The aim of this study is to assess the potential utility of gadolinium-enhanced three-dimensional MR angiography (3D MR angiography) for arterial catheterization of hepatic tumor. Thirty-five consecutive patients with suspected abdominal tumors underwent MR angiography with a gadolinium-enhanced 3D fast gradient echo sequence. Visualization of the vascular tree of visceral arteries, and their variations, the apparent length of common hepatic artery (CHA), and the tilt of celiac trunk were prospectively evaluated by 3D MR angiography. The results were compared with those obtained by the conventional angiography. In 27 patients with hepatic tumors, the prospective planning with 3D MR angiography was compared with the actual catheterization. Celiac trunk, CHA, and superior mesenteric artery (SMA) were visualized on 3D MR angiography in all 35 patients. There was a significant linear correlation of the length of CHA and the tilt of SMA as measured by 3D MR angiography and conventional angiography (r=0.75, r=0.64, respectively). The 3D MR angiography provided useful clinical information for planning of arterial catheterization in all 27 patients with hepatic tumors. Thus gadolinium-enhanced 3D MR angiography is considered to be of value for the planning of arterial catheterization of hepatic tumor.
The advantages of laparoscopic cholecystectomy (LC) over open cholecystectomy (OC) seem to be related to the lesser surgical trauma. The objective of our study was to determine whether or not cholecystectomy leads to the release of interleukin (IL) -6 and C-reactive protein (CRP), and to compare the parameters in patients treated with LC and with OC. We compared the levels of IL-6 and CRP in LC patients (n=10) with those in OC patients (n=10). The level of IL-6 in OC was significantly higher than that in LC after operation. The level of CRP in OC was significantly higher than that in LC after operation. There was a correlation between the operation time and CRP level at 36 hours postoperatively in LC. LC is less stressful than OC in terms of the acute phase inflammatory response. Even in laparoscopic surgery, however, prolonged operation seems to increase the surgical stress.
We clinically examined 56 patients with metastatic liver cancer who received hepatic arterial infusion chemotherapy via a reservoir at the Department of Surgery, Public Fujioka General Hospital between January 1989 and March 1999. There were 28 males and 28 females. Patient ages ranged from 40 to 83 years, with a mean of 64.1 years. Primary cancers consisted of colorectal cancer in 34 patients, gastric cancer in 8 patients, gallbladder cancer in 4 patients, breast cancer in 4 patients, leiomyosarcoma in 2 patients, pancreatic cancer in 1 patient, bile duct cancer in 1 patient, ampullary carcinoma in 1 patient and ovarian cancer in 1 patient. Thirty-one patients had simultaneous lesions, while 25 patients had metachronal lesions. A catheter was inserted under laparotomy in 25 patients. A catheter was percutaneously inserted through the femoral artery in 31 patients. Agents included 5-fluorouracil (5-FU), epirubicin hydrochloride (EPI) and mitomycin-C (MMC). There were no serious complications. In 42 patients who received hepatic arterial infusion chemotherapy excluding patients who underwent surgery for metastatic liver cancer and patients who died of other diseases, the mean survival was 421.1 days. When response was evaluated, complete response (CR) was achieved in 3 patients, partial response (PR) in 12 patients, no change (NC) in 11 patients and progressive disease (PD) in 16 patients. The response rate was 35.7%. One-year, 2-year and 3-year cumulative survival rates were 59%, 23% and 8%, respectively. These percentages in the hepatic arterial infusion chemotherapy group were higher than cumulative survival rates in the systemic chemotherapy group and the untreated group. Therefore, hepatic arterial infusion chemotherapy may prolong survival.
The urinary incontinence in radical prostatectomy partly arises from the damage to the external urethral sphincter during the operation. The present study demonstrated that, as a means of preventing the damage to the sphincter, the prostate shape and the external urethral sphincter could be preoperatively identified using magnetic resonance (MR) imaging. Five necropsy specimens were examined. MR images were obtained in the sagittal plane, and the specimens were then cut and macroscopically examined. Two prostate shapes, croissant and doughnut, were easily identified by both methods. In the four croissant-shaped prostates, the external urethral sphincter was very well developed at the anterior surface of the prostate gland, and the membranous urethra was long. On the other hand, in the doughnut-shaped prostate it developed anteriorly and posteriorly, and the membranous urethra was short. Knowledge as to the prostate shape and the urethral sphincter acquired by MR imaging can help the surgeon to preserve the external urethral sphincter during prostatectomy
Ductal carcinoma in situ (DCIS) of the breast has become a relatively common disease in women, while it remains a rare disease in men. We described a case of DCIS in a 67-year-old man. The patient had have a painless, defined, elastically firm and even tumor without skin retraction at his left retroareolar region. After excisional biopsy, he underwent mastectomy with dissection of axillary lymph nodes. All lymph nodes sampled were negative. The patient is free of disease without adjuvant-therapy at present.