5-Fluorouracil(5-FU)and cis-dichlorodiammineplatinum(CDDP)combined with 60Gy of radiation was administered to a 65-year-old man with advanced esophageal cancer complicated with chronic renal failure treated with hemodialysis(HD). Continuous infusion of 5-FU 680mg/m2 on Days 1∼5 and 8∼12, and drip infusion of CDDP 40mg/m2 on Days 1 and 8 were administered twice with a 5-week interval. The CDDP dosage was reduced to 40% and HD was started 30 minutes after CDDP administration. Concurrent radiotherapy was started on Day 1 at 2Gy/d for 5d/week. The concentration of both free CDDP and total CDDP was measured using the atomic absorption method after the second treatment period. The area under the curve(AUC)of free CDDP was 3.3μg·h/ml. Both Grade 4 anemia and Grade 3 leukopenia were observed, but the renal failure did not progress. All toxicities were tolerable and the CDDP dose reduction and HD method were appropriate for the patient.
The patient was a 79-year-old woman. We became introduction consultation than a nearby doctor in alpha-fetoprotein(AFP)high level. Abdominal ultrasonography showed 30mm great tumor in liver lateral segment area and gastric fiber showed type2 tumor which is AFP producing gastric cancer. On admission AFP level is high(403ng/ml). Multiple liver metastases were noted it by abdominal angiography. We started FLAP(5-fluorouracil, leucovorin, etoposide, cisplatin)combination chemotherapy by a diagnosis of AFP producing gastric cancer StageIV. It is reduction of a liver tumor after one course, and the stomach lesion almost disappeared after three courses end points.
We report a case of groove pancreatitis. A 60-year-old man was admitted to our hospital because of nausea and vomitting. CT showed a mass lesion in the groove between the pancreas head, duodenum and common bile duct. He was given a diagnosis of the groove pancreatitis, and underwent endoscopic balloon dilation. Groove pancreatitis is rare, and we discuss this case with references.
Hepatic portal venous gas(HPVG)is a rare condition with a poor prognosis. A 40-year-old man underwent esophagectomy for stage IV esophageal cancer followed by chemotherapy. Four months later, he admitted to our hospital because of the increases of residual tumors and started chemoradiotherapy(CRT)with 5-FU, CDDP and radiation. Computed tomography(CT)scan revealed PR, and blood examination showed decreases in WBC and platelet counts. Fourty days after CRT, he suddenly complained severe pain in the left chest and abdomen, and vomiting. CT scan showed HPVG in the left lobe of the liver and pneumatosis cystoides intestinalis in the wall of the gastric tube. He died of multiple organ failure. To our knowledge, this is a first case of HPVG associated with CRT for esophageal cancer.
A 68-year-old man was referred to our hospital because of eosinophilia in peripheral blood and pancreatic tumor on abdominal US. He was accustomed to eating the raw flesh of wild boar and keeping wild boar, and under medical treatment for Diabetes. Pancreatic tumor was diagnosed to the pancreatic ductal cancer by the imaging examination and endoscopic transpapillary brushing cytology for pancreatic duct. The diagnosis of hepatic eosinophilic granuloma was done by aspiration biopsy for hepatic multiple small nodules. Because of the strong positive finding for nematose in the assay of multi dot-ELISA for parasite, hepatic eosinophilic granuloma caused by visceral larva migrans was accidentally complicated by pancreatic cancer, and operation for the pancreatic cancer was done. To bear this disease in mind and to research his life history, is important to diagnose hepatic multiple nodules with eosinophilia.
A 40's-year-old woman who had abdominal pain with fever was referred to our hospital for further examinations. Abdominal computed tomography showed no focal lesion, and no causative lesion was found after a gynecological examination, upper gastrointestinal endoscopy and colonoscopy. Tuberculin test and QuantiFERON-TB® were positive, and thus tuberculous peritonitis was suspected. The level of adenosine deaminase (ADA) in ascites was high, and 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) showed that FDG accumulated diffusely along the peritoneum. These findings supported the findings of tuberculous peritonitis. Final diagnosis of tuberculous peritonitis was done from laparoscopic biopsy. Combination of QuantiFERON-TB®, ADA and FDG-PET was useful in diagnosing tuberculous peritonitis.
An 83-year-old man was admitted to our hospital with jaundice. At the age of 79, he had undergone distal gastrectomy with Roux-Y reconstruction and cholecystectomy due to early gastric cancer and gall bladder carcinoma. CT and MRI revealed severe dilatation from the common bile duct (CBD) to the intra-hepatic bile duct. Blood tests showed high serum levels of bilirubin and CA19-9. Cytology of the bile juice was Class V. Percutaneous transhepatic bile duct drainage was performed. Curative surgical resection was not indicated due to his age and general condition. Neither percutaneous nor endscopical fistulization were successful. Finally magnetic compression anastomosis was performed. Under general anesthesia, the first magnet was placed in the CBD through a cutaneous fistula. The second one was placed in the duodenum through the jejunum. The two magnets attached the walls of the CBD and duodenum. Three weeks after the maneuver, the anastomosis was completed with only a slight fever.
A 60-year-old man with pancreatic cancer was admitted due to massive ascites in the course of gemcitabine treatment. Cachexic condition progressed due to peritonitis carcinomatosa. Continuous infusion of low dose 5-FU with octreotide was carefully started. Almost all of ascites disappeared after 4 courses of treatment and his general condition markedly improved. This patient died of pneumonia about 13 months after diagnosis of peritonitis carcinomatosa. Autopsy was undergone, and the effect of chemotherapy was confirmed.