[A Case of Intractable Pyogenic Spondylitis Due to Suture Failure and MRSA Infection Secondary to Surgery for Ascending Colon Cancer].

A 79-year-old man diagnosed with ascending colon cancer underwent laparoscopic right hemicolectomy(Stage Ⅱ). Postoperatively, suture failure occurred on Day 5 and was alleviated with conservative therapy. However, on Day 23, he was diagnosed with MRSA-induced sepsis with a body temperature of 39 °C. After administration of vancomycin, his general conditions stabilized, although intermittent low-grade fever and a high C-reactive protein(CRP)level persisted. Although the source of the infection could not be easily identified, he was diagnosed with suppurative spondylitis after lumbar MRI examination on Day 43. The CRP level was normalized with long-term administration of antibiotics and the symptoms were gradually improved with rehabilitation. The patient was discharged after approximately 4 months and could walk without assistance 8 months postoperatively. In this case, purulent spondylitis may have occurred via hematogenous infection due to the suture failure after surgery for ascending colon cancer. Purulent spondylitis is a relatively rare disease. However, it may lead to the patient requiring long-term treatment and cause serious sequelae. Therefore, it is important to keep this disease in mind when treating patients with postoperative fever of unknown origin or aggravating lower back pain.

[A Fatal Case of Meningeal Carcinomatosis in a Rectal Cancer Patient Diagnosed with Pathologic Complete Response after Neoadjuvant Chemoradiotherapy].

A 48-year-old man visited our hospital complaining of abdominal pain constipation and mucous bloody stool. He was diagnosed rectal cancer with remarkable local infiltration in the pelvic organs and no distant metastasis. The pathological diagnosis was poorly differentiated adenocarcinoma and signet ring cell carcinoma. He was administered neoadjuvant chemoradiotherapy(45 Gy/30 Fr, S-1 100 mg/day 2-weeks administration, 1-week withdrawal)and underwent abdominal perineal rectal amputation. No cancer cells remained in the excised organs, so he was diagnosed with pathologic complete response(pCR). The serum CEA level decreased from 35.1 to 5.9 ng/mL at this point. Due to recurrence of peritoneal dissemination during postoperative adjuvant chemotherapy(CapeOX), the regimen was changed to FOLFIRI plus Pmab. After 4 courses of FOLFIRI plus Pmab, he complained dizziness and headache. Therefore, head computed tomography and magnetic resonance imaging were performed. However, there were no abnormal findings. An evaluation of his cerebrospinal fluid resulted in a diagnosis of meningeal carcinomatosis by fluid cytology(adenocarcinoma/class Ⅴ). His medical condition worsened rapidly and he ultimately died 2.5 months after the onset of his headache. The serum CEA level ultimately reached 2,992.6 ng/mL. The patient had been deemed to have pCR following the administration of neoadjuvant chemoradiation and surgery. His serum CEA level had increased continuously during the early period of postoperative chemotherapy without any abdominal imaging or neurological findings. After the onset of the primary symptoms of meningeal carcinomatosis, his condition deteriorated rapidly. When we encounter patients with colorectal cancer, especially those with poorly differentiated adenocarcinoma, and a continuously increasing CEA level despite no remarkable findings, we should suspect meningeal carcinomatosis and perform further examinations, including sampling the cerebrospinal fluid.

[Complete Response to Chemotherapy after Resection of Rectal Cancer with Virchow's Lymph Node Metastasis].

A 62-year-old woman was admitted to our hospital because of bloody stool. Colonoscopy revealed stenosis by a type 2 tumor of the recto-sigmoid colon. A biopsy specimen contained moderately differentiated adenocarcinoma. Thoraco-abdominal computed tomography (CT) showed liver metastasis (S7, 10 mm) and enlargement of Virchow's lymph node (17 mm) and several para-aortic lymph nodes (15 mm on average). Because of oozing from the tumor and severe stenosis of the recto-sigmoid colon, we performed laparoscopic-assisted high anterior resection of the primary lesion. After surgery, 3 courses of mFOLFOX6, 20 courses of mFOLFOX6 plus bevacizumab, and 5 courses of infusional 5-FU plus Leucovorin plus bevacizumab were administered. Thoraco-abdominal CT demonstrated complete response to the 1 year 2 months of chemotherapy. The patient has been alive without relapse for 2 years after surgery.

Prognostic predictive value of endoscopic ultrasound findings for invasive ductal carcinomas of pancreatic head.

OBJECTIVES: Accurate preoperative prediction of the prognosis of patients with invasive ductal carcinoma of pancreatic head (pancreatic head cancer) is important for selecting treatment methods. We retrospectively examined the prognostic predictive values of endoscopic ultrasound (EUS) findings for patients with this disease. METHODS: The subjects were 66 patients with pancreatic head cancer who had undergone EUS. We examined each EUS finding as a possible prognostic predictor, including heterogeneity of internal echo, irregularity of peripheral echo, clarity of boundary echo, dilatation of the main pancreatic duct (MPD), dilatation of the common bile duct, lymph node swelling, vessel invasion, and the presence of ascites, by univariate and multivariate analysis for survival. RESULTS: Irregular peripheral echo, portal vein invasion, superior mesenteric artery/celiac artery invasion, and the presence of ascites were significant predictors of a poorer prognosis by univariate analysis for survival. In resectable cases, EUS findings of MPD dilatation and portal invasion were significant prognostic predictors by univariate analysis, and MPD dilatation was an independent prognostic predictor by multivariate analysis. CONCLUSION: EUS may be useful for predicting the prognosis of patients with pancreatic head cancer, based on the accuracy it provides in evaluating locoregional spreading.