Conventional myeloablative conditioning regimens for allografting rely on the use of toxic myeloablative and immunosuppressive therapies to achieve engraftment and control hematological neoplasia. Unfortunately, these regimens have resulted in substantial morbidity and mortality, and must be restricted to young patients in good medical condition. Clinical studies have shown that conditioning regimens can be reduced in intensity since the stem cell allograft can create its own space in the host's bone marrow. After obtaining approval of Institutional Review Board, we started a trial of reduced intensity conditioning (RIC) stem cell transplantation (RIST) in October 2002. In this single center retrospective study, we studied 20 adults with hematological malignancies, who received RIC prior to their first allograft. The median age of our patients was 50. 2 years. These patients demonstrated various diseases including 8 cases of malignant lymphoma. At 3 years, the probabilities of overall survival, progression free survival, relapse rate and transplant-related mortality rate were 57. 8, 46. 7, 31 and 30% for the whole cohort, respectively. Regarding engraftment of the donor's blood cells, the rate of white blood cell engraftment was 100%. Rate of platelet engraftment till day 50 after transplant was 94. 3%. The incidence of grade II-IV acute graft-versus-host disease (GVHD) and chronic GVHD were 44. 4 and 82. 1%, respectively. We then performed multivariate analysis of transplant related mortality. We concluded that the purpose of RIST was achieved, because age distribution and presence of organ dysfunctions did not significantly differ. We summarize satisfactory transplantation results were achieved with RIST, and their future indications' were promising.

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A 59-year-old man with a history of distal gastrectomy with D₂ dissection for type IIc gastric cancer 6 years earlier admitted for abdominal pain. The gastric cancer was resected surgically. Pathological findings of resected specimen were P₀, H₀, n₀, ly₀, v₀, and m, poorly differentiated adenocarcinoma with signet-ring cell carcinoma. So, no adjuvant chemotherapy was done. On admission, dilatation of colon was found in the abdominal X ray film Barium enema radiography showed a stenotic change in the transeverse colon. Colonoscopy showed severe stenosis and a mucosal surface was reddish and edematous. Histological examination of the biopsy specimen showed no malignant tissue. We resected the transverse colon surgically, but no definite peritoneal dissemination was found. Pathological findings of the transverse colon showed poorly differentiated adenocarcinoma invading from the submucosa to subserosa with severe fibrosis but no carcinoma invasion to the mucosal layer. We thought this stenotic leisions was metastatic colonic cancer. Both primary gastric cancer and the colonic lesion were similar to histological findings and immunohistochemical staining, but we could not exclude this case as primary colon cancer absolutely.

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Percutaneous endoscopic gastrostomy (PEG) has been widely used in patients with impaired swallowing mechanisms. We experienced a case of PEG-related abdominal abscess at the coplacement site of PEG and ventriculoperitoneal shunt. Pre-operatrive screening of shunt placement using abdominal CT may be effective for prevention of such complication. Accumulating data shows that 10-20% of any complication is associated with PEG insersion. For safe application of PEG, appropriate decision of indication and precice pre-operative examination is recommended.

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A 72-year-old man admitted to our hospital for abdominal pain. Upper GI series and gastroendoscopy showed 2 type tumor existing from upper portion beyond lower portion of the stomach which was 9cm in diameter. Gastroendoscopical biopy specimen revealed T-cell lymphoma and abdominal CT revealed swellings of regional lymph nodes, so we diagnosed as Stage II E accoding to the classification of Ann Arbor. A total gastrectomy with D2 lymph node dissection was performed. We also found 2 sites of mass within 40-60cm portion from the end of ileum during surgery, and we resected all of them. All of the abdominal mass were pathologically diagnosed as T-cell lymphoma of the stomach and small intestine. Lymph nodes involvements of No4d and the resional small intestine were found pathologically. This case was sero-positive for human lymphotropic virus type 1. After the operation, the patient's condition had been good, and he admitted to the department of internal medicine in our hospital to receive the adjuvant chemotherapy. He reseived the chemotherapy of 6 cycles followed a radiation therapy. Suddenly he complained of severe abdominal pain seven months after surgery during the radiation therapy, he suddenly complained of severe abdominal pain, and he underwent an emergency surgery with a diagnosis of pan-peritonitis due to small intestinal perforation. He complicated with DIC and died 9 days after surgery. The case was presented together with a review of the literature.

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