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Biomedical subjects

T Sonomura

Publications and source records attributed to T Sonomura.

At least 19 recordsLinked to original sources
PubMed2006

Brachytherapy technique for abdominal wall metastases of colorectal cancer: ultrasound-guided insertion of applicator needle and a skin preservation method.

PURPOSE: To report a technique of interstitial brachytherapy for the treatment of subcutaneous metastatic abdominal wall tumors. MATERIAL AND METHODS: We developed a brachytherapy technique consisting of ultrasound-guided insertion of applicator needles to avoid the organs at risk, such as intestines, and saline injection into the subcutaneous tissue between the tumor and the skin to decrease the skin dose. We encountered three patients with painful metastases from rectal carcinoma in the abdominal wall refractory to external radiotherapy. They were subjected to this brachytherapy with a single dose of 20 Gy. RESULTS: The procedure was safely achieved in all three patients. Long-lasting pain reduction and tumor shrinkage was obtained without early or late complications. CONCLUSION: This interstitial brachytherapy technique seems to be feasible in the treatment of metastatic abdominal wall tumors.

Abdominal Neoplasms↗
PubMed2006

Usefulness of mini-tracheostomy and torque controlled insertion of applicator in fractionated endobronchial brachytherapy.

Endobronchial brachytherapy was developed as effective treatment of endobronchial cancer and fractionated schedule is applied to decrease late toxicity. However, repeated bronchofiberscopy is onerous to the patient and restricts the treatment schedule itself. We applied mini-tracheostomy for a ready access route, and a torque controlled technique for easy insertion of the endobronchial applicator. Eight patients with tracheobronchial cancer invasion were treated with endobronchial brachytherapy of 18-30 Gy/3-5 fractions/1.5-2.5 weeks (median 24 Gy/4 fractions/2 weeks) at reference points of 5 mm from the bronchial surface. The averaged individual irradiation and single session times were 4 min and 24 min, respectively. There were no procedure-related complications. These technical improvements may facilitate flexible fractionated dose prescriptions.

Aged↗
PubMed2005

Selective conformal radiotherapy for arteriovenous malformation involving the spinal cord.

Radiotherapy has seldom been used in the treatment of arteriovenous malformations (AVM) involving the spinal cord because of the cord's limited radiation tolerance. A 57-year-old woman with progressive myelopathy due to AVM was treated with a selective conformal radiation therapy (55.6 Gy/20 days) on the nidus region preserving the spinal cord, drainer veins and involved bones. The drainers and symptoms were minimized at the end of treatment and disappeared over 2 years. This case illustrates the usefulness of selective conformal radiation therapy.

Arteriovenous Malformations↗
PubMed1999

T1 and T2 lip cancer: a superselective method of facial arterial infusion therapy--preliminary experience.

PURPOSE: To formulate and evaluate a facial arterial infusion chemotherapy for squamous cell lip carcinoma. MATERIALS AND METHODS: The study included six patients (age range, 46-84 years) with squamous cell carcinoma of the lower lip. There were two T1 tumors, three T2 tumors, and one T1-compatible postoperative recurrent tumor. A 4-F, double-lumen balloon catheter was inserted into the external carotid artery through the superficial temporal artery and placed for selective infusion into the tumor-feeding facial artery. Patients received a combination of mitomycin C (4.4 mg/m2 per body surface area) on day 1 and 3.2 mg/m2 of peplomycin sulfate on days 1-7 (22.4 mg/m2 per week), or, when peplomycin sulfate was contraindicated, 16 mg/m2 of cisplatin only on days 1-5 (80 mg/m2 per week). Two to three cycles of chemotherapy were given until tumor disappearance was histologically confirmed. RESULTS: Complete tumor disappearance was achieved in all cases. One patient had a self-limiting asthma attack during peplomycin sulfate treatment, and another had transient partial hair loss. No disfigurement, recurrence, or late complications were observed at a mean follow-up of 5.0 years (range, 2.3-11.2 years). CONCLUSION: The described facial arterial infusion chemotherapy appears to be a safe and curative treatment for T1 and T2 squamous cell lip carcinomas.

Aged↗
PubMed1998

[Experimental study of percutaneous hot ethanol injection therapy (PHEIT) by continuous heating device for hepatocellular carcinoma].

Percutaneous ethanol injection therapy (PEIT) is widely used as a local treatment for hepatocellular carcinoma (HCC). However, because only a small amount of ethanol can be used in one PEIT session and because the antitumor effect is limited, this modality is indicated only when there are three or fewer tumors and when the tumor diameter is < or = 3 cm. To obtain a more potent and certain antitumor effect, we have devised a new treatment called percutaneous hot ethanol injection therapy (PHEIT), and developed a Continuous Heating Device with which ethanol can be heated and locally injected at a specified temperature. The continuous Heating Device is composed of three major components: a syringe heater, a needle thermocontroller, and a needle tip thermosensor. A disposable syringe filled with liquid is inserted into the syringe heater, which heats the liquid to a desired temperature by adjusting the voltage. The needle thermocontroller is a puncture guide needle to which a heating device has been attached. The needle-tip thermosensor constantly measures, displays and records the temperature of the liquid at the needle tip during injection. Also, because the Continuous Heating Device is a closed-circuit system, there is no risk of accidental a fire, which ensures procedural safety. It is also possible to use this device to safely heat and inject a variety of other liquids, such as physiological saline and anticancer agents and thus contribute to the widespread development of ultrasound-guided injection therapy.

Animals↗
PubMed1997

Brain MR imaging in patients with hepatic cirrhosis: relationship between high intensity signal in basal ganglia on T1-weighted images and elemental concentrations in brain.

In patients with hepatic cirrhosis, the globus pallidus and putamen show high intensity on T1-weighted MRI. While the causes of this high signal have been thought to include paramagnetic substances, especially manganese, no evidence for this has been presented. Autopsy in four cases of hepatic cirrhosis permitted measurement of metal concentrations in brain and histopathological examination. In three cases the globus pallidus showed high intensity on T1-weighted images. Mean manganese concentrations in globus pallidus, putamen and frontal white matter were 3.03 +/- 0.38, 2.12 +/- 0.37, and 1.38 +/- 0.24 (micrograms/g wet weight), respectively, being approximately four- to almost ten-fold the normal values. Copper concentrations in globus pallidus and putamen were also high, 50% more than normal. Calcium, iron, zinc and magnesium concentrations were all normal. The fourth case showed no abnormal intensity in the basal ganglia and brain metal concentrations were all normal. Histopathologically, cases with showing high signal remarkable atrophy, necrosis, and deciduation of nerve cells and proliferation of glial cells and microglia in globus pallidus.. These findings were similar to those in chronic manganese poisoning. On T1-weighted images, copper deposition shows no abnormal intensity. It is therefore inferred that deposition of highly concentrations of manganese may caused high signal on T1-weighted images and nerve cell death in the globus pallidus.

Basal Ganglia↗
PubMed1997

Scoop biopsy of intracaval tumor thrombi: a preliminary report of a minimally invasive technique to obtain large samples.

PURPOSE: The purpose of this study is to safely improve the yield of intracaval biopsy. MATERIALS AND METHOD: A co-axial system was composed of an inner catheter with a smoothly tapered tip with a shark jaw, and an outer sheath. The biopsy procedure consisted of four steps: (1) the tip was stuck into the target thrombi; (2) the inner sheath was advanced deeply into the target and the jaw was opened within the mass; (3) the outer sheath was advanced to envelope the inner cather; (4) then the system was withdrawn. After simulation experiments seven patients underwent this scoop biopsy. RESULTS: A simulation experiment proved that this technique brought much larger samples with minimal damage of the target surface. Seven patients who had been suspected of intracaval tumor thrombi underwent this procedure and confidential pathological examination without any complications. CONCLUSION: This scoop biopsy procedure was thought to be helpful in obtaining large samples safely.

Aged↗
PubMed1997

Radiotherapy for hypoglycaemia associated with large leiomyosarcomas.

A patient with recurrent severe hypoglycaemia attacks due to a large, irresectable retroperitoneal leiomyosarcoma was treated with radiotherapy (60 Gy). The blood glucose level gradually and steadily improved as the cumulative radiation dose was increased. Weaning of hyperalimentation was started when the cumulative dose reached 21.6 Gy. The patient became completely free from hypoglycaemic attacks despite no significant diminishment of local tumour size and untreated multiple lung metastases. The patient was discharged and the attacks did not recur until expiration as a result of tumour bleeding. This case report supports the clinical usefulness of radiation therapy in treating hypoglycaemia induced by non-islet cell tumour.

Aged↗
PubMed1997

[Comparison of Gore-tex covered Ultraflex stent and bare Ultraflex stent: preliminary clinical results].

We clinically compared the covered Ultraflex stent and the bare Ultraflex stent for malignant esophageal strictures. Materials were 6 cases with esophageal carcinomas. We placed the Gore-tex covered stents (A group) in 4 cases including 2 cases of esophagorespiratory fistulae, and the bare stents (B group) in 2 cases. The stents were well-expanded in all cases. After stenting, dysphagia was improved in all cases. Fistulae were obstructed by the cover in 2 cases in A group. Mean survival term was 123 days in A group and 45 days in B group. Complications were fistulation of bare portion of the covered stent in one case in A group, and tumor bleeding in one case in B group. Considering of the risk of fistula or tumor bleeding, the cover is necessary to increase the safety and efficacy of the esophageal stent.

Aged↗
PubMed1997

Factors associated with survival exceeding 5 years after transcatheter arterial embolization for hepatocellular carcinoma.

During the period between April 1981 and March 1988, 232 consecutive patients underwent transcatheter arterial embolization (TAE) for hepatocellular carcinoma at the Department of Radiology, Wakayama Medical College. A > or = 5-year course calculated from the time of the initial TAE was able to be confirmed in 216 patients, who became the subjects of this study. Five-year survival rates were calculated by the direct method, while the clinical features existing at the time of the initial therapy and the clinical course of patients surviving > or = 5 years were studied. The 5-year survival rate was 6.0%. Comparison of the patients dying within 1 year and the patients surviving for > or = 5 years revealed differences in the severity of liver cirrhosis and the tumor type. The long-term survivors tended to have low serum alpha-fetoprotein values. The clinical picture of the patients surviving > or = 5 years after TAE was characterized by relatively mild liver cirrhosis (Child's class A or B), a serum alpha-fetoprotein value of < or = 1,500 ng/dL, relatively small nodular-type tumors with a maximum main tumor diameter of < or = 5.5 cm, a tumor-occupying rate of less than 20%, and absence of portal vein involvement by the tumor. There were patients in whom a relatively small number of TAE sessions was effective in controlling the tumor for a prolonged period, with the patients then dying of causes unrelated to the tumor, as well as patients in whom proliferation of the tumor was controlled by numerous applications of transcatheter therapy, resulting in > or = 5-year survival but with eventual death due to the tumor. Transcatheter arterial embolization makes a major contribution to achieving long-term survival of > or = 5 years in patients with hepatocellular carcinoma.

Adult↗
PubMed1997

[Evaluation of hepatic encephalopathy and portal hemodynamics by Doppler ultrasonography after a transjugular intrahepatic portosystemic shunt].

TIPS (transjugular intrahepatic portosystemic shunt) is an efficacious treatment for esophagogastric varices, ascites and hypertensive gastrointestinal vasculopathy associated with portal hypertension. The main complication after the procedure is hepatic encephalopathy. We tried to elucidate the correlation between hepatic encephalopathy and changes in portal hemodynamics after TIPS, based on observation by Doppler ultrasonography. We carried out Doppler ultrasonography in 28 cases of TIPS to assess hepatopetal and hepatofugal blood flow in the right and left portal branches. Hepatic encephalopathy occurred after TIPS in 9 cases out of 28 (32%), and new onset of disease was observed in 6 of 9. Doppler ultrasonography revealed hepatofugal blood flow in both right and left portal branches in 6 cases, 5 of which showed encephalopathy. Hepatopetal blood flow of the right and left portal branches was observed in 17 of 28 cases after TIPS. Hepatic encephalopathy occurred in only 2 of 17 cases. The changes in portal vein hemodynamics after TIPS were investigated by color Doppler ultrasonography, which were considered to be very useful for prediction of hepatic encephalopathy and indication of medical treatment to prevent the occurrence of this disease.

Adult↗
PubMed1996

[Shunt patency after creation of a transjugular intrahepatic portosystemic shunt: evaluation with Doppler ultrasound].

TIPS (transjugular intrahepatic portosystemic shunt) is a new interventional radiologic procedure that is useful in the treatment of variceal bleeding and ascites due to portal hypertension. It is most important that the shunt remains patent for a long time after placement. The potential role of ultrasound in evaluating the patency of the shunt after TIPS has been studied. Duplex and color doppler sonography were performed in 20 patients with portal hypertension after TIPS. Imaging was done in 38 case. The findings were compared with those of follow-up angiography. Shunt patency was evaluated with Doppler US in 28 case. In 27 of them, the equivalent patent shunt was confirmed by angiography; the exception was one case of occlusion in follow-up angiography. Doppler signals in the shunt could not be detected in 10 cases. Follow-up angiography showed occlusion in 7 cases and patency in the other 3. Doppler US sensitivity was 90%, and its specificity was 88%. These results indicate that Doppler US is one of the most useful methods for evaluating shunt patency after TIPS.

Adult↗
PubMed1996

[Gore-tex covering of ultraflex stent and its usefulness for malignant esophageal stenosis: preliminary clinical results].

Malignant esophageal stenoses develop esophagorespiratory fistulae or perforations so frequently that esophageal stents must be required. We devised a covered stent with a thin Gore-Tex sheet and a nitinol stent system, Ultraflex, without increasing the size of the introducer assembly. Nine patients with malignant esophageal stenoses, including seven patients with perforation or fistulation, were carefully treated with the covered stent. All stent deployments were successfully carried out under fluoroscopic guidance. The average time required for full self-expansion was two weeks. The average grade of dysphagia improved from 3.7 to 1.2. Clinical symptoms due to esophagorespiratory fistulae were improved in three of four patients. No clinical or technical complications, such as migration, were observed, but a fistula developed at the bare site of the stent. This covering method for the flexible stent was simple and safe, and was considered to be useful in the treatment of malignant esophageal stenosis.

Adenocarcinoma↗
PubMed1995

[Alginate gel beads for chemoembolization: initial report].

Alginate gel beads (AGB) were studied as a new material for chemoembolization therapy. AGB were quickly produced by dripping a sodium alginate solution through a cannula into a calcium chloride solution, with bead size controlled by cannular size. AGB containing adriamycin or contrast medium were produced from the corresponding mixture. Sixty percent of adriamycin was eluted from AGB within one hour and 90% within 24 hours, while 95% of iopamidol was eluted in 30 minutes. AGB released these contents slower than gelatin sponge particles. Four dogs underwent transcatheter hepatic arterial embolization with AGB. Normal daily activity was recorded until sacrifice on the fourteenth day. There was no hepatic infarction in those embolized with AGB of 0.5 to 1.0 mm in diameter. Partial liver infarction was found in one with compelled embolization and in two with fragile beads. These observations suggested that AGB constitute an instantly preparable embolic material with slow-release activity and flexible solidity.

Alginates↗
PubMed1994

[Optimal size of embolic material in transcatheter arterial embolization of the liver].

The purpose is to determine the optimal size of gelatin sponge, less toxic and more effective, in transcatheter arterial embolization (TAE) of the liver. In experimental study on toxicity, gelatin sponge particles (GSP) were divided by their size into four groups, 0-200 microns, 200-500 microns, 500-1000 microns and 1000-2000 microns. In each group, three mongrel dogs underwent TAE. After a week, the livers were investigated pathologically, and the rate of liver necrosis was measured. The average rate was 23.7 percent with GSP of 0-500 microns, while 0.5 percent with 500-2000 microns. Microscopically, coagulation necrosis was found in 6 of 6 dogs with 0-500 microns, while in 2 of 6 with 500-2000 microns and bile duct injury was found in 5 of 6 dogs with 0-500 microns, while none with 500-2000 microns. In clinical study on effectiveness, ten patients with hepatocellular carcinomas underwent TAE with GSP of 0-500 microns, 500-1000 microns and 1000-2000 microns respectively. After a week, the rate of tumor necrosis was measured by CT. The average rate was 94.8 percent with 0-500 microns, 93.5 percent with 500-1000 microns and 86.8 percent with 1000-2000 microns. These results suggest that the optimal size of GSP is 500-1000 microns.

Animals↗
PubMed1994

[Self-expandable metallic stent therapy for inferior vena cava obstruction secondary to malignancy: clinical observations].

To evaluate the self-expandable metallic stent therapy for inferior vena caval obstruction (IVCO) secondary to malignant liver tumors, changes in caval pressure, the symptoms and hemobiochemical values were observed. Among 16 IVCO cases with higher caval pressure than 20 cmH2O at the peripheral caval lumen to the stenosis, nine cases consisting of five extracaval compression cases and four intravenous tumor thrombi cases subjected the stent therapy. Other three subjected radiotherapy and the other four cases inactive supportive care. Immediately after the Z-stent implantation, the averaged caval pressure distal to the stenosis decreased from 27.7 +/- 3.5 cmH2O to 14.7 +/- 2.6 cmH2O. One case developed 8 cmH2O increase of right atrial pressure but no lung edema. The urine excretion volume increased after stent. The decrease in caval pressure correlated with the urine volume of the day after the stenting (gamma = 0.83), symptomatic improvements of leg edema (gamma = 0.68), ascites (gamma v 0.51) and scrotal edema (gamma = 0.70). Five cases showed gradual increase in platelet number. All elevated LDH and elevated fibrinogen value decreased. These changes would suggest physiologic benefits of the IVC stent therapy. Compression cases showed better improvements and courses than the thrombi cases. Two thrombi cases endured severe conditions suspected of triggered by the procedure. Conclusively, the stent therapy to the IVC obstruction was thought to effect hemodynamically and hematobiochemically.

Aged↗
PubMed1994

[A twining method for struts connection in Z-stents].

To compose Gianturco Z-stents without welding, a twining method was applied. The link portion of the struts of were spirally entwined by a thin stainless steel wire of 0.1 mm in diameter. The directional balance of spring force of the twined stents compared favorably with that of the conventionally welded stents. This twining method has theoretical benefit of less susceptible to corrosion than soldering. Then the twining method was thought to be beneficial in composing Z-stents.

Equipment Design↗