The aim of the present study was to clarify the morphologic characteristics of time–intensity curves (TICs) that are useful for distinguishing benign from malignant lesions. One hundred three patients with breast lesions underwent dynamic breast MRI. The areas under the receiver operating characteristic (ROC) curves (AUC) from every component of TIC were compared between benign and malignant disease. As a result, angle of cross line between 1 and 4 min is more useful than rapid enhancement for distinguishing benign from malignant lesions.

UNLABELLED:The anti-tumor effects and tissue distribution of carboplatin (CBDCA) incorporated into hydroxyapatite (HAP) particles was studied.MATERIALS AND METHODS:Seven days after the intraperitoneal (i.p.) implantation of AH130 tumor cells into Donryu rats, the animals were randomized into four groups: group I was treated with saline i.p.; Group II, with CBDCA i.v.; group III with CBDCA i.p.; and group IV with HAP-CBDCA i.p.RESULTS:The survival rate of group IV was better than that of the other groups (p < 0.05). The area under the ascitic platinum concentration-time curve and tissue concentrations of platinum in the omentum after 24 hours of treatment were higher in group IV than in groups II or III (p < 0.05). The platinum concentrations in the kidneys of group IV were lower than in group III (p < 0.05).CONCLUSION:The HAP-CBDCA combination enhances the anti-tumor effects of the drug and reduces the nephrotoxicity in rats with peritoneal carcinomatosis.

A 66-year-old man complained of epigastralgia and a close examination was done. A type 3 gastric carcinoma was found. The tumor invading the pancreas and swelling lymphnodes around the stomach were confirmed according to abdominal CT. We considered it difficult to resect the tumor completely, and so we used combined chemotherapy of TS-1 plus CDDP. TS-1 was taken at 120 mg/day for 28 days followed by 14 days rest. CDDP was injected at 140 mg on day 8. Because the tumor in the stomach changed to scar and swelling lymphnodes diminished after two courses of therapy, total gastrectomy was done. After operation, combined chemotherapy of LV and 5-FU resulted in no recurrence to date. Although combined chemotherapy of TS-1 plus CDDP is effective for advanced gastric carcinoma, the number of days TS-1 is taken and the duration of the preoperative chemotherapy must be investigated in forthcoming study.

症例は85歳男性で肺疾患にて通院中であった.心窩部痛,嘔気・嘔吐を繰り返したため精査入院となった.入院時血液検査では低蛋白血症と腫瘍マーカーの高値を認めた.上部消化管内視鏡検査と上部消化造影検査で8×7cmの胃前庭部腫瘤の十二指腸への嵌入が認められ,腹部CTでは肝S6にLDAを認めた.以上よりAFP産生胃癌の十二指腸嵌入および肝転移と診断した. Poor risk症例であることを考慮し, #4d, 6のリンパ節郭清を伴う胃部分切除と肝楔状切除を選択した.その後は化学療法も施行せずに, 1年8カ月再発を認めていない.胃癌の十二指腸嵌入は多くは前庭部から幽門部に発生した隆起性早期胃癌であり,自験例では噴門の弛緩や十二指腸の拡張から比較的早期に嵌入し,そのまま進行癌へ発育していったとも考えられた.

Radiotherapy is now commonly employed in patients with inoperable esophageal cancer which invased neighbor organs directly. A rare, but often fatal complication of radiotherapy is perforation with mediastinal abscess. We successfully treated a 65-year-old male patient who developed an esophageal cancer with trans-esophageal drainage and irrigation. This technique may also be useful in the treatment of patients with anastomotic leaks after esophagectomy or idiopathic esophageal rupture.

切除不能進行胃癌に対し腹腔動注併用化学療法が奏功した症例を経験したので報告する. 症例は59歳の男性. 上腹部痛を主訴に来院し, 上部消化管内視鏡検査にてBorrmann IV型胃癌を指摘された. 1999年6月手術施行するもT4, N3, P1, H0, M1, CY1: stage IVのため試験開腹とし, 左右横隔膜下にリザーバーを留置してmodified low doseCDDP+5FU regimenにて化学療法を施行した. 9月にTh9/10のレベルでAorta内に動注用リザーバーを留置し, 以後外来通院にて腹腔動注併用化学療法を施行した. 2000年4月食思不振にて再入院するまでQOLを損なうことなく外来通院にて腹腔動注併用化学療法が施行できた.

症例は46歳の男性. 腹痛を主訴に来院. 注腸X線, 内視鏡検査にて盲腸底部に大小不同の結節集簇性病変と, 回盲弁直上およびその2cm肛門側の上行結腸, 直腸にそれぞれ2mm, 10mm, 5mmの粘膜下腫瘍 (SMT) を認めた. 直腸のSMTに対してはポリペクトミーを施行し, 盲腸の結節集簇性病変と上行結腸の2か所のSMTに対して回盲部切除を施行した. 3個のSMT はいずれも粘膜下層に存在し, 好酸性顆粒をもつ多型細胞が胞巣状に増生しており顆粒細胞腫と診断された. 免疫組織学的染色では, S-100蛋白陽性, NSE (neuron-specific-enolase) 陽性, desmin陰性であり神経原性と考えられた. 欧米では悪性例も報告されており, 確実な切除が重要である. 本症例においては7年を経過した現在, 再発を認めていない. 大腸における多発性の顆粒細胞腫は過去2例を認めるのみで極めてまれである.

Hydroxyapatite(HAp) particles has excellent compatibility with human tissue and can be safely administered into the peritoneal cavity of rats with no significant complications (Artif. Organs Today 3 : 185-192, 1994). We explored the possibility of HAp as a drug carrier for carboplatin using AH130 abdominal carcinomatosis. HAp particles are biodegradable following intraperitoneal administration(i. p.) and were taken up especially in greater omentum. The pharmacokinetics of HAp-CBDCA were examined using Donryu rat models with AH130 abdominal carcinomatosis. The platinum(Pt) levels in serum and ascites were higher in HAp-CBDCA i. p. than free-CBDCA i. v. groups. HAp-CBDCA i. p. were effective in prolonging the survival of rats model with AH130 abdominal carcinomatosis. HAp-CBDCA administration was experimentally confirmed to be safe. For the clinical application, HAp-CBDCA (HAp-particles : 5 g, CBDCA : 150 mg) was administered into the pleural cavity(i. pc.) at operation on the two advanced esophageal cancer and the pharmacokinetics of CBDCA were also examined. The serum levels of Pt were higher in the HAp-CBDCA(i. pc.) from 5 minute to 30 minute than those in the free-CBDCA(i. pc.). These results demonstrated the efficacy of HAp particles as a drug carrier for anticancer drugs, with ultimate improvement in overall survival.

We evaluated the tissue distribution and antitumor effects of freeze-dried, liposome-entrapped carboplatin (lipo-CBDCA) injected via the portal vein (ipv.) to rats bearing AH 130 tumors. The liposomes consisted of egg lecithin and cholesterol. The serum concentration of platinum (Pt) was higher following the lipo-CBDCA i.p.v than following the free CBDCA given i.p.v or i.v, at 3 and 6 hours after administration. The liver concentration of Pt was increased after administration of the liposome preparation vs. free drug. The in vivo antitumor effect of lipo-CBDCA was evaluated in rats inoculated with AH 130 tumor. Administration of free CBDCA i.p.v prolonged the survival of tumor-bearing rats. Survival was further prolonged by lipo-CBDCA vs. the control group or the group receiving free CBDCA. All rats treated with lipo-CBDCA i.p.v survived, and their liver metastases were disappeared completely. No serious effects were observed in studies of liver and kidney function. These results indicate that administration of lipo-CBDCA via the portal vein may be more effective in treating liver metastases than free CBDCA, and appeared non toxic to rats.

We report herein the case of a 40-year-old man with AIDS who was admitted to hospital with severe abdominal pain, fever, and chills. He underwent an emergency laparotomy which revealed a perforated appendix with suppurative peritonitis. An appendectomy with peritoneal drainage was carried out, but the postoperative course was complicated by fever without leukocytosis; however, he gradually improved following treatment with intravenous antibiotics, granulocyte colony-stimulating factor (G-CSF) and immunoglobulins, and made a complete recovery. His postoperative course demonstrates the effectiveness of this treatment regimen for patients with AIDS complicated by infection without an increase in the white blood cell count (WBC).

Carcinomatous peritonitis with resultant ascites can be the result of progression of gastrointestinal malignancies, especially of gastric origin. Various methods, including intraperitoneal and intravenous routs, have been tried to improve the efficacy of chemotherapeutic agents or biological response modifiers. Nevertheless, prognosis of such patients remains grim. Hydroxyapatite (HAp) has excellent compability with human tissues and has been used in orthopedic and dental procedures, and percutaneous devices for hyperalimentation. The drug carrier HAp particle has pores 23∼59 μm in diameter with a surface area of 25 m2/g. The efficacy of intraperitoneal administration of lentinan-loaded hydroxyapatite particles(HAp-LNTN) was explored using a Donryu rat model of tumor cell AH-130 carcinomatous peritonitis. The drug delivery system HAp-LNTN contained 200 mg HAp and 0.5 mg LNTN. The pharmacokinetics of LNTN following intraperitoneal administration of HAp-LNTN was studied. Serum levels of HAp-LNTN were elevated for 24hours compared with free-LNTN. Intraperitoneal administration of HAp-LNTN was effective in prolongation of survival of rats bearing AH-130 in the peritoneal cavity, day 35 to 55. Furthermore, the pharmocokinetics of carboplatin (CBDCA) following intraperitoneal administration of HAp-CBDCA was studied. Serum levels of CBDCA were higher in the HAp-CBDCA group compared to the free-CBDCA group from postdrug administration hour 6 until day 3. These results suggest that the efficacy of anticancer drugs is enhanced by utilizing HAp as a drug delivery system.