Complete Response to S-1 Monotherapy Over 3 Years in an Elderly Patient with Advanced Non-Small-Cell Lung Cancer

The number of elderly patients with cancer continues to increase.The optimal chemotherapeutic regimen for inoperable non-small-cell lung cancer (NSCLC) in elderly patients, especially over 80 years old, remains controversial.S-1,a newly developed oral fluorouracil antitumor drug,has been reported to be effective in the treatment of gastrointestinal and pancreatic tumors and/or NSCLC. We experienced a case of an elderly patient with advanced-stage NSCLC who responded well to S-1 monotherapy with tolerable toxicities and has had three years of disease-free survival. S-1 appears to have significant activity with mild toxicities for selected elderly NSCLC patients and in our view warrants further clinical study. Shinshu Med J 59 : 321-325, 2011Article信州医学雑誌 59(5): 321-325(2011)departmental bulletin pape

Comparison of Distance of 6-min Walk Test and the Incremental Shuttle Walk Test with Lung Function or Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

Article信州医学雑誌 61(2):57-64(2013)journal articl

Legal Training and Front Line of Criminal Defense

平成30年11月4日（日）に，第12回広島大学ホームカミングデー企画（法科大学院講演会）「刑事弁護の最前線と法曹養成」として，東千田未来創生センターにおいて，弁護士（大阪弁護士会）の亀石倫子氏，弁護士（広島弁護士会）で元広島大学大学院法務研究科教授の久保豊年氏を講師に迎え，第1部では講演会を，第2部では本研究科の新井誠教授，堀田尚徳准教授が加わりパネルディスカッションを開催しました。 本稿は，当日のテープ録音をもとに，その概要を報告するものです。（なお，講演会とパネルディスカッションに引き続き行われた，フロアとの質疑応答については，紙幅の関係上，省略させていただきました。

Dynamic FDG PET / CT in MSLs

We aimed to assess the differential diagnostic efficacy of dynamic F-18 fluorodeoxyglucose (FDG) positron emission tomography / computed tomography (PET / CT) and to evaluate the appropriate scan timings for diagnosis of musculoskeletal lesions (MSLs). Dynamic scans (5–15 [phase 1], 15–25 [phase 2], and 25–35 [phase 3] min after F-18 FDG injection) and dual-time-point scans (1 and 2 h after injection) were acquired for 23 MSLs [4 benign MSLs (BMSLs). 10 primary malignant musculoskeletal tumors (PMMSTs), and 9 metastatic musculoskeletal tumors (MMSTs)]. We compared the maximum standardized uptake values (SUVmax) and corresponding retention indices for dynamic (RI-SUVdyn) and dual-time-point (RI-SUVdual) scans and evaluated diagnostic efficacy using receiver operating characteristic (ROC) curve analyses. The SUVmax gradually decreased or was almost identical with minimal fluctuation in 3 BMSLs and 1 PMMST. SUVmax increased over time after phase 2 in 18 malignant MSLs (MMSLs). There were significant differences in SUVmax (for all time phases) and RI-SUV dual between BMSLs and MMSLs and between PMMSTs and MMSTs. In the ROC analyses, the areas under the curve for SUV in phases 2 and 3 were highest for differentiating BMSLs from MMSLs and PMMSTs from MMSTs, respectively. Dynamic F-18 FDG PET / CT is valuable for diagnosis of musculoskeletal lesions

Preliminary clinical assessment of dynamic carbon-11 methionine positron-emission tomography/computed tomography for the diagnosis of the pathologies in patients with musculoskeletal lesions : a prospective study

Background: This study prospectively assessed the diagnostic capacity of dynamic carbon-11 methionine (C-11 MET) positron-emission tomography (PET)/computed tomography for the diagnosis of pathologies in patients with primary unknown musculoskeletal lesions (MSLs). In total, 13 patients with MSLs underwent dynamic scans (5–10 [phase 1], 10–15 [phase 2], 15–20 [phase 3], 20–25 [phase 4], 25–30 [phase 5], and 30–35 [phase 6] min post-injection of C-11 MET). We statistically compared the maximum standardised uptake values (SUVmax) and corresponding retention index for dynamic scans (RI-SUV) for five benign MSLs (BMSLs), five primary malignant musculoskeletal tumours (PMMSTs), four metastatic musculoskeletal tumours (MMSTs), and three malignant lymphoma (ML) cases and explored their diagnostic capacities using receiver operating characteristic (ROC) curve analyses. Results: SUVmax gradually decreased or remained similar with minimal fluctuations in all BMSL cases and four of five PMMST cases. In contrast, SUVmax increased over time in one case of PMMST and in all cases of MMST and ML. Significant differences were observed in SUVmax for all time phases and RI-SUV between BMSLs and MMSLs, in SUVmax for all time phases between PMMSTs and BMSLs, in SUVmax for all time phases and RI-SUV between non-PMMST-malignant tumours and BMSL, and in RI-SUV between non-PMMST-malignant tumours and PMMST. In ROC analyses, the areas under the curve yielded the highest values at 1.00 for differentiating most intergroup comparisons. Conclusions: Dynamic C-11 MET PET scans have the potential to be good predictors of discriminating MSLs in patients with primary unknown MSLs in clinical practice

The association of Toll-like receptor 4 gene polymorphisms with the development of emphysema in Japanese subjects: a case control study

<p>Abstract</p> <p>Background</p> <p>The principal role of Toll-like receptor 4 (TLR4) is the induction of immune responses to lipopolysaccharides. Previously, mice deficient in the <it>TLR4 </it>gene exhibited up-regulation of the NADPH oxidase system in the lungs. This resulted in increased oxidant generation and elastolytic activity, which led to pulmonary emphysema. It was suggested that TLR4 might maintain constitutive lung integrity by modulating oxidant generation. We investigated whether single nucleotide polymorphisms (SNPs) in the <it>TLR4 </it>gene were associated with the emphysema phenotype in Japanese subjects with chronic obstructive pulmonary disease (COPD).</p> <p>Results</p> <p>Seven SNPs in the <it>TLR4 </it>gene (<it>rs10759930</it>, <it>rs1927914</it>, <it>rs12377632</it>, <it>rs2149356, rs11536889</it>, <it>rs7037117</it>, and <it>rs7045953</it>) were genotyped with allelic discrimination assays. The frequencies of SNPs were compared between 106 patients with the emphysema phenotype of COPD and 137 healthy smokers. We found that the positivity of the individuals with the major G allele of <it>rs11536889 </it>was significantly less in the emphysema group than the control group (<it>p </it>= 0.019). The frequencies of the minor C allele and the distribution of the CC genotype as well as the frequency of the major haplotype that carried the minor C allele of <it>rs11536889 </it>were all significantly higher in the emphysema group than the control group (<it>p </it>= 0.0083, 0.019, and 0.004, respectively). Furthermore, the strength of the association of the CC genotype with the emphysema phenotype was in an odds ratio of 2.60 with 95% confidence intervals from 1.17 to 5.78. However, these significances were not apparent after adjust for age and smoking history by logistic regression. No associations were observed between the <it>rs11536889 </it>and the low attenuation area score, the forced expiratory volume, and the carbon monoxide diffusion capacity in the emphysema group.</p> <p>Conclusions</p> <p>The minor C allele of the <it>rs11536889 </it>SNP in the <it>TLR4 </it>gene is likely associated with the risk of developing emphysema in the Japanese population.</p

The diagnostic ability of SPECT/CT fusion imaging for gastrointestinal bleeding : a retrospective study

Background Blood loss from the gastrointestinal tract can be an acute and life-threatening event. For the treatment of gastrointestinal bleeding, it is important to accurately detect gastrointestinal bleeding and to localize the sites of bleeding. The purpose of this study was to retrospectively assess the capabilities of SPECT/CT in the diagnosis of gastrointestinal bleeding by a comparison with planar imaging alone as well as planar and SPECT. Methods We conducted a retrospective analysis of 20 patients (21 examinations) who underwent gastrointestinal bleeding scintigraphy in the past 7 years and in whom the bleeding site was identified by endoscopy or capsule endoscopy, or in whom no evidence of gastrointestinal bleeding was identified during the clinical course. Five patients (5 examinations) were diagnosed by planar imaging (planar group). Eight patients (9 examinations) were diagnosed by planar imaging and SPECT (planar + SPECT group). Seven patients (7 examinations) were diagnosed by planar imaging and SPECT/CT (planar + SPECT/CT group). We calculated the diagnostic ability of each method in detecting the presence of bleeding, as well as the ability of each method to identify the sites of bleeding. The sensitivity, specificity, and accuracy of the methods were compared. Results The diagnostic ability of the three imaging methods in detecting the presence of gastrointestinal bleeding was as follows. Planar imaging showed 100% sensitivity (3/3), 100% specificity (2/2), and 100% accuracy (5/5). Planar + SPECT imaging showed 85.7% sensitivity (6/7), 100% specificity (2/2), and 88.9% accuracy (8/9). Planar + SPECT/CT imaging showed 100% sensitivity (6/6), 100% specificity (1/1), and 100% accuracy (7/7). The diagnostic ability of the three modalities in detecting the site of bleeding was as follows: planar, 33.3% (1/3); planar + SPECT, 71.4% (5/7); and planar + SPECT/CT, 100% (6/6). Conclusions All 3 imaging methods showed good accuracy in detecting the presence of gastrointestinal bleeding. The addition of SPECT or SPECT/CT made the anatomical position of the uptake clear and contributed to the localization of the site of gastrointestinal bleeding. Planar + SPECT/CT imaging therefore showed the highest diagnostic ability for detecting the site of gastrointestinal bleeding

コウクウ ガク ガンメン アクセイ シュヨウ ノ エンカク テンイ ヒョウカ ニオケル クカンブ CT ケンサ ノ イチズケ

Abdominal CT examinations for the scouting of distant metastasis (DM) of orofacial malignant tumors were retrospectively evaluated, for the purpose of establishing the standard way of examination. Out of 159 patients with oral malignancies, 247 abdominal CT examinations were performed for the purpose of scouting DM. During the examination, intravenous contrast enhancement (CE) was performed in 166 examinations. DM were detected in 13 patients (8.2%). DM were found in 6 at administration, and 8 were late DM. Nine DM were detected out of 166 (5.4%) examinations with CE, and 5 were detected out of 81 (6.2%) examinations without CE. In detecting the DM, no improvement was found by CE. DM attacked lungs in 13, mediastinum in 3, liver in 2, paraaortic lymph nodes in 1, chest wall in 1, and vertebra in 1. Only 2 patients with DM were free from cervical metastasis, and the remainder was combined with cervical metastasis, regardless the status of the primary sites. Conclusions: Abdominal CT was useful for detecting DM. Intravenous CE was not necessary for scouting the DM. Patients with cervical metastasis had a high potential for developing DM

18F-2-fluoro-2-deoxyglucose uptake in or adjacent to blood vessel walls

Incidental 18F-2-fluoro-2-deoxyglucose (FDG) uptake in blood vessel walls is sometimes demonstrated during routine oncologic imaging with positron emission tomography/computed tomography (PET/CT). FDG uptake in vessel walls can also be seen under some non-physiological conditions such as vasculitis and arteriosclerosis. Radiologists need to be aware of the diseases which can exhibit FDG uptake in the vessel wall for proper interpretation

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration for the Diagnosis of Intrathoracic Lesions : Experience of a Single Academic Medical Center

Article信州医学雑誌 60(5): 249-255(2012)journal articl