[Long-Term Survival Following Multidisciplinary Therapy for Pancreatic Head Cancer with Liver Metastasis].

A 71-year-old female was referred to our hospital for liver dysfunction. After careful examination, she was diagnosed with resectable pancreatic head cancer. Pancreatoduodenectomy was scheduled. In the laparotomy, 2 nodules on the liver were found. A frozen section examination of the liver nodule revealed adenocarcinoma. S-1 chemotherapy was administered for about 17 months to treat the unresectable pancreatic cancer. After chemotherapy, computed tomography(CT) revealed that the pancreatic tumor remained unchanged, and there was no distant metastasis. Positron emission tomography( PET)-CT revealed no significant uptake in the pancreatic tumor and no distant metastasis. The patient was then observed for about 10 months without chemotherapy. After that, CT showed that the size of the pancreatic tumor had increased, but there were no signs of distant metastases. Therefore, pancreatoduodenectomy was performed. Histopathological examination revealed invasive ductal adenocarcinoma in the pancreas head. The patient underwent adjuvant chemotherapy with S-1 for 5 months. So far, she has survived without any recurrence for 57 months after the initial surgery.

Sarcoid reaction in the spleen after sigmoid colon cancer resection: a case report.

BACKGROUND: A sarcoid reaction is a phenomenon characterized by histologically proven granulomatous lesions without evidence of sarcoidosis. This pathology is a benign tumor itself, but several reports have described sarcoid reactions accompanying malignant tumors. Sarcoid reactions occur in various cancers, such as skin, lung, ovary, stomach, and breast cancers. However, only a few published reports have described sarcoid reactions in patients with colorectal cancer. CASE PRESENTATION: A 76-year-old woman underwent laparoscopic sigmoidectomy for sigmoid colon cancer. The postoperative follow-up computed tomography and 18-fluorodeoxyglucose positron emission tomography-computed tomography findings were suspicious for splenic metastasis of the sigmoid colon cancer. The patient then underwent laparoscopic splenectomy. Histopathological examination of the resected lymph nodes and spleen showed a non-caseating epithelioid cell granuloma. The patient was diagnosed with a sarcoid reaction. CONCLUSIONS: To our knowledge, this is the first report of a sarcoid reaction in the spleen and regional lymph nodes after colon cancer resection. The effect of a sarcoid reaction on the prognosis in patients with colorectal cancer has not been fully determined because of the small number of such cases. Further analyses involving a larger number of cases are necessary to evaluate the relationship between sarcoid reactions and prognosis in patients with colorectal cancer. We herein present an extremely rare case of a sarcoid reaction in the spleen and regional lymph nodes.

[The effects of Rebamipide and Polaprezinc mouthwash and uptake on mucositis induced by chemotherapy].

Mucositis is one of the most frequent side effects induced by chemotherapy that damages the patients' QOL and response rate. The efficacy of Rebamipide and Polaprezinc mouthwash and uptake was evaluated. Nine patients who underwent chemotherapy and had some complaints related with mucositis were included as subjects. Rebamipide (300 mg) and Polaprezinc (150 mg) mouthwashing and uptake were performed by the subjects 4 times per day. Macroscopic examination and symptom research were performed until three months after beginning this medication. Macroscopic mucositis was shown in 5 patients previously and 4 patients improved. Seven patients had symptomatic improvement(p=0. 018). Rebamipide and Polaprezinc mouthwash and uptake is effective for patients who have mucositis induced by chemotherapy.

Biphasic clinical characteristics of mild to moderate chest trauma according to age.

PURPOSE: Mild to moderate chest trauma is a common disease, although its clinical characteristics are not well known. We investigated the clinical profiles and the early and long-term outcome of hospitalized patients with chest trauma, focusing particularly on elderly patients. METHODS: The clinical records of patients who were hospitalized in Higashisumiyoshi Morimoto Hospital for chest trauma between January 2001 and December 2004 were retrospectively reviewed. The clinical profiles, treatment methods, and outcomes were investigated. The primary endpoint was a repeat visit to the hospital for another traumatic condition after discharge, and the secondary endpoint was death. The patients were divided into two groups with respect to the age of 60 years, and differences were compared statistically. RESULTS: In all, 53 patients (34 men) were hospitalized for chest trauma in our hospital between January 2001 and December 2004. The mean age was 54.9 years (17-85 years). The distribution of age showed biphasic peaks-in the tens to twenties, and sixties to seventies. Injuries were significantly more likely to be caused by a fall in elderly patients than in younger patients (P < 0.05). The elderly patients revisited our hospital with another trauma more frequently than did the younger patients (P < 0.05). CONCLUSION: Elderly patients were likely to suffer both falls and a further traumatic condition. This probably reflects the general deterioration of physical abilities, such as lowered cognitive and somatic performances.

[Severe gastric and duodenal ulcer after chemotherapy of mFOLFOX6 and bevacizumab].

A 74-year-old female had metastatic left inguinal lymph nodes 20 months after rectal amputation for cancer, and an attempt to adapt chemotherapy of mFOLFOX6/bevacizumab was made after resection of the nodes. She felt nausea 2 days and continued 1 week after starting chemotherapy. Then, an endoscopic examination revealed both active gastric and duodenal ulcers. Clipping and proton pump inhibitor medication was started. The ulcers healed to the healing stage at 18 days and to the scar stage at 28 days. Gastrointestinal complications often occur after chemotherapy, but severe ulcers are rarely reported. The chemotherapy included anti-VEGF antibody, but the ulcers have healed back to normal.

[A case of severe electrolytic disorder after adjuvant chemotherapy for esophageal cancer].

A 69-year-old female who had undergone esophagectomy for esophageal cancer was given adjuvant chemotherapy (5-FU 750 mg/body x 5 day, cisplatinum (CDDP) 100 mg/body x 1 day). An electrolytic disorder was found on day 2, and her consciousness became unclear on 5 day (respective Na, K and Cl values of 113, 2.2 and 67 mEq/L in blood). It took 59 days for infusion therapy to control electrolyte for loss in urine. As the b2-microglobulin level was high in urine and the ADH level in blood was normal, cisplatinum nephrotoxicity was thought to make this accident. Electrolytes should be checked carefully for disorder during chemotherapy.

[A case of synchronous gastric and hepatocellular carcinoma successfully treated by TS-1 and hepatic arterial infusion chemotherapy (HAI) of low-dose CDDP].

A 75-year-old man underwent distal gastrectomy for advanced gastric cancer with liver and lymph node metastases and synchronous hepatocellular carcinoma in April 2004. HAI with low-dose CDDP/TS-1 combination therapy was initiated after gastrectomy. Liver and lymph node metastases decreased significantly, with achievement of a partial response (PR) and a complete response (CR), respectively, and the hepatocellular carcinoma was reduced to 54.1% of its initial size after 3 sessions of this chemotherapy. These results suggested that combined chemotherapy with TS-1 and HAI with low-dose CDDP was not only useful for liver and lymph node metastases from gastric cancer, but for hepatocellular carcinoma as well.