[Analysis of 12 cases of brain metastasis from colorectal cancer].

This retrospective study was performed to evaluate the outcomes of 12 patients with brain metastasis from colorectal cancer treated between 1999 and 2008. The range of patients was 33-72 years old (median: 64 years old). The male to female ratio was 2:1. The primary site was the colon in 4 patients and rectum in 8 patients. The site of brain metastasis was the cerebrum in 8 and cerebellum in 4. All brain lesions were metachronously detected. Three patients had a single lesion each, while the remaining 9 had multiple lesions. The range of the period from the resection of the primary lesion to the detection of brain metastasis was 144-2,062 days (median: 868 days). The types of treatment included whole brain radiotherapy after cerebral metastatectomy in three patients with a single lesion, whole brain radiotherapy only in 7 patients with multiple lesions, and modified FOLFOX6 (mFOLFOX6) regimen combined with whole brain radiation in recently treated two patients with multiple brain and lung metastases. The median overall survival period was 107 days. The longest survivor was a patient who survived for 505 days after the start of mFOLFOX6 plus radiation therapy. It appears that how we control metastases has become more important in recent years. For example, using new drugs, extracranial metastases of controllable cancer have become better controllable over longer periods.

Evaluation of quality of life and psychological response in cancer patients treated with radiotherapy.

PURPOSE: The importance of the quality of life (QOL) and mental condition of patients being treated for cancer is now recognized. In this study, we evaluated QOL and mental condition in patients with cancer before and after radiotherapy. MATERIALS AND METHODS: The subjects were 170 patients who had undergone radiotherapy. The examination of QOL was performed using the quality of life questionnaire for cancer patients treated with anticancer drugs (QOL-ACD), and mental condition (anxiety and depression) was examined using the hospital anxiety and depression scale (HADS). These examinations were performed at the start of radiotherapy and immediately after radiotherapy. RESULTS: The QOL score was slightly higher in all patients after the completion of radiotherapy than before the start of radiotherapy. In the palliative radiotherapy group, QOL score was significantly improved by treatment. Anxiety and depression were improved after radiotherapy. There was a correlation between the degrees of improvement of the HADS and QOL score. CONCLUSION: We could treat cancer patients by radiotherapy without reducing their QOL, and improvement in QOL was significant in the palliative radiotherapy group. Mental condition was also improved after radiotherapy.

Multidetector computed tomography diagnosis of primary and secondary epiploic appendagitis.

PURPOSE: The aim of this study was to evaluate the epiploic appendages in patients with acute abdomen using multidetector computed tomography (MDCT) and to determine the incidence of primary and secondary epiploic appendagitis (EA). MATERIALS AND METHODS: A radiologist reviewed MDCT images from 1338 patients with acute abdomen for visible epiploic appendages. Two radiologists then reviewed the MDCT images showing inflamed epiploic appendages and diagnosed primary EA, secondary EA, or other conditions by consensus. The CT criteria for primary EA are a round or oval pericolonic fatty lesion with a hyperattenuated rim and adjacent fat stranding, without other causes of inflammation. Secondary EA is diagnosed if an epiploic appendage is found to be due to inflammation from other inflammatory entities. RESULTS: Epiploic appendages were identified in 19 patients. Four patients (0.3%) had a retrospective CT diagnosis of primary EA. Twelve patients (0.9%) had a retrospective CT diagnosis of secondary EA (primary condition was diverticulitis in 10 patients and inflammatory bowel disease in 2 patients). The remaining three patients had calcification of an epiploic appendage suggestive of old EA. CONCLUSION: Primary EA should be included in the differential diagnosis of acute abdomen. Occasionally, inflammation of the epiploic appendages is secondary to other inflammatory conditions.

Relationship between (99m)Tc-GSA scintigraphic indices of liver function reserve and portal circulation in patients with chronic liver disease.

OBJECTIVES: In order to predict the prognosis or complications of portal hypertension in patients with chronic liver disease, it is important to evaluate both hepatic functional reserve and portal circulation. On (99m)Tc-galactosyl human serum albumin ((99m)Tc-GSA) scintigraphy, the index of blood clearance (HH15) and receptor index (LHL15) have been widely used to evaluate the hepatic functional reserve. However, the relationship between these indices and portal circulation is unknown. The purpose of this study was to examine the relationship between HH15 and LHL15 and portosystemic shunts evaluated with arteriographic portography or esophagogastroduodenoscopy. METHODS: A total of 82 patients with chronic liver disease (mean age, 66.7 years) who underwent (99m)Tc-GSA scintigraphy, arteriographic portography, and esophagogastroduodenoscopy were enrolled. HH15 and LHL15 were obtained from dynamic (99m)Tc-GSA scintigraphy. The patients were divided into three groups according to the arteriographic portography findings: group 1, no portal collateral circulation; group 2, mild collateral development; and group 3, moderate to severe collateral development. They were also divided into three groups based on the esophagogastroduodenoscopic findings: group A, no varices; group B, small-caliber varices; and group C, enlarged varices. The Kruskal-Wallis test was used to compare each index among these groups. Receiver operating characteristic (ROC) analysis was used to determine whether each index was an indicator for the presence of portosystemic shunts. RESULTS: Both HH15 and LHL15 differed significantly between groups 1 and 2 and between groups 1 and 3. However, only HH15 differed significantly between groups A and B and between groups A and C. On the basis of the ROC analysis, the HH15 threshold value of 0.62 yielded both excellent sensitivity (83.9%) and specificity (84.6%) for the presence of portosystemic shunts, as evaluated with arteriographic portography. The HH15 threshold value of 0.64 yielded both good sensitivity (66.1%) and specificity (69.2%) for the presence of portosystemic shunts, as evaluated with esophagogastroduodenoscopy, whereas no adequate threshold value of LHL15 was found for the presence of portosystemic shunts. CONCLUSIONS: HH15 is a potent indicator of the presence of portosystemic shunts in chronic liver disease.

Arteriovenous malformation of the gallbladder: CT and angiographic findings.

We encountered a case of arteriovenous malformation (AVM) of the gallbladder in a patient with hepatocellular carcinoma (HCC). Contrast-enhanced computed tomography (CT) showed serpentine vessels around and within the gallbladder wall. Angiography showed dilated and tortuous cystic arteries, a racemose vascular network, and early-filling cystic veins. Transcatheter arterial embolization of two cystic arteries feeding the AVM was performed with platinum microcoils prior to transcatheter arterial chemoembolization for HCC to prevent embolic particles from flowing into these arteries. Follow-up contrast-enhanced CT showed blood flow in the gallbladder AVM, which appeared to be fed by the arterial collaterals.