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Volume 59 (2008)
- Issue 6 Pages 519-
- Issue 5 Pages 439-
- Issue 4 Pages 373-
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- Issue 2 Pages 77-
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Volume 59, Issue 5
Displaying 1-11 of 11 articles from this issue
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Special Issue of Advances in Diagnostic Equipment in the field of Bronchoesophagology
Review
Review
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Masahiro Kaneko, Takaaki Tsuchida2008 Volume 59 Issue 5 Pages 439-444
Published: October 10, 2008
Released on J-STAGE: October 25, 2008
JOURNAL RESTRICTED ACCESSThe respiratory system consists of the hollow organ from the trachea to the respiratory bronchiole and the parenchyma organ including the alveoli.
Generally, the respiratory tract from the trachea to the hilum of the lung can be macroscopically observed by diagnostic imaging with a video bronchoscope. Diagnoses are occasionally made according to auto fluorescence image (AFI), narrow band image (NBI) or endobronchial ultrasonogram (EBUS). We expect that in the future it will be possible to make pathological diagnoses using endoscopic techniques such as magnification observation and optical coherent tomography (OCT).
Bronchography was formerly used to observe the airways below the hilum of the lung. Recently, it is no longer used for this purpose because of considerable burden on the examinee. In place of this technique, three-dimensional reconstruction of the bronchi based on high-resolution CT imaging and ultra-thin bronchoscopy have been developed. Their widespread use are anticipated in the future.
High-resolution CT imaging and fluorodeoxyglucose positron-emission tomography (FDG-PET) are frequently used for diagnostic imaging of lesions in the peripheral lung field. Trans-bronchial biopsy is commonly adopted to make a definitive diagnosis of such lesions. A fluoroscope is usually used as a guide for the biopsy instrument. Recent introduction of CT and ultrasound guided biopsy has contributed to improvement in diagnostic yield. In the future, hopes focus on further integration of diagnostic imaging with endoscopic guidance technology and establishment of a system enabling adequate sampling from minimal abnormality.View full abstractDownload PDF (554K) -
Kiyohiko Shuto, Hisahiro Matsubara2008 Volume 59 Issue 5 Pages 445-451
Published: October 10, 2008
Released on J-STAGE: October 25, 2008
JOURNAL RESTRICTED ACCESSRapid advances have been seen recently in imaging modalities and analytical software for radiological imaging of digestive cancer disease, which started from diagnosis of existence and qualitative diagnosis. Today, in addition to the previous TNM staging technique a new imaging technology has been developed. The new technology, which we have named “functional imaging”, enables biological evaluation of the malignant potential of cancer, including tissue blood flow, tissue metabolism and cell activity. In this paper concerning esophageal squamous cell cancer, we described both the current status of radiological imaging and this new imaging technology for the near future.
The new imaging technique mainly consists of diffusion-weighted magnetic resonance imaging (DWI), CT perfusion and high-barium radiography using a flat panel X-ray detector (FPD). From our earlier data, we recognize that DWI is possible of a good diagnostic power by no means inferior to FDG-PET in detecting nodal metastasis. Chemoradiotherapy effect is predicted by evaluating tumor blood flow using CT perfusion. High-barium esophagography with FPD enables discrimination of superficial cancer. New diagnostic imaging may be established using these technologies.View full abstractDownload PDF (1497K) -
Haruhiro Inoue, Akira Yokoyama, Hitomi Minami, Makoto Kaga, Keiko Kudo ...2008 Volume 59 Issue 5 Pages 452-458
Published: October 10, 2008
Released on J-STAGE: October 25, 2008
JOURNAL RESTRICTED ACCESSHigh-resolution endoscopy with NBI magnifying function allows us to detect even minute neoplastic lesion. As a diagnostic process, detection of a brown spot or brownish area is the first step to detect such lesions. At the second step magnifying endoscopy is carried out using NBI magnification. IPCL patterns which reflect structural atypia of the epithelium can be classified into five categories.
Ultra-high magnification endoscopy using endocytoscopy facilitates the observation of cell-level structures in vivo. Endocytoscopic findings are classified into five categories of ECA classification. This endocytoscopic image may be regarded as the third step of diagnosing tissue atypia.View full abstractDownload PDF (1096K) -
Osamu Kawamura, Motoyasu Kusano2008 Volume 59 Issue 5 Pages 459-466
Published: October 10, 2008
Released on J-STAGE: October 25, 2008
JOURNAL RESTRICTED ACCESSDevelopments of new diagnostic equipments for GERD, i.e., wireless esophageal pH monitoring and intraluminal impedance monitoring have been changing our understanding of GERD pathophysiology. The Bravo system is a well tolerated alternative to catheter based pH measurement. Experience with the technique is increasing, and normal values are being established. If the accuracy of catheter based detection of reflux events is shown to be limited, the Bravo system may establish itself as the new standard for pH measurement in the investigation and diagnosis of GERD. Intraluminal impedance monitoring made it possible to detect non-acid reflux and gas reflux. By development of this new technique, GER no longer means acidic GER only, but it also means non-acidic one. Esophageal or extraesophageal symptoms of GERD may be related to less acidic or gas reflux that is not detected by pH metry. Intraluminal impedance monitoring is the only recording method that can achieve high sensitivity for detection of all types of reflux episodes.View full abstractDownload PDF (730K) -
Terue Okamura, Koichi Koyama, Nozomi Ozawa, Ibuki Hayashi2008 Volume 59 Issue 5 Pages 467-476
Published: October 10, 2008
Released on J-STAGE: October 25, 2008
JOURNAL RESTRICTED ACCESSFDG-PET is a useful tool for imaging malignant tumors based on glucose metabolism. CT and MRI are diagnostic imaging tools based on morphology.Morphological diagnostic modalities for tumor investigations have inherent limitations. FDG-PET has been reported to be useful for evaluating tumor viability in diagnosis and management of head and neck tumors. However, because with FDG-PET it is difficult to identify anatomical structures, CT or MRI is required as a reference for interpretation. PET/CT scanners provide fusion of PET and CT images obtained at the same time and combine both morphological and metabolic imaging information. PET/CT has improved diagnostic impact because of the accurate anatomical structures in which FDG accumulates, and it can therefore be used to diagnose malignant tumors. PET/CT has been widely used for laryngeal, hypopharyngeal and esophageal cancers. Squamous cell carcinomas (SCCs) are most often found in laryngeal, hypopharyngeal and esophageal malignant tumors. High FDG uptake is shown in SCCs. In these cancers, PET/CT is used not only for staging, monitoring therapy response and detecting recurrence, but also for detecting second primary cancers. Second primary cancer arises more frequently in head and neck cancers. It is convenient to detect distant metastases and second primary cancers by investigation of the whole body in one PET/CT scan, and these are important factors for prognosis. Furthermore, PET/CT is also expected to be adopted in radiotherapy treatment planning such as IMRT. Attention needs to be paid to false positive lesions caused by inflammation, physiological uptake and inherent limitations.View full abstractDownload PDF (1009K) -
Yasuyuki Kurihara, Kunihiro Yagihashi, Ryoko Hagino, Shin Matsuoka, Yo ...2008 Volume 59 Issue 5 Pages 477-485
Published: October 10, 2008
Released on J-STAGE: October 25, 2008
JOURNAL RESTRICTED ACCESSThis pictorial essay summarizes several CT and MRI features of common abnormalities of the trachea and main-stem bronchi using many demonstrative images, including high-resolution CT, MRI, multiplanar reconstruction images, three-dimension volume rendering images, and virtual bronchoscopic images. We also introduce recent advances in virtual bronchoscopic navigation technique and newly developed software dedicated to analysis and measurement of the airway.View full abstractDownload PDF (740K) -
Mitsuru Matsuki, Yuki Inada, Shuji Kanazawa, Go Nakai, Yoshifumi Narum ...2008 Volume 59 Issue 5 Pages 486-491
Published: October 10, 2008
Released on J-STAGE: October 25, 2008
JOURNAL RESTRICTED ACCESSEsophageal cancer is associated with lymph nodes metastases, even in cases with superficial local invasion, and metastatic lymph nodes spread widely;therefore, lymph node dissection in two or three regions of the cervix, mediastinum, and abdomen is standard. Accordingly, in some cases, a radical lymphadenectomy is performed, which can cause problems because of over surgery, and moreover, endoscopic surgery is performed in cases with superficial cancers, therefore there is increased clinical significance to the evaluation of lymph nodes metastases. Commonly, lymph nodes have been evaluated based on size criteria using CT and MRI, however we are fully aware of their limitations. Accordingly, we examined the usefulness of sentinel lymph nodes navigation on CT, MRI, and MR lymphography using ultrasmall superparamagnetic iron oxide (USPIO). A problem with sentinel lymph nodes navigation is skipped metastases over the sentinel lymph nodes, which are not able to be detected, and a limitation of MR lymphography is low detection of lymph nodes because of low spatial resolution and motion artifacts that result from cardiac and aortic pulsation, although this has high accuracy in the diagnosis of metastatic lymph nodes. Further examination is required in order to solve those problems.View full abstractDownload PDF (1673K)
Original
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Toshifumi Hasegawa, Shigemichi Iwae, Kouichiro Yonezawa, Hirokazu Koma ...2008 Volume 59 Issue 5 Pages 492-496
Published: October 10, 2008
Released on J-STAGE: October 25, 2008
JOURNAL RESTRICTED ACCESSTen cases (5 males and 5 females) of anaplastic carcinoma of the thyroid treated at Hyogo Cancer Center between February 1994 and October 2006 were reviewed. Patient ages ranged from 47 to 84 years with a median of 65.5 years. Only one case is alive after 12 years and 8 months;8 cases died of the disease and one died of a different disease. The 8 cases who died from the carcinoma consisted of 4 cases of suffocation by primary tumor invasion and 4 cases of distant metastasis. All 9 cases died within one year after their treatment.
The 6 cases were treated by surgery with postoperative radiotherapy and the 2 cases of them underwent chemotherapy. The local tumor was resected radically in the 3 cases and was not resected radically but debulked in the 3 cases. Only 1 long-time survivor whose preoperative pathological diagnosis was squamous cell carcinoma was treated by induction chemotherapy, radical operation with pharyngolaryngoesophagectomy, and postoperative radiotherapy. Half of the 6 surgical cases died of suffocation. The 4 non-surgical cases were treated by combination therapy with chemotherapy and radiotherapy. The 3 cases of the 4 non-surgical cases died of distant metastasis.
The rate of life at home during survival time was higher in the cases treated surgically than in the non-surgery cases. The possibility is suggested that the rate of life at home during survival time was higher with surgical treatment even the debulking operation and the improvement of QOL was achieved. But the debulking operation was not more effective for the improvement of the survival time and the local control, compared with the cases treated without surgery.View full abstractDownload PDF (318K)
Case Report
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Hideaki Kanazawa, Nobuhiko Isshiki2008 Volume 59 Issue 5 Pages 497-505
Published: October 10, 2008
Released on J-STAGE: October 25, 2008
JOURNAL RESTRICTED ACCESSThe success of type II thyroplasty depends on how adequately each minute but delicate procedure is performed in order to maintain adequate separation of the mid-line incised thyroid alae. The key issues include : 1) not to undermine extensively around the anterior commissure from the cartilage framework, and 2) not to compress the anterior commissure excessively backward by placement of an insertion material.
To maintain the appropriate distance between the incised thyroid alae, adjusted during the operation, a titanium bridge (TB) is essential. For permanent stability, a pair is used, one each below and above the anterior commissure.
The use of an on-site fabricated silicone block (SB) cannot be recommended because it may not stay as originally implanted.
Three patients who exhibited poor results after type II thyroplasty for adductor spasmodic dysphonia (AdSD) elsewhere visited our clinic for revision. In all three cases, the trouble derived from inadequate use of the material for maintaining optimal separation. This experience led us to complete an ideal way of maintaining the thyroid cartilage framework as expanded during surgery.View full abstractDownload PDF (1356K) -
Takeshi Hirata, Masahiko Taguchi, Hajime Kitamura, Haruhiko Nakamura2008 Volume 59 Issue 5 Pages 506-511
Published: October 10, 2008
Released on J-STAGE: October 25, 2008
JOURNAL RESTRICTED ACCESSWe experienced a case of eosinophilic pneumonia that required differential diagnosis with lung cancer. A 64-year-old woman was admitted to our hospital complaining of fever elevation and cough. X-ray findings showed an abnormal nodular shadow in her left upper lung field. A mass shadow with infiltrates was also present in her chest CT view. FDG-PET/CT scanning revealed a strong positive reaction in the left upper lobe lesion. Fiberoptic bronchoscopy showed white plaques with edematous changes. We were able to obtain definitive diagnosis of eosinophilic pneumonia because the microscopic findings of the tissue specimen revealed infiltration of numerous eosinophils into the bronchial wall without findings of malignancy. Administration of antiallergic agents and steroid therapy improved the patient's clinical findings. Transbronchial lung biopsy (TBLB) is useful for differential diagnosis between malignant and benign diseases.View full abstractDownload PDF (443K)
Glossary
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[in Japanese]2008 Volume 59 Issue 5 Pages 512-513
Published: October 10, 2008
Released on J-STAGE: October 25, 2008
JOURNAL RESTRICTED ACCESSDownload PDF (266K)
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