Relationship between volume of the seminal vesicles and sexual activity in middle-aged men.

The relationship between volume of the seminal vesicles and the frequency of sex and sexual function in middle-aged men is not clear. This study included 81 patients who were diagnosed with localized prostate cancer. Volume of the seminal vesicles was examined using a volume analyser from computed tomography. Sexual function was subjectively evaluated using the Expanded Prostate Cancer Index Composite and Erection Hardness Score. The frequency of sex was surveyed using our original questionnaire. The mean ± SD age of the patients was 67.7 ± 5.3 years. There was no relationship between the volume of seminal vesicles and age of the patients. Volume of the seminal vesicles in patients who answered that they had sexual activity at least once a year was significantly larger than in those who answered no sexual activity for several years (P < .01) Moreover, among sexually active, middle-aged men, volume of the seminal vesicles was significantly larger in those who had a sexual frequency once every 3 months than in those who had a sexual frequency once every 6 months or once a year (P < .05). Our study suggests that the volume of seminal vesicles of middle-aged men is correlated with sexual activity.

Recurrence-free survival more than 10 years after liver resection for hepatocellular carcinoma.

BACKGROUND: High recurrence rates after liver resection with curative intent for hepatocellular carcinoma (HCC) remain a problem. The characterization of long-term survivors without recurrence after liver resection may help improve the therapeutic strategy for HCC. METHODS: A nationwide Japanese database was used to analyse 20 811 patients with HCC who underwent liver resection with curative intent. RESULTS: The 10-year recurrence-free survival rate after liver resection for HCC with curative intent was 22.4 per cent. Some 281 patients were recurrence-free after more than 10 years. The HCCs measured less than 5 cm in 83.2 per cent, a single lesion was present in 91.7 per cent, and a simple nodular macroscopic appearance was found in 73.3 per cent of these patients; histologically, most HCCs showed no vascular invasion or intrahepatic metastases. Multivariable analysis revealed tumour differentiation as the strongest predictor of death from recurrent HCC within 5 years. CONCLUSION: Long-term recurrence-free survival is possible after liver resection for HCC, particularly in patients with a single lesion measuring less than 5 cm with a simple nodular appearance and low tumour marker levels.

Comparison of Renal Scintigraphy and Computed Tomographic Renal Volumetry for Determining Split Renal Function and Estimating Post-Transplant Renal Function.

BACKGROUND: In living donor kidney transplantation, the decision regarding which donor kidney to transplant is based on characteristics such as vascular anatomy and split renal function (SRF). Computed tomography (CT) was used to assess vascular anatomy and renal scintigraphy was used to evaluate SRF. The ability of split renal volume (SRV) calculated from volumetric examination of CT scans and that of SRF of renal scintigrams derived from Tc-99m mercaptoacetyltriglycine-3 (MAG3) renography to predict donor residual single kidney function after donor nephrectomy were compared. MATERIAL AND METHODS: CT images and renal scintigrams from 35 live kidney donors who had at least 1 year post-donation renal function follow-up were analyzed. RESULTS: Predonation GFR was 99.1 ± 17.2 mL/min/1.73 m(2). The average right and left kidney volumes were 138.8 ± 29.4 mL and 136.1 ± 29.2 mL, respectively. SRV was strongly and significantly correlated with SRF-MAG3 (r = 0.714). The residual renal functions predicted from calculating SRV and SRF-MAG3 were 46.2 ± 8.3 mL/min/1.73 m(2) and 46.0 ± 9.2 mL/min/1.73 m(2), respectively. Both SRV (r = 0.708) and SRF-MAG3 (r = 0.634) showed significant linear correlations with residual renal function after 1 year, with SRV showing a stronger correlation. CONCLUSION: Calculating SRV from predonation CT examination is a valid method to estimate postdonation renal function after 1 year. CT volumetry may become a standard method in the near future.

Prospective and randomized trial of lipiodol-transcatheter arterial chemoembolization for treatment of hepatocellular carcinoma: a comparison of epirubicin and doxorubicin (second cooperative study). The Cooperative Study Group for Liver Cancer Treatment of Japan.

A randomized, controlled clinical trial was conducted to compare the use of epirubicin (EPI) and doxorubicin (DOX) in Lipiodol (Laboratoire Guerbet, Roissy-Charles-de-Gaulle Cedex, France)-transcatheter arterial chemoembolization as a treatment of hepatocellular carcinoma. One hundred ninety-two hospitals participated, and 415 patients were enrolled in the study during the period between October 1989 and December 1990. The patients were randomly allocated to group A (EPI) or group B (DOX) by a centralized telephone registration. The actual doses of EPI and DOX were 72 mg/body and 48 mg/body, respectively. The 1-, 2-, and 3-year survival rates were, respectively, 69%, 44%, and 33% for group A and 73%, 54%, and 37% for group B. There were no statistically significant differences (P = .2296, log-rank test). When each group of patients was classified retrospectively into high-risk and low-risk subgroups based on the severity index calculated by the Cox regression model from the significant prognostic factors (the pretreatment tumor size, the pretreatment serum alpha-fetoprotein level, tumor encroachment, and Child's classification), the survival curve of the low-risk DOX subgroup was significantly superior to that of the low-risk EPI subgroup (P = .0182). However, there was no significant difference between the high-risk subgroups (P = .4606). The change in the serum alpha-fetoprotein level, the extent of Lipiodol accumulation in the tumor, and the extent of tumor reduction after the treatment did not show any significant differences between the groups. The white blood cell count in group B showed a tendency to decrease slightly more than in group A at 3 weeks after Lipiodol-transcatheter arterial chemoembolization. In conclusion, there was no statistically significant difference between the survival curves of the EPI and DOX groups in Lipiodol-transcatheter arterial embolization treatment of hepatocellular carcinoma.

Resection after intraarterial chemotherapy of a hepatoblastoma originating in the caudate lobe.

A rare case of hepatoblastoma originating in the caudate lobe was treated successfully with intraarterial chemotherapy followed by extensive lobectomy of the left side of the liver. Imaging modalities demonstrated a solitary huge tumor, initially inoperable, occupying almost the entire liver in a 4-month-old female infant. Transcatheter intrahepatic arterial chemotherapy with 10 mg doxorubicin, 20 mg cisplatin, and 3 ml Lipiodol, repeated twice at a 1-month interval, led to a remarkable reduction in tumor size and thereby made it resectable. The volume ratio between the intact hepatic parenchyma and the tumor changed from 1:1.70 to 1:0.13, as assessed by serial computed tomography scans, and the patient's initial alpha-fetoprotein level of 223,210 ng/ml declined to 53 ng/ml. The present case is the first in the literature, to our knowledge, of a resected hepatoblastoma in the caudate lobe. Clinical details of the tumor and surgical issues are discussed.

A hepatoblastoma originating in the caudate lobe radically resected with the inferior vena cava.

Complete resection of a rare hepatoblastoma in the caudate lobe, involving the inferior vena cava (IVC), is reported. After systemic chemotherapy, a 5-year-old child underwent exploratory laparotomy at another hospital, but resection was not attempted because the tumor in the caudate lobe had extensively invaded the retrohepatic IVC. However, because not only the lack of distant metastases but also the establishment of extrahepatic collaterals were confirmed by imaging, we thought it was possible to radically resect the tumor. We successfully performed an extended left hepatic lobectomy including total excision of the caudate lobe and the involved portion of the IVC. Although we did not reconstruct the IVC, no clinical manifestations arising from caval congestion were seen. The serum alpha-fetoprotein value declined below the normal limit. Our experience with this case has introduced a radical resectability for hepatic malignancy in the caudate lobe, even if it has extended into the IVC.

A new method for mapping hepatic subsegment: counterstaining identification technique.

Hepatic subsegmentectomy requires identification of the borders of tumor-bearing subsegment, usually achieved by injecting dye into the portal veins feeding the domain. We describe an alternative technique for performing systematic subsegmentectomy in patients with cirrhosis and hepatocellular carcinoma, in whom hepatic arterial and portal venous embolizations were already performed as a preoperative adjuvant. Under ultrasonic guidance, each of the neighboring portal units is sequentially stained, thus defining the avascular subsegment to be resected as the nonstaining area. This allows the subsegment to be totally resected. This counterstaining identification technique can be used for all subsegments undergoing complete embolization and for other situations in which the usual staining method is impossible because of the presence of arterioportal shunting or portal tumor thrombus.

Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report.

Extensive liver resection for hilar bile duct carcinoma with jaundice has high morbidity and mortality rates because of postoperative liver failure. To minimize postoperative liver dysfunction, a portal venous branch was embolized before surgery to induce atrophy of the lobe to be resected and hypertrophy of the contralateral lobe in 14 patients with hilar bile duct carcinoma. Bile was drained before surgery in 11 patients with jaundice. Portal embolization did not produce major side effects, and moderate increases of serum transaminase activity or bilirubin returned to baseline values within 1 week. Hepatectomy with bile duct resection and lymphadenectomy was performed 6 to 41 days after embolization, at which time the embolized lobe was atrophied in 12 of the patients. Extended right or left lobectomy or left trisegmentectomy (10, 3, and 1 cases, respectively) with biliointestinal reconstruction was performed. One patient with jaundice and suppurative cholangitis died 30 days after hepatectomy. Another patient died 3 months after surgery of aggravated hepatitis. After surgery, no bile leakage occurred and hyperbilirubinemia was usually moderate and reversible.

Hepatic artery embolization for inoperable hepatocellular carcinoma; prognosis and risk factors.

During a 7-year period in our hospital, 69 patients with inoperable hepatocellular carcinoma (HCC) underwent 111 courses of transcatheter hepatic artery embolization (TAE) and/or chemoinfusion with lipiodol. Patient survival was 0.5-37 months following therapy and the factors affecting prognosis were evaluated. Survival rates at 1, 2 and 3 years after TAE were 53%, 24% and 15%, respectively. Survival rates at 1, 2 and 3 years in relation to tumor size were 100%, 100% and 100% in 5 patients (tumor size less than 2 cm in diameter), 81%, 33% and 16% in 23 patients (2.1-5.0 cm), and 35%, 9% and 0% in 41 patients (greater than 5.1 cm). An analysis of prognostic factors showed that the size of the main tumor significantly influenced the prognosis following TAE (P less than 0.01), whereas the frequency of TAE, intrahepatic metastasis and the degree of liver dysfunction showed a slight correlation (P less than 0.1). These results suggest that TAE has a significant potential for becoming the first choice of treatment for patients with small multiple HCCs (less than 2 cm), provided that neither severe hepatic dysfunction nor a tumor thrombus in the main portal vein is present.

Computed tomography of pancreatic adenocarcinoma: comparison of tumor size measured by dynamic computed tomography and histopathologic examination.

Our objective was to assess the detection rate and the accuracy of tumor size determination in pancreatic ductal adenocarcinoma using dynamic computed tomography (CT). Preoperative dynamic CT was evaluated in 35 surgically resected pancreatic ductal adenocarcinomas and the findings were compared with the results of histopathological examination. Pancreatic adenocarcinoma was visualized by dynamic CT as a low-density mass in 97% of cases. All three lesions < or = 2 cm in size were demonstrated in good contrast to normal pancreatic parenchyma. The tumor size measured on dynamic CT showed a good correlation with that measured histopathologically, especially in small tumors. Dynamic CT was useful for evaluating the extent of pancreatic adenocarcinoma, especially for small tumors. The detectability of lesions by CT depended on the manner of tumor extension and the degree of associated pancreatitis as well as the tumor size.

Sonographic detection of large spontaneous spleno-renal shunts and its clinical significance.

The ultrasonographic findings of large spleno-renal shunts seen in five patients with liver cirrhosis and confirmed by CT and/or portography, are described. These spleno-renal shunts were seen in the left inter- or subcostal sections as transonic, mass-like lesions located between the splenic hilum and the left kidney, and by continuous scanning, they were found to be part of a tortuous, large tubular structure. Oesophageal varices were absent or minimal in these patients, and none of them had ever bled.

Case report: hepatocellular carcinoma diagnosed radiologically, treated by transcatheter arterial embolization and limited-field radiotherapy.

Even though the resection rate for hepatocellular carcinoma (HCC) has risen recently, many patients cannot be treated surgically because of the advanced stage of the tumour and/or coexisting cirrhosis. An alternative therapeutic approach for some of these patients is transcatheter arterial embolization (TAE) which has become very common in Japan. However, it is not a curative measure, and an additional therapy is required to eradicate the residual disease. In this communication, we report a case in which a patient with HCC has been successfully treated by TAE followed by limited-field radiotherapy. The results suggest that this is a very promising therapeutic approach for HCC and that the potential of limited-field radiotherapy for HCC with or without TAE also needs to be explored.

The value of ultrasonography for hepatic surgery.

Ultrasonography plays an important role in the early detection of hepatocellular carcinoma. Ultrasonography detected 53% of 287 patients with small (less than or equal to 5 cm) hepatocellular carcinomas. Among 486 patients with hepatocellular carcinomas, sensitivities of intra-operative ultrasonography in detecting 451 small primary hepatocellular carcinoma nodules, intrahepatic metastasis in 330 patients with small hepatocellular carcinoma and 63 tumor thrombi were 98, 48 and 67%, respectively. The sensitivity of intra-operative ultrasonography in detecting small primary tumors was 10% better than ultrasonography, computed tomography, and angiography. The sensitivity of intra-operative ultrasonography in intrahepatic metastasis and tumor thrombus was two to three times better than pre-operative examination. Intra-operative ultrasonography was useful in detecting nonpalpable tumors and in guiding the transection of the liver, biopsy, and cryosurgery. Moreover, intra-operative ultrasonography made possible new hepatectomy procedures: systematic subsegmentectomy and hepatectomies which preserve the inferior right hepatic vein. Systematic subsegmentectomy guided by intra-operative ultrasonography resulted in better survival rates than the limited resection in patients with small hepatocellular carcinoma two years after hepatectomy; by the sixth year, this difference was significant (p less than 0.05). Ultrasonography and intra-operative ultrasonography are indispensable in the early detection, accurate diagnosis, operative guidance and postoperative care of hepatocellular carcinoma.

Late contrast-enhanced CT for small pancreatic carcinoma: delayed enhanced area on CT with histopathological correlation.

PURPOSE: To determine the appearance of pancreatic adenocarcinoma on delayed contrast enhanced computed tomography (CT) and verify the diagnostic significance. PATIENTS AND METHODS: Twenty-two surgically resected lesions of pancreatic adenocarcinoma were studied with dynamic CT and findings were compared with those on histopathology. RESULTS: Ten (45%) of 22 pancreatic adenocarcinoma demonstrated masses on unenhanced CT, while 21 (95%) demonstrated on early contrast-enhanced CT (early CT), and 15 (68%) demonstrated masses on delayed contrast-enhanced CT (late CT). Pancreatic mass was demonstrated as a low-density area on unenhanced and early CT, but mass density varied on late CT. Delayed enhancement of the mass was predominantly observed in small lesions; 3 (75%) of 4 lesions 2 cm or smaller were detected as high-density areas. Histologically, delayed enhanced lesions showed severe or moderate degrees of fibrosis. CONCLUSION: Late CT is useful for the detection of pancreatic adenocarcinoma with fibrosis as a high-density area, especially in small lesions.

CT evaluation of small polypoid lesions of the gallbladder.

BACKGROUND/AIMS: The ability of CT to differentiate small polypoid lesions of the gallbladder was evaluated. MATERIAL AND METHODS: CT followed by cholecystectomy was performed in 20 patients with small polypoid lesions (< or = 20mm) of the gallbladder measured by preoperative ultrasonography. Detectability of the lesions on both unenhanced and enhanced CT, and the configuration and density of the polypoid lesions on enhanced CT were evaluated in comparison with histopathology. RESULTS: Unenhanced CT detected 8 of 20 polypoid lesions (40%), whereas enhanced CT detected all lesions. All the cholesterol polyp (n = 9) and hyperplastic polyp (n = 2) were not detected on unenhanced CT. Configurations of the polypoid lesions were classified into three types; pedunculated, sessile, and mass forming type. All of cholesterol polyp and hyperplastic polyp were demonstrated as pedunculated type, and adenomyomatosis (n = 2) as mass forming type in all lesions, respectively. Two of adenoma were seen as pedunculated type in one and as mass forming type in the other. Adenocarcinoma (n = 5) was depicted as sessile type in four lesions and as pedunculated type in one. The density of the lesions compared with the liver parenchyma on enhanced CT was not specific. CONCLUSIONS: The configuration of polypoid lesions depicted on enhanced CT and visualization of them on unenhanced CT are helpful in differentiating neoplastic lesions which should be resected from other benign lesions.

Imaging of large early and early advanced hepatocellular carcinomas of more than 5 cm in diameter: report of two cases.

In an attempt to clarify the imaging characteristics of large early and early advanced hepatocellular carcinoma (HCC), we present two such cases which were greater than 5 cm in diameter. One case had four early HCCs and the other had early advanced HCC which was followed for five years and nine months. Multiphasic CT, CT arteriography (CTA), CT arterial portography (CTAP), and MR imaging were performed. Early HCC was shown as a low density mass by multiphasic contrast CT, CTAP and as a hyperintense mass on a T1-weighted image (WI) and isointense on T2WI. Early advanced HCC was demonstrated as a hypodense mass with hyperenhancing interior nodules on CTA, and isodense with hypodense internal foci on CTAP. One follow-up case showed a multi-step progression from early to early advanced HCC, and finally to overtly advanced HCC. Despite the unusually large size of these two tumors, the findings of multiphasic CT, CTA, CTAP, and MR imaging were consistent with those seen in common-sized (less than 2 cm) early and early advanced HCCs. Multi-step progression of hepatocarcinogenesis was observed in one case.

Early diagnosis of hepatocellular carcinoma.

We describe the results of our study on the early detection of the development of hepatocellular carcinoma among patients with chronic liver disease. Over a period of 18 years, 33 patients were diagnosed as having hepatocellular carcinoma. From 1970 to 1978, we used serum alpha-fetoprotein determination, liver palpation, and radionuclide liver scans. In addition to alpha-fetoprotein determination, computed tomography and ultrasonography were introduced in 1979. However, we did not have any general guidelines for the use of these imaging modalities. From 1984 onwards, ultrasonography and serum alpha-fetoprotein determination have been performed every three months and computed tomography every year in patients whose right hepatic lobe had atrophied due to liver cirrhosis. On the basis of this screening program, 50% of the detected hepatocellular carcinoma (9/18) were found to be smaller than 1.9 cm in diameter, and tumor resection was performed in 11 out of 18 patients (61%).

Accelerated tumor growth and changes in images concomitant with vascularization in a patient with hepatocellular carcinoma.

We examined serial changes of tumor images in a patient with hepatocellular carcinoma. The hepatocellular carcinoma was initially detected as a homogeneous low-echo area with unclear margins, which was not enhanced by contrast media on computed tomograms, and did not reveal any vascular abnormalities on hepatic angiography. About 11 months later, the tumor growth accelerated, with a parallel increase in serum alpha-fetoprotein levels, and the ultrasonographic features of the tumor changed from a homogeneous low-echo area to a mixed low- and high-echo area with a peripheral low-echo zone. Hepatic angiography revealed a hypervascular tumor at this time. The present case indicates that tumor growth and imaging patterns of hepatocellular carcinoma are closely related to vascularization of the tumor.

Effect of percutaneous ethanol injection for postoperative recurrence of hepatocellular carcinoma in combination with transcatheter arterial embolization.

BACKGROUND/AIMS: This study was conducted to clarify the effect of percutaneous ethanol injection (PEI) in combination with transcatheter arterial embolization (TAE) on prolonging the survival time of patients with postoperative recurrence of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: The subjects were 97 consecutive patients (pts) treated for postoperative recurrent HCC between February 1987 and March 1993. Of these, 25 pts received both TAE and PEI and 72 pts received TAE alone. In the TAE & PEI group, treatment was selected according to the indications: 15 pts received TAE for multiple recurrences following PEI, and the other 10 pts received PEI for a new or residual lesion following TAE. Fourteen demographic, pathological, and clinical variables were evaluated to estimate the relative risk of pts treated with TAE & PEI or with TAE alone. RESULTS: The 1-, 3- and 5- year survival rates in the TAE & PEI group were 100%, 73.2% and 27.2%, respectively, and those in the TAE alone group were 88.9%, 30.2% and 5.5%, respectively. Based on multi-variate Cox regression analysis, the relative risk of cancer death in the TAE & PEI group was 0.32 (95% confidence interval, 0.15 to 0.67). CONCLUSION: The combination of TAE and PEI had a positive palliative effect and increased survival time of patients with postoperative recurrent HCC, compared to results obtained by TAE alone.