RESUMEN
Multiple myeloma (MM) is a clonal plasma cell disorder affecting the immune system with various systemic symptoms. MM remains incurable even with high dose chemotherapy using conventional drugs, thus necessitating development of novel therapeutic strategies. Gossypol (Gos) is a natural polyphenolic compound extracted from cotton plants, and has been shown to possess anti-neoplastic activity against various tumors. Recent studies have shown that Gos is an inhibitor for Bcl-2 or Bcl-XL acting as BH3 mimetics that interfere interaction between pro-apoptotic BH3-only proteins and Bcl-2/Bcl-XL. Since most of the patients with MM overexpress Bcl-2 protein, we considered Gos might be a promising therapeutic agent for MM. We herein show that Gos efficiently induced apoptosis and inhibited proliferation of the OPM2 MM cell line, in a dose- and time-dependent manner. Gos induced activation of caspase-3 and cytochrome c release from mitochondria, showing mitochondrial dysfunction pathway is operational during apoptosis. Further investigation revealed that phosphorylation of Bcl-2 at serine-70 was attenuated by Gos treatment, while protein levels were not affected. In addition, Mcl-1 was downregulated by Gos. Interestingly, phosphorylation of JAK2, STAT3, ERK1/2 and p38MAPK was inhibited by Gos-treatment, indicating that Gos globally suppressed interleukin-6 (IL-6) signals. Moreover, JAK2 inhibition mimicked the effect of Gos in OPM2 cells including Bcl-2 dephosphorylation and Mcl-1 downregulation. These results demonstrated that Gos induces apoptosis in MM cells not only through displacing BH3-only proteins from Bcl-2, but also through inhibiting IL-6 signaling, which leads to Bcl-2 dephosphorylation and Mcl-1 downregulation.
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Interleucina-6/biosíntesis , Mieloma Múltiple/genética , Proteína 1 de la Secuencia de Leucemia de Células Mieloides/biosíntesis , Proteínas Proto-Oncogénicas c-bcl-2/biosíntesis , Apoptosis/efectos de los fármacos , Línea Celular Tumoral , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Gosipol , Humanos , Mieloma Múltiple/tratamiento farmacológico , Mieloma Múltiple/patología , Fosforilación , Transducción de Señal/efectos de los fármacosRESUMEN
We demonstrate a one step technique to synthesis the carbon fibers (CNFs) with branched nanographene sheets by the pulsed discharge (PD) plasma chemical vapor deposition (CVD) process. Highly crystalline branched nanographene sheets were directly grown from the surface of the carbon fibers to obtain a three dimensional (3D) nanostructure. The growth process can be explained from the catalyst support growth of the CNFs, and subsequently nucleation and growth of the nanographene sheets from the crystalline surface of the CNF. The deposited nanostructured films with different pulse discharge were used as an electrode for electrochemical double-layer capacitors (EDLC). It is observed that the capacitance is dependent on the morphology of the electrode materials and an optimum capacitance is obtained with the branched nanographene on CNFs.
RESUMEN
PURPOSE: To present 10-year outcomes and risk factors for sac enlargement after endovascular aneurysm repair (EVAR) using the Zenith AAA Endovascular Graft (Cook, Inc, Bloomington, Indiana) in a Japanese population. MATERIAL AND METHODS: During the period 1999-2011, 127 patients underwent elective EVAR using Zenith endografts at a single institution. A retrospective investigation looked at initial rates of technical success and complications, 10-year rate of freedom from all-cause and aneurysm-related mortality, freedom from secondary intervention and sac enlargement, and risk factors for second intervention and sac enlargement. RESULTS: The median age of the patients was 78 years, and the median follow-up time was 43 months. The initial technical success rate was 98.4% (125 of 127 patients). Major adverse events occurred in 7 of 127 (5.5%) patients. Rates of freedom from all-cause and aneurysm-related mortality at 1, 3, 5, and 10 years were 95%, 87%, 77%, and 39% (all-cause mortality) and 100%, 100%, 99%, and 93% (aneurysm-related mortality). Rates of freedom from secondary intervention at 1, 3, 5, and 10 years were 97%, 91%, 88%, and 70%. Rates of primary freedom from sac enlargement at 1, 3, 5, and 10 years were 99%, 87%, 75%, and 67%. Multivariate analysis revealed aneurysm sac diameter as an independent risk factor for a secondary intervention. Preoperative sac diameter combined with an angulated short (AS) proximal neck was a risk factor for sac enlargement. CONCLUSIONS: The 10-year results of EVAR using Zenith endografts in a Japanese population were comparable to results from Western countries. Larger aneurysms and AS neck were predictors of sac enlargement after EVAR.
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Aneurisma de la Aorta Abdominal/mortalidad , Aneurisma de la Aorta Abdominal/cirugía , Disección Aórtica/mortalidad , Prótesis Vascular/estadística & datos numéricos , Procedimientos Endovasculares/mortalidad , Stents/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Humanos , Japón/epidemiología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
T-cell protein tyrosine phosphatase (TC-PTP, also known as PTPN2) is a negative regulator of the JAK/STAT pathway. STAT5 is activated by BCR-ABL kinase and STAT1 is an important transcription factor for interferon (IFN)-α-induced signaling in chronic myeloid leukemia (CML). We used siRNA to delete TC-PTP in the CML cell line, KT-1, and examined changes in the sensitivity to imatinib and IFN-α. Suppression of TC-PTP induced activation of STAT5, leading to imatinib resistance, while prolonged phosphorylation of STAT1 was induced by IFN-α, triggering cell death in KT-1 cells. These findings suggest that TC-PTP modulates sensitivity to imatinib and IFN-α in CML.
Asunto(s)
Benzamidas/farmacología , Resistencia a Antineoplásicos , Interferón-alfa/farmacología , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológico , Piperazinas/farmacología , Proteína Tirosina Fosfatasa no Receptora Tipo 2/metabolismo , Pirimidinas/farmacología , Factor de Transcripción STAT1/metabolismo , Antivirales/farmacología , Apoptosis/efectos de los fármacos , Western Blotting , Proliferación Celular/efectos de los fármacos , Proteínas de Fusión bcr-abl/antagonistas & inhibidores , Proteínas de Fusión bcr-abl/metabolismo , Humanos , Mesilato de Imatinib , Leucemia Mielógena Crónica BCR-ABL Positiva/metabolismo , Leucemia Mielógena Crónica BCR-ABL Positiva/patología , Fosforilación/efectos de los fármacos , Inhibidores de Proteínas Quinasas/farmacología , Proteína Tirosina Fosfatasa no Receptora Tipo 2/antagonistas & inhibidores , Proteína Tirosina Fosfatasa no Receptora Tipo 2/genética , ARN Interferente Pequeño/genética , Transducción de Señal , Células Tumorales CultivadasRESUMEN
PURPOSE: To clarify the efficacy of transcatheter hepatic sub-subsegmental, subsegmental, and segmental arterial chemoembolization using lipiodol (subseg/seg lip-TACE) for hepatocellular carcinoma (HCC), long-term outcomes of patients who had been treated using subseg/seg lip-TACE alone were retrospectively examined. MATERIALS AND METHODS: Subjects comprised 199 patients with HCC (T1/2/≥3=30/108/61; Child-Pugh A/B/C=115/52/32; Japan Integrated Staging [JIS] score≤1/2/≥3=88/64/47) who underwent subseg/seg lip-TACE using lipiodol mixed with an anticancer drug followed by injection of gelatin sponge particles. Each patient was followed-up every 3 months, and repeat subseg/seg lip-TACE and/or conventional lip-TACE was performed in cases showing recurrence. One-, 3-, 5-, 7-, and 10-year cumulative survival rates were calculated. Subgroup analyses were performed by stratifying the population according to T-factor, Child-Pugh classification, and JIS score. RESULTS: Median duration of follow-up was 3.8 years (range 0.2 to 16.4). Median overall survival was 3.8 years. One-, 3-, 5-, 7- and 10-year survival rates were 91.5, 66.1, 38.8, 20.3, and 9.4% for all patients, and 95.5, 76.9, 51.9, 27.9 and 20.4% for patients with JIS≤1, respectively. Significant survival differences were found across two subgroups of staging systems (T2 vs. T3≤[P=0.0012] and JIS score≤1 vs. 2 [P=0.0036]). CONCLUSION: This study demonstrated that subseg/seg lip-TACE is a feasible treatment for obtaining prolonged survival in patients with localized HCC showing rich vasculature. Outcomes are influenced by both tumor stage and liver function, as seen in the best prolonged survival in patients with JIS score≤1.
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Antineoplásicos/administración & dosificación , Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Aceite Etiodizado/administración & dosificación , Neoplasias Hepáticas/terapia , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico por Imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
PURPOSE: This study was designed to clarify the advantages of biodegradable stents in terms of mucosal reaction and biodegradation after placement. We designed a biodegradable stent and assessed stent degradation and changes in the normal bile ducts of dogs. METHODS: The biodegradable stent is a balloon-expandable Z stent consisting of poly-L-lactic acid (PLLA) with a diameter of 6 mm and a length of 15 mm. We assessed four groups of three beagle dogs each at 1, 3, 6, and 9 months of follow-up. After evaluating stent migration by radiography and stent and bile duct patency by cholangiography, the dogs were sacrificed to remove the bile duct together with the stent. The bile duct lumen was examined macroscopically and histologically, and the stent degradation was examined macroscopically and by scanning electron microscopy (SEM). RESULTS: Bile duct obstruction was absent and none of the stents migrated. Macroscopic evaluation showed moderate endothelial proliferation in the bile ducts at the implant sites at 3 and 6 months and a slight change at 9 months. Slight mononuclear cell infiltration was histologically identified at all time points and epithelial hyperplasia that was moderate at 3 months was reduced to slight at 6 and 9 months. Stent degradation was macroscopically evident in all animals at 9 months and was proven by SEM in two dogs at 6 months and in all of them at 9 months. CONCLUSIONS: Our results suggest that PLLA bioabsorbable stents seems to be useful for implantation in the biliary system with further investigation.
Asunto(s)
Conductos Biliares , Stents , Implantes Absorbibles , Animales , Materiales Biocompatibles , Colangiografía , Medios de Contraste/administración & dosificación , Diatrizoato de Meglumina/administración & dosificación , Perros , Ácido Láctico , Masculino , Modelos Animales , Poliésteres , Polímeros , Diseño de PrótesisRESUMEN
Constitutive activation of NF-κB and STAT3 plays an important role in the cellular proliferation and survival of multiple myeloma cells. We first found that auranofin (AF), a coordinated gold compound, induced a significant level of cell cycle arrest at G1 phase and subsequent apoptosis of myeloma cells. Further, AF inhibited constitutive and IL-6-induced activation of JAK2 and phosphorylation of STAT3 followed by the decreased expression of Mcl-1. AF down-regulated the activation of NF-κB, and the combination of AF and a specific NF-κB inhibitor resulted in a marked decrease of Mcl-1 expression. These results suggest that AF inhibits both IL-6 induced-JAK/STAT pathway and NF-κB activation in myeloma cells.
Asunto(s)
Antineoplásicos/farmacología , Apoptosis/efectos de los fármacos , Auranofina/farmacología , Mieloma Múltiple/metabolismo , Transducción de Señal/efectos de los fármacos , Western Blotting , Ciclo Celular/efectos de los fármacos , Línea Celular Tumoral , Regulación hacia Abajo , Ensayo de Inmunoadsorción Enzimática , Expresión Génica/efectos de los fármacos , Humanos , Proteína 1 de la Secuencia de Leucemia de Células Mieloides , FN-kappa B/efectos de los fármacos , FN-kappa B/metabolismo , Proteínas Proto-Oncogénicas c-bcl-2/efectos de los fármacos , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Factor de Transcripción STAT3/efectos de los fármacos , Factor de Transcripción STAT3/metabolismo , TransfecciónRESUMEN
The purpose of this report was to demonstrate initial Japanese cases of abdominal aortic aneurysm (AAA) with complex anatomy of proximal neck treated using a Zenith fenestrated endograft with branched endovascular technique and to describe the device's design and technical considerations. Planning and sizing of endografts were performed using high-resolution computed tomography on a three-dimensional workstation. Branched endograft technique combined with reinforced fenestrated device and balloon-expandable stent graft was used in two patients because of challenging morphology for the fenestrated device with a bare stent. Successful exclusion of the aneurysm sac was achieved in both patients with antegrade perfusion in incorporated visceral vessels. Endovascular repair using a fenestrated device with graft material incorporating the visceral arteries is feasible. The combination of the reinforced fenestration and the balloon-expandable stent graft can provide an adequate sealing effect for the compromised anatomy. Initial and midterm results are reported with further follow-up and patient accrual.
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Aorta Abdominal/anomalías , Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/métodos , Prótesis Vascular , Stents , Anciano , Anciano de 80 o más Años , Angiografía de Substracción Digital/métodos , Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Medios de Contraste , Diseño de Equipo , Estudios de Factibilidad , Estudios de Seguimiento , Humanos , Imagenología Tridimensional/métodos , Masculino , Estudios Prospectivos , Intensificación de Imagen Radiográfica/métodos , Arteria Renal/diagnóstico por imagen , Arteria Renal/cirugía , Tomografía Computarizada por Rayos X/métodosRESUMEN
A 48-year-old female with the von Hippel-Lindau disease had the recurred renal cell carcinomas (RCCs) in the left remnant kidney after the right nephrectomy and partial resection of the left kidney due to the multiple RCCs. We performed radiofrequency ablation (RFA) under CT guidance for the treatment of that recurred tumor. As the tumors were adjacent to the descending colon, we injected the carbon dioxide gas (a dissection technique) during a radiofrequency ablation (RFA) procedure to displace the descending colon from the tumors. As a result, we were able to successfully achieve RFA for the recurred tumors without any complications including the intestinal thermal injury such as wall thickening or perforation. The patient survives well 5 months after RFA without the local recurrence. RFA in the solitary kidney is safe and effective treatment to preserve the remaining renal function, and the dissection technique using with carbon dioxide gas is also useful to avoid the thermal injury of the adjacent organs.
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Carcinoma de Células Renales/cirugía , Ablación por Catéter/métodos , Neoplasias Renales/cirugía , Enfermedad de von Hippel-Lindau/complicaciones , Dióxido de Carbono/administración & dosificación , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia , NefrectomíaRESUMEN
The purpose of this study was to evaluate the accuracy of centerline of flow (CLF) measurement for precise sizing of the Zenith AAA endovascular graft (Zenith) and to identify predictive factors of risk of inadequate endograft sizing. We analyzed 42 consecutive patients treated using the Zenith with pre- and postoperative multidetector CT between 2001 and 2007. Endograft sizing was retrospectively performed using CLF on a three-dimensional workstation. The following parameters were investigated: (a) change in distance from lowest renal artery to hypogastric artery between CLF on preoperative CT (CLFp) and CLF of graft path on postoperative CT (CLFg); (b) supposed success rate of adequate endograft length selection; and (c) predictive factors for significant alteration (>10 mm) between CLFp and CLFg. Median change in distance from lowest renal artery to hypogastric artery was 4 mm. CLFg was >10 mm shorter than CLFp in 10 of 84 limbs (12%). Multivariate analysis demonstrated tortuosity index (TI) of infrarenal abdominal aorta (p = 0.019), aneurysm diameter (p = 0.035), and ipsilateral side of the main body insertion (p = 0.042) as predictive factors of significant alteration between CLFp and CLFg. Adequate endograft length selection was achieved in 39 of 42 cases (93%). All three inadequate endograft length selections were associated with tortuous aorta (TI > 20 mm). In conclusion, distance calculations based on CLF measurement provided accurate length selection of the Zenith in the majority of cases. TI, aneurysm diameter, and ipsilateral side were predictive factors for significant alteration. The CLF and aortic measurements including the TI may allow for improved sizing for Zenith placements.
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Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Ajuste de Prótesis/métodos , Anciano , Anciano de 80 o más Años , Angiografía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Velocidad del Flujo Sanguíneo , Femenino , Humanos , Imagenología Tridimensional , Modelos Logísticos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Arteria Renal , Estudios Retrospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Estómago/irrigación sanguínea , Tomografía Computarizada por Rayos XRESUMEN
Drug-induced pneumonitis is a serious and an unpredictable side effect of chemotherapy in patients with malignant lymphoma. We present the case of a 51-year-old man who developed drug-induced pneumonitis during chemotherapy for non-Hodgkin's lymphoma in which pneumonitis was detected earlier by 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) than by high-resolution computed tomography (HRCT). After five courses of chemotherapy, 18F-FDG-PET was performed for assessing residual lesions, and diffuse lung uptake was incidentally observed. No symptoms were present, and HRCT performed immediately following PET revealed no abnormalities. Mild dyspnea appeared 3 days after PET, and additional HRCT revealed patchy ground-glass opacities disseminated with the appearance of interlobular septum thickening. Drug-induced pneumonitis was finally diagnosed, and treatment was initiated. 18F-FDG-PET can be an imaging modality for detecting drug-induced pneumonitis at an extremely early stage in which HRCT is incapable of revealing any abnormal changes.
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Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Fluorodesoxiglucosa F18 , Linfoma no Hodgkin/diagnóstico , Neumonía/inducido químicamente , Neumonía/diagnóstico , Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada por Rayos X , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ciclofosfamida/efectos adversos , Ciclofosfamida/uso terapéutico , Doxorrubicina/efectos adversos , Doxorrubicina/análogos & derivados , Doxorrubicina/uso terapéutico , Humanos , Linfoma no Hodgkin/complicaciones , Linfoma no Hodgkin/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Prednisona/efectos adversos , Prednisona/uso terapéutico , Radiofármacos , Sensibilidad y Especificidad , Vincristina/efectos adversos , Vincristina/uso terapéuticoRESUMEN
Multiple myeloma is an incurable B-cell malignancy requiring new therapeutic strategies in clinical settings. Interleukin (IL)-6 signaling pathways play a critical role in the pathogenesis of multiple myeloma. The traditional Chinese medicine cantharidin (CTD) has been shown to inhibit cellular proliferation and induce apoptosis of various cancer cells. The aim of this study was to investigate the possibility of CTD as a novel therapeutic agent for the patients with multiple myeloma. We investigated the in vitro effects of CTD for its antimyeloma activity, and further examined the molecular mechanisms of CTD-induced apoptosis. CTD inhibited the cellular growth of human myeloma cell lines as well as freshly isolated myeloma cells in patients. Cultivation with CTD induced apoptosis of myeloma cells in a cell-cycle-independent manner. Treatment with CTD induced caspase-3, -8, and -9 activities, and it was completely blocked by each caspase inhibitor. We further examined the effect of CTD on the IL-6 signaling pathway in myeloma cells, and found that CTD inhibited phosphorylation of STAT3 at tyrosine 705 residue as early as 1 h after treatment and down-regulated the expression of the antiapoptotic bcl-xL protein. STAT3 directly bound and activated the transcription of bcl-xL gene promoter, resulting in the induction of the expression of bcl-xL in myeloma cells. The essential role of STAT3 in CTD effects was confirmed by transfection with the constitutively active and dominant negative form of STAT3 in U266 cells. In conclusion, we have demonstrated that CTD is a promising candidate to be a new therapeutic agent in signal transduction therapy.
Asunto(s)
Apoptosis/efectos de los fármacos , Cantaridina/farmacología , Inhibidores Enzimáticos/farmacología , Quinasas Janus/metabolismo , Factores de Transcripción STAT/metabolismo , Cantaridina/uso terapéutico , Caspasa 3/metabolismo , Caspasa 8/metabolismo , Caspasa 9/metabolismo , Ciclo Celular/efectos de los fármacos , Regulación hacia Abajo , Inhibidores Enzimáticos/uso terapéutico , Humanos , Técnicas In Vitro , Interleucina-6/metabolismo , Mieloma Múltiple/tratamiento farmacológico , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Transducción de Señal , Proteína bcl-X/metabolismoRESUMEN
PURPOSE: To clarify whether the ipsilateral limb level of the main body of the graft above or below the aortic bifurcation affects midterm outcomes of endovascular abdominal aortic aneurysm repair (EVAR) with the Zenith abdominal aortic aneurysm endovascular graft. MATERIALS AND METHODS: The authors analyzed 70 consecutive patients treated with the Zenith endograft between 1999 and 2006 with a retrospective review of prospectively collected clinical and imaging data. Patients were divided into two groups--those in whom the ipsilateral limb of the main body was placed above the aortic bifurcation (group A, n = 34) and those in whom the ipsilateral limb of the main body was placed below the aortic bifurcation (group B, n = 36). The frequency of sac enlargement, late type I or III endoleak, and secondary intervention and freedom from major adverse events associated with an aneurysm were compared. RESULTS: The median follow-up was 38 months (range, 1-84 months). The frequency of sac enlargement was 12% (four of 34 patients) in group A and 8% (three of 36 patients, P = .94) in group B. The frequency of late type I or III endoleak was 9% (three of 34 patients) in group A and 6% (two of 36 patients, P = .95) in group B. The frequency of secondary intervention was 15% (five of 34 patients) in group A and 6% (two of 36 patients, P = .38) in group B. Rate of freedom from major adverse events at 60-month follow-up was 62% in group A and 80% in group B (P = .54). CONCLUSIONS: Placement of the ipsilateral limb of the main body above the aortic bifurcation should be considered as one option in patients with an inadequate iliac anatomy at this time. Further follow-up and accumulation of patients will help clarify outcomes with regard to differences in ipsilateral limb level.
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Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/métodos , Anciano , Anciano de 80 o más Años , Angiografía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Distribución de Chi-Cuadrado , Femenino , Estudios de Seguimiento , Migración de Cuerpo Extraño , Humanos , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Interpretación de Imagen Radiográfica Asistida por Computador , Estudios Retrospectivos , Estadísticas no Paramétricas , Tomografía Computarizada Espiral , Resultado del TratamientoRESUMEN
The purpose of this study was to retrospectively clarify the current status in Japan of TACE using Lipiodol together with anticancer agents to treat hepatocellular carcinoma (HCC). We retrospectively surveyed 4,659 (average annual total) procedures for HCC over the years 2002-2004 at 17 institutions included in the TACE Study Group of Japan. The survey included six questions that were related mainly to TACE and Lipiodol for HCC treatment. The most frequently applied among the 4,659 procedures at the 17 institutions were TACE (2,310; 50%) and local ablation (1,395; 30%). Five of the institutions applied 201-300 procedures and 4 applied 101-200. Lipiodol was used in "all procedures" and in "90% or more" at seven and nine institutions, respectively. Almost all institutions applied 4-6 (mean, 5) ml of Lipiodol during TACE to treat tumors 5 cm in diameter. In conclusion, this survey clarified that TACE using Lipiodol and anticancer agents is a popular option for HCC treatment in Japan.
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Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/estadística & datos numéricos , Revisión de la Utilización de Medicamentos/estadística & datos numéricos , Aceite Yodado , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/terapia , Biopsia con Aguja , Carcinoma Hepatocelular/mortalidad , Cateterismo/métodos , Medios de Contraste/administración & dosificación , Estudios Transversales , Femenino , Humanos , Inmunohistoquímica , Japón , Neoplasias Hepáticas/mortalidad , Masculino , Estadificación de Neoplasias , Pronóstico , Medición de Riesgo , Sensibilidad y Especificidad , Encuestas y Cuestionarios , Tasa de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: The heterogeneity of acute myeloid leukemia (AML) has been established by many new insights into the pathogenesis and treatment of patients with AML. Understanding the basic cellular and molecular pathogenesis of leukemic cells is vital to the development of new treatment approaches. OBJECTIVE/METHODS: To review progress until now with agents that are showing promise in the treatment of AML, we summarize the published preclinical and clinical trials that have been completed. RESULTS: Based on recent progress of investigations, more specifically targeted agents have been developed for the treatment of AML such as tyrosine kinase inhibitors, monoclonal antibodies, epigenetic agents, antiangiogenic agents, and farnesyl transferase inhibitors. CONCLUSION: In the future, in addition to performing therapeutic trials of these agents, it will be important to identify other highly specific therapeutic agents based on our evolving understanding of the biology of AML.
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PURPOSE: To report a case of deteriorating consumptive coagulopathy with type III endoleak following endovascular aneurysm repair (EVAR) of the abdominal aorta associated with liver cirrhosis. CASE REPORT: A 72-year-old man with liver cirrhosis developed type III endoleak following EVAR. Spontaneous intramuscular hematoma developed due to deteriorating consumptive coagulopathy induced by type III endoleak and liver dysfunction. Although additional EVAR was performed at 52 months after primary EVAR, the patient died due to multiorgan failure and multifocal hematoma of the muscles and subserosa. CONCLUSION: EVAR for patients with liver dysfunction and coagulopathy should be considered with great caution. We suggest that prompt and adequate treatment using an endovascular technique or surgical repair should be performed for patients with liver dysfunction, coagulopathy, and turbulent endoleak, even if the coagulopathies are worse compared to before EVAR.
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Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Prótesis Vascular , Coagulación Intravascular Diseminada/etiología , Cirrosis Hepática/complicaciones , Falla de Prótesis , Stents , Anciano , Angiografía de Substracción Digital , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/etiología , Transfusión de Componentes Sanguíneos , Implantación de Prótesis Vascular/instrumentación , Coagulación Intravascular Diseminada/complicaciones , Coagulación Intravascular Diseminada/cirugía , Coagulación Intravascular Diseminada/terapia , Resultado Fatal , Hematoma/etiología , Humanos , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/cirugía , Masculino , Plasma , Politetrafluoroetileno , Diseño de Prótesis , Reoperación , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
PURPOSE: To retrospectively clarify the utility of metallic stent placement for the treatment of the malignant obstruction of the superior vena cava (SVC) in 71 patients with VC syndrome (SVCS) on the basis of long-term follow-up data. MATERIALS AND METHODS: Seventy-one patients underwent stent placement and were followed until death. The applicability of the spiral Z-stent (S-Z-stent) mainly used the initial and follow-up results, stent placement for bilateral BCV obstruction and the value of concurrent anticancer therapy were studied. RESULTS: The technical success rate was 100%, the initial clinical success rate was 87% (62/71), the primary clinical patency rate was 88% (57/65), and the secondary clinical patency rate was 95% (62/65). The obstruction rate of the stent was 12% (8/65), and an additional stent was useful for relief of recurrent SVCS. Survival of 57 patients in whom there was no recurrence of SVCS until death ranged from 1 week to 29 months (mean, 5.4 months and the S-Z-stent appeared to be suitable for the treatment of the malignant obstruction of SVC. Unilateral stent placement was effective for relief of SVCS with bilateral BCV obstruction. Patients who received concurrent anticancer therapy survived 2 months longer than those who did not. CONCLUSION: Stent placement is an effective treatment for SVCS. Further, the utility of S-Z-stent for SVCS, an additional stent for recurrence, unilateral stent for patients with bilateral BCV obstruction, and anticancer therapy after stent placement were verified.
Asunto(s)
Implantación de Prótesis Vascular/instrumentación , Metales , Neoplasias/complicaciones , Stents , Síndrome de la Vena Cava Superior/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Implantación de Prótesis Vascular/efectos adversos , Venas Braquiocefálicas/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/tratamiento farmacológico , Neoplasias/mortalidad , Neoplasias/radioterapia , Neoplasias/cirugía , Flebografía , Diseño de Prótesis , Recurrencia , Estudios Retrospectivos , Síndrome de la Vena Cava Superior/diagnóstico por imagen , Síndrome de la Vena Cava Superior/etiología , Síndrome de la Vena Cava Superior/mortalidad , Síndrome de la Vena Cava Superior/fisiopatología , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
PURPOSE: A patient with abdominal lymphoma who had been in complete remission for 6 years presented with a 1-month history of dysarthria. The aim of our report is to discuss the discordance of the patient's results between magnetic resonance (MR) imaging and F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET). MATERIALS AND METHODS: After the onset, FDG PET and brain MR imaging were performed. The FDG PET study included whole-body and brain scan. The MR study included pre- and postcontrast T1, T2, fluid-attenuated inversion recovery and diffusion-weighted sequences. RESULTS: Brain MR imaging showed a localized abnormal signal around the left Sylvian fissure in any sequence, although a postcontrast study exhibited poor enhancement in the lesion. Brain PET showed a widespread area of slightly increased uptake in the brain on the left side, which was quite inconsistent with the MR results. After 4 months, follow-up MR imaging revealed a widespread abnormal signal, with enhancing masses, in the hypermetabolic region. CONCLUSIONS: Hypermetabolic changes on FDG PET preceded signal changes on MR imaging, potentially suggesting that hypermetabolism occurred in the microscopic infiltration of lymphoma cells.
Asunto(s)
Neoplasias del Sistema Nervioso Central/diagnóstico , Neoplasias del Sistema Nervioso Central/metabolismo , Linfoma/diagnóstico , Linfoma/metabolismo , Neoplasias del Sistema Nervioso Central/diagnóstico por imagen , Disartria/patología , Fluorodesoxiglucosa F18/metabolismo , Humanos , Linfoma/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Pronóstico , Radiografía , RecurrenciaRESUMEN
A clinical study on the use of porous gelatin particles(sterile gelatin embolization material, YM 670, Gelpart) in transcatheter arterial embolization (TAE) was performed in patients with hepatocellular carcinoma, and the efficacy (embolization,anti-tumor effect, recanalization and operationality) and safety (tolerability) were studied. An additive agent comprising porous gelatin particles and low osmolarity contrast media was administered peripherally through a catheter into the hepatic artery proper of 63 patients with hepatocellular carcinoma. Good hepatic arterial embolization was confirmed in all cases (embolization: 100%), and a tumor necrosis effect was obtained in most cases (35/62 patients, 56.5%). Moreover, operationality was assessed as "highly easy to use" or "easy to use" in all cases. Frequencies of adverse events in which a relationship to TAE was not excluded and abnormalities of clinical laboratory data were high at 71.4% and 9 8.4%, respectively. The most common adverse reactions were pyrexia, abdominal pain, queasiness and blood pressure increase;abnormalities in clinical laboratory data included hepatic function with increased AST (GOT), increased ALT (GPT), decreased cholinesterase, increased LDH and increased total bilirubin. These adverse reactions and abnormalities in clinical laboratory data, however, were transient and attributed to the TAE procedure itself, and no adverse reactions related to YM 670 as an embolic material were observed. In addition, with regard to tolerability (safety), the treatment was assessed as suitable for use in all the present cases.