Radiotherapy for inoperable and refractory endometriosis presenting with massive hemorrhage: a case report

INTRODUCTION: Many patients with endometriosis are treated with medication or by surgical approaches. However, a small number of patients do not respond to medication and are inoperable because of comorbidities. This case report shows the effectiveness of radiotherapy for refractory endometriosis and includes a time series of serum estradiol levels. CASE PRESENTATION: A 47-year-old Asian woman presented to our facility with uncontrolled endometriosis refractory to medication. Our patient was considered inoperable because of severe idiopathic thrombocytopenic purpura, and underwent radiotherapy for massive genital bleeding requiring blood transfusions. A radiation dose of 20Gy in 10 fractions was delivered to the pelvis, including the bilateral ovaries, uterus, and myomas. An additional 10Gy in five fractions was delivered to the endometrium to control residual bleeding. Genital bleeding was completely inhibited on day 46 after radiotherapy. Hormonal analysis revealed that radiotherapy induced post-menopausal status. Two years after radiotherapy, atypical genital bleeding had not recurred and has been well controlled without side effects. CONCLUSIONS: Disrupted ovarian function is an adverse effect of radiotherapy. However, radiotherapy can be useful for inducing menopause. In cases of medication-refractory or inoperable endometriosis, radiotherapy would be an effective treatment option

POTENCIAL DA TILÁPIA-DO-NILO PARA PROCESSAMENTO EM CONSERVA

A tilápia é um peixe magro de carne branca e com alto teor deproteína. É uma matéria-prima com potencial para o desenvolvimentode produtos de pescado prontos para consumo, tanto para omercado doméstico como para o mercado internacional. Esseartigo de revisão aborda os principais aspectos do processamentode pescado em conserva, desde a recepção da matéria-primaaté o armazenamento do produto fi nal. Destaque foi dado para aevolução da produção nacional de tilápia-do-nilo e sua qualidadepara o processamento em conserva, considerando os métodosde insensibilização, problemas com off -fl avor e o processamentotérmico. Analisando-se os conhecimentos tecnológicos existentesconclui-se que há elementos para o desenvolvimento de pesquisascom resultados promissores

Endometrial Cancer Arising in Adenomyosis That Could Not Be Diagnosed by Endometrial Biopsy: A Case Report

Uterine adenomyosis is an estrogen-dependent tumor and one of the most common benign diseases in sexually mature women. The frequency of endometrial cancer associated with adenomyosis has been reported to be 18%–66%. On the other hand, endometrial cancer arising in adenomyosis (EC-AIA) is extremely rare. EC-AIA is now considered a different entity from and has a worse prognosis than endometrial cancer with adenomyosis (EC-A). In the present study, we report a case of endometrial cancer with adenomyosis in which endometrial biopsy failed to provide a definitive diagnosis. A 63-year-old female patient presented with endometrial thickening. Endometrial cytology was positive, and magnetic resonance imaging (MRI) showed small lesions suggestive of endometrial cancer with shallow invasion and adenomyosis. However, an endometrial biopsy showed only metaplasia, and careful follow-up was initiated. Subsequent endometrial cytology showed enlarged and round nuclei, uniform chromatin distribution, no thickening of nuclear margins, and abundant cytoplasm appearing in a sheet-like arrangement, suggesting atypical cells of endometrial glands with metaplasia. Three suspicious positive results and one positive result were observed, but repeated biopsies did not lead to the diagnosis of malignancy. The patient underwent diagnostic hysterectomy 19 months after the initial visit. The postoperative histopathological diagnosis was stage IA endometrial cancer (endometrioid carcinoma G1). This case of endometrial cancer associated with adenomyosis was difficult to diagnose. Our findings demonstrate that EC-AIA should be considered even if no lesions were detected by endometrial biopsy

Difference of signal change by a language task on autistic patients using functional MRI

[Objective] Cerebral function with a language task was evaluated by functional magnetic resonance imaging (fMRI), and the differences of activated pattern and signal changes were compared between autistic patients and normal controls. [Methods] Ten autistic and ten normal subjects were tested by fMRI with a language task requiring the attribution of complex mental states. Activation maps analyzed between two groups were generated and the asymmetry indexes calculated by the quotient of activated pixels of the right frontal lobe divided by those of the left frontal lobe were statistically compared by unpaired t-test. [Results] Both the autistic and the normal subjects showed activation at the bilateral prefrontal cortical areas and the ventral occipito-temporal regions. However, the autistic patients demonstrated more activation at the right frontal lobe than the normal controls. Thus it was considered that in the autistic patients the right-hemisphere was more dominant for the language task than that of the normal controls. The result is consist to the theory that autism is related to early left-hemisphere dysfunction. [Conclusions] We considered that fMRI may be a useful non-invasive method to evaluate the cerebral functional abnormality in autistic patients

A New Deep State-Space Analysis Framework for Patient Latent State Estimation and Classification from EHR Time Series Data

Many diseases, including cancer and chronic conditions, require extended treatment periods and long-term strategies. Machine learning and AI research focusing on electronic health records (EHRs) have emerged to address this need. Effective treatment strategies involve more than capturing sequential changes in patient test values. It requires an explainable and clinically interpretable model by capturing the patient's internal state over time. In this study, we propose the "deep state-space analysis framework," using time-series unsupervised learning of EHRs with a deep state-space model. This framework enables learning, visualizing, and clustering of temporal changes in patient latent states related to disease progression. We evaluated our framework using time-series laboratory data from 12,695 cancer patients. By estimating latent states, we successfully discover latent states related to prognosis. By visualization and cluster analysis, the temporal transition of patient status and test items during state transitions characteristic of each anticancer drug were identified. Our framework surpasses existing methods in capturing interpretable latent space. It can be expected to enhance our comprehension of disease progression from EHRs, aiding treatment adjustments and prognostic determinations.Comment: 21 pages, 6 figure

Analysis of Factors Regarding Spa Therapy in Patients with Rheumatoid Arthritis

1998年4月より9月までの6ヶ月間に当院へ入院し温泉療法をうけた慢性関節リウマチ患者6例を対象に,温泉治療経験の有無,年齢,機能障害度(クラス),罹患年数の4項目が温泉療法効果に及ぼす影響につき検討した｡温泉治療経験の有無では治療経験を有する患者においてMHAQ(modified health assessment questionnaile),患者による疼痛評価,患者による全般活動性評価に有意な改善が見られ,年齢(75才以上,75才未満)では,75才未満においてMHAQに有意な改善傾向が見られた｡機能障害度(クラス3以上,クラス2以下),罹患年数(15年以上,15年未満)においては有意差は見られなかった｡温泉の永続効果を保つためには,年1～2回の入院を繰り返すことが効果的であることが示唆された｡In patients with rheumatoid arthritis (RA) who received spa therapy (ST) on admission, we examined factors for treatment response. This study included 6 RA patients and the following 4 parameters were investigated: presence or absence of previous ST, age, duration of RA, and grade of the functional disorder. Treatment response was evaluated according to the American College of Rheumatology core set measures. With respect to the presence or absence of previous ST, modified health assessment questionnaire (MHAQ), pain scale and patient global assessments in the group with previous ST were significantly improved compared to those in the group without previous ST. With respect to age, MHAQ in the group consisting of patients less than 75 years old was significantly improved compared to that in the group consisting of patients 75 years old or older. With respect to the grade of the functional disorder (class 2 or lower vs. class 3 or higher) and the duration of RA (less than 15 years vs. 15 years or more), there were no significant differences. These results suggest that repeated therapy is more effective in ST and treatment response may be relatively poor in elderly patients with RA aged over 75 years

ノウソッチュウ チョウキュウセイキ ニオケル ガゾウ シンダン プロトコール

We described our imaging protocol for apoplexy to select a therapeutic way. The recent advance of MR technology much contributes to diagnosis of cerebral ischemic disease. Especially the EPI method is now applied to clinical MR machine and make possible to obtain diffusion-weighted images (DWI) with excellent quality, which can detect super-acute phase of cerebral infarction. Then we choose MRI as the first modality conducted for patients of apoplexy and measured DWI and perfusion MRI before conducting conventional cerebral angiography. The mismatch area between DWI and perfusion MRI will suggest the necessity of re-circulation therapy because rescuable neuronal cells from ischemia will exist in the mismatch area. Furthermore cerebral hemorrhage can be detected using EPI-T2 weighted images and DWI, and the luxury perfusion will be also evaluated by perfusion MRI. Therefore we considered that MR examination could be the first modality conducted for diagnosis of cerebral vascular accident of acute phase

Spontaneous Regression of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus

An 83-year-old man underwent transcatheter arterial chemoembolization (TACE) for a 20-mm hepatocellular carcinoma (HCC) in Couinaud’s segment 4. Computed tomography (CT) 4 months after TACE showed tumor thrombus in the portal vein in addition to diffuse metastases and arterioportal shunts in the left lobe. Although we performed the best supportive care, the tumor thrombus in the portal vein and tumors in the left lobe had completely disappeared on CT 16 months after the TACE. Rapidly grown portal vein tumor thrombus and arterioportal shunt might be the causes of spontaneous regression of HCC, probably associated with tumor hypoxia

Comportamento funcional da CMS reestruturada de tilápia híbrida vermelha / Functional behavior of the restructured red hybrid tilapia CMS

O desenvolvimento de reestruturados de tilápia com incorporação de aditivos extensores se constitui em uma forma de aproveitamento da carne mecanicamente separada (CMS) de tilápia hibrida vermelha ainda não explorada comercialmente no Brasil. O objetivo do trabalho foi avaliar as características funcionais da CMS reestruturada por meio da interação entre os aditivos: sal, tripolifosfato, fécula de mandioca, concentrado protéico de soja, carragena e fibra vegetal.   Foram avaliados o pH, a capacidade de retenção de água, a perda de peso no cozimento e a força de penetração das amostras. A CMS de tilápia híbrida vermelha é uma matéria-prima com elevado teor proteico (média de 12%), elevado teor de lipídeo (média de 15%) e pode ser utilizada para elaboração de diferentes coprodutos de tilápia. O sal (0,7%) e o tripolifosfato (0,35%) são ingredientes que permitiram estabelecer coesão na CMS. A interação entre a proteína concentrada de soja (2,8%), fécula (2%), fibra (4%) e carragena (0,5%) apresentou respostas satisfatórias de rendimento, capacidade de retenção de água e força de penetração (textura) do produto reestruturado. Conclui-se que foi possível obter reestruturados com adição de 100% de CMS de tilápia híbrida vermelha com boas características de processamento, demonstrando a viabilidade de sua produção

Brain Tumor CE on T1-Cube versus 3D SPGR

Purpose: T1-Cube (GE HealthCare) is a relatively new 3-dimensional (3D) fast spin-echo (FSE)-based magnetic resonance (MR) imaging sequence that uses a variable flip angle to acquire gap-free volume scans. We compared the gadolinium enhancement characteristics of a heterogeneous population of brain tumors imaged by T1-Cube and then 3D fast spoiled gradient recall acquisition in steady state (3D FSPGR) 3-tesla MR imaging to identify the superior modality for specific diagnostic purposes. Methods: We examined 61 lesions from 32 patients using the 2 sequences after administration of gadopentetic acid (Gd-DTPA; 0.1 mmol/kg). Two neuroradiologists independently measured each lesion twice using a region-of-interest (ROI) method. We measured the contrast-to-noise ratio (CNR), the difference in signal intensity (SI) between the tumor and normal white matter relative to the standard deviation (SD) of the SI within the lesion, for both post-contrast 3D FSPGR and post-contrast T1-Cube images of the same tumor and compared modality-specific CNRs for all tumors and in subgroups defined by tumor size, enhancement ratio, and histopathology. Results: The mean CNR was significantly higher on T1-Cube images than 3D FSPGR images for the total tumor population (1.85 ± 0.97 versus 1.12 ± 1.05, P < 0.01) and the histologic types, i.e., metastasis (P < 0.01) and lymphoma (P < 0.05). The difference in CNR was even larger for smaller tumors in the metastatic group (4.95 to 23.5 mm2) (P < 0.01). In contrast, mean CNRs did not differ between modalities for high grade glioma and meningioma. Conclusions: Gadolinium enhancement of brain tumors was generally higher when imaged by T1-Cube than 3D FSPGR, and T1-Cube with Gd enhancement may be superior to 3D FSPGR for detecting smaller metastatic tumors