[Show abstract][Hide abstract] ABSTRACT: A 73-year-old man who consulted our hospital with a chief complaint of upper abdominal pain was admitted with a diagnosis of acute pancreatitis. An image of a localized irregular narrow segment was observed in the main pancreatic duct of the pancreatic head upon ERCP, with a poorly contrasting region measuring 8 mm in size, corresponding to the narrow segment observed on abdominal CT. A blocked main pancreatic duct and common bile duct were observed in the vicinity of the pancreaticobiliary duct upon MRCP. Based on the laboratory finding, pancreaticoduodenectomy and right nephrectomy were performed with a preoperative diagnosis of pancreatic cancer and right renal cell cancer. As no malignant findings were observed in the resected specimen, and only plant tissue was found in the main pancreatic duct in histopathological laboratory findings, it was diagnosed as obstructive pancreatitis caused by a foreign substance in the main pancreatic duct. The mechanism of the appearance of the foreign substance in the main pancreatic duct was unknown in this case because the patient had no history of drug use that was likely to influence the function of the papillary sphincter muscle or a history of choledocholithiasis, and because no evident morphological defects in the duodenal papilla were found through imaging.
No preview · Article · Jan 2014 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: This case involved a 76-year-old woman found to have occult blood in her stool. The patient underwent further testing in the form of lower gastrointestinal tract endoscopy, which revealed type Ip polyps in the descending colon. These were diagnosed as hyperplastic polyps, so a polypectomy was performed, but poorly differentiated adenocarcinoma and mucinous carcinoma were found in most of the resection specimens. Margins were positive, so further resection of the bowel was performed. Preoperative image findings also suggested para-aortic lymph node metastasis, therefore para-aortic lymph node dissection was also performed. Residual tumor cells were not found in the resected intestine but para-aortic lymph node metastasis was present, so the final diagnosis was adenocarcinoma, por2, muc>tub2 type 0-Ip, pSM (>5,000 μm), int, INFb, ly0, v1, M1 Stage IV. Characteristic endoscopic findings in this case indicated that lesions had invaded deep into the submucosa and had resulted in distal lymph node metastasis. The cross-sectional morphology of these lesions and their relationship to histological findings are described here, along with a discussion of some of the literature.
No preview · Article · Jan 2013 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. The recent molecular-targeted therapies (imatinib and sunitinib) have improved the treatment of GIST remarkably. However, it would be ideal if the amount of these drugs could be adjusted according to each patient because they have various side effects and are very expensive. We experienced a case of non-curative resectable GIST maintained as a long, stable disease after operation, despite tapering down the dose of imatinib mesylate for personal reasons. Case: A woman aged 50. She had received surgery for a lower abdominal tumor, and had been diagnosed with GIST of the small intestine and disseminations. When she suspended taking imatinib (400 mg/day) after her operation, these tumors regrew. After restarting imatinib at 400 mg/day in an alternate-day administration lasting 2 weeks followed by a 2 week interval, the disseminated tumors were in significant for 60 months after the operation.
No preview · Article · Oct 2011 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: A 55-year-old woman underwent total mastectomy and axillary lymphnode dissection in 2001. Widespread lymphnode metastasis was found histologically (26/33). Neither PgR nor ER was positive. She underwent an AC regimen and paclitaxel chemotherapy. As CEA began to rise in 2002, she was given paclitaxel and docetaxel chemotherapy sequentially. As CEA rose again in 2004, capecitabine was begun. Painful erythema of the palms and soles of the feet appeared at the end of the second cycle. After admission, severe bone marrow suppression and jaundice were found. The bilateral hands, palms and soles of the feet became bullous and erosive with desquamation. The erosive lesions began to heal with epithelization in the third week. After general conditions had improved, capecitabine was restarted at a reduced dose. This patient had continued taking capecitabine even though she noticed the occurrence of the adverse effect. Patients and doctors must share confidential information when performing chemotherapy at the outpatient clinic.
No preview · Article · Aug 2007 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: Hepatic arterial infusion chemotherapy with levofolinate (l-leucovorin) and fluorouracil regimen was performed using an implanted port system on unresectable hepatic metastasis patients with colorectal cancer. A comparative study was performed on two groups in which the levofolinate was administered arterially or intravenously. Levofolinate 200-250 mg/m(2) was infused for two hours intra-arterially or intravenously, and 5-FU 400-600 mg/m(2) was administered as a bolus in midinfusion. The regimen was repeated weekly for six weeks, followed by no medication for two weeks. Six patients were administered intra-arterially and 7 patients intravenously. The response rate was higher in the group in which levofolinate was given intravenously. The adverse effect was lower in the former than in the latter group. When 5-FU and levofolinate was performed using an implanted port system, it seemed better to administer levofolinate intravenously.
No preview · Article · Mar 2006 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: There is no established system for predicting prognosis and evaluating the efficacy of antiseptic treatments such as polymyxin B-immobilized fiber (PMX) according to the severity of peritonitis in patients with colonic perforation. We investigated the predictive value of various severity scoring systems for survival and for the efficacy of antiseptic treatments, to identify high-risk patients.
We reviewed 26 consecutive patients who underwent emergency operations between 1996 and 2003 for colorectal perforation not caused by trauma or iatrogenic disease. Several severity scores, i.e., Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), Mannheim Peritonitis Index (MPI), and Multiple Organ Failure (MOF) were calculated and analyzed as predictive scoring systems for prognosis, survival and efficacy of PMX treatment.
An APACHE II score of 19, a SOFA score of 8, an MPI score of 30, and an MOF score of 7 or more were significantly related to a poor prognosis. With or without PMX treatment, an APACHE II score of 15 or less, a SOFA score of 7 or less, an MPI score of 27 or less, and an MOF score of 7 or less were all related to a good prognosis. Conversely, all patients died when the severity scoring points were higher than 20 in APACHE II, higher than 12 in SOFA, and higher than 39 in MPI. When PMX treatment was given to patients with an intermediate score, no correlation between survival and its efficacy was found, except in the MOF scoring system.
These severity scoring systems can assist with the prediction of prognosis. They may also be useful for determining if PMX treatment would be unnecessary or ineffective in certain patients. However, the optimal application of PMX treatment in selected patients according to the severity scoring systems needs further investigation.
[Show abstract][Hide abstract] ABSTRACT: No ideal and generally accepted prognostic factors and scoring systems exist to determine the prognosis of peritonitis associated with colonic perforation. This study was designed to investigate prognostic factors and evaluate the various scoring systems to allow identification of high-risk patients.
Between 1996 and 2003, excluding iatrogenic and trauma cases, 26 consecutive patients underwent emergency operations for colorectal perforation and were selected for this retrospective study. Several clinical factors were analyzed as possible predictive factors, and APACHE II, SOFA, MPI, and MOF scores were calculated.
The overall mortality was 26.9%. Compared with the survivors, non-survivors were found more frequently in Hinchey's stage III-IV, a low preoperative marker of pH, base excess (BE), and a low postoperative marker of white blood cell count, PaO2/FiO2 ratio, and renal output (24h). According to the logistic regression model, BE was a significant independent variable. Concerning the prognostic scoring systems, an APACHE II score of 19, a SOFA score of 8, an MPI score of 30, and an MOF score of 7 or more were significantly related to poor prognosis.
Preoperative BE and postoperative white blood cell count were reliable prognostic factors and early classification using prognostic scoring systems at specific points in the disease process are useful to improve our understanding of the problems involved.
No preview · Article · May 2005 · Hepato-gastroenterology
[Show abstract][Hide abstract] ABSTRACT: The incidence of once-rare granular echinococcosis of the liver has recently increased and moved away from endemic areas. We report a case of granular echinococcosis of the liver. A 55-year-old Peruvian woman admitted for fever and abdominal pain was admitted with hypotension, tachycardia, hyperthermia, tenderness in the right-upper abdomen, and whole-body redness and itching. Blood studies showed mildly elevated LDH and hypoxia. Abdominal US, CT, and MRI showed an 8 cm cyst in the left lobe of the liver. Suspecting a liver abscess, we conducted US-guided abscess drainage. We detected echinococcus granulosus in the cloudy yellow-brown fluid aspirated from the abscess. We prescribed Albendazole for 2 weeks, then conducted left hepatic lateral segmentectomy. In suspected liver abscess or cyst, we must keep this disease in mind, diagnosing and treating such cases carefully.
No preview · Article · Jan 2004 · Nippon Shokaki Geka Gakkai zasshi