[Efficacy of continuous hepatic arterial infusion of high-dose 5-FU for liver metastases of gastric cancer].

We studied the efficacy of continuous hepatic arterial infusion of high-dose 5-FU (high-dose CHAI) in two patients with multiple (five or more) bilobar liver metastases of gastric cancer. 5-FU was given continuously via the hepatic artery at 1 g/day for 3 days, followed by one day off therapy and repetition of the initial treatment as one course. Case 1 was a 67-year-old man with Borrmann type 2 gastric cancer who had undergone total gastrectomy. Metachronous multiple liver metastases (maximum diameter: 3.5 cm) were detected at 11 months after surgery. One month later, we started high-dose CHAI and gave two courses with a 4-day interval between them. After that, 5-FU was given twice by hepatic arterial infusion (HAI) at dose of 1.5 g/week. The tumor diameter had decreased by 50% at 3 months after high-dose CHAI. Case 2 was a 64-year-old man with Borrmann type 3 gastric cancer who had synchronous multiple liver metastases (maximum diameter: 9 cm) and liver dysfunction. One month after distal gastrectomy, we started high-dose CHAI and finished one course. After that, liver function returned to normal and 5-FU was given by HAI at dose of 1 g/week on an outpatient basis. The tumor diameter decreased to 1/3 of the initial size at four months after high-dose CHAI. High-dose CHAI using 5-FU may be safe and effective for liver metastases from gastric cancer.

[Efficacy of combination therapy (hepatectomy and prophylactic arterial chemoinfusion) for liver metastases of colorectal cancer].

From 1979 to 1997, 146 patients had hepatectomy for metastases of colorectal cancer (curative B: 122; curative C: 24). We categorized the severity of liver metastases as follows, H1: one lobe; H2: bilateral but less than five, and H3: bilateral with five or more lesions. In H1 and H2 patients, we compared the survival rate after resection alone (including repeat hepatectomy) with that after combination therapy (resection and prophylactic arterial chemoinfusion of 12-24 g of 5-FU). In H1 patients, the 3-year survival rate of the resected group (n = 74) and combination group (n = 6) was 47.2 and 53.3, respectively. In H2 patients, the resected group (n = 16) and combination group (n = 7) had survival rates of 34.5 and 100%, respectively. In H1 cases, the 3-year recurrence rate in the remnant liver was 63.4 versus 16.7% and in H2 cases it was 58.0 versus 0%. H3 patients received one week of continuous prophylactic arterial chemoinfusion [total dose of 5-FU = 6 g]. All four patients in the H3 combination group are alive at 20, 13, 13, and 12 months after resection, while the median survival of the resection only group (n = 4) was 12.5 months. We suggest that our combination therapy may be applicable to all patients with liver metastases of colorectal cancer.

[A case report: successful resection of advanced intrahepatic cholangiocarcinoma responding to preoperative hepatic artery infusion of 5-FU].

A patient with advanced intrahepatic cholangiocarcinoma had a tumor embolus in the right main branch of the portal vein and lymph node metastases. Hepatic arterial infusion (HAI) therapy with 5-FU (1 g/day) was given as a continuous infusion for 6 days. The treatment was repeated after a one-week interval. As a result the tumor diameter decreased by half, and the tumor embolus contracted. Cytoreductive surgery was then performed. The patient has been disease-free for over 9 months postoperatively with adjuvant HAI with 5-FU. We consider preoperative HAI with 5-FU (two courses of 1 g/day x 6 days) is both safe and effective.

[A new two-part therapy for multiple bilobar liver metastases of colorectal cancer--treatment of one lobe with partial hepatectomy and the other with arterial chemotherapy].

We studied a new two-part therapy for patients of multiple (more than five) bilobar liver metastases from colorectal cancer, in which one lobe is treated with partial hepatectomy and the other with arterial chemotherapy. The patient was a 72-year-old woman who had undergone sigmoidectomy and partial hepatectomy on March 9, 1995, for advanced sigmoid cancer with liver metastasis. In December 1995, new foci were detected in the remaining liver. Intraoperative echography during reoperation revealed 6 foci in the right lobe, 2 in the left lobe and 1 in the caudate lobe. During reoperation, we performed partial hepatectomy at the left lobe metastases and microwave coagulation in the caudate lobe. A catheter was inserted into the right hepatic artery, and the right hepatic artery was ligated with the catheter. From 2 weeks after operation, CDDP (20 mg) and 5-FU (1,500 mg) were given weekly by infusion from the arterial root. As a result, the serum CEA level fell to 3.6 ng/ml on June 26, 1996, and 1.9 mg/ml on August 14, 1996. A right lobectomy would have been performed if no metastasis appeared in the remainder of the left lobe over a one-year period. However, no foci were detected on a CT scan on March 26, 1997. This new two-part therapy warrants detailed investigation for bilobar bilateral liver metastases of colorectal cancer.

[Results of clinical study with epirubicin hydrochloride injectable solution in hepatoma].

A 10-center cooperative clinical study with a new formulation of epirubicin hydrochloride injectable solution (Epirubicin-RTU) was conducted in patients with hepatocellular carcinoma. Epirubicin-RTU 60 mg/m2 was injected into the hepatic artery and a three-week drug-free interval followed. Of 15 patients with hepatocellular carcinoma registered in this study, 14 patients were eligible, and they all completed the entire course. The objective was to investigate the safety of treatment with Epirubicin-RTU in 14 eligible patients. The adverse drug reactions frequently observed in these 14 eligible cases were leukopenia, neutropenia, thrombocytopenia, alopecia, and fever. They were all reversible and tolerable. With these results. Epirubicin-RTU was considered to be a safe pharmaceutical product to inject into the hepatic artery.

[Radiological diagnosis of viral encephalitis].

Most of viral encephalitis may demonstrate no specific change on CT and MR images. Brain swelling, edema, abnormal density (CT) and abnormal intensity (MR) can be detected in herpes simplex encephalitis and enterovirus encephalitis (coxsackie, echo, polio). The common finding on CT and MRI in patients with HIV encephalopathy are atrophy, leukomalacia. Progressive multifocal leukoencephalopathy (PML) shows multifocal oval or round white matter T2-hyperintensities on MR images. Subacute sclerosing panencephalitis (SSPE) may present slight changes in the subcortical and periventricular white matter, as well as basal ganglia. Progressive disorder makes widespread T1-low, T2-high intensity area and atrophy. MRI of acute disseminated encephalomyelitis (ADEM) shows multifocal subcortical hyper intense foci on T2-weighted studies. The deep white matter, brainstem, thalamus and cerebellum can be affected. Most of ADEM lesions resolve. Imaging findings of acute lymphocytic meningitis by echovirus and coxsackievirus are usually normal.

[MR angiography and MR cholangiopancreatography].

MR angiography is an adjunctive for noninvasive evaluation of blood vessels and MR cholangiopancreatography is for bile duct and pancreatic duct. Clinical applications of MR angiography has been focused mainly on head and neck and its applications to the abdomen are still limited. However, this technique has the good potential for the evaluation of portal vein system. MR cholangiopancreatography can depict bile ducts and pancreatic duct simultaneously and three-dimensionally. This technique can evaluate the causes of the lesion and its extent noninvasively. In this article the practical uses of MR angiography and MR cholangiography in the abdomen are discussed.

Dynamic CT of pancreatic tumors.

Dynamic computed tomography was performed on 19 patients with clinically diagnosed pancreatic and peripancreatic tumors. There were 10 patients with pancreatic cancer, three with inflammatory pancreatic masses, two with cystadenoma, one with insulinoma, and three with peripancreatic tumors. Computed tomography was performed with a Varian-V-360-3 scanner; scanning was for 30 consecutive sec at 3 sec intervals after the bolus injection of 50 ml of contrast medium into the antecubital vein. Dynamic computed tomography (CT) may be more useful than conventional contrast CT because it facilitates: (1) correct evaluation of tumor vascularity allowing a differential diagnosis; (2) location of the boundary between tumor and a nontumor tissue; (3) detection of small tumors; and (4) visualization of pancreatic invasion by peripancreatic tumors. In addition, contrast enhancement and the degree of vascular proliferation can be quantitatively assessed by analyzing time-density curves.

Use of meglumine iotroxate in the detection of liver tumors by computed tomography.

Experience with contrast enhanced computed tomographic (CT) examinations of 13 patients with hepatic tumors using a new cholangiographic contrast material, meglumine iotroxate, is described. After infusion, small density differences between the tumor and liver were accentuated. In 11 cases postcontrast CT using meglumine iotroxate improved visualization of lesions compared with conventional pre-and postcontrast CT using urographic contrast material. Our results indicate that contrast enhanced CT using meglumine iotroxate is a promising alternative to conventional CT in the detection of hepatic tumors.

Dynamic computed tomography of hepatocellular carcinoma.

Nineteen patients with clinically proven hepatocellular carcinoma were studied by dynamic computed tomographic (CT) scanning. Ten consecutive 3 sec scans were performed within 30 sec, providing uninterrupted data collection. Dynamic CT scanning was useful in recognizing tumor vascularity, multiple small tumors, isodense tumors on conventional CT scans, the capsule of an encapsulated hepatocellular carcinoma, arteriovenous shunts, and vascular pools. Time-density curves were useful in evaluating the hemodynamics of the tumors; these could be classified into three types according to differences in their enhancement patterns.

Dynamic computed tomography of isodense hepatocellular carcinoma.

Dynamic computed tomography (CT) was performed on 11 patients with isodense hepatocellular carcinoma (hepatoma). Ten consecutive 3 s scans were performed within 30 s following the bolus injection of contrast medium. Except for the diffuse type, isodense hepatoma enhanced strongly in the arterial phase. The degree of enhancement declined in the portal phase. In the case of diffuse hepatoma, fine tumor nodules enhanced slightly, showing mottled patterns intermingled with low and high density areas in one patient. Time-density curves indicated that the tumor density increased rapidly in the arterial phase but decreased in the portal phase, approximating that of the surrounding liver. When CT is used as a screening method to detect hepatoma, the possibility of an isodense tumor should always be kept in mind. Dynamic CT is essential for the detection of isodense hepatoma as well as diffuse, small tumors. If simultaneous multilaminographic CT is available in the future, dynamic CT may be the best method to evaluate a suspected lesion.

Visualization of tumor vessels in hepatocellular carcinoma. Power Doppler compared with color Doppler and angiography.

PURPOSE: To assess the visualization of tumor vessels in hepatocellular carcinoma (HCC) by power Doppler sonography. MATERIAL AND METHODS: We examined 40 patients with 47 HCC lesions by means of power Doppler sonography and compared its visualization of tumor vessels with those of color Doppler and angiography. RESULTS: In 38 (81%) of the 47 lesions, power Doppler sonography improved the visualization of tumor vessels compared with color Doppler sonography; in the remaining lesions no significant difference was noted. In lesions located within 7 cm in depth, there was no significant difference between power Doppler sonography and angiography. In 10 (83%) out of 12 small (< or = 2 cm in diameter) lesions and in 11 (85%) out of 13 hypovascular lesions, power Doppler sonography performed considerably better than angiography. In deeper-seated lesions, however, angiography was significantly superior to power Doppler sonography. CONCLUSION: Power Doppler sonography is more sensitive in detecting the fine tumor vessels in most HCCs than color Doppler sonography. In addition, power Doppler sonography can replace angiography in evaluating tumor vascularity in HCCs except in lesions that are deep-seated or located near the heart. In these lesions, angiography can complement power Doppler sonography in demonstrating tumor vessels.