[en] Prostate movements are problematic for radiotherapy with its associated tight margins and dose escalation. The daily prostate position is influenced by the bladder and rectal volumes, and one of the most problems with dose escalation is that of rectal injury. Recently, image-guided radiotherapy using computed tomography (CT/LINIAC) has been developed in Japan. This new integrated CT/LINIAC combination, in which the CT scanner is inside the radiotherapy treatment room and the same patient couch is used for CT scanning and treatment, should allow for accurate correction of interfractional setup errors. Taking advantage of such a machine, we decided to treat prostate cancer using CT/LINIAC system with tracking of the daily prostate motion for the consecutive fifteen sessions of each patient (total: 35 patients/525 sessions). The purpose of this study was to measure the overall precision of this system when compared with conventional skin marking system for radiotherapy of prostate cancer. From our investigations, we conclude that the technical development of CT/LINIAC system bears an enormous potential for the correction of interfractional treatment errors, and this technology can be generalized to the treatment of other tumors in the body, especially if the treatment target is subjected to daily interfractional internal organ motion. (author)

[en] CT established the diagnosis of urolithiosis, which was hardly seen on x-ray, in three cases. CT was useful for the visualization of stones negative on x-ray films and urinary stones difficult to diagnose because of their overlap with the pelvic bones, and in the selection of the route of arrival at stones during surgery. (Chiba, N.)

[en] We examined fifteen cases with focal fluorodeoxyglucose (FDG) uptake in the thyroid gland detected by FDG-positron emission tomography (PET) screening for cancer. Examination of the thyroid gland was carried out by using computer tomography, ultrasound sonography, laboratory test and fine needle aspiration cytology (FNAC). Surgical operation was performed to the patient who was suspected of having thyroid cancer by FNAC or clinical findings. Thyroid cancer was histologically confirmed in 4 cases. Malignancy was not ruled out by FNAC in one patient. Seven patients were suspected of having benign thyroid tumor (adenoma, adenomatous goiter). Three patients were diagnosed with thyroiditis (Hashimoto thyroiditis, subacute thyroiditis, painless thyroiditis) by laboratory tests. It was not easy to differentiate between cancer and benign diseases only by FDG-PET. However, it was useful to detect thyroid tumor especially if the tumor is hardly palpable. FDG-PET was also valuable as a diagnostic imaging technique to evaluate metastasis and the extent of cancer. (author)

[en] The purpose of this study was to optimize the image reconstruction interval in helical CT of liver for improving the detectability of a small tumor. The target size and contrast were defined to be 8-10 mm and 0.5-1%, respectively. Experiments were conducted with CT apparatus GE Yokogawa ProSeed SA and with phantoms of a hemisphere (Φ8 mm, absorption difference 0.3-1.0%, for rapid CT assessment) and a micro-sphere (Φ0.5 mm, made by authors). Helical CT was done with slice thickness of 7 or 10 mm. Position dependency of the contrast was shown to be accompanied by shape change of slice sensitivity profile and reconstruction with 1/2 slice thickness was shown to give the sufficient image information along the body axis. To detect 8 mm sphere mass, reconstruction with 7 mm thickness was shown desirable. (K.H.)

[en] The usefulness of MR mammography (MRM) in breast-conserving therapy was evaluated. The intraductal spread (IDS) is a serious problem in breast-conserving therapy, because it is well-known that IDS frequently causes local recurrence in preserved breast. A 1.5 T MR imager was used with a dedicated breast coil. The MR findings of breast cancer were irregular shape, inhomogenious structure, hyperenhancement in early phase of dynamic study and ringed enhancement. IDS was manifested by linear and band-like enhancements in MRM. Nodular enhancements away from main lesion were suggestive of daughter nodules. MRM was a useful method for detecting IDS and daughter nodules in breast cancer. (author)

[en] We reported the results of 16 cases of sentinel lymph node biopsy (SLNB) using tin colloid, between Sept/1998 and Aug/1999. Our method was: injection of ¹³¹Tc Tin colloid 40 Mbeq/4 ml around the breast cancer, 6 hours prior to the biopsy, detection by γ-scintillation camera, 2 hours prior to the biopsy, operation using γ-probe (NAVIGATOR), serial pathological examination of SLN using cytokeratin. Sentinel lymph node (SLN) was detected 11 cases (69.8%). SLN was poorly detected in the cases of post menopausal patient and the cases which tumor was located at the medial side of the breast. In 8 cases (50%) we can avoid axillar dissection, totally. Our detection rate of SLN was not so high comparing to other reports. We will try to detect SLN much, using tin colloid together with dye or saline. (author)

[en] We have treated 5 cases of sacral radiation ulcer surgically. All patients with cervical or vulval cancer were treated with external radiotherapy more than 20 years ago. Three patients have rectovaginal fistulas and four patients have osteoradionecrosis of the sacrum. Fecal and/or urinary diversion were accomplished preoperatively in four patients. After debridement of ulcers, these defects were covered by pedicled musculocutaneous flaps. In two of five, marginal necrosis was seen in a great saphenous veno-neuro accompanying artery fasciocutaneous flap and an inferior gluteus maximus musculocutaneous flap. In two of five, seroma was seen. One patient died of the sepsis from pelvic infection with rectal fistula. Among the other four patients, there was no recurrence during the follow up period. The principle for surgically treating radiation ulcer is to completely resect all radionecrotic tissues and cover these defects with well vascularized tissues. It is useful to distinguish damaged tissue from health tissue by MRI. In a case having a rectovaginal fistula, it is recommended that fecal and urinary diversion will be done at first and debridement of ulcer and reconstructive surgery will be done later. (author)

[en] In 2 years and 5 months from April 1980 to May 1982, I had maked examination for computed tomography (CT) in head region by TCT-60A (TOSHIBA), and so reported the evaluation of following those results; 1) The number of CT scan was 1228 patients and total 1513 scannings. The contents of its scan were plain CT (86.1%), CE (contrast enhancement) CT (7.3%) and both application methods (6.6%), and included from 1 CT time (85.3%), 2 CT times (9.6%), 3 CT times (3.3%),... til 7 CT times. Our CT scan cases were 720 males (58.6%) and 508 females (41.4%);its scan age level was mostly 40 y.o. -- over 70 y.o., but low age patients (under 10 y.o.) indicated number of 15.3%. In consideration of this fact the advantage of CT scan was very easily and safely procedure free from body lesion. 2) In number of CT scan: the most many patients were visiting department of internal medicine clinic, and following pediatric clinic, surgery and orthopedic department. Above all CT scan cases were included of other all clinical departments in our hospital. (CT scan was very useful for neurological examination). 3) In CT diagnosis our cases were it of cerebral infarction 128 (10.4%), cerebral hemorrage 19 (1.5%) and brain tumor 24 (2.3%), in small cases other craniocerebral diseases. 4) The visiting cases in internal medicine often complain of cerebrovascular symptomes, and in pediatric clinic chief complain was often suspected mental retardation and neurological sign. In surgery department it was suspected metastatic brain tumor from other malignant cancers, and in orthopedic surgery often skull injury or traffic accident. (J.P.N.)

[en] The cardiac sympathetic nervous system function of diabetic patients with no definite cardiovascular complications other than hypertension was evaluated by ¹²³I -MIBG myocardial scintigraphy. The subjects consisted of 82 diabetic patients, 59 men, 23 women, mean age 57 years, 17 with hypertension and 65 with normal blood pressure, and they were compared with normal controls (8 men and 3 women, mean age 54 years). Myocardial scintigraphy was performed 10 minutes and 4 hours after administration of MIBG. The superior mediastinum and whole myocardium were set as regions of interest, and the heart-to-mediastinum ratio (H/M ratio) and the washout rate (%WR) were calculated. The mean observation period was 18±12 months, and 17 of the 65 diabetic patients with normal blood pressure before the study developed hypertension during the observation period. There were significant differences in H/M ratio and %WR between the diabetic patients and normal controls (H/M ratio; 1.96±0.34 vs 2.27±0.20, %WR; 24.71±16.99% vs 12.89±11.94). The diabetic patients with hypertension had higher morbidity with diabetic retinopathy and a lower H/M ratio. The 17 patients who developed hypertension during the observation period showed an increase in %WR and a reduction in the H/M ratio. Five patients who died during the observation period had a reduced H/M ratio and increased of %WR. ¹²³I-MIBG myocardial scintigraphy in diabetic patients was shown to be useful for detecting cardiac sympathetic nervous system dysfunction, predicting the development of hypertension, and identifying patients who had a poor outcome. Diabetic patients with abnormal signals on MIBG myocardial scintigraphy need to be monitored much more carefully. (K.H.)

[en] Between April 2002 and December 2005, we treated 15 patients who were suffering from pre-sacral recurrence of rectal cancer with or without liver metastases, using multi-portal irradiation and oral intake of tegafur-uracil (UFT) (300 mg/day), to assess pain relief and local control. Radiation therapy was given 2.1 to 2.4 Gy daily fractions, and total tumor dose was set up at a landmark of 66 Gy/30 fractions/6 weeks (time-dose-fractionation (TDF)=115, corresponding to 70 Gy), varying by recurrent tumor volume. The follow-up time was ranged from 3 to 37 months (median=14.7 months), and median survival was 14.8 months. Pain remission time was 3 to 36 months (median=10.4 months). No severe morbidity which induced by radiation therapy was observed in follow-up duration. The median survival has become unfavorite, but the multi-portal irradiation of high dose delivery is useful for improvement of quality of life (QOL) and beneficial as a palliative therapy. To improvement of local control and prognosis, combined modality with more effective regimen of chemotherapy is expected. (author)