A retrospective analysis of the risk factors for allergic reactions induced by the administration of oxaliplatin.

This study retrospectively investigated the clinical features and risk factors of allergic reactions induced by oxaliplatin administration. This study investigated the incidence of allergic reactions and analysed the background and laboratory data in patients with colorectal cancer treated with oxaliplatin-based chemotherapy at Kyushu Medical Center between April 2012 and September 2012. A total of 62 patients were included in this study. The number of patients in the allergic and non-allergic groups was 7 and 55 respectively. The incidence of allergic reactions was 11.3%. We compared the patients' characteristics and laboratory data between the two groups and found that the average dose of dexamethasone in the allergic group was significantly lower than that observed in the non-allergic group (P = 0.0111). Furthermore, the incidence of allergic reactions in the group that received prophylaxis of less than 12 mg of dexamethasone was significantly higher than that observed in the group that received more than 12 mg of dexamethasone (P = 0.0103). In conclusion, a lower dexamethasone dose is a possible risk factor for allergic reactions induced by the administration of oxaliplatin; however, given the retrospective design used in this study, further validation of this finding is warranted.

Characteristic evaluation of a Lithium-6 loaded neutron coincidence spectrometer.

Characteristics of a (6)Li-loaded neutron coincidence spectrometer were investigated from both measurements and Monte Carlo simulations. The spectrometer consists of three (6)Li-glass scintillators embedded in a liquid organic scintillator BC-501A, which can detect selectively neutrons that deposit the total energy in the BC-501A using a coincidence signal generated from the capture event of thermalised neutrons in the (6)Li-glass scintillators. The relative efficiency and the energy response were measured using 4.7, 7.2 and 9.0 MeV monoenergetic neutrons. The measured ones were compared with the Monte Carlo calculations performed by combining the neutron transport code PHITS and the scintillator response calculation code SCINFUL. The experimental light output spectra were in good agreement with the calculated ones in shape. The energy dependence of the detection efficiency was reproduced by the calculation. The response matrices for 1-10 MeV neutrons were finally obtained.

Pancreatic sphincter precutting to gain selective access to the common bile duct: a series of 172 patients.

BACKGROUND AND STUDY AIMS: Several precutting techniques have been described in cases of failed access to the common bile duct. We describe our experience with pancreatic sphincter precutting in an upward direction, and report its success rates and complications. PATIENTS AND METHODS: A total of 172 patients underwent a procedure using this technique between January 1989 and December 2001. The technique consisted of a medium-to-large precut along the midline, above the papillary elevation, using either the common channel or the pancreatic duct in the ampulla of Vater as a guide. The septum between the pancreatic duct and the bile duct was removed and separate openings to the pancreatic and bile ducts were created, followed by complete biliary sphincterotomy. RESULTS: Biliary cannulation and sphincterotomy was successful in 163 of the 172 study patients (95 %). Mild complications, which were all managed conservatively, occurred in 17 patients (10 %). This complication rate was significantly higher than our complication rate for standard endoscopic sphincterotomy, which was 0.8 % in 1770 patients ( P < 0.0001). CONCLUSIONS: Pancreatic sphincter precutting is an effective and safe technique for patients in whom selective cannulation of the common bile duct has failed. Further prospective comparative studies of other precutting techniques will better define its clinical value.

Simultaneous determination of ingredients in an ointment by hydrophobic interaction electrokinetic chromatography.

Hydrophobic interaction electrokinetic chromatography was used to simultaneously determine seven active ingredients (diphenhydramine hydrochloride, dibucaine hydrochloride, chlorhexidine hydrochloride, phenylephrine hydrochloride, hydrocortisone acetate, allantoin and tocopherol acetate) in an ointment. Not only hydrophobic but also ionic compounds were successfully separated by use of a separation solution composed of acetonitrile-water (80:20, v/v), tetradecylammonium salt and ammonium chloride. The migration behavior of the hydrophobic compound depended on tetradecylammonium concentration, while that of the ionic compounds depended on ammonium chloride concentration. An addition of triethylamine to the separation solution markedly improved the reproducibility of the peak areas of cations with a relative standard deviation (RSD) of less than 1.7% (n=6). The established method was validated and confirmed to be applicable to the determination of the active ingredients in a commercial ointment. Sample preparation was performed by liquid-liquid extraction and no interference from the formulation excipients was observed. Good linearities were obtained, with correlation coefficients above 0.999. Recoveries and precisions ranged from 98.0 to 100.8%, and from 0.4 to 2.9% RSD, respectively. These results suggest that hydrophobic interaction electrokinetic chromatography can be used for the determination of ionic compounds as well as hydrophobic compounds in ointment.

Impaired heart rate response during incremental exercise in patients with acute myocardial infarction and after coronary artery bypass grafting: evaluation of coefficients with Karvonen's formula.

Heart rate (HR) response during exercise in patients with ischemic heart disease was evaluated, and the appropriateness of Karvonen's method for determining rehabilitation exercise target HR was investigated. The study group comprised 24 patients with acute myocardial infarction (AMI) and 37 patients who had undergone coronary artery bypass grafting (CABG). Cardiopulmonary exercise testing (CPX) was performed with a cycle ergometer and changes in HR (deltaHR)/changes in work rate (deltaWR) and interval changes of the coefficient of Karvonen's formula were evaluated. In the AMI group and the CABG group, deltaHR/deltaWR were significantly lower than those of age-matched control subjects (p<0.01). Karvonen's coefficients ranged from 0.37 to 0.54 when calculated from actual peak HR and 0.21 to 0.32 calculated from the predicted peak HR. An impaired HR response was found in patients with AMI and those who had had CABG up to 6 months previously. Because the Karvonen's coefficient values, which ranged from 0.6 to 0.8, were elevated for these patients, and considering the data from the CPX, increased exercise is recommended for such cases.

Intraductal papillary tumors of the pancreas. Histopathologic correlation of MR cholangiopancreatography findings.

PURPOSE: To evaluate MR cholangiopancreatography (MRCP) findings of intraductal papillary tumors of the pancreas and correlate them with histopathology. MATERIAL AND METHODS: Seventeen patients with intraductal papillary tumor of the pancreas underwent MRCP before surgery. MRCP findings were correlated to histopathology with regard to the presence of septa and excrescent nodules in the cystic lesion, communication between the cystic lesion and the main pancreatic duct (MPD), degree of dilatation of MPD, and dilatation of the common bile duct (CBD). RESULTS: MRCP demonstrated septa in 17 cases (100%), excrescent nodules in 8 cases (47.1%), communication between the intraductal papillary tumor and the MPD in 14 cases (82.3%), dilatation of MPD over 50% in 6 cases (35.3%), and dilatation of CBD in 3 cases (17.6%). These findings showed excellent correlation with histopathology. The septum on MRCP corresponded with a layer of connective tissue with pancreatic duct epithelium. Excrescent nodules in the carcinomas consisted not only of malignant cells, but also of dysplasia and adenoma. Excrescent nodules in adenomas were consistent not only with minimal papillary growth of adenoma, but also with proliferation of fibrosis, and hematoma and organized fibrin with minimal fibrosis. Pancreatic tissue was affected by chronic pancreatitis in all cases. Cases with dilatation of CBD on MRCP were due to microscopic invasion by the carcinoma. CONCLUSION: MRCP appearances of intraductal papillary tumors are well correlated with the findings at histopathology.

Simultaneous determination of eleven ingredients in ophthalmic solutions by cyclodextrin-modified micellar electrokinetic chromatography with tetrabutylammonium salt.

Cyclodextrin-modified micellar electrokinetic chromatography was applied to determine simultaneously 11 active ingredients in ophthalmic solutions. All the ingredients were successfully separated by using the mixed carrier system containing sodium dodecyl sulfate with beta-cyclodextrin and tetrabutylammonium phosphate. The effects of the cyclodextrin type on selectivity were also examined. Excellent separation of the all ingredients was obtained by the use of dimethyl-beta-cyclodextrin. The established method was validated and confirmed to be applicable to the determination of the active ingredients in a commercial ophthalmic solution. These results suggest that capillary electrophoresis can be applied to the quantitative analysis as well as qualitative analysis in pharmaceuticals.

Correlation of 99mTc-GSA hepatic scintigraphy with liver biopsies in patients with chronic active hepatitis type C.

99mTc-DTPA-galactosyl human serum albumin (99mTc-GSA) liver scintigraphy was performed in 230 patients with chronic active hepatitis type C, and its quantitative indices were compared with histological findings. 99mTc-GSA findings correlated well with four indices of the histology activity index (HAI), especially with the fibrosis score. Ninety patients were given interferon treatments, and 99mTc-GSA findings were compared with the results of the treatments. We classified the effects of interferon treatment into three groups according to clinical outcome: group 1: good effect (HCV-RNA negative, n = 34), group 2: moderate effect (HCV-RNA positive, but the value of GPT was normal for six months after the end of treatment, n = 19) and group 3: no effect (n = 37). Quantitative indices of 99mTc-GSA showed significant differences between groups. Follow-up study with 99mTc-GSA scintigrams was obtained in eight patients. The results of 99mTc-GSA improved in three patients in group 1 and deteriorated in five patients in group 3. There is a possibility that 99mTc-GSA scintigraphy can be used to predict the clinical outcome of chronic active hepatitis type C after interferon treatment.

[Evaluation of hepatic artery occlusion after intra-arterial infusion of SMANCS in patients with hepatocellular carcinoma].

Although intra-arterial infusion of SMANCS is effective for the treatment of hepatocellular carcinoma, injury of the hepatic artery is occasionally encountered. We analyzed 78 patients with hepatocellular carcinoma who received intraarterial infusion of SMANCS. Twenty-seven patients who were treated by epirubicin were used as a control. Complete occlusion of the right hepatic artery was induced in 15 patients who received SMANCS infusion. The average number of administrations was 1.9 in the occluded group, 1.5 in the non-occluded group, and 1.6 in the epirubicin group. There was no statistically significant difference in the dose of drugs in a single session between the three groups (3.5 +/- 1.5 ml in the occluded group, 3.6 +/- 1.5 ml in the non-occluded group and 4.2 +/- 1.2 ml in the epirubicin group), and there was no statistically significant difference in total dose between the three groups (6.8 +/- 2.6 ml in the occluded group, 5.5 +/- 3.6 ml in the non-occluded group and 6.8 +/- 4.3 ml in the epirubicin group). However, total dose per tumor volume was significantly larger in the occluded group (1.1 +/- 1.0 cm3) than in the non-occluded group (0.5 +/- 0.5 cm3) (p < 0.05). Excess infusion of SMANCS for small hepatocellular carcinomas appears to be an important factor in vascular injury.

[Intra-arterial infusion of SMANCS for treatment of patients with hepatocellular carcinoma--adverse reactions and complications].

Although intra-arterial infusion of SMANCS has been demonstrated to be highly effective for treatment of patients with hepatocellular carcinoma, it is reported to cause critical adverse reactions and complications. We examined the adverse reactions of SMANCS on the hepatic artery in 78 patients with hepatocellular carcinoma, who were infused with SMANCS from right, left or proper hepatic artery at our hospital. SMANCS caused right hepatic artery occlusion in 15 patients (19%) and the average amount of infused SMANCS was 6.8 mg. The tumor volume in the artery occluded patients was smaller than that in the artery non-occluded patients. Then, the mechanism by which SMANCS caused arterial occlusion was its induction of arterial injuries by excess infusion. When SMANCS was infused to whole liver, it induced decreased hepatic functional reserve and liver atrophy, followed by delayed liver failure. Other adverse reactions were no different from those in patients infused with epirubicin-lipiodol emulsion.

Recanalization after coil embolotherapy of pulmonary arteriovenous malformations: study of long-term outcome and mechanism for recanalization.

OBJECTIVE: We investigated the efficacy of steel coils for embolotherapy of pulmonary arteriovenous malformations (PAVMs) by reimaging the embolized PAVMs. CONCLUSION: We found a high incidence (57%; 8/14) of recanalization in PAVMs embolized with steel coils. Contrast-enhanced CT is useful for detection of recanalized PAVMs. Half of the recanalized PAVMs were fed by bronchial artery branches. Thus, coil embolization should be performed as close as possible to the PAVM to avoid future development of bronchial artery-to-pulmonary artery anastomoses that may cause recanalization.

Small cystic insulinoma: value of arterial stimulation venous sampling.

Cystic insulinomas are rare, with only three cases having been reported in the literature. It is not difficult to determine the site of such neoplasms, as cystic insulinomas are usually 4-10 cm in diameter. We report a patient with a histologically confirmed cystic insulinoma. This case is unique because of the small size (1.3 cm) of the tumor. Arterial stimulation venous sampling was useful for localizing and distinguishing this tumor from other pancreatic lesions.

Gastrointestinal physiology-regulated dogs for bioavailability evaluation of an oral controlled-release dosage form composed of pulsatile release granules.

Gastrointestinal (GI) physiology-regulated beagle dogs (regulated dogs) were regulated by a combined treatment using intramuscular pentagastrin and intravenous atropine sulfate. In the regulated dogs, the gastric pH was shifted to around 2, and the GI transit time was prolonged to approximate that in humans. Pranoprofen, an acidic anti-inflammatory agent, was granulated around sucrose seeds, and then coated with low substituted hydroxypropyl cellulose used as a swelling agent to afford plain granules (A-granule). Then, A-granule was coated stepwise with ethyl cellulose used as an outer shell material to afford two kinds of pulsatile release granules (B- and C-granules). In the dissolution study using pH 1.2 and 6.8 media, A-, B- and C-granules exhibited lag times of 0, 1 and 2h, respectively. Even in intact beagle dogs, the absorption profiles for A- and B-granules corresponded with those expected from the dissolution profiles. In contrast, the bioavailability of C-granule was only 35% in the intact dogs, but was 55% in the regulated dogs. Thus, the absorption of pranoprofen from pulsatile release granules after a longer lag time should be influenced by the location in the GI tract. Next, a controlled-release (CR) dosage form of pranoprofen was tentatively prepared by combining A-, B- and C-granules at the ratio of 3:4:3 (w/w in contents of pranoprofen). The bioavailability of the CR dosage form was significantly diminished in the intact dogs, being about 70% as much as that in the regulated dogs. Therefore, the regulated dogs would be superior to the intact dogs in avoiding the underestimation of the bioavailability of a CR dosage form with a pulsatile release property.

Correlation of Tc-99m GSA hepatic studies with biopsies in patients with chronic active hepatitis.

To determine whether scintigraphic findings of Tc-99m DTPA-galactosyl-HSA (GSA) correspond to histopathologic findings, Tc-99m GSA hepatic scintigraphy and biopsy were compared in 65 patients with chronic active hepatitis. After injecting 185 MBq of Tc-99m GSA, anterior images were obtained at 5 minutes and 15 minutes. Scintigrams were classified into three grades according to the extent of visualization of the cardiac blood pool on 5 minute and 15 minute images. Biopsies were subjectively graded for findings of necrosis and fibrosis. Scintigraphic grades on 5 minute images were correlated with hepatic necrosis and fibrosis and those on 15-minute images with hepatic fibrosis. Scintigraphic abnormalities of Tc-99m GSA correlated well with histopathologic abnormalities, especially with hepatic fibrosis and necrosis in patients with chronic active hepatitis.

Treatment of hepatocellular carcinoma: value of percutaneous microwave coagulation.

OBJECTIVE: Percutaneous microwave coagulation therapy (PMCT) is a new therapeutic technique for the treatment of solid neoplasms that uses an energy source different from those of other interstitial therapies. We report our initial experience using PMCT to treat hepatocellular carcinomas. MATERIALS AND METHODS: NIne hepatocellular carcinomas exceeding 3 cm in diameter in nine patients were treated with PMCT. Within 2 weeks before PMCT, all patients had been treated with transcatheter arterial embolization therapy, which had failed to produce complete necrosis of the tumors. PMCT was done under local anesthesia. A 14-gauge guiding needle was inserted percutaneously toward the lesion under sonographic guidance, and a needle electrode was positioned precisely within the lesion. Microwaves of 2450 MHz in frequency were produced for 60 sec with a 60-W emission. Three to 12 microwave emissions were administered in each case. RESULTS: Dynamic CT showed that unenhanced areas indicative of coagulation necrosis developed in all lesions. All lesions appeared smaller without enhancement: on CT, the tumor diameters (mean +/- SD) were 48 +/- 13 mm before treatment and 41 +/- 13 mm 1 month after treatment. Follow-up studies showed that five lesions were controlled without any signs of recurrence. All patients tolerated the treatments well, and no serious complications occurred. CONCLUSION: Our preliminary experience suggests that PMCT may be a useful alternative to other forms of interstitial therapy for the treatment of hepatocellular carcinomas.