Intra-abdominal bleeding caused by amyloid transthyretin amyloidosis in the gastrointestinal tract: a case report.

Diagnosis of gastrointestinal (GI) amyloidosis is often very difficult because of its nonspecific symptoms. However, a few reports have indicated that serious symptoms such as fatal GI bleeding and obstruction or perforation sometimes lead to a diagnosis of GI amyloidosis. A 79-year-old man was transported to our emergency department with a 1-week history of worsening abdominal pain. Abdominal contrast-enhanced computed tomography showed extravasation from part of the transverse colon wall and moderate ascites. Because intra-abdominal bleeding was suspected, the patient urgently underwent partial resection of the transverse colon, which was the source of the bleeding. Postoperative pathological examination of the tissue specimens led to a diagnosis of amyloid transthyretin amyloidosis. This is the first reported case in which intra-abdominal bleeding led to a diagnosis of GI amyloidosis. We should consider the possibility of GI amyloidosis when intraperitoneal bleeding is observed in elderly patients.

Far-advanced Colorectal Liver Metastases Successfully Managed With Modified ALPPS and Radiofrequency Ablation in Combination With Chemotherapy.

BACKGROUND: Large numbers of synchronous colorectal liver metastases are associated with poor prognosis. CASE REPORT: A 47-year-old male patient with rectal cancer and unresectable colorectal liver metastases (over 15 cm in diameter and over 30 metastases) was treated with a multidisciplinary treatment including systemic chemotherapy with mFOLFOX6/panitumumab and surgical therapies (colostomy, modified associating liver partition and portal vein ligation for staged hepatectomy together with radiofrequency ablation). For solitary recurrent colorectal liver metastases, percutaneous radiofrequency ablation with chemoembolization and open radiofrequency ablation in combination with the same systemic chemotherapy was performed. Since the diagnosis 3 years ago, he has been leading a good quality of life, free of any tumor or treatment. CONCLUSION: For patients with far-advanced but liver-only colorectal liver metastases, surgical therapy, systemic chemotherapy, and interventional treatment can be important for achieving good prognosis.

Cost-effectiveness of self-expandable metallic stents as bridge to surgery for obstructive colorectal cancer.

AIM: Self-expandable metallic stent (SEMS) placement is an emergent decompression approach for patients with obstructive colorectal cancer, alongside drainage tube (DT) and emergency surgery (ES). Few reports have compared the health care cost of each treatment. We aimed to compare the efficacy of SEMS as a bridge to surgery (BTS), including health care costs during decompression and colorectal resection, with those of DT and ES. METHODS: This retrospective study enrolled patients treated for acute obstructed colorectal cancer at a single institution from January 2007 to December 2019. A total of 45 patients that underwent placement of a DT, emergency colostomy, or SEMS insertion followed by elective radical colectomy or rectectomy for obstructed colorectal cancer were included, and their data were analyzed. RESULTS: Among 45 patients with obstructive colorectal cancer, 29 (55.6%) patients underwent SEMS, 7 (15.6%) underwent DT, and 9 (20.0%) underwent ES as BTS. The time to oral intake from the decompression treatment in the SEMS group was significantly shorter than that of the DT and ES group (1 vs. 13 vs. 3 day, p < 0.001). Total hospitalization during the decompression and colorectal resection in the SEMS group was significantly shorter that in the DT and ES groups (23 vs. 34 vs. 44 day, p < 0.001). The total health care cost for the decompression and the colorectal resection of DT and SEMS treatment was significantly less inexpensive than ES treatment (180.8 vs. 206.7 vs. 250.3 × 104 yen, p = 0.030). CONCLUSIONS: SEMS insertion as a BTS might represent a cost-effective and safe approach compared to other treatments.

[Assessment of Preoperative Nutritional Status and Risk Factors for Complications Related to Infection after Obstructive Colorectal Cancer Surgery].

Recently, it was reported that abdominal infection affected the survival rate after colorectal cancer surgery. We retrospectively assessed the risk factors for complications related to infection after obstructive colorectal cancer surgery. In the multivariate analysis, the following variables were found to be independent risk factors for complications related to infection after obstructive colorectal cancer surgery: PNI(p=0.02, OR=14.5)and the duration of surgery(p<0.01, OR=24.0). In addition, the lack of improvement of PNI after preoperative decompression led to an increase in the incidence of complications related to infection after surgery. Therefore, efforts should be made to prevent prolonged duration of surgery and thereby, improve preoperative nutrition while choosing the appropriate method for obstructive colorectal cancer surgery.

Primary extramedullary plasmacytoma of the sigmoid colon with perforation: a case report.

BACKGROUND: Extramedullary plasmacytomas account for 4% of all plasma cell tumors and occur mainly in the upper respiratory tract; gastrointestinal system involvement is rare. Extramedullary plasmacytoma of the colon with perforation has not been reported. CASE PRESENTATION: A 77-year-old woman with a 1-year history of lower abdominal pain and nausea was admitted to our hospital. An abdominal computed tomography scan revealed a sigmoid tumor with perforation. The patient underwent emergency surgery. Pathological examination led to a diagnosis of plasmacytoma of the colon. The patient did not undergo postoperative adjuvant chemotherapy. She has had no recurrence in 14 months of regular follow-up. CONCLUSIONS: We have herein described a rare case of extramedullary plasmacytoma of the gastrointestinal tract with perforation involving the sigmoid colon.

[Experience of Nine Cases of Endoscopic Gastroduodenal Stenting for Malignant Gastroduodenal Obstruction].

BACKGROUND: We reported our results of endoscopic gastroduodenal stenting for malignant gastroduodenal obstruction. METHODS: This retrospective study investigated cases of malignant gastric and duodenal obstruction treated with gastroduodenal stenting between April 2014 and December 2016. RESULTS: The mean operative time was 34 minutes. The mean time to the first intake of solid food was 2.7 days, and the median time was 3 days. Complications were restenosis, vomiting, anemia, anorexia, and gastric pain. In 8 patients, the GOOSS score was improved. In 5 patients, the CONUT score was improved. In 6 patients, the albumin level was improved. The mean overall survival time was 130 days, and the median time was 112 days. CONCLUSION: Our study suggested that gastroduodenal stenting for malignant gastroduodenal obstruction was minimally invasive and improved quality of life(QOL)in a short time.

[A Case of Study Stable Disease after Hepatic Arterial Infusion Chemotherapy in a Patient with Systemic Chemotherapy-Resistant Liver Metastases of Colon Cancer].

A 62-year-old man was underwent sigmoidectomy for sigmoid colon cancer(T3N1H0P0, Stage III a). He received a postoperative systemic chemotherapy with SOX. Five months after the operation, multiple liver metastases were detected by CT scan. Systemic chemotherapy(bevacizumab and SOX, bevacizumab and FOLFIRI)did not reduce the liver metastases. So 4 courses of hepatic arterial infusion(HAI)chemotherapy with CDDP 10mg/day and 5-FU 500mg/day for 2weeks were performed without severe adverse events. All the liver metastases decreased in size remarkably, and the hepatic resection was able to be performed. We think HAI chemotherapy is one of the useful options for resistance to systemic chemotherapy for liver metastases from colorectal cancer.

[Effective transarterial neoadjuvant chemotherapy with paclitaxel (TXL) in a case of locally advanced breast cancer].

The patient was a 49-year-old woman who had locally advanced breast cancer with skin invasion. She was placed on neoadjuvant weekly systemic chemotherapy of TXL (65 mg/m2) and ADM (20 mg/m2). After systemic chemotherapy, she underwent 2 courses of transarterial neoadjuvant chemotherapy of TXL (day 1, 8, 15). We administered TXL (45 mg/m2) into the subclavian artery and TXL (20 mg/m2) into the internal thoracic artery. Although she experienced grade 3 leukopenia during systemic chemotherapy, she experienced only grade 2 alopecia and grade 1 nausea during transarterial chemotherapy. After chemotherapy, she underwent radical mastectomy. We report herein a case in which transarterial neoadjuvant chemotherapy with TXL was effective.

[A case of advanced gastric cancer with invasion of pancreas effectively treated by combined chemotherapy of TS-1 and paclitaxel (TXL)].

The patient was a 55-year-old woman who had unresectable advanced gastric cancer with celiac lymph node metastases and invasion of pancreas. The lesions were considered surgically incurable, so she was placed on neoadjuvant chemotherapy consisting of TS-1 and low-dose CDDP, for a total of 3 courses of TS-1 (100 mg/day, 12 weeks) and 2 courses of low-dose CDDP (10 mg/day, 100 mg). The only side effect of this chemotherapy was light anorexia, and the patient maintained a good QOL. After chemotherapy, the tumor had decreased partially in size, but there was little change in the abdominal lymph node metastases. She was considered to have little response and underwent palliative distal gastrectomy, because of the incomplete dissection of abdominal lymph node metastases. After the operation, she was treated with 2 courses of TS-1 100 mg/day (3 weeks administration and 2 weeks rest) and CDDP 70 mg or 50 mg/body (day 8). She had grade 3 anorexia. After discharge, she was treated by combined therapy of TS-1 100 mg/day (2 weeks administration and 2 weeks rest) and TXL 60 mg/body (day 1, 8, 15). After 2 courses of TS-1/TXL therapy, the abdominal lymph node metastases had decreased in size and the tumor markers were reduced remarkably: CEA 146.1-->26.9 ng/ml, and CA19-9,351.5-->210.6 U/ml. The patient received 5 courses of TS-1/TXL therapy, and she had no trouble with side effects. She maintained a good QOL. TS-1/TXL therapy was associated with few adverse events in hospital visits, and thought to be an effective adjuvant chemotherapy against advanced gastric cancer.