Effectiveness of therapeutic standard concentration barium enema for colonic diverticular bleeding: Preliminary results.

PURPOSE: To evaluate the effectiveness of a therapeutic barium enema as a treatment for colonic diverticulum bleeding, by using a standard concentration as a diagnostic examination. METHODS: We retrospectively analyzed 68 cases of the patients admitted to our hospital with colonic diverticular bleeding between October 2012 and September 2017. We evaluated the following items: (1) the presence/absence of a previous history of diverticular bleeding, (2) the use of medications (anticoagulants, nonsteroidal anti-inflammatory drugs, and antiplatelet drugs), (3) the location of bleeding, (4) the presence/absence of previous treatment and the result, (5) the time between bleeding and the beginning of the barium enema, (6) procedural success, (7) the clinical success of the initial hemostasis, (8) the clinical success of preventing recurrence, and (9) complications such as perforation and diverticulitis associated with this procedure. RESULTS: Four patients (three men and one woman; age range 60-85 years; median age 76 years) who underwent therapeutic barium enema with a concentration equivalent for diagnostic purpose (78 w/v%) were included. The follow-up period ranged from 11 to 12 months (median 12 months). All three patients who received a barium enema for initial hemostasis were successfully treated. All four patients remained free from recurrence during the follow-up period. There was no complication due to barium in this series. CONCLUSION: Although we had no statistical evidence, a therapeutic barium enema with a standard concentration as a diagnostic examination may be effective for both the initial hemostasis and preventing the recurrence of colonic diverticular bleeding without complications.

Effect of α-linolenic acid-rich diacylglycerol oil on protein kinase C activation in the rat digestive tract and lingual mucosa.

1,2-Diacylglycerol with short chain fatty acids is an endogenous activator of protein kinase C (PKC), which involved in multiple cellular processes implicated in cancer. The aim of the present study was to assess the effects of dietary α-linolenic acid-rich diacylglycerol (ALA-DAG) oil on PKC activation in the rat digestive tract and lingual mucosa in comparison with the effects of α-linolenic acid-rich triacylglycerol (ALA-TAG) oil, and common dietary oil. Membranous PKC activity in the lingual mucosa of male Wistar rats was significantly activated by treatment of the tongue with 1,2-tetradecarnoylphorbol-13-acetate (100 µM) twice in 1 day. In contrast, animals consuming a diet containing either ALA-DAG oil (7.5% or 30%), ALA-TAG oil (7.5% or 30%), or rapeseed oil (30%) for 4 weeks exhibited no significant differences in the cytosolic and membrane PKC activity in the lingual, esophageal, gastric, small intestinal, and colonic mucosa. Dose-related increases in PKC activity were not observed in the ALA-DAG oil-fed groups. Thus, the effects of dietary ALA-DAG oil on PKC activation in the digestive tract and lingual mucosa was similar to those of the ALA-TAG and rapeseed oils. These findings suggest that replacement of common dietary oil with ALA-DAG oil would not increase the risk of carcinogenesis.

Diagnosis of early colorectal cancer invasion depth by quantitative evaluation of the basal indentation in CT colonography.

OBJECTIVE: To investigate the feasibility of diagnosing the invasion depth of early colorectal cancer (CRC) by quantitatively evaluating the basal indentation (BI)-i.e., the intestinal lateral deformity-in CT colonography (CTC). MATERIALS AND METHODS: 34 early CRCs (13 Tis CRCs and 21 T1 CRCs) in 32 patients who underwent a preoperative CTC were retrospectively examined. Two radiologists calculated the depth of the BI on a computed tomographic air-contrast enema (CT enema) image, the depth of the BI due to the geometric function (BI-G) on a cross-sectional multiplanar reconstruction (CS-MPR) image, and the ratio of the BI to the BI-G (i.e., the "BI ratio") for each lesion. The BI ratios of the Tis and T1 CRCs were compared. RESULTS: The BI ratios were significantly higher in the T1 CRCs than in the Tis CRCs (p < 0.0001). The optimum cutoff value of the BI ratio for differentiating the T1 CRCs from the Tis CRCs was 1.64, with a sensitivity, specificity, and area under the curve of 90.5 %, 100 %, and 0.974, respectively. CONCLUSIONS: We have demonstrated for the first time that quantitatively evaluating the BI can improve the accuracy of diagnosis of early CRC invasion depth.

Oral administration of the amino acids cystine and theanine attenuates the adverse events of S-1 adjuvant chemotherapy in gastrointestinal cancer patients.

BACKGROUND: Nutritional therapy is used to reduce the adverse events (AEs) of anticancer drugs. Here, we determined whether the amino acids cystine and theanine, which provide substrates for glutathione, attenuated the AEs of S-1 adjuvant chemotherapy. METHODS: Patients scheduled to receive S-1 adjuvant chemotherapy were randomized to the C/T or the control groups. The C/T group received 700 mg cystine and 280 mg theanine orally 1 week before the administration of S-1, which then continued for 5 weeks. Each group received S-1 for 4 weeks. Blood sampling was performed and AEs were evaluated (CTCAE ver. 4.0) before and after the administration of S-1. S-1 was discontinued when AEs ≥ grade 2 occurred. RESULTS: The incidences of AEs of any grade and those over grade 2 were lower in the C/T group than in the controls. The incidence of diarrhea (G ≥ 2) was significantly less (p < 0.05) in the C/T group (3.1 %) than in the controls (25.8 %). The duration and completion rate of the S-1 adjuvant chemotherapy were significantly longer (p < 0.01) and higher (p < 0.01), respectively, in the C/T group (complete ratio: 75.0 %, duration: 24.8 ± 5.8 days) than in the controls (complete ratio: 35.5 %, duration: 20.0 ± 7.7 days). CONCLUSIONS: The oral administration of cystine and theanine attenuated the AEs of S-1 adjuvant chemotherapy and increased the S-1 completion rate, suggesting that cystine and theanine is a useful supportive care for chemotherapy.

Efficacy of preoperative transcatheter arterial chemoembolization combined with systemic chemotherapy for treatment of unresectable hepatoblastoma in children.

PURPOSE: The purpose of this study was to evaluate, retrospectively, the clinical efficacy of preoperative transcatheter arterial chemoembolization (TACE) combined with systemic chemotherapy for unresectable hepatoblastoma. MATERIALS AND METHODS: Five boys and three girls (mean age 15.2 months) were treated with preoperative TACE combined with systemic chemotherapy for unresectable hepatoblastomas. Mean tumor diameter and mean alfa-fetoprotein (AFP) level were 11.8 cm and 549,386 ng/mL, respectively. Pretreatment, the extent of disease (PRETEXT) was: II, 1; III, 6; IV, 1. For all patients, preoperative systemic chemotherapy was administered before TACE. At each TACE, carboplatin and adriamycin mixed with iodized oil were infused into the feeding arteries. Tumor response and prognosis after treatment were evaluated. RESULTS: TACE resulted in few Grade 1 adverse effects (AEs), without G3 or more AEs, according to CTACAE 3.0. Mean tumor shrinkage was 60.9%, and the mean AFP decrease from initial levels was 94.8%. In all cases TACE combined with systemic chemotherapy enabled subsequent safe and complete surgical resection. After a mean follow-up of 59 months, tumor-free survival was 75%. CONCLUSION: Preoperative TACE combined with systemic chemotherapy was effective in inducing surgical resectability of unresectable hepatoblastoma.

Treatment outcome of high-dose-rate interstitial radiation therapy for patients with stage I and II mobile tongue cancer.

OBJECTIVES: The aim of the study was to investigate the outcomes of high-dose-rate interstitial radiation therapy for patients with Stage I and II mobile tongue cancer retrospectively. METHODS: Sixty-seven patients with Stage I and II mobile tongue cancer were treated with high-dose-rate interstitial radiation therapy, with or without external beam radiation therapy, between 1997 and 2007. The median dose of interstitial radiation therapy was 50 Gy in 10 fractions over 6 days. Thirty-five patients received external beam radiation therapy before interstitial radiation therapy. The median dose of external beam radiation therapy was 20 Gy delivered with single-lateral or bilateral fields, including the primary tumor site and upper jugular lymph nodes. Thirty-seven patients received concurrent chemotherapy, including carboplatin, cisplatin, fluorouracil or tegafur, gimeracil and oteracil (TS-1) systemically or with intra-arterial injection. Thirty-three patients received intratumoral injection of bleomycin before catheter insertion. The median follow-up time was 58.6 months (range 15.1-102.4 months). RESULTS: The 5-year overall, cause-specific, progression-free survival rate and local control rate were 88.7, 92.1, 76.0 and 94.0%, respectively. Fourteen patients developed cervical lymph node recurrence, 11 of which were distributed within the external beam radiation therapy field. We found local failures in four cases within 2 years after the treatment and in three cases after >7 years, even though the latter were difficult to distinguish from second primary cancers. CONCLUSIONS: The treatment results of our institutions were equivalent to previous reports. Most cervical lymph node metastases occurred within the external beam radiation therapy field, which implied that the external beam radiation therapy dose of 20-30 Gy was insufficient to prevent late cervical lymph node metastases.

Safety margins of hepatocellular carcinoma demonstrated by 3-dimensional fused images of computed tomographic hepatic arteriography/unenhanced computed tomography: prognostic significance in patients who underwent transcatheter arterial chemoembolization.

OBJECTIVE: To investigate the relation between safety margins (SMs) and treatment efficacy for hepatocellular carcinoma (HCC) by transcatheter arterial chemoembolization (TACE) using 3-dimensional fusion images of computed tomographic (CT) hepatic arteriography and unenhanced CT. METHODS: Fifty-three patients with HCC who underwent subsegmental/segmental TACE were followed up. Lipiodol accumulation patterns within the lesion were classified as determined by unenhanced CT immediately after TACE. Lipiodol accumulation patterns around the lesion were classified as determined by 3-dimensional fusion images with special reference to the SMs, which were compared with the local recurrence (LR) rates. RESULTS: Local recurrence was detected in 29 patients (55%) during the follow-up period. When an SM less than 3 mm was defined as insufficient, the LR rates in groups with and without sufficient SMs were 33% (9/25) and 71% (20/28), respectively (P = 0.0136). In 38 nodules with complete Lipiodol accumulation, 10 (63%) of 16 nodules with LR showed the narrow SM (<3 mm), whereas 5 (23%) of 22 nodules without LR showed the narrow SM (P = 0.1341). Multivariate analyses showed that complete Lipiodol accumulation seemed to be an independent prognostic factor (P = 0.0288). CONCLUSIONS: 3-Dimensional fusion image was suggested to be valuable for the early detection of viable components within the HCC with insufficient SMs after TACE.

Detection of residual lymph node metastases in high-risk papillary thyroid cancer patients receiving adjuvant I-131 therapy: the usefulness of F-18 FDG PET/CT.

OBJECTIVE: The aims of this retrospective study were to evaluate the incidence of residual lymph node (LN) metastases in high-risk papillary thyroid cancer (PTC) patients receiving adjuvant I-131 therapy, especially in those without I-131 accumulation, and to evaluate the clinical usefulness of F-18 FDG PET/CT to detect those lesions. METHODS: The 37 PTC patients receiving adjuvant I-131 therapy were retrospectively evaluated. We examined the incidence of residual LN metastasis and compared the accumulation of F-18 FDG and I-131 in those lesions, and compared the serum thyroglobulin (Tg) levels between patients with and without residual LN metastases. RESULT: A total of 33 lesions were diagnosed as residual LN metastases in 9 patients. FDG accumulated in all of the lesions, but 19 lesions (57.6%) of them had no I-131 accumulation. The SUVmax was significantly higher in lesions without I-131 accumulation than in lesions with I-131 accumulation (6.6 +/- 2.8 vs. 4.2 +/- 1.8; P = 0.007). The serum Tg levels were significantly higher in patients with residual LN metastases than in patients without it (709.9 +/- 1470.8 vs. 25.6 +/- 37.1 ng/mL; P = 0.005). The incidence of residual LN metastasis was significantly higher in patients with a detectable serum Tg level than in patients without it (35.0% vs. 0%, P = 0.03). CONCLUSION: These results indicate that the residual LN metastasis was relatively common in high-risk PTC patients receiving adjuvant I-131 therapy whose serum Tg levels remained detectable, and those lesions often had no I-131 accumulation. FDG-PET/CT would be recommended for PTC patients with detectable serum Tg levels to detect residual LN metastases.

Pulmonary complications after hepatic artery chemoembolization or infusion via the inferior phrenic artery for primary liver cancer.

PURPOSE: The purpose of this study was to determine the frequency, patterns of disease, and risk factors for development of pulmonary complications after liver chemoembolization via the inferior phrenic artery (IPA). MATERIALS AND METHODS: Forty-four selective transcatheter hepatic chemoembolization (THCE) procedures via the IPA were performed in patients with primary liver cancers with use of a mixture of anticancer agents and iodized oil (Lipiodol) with or without transcatheter arterial embolization. The grades of pulmonary complications were assessed on triphasic helical computed tomographic (CT) images after THCE and were correlated with angiographic findings of the IPA, infused dosages of Adriamycin and Lipiodol, and hepatic venous tumor thrombus on triphasic CT images before THCE. RESULTS: THCE via the IPA frequently resulted in lung CT changes: Lipiodol accumulation in the lung field (52%), consolidation (68%), and pleural effusion (41%). Among 44 patients, two (5%) developed respiratory symptoms. An excellent correlation was shown between Lipiodol accumulation and the presence of angiographic abnormalities of the IPA (P <.005). A significant correlation was also shown between the grades of pulmonary complications and the numbers of angiographic abnormalities (P <.01). The grades of pulmonary complications increased according to the infused dosage of Adriamycin and Lipiodol (P <.05). CONCLUSIONS: Angiographic abnormalities such as arteriovenous shunts, dilated anastomotic branches, and dense pleural staining are important risk factors for pulmonary complications of THCE via the IPA. Embolization for shunts may be required to prevent such complications, especially in cases with shunts to pulmonary vessels or hepatic veins.

Learning of herbivore-induced and nonspecific plant volatiles by a parasitoid, Cotesia kariyai.

Learning of host-induced plant volatiles by Cotesia kariyai females was examined with synthetic chemicals in a wind tunnel. Wasps were preconditioned by exposure to volatiles and feces simultaneously. A blend of four chemicals, geranyl acetate, beta-caryophyllene, (E)-beta-farnesene, and indole, which are known to be specifically released from plants infested by host larvae Mythimna separata (host-induced blend), elicited a response in naive C. kariyai, but did not enhance the response after conditioning. A blend of five chemicals, (E)-2-hexenal, (Z)-3-hexen-1-ol, (Z)-3-hexen-1-yl acetate, beta-myrcene, and linalool, which are known to be released not only from plants infested by the host larvae, but also from artificially damaged plants or undamaged ones (unspecific blend), elicited little response in naive wasps, but significantly enhanced the wasps' response after conditioning. With a blend of the above nine chemicals, wasps could learn the blend at lower concentrations than they did in the nonspecific blend. Hence, both the host-induced and nonspecific volatile compounds appear to be important for C. kariyai females to learn the chemical cues in host location.