Objective: To evaluate the results of a thoracoabdominal hepatectomy and a transdiaphragmatic hepatectomy for hepatocellular carcinoma in patients with impaired liver function.
We report 2 cases of orbital non-Hodgkin's lymphoma (NHL) with hemophagocytic syndrome (HPS). Patient 1 was a 64-year-old man with a diagnosis of peripheral T-cell lymphoma originating in the right orbita (clinical stage: IV B). Epstein-Barr virus DNA was demonstrated in tissue specimens by polymerase chain reaction. Laboratory findings on admission were WBC: 4,700/microliter, Hb: 12.1 g/dl, Plt: 14.6 x 10(4)/microliter, LDH: 951 IU/l, sIL-2R: 2,553 IU/ml, and ferritin: 5998.1 ng/ml. Patient 2 was a 73-year-old man with a diagnosis of diffuse large B-cell lymphoma originating in the right orbita (Clinical stage: IV B). Laboratory findings on admission were WBC: 9,100/microliter, Hb: 7.7 g/dl, Plt: 15.4 x 10(4)/microliter, LDH: 1,043 IU/l, sIL-2R: 10,090 IU/ml, and ferritin: 2079.3 ng/ml. Both patients had high-grade fever and extremely high serum cytokine levels. Bone marrow aspiration disclosed many histiocytes with hemophagocytosis. In both cases, combined chemotherapy was transiently effective, but patient 1 died of relapse of HPS and patient 2 of cerebral bleeding. Orbital non-Hodgkin's lymphoma with HPS is rare. These cases were interesting in terms of the relationship between HPS and the primary site of lymphoma.
In an attempt to ascertain for possible facilitation of tumor metastasis after hepatectomy, a series of experiments was carried out using the RBT-1 carcinoma.The animals were separated into three groups: Group A, received no treatments, Group B, received a sham operation, and Group C underwent partial hepatectomy. Three groups had viable tumor cell injected into the tail vein after the treatment.The mean survival periods in Group A, B, and C were 32.7, 28.8, and 24.8 days, respectively. When a comparison was made with all groups, survival time was significantly shorter in Group B and C than Group A (p < 0.01), and in Group C, compared with Group B (p < 0.05). Fourteen days after initial injection of RBT-1 tumor ten rats in each group were sacrificed and their lungs were assessed for evidence of metastatic spread of tumor. The mean number of metastatic nodules in Group A, B, and C were 5.1, 11.5, and 49.8, respectively. The number of metastatic nodules in the lungs was significantly increased in Group B (p < 0.05) and C (p < 0.01), compared to Group A, and in Group C, compared with Group B (p < 0.01). The facilitation of metastasis by surgical treatment was examined in relation to serum adrenocortical hormones. After the treatment, serum corticosterone levels were transiently increased in Group B (p < 0.01) and C (p < 0.01), compared to Group A, and in Group C (p < 0.01), compared with Group B.These results are taken to mean that facilitation of tumor metastasis after hepatectomy was possibly increased.
In radiotherapy, setup precision has great influence on the therapeutic effect. In addition, body movements during the irradiation and physical alternations during the treatment period might cause deviation from the planned irradiation dosage distribution. Both of these factors could undesirably influence the dose absorbed by the target. In order to solve these problems, we developed the "body surface navigation and monitoring system" (hereafter referred to as "Navi-system"). The purpose of this study is to review the precision of the Navi-system as well as its usefulness in clinical radiotherapy. The Navi-system consists of a LED projector, a CCD camera, and a personal computer (PC). The LED projector projects 19 stripes on the patient's body and the CCD camera captures these stripes. The processed image of these stripes in color can be displayed on the PC monitor along with the patient's body surface image, and the digitalized results can be also displayed on the same monitor. The Navi-system calculates the height of the body contour and the transverse height centroid for the 19 levels and compares them with the reference data to display the results on the monitor on a real-time basis. These results are always replaced with new data after they are used for display; so, if the results need to be recorded, such recording commands should be given to the computer. 1) Evaluating the accuracy of the body surface height measurement: from the relationship between actual height changes and calculated height changes with torso surface by the Navi-system, for the height changes from 0.0 mm to ± 10.0mm, the changes show the underestimation of 1.0-1.5 mm and for ± 11.0mm to ± 20.0 mm, the underestimation of 1.5-3.0 mm. 2) Evaluating the accuracy of the transverse height centroid measurement: displacement of the inclined flat panel to the right by 5.0 mm, 10.0 mm, 15.0 mm and 20.0 mm showed the transverse height centroid calculated by the Navi-system for 0.024 ± 0.007 line/pair (mean ± SD), 0.045 ± 0.006 line/pair, 0.066 ± 0.006 line/pair and 0.089 ± 0.007 line/pair, respectively. Also, displacement of the inclined flat panel to the left by 5.0 mm, 10.0 mm, 15.0mm and 20.0 mm showed the transverse height centroid calculated by the Navi-system for 0.015 ± 0.007 line/pair (mean ± SD), 0.034 ± 0.007 line/pair, 0.053 ± 0.008 line/pair and 0.071 ± 0.007 line/pair, respectively. 3) Clinical usefulness of the Navi-system: on using the Navi-system, the frequency of radiotherapy replanning increased from 5.2% to 21.8%, especially in pelvic or abdominal irradiation. We developed a new navigation system for the purpose of compensating for the weakness of MVCT, CBCT and other systems, as well as for having a screening function. This Navi-system can monitor the patient continuously and measure change in height of the patient's body surface from the basic plane, in real time. It can also show the results both qualitatively and quantitatively on the PC monitor.
急性肝不全(ALF)を中心として各種肝疾患において,血管内皮細胞の障害のマーカーであるThrombomodulin (TM)を測定し,臨床的意義を検討した.急性肝不全では,血清中TM濃度は急性肝炎に比し有意に上昇していた.また血清中TM濃度は血清クレアチニン濃度と有意の相関を示していた.そこで腎不全のない時点での急性肝疾患の血清中TM濃度を比較すると,やはり急性肝不全では,急性肝炎に比し有意に上昇していた.しかし播種性血管内凝固症候群(DIC)のマーカーであるトロンビン・アンチトロンビンIII複合体(Thrombin・Antithrombin III complex, TAT)とは相関はみられなかった.このことから,血清中TM濃度は急性肝不全の進展を把握するマーカーになりうると推定された.さらに今後,肝静脈血中のTMを測定しTATとの関連を検討することで,障害発現のメカニズムを解明していく必要があると考えられた.
