[Diagnosis of the postoperative local recurrence of rectal cancer by FDG-PET--a case report].

Positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) as the tracer of glucose metabolism was performed to identify a postoperative recurrent lesion of rectal cancer. A 66-year-old-man underwent trans-sacral local resection of the rectum for rectal cancer in 1992. A local recurrent mass was discovered, and abdomino-perineal resection of the rectum was performed in 1999. The serum CEA level increased gradually August in 2000, but there was no sign of recurrence on CT or MRI. FDG-PET was performed to reveal a presacral recurrent lesion. Total pelvic evisceration combined with resection of the sacrum, and a bilateral ureterostomy were performed in April 2001. The beneficial role of FDG-PET in the diagnosis of the postoperative local recurrence of rectal cancer is emphasized.

[A case of recurring breast cancer causing pericardial metastasis showing a good response following local treatment with methotrexate].

A 52-year-old woman was admitted with a chief complaint of dyspnea. She had undergone right mastectomy for Stage IIB breast cancer 2 years and five months earlier. Chest roentgenogram revealed cardiomegaly and bilateral pleural effusion, and a cardiac echogram showed marked retention of pericardial effusion. A diagnosis of cardiac tamponade was made and pericardiocentesis for continuous drainage was carried out cytologically, the effusion was class V and showed evidence of pericardial metastasis of breast cancer. Pericardiocentesis followed by methotrexate instillation 6 times in a dose of 110 mg successfully controlled the cardiac tamponade, after which the catheter could be removed from the pericardial space. Systemic chemotherapy (CEF) was started at the same time. The patient was discharged very much improved after these treatments, but she died of brain metastasis after 9 months. This case suggests that intrapericardial application of methotrexate may be very useful in the management of carcinomatous cardiac tamponade without any serious side effects.

[A patient with esophageal cancer with subcutaneal abscess and esophago-tracheal fistula who survived more than 2 years following treatment by drainage and chemoradiation therapy].

A 48-year-old man presented at the hospital because of neck swelling and pain. A diagnosis of esophageal cancer with subcutaneous abscess was made based on examination and biopsy results. The cancer was Ce T4NxMx Stage III-IVa. Curative surgery was considered impossible, so chemoradiation therapy was performed (5-FU 500 mg + CDDP 5 mg/day + 2 Gy/day x 31 days) after drainage. During the therapy, an esophago-tracheal fistula was observed, but it later vanished. After chemoradiation therapy, the abscess and tumor vanished. No serious adverse reactions were observed. Now, 2 years after therapy, no recurrence has been found. The patient is now in good health with no symptoms and undergoes regular check-ups. Chemoradiation therapy is effective for inoperable advanced esophageal cancer.

[A case of locally advanced breast cancer successfully resected after selective intra-arterial chemotherapy].

A 25-year-old female with a large tumor on her left breast was examined at our hospital from August, 1999. Ipsilateral supraclavicular, infraclavicular and axillary lymph nodes were swollen. She was diagnosed as having locally advanced breast cancer of stage IIIb by fine needle aspiration cytology. After the administration of docetaxel (60 mg/m2/3 weeks x 3) failed to improve her condition, we changed the treatment to selective intra-arterial chemotherapy with THP-ADR (60 mg/body/day, day 1 & 8, 41 & 48) by Seldinger's method. The target vessels were the internal thoracic, lateral thoracic, thoracodorsal and deep cervical arteries. We also combined 5-FU 500 mg/body div and CPA 500 mg/body i.v. on the same days with intra-arterial chemotherapy. As a result, the main tumor and metastatic lymph node swelling was remarkably reduced (down-staging was obtained). No recurrence was found for 5 months after curative resection.

[Repetitive chemo-embolization with degradable starch microspheres (DSM) to each left and replaced right hepatic artery in a patient with multiple liver metastases of colon cancer].

In a patient with a right hepatic artery arising from the superior mesenteric artery bearing multiple liver metastases from colon cancer, hepatic arterial chemo-embolization was performed in combination with degradable starch microspheres (DSM) administered independently to the left and replaced right hepatic artery via a percutaneal approach. As the first line chemotherapy from hepatic artery with DSM 300 mg, 5-FU 500 mg and MMC 10 mg resulted in PD. DSM 300 mg, epirubicin (EPI) 50 mg, MMC 4 mg was administered with the RHA:LHA ratio of 3:1 as a second line. Four weeks later it was evaluated as NC by angiography and by tumor-marker dropped extremely. The same regimen was repeated every four weeks, and the NC status remained for 20 weeks in total. Each time, the left and replaced right hepatic artery got perfect re-perfusion and DSM enabled an effective whole liver distribution of anti-cancer drugs and repetitive administrations of them. This regimen could be an alternative choice for patients with a replaced right hepatic artery who have liver metastasis of colon cancer.

[A case of locally advanced rectal carcinoma with liver metastasis treated with a combination of CRT, HAI, and systemic chemotherapy].

A 55-year-old man with locally advanced rectal carcinoma and liver metastasis was treated with a combination of chemo-radiotherapy (5-FU suppository 100 mg/day and 63 Gy of RT), hepatic arterial infusion chemotherapy (5-FU 1,000 mg/3 h, biweekly), and systemic chemotherapy (5'-DFUR 800 mg/day + cimetidine 800 mg/day). His rectal tumor was reduced and his symptoms such as pain and bleeding had markedly decreased. The river metastasis did not change during the entire course. HAI and administration of 5-FU suppository, 5'-DFUR, and cimetidine were continued. As of 18 months after the onset of the combination therapy, NC has been maintained, and the general condition of the patient is favorable.

[Evaluation of intermittent hepatic arterial infusion chemotherapy for multiple liver metastasis of colorectal cancer].

Five patients with synchronous multiple hepatic metastasis of colorectal cancer were treated with hepatic arterial infusion chemotherapy. All cases received intermittent 5-FU infusion (5-FU 250-1,000 mg/2-3 hrs/1-2 weeks) on an outpatient basis. In the evaluation of 5 cases, 3 PR and 1 NC were observed. One case administered arterial infusion for adjuvant chemotherapy has no recurrence in liver. In two patients, extra-hepatic metastases were found. In conclusion, this therapy was effective and useful for hepatic metastasis. Moreover, other forms of treatment for extra-hepatic metastasis must be used.

[Intraperitoneal cisplatinum chemotherapy in patients with carcinomatous peritonitis due to colorectal scirrhous cancer--case report].

Two patients received intraperitoneal cisplatinum chemotherapy for carcinomatous ascites due to colorectal cancer recurrence. The patients were a 47-year-old man who had rectal cancer and 51-year-old woman who had colon cancer. They had received the operation and adjuvant chemoradiation therapy and chemotherapy respectively. However, five months and two years after resection, respectively, they presented massive ascites due to carcinomatous peritonitis and were given cisplatin injection intraperitoneally. The amount of ascites was significantly diminished. One patient had been discharged and been able to stay at home, and the other patient underwent gastrostomy for ileus. The results suggested that intraperitoneal cisplatinum chemotherapy may be useful for the patient with carcinomatous ascites due to colorectal cancer.

[Palliative chemo-radiotherapy for abdominal recurrence of esophageal carcinoma--case report].

A 71-year-old man with stage IV esophageal carcinoma was treated by chemo-radiotherapy (5-FU 500 mg/day + CDDP 10 mg/day for 4 weeks and 67.6 Gy of RT). The esophageal tumor showed a complete response to the treatment. Six months later, he had obstructive jaundice due to an abdominal recurrent mass. A secondary (palliative) CRT was performed (5-FU 500 mg/day + CDDP 10 mg/day for 3 weeks and 45 Gy of RT). The abdominal tumor became remarkably smaller and jaundice disappeared. Though the patient died from pulmonary carcinomatous lymphangitis, the primary lesion showed CR. CRT was very effective for local treatment and for palliative therapy.

[A case of multiple bone metastases from advanced breast cancer effectively treated with pamidronate].

A 57-year-old woman, with bone, lymph node and skin metastases underwent mastectomy and extirpation of skin tumors. Chemoenderine-therapy was performed from the 15th day after operation, with a toremifene and CEF regimen consisting of cyclophosphamide, epirubicin and 5-fluorouracil. She had nausea and neurological symptoms from hypercalcemia (21.5 mg/dl) on the 28th day after operation. Her serum PTHrP level was found to be high at 214 pmol/l. We administered pamidronate in a dose of 45 mg biweekly, and she improved. The CEF regimen and pamidronate therapy was continued for 6 cycles and the regions of bone metastases were reduced on the bone scintography. Thereafter she has been administered pamidronate 30 mg/4 weeks as an outpatient with no further symptoms, and serum Ca and PTHrP have remained normal. In conclusion, pamidronate combined with chemotherapy can be a therapeutic option for not only hypercalcemia but also bone metastases of breast cancer.

[A resected case of gastric carcinoma with complete remission of Virchow's node metastasis by 5'-DFUR administration].

5'-DFUR was administered orally at 800 mg/day, for total dosage of 57.6 g to the gastric cancer patient, classified Borrmann Type 2, with Virchow's node metastasis. Gastric tumor had diminished in size on the fluoroscopy and the endoscopy. We then made distal gastrectomy. The resected stomach showed moderately differentiated tubular adenocarcinoma on the pathological examination. Side effect was diarrhea.

Distribution of immunoreactive pancreatic phospholipase A2 (IPPL-2) in various human tissues.

Immunoreactive pancreatic phospholipase A2 exists in various human tissues other than the pancreas. Considerable amounts were detected in the lung, stomach, small intestine and kidney. Immunoreactive pancreatic phospholipase A2 in extra-pancreatic tissues was not accompanied by proportional phospholipase A2 activity in contrast to that in the pancreas.

Purification and some properties of membrane-associated phospholipase A2 of human spleen.

Membrane-associated phospholipase A2 was purified to homogeneity from human spleen. The enzyme was solubilized from the particulate fraction by the addition of KBr, and purified by reverse-phase high-performance liquid chromatography. The estimated molecular weight of the enzyme was 14,000. The enzyme had a pH optimum around 9.5, required the presence of Ca2+ for its activity, and hydrolyzed phosphatidylethanolamine more efficiently than phosphatidylcholine.

[Changes in serum pancreatic enzymes and pancreatic secretory trypsin inhibitor in patients with severe acute pancreatitis].

Serum pancreatic enzymes (amylase, trypsin, pancreatic elastase 1, pancreatic phospholipase A2) and serum pancreatic secretory trypsin inhibitor (PSTI) were measured in 22 patients with moderate or severe acute pancreatitis. Serum levels of all pancreatic enzymes were elevated at the initial determination, but they fell rapidly to normal in both moderate and severe pancreatitis. In contrast, PSTI in severe pancreatitis increased after admission and reached the maximum on the second to the forth day after onset. There was a significant positive correlation between the level of PSTI and that of acute phase reactant (fibrinogen, alpha 1-antitrypsin), and serum PSTI in severe acute pancreatitis changed as if it was one of acute phase reactants. There was also a significant negative correlation between the level of serum PSTI and that of alpha 2-macroglobulin.

Hydrolytic activities of human pancreatic phospholipase A2 and endotoxin-stimulated endogenous phospholipase A2 toward membrane phospholipids of erythrocytes.

The problem of whether human pancreatic phospholipase A2 (PLA2) can really hydrolyze membrane phospholipids in vitro was studied to understand pathophysiology of acute pancreatitis. Total amount of lysophospholipids generated in erythrocytes by exogenously added human pancreatic PLA2 (2 micrograms/ml) was only 12% of the amount of sphingomyelin, which was not decomposed by the enzyme. About fivefold the amount of lysophospholipids was generated in ghost membranes during one-sixth of the incubation time compared to that in intact erythrocyte membranes. Escherichia coli lipopolysaccharide (LPS) (10 micrograms/ml) was able to stimulate membrane-associated PLA2 of erythrocytes, the amount of lysophospholipids generated being 12.5% of that of sphingomyelin without adding the exogenous PLA2. The stimulation of membrane-associated PLA2 in erythrocytes was inhibited by pretreatment of lipopolysaccharide with polymyxin-B sulfate. When intact erythrocytes were incubated with human pancreatic PLA2 and LPS, the amount of generated lysophospholipids was 24% of that of sphingomyelin. These results suggested that the exogenously added human pancreatic PLA2 cannot degrade phospholipids of intact erythrocytes so extensively under physiological conditions, and, in acute pancreatitis, unknown factors may be involved in the hydrolysis of phospholipids. LPS, which activates membrane-associated PLA2, may be one of the factors, and thus membrane phospholipids are hydrolyzed in the disease.

Inhibitory effect of gabexate mesilate on pancreatic phospholipase A2-mediated hydrolysis of ghost membranes.

Human erythrocyte ghost membranes were incubated with human pancreatic phospholipase A2 [EC 3.1.1.4] in the presence of gabexate mesilate (FOY, ethyl 4-(6-guanidinohexanoyloxy)-benzoate methanesulfonate) in Tris-buffered saline (10 mM Tris-HCl, 150 mM NaCl, 2 mM CaCl2, pH 7.4). Membrane phospholipids were extracted by chloroform-isopropanol, 7:11 (v/v), and separated by thin-layer chromatography. Gabexate mesilate at a concentration of 400 microM caused a 50% inhibition of the enzyme-mediated hydrolysis of membrane phospholipids. When phosphatidylcholine micelles were incubated with the enzyme in the presence of gabexate mesilate, the mode of inhibition of the enzyme action by the drug appeared to be noncompetitive and Ki of gabexate mesilate for phospholipase A2 was 0.77 mM.