Balloon occluded retrograde transvenous obliteration and percutaneous transhepatic obliteration for ruptured duodenal varices after operation for rectal cancer with multiple liver metastasis: report of a case.

We report a patient with duodenal varices oozing blood who had undergone low anterior resection of the rectum and resection of the liver tumor because of multiple liver metastasis from rectal cancer 80 months previously. Although endoscopic variceal ligation (EVL) was carried out for the ruptured duodenal varices, their bleeding persisted and hepatic encephalopathy also appeared. Finally, balloon occluded retrograde transvenous obliteration (BRTO) with percutaneous transhepatic obliteration (PTO) was carried out for the duodenal varices. Percutaneous transhepatic portography revealed detailed hemodynamics. Following PTO, the duodenal varices were stagnated by BRTO, and no complications were recognized. No re-bleeding episode has been observed since the treatment. In addition, the hepatic encephalopathy was also improved.

[A case of advanced rectal cancer responding to 5-fluorouracil based preoperative chemoradiation therapy].

We report a case of a 67-year-old female with advanced rectal cancer that showed a significant response after administration of preoperative chemoradiation therapy. 5-fluorouracil (5-FU, 300 mg/m2/day) was administered by 24-hour continuous intravenous infusion after the cancer had been decreased in size by radiation (2 Gy) administered for 20 days preoperatively. Consequently, the patient underwent a low anterior resection with lymph node dissection (D 2), which resulted in a curative resection of the cancer cells macroscopically. Histological examination revealed no residual cancer cells in the resected specimen (CR). Preoperative chemoradiation therapy appears a promising regimen for patients with advanced lower rectal cancer, and can be considered to extend the indication for laparoscopic operations for advanced rectal cancer.

Investigation of QOL of hospice patients by using EORTC-QLQ-C30 questionnaire.

This study was designed to investigate the quality of life (QOL) of cancer patients being cared for in a hospice, in the expectation that the results would serve as useful basic materials for improving the care of such patients. The subjects were 24 patients who had been diagnosed as having cancer and were hospitalized in the hospice wing of a hospital. The study was carried out as a crossing investigation using the Japanese version of the EORTC-QLQ-C30 Ver.3 questionnaire prepared by the European Organization for Research and Treatment of Cancer. The results of the survey showed that it was important to be prepared to prevent or treat diarrhea at the time of bowel movement and confirmed the need for care aimed at reducing fatigue. In addition, the emotional functioning and financial problems of the patients showed strong correlations with the QOL, revealing the need for psychological and financial support of cancer patients in hospices.

Study of life satisfaction and quality of life of patients receiving home oxygen therapy.

An investigation was conducted by mail using a questionnaire regarding the life satisfaction and quality of life (QOL) of patients receiving home oxygen therapy (HOT) to evaluate their support. QOL was evaluated according to 4 scales: (1) activities, (2) state of health and quality of living, (3) physical symptoms, and (4) economic state. The answers of 90 patients (recovery rate: 60%) who responded to the investigation were analyzed, and the following points were clarified. 1. Most of the subjects visited the hospital regularly, and about half the subjects (50.6%) had been treated by hospitalization during the 3 years prior to the investigation. 2. A large majority of the subjects (77.4%) answered they were satisfied with life. 3. Life satisfaction was closely related to the patients' roles and hobbies, and their activities in their communities and families. 4. The quality of living and the state of health were closely related to mental activity. 5. The economic state was closely related to all items of life satisfaction, quality of living, and state of health. From these results, expansion of the range of activities of patients receiving HOT and providing an economic basis for their living as well as preventing exacerbation of the disease are considered to be important for improving their life satisfaction.

Genetic detection of liver micrometastases that are undetectable histologically.

BACKGROUND: Predicting liver metastasis from colon cancer is essential for improving its prognosis. We studied to what extent genetic detection of cancer cells in the resected liver tissue can predict the incidence of macroscopic liver metastasis with a similar mouse model to clinical colorectal cancer that causes a several decade percentage of metachronous hepatic metastases after resection of the primary lesions. MATERIALS AND METHODS: A LS174T human colorectal cancer cell suspension was injected into the spleens of nude mice. One to 10 days after splenic injection, 3 x 3 mm of liver tissue was removed, and a splenectomy was performed. Liver tissue was used for genetic detection and histological examination. Five weeks after splenic injection, the number of macroscopic metastases on the surface of the liver was counted. RESULTS: Eight of the 45 cases were positive for tumor cells in liver tissue genetically, while only 1 was positive for tumor cells histologically. Macroscopic liver metastases were seen 5 weeks after splenic injection in 11 of 37 (29.7%) cases negative for tumor cells genetically and in 8 of 8 (100%) cases positive for tumor cells genetically. Five or more metastases were seen in 3 of 37 (8.1%) cases negative for tumor cells genetically and in 7 of 8 (87.5%) cases positive for tumor cells genetically. CONCLUSIONS: The cases which were positive for tumor cells in liver tissue genetically at the time of splenectomy had more significantly macroscopic liver metastases some weeks later than the cases negative for tumor cells. This study suggests that if micrometastasis was detected genetically, the development of metachronous macroscopic liver metastasis could be predicted.

[A case of long surviving advanced recurrent breast cancer with multiple bone metastases responding to treatment with 5'-DFUR combined with MPA].

The patient was a 69-year-old woman who had undergone right standard radical mastectomy on August 8, 1991, and was treated with chemo- and hormonal therapy of ADM, UFT and TMA. Three years later she showed multiple bone metastases with elevation of CEA, and 5'-DFUR 1,200 mg/day and MPA 800 mg/day were administered. Two years later her CEA levels were decreased, 5'-DFUR was discontinued and MPA 1,200 mg/day only was continued. Two months later a side effect of MPA, her body weight gain, was observed, and the dosage of MPA was reduced from 1,200 mg/day to 800 mg/day. Then the side effect was resolved. Bone scintigraphy and MRI showed that bone metastatic lesions were reduced 6 years after 5'-DFUR and MPA therapy. It is suggested that this combination therapy may be useful for advanced recurrent breast cancer patients with multiple bone metastases.