Effects of the chelating agent DTPA on naturally accumulating metals in the body.

Diethylenetriaminepentaacetate (DTPA) is the most widely used chelating agent for Pu and Am. Volunteers were assigned to receive intravenous injections or aerosol inhalations of 1 g of DTPA on days 1-4; volunteers received once daily injections of CaDTPA or ZnDTPA, CaDTPA inhalation as an aerosol, or CaDTPA injection on day 1 and ZnDTPA on days 2-4. CaDTPA injection or inhalation increased the excretion rates of Zn in urine with concomitantly reduced levels of serum Zn. Injection of CaDTPA reduced activities of serum alkaline phosphatase (AP) in parallel with the kinetics of Zn, whereas CaDTPA and ZnDTPA injection reduced activities of lactate dehydrogenase (LDH), and reduced activities of creatinine kinase (CK) were observed upon CaDTPA injection and its inhalation. Intravenous administration of CaDTPA and ZnDTPA enhanced excretion rates of Mn in urine, whereas transient reduction of Mn levels in serum was detected only via CaDTPA injection. Both CaDTPA and ZnDTPA transiently reduced levels of Mg in serum without affecting the excretion rates. On the other hand, both DTPAs increased excretion rates of toxic metals such as Pb and Cd, and CaDTPA also increased the rates of Hg. These results suggest that DTPA, and especially CaDTPA, removes essential metals and that the activities of these metalloenzymes are good indicators for the imbalance of essential metals during the DTPA administration. Our results also show that CaDTPA injection is more potent for removing these metals than ZnDTPA and inhalation of CaDTPA, and DTPA may be useful for the treatment of acute heavy metal poisoning with Pb, Cd, or Hg.

Prediction of the ablated area prior to radiofrequency ablation for liver tumor under CT guidance.

PURPOSE: To evaluate the usefulness of a method we developed to predict the ablation area at the time of CT guided radiofrequency (RF) ablation for liver tumors on a CT workstation. MATERIAL AND METHODS: Ten tumors (mean diameter 15.5 mm, range, 9.0-21.5 mm) in seven patients with hepatocellular carcinoma for which CT guided RF ablation was performed were subjects of this study. After advancing the electrode, plain CT was obtained. Then a simulated ball to predict the ablated area was created on the workstation. After confirming that the tumor was sufficiently within the ball, ablation was performed. The distance of the edge of the actual ablated area from that of the predicted ablated area was measured at six points in three cross-sectional directions on CT images after ablation. RESULTS: The procedures were successfully performed without complications. No local recurrence occurred. Mean absolute value of the distance of the gap between the actual and predicted ablated areas was 3.06 ± 2.18 mm (range: 0 to 9 mm). At 29 (55.8%) points, the actual ablated area was smaller than the predicted ablated area; it was larger in 17 (32.7%), and was the same in 6 (11.5%) points. CONCLUSION: Our method produces an acceptable simulation during RF ablation under CT guidance.

Therapeutic results of a novel enzyme-targeting radiosensitization treatment, Kochi oxydol-radiation therapy for unresectable carcinomas II, in patients with stage I primary breast cancer.

Linac-based stereotactic radiotherapy has little effect on the majority of advanced neoplasms. Therefore, the novel radiosensitizer Kochi oxydol-radiation therapy for unresectable carcinomas (KORTUC) II, which contains hydrogen peroxide and sodium hyaluronate, was developed. The effectiveness of KORTUC II for the treatment of chemotherapy-resistant supraclavicular lymph node metastases, recurrent breast cancer and stage IV primary breast cancer has previously been demonstrated. The present study evaluated the safety and efficacy of KORTUC II for patients with stage I primary breast cancer. A total of 15 patients (age range, 40-76 years) were enrolled. The injection of 3 ml of KORTUC II agent was initiated from the sixth radiotherapy fraction and was performed twice a week, under ultrasonographic guidance. The therapeutic effects were evaluated by PET-CT and/or MRI examinations prior to and following KORTUC II treatment. All patients exhibited complete responses and the overall survival rate was 100% after a follow-up period of five years. The mean duration of follow-up at the end of March 2015 was 53 months. Based on these results, KORTUC II treatment exhibited marked therapeutic effects with satisfactory treatment outcomes and an acceptable extent of adverse events.

Use of proximal side-hole micro-balloon catheter in transcatheter hepatic arterial chemoembolization.

We report on a 70-year-old man with unresectable multiple hepatocellular carcinomas who underwent treatment with transcatheter hepatic arterial chemoembolization. In treating a tumor in segment 1 of the liver, the proximal side-hole micro-balloon catheter, which has been newly developed, was useful.

Therapeutic response to a novel enzyme-targeting radiosensitization treatment (KORTUC II) for residual lesions in patients with stage IV primary breast cancer, following induction chemotherapy with epirubicin and cyclophosphamide or taxane.

Linac-based radiotherapy has a negligible effect on the majority of advanced neoplasms. Therefore, a novel radiosensitization treatment Kochi Oxydol Radiation Therapy for Unresectable Carcinomas II (KORTUC II), which utilizes hydrogen peroxide and sodium hyaluronate was developed. The effectiveness of KORTUC II for the treatment of chemotherapy-resistant supraclavicular lymph node metastases and recurrent breast cancers has previously been demonstrated. The present study evaluated the safety and efficacy of KORTUC II in patients with stage IV primary breast cancer. Seven patients (age range, 36-65 years) were enrolled. All patients received induction chemotherapy prior to KORTUC II treatment and underwent positron emission tomography-computed tomography (PET-CT) examinations prior to and 2-7 months following KORTUC II treatment, and every six months thereafter where possible. The radiotherapy regimen (x-ray irradiation) was 2.75 gray (Gy)/fraction, 5 fractions/week for 16-18 fractions with a total radiation dose of 44-49.5 Gy. Administration of the KORTUC II agent (3-6 ml: 3 ml for a lesion <3 cm in diameter and 6 ml for a lesion ≥3 cm) was initiated from the sixth radiotherapy fraction, and was conducted twice a week under ultrasonographic guidance. The therapeutic effects were evaluated by PET-CT examinations prior to and following KORTUC II treatment. Of the seven lesions from the seven patients, five exhibited complete responses, two exhibited partial responses and none exhibited stable disease or progressive disease. The overall survival rate was determined to be 100% at 1 and 86% at 2 years post-treatment. The mean duration of follow-up by December 2014 was 51 months. The results of the PET-CT studies indicated that KORTUC II treatment demonstrated marked therapeutic effects with satisfactory treatment outcomes and acceptable adverse effects.

Therapeutic response to a novel enzyme-targeting radiosensitization treatment (Kochi Oxydol-Radiation Therapy for Unresectable Carcinomas) in patients with recurrent breast cancer.

Linear accelerator-based radiotherapy has little effect on the majority of locally advanced neoplasms. Thus, the novel radiosensitizer Kochi Oxydol Radiation Therapy for Unresectable Carcinomas, Type II (KORTUC II), which contains hydrogen peroxide and sodium hyaluronate, was developed. The effectiveness of KORTUC II for the treatment of chemotherapy-resistant supraclavicular lymph node metastases has been previously demonstrated. The present study evaluated the safety and effectiveness of KORTUC II in patients with recurrent breast cancer. A total of 20 patients (age range, 39-84 years) were enrolled in the study. The majority of patients underwent positron emission tomography (PET)-computed tomography (CT) examinations prior to and 1-7 months following KORTUC II treatment, and every 6 months thereafter when possible. The radiotherapy regimen was 2.75 Gy/fraction, 5 fractions/week, for 16-18 fractions, with a total radiation dose of 44.00-49.50 Gy (X-ray irradiation), or 4.00 Gy/fraction, 3 fractions/week, for 10-12 fractions, with a total radiation dose of 40.00-48.00 Gy (electron beam irradiation). The injection of 3-6 ml of the KORTUC II agent was initiated at the fifth radiotherapy fraction, and was performed twice/week under ultrasonographic guidance. The therapeutic effects were evaluated by PET-CT examinations prior and subsequent to KORTUC II treatment, which was observed to be well tolerated with minimal adverse effects. Of the 24 lesions presented by the 20 patients, 18 exhibited complete response, 5 partial response, 0 stable disease and 1 progressive disease. The overall survival rate was 100% at 1 year and 95% at 2 years. The mean duration of follow-up at the end of June 2014 was 51 months. Based on the results of the PET-CT studies conducted, KORTUC II treatment demonstrated marked therapeutic effects, with satisfactory treatment outcomes and acceptable adverse events.

Correlation of liver parenchymal gadolinium-ethoxybenzyl diethylenetriaminepentaacetic acid enhancement and liver function in humans with hepatocellular carcinoma.

Animal studies have demonstrated that liver function parameters affect the degree of liver enhancement by gadolinium-ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA). The present study prospectively investigated whether liver function parameters and liver damage scores similarly correlate with the degree of liver enhancement by Gd-EOB-DTPA in humans with hepatocellular carcinoma (HCC). A total of 41 patients (32 males, 9 females; mean age, 71.9 years; range, 38-86 years) with suspected HCC provided written, informed consent to undergo a Gd-EOB-DTPA (30 µmol/kg of body weight)-enhanced T1-gradient-echo (GRE) magnetic resonance imaging (MRI) study. The signal intensity of the liver parenchyma was quantified at various time points following injection of Gd-EOB-DTPA. We investigated the correlations between maximal relative enhancement (RE) values and liver function parameters, and liver damage scores. Correlations between parameters and maximum RE values were determined using the Student's t-test and univariate regression analyses. The effect of potential confounding factors was controlled by multiple stepwise regression analysis. Two-tailed values of p<0.05 were considered to indicate a statistically significant difference. The RE values were maximal in 8 and 33 patients at 20 and 30 min, respectively, following Gd-EOB-DTPA injection and did not significantly differ between respective liver damage scores. Univariate analyses revealed that maximal RE values were associated with serum aspartate aminotransferase, total bilirubin, albumin and 15-min indocyanine green retention rates. Multiple stepwise regression analyses revealed that serum albumin and total bilirubin remained independently significant. The degree of liver parenchyma enhancement by Gd-EOB-DTPA depends on liver function parameters in humans, as in animals. The results from this study suggest that Gd-EOB-DTPA has potential for use as a liver function test, and for providing a short examination time for liver MRI results in patients with normal liver function.

Differences in Trocar Positioning within the Vertebral Body Using Two Different Positioning Methods: Effect on Trainee Performance.

Purpose. To evaluate the educational effect of the Japanese Society of Interventional Radiology 7th Academic Summer Seminar from a technical perspective. Materials and Methods. Nineteen trainees participated in the seminar. The seminar consisted of vertebroplasty trainings using swine with the single-plane landmark method and with the ISOcenter Puncture (ISOP) method. All trainees were advised by an instructor as they operated the instruments and punctured the vertebra. For each trainee, the accuracy in the final position of the needle tip of the initial puncture in each swine training was evaluated. Results. Error in the final position of the needle tip of ≥5 mm from the target puncture site occurred in the lateral direction in 42% (8/19) of trainees with the landmark method and 5% (1/19) with the ISOP method. No error ≥5 mm occurred in the vertical or anteroposterior directions. In terms of puncture accuracy, error in the lateral direction was significantly lower with the ISOP method than with the landmark method (2.2 ± 1.5 mm versus 5.6 ± 3.2 mm). Conclusion. This seminar was effective training for trocar placement for beginners. The puncture was more accurate with the ISOP method than with the landmark method.

Power Doppler and gray-scale sonography standardized by BI-RADS for the differentiation of benign postoperative lesion and local recurrence after breast-conserving therapy.

The diagnosis of ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy is of great interest to breast physicians. The present study compared the utility of gray-scale sonography standardized by a breast imaging reporting and data system (BI-RADS) and power Doppler sonography for differentiating between benign scar formation and IBTR after breast-conserving therapy. Gray-scale sonography detected 83 solid breast lesions classified as BI-RADS categories 3-5 in 272 patients after breast-conserving therapy, and these lesions were entered into the study (53 lesions as category 3, probably benign; 30 lesions as categories 4-5, suspected malignancy). Power Doppler sonography revealed intratumoral flow in 19 of 83 solid breast lesions. BI-RADS category 3 was accepted as probably benign and BI-RADS categories 4-5 were considered as suspicious for breast tumor recurrence in the gray-scale ultrasound criteria. Positive and negative intratumoral flow were employed as suspicious for breast tumor recurrence and probably benign, respectively, in the power Doppler sonography criteria. Sensitivity was higher for power Doppler sonography (94.7±10.0%) than for gray-scale sonography (57.9±22.2%). Specificity was also higher for power Doppler sonography (98.4±3.0%) than for gray-scale sonography (70.3±0.6%). These results suggest that power Doppler sonography can complement gray-scale sonography standardized by BI-RADS in differentiating between IBTR and benign scar lesions.

Ginsenoside Rd prevents and rescues rat intestinal epithelial cells from irradiation-induced apoptosis.

Panax ginseng has been shown to have a protective effect for irradiated animals or cells. Ginsenosides are the most active components isolated from ginseng, and ginsenoside Rd has been identified as one of the effective compounds responsible for the pharmaceutical actions of ginseng. In the present study, we studied the molecular mechanisms for the radio-protective action of ginsenoside Rd in rat intestinal epithelial IEC-6 cells. Cells were irradiated with gamma-ray, and apoptosis was examined using Hoechst staining and Western blot analysis. Treatment with ginsenoside Rd before gamma-irradiation inhibited irradiation-induced apoptosis in IEC-6 cells. Administration of Rd after irradiation also inhibited apoptosis in these cells. Irradiation of IEC-6 cells resulted in inactivation of Akt phosphorylation that was abrogated by Rd. On the other hand, irradiation activated phosphorylation of ERK1/2 but did not affect that of p38 MAPK. Inhibition of Akt phosphorylation prevented the reduction of apoptosis by Rd following irradiation. Pretreatment with an inhibitor of the MEK pathway further decreased the number of apoptotic cells. Rd decreased the ratios of Bax/Bcl-2 and Bax/Bcl-xL, the levels of cytochrome c, and the cleaved form of caspase-3 in irradiated IEC-6 cells. Our results suggest that ginsenoside Rd protects and rescues rat intestinal epithelial cells from irradiation-induced apoptosis through a pathway requiring activation of PI3K/Akt, inactivation of MEK, and also inhibition of a mitochondria/caspase pathway.

A case of primary aldosteronism due to unilateral adrenal hyperplasia.

The case of a patient with primary aldosteronism due to unilateral adrenal hyperplasia (UAH) is reported. A 43-year-old man with an 8-year history of hypertension presented at our institution with hypokalemia, increased plasma aldosterone concentration (PAC), and suppressed plasma renin activity (PRA). An abdominal CT scan showed almost normal adrenal glands with slight enlargement in the left gland. 131I-Norcholesterol adrenal scintigraphy under dexamethasone suppression showed bilaterally decreased uptake. To rule out idiopathic hyperaldosteronism, an adrenal vein sampling before and after ACTH stimulation was performed and a left-sided lateralization of PAC was observed. A left adrenalectomy was performed, and the patient had a good clinical and biochemical response. Micronodular hyperplasia was discovered in the adrenal gland histologically, and in the immunohistochemical analysis, positive staining for 3beta-hydroxysteroid dehydrogenase in micronodular lesions confirmed the diagnosis of UAH. Although UAH is a rare subset of primary aldosteronism, it is surgically correctable as a unilateral autonomous aldosterone-producing lesion. Careful investigations, including bilateral adrenal vein sampling, should be performed for the diagnosis.

Retained surgical sponge in the thigh: report of the third known case in the limb.

We report a retained surgical sponge (gossypiboma) in the thigh, which mimicked a neoplasm. A 25-year-old man, who had a past history of external fixation for femoral shaft fracture, complained of swelling in the left thigh with pain. A radiograph of the thigh showed periosteal reaction. T1-weighted magnetic resonance (MR) images showed a well-defined mass with heterogenous signal intensity, and T2-weighted images showed tortuous lines of low signal intensity within the mass. Surgical excision revealed a retained gauze sponge within the mass. Histopathological examination revealed foreign body reaction related to the retained gauze sponge. Our case, the third to our knowledge of gossypiboma in a limb, demonstrated characteristic MR imaging findings.

MR imaging of meniscal malformations of the knee mimicking displaced bucket-handle tear.

We report two cases of patients with lateral meniscal malformations of the knee that were found incidentally. Magnetic resonance imaging (MRI) of both cases showed a fragment-like meniscus structure located in the intercondylar notch, very similar to the "fragment in the intercondylar notch sign" observed in displaced bucket-handle tear. Arthroscopic examinations revealed a ring-shaped lateral meniscus in one case, and "flipped-over" lateral meniscus in the other. In the latter, a similar lateral meniscal malformation was observed contralaterally at MR arthrography.