Programmed chemotherapy for patients with metastatic unresectable gastric cancer.

BACKGROUND: Recent advances in the treatment of metastatic unresectable gastric cancers (MGC) include the development of new antitumor drugs and new regimens for their use. However, the selection of individually designed regimens by gastric cancer (GC) subtype remains problematic. Here, we investigated the clinical usefulness of programmed chemotherapy. METHODOLOGY/PRINCIPAL FINDINGS: MGC patients were classified into three groups by clinical condition. We implemented a chemotherapy program consisting of S-1 combination regimens. Median survival time (MST) of level 1 patients was 416 days (95% CI: 313-506 days), with an overall response rate of 47%. MSTs of level 2 and 3 patients were 208 (95% CI: 153-287 days) and 95 days (95% CI: 28-136 days), respectively. Grade 3-4 toxicities were neutropenia in 12% and anorexia in 6%. All treatment- related toxicities were resolved, and no treatment-related deaths occurred. CONCLUSIONS/SIGNIFICANCE: This program provided reasonable selection of case-matching regimens and may improve the survival of patients with MGC. Further, it may represent the first clinical tool to provide efficient chemotherapy course selection for MGC. Ongoing analysis of newly developed drugs and regimens will allow the efficacy of this chemotherapy program to be improved.

Cerebral air embolism as a complication of peptic ulcer in the gastric tube: case report.

BACKGROUND: The reported incidence of ulcer formation in the gastric tube in esophageal replacement is rare. CASE PRESENTATION: This is the first report of a case of cerebral air embolism as a result of spontaneous perforation of an ulcer in the constructed gastric tube into the pulmonary vein during post-operative follow-up in a patient with esophageal cancer. CONCLUSIONS: Cerebral air embolism is a rare complication of penetrating gastric ulcer, but should be considered in patients with a history of esophagectomy with gastric conduit that present with acute neurologic findings.

[A case of pancreatic arteriovenous malformation creating a common bile duct-duodenal fistula with the onset of hemorrhagic duodenal ulcer].

A 50-year-old man had been treated for hemorrhagic duodenal ulcer. Although the patient was treated by proton pump inhibitors (PPI), the ulcer did not show any sign of improvement. Therefore, we also examined the pancreas, and obtained CT findings suggestive of arteriovenous malformation (AVM) from the head to the body of the pancreas. Pancreatic AVM was diagnosed based on angiography. He was readmitted for high fever and abdominal pain. On day 2, CT demonstrated a cystic lesion containing gas at the pancreatic head, and CT showed pneumobilia on day 15. The next day, pancreaticoduodenectomy was carried out and a common bile duct-duodenal fistula was confirmed. This report describes a rare case of pancreatic AVM complicated with a common bile duct-duodenal fistula.

[Rupture of ileal varices in a type C liver cirrhosis patient: a case report].

A 74-year-old woman was admitted to our hospital with recurrent massive lower gastrointestinal bleeding. She had a history of type C liver cirrhosis and appendectomy, and had undergone endoscopic ligation of esophageal varices one year before. Three-dimensional CTA revealed ileal varices in the right lower quadrant of the abdomen. Superior mesenteric arteriography demonstrated varices at the corresponding area and collateral veins from the superior mesenteric vein to the right ovarian vein. Ileal varices were diagnosed and ileal resection was performed. At surgery, exposed vessels were present at the mucosal surface of the resected specimen and they were thought to be the origin of hemorrhage. In conclusion, bleeding from small intestinal varices, though uncommon, should be considered when the origin of melena is unidentified in a patient with liver cirrhosis.

[An autopsy case of colon cancer associated ulcerative colitis complicated focal squamous cell carcinoma].

A 28-year-old woman with ascites was admitted to our hospital. We diagnosed peritonitis carcinomatosa caused by colon cancer complicated by ulcerative colitis. We performed peritoneal tap and infusion of mitomycin C, and administered 5-fluorouracil. Her clinical status gradually worsened, and she died 5 months later. At autopsy, the histological examination showed many mucinous adenocarcinoma and signet ring cell carcinoma with dysplasia. There were also some areas of squamous cell carcinoma with squamous metaplasia and dysplasia far from rectum. Squamous cell carcinoma and adenosquamous cell carcinoma of the colon are rare complications of ulcerative colitis. We reported this case as an addition to the literature on the subject.

[A case of hepatosplenic cat scratch disease].

A 43-year-old man was admitted with idiopathic fever. Abdominal ultrasonogram demonstrated multiple hypoechoic lesions in the spleen. Abdominal CT scan showed multiple hypodense lesions in the liver and spleen. The patient had a cat in his house, and the presence of a very high serous antibody titer for Bartonella henselae led to the diagnosis of hepatosplenic cat scratch disease. It is important to consider this disease in the differential diagnosis of idiopathic fever when multiple lesions are detected in the liver and spleen.