Roles of expressed gratitude and apologies in predicting reciprocal responsiveness

Research has indicated the critical role of responsiveness in facilitating close relationships, but what communication leads to enhanced responsiveness has not been fully explored. We hypothesized that gratitude and apologies facilitate responsiveness within friendship relationships in Japan. In Experiment 1 (n = 669), receiving gratitude, apologies, or both gratitude and apologies increased recipients' perceptions of the expresser's responsiveness more than receiving a message without either gratitude or apologies. In Experiment 2 (n = 139), the participants who received gratitude as well as receiving both gratitude and apologies (but not just apologies) wrote more responsive messages back to the expresser than those who received a message without either gratitude or apologies. Gratitude and apologies played unique roles in promoting responsiveness within friendship relationships.

A novel repeat biopsy nomogram based on three-dimensional extended biopsy

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Background: There is no perfect cohort in which nomograms are developed because no biopsy method can detect all cancers. To minimize this inherent verification bias, having a cohort with fewer false negative cases is advantageous. Based on a cohort examined with three-dimensional (3D) extended biopsy protocol, we developed a novel nomogram for diagnosis of prostate cancer on repeat biopsy.

Methods: Of 4,074 consecutive male patients undergoing prostate biopsy at our institutions between 2000 and 2009, 775 men with at least one previous negative biopsy underwent repeat biopsy with 3D protocol. Men with previous atypical glands or atypical small acinar proliferation and/or without available prostate-specific antigen (PSA) kinetics information were excluded. The remaining 515 men constituted the study cohort. We developed a logistic regression-based nomogram with 70% of the cohort selected randomly; we validated it with the remaining 30%. Predictive accuracy and performance characteristics were assessed using the area under the receiver operating characteristic curve (AUC) and calibration plots, respectively. The threshold probability was evaluated with decision curve analysis.

Results: We developed a novel repeat biopsy nomogram incorporating age, free to total PSA ratio, prostate volume, history of previous extended biopsy, and PSA doubling time. Validation confirmed predictive accuracy with an AUC value of 0.791. Calibration plots showed good agreement. The decision curve of the nomogram was superior to the decision curve of biopsying all men in a range of threshold probability over 0.15. At the threshold of 0.2, the number of unnecessary biopsies could be reduced by 10 per 100, without missing PCa.

Conclusions: We developed a novel repeat biopsy nomogram based on a cohort examined with 3D extended biopsy. This repeat biopsy nomogram is clinically beneficial, saving a substantial number of unnecessary biopsies.

No significant financial relationships to disclose.

Olfactory discrimination of structurally similar alcohols by cockroaches

The capability of the cockroach Periplaneta americana to discriminate odors of structurally similar aliphatic alcohols was studied by using an operant conditioning paradigm. Cockroaches were trained to discriminate three odors: one odor associated with sucrose solution (reward) and two odors associated with NaCl solution (non-reward). After training, their odor preferences were tested by counting the number of visits to each odor source. We tested the capability of cockroaches to discriminate (1) three normal aliphatic alcohols with different numbers of carbon (1-pentanol, 1-hexanol and 1-octanol), (2) three C6 aliphatic alcohols (1-hexanol, 2-hexanol and trans-2-hexen-1-ol), (3) binary mixtures of two of these three alcohols and their components, and (4) 1-hexanol solution of three different concentrations (1, 10 and 100 micro g micro l(-1)). Cockroaches exhibited higher preferences for the odors associated with reward in these tests, and we therefore conclude that cockroaches can discriminate these odors. However, discrimination of 1-hexanol and trans-2-hexen-1-ol and their binary mixture was imperfect, in that some statistical tests suggested significant level of discrimination but other tests did not. In addition, the cockroaches learned to associate a 1-hexanol solution of the highest or lowest concentration with sucrose reward but failed to learn to associate 1-hexanol of an intermediate concentration with reward.

Applicability of a mobile accelerator for intraoperative radiation therapy to colorectal cancer

PURPOSE

Intraoperative radiation therapy is reportedly effective for local control and pain relief in colorectal cancer. However, this treatment requires a large number of medical personnel, which hinders expanded use of this method. A mobile electron linear accelerator for intraoperative radiation therapy has been developed and is now commercially available. This report analyzes the applicability of this accelerator to colorectal cancer. The applicability of the mobile accelerator is analyzed based on its specifications by simulating the intraoperative radiation therapy delivered to these patients with a conventional intraoperative radiation therapy unit.

METHODS

From 1987 to 1999, 49 colorectal cancer patients underwent 54 surgical resections and received intraoperative radiation therapy to 75 sites.

RESULTS

The mean intraoperative radiation therapy dose for colorectal cancer with the conventional unit was 22 (range, 10-30) Gy. The mean electron energy level was 10 (range, 3-30) MEV. Applicator size ranged from 4 to 10 cm in diameter. The mobile accelerator can achieve a dose rate of 10 Gy/min and an applicator unit size range of 3 to 10 cm in diameter, facilitating intraoperative radiation therapy for colorectal cancer. The electron energy limitation (12 MEV at maximum) suggests that the indications for this machine are limited. In our experience, 30 percent of patients received intraoperative radiation therapy with electron energy levels exceeding 12 MEV. Of these cases, 81 percent had macroscopic residual tumor and 69 percent had pain.

CONCLUSION

An intraoperative radiation therapy mobile accelerator can cover 72 percent of the irradiation sites covered using our conventional unit. This accelerator is useful for intraoperative radiation therapy with curative intent for patients with no or slight residual tumor. Patients with gross residual tumor and pain may not be suitable.

A novel monoclonal antibody that recognizes human perivascular cells of the central nervous system under a specific immune reaction

Perivascular cells or fluorescent granular perithelial cells of the central nervous system are newly recognized members of monocyte/macrophage populations. In this study a monoclonal antibody, GP-3, that labels proteinous lysosomal antigen of human perivascular cells, has been established. It selectively label the cells in foamy-macrophage infiltrating diseased areas, such as Wallerian degeneration and contusion, without significant reaction to the cells in normal areas, infiltrating macrophages or microglia. These findings suggest that the perivascular cell is an independent cell type and the antigen molecule is fairly specific to perivascular cells and plays an unknown role in immune-nervous system interaction.

Involvement of fibrinolytic factors in mid trimester amniotic fluid with development of severe early-onset preeclampsia

Impaired placental development is a well-known pathogenesis in preeclampsia. The present study was undertaken to elucidate the involvement of fibrinolytic factors in amniotic fluid in midtrimester with development of severe early-onset preeclampsia. Amniotic fluid was obtained by amniocentesis at 15 to 18 weeks of gestation. All specimens were retrospectively identified according to the hospital records as coming from gestations that later had severe early-onset preeclampsia (severe preeclamptic group, n = 9) or gestations with normal outcomes (control group, n = 73). Fibrinolytic factors such as tissue plasminogen activator (t-PA), plasminogen activator inhibitor type 1 (PAI-1), and t-PA-PAI-1 complex (PAI-C) of specimens were measured by enzyme-linked immunoassay. In the control group, concentrations of t-PA as well as PAI-1 in amniotic fluid remained at similar levels from 15 to 18 weeks, although PAI-1 levels were more than 10 times higher compared with t-PA levels. Levels of t-PA and PAI-1 in the severe preeclamptic group were not different from those of the control group. PAI-C levels gradually decreased from 15 through 18 weeks of gestation in the control group. PAI-C levels of the severe preeclamptic group were significantly lower than those of the control group (55.5 +/- 18.0% versus control; mean +/- standard deviation [SD], p <0.001). PAI-C, as the most specific indicator of the early stage of fibrinolytic activities, showed lower levels in midtrimester amniotic fluid in the severe preeclamptic group, suggesting fibrinolytic activities of amniotic fluid may have a significant role in the development of severe early-onset preeclampsia via impaired placental development in the latent stage of preeclampsia.

Intraoperative irradiation after surgery for locally recurrent rectal cancer

PURPOSE

This study retrospectively evaluated the effects of intraoperative electron beam irradiation on patients with locally recurrent (pelvic) rectal cancer.

METHODS

From November 1, 1975, to December 31, 1997, 51 patients underwent surgery for locally recurrent rectal or rectosigmoid cancer, and 27 patients received intraoperative electron beam irradiation. The intraoperative electron beam irradiation dose was 15 to 30 Gy. Kaplan-Meier survival estimates at three and five years were analyzed for the 47 patients who recovered postoperatively.

RESULTS

Statistically significant factors related to survival included intraoperative electron beam irradiation vs. no intraoperative electron beam irradiation (P=0.0007), amount of residual tumor (slight vs. gross; P=0.0022), and symptom status (P=0.0024). Factors not associated with survival included distant metastases at reoperation, type of surgery for the recurrent tumor, external beam irradiation, pathologic grade, age, and gender. Surgical resection without intraoperative electron beam irradiation resulted in three-year and five-year survival rates of 5 and 0 percent, respectively. For patients who received intraoperative electron beam irradiation, the three-year survival rate was 43 percent and five-year survival rate was 21 percent. Intraoperative electron beam irradiation was a statistically significant factor related to survival in patients with and without distant metastasis (P=0.04 and P=0.0035, respectively), with slight residual tumor (P=0.0003), or with palliative surgery (P=0.0276).

CONCLUSION

The trends seen in resection with intraoperative electron beam irradiation are encouraging with regard to improvements in survival as compared with studies not using intraoperative electron beam irradiation treatment.

Elevated IL-6 in midtrimester amniotic fluid is involved with the onset of preeclampsia

PROBLEM

The primary defect of placental development in preeclampsia is speculated to occur at midtrimester gestation. Abnormal feto-maternal immune reactions have been considered as factors in such defective placentation.

METHOD OF STUDY

Midtrimester amniotic fluid specimens were retrospectively identified as coming from gestations that later had severe preeclampsia develop, gestations with normal outcomes, and gestations measured for cytokines tumor necrosis factor-alpha (TNF-alpha), interleukin (IL-1 beta, IL-6, and IL-8). The effect of each cytokine on thrombomodulin levels was tested in cultured trophoblast cells.

RESULTS

Among the measured cytokines, IL-6 and IL-8 were significantly elevated in the midtrimester amniotic fluid of the future preeclamptic group. Trophoblasts stimulated with TNF-alpha plus IL-6 had significantly decreased levels of cellular thrombomodulin compared to those without cytokine addition.

CONCLUSIONS

Elevated cytokines in midtrimester amniotic fluid suggest an abnormal fetomaternal immune response occurring before the clinical manifestation of preeclampsia. Cytokine-induced suppression of thrombomodulin in trophoblasts may be directly involved in the pathogenesis of preeclampsia.

Elevated fetal fibronectin in midtrimester amniotic fluid is involved with the onset of preeclampsia

OBJECTIVE

To examine early midtrimester amniotic fluid for its significance in pregnancy outcomes, especially with connection to the pathogenesis of preeclampsia.

METHODS

A prospective, nested, case-control study was conducted. Fetal fibronectin in early midtrimester (16-20 weeks gestation) amniotic fluid was measured by EIA method. Results were compared by their pregnancy outcomes.

RESULTS

Amniotic fluid levels of fetal fibronectin were significantly higher in the group subsequently developing severe preeclampsia (106.8 +/- 13.2 micrograms/ml, mean +/- SD, n = 12) compared with matched controls (66.7 +/- 7.1 micrograms/ml, n = 12) (p < 0.05).

CONCLUSION

High levels of fetal fibronectin were found in the amniotic fluid of women subsequently developing severe preeclampsia before any symptom appear. Involvement of extracellular injury or cellular hyperactivity in the midtrimester placental site with the onset of preeclampsia is suggested.

[Method for determining optimal intracavitary radiotherapy conditions for carcinoma of the uterine cervix with tumor infiltration of the vaginal wall]

Stage III carcinoma of the uterine cervix is occasionally accompanied by tumor infiltration of the vaginal wall. Currently, the vaginal wall has to be irradiated in the same manner as the uterine cervix. The authors have developed a system for determining the optimal irradiation conditions for treating the two regions, uterine cervix and vaginal wall, at the same time. A comparison of two methods is shown in simulation, and then a clinical case is reported. The first method consists of two treatment plans, one for the uterine cervix without tumor infiltration of the vaginal wall, and the other for the vaginal wall without carcinoma of the uterine cervix. The second, newly developed method considers the two regions together. Irradiation times of ovoid sources obtained with the second method are 15-25% less than those of the first method. Isodose curves obtained with the two methods are very different, and thus the uterine cervix and vaginal wall must be considered together in order to determine irradiation conditions.

Primary non-Hodgkin's lymphoma of the larynx

Three cases of primary non-Hodgkin's lymphoma of the larynx are described. Histologically, two tumours belonged to the category of low grade B-cell lymphomas of the small cell type (extranodal marginal zone B-cell lymphoma and lymphoplasmacytoid lymphoma), and the third was classified as a peripheral T-cell lymphoma of unspecified type. The clinical stage was IE in two cases, and IV in another case. In two cases, complete remission was obtained with radical radiotherapy. But in the other case, which was histologically lymphoplasmacytoid lymphoma, the response to radiotherapy was poor, and surgery was required. There was no relapse subsequent to treatment. Primary non-Hodgkin's lymphoma of the larynx is rare. Several reported cases have clinical features similar to those of MALT-type lymphomas arising in other extranodal sites. Although most of the reported cases have been cured with radiotherapy, in some cases dissemination to other extranodal sites may occur. Therefore careful periodic evaluation is imperative.

[Clinical evaluation of intra-operative radiotherapy combined with subtotal cystectomy for invasive bladder carcinoma]

From 1981 to 1994, intra-operative radiotherapy after subtotal cystectomy was performed on 22 patients with invasive bladder carcinoma on whom radical cystectomy could not be recommended because of old age or condition. All the patients received 25 to 30 Gy of radiotherapy focused on trigonum and internal urethral orifice after subtotal cystectomy with uretero-cutaneostomy. Of 22 patients, 15 patients died. Five patients died of bladder cancer, one died of gastric cancer, one died of rectal cancer and the others died of pneumonia, heart failure, sepsis and senility. The five-year survival rate was 41% and the cause-specific five-year survival rate was 75%. Local recurrence was seen only in one patients, who received second intra-operative radiotherapy and recovered well in complete remission. We believe that intra-operative radiotherapy after subtotal cystectomy is useful for patients with invasive bladder carcinoma on whom radical cystectomy could not be recommended because of old age or condition.

The imbalance of plasminogen activators and inhibitor in preeclampsia

OBJECTIVE

To evaluate the role of plasminogen activators (tPA uPA) and inhibitor (PAI-1) in the pathogenesis of preeclampsia.

STUDY DESIGN

tPA uPA and PAI-1 antigens were measured in amniotic fluid, maternal plasma, and placental homogenates in normal pregnancy by ELISA method and compared with that of preeclampsia.

RESULTS

In normal pregnancy, tPA, uPA and PAI-1 levels increase as the gestation advance, but the increment of PAI-1 in amniotic fluid (28.3-fold) is larger than that of tPA and uPA (1.8-fold, 8.5-fold) (p < 0.001). Decidua homogenates contained larger amount of PAI-1 than villi. Whereas, villi had higher levels of tPA uPA than decidua (p < 0.01). In preeclampsia, the significantly higher levels of PAI-1 were observed in AF and decidua tissue as compared to the normals (p < 0.01), and the increment of PAI-1 in preeclampsia is larger than that of tPA, uPA.

CONCLUSIONS

The elevated PAI-1 level is associated with the preeclampsia and the imbalance between the plasminogen activators (tPA, uPA) and the inhibitor (PAI-1) might be involved in the pathogenesis of preeclampsia.

[Techniques for determining position from more than two radiographs intersecting at arbitrary angles in brachytherapy]

The least squares method and geometrical solution for calculating position were used in the two-projection method. Five coordinate systems were defined as a normal system, image system on film intersecting the beam central axes at an arbitrary angle and the projection, virtual coordinate and virtual image coordinate systems with beam central axis as one of the three coordinate axes to determine the geometrical relationship between a point and image on the film. Normal coordinates of the point were calculated by six geometrical solution sets and two forms of the least squares method using the rotation matrixes of the coordinate systems. One least squares method solves simultaneous nonlinear equations, and the other derives a strict solution from simultaneous linear equations. The latter least squares method has little physical meaning and is not as useful as the former. Although the former has physical meaning, the iterative approximation method should be used to determine position since a strict solution cannot be obtained directly. By these least squares methods, position is determined with less error using the projections at more than two focal spots.

[Determination of source position for four radiography systems with orthogonal projections in brachytherapy]

Four configurations of two X-ray tube positions are available for determining the position of a point using two orthogonal films. For each configuration, there are many formulas for calculating the coordinate of a point: the least squares methods with and without physical meaning, such as six sets of geometrical solutions, an approximation method with constant magnifications and so on. It is troublesome for a person in charge of treatment planning to directly derive a formula or select an appropriate formula from numerous ones for the four configurations. Thus, a method to easily apply the published formula for a configuration to the other three configurations is described in simulations and a clinical case using rotation matrixes of the right-handed coordinate system. Each diagonal element of the rotation matrixes is 1 or -1, and the other elements are 0.

Analysis of the target cell for Epstein-Barr virus infection in Epstein-Barr virus associated hemophagocytic syndrome (EBV-AHS)

Epstein-Barr virus (EBV) infected cells were examined in three cases of EBV-associated hemophagocytic syndrome (EBV-AHS) by analysis of the heterogeneity of terminal repetitive sequences in the EBV genome, indicating monoclonal expansion of EBV-infected cells in all cases. Involvement of T lymphoid cells was determined by the finding of in situ hybridization using [35S]-labeled RNA probes specific for the small EBV-encoded nuclear RNAs, EBER1 and EBER2, in combination with immunostaining for the TCR-beta chain, CD45RO, CD20, CD30 and CD68 antigens in these three cases. The majority of lymphoid cells showing EBER transcripts were stained by antibodies against CD45RO and TCR-beta. In contrast, EBER-specific signals were not detectable on B cells or hemophagocytic cells. These data support the concept that subclinical EBV-associated T cell proliferation is the primary characteristic of EBV-AHS, rather than proliferations of hemophagocytosing histiocytes.

Induction chemoradiotherapy followed by surgery for stage III non-small cell lung cancer

Twenty-five patients with stage III, non-small cell lung cancer were treated with cisplatin-based chemotherapy and thoracic radiation therapy followed by surgery. Thirteen patients had stage IIIA disease and 12, stage IIIB disease. The chemotherapy and radiotherapy were intensively combined with only a few days' interval between them. Radiation therapy delivering a total dose of 50-70 Gy was started 10 days after the beginning of chemotherapy. A few additional courses of chemotherapy were repeated until a thoracotomy was performed. All but two surgically-treated patients underwent tumor resection, with 19 lobectomies and four pneumonectomies. Eighteen patients underwent curative and five, non-curative resections. Pathological examination of the resected specimen provided accurate intrathoracic information. Six patients (24%) showed a pathologically complete response, with no cancer cells detected in the resected specimens. Severe postoperative complications occurred in five patients (20%), with one death. The disease recurred in five of the 18 patients who underwent a curative resection. A second primary tumor developed in two other patients. Seventeen patients (68%) are alive, with a median follow-up of 37 months after thoracotomy. The estimated three-year survival was 67% for all patients.

[Determination of the point position for brachytherapy from the shift-projection method using the least squares method and geometrical solutions]

We have derived formulas by the least squares method and six sets of geometrical solutions for calculating the position for brachytherapy from shift-projection images on one or two films. There are four types of expression for each coordinate in both methods, the shift-film technique with double exposures on a film and the stereo-shift technique with two films. Some geometrical solutions for the shift-film technique are equal to well-known conventional formulas. In the case of the stereo-shift technique, each conventional formula for the two coordinates is equal to the mean of the two geometrical solutions of each coordinate, and the one for the other coordinate is equal to one of the geometrical solutions. Formulas for the shift-film technique can be easily reduced to those for the stereo-shift technique. The error of the position calculated by the least squares method was the smallest among all the formulas for the shift-film technique in simulation.

Analyses of distant metastases in squamous cell carcinoma of the head and neck and lesions above the clavicle at autopsy

The frequency of distant metastases was studied in 112 patients who had squamous cell carcinoma of the head and neck. All of these patients died of the tumor and underwent postmortem examinations. Forty-one (37%) of the 112 patients had distant metastases at the time of death. There was a significant correlation between development of distant metastases and the presence of cervical nodes. Of the patients who had distant metastases, 63% had evidence of tumor in the cervical nodes, whereas 37% of these patients were free of disease in the neck. Patients with residual or recurrent tumors in the cervical nodes had a high risk of distant metastases.

Useful interventional thrombolytic and anticoagulant therapy for thrombosis due to embolization (TAE) in Budd-Chiari syndrome

Transarterial embolization given for hepatoma in a patient with Budd-Chiari syndrome resulted in hepatic infarction and inferior vena cava thrombosis. Transarterial membranotomy and repeated infusion of thrombolytic agents and anticoagulants directly in the thrombus brought about improvement of the circulation surrounding the liver and IVC, and recovery from hepatic failure.

Two-radiograph reconstruction using six geometrical solution sets and least-squares method

When two radiographic projections are available for reconstruction, it was found that six different combinations of equations could be used to obtain the geometrical solutions for the position of any point. No errors in the image coordinates read from the radiographs resulted in identical solutions for the six equations. Inaccuracies or errors present in the image coordinates generated differences among the six solutions. In this case, a least-squares method could be used to determine the optimum position. The utility of such a least-squares optimizing approach is presented in the context of a clinical example.

[Intraoperative radiotherapy for local recurrence of intrapelvic malignancies]

From 1986 to 1992, seventeen patients with recurrent intrapelvic malignancies have been treated with intraoperative radiotherapy (IOR) in Saitama Cancer Center. They were 8 males and 9 females. The age ranged 44 to 83 (mean:61.6). The primary organs involved were rectum in 7, urinary bladder in 5, uterine cervix in 3 and ovary in 2. Invasion of recurrent disease into bony pelvis was noted in all but one patient. A total of 27 IORs were done on 18 occasions for 17 patients. The mean radiation dose was 25.6 Gy (range: 12-30). The cones used were 4 to 7 (mean: 5.4) cm in diameter. Debulking surgery was performed in 13 patients just before IOR. Chemotherapy and/or external radiotherapy were done in addition to IOR in most of the cases. As of May 1992, 14 patients had died with a mean survival time of 10 months (range:0.5-29.8). IOR seems to be useful in controlling the intrapelvic recurrent disease and may warrant further investigation.

Radiotherapy in inoperable stage I lung cancer

In 38 cases of Stage I lung cancer, for which surgery was not indicated because of poor cardiopulmonary function or other reason, radical irradiation yielded excellent results. The five year survival rate was 42.1%, the 10-year survival rate 28.4% and the 15-year survival rate 17.1%. Postradiation complications which can be life-threatening, were acceptably low in incidence, and there was no radiation-related death. The results support the concept of radical irradiation being acceptable as a treatment modality for Stage I lung cancer if the patients concerned cannot have surgery because of poor cardiopulmonary function or some other reason.

Antibody response determined with antibody-dependent cell-mediated cytotoxicity (ADCC), neutralizing antibody, and varicella skin test in children with natural varicella and after varicella immunization

Humoral and cellular immune responses were examined in 115 children with varicella and in 21 children who had been immunized with live varicella vaccine. Antibody determined with antibody-dependent cell-mediated cytotoxicity (ADCC) was detected earlier than neutralizing antibody (NT) in both groups. While humoral and cellular immunity were detected simultaneously in the natural varicella group, cellular immunity was detected earlier than humoral immunity in the immunized group. This suggests that ADCC, rather than NT, is involved in the early stages of recovery from varicella-zoster virus (VZV) infection.

[Determination of the point position from two orthogonal X-ray photographs using least squares method and geometrical solutions]

Six sets of solutions for calculating the position of an interest point were obtained geometrically using four measured image coordinates on two X-ray photographs orthogonally projected. When the image coordinates had no error, all the solutions gave the same position without error. When an error occurred, the calculated positions differed from each other due to the propagation of error. Some solutions could not be used for this determination owing to a large propagation of error. Under conditions similar to those of clinical practice, the ratio of maximum error of position calculated by the six geometrical solutions to minimum error was about 426. The least squares method that we proposed gave results with less error. When one of the image coordinates could not be measured for some reason, the least squares method became automatically equivalent to one of the six geometrical solutions.

[Experiences in clinical application of an automated calculation system that determines the optimum intracavitary irradiation condition in the treatment of carcinomas of the uterine cervix]

An automated calculation system that determines the optimum intracavitary irradiation condition for treating carcinomas of the uterine cervix has been developed on the basis of the Manchester system. Using Vax-11 computer, the system has been successfully applied in treating 105 patients since December, 1984. Trouble with the system almost occurred during its use in the first year of its clinical application. One problem related to the method of calculation, which was quickly settled, and the other was mainly a human error. The calculation system has proven especially useful for radiotherapists.

[Intraoperative radiotherapy (IORT) in prostatic cancer]

Between February 1982 and February 1986, 30 patients with prostatic cancer received intraoperative radiotherapy (IORT). First 10 cases were treated by the transperineal approach, and after April 1983, 20 cases were done by the retropubic approach. We chose the retropubic approach, because it has advantages over the transperineal approach, which has a risk of rectal damage, lymph-adenectomy can not be performed and the patient can not sit down for a long time after the operation. In the IORT procedure for prostatic cancer by the retropubic approach, a longitudinal lower abdominal incision is made, and pushing down the bladder, the treatment cone is inserted to the prostate. We performed lymph-adenectomy at the same operation, if hard and large lymph-nodes were touched. Of 30 patients, 2 had stage B disease, 10 had stage C and 18 had stage D disease. The overall 5-year survival rate (Kaplan-Meier method) after IORT was 42.6% where as that the 31 cases seen (stage C: 6 cases, stage D: 25 cases) since the Center was founded (October 1975) until the introduction of IORT was 3.2%. Although no definite conclusion can be drawn because all cases received multidisciplinary therapy, IORT appears useful for the treatment of carcinoma of the prostate.

A method for calculating the optimum irradiation condition for intracavitary radiotherapy using quadratic programming

A method of calculating optimum irradiation conditions for intracavitary radiotherapy using quadratic programming has been formulated and then modified for practical application. The allowable range of obtained dose, which is usually fixed in advance, is automatically computed to be as small as possible. The variance of the product of the activity and the irradiation time of the tandem source is also minimised to avoid the occurrence of cold and/or hot spots. Optimum irradiation conditions for conventional intracavitary radiotherapy of carcinoma of the uterine cervix were obtained on the basis of isodose curves passed through the points A of the Manchester system. Those for carcinoma of the other organs and special cases of carcinoma of the uterine cervix can be determined after consideration of the tumour state.

Synergic effect of cisplatin, Adriamycin, and cyclophosphamide combination chemotherapy and radiotherapy in non-small cell lung cancer

61 patients with inoperable non-small cell lung cancer were treated by combination chemotherapy with cisplatin, Adriamycin and cyclophosphamide. 23 patients received radiotherapy in addition to the chemotherapy. 49 out of 55 adequately treated patients were evaluable for tumor response. Of 29 patients who received chemotherapy alone, 6 (21%) achieved partial responses. Of 20 patients who received combined chemotherapy and radiotherapy, 16 (80%) achieved complete or partial responses. The median survival time was 18 months for 22 patients treated with combined therapies.

Computed tomography in the evaluation and treatment of endometrial carcinoma

Since patients with endometrial carcinoma tend to be elderly, diabetic and hypertensive, individualization of treatment is very important. The therapy for each patient with endometrial carcinoma should be individualized and determined by the stage and factors predisposing to extrauterine spread of the tumor. Such risk factors include the grade of the tumor and depth of myometrial invasion. Unfortunately, staging based on pelvic examination is inaccurate in endometrial carcinoma and the depth of myometrial invasion cannot be assessed preoperatively. In order to assess its uses in the staging and treatment planning of endometrial cancer, CT was performed in 28 previously untreated patients with endometrial cancer. Twenty patients subsequently underwent surgery and the CT findings were correlated with the surgical and pathologic findings. CT proved to be useful in determining the depth of myometrial invasion and whether cervical involvement is present or not. Such information provided by CT helps to plan treatment more adequately and accurately for the individual patients.

[Utilization of minicomputer for the quality control of radioimmunoassay (author's transl)]

In our nuclear medicine laboratory the quality control (QC) of radioimmunoassay (RIA) has been performed along the line of WHO program for standardization and quality control of RIA. The QC procedure was automated using a minicomputer in order to avoid tedious and time-consuming hand processing. The program was written with BASIC language. The counts of radioactivity measured in autowell counters are regarded in PTR, through which the data are read into a minicomputer (Scintipac 200). After informations on the concentrations of standards are registered through keyboard of CRT, the data processing is performed including curve fitting, dose calculation and quality control. As the indicators for QC response error relationship (RER), standard curve, precision profile and QC chart are displayed on CRT. On the basis of rejection criteria using these indicators, bad assays are identified to be omitted from reporting. The subroutine installed in the minicomputer system is used for the storage of data on QC samples in each assay, which are used for construction of QC charts. The use of a minicomputer enables implementation of QC of RIA on routine basis with ease and speed.

[An evaluation of characteristics of motion corrector attached to a gamma-camera (author's transl)]

The characteristics of the motion corrector system attached to LFOV gamma-camera (Searle) was evaluated using a T-shaped plane source and point sources. The random movement without rotation of a T-shaped plane source was successfully corrected. However, rotating motion of the plane source was not corrected. When a point source placed on a rotating table, ring images were obtained. When motion corrector was used, the radius of ring images was increased with the increase of rotating speed and it was decreased with the increase of radioactivity of the source. Line images were obtained when point sources were placed on a shaker, which caused linear periodic motion of the sources. The use of the motion corrector reduced the length of line images.