We studied the prognosis of 185 stage IV gastric cancer cases. The univariate analysis and multivariate analysis suggested that liver metastases (H) and peritoneal disseminations (P) were prognostic factors, the number of factors may be it, and lymph nodes metastases (N) and invasion to the other organs (T) were not it. Based on these findings, we proposed a subclassification of stage IV: IVa [T1-3N3-or T4N2] and IVb [the others]. The survival rates for IVa significantly exceeded those of IVb and did not differ from those of 25 stage IIIb gastric cancer cases.
We reviewed the effects and complications of transcatheter arterial chemoembolization (TACE), using degradable starch microspheres (DSM) in eight patients with hepatic metastases from gastric cancer. The rate of complete remission (CR) +partial remission (PR) was 62.5%, and the actual survival rates at one and two years post-treatment were 87.5%, and 52.5% respectively. The median survival time was 36.1 months. Almost all side effects were acceptable but in one case, we observed liver abscess. From this study, we suggest that DSM-TACE might be a safe and effective multimodal treatment for metastatic liver tumors in patients with gastric cancer.
To clarify the diagnosis and treatment for unresectable pancreatic cancer from April 2001 when gemcitabine was released, we conduct a retrospective survey in the Hokuriku area. We analyzed clinical data of 254 patients. Seventy-two percent of the patients was treated by any method, and 90.7% of those were treated with a protocol including gemcitabine. Gemcitabine was administered a standard protocol (1000mg/m2 for 3 consecutive weeks with one week rest) in 62.2% patients, and dose of gemcitabine was reduced or schedule was changed in others. The median survival time was 8.2 months in the therapy group, and were is no differences between gemcitabine monotherapy, multi-drug therapy including gemcitabine and radiation combining gemcitabine in survival time. Multivariable analysis clarify patient's age, performance status, ascites, pleural effusion, and any therapy were prognostic factors. This investigation revealed chemotherapy for unresectable pancreatic cancer with gemcitabine have been spread around the Hokuriku area, in addition various ways have been tried.
A 25-year-old-woman with four years history of pancolonic ulcerative colitis (UC) underwent laparoscopy-assisted restorative proctocolectomy. She developed postoperatively abdominal pain, high fever, bloody diarrhea. Computed tomography showed thickening of duodenal and small intestinal wall, and endoscopic examination revealed diffuse mucosal edema, redness, erosion and ulceration involving duodenum, small intestine and ileal pouch that was similar in appearance to UC. She experienced massive melena five times and was successfully treated by transcatheter arterial embolization. Some antibiotics and predonisolone failed to decrease activity of the lesion but the symptoms and endoscopic findings improved since intravenous dexamethasone injection.
A 56-year-old man, who had epigastralgia and abnormal liver function test, was admitted to our hospital. ERCP showed common bile duct dilation and stones. We therefore performed endoscopic lithotripsy after endoscopic sphincterotomy. Ten months later, MRCP showed recurrent CBD stones. After rehospitalization, resection of the dilated bile duct was carried out. This case was diagnosed Todani's type Ib congenital cystic dilatation of common bile duct. Todani's type Ib is rare type of congenital dilatation of bile duct, and is interesting embryologically.
Laparoscopic cholecystectomy was performed in a 54-year-old man because of gallbladder neck cancer suspected on endoscopic ultrasonography and computed tomography. The pathological diagnosis was carcinoid tumor of the gallbladder. Our case had the pedunculated morphology which was distinguishing characteristic. We analyzed the relationship between location and morphology in previously reported cases of gallbladder carcinoid tumor in Japan. The result indicated that carcinoid tumor of the gallbladder neck became pedunculated or subpedunculeted more frequently than in the rectum or stomach.
A solitary liver nodule about 1cm in diameter was detected in a 68-year-old male HBV carrier during therapy for advanced lung cancer. A multiple IIc-like depressed lesion originating in the stomach soon became elevated as the liver lesion progressed. HE staining produced hepatoma-like histological findings for the tumors of the lung, liver and stomach, while immunohistochemical staining showed them to be positive for PIVKA-II and weakly positive for HP-1. Autopsy led to a diagnosis of a moderately differentiated hepatocellular carcinoma producing bile juice with metastasis to the lung and stomach. It is not clear why advanced metastasis in the lung occured while the hepatocellular carcinoma in the liver was still small, but one possible explanation lies in the localization of the hepatic cancer: the tumor was located near a branch of the hepatic vein and vascular invasion may have caused early pulmonary metastasis via the hepatic venous flow.
We report a 47-year-old man with abdominal distension without other distinct signs. Massive ascites with any singular lesions was revealed on computed tomography, and the ascites was high-amylase and high-protein. on these findings, pancreatic ascites was suspected and he was first treated with conservative therapy, but it failed. Computed tomography one month from the start of therapy demonstrated a pancreatic cyst, and endoscopic retrograde pancreatography revealed transudation of contrast medium from the cyst. A pancreatic duct stent was placed, and the ascites was smoothly eliminated. Endoscopic pancreatic stenting is considerable treatment for pancreatic ascites.