A case of traumatic intrapleural foreign body with progressive supranuclear palsy removed by thoracoscopic surgery.

Traumatic intrathoracic foreign bodies are said to occur in many cases when the patient himself/herself is aware of the trauma. However, at the time of injury, the patient may sometimes be accompanied by loss of consciousness. We report a case of traumatic intrathoracic foreign body that was difficult to diagnose due to loss of consciousness at the time of injury. A 51-year-old female was brought to our emergency department with a fall trauma due to loss of consciousness while bathing. The head computed tomography and electrocardiogram showed no abnormalities, and the laceration of approximately 3 cm in length was found on the left side thorax, and it was sutured and the patient was sent home. Four days later, she returned to our hospital with a complaint of left anterior chest pain, and chest X-ray showed a left degree pneumothorax and mediastinal emphysema. She underwent semi-emergency thoracoscopic removal of the foreign body, and was discharged from the hospital on the fourth postoperative day. She had progressive supranuclear palsy, and her memory at the time of injury was not clear due to loss of consciousness caused by central autonomic neuropathy, and she also had dementia, making it difficult to interview her. She had no thoracic symptoms, and the glass fragment that had strayed into the thoracic cavity was not exposed outside the body, making the diagnosis difficult at the time of initial examination. When a patient with loss of consciousness is difficult to interview at the time of injury, it is advisable to perform an imaging examination appropriate for the site of injury, taking into consideration the presence of foreign bodies.

Clinicopathological features of CA19-9-producing gastric cancer.

BACKGROUND/AIMS: The aims of this study were to define CA19-9-producing gastric cancer and investigate its clinicopathological features. METHODOLOGY: Twenty-three patients showing high preoperative serum CA19-9 levels (> or = 38 U/mL) were enrolled in this retrospective cohort study. The CA19-9 cut-off level was determined on the basis of receiver operating characteristic analysis of CA19-9 levels obtained from patients having survived for 3 years after surgery. Patients in whom the CA19-9 level was the cut-off level or higher were defined as having CA19-9-producing gastric cancer (Group A), and their clinicopathological features were compared with those of patients showing CA19-9 levels less than the cut-off level (Group B). RESULTS: The preoperative serum CA19-9 cut-off level was set at 77 U/mL. In Group A, lymph node metastasis was seen in all 11 patients, with the incidence being higher than that in Group B (p <0.001). The number of patients with stage III or greater disease was 10 in Group A, compared with only 3 in Group B (p < 0.001). The independent prognostic factors were preoperative serum CA19-9 levels, venous invasion and tumor stage. CONCLUSIONS: CA19-9-producing gastric cancer is a type of gastric cancer with poor prognosis and characterized by preoperative serum CA19-9 > or = 77 U/mL.

Palliative surgical treatment for enterostasis caused by recurrent gastric cancer: analysis of survival and QOL based on pathological features.

To improve quality of life (QOL) and prolong survival, enterostasis caused by recurrent gastric cancer must be treated appropriately. We reviewed the current treatment retrospectively. The subjects were 43 patients with enterostasis caused by recurrent gastric cancer and treated by surgical procedures at our hospital from 1988 to 1997. Survival and QOL were analyzed in relation to the mode of recurrence, the pathological diagnosis at the initial operation, and surgical procedures. The patients treated by colostomy, ileostomy, or bypass for local occlusion caused by isolated peritoneal recurrence or lymph node recurrence had significantly better quality of life and longer survival [discharge rate: colostomy and ileostomy, 81.8% (9/11); bypass, 77.8% (14/18); survival time: colostomy and ileostomy, 223.5 +/- 171.9 days; bypass, 129.6 +/- 91.0 days] than those who underwent exploratory laparotomy, gastrostomy, or enterostomy and had diffuse disseminated lesions of peritoneal recurrence [discharge rate: 21.4% (3/14); survival time: 44.6 +/- 31.5 days; P < 0.05]. In the patients in whom the pathological diagnosis at initial surgery was differentiated type or poorly solid type, the risk of exploratory laparotomy alone was low (5.6%; 1/18; P < 0.01). Enterostasis with pathological diagnosis at initial surgery of differentiated type or poorly solid type should be treated with aggressive laparotomy and colostomy, ileostomy, or bypass to improve survival and QOL.

Immunotherapy using fusions of autologous dendritic cells and tumor cells showed effective clinical response in a patient with advanced gastric carcinoma.

Immunotherapy using tumor antigen-loaded dendritic cells is a new approach for the treatment of various types of malignant tumors. Here, we describe a patient with advanced gastric carcinoma who received immunotherapy using fused autologous dendritic cells and carcinoma cells (fusions) and showed effective clinical responses to the treatment. A 74-year-old man showed massive ascitic effusion due to peritonitis carcinomatosa after surgical operation for gastric carcinoma. A gastric carcinoma cell line was established from the patient's tumor tissue. Dendritic cells were obtained by cultivation of the adherent cell fraction of the patient's peripheral blood mononuclear cells (PBMCs) with granulocyte macrophage-colony stimulating factor, interleukin-4, and tumor necrosis factor-alpha. The cells were mixed with irradiated tumor cells and treated with 50% polyethyleneglycol (PEG) for the generation of fusions, as described previously. The PEG-treated cells were injected subcutaneously every 2 weeks. Low-grade fever was observed after the first and second treatments. After the third treatment, ascitic effusion and leg edema decreased markedly, without any other treatments. Serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 decreased to levels lower than those at the initiation of treatment. PBMCs collected after the fifth treatment elicited cytotoxic activity against autologous tumor cells. Although treatment was continued in the same way, recurrence of the disease was observed about 5 months after the start of the treatment. This is the first report of immunotherapy utilizing fusions of autologous dendritic cells and tumor cells resulting in effective clinical responses in advanced gastric carcinoma, without severe adverse effects.