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Combination chemotherapy with pertuzumab, trastuzumab, and docetaxel is recommended as the first-line treatment for patients with HER2-positive unresectable or metastatic breast cancer. We report 2 cases of unresectable breast cancer for which pertuzumab, trastuzumab, and docetaxel therapy was effective. Case 1: A woman in her 40s was diagnosed with TxN3aM0, Stage ⅢC, HER2-positive, hormone receptor-positive advanced breast cancer. After administration of 6 courses of pertuzumab, trastuzumab, and docetaxel therapy, she underwent surgery(Bt+Ax[Ⅱ]). Histopathological examination revealed that chemotherapy effect was Grade 3. Case 2: A woman in her 60s was diagnosed with de novo Stage Ⅳ, HER2- positive, hormone receptor-negative breast cancer. She was administered 8 courses of pertuzumab, trastuzumab, and docetaxel therapy as the third-line treatment, because she initially refused treatment. Thereafter, she underwent surgery(Bt+Ax [Ⅰ]). In both cases, histopathological examination revealed complete response after chemotherapy. Thus, combination therapy of pertuzumab and trastuzumab may improve the prognosis in patients with HER2-positive breast cancer.

Purpose: The AI-300 automated infusion device (Sumitomo Heavy Industries, Ltd., Tokyo, Japan) is subject to administration error as a function of smaller volumes of 18 F-FDG dispensed via a three-way cock supplied with a disposable kit. The present study aimed to validate the administration accuracy of the AI-300 using an improved disposable kit for quantitative positron emission tomography (PET) assessment., Methods: We determined administration accuracy between the improved and previous disposable kits by measuring variations in dispensed volumes and radioactive concentrations of 18 F-FDG according to the criteria of the Japanese Society of Nuclear Medicine. A reference value was generated by measuring radioactivity using a standard dose calibrator., Results: The values obtained using the previous kit deviated from the reference values by a maximum of -10.6%, and the deviation depended on dispensed volumes of 18 F-FDG<0.25 mL. In contrast, the values were relatively stable when using the improved kit with dispensed 18 F-FDG volumes < 0.25 mL. Variations in radioactive concentrations were relatively stable using the improved kit, whereas that of the previous kit was slightly unstable at high radioactive concentrations., Conclusion: The administration accuracy of the AI-300 using the previous kit varied considerably according to smaller dispensed volumes, but the improved kit might alleviate this problem. The present results indicated that the improved disposal kit should be immediately implemented to eliminate uncertainty surrounding quantitative PET findings.

Objective: The present study aimed to clarify gross tumor volume (GTV) contouring accuracy at the diaphragm boundary using respiratory-gated PET/CT., Methods: The lung/diaphragm boundary was simulated using a phantom containing 18 F solution (10.6 kBq/mL). Tumors were simulated using spheres (diameter, 11-38 mm) containing 18 F and located at the positions of the lungs and liver. The tumor background ratios (TBR) were 2, 4, and 8. The phantom was moved from the superior to inferior direction with a 20-mm motion displacement at 3.6 s intervals. The recovery coefficient (RC), volume RC (VRC), and standardized uptake value (SUV) threshold were calculated using stationary, non-gated (3D), and gated (4D) PET/CT., Results: In lung cancer simulation, RC and VRC in 3D PET images were, respectively, underestimated and overestimated in smaller tumors, whereas both improved in 4D PET images regardless of tumor size and TBR. The optimal SUV threshold was about 30% in 4D PET images. In liver cancer simulation, RC and VRC were, respectively, underestimated and overestimated in smaller tumors, and when the TBR was lower, but both improved in 4D PET images when tumors were >17 mm and the TBR was >4. The optimal SUV threshold tended to depend on the TBR., Conclusions: The contouring accuracy of GTV was improved by considering TBR and using an optimal SUV threshold acquired from 4D PET images.

Objective: The present study aimed to reveal the influence of combination of different collimators and energy windows on the planar sensitivity and the spatial resolution during experimental 223 Ra imaging, and to determine optimal imaging parameters., Methods: A vial type source containing 223 Ra solution (4.55 MBq / 5.6 ml) was placed in the air at 100 mm away from the collimator surface. Planar images were acquired with LEHR, LMEGP, ELEGP and MEGP collimators on two dual-head gamma cameras (Symbia intevo (Siemens) and Infinia 3 (GE)). We compared three energy window combinations: 1) single window at 82 keV, 2) double window at 82+154 keV, 3) triple window at 82+154+270 keV. The energy spectrum, the sensitivity and the spatial resolution, such as full-width at half-maximum (FWHM) and full-width at tenth-maximum (FWTM), of each collimator were assessed., Results: Five energy spectra (at around 82, 154, 270, 351 and 405 keV) were essentially observed among four collimators. The sensitivity was high for LEHR collimator, then ELEGP and LMEGP collimator was 3-4 fold, which is greater than MEGP collimator. The 82 keV energy window of four collimators has best spatial resolution. Moreover, the spatial resolution of the 82 keV energy window with LMEGP and ELEGP collimator was almost equal to that of the triple window with MEGP collimator., Conclusions: Optimal imaging parameters were single energy window using LMEGP or ELEGP, and then triple energy window using MEGP collimator.

Purpose: Several cross-calibration schemes have been proposed to produce quantitative values in bone SPECT imaging. Differences in the radionuclide sources and geometric conditions can decrease the accuracy of cross-calibration factor (CCF). The present study aimed to validate the effects of calibration schemes using different sources under various geometric conditions., Methods: Temporal variations as well as variations in acquisition counts and the shapes of 57 Co standard and 99m Tc point sources and a 99m Tc disk source were determined. The effects of the geometric conditions of the source-to-camera distance (SCD) and lateral distance on the CCF were investigated by moving the camera or source away from the origin. The system planar sensitivity of NEMA incorporated into a Symbia Intevo SPECT/CT device (Siemens®) was defined as reference values., Results: The temporal variation in CCF using the 57 Co source was relatively stable within the range of 0.7% to 2.3%, whereas the 99m Tc source ranged from 2.7% to 7.3%. In terms of source shape, the 57 Co standard point source was the most stable. Both SCD and lateral distance decreased as a function of distance from the origin. Errors in the geometric condition were higher for the 57 Co standard point source than the 99m Tc disk source., Conclusions: Different calibration schemes influenced the reliability of quantitative values. The 57 Co standard point source was stable over a long period, and this helped to maintain the quality of quantitative SPECT/CT imaging data. The CCF accuracy of the 99m Tc source decreased depending on the preparative method. The method of calibration for quantitative SPECT should be immediately standardized to eliminate uncertainty.

The purpose of this study was to develop the JJ1017 Knowledge-based Application (JKA) to support the continuing maintenance of a site-specific JJ1017 master defined by the JJ1017 guideline as a standard radiologic procedure master for medical information systems that are being adopted by some medical facilities in Japan. The method consisted of the following three steps: (1) construction of the JJ1017 Ontology (JJOnt) as a knowledge base using the Hozo (an environment for building/using ontologies); (2) development of modules (operation, I/O, graph modules) that are required to continue the maintenance of a site-specific JJ1017 master; and (3) unit testing of the JKA that consists of the JJOnt and the modules. As a result, the number of classes included in the JJOnt was 21,697. Within the radiologic procedure classes included in the above, the ratio of a JJ1017 master code for an external beam radiotherapy was the highest (51%). In unit testing of the JKA, we checked the main operations (e.g., keyword search of a JJ1017 master code/code meaning, editing the description of classes, etc.). The JJOnt is a knowledge base for implementing features that medical technologists find necessary in medical information systems. To enable medical technologists to exchange/retrieve semantically accurate information while using medical information systems in the future, we expect the JKA to support the maintenance and improvement of the site-specific JJ1017 master.

Quantitative assessment of 18F-FDG PET can predict treatment responses or outcomes. Here, I briefly describe some world trends in standardizing PET images for image-based assessments of treatment responses, followed by present and future strategies for defining the optimal acquisition conditions for quantitative PET imaging. Finally, information is provided about new technical approaches to improving the quantitation of semi-quantitative indexes such as point spread function, time-of-flight and respiratory gating.

Objective: The present study aimed at determining the quantitative accuracy of phase-based respiratory-gated PET/CT imaging using phantom and clinical studies., Methods: The effects of target size, target-to-background ratio (TBR), and respiratory motion on PET images were estimated using a NEMA body phantom comprising six spheres (diameter 10-37mm) in a solution of F-18 of three different TBRs (4, 6, 8). The phantom was moved in a superior-inferior direction at motion displacements of 0, 10, 20 and 30 mm. Stationary images of the phantom as well as non-gated (3D) and gated (4D) images of the phantom while moving were reconstructed and the recovery coefficient (RC) of individual spheres was calculated from each image. We then determined the RC improvement rate to evaluate improvements conferred by 4D-PET/CT. We retrospectively analyzed data from 14 patients with lung cancer who were examined by 3D- and 4D-PET/CT. Each lesion on the 3D-PET/CT and each of the five phases of the 4D-PET/CT were analyzed., Results: Larger motion displacement and TBR resulted in increased RC degradation for small spheres. The RC improvement rate showed that 4D acquisition improved the RC of spheres with larger motion displacement exceeding 13 mm in diameter. 4D-PET/CT alone can reduce the effects of motion blurring, but partial volume effects may still be the dominant source of quantitative inaccuracy for small lesions. The trends of phantom and clinical studies for evaluating the improvement rate were similar., Conclusions: 4D-PET/CT significantly improved the quantitative accuracy of PET images particularly when larger motion displacement exceeded 17mm in diameter such as in lung cancer.

In the present study, we measured breath alcohol concentration(BAC)after the administration of alcohol-containing docetaxel(OTX)in breast cancer patients, and examined the safety of OTX outpatient administration. Twenty breast cancer patients who received OTX chemotherapy at our outpatient facility were included. The administered doses were 100mg/m2 in 5 cases, 75mg/m / 2 in 13 cases, and 60 mg/m2 in 2 cases. BAC was measured 3 times: immediately after infusion, 30 minutes after infusion, and 60 minutes after infusion. No symptoms of hot flash or drunkenness due to alcohol were observed. BAC was detected in 10 cases(50%)immediately after infusion, in 7 cases(35%)at 30 minutes after infusion, and in 1 case(5%) at 60 minutes after infusion. BAC was more than 0.15mg/L in only 1 case(5%)and reduced to less than 0.15mg/L in all cases after 30 minutes. Our results suggest that the effects of alcohol are alleviated 60 minutes after infusion and that patients receiving OTX could return home safely.

Objective: PET images are affected by scanner model, reconstruction conditions, injected dose, scan duration, patient health status and FDG radiopharmaceutical supply systems. The present study compares images of 40 patients using commercial and in-house FDG systems with one PET scanner (Aquiduo)., Methods: The PET images were evaluated using the physical indexes of NECpatient, NECdensity and SNRliver proposed by the Japanese guidelines for oncological FDG-PET/CT, and by visual assessment., Results: There were no significant differences in the physical indexes between PET images generated using commercial and in-house FDG. The physical indexes were also acceptable according to the recommended Japanese guidelines. NECdensity was higher when a higher dose/body weight of commercial FDG was injected (correlation coefficient: r=0.576, p<0.001) and lower when BMI was lower and in-house FDG was injected (r=-0.786, p<0.0001). These results suggest that scan duration should be increased if the injected dose of commercial FDG/body weight is <5.5 MBq/kg, and if individuals with BMI >21.4 kg/m(2) are injected with in-house FDG., Conclusions: Scan duration should be varied depending on FDG supply systems to ensure more accurate image quality and quantitative values during evaluations of response to therapy and prognostic prediction.

Here we present a case of breast cancer in which cardiac dysfunction had previously been observed on trastuzumab(TRS) administration; the condition then improved but reoccurred on readministration of TRS. A 52-year-old woman received preoperative chemotherapy for StageIIIC left breast cancer(fluorouracil, epirubicin and cyclophosphamide followed by docetaxel and TRS), and then underwent partial mastectomy and axillary lymph node dissection. For adjuvant therapy, she received endocrine therapy and TRS. Radiation therapy was administered to the left residual breast. The patient complained about palpitation in the 5th cycle of TRS, and left ventricle ejection fraction(LVEF)decreased to 45.3% from 64%. Therefore, we stopped TRS administration. Palpitation improved, and LVEF increased to 53% after 2 months. TRS was administered again; however, palpitation reoccurred and LVEF decreased to 44%. TRS administration was once again discontinued. However, according to the HERA trial report regarding patients with a history of anthracycline and radiation therapy, TRS administration could be resumed when LVEF is greater than 50%, but we should be more careful during readministration of TRS.

Quality control (QC) detects changes in the performance of gamma cameras that could adversely affect interpretations of clinical studies. We used plate and sheet (57)Co flood sources to measure extrinsic uniformity during daily QC. Each source, when placed on the top of a collimated detector, allowed the acquisition of uniform images from both detectors, thus reducing the amount of time needed to perform daily QC. No serious problems with the gamma camera system were revealed by visual checks, and changes in detector sensitivity were rapidly determined by observing daily variations in the measured values of extrinsic uniformity. Furthermore, (57)Co flood sources confer advantages in that they shorten the time required for preparation of flood sources and reduce the consequent exposure of medical staff to radiation.

Objectives: Accurate calibration of dose calibrators (DC) is required for quantitative positron emission tomography (PET) studies to generate meaningful information. Values measured by DC depend not only on the radioactive nuclide but also the environment where measurements are taken. Therefore, DC must be calibrated at each location. The present study aimed to determine appropriate calibration values, and evaluate the performance of DC using a traceable (68)Ge/(68)Ga calibration source that is available as a surrogate (18)F source., Methods: We used a (68)Ge/(68)Ga calibration source to determine the optimal DC value for measuring (18)F activity in the operating environment. Variations in sensitivity and geometry as well as measurement uncertainty were evaluated using the (68)Ge/(68)Ga source. We adopted the criteria of the Guide for the expression of uncertainty in measurement (GUM) to evaluate DC performance., Results: Although the manufacturer's recommended (18)F calibration number for the CRC-25PET is 480, we found that the optimal number was 482. Over a period of one year, the sensitivity of the DC varied <0.1%, and the expanded uncertainty of DC measurements was 2.2%., Conclusion: Measurements of the certified activity of a traceable national standard were corrected, and the uncertainty of measurements as well as the accuracy of a DC were determined. Calibration numbers for DC should be regularly determined using (68)Ge/(68)Ga calibration sources at each location to ensure the most accurate results.

The human malaria parasite Plasmodium falciparum is responsible for the death of more than a million people each year. The emergence of strains of this malaria parasite resistant to conventional drug therapy has stimulated the search for antimalarial compounds with novel modes of action. Here the structure-function relationship studies for two Plasmodium proteins are presented. One example is the structural studies for S-adenosyl-L-homocysteine hydrolase from Plasmodium falciparum (PfSAHH) and the other example is those for 1-deoxy-D-xylulose reductoisomerase from Plasmodium falciparum (PfDXR). In the former study, the clue for design of species specific PfSAHH inhibitors was obtained by the structural comparison of the active site of PfSAHH with that of human SAHH (HsSAHH). Our study revealed that the inhibitor selectivity depends on the difference of only one amino acid residue in the active site; Cys59 in PfSAHH vs. Thr60 in HsSAHH. In the latter study, the inhibition of PfDXR enzyme by fosmidomycin has proved to be efficient in the treatment of uncomplicated malaria in recent clinical trials conducted in Gabon and Thailand. Our crystal structure analyses of PfDXR/inhibitor complexes revealed the molecular basis of fosmidomycin's action in P. falciparum. We expect that the structure-function relationship studies on Plasmodium proteins are useful for developing the more effective antimalarial compounds.

Objective: The clinical significance of preoperative chemotherapy, including trastuzumab for HER2-positive breast cancer, was examined based on hormone receptors(HR)to clarify future issues., Subjects: 104 HER2-positive breast cancer patients who completed preoperative chemotherapy and underwent surgery from May 2005 to August 2010. All patients received sequential treatment with taxane±trastuzumab for FEC(5-FU+epirubicin+cyclophosphamide)therapy, and from 2008 they received trastuzumab postoperatively for one year., Results: Concerning the histological effects, the rate of comprehensive pCR(CpCR)in the 104 patients(31 HR-negative administered trastuzumab, 15 HR-negative not administered trastuzumab, 28 HR-positive administered trastuzumab, 30 HR-positive not administered trastuzumab)was 65%, 47%, 21% and 23% for each group, respectively CpCR was a significant factor(p<0. 05)in prolonged distant disease-free survival(DDFS)in the HR-negative group. Distant metastasis occurred in 14 patients, namely, brain metastasis in 7 patients(4 HR-negative administered trastuzumab, 1 HR-negative not administered trastuzumab, 2 HR-positive administered trastuzumab). The therapeutic efficacy was pINV in 5 of these 7 patients(3HR-negative administered trastuzumab, 1 HR-negative not administered trastuzumab, 1 HR-positive administered trastuzumab), and 4 of those 5 patients received trastuzumab postoperatively., Discussion: The responsiveness to preoperative chemotherapy including trastuzumab for HER2-positive breast cancer differs between HR-positive and HR-negative. pINV patients seem to be at a high risk for brain metastasis regardless of HR, and it may be difficult to suppress its occurrence only with trastuzumab adjuvant therapy.

Objectives: This study examined the relationships among the support system for return to work, work rules about sick leave, and incidence of sick leave due to mental health failure., Methods: A questionnaire was distributed to 150 workplaces with a history of use of the occupational health promotion center of a certain prefecture. The questionnaire asked about the number and duration of sick leaves due to mental health failure, the support system for return to work, and work rules about sick leave., Results: A significant correlation between the number of permanent staff and maximum period of sick leave was found (r=0.489, p<0.001), as well as a significant correlation between the number of permanent staff and the period of monetary compensation during sick leave (r=0.315, p=0.031). In addition, in 9 workplaces with more than 1,000 permanent staff, a significant correlation between the period of monetary compensation period during sick leave and incidence of sick leave was found (r=0.670, p=0.048), as well as a significant correlation between the period of monetary compensation during sick leave and the average length of sick leave (r=0.866, p<0.001)., Conclusions: The results of this study suggest the possibility that monetary compensation is associated with the duration of sick leave due to mental health failure. Hereafter, to construct a support system for mental health, consideration of the effect of monetary compensation appears to be required.

The aim of this review is to provide a summary of the known effects of exercise on neutrophil immune functions of athletes. We measured three neutrophil immune functions (i.e., phagocytic activity (PA), reactive oxygen species (ROS) production, and serum opsonic activity (SOA)) in various types of exercise. The following is our recent findings. (1) A regular exercise increases ROS production and decreases PA. We call this change a normal pattern, and an abnormal pattern except this change. (2) A prolonged, strenuous activity (e.g., rugby match and marathon) decreases both ROS production and PA. This is one of the abnormal pattern. (3) The exercise loading performed after a camp training decreases ROS production whereas PA does not change. This is another abnormal pattern. (4) When judoists who had stopped judo training for 6 months restarted their training, the exercise loading at the beginning of their training decreases PA whereas ROS production does not change. This is another abnormal pattern. (5) A regular exercise 2 months after the beginning of their training increases ROS production and decreases PA. This change is a normal pattern. SOA showed a similar pattern of changes to ROS under all conditions. The changes in neutrophil immune functions after performing various exercises might result from the balance between external factors (intensity and style of exercise) and internal factors (e.g., fatigue and physical pain). Therefore, the changes in three neutrophil immune functions after exercise might be an index of athletes' condition.

Unlabelled: It has been thought that there is a possibility that infusion speed generally affects the manifested frequency of infusion reaction and its strength. The infusion prescription time of trastuzumab should be over 90 minutes according to the package insert. In the infusion US, is possible over 30 minutes after the second time. We sought to evaluate the safety and tolerability of trastuzumab administered as a 30-minute infusion., Patients: Eighteen patients of HER2-positive breast cancer were treated, and their age ranged from 37 to 65 years old(median, 54 years old)., Method: PATIENTS were infused with 8 mg/kg of trastuzumab over 90 minutes and, if tolerated, all subsequent maintenance doses of 6 mg/kg are over 30 minutes., Result: The infusion times for 30 minutes were twice to 17 times(16 times the median). Mild infusion reactions were seen in 2 cases at the time of the initial prescription, but the infusion reaction was not judged from the prescription for 30 minutes. Mild eczema was admitted by 3 cases after prescription. No decline in cardiac function was seen., Conclusion: Our data strongly suggest that trastuzumab can be safely infused over 30 minutes for 6 mg/kg maintenance doses. However, it is thought that the number of cases will increase in future, and confirmation is necessary.

Unlabelled: As adjuvant chemotherapy for breast cancer, the addition of taxane to regimens containing anthracycline has been shown to be effective. However, in Japan, it is not probability yet as for safety. We examined the feasibility of FEC 100 followed by DOC 100 as adjuvant chemotherapy for breast cancer., Methods: Node-positive breast cancer patients or node-negative high-risk patients were eligible. The treatment completion rate and toxicity were evaluated in 3 courses of FEC 100 mg/m2 followed by 3 courses of DOC 100 mg/m2., Results: Twenty-one patients were registered and completion rate was 100%. The relative dose intensity (RDI) was 94.2% for FEC 100 and 97.8% for DOC 100. Grade 3 or higher neutropenia observed in 38% and febrile neutropenia developed in 14%. Non-hematological toxicities were slight., Conclusion: The regimen of FEC 100 followed by DOC 100 was safe in adjuvant chemotherapy for breast cancer in our country.

Capecitabine + docetaxel combination therapy proves highly effective against the advanced or recurrent breast cancer. Therefore, it has been investigated as a first-line treatment for metastatic breast cancer. Hand-foot syndrome (HFS), a typical side effect of capecitabine, decreases the QOL of patients and sometimes prevents further medication using capecitabine. A 56-year-old woman who had liver, bone and local skin metastases two years after her left breast cancer operation, was treated with capecitabine + docetaxel combination therapy. Severe HFS disturbed the continuation of the therapy. Some other chemo-therapies were attempted after discontinuing the therapy; however, the metastases progressed. Finally, we tried to prevent HFS with vitamin B6 and started the capecitabine + docetaxel combination therapy. HFS was controlled completely. The liver tumor disappeared in MRI and CT images after 18 courses. In this case, vitamin B6 seemed to be effective to control HSF and allow continuation of capecitabine + docetaxel combination therapy.

We aimed to study tracer kinetics in radioisotope (RI) cisternography. For this purpose, we analyzed the RI images of 36 individuals in whom absence of cerebrospinal fluid (CSF) leakage was confirmed. For the semiquantitative assessment of tracer clearance, the geometric mean of the RI count in the anterior and posterior images was obtained for the entire head as well as for the whole spinal axis. After correcting for the radioactive decay of the tracer, tracer clearance was expressed as a ratio of the count in the range of the whole CSF space at different time points to that at the time of tracer delivery. Tracer clearance from the CSF space was not related to the degree of cranial transport of the tracer in 1 hour, but was significantly related with the age of the patients. At 24 hours after the injection, tracer clearance was significantly faster in the younger patients (Group I: age < 40 years) than in the older patients (Group II: age > or = 40 years). The cranial transport of the tracer appeared to be rapid in group I; however, the difference between these 2 groups was not significant. These results indicate that age should be taken in account while establishing the reference values for tracer kinetics in normal individuals.

We encountered 2 cases of AFP-producing gastric cancer. In the first patient, an 82-year-old man was found to have advanced type II advanced carcinoma in the stomach with a massive tumor embolus in the portal vein. In the second case, an 80-year-old man was given a diagnosis of multiple liver metastases of gastric cancer with portal vein thrombosis. Our diagnosis of gastric cancer in both cases was AFP-producing. It was supposed that the elevation of serum level of AFP might be caused by enteroblastic differentiation in the first case and hepatoid differentiation in the second case. Although, in both cases, the biopsy specimens of the gastric neoplasm proved moderately to poorly differentiated adenocarcinoma without hepatoid differentiation, the localization of Glypican 3 in gastric cancer cells was observed using immunostaining with a monoclonal antibody. In both cases, Glypican 3 was a sensitive and useful marker for AFP-producing gastric cancer with or without hepatoid differentiation.

It is not easy to connect a Web-based server with an existing DICOM server, and using a Web-based server on the Internet has risks. In this study, we designed and developed a secure DICOM-Network Attached Server (DICOM-NAS) through which the DICOM server in a hospital LAN was connected to the Internet. After receiving a client's image export request, the DICOM-NAS sent it to the DICOM server using the DICOM protocol. The server then provided DICOM images to the DICOM-NAS, which transferred them to the client, using HTTP. The DICOM-NAS plays an important role between the DICOM protocol and HTTP, and stores the requested images only temporarily. The DICOM server keeps all of the original DICOM images. If an unauthorized user attempts to access the DICOM-NAS, medical images cannot be accessed because images are not stored in the DICOM-NAS. Furthermore, the DICOM-NAS has features related to reporting and MPR. Therefore, the DICOM-NAS does not require a large storage capacity, but can greatly improve information security.

Semi-quantitative radionuclide cisternography was performed to evaluate CSF leakage for patients with long-lasting headache and/or neck pain or refractory dizziness which appeared to be related to posture as well as patients with spontaneous intracranial hypotension (SIH). Radioactivity in the whole CSF space was counted and was plotted against time. SIH cases showed rapid decrease of radioactivity in the CSF space. Chronic headache patients were divided into Group I (rapid decrease of activity similarly to those in patients with SIH, to less than 80% at 5h and 40% at 24h), Group II (gradual decrease to less than 40% at 24h), and Group III (activity remained more than 80% at 5h and 40% at 24h). Of 16 patients in Group I, epidural blood patch was attempted in 14, and improvement of symptoms was obtained in 10. In 3 patients who underwent post-treatment RI study, tracer kinetics was normalized. These findings may indicate that some of patients with chronic headache actually have CSF leakage that can be treated with epidural blood patch.

We evaluated radionuclide cisternography for the diagnosis of intracranial hypotension in terms of the rate of appearance of abnormal findings in 23 patients, their correlation with therapy, and the most suitable scanning method and timing for visualization of leakage. During the first hour after injection, dynamic lumbar images or consecutively repeated whole-body images were acquired. Whole body images then were acquired at 1, 5, and 24 hours. Until 5 hours after injection, patients were kept in bed resting. Visualization of the leakage (direct finding) and that of the bladder (indirect finding) were observed in 78.3% (18/23) and 60.9% (14/23), respectively. Leakage was visualized most frequently at 5 hours after injection. There were three cases in which the leakage was only visualized at 24 hours. Therefore, there must be cases that show intermittent CSF leakage. To avoid overlooking these cases, a 24-hour whole-body image is also important. The appropriate procedure of radionuclide cisternography is very important to detect CSF leakage, and our procedure proved to be more effective for detecting the abnormal findings.

Objective: In order to study the gender-related effects of weight reduction on the physical condition of male and female college judoists during weight reduction periods, we examined changes in anthropometric, nutritional intake and biochemical parameters in 43 male and female college judoists 20 days (pre-weight reduction) before and one day (post-weight reduction) before the game., Methods: Subjects were divided into two groups. Thirty subjects (22 males, 8 females) who required weight reduction were defined as the weight reduction (WR) group, and the remaining 13 subjects (5 males, 8 females) were defined as the non-reduction (non-WR) group., Results: In both WR groups, anthropometric parameters and nutritional intake significantly decreased after weight reduction compared to the pre-values. The change ratios of nutritional intake during the weight reduction period in the female WR group were higher than those in the male WR group. Serum lipids and electrolytes significantly decreased after the weight reduction compared to the pre-values in both WR groups. In the female WR group, Cr and UA significantly increased after the weight reduction compared to the pre-values. Although it was not significant, Ht increased after the weight reduction compared to the pre-values only in the female WR group. TP, Cr, UA, BUN, CK, LDH and IgA significantly increased after the weight reduction compared to the pre-values in the weight reduction compared to the pre-values in the male WR group. In contrast, in both non-WR groups, these parameters did not change significantly during the research period., Conclusions: Our findings suggest that nutritional exhaustion and dehydration may be the major effects brought about by energy and fluid restriction in female college judoists during a weight reduction period. On the other hand, in male college judoists undergoing weight reduction, the data suggest that muscle damage and myogenic protein catabolism may be caused chiefly by exercise. These differences may be due to the difference in the method of weight reduction for the different genders, namely, mainly exercise in males and mainly energy and fluid restriction in females.

The current medical system does not allow sufficient time for medical interviews, a situation that can create problems in patient-doctor relationships and result in a variety of problems. The importance of narrative based medicine (NBM) has been raised as a result of the overemphasis on evidence based medicine (EBM) in recent years. From this point of view, we have developed an electronic medical recording (EMR) system for clinics that uses the Internet and is based on patient participation, in pursuit of NBM. This system enables the patient to report information prior to the face-to-face interview with his or her doctor. In this way, the patient has more time to summarize and explain physical conditions and concerns. These reports from patients are automatically saved to the EMR database, without any additional workload. Therefore, this system will provide more effective communication between patient and doctor. In addition, the doctor is able to receive the results of medical treatment directly, in addition to the patient's other records. These sets of records will contribute to more efficient operation of the clinic. At this time, we have improved this system on the assumption that outsourcing the server will avoid the burden of maintenance. This prototype system uses a personal identification number (PIN) and an encode/decode algorithm for security. The secure PIN enables us to use conventional e-mail. Through experimental clinical testing, the effects on mutual understanding in medical examinations were studied. We are confident that this system based on patient narratives will contribute greatly to the spread of EMR systems for clinics operated by family physicians.

Organ movements that occur naturally as a result of vital functions such as respiration and heartbeat cause deterioration of image quality in nuclear medicine imaging. Among these movements, respiration has a large effect, but there has been no practical method of correcting for this. In the present study, we examined a method of correction that uses ultrasound images to correct baseline shifts caused by respiration in cardiac nuclear medicine examinations. To evaluate the validity of this method, simulation studies were conducted with an X-ray TV machine instead of a nuclear medicine scanner. The X-ray TV images and ultrasound images were recorded as digital movies and processed with public domain software (Scion Image). Organ movements were detected in the ultrasound images of the subcostal four-chamber view mode using slit regions of interest and were measured on a two-dimensional image coordinate. Then translational shifts were applied to the X-ray TV images to correct these movements by using macro-functions of the software. As a result, respiratory movements of about 20.1 mm were successfully reduced to less than 2.6 mm. We conclude that this correction technique is potentially useful in nuclear medicine cardiology.

Eleven patients on hemodialysis that were surgically treated for renal cell carcinomas during the recent 10 years at our institutes were clinically analyzed. Patients' ages at presentation ranged from 35 to 70 years with an average of 54.8 years. Nine of the 11 patients were males and 2 were females. Periods between the introduction of hemodialysis and the presentation ranged from 1 to 21 years with an average of 11.7 years. The most frequent cause of hemodialysis was chronic glomerulonephritis. Five patients presented with macroscopic hematuria, which was the most frequent clinical manifestation. Transperitoneal nephrectomy through a lumbar oblique incision was performed in 9 of 12 surgical procedures. Transperitoneal resection and retroperitoneal endoscopic resection were performed on 2 patients and 1 patient, respectively. Blood transfusion was performed on 2 patients with retroperitoneal hemorrhage before or after operation and 2 patients with pre-existing renal anemia. Pathologically, 9 patients had pT1a disease. Patients were followed up for up to 7 years and 11 months. One patient died of the disease and 2 patients died of unknown causes. In conclusion, surgical removal of renal cell carcinomas was well tolerated, safe and effective treatment in patients under hemodialysis.

A 44-year-old male was referred to our hospital for further treatment of lung and adrenal metastases from leiomyosarcoma occurring in the left spermatic cord. He had undergone high orchiectomy 5 months before, but no adjuvant therapy was done. Although systemic CYVADIC therapy (cyclophosphamide, vincristine, doxorubicin hydrochloride, dacarbazine) was performed in our hospital, he died of metastatic disease 10 months after the initial therapy. Leiomyosarcoma arising in the spermatic cord is a rare entity. We present a case of leiomyosarcoma of the spermatic cord, and to our knowledge, this is the 23rd case reported in Japan.

Objective: This study aims to examine the distribution of hemolytic complement activity, the prevalence of hypocomplementemia and the disorders causing hypocomplementemia among individuals taking part in a mass screening program., Methods: The subjects consisted of 1340 male Japanese participating in a mass screening program at a Ground Self-Defense Force base in Asaka. We measured the hemolytic complement activity (CH50) after overnight fasting. The CH50 levels for hypercomplementemia and hypocomplementemia were defined as those outside the range of mean +/- 2 SD, respectively. We next measured the concentration of complement components: CIq, C4, B, C3, C5, C9, and C1-inhibitor for men with hypocomplementemia. Rheumatoid factor, ANA, HBsAg, HbsAb, and HCVAb were also measured., Results: The mean +/- SD of age was 43.7 +/- 5.7. The CH50 levels ranged from 7.2 to 66.4 U/ml (mean +/- SD = 37.1 +/- 4.0 U/ml). Twenty-one and 37 men were classified as having hypocomplementemia (CH50 < 29.1 U/ml) and hypercomplementemia (CH50 > 45.1 U/ml), respectively. The age of the individuals with hypocomplementemia was 43.9 +/- 5.6 (Mean +/- SD) years. Three men with C9 deficiencies, 2 men with C5 deficiencies and 7 men with cold activation were identified among the 21 hypocomplementemic men. Three hepatitis C and 2 hepatitis B patients were also found among the 21 hypocomplementemic men. Other disorders found among the hypocomplementemic men were 3 glomerulonephritides and 1 possible SLE., Conclusion: We examined the distribution of CH50 levels in 1340 adult male Japanese. We identified 21 men with hypocomplementemia, and also found 5 cases of complement component deficiencies among 21 hypocomplementemic men. In addition the measurement of the complement activity may have also helped detect the presence of hepatitis, hypocomplementemic glomerulonephritis and collagen disease at an early stage.

Objectives: To identify epidemiological characteristics of heterosexually acquired AIDS in Japan, with emphasis on potential influence on future trends., Methods: National AIDS Surveillance data in Japan were compared with those in the UK and US, where detailed information is available from well-established surveillance procedures. Data on AIDS cases diagnosed until the end of 1996, particularly those acquired heterosexually, were analyzed by year of diagnosis, gender and age group., Results: The number of heterosexually acquired AIDS cases in Japan has continued to increase, while those in the UK and US leveled out or decreased recently. The increase during a two-year period after reaching a certain number of cases per year was found to be 2.3-fold in Japanese, 2.4-fold in UK whites and 5-fold in US whites. The male to female ratio (M/F) for heterosexually acquired AIDS was 6.3 among Japanese, while the ratio was 1.1 and 0.5 in the UK and US, respectively. The age distribution at AIDS diagnosis demonstrated a peak from 35 to 54 years of age among Japanese males, as compared to 30 to 34 among males in the UK and the US. No significant difference was apparent in the age distribution among females in the three countries., Conclusions: The relatively small number of AIDS cases in Japan is attributable to the late introduction of HIV and the limited chance of heterosexual transmission from homosexual/bisexual men and injecting drug users. In addition, transmission has probably most often occurred between middle-aged Japanese males and non-Japanese females. As there is a growing risk of HIV infection among Japanese females and young Japanese males, new prevention strategies targeting these groups are urgently required.

Down's syndrome is an inherited disorder caused by trisomy of chromosome 21. In patients with Down's syndrome, an increased risk of leukemia has been observed. Recently, the coincidence of testicular cancer with this syndrome has been also emphasized. We present a case of Down's syndrome associated with testicular seminoma. This is the 19th case of Down's syndrome associated with testicular tumor in Japan.

Generic drugs are widely used with the object of cost saving in many Japanese therapeutic scenes now. The products containing the same active ingredient(s), even if they are innovative drugs or generic ones, must be designed to possess the equivalent quality. In this report, we observed the dissolution behavior patterns of three generic drugs that contain Tegafur and Uracil, drugs A, B, and C, and compared them with that of an innovative product, UFT. Drugs B and C were similar to UFT in the dissolution rate of Tegafur, but drug A was not. On the dissolution rate of Uracil, all the generic products, drugs A, B and C, did not amount to the level equivalent to that of UFT. Therefore, these generic products did not indicate the same dissolution behavior pattern as UFT. It was suggested that the pharmaceutical technology used in the manufacture was not equivalent even if the products of the same dosage form contain the same kind and content of the active ingredient(s).

The role and value of chemotherapy for soft tissue sarcomas remain unclear. Seventeen patients with pulmonary metastatic soft tissue sarcomas underwent treatment with chemotherapy, and the clinical efficacy and prognosis were studied. Six patients with synovial sarcomas, 4 with malignant fibrous histiocytomas, 4 with neurosarcomas, and the remaining 3 patients with leiomyosarcoma, extraskeletal osteosarcoma, and extraskeletal chondrosarcoma, were studied. Cases with small round cell sarcomas were excluded. The chemotherapy agents were ifosfamide in 10 cases, combination of ifosfamide and adriamycin in 5 cases, or cisplatin and adriamycin in 2 cases. Of the 17 patients, seven had partial responses radiographically and five had pulmonary metastases from synovial sarcoma. Eight patients underwent resection of pulmonary metastases following chemotherapy, and they were found to be residual tumor cells histologically. Twelve of the patients died of disease at 6-108 months (median, 30 months) from the time of the initial therapy, and five patients have survived from 1-53 months (median, 30 months). The absolute three-year survival rate, according to the Kaplan-Meier method, for all 17 patients was 39%. In the two cases with no change and progressive disease, all patients were dead within 2 years, while in the seven partial response cases, two patients were dead, four were alive with pulmonary metastases, and only one case was disease-free at this writing. The survival rate for patients with partial response was significantly higher than for patients with no response. Although the cure rate of pulmonary metastatic soft tissue sarcomas is still low, the combination of chemotherapy and surgery has been shown to result in prolonged survival.

A 73-year-old male was admitted with dyspnea and cough. The chest X-ray showed left massive pleural effusion and diffuse pleural tumor in the left thorax. It was diagnosed as epithelial-cell type mesothelioma by pleural needle biopsy. After conforming the regression of the tumor from conducting two courses of combined treatment with cisplatin and doxorubicin, panpleuropneumonectomy was performed. He died from sepsis on the thirty second day after operation due to complication of postoperative diaphragmatic hernia and gastric perforation. When conducting a panpleuropneumonectomy to diffuse pleural mesothelioma, the most appropriate approach must be taken to the combined with resection and reconstruction of the diaphragma.

A 58-year-old man admitted to hospital because of hemoptysis. Chest X-ray showed a large mass in the right middle lobe. A tumor marker CYFRA was slightly elevated. Despite a detailed examination after admission, no definite diagnosis was made. Lung cancer was suspected and a middle lobectomy was performed. Histopathological specimen of resected lung showed typical "sulfur granule" of actinomycosis. Pulmonary actinomycosis should be included in the differential diagnosis of a pulmonary mass lesion.

Between August, 1985 and December. 1995 ileal conduit was performed in 36 cases of bladder cancer (30 males, 6 females). A survey based on a questionnaire was carried out on 15 patients to assess their quality of life (QOL) after the surgery. The questionnaire dealt with the working situation, appetite, sleep, defecation, bathing, travel, general health condition, satisfaction, sexual life and erection. Although only 64.0% of the patients returned to work, appetite, hours of sleep and bathing frequency showed only a slight decrease. We performed total cystectomy without using the nerve sparing method. After the operation, three patients could have an erection and enjoy sexual life. Because the ileal conduit resulted in few complications and only a slight reduction in QOL, it was considered an appropriate operation.

A retrospective study was done on 33 patients treated for superficial bladder cancer, pTa and pT1, with grade 3 components between 1986 and 1995. All patients had undergone transurethral resection of the tumor (TUR-Bt), which was followed by total cystectomy in 7 patients. Three patients died of pulmonary diseases or heart attack and 6 patients subsequently died of bladder cancer. The 2-year and 5-year disease-specific survival rates of these patients were 83% and 75%, respectively, and the mean duration of follow-up was 50 months. Comparison of the disease-specific survival rates for several factors revealed that the configuration and size of the tumors were significantly predictable factors for prognosis. In well-selected patients with grade 3 superficial bladder cancer, bladder preservation seems to be possible by TUR with or without adjuvant therapies. Hence further studies on a larger series are needed to elucidate more feasible and reliable prognostic factors to avoid unnecessary cystectomy and improve the quality of life of the patients.

The interaction between magnesium sulphate (MgSO4) and vecuronium was investigated during isoflurane-nitrous oxide-oxygen anesthesia. Neuromuscular function was evaluated by recording the single twitch of the abductor policis muscle. Anesthesia was induced with thiamylal followed by injection of vecuronium. The effects of pretreatment with MgSO4 (20 or 40 mg.kg-1) on the potency of vecuronium were compared with observations in patients without MgSO4 pretreatment (control). We also examined the serum concentration of magnesium ions after administration of MgSO4. We found that the neuromuscular effect of vecuronium was not influenced by pretreatment with MgSO4 20 mg. On the contrary, the onset time of vecuronium was decreased and the duration of action until 25% recovery was increased by pretreatment with MgSO4 40 mg. The serum concentration of magnesium ions after administration of MgSO4 40 mg was significantly higher than that after 20 mg. We conclude that pretreatment with MgSO4 40 mg but not 20 mg enhances vecuronium-induced neuromuscular block.