four patients. No clinical or technical complications, such as migration, were observed, but a fistula developed at the bare site of the stent. This covering method for the flexible stent was simple and safe, and was considered to be useful in the treatment of malignant esophageal stenosis.

Twelve cases, including varicose veins (7), deep venous thrombosis (3), A-V malformation (1) and skin ulcer (1), were examined by three-dimensional CT venography (3D CTV), and comparison was made with conventional ascending venography. In the "double phase method," the first phase scan (40 seconds) of the femoral region was performed in order to rule out deep venous thrombosis, and the second phase scan (30 seconds) of the lower leg was performed to visualize varicose veins. Veins of the thigh and popliteal space were relatively well visualized. It is thought that 3D-CTV is particularly useful for spatially evaluating deep venous thrombosis and varicose veins.

Three types of modified Gianturco Z stents, which included some solder at the bend portion in group 1, a little solder in group 2 and no solder in group 3, were placed in the jugular vein in order to evaluate the degree of intimal hyperplasia growth in five dogs. Four weeks later, venography and histological examination after venectomy were performed. Stenosis was 32.7 +/- 6.9% at the bend portion in group 1, 27.0 +/- 6.0% in group 2 and 14.0 +/- 6.5% in group 3. The results indicate that stents without solder are preferable for the venous system.

To evaluate the self-expandable metallic stent therapy for inferior vena caval obstruction (IVCO) secondary to malignant liver tumors, changes in caval pressure, the symptoms and hemobiochemical values were observed. Among 16 IVCO cases with higher caval pressure than 20 cmH2O at the peripheral caval lumen to the stenosis, nine cases consisting of five extracaval compression cases and four intravenous tumor thrombi cases subjected the stent therapy. Other three subjected radiotherapy and the other four cases inactive supportive care. Immediately after the Z-stent implantation, the averaged caval pressure distal to the stenosis decreased from 27.7 +/- 3.5 cmH2O to 14.7 +/- 2.6 cmH2O. One case developed 8 cmH2O increase of right atrial pressure but no lung edema. The urine excretion volume increased after stent. The decrease in caval pressure correlated with the urine volume of the day after the stenting (gamma = 0.83), symptomatic improvements of leg edema (gamma = 0.68), ascites (gamma v 0.51) and scrotal edema (gamma = 0.70). Five cases showed gradual increase in platelet number. All elevated LDH and elevated fibrinogen value decreased. These changes would suggest physiologic benefits of the IVC stent therapy. Compression cases showed better improvements and courses than the thrombi cases. Two thrombi cases endured severe conditions suspected of triggered by the procedure. Conclusively, the stent therapy to the IVC obstruction was thought to effect hemodynamically and hematobiochemically.

In order to differentiate recurrence of brain tumor from radiation necrosis, we performed 201Tl brain SPECT in 16 post-operative patients. Five of them had residual anaplastic astrocytoma. Final diagnosis of the other 11 patients was recurrent astrocytoma (n = 6), cerebral radiation necrosis (n = 5), based on re-operation (n = 9) and more than one year follow-up finding (n = 2). Early and delayed images were obtained at 10-15 min. and 4 hrs. after i.v. injection of 111 MBq of 201Tl chloride. Counts ratio of a lesion to the normal brain (L/N) was calculated by creating rectangular ROI over each area. All of the patients with recurrent or residual tumor showed L/N ratios of more than 2.5 on the early images (mean 4.70 +/- 2.65). On the other hand, L/N ratios on the early images were less than 2.5 in patients with radiation necrosis (mean 2.05 +/- 0.25, p less than 0.001). In conclusion, a quantitative assessment using 201Tl brain SPECT may be useful in differentiating recurrence of brain tumor from radiation necrosis.

Six AIDS patients with Pneumocystis carinii pneumonia (PCP) underwent 67Ga scan as part of their evaluation. Only one patient of them showed the characteristic 67Ga distribution pattern for PCP, that is, diffuse, increased, bilateral lung activity greater than liver activity. Two patients who were receiving therapy for PCP and one patient with recurrent PCP showed focal or uneven 67Ga lung uptake. In the four patients, the scan showed more extensive lesion than the chest radiograph. The other two patients who died 2 months later of cellular immunodeficiency showed no or very slight lung uptake of 67Ga. In summary, 67Ga scanning is useful diagnostic procedure in evaluation of PCP in patients with AIDS.

Transcatheter hepatic arterial embolization (TAE) with gelatin sponge particles soaked in anticancer agents has been widely employed in the treatment of Hepatocellular carcinoma (HCC). The mechanism of TAE has been explained by blocking of blood flow to the tumor, however the role of anticancer agents used with embolic materials has remained unclear. The purpose of this study is to prove the role of anticancer agents used in TAE. 1) In eighteen cases of HCC and 4 cases of metastatic liver cancer, TAE was performed with gelatin sponge, anticancer agents and contrast media. The livers were examined by CT 4, 24 and 48 hours after TAE. A selective retention of contrast media containing anticancer agent in the tumor area was observed in 14 of 14 cases examined 4 hr. in 15 of 17 cases examined 24 hr and in 6 of 6 cases examined 48 hr after TAE. In the cases of metastatic liver cancer, retention of contrast media, was also observed in 4 of 4 cases examined at 24 hr and 3 of 3 cases examined 48 hr after TAE. 2) TAE was done in 12 cases of HCC by using gelatin sponge soaked in anticancer agent mixed with 99M-Tc-pertechnetate. Livers were observed by a scintillation camera 4 hr and 24 hr after TAE. A selective retention of 99M-Tc-pertechnetate in the tumor was observed in 12 of 12 cases examined 4 hr and in 3 of 3 cases examined 24 hr after TAE. 3) In one cases of HCC, hepatectomy was performed 2 days after TAE.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of hepatic artery embolization with Lipiodol (Lp) and Gelatin sponge particles (GSP) on liver tissue was evaluated in 17 dogs embolized with GSP, 12 dogs with Lp and 19 dogs with Lp + GSP. Survival rate and extent of liver damage were used as evaluation criteria. None of the dogs with GSP died during the 4 week period, two exhibited small liver infarctions. Of the dogs with 0.2 to 5 ml/kg Lp, two dogs with 4 ml/kg or 5 ml/kg Lp died of cardiac failure. Gross liver examination did not show any liver infarction. Eight of the 19 dogs with Lp + GSP died of liver failure. Gross examination of the surviving dogs demonstrated infarction in 9 of the 11 livers with 100% incidence in those with 0.2 ml/kg or 0.5 ml/kg Lp. Liver infarction increased in size with the increase of Lp volume. In combination with Lp + GSP, the Lp volume should be less than 0.1 ml/kg.