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A 63-year-old man with multiple HCC in his left liver lobe was enrolled as the first patient in a pilot study of boron neutron capture therapy (BNCT) involving the selective intra-arterial infusion of a 10BSH-containing water-in-oil-in-water emulsion (10BSH-WOW). The size of the tumorous region remained stable during the 3 months after the BNCT. No adverse effects of the BNCT were observed. The present results show that 10BSH-WOW can be used as novel intra-arterial boron carriers during BNCT for HCC.

We retrospectively studied the CT findings of sternal bone in 129 patients with hematological diseases who underwent bone marrow aspiration in Tokyo Metropolitan Bokutoh Hospital between August 2005 and July 2007. Sternal findings demonstrated sternal foramen (3 cases), incomplete fracture (1 case) and irregularity and decreased bone density of the visceral cortical bone (first intercostal space: 66 cases, third intercostal space: 3 cases). Irregularity and decreased bone density of the visceral cortical bone were significantly related to findings of decreased bone density in the third lumbar spine, indicating osteoporosis. These findings suggest that sternal bones demonstrated various bone diseases such as sternal foramen, fracture and osteoporosis, and that bone marrow aspiration from sternal bones might not be as safe as previously thought.

We herein report a case of T4 esophageal carcinoma, which was resected after chemo-radiation therapy. In addition, the metachronous lung metastasis was also resected. A 59-year-old female with esophageal carcinoma, which invaded the left main bronchus, underwent chemo-radiation therapy (the combination of systemic chemotherapy of 5-FU/CDDP and external radiation therapy) from January 2004. After the therapy, although the imaging showed a downstaging of esophageal carcinoma, a severe esophageal stricture appeared with ingestion defective. So hyper-alimentation was performed. After the state of nutrition was improved, esophagectomy was performed on March 2004 without a complication. Histopathological study revealed that no viable cells remained. Nine months after esophagectomy, chest CT scan revealed that a solitary pulmonary tumor appeared in S6 of the right. The solitary tumor enlarged gradually. On August 2005, a surgical resection for the solitary pulmonary tumor was performed. Histopathologically, the lesion was compatible for metastasis from esophageal carcinoma. The patient is alive without recurrence more than 23 months after the last surgery.

The authors evaluated various head and neck lesions seen from April 1988 through March 1990 both by plain and enhanced CT, examined the incidence of rim effect (or rim enhancement), classified these effects, and discussed underlying mechanisms. Materials consisted of 177 cases including primary tumors (28 benign and 49 malignant cases) and lymphadenopathy associated with malignancy (9 cases, metastatic nodes and malignant lymphomas), inflammatory lesions (20 cases), cystic lesions (12 cases), other lesions (7 cases, jugular thrombosis, carotid atheroma and aural lesions), and 22 cases without abnormal findings. Among the 177 cases, rim effects were observed in 22 cases (12%). These effects were analyzed and classified. The incidences of rim effect according lesion type are as follows; cervical lymphadenopathy associated with malignancy 5/9 (56%), primary tumors 8/77 (10%), inflammatory lesions none, cystic lesions 7/12 (58%), and others 3/7 (43%). The highest incidence was seen with cystic lesions including mucoceles of the paranasal sinuses and cervical cysts. Rim effects were classified as follows; Type 1: cystic pattern, Type 2: parenchymatous pattern, Type 3: vascular pattern and Type 4: others. Type 1 was seen in 15 cases (68%), Type 2 in 3 cases (14%), Type 3 in 3 cases (14%), and Type 4 in 1 case (5%). Type 1 included 6 cystic lesions, 3 malignant lymphadenopathies, 3 benign tumors and others. Type 2 included 2 malignant lymphadenopathies and 1 benign tumor, and Type 3, 2 jugular thromboses and 1 carotid atheroma. There was only one Type 4, a cystic lesion. Of interest is the mode of incidences among cervical lymphadenopathies associated with malignancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Twenty-one cases of isolated medial orbital wall fractures were reported and CT findings by coronal planes were evaluated as to the effects of fractures upon the ethmoidal cells and nasal meati. Three coronal planes, which respectively contain such structures as Agger nasi, Pars membranacea and superior meatus, were selected for the study. The extent of fracture was evaluated by dividing the medial wall into three equal portions, i.e., superior, middle and inferior. The prolapsed volume was evaluated in three classes of occupying 1/3, 2/3 and 3/3 of the ethmoid. The presence of soft tissue density was recorded at the three surfaces, upper, medial and lower, around the prolapsed orbital content. The extent of the fracture was most often seen in such cases as involving all the three divisions in 41. 3%. The prolapsed volume occupying 1/3 was seen in 28. 6%, and 2/3 in 23. 8%. The presence of soft tissue density was seen in 38. 1% of upper surface, in 36. 5% of medial, and 11. 1% of lower. Summarizing the total effects of the fractures, the coronal plane containing Pars membranacea was most severely damaged followed by the plane of the superior meatus. Two rare cases of fronto-ethmoidal mucoceles, caused by the traumas of 23 and 14 years before respectively, were also included and reported. The ophthalmological prognosis was favorable in 90. 5% of cases by observations extending more than 6 months. Five cases were surgically treated including two cases of mucoceles. It follows from the present study that the main stay in the treatment for the medial orbital wall fracture is conservative and selective indications for the surgery is the persistent and annoying diplopia in spite of about two weeks' observations.

CT values were estimated at the fatty layer in contact with the posterior wall of the maxillary sinus in various condition, i.e., normal, sinusitis, postop. sinus, and mucocele. By the unilateral sinusitis (40 cases), CT values obtained by the affected sides were significantly higher than those of the non-affected normal sides. A single maxillary bone was used for experiments to show that the dense++ materials filing the sinus do not affect the CT values of the fatty layer, thus confirming the above clinical data was real and not artifact. In addition, by the mucocele of the maxillary sinus (9 cases) with negligible inflammatory change in the sinus, the CT values of the fatty layer did not show any remarkable increase such as seen by sinusitis. These data lead us to the impression that the increased density is due to the transmitted effects of maxillary sinusitis through the posterior wall. In postop, sinuses (11 cases) with various postop. periods, CT values were slightly higher than those in normal sinuses, suggesting that the sinus infection was under improvement. The enhancement performed by 14 cases (28 sides) showed increased density of the fatty layer, but the increase was similar in both affected and non-affected sinuses. This suggests that the increased rate of circulation at the fatty layer is not the contributory factor to higher CT values. The results described above, combined with the previous reports concerning the bony changes in sinusitis, will lead to the conclusion that the increased CT values at the fatty layer is caused by the direct engagement of the inflammatory conditions in the sinus cavities.

A complex set of sinuses, eminences and ridges lies in the posterior border of the tympanic cavity (posterior tympanum). The facial nerve canal is located between the facial sinus and the sinus tympani. The posterior limit is the posterior semicircular canal. The posterior tympanum is often the site of residual collection of granulation tissue or cholesteatoma, and is not directly visualized by the usual surgical approaches. Thus preoperative knowledge of cholesteatoma in these area is of obvious importance. It has been accepted that high-resolution computed tomography (HRCT) has the significant advantage to provide specific information of the middle ear. Contribution of the HRCT for diagnosis of posterior tympanum was examined by three temporal bone specimens and one hundred subjects with normal middle ear. In the experiments using the temporal bone specimens, each structure in the posterior tympanum was labeled by a fine needle. HRCTs were subsequently obtained to confirm the labeled structure. In one hundred subjects, it was examined whether each structure was also confirmed by the routine HRCT. Results are as follows: (1) Axial HRCT sections provided essential informations for the preoperative evaluation of the posterior tympanum. (2) Such bony structures as the pyramidal eminence and the pyramidal ridge were the most prominent structures on the posterior wall. (3) Laterally close to the pyramidal eminence lies one sinus which was marked by the needle placed in the facial sinus proper or in the lateral tympanic sinus; It is the facial sinus in a wide sense.(ABSTRACT TRUNCATED AT 250 WORDS)

腫瘍スキャンおよび骨髄スキャンの性質を有する111InCl3を用い, その生体内分布を数量的に表現した。臨床的に悪性腫瘍の診断が下されたか, または, その存在が疑われた患者38人 (46回) でスキャンをし, スキャン像で異常集積を呈した部位, 臨床的に病変の疑われた部位, および放射線照射部位は正常分布像の統計作成上は除外した。判定は111InCl31～3mCi静注後48時間のスキャン像で行った。人体をおもな部位23に分け, 111InCl3における各部位の描出を肝臓を基準として数量的に表すと, 描出されやすい順序は, 腰椎, 縦隔, 鼻咽頭, 睾丸, 心臓, 骨盤であった。正常分布より111InCl3は骨髄スキャン剤として有用と考える。

48人の患者に, 英国で開発された99mTc-モノフルオロフォスフェイトによる骨シンチグラフィを行った。24例が異常を示し, 24例が正常であった。単純骨X線写真との所見の比較では, 骨シンチグラムのほうが高率に異常を示した。しかしながらX線写真にて異常を呈し, シンチグラム上とくに異常を示さない症例も見られた。われわれの経験では, 本剤は従来の99mTc織リン酸化合物と同様に臨床的に有用であろうと考えられる。また悪性腫瘍の発見のみならず, 代謝性骨疾患の診断にも有用と思われる。

The understanding of the CT artifact is important in diagnosing the various sinus lesions. We investigated several conditions causing thickening of maxillary sinus walls on CT. In unilateral sinusitis by conventional plane films of Waters-view the walls of the affected maxillary sinus showed a tendency (7/13 cases) to be thicker than those of non affected sides, suggesting the thickening is real, at least in part, and caused by inflammation. On the other hand, this tendency of sinus wall thickening in the affected sinuses is greater (12/13 cases) by CT. This indicates that CT artifacts may play a role in wall thickening. Specimens of anterior walls of the maxillary sinuses were obtained by sinusectomies in 14 sides. The actual thickness of the walls evaluated and compared with that of CT images. The thickness by CT was greater in all the 14 sides, confirming the CT artifact. This CT artifact was more influenced in sinuses of sinusitis than in normal sinuses. CT number of soft tissues in the maxillary sinuses showed a tendency to correlate with the apparent thickess of the anterior wall on CT. Phantom studies are in progress to more clarify this CT artifact.

The posterior tympanum consists of several irregular eminences, ridges, and sinuses. These sinuses do not communicate with the mastoid air cell system, and cholesteatoma and/or granulation tissue prefer to fill them. This area cannot be visualized with ease by the usual surgical approach, and is thus quite important for surgeons. Recent developments in high-resolution computed tomography (HRCT) allow more than ever precise identification of subtle changes in the posterior tympanum. Axial HRCT sections provide essential information for the preoperative evaluation of the posterior tympanum. The performance of surgeons has been promoted both in evaluation and treatment planning of patient with suspected posterior tympanic lesions. HRCT findings were compared with the operative findings in 52 patients (54 ears) who had the operation for chronic otitis media. Important findings by HRCT diagnosis of posterior tympanum are as follows: (1) Bone destruction in the posterosuperior part of the tympanic anulus and in the lateral wall of the facial sinus are the important findings for the diagnosis of invasion of cholesteatoma in the posterior tympanum. (2) Similarly important finding is the bone destruction of the pyramidal eminence. This was found in 6 of 9 cases with cholesteatomas extending into the sinus tympani. (3) The soft tissue density in the posterior tympanum does not necessarily indicate pathological processes. Effusion in the posterior tympanum is imaged as soft tissue density, and can not be differentiated from cholesteatoma or granulation by present HRCT.