[The Incidence and Management of Hypersensitivity and Infusion Reactions in an Outpatient Chemotherapy Center].

Hypersensitivity reactions(HSRs)are adverse events that are potentially caused by all anticancer agents. HSRs are unpredictable and can occur at any time, and prompt intervention is needed when symptoms occur. The types of symptoms and their degrees vary with the anticancer agent used and the number of chemotherapy cycles. Here, we evaluated the degree of HSRs and their frequencies in the outpatient chemotherapy center of Gunma University Hospital. Among 55,046 patients, 141 (0.26%)cases of HSRs and 70(0.13%)cases of infusion reactions were identified. Oxaliplatin and docetaxel conferred higher incidences of HRSs, whereas infliximab and rituximab conferred higher incidences of infusion reactions. The most common symptoms were skin reactions. HSRs to oxaliplatin were observed after a median of 7 cycles of chemotherapy, and the number of the patients developing HSRs was the highest during the second cycle of chemotherapy. The incidences of HSRs and the profiles of the anticancer drugs exhibiting higher frequencies of HSRs were similar to those in previous reports. The present study provides valuable information about appropriate management for HSRs depending on the anticancer agents used.

Incidence, risk factors, and management options for portal vein thrombosis after hepatectomy: a 14-year, single-center experience.

BACKGROUND: Portal vein thrombosis (PVT) after hepatectomy is rare; however, it increases mortality and morbidity. Few studies have been conducted that focused on PVT following major hepatectomy. METHODS: Patients who underwent hepatectomy at a single institution were retrospectively reviewed, and risk factors and management options were evaluated. RESULTS: Of the 1,193 patients undergoing hepatectomy, 25 patients developed PVT. Right-sided hepatectomy, caudate lobectomy, splenectomy, and postoperative bile leakage were independent risk factors for PVT following hepatectomy. PVT occurred more frequently after major hepatectomy compared with minor hepatectomy. Increased instability and reduced portal venous flow caused by kinking was the reason for increasing the risk of PVT after right-sided hepatectomy with caudate lobectomy. The new operative procedure, suturing the posterior wall of the portal vein with the anterior wall of the inferior vena cava, was effective for reducing the risk of PVT following right-sided hepatectomy. Operative thrombectomy showed significant benefits for PVT detected within 5 days after hepatectomy. CONCLUSIONS: PVT frequently occurs following major hepatectomy. Urgent operative thrombectomy is strongly recommended for PVT with early detection.

Usefulness of laser speckle flowgraphy for the assessment of ocular blood flow in extracranial-intracranial bypass.

Laser speckle flowgraphy (LSFG) is a noninvasive technique that can measure relative blood flow velocity in the optic fundus. The authors present a case of symptomatic internal carotid artery occlusion treated with superficial temporal artery (STA)-middle cerebral artery (MCA) bypass in which an improvement of ocular circulation was confirmed by LSFG. A 47-year-old man presented with a 1-month history of repeated left blurred vision and motor weakness of the right leg. Diffusion-weighted magnetic resonance imaging revealed a small infarction in the left frontal lobe. Carotid angiography revealed that the left internal carotid artery was occluded at the C4 portion. Single-photon emission computed tomography indicated that the cerebral blood flow in the left MCA territory was markedly impaired. Ophthalmologic examination revealed ischemic change of the left optic fundi, and LSFG revealed decreased blood flow around the left optic disc. Left STA-MCA bypass was successfully performed. Both ischemic ocular symptoms and the ischemic symptoms of the right leg were completely recovered after surgery. Postoperative ophthalmologic examination revealed improvement of both ischemic changes of the left optic fundi. Moreover, LSFG revealed improvement of the blood flow around the left optic disc. LSFG can be a promising clinical tool for the assessment of ocular circulation before and after bypass surgery for occlusive cerebrovascular disease.

[Efficacy of fusion image for the preoperative assessment of anatomical variation of the anterior choroidal artery].

We report two cases with internal carotid artery(ICA)aneurysms, in which fusion image effectively indicated the anatomical variations of the anterior choroidal artery (AchoA). Fusion image was obtained using fusion application software (Integrated Registration, Advantage Workstation VS4, GE Healthcare). When the artery passed through the choroidal fissure, it was diagnosed as AchoA. Case 1 had an aneurysm at the left ICA. Left internal carotid angiography (ICAG) showed that an artery arising from the aneurysmal neck supplied the medial occipital lobe. Fusion image showed that this artery had a branch passing through the choroidal fissure, which was diagnosed as hyperplastic AchoA. Case 2 had an aneurysm at the supraclinoid segment of the right ICA. AchoA or posterior communicating artery (PcomA) were not detected by the right ICAG. Fusion image obtained from 3D vertebral angiography (VAG) and MRI showed that the right AchoA arose from the right PcomA. Fusion image obtained from the right ICAG and the left VAG suggested that the aneurysm was located on the ICA where the PcomA regressed. Fusion image is an effective tool for assessing anatomical variations of AchoA. The present method is simple and quick for obtaining a fusion image that can be used in a real-time clinical setting.

Quantitative assessment of cerebral hemodynamics using single photon emission computed tomography with venous blood sampling.

OBJECTIVE: Quantitative cerebral blood flow (CBF) measured by single photon emission computed tomography (SPECT) with arterial blood sampling is one of the most reliable methods to assess the hemodynamics in individual patients. SPECT with venous blood sampling is less invasive. The present study compared the measurement of CBF using N-isopropyl-p-(iodine-123)-iodoamphetamine SPECT with venous blood sampling and with arterial blood sampling in patients with major cerebral artery occlusive disease. METHODS: Two normal subjects and 14 patients with major cerebral artery occlusive disease underwent SPECT with arterial and venous blood sampling. The microsphere method was used for quantitative SPECT imaging. Whole brain radioactivity was corrected when the detectors rotated in the forward direction (F1-F7). Venous sampling was performed 30min after radiotracer injection. Arterial blood radioactivity was estimated by multiple regression analysis from these parameters. The cerebrovascular reactivity to acetazolamide was also measured. RESULTS: Multiple regression analysis established the following formula:(where Ca10 is the arterial blood radioactivity at 10min, F1-F7 are the whole brain radioactivity in the forward direction, Cv30 is the venous blood radioactivity at 30min). Mean CBF values were 32.2±6.6ml/100g/min for measured arterial radioactivity and 42.2±7.8ml/100g/min for calculated arterial radioactivity based on venous radioactivity. CONCLUSIONS: The present modified method of calculating quantitative CBF from whole brain and venous blood radioactivities correlated well with values determined with arterial blood radioactivity.

Compromise of brain tissue caused by cortical venous reflux of intracranial dural arteriovenous fistulas: assessment with diffusion-weighted magnetic resonance imaging.

BACKGROUND AND PURPOSE: Cortical venous reflux (CVR) is a high risk factor for aggressive behavior of intracranial dural arteriovenous fistulas (DAVF). The pathological conditions in brain tissue affected by CVR were investigated by diffusion-weighted magnetic resonance imaging. METHODS: A retrospective review identified 56 patients with DAVFs who underwent diffusion-weighted imaging before treatment. Twenty patients had neurological symptoms corresponding to the brain area affected by CVR (Group I), 21 patients with CVR had no focal brain dysfunctions (Group II), and 15 patients had no CVR (Group III). Apparent diffusion coefficient (ADC) was measured for 11 brain areas predefined based on normal venous drainage patterns in the 56 patients and in 21 normal volunteers. The mean ADC ratio was calculated for each area by dividing the ADC value of patients by that of normal volunteers. RESULTS: Areas affected by CVR in Group I showed a mean ADC-to-control ratio of 0.72, which was significantly lower than that of Group II (0.96, P<0.01). Follow-up studies demonstrated significantly increased ADC ratios in brain areas affected by CVR after the DAVFs were treated successfully. The mean ADC ratio of an affected area remained low, with persistent symptoms in 1 patient who underwent palliative treatment. CONCLUSIONS: Decreased ADC was observed in the brain parenchyma affected by CVR and was associated with regional brain dysfunction. Successful treatment of the DAVF increased the ADC toward normal levels. The ADC may be a useful indicator of the severity of CVR.

Should the inferior vena cava be reconstructed after resection for malignant tumors?

BACKGROUND: Caval replacement after circumferential resection of the inferior vena cava remains controversial. The aim of the current study is to determine whether or not inferior vena cava replacement should be performed. METHODS: We reviewed 36 cases undergoing resection of the inferior vena cava concomitant with resection of malignant neoplasms. Our criteria for circumferential resection of the inferior vena cava were half or more of the circumference of the vessel wall invaded by tumor, a primary tumor of the caval wall, or massive intraluminal tumor thrombus suspected of adhering to the caval wall. We detailed 10 patients undergoing circumferential resection of the inferior vena cava. RESULTS: Most of patients who did not undergo replacement of the inferior vena cava showed no sign of swelling of the lower limbs, but one showed persistent leg edema with oliguria. This patient had poor development of collateral circulation and mild obstruction of the inferior vena cava before surgery. Two patients who underwent replacement of inferior vena cava had no venous sequelae, although they had poor development of collateral circulation before surgery. CONCLUSION: Caval replacement after circumferential resection of the inferior vena cava may be necessary in patients who have preoperative poor development of collateral circulation or who have oliguria or unstable hemodynamics intraoperatively.

Quantitative assessment of surgical decompression of the cervical spine with cine phase contrast magnetic resonance imaging.

OBJECTIVE: We measured cerebrospinal fluid flow velocity by use of cine phase contrast magnetic resonance imaging to quantitate the effectiveness of surgical decompression in patients with cervical myelopathy. METHODS: Forty-seven patients with cervical myelopathy attributable to either spondylosis or ossification of the posterior longitudinal ligament were studied. Thirty-five patients underwent anterior cervical decompression and fusion; 12 others underwent expansive laminoplasty. Patients were examined preoperatively and postoperatively by use of a 1.5-T scanner with a pulse-gated cine phase contrast sequence. Cerebrospinal fluid flow direction and velocity in the ventral subarachnoid space were determined at the C1 and T1 levels. Forty-four healthy control subjects were examined to determine normal flow velocity parameters. Severity of cervical myelopathy was evaluated preoperatively and postoperatively by use of Japan Orthopedic Association scores to calculate the extent of recovery. RESULTS: Preoperatively, cerebrospinal fluid flow velocity in the caudal direction was significantly lower at both C1 and T1 than velocities measured in healthy controls. Both decompressive procedures essentially returned patient velocities to control values. Clinical recovery from myelopathy did not differ between anterior and posterior decompression. Postoperative increase in flow velocity correlated with clinical recovery after posterior (P < 0.0008) but not anterior decompression. CONCLUSION: Cine phase contrast magnetic resonance imaging provides quantitative assessment of cervical spine decompression, with particularly good clinical applicability to posterior procedures.