[Non-A Non-B Aortic Dissection Complicated with Right Aortic Arch Treated by Extended Thoracic Aortic Repair].

A 44-year old man with a history of Stanford type B acute aortic dissection was admitted for the treatment of acute aortic dissection. Computed tomography( CT) scan showed a descending entry-type non-A non-B aortic dissection with a maximum diameter of 65 mm occurring in a patient with Edwards typeⅢ right aortic arch whose left subclavian artery was obliterated. The patient was initially treated conservatively and underwent one-stage extended aortic repair from the ascending aorta to the descending thoracic aorta via median sternotomy 22 days after the symptom onset. Although the patient suffered from right empyema postoperatively, he was discharged from the hospital on postoperative day 64 after 4 weeks antibiotics therapy. The patient was also complicated by right recurrent nerve palsy, hoarseness improved over the 8 months after surgery.

[A Case of Carcinomatosis of the Bone Marrow Due to Rectal Cancer].

A 33-year-old man was admitted due to dyschezia and melena. Colonoscopy revealed a circulating type 4 rectal tumor. Further examination revealed intestinal obstruction due to rectal cancer, paraaortic lymph node metastasis, and multiple bone metastases, and an ileus tube was transanally inserted for decompression. Bone scintigraphy revealed multiple abnormal uptake regions in the entire skeleton. We planned to perform primary tumor resection and postoperative adjuvant chemotherapy and radiotherapy administration. Peritoneal signs in the lower abdomen appeared after 6 days of tube insertion. Abdominal computed tomography demonstrated intestinal perforation, and emergency surgery was performed. During the surgery, tube penetration in the anterior abdominal wall was observed in the sigmoid colon proximal to the tumor. Postoperatively, the patient developed disseminated intravascular coagulation(DIC). The patient had multiple bone metastases and juvenile cells in peripheral blood figure analysis; therefore, we concluded that DIC was caused by carcinomatosis of the bone marrow. After an informed consent was obtained, FOLFOX4 with simultaneous DIC treatment was initiated, and DIC remission was observed. The patient was transferred to a different hospital near his home, but died 35 days postoperatively.

[A Case of Sinusoidal Obstruction Syndrome and Nodular Regenerative Hyperplasia after Using Oxaliplatin for Rectal Cancer].

We present a case of a 44-year-old woman with rectal cancer(cT2N3M0, cStage Ⅲb)treated with 4 capecitabine-oxaliplatin( CAPOX)therapy courses, followed by laparoscopic intersphincteric resection. The patient received 7 postoperative, adjuvant CAPOX therapy courses. After 16 months since the final CAPOX administration, computed tomography(CT) revealed multiple liver tumors, showing early enhancement, and a jejunal mesenteric mass suspected to be a gastrointestinal stromal tumor(GIST). To overcome the percutaneous needle biopsy limitation, laparoscopic partial hepatectomy and laparoscopic- assisted partial intestinal resection were performed. Two liver lesions were diagnosed as nodular regenerative hyperplasia( NRH)with sinusoidal obstruction syndrome(SOS), supported by the hyperplasia and sinusoidal dilatation pathological findings, consequential to using oxaliplatin. Considering the rarity of NRH, using oxaliplatin may be proven vital in the differential diagnosis.

[Successful Control of Hyperammonemia with BRTO of a Splenorenal Shunt Induced by CAPOX Therapy].

Among portosystemic shunts, splenorenal shunts can cause increased portal pressure, which in turn can bring about hyperammonemia, resulting in hepatic encephalopathy. In recent years, it has been reported that oxaliplatin(OX), a key chemotherapy drug in colorectal cancer, can precipitate splenorenal shunts due to sinusoidal injury. We report a case of hyperammonemia post oxaliplatin therapy. A 72-year-old male patient who had undergone surgical resection for(RS)rectal cancer with hepatic metastasis had been receiving capecitabine plus OX(CAPOX)as adjuvant chemotherapy. During his 7th course of treatment, he visited the outpatient clinic with complaints of weakness, dysarthria, and urinary incontinence. Laboratory findings showed an elevated NH3 level (200 µg/dL), and subsequent abdominal computed tomography revealed a splenorenal shunt, which was attributed to OX. Balloon-occluded retrograde transvenous obliteration(BRTO)was then performed. The patient has been routinely followed up in the outpatient clinic and has had no recurrence of hyperammonemia or cancer 14 months after the procedure. In retrospect, the splenorenal shunt was present on his first visit, therefore, hyperammonemia could have been prevented at the time of commencement of chemotherapy. We report our case, along with the relevant literature.

[A Case of Long-Term Survival of a Patient with a Nodal Recurrence of Intrahepatic Cholangiocarcinoma Who Attained Complete Remission with S-1 Monotherapy].

An 82-year-old man was referred to our hospital after a hepatic tumor was identified on ultrasonography.Computed tomography(CT)revealed a hypovascular tumor measuring 3 cm in diameter in the lateral section.He was diagnosed as having intrahepatic cholangiocarcinoma(ICC), and a left hemihepatectomy was performed in November 2012. During the postoperative follow-up in August 2013, CT revealed swollen lymph nodes around the greater curvature of the stomach and upper edge of the pancreas.By using endoscopic ultrasonography fine-needle aspiration(EUS-FNA), lymph node metastases of the ICC was diagnosed.S -1 monotherapy was initiated instead of gemcitabine and cisplatin regimens because of renal dysfunction.In July 2014, CT revealed that both lymph nodes were shrinking, and in January 2015, S-1 administration was discontinued upon the patient's request.However, the patient survived for 4 years without S-1 administration, and no recurrent tumors were recognized on CT in November 2018.O ur diagnosis indicates complete remission.

[A case of complete response(CR)to S-1 and paclitaxel(PTX)combination therapy in a patient with unresectable gastric cancer].

We report a case of a patient with unresectable gastric cancer who showed complete response(CR)to S-1 and paclitaxel (PTX)combination therapy. The patient(a 67-year-old woman)was diagnosed with unresectable advanced gastric cancer with metastases in the Virchow's lymph nodes and para-aortic lymph nodes. Systemic chemotherapy with 70mg/m2 S-1 (days 1-14)and 70mg/m2 PTX(day 1)was administered every 3 weeks. At the end of 7 courses of chemotherapy, the primary lesion and swollen lymph nodes became markedly smaller. After 7 courses, an additional 39 courses were administered over 2.5 years. No notable adverse events were seen, and the patient's performance status(PS)was 0. CR was monitored by imaging studies. No cancer cells were detected on cytological examination of the primary lesion. Monotherapy with 70mg/m2 S-1(days 1-28, 2-week drug holiday)has been administered for the past 3 years. The patient is currently treated as an outpatient and maintains CR and a PS of 0.