[Evaluation of chemosensitivity testing by CD-DST, and TS and DPD activity in cases of colorectal liver].

We evaluated the usefulness of the following three in vitro assays in cases of resected colorectal liver metastases. Chemosensitivity by collagen gel droplet drug sensitivity test (CD-DST) was very low in all cases, suggesting this method is not predictive for this disease. In contrast, thymidylate synthetase (TS) activity and dihydropyrimidine dehydrogenase (DPD) activity in tumor tissue were high in many patients with recurrent disease. Thus, these enzyme activities are promising for assessment of clinical outcome following hepatic resection of colorectal liver metastases. Further analyses with large numbers of cases are needed to determine the significance of these in vitro studies.

[Usefulness of hepatic arterial infusion chemotherapy for liver metastasis in gastric cancer].

UNLABELLED: We have performed intra-hepatic arterial chemotherapy for 9 patients with liver metastasis arising from gastric cancer. We mainly used 5-FU and CDDP as antineoplastic drugs. RESULTS: The median survival after gastrectomy was 600 days. Of 9 cases, 2 showed CR, 4 PR, 2 NC, 1 PD. The response rate was 67%. The 9 cases were classified into 2 groups. One group, the short-term survival group, concised of 5 patients that had no more than 2 years survival and the other, the long-term survival group, consisted 4 patients that had more than 2 years survival. We compared these 2 groups and found no difference in the primary lesions between the 2 groups. The patients in the long-term survival group had fewer and smaller metastatic lesions in the liver than the patients of the short-term survival group. The patients in the long-term survival group had no unresectable lesions except liver metastasis when gastrectomy was performed. However, 2 patients in the short term survival group had unresectable lymphatic involvement at the time gastrectomy was performed. Of 9 patients, 6 died from the extrahepatic lesion. CONCLUSION: The intra-arterial chemotherapy was effective and useful for liver metastasis arising from gastric cancer. However, the majority of patients died from extrahepatic lesions. We should therefore consider the use of systemic chemotherapy with intra-arterial chemotherapy.

[Comparison of exercise-stress single photon emission computed tomography with thallium-201 reinjection and postextrasystolic potentiation to assess myocardial viability in patients with myocardial infarction].

Myocardial viability was examined in 20 patients with myocardial infarction 24 +/- 3 (mean +/- standard deviation) days after onset. Postextrasystolic potentiation (PESP) was measured by left ventriculography and thallium-201 (Tl) single photon emission computed tomography (SPECT) redistribution was assessed after stress loading and reinjection of Tl. The results were compared with the improvement of left ventricular segmental wall motion after coronary revascularization which was performed successfully in all patients. The uptake of Tl was impaired initially in 41 segments, classified into three groups: normal group, 13 segments with smooth reversion to normal; new fill-in group, 15 segments with a new fill-in after reinjection of Tl; no fill-in group, 13 segments with no fill-in after reinjection. When evaluated by the PESP before coronary revascularization, segmental wall motion was significantly augmented in all segments in the normal group and new fill-in group (p < 0.001), but not in the no fill-in group. After coronary revascularization, left ventriculography revealed that segmental wall motion was significantly improved in normal group and new fill-in group, but not in the no fill-in group except for mild improvement in five segments. The sensitivity and specificity of PESP (90% and 93%) and Tl SPECT (80% and 100%) for improvement of segmental wall motion after the coronary revascularization were very high, with the accuracy of either method attaining 87%. This result indicates that both Tl SPECT and PESP are useful for detecting viable myocardium in patients with recent myocardial infarction.

[Clinical significance of diffuse vasoconstriction of coronary arteries--a study using hyperventilation thallium-201 myocardial imaging].

Hyperventilation Thallium-201 imaging was evaluated for the examination of the existence of ischemia in the cases of diffuse vasoconstriction under the ergonovine maleate provocative test for coronary artery. Transient myocardial perfusion defect (PD) was demonstrated in 14 patients with ergonovine induced vasospasm (group S), and 13 of these patients also demonstrated redistribution (RD) (92.4%). In 14 patients with diffuse vasoconstriction (group D), nine demonstrated PD, and all of them revealed RD. On the other hand, only one of ten (10%) patients demonstrated PD and RD in a group of patients without spasm or diffuse vasoconstriction (group N). In addition, the left ventricular myocardium was divided into nine segments on a SPECT image, and the mean minimum washout rate (WOR) of each segment was evaluated. These values were compared with the percent change of the lung/heart ratio between early and delayed images (delta L/H%). Both the mean minimum WOR mean and delta L/H% of group D were significantly smaller than that of group N (p < 0.001), and only approximated to group S. Thus, the possibility of myocardial ischemia of diffuse vasoconstrictive coronary artery is implicated and such patients are supposed to be treated medically as vasospastic angina.