A case of cancer of the ampulla of Vater accompanied by malrotation.

Intestinal malrotation is caused by a developmental anomaly of the embryonic intestine. Most cases develop in neonates, and development in adulthood is rare and difficult to diagnose before surgery. Pancreaticoduodenectomy was performed for cancer of the ampulla of Vater accompanied by incomplete fixation in a 63-year-old male patient. A branch of the superior mesenteric artery was present on the resection line and was deemed likely to cause circulatory disorder in the small intestine, and the duodenum and jejunum were covered with a membranous structure making dissection, anatomical identification, and jejunectomy difficult. Herein, we report the case with a review of the literature.

[A pilot study of intraperitoneal gemcitabine for reduction of peritoneal dissemination in advanced pancreatic cancer].

We schemed intraperitoneal gemcitabine (ipGEM) for reduction of peritoneal dissemination to three patients with unresectable and one patient with recurrent pancreatic cancer, followed by intraperitoneal catheter and subcutaneous port placement. Two locally advanced cases were performed for intra-operative radiotherapy, and one of 2 locally advanced cases was performed for gastrojejunostomy. And another locally advanced case had ileostomy. The recurrent case was resected for metastatic tumor of abdominal wall. In one of locally advanced cases, we couldn't perform ipGEM for progression of disease. In two remaining locally advanced cases, we could keep on doing ipGEM, and the patients did not experience with abdominal discomfort or hematological toxicity.

[A case of intraluminal/external irradiation, chemotherapy and T-tube stent treatment for the local recurrence of the postoperative four-year bile duct cancer].

The patient was a 73-year-old man. In 2001, PPPD was performed. After confirmation of an expanded intrahepatic bile duct and anastomic stenosis in July 2005, PTBD was performed into the B3. Adenocarcinoma was detected with bile cytodiagnosis, and was diagnosed as a recurrence of the left bile-duct anastomotic site. Under the informed consent, chemo-radiotherapy was performed in addition to beam radiotherapy (30 Gy) in September 2005. Then we performed an intracavitary irradiation at 25 Gy. UFT (200 mg) was administered along with the radiation therapies. After that, an internal fistularization due to the T-tube was done. Liver metastasis was confirmed by abdominal CT in 2006. We started administering of GEM (600 mg/body) every other week after the recurrence of the bile duct cancer. The patient had survived for 24 months from the recurrence. We report a good result of the recurrent bile duct cancer treated with combined modality therapy.

[Chemoradiotherapy of unresectable and recurrent cholangiocarcinoma].

UNLABELLED: This study is for chemoradiotherapy of unresectable and recurrent cholangiocarcinoma (CCC). SUBJECTS AND METHODS: Between April 2005 and March 2007, 5 patients were evaluated for unresectable and recurrent CCC. All patients were performed percutaneous transhepatic biliary drainage (PTBD) and treated with chemoradiotherapy. The radiation method was an external beam radiotherapy (EBRT) and remote after loading system (RALS). The chemotherapy was 5-FU and gemcitabine by intravenous injection. RESULTS: Three patients had unresectable and 2 had recurrent CCC. As for the side effects, 4 patients had a slight neutropenia and 1 had an uncontrollable gastric bleeding. No patient had cholangitis. The mean survival time for unresectable and recurrent CCC was 13.7 months and 17 months, respectively. CONCLUSIONS: Our results indicated that chemoradiotherapy had been consistent with efficacy in patients with unresectable and recurrent CCC.