BACKGROUND/AIMS:Hepatitis C virus (HCV) associated HCC shows a high rate of recurrence even after curative treatment. Outcomes of pegylated interferon PEGIFN a-2b/ribavirin (RBV) therapy for HCV-associated HCC have yet to be elucidated. We investigated therapeutic response and hepatic functional reserve improvement in patients receiving PEG-IFN a-2b/RBV after curative HCC treatment. METHODOLOGY:We investigated survival rate, metachronous recurrence and hepatic functional reserve in 54 patients with initial HCV-associated Stage I/II HCC; 29 patients were administered a preparation of PEG-IFN a-2b/RBV after HCC treatment (Secondary IFN group) and 25 were not (Non-secondary IFN group). RESULTS:A significant difference was observed in cumulative survival rates among HCV-associated HCC patients with rates of 100% after 1 year and 90.2% after 3 years in the secondary IFN group compared to 96.0% and 61.2%, respectively, in the non-secondary IFN group. Univariate analysis identified secondary IFN treatment, alanine aminotransferase and albumin levels as factors contributing to survival. Serum albumin level decreased temporarily but subsequently increased and improved hepatic functional reserve was observed in PEG-IFN a-2b/RBV therapy. CONCLUSIONS:PEG-IFN a-2b/RBV therapy after HCC treatment can improve hepatic functional reserve and may therefore represent a therapeutic option in the event of recurrence. PEG-IFN a-2b/ RBV therapy following HCC treatment shows promise for improving the prognosis of HCC.

The efficacy of double filtration plasmapheresis (DFPP) plus interferon (IFN)-beta induction therapy was preliminarily investigated in re-treated patients with chronic genotype 1b hepatitis C and high viral load (patients with relapse or non-response to previous IFN therapies). In eight patients with chronic hepatitis C, DFPP was performed five times over 2 weeks during IFN-beta therapy, and 3 MU of IFN-beta was administered twice a day for 2 weeks. Combination therapies with ribavirin and pegylated IFN-alpha 2b (PEG-IFN-alpha 2b) or pegylated IFN-alpha 2a (PEG-IFN-alpha 2a) were subsequently used. After 4 weeks, hepatitis C virus (HCV)-RNA tended to be more greatly decreased with DFPP combination therapy than with previous IFN therapy (4.5 +/- 2.0 log(10)IU/mL vs. 2.9 +/- 1.2 log(10)IU/mL). Rates of both rapid virological response and complete early virological response were significantly higher with DFPP and IFN-beta induction therapy than with previous IFN therapy. DFPP plus IFN-beta induction therapy produced a great reduction of viral load during the early stage of treatment and achieved a high early virological response, suggesting that this combination therapy may be useful as a new treatment modality for chronic hepatitis C patients in difficult-to-treat states. This combination may contribute to sustained virological response (SVR). The effects of DFPP on SVR and its significance remain to be clarified.

BACKGROUND: The effectiveness of additional chemotherapy in preventing intrahepatic distant tumor recurrence of hepatocellular carcinoma (HCC) has not been fully established. The authors compared the efficacy of 2 platinum-based chemotherapeutic agents in combination with radical local treatment for preventing intrahepatic distant recurrence (IDR). METHODS: Seventy-eight patients with stage I/II HCC aged 45 to 85 years underwent transcatheter arterial chemoembolization and/or radiofrequency ablation after they received hepatic arterial infusion (HAI) of platinum compounds. The HAI consisted of cis-diammine(1,1-cyclobutanedicarboxylato)platinum(II) (carboplatin) in 25 patients and cis-diamminedichloroplatinum (II) (cisplatin) in 53 patients. Multivariate analysis was used to identify independent factors that were associated with IDR. RESULTS: Cumulative IDR rates at 1 year, 2 years, and 3 years were 21.7%, 52.2% and 75.7%, respectively, in the carboplatin group and 8.1%, 22.7%, and 36.9%, respectively, in the cisplatin group. The cisplatin group had a significantly lower IDR rate compared with the carboplatin group. The selection of a platinum agent was 1 of the independent factors for IDR in a multivariate Cox proportional hazards model. CONCLUSIONS: HAI chemotherapy with cisplatin before radical local treatment was effective in patients with HCC. The authors concluded that radical local treatment with concurrent HAI using cisplatin may contribute to a longer progression-free period, which could be predicted with intrahepatic imaging in patients with stage I/II HCC. Cancer 2011; 117: 4018-25. (C) 2011 American Cancer Society.

症例は60代男性.200X年肝機能障害にて当院へ紹介された. 肝胆道系酵素の上昇を認め,腹部造影CTで肝S8濃度低下,左腎下極に低吸収域を認めた.腹部MRIにて肝両葉に小結節の散在が認められ,腫瘍生検にて肝細胞癌あるいは腎細胞癌肝転移と診断されたが確定診断には至らなかった.肝細胞癌に準じた治療を施行するも進行早く第22病日死亡.剖検所見では上皮成分の腎淡明細胞癌が肉腫様変性を生じ,肺転移を形成せずに広汎な壊死を伴った急速な多発肝転移を呈した腎細胞癌肝転移と診断された.非典型的な画像所見とその転移様式の考察に剖検所見が有用であった.

BACKGROUND/AIMS:Intra-arterial injection therapy is performed to ensure more localized administration; however, this approach has led to more cases of catheter obstruction during the course of treatment for pancreatic cancer than in any other type of cancer. Therefore, the purpose of this study was to verify the resistance of catheters to gemcitabine.METHODOLOGY:The catheters were prepared by injecting gemcitabine into the lumen, which was subsequently closed by clipping both ends. After incubation, the gemcitabine in the lumen of the catheter was removed, the breaking strength was measured by pulling 1 side of the catheter at a speed of 500 mm/min to test the tensile strength. To verify the surface of the lumen, the lumen was observed with an electron microscope.RESULTS:Soaking the lumen revealed no significant differences in breaking strength due to abusive treatment conditions. Electron microscopy revealed residual microscopic amounts of gemcitabine in the lumen but with no marked deterioration or alteration in the quality of the tube surface.CONCLUSIONS:Gemcitabine had no chemical effect on the intra-arterial injection catheter. It is possible that a thrombotic tendency in pancreatic cancer patients may be responsible for the high frequency of catheter occlusion in patients with this disease.

A69-year-old man was diagnosed with sigmoid colon cancer and underwent resection of the sigmoid colon. He was later diagnosed with multiple liver metastases 11 months after resection of the sigmoid colon cancer. He was treated by intraarterial chemoembolization using degradable starch microspheres (DSM) and radiofrequency ablation therapy. As a systemic therapy, combined oral administration of tegafur/uracil (UFT) and Leucovorin(Uzel) was started (UFT 450 mg/day, Leucovorin 75 mg/day, 4 weeks of therapy followed by a 1-week treatment break). Two months after 4 courses, the liver metastases had markedly diminished and CEA was within the normal range. The metastases had almost disappeared and tumor markers decreased to within normal limits. This treatment was very safe and effective. Such a strategic multidisciplinary treatment can lead to a better prognosis for colorectal cancer with liver metastases.

AIM:To conduct a single-stage, combined computed tomography (CT) arterial portography (CTAP) and CT arteriography (CTA) imaging operation, we used Y-shaped sheaths with 2 valves, which allowed the insertion of 2 catheters simultaneously.METHODS:Of 1254 patients who underwent abdominal angiography for transarterial embolization and/or intraarterial chemotherapy in our department from May 2002 to November 2009, 664 patients in whom Y-shaped sheaths with 2 valves were used underwent CT angiography using a combination of CTA and CTAP. The Seldinger method was used to insert a 10 cm Y-shaped short sheath with 2 valves into the femoral artery. Under radiographic guidance, a 3.2 French (Fr) catheter was placed in the celiac artery or proper hepatic artery, and a second 3.2 Fr catheter was then placed distal to the inferior pancreaticoduodenal artery of the superior mesenteric artery. CTAP was then performed followed by CTA 10 min later. Photographs were taken during the early and late phases of the procedure.RESULTS:Insertion of 3.2 Fr catheters was not possible in 6 of 664 (0.9%) patients with strong curvature of the femoral artery and 4 of 664 (0.6%) patients with strong curvature of the abdominal aorta. In addition, performing CTAP and CTA as a single-stage combined intervention was not possible in 14 of 664 (2.1%) patients whose right hepatic artery originated from the superior mesenteric artery and in 8 of 664 (1.2%) patients whose left hepatic artery branched from the left gastric artery. There were no sheath-related complications such as those related to arterial dissection or hemostasis.CONCLUSION:Although transfers to and from the CT room were necessary for anatomically variant patients, CT angiography using the Y-shaped sheath for combined CTAP and CTA was considered useful.

症例は55歳，女性．2002年4月，卵巣癌に対し，某院にて初回手術施行．IIIb期，類内膜腺癌，ダグラス窩転移陽性にて術後TC療法（PTX+CBDCA）を6コース施行．11月second look operation施行．腹腔内細胞診陰性．TC療法2コース施行後，CBDCAに対する副作用が出現し，CPT-11+PTXに変更し，加療された．2007年6月腹部CTにて，肝円索の転移性病変指摘．その後経過観察中に同病変の増大を認め，10月当院紹介入院となった． 肝円索の播種性病変に対し，DSM-TAE施行後，RFAを施行．11月にDSM-TAE 2回目施行後，2回目のRFAによる追加治療を施行した．術後，炎症所見上昇，肝機能増悪し，CTにて左葉は肝梗塞に陥るものの保存的治療で改善した．術後3カ月後のCTにて肝円索浸潤肝転移播種性病変は完全嚢胞化し，CA125は正常化した．加療後20カ月の現在再発所見は認められていない．卵巣癌肝円索浸潤肝転移に対し，DSM-TAE，RFAにて治療した報告例はない．一方，その問題点を含め，示唆的な症例と考えられ報告する．

BACKGROUND/AIMSRadiofrequency ablation (RFA) is a new modality for hepatocellular carcinoma (HCC). However, the effects of RFA on hepatic reserve have not yet been thoroughly studied. In the present study, it was evaluated the effect of branched chain amino acid (BCAA) administration after RFA.METHODOLOGYFifty-seven patients with initial, single HCC lesions measuring not more than 30mm in whom RFA was selected in first-line therapy were enrolled. Twenty-eight patients with the Child-Pugh B/C grade who received RFA therapy were divided into two groups: 11 who received a BCAA-enriched nutrient mixture, and 17 who did not. Changes in serum albumin were evaluated before RFA and 1, 6 and 12 months after RFA.RESULTSMultivariate analysis showed that the Child-Pugh grading is the most important factor related to intrahepatic distant recurrence following by RFA. Serum albumin levels decreased 1 month after RFA. Although a tendency toward recovery was noted 6 months after RFA, a decreasing tendency was noted again one year after RFA compared to the pre-RFA baseline. However, a tendency toward improvement was noted in Child-Pugh B grade patients who received BCAA mixture.CONCLUSIONSBCAA mixture made it possible to maintain serum albumin levels and hepatic reserve.

症例は43歳女性．2005年8月飲酒後，吐血し，救急車にて某院搬送入院．上部消化管内視鏡にて孤立性胃穹窿部静脈瘤からの出血を認めたが，自然止血にて経過観察していた．再出血の可能性を認め，バルーン下逆行性経静脈的塞栓術目的に当院へ紹介転院となった．造影CTにて胃内腔へ突出する胃静脈瘤とそれに連続する胃腎短絡路を認めた．胃腎短絡路の存在からバルーン下逆行性経静脈的塞栓術可能と判断し，血管造影施行．右内頸静脈により6Frバルーンカテーテルを胃腎短絡路に挿入，逆行性造影を施行したところ，造影剤は通常より左側の細い胃腎短絡路より流出し，胃静脈瘤本体への造影剤の停滞は不十分であった．そこで，右大腿静脈から6Frシェファードフックカテーテルを左腎静脈に挿入し，マイクロバルーンカテーテルを細い短絡路に挿入し，閉塞下に造影したところ，十分な静脈瘤血行路の描出が得られ，閉塞が可能となり，2カ所の閉塞により胃静脈瘤への造影剤の停滞が十分であると判断し，5%EOIを注入し塞栓可能となった．術後CTにても短絡路は消失し，胃静脈瘤は消失した．

The fluorescence spectra of Michler's ketone (4,4′-bis(dimethylamino)benzophenone) with varying composition of starting chemicals of silicon alkoxides and solvents have been observed during various stages of the sol–gel reaction. Among the reaction systems, the fluorescence spectra in the systems including phenyl and methyl substituted alkoxysilanes or chloroform as a starting reactant showed an explicitly broad and red-shifted TICT (twisted intramolecular charge transfer)-like fluorescence, though the shift was not large compared with that observed in solution. The results showed that a possibility to control flexible conformation of Michler's ketone in rigid environment.

This study attempted to reproduce the particular morphological features of the carbonaceous material deposited on the shell wall of heat-exchangers in the commercial pyrolytic process converting ethylene dichloride (EDC) into vinyl chloride monomer to investigate the mechanism and factors affecting the deposition. Scanning electron microscope shows the carbonaceous material as an aggregate of nanospheres which coat the whole wall of the reactor. The effects of time and temperature in the heat-treatment were examined in an stainless steel reactor at 220-250degreesC using pure EDC and commercial feed EDC in the process. The yield of carbonaceous material from pure EDC increased almost proportionally with the period of heat-treatment from 0.12 wt% at 6 h to 0.73 wt% at 48 h. The aggregate of the spheres found on the wall also increased in diameter according to the period of the heat-treatment. The higher temperature increased both yield and size of the carbonaceous spheres. The feed EDC which contained chloro-olefins and dienes provided a much higher yield of carbonaceous deposition. Addition of 1% benzene to pure EDC at 250degreesC reduced the yield and particle size of deposited carbonaceous material. Addition of 1-methylnaphthalene to pure EDC produced a higher yield of carbonaceous particles than pure EDC at 250degreesC, maintaining the shape of the individual spheres. Biphenyl and tetralin slightly reduced the yield. Oxidized iron surface (FC2O3) increased the yield, whereas glass surface reduced the yield of carbonaceous material. Dehydrochlorination, which occurs in this temperature range, appears to increase the yield of carbonaceous material. Based on the morphology and yield of deposited carbonaceous material, the mechanism and reduction of carbonaceous deposition are discussed.

Transcranial magnetic stimulation (TMS) can activate discrete areas of the cerebral cortex through the intact skull of healthy conscious volunteers. A magnetic coil generates a brief and focused magnetic field that penetrates the skull to activate the specific area of cerebral cortex beneath. This non-invasive procedure is painless, well tolerated by participants and now widely used to explore brain function. We used TMS to investigate asymmetrical cortical regulatory influences on one aspect of immune function: secretion of the antibody immunoglobulin A (S-IgA) into saliva. The right and left temporo-parietal-occipital cortex of 16 healthy, conscious subjects was stimulated on two different occasions, at least 1 week apart. There was an immediate increase in S-IgA concentration following both right and left stimulation. Saliva volume was reduced immediately post-right but not left stimulation. When secretion (microg/min) of S-IgA was calculated (controlling for changing saliva volume) an increase was apparent following left but not right hemisphere stimulation. Furthermore, a significant difference between the relationship between S-IgA concentration and volume of saliva post-left and right stimulation was observed. We conclude that TMS can be used as a tool to investigate cortical regulation of autonomic and immune function in healthy, conscious human subjects and that secretion of saliva and S-IgA is differentially affected by stimulation of the left and right cerebral cortex.

Pediatrics InternationalVolume 43, Issue 2 p. 166-168 Acute disseminated encephalomyelitis in a boy with elevated plasma levels of thrombin–antithrombin III complex Tatsuro Nobutoki, Tatsuro Nobutoki Department of Pediatrics, National Mie Hospital, Mie, JapanSearch for more papers by this authorTakashi Nakano, Takashi Nakano Department of Pediatrics, National Mie Hospital, Mie, JapanSearch for more papers by this authorJunya Takahashi, Junya Takahashi Department of Pediatrics, National Mie Hospital, Mie, JapanSearch for more papers by this authorKazuo Higuchi, Kazuo Higuchi Department of Pediatrics, National Mie Hospital, Mie, JapanSearch for more papers by this authorToshiaki Ihara, Toshiaki Ihara Department of Pediatrics, National Mie Hospital, Mie, JapanSearch for more papers by this authorHitoshi Kamiya, Hitoshi Kamiya Department of Pediatrics, National Mie Hospital, Mie, JapanSearch for more papers by this author Tatsuro Nobutoki, Tatsuro Nobutoki Department of Pediatrics, National Mie Hospital, Mie, JapanSearch for more papers by this authorTakashi Nakano, Takashi Nakano Department of Pediatrics, National Mie Hospital, Mie, JapanSearch for more papers by this authorJunya Takahashi, Junya Takahashi Department of Pediatrics, National Mie Hospital, Mie, JapanSearch for more papers by this authorKazuo Higuchi, Kazuo Higuchi Department of Pediatrics, National Mie Hospital, Mie, JapanSearch for more papers by this authorToshiaki Ihara, Toshiaki Ihara Department of Pediatrics, National Mie Hospital, Mie, JapanSearch for more papers by this authorHitoshi Kamiya, Hitoshi Kamiya Department of Pediatrics, National Mie Hospital, Mie, JapanSearch for more papers by this author First published: 23 December 2001 https://doi.org/10.1046/j.1442-200x.2001.01355.x Correspondence TatsuroNobutoki Department of Pediatrics, Mie University, School of Medicine, 2-174 Edobashi, Tsu city, Mie 514-8507, Japan. Email: syouni@clin.medic.mie-u.ac.jp Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume43, Issue2April 2001Pages 166-168 RelatedInformation

An isotropic carbon produced on the wall side of the tube in the heat exchanger of the commercial pyrolysis process of ethylene dichloride into vinyl chloride monomer was characterized in terms of its morphology, optical texture, and graphitizability.

A novel cell display system was developed for cloning the variable region (V) genes of antigen-specific human antibodies. The system is based on an antibody library displayed on the surface of COS cells, using a plasmid vector designed to direct expression of membrane-bound antibodies. COS cells expressing antigen-specific antibodies were separated using a flow cytometer for their binding to a fluorescent dye-labeled antigen. To test the performance of this system, we cloned V genes of 4 antibodies directed against hepatitis B surface antigen (HBsAg) from a library prepared from peripheral blood lymphocytes of a vaccinated donor. These membrane-bound anti-HBsAg antibodies were easily converted to soluble forms, all of which showed a size similar to human serum IgG in SDS–PAGE and the same specific binding to HBsAg as membrane-bound forms in ELISA. All VH and Vκ gene segments of the 4 clones isolated in this study belonged to VHIII and VκI subgroups, respectively. These findings demonstrate the potential and selection capabilities of our cell display system for cloning the V genes of antigen-specific human antibodies.

A variety of cokes formed in the reactor and transfer lines of a commercial ethylene dichloride pyrolysis process producing a vinyl chloride monomer were characterized by optical and electron scanning microscopies to determine the mechanism by which they were formed and to find means for suppressing this coke formation. Typical columnar pyrolytic carbon was found on the reactor wall, which was anisotropic carbon of granular appearance. Deposits of carbon found in the transfer lines of product and feed varied in amount and composition, depending on the location of the deposition. The latter carbon appeared to be formed through a mechanism similar to refluxing carbonization of reactive species such as chloroprene and acetylene, which are easily oligomerized, can precipitate on the wall, and finally yield carbon after the repeated dissolution and precipitation. The temperature and kinds of reactive species in the product and feed may define the extent of adhesion, coalescence, and growth of carbon primary granules and may induce their softening during carbonization.