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The prognosis for highly advanced esophageal squamous cell carcinoma (ESCC) remains poor, and there is currently no standard treatment. The purpose of this study was to examine the benefits of trimodality therapy [chemoradiation plus surgery, (CRT + S)] by evaluating the surgical outcomes of patients with ESCC in Keiyukai Sapporo Hospital, Japan. We assessed the preoperative and postoperative adverse events, treatment effects of preoperative CRT, metastatic diagnosis of the dissected lymph nodes, and survival. Between 2012 and 2018, 148 patients with highly advanced ESCC who underwent preoperative CRT + S were analyzed for diagnosis and staging, preoperative complications, clinical and histopathological effects of CRT in the resected specimens, survival rates, and recurrences. The grade 3 and higher complications of preoperative CRT were neutropenia in 3 cases and thrombocytopenia in 1 case. Among the postoperative complications, there were 2 cases (1.4%) of direct surgical death, only tracheobronchial bleeding and liver failure. Using the 11th edition of the classification of esophageal cancer by the Japanese Esophageal Society, 60 patients (40.5%) were classified as grade 3 (negative for cancer cells, pathological complete response). However, 20 of them (33.3%) had metastatic tumor cells in the lymph nodes. The overall 5-year survival rate was 58.5%. Including references to the pathological findings and recurrence patterns, there is no effective diagnostic method for selecting the subsequent approach based on the effectiveness of CRT. Planned surgery following CRT was the only solution for achieving better treatment results. CRT + S is a promising treatment with low direct surgical mortality.

Reinforcement signals such as food reward and noxious punishment can change diverse behaviors. This holds true in fruit flies, Drosophila melanogaster, which can be conditioned by an odor a...

Dynamic changes in the properties of adsorbed protein layers at material surfaces make it difficult to analyze a cell adhesion behavior. Adhesion is affected by the ligand molecules in the adsorbed protein layers on the material's surface. This study aimed to quantitatively analyze the initial cell adhesion onto a polymeric surface modified with immobilized cell adhesion molecules with a well-defined structure. Peptides containing an arginine-glycine-aspartic acid (RGD) sequence were introduced at almost all the termini of the grafted poly(2-methacryloyloxyethyl phosphorylcholine) [poly(MPC)] chains using a click reaction at a highly protein-resistant poly(MPC) brush layer. Thus, the surface could bind to the cell membrane proteins only through the immobilized RGD. Furthermore, the degree of polymerization of the grafted poly(MPC) chains could control the hydrated poly(MPC) brush layer softness, as determined by measuring the dissipation energy loss using a quartz crystal microbalance. At the initial stage of cell adhesion, the density of cells adhering to the RGD-immobilized poly(MPC) brush layers did not depend on the poly(MPC) brush layer softness. However, spreading of the adherent cells was inhibited on the RGD-immobilized poly(MPC) brush layers with a higher softness. Hence, the results suggested that the layer softness did not affect the binding number between the RGD and cell membrane protein during initial cell adhesion; however, the intracellular signaling triggered by the RGD-receptor interaction was inhibited. The poly(MPC) brush surface carrying immobilized cell adhesion molecules has the potential to analyze precisely the effect of the properties of cell adhesion molecules on initial cell adhesion.

Background: Molecules that are highly expressed in tumour endothelial cells (TECs) may be candidates for specifically targeting TECs. Using DNA microarray analysis, we found that the lysyl oxidase (LOX) gene was upregulated in TECs compared with its expression in normal endothelial cells (NECs). LOX is an enzyme that enhances invasion and metastasis of tumour cells. However, there are no reports on the function of LOX in isolated TECs. Methods: TECs and NECs were isolated to investigate LOX function in TECs. LOX inhibition of in vivo tumour growth was also assessed using beta-aminopropionitrile (BAPN). Results: LOX expression was higher in TECs than in NECs. LOX knockdown inhibited cell migration and tube formation by TECs, which was associated with decreased phosphorylation of focal adhesion kinase (Tyr 397). Immunostaining showed high LOX expression in human tumour vessels in vivo. Tumour angiogenesis and micrometastasis were inhibited by BAPN in an in vivo tumour model. Conclusion: LOX may be a TEC marker and a possible therapeutic target for novel antiangiogenic therapy.

We investigate the diagnostic reliability of differentiating between lipid-poor adrenal adenomas and metastatic adrenal tumors originating from hepatocellular carcinoma (HCC) using a routine dynamic CT protocol for liver imaging. Eighteen metastatic adrenal tumors originating from HCC and 13 lipid-poor adrenal adenomas were identified. Dynamic CT data were analyzed for CT attenuation of adrenal lesions before and after contrast administration. When a cutoff of 36 HU was set for adrenal lesions at pre-contrast attenuation, the sensitivity and specificity for the diagnosis of metastatic lesions were 94.4%and 92.3%, respectively. Attenuation criteria on pre-contrast CT may help optimize the differentiation between these lesions.

BACKGROUND: We isolated tumour endothelial cells (TECs), demonstrated their abnormalities, compared gene expression profiles of TECs and normal endothelial cells (NECs) by microarray analysis and identified several genes upregulated in TECs. We focused on the gene encoding biglycan, a small leucine-rich repeat proteoglycan. No report is available on biglycan expression or function in TECs. METHODS: The NEC and TEC were isolated. We investigated the biglycan expression and function in TECs. Western blotting analysis of biglycan was performed on sera from cancer patients. RESULTS: Biglycan expression levels were higher in TECs than in NECs. Biglycan knockdown inhibited cell migration and caused morphological changes in TECs. Furthermore, immunostaining revealed strong biglycan expression in vivo in human tumour vessels, as in mouse TECs. Biglycan was detected in the sera of cancer patients but was hardly detected in those of healthy volunteers. CONCLUSION: These findings suggested that biglycan is a novel TEC marker and a target for anti-angiogenic therapy.

Intrahepatic and extrahepatic recurrence remains a significant problem for hepatocellular carcinoma (HCC). The aim of this study was to determine the usefulness of diffusion-weighted magnetic resonance imaging (DWI) for histological tumor grading and preoperative prediction of early HCC recurrence within 6 months of operation.A total of 44 patients who had undergone hepatic resection for HCC (50 nodules) were reviewed retrospectively. DWI was performed within 30 days before hepatectomy, and apparent diffusion coefficients (ADCs) were measured using 2 methods: mean ADC and minimum-spot ADC. Relationships between ADCs and histological differentiation and between ADCs and early recurrence of HCC were analyzed.Mean ADC was significantly lower in poorly differentiated HCC (n=18, 1.07±0.15×10(-3) mm2/s) than in moderately differentiated HCC (n=29, 1.29±0.21×10(-3) mm2/s; P.05). Minimum-spot ADC was significantly lower in poorly differentiated HCC (n=18, 0.69±0.19×10(-3) mm2/s) than in well-differentiated HCC (n=3, 1.15±0.10×10(-3) mm2; P.01) or in moderately differentiated HCC (n=29, 0.98±0.18×10(-3) mm2/s; P.0001). Of 34 patients who were able to be observed for6 months after resection, 9 showed early recurrence. Minimum-spot ADC was significantly lower in patients with early recurrence (n=9, 0.64±0.24×10(-3) mm2/s) than in patients without early recurrence (n=25, 0.88±0.19×10(-3) mm2/s; P.05). On multivariate analysis, minimum-spot ADC was a significant risk factor for early recurrence (P.05).Quantitative measurement of ADC of HCC with magnetic resonance diffusion weighted imaging is a promising functional imaging tool in the prediction of histological grade and early recurrence before treatment.

In most cases of systemic lupus erythematosus (SLE), glomerular lesions are the main renal complication. Although tubulointerstitial lesions are often associated with severe glomerular lesions, predominant or isolated tubulointerstitial injury in the presence of minimal glomerular abnormalities with SLE, so-called predominant tubulointerstitial lupus nephritis, is rare and there is no report on CT and MR imaging findings of predominant tubulointerstitial lupus nephritis. Herein, we describe the case of a 48-year-old woman with SLE who presented with acute renal deterioration attributable to acute tubulointerstitial nephritis with an emphasis on CT and MR imaging findings. CT demonstrated multiple wedge-shaped areas or streaky zones of lesser enhancement that extend from the papilla to the renal cortex. MR images revealed relatively clear corticomedullary junction with slightly irregular cortex on T1-weighted images, and wed-shaped areas of decreased signal intensity corresponding CT findings increased signal intensity in the central parenchyma on T2-weighted image. The enhancement effect was weak and delayed in the central parenchyma on dynamic MR images after bolus administration of contrast. These imaging features seemed to reflect the tubulointerstitial dysfunction and infiltration in this case.

Intravenous pyogenic granuloma is a rare solitary form of lobular capillary hemangioma that usually occurs in the veins of the neck and upper extremities. We report two cases of intravenous pyogenic granuloma localized in the finger, giving details of the magnetic resonance imaging (MRI) findings. These two cases had similar locations in fingers and identical MRI findings. The differential diagnoses of this rare entity are also discussed.

Echinococcosis is a parasitic infection of humans caused by the larval stage of the tapeworm Echinococcus. Primary alveolar echinococcosis of the adrenal gland is rare. We report a case of alveolar hydatid disease of the adrenal gland that presented as a multiloculated cystic mass without calcification. The lesion was purely cystic in nature, suggesting that it was at an early stage of development.

Purpose Magnetic resonance cholangiopancreatography (MRCP) is not sufficient to detect pancreaticobiliary maljunction (PBM) in young infants because the main pancreatic duct is not visualized and respiratory artifacts occur. To our knowledge, there are no reports highlighting the diagnostic accuracy of evaluation using the axial planes of helical computed tomographic (CT) scanning with contrast medium instead of 3-dimensional (3D) reconstruction. The aim of this study was to describe our experience and the characteristics of 3 children with PBM diagnosed using the axial planes of helical CT with contrast medium, although they showed negative findings of PBM by MRCP, instead of 3D reconstruction. Methods Three patients aged from 1 month to 3 years were diagnosed with PBM using the axial planes of helical CT with contrast medium though MRCP could not show the common channel and/or the entrance of the common channel into the duodenum. Results In all 3 patients, PBM of the common channel was not revealed by MRCP. On the other hand, axial planes of contrast-enhanced helical CT scans showed PBM clearly. Conclusions Our experience suggests that axial planes of the contrast-enhanced helical CT scan comprise an accurate tool for the diagnosis of fusiform-type PBM and could replace MRCP in younger children. Further studies are necessary for better assessment of the potential advantages and pitfalls of this modality.

Purpose To investigate the clinical outcomes of patients with pathologically proven, peripherally located, Stage I non–small-cell lung cancer who had undergone stereotactic body radiotherapy using real-time tumor tracking radiotherapy during the developmental period. Methods and Materials A total of 41 patients (25 with Stage T1 and 16 with Stage T2) were admitted to the study between February 2000 and June 2005. A 5-mm planning target volume margin was added to the clinical target volume determined with computed tomography at the end of the expiratory phase. The gating window ranged from ±2 to 3 mm. The dose fractionation schedule was 40 or 48 Gy in four fractions within 1 week. The dose was prescribed at the center of the planning target volume, giving more than an 80% dose at the planning target volume periphery. Results For 28 patients treated with 48 Gy in four fractions, the overall actuarial survival rate at 3 years was 82% for those with Stage IA and 32% for those with Stage IB. For patients treated with 40 Gy in four fractions within 1 week, the overall actuarial survival rate at 3 years was 50% for those with Stage IA and 0% for those with Stage IB. A significant difference was found in local control between those with Stage IB who received 40 Gy vs. 48 Gy (p = 0.0015) but not in those with Stage IA (p = 0.5811). No serious radiation morbidity was observed with either dose schedule. Conclusion The results of our study have shown that 48 Gy in four fractions within 1 week is a safe and effective treatment for peripherally located, Stage IA non–small-cell lung cancer. A steep dose–response curve between 40 and 48 Gy using a daily dose of 12 Gy delivered within 1 week was identified for Stage IB non–small-cell lung cancer in stereotactic body radiotherapy using real-time tumor tracking radiotherapy.

Background: To evaluate the vascular supply of regions of the pancreas on computed tomography (CT) during arteriography with selective catheterization. Methods: Thirteen patients were included. In each patient we performed conventional arteriography followed by CT during arteriography of each of the arteries: the superior mesenteric artery (SMA), gastroduodenal artery (GDA), and splenic artery (SPA). The regions of the pancreas that were most enhanced on CT during arteriography were considered to be the areas receiving the greatest infusion of blood from the selected artery. Results: In all 13 patients, the uncinate process, the superior head, and the tail of the pancreas were predominantly supplied by the SMA, GDA, and SPA, respectively. The inferior head of the pancreas was predominantly supplied by the SMA in five patients, the GDA in nine patients, and both the SMA and GDA in one patient. The body of the pancreas was predominantly supplied by the SMA, GDA, and SPA in seven, two, and ten patients, respectively. Conclusions: The uncinate process predominantly infused by the SMA, the superior head by the GDA, and the tail by the SPA. The patterns of the vascular supply of the inferior head and the body vary from patient to patient.

Background: Airflow limitation in chronic obstructive pulmonary disease (COPD) is caused by a mixture of small airway disease and emphysema, the relative contributions of which may vary among patients. Phenotypes of COPD classified purely based on severity of emphysema are not well defined and may be different from classical phenotypes, pink puffers and blue bloaters. Methods: To characterize clinical phenotypes based on severity of emphysema, we recruited 274 subjects with COPD, excluding physician-diagnosed bronchial asthma. For all subjects, we conducted a detailed interview of disease history and symptoms, quality of life (QOL) measurement, blood sampling, pulmonary function tests before and after inhalation of salbutamol (0.4 mg), and high-resolution computed tomography. Results: Severity of emphysema visually evaluated varied widely even among subjects with the same stage of disease. No significant differences were noted among three groups of subjects classified by severity of emphysema in any of age, smoking history, chronic bronchitis symptoms, blood eosinophil count, serum IgE level or bronchodilator response. However, subjects with severe emphysema displayed significantly lower body-mass index (BMI) and poorer QOL scores, evaluated using St. George9s respiratory questionnaire (SGRQ), compared to subjects with no/mild emphysema (BMI: 21.2±0.5 vs. 23.5±0.3, respectively; SGRQ total score: 40±3 vs. 28±2, respectively; p

Computed tomography (CT)-guided transbronchial biopsy (TBB) using an ultrathin bronchoscope with simulation by virtual bronchoscopy (VB) is effective for diagnosing small peripheral pulmonary lesions. However, we occasionally lose the proper bronchi to the lesion when a bronchoscope is inserted into peripheral bronchi with severe rotation. To overcome this problem, the virtual bronchoscopic navigation system that can display real-time VB images during TBB procedures in comparison with actual bronchi has been developed. We evaluated the usefulness of the virtual bronchoscopic navigation system for CT-guided TBB using an ultrathin bronchoscope (navigation method) to diagnose small peripheral pulmonary lesions, and compared the results to those with previous method that uses VB images in a simulation (simulation method). We performed CT-guided TBB using an ultrathin bronchoscope for 69 patients with 71 small peripheral pulmonary lesions (mean diameter, 13.7 mm) between November 2002 and November 2005 with the navigation method. CT-guided TBB with the navigation method was performed safely without any serious complications for all patients. Mean time to the initial scan, time to the first biopsy and total examination time were 5.3, 8.5 and 24.5 min, respectively. Fifty lesions (70%) were diagnosed by this procedure. Compared to simulation method, diagnostic sensitivity was higher in the navigation method, but the difference was not significant. However, the time to the first biopsy and total examination time were significantly shorter in the navigation method than in the simulation method (p

We investigated factors related to the diagnostic sensitivity of CT-guided transbronchial biopsy (TBB) using an ultrathin bronchoscope and virtual bronchoscopy (VB) navigation for small peripheral pulmonary lesions.We have performed this procedure on 83 patients with 85 small peripheral pulmonary lesions (20 mm in diameter). We analyzed the relationship between the diagnostic sensitivity and the location of the lesions, the bronchial generation to which an ultrathin bronchoscope was inserted, and the lesion-bronchial and lesion-pulmonary arterial relationships on high-resolution CT.Fifty-six of the 85 lesions (66%) were diagnosed following CT-guided TBB using an ultrathin bronchoscope with VB navigation. The lesions located in the left superior segment of the lower lobe (S6) had a significantly low diagnostic sensitivity compared to other locations (p0.01). When an ultrathin bronchoscope could be inserted to the fifth or greater bronchial generation, the yield was above the average diagnostic sensitivity of 66%. Moreover, not only the patients with the presence of a bronchus leading directly to a lesion (CT-bronchus sign), but also the patients with the presence of a pulmonary artery leading to a lesion (CT-artery sign), had high diagnostic sensitivity (p0.01). Multivariate analysis revealed that the location of lesion was an independent predictor of diagnostic sensitivity (p0.05).The location of the lesion, the bronchial generation to which an ultrathin bronchoscope was inserted, and the presence of a bronchus as well as a pulmonary artery leading to the lesion were valuable for predicting successful CT-guided TBB using an ultrathin bronchoscope with VB navigation.

The purpose of this study was to prepare a thick polymer brush layer composed of poly(2-methacryloyloxyethyl phosphorylcholine (MPC)) and assess its resistance to protein adsorption from the dissolved state of poly(MPC) chains in an aqueous condition. The thick poly(MPC) brush layer was prepared through the surface-initiated atom transfer radical polymerization (SI-ATRP) of MPC with a free initiator from an initiator-immobilized substrate at given [Monomer]/[Free initiator] ratios. The ellipsometric thickness of the poly(MPC) brush layers could be controlled by the polymerization degree of the poly(MPC) chains. The thickness of the poly(MPC) brush layer in an aqueous medium was larger than that in air, and this tendency became clearer when the polymerization degree of the poly(MPC) increased. The maximum thickness of the poly(MPC) brush layer in an aqueous medium was around 110 nm. The static air contact angle of the poly(MPC) brush layer in water indicated a reasonably hydrophilic nature, which was independent of the thickness of the poly(MPC) brush layer at the surface. This result occurred because the hydrated state of the poly(MPC) chains is not influenced by the environment surrounding them. Finally, as measured with a quartz crystal microbalance, the amount of protein adsorbed from a fetal bovine serum solution (10% in phosphate-buffered saline) on the original substrate was 420 ng/cm(2). However, the poly(MPC) brush layer reduced this value dramatically to less than 50 ng/cm(2). This effect was independent of the thickness of the poly(MPC) brush layer for thicknesses between 20 nm and about 110 nm. These results indicated that the surface covered with a poly(MPC) brush layer is a promising platform to avoid biofouling and could also be applied to analyze the reactions of biological molecules with a high signal/noise ratio.

Rationale: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation caused by emphysema and/or airway narrowing. Computed tomography has been widely used to assess emphysema severity, but less attention has been paid to the assessment of airway disease using computed tomography. Objectives: To obtain longitudinal images and accurately analyze short axis images of airways with an inner diameter 2 mm located anywhere in the lung with new software for measuring airway dimensions using curved multiplanar reconstruction. Methods: In 52 patients with clinically stable COPD (stage I, 14; stage II, 22; stage III, 14; stage IV, 2), we used the software to analyze the relationship of the airflow limitation index (FEV1, % predicted) with the airway dimensions from the third to the sixth generations of the apical bronchus (B1) of the right upper lobe and the anterior basal bronchus (B8) of the right lower lobe. Measurements and Main Results: Airway luminal area (Ai) and wall area percent (WA%) were significantly correlated with FEV1 (% predicted). More importantly, the correlation coefficients (r) improved as the airways became smaller in size from the third (segmental) to sixth generations in both bronchi (Ai: r = 0.26, 0.37, 0.58, and 0.64 for B1; r = 0.60, 0.65, 0.63, and 0.73 for B8). Conclusions: We are the first to use three-dimensional computed tomography to demonstrate that airflow limitation in COPD is more closely related to the dimensions of the distal (small) airways than proximal (large) airways.

A very rare case of mesenteric teratoma is reported. Complete tumor resection is the main prognostic factor for survival in such cases. Therefore, an important factor for successful surgery is the exact preoperative visualization of the extent of the tumor, including visualization of the abdominal arteries. This report describes the use of spiral computed tomography with 3-dimensional reconstruction for visualization of the extent of multiple mesenteric teratomas.

Background: Hepatectomy is particularly difficult when the tumor is large, close to the inferior vena cava or the main trunk of the hepatic or portal vein, or in the caudate lobe, as well as when the operation is a re-hepatectomy, because two-dimensional computed tomography (CT) often does not clearly show tumor location relative to blood vessels. Study Design: To evaluate the efficacy of three-dimensional computed tomography (3D-CT), reconstructed from multidetector-row computed tomography (MD-CT) with contrast, MD-CT was performed in 17 patients before hepatectomy. Results: The third-order branches of the hepatic artery and the portal vein were clearly shown in all cases. Both the hepatic vein, which drained the same segment that the portal vein fed, and the portal vein were also clearly shown. These vessels could be visualized from any perspective. In 2 patients who underwent hemihepatectomy, large tumors (23.0 and 17.0 cm) displaced the vasculature, but the positions of tumor and vessels could be precisely evaluated by 3D-CT. In patients who required replacement of the vena cava with synthetic grafts, the distance and direction of pressure to IVC by tumor was accurately estimated by 3D-CT. In patients who were limited to segmentectomy or partial hepatectomy because of prior hepatectomy or tumor position, evaluation of the glissons was facilitated by 3D-CT. Conclusions: Three-dimensional-CT was extremely useful for preoperative simulation because it provided important information that could not be obtained with 2D-CT.

We evaluated a new simulation method for ultraselective transbronchial lung biopsy using the pulmonary artery.A new method for enhanced virtual bronchoscopy using the pulmonary artery was developed for ultraselective transbronchial lung biopsy. In a volunteer study of healthy adults, three radiologists with different levels of experience independently reconstructed conventional virtual bronchoscopy and enhanced virtual bronchoscopy using the pulmonary artery until reaching the farthest point of the bronchus and pulmonary artery. The bronchovascular branch order and the minimum luminal diameter (e.g., for bronchus and artery) for reconstruction were compared. In a clinical study, virtual bronchoscopy and enhanced virtual bronchoscopy using the pulmonary artery were compared with regard to accessibility to target lesions in 40 patients with small pulmonary nodules or ground-glass opacities. A comparison between the simulated bronchial route reconstructions and actual bronchoscopic routes on biopsy was made to determine the efficacy of each reconstruction method.In the volunteer study, quality of enhanced virtual bronchoscopy using the pulmonary artery was not significantly affected by the experience levels of the radiologists. In the clinical study, bronchial reconstruction was successful in guiding to a bronchoscopic tumor in 35 (87.5%) of 40 cases. The maximum bronchial order on reconstruction was the sixth for the virtual bronchoscopy group and the eighth for the group with enhanced virtual bronchoscopy using the pulmonary artery (p0.001, Wilcoxon's signed rank test). The bronchial route reconstructed on enhanced virtual bronchoscopy using the pulmonary artery agreed with the actual biopsy routes in 30 cases (85.7%), but those reconstructed on virtual bronchoscopy alone agreed in only eight cases (22.9%) (p0.001, chi-square test).Enhanced virtual bronchoscopy using the pulmonary artery is feasible and helpful for ultraselective transbronchial lung biopsy of small nodules in the lung.

The purpose of this study was to determine clinical roles for 3D CT hepatic venography in the evaluation of peripheral hepatic venous anatomy during living-donor liver transplantation.Subjects comprised 54 donors (age range, 20-60 years) who had undergone surgery to donate a liver for transplantation. Visualization of each hepatic venous branch and total visualization using 3D CT hepatic venography were evaluated. Maximum venous branch order visualized was graded as nil, first branch, second branch, or third branch or more. The distance between the hepatic surface and the tip of each hepatic venous branch was classified as 0-5 mm, 6-10 mm, 11-15 mm, 16-20 mm, or 21-25 mm. Quality of total 3D CT hepatic venography was evaluated subjectively as poor, good, fair, or excellent. Dominance of large hepatic veins in the right lobe, peripheral branching pattern of the middle hepatic vein, and branching pattern of the vein draining segment IVb were also assessed.Most hepatic venous branches (96.2% [275/286]) were visualized up to at least the second-order branches, and 93.7% (268/286) of branches were within 10 mm of the hepatic surface. As for total visualization, 98% (53/54) of cases were regarded as excellent. The dominant vein in the right lobe was the right hepatic vein in 27 cases, inferior hepatic vein in 25, and middle hepatic vein in one. The branching pattern of the middle hepatic vein was type 1 in 36 cases, type 2 in nine, and type 3 in eight. Segment IVb vein branched from the middle hepatic vein in 20 patients, and from the left hepatic vein in 34.Because 3D CT hepatic venography visualizes peripheral hepatic venous branches in detail, the technique is useful for determining operative indications in living-donor liver transplantation.

Study objectives We evaluated the feasibility, safety, and efficacy of CT-guided transbronchial biopsy (TBB) using an ultrathin bronchoscope with navigation by virtual bronchoscopy (VB) for small peripheral pulmonary lesions of Design A pilot study. Setting A national university hospital. Patients We performed CT-guided TBB after VB navigation for 25 patients with 26 small peripheral pulmonary lesions (average diameter, 13.2 mm) between June 1, 2001, and October 31, 2002. Of the 26 lesions, 10 were in the right upper lobe, 2 were in the right middle lobe, 6 were in the right lower lobe, and 8 were in the left upper lobe. Nineteen lesions were not detected on chest radiographs. Interventions VB images were reconstructed from helical CT scans. CT-guided TBB was performed using an ultrathin bronchoscope after studying the VB image. Results CT-guided TBB was performed safely without any complications for all patients. The bronchi seen under VB imaging were highly consistent with the actual bronchi confirmed using an ultrathin bronchoscope. The ultrathin bronchoscope was inserted between the fifth and eighth generation bronchi. The average durations of the initial scan, the first biopsy, and the total examination were 5.46, 12.96, and 29.27 min, respectively. Seventeen lesions (65.4%) were diagnosed from pathology examinations (primary lung cancers, 13; atypical adenomatous hyperplasia, 1; metastatic cancer, 1; sarcoidosis, 1; and nontuberculous mycobacteriosis, 1). Diagnoses were not obtained for the remaining lesions due to an insufficient number of specimens (six specimens) or to the inability to reach the lesions even using the ultrathin bronchoscope (three specimens). Conclusions In summary, CT-guided TBB using an ultrathin bronchoscope with VB navigation was safely performed and was effective for diagnosing small peripheral pulmonary lesions.

Background: Accurate staging of mediastinal and hilar lymph nodes is a critical factor determining operability in patients with non-small cell lung cancer (NSCLC). Positron emission tomography with 2-[18F] fluoro-2-deoxy-D-glucose as a tracer (FDG-PET) has recently been reported to be more effective in detecting tumor involvement in mediastinal and hilar lymph nodes than computed tomography (CT). Objective: In this study, we analyzed the accuracy of FDG-PET in mediastinal and hilar lymph node staging in patients with NSCLC and the factors associated with false-positive or false-negative FDG-PET findings in mediastinal and hilar lymph node staging. Methods: Fifty-four patients with NSCLC who underwent preoperative analysis including chest CT and whole-body FDG-PET were evaluated retrospectively. Using FDG-PET, lesions were considered to be positive if a definite, localized area of higher uptake, excluding physiologic uptake, than in surrounding normal tissue was present. On CT findings, lymph nodes were considered to be positive if they were >10 mm in short-axis diameter, except subcarinal lymph nodes (#7), which were considered to be positive if they were >15 mm in short-axis diameter. All patients underwent surgical resection of primary tumors and mediastinal and hilar lymph nodes between 1999 and 2001 in our institute. Resected lymph nodes were histologically examined for the existence of tumor cells. Results: A total of 306 lymph nodes were resected and used for analysis. The sensitivity, specificity, positive predictive value and negative predictive value of FDG-PET were 73, 98, 70 and 98%, while those of CT were 55, 96, 55 and 96%, respectively. When pre-operative nodal staging was compared with post-operative histopathological staging, 44 patients (81%) were correctly staged, 7 (13%) were overstaged and 3 (6%) were understaged by FDG-PET, while 39 patients (72%) were correctly staged, 8 (15%) were overstaged and 7 (13%) were understaged by CT. All 7 overstaged patients by FDG-PET had other pulmonary complications, including interstitial pneumonitis (n = 2), previous pulmonary tuberculosis (n = 3), silicosis (n = 1) and emphysema (n = 1), although they were not in the active stage. In 3 understaged patients by FDG-PET, lymph nodes were also undetectable by CT. Conclusion: FDG-PET is superior to CT in mediastinal and hilar lymph node staging of patients with NSCLC. However, care should be taken in lymph node staging for patients who have other pulmonary complications, including interstitial pneumonitis, previous pulmonary tuberculosis and silicosis.

Fulminant hepatic failure is associated with a high mortality rate. Thus, accurate assessment of hepatic functional reserve and hepatic regeneration is important. We describe a 67-year-old woman who survived subacute hepatic failure. We had an opportunity to monitor the clinical course of the patient using single photon emission computed tomography (SPECT) with 99mTc-galactosyl-human serum albumin (99mTc-GSA) and frequent hematological examinations. On admission, prothrombin time was remarkably prolonged (23.1% of control). The liver uptake of 99mTc-GSA was also considerably low. She responded well to treatment. Four weeks after admission, SPECT analysis showed a dramatic increase in liver uptake of 99mTc-GSA, suggesting promotion of hepatic regeneration. Moreover, functional liver volume calculated from the SPECT data showed a marked increase at 4 weeks after admission, whereas CT scan showed no change at that point. This indicated that SPECT with 99mTc-GSA reflected functional hepatocytes more accurately than liver volume determined by CT scan, which cannot exclude nonfunctional hepatocytes. The patient's condition improved in parallel with the improvements in the indices measured by SPECT and hematological examinations. SPECT analysis is practically useful for the prompt assessment of improvement in patients with fulminant hepatic failure.

We have recently developed new software to obtain longitudinal images and accurate short axis images of airways with an inner diameter > 2 mm located anywhere in the lung, using curved multiplanar reconstruction. Using this software, we demonstrated in patients with COPD that FEV1 (%predicted) was highly correlated with airway dimensions and the correlation coefficients improved as the airway became smaller in size (3). In this study, our aims are to further confirm the significant relationship between airway dimensions and airflow limitation in larger number of subjects, and to examine the relationship of airway dimensions with lung volumes in 95 patients with COPD (stage 0, 10; stage I, 23; stage II, 35; stage III, 24; stage IV, 3). We analyzed the airway dimensions from the 3rd to the 6th generations of the apical bronchus (B1) of the right upper lobe and the anterior basal bronchus (B8) of the right lower lobe. Lung volumes were measured by the helium closed circuit method. Both airway luminal area (Ai) and wall area percent (WA%) of all the generations, except a few, from the two bronchi were significantly correlated with RV and RV/TLC, but not with TLC or FRC. More importantly, the correlation coefficients (r) between airway dimensions and RV/TLC improved as the airways became smaller in size from the 3rd to 6th generations in both bronchi (r = −0.483, −0482, −0.553, −0.624 for Ai of B8; r = 0.316, 0.380, 0.499, 0.551 for WA% of B8). These findings provide further evidence that distal (small) airways rather than proximal (large) airways are the determinants for airflow limitation in COPD.

To evaluate the relationship between renal cortical volume, measured by an automatic contouring software, with body mass index (BMI), age and renal function.The study was performed in accordance to the institutional guidelines at our hospital. Sixty-four patients (34 men, 30 women), aged 19 to 79 years had their CT scans for diagnosis or follow-up of hepatocellular carcinoma retrospectively examined by a computer workstation using a software that automatically contours the renal cortex and the renal parenchyma. Body mass index and estimated glomerular filtration rate (eGFR) were calculated based on data collected. Statistical analysis was done using the Student t-test, multiple regression analysis, and intraclass correlation coefficient (ICC).The ICC for total renal and renal cortical volumes were 0.98 and 0.99, respectively. Renal volume measurements yielded a mean cortical volume of 105.8cm(3)±28.4SD, mean total volume of 153cm(3)±39SD and mean medullary volume of 47.8cm(3)±19.5SD. The correlation between body weight/height/BMI and both total renal and cortical volumes presented r=0.6, 0.6 and 0.4, respectively, p0.05, while the correlation between renal cortex and age was r=-0.3, p0.05. eGFR showed correlation with renal cortical volume r=0.6, p0.05.This study demonstrated that renal cortical volume had a moderate positive relationship with BMI, moderate negative relationship with age, and a strong positive relationship with the renal function, and provided a new method to routinely produce volumetric assessment of the kidney.

For lung cancer patients with poor pulmonary function because of emphysema or fibrosis, it is important to predict the amplitude of internal tumor motion to minimize the irradiation of the functioning lung tissue before undergoing stereotactic body radiotherapy.Two board-certified diagnostic radiologists independently assessed the degree of pulmonary emphysema and fibrosis on computed tomography scans in 71 patients with peripheral lung tumors before real-time tumor-tracking radiotherapy. The relationships between the computed tomography findings of the lung parenchyma and the motion of the fiducial marker near the lung tumor were investigated. Of the 71 patients, 30 had normal pulmonary function, and 29 had obstructive pulmonary dysfunction (forced expiratory volume in 1 s/forced vital capacity ratio of70%), 6 patients had constrictive dysfunction (percentage of vital capacity80%), and 16 had mixed dysfunction.The upper region was associated with smaller tumor motion, as expected (p = .0004), and the presence of fibrosis (p = .088) and pleural tumor contact (p = .086) were weakly associated with tumor motion. The presence of fibrotic changes in the lung tissue was associated with smaller tumor motion in the upper region (p.05) but not in the lower region. The findings of emphysema and pulmonary function tests were not associated with tumor motion.Tumors in the upper lung region with fibrotic changes have smaller motion than those in the upper region of the lungs without fibrotic changes. The tumor motion in the lower lung region was not significantly different between patients with and without lung fibrosis. Emphysema was not associated with the amplitude of tumor motion.

The present research was conducted to establish the normal splenic volume in adults using a novel and fast technique. The relationship between splenic volume and age, gender, and anthropometric parameters was also examined.The splenic volume was measured in 230 consecutive patients who underwent computed tomography (CT) scans for various indications. Patients with conditions that have known effect on the spleen size were not included in this study. A new technique using volumetric software to automatically contour the spleen in each CT slice and quickly calculate splenic volume was employed. Inter- and intra-observer variability were also examined.The average splenic volume of all the subjects was 127.4+/-62.9 cm(3), ranging from 22 to 417 cm(3). The splenic volume (S) correlated with age (A) (r=-0.33, p0.0001), body weight (W) (r=0.35, p0.0001), body mass index (r=0.24, p0.0001) and body surface area (BSA) (r=0.31, p0.0001). The age-adjusted splenic volume index correlated with gender (p=0.0089). The formulae S=W[6.47A(-0.31)] and S=BSA[278A(-0.36)] were derived and can be used to estimate the splenic volume. Inter- and intra-observer variability were 6.4+/-9.8% and 2.8+/-3.5% respectively.Of the anthropometric parameters, the splenic volume was most closely linked to body weight. The automatically contouring software as well as formulae can be used to obtain the volume of the spleen in regular practice.

Purpose: Internal fiducial gold markers, safely inserted with bronchoscopy, have been used in real-time tumor-tracking radiotherapy for lung cancer. We investigated the histopathologic findings at several points after the insertion of the gold markers. Methods and Materials: Sixteen gold markers were inserted for preoperative marking in 7 patients who subsequently underwent partial resection of tumors by video-assisted thoracoscopic surgery within 7 days. Results: Fibrotic changes and hyperplasia of type 2 pneumocytes around the markers were seen 5 or 7 days after insertion, and fibrin exudation without fibrosis was detected 1 or 2 days after insertion. Conclusions: Because fibroblastic changes start approximately 5 days after gold marker insertion, real-time tumor-tracking radiotherapy should be started >5 days after gold marker insertion.

The asialoglycoprotein receptor (ASGPR) is abundantly expressed on the sinusoidal surfaces of hepatocytes. However, regional expression and clinical significance of the ASGPR in acute hepatic damage is presently unknown. Our aim was to clarify the clinical significance of the regional expression of ASGPR in human livers with acute hepatitis (AH) and fulminant hepatic failure (FHF). Eighteen volunteers, 42 patients with AH and 10 with FHF were studied using a newly developed, conventional 99mTc-GSA SPECT analysis. Using Cantlie's line as a guide, ASGPR expression was analyzed separately in the right and left hepatic lobes, as well as in the whole liver, using novel indices (the liver uptake ratio [LUR] and liver uptake density [LUD], which reflect the amount and density of ASGPRs in the liver, respectively). Mean LUR and LUD values for the whole liver and the right and left lobes decreased in accordance with the severity of acute hepatic damage. In the FHF group, the reduction in LUR and LUD values in the right lobes was more significant than in the left lobes. The LUR and LUD values for the whole liver correlated well with hepatic functional reserve and total bilirubin levels. The right LUR and LUD values in particular correlated well with these parameters. A time-course observation of 13 patients with either AH or FHF revealed that the expression of ASGPRs in the right lobe recovered faster than in the left. We first evaluated the regional expression of AGSPRs by 99mTc-GSA SPECT analysis in both AH and FHF patients, which is a clinically useful and reliable indicator for assessing the severity of regional hepatic damage and evaluating regional liver regeneration.

Study objectives We evaluated the feasibility, safety, and efficacy of transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS) and virtual bronchoscopy (VB) navigation for small peripheral pulmonary lesions ≤ 30 mm in diameter. Design Pilot study. Setting A national university hospital. Patients We performed TBB using EBUS-GS with VB navigation for 29 patients with 30 small peripheral pulmonary lesions (average diameter, 18.6 mm) between January 1, 2004, and August 31, 2004. Interventions VB images were reconstructed from helical CT data. TBB was then performed using EBUS-GS with VB navigation. Results In all patients, TBB was performed safely with no complications. Bronchi seen on VB imaging were highly consistent with the actual structures confirmed using fiberoptic bronchoscopy. Following VB navigation, the endobronchial ultrasonography (EBUS) probe was inserted into third-to sixth-generation bronchi. Twenty-four lesions (80%) were visualized on EBUS images. Average durations of the initial EBUS examination of lesions, first biopsy, and the total procedure were 9.56 min, 11.99 min, and 25.72 min, respectively. Nineteen lesions (63.3%) were diagnosed from histopathologic or cytologic examination. Diagnostic sensitivities were 44.4% (8 of 18) for lesions Conclusions In summary, TBB using EBUS-GS with VB navigation was safely performed and was effective in diagnosing small peripheral pulmonary lesions.

The usefulness of endobronchial ultrasonography (EBUS) with guide-sheath (GS) as a guide for transbronchial biopsy (TBB) for diagnosing peripheral pulmonary lesions (PPL)s and for improving diagnostic accuracy was evaluated in this study. EBUS-GS-guided TBB was performed in 24 patients with 24 PPLs of < or =30 mm in diameter (average diameter=18.4 mm). A 20-MHz radial-type ultrasound probe, covered with GS was inserted via a working bronchoscope channel and advanced to the PPL in order to produce an EBUS image. The probe with the GS was confirmed to reach the lesion by EBUS imaging and X-ray fluoroscopy. When the lesion was not identified on the EBUS image, the probe was removed and a curette was used to lead the GS to the lesion. After localising the lesion, the probe was removed, and TBB and bronchial brushing were performed via the GS. Nineteen peripheral lesions (79.2%) were visualised by EBUS. All patients whose PPLs were visible on EBUS images subsequently underwent an EBUS-GS-guided diagnostic procedure. A total of 14 lesions (58.3%) were diagnosed. Even when restricted to PPLs

The asialoglycoprotein receptor (ASGPR) is abundantly expressed on the sinusoidal surfaces of hepatocytes. We aimed to clarify the clinical significance of the regional distribution of ASGPRs in the human liver, especially in chronic viral hepatitis. Eighteen volunteers, 34 patients with chronic hepatitis, and 33 patients with cirrhosis (11/Child-Pugh A, 11/Child-Pugh B, 11/Child-Pugh C) were studied using a newly developed, conventional technetium-99m-diethylenetriaminepentaacetic acid-galactosyl human serum albumin (99mTc-GSA), single photon emission computed tomography (SPECT) method. Using Cantlie's line as a guide, ASGPR dynamics were analyzed separately in the right and left lobes, as well as in the whole liver, using novel indices (the liver uptake ratio [LUR] and the liver uptake density [LUD], which reflect the amount and density of ASGPRs in the liver, respectively). Mean LUR and LUD values for the whole liver and the right and left lobes decreased with increasing progression of chronic viral hepatitis. The LUR for the whole liver correlated well with parameters measuring the hepatic functional reserve and the platelet count. The right LUR correlated particularly well with conventional liver function tests, and comparison of the right LUD with histologic findings showed that it was a good indicator of periportal and/or bridging necrosis and fibrosis. In conclusion, our 99mTc-GSA SPECT method was clinically useful in evaluating regional hepatic function and the progression of chronic viral hepatitis using dynamic changes in ASGPRs. (Hepatology 2003;38:1401-1409.)

A 65-year-old man was admitted to our hospital because multiple small nodular shadows measuring five to 12 mm in diameter in both lung fields were noticed on chest radiographs and CT scans during a regular checkup for pulmonary emphysema. The levels of ESR and CRP were within normal limits, but those of CEA and CYFRA were slightly elevated. Mycobacterium avium (M. avium) was detected in sputum cultures and in a sputum examination using PCR. Non-necrotizing granulomas were detected in the specimens obtained from a lesion of the right S6b by CT-guided transbronchial biopsy using an ultrathin bronchoscope after navigation with virtual bronchoscopy. On the basis of these findings, M. avium pulmonary disease was diagnosed. The patient is being followed up, but because he has no symptoms, without medication. To our knowledge, there have been no previous reports of M. avium-intracellulare complex pulmonary disease, which is characterized by multiple small nodular shadows. It is speculated that multiple centrilobular lesions developed simultaneously without extension to the bronchial walls, leading in this case to multiple small nodules in both lung fields.

We diagnosed unroofed coronary sinus preoperatively by the 3D volume rendering and endocardial views with 64-slice MDCT, and those clearly showed the defect of the roof of the coronary sinus and the relationship with the surrounding structure. MDCT is a good non-invasive tool for the evaluation of unroofed coronary sinus, and the reconstructed endocardial view is useful for preoperative surgical planning.

7242 Background: It is critical issues to obtain the proper and sufficient amounts of tissue samples of lung cancer when it is diagnosed, and examine the expressions and mutations of target molecul...