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Background Conversion from sorafenib to regorafenib is primarily an evidence-based treatment strategy in patients with advanced hepatocellular carcinoma (HCC). This study aimed to assess the safety and efficacy of sequential therapy with sorafenib and regorafenib in patients with advanced HCC by analysis of outcomes in clinical practice with the aim to complement phase III findings. Methods The medical records of patients with advanced HCC receiving regorafenib were retrieved to collect data on sorafenib administration at seven Japanese institutions. Radiological responses and adverse events were evaluated using the Response Evaluation Criteria in Solid Tumors version 1.1 and the Common Terminology Criteria for Adverse Events version 4.0, respectively. Results Before March 2018, 44 patients were administered regorafenib for advanced HCC. The median sorafenib treatment duration was 8.4 months. The most common adverse events were similar to those reported by the RESORCE trial. The median overall survival (OS) was 17.3 months (95% confidence interval [CI] 11.4–22.9), and 17 of 37 patients (45.9%) discontinued regorafenib and received sequential systemic therapy after regorafenib. These patients had significantly longer OS than those who were treated by the best supportive care or sub-optimal therapy (not reached versus 8.7 months [95% CI 5.8–11.7]; P

Background: There is no standard posttreatment for patients with advanced hepatocellular carcinoma (HCC) in whom lenvatinib therapy has failed. This study aimed to investigate rates of migration to posttreatment after lenvatinib and to explore candidates for second-line agents in the patients with failed lenvatinib therapy. Methods: We retrospectively collected data on patients with advanced HCC who received lenvatinib as the first-line agent in 7 institutions. Results: Overall survival and progression-free survival (PFS) of 178 patients who received lenvatinib as the first-line agent were 13.3 months (95% confidence interval [CI], 11.5–15.2) and 6.7 months (95% CI, 5.6–7.8), respectively. Sixty-nine of 151 patients (45.7%) who discontinued lenvatinib moved on to posttreatment. The migration rates from lenvatinib to the second-line agent and from the second-line agent to the third-line agent were 41.7 and 44.4%, respectively. Based on multivariate analysis, response to lenvatinib (complete or partial response according to modified RECIST) and discontinuation of lenvatinib due to radiological progression, as well as male were associated with a significantly higher probability of migration to posttreatment after lenvatinib. On the other hand, alpha-fetoprotein levels of 400 ng/mL or higher was correlated with a significantly lower probability of migration to posttreatment after lenvatinib. Of 63 patients who received second-line systemic therapy, 53 (84.2%) were administered sorafenib. PFS, objective response rate (ORR), and disease control rate (DCR) for sorafenib treatment were 1.8 months (95% CI, 0.6–3.0), 1.8%, and 20.8%, respectively. According to the Cox regression hazard model, Child-Pugh class B significantly contributed to shorter PFS. PFS, ORR, and DCR of 22 patients who received regorafenib after lenvatinib in any lines were 3.2 months (range, 1.5–4.9 months), 13.6%, and 36.3%, respectively. Similarly, PFS, ORR, and DCR of 17 patients who received regorafenib after lenvatinib in the third-line (after sorafenib) were 3.8 months (range, 1.1–6.5 months), 17.6%, and 41.2%, respectively. Conclusion: Sorafenib may not be a candidate for use as a posttreatment agent after lenvatinib, according to the results of the present study. Regorafenib has the potential to become an appropriate posttreatment agent after lenvatinib.

Background: The present study aimed to assess the efficacy and safety of lenvatinib and verify the possibility of lenvatinib for the expanded indication from the REFLECT trial in patients with advanced hepatocellular carcinoma (HCC) in real-world practice, primarily focusing on the population that was excluded in the REFLECT trial. Methods: We retrospectively collected data on patients with advanced HCC who were administered lenvatinib in 7 institutions in Japan. Results: Of 152 advanced HCC patients, 95 and 57 patients received lenvatinib in first-line and second- or later-line systemic therapies, respectively. The median progression-free survival in Child-Pugh class A patients was nearly equal between first- and second- or later-line therapies (5.2 months; 95% CI 3.7–6.9 for first line, 4.8 months; 95% CI 3.8–5.9 for second or later line, p = 0.933). According to the modified Response Evaluation Criteria in Solid Tumors, the objective response rate of 27 patients (18%) who showed a high burden of intrahepatic lesions (i.e., main portal vein and/or bile duct invasion or 50% or higher liver occupation) at baseline radiological assessment was 41% and similar with that of other population. The present study included 20 patients (13%) with Child-Pugh class B. These patients observed high frequency rates of liver function-related adverse events due to lenvatinib. The 8-week dose intensity of lenvatinib had a strong correlation with liver function according to both the Child-Pugh and albumin – bilirubin scores. Conclusion: Lenvatinib had potential benefits for patients with advanced HCC with second- or later-line therapies and a high burden of intrahepatic lesions. Dose modification should be paid increased attention among patients with poor liver function, such as Child-Pugh class B patients.

Background and aims Some follow-up studies of large regenerative nodules (LRNs) and dysplastic nodules (DNs) were reported previously. However, the pre-malignant potentiality of LRNs has remained controversial up to now. No LRNs showed malignant transformation in our previous study. We aimed to evaluate the pre-malignant potentiality of LRNs and DNs with a greater number of cases and longer follow-up periods. Methods From 1982 to 2005, 1,500 consecutive nodular lesions up to 2 cm in diameter were subjected to US guided thin-needle biopsy in cirrhotic patients at Chiba University Hospital. Of these lesions, 68 LRNs in 60 cases and 20 DNs in 22 cases were followed up for more than 6 months without any anti-cancer therapy. The last US examination was in 2010. The total study period was 28 years. We analyzed the histological findings and the clinical data of all cases retrospectively. The outcome of the lesions was examined. Results The mean follow-up period was 38.9 (16–119) months in LRNs and 31.9 (6–101 months) in DNs. Rate of nodule enlargement was higher in DNs (8/24 nodules, 33 %) than LRNs (11/68 nodules, 16 %), (p = 0.0743, not significant). Rate of malignant transformation was also higher in DNs (10/24 nodules, 42 %) than LRNs (9/68 nodules, 13 %), (p = 0.0040, significant). The rate of disappearance in images was similar between LRNs and DNs. Conclusions We should recognize LRN as low risk pre-malignant lesions whereas DNs as high risk lesions.

The radiation environment inside residential houses was measured at MinamiSoma-shi and Iitate-mura in Fukushima Prefecture. The average measured reduction coefficients, which are the ratios of the indoor and outdoor ambient-dose-equivalent rates were 0.35 and 0.45 at the centers of the first and second floors, respectively. The indoor dose rates on the second floors were larger than those on the first floors. The indoor dose rates increased with measurement height. The indoor and outdoor photon energy spectra were measured, revealing that the indoor scattered photon component is larger than the outdoor one.

The biological dose of nuclear workers engaged in emergency response tasks at Tokyo Electric Power Company (TEPCO) Fukushima Daiichi Nuclear Power Station was estimated in the present study. As the national core center for radiation emergency medical preparedness in Japan, the National Institute of Radiological Sciences (NIRS) received all individuals who were suspected of being overexposed to acute radiation. In the course of health examinations at NIRS, biological dosimetry was performed by the dicentric chromosome assay (DCA). Twelve individuals were examined from 21 March-1 July 2011. The results indicated that the estimated exposure doses for all individuals were lower than 300 mGy, with the mean value of about 101 mGy. These results by DCA were in accordance with those obtained by physical dosimetry based on personal dosimeter recording assessment. The results corroborate the fact that no acute radiation syndrome was observed among the workers examined.

Aim: The number of hepatitis A cases in Japan as well as in other developed countries has been progressively decreasing during the last several years. There is no universal hepatitis A vaccination program in Japan, and a hepatitis A virus (HAV) epidemic in Japan is not unlikely. In 2011, a hepatitis A outbreak associated with a revolving sushi bar occurred in Chiba, Japan. We aimed to analyze this outbreak. Methods: Twenty-seven patients associated with this outbreak were admitted to the National Hospital Organization Chiba Medical Center. Molecular epidemiologic investigations were conducted. Results: Twenty-six of the 27 patients had gone to the same revolving sushi bar, and then clinical symptoms appeared. HAV RNA was detected by reverse transcription polymerase chain reaction in 23 of the 27 (85.1%) patients whose sera had tested positive for anti-HAV immunoglobulin M. All isolates from this outbreak were clustered within subgenotype IA, displaying 100% sequence homology with each other in 232 bp from all 23 patients. All isolates belong to the IA-1 sublineage, which is endemic to Japan. Conclusion: A revolving sushi bar was associated with a hepatitis A outbreak, and molecular epidemiological investigations proved useful.

Purpose The International Commission on Radiological Protection recommends removing the prostate before cremation if death occurs within 12 months after 125 I brachytherapy. However, the incidence of death within this time frame has not been robustly investigated in any country. The purpose this study was to investigate the incidence and cause of death and actions taken when death has occurred within 12 months after 125 I brachytherapy for prostate cancer in Japan. Methods and Materials Data were extracted from the Japan Radioisotope Association database to investigate the total number of implantation cases, number of early deaths after implantation, cause of death, and postmortem actions between September 2003 and the end of June 2010 in Japan. Early death was defined as occurring within 12 months after 125 I brachytherapy for prostate cancer. Results During the study period, 15,427 patients underwent 125 I brachytherapy and 43 (0.28%) died within 12 months after implantation. For 37 of the 43 patients (86%), the brachytherapy source was retrieved together with the prostate gland at autopsy; however, autopsy could not be performed in six (14%) of the deceased patients. The largest proportion of early deaths was because of cerebrovascular or cardiovascular disease (17/43, 40%), followed by malignant tumor (15/43, 35%), and respiratory disease or infection (7/43, 16%). Conclusions The incidence of early deaths within 12 months after 125 I brachytherapy in Japan was 0.28%. In almost all cases, the brachytherapy sources were removed in the intact prostate before the body was cremated and stored appropriately.

Atomic Energy Research Institute of Kinki University has devoted in the education of nuclear engineering using UTR-KINKI since its establishment in 1961. After the adoption of “Nuclear Energy Human Resources Development Program” by METI in 2007, the activities were facilitated fruitfully to the experience-based practices for the 9 universities. This paper introduces these activities firstly. We are mainly suffering from keeping enough machine time for the reactor practices. Even if they felt the interests in the practices, it is impossible to keep in touch with each student′s learning for their comprehensive curriculum after their participations of the practice. This paper describes a proposed systematic education, which is a combination of reactor practice and distance learning using Internet communication tools.

The scanning method with GM survey meter is useful for detection of surface radiological density. The detection ability is varied with several parameters; those are the distance between the sample and the window of GM tube, the scanning speed and the background dose rates. We made an experimental system. In that system, a radiation source can be moved at any constant velocity with a linear scanning device. The obtained data shows that the change of count rate has some patterns due to each scanning velocity. The count rate increased with the source coming closer, and decreased with the source moving away. The maximum count rate under the scanning condition, those are 5 mm distance and 50 mm/s scanning velocity, point source on a stainless steel plate was 23% of the count rate on the fixed source. The detection ability in various scanning conditions was evaluated from the measured data. As a result, it was confirmed to be able surely to detect the lower level of the surface radiological density limit by means of the scanning condition applied to the routine work, 5 mm distance and 50 mm/s scanning velocity.

核燃料物質に関連する国際的な管理の体制，特に，保障措置に絡む国内外の状況と対応についての歴史的経緯及び現状を整理した。また，天然/劣化ウラン300g，トリウム900g以下の，いわゆる少量の核燃料物質に焦点をあて，それらを使用する際の法的要件と手続きにおける留意事項をまとめ，そのような物質を使用する事業所がとるべき適切な対応について，東京大学の例を挙げつつ，教育プログラムの策定と実施に着目し，考察をした。

胆道出血は, 経皮経肝的穿刺手技において注意すべき合併症の一つで, 仮性動脈瘤の関与が指摘されている. 我々は, 自然消退への経過を示した経皮的肝生検後の胆道出血例を経験した. 本例の臨床経過において, カラードプラを用い, 仮性動脈瘤に対応すると考えられたカラーモザイク所見の推移を観察したので報告する. 症例は63歳, 女性, 自己免疫性肝硬変. 経皮的肝生検後に, 腹痛, 肝胆道系酵素の上昇と貧血の進行を認めた. カラードプラ法では, 肝右前区域にモザイク信号を呈する小瘤状部を認め, FFT波形解析にて高度の乱流所見を示していた (カラーモザイク). 肝生検施行部との対応から, 穿刺手技後の肝仮性動脈瘤と, それに伴った胆道出血が強く疑われた. 緊急入院後, 内視鏡的逆行性胆道造影検査にて胆道出血が確認されたため, 経鼻的胆道ドレナージを留置した. 経動脈的塞栓術の適応を考慮しつつ保存的に経過を見ていたが, その後は胆道出血を認めなかった. 肝生検2週後の超音波では, カラーモザイクは微弱化し, 乱流所見は軽減していた. さらに, 9日後の超音波では同所見は消失し, その後, 再発を見ていない. カラードプラ法におけるカラーモザイク所見は, 本症の診断, 経過観察に有用と考えられた.

To evaluate the therapeutic efficacy of percutaneous ethanol injection (PEI) for patients withor = 3 lesions of small (or = 3 cm diameter) hepatocellular carcinoma (HCC).PEI was applied to 270 patients with small HCC as the first-line treatment option during a 20-year period.(1) There was no treatment-related deaths, and only 2.2% of severe complications; (2) PEI induced a complete response of all HCCs according to CT evaluation performed within one month after the procedure, and the local recurrence rate at 3 years was 10%; (3) the overall 3- and 5-year survival rates after treatment were 81.6 and 60.3%, respectively, but the rates were higher, 87.3 and 78.3%, in Child A patients with a solitary tumoror = 2 cm in diameter; (4) factors significantly influencing survival were liver function (P = 0.0033) and serum alpha-fetoprotein level (P = 0.0014), and (5) the recurrence rate at remote sites in the liver was lower in patients with HCCor = 2 cm (P = 0.0395) and in those with a solitary HCC (P0.0001) according to Cox's proportional hazard model. (6) Radiofrequency ablation would not have been performed in approximately 25% of these patients.PEI is considered a reliable treatment for small HCC in terms of safety and efficacy.

Some of technologically enhanced naturally occurring radioactive material (TENORM), such as radon and monazite sand, gradually became a target for radiological protection. In order to regulate TENORM safely and economically, it is essential to consider the characteristics of TENORM such as ubiquity, huge volume, and very low activity levels. In this paper, radiation protection principles and standards for NORM/TENORM are summarized based on the reports published by the international organizations (e. g. ICRP and IAEA) to assist the development of national regulatory framework. The survey results on the present Japanese situations on industries related to NORM/TENORM are provided, and the categorization for NORM/TENORM, which is established by the Radiation Council of Japan, is explained how to control NORM/TENORM based on their exposure doses instead of their activity levels. Finally, basic processes to solve the problems related to NORM/TENORM are discussed.

We administered trientine hydrochloride, a drug used in the treatment of Wilson's disease, to patients with hepatocellular carcinoma after radical treatment with percutaneous ethanol injection or radiofrequency ablation, and examined its effect on the reduction of liver-tissue copper content. We enrolled 24 patients with 3 or fewer primary lesions of Child class A or B hepatocellular carcinoma with diameters of 3 cm or less who had undergone radical treatment with percutaneous ethanol injection or radiofrequency ablation. Trientine hydrochloride was orally administered in a single daily dose of 250 mg to 12 patients before a meal (at fasting, group 1) or at a total daily dosage of 750 mg, divided into 3 doses, to 12 patients (group 2). This study was a randomized between-groups comparative study of 12 weeks' duration. We used the particle-induced x-ray-emission method to determine liver-tissue mineral content. Urine copper and serum mineral levels were also measured, and transaminase levels were examined. Liver-tissue copper content decreased significantly, to 160.1 microg/g dry weight, after treatment, compared with the pretreatment level of 306.8 microg/g dry weight (P

Aim: To study whether cancer cell differentiation in small hepatocellular carcinoma (HCC) can be assessed by computed tomography (CT) and magnetic resonance (MR) imaging. Methods: We retrospectively evaluated the relationship between cancer cell differentiation in 127 HCC 3 cm or less in diameter (113 patients) and CT and MR images. Images were reviewed in a consensus conference by three authors (SA, TY, and ME). Histopathological diagnosis of HCC was made from liver specimens obtained by sonographically guided biopsy. Results: The degree of histological differentiation of cancer cells was significantly different between HCC that were isodense with liver parenchyma in both artery-dominant and equilibrium phases in contrast-enhanced CT and tumors that were hyperdense in the artery-dominant phase and iso- or hypodense in the equilibrium phase (P = 0.0054), as well as tumors that were iso- or hypodense artery-dominant and hypodense equilibrium (P = 0.0002). Histological differentiation of lesions that were hyperintense in T1-weighted images and hypointense in T2-weighted images differed significantly from those with the opposite MR characteristics (P = 0.0122). In T1-weighted fat-suppression images and T2-weighted images, respectively, the degree of histological differentiation was significant between the hypointense/hyperintense and the hyperintense/hypointense patterns (P

Background/Aims: The aim of this study was to investigate the relationship between trace metals and the prevalence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis or hepatic cirrhosis caused by hepatitis C virus (HCV). Methods: We measured the contents of copper, iron, and zinc in HCC tissue (n = 112), dysplastic nodules (n = 7), and liver parenchyma in patients with (n = 112) and without (n = 12; 7 with grade F3 fibrosis, 5 with grade F4 fibrosis) HCC. Metals were quantified in thin-needle biopsy specimens using the particle-induced X-ray emission method (PIXE). Results: Copper level in liver parenchyma was higher in patients with HCC than in those without HCC (p < 0.01), while there was no such difference in hepatic iron. In patients with grade F4 fibrosis, copper content in the liver parenchyma was higher in the presence of HCC than in its absence (p < 0.05). Multiple regression analysis showed that the only factor significantly associated with the coexistence of HCC in HCV-positive patients with chronic liver disease was the copper level in the liver parenchyma. Conclusions: Hepatic copper overload may contribute to the development of HCC in HCV-positive patients with chronic hepatitis or cirrhosis.

Workers decommissioning the Fukushima-Daiichi nuclear power plant damaged from the Great East Japan Earthquake and resulting tsunami are at risk of injury with possible contamination from radioactive heavy atoms including actinides, such as plutonium. We propose a new methodology for on-site and rapid evaluation of heavy-atom contamination in wounds using a portable X-ray fluorescence (XRF) device. In the present study, stable lead was used as the model contaminant substitute for radioactive heavy atoms. First, the wound model was developed by placing a liquid blood phantom on an epoxy resin wound phantom contaminated with lead. Next, the correlation between the concentration of contaminant and the XRF peak intensity was formulated considering the thickness of blood exiting the wound. Methods to determine the minimum detection limit (MDL) of contaminants at any maximal equivalent dose to the wound by XRF measurement were also established. For example, in this system, at a maximal equivalent dose of 16.5 mSv to the wound and blood thickness of 0.5 mm, the MDL value for lead was 1.2 ppm (3.1 nmol). The radioactivity of 239Pu corresponding to 3.1 nmol is 1.7 kBq, which is lower than the radioactivity of 239Pu contaminating puncture wounds in previous severe accidents. In conclusion, the established methodology could be beneficial for future development of a method to evaluate plutonium contamination in wounds. Highlights: Methodology for evaluation of heavy-atom contamination in a wound was established. A portable X-ray fluorescence device enables on-site, rapid and direct evaluation. This method is expected to be used for evaluation of plutonium contamination in wounds.

Background: Extracorporeal shock-wave lithotripsy (ESWL) is a treatment that preserves the gallbladder. Problems after ESWL treatment include stone recurrence and the development of biliary symptoms. Methods: Two hundred and sixty-two patients with cholesterol-type gallstones, the best indication for ESWL treatment, and 42 control patients with cholesterol-type gallstones who received no treatment entered this study. We evaluated the factors associated with recurrence of gallstones after stone clearance and the development of biliary symptoms after ESWL treatment. Results: The 3-, 5- and 7-year cumulative probabilities of gallstone recurrence were 20.6, 27.1 and 33.1%, respectively, with the recurrence probability significantly lower in patients with good gallbladder contractility. In patients with recurrence, ursodeoxycholic acid (UDCA) treatment was effective. In 69 patients with residual gallstones, the 3-, 5- and 7-year cumulative risks of biliary symptoms were 17.3, 24.9 and 30.5%, respectively. With residual gallstones, the risk of biliary symptoms developing was significantly lower in patients with a ≤ 3 mm fragment size at the end of ESWL treatment and in those treated consistently with UDCA for 6 months or more after treatment with ESWL. The risk of biliary symptoms was significantly lower in ESWL-treated patients with residual stones who had a ≤ 3 mm fragment size after treatment compared to those of control patients. Conclusions: Ursodeoxycholic acid was effective in clearing stones in patients with gallstone recurrence. In patients with residual stones, the fragmentation of stones to ≤ 3 mm and UDCA administration effectively reduced the risk of subsequent biliary symptoms.

Background and Aims: Relationships between chronic liver disease and trace metals have not been clearly understood. To examine connections between severity of hepatic fibrosis in chronic hepatitis C and copper, iron and zinc we measured the contents of these metals in liver tissue and serum in the patients. Methods: Forty-one patients (26–62 years), 13 with fibrosis representing grade F1, 16 with F2, seven with F3, and five with F4, entered this study. Metals were quantified in needle liver-biopsy specimens by particle-induced X-ray emission. In serum, metals were measured by flameless atomic absorption spectrometry. Results: Hepatic copper content increased with progression of hepatic fibrosis (P < 0.05). The copper content correlated positively with bilirubin (r = 0.466, P = 0.0023), and with type IV collagen (r = 0.402, P = 0.0086) and correlated negatively with albumin (r = – 0.404, P = 0.080). However, hepatic iron and zinc contents did not show a significant differences between grades of fibrosis. Conclusions: Copper accumulation in fibrotic livers caused by chronic hepatitis C may contribute to hepatic injury. The real mechanism is not known at present, but excess copper may damage the liver by oxidative stress.

A measurement of neutron dose rate on iron-polyethylene shielding structure was carried out by 252Cf source. Simulated geometry was slit-like opening of polyethylene in iron slab and polyethylene slab shielding.These experiment was done at research facility of Hazama Co,. Iron slab and polyethylene slab thickness were 10 cm each. A gap of the polyethylene was simulated. Neutron REM-counter, polyethylene covered BF3 counter (STUDSVIK 2202-D), was used for measurement of streaming neutron dose equivalent. The solid state track detector (SSTD), allyl-diglycol-carbonate, were used for measurement of fast neutron dose equivalent in the range of 170Kev to 15Mev.The experimental data was obtained against gap width, source location and detector location.Obtained data shows strong correlation between dose rate and above parameters.These data was investigated in the view of to make use of actual facility design and compared with calculation such as MCNP4B.From the result of gap streaming experiment and calculation,...

aNuclear facilities with strong radioactivity need massive concrete shields. In the view of shielding design, there arise some difficulties in the estimation of radiation doses from a gap or a void between the hatch and the wall. So, there is a need of experimental data and calculational procedures on such geometry for a reasonable shielding design. The experiments were carried out by 252Cf neutron source. A gap between the shielding hatch and the wall, and the offset of the shielding hatch were simulated by piling up the concrete slabs to the height of 30 cm. The thickness of the slabs are 10 cm each. Neutron dose was measured by REM-counter and CR-39 plate. To simulate various types of the shielding hatch, gap width and offset length of each gap were changed.Results of the experiments shows that the dose rate goes up with increment of gap width when the offset was fixed. The experimental data were also compared with the calculations by MCNP4B. We obtain the guide of design for radiation shielding hatch.

To objectively evaluate the parenchymal echo pattern of cirrhotic liver and chronic hepatitis, the authors applied an image analyzing system (IAS) using a neural network. Autopsy specimens in a water tank (n=13) were used to examine the relationship between the diameter of the regenerative nodule and the coarse score (CS) calculated by IAS. CS was significantly correlated with the diameter of the regenerative nodule (p

Objective To develop a set of process-of-care quality indicators (QIs) that would cover a wide range of gastric cancer care modalities and to examine the current state of the quality of care provided by designated cancer care hospitals in Japan. Design A retrospective medical record review. Settings Eighteen designated cancer care hospitals throughout Japan. Participants A total of 1685 patients diagnosed with gastric cancer in 2007. Main Outcome Measures Provision of care to eligible patients as described in the 29 QIs, which were developed using an adaptation of the RAND/UCLA (University of California, Los Angeles) appropriateness method by a panel of nationally recognized experts in Japan. Results Overall, the patients received 68.3% of the care processes recommended by the QIs. While ‘deep venous thrombosis prophylaxis before major surgery’ was performed for 99% of the cases, ‘documentation before endoscopic resection’ was completed for only 12% of the cases. The chemotherapy care was less likely to meet the QI standards (61%) than pre-therapeutic care (76%), surgical treatment (66%) and endoscopic resection (71%; overall difference: P < 0.001). A comparison based on the types of care showed that documentation and patient explanation were performed less frequently (60 and 53%, respectively) than were diagnostic and therapeutic processes as recommended in the QIs (85%; overall P < 0.001). Conclusions Although many required care processes were provided, some areas with room for improvement were revealed, especially with respect to chemotherapy, documentation and patient explanation. Continuous efforts to improve the quality and develop a system to monitor this progress would be beneficial in Japan.

The clinical findings in 26 patients in whom hepatocellular carcinoma (HCC) was detected after the start of interferon (IFN) therapy for chronic hepatitis C were analysed. Histological study before IFN therapy showed that 34.6% of patients were categorized as stage 3 (septal fibrosis with architectural distortion; the 0-4 scale) and 80.8% demonstrated at least some evidence of septal fibrosis or more advanced features. The AFP levels examined before IFN therapy were more than 20 ng/mL in 13 patients (84.6% of those studied). One of 26 patients had a complete response to IFN therapy, while six of 26 patients had only a partial response. HCC was detected within 1 year after the start of IFN therapy in 76.9% of patients. Thus, the possibility of the early occurrence of HCC or its existence at the time of therapy should be seriously considered when IFN therapy is contemplated. Patients with stage 3 or 3-4 histology may already have a small undetectable HCC before IFN therapy. Thus, for this reason, every patient treated with IFN should be examined at short regular intervals for the development of HCC during and after IFN therapy.

千葉県富浦町にて年齢40歳以上の住民1,627名についてHCV感染の疫学調査を行い,同時にHCV抗体陽性であった184名に超音波検査による肝細胞癌の検診を実施した.HCV抗体陽性率は男性にて女性よりも,年齢50歳以上にて50歳以下よりも,職業別では漁業に従事する男性にて農業に従事する男性よりも高かった.HCV抗体陽性率は男性と女性ともに輸血,手術,覚醒剤注射,薬物自己注射,針治療などの既往歴を持つ例にて原因となる動機を待たない例よりも高かった.HCV抗体陽性者の超音波検査により肝細胞癌9例を検出した.9例のうち8例に輸血や手術などHCV感染の原因となる動機を認めた.9例のうち8例は腫瘍径が≦20mmであり,エタノール注入療法などの腫瘍の局所治療が有効であった.HCV抗体測定と超音波検査を組み合わせたスクリーニングが肝細胞癌の早期診断に役立つ結果であった.

門脈腫瘍塞栓を有する肝細胞癌34例において,カラードプラによる腫瘍塞栓の診断,病態の把握ならびに治療効果の判定を試みた.カラードプラにより,門脈両側に沿って流れる求肝性拍動性血流が15例(44%),腫瘍塞栓内遠肝性拍動性血流が15例(44%),門脈の拍動性逆流が5例(15%),求肝性門脈側副血行路が6例(18%)に見られた.門脈両側の求肝性拍動性血流あるいは腫瘍塞栓内遠肝性拍動性血流の所見は腫瘍塞栓に特徴的な所見であり,全体の74%に見られた.肝細胞癌に対する治療後にこれらの所見が残存した例には,腫瘍塞栓の進展を見た例が多く,予後は不良であった.門脈の拍動性逆流が見られた例では,肝機能障害と食道静脈瘤は高度であり,予後は不良であった.求肝性門脈側副血行路の発達がみられた例では,腫瘍占拠率は低く,肝機能障害は軽度であった.カラードプラは,門脈腫瘍塞栓の診断,臨床病態の把握ならびに治療効果の判定に有用であった.

Patient age and gender may be associated with response to peginterferon alpha plus ribavirin, the current standard of care (SOC) for chronic hepatitis C genotype 1. We queried whether there was an association between age, gender, and treatment response to SOC in Japanese patients infected with hepatitis C virus (HCV) genotype 1. Between 2006 and 2009, HCV-infected Japanese patients treated with peginterferon alpha-2b plus ribavirin for 48 weeks were enrolled. Patients were allocated into four groups according to age and gender, and epidemiological data and treatment outcomes were retrospectively analyzed. HCV RNA was measured with COBAS AMPLICOR HCV Monitor Test v. 2.0. The overall sustained virological response (SVR) rate was 49.8%: patients aged ≤65 and >65 years, 50.9 and 44.0%, respectively; male and female, 56.5 and 39.0%. SVR rates of SOC against HCV genotype-1 females aged >65 years (19.0%) were inferior to those in males aged >65 years (57.8%) in Japan. Multivariate logistic regression analysis showed that SVR was attained independently of adherence 80/80/80 in all groups. Adherence to medication is also a key factor for the eradication of HCV in patients aged >65 years. As the SVR rate of patients aged ≤65 years was similar to that of patients aged >65 years, SOC could be useful for treating some of the elderly patients.

Advanced chronic hepatitis C patients with sustained virolological response by antivirals remain at risk for hepatocellular carcinoma (HCC). We investigated the incidence of HCC during and immediately after peginterferon-alfa-2a and ribavirin (RBV) treatment in patients with chronic hepatitis C in Japan. HCC was detected in 8 of 238 patients during and after these treatments (mean follow-up period: 572 ± 252 days). In conclusion, occurrence of HCC is not a rare event during and immediately after peginterferon-alfa-2a plus RBV treatment. In cases with cirrhosis, higher α-fetoprotein levels, old age, or a previous history of HCC treatment, clinicians should be especially alert for the possible development of HCC during and immediately after peginterferon-alfa-2a and RBV treatment. Clinicians should regularly check for the possible development of HCC even in chronic hepatitis C patients under treatment.

The purpose of this article was to investigate the detection rate of gastroduodenal artery blood flow (GDABF), and to measure its velocity and volume flow rate using Doppler color imaging. The GDABF was detected in 40 of 41 (98%) normal subjects with longitudinal scanning and in 36 (88%) with transverse scanning. The velocity of the GDABF was 21 ± 8 cm/sec (m ± SD) and the volume flow rate was 67 ± 20 mL/min. Without color Doppler, the vascular lumina of the GDA was demonstrated in 27 (66%) subjects by longitudinal scanning and in 26 (63%) by transverse scanning. The hemodynamics of the GDA were revealed noninvasively using Doppler ultrasonography in a patient with a malignant islet cell tumor of the pancreas and one with a ductal cell carcinoma of the pancreas. © 1993 John Wiley & Sons, Inc.

Summary. Extremely low levels of serum hepatitis C virus (HCV) RNA can be detected by COBAS TaqMan HCV test. To investigate whether the COBAS TaqMan HCV test is useful for measuring rapid virological response (RVR) and early virological response (EVR) to predict sustained virological response (SVR), we compared the virological response to PEG-IFN-alfa 2a plus RBV in 76 patients infected with HCV genotype 1 when undetectable HCV RNA by the COBAS TaqMan HCV test was used, with those when below 1.7 log IU/mL HCV RNA by COBAS TaqMan HCV test was used, which corresponded to the use of traditional methods. Among the 76 patients, 28 (36.8%) had SVR, 13 (17.1%) relapsed, 19 (25.0%) did not respond, and 16 (21.0%) discontinued the treatment due to side effects. The positive predictive values for SVR based on undetectable HCV RNA by COBAS TaqMan HCV test at 24 weeks after the end of treatment [10/10 (100%) at week 4, 21/23 (91.3%) at week 8 and 26/33 (78.7%) at week 12] were superior to those based on

Color Doppler flow imaging was performed in 121 patients with portal hypertension. Portosystemic collateral shunts originating from the left portal veins were seen in 41 of the patients. A single collateral shunt was seen in 27 of these, and multiple collateral shunts were seen in the other 14. Collateral shunts running in the ligamentum teres were seen in 26 of the 41 patients; the veins ran through the liver parenchyma in 25 of these. B-mode ultrasound imaging could not clearly demonstrate vascular structures in 55% of the collateral shunts. Color Doppler flow imaging provided a clear picture of the course of the portosystemic collateral shunts originating from the left portal vein. © 1992 John Wiley & Sons, Inc.

A 15m-long plastic scintillation fiber (PSF) detector has been applied to the on-line evaluation of spatial dose-distribution inside radiation facilities. The aim of this study is to realize the real-time measurement system which is not only simple but also reliable for monitoring use. Determination of radiation-incident points was made by the measurement of time difference that two directional signals of the scintillation light reach both ends of the PSF [so called “time-of-flight (TOF) method”]. The PSF used had practically enough sensitivity to detect both fast neutrons and gamma-rays.