[Postoperative Recurrence of Pancreatic Cancer Successfully Treated with the Gemcitabine plus Oxaliplatin Regimen Resulting in Long-Term Survival-ACase Report].

A 38-year-old woman who presented with complaints of back pain was diagnosed with cancer of the pancreatic body. Since invasion of the celiac artery/superior mesenteric artery was suspected, she was referred to our department for chemotherapy. She received 4 courses of gemcitabine plus S-1(GS), and she underwent distal pancreatectomy with en bloc celiac axis resection/portal vein resection/reconstruction using a left renal vein graft(OP-CAR). Histopathological examination of the resected specimen revealed a positive margin(R1). She received 11 courses of GS as postoperative adjuvant chemotherapy. She developed marked abdominal distension due to metastatic ovarian enlargement, and bilateral salpingo-oophorectomy was performed. The intraoperative findings revealed multiple peritoneal dissemination. Peritoneocentesis was performed, and the patient was started on gemcitabine plus oxaliplatin(GEMOX)for control of the ascites. This treatment was followed by a rapid decrease in the size of the ascites and resolution of the symptoms of stenosis. The serum tumor marker levels decreased over the following 18months. She received a total of 35 courses of GEMOX. This patient showed long-term survival after the start of treatment: she survived for 5 years and 11 months after the initial examination and for 5 years and 6 months after the surgery. Our experience in this case suggests that GEMOX could be a useful treatment option to improve prognosis.

[Long-Term Survivors after Resection for Primary Pancreatic Carcinoma Stage IV].

We discuss the prognosis of cases of Stage IV pancreatic carcinoma with distant metastases(7th Edition of General Rules for the Study of Pancreatic Cancer, Japan Pancreas Society)for which any treatment was performed at our hospital. Fiftythree patients were radiographically or pathologically diagnosed as having Stage IV pancreatic carcinoma with definite prognosis, and received treatments, includingsurg ery or chemotherapy, at our department. Twenty-two cases showed more metastases, and celiac artery or superior mesenteric artery invasion was suspected in 28 cases. The 5-year survival rate of all 53 cases was 3.8%, and the median survival time(MST)was 6.2 months. The MST in the palliative surgery cases was 6.7 months, and that in the cases given best supportive care(BSC)was only 1.9 months. There were no 2-year survivors in the group given chemotherapy without any other treatments and in the group given BSC alone, while the longest survival time and MST were 66.9 and 31.3 months(p<0.001), respectively, in the 10 patients treated by primary tumor resection. There was only 1 patient who showed relapse-free survival. Primary site resection and chemotherapy over 4 cycles was revealed as an independent prognostic factor by multivariable analysis. Patients with Stage IV pancreatic carcinoma have a poor prognosis. However, the possibility of achievingimproved prognosis was noted with combined-modality therapy, including aggressive resection in limited cases showinga good response to chemotherapy or cases in whom preoperative metastasis assessment was difficult.

Overwhelming pneumococcal bacteremia revealed by a peripheral blood smear in a 74-year-old healthy woman.

A 76-year-old woman, who had never been seriously ill, was admitted to our hospital with fever and shaking chills. She progressively developed septic shock. We detected Streptococcus pneumoniae in a routine examination of a Giemsa-stained peripheral blood smear. Despite intensive care with antibiotic therapy, she died within several hours after admission. A peripheral blood smear occasionally shows bacteria in cases of overwhelming septicemia, thus indicating a severe impairment of splenic function. We suggest that, in cases of severe septicemia, an examination of a peripheral blood smear is therefore useful for the rapid detection of organisms in comparison to a traditional blood culture.