Development and validation of the comprehensive assessment scale for chemotherapy-induced peripheral neuropathy in survivors of cancer

Background

Appropriate assessment is essential for the management of chemotherapy-induced peripheral neuropathy (CIPN), an intractable symptom that cannot yet be palliated, which is high on the list of causes of distress for cancer patients. However, objective assessment by medical staff makes it easy to underestimate the symptoms and effects of CIPN in cancer survivors. As a result, divergence from subjective evaluation of cancer survivors is a significant problem. Therefore, there is an urgent need to develop a subjective scale with high accuracy and applicability that reflects the experiences of cancer patients. We developed a comprehensive assessment scale for CIPN in cancer survivors, named the Comprehensive Assessment Scale for Chemotherapy-Induced Peripheral Neuropathy in Survivors of Cancer (CAS-CIPN), and demonstrated its reliability and validity.

Methods

We developed a questionnaire based on qualitative studies of peripheral neuropathy in Japanese cancer patients and literature review. Twelve cancer experts confirmed the content validity of the questionnaire. A draft version comprising 40 items was finalized by a pilot test on 100 subjects. The participants in the present study were 327 Japanese cancer survivors. Construct validity was determined by factor analysis, and internal validity by confirmation factor analysis and Cronbach’s α.

Results

Factor analysis showed that the structure consisted of 15 items in four dimensions: “Threatened interference in daily life by negative feelings”, “Impaired hand fine motor skills”, “Confidence in choice of treatment/management,” and “Dysesthesia of the palms and soles.” The CAS-CIPN internal consistency reliability was 0.826, and the reliability coefficient calculated using the Spearman-Brown formula [q = 2r/(1 + r)] was 0.713, confirming high internal consistency and stability. Scores on this scale were strongly correlated with Gynecologic Oncology Group-Neurotoxicity scores (r = 0.714, p < 0.01), confirming its criterion-related validity.

Conclusions

The CAS-CIPN is an assessment tool with high reliability and validity for the comprehensive evaluation of CIPN in cancer survivors. The CAS-CIPN is simple to use, and can be used by medical professionals for appropriate situational assessment and intervention.

Local VEGF administration enhances healing of colonic anastomoses in a rabbit model

BACKGROUND/AIMS

Many studies report the role of vascular endothelial growth factor (VEGF) in wound healing, but few describe local VEGF administration to the digestive tract. Leakage from colonic anastomoses, including those due to ischemia, represents a major complication causing increased mortality and morbidity. Angiogenesis is crucial to anastomotic healing and restoration of blood supply, and VEGF is a potent angiogenic factor showing improved healing in various models of reconstruction and anastomosis. Here, we examine the effects of local VEGF-A(165) administration on postoperative rabbit colon anastomosis.

METHODS

Two colotomies per animal were made in the sinistral colon on opposite sides of the mesentery. Randomly assigned VEGF (10 microg/0.1 ml) or saline (0.1 ml) was injected into the muscularis propria on both sides of each colonic anastomosis before closing the access laparotomy using single-layer sutures. On postoperative days 3, 4 and 7, the bursting pressure of partially healed anastomoses was measured. On postoperative day 4, anastomotic tissues were examined for the following: hydroxyproline; histopathologically for inflammatory infiltrate and tissue organization and immunohistochemically for capillary proliferation and density; vessel density of midzone collaterals around anastomoses by microangiography.

RESULTS

Compared to saline, VEGF administration significantly improved bursting pressure (p = 0.014, paired t test) and increased hydroxyproline (p = 0.027, paired t test) on postoperative day 4. Inflammatory cell infiltration and fibroblast proliferation were prominent, and submucosal capillary vascular counts were significantly higher for VEGF.

CONCLUSIONS

Administration of VEGF to colonic anastomosis accelerates wound healing and strengthens the anastomosis by increased angiogenesis.

Overexpression of glucose transporter 1 in esophageal squamous cell carcinomas: a marker for poor prognosis

Recently, Glut1 (human erythrocyte glucose transporter) expression has been demonstrated in various tumors. The aim of this study is to evaluate the prognostic utility of Glut1 expression in esophageal carcinomas. We studied Glut1 expression by immunohistochemistry of paraffin sections from 63 esophageal squamous cell carcinomas. All 63 carcinomas expressed Glut1. The mean percentage of positively stained tumor cells was 77.8% (median, 84.7%). There were two staining patterns in positive cells: 'strongly positive' and 'weakly positive'. The percentage of 'strongly positive' cells (%Glut1-SP) ranged from 0% to 95.6% (mean, 32.3%; median, 27.4%). The 5-year survival rate for patients with a high %Glut1-SP (> 30%) was significantly lower than that for patients with a low %Glut1-SP (< 30%) (P < 0.01). Statistical analysis revealed that the relative risk of death for patients with high %Glut1-SP was 2.02 times that for patients with low %Glut1-SP (P = 0.064), suggesting a possible independent predictive value for %Glut1-SP.

Dietary intakes of flavonols, flavones and isoflavones by Japanese women and the inverse correlation between quercetin intake and plasma LDL cholesterol concentration

The intake of flavonols, flavones and isoflavones by Japanese women was calculated from our food-phytochemical composition table. The relationship between intake of these phytochemicals and various anthropometric and blood chemistry data was analyzed in a cross-sectional study. The subjects were 115 women volunteers, aged 29-78 y, living in the northern part of Japan. Each subject completed a 3-d dietary record and received a health check up, including urine and blood sampling for biochemical analysis. Total mean intakes of flavonoids (sum of flavonols and flavones) and isoflavones were 16.7 and 47.2 mg/d, respectively. The major source of flavonoids was onions (45.9%) and that of isoflavones was tofu (37.0%). Total intake of isoflavones exceeded that of other dietary antioxidants, such as flavonoids, carotenoids (3.5 mg/d) and vitamin E (8.2 mg/d), and was approximately one half of the vitamin C intake (109 mg/d). The total intake of flavonoids was inversely correlated with the plasma total cholesterol concentration (TC) (r = -0.236, P: < 0.05) and plasma LDL cholesterol concentration (LDL-C) (r = -0.220, P: < 0.05), after the adjustment for age, body mass index and total energy intake. As a single component, quercetin was inversely correlated with both TC (r = -0.261, P: < 0.01) and LDL-C (r = -0. 263, P: < 0.01). Among Japanese, flavonoid and isoflavone intake is the main component among nonnutrient phytochemicals with antioxidant potential in the diet. These results suggest that a high consumption of both flavonoids and isoflavones by Japanese women may contribute to their low incidence of coronary heart disease compared with women in other countries.

Application of a newly developed, highly sensitive camera and a 3-dimensional high-definition television system in experimental ophthalmic surgeries

OBJECTIVE

To apply a new television system, which displays highly sensitive, high-quality 3-dimensional (3-D) images, in performing experimental ophthalmic surgeries.

METHODS

By combining a high-gain avalanche rushing-amorphous photoconductor (HARP) camera, recently developed in Japan, which has 600 times greater sensitivity than conventional television cameras, and a single-camera, 3-D high-definition television system, which displays high-quality 3-D images, we performed cataract/intraocular lens surgeries and pars plana vitrectomies under various illumination intensities in pig cadaver eyes.

RESULTS

Cataract/intraocular lens surgeries were performed using 7.3% the intensity of ordinary surgical microscopic illumination; vitrectomies were performed using 30.2% the intensity of an ordinary endoillumination probe with the HARP camera and by observing the stereoscopic display of the single-camera 3-D high-definition television system. Images identical to those observed by the surgeon were displayed on the stereoscopic display monitor.

CONCLUSION

The system not only allowed surgeries to be performed under lower intensities of operating light but also provided real-time, highly sensitive 3-D images identical to those observed by the surgeon; thus, the device may be effectively used for education, team surgery, and telesurgery.

CLINICAL RELEVANCE

The new television system for ocular surgeries to be performed under lower intensities of operating light as well as providing real-time, highly sensitive 3-D images identical to those observed by the surgeon may be effectively used for education and telesurgery.

Molecular cloning and expression of human neurochondrin-1 and -2

Human neurochondrins have been cloned from a brain cDNA library. The human neurochondrin-1 and -2 predict leucine-rich (15.8 and 15.9%) proteins of 729 and 712 amino acid residues, with molecular weights of 78.9 and 77.2 kDa, respectively. The deduced amino acid sequence indicates 98% identity among human, mouse and rat species. Northern analysis indicates that about 4 kb human neurochondrin mRNAs are abundant in the fetal and the adult brain.

Induction of hydroxyapatite resorptive activity in bone marrow cell populations resistant to bafilomycin A1 by a factor with restricted expression to bone and brain, neurochondrin

Bone, one of the favored sites for tumor metastasis, is a dynamic organ undergoing formation and resorption. We found bone metastasis with osteolytic lesion in the bone marrow of the femur by injecting BW5147 T-lymphoma cells into the tail vein of AKR mice. To understand this bone destruction, we constructed a cDNA library from BW5147 with a cloning vector that allowed in vitro synthesis of mRNAs, and then identified a particular cDNA clone by adding the conditioned medium from Xenopus oocytes following injection of the mRNA synthesized in vitro to primary bone marrow heterogeneous cell populations on hydroxyapatite thin films. By means of this method, we isolated a factor with 16% leucine residues, termed neurochondrin, that induces hydroxyapatite resorptive activity in bone marrow cells resistant to bafilomycin A1, an inhibitor of macrophage- and osteoclast-mediated resorption. Expression of the gene was localized to chondrocyte, osteoblast, and osteocyte in the bone and to the hippocampus and Purkinje cell layer of cerebellum in the brain. This may provide insights into the molecular mechanisms underlying bone resorption with potential implications for the activation of cells other than macrophages and osteoclasts in bone marrow cells.

Two isoforms of a human actin-related protein show nuclear localization and mutually selective expression between brain and other tissues

Actin-related proteins (Arps), which are divergent, but apparently homologues to actin, are categorized into 10 classes. While Arps belonging to classes 1-3 were found to be localized in the cytoplasm across eukaryotic phyla, other classes of Arps were found mostly in invertebrates and suggested to contribute to structural modulation of chromatin. Here we report the identification and the characterization of two human isoforms of an Arp not belonging to classes 1-3, which we designated hArpN alpha and hArpN beta. Both proteins were expressed in HeLa cells and they were found localized within the nucleus. Most interestingly, in different human tissues, hArpN alpha and beta were found to be expressed mutually exclusively, and the expression of hArpN alpha was absolutely restricted to the brain. These findings suggest that, in vertebrates, members of distantly related Arps might have tissue-specific functions in the nucleus, possibly through structural modulation of chromatin.

Detection of hepatic tumors: arterial-phase MR imaging versus spiral CT arteriography

BACKGROUND

To compare the utility of arterial-phase magnetic resonance (APMR) imaging and spiral computed tomography arteriography (CTA) for detection of hepatic tumors.

METHODS

Both APMR imaging and CTA were performed in 24 patients with liver tumors. APMR imaging was initiated at 25-30 s after an intravenous bolus injection of gadolinium-diethylenetriamine pentaacetic acid using the fast multiplanar spoiled GRASS technique. CTA was initiated at 3 s after hepatic arterial injection of 30-64% nonionic contrast agent. APMR and CTA images were separately reviewed retrospectively by two blinded readers. Afterward, matched pair was reviewed to determine which had better lesion conspicuity.

RESULTS

The sensitivities for hepatic tumors were 67.2 and 86.6% in APMR and CTA, respectively (p < 0.01). Seven (12.5%) and 21 (23.9%) false-positive lesions were seen at APMR and CTA, respectively (NS). Lesion conspicuity was comparable between APMR and CTA.

CONCLUSIONS

Although APMR imaging is an useful noninvasive method to detect hypervascular liver tumors, APMR imaging is still not an alternative to CTA with respect to tumor detectability.

Induction of midkine expression in reactive astrocytes following rat transient forebrain ischemia

Midkine (MK), a retinoic acid-responsive gene product, is a 13-kDa heparin-binding protein with neurotropic activity. Previous studies demonstrated the expression of MK in embryonal and neonatal brains and its potent neurotropic activities in vitro. Data concerning its role in the mature central nervous system, however, are still limited. We examined the changes of MK expression in the adult rat brain following transient forebrain ischemia, by Northern blot, in situ hybridization and immunohistochemical analyses. In the control brain, MK mRNA was expressed in the cortical and hippocampal neurons. Following the ischemia, up-regulation of MK mRNA and a corresponding increase of its protein products were found in the hippocampal CA1 subfield. The maximal expression was demonstrated on day 4 after the insult. The cells expressing MK were distributed around the depleted CA1 pyramidal cells and identified as reactive astrocytes by double immunostaining. These data suggest that MK may be an insult-induced molecule which participates in the reparative processes following neuronal injury.

Protection by alpha G-rutin, a water-soluble antioxidant flavonoid, against renal damage in mice treated with ferric nitrilotriacetate

The protective effect of alpha G-Rutin against ferric nitrilotriacetate (Fe-NTA)-induced renal damage was studied in male ICR mice. Fe-NTA induces renal lipid peroxidation, leading to a high incidence of renal cell carcinoma in rodents. Administration of alpha G-Rutin (50 mumol as rutin/kg) by gastric intubation 30 min after i.p. injection of Fe-NTA (7 mg Fe/kg) most effectively suppressed renal lipid peroxidation. Repeated i.p. injection of Fe-NTA (2 mg Fe/kg/day for the first 3 days and 3 mg Fe /kg/day for 12 days, 5 days a week) causes subacute nephrotoxicity as revealed by induction of karyomegalic cells in renal proximal tubules. A protective effect was observed in mice given alpha G-Rutin 30 min after each Fe-NTA treatment. To elucidate the mechanism of protection by alpha G-Rutin, the pharmacokinetics and hydroxyl radical-scavenging effect of alpha G-Rutin were investigated by HPLC analysis and by electron spin resonance (ESR) spin trapping with 5,5-dimethyl-1-pyrroline-N-oxide (DMPO), respectively. When mice were given alpha G-Rutin (50 mumol as rutin/kg) by gastric intubation, rapid absorption into the circulation was observed. The plasma concentration of alpha G-Rutin reached the highest level 30 min after oral administration and then decreased to the control level within 60 min, alpha G-Rutin inhibited the formation of DMPO-OH in a concentration-dependent manner. Further, chelating activity of alpha G-Rutin to ferric ions was shown by spectrophotometric analysis. These results suggest that absorbed alpha G-Rutin works as an antioxidant in vivo either by scavenging reactive oxygen species or by chelating ferric ions and this serves to prevent oxidative renal damage in mice treated with Fe-NTA.

Neuronal and muscular inclusions in rats with hindlimb dysfunction after treating with difluorobenzhydrylpiperadine

Rats showing an ataxic gait induced by 20 wk of treatment with 0, 30, or 60 mg/kg of difluorobenzhydrylpiperadine (DFBP), a detriazinyl metabolic of almitrine, were examined by light microscopy and transmission electron microscopy. Vacuolar degeneration associated with lamellar inclusions was observed in musculus soleus and m. interossei of the hindlimbs in DFBP-treated rats. The inclusions were also produced within sensory neurons, satellite and Schwann cells, and vascular endothelial cells of thoracic and lumbar dorsal root ganglia as well as muscle spindles of affected muscles. Membrane-bound vacuoles containing electron-dense granules were seen in the peripheral nerves. This study demonstrated neuronal and muscular toxicity of DFBP in rats.

A canine case of profound granulomatosis due to Paecillomyces fungus

A 5-year-old dog showed remarkable edematous swelling of the left hock with lameness and local cellulitis, and paecillomyces fungus was isolated from ulcerative lesion of the hock joint and mediastinum. At autopsy severe effusive pleuritis was shown and numerous necrotizing and granulomatous lesions with fungal elements were seen in the liver, pancreas, kidney and mediastinal lymph nodes.

Hemodynamics of small hepatocellular carcinomas (5 cm or less in diameter): cases with discrepant findings between dynamic MR images and hepatic arteriograms

BACKGROUND

The degrees and patterns of contrast enhancement of small hepatocellular carcinomas (HCCs) on dynamic magnetic resonance (MR) images were compared with those on hepatic arteriograms in 61 patients.

METHODS

Dynamic MR imaging was performed within 1 week before hepatic angiography prior to treatment, 3-4 weeks after treatment, and then once every 1-3 months if necessary. Hepatic arteriography was carried out with a coaxial microcatheter inserted into the proper hepatic artery or its distal branches.

RESULTS

In 58 of 61 cases, the degrees of contrast enhancement of the tumor in dynamic MR imaging were roughly consistent with those in hepatic arteriography before treatment. In the remaining three cases, however, the tumors were depicted as hyperintense in the arterial dominant phase of the dynamic MR imaging, whereas the tumors were not detected by hepatic arteriography. The tumor detectability is 97% by dynamic MR imaging and 92% by hepatic arteriography. Furthermore, when an HCC nodule was not clearly enhanced by hepatic arteriography after treatment, it was possible by dynamic MR imaging to obtain accurate information on whether the HCC nodule had parasitic arteries.

CONCLUSIONS

Dynamic MR imaging was superior to hepatic angiography in contrast resolution. It was therefore considered to be useful in assessing the degrees and patterns of contrast enhancement of small HCCs before and after treatment.

A clinical trial of therapeutic electrical stimulation for amyotrophic lateral sclerosis

This paper describes the effects of therapeutic electrical stimulation (TES) on the wasting muscles in a patient with amyotrophic lateral sclerosis. The patient is a 47-year-old male, and he has a history of progressive muscle weakness and atrophy, affected more in the right side. Percutaneously indwelling intramuscular electrodes were implanted to the affected muscles in the right upper and lower extremities but no electrode in the corresponding left region. Within a month of TES therapy, a rapid improvement of extremity motion appeared in the TES treated side. Long-term application of TES more than 3 months increased the strength of the muscle which had been evidently weaker than the non-treated side. CT findings of both the upper and lower extremities with TES therapy showed an increase in the density and a reduction in the moth-eaten image. An increase in the thickness of the muscles was also observed in the TES treated side while deterioration was observed in the muscles on the non-treated side.

Three-dimensional Hi-Vision video imaging in ear surgery

We report here a newly developed video system which combines a three-dimensional and high-definition television system (Hi-Vision) for microsurgery of the ear. This system provides a high-quality three-dimensional documentation for easy understanding of the otherwise difficult to visualize areas in the of the otomicrosurgical procedure, making it convenient and beneficial for easy understanding of the otherwise difficult to visualize areas in the middle and inner ear, especially in the context of postgraduate training.

Dynamic MRI of the diaphragm

OBJECTIVE

To demonstrate the appearance of the diaphragm on single-slice dynamic MRI.

MATERIALS AND METHODS

We evaluated the diaphragm using gadolinium-enhanced single-slice dynamic MR in 53 patients.

RESULTS

The diaphragm was partially depicted in 49 cases (92.5%). Its thickest part measured 4.4 +/- 2.2 mm, range 3 to 15 mm. Enhanced high-intensity thin layer structures were partially identified between the diaphragm and liver parenchyma in 46 cases (86.8%) at 16 to 144 s (mean +/- SD, 65.7 +/- 32.6 s) after intravenous injection of Gd-DTPA.

CONCLUSION

Dynamic MR has value and limitations in demonstrating the diaphragm.

Differences in taste responses to Polycose and common sugars in the rat as revealed by behavioral and electrophysiological studies

Behavioral and electrophysiological experiments were performed to examine the suggestion that rats have two types of carbohydrate taste receptors, one for polysaccharides (e.g., Polycose) and one for common sugars (e.g., sucrose). Qualitative difference between the tastes of Polycose and sugars including sucrose, maltose, glucose, and fructose was surveyed by means of a conditioned taste aversion paradigm in which the number of licks for 20 s to each taste stimulus was measured. Aversive conditioning to Polycose did not generalize to sugars, while aversive conditioning to sucrose generalized to other sugars, but not to Polycose. In the electrophysiological study, taste responses of the whole chorda tympani were recorded. A proteolytic enzyme, pronase E, suppressed nerve responses to both Polycose and sugars to less than 50%. A novel anti-sweet peptide, gurmarin, strongly suppressed responses to sugars, but had essentially no effect on Polycose responses. On the other hand, KHCO3 enhanced responses to sugars to about 300%, but had little effect on Polycose responses. These results have confirmed the notion that rats can differentiate the tastes between Polycose and common sugars and that rats have two types of carbohydrate receptors.

Extracapsular invasion of small hepatocellular carcinoma: MR and CT findings

OBJECTIVE

The purpose was to examine whether MR and CT imaging can detect extracapsular invasion of hepatocellular carcinoma (HCC) and, if this is possible, to determine its characteristic signs on MR and CT images.

MATERIALS AND METHODS

Thirty-eight patients with small HCC (< or = 3.0 cm in diameter) were studied to correlate the findings in surgically resected specimens with the findings on MR and CT images.

RESULTS

Ten of 38 patients had histologically proven extracapsular invasion of HCC. Of these 10 patients with extracapsular invasion, partial projections of the tumor into the surrounding area or satellite nodules in the immediate vicinity of the tumor were observed in 9 patients on T1-weighted images and in 5 patients on postcontrast CT images. Partial tumor projection or satellite nodules were not observed in patients without extracapsular invasion of HCC. The detection rate for these characteristic signs was 90% on MR and 50% on CT.

CONCLUSION

Magnetic resonance and CT imaging were useful for detection of extracapsular invasion of HCC. The characteristic signs for extracapsular invasion of HCC were partial tumor projection into the surrounding area and satellite nodules in the immediate vicinity of the tumor.

Functional imaging of the human olfactory cortex by magnetic resonance imaging

Our understanding of the neural mechanism of human olfaction is still equivocal. Several recent reports document that functional magnetic resonance imaging (MRI) has a potential to visualize dynamic brain function in humans without invasion. In the present study, we applied functional MRI with odor stimulation for the purpose of clarifying the localization of olfactory cortices in the human. We obtained a significant increase in cerebral blood flow in the piriform cortex, orbitofrontal cortex, and inferior medial frontal lobe, corresponding to olfactory cortices. These results suggest that, in the near future, precise diagnosis of the patients with olfactory disorders will be possible using functional MRI with odor stimulation.

Hepatocellular carcinoma with tumor thrombus in the inferior vena cava and right atrium

Tumor thrombus (TT) in the inferior vena cava (IVC) and right atrium (RA) is rarely encountered. We have diagnosed before death and treated a case of hepatocellular carcinoma (HCC) with TT in the IVC and RA, accompanied by a brain metastasis. The image characteristics on computed tomography (CT), magnetic resonance imaging (MRI), and conventional angiography are discussed.

[Analysis of three-dimensional imaging of the right hepatic vein and right portal vein branch using 2D-TOF MR angiography: evaluation of utility of MR angiography in determining puncture course on TIPS]

2D-TOF MR angiographies were performed in seven patients of liver cirrhosis with hepatocellular carcinoma to investigate three-dimensional anatomical relationships of the right hepatic vein and first order of right portal vein branch. The puncture course was set up in three-dimensional rectangular coordinates, and the bend angle and turning angle of the modified Ross needle, and puncture distance were calculated of the data measured on the A-P and L-R projection images of MR angiograms. The utility and limitation of 2 D-TOF MR angiography to determine the puncture course on TIPS were discussed in this study.

[A case of Borrmann type 4 gastric cancer responding to sequential methotrexate and 5-fluorouracil combined with CDDP]

A case of Borrmann type 4 gastric cancer responding to sequential methotrexate and 5-fluorouracil combined with cis-diamminedichloroplatinum (CDDP) is reported. A 57-year-old woman was admitted to our hospital complaining of abdominal fullness. Upper gastrointestinal series and gastrofiberscopy revealed almost the entire stomach was involved with Borrmann type 4 cancer. Gastrectomy could not be performed because of peritoneal dissemination. However, the patient responded to sequential methotrexate and 5-fluorouracil therapy and CDDP administration. She enjoyed more than one year of hospital-free survival period and survived for almost two years.

Three-dimensional Hi-vision system for microneurosurgical documentation based on wide-vision telepresence system using one camera and one monitor

A three-dimensional (3-D) high-definition television (Hi-Vision) system suitable for attachment to a stereoscopic operating microscope allowing 3-D medical documentation using one Hi-Vision camera and one Hi-Vision monitor is described. The system provides 3-D high-definition microneurosurgical recorded images suitable for viewing on a screen or monitor, or for printing.

[Superselective bronchial arterial infusion therapy with cisplatin and epirubicin hydrochloride, mitomycin C-iohexol-Lipiodol emulsion (EMILE) for hilar lung adenocarcinoma: preliminary clinical experience]

A case of hilar lung adenocarcinoma was treated by superselective bronchial arterial infusion therapy with cisplatin and epirubicin hydrochloride, mitomycin C-iohexol-Lipiodol emulsion (EMILE) using Tracker -18 infusion catheter. The tumor size was reduced on follow-up CT scans. However, EMILE was also distributed to nontumorous lung tissues around the tumor, and a shrinkage of the right upper lobe and elevations of the right hilus and diaphragm followed. No major complaints and clinical complications during and after the treatment occurred. This therapy was safe and effective for local tumor reduction in a case of hilar lung adenocarcinoma.

Lipiodol retention and massive necrosis after lipiodol-chemoembolization of hepatocellular carcinoma: correlation between computed tomography and histopathology

This retrospective study examined the computed tomography (CT) criteria for judging the effectiveness of transcatheter arterial Lipiodol-chemoembolization (Lp-chemo-TAE) in 35 cases with hepatocellular carcinoma (HCC). Massive necrosis, defined as involving 97% or more of the HCC nodule, was observed in 15 cases after Lp-chemo-TAE, whereas nonmassive necrosis, defined as involving < or = 96% of the HCC nodule, was observed in the remaining 20 cases. In 12 of 15 cases (80%) with massive necrosis, uniform dense retention of Lipiodol (Lp) was observed throughout the HCC nodule on CT images 3-4 weeks after Lp-chemo-TAE as opposed to only one (5%) of 20 cases with nonmassive necrosis (p < 0.01). Eight of nine cases (89%) with massive necrosis had tumor attenuation values of 365 Hounsfield units (HU) or greater on CT images 3-4 weeks after embolization, as opposed to only four (27%) of 15 cases with nonmassive necrosis (p < 0.01). We conclude that the effectiveness of the Lp-chemo-TAE can be judged on CT from the degree and duration of Lp retention in the HCC nodule and the measurement of the attenuation value of the HCC nodule.

Paraneoplastic cerebellar degeneration and limbic encephalitis in a patient with adenocarcinoma of the colon

The rare association of two neurological paraneoplastic syndromes, paraneoplastic cerebellar degeneration and limbic encephalitis occurred in a 55 year old woman with a microscopic adenocarcinoma in a colonic polyp. Complete removal of the tumour by polypectomy brought about a favourable recovery from limbic encephalitis but the cerebellar ataxia remained. High titres of antineuronal nuclear antibody resembling anti-Hu were demonstrated in serum by immunohistochemistry using rat brain as a substrate. The antibody identified a protein band of 41 kDa on a Western immunoblot.

A selective impairment in the phonological output lexicon

It has been proposed that words are stored in a functional structure which consists of a semantic system and modality-specific input and output lexicons. We report a patient with disturbed word finding for given letters, but not for specific categories. The patient had difficulty in phonological similarity judgements of pictures, but performed normally on semantic similarity judgements. We conclude that this patient's impairments stemmed from a disturbance restricted to the subsystem for active judgement and selection of representations in the phonological output lexicon.

Rupture of hepatocellular carcinoma: predictive value of CT findings

To assess the value of CT in predicting spontaneous rupture of hepatocellular carcinoma, we reviewed CT scans obtained within 3 months before the rupture of hepatocellular carcinoma in 23 patients (rupture group) and within 3 months before death of any cause other than rupture of hepatocellular carcinoma in 20 patients with tumor contacting or protruding out of the liver margins (nonrupture group). All the carcinomas in the rupture group were located in the periphery of the liver. They protruded out of the liver margins in 18 cases and contacted the liver margins without protrusion in five cases. For the rupture and nonrupture groups, respectively, mean numbers of involved liver segments were 4.2 +/- 2.3 and 2.3 +/- 1.3 (p less than .01); mean maximal tumor areas were 102.0 +/- 57.0 cm2 and 57.7 +/- 50.9 cm2 (p less than .05); frequencies of tumor protrusion was 78% and 50% (NS); mean maximal lengths of protruded margins of the tumor were 188.1 +/- 81.4 mm and 77.2 +/- 50.3 mm (p less than .01); frequencies of extrahepatic invasion of the tumor were 44% and 20% (NS); and frequencies of ascites were 78% and 50% (NS). No significant differences in age or sex of the patients and clinical stage of the cancer were evident between the two groups. Multiple regression analysis (p less than .005, r2 = .428) indicated that, of the CT findings, maximal length of protrusion correlated best (p less than .05) with subsequent rupture. We conclude that increased tumor size and extent of extrahepatic protrusion are associated with an increased risk for rupture of hepatocellular carcinoma.

Molecular biological studies in atherothrombotic brain infarction

Strokes due to atherosclerosis are the most prominent neurological disease affecting adults, and efforts to reduce stroke occurrence, in addition to stroke-risk reduction, will require insights into molecular mechanisms. Our studies showing abnormal metabolism of low and high density lipoproteins (LDL and HDL) in vivo and of RFLP in apoprotein AI, the major protein of HDL, in stroke-prone subjects suggest that greater exploration of fundamental mechanisms of atherothrombotic brain infarction (ABI) should yield preventative strategies, the ultimate treatment for strokes.

Gallium-67 citrate scintigraphy in the pre-operative evaluation of soft tissue tumors of the extremities

We conducted a study of 90 patients with soft tissue tumor in their arms or legs, in order to determine the usefulness of scintigraphy with gallium-67 citrate as a diagnostic means. All patients had adequate scan images, and tumor tissues had been histologically confirmed by surgical resection. The subjects consisted of 19 patients with malignant tumors, 55 patients with benign tumors, and 16 patients with other disorders in which soft tissue tumor-like lesions occurred. When the activity of the tumor was more than the activity of the normal region of the contralateral extremity, it was estimated to be positive. The positive rate was found in 78% (15/19) of patients with malignant tumors, in 25% (14/55) of patients with benign tumors and in 31% (5/16) of patients with other disorders. Classified by diseases, high positive rates were observed in liposarcoma, leiomyosarcoma, malignant lymphoma, neurinoma, extra-abdominal desmoid and sarcoidosis. Out of 7 patients in which the activity of the tumor was equal to, or higher than that of the liver, 6 patients had malignant tumors and one patient was diagnosed as having an abscess. It seemed possible to distinguish between liposarcoma and lipoma by means of a gallium-67 scan. Furthermore, the gallium-67 scan was useful in detecting lesions of sarcoidosis as well as in evaluating the response to treatment.

Triethylene-tetramine (trien) therapy for Wilson's disease

Triethylene tetramine (trien), in increasing dose from 1.0-2.0 g/day to 2.5-3.0 g/day, was used for 4 Japanese patients with Wilson's disease who were intolerant of D-penicillamine (D-PC). Before the treatment, urinary copper excretion (UCE) was 70-96 micrograms/day. UCE increased to 1,512-2,352 micrograms/day on the day of initial administration, and remained at levels between 350-1,100 micrograms/day, thereafter. During 2 months of trien therapy, neurological deficits regressed in three patients, and only slightly in one patient. No adverse effects were observed. These results and the retrospective survey on 17 patients treated with D-PC confirmed that trien is less potent but a safer copper chelating agent than D-PC. The transient aggravation of neurological deficits seen in two patients during the early stage of the treatment suggested that trien, as D-PC, should be started in small doses and gradually increased.

[The role of tissue plasminogen activator in chronic subdural hematomas]

The role of tissue plasminogen activator (TPA) in chronic subdural hematomas was investigated. Fifteen cases of hematoma fluid and 26 cases of outer membrane and adjacent dura mater were used for the analysis, which were obtained at surgical treatment. Isolation of TPA was done by using a lysine-sepharose affinity chromatoculumn, then, TPA was measured by a fibrin plate method. The value of TPA in hematoma fluid was 0.035 +/- 0.018 IU/ml (mean +/- SD), that was extremely low. The value of TPA in the dura mater was 28.1 +/- 20.4 IU/g, which was significantly higher than that of normal dura mater. The values of TPA in the outer membrane were ranged widely from 12.1 to 123.6 IU/g (55.0 +/- 39.7 IU/g). In each case, however, TPA of the outer membrane was always higher than that of dura mater and they were highly related. TPA value of the outer membrane was tend to be high in the patients who had an obvious history of head injury and were treated surgically 40 to 60 days after the head injury. Some cases of posttraumatic subdural fluid collection were reported to be evoluted to chronic subdural hematomas at around 60 days after the head injury. From these facts, the changes of TPA activity may play a role in the evolution of chronic subdural hematomas. In relation to the pathological findings, TPA value was tend to be high in the cases that had a well developed sinusoidal layer. Since main location of TPA is in the endothelium, this result suggests that the sinusoidal layer may produce TPA.

[Anatomical asymmetries of the frontal and parietal lobes (author's transl)]

The anatomical asymmetries of the cerebral hemispheres were described by several investigators. These evaluations were done in postmortem condition. With the introduction of the CT scan, the cytoarchitecture of the human brain in vivo are well appreciated. The purpose of this study is to demonstrate the functional and anatomical asymmetries on the frontal and parietal lobes.