RESUMO
Our patient was a man in his 70s who underwent proximal gastrectomy with double tract reconstruction in 2013. He was diagnosed with cStage â £ unresectable remnant gastric cancer with paraaortic lymph node metastases in 2021. He was treated with 5 courses of S-1 plus oxaliplatin therapy. Computed tomography revealed that the lymph node metastases had decreased in size after treatment. We performed conversion surgery and achieved R0 resection. Furthermore, the elevated jejunum was preserved and total gastrectomy was possible without re-anastomosis. Postoperative adjuvant chemotherapy with S-1 was started and he remains alive without recurrence at 6 months postoperative.
Assuntos
Neoplasias Gástricas , Masculino , Humanos , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/patologia , Metástase Linfática , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Excisão de Linfonodo , Gastrectomia/métodosRESUMO
The patient was 40s male, who underwent laparoscopic low anterior resection for his upper rectal cancer with final pathology results of tub2, pT3(SS), no lymph metastasis and fStage â ¡. He was followed up without adjuvant chemotherapy. Half a year after surgery, tumor marker was elevated and CT scan revealed multiple liver metastases. He was treated with oxaliplatin, irinotecan, Leucovorin and 5-fluorouracil(FOLFOXIRI)plus bevacizumab because of RAS mutant type. In the third courses, he has pain in the lower extremities and was diagnosed with acute lower extremity arterial occlusion. Subsequently, chemotherapy was resumed with the exception of bevacizumab, in combination with DOAC, which resulted in tumor shrinkage and allowed resection of the liver metastases.
Assuntos
Neoplasias Hepáticas , Neoplasias Retais , Masculino , Humanos , Bevacizumab , Camptotecina , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Recidiva Local de Neoplasia/tratamento farmacológico , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/cirurgia , Neoplasias Retais/patologia , Fluoruracila , Leucovorina , Doença Aguda , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/secundárioRESUMO
A 64-year-old woman underwent right hemicolectomy for transverse colon cancer. Histopathological findings revealed T, type 2, 24×22 mm, tub2, pT2N1a(1/23)M0, and pStage â ¢a. Postoperative adjuvant chemotherapy was not administered at the patient's request. One year after surgery, carcinoembryonic antigen(CEA)level was elevated, and Gd-EOB-DTPA- enhanced MRI revealed a nodule in segment 2 and 4/8 of the liver. Based on the diagnosis of hepatic metastasis, laparoscopic partial hepatectomy was performed. Three years after hepatectomy, CEA level was found to be elevated again, and chest CT showed a solitary pulmonary nodule in segment 7 of the right lung. With a diagnosis as pulmonary metastasis, FOLFIRI plus bevacizumab was performed. After 41 courses of FOLFIRI plus bevacizumab, the pulmonary nodule decreased in size, and no new lesions appeared. The chemotherapy was terminated at the patient's request. Six months later, the pulmonary nodule increased in size, and thoracoscopic partial pulmonary resection was performed. Hepatic and pulmonary resection specimens were histopathologically consistent as metastasis of colorectal cancer. The patient has been alive without recurrence for about 4 years after final surgery(pulmonary resection)without postoperative adjuvant chemotherapy. We report a case of long-term survival with metachronous hepatic and pulmonary metastases from transverse colon cancer by multidisciplinary treatment.
Assuntos
Colo Transverso , Neoplasias do Colo , Neoplasias Hepáticas , Neoplasias Pulmonares , Feminino , Humanos , Pessoa de Meia-Idade , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/uso terapêutico , Antígeno Carcinoembrionário/metabolismo , Colo Transverso/cirurgia , Colo Transverso/patologia , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/cirurgia , Neoplasias do Colo/patologia , Hepatectomia , Fígado/patologia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/secundárioRESUMO
A woman in her 90s underwent laparoscopic hernia repair for a recurrent left inguinal hernia with abdominal wall defect 2 years ago. She came to our department with a complaint of a mass in the hernia wound, which was suspected to be a skin cancer, and the pathology diagnosis was adenocarcinoma. A colonoscopy was performed and she was diagnosed with sigmoid rectal cancer with only skin metastasis and the operation was performed. Laparoscopic anterior resection of the rectum, excision of the skin tumor, mesh removal, and rectus abdominis skin grafting were performed, and these were radical surgery. Simultaneous cutaneous metastasis of rectal cancer is extremely rare, being part of the 2.0% of other sites, and is reported with some literature review.
Assuntos
Adenocarcinoma , Hérnia Inguinal , Laparoscopia , Neoplasias Retais , Neoplasias do Colo Sigmoide , Neoplasias Cutâneas , Feminino , Humanos , Adenocarcinoma/cirurgia , Hérnia Inguinal/cirurgia , Hérnia Inguinal/diagnóstico , Neoplasias Retais/cirurgia , Neoplasias do Colo Sigmoide/cirurgia , Neoplasias Cutâneas/cirurgia , Idoso de 80 Anos ou maisRESUMO
A woman in her 80s, had undergone radical surgery for an endometrial carcinoma 9 years earlier, and her 5-year postoperative follow-up had been completed without recurrence. She consulted an orthopedic surgeon with a chief complaint of a mass in the left inguinal region, and was referred to surgery after MRI scan revealed lymph node metastases in the left inguinal and external iliac region and a sigmoid colon tumor. Due to postoperative adhesion of the uterine cancer, the colonoscope could not be inserted to the tumor, and no tissue diagnosis was made. CT and PET scans revealed a sigmoid colon tumor plus periungual lymph node metastasis, and it was determined that radical surgery was possible, and the patient underwent resection. Surgery was performed by laparoscopic resection of the sigmoid colon and lymphadenectomy, with R0 resection. The sigmoid colon tumor and lymph nodes were of the same histology as the 9-year-old endometrial carcinoma, leading to the diagnosis of colon and lymph node recurrence 9 years after endometrial carcinoma surgery.
Assuntos
Carcinoma , Neoplasias do Endométrio , Neoplasias do Colo Sigmoide , Feminino , Humanos , Carcinoma/cirurgia , Neoplasias do Endométrio/cirurgia , Excisão de Linfonodo , Linfonodos/patologia , Metástase Linfática/patologia , Neoplasias do Colo Sigmoide/cirurgia , Neoplasias do Colo Sigmoide/patologia , Idoso de 80 Anos ou maisRESUMO
A 78-year-old man who was diagnosed as having hepatocellular carcinoma(segment 4/8)underwent laparoscopic hepatectomy. About 5 hours after the start of the operation, SpO2 and systolic blood pressure suddenly dropped to 87% and 40 mmHg. EtCO2 level decreased to 8 mmHg and PaCO2 was 48.5 mmHg. Based on the discrepancy between the PaCO2 and EtCO2, the patient was diagnosed as having pneumoperitoneum-induced carbon dioxide embolism. The surgical procedure was immediately interrupted and the patient was hyperventilated with pure oxygen. After surgical interruption, general status was recovered to the normal condition. We carefully restarted the operation and completed it laparoscopically. The patient was discharged from the hospital on the 15th day without any postoperative complications. Carbon dioxide embolization is a serious life-threatening complication that requires careful monitoring.
Assuntos
Laparoscopia , Neoplasias Hepáticas , Choque , Masculino , Humanos , Idoso , Dióxido de Carbono , Hepatectomia , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgiaRESUMO
Case 1 is a 56-year-old man. During postoperative adjuvant chemotherapy for pancreatic cancer, weakness in the right upper and lower limbs appeared, and a head CT scan was performed, but no abnormal findings were noted. Diffusion- weighted MRI scan of the head showed multiple cerebral infarcts, and a diagnosis of Trousseau syndrome was made. Case 2 is an 86-year-old man. During chemotherapy for postoperative recurrence of distal bile duct carcinoma, he developed weakness in the right upper and lower limbs, and a head MRI scan was performed. Diffusion-weighted MRI showed scattered high-signal areas, and a diagnosis of Trousseau syndrome was made. Trousseau syndrome is a condition in which stroke is caused by hypercoagulability associated with malignant tumor. The initial symptoms of cerebral infarction in patients with cancer are similar to those of chemotherapy-induced adverse events and brain metastases, and therefore, a head MRI scan is recommended even if there is no obvious abnormality on head CT scan.
Assuntos
Infarto Cerebral , Neoplasias Pancreáticas , Masculino , Humanos , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Infarto Cerebral/induzido quimicamente , Infarto Cerebral/diagnóstico por imagem , Imageamento por Ressonância Magnética/efeitos adversos , Tomografia Computadorizada por Raios X/efeitos adversos , Neoplasias Pancreáticas/complicaçõesRESUMO
The patient was a 74 year-old woman. She came to the hospital with the chief complaint of vomiting, difficulty walking, and disorientation. The MRI study showed increased FLAIR and DWI signals in the bilateral medial thalamus. Abdominal enhanced CT scan showed a 2.4 cm tumor in the jejunum. And ileus due to small intestinal tumor was observed. She diagnosed Wernicke's encephalopathy associated with gastrointestinal transit disorder. Vitamin B1 300 mg/day for 3 days was started, and eye movements and disorientation improved on the day following the start of administration. On the 10th day after admission, partial resection of the small intestine was performed for a small intestinal tumor. She was diagnosed as small intestinal cancer. She was transferred to the hospital on the 20th postoperative day.
Assuntos
Neoplasias Duodenais , Íleus , Obstrução Intestinal , Encefalopatia de Wernicke , Feminino , Humanos , Idoso , Encefalopatia de Wernicke/tratamento farmacológico , Encefalopatia de Wernicke/etiologia , Encefalopatia de Wernicke/cirurgia , Tiamina , Íleus/etiologia , Íleus/cirurgia , Intestino Delgado/cirurgia , Intestino Delgado/patologia , ConfusãoRESUMO
A 77âyearâold man came to our hospital with complaints of abdominal pain and difficulty to defecate. Abdominal CT scan showed an abnormal region in the ascending colon, which was suspected to be an ascending colon cancer. Dâdimer was remarkably high, and the platelet count was 63,000/µL; these results suggested disseminated intravascular coagulation caused by tumor activation. After he was admitted, we performed a contrast enhanced CT, and found no signs of remote metastasis. We decided to resect the tumor without colonoscopy examination in order to release the DIC state. After the surgery, the platelet count did not increase, and leukopenia was observed. We conducted a bone marrow biopsy, and made a diagnosis of disseminated carcinomatosis from colon cancer. The patient's condition did not improve, and he died on day 42 after admission. Pathological autopsy was performed and several minimal remote metastases were found throughout the body.
Assuntos
Neoplasias da Medula Óssea , Carcinoma , Neoplasias do Colo , Coagulação Intravascular Disseminada , Neoplasias Peritoneais , Idoso , Medula Óssea , Neoplasias do Colo/cirurgia , Coagulação Intravascular Disseminada/etiologia , Humanos , MasculinoRESUMO
A woman in the 60s. She was referred to our hospital because the fecal occult blood test was positive. Colonoscopy was performed. Cancer is found in the transverse colon. There were no metastases in the lungs and liver. Laparoscopic left hemicolectomy was performed. Histopathological examination was adenocarcinoma(tub1>tub2>muc), pT1b, pN2, ly2, v1, pPM0, pDM0, pRM0, budding(0, Grade 1), fStage â ¢b. After postoperative adjuvant chemotherapy, she visited an outpatient clinic 8 months after surgery with a complaint of swelling of both inguinal lymph nodes. The swollen inguinal lymph node was relatively soft and there was no evidence of infection. A biopsy of the bilateral lymph nodes was performed. Histopathological examination revealed adenocarcinoma containing mucus components. These findings were consistent with histological findings in transverse colon cancer. Based on these results, we diagnosed metastatic recurrence from transverse colon cancer to both inguinal lymph nodes.
Assuntos
Adenocarcinoma , Colo Transverso , Neoplasias do Colo , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/cirurgia , Colo Transverso/cirurgia , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/cirurgia , Feminino , Humanos , Linfonodos/cirurgia , Metástase LinfáticaRESUMO
We theoretically analyze directional surface electromagnetic waves supported at an interface between an isotropic medium and anisotropic metal with effective uniaxial negative permittivity. We identify two types of surface wave solutions, resulting in unique hyperbolic dispersion in the wavevector space. Such anisotropic metal can be realized by alternating dielectric and metallic layers with deep subwavelength thicknesses or metallic nanowires in dielectric host. Such systems serve as a platform for many applications in nanophotonics.
RESUMO
BACKGROUND: Recently, the relationship between nutrition and reproduction is being studied. In particular, when older women receive reproductive treatment, egg aging causes greater problems than organic factors. METHODS: This study investigated the relationship between nutrition and reproduction with a focus on factors that cause aging, including oxidation, glycation, and chronic inflammation. A large volume of data concerning each nutrient's relationship with reproductive medicine was collected from a number of observational studies. MAIN FINDINGS: The results showed that refined carbohydrates should be avoided and care should be taken to achieve proper intake of omega-3 fatty acids. Folic acid and vitamin D were also effective. For men, antioxidant measures are especially effective. The effects of antioxidants are related to insulin resistance, which causes chronic inflammation. CONCLUSION: Recent research has shown that rather than meal content, meal intervals are more important for improving insulin resistance. Future research should examine lifestyle-related nutrition factors and their relationships to reproductive treatment.
RESUMO
Here we report a case of a 41-year-old male patient who underwent resection of a desmoid tumor originating from the greater omentum with no history of open surgery. An elastic hard mass was palpated in the left upper abdomen, but there were no abnormalities on serum chemical tests, including tumor markers. Computed tomography showed a parenchymal tumor located near the descending colon. Integrated positron-emission tomography and computed tomography revealed moderate accumulation of tracer in the tumor. An intra-abdominal malignant mesenchymoma was suspected and surgery was performed. The tumor was located in the anterior portion of the greater omentum. It partially invaded the diaphragm, and the affected regions were concurrently resected. The resected specimen measured 80 mm at longest diameter. The cut surface was grayish white and parenchymal. The histopathological findings showed the atypical spindle shaped tumor cells grown with collagen fiber progression. Immunohistochemical staining for ß-catenin showed strong staining in the nuclei and cytoplasm of tumor cells. The patient was diagnosed with desmoid tumor originating from the greater omentum. The desmoid tumor with no history of open surgery was rare. We report this rare case, along with a discussion of the literature.
Assuntos
Fibromatose Agressiva , Omento , Adulto , Biomarcadores Tumorais , Fibromatose Agressiva/cirurgia , Humanos , Masculino , Mesentério , Omento/cirurgia , Tomografia Computadorizada por Raios XRESUMO
A 58-year-old woman underwent surgery and systemic chemotherapy(FOLFIRI plus panitumumab)for ascending colon cancer with multiple lymph node and liver metastases; the preoperative Virchow lymph node aspiration cytology showed adenocarcinoma.After 4 courses of chemotherapy, contrast-enhanced CT showed an embolus in the left subclavian vein.An anticoagulation therapy was started, but the embolus tended to increase.Three months later, the patient developed dyspnea and was diagnosed with pulmonary artery thromboembolism and superior vena cava thrombosis.Transcatheter examination was performed because of the anticoagulation-resistant embolism, and the biopsy revealed tumor embolism due to colon cancer.She died of respiratory failure 10 days after the biopsy.The tumor directly infiltrating the vein because of left subclavian lymph node metastases might have resulted from increased tumor emboli.Although cases of tumor emboli infiltrating the veins and developing from lymph node metastases are rare, a transcatheter biopsy may help to detect them.
Assuntos
Adenocarcinoma , Neoplasias do Colo , Células Neoplásicas Circulantes , Protocolos de Quimioterapia Combinada Antineoplásica , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-IdadeRESUMO
A 78-year-old woman had a semicircular ulcerative lesion of AV 7 cm, as detected using colonoscopy, and pathologic examination based on a biopsy showed well-differentiated adenocarcinoma. On contrast-enhanced CT of the liver, a number of nodular lesions that seemed to be liver metastases were observed. It was decided to administer chemotherapy containing mFOLFOX6 plus panitumumab. Bilateral hemorrhage of the ocular conjunctiva and eyelid edema were observed from the 4th day of chemotherapy. Edema of the lips, epidermolysis, and erythema appeared in addition to vision impairment. We diagnosed her with SJS based on these symptoms. We also administered steroid pulse therapy. Eyelid edema improved, and vision impairment improved 24 hours after the initiation of treatment. For severe cases with visual impairment, systemic administration of corticosteroids is recommended. In this case, administering steroid pulse therapy from an early stage resulted in improvement without sequelae.
Assuntos
Adenocarcinoma , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias do Colo , Síndrome de Stevens-Johnson , Adenocarcinoma/tratamento farmacológico , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Colo/tratamento farmacológico , Feminino , Humanos , Síndrome de Stevens-Johnson/etiologiaRESUMO
We report a case of multiple lung metastases of RAS mutant type descending colon cancer with development of nephrotic syndrome after the introduction of FOLFIRI plus ramucirumab(RAM). A female patient in her 50s underwent adjuvant chemotherapy with capecitabine and oxaliplatin after primary tumor and partial lung resection. For recurrent multiple lung metastases, 4 years of capecitabine and bevacizumab therapy was administered. FOLFIRI plus RAM therapy was introduced because of tumor progression. After treatment, the patient showed increased urine protein content, decreased serum albumin levels, marked hypertension, and increased edema, and was diagnosed with nephrotic syndrome. The patient's condition improved with prednisolone, additional doses of antihypertensive, and diuretics. Even in cases where it is possible to control proteinuria during bevacizumab administration, it is necessary to keep in mind that RAM administration as second-line therapy may cause nephrotic syndrome.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Colorretais , Síndrome Nefrótica , Anticorpos Monoclonais Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab , Camptotecina , Colo Descendente , Feminino , Fluoruracila , Humanos , Leucovorina , Pessoa de Meia-Idade , Síndrome Nefrótica/induzido quimicamente , RamucirumabRESUMO
A 75-year-old woman presented with the chief complaint of right lower abdominal pain. There was mild tenderness in the lower right abdomen and a mass was palpated. There were no peritoneal irritation symptoms. A CT examination was performed. The ascending colon was invaginated with a part of the cecum and ileum. Wall thickening was observed in the advanced part. Colon cancer was suspected. The preoperative diagnosis was considered to be an intussusception with cecal cancer at the advanced part. A laparoscopic ileocecal resection was performed. The intraoperative findings were as follows. The tumor was invading the ascending colon, but it was possible to restore it by pressing on the developed part with forceps. The pathological diagnosis was Type 2, muc>tub1, pT4aN0M0, pStageâ ¡b. The postoperative course was good. Water intake was started on the next day, meals were started from the second day, and the patient was discharged on the 9th day after the operation. Cecal cancer complicated with intussusception is a relatively rare disease. We report a case that was laparoscopically operable.
Assuntos
Neoplasias do Ceco , Intussuscepção , Idoso , Neoplasias do Ceco/complicações , Neoplasias do Ceco/cirurgia , Ceco , Colectomia , Feminino , Humanos , Intussuscepção/etiologia , Intussuscepção/cirurgiaRESUMO
We demonstrate experimentally the lateral circular birefringence of a tunable birefringent polymer, the first example of the spin Hall effect of light in a polymeric material, and we demonstrate that this light shift can be significantly enhanced by tuning the effective birefringence in the polymer. We report experimental observations of this effect using polarimetric techniques and quantum-weak-measurement techniques, reporting a weak amplification factor of 200.
RESUMO
The photonic spin Hall effect in transmission is a transverse beam shift of the out-coming beam depending on polarization of the incoming beam. The effect can be significantly enhanced by materials with high anisotropy. We report, to the best of our knowledge, the first experimental demonstration of the photonic spin Hall effect in a multilayer hyperbolic metamaterial at visible wavelengths (wavelengths of 520 and 633 nm). The metamaterial is composed of alternating layers of gold and alumina with deeply subwavelength thicknesses, exhibiting extremely large anisotropy. The angle-resolved polarimetric measurements showed the shift of 165 µm for the metamaterial of 176 nm in thickness. Additionally, the transverse beam shift is extremely sensitive to the variations of the incident angle changing theoretically by 270 µm with 1 milli-radian (0.057°). These features can lead to minituarized spin Hall switches and filters with high angular resolution.
RESUMO
BACKGROUND: Intraperitoneal administration of paclitaxel had been considered a promising option to treat peritoneal metastasis, the most frequent pattern of recurrence in gastric cancer after D2 gastrectomy, but its safety and efficacy after gastrectomy had not been fully explored. METHODS: A phase II randomized comparison of postoperative intraperitoneal (IP) vs. intravenous (IV) paclitaxel was conducted. Patients with resectable gastric linitis plastica, cancer with minimal amount of peritoneal deposits (P1), or cancer positive for the peritoneal washing cytology (CY1) were eligible. After intraoperative confirmation of the above disease status and of resectability, patients were randomized to be treated either by the IP therapy (paclitaxel 60 mg/m2 delivered intraperitoneally on days 0, 14, 21, 28, 42, 49, and 56) or the IV therapy (80 mg/m2 administered intravenously using the identical schedule) before receiving further treatments with evidence-based systemic chemotherapy. The primary endpoint was 2-year survival rate. RESULTS: Of the 86 patients who were randomized intraoperatively, 83 who actually started the protocol treatment were eligible for analysis (n = 39, IP group; n = 44, IV group). The 2-year survival rate of the IP and IV groups was 64.1% (95% CI 47.9-76.9) and 72.3% (95% CI 56.3-83.2%), respectively (p = 0.5731). The IP treatment did not confer significant overall or progression-free survival benefits, and was associated with particularly poor performance in patients with residual disease, including the CY1 P0 population. CONCLUSIONS: We were unable to prove superiority of the IP paclitaxel over IV paclitaxel delivered after surgery to control advanced gastric cancer with high risk of peritoneal recurrence.