[Compliance with FOLFOX4 for Stage III colon cancer in the adjuvant setting].

AIMS: The usefulness of oxaliplatin(L-OHP)as adjuvant chemotherapy for Stage III colon cancer has been shown in clinical trials, such as the MOSAIC trial. The Leucovorin, fluorouracil, and oxaliplatin(FOLFOX)regimen has been recommended as adjuvant chemotherapy for colorectal cancer in Japan. In the MOSAIC trial, 74.7% of patients completed all planned treatment cycles. Neurological toxicity caused byL -OHP is one of the factors for discontinuing treatment. Therefore, we planned to administer FOLFOX4 as postoperative adjuvant chemotherapy and evaluated the safety and feasibility of this regimen. METHODS: From November 2009, 13 patients with Stage III colon cancer who had undergone complete resection of a primary tumor were enrolled. Patients received 4 cycles of FOLFOX4, followed by 4 cycles of the simplified fluorouracil and Leucovorin (LV5FU2)regimen and 4 additional cycles of FOLFOX4(12 cycles in total). RESULTS: Thirteen patients were treated with our FOLFOX4 regimen. In total, 11 patients(84.6%)completed all 12 planned treatment cycles. The median L-OHP dose per patient was 560mg/m / 2(compared with the per-protocol 12-cycle dose of 680 mg/m2). Grade 1 neurological toxicity during treatment was reported in 10 patients(76.9%). Neurological toxicity was reduced during the 4 cycles without L-OHP. CONCLUSION: Our FOLFOX4 regimen showed reduced neurological toxicity compared to other trials and can be used safely.

Primary adenocarcinoma of the fourth portion of the duodenum: "A case report and literature review".

INTRODUCTION: Primary adenocarcinoma of the 4th portion of the duodenum is reported less frequently than those other portions of the duodenum. Therefore, few reports discuss the diagnosis and treatment of this malignancy. PRESENTATION OF CASE: A 54-year-old woman was admitted to our hospital with a complaint of nausea and vomiting after a meal. Upper gastrointestinal examination and a duodenogram revealed a Type 2 tumor of the 4th portion of the duodenum, which was diagnosed as well-differentiated tubular adenocarcinoma by endoscopic biopsy. Partial resection of the duodenum and jejunum was performed on the basis of intraoperative evaluation of negative lymph node metastasis around the pancreas and proximal duodenum with no macroscopic invasion toward the pancreas and proximal duodenal margin. Her postoperative course was uneventful without any sign of recurrence 5 years later. DISCUSSION: Primary adenocarcinoma in the 4th portion is relatively less common. It is not easy to diagnose this disease. Patients with primary duodenal adenocaricinoma, who are medically fit to undergo surgery, should be given the option of aggressive resection. Duodeno-cephalo-pancreatectomy remains the standard treatment for adenocarcinomas of the 1st and 2nd portion of the duodenum. Partial resection is the preferred surgical method for patients with adenocarcinoma of the 3rd and 4th portions of the duodenum. CONCLUSION: This report describes a rare case of primary adenocarcinoma of the 4th portion of the duodenum, successfully treated by partial resection of the duodenum and jejunum. However, larger studies are required to clarify the indications for the preferred surgical method for this malignancy.

Hepatobiliary cystadenocarcinoma with rapid growth: report of a case.

We describe a case of histologically proven hepatobiliary cystadenocarcinoma with an emphasis on the longterm clinical course. The patient was a 75-year-old man who had been diagnosed as having a simple hepatic cyst at our hospital and had been followed up by abdominal sonography (US) for about 10 years. However, the lesion subsequently showed a sudden increase in size and a marked change in US findings, i.e., from a benign hepatic cyst to a complete solid lesion. Contrast-enhanced US revealed the lesion to be filled with fine vessels. This rapid change led us to strongly suspect a hepatobiliary cystadenocarcinoma and, thus, left lateral segmentectomy was performed. The patient is doing well 6 months after the surgical treatment.

High incidence of reflux esophagitis observed by routine endoscopic examination after gastric pull-up esophagectomy.

A gastric tube has been widely used for reconstruction of the esophagus after esophagectomy for esophageal cancer. Reflux esophagitis after esophagectomy is frequently observed. Therefore we retrospectively investigated the risk factors for reflux esophagitis after gastric pull-up esophagectomy in 74 outpatients with thoracic esophageal cancer. Reflux esophagitis was diagnosed endoscopically. Esophagitis was classified according to the Los Angeles classification. Reflux symptoms, medications, and the surgical procedure were reviewed. The relation between reflux symptoms and reflux esophagitis and the influence of the anastomotic site were evaluated. Reflux esophagitis was observed in 53 patients. Severe esophagitis (grade C or D) was found in 75.6% of these patients. Although all patients with esophagitis took antacid agents, histamine receptor-2 blocker was effective in only 35% of them. The correlation between reflux symptoms and reflux esophagitis was not significant. Reflux esophagitis was present in 56.4% of patients with neck anastomosis and in 88.6% of patients with intrathoracic anastomosis ( p = 0.0039). We concluded that routine endoscopic examination is necessary after gastric pull-up esophagectomy because reflux esophagitis is not diagnosed based on reflux symptoms. When a gastric tube is used for reconstruction after esophagectomy, neck anastomosis is recommended to lower the risk of reflux esophagitis.

The lipolytic responsiveness to endotoxin in subcutaneous adipose tissue is greater than mesenteric adipose tissue.

In sepsis and endotoxemia, metabolism is characterized by accelerated catabolism. In the present study, lipolytic responsiveness of subcutaneous and mesenteric adipose tissue to the sub-lethal dose of endotoxin injection (5 mg/kg) was evaluated using microdialysis techniques in rats. All rats were urethane-anesthetized and implanted with microdialysis probes in their subcutaneous and mesenteric adipose tissue. Lipolysis in each adipose tissue was assessed by measuring the glycerol concentration (an index of lipolysis) in the dialysate from the microdialysis probe. Lipolysis was continuously monitored for 7-hours, prior to and following the injection of endotoxin. The control animals were injected with only saline. Lipolysis in subcutaneous adipose tissue began to increase by 1-hours after endotoxin injection, and reached a peak 60% higher than the basal level by 2-hours after injection. This activated lipolysis after endotoxin was markedly greater than that in the control animals and maintained for 5 hours. In mesenteric adipose tissue, lipolysis after endotoxin injection was greater than in the control animals, but not significant. The endotoxin-induced lipolysis in the subcutaneous adipose tissue was significantly greater than that in the mesenteric adipose tissue. We conclude that the sub-lethal dose of endotoxin injection cause active lipolysis in adipose tissues, and that the lipolytic responsiveness to endotoxin in subcutaneous adipose tissue is greater than in mesenteric adipose tissue.