Continuous measurement of temperature in non-24 hour sleep-wake syndrome.

The onset of the low temperature (LT) zone which was defined as a period when the rectal temperature was below its daily mean is a convenient circadian phase marker. In this study, we document three cases of non-24 h sleep-wake syndrome in which identification of the LT zone as an evening circadian phase marker contributed to clinical judgments. We found that the LT zone was correlated well with dim light melatonin onset. Moreover, calculating the LT zone was useful in determining phase position in irregular sleep pattern and in determining the timing of bright light therapy.

Trials of bright light exposure and melatonin administration in a patient with non-24 hour sleep-wake syndrome.

We report a patient with non-24 h sleep-wake syndrome (non-24) whose free-running sleep-wake cycle was successfully treated with both scheduled bright light exposure and melatonin treatment. In the present study, morning bright light as well as evening melatonin phase-advanced sleep-wake cycles and melatonin rhythm. Both these procedures achieved appropriate entrainment to a 24 h day. However, the patient did not continue morning bright light therapy after the discharge. Rising at appropriate times in the morning for bright light therapy was difficult for him to continue. Melatonin treatment was better tolerated because of its ease of application.

Detection of hepatocellular carcinoma by intraarterially enhanced ultrasonography with CO2 microbubbles. Comparison with DSA, dynamic CT, and Lipiodol CT.

PURPOSE: To evaluate the diagnostic value of contrast-enhanced US with CO2 microbubbles (EU) for HCCs. Detectability was compared with DSA, dynamic CT, and Lipiodol CT. MATERIAL AND METHODS: Forty-seven histologically proven HCCs detected with US were evaluated with EU, DSA, and dynamic CT. In 23 patients (35 lesions), Lipiodol CT was also performed. The size of the tumors ranged from 8 to 71 mm (average 28.1 mm); 24 lesions were smaller than 20 mm and 23 lesions were larger than 20 mm. RESULTS: Overall detection was possible in 40 of 47 lesions (85%) by EU, in 32 of 47 (68%) by DSA, in 33 of 47 (74%) by dynamic CT, and in 27 of 35 (77%) by Lipiodol CT. In tumors smaller than 20 mm, detection was possible in 21 of 24 lesions (88%) by EU, 14 of 24 (58%) by DSA, 14 of 24 (58%) by dynamic CT, and 11 of 17 (65%) by Lipiodol CT. CONCLUSION: EU has significant diagnostic value for detection of HCCs, particularly tumors smaller than 20 mm.

Prognostic factors in liver metastases after transcatheter arterial embolization or arterial infusion.

From January 1986 to December 1988, 85 patients (55 men and 30 women, mean age 59 years) with metastatic liver tumors were treated with hepatic artery embolization (TAE) or infusion (HAI). Sixty-eight patients with successful catheterization were treated with TAE using iodized oil (Lipiodol) mixed with anticancer agent (ACA). In 12 of 68 patients with hypervascular tumors gelatin sponge was added. Patients with unsuccessful catheterization were treated with hepatic artery infusion of ACA. Forty-three patients received oral chemotherapy following TAE or HAI. Overall, the 6-month, and 1- and 2-year survival rates were 69.5, 31.8 and 4.1 per cent, respectively (mean 233 days). A univariate analysis of prognostic factors showed that number of metastases, stage, treatment times and oral chemotherapy were all significant factors (p less than 0.05). Ascites, jaundice, percentage of hepatic replacement and treatment protocol also had some influence (p less than 0.1). Sex, age, primary site, elevation of tumor markers, other metastatic lesions, portal vein involvement and difference in anticancer agent had no prognostic significance. A multivariate analysis using Cox's proportional hazard model revealed that the number of treatments had the most important prognostic significance, followed by oral chemotherapy, stage and percentage of hepatic replacement.