卵巣明細胞癌と類内膜癌の鑑別に関するMRIについての知見

BACKGROUND: Common cancerous histological types associated with endometriosis are clear cell carcinoma (CCC) and endometrioid carcinoma (EC). CCC is regarded as an aggressive, chemoresistant histological subtype. Magnetic resonance imaging (MRI) offers some potential advantages to diagnose ovarian tumors compared with ultrasonography or computed tomography. This study aimed to identify MRI features that can be used to differentiate between CCC and EC. METHODS: We searched medical records of patients with ovarian cancers who underwent surgical treatment at Nara Medical University Hospital between January 2008 and September 2018; we identified 98 patients with CCC or EC who had undergone preoperative MRI. Contrasted MRI scans were performed less than 2 months before surgery. Patients were excluded from the study if they had no pathology, other pathological subtype of epithelial ovarian cancer, and/or salvage treatment for recurrence and metastatic ovarian cancer at the time of study initiation. Clinically relevant variables that were statistically significant by univariate analysis were selected for subsequent multivariate regression analysis to identify independent factors to distinguish CCC from EC. RESULTS: MRI of CCC and EC showed a large cystic heterogeneous mixed mass with mural nodules protruding into the cystic space. Univariate logistic regression analysis revealed that the growth pattern (broad-based nodular structures [multifocal/concentric sign] or polypoid structures [focal/eccentric sign]), surface irregularity (a smooth/regular surface or a rough/irregular/lobulated surface), "Width" of mural nodule, "Height-to-Width" ratio (HWR), and presence of preoperative ascites were factors that significantly differed between CCC and EC. In the multivariate logistic regression analysis, the growth pattern of the mural nodule (odds ratio [OR] = 0.69, 95% confidence interval [CI]: 0.013-0.273, p = 0.0004) and the HWR (OR = 3.71, 95% CI: 1.128-13.438, p = 0.036) were independent predictors to distinguish CCC from EC. CONCLUSIONS: In conclusion, MRI data showed that the growth pattern of mural nodules and the HWR were independent factors that could allow differentiation between CCC and EC. This finding may be helpful to predict patient prognosis before operation.博士（医学）・乙第1433号・令和元年9月27日© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated

Patient Dose on the Radiological Diagnosis of Abdomen - The Situation of Patient nose at Hospitals in Okayama Prefecture -

In 1995, we have published a paper about the basic data on the relation between X-ray exposure equipment and patient dose in Vol. 17 of the Journal "Environment Research and Control". In this time, we questioned hospitals in Okayama Prefecture about exposure equipments of abdomen. And we compared each hospital's exposure equipments with the basic data, calculated each patient dose, then we studied that differences. Various imaging system, for example; screen/film or imaging plate has been used at each hospitals, so that exposure are various and patient doses are very different. The exposure equipment decide that the X-ray photograph is good or bad, so we cannot treat it easily. But we think that we have to try to take X-ray photographs which are suit the purpose of diagnosis which as a small patient dose as possible

Clinical evaluation was examined between mixed type barium sulfate suspensions "BarytgenHD" and "Barytgen"

混合粒子型硫酸バリウムバリトゲンHD200w/v%懸濁液について,バリトゲン160w/v%懸濁液と比較検討を行った｡懸濁液安定性は両者共良かった｡臨床評価においては,付着性,胃小区描出能は同程度であり,辺縁の描出能は良かったが凝集･ムラ付き,気泡は多くみられ懸濁液濃度について検討を加える必要があると考える｡飲み易さは,バリトゲンHD200w/v%懸濁液のほうが濃度が高いのにもかかわらず飲み易く好評であった｡Both barium sulfate suspensions, Barytgen HD and Barytgen, had good stability. Although significant difference was not abserved in coating and visualization of gastric area, BarytgenHD showed better marginal visualization of gastric margin. Further study is needed to improve the visualization of sticky coating of gastric mucosa and many bubbles. BarytgenHD was easily to drink instead of high density barium sulfate suspensions

Clinical application of the contrast media containing soft drinks for the X-ray examination of the stomach

胃X線検査の被験者を増やし、検査を円滑に行う上で造影剤である硫酸バリウム懸濁液の飲みにくさが障害の一つとなっている。これを改善する目的で、懸濁液に市販の粉末清涼飲料を混入したところ、64.2％の人が通常のものよりも飲みやすいと答えた。臨床上も造影剤の付着が悪くなったり、胃の蠕動を促進する等の問題は生じず、有用であると考えられた。Barium sulfate suspensions are disliked by many people. This is one of the obstacles to increase persons who consult doctors and to have medical examinations smoothly. We mixed soft drinks into the suspensions to improve this problem. As a result, they were popular among 64.2% people, there were not any clinical troubles that the suspensions did not stick to the mucous membrane of the stomach well, the peristalsis of the sotmach were promoted, and so on. These results suggest that the contrast media containing soft drinks is useful for the X-ray examinations of the stomach

Relationship between X-ray Exposure and Patient Dose on the Radiological Diagnosis

Patient dose is important consideration in the radiological examination and our environment regarding radiation. Many studies have been published about patient dose, but those data were classified by each organ or tissue. Actuarially, patient dose should be checked by each examined part of patient and each exposure equipment. In this paper, we measured absorbed dose at the depth of 0-200mm with the Mix-DP phantom. The phantom is made by tissue equivalent meterial and is designed to similitude abdominal part. Percentage Depth Dose (PDD) was calculated from these doses. Three single-phase generators and three three-phases generators were used in this measurement. These measurements were analyzed by each equipment, and consequently the clear difference of PDD between the exposure equipments was not found. As the result, we can estimate patient dose at a random depth by using PDD. Furthermore, we can easily know patient dose from the tube-voltage and current time product by the calculation including PDD.These data are very useful to manager patient dose on radiological diagnosis

Basic properies of beam flatness analyzer (THEBES 7000)

癌の有力な治療法の1つである放射線治療はシステム全体の許容誤差が±5％と、正確な治療が要求されている。正確な線量を正確な場所に照射されなければならない。そのためには日頃から照射装置のQuality Control が重要である。Beam平坦度の測定はその中でも、重要な項目で1／6月の測定頻度が勧告されている。今回、市販のBeam Flatness Analyzer (7000型 THEBES) を使用する機会を得たので、その基礎的性能であるChamber 相互の感度のちがい、測定値の再現性、識別可能な最小線量について実験を行った。各項目とも誤差が非常に少なく、日常の使用に際してそのデータは十分信頼できるものであることがわかった。Lrradiation, which is one of the effective therapies to Cancer, is required to be accurate within ±5% of the tolerable error of the total system. An accurate dose has to be irradiated accurately at a target volume. For that Quality Control of the irradiation equipment is cotinually important. As the measurement of Beam Flatness is an important item, it is obligated to be measured once a week. In this paper as we have an opportunity to use a Beam Flatness Analyzer sold on a corporation of medical instrument, we experiment about the difference of sensitivity of mutual Chamber which is its basic property, the reproducibility of the measured score, and the minimum value of measuralbe dose. We find that the difference in every item is so small that its data is very reliable in a daily use

Influence of the Bone for Electron-beam Therapy

電子線治療は,体表面またはその近傍に発生する悪性腫瘍の治療にしばしば用いられる治療法である｡電子線はエネルギーに対応した飛程を持っており,飛程を越えると急激に線量は減少する。この性質は腫瘍に一定の線量を照射し,腫瘍後方に存在する決定臓器を保護することができるので,病巣を選択的 に治療するのに好都合である｡しかし,照射野内に人体軌部組織より密度の違う物質が存在する場合,散乱,吸収の影響が大きく,電子線線量分布は乱れたものとなる｡今回,人体内にある骨を想定してVolumeの違う骨Phantomを使 用して影響を調べたところ,骨幅によって骨後方および断端に線量の乱れが生じることがわかった｡すなわち,骨の中央ではある程度後方に距離が離れると,線量は大きく減少する現象が見られた。また,横方向の線量分布は骨断端近くで一旦線量の減少が見られ,断端を離れると急激に増加する｡したがって,実際の臨床において,Target Volume近くに骨が存在する場合は総線量の決定に際して注意が必要である｡The Electron-beam therapy is often used for the treatment to malignant tumors on the surface or its neighborhood of the body. An electron-beam has the range depended on its energy, and its dose is rapidly decreased at the points beyond the range. This property is available to irradiating a tumor with leaving the critical organs unexposed. However, we should take notice that the dose-distributions are disordered if materials of various densities are in the irradiation field. In this paper, we examined how the dose-distribution are disordered by using the phantom made from human bones of various volumes. As a result, the peculiar disorders of the dose-distribution due to the difference of the bone width were found at the back and edge of a bone. Moreover, the dose at the edge of a bone was decreased, but the dose at the side of a bone was rapidly increased in the distance position from the bone. It is necessary to take account of that the above peculiar phenomenon affect the total dose for the treatment when bones exist near the target volume in the irradiation field

Two Cases of Dedifferentiated Endometrioid Carcinoma: Case Presentation and Brief Review of the Literature

Endometrioid carcinoma is the most common histological type of uterine endometrial cancer and particularly dedifferentiated endometrioid carcinomas (DEC) are less commonly observed. Silva et al. reported the biological features of UC based on the undifferentiated component of DEC, although the component represented only 20% of undifferentiated carcinoma. In this study, we report two cases of DEC with different presentation. Case 2 presented with the invasion to the bladder, rectum, and LN metastases. In contrast, the tumor in case 1 advanced into the endometrial cavity, similar to an endometrial polyp, without myometrial invasion. Hence, the diagnosis was established early. While we strive to improve the diagnosis of DEC, it is also crucial to better assess the prognosis and the appropriate treatment for the patients with established diagnosis of DEC

Preoperative plasma D-dimer level is a useful prognostic marker in ovarian cancer

A high pre-treatment plasma D-dimer level was recently identified as a poor prognostic factor in several malignancies. The aim of this study was to evaluate the prognostic significance of plasma D-dimer levels in epithelial ovarian cancer (EOC). Data of 199 patients were retrospectively analysed. The relationships between pre-treatment D-dimer levels and other clinical parameters and prognosis were evaluated. Univariate analysis identified age, pre-treatment plasma D-dimer level, massive ascites, residual tumours, pre-treatment CA125 level, histological type, and FIGO stage as predictors of overall survival. The multivariate analysis showed that a high pre-treatment plasma D-dimer level (p=.017), residual tumours (p < .001), and FIGO stage (p = .036) were independent risk factors of overall survival. Venous thromboembolism (VTE) did not influence overall survival (p=.091). High pre-treatment D-dimer levels are associated with a poor prognosis independent of VTE status in EOC patients, and might be a useful prognostic biomarker.Impact statement What is already known on this subject? In recent years, a high pre-treatment plasma D-dimer level has been identified as a prognostic factor in several malignancies, but only a handful of studies have assessed the role of pre-treatment plasma D-dimer levels in patients with EOC patients. Thus, the clinical significance and prognostic value of the plasma D-dimer level in EOC remain controversial, and there is also debate related to the association of the higher mortality rate among cancer patients with elevated D-dimer levels with VTE. What do the results of this study add? In our study, high pre-treatment D-dimer levels are associated with a poor prognosis independently of VTE in EOC patients. What are the implications of these findings for clinical practice and/or further research? The D-dimer level might emerge as a valuable prognostic biomarker, which will help doctors in the choice of initiating a more aggressive therapy, the combination of chemotherapy with anticoagulation therapy

Cord blood BPA and reproductive and thyroid hormone levels of neonates

Background: Bisphenol A (BPA) is widely used and BPA exposure is nearly ubiquitous in developed countries. While animal studies have indicated adverse health effects of prenatal BPA exposure including reproductive dysfunction and thyroid function disruption possibly in sex-specific manner, findings from epidemiological studies have not been enough to proof these adverse effects. Given very limited research on human, the aim of this study was to investigate associations between cord blood BPA levels and reproductive and thyroid hormone levels of neonates and whether associations differed by neonate sex. Methods: Among 514 participants of the Hokkaido study who were recruited from 2002 to 2005 at one hospital in Sapporo, Japan. BPA level in cord blood was determined by ID-LC/MS/MS and the limit of quantification was 0.040 ng/ml. 9 types of reproductive hormone levels in cord blood were measured and thyroid hormone levels were obtained from neonate mass screening test data. 283 subjects those who had both BPA and hormone levels measurements were included for the final analyses. Results: Geometric mean of cord blood BPA was 0.051 ng/ml. After adjustment, BPA level was negatively associated with prolactin (PRL) (β=-0.38). There was an interaction between infant sex and BPA levels on PRL, weak negative association was found in boys (β=-0.12) whereas weak positive association was found in girls (β=0.14). BPA level showed weak positive association with testosterone, estradiol and progesterone levels in boys. No association was found between BPA and thyroid hormone levels. Conclusions: Our findings suggested that fetal BPA levels might be associated with certain reproductive hormone levels of neonate with sex-specific manner, though further investigations are necessary