RESUMEN
Case 1 involved a 54-year-old woman with a complaint of a lump in the left breast since October. A diagnosis of invasive micropapillary carcinoma(IMPC)was made by core needle biopsy. The profile of the carcinoma was as follows: ER(Allred 8=5+3), PgR(Allred 8=5+3), HER2(1+), Ki-67 index 30%. The patient underwent 4 courses of EC(epirubicin 90mg/ m2, cyclophosphamide 600 mg/m2), followed by 4 courses of triweekly docetaxel and nab-paclitaxel chemotherapy. Bp+Ax was underwent in May 2013. Pathologically, no residual tumor was observed. Case 2 involved a 61-year-old woman with the chief complaint of a lump in the right breast, diagnosed as IMPC by core needle biopsy. The profile of the carcinoma was as follows: ER(Allred 8=5+3), PgR(Allred 0=0+0), HER2(1+), Ki-67 index 30%. Pre-operative treatment consisted of letrozole(2.5mg/day)from May 2013 and hormone therapy for 6 months. Bp+SNB was performed in November 2013. Histopathologically, no remnant of IMPC component was observed apart from an 11mm papillo-tubular carcinoma. In spite of the fact that IMPC is considered highly malignant, pre-operative chemotherapy and hormonal therapy may be effective.
Asunto(s)
Neoplasias de la Mama , Carcinoma Papilar , Terapia Neoadyuvante , Neoplasias de la Mama/terapia , Carcinoma Papilar/terapia , Epirrubicina , Femenino , Humanos , Persona de Mediana EdadRESUMEN
A 62-year-old man was diagnosed with liver metastasis of sigmoid colon cancer, which resulted in bowel obstruction. SOX plus bevacizumab therapy was administered to perform hepatectomy, after the artificial anus construction; however, substantial liver dysfunction occurred. Therefore, we only performed primary tumor resection and waited for improvement in liver function. After 2 months, liver function improved and liver metastasis increased. However, another metastasis was not recognized, so hepatectomy was carried out, and R0 resection was performed. The oxaliplatin-induced liver function disorder was reversible; however, preoperative chemotherapy for resectable colorectal liver metastases increases the risk of missing the resection window. It is necessary to carefully examine the tumor type and preoperative liver function.
Asunto(s)
Enfermedad Veno-Oclusiva Hepática/inducido químicamente , Neoplasias Hepáticas/tratamiento farmacológico , Hígado/lesiones , Compuestos Organoplatinos/efectos adversos , Neoplasias del Colon Sigmoide/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bevacizumab/administración & dosificación , Combinación de Medicamentos , Hepatectomía , Humanos , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Compuestos Organoplatinos/administración & dosificación , Oxaliplatino , Ácido Oxónico/administración & dosificación , Neoplasias del Colon Sigmoide/patología , Neoplasias del Colon Sigmoide/cirugía , Tegafur/administración & dosificaciónRESUMEN
BACKGROUND: Hyperbaric oxygen (HBO) therapy is a controversial treatment for adhesive postoperative small bowel obstruction (ASBO), with only a few retrospective studies reported. The aim of this study was to assess the clinical impact of HBO therapy in the treatment of ASBO. METHODS: Patients with ASBO were randomly assigned to no-HBO (standard arm) or HBO (intervention arm). Patients of the intervention arm were treated once daily at a pressure of 2.0 atm absolute and received 100% oxygen. The primary endpoint was the success rate of medical treatment. This study was registered at the UMIN Clinical Trial Registry as UMIN000010399. RESULTS: The no-HBO group included 40 patients, and the HBO group included 33 patients. Patient characteristics, time to oral intake, and length of hospital stay were similar between the two groups. No significant differences were noted between the no-HBO and HBO groups in the need for long intestinal tube decompression (20.0 versus 18.2%, respectively, p = 1.000) and the need for operative intervention (10.0 versus 18.2%, respectively, p = 0.332). The overall success rate of medical treatment was 72.5% in the no-HBO group and 78.8% in the HBO group (p = 0.594). CONCLUSIONS: In this randomized controlled trial, HBO for ASBO has no additional effect in medical treatment.
Asunto(s)
Oxigenoterapia Hiperbárica , Obstrucción Intestinal/etiología , Obstrucción Intestinal/terapia , Intestino Delgado , Complicaciones Posoperatorias/terapia , Anciano , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Adherencias Tisulares , Resultado del TratamientoRESUMEN
A 69-year-old woman underwent total gastrectomy for advanced gastric cancer with pyloric stenosis. She had a good postoperative course and was discharged 2 weeks after surgery. She received adjuvant chemotherapy with S-1 after discharge. One month after the initiation of the adjuvant chemotherapy, she complained of wobbling and weakness of her limbs. She stopped intake of S-1, but the symptoms did not improve. She was admitted to the hospital, but she became unconscious and had headache and blurred vision. We conducted a cerebrospinal fluid examination and made a diagnosis of meningeal carcinomatosis. After we started intrathecal infusion of methotrexate and Ara-C, referring to case reports clinical symptoms, including unconsciousness, headache, and left upper limb paralysis, improved and the CEA level in cerebrospinal fluid decreased.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Meningitis/etiología , Neoplasias Gástricas/tratamiento farmacológico , Anciano , Trifosfato de Arabinofuranosil Citosina/administración & dosificación , Biopsia , Quimioterapia Adyuvante , Femenino , Gastrectomía , Humanos , Meningitis/patología , Metotrexato/administración & dosificación , Recurrencia , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugíaRESUMEN
The patient was a 66-year-old woman with a history of right breast cancer 20 years prior. Her chief complaint was hematochezia, and she was diagnosed as having rectal cancer. She underwent laparoscopic high anterior resection. We made a diagnosis of moderately differentiated adenocarcinoma, type 2, 25×20 mm, pMP, pN0, Stage I, KRAS being wild-type. Multiple liver metastases were detected 6 months after the surgery. Tumor contacted with grison. The tumor was not completely resected as evidenced by the small liver remnant volume. Conversion therapy was administered, and the patient received 6 courses of FOLFIRI plus cetuximab therapy. Alopecia and grade 1 eruption were observed as adverse effects of the chemotherapy. The tumor size was reduced, and we resected the tumor by performing right lobectomy and partial hepatectomy. At 1 year 3 months after surgery, no recurrence was observed.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias del Recto/tratamiento farmacológico , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Camptotecina/administración & dosificación , Camptotecina/análogos & derivados , Cetuximab/administración & dosificación , Colectomía , Terapia Combinada , Femenino , Fluorouracilo/administración & dosificación , Hepatectomía , Humanos , Leucovorina/administración & dosificación , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Resultado del TratamientoRESUMEN
The first patient was a 62-year-old woman who was referred to our hospital with the complaint of a left breast tumor. She was diagnosed with invasive ductal carcinoma(T1N0M0, stage I). The tumor was ER-positive, PgR-negative, and HER2- negative. She was treated with toremifene, letrozole, and anastrozole as neoadjuvant hormone therapy for 4 months, but the tumor increased in size. The clinical response was judged as progressive disease, and a left partial mastectomy and axillary lymph node dissection were performed. Chemotherapy and radiotherapy were performed after surgery. The second patient was a 68-year-old woman who was referred to our hospital with the complaint of a right breast tumor. She was diagnosed as invasive ductal carcinoma(T1N0M0, stage I). The tumor was ER-positive, PgR-negative, and HER2-negative. She was treated with letrozole as neoadjuvant hormone therapy for 4 months, but the tumor increased in size. The clinical response was judged as progressive disease, and a right partial mastectomy and axillary lymph node dissection were performed. Chemotherapy and radiotherapy were performed after surgery. Although the evidence is still insufficient, with neoadjuvant hormone therapy for hormone-sensitive breast cancer, improved tumor shrinkage and breast conservation have been reported. We experienced two cases in which the tumor increased in size during neoadjuvant hormone therapy; however, even though these cases showed no apparent effect, chemotherapy may be effective in future cases.
Asunto(s)
Antineoplásicos Hormonales/uso terapéutico , Neoplasias de la Mama/terapia , Carcinoma Ductal de Mama/terapia , Quimioradioterapia , Terapia Neoadyuvante , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/química , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/química , Femenino , Humanos , Persona de Mediana Edad , Posmenopausia , Receptores de Estrógenos/análisisAsunto(s)
Malformaciones Arteriovenosas/diagnóstico por imagen , Úlcera Duodenal/complicaciones , Páncreas/irrigación sanguínea , Vena Porta , Trombosis de la Vena/complicaciones , Malformaciones Arteriovenosas/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Trombosis de la Vena/diagnóstico por imagenRESUMEN
Cholecystectomy is the standard treatment for symptomatic gallstone or acute cholecystitis, and a growing number of elderly patients are undergoing resection. The aim of this study is to evaluate the clinical outcome of cholecystectomy in elderly patients. We retrospectively reviewed the medical records of 337 patients with symptomatic gallstone or acute cholecystitis who underwent cholecystectomies between January 2011 and June 2013. Perioperative data were compared between octogenarians and younger patients. A subgroup undergoing cholecystectomy for acute cholecystitis (n = 146, 43.3 %) was further analyzed. The octogenarian group included 34 patients (10.1 %), while the younger patient group included 303 patients (89.9 %). The octogenarian group was associated with higher rates of comorbidities and acute cholecystitis. The octogenarian group had significantly low laparoscopic completed rates, high postoperative complication rates, and longer postoperative hospital stays. Among the acute cholecystitis group, 24 patients (16.4 %) were octogenarians and 122 patients (83.6 %) were younger patients. No significant difference was found in the morbidity and postoperative hospital stay between the two groups. Only one patient (0.3 %), an octogenarian, died of pneumonia. Cholecystectomy for symptomatic gallstone or acute cholecystitis can be safely performed even in octogenarians. However, care should be taken because they have comorbidities and limited functional reserves.
Asunto(s)
Colecistectomía , Colecistitis/cirugía , Cálculos Biliares/cirugía , Enfermedad Aguda , Factores de Edad , Anciano de 80 o más Años , Colecistectomía/efectos adversos , Colecistectomía Laparoscópica/efectos adversos , Femenino , Humanos , Tiempo de Internación , Masculino , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Carcinoid tumors located in the minor duodenal papilla are extremely rare, with only a few cases reported in the literature. Herein, we report the case of a 71-year-old man with a 12-mm carcinoid tumor at the minor duodenal papilla with lymph node metastases. Multidetector-row computed tomography with contrast enhancement revealed a 12-mm well-enhanced tumor in the duodenum. Upper gastrointestinal endoscopy showed a 12-mm submucosal tumor at the minor papilla of the duodenum. Biopsy specimens revealed a carcinoid tumor, and a subtotal stomach-preserving pancreatoduodenectomy was performed. Carcinoid tumors at the minor duodenal papilla have a high prevalence of nodal disease, even for tumors <2 cm in diameter. Therefore, we believe that radical resection with tumor-free margins (i.e. pancreatoduodenectomy) is the treatment of choice.
Asunto(s)
Tumor Carcinoide/patología , Neoplasias Duodenales/patología , Conductos Pancreáticos/patología , Anciano , Tumor Carcinoide/cirugía , Neoplasias Duodenales/cirugía , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Masculino , Tomografía Computarizada Multidetector , Conductos Pancreáticos/cirugía , Pancreaticoduodenectomía , PronósticoRESUMEN
PI-kinase-related protein kinase ATR forms a complex with ATRIP and plays pivotal roles in maintaining genome integrity. When DNA is damaged, the ATR-ATRIP complex is recruited to chromatin and is activated to transduce the checkpoint signal, but the precise kinase activation mechanism remains unknown. Here, we show that ATRIP is phosphorylated in an ATR-dependent manner after genotoxic stimuli. The serine 68 and 72 residues are important for the phosphorylation in vivo and are required exclusively for direct modification by ATR in vitro. Using phospho-specific antibody, we demonstrated that phosphorylated ATRIP accumulates at foci induced by DNA damage. Moreover, the loss of phosphorylation does not lead to detectable changes in the relocalization of ATRIP to nuclear foci nor in the activation of downstream effector proteins. Collectively, our results suggest that the ATR-mediated phosphorylation of ATRIP at Ser-68 and -72 is dispensable for the initial response to DNA damage.
Asunto(s)
Proteínas de Ciclo Celular/metabolismo , Núcleo Celular/metabolismo , Daño del ADN/fisiología , Reparación del ADN/fisiología , Exodesoxirribonucleasas/metabolismo , Fosfoproteínas/metabolismo , Proteínas Serina-Treonina Quinasas/metabolismo , Proteínas Adaptadoras Transductoras de Señales , Proteínas de la Ataxia Telangiectasia Mutada , Línea Celular/metabolismo , Línea Celular/efectos de la radiación , Reparación del ADN/efectos de la radiación , Proteínas de Unión al ADN , Células HeLa , Homeostasis/fisiología , Homeostasis/efectos de la radiación , Humanos , Fosforilación , Rayos UltravioletaRESUMEN
The carnitine-dependent transport of long-chain fatty acids is essential for fatty acid catabolism. In this system, the fatty acid moiety of acyl-CoA is transferred enzymatically to carnitine, and the resultant product, acylcarnitine, is imported into the mitochondrial matrix through a transporter named carnitine-acylcarnitine translocase (CACT). Here we report a novel mammalian protein homologous to CACT. The protein, designated as CACL (CACT-like), is localized to the mitochondria and has palmitoylcarnitine transporting activity. The tissue distribution of CACL is similar to that of CACT; both are expressed at a higher level in tissues using fatty acids as fuels, except in the brain, where only CACL is expressed. In addition, CACL is induced by partial hepatectomy or fasting. Thus, CACL may play an important role cooperatively with its homologue CACT in a stress-induced change of lipid metabolism, and may be specialized for the metabolism of a distinct class of fatty acids involved in brain function.