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Purpose@#No standard salvage regimen is available for relapsed or refractory sarcoma. We investigated the efficacy and toxicity of the vincristine, irinotecan, and temozolomide combination (VIT) for relapsed or refractory sarcomas of variable histology in children and young adults. @*Materials and Methods@#We retrospectively reviewed data from the relapsed or refractory sarcoma patients who were treated with VIT. The VIT protocol was given every 3 weeks as follows: vincristine, 1.5 mg/m2 intravenously on day 1, irinotecan, 50 mg/m2/day intravenously on days 1-5, and temozolomide, 100 mg/m2/day orally on days 1-5. @*Results@#A total of 26 patients (12 males) with various sarcoma histology were included in the study. Most common diagnosis was rhabdomyosarcoma (n=8) followed by osteosarcoma (n=7). Median age at the start of VIT was 18.5 years (range, 2.0 to 39.9). VIT was delivered as 2nd to 7th line of treatment, with 4th line most common (9/26, 34.6%). Median number of VIT courses given was 3 (range, 1 to 18). Of the 25 evaluable patients, there was two partial response (PR) and 11 stable disease (SD) with an overall control rate (complete remission+PR+SD) of 52%. PR was seen in one (50%) of the two evaluable patients with Ewing sarcoma and one (14.3%) of the seven patients with osteosarcoma. Overall survival and progression-free survival rates were 79.3% and 33.9% at 1 year, and 45.5% and 25.4% at 2 years, respectively. There was no treatment-related mortality. @*Conclusion@#The VIT regimen was effective and relatively safe in our cohort of sarcoma patients.
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The quality of life associated with eating is becoming an increasingly significant problemfor patients who undergo esophagectomy as a result of the improved survival rate afteresophageal cancer surgery. Delayed gastric emptying (DGE) is a common complication afteresophagectomy. Although several strategies have been proposed for the managementand prevention of DGE, no clear consensus exists. The purpose of this review is to presenta brief overview of DGE and to help clinicians choose the most appropriate treatmentthrough an analysis of DGE by cause. Furthermore, we would like to suggest some tips toprevent DGE based on our experience.
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PURPOSE: This study aimed to compare lung perfusion scan with single photon emission computed tomography/computed tomography (SPECT/CT) for the evaluation of lung function and to elucidate the most appropriate modality for the prediction of postoperative lung function in patients with lung cancer.METHODS: A total of 181 patients underwent Tc-99m macroaggregated albumin lung perfusion scan and SPECT/CT to examine the ratio of diseased lung and diseased lobe. Forty-one patients with lung cancer underwent both preoperative and postoperative pulmonary function tests within 1 month to predict postoperative pulmonary function. Predicted postoperative forced expiratory volume in 1 s (ppoFEV₁) was calculated by the % radioactivity of lung perfusion scan and SPECT, and the % volume of the residual lung, assessed on CT.RESULTS: The ratios of diseased lung as seen on lung perfusion scan and SPECT showed significant correlation, but neither modality correlated with CT. The ratios of the diseased lung and diseased lobe based on CT were higher than the ratios based on either perfusion scan or SPECT, because CT overestimated the function of the diseased area. The lobar ratio of both upper lobes was lower based on the perfusion scan than on SPECT but was higher for both lower lobes. Actual postoperative FEV₁ showed significant correlation with ppoFEV₁ based on lung perfusion SPECT and perfusion scan.CONCLUSIONS: We suggest SPECT/CT as the primary modality of choice for the assessment of the ratio of diseased lung area. Both perfusion scan and SPECT/CT can be used for the prediction of postoperative lung function.
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Humanos , Volume Expiratório Forçado , Neoplasias Pulmonares , Medidas de Volume Pulmonar , Pulmão , Perfusão , Radioatividade , Testes de Função Respiratória , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
PURPOSE@#This study aimed to compare lung perfusion scan with single photon emission computed tomography/computed tomography (SPECT/CT) for the evaluation of lung function and to elucidate the most appropriate modality for the prediction of postoperative lung function in patients with lung cancer.@*METHODS@#A total of 181 patients underwent Tc-99m macroaggregated albumin lung perfusion scan and SPECT/CT to examine the ratio of diseased lung and diseased lobe. Forty-one patients with lung cancer underwent both preoperative and postoperative pulmonary function tests within 1 month to predict postoperative pulmonary function. Predicted postoperative forced expiratory volume in 1 s (ppoFEVâ‚) was calculated by the % radioactivity of lung perfusion scan and SPECT, and the % volume of the residual lung, assessed on CT.@*RESULTS@#The ratios of diseased lung as seen on lung perfusion scan and SPECT showed significant correlation, but neither modality correlated with CT. The ratios of the diseased lung and diseased lobe based on CT were higher than the ratios based on either perfusion scan or SPECT, because CT overestimated the function of the diseased area. The lobar ratio of both upper lobes was lower based on the perfusion scan than on SPECT but was higher for both lower lobes. Actual postoperative FEVâ‚ showed significant correlation with ppoFEVâ‚ based on lung perfusion SPECT and perfusion scan.@*CONCLUSIONS@#We suggest SPECT/CT as the primary modality of choice for the assessment of the ratio of diseased lung area. Both perfusion scan and SPECT/CT can be used for the prediction of postoperative lung function.
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PURPOSE: We conducted a retrospective analysis to determine if adjuvant chemotherapy prolongs overall survival in patients with pathologic stage IB lung adenocarcinoma who had undergone complete resection and were defined as high-risk by a newly developed recurrence risk scoring model. MATERIALS AND METHODS: Patients who underwent curative resection for stage IB lung adenocarcinoma were analyzed with a newly developed recurrence risk scoring model and divided into a low-risk group and a high-risk group. The patients in the high-risk group were retrospectively divided into two groups based on whether they underwent adjuvant chemotherapy or observation. Recurrence-free survival and overall survival were compared between these two groups. RESULTS: A total of 328 patients who underwent curative resection between 2000 and 2009 were included in this study, of whom 110 (34%) received adjuvant chemotherapy and 218 (67%) underwent observation without additional treatment. According to our risk model, 167 patients (51%) were high-risk and 161 (49%) were low-risk. The 5-year recurrence-free survival rates and overall survival were 84.4% and 91.5% in low-risk patients and 53.9% and 74.7% in high-risk patients (p < 0.001). In high-risk patients, the 5-year overall survival rates were 77% among patients who underwent observation and 87% among those who underwent adjuvant chemotherapy (p=0.019). CONCLUSION: Adjuvant chemotherapy prolonged overall survival among high-risk patients who had undergone complete resection for stage IB lung adenocarcinoma.
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Humanos , Adenocarcinoma , Quimioterapia Adjuvante , Pulmão , Recidiva , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
BACKGROUND: The aim of this study was to evaluate the feasibility of single-port video-assisted thoracic surgery (VATS) in the treatment of secondary spontaneous pneumothorax (SSP). METHODS: Twenty-four patients who were scheduled to undergo single-port VATS for SSP were studied. The medical records of the patients were retrospectively reviewed. The mean follow-up duration was 26.1+/-19.8 months. In order to evaluate the feasibility of single-port VATS for SSP, the postoperative results of single-port VATS (n=15) in patients with emphysema were compared with those of emphysematous patients who underwent three-port VATS (n=15) during the study period. RESULTS: Single-port VATS was feasible in 19 of 24 patients (79.2%), while an additional port was needed in five patients. In the single-port VATS patients, the median operation time, duration of chest tube drainage, and hospital stay were 84.0 minutes, one day, and two days, respectively. Postoperative complications included prolonged chest tube drainage for more than five days (n=1), wound infection (n=1), and vocal fold palsy (n=1). No recurrence of pneumothorax was observed during the follow-up period. The median operation time, duration of chest tube drainage, and hospital stay of the emphysematous patients who underwent single-port VATS were shorter than those who underwent three-port VATS group (p<0.05 for all parameters). CONCLUSION: Single-port VATS proved to be a feasible procedure in the treatment of patients with secondary spontaneous pneumothorax.
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Humanos , Tubos Torácicos , Drenagem , Enfisema , Seguimentos , Tempo de Internação , Prontuários Médicos , Pneumotórax , Complicações Pós-Operatórias , Recidiva , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Paralisia das Pregas Vocais , Infecção dos FerimentosRESUMO
Herein, we report a rare case of concurrent gastric and pulmonary mucosa-associated lymphoid tissue (MALT) lymphomas. A 65-year-old man who had been diagnosed with Helicobacter pylori-positive gastric MALT lymphoma received eradication therapy and achieved complete remission. During follow-up, he developed de novo pulmonary MALT lymphoma as a sequela of pulmonary tuberculosis, accompanied by recurrent gastric MALT lymphoma. Polymerase chain reaction (PCR) products of the CDR3 region of the immunoglobulin heavy chain gene showed an overall polyclonal pattern with bands at 400 base pairs (bp) and 200 bp predominant in the pulmonary tissue, as well as two distinctive bands in the gastric tissue at 400 bp and 200 bp. This case suggests that multiorgan lymphomas are more likely to be independent from each other when they are far apart, involve different organ systems, and have independent precipitating factors.
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Idoso , Humanos , Masculino , Mucosa Gástrica/patologia , Inflamação/patologia , Neoplasias Pulmonares/etiologia , Linfoma de Zona Marginal Tipo Células B/etiologia , Mucosa Respiratória/patologia , Neoplasias Gástricas/etiologia , Tuberculose Pulmonar/complicaçõesRESUMO
Herein, we report a rare case of concurrent gastric and pulmonary mucosa-associated lymphoid tissue (MALT) lymphomas. A 65-year-old man who had been diagnosed with Helicobacter pylori-positive gastric MALT lymphoma received eradication therapy and achieved complete remission. During follow-up, he developed de novo pulmonary MALT lymphoma as a sequela of pulmonary tuberculosis, accompanied by recurrent gastric MALT lymphoma. Polymerase chain reaction (PCR) products of the CDR3 region of the immunoglobulin heavy chain gene showed an overall polyclonal pattern with bands at 400 base pairs (bp) and 200 bp predominant in the pulmonary tissue, as well as two distinctive bands in the gastric tissue at 400 bp and 200 bp. This case suggests that multiorgan lymphomas are more likely to be independent from each other when they are far apart, involve different organ systems, and have independent precipitating factors.
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Idoso , Humanos , Masculino , Mucosa Gástrica/patologia , Inflamação/patologia , Neoplasias Pulmonares/etiologia , Linfoma de Zona Marginal Tipo Células B/etiologia , Mucosa Respiratória/patologia , Neoplasias Gástricas/etiologia , Tuberculose Pulmonar/complicaçõesRESUMO
Behcet's disease is characterized by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. Thrombosis associated with vascular inflammation in patients with Behcet's disease presents various clinical symptoms. Warfarin is usually administered for treatment of thrombosis. However, warfarin can interact with many medications that cause various problems. A 43-year-old woman with Behcet's disease presented with a swollen right leg. Deep vein thrombosis (DVT) was confirmed, and treated with warfarin. Due to exacerbation of Behcet's disease, she received azathioprine along with warfarin. Subsequently, the international normalized ratio (INR) decreased and DVT was exacerbated. Despite an increase in the warfarin dose, the patient did not reach the target INR. After discontinuation of azathioprine, DVT improved and the warfarin dose was decreased. There were no specific findings associated with a hypercoagulable status. This finding suggests the interaction of azathioprine and warfarin. Therefore, clinicians should be cautious regarding the possibility of drug interactions between azathioprine and warfarin.
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Adulto , Feminino , Humanos , Azatioprina , Interações Medicamentosas , Inflamação , Coeficiente Internacional Normatizado , Perna (Membro) , Pele , Estomatite Aftosa , Trombose , Úlcera , Uveíte , Trombose Venosa , VarfarinaRESUMO
PURPOSE: Postoperative thyroid remnant radioablation therapy is necessary to reduce the recurrence and mortality rates as well as to prepare the patients for a proper long term surveillance of well-differentiated thyroid cancers. The radiation safety rules of the government require the patient to be isolated in a hospital if the expected radiation exposure to the family members would be greater than 5 mSv (500 mRem). The purpose was to measure the radiation received by the family members of patients who received large doses of NaI-131. MATERIAL AND METHODS: We have administered 12 therapy doses ranging from 3.70-5.55 GBq (100 to 150 mCi) to 11 patients, and released them immediately if they met the radiation safety criteria. Informed consent was obtained from the subjects prior to the therapy, and each of them agreed to follow written radiation safety instructions. TLD badges were used to measure the radiation dose received by the family members and the room adjacent to the patient's bed room during the first 72 hours. RESULTS: The average dose received by the family members who spent the most time in the closest distance with the patients was 0.04 mSv with a range of 0.01-0.17 mSv. Even the highest dose was only about 3% of the limit set by the government. The average radiation dose to the outer wall of the patient's room was 0.15 mSv. CONCLUSION: It is concluded that I-131 ablation therapy can be administered to outpatients safely to thyroid cancer patients who meet the established radiation safety criteria and follow the instructions.
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Humanos , Consentimento Livre e Esclarecido , Mortalidade , Pacientes Ambulatoriais , Recidiva , Glândula Tireoide , Neoplasias da Glândula TireoideRESUMO
PURPOSE: We wanted to evaluate whether both the colonic transit time (CTT) and defecography are necessary for diagnosing constipated patients, and we also wanted to assess the defecographic findings of patients with outlet obstruction on CTT. MATERIALS AND METHODS: Over the recent 3 years, 26 patients (21 women and 5 men, mean age: 59 years) underwent both CTT and defecography because of their chronic constipation or defecation difficulty. The mean interval between the 2 studies was 48 days. Colonoscopy, barium enema and manometry were performed in 22, 8 and all the patients, respectively. RESULTS: On CTT, 13 patients (50.0%) were normal and 13 patients (50.0%) were abnormal; the abnormal results were composed of outlet obstruction (n=8, 30.8%), outlet obstruction and colon inertia (n=2, 7.7%), colon inertia (n=2, 7.7%), and outlet obstruction and hindgut dysfunction (n=1, 3.8%). On defecography, 6 patients (23.1%) were normal and 20 patients (76.9%) were abnormal; the results were composed of rectocele (n=8, 30.7%), rectocele and perineal descent syndrome (PDS; n=4, 15.4%), PDS and rectal intussusception (n=3, 11.5%), spastic pelvic floor syndrome (SPFS; n=3, 11.5%), rectocele and SPFS (n=1, 3.8%), and rectal intussusception (n=1, 3.8%). Of the 11 patients with outlet obstruction on CTT, rectocele (n=4, 36.4%), SPFS (n=1, 9.1%), rectocele and PDS (n=1, 9.1%), and PDS and rectal intussusception (n=1, 9.1%) were demonstrated on defecography, except for the 4 normal cases. CONCLUSION: Both CTT and defecography were necessary for diagnosing the patients with chronic constipation in compensation, and 63.6% of the patients with pelvic outlet obstruction showed an abnormal pelvic defecation function.
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Feminino , Humanos , Masculino , Bário , Colo , Colonoscopia , Compensação e Reparação , Constipação Intestinal , Defecação , Defecografia , Enema , Intussuscepção , Manometria , Espasticidade Muscular , Diafragma da Pelve , RetoceleRESUMO
Nodular hepatic involvement of multiple myeloma is very rare. We report here on a case of nodular hepatic involvement of multiple myeloma that mimicked intrahepatic cholangiocarcinoma. In patients with multiple myeloma, hepatic involvement of the multiple myeloma might be included in the differential diagnosis of hepatic mass.
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Humanos , Colangiocarcinoma , Diagnóstico Diferencial , Fígado , Mieloma MúltiploRESUMO
Nodular hepatic involvement of multiple myeloma is very rare. We report here on a case of nodular hepatic involvement of multiple myeloma that mimicked intrahepatic cholangiocarcinoma. In patients with multiple myeloma, hepatic involvement of the multiple myeloma might be included in the differential diagnosis of hepatic mass.
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Humanos , Colangiocarcinoma , Diagnóstico Diferencial , Fígado , Mieloma MúltiploRESUMO
Lymphangioleiomyomatosis (LAM) is a rare disease in women in childbearing age leading to progressive respiratory failure. LAM is characterized by an abnormal harmartomatous proliferation of smooth muscle cells surrounding the blood vessels, lymphatics and airways in the lung. This proliferation leads to airway obstruction, cystic alveolar change and lymphatic obstruction. Patients present with dyspnea, pneumothorax, cough, chest pain, hemoptysis, and chylous effusion. Although lung transplantation is the only therapeutic modality in end-stage LAM with respiratory failure, there has not been any report of successful treatment in Korea. We report one case of successful left single lung transplantation in a 40 year old woman suffering from end-stage LAM.
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Adulto , Feminino , Humanos , Obstrução das Vias Respiratórias , Vasos Sanguíneos , Dor no Peito , Tosse , Dispneia , Hemoptise , Coreia (Geográfico) , Transplante de Pulmão , Pulmão , Linfangioleiomiomatose , Miócitos de Músculo Liso , Pneumotórax , Doenças Raras , Insuficiência RespiratóriaRESUMO
Mechanical circulatory support (MCS) has been used for myocardium failure, but moreover, it may be essential for the life support in cardiac arrest or cardiogenic shock. Many commercial devices can be used effectively for the long-term support. However, there are some limitations in the aspects of the cost and technical support by production company. Short-term support with centrifugal type has been reported numerously with the purpose of bridging to heart transplantation or recovery. We successfully treated 5 patitents who were in the status of cardiogenic shock (n=3) or arrest (n=2) with the technique of extracorporeal life support system (ECLS) or left ventricular assist device (LVAD) using the centrifugal type pump. The MCS were performed emergently (n=2) under cardiac arrest caused by ischemic heart disease, and urgently (n=3) under cardiogenic shock with ischemic heart disease (n=1) or acute fulminant viral myocarditis (n=2). All patients were weaned from MCS. Complications related to the use of MCS were bleeding and acute renal failure, but there were no major complications related to femoral cannulations. Mechanical circulatory support may be essential for the life support and rescue in cardiac arrest or cardiogenic shock.
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Humanos , Injúria Renal Aguda , Circulação Assistida , Ponte Cardiopulmonar , Cateterismo , Parada Cardíaca , Transplante de Coração , Coração Auxiliar , Hemorragia , Sistemas de Manutenção da Vida , Isquemia Miocárdica , Miocardite , Miocárdio , Choque CardiogênicoRESUMO
PURPOSE: To assess whether ring enhancements of liver metastases on Mn-DPDP enhanced, early MR images were well visualized on delayed images, as compared with those of hepatocellular carcinomas (HCC), and to investigate the detection accuracy and conspicuity of each tumor. MATERIALS AND METHODS: Twenty patients with liver metastases and 15 with HCC were studied by Mn-DPDP enhanced, T1-weighted MR images. Peripheral ring enhancement and conspicuity were investigated. Differences in detection accuracy and frequency of ring enhancement in liver metastases and HCC were assessed. RESULTS: In liver metastases (n=69), 44 cases (63.8%) without ring enhancement and 25 (36.2%) with were noted on early images. Sixteen cases (23.2%) without ring enhancement, 38 (55.1%) with ring enhancement similar to the early images, and 15 (21.7%) with prominent ring enhancement were noted on delayed images. In HCC (n=37), 36 cases (97.3%) without ring enhancement and 1 case (2.7%) with were noted on early images. There was no difference of detection accuracy in liver metastases or HCC between the 2 readings. Ring enhancement and conspicuity of each tumor were superior on delayed images. Ring enhancement in liver metastases was better seen on delayed images. CONCLUSION: Ring enhancement in liver metastases was well presented on Mn-DPDP enhanced, delayed MR images, which was useful to differentiate liver metastases from HCC.
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Humanos , Carcinoma Hepatocelular , Fígado , Imageamento por Ressonância Magnética , Metástase Neoplásica , LeituraRESUMO
BACKGROUND: The femoral artery is the most common site of cannulation for cardiopulmonary bypass in surgery for type A aortic dissection. Recently, many surgeons prefer the axillary artery to the femoral artery as the arterial cannulation site for several benefits. We evaluated the safety and usefulness of axillary artery cannulation in surgery for acute type A aortic dissection. MATERIAL AND METHOD: Between Oct. 1995 and Sep. 2001, 71 patients underwent operations for acute type A aortic dissection. The arterial cannula was inserted into the axillary artery in 31 patients (AXILLARY group, mean age=56), and into the femoral artery in 40 patients (FEMORAL group, mean age=57). We retrospectively compared the incidence of mortality, morbidities, and hospital course. RESULT: The mean duration of cardiopulmonary bypass and circulatory arrest were significantly shorter in the AXILLARY group (207 min and 39min, respectively) than in the FEMORAL group (263 min and 49 min, respectively; p<0.05). Postoperative hospital stay was significantly shorter in the AXILLARY group than in the FEMORAL group (mean 15 days vs. 35 days, p<0.05). Although there was no difference in the incidence of new-onset permanent neurological dysfunction (3.2% in the AXILLARY group, 2.5% in the FEMORAL group), the incidence of transient neurological dysfunction was significantly lower in the AXILLARY group (12.9% vs. 25%, p<0.05). In the FEMORAL group, two patients needed urgent conversion to cannulation site due to arch vessel malperfusion. In the AXILLARY group, there was only one patient who had a complication related to the cannulation, i.e., median nerve injury. CONCLUSION: Axillary artery cannulation was safe and helpful in decreasing the cerebral ischemic time and incidence of transient neuroligcal dysfunction in surgery for acute type A aortic dissection. It enabled us to approach the patients with aortic arch pathology more aggressively.
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Humanos , Dissecção Aórtica , Aorta Torácica , Artéria Axilar , Ponte Cardiopulmonar , Cateterismo , Catéteres , Artéria Femoral , Incidência , Tempo de Internação , Nervo Mediano , Mortalidade , Patologia , Estudos RetrospectivosRESUMO
PURPOSE: To evaluate the usefulness of MRCP in the diagnosis of the variable causes of common bile duct(CBD) dilatation, except stone or tumor MATERIALS AND METHODS: Twenty-six patients(M:F=15:11, mean age; 62 years) with both MRCP and ERCP were included in this study. Dynamic MRCP(n=12) and contrast-enhanced MRI(n=10) of abdomen were also added. Dilatation of CBD, intrahepatic ducts and pancreatic duct was evaluated, including coexistence of intrahepatic ductal stone, pancreatic pseudocyst, and papillitis or papillary edema. The criteria of CBD dilatation was over than 7 mm(n=21, without cholecystectomy) or 10 mm(n=5, with cholecystectomy) in diameter on T2-weighted coronal image. RESULTS: The mean diameter of CBD was 12.7 mm without cholecystectomy(9-19 mm) and 13.0 mm with cholecystectomy(10-15 mm), respectively(p>0.05). Cholangitis(n=11, 42.3%), chronic pancreatitis(n=8, 30.8%), stenosis of distal CBD(n=6, 23.1%), periampullary diverticulum(n=3, 11.5%), stenosis of ampulla of Vater(n=2, 7.7%), dysfunction of sphincter of Oddi(n=2, 7.7%), acute focal pancreatitis in the pancreatic head(n=2, 7.7%), papillitis(n=1, 3.8%), pseudocyst in the pancreatic head(n=1, 3.8%), and ascaris in CBD(n=1, 3.8%) were noted. Pancreatic duct dilatation(n=10, 38.5%) and duodenal diverticulum(n=3, 11.5%) were also seen on MRCP. On dynamic MRCP(12 patients), distal CBD was visualized in 2 patients(16.7%), which was not shown on routine MRCP. Only 1 patient(10.0%) showed papillitis with slightly enhancing papilla on contrast-enhanced MRI(10 patients). CONCLUSION: MRCP was thought to be helpful in the evaluation of the causes of CBD dilatation, not caused by stone or tumor, especially in the cases of stenosis of distal CBD and chronic pancreatitis, dysfunction of sphincter of Oddi on dynamic MRCP, and cholangitis and pericholangitic abnormality on contrast-enhanced MRI
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Abdome , Ascaris , Bile , Colangiopancreatografia Retrógrada Endoscópica , Colangite , Ducto Colédoco , Constrição Patológica , Diagnóstico , Dilatação , Edema , Imageamento por Ressonância Magnética , Ductos Pancreáticos , Pseudocisto Pancreático , Pancreatite , Pancreatite Crônica , Papiledema , Esfíncter da Ampola HepatopancreáticaRESUMO
PURPOSE: To evaluate the MR findings of gastrointestinal graft-versus-host disease (GVHD) after allogenic bone marrow transplantation. MATERIALS AND METHODS: Five patients (M:F=3:2, age range: 9-58 years) with suspected gastrointestinal GVHD underwent abdominal MRI, and the findings were evaluated. Because of acute myelocytic leukemia (n=4) or non-Hodgkin's lymphoma (n=1), all had undergone allogenic bone marrow transplantation 2-6 (mean, 3.5) weeks earlier. T2-weighted half-Fourier acquisition snapshot turbo spin-echo, T1-weighted spoiled gradientecho (SGE), and postcontrast T1-weighted SGE MR imaging, with and without fat-suppression, was performed. RESULTS: All five patients showed bowel wall thickening and marked contrast enhancement in the jejunum (n=5), ileum (n=4), duodenum (n=3), sigmoid colon (n=3), gastric antrum (n=2), and rectum (n=2). Bowel wall thickening showed a target appearance in the jejunum (n=2, 40.0%), ileum (n=1, 25.0%), sigmoid colon (n=1, 33.3%), and rectum (n=1, 50.0%), while the remaining cases showed diffuse wall thickening without layering. Small amount of ascites was noted in four patients (80%), and multiple small conglomerated retroperitoneal lymph nodes in three (60%). In all patients, a signal intensity of slightly enlarged liver due to iron overload secondary to multiple blood transfusions, gave rise to decreased signal intensity at both T1-and T2-weighted MR imaging. CONCLUSION: In patients with GVHD, the commonly noted MR findings were bowel wall thickening with contrast enhancement, ascites and retroperitoneal lymphadenopathy.
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Humanos , Ascite , Transfusão de Sangue , Transplante de Medula Óssea , Colo Sigmoide , Duodeno , Trato Gastrointestinal , Doença Enxerto-Hospedeiro , Hepatomegalia , Íleo , Sobrecarga de Ferro , Jejuno , Leucemia Mieloide Aguda , Linfonodos , Doenças Linfáticas , Linfoma não Hodgkin , Imageamento por Ressonância Magnética , Antro Pilórico , RetoRESUMO
PURPOSE: To evaluate the therapeutic efficacy of intra-arterial infusion of Cis-Diamminedichloroplatinum (C-DDP) for the treatment of hepatocellular carcinomas with widespread involvement. MATERIALS AND METHODS: We retrospectively analyzed 22 patients who between July 1994 and June 1996 had undergone intra-arterial c-DDP infusion therapy for the treatment of hepatocellular carcinomas with widespread involvement. The hepatomas involved both lobes in ten, portal venous obstructions in fourteen, arterio-portal shunts in nine, and arterio-venous shunts in two. Proper hepatic artery was selected for infusion of 100mg/BSA of C-DDP. The same procedure was repeated every 3 to 4 weeks, and the total number of infusions was 65. On the basis of WHO criteria, response was classified as complete remission, partial remission, stable, or progression of the disease. Six-month and one-year survival rates were estimated, and adverse reactions were evaluated. RESULTS: Complete remission was noted in one patient (4.5%) and partial remission in three (13.6%), while 18 showed no response or progression after treatment. The six month survival rate was 59.1%, and the one-year survival rate was 32.1%. Adverse reactions included nausea/vomiting (59.8%), abdominal pain (9.2%), fever (8.0%), acute renal failure (2.3%) and hepatic encephalopathy (1.1%). These adverse reactions were, however, transient and reversible. CONCLUSION: Although the response rate is not high, intra-arterial C-DDP infusion therapy can be used as an alternative treatment for hepatocellular carcinomas with widespread involvement; adverse reactions are tolerable.