Cloacogenic anal carcinoma presenting with humoral hypercalcemia: report of a case.

We present herein the case of a 60-year-old man found to have a rare type of cloacogenic anal carcinoma. The disease was advanced and aggressive with local invasion to the prostate as well as distant lymph node metastases to the neck and paraaortic region on presentation. Therefore, a palliative abdominoperineal resection was performed, 10 weeks following which the patient developed humoral hypercalcemia. Despite treatment with hydration, furosemide, steroids, and calcitonin, serum calcium continued to rise and the patient died on the 95th postoperative day. Laboratory findings revealed a decreased parathyroid hormone (PTH) level and marked elevation of parathyroid hormone-related protein (PTHRP). The detection of the PTHRP in the tumor extract and the positive immunohistochemical staining for this in the tumor cells suggested that the humoral hypercalcemia was definitely caused by its associated tumor production. Although hypercalcemia is not an uncommon complication of solid cancers in their late stage, only three other cases of rectal cancer with hypercalcemia have ever been reported. To our knowledge, this is the first documentation of cloacogenic anal carcinoma accompanied by PTHRP-induced severe humoral hypercalcemia.

[Nutritional management following resection of esophageal cancer--effect of early postoperative enteral hyperalimentation].

We studied the effect of early postoperative enteral hyperalimentation on the nutritional state and hormones in digestive organs in twenty patients who underwent resection of thoracic esophageal carcinoma and reconstruction of new esophagus. Following results were obtained. 1. Although enteral hyperalimentation was started in the early postoperative period (postoperative 3 day), the incidence of complications including diarrhea was decreased dramatically and satisfactory nutritional effect was obtained due to the development of many excellent chemically defined enteral nutrients. 2. Gut hormones including CCK showed the same response as in the preoperative period to the loading of enteral nutrients. And that, it is suggested that the response of CCK is affected by the lipid content in the nutrients and that this response was effective to prevent the postoperative biliary stasis. 3. Enteral nutrition made it possible to self-regulate water absorption from digestive organs, to control body fluid volume and to prevent over hydration or hypovolemia to comparison with parenteral nutrition.

Prophylaxis of postoperative biliary stasis: a retrospective and prospective study.

Postoperative biliary stasis is a common state before the onset of postoperative acute cholecystitis. In order to study its characteristics and methods of prophylaxis, we examined the frequency of biliary stasis and postoperative recovery of gallbladder contractility ultrasonographically from the 2nd to the 28th postoperative day in 43 esophagectomy cases. A retrospective study in 17 patients revealed a high incidence of biliary stasis during the early postoperative period and improvement by the initiation of enteral nutrition. Furthermore, the contractility of the gallbladder recovered remarkably soon after the operation. This first randomized prospective study concerning prophylaxis of biliary stasis in 26 patients showed that postoperative biliary stasis was prevented by early initiation of enteral nutrition.

Pedunculated hepatoma--report of two cases and review of the literature.

Although pedunculated hepatoma has received little attention in the United States and Europe, in Japan more than forty cases have been reported, probably owing to the relatively high frequency of hepatoma. Formerly preoperative diagnosis was difficult in the early period. Recently it can be made by ultrasound, computed tomography and angiography, however, the choice of operative procedure is not uniform. In some cases good results were obtained by only tumor excision or partial hepatic resection, whereas other cases presented undergoing more extended resection show a poorer course. In the present case 1, intrahepatic recurrence was recognized three months after surgery in spite of relatively early diagnosis. Reviewing the literature, it appears that the degree of invasion at the pedicle is mainly related to prognosis. If invasive, segmentectomy or lobectomy is necessary and postoperative adjuvant therapy is needed.