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1.
Surg Open Sci ; 6: 1-4, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34355156

RESUMO

BACKGROUND: Perforated appendicitis without an associated abscess necessitates emergency surgery. However, it is difficult to predict the presence of perforation before surgery, and the predictive factors are still unclarified. Our purposes were to characterize a patient population with perforated appendicitis without an associated abscess to identify the preoperative predictive factors of appendiceal perforation. METHODS: We retrospectively identified 150 patients who underwent appendectomy for acute appendicitis at our institution from June 2018 to November 2020. Logistic regression analysis was performed to analyze the concurrent effects of various factors on the prevalence of perforated appendicitis. RESULTS: Forty (29%) of 150 patients had appendiceal perforation detected intraoperatively. Of these 40 patients, only 19 had appendiceal perforation detected on preoperative computed tomography. Multivariable analysis found that a higher C-reactive protein level, higher total bilirubin level, and the presence of an appendiceal fecalith were independent predictive factors for appendicitis with perforation. CONCLUSION: Our analysis suggests that the presence of an appendiceal fecalith, a total bilirubin level of more than 21.38 µmol/L, and a C-reactive protein level of more than 3.0 × 104 µg/L are predictive factors of perforated appendicitis.

2.
Oncology ; 99(10): 632-640, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34280933

RESUMO

INTRODUCTION: Patients with unresectable or recurrent gastric cancer who have an objective response (OR) to nivolumab monotherapy are expected to have a good long-term prognosis. However, the OR rate for nivolumab treatment is low at 11%, and there is a need for biomarkers to predict the treatment response. This study aimed to analyze the significance of systemic inflammation-related variables and clinicopathologic characteristics as predictive markers of response to nivolumab monotherapy in patients with advanced gastric cancer. METHODS: In this retrospective cohort study, we enrolled 71 consecutive patients who received nivolumab monotherapy for unresectable or recurrent gastric cancer. Receiver operating characteristic curve analysis was performed to determine the cutoff values of systemic inflammation-related variables, predictors of treatment response, and other prognostic factors related to nivolumab therapy. We focused on systemic inflammation-related variables measured before nivolumab induction and 2 weeks after its first administration and performed multivariate analysis to assess whether they could be used as prognostic factors. RESULTS: Multivariate analysis revealed that a lymphocyte-to-monocyte ratio (LMR) of ≤3.28 after 2 weeks of initial nivolumab treatment (2wLMR) is a statistically significant predictor of treatment response (p = 0.012). The progression-free survival (PFS) rate of patients with liver metastasis was significantly worse than that of the other patients (1-year PFS: 0.0 vs. 24.4%, respectively; p = 0.005). The overall survival (OS) of patients with a low 2wLMR was significantly longer than that in patients with a high 2wLMR (1-year OS: 37.4 vs. 18.9%, respectively; p = 0.022). CONCLUSIONS: Thus, the 2wLMR could be a useful biomarker to predict response to nivolumab treatment and the prognosis of unresectable and recurrent gastric cancer.


Assuntos
Linfócitos/patologia , Neutrófilos/patologia , Neoplasias Gástricas/sangue , Neoplasias Gástricas/tratamento farmacológico , Adulto , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nivolumabe , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/patologia
3.
Am J Case Rep ; 22: e931114, 2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33844677

RESUMO

BACKGROUND Protein-losing enteropathy as a complication of superior mesenteric artery occlusion is extremely rare and severe, and sometimes requires intestinal resection. However, the ideal treatment strategy has not yet been determined. CASE REPORT A 77-year-old man with underlying hypertension and diabetes was admitted to the Emergency Department with acute abdominal pain after eating. Contrast-enhanced computed tomography revealed complete occlusion of the superior mesenteric artery with thrombosis, and superior mesenteric artery occlusion was diagnosed. It was successfully treated with interventional therapy, followed by continuous intra-arterial prostaglandin E1 infusion and continuous intravenous heparin infusion. However, the patient developed hypoproteinemia and diarrhea about 10 days after the interventional therapy. Colonoscopy and X-ray studies did not reveal any abnormal findings; however, technetium-99m-labeled human serum albumin scintigraphy indicated protein-losing enteropathy. With total parenteral nutrition and protein-rich oral nutrition, with protein intake at twice the amount in a standard diet, serum albumin improved from 15 g/L to 32 g/L after treatment. Additionally, we administered diuretics to avoiding edema related to the hypoproteinemia. The patient recovered from the hypoproteinemia and diarrhea without complications. CONCLUSIONS Protein-losing enteropathy is an extremely rare but critical complication of superior mesenteric artery occlusion. Treating the underlying pathology is the mainstay of protein-losing enteropathy and dietary modifications also play a critical role. Our patient was successfully treated with strict nutritional therapy, combined oral protein-rich nutrition and total parenteral nutrition, which avoided surgery.


Assuntos
Hipoproteinemia , Oclusão Vascular Mesentérica , Enteropatias Perdedoras de Proteínas , Idoso , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/cirurgia , Enteropatias Perdedoras de Proteínas/diagnóstico por imagem , Enteropatias Perdedoras de Proteínas/etiologia , Enteropatias Perdedoras de Proteínas/terapia , Cintilografia
4.
Int J Surg Case Rep ; 49: 136-139, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30005366

RESUMO

INTRODUCTION: Pseudolymphoma of the liver is a very rare disease. It is usually resected and pathologically diagnosed because of the difficulty of discrimination from the malignant neoplasm. For this reason, few cases which were observed for several years have been reported. We present a case of this disease observed and slightly enlarged for two years. PRESENTATION OF CASES: The patient was a 46-year-old woman who underwent laparoscopic partial nephrectomy for right renal cell carcinoma two years ago. The preoperative computed tomography (CT) showed the mass 7 mm in diameter with localized parenchymal atrophy of the liver (segment Ⅵ). Two years later, CT showed enlarged mass from 7 to 11 mm in diameter. We performed laparoscopic partial hepatectomy because the patient desired definite diagnosis by surgery. The resected specimen showed white and solid mass. The lymphocyte and plasma cells are histologically observed. Immunohistological staining showed CD10 positive, Bcl-2 negative, and cyclin D1 negative. The pathological diagnosis was pseudolymphoma of the liver. DISCUSSION: Pseudolymphoma is rarely observed in the liver. It is reported that chronic hepatitis, collagen diseases, and malignant diseases were often accompanied, but detail pathogenesis has been unknown. She had the history of renal carcinoma, but the lesion was not vanished regardless of clearance of renal neoplasm. Surgical resection is usually performed because discrimination with malignant neoplasm is difficult. The present case is probably the first one, which is followed for long term duration. CONCLUSION: The present case may contribute to clarify the pathophysiology of this entity.

5.
Nihon Shokakibyo Gakkai Zasshi ; 110(6): 1022-9, 2013 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-23739735

RESUMO

We report a case of juvenile gastric polyposis associated with antiphospholipid syndrome. A 42-year-old woman was admitted with a chief complain of fatigue. Six years earlier, antiphospholipid syndrome was diagnosed and treated with aspirin. Two years earlier, gastric polyps were endoscopically observed, the number and size of which subsequently increased. Juvenile gastric polyposis was diagnosed on the basis of the pathological features of the biopsy specimens. Bleeding was repeatedly identified from the polyposis. Total gastrectomy was performed because of worsening anemia and hypoalbuminemia.


Assuntos
Pólipos Adenomatosos/complicações , Síndrome Antifosfolipídica/complicações , Neoplasias Gástricas/complicações , Pólipos Adenomatosos/cirurgia , Adulto , Feminino , Gastrectomia , Humanos , Neoplasias Gástricas/cirurgia
6.
Gan To Kagaku Ryoho ; 36(5): 847-9, 2009 May.
Artigo em Japonês | MEDLINE | ID: mdl-19461192

RESUMO

The case was a 70-year-old man with type-2 gastric cancer in the lesser curvature accompanied by multiple liver metastases. He received combination chemotherapy of S-1 and CDDP. S-1 was administered at 100 mg/body/day for 21 days followed by withdrawal for 14 days, and CDDP was prescribed at 80 mg/body/day div on day 8. After 3 courses of treatment, the multiple liver metastases disappeared. The primary gastric lesion had changed to a scar and endoscopic biopsy revealed no cancer cell. After the 4th course, we changed the therapy to S-1 alone and after that to UFT alone. Now, 3 years and 3 months after inducing CR, the patient continues to receive UFT with no regrowth of the tumor.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cisplatino/uso terapêutico , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Ácido Oxônico/uso terapêutico , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Tegafur/uso terapêutico , Idoso , Biópsia , Combinação de Medicamentos , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Estadiamento de Neoplasias , Indução de Remissão , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios X
7.
Gan To Kagaku Ryoho ; 35(8): 1383-6, 2008 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-18701854

RESUMO

A 74-year-old male with advanced gastric cancer(cT3N1M0H0P0CY0, cStage III A)was treated with paclitaxel/ CDDP as neoadjuvant chemotherapy. Paclitaxel (80 mg/m(2)) and CDDP (25 mg/m(2)) were administered on days 1, 8 and 15 as one cycle. After the second course, a significant tumor reduction was obtained. Total gastrectomy, splenectomy, and D2 type nodal dissection were performed. The histological diagnosis revealed complete disappearance of cancer cells in the stomach and all of the lymph nodes, a so-called pathologically complete response. The patient has now been in good health without any recurrence for 9 months after surgery. This case suggests that neoadjuvant chemotherapy with paclitaxel/CDDP is a potential regimen for advanced gastric cancer.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cisplatino/uso terapêutico , Terapia Neoadjuvante , Paclitaxel/uso terapêutico , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Idoso , Endoscópios Gastrointestinais , Gastrectomia , Humanos , Masculino , Estadiamento de Neoplasias , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/cirurgia , Tomografia Computadorizada por Raios X
8.
Hepatogastroenterology ; 51(60): 1674-5, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15532802

RESUMO

A case of combined pancreatoduodenal injury requiring pancreatoduodenectomy is described. A two-stage approach was used, which included a pancreatoduodenectomy followed by a tube pancreatostomy for complete external drainage of pancreatic juice and subsequent second-stage pancreatojejunostomy. This approach, first advocated by Miyagawa et al., enabled us to handle the normal soft pancreas without any complications. It is suggested that the described second-stage pancreatojejunostomy can be considered as an alternative method of restoring pancreatoenteric continuity following pancreatoduodenectomy in emergency cases.


Assuntos
Traumatismos Abdominais/cirurgia , Duodeno/lesões , Pâncreas/lesões , Pancreaticoduodenectomia/métodos , Pancreaticojejunostomia/métodos , Traumatismos Abdominais/diagnóstico , Acidentes de Trânsito , Anastomose Cirúrgica , Terapia Combinada , Duodeno/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/cirurgia , Pâncreas/cirurgia , Medição de Risco , Resultado do Tratamento
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