RESUMEN
BACKGROUND: Although combination therapy consisting of 5-fluorouracil (5-FU) and cisplatin for the treatment of gastric cancer has been reported, no consistent regimen has been established. Our aim was to determine the optimal treatment schedule of this therapy, for patients with advanced or recurrent gastric cancer. PATIENTS AND METHODS: We conducted a phase II study to evaluate the efficacy and safety of combination therapy consisting of intermittent 5-FU and low-dose cisplatin in 26 patients with advanced or recurrent gastric cancer. The treatment cycle consisted of intravenous cisplatin at 3.3 mg/m(2)/day for 5 consecutive days. 5-FU was administered as a continuous intravenous infusion at 300-500 mg/body every other day (days 1, 3, 5) for 4 weeks. RESULTS: The partial response rate was 34.6%. The median survival duration was 12.8 months and the one-year survival was 53.1%. There were a few adverse effects. CONCLUSION: Our results suggest that this mode of combination therapy led to a fairly favorable outcome for patients with advanced or recurrent gastric cancer.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Neoplasias Gástricas/patologíaRESUMEN
Hepatocellular carcinoma accompanied by portal hypertension and hypersplenism is difficult to treat medically and surgically due to pancytopenia and the development of collateral circulation. In this study, we were able to safely and simultaneously perform a laparoscopically-assisted splenectomy and partial hepatectomy. The characteristics of this procedure include: (1) the shared use of a medial wound made through laparoscopically-assisted surgery; (2) improved safety for manipulating areas that were difficult to observe with a camera in a case of splenomegaly; (3) a preventive ligation of the splenic artery; (4) improved hemostatic function using LigaSure Impact; and (5) hemorrhage control through manual manipulations and the Pringle maneuver during liver parenchymal transection. The surgery was safely performed using the above points.
Asunto(s)
Carcinoma Hepatocelular/cirugía , Laparoscópía Mano-Asistida , Hepatectomía/métodos , Hiperesplenismo/etiología , Neoplasias Hepáticas/cirugía , Esplenectomía/métodos , Anciano , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/diagnóstico , Estudios de Seguimiento , Humanos , Hiperesplenismo/diagnóstico , Hiperesplenismo/cirugía , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/diagnóstico , MasculinoRESUMEN
BACKGROUND/AIMS: We investigated whether the serum Thymidine phosphorylase (TP) levels in venous blood drainage specimens were associated with the prognosis and risk of liver metastasis in patients with resectable colorectal cancer. METHODOLOGY: From 88 patients with colorectal cancer, specimens of venous blood drainage were obtained during operation. The serum TP levels were measured by a highly sensitive Enzyme-Linked Immunosorbent Assay (ELISA) method. RESULTS: Subsequently, 88 patients were divided into two groups based on the levels of TP. The dividing line was determined to be 55ng/mL. The TP-high group (> 55ng/mL) had a significantly shorter overall survival than the TP-low group (< 55ng/mL). A multivariate analysis indicated that the serum TP level in venous blood drainage specimens to be a better prognostic factor independent of the traditional pathologic parameters. The serum TP levels of 3 patients with metachronous liver metastasis were high (> 55ng/mL). CONCLUSIONS: These findings suggest that the serum TP levels in venous blood drainage specimens reflect the prognosis of patients with colorectal cancer undergoing curative resection, particularly the risk of liver metastasis.
Asunto(s)
Neoplasias Colorrectales/sangre , Timidina Fosforilasa/sangre , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , VenasAsunto(s)
Carcinoma Ductal Pancreático/patología , Carcinoma Ductal Pancreático/cirugía , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugía , Antígeno CA-19-9/sangre , Carcinoma Ductal Pancreático/sangre , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/sangre , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias Pancreáticas/sangre , Pancreaticoduodenectomía , Píloro/cirugía , Factores de TiempoRESUMEN
A pancreatic fistula is one of the most frequent complications and is still responsible for most mortality after pancreatic surgery. We propose a gastric wall-covering method, a new and novel surgical technique in pancreatic surgery for the prevention of pancreatic fistula, in which the pancreatic cutting surface is covered completely with the gastric wall. Ten patients underwent our new surgical technique, gastric wall-covering method, in 7 patients with distal pancreatectomy and in 3 with partial resection of the head of the pancreas. There were no episodes of pancreatic fistula or any complications. Our novel technique is simple, technically feasible, and useful for the prevention of the pancreatic leakage following pancreatic surgery.
Asunto(s)
Pancreatectomía/métodos , Fístula Pancreática/prevención & control , Neoplasias Pancreáticas/cirugía , Estómago/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Rectal carcinoids comprise only about 1% of all anorectal neoplasms. In addition, ganglioneuroma of the gastrointestinal tract is a rare tumor composed ganglion cells, nerve fibers, and supporting cells. Multiple carcinoid tumors with diffuse ganglioneuromatosis limited to the rectum are quite unusual. CASE PRESENTATION: A 69-year-old man was referred to us because of about 100 small submucosal rectal tumors. He underwent abdominoperineal resection. Pathology revealed carcinoid tumors for about 30 submucosal nodules and diffuse ganglioneuromotosis. To date (6 months later) he remains well with no recurrence. CONCLUSION: Although the optimal treatment for the multiple rectal carcinoids remains to be clearly established, it is believed that not all patients with multiple rectal carcinoids (measuring less than 1 cm in diameter) need to have a radical operation. However, the treatment plan for each case should be individualized and a careful follow-up is mandatory.
Asunto(s)
Tumor Carcinoide/patología , Ganglioneuroma/patología , Invasividad Neoplásica/patología , Neoplasias Primarias Múltiples/patología , Neoplasias del Recto/patología , Anciano , Biopsia con Aguja , Tumor Carcinoide/cirugía , Colectomía/métodos , Estudios de Seguimiento , Ganglioneuroma/cirugía , Humanos , Inmunohistoquímica , Mucosa Intestinal/patología , Masculino , Neoplasias Primarias Múltiples/cirugía , Proctoscopía/métodos , Neoplasias del Recto/cirugía , Medición de Riesgo , Resultado del TratamientoRESUMEN
We herein report the case of an idiopathic liver cystic mass which aggressively infiltrated the thoraco-abdominal wall. A 74-year-old woman who had a huge cystic lesion in her right hepatic lobe was transferred to our hospital for further examinations. Imaging studies revealed a simple liver cyst, and the cytological findings of intracystic fluid were negative. She was followed up periodically by computed tomography (CT) scans. Seven years later, she complained of a prominence and dull pain in her right thoraco-abdominal region. CT revealed an enlargement of the cystic lesion and infiltration into the intercostal subcutaneous tissue. We suspected the development of a malignancy inside the liver cyst such as cystadenocarcinoma, and she therefore underwent surgery. A tumor extirpation was performed, including the chest wall, from the 7th to the 10th rib, as well as a right hepatic lobectomy. Pathologically, the lesion consisted of severe inflammatory change with epithelioid cell granuloma and bone destruction without any malignant neoplasm. No specific pathogens were evident based on further histological and molecular examinations. Therefore the lesion was diagnosed to be a destructive granuloma associated with a long-standing hepatic cyst. Since undergoing surgery, the patient has been doing well without any signs of recurrence.
Asunto(s)
Quistes/complicaciones , Granuloma/diagnóstico , Granuloma/etiología , Hepatopatías/diagnóstico , Hepatopatías/etiología , Pared Abdominal/patología , Anciano , Cistadenocarcinoma/diagnóstico , Cistadenocarcinoma/patología , Quistes/diagnóstico , Quistes/patología , Quistes/cirugía , Diagnóstico Diferencial , Femenino , Granuloma/cirugía , Hepatectomía , Humanos , Hepatopatías/cirugía , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patología , Tomografía Computarizada por Rayos XRESUMEN
A 71-year old woman who underwent a modified radical mastectomy for invasive ductal carcinoma of the left breast, developed postoperative chylous leakage. Though conservative management was uneffective, a direct surgical repair led to good results. Because the morbidity of a reoperation to the superficial chest wall is low, timely surgical treatment is therefore strongly recommended in cases of high output chylous leakage following a mastectomy.
Asunto(s)
Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/cirugía , Ascitis Quilosa/diagnóstico , Escisión del Ganglio Linfático/efectos adversos , Vasos Linfáticos/cirugía , Complicaciones Posoperatorias/diagnóstico , Anciano , Axila , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/patología , Ascitis Quilosa/etiología , Ascitis Quilosa/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Mastectomía/efectos adversos , Posmenopausia , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Reoperación , SucciónRESUMEN
BACKGROUND/AIMS: In the present study the importance of measurement of portal venous pressure was focused on to predict the postoperative liver function before liver surgery, particularly in cirrhotic patients. METHODOLOGY: Ninety-two patients who underwent a hepatic resection for hepatocellular carcinoma (HCC) were retrospectively evaluated to predict their postoperative liver function by measuring the portal venous pressure. RESULTS: The portal venous pressure was not significantly correlated with the preoperative value of the indocyanine green (ICG) retention test. In patients with an ICG of over 20%, the risk of occurrence of postoperative hyperbilirubinemia was high when a major hepatic resection was the procedure of choice. Even in patients with an ICG of below 20%, a few patients developed complications after surgery when major resection was carried out. For patients undergoing a small excision, the complications were nil when the ICG was below 20% and the pressure was below 200mm in saline. CONCLUSIONS: The portal venous pressure was found to reflect to what degree the liver parenchyma is damaged. Measuring the portal venous pressure is useful for determining the final indications for surgery also in cirrhotic patients with HCC.
Asunto(s)
Carcinoma Hepatocelular/cirugía , Hepatectomía/métodos , Hiperbilirrubinemia/prevención & control , Cirrosis Hepática/cirugía , Neoplasias Hepáticas/cirugía , Presión Portal , Adulto , Anciano , Biopsia con Aguja , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/diagnóstico , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico , Pruebas de Función Hepática , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/diagnóstico , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Selección de Paciente , Complicaciones Posoperatorias/prevención & control , Valor Predictivo de las Pruebas , Cuidados Preoperatorios/métodos , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
Parapapillary choledochoduodenal fistula is a rare disorder. We herein report a case of parapapillary choledochoduodenal fistula associated with cholangiocarcinoma. A 61-year-old woman was admitted to our hospital for further examination of a liver tumor. She had no clinical symptoms, but computed tomography scans showed an irregularly contoured liver tumor which was histologically confirmed to be adenocarcinoma, by a needle biopsy examination. Duodenal fiberscopy revealed a fistula orifice 1.0 cm proximal to the orifice of the papilla of Vater, and endoscopic retrograde cholangiography through the fistula showed a communication to the common bile duct. Hypotonic duodenography demonstrated reflux of contrast material into the choledochoduodenal fistula. The bile sample collected from the common bile duct showed extremely high levels of pancreatic enzymes, including amylase, phospholipase-A2, and elastase-I. Furthermore, Helicobacter DNA was detected in bile by polymerase chain reaction (PCR) analysis. This experience suggests to us that parapapillary choledochoduodenal fistula may be a risk factor for biliary tract carcinoma, and surgical management is the treatment of choice for this rare condition, even when the patient has no significant clinical symptoms.
Asunto(s)
Neoplasias de los Conductos Biliares/etiología , Conductos Biliares Intrahepáticos , Fístula Biliar/complicaciones , Colangiocarcinoma/etiología , Enfermedades del Conducto Colédoco/complicaciones , Enfermedades Duodenales/complicaciones , Fístula Intestinal/complicaciones , Adenocarcinoma/etiología , Ampolla Hepatopancreática , Amilasas/análisis , Bilis/microbiología , Fístula Biliar/microbiología , Enfermedades del Conducto Colédoco/microbiología , Enfermedades Duodenales/microbiología , Femenino , Helicobacter pylori/aislamiento & purificación , Humanos , Fístula Intestinal/microbiología , Persona de Mediana Edad , Factores de RiesgoRESUMEN
A 56-year-old man diagnosed a having multiple hepatocellular carcinoma (HCC) with liver cirrhosis underwent transcatheter arterial embolization (TAE). Five months later, recurrent HCC was detected in the liver as well as in the left adrenal gland. A second TAE was performed to treat the intrahepatic recurrence, which was followed by hand-assisted laparoscopic surgery (HALS) for the metastatic tumor in the left adrenal gland. The combination of the two procedures successfully controlled HCC. To our knowledge, this is the first report describing an adrenalectomy by HALS for adrenal metastasis from an HCC.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía/métodos , Carcinoma Hepatocelular/secundario , Carcinoma Hepatocelular/cirugía , Laparoscopía/métodos , Neoplasias Hepáticas/patología , Neoplasias de las Glándulas Suprarrenales/terapia , Carcinoma Hepatocelular/terapia , Embolización Terapéutica , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/terapiaAsunto(s)
Enfermedades Duodenales/etiología , Cuerpos Extraños/complicaciones , Fístula Gástrica/etiología , Fístula Intestinal/etiología , Magnetismo/efectos adversos , Niño , Enfermedades Duodenales/diagnóstico , Enfermedades Duodenales/cirugía , Femenino , Fístula Gástrica/diagnóstico , Fístula Gástrica/cirugía , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/cirugía , Juego e Implementos de JuegoRESUMEN
We report a case of toxic megacolon associated with fulminant pseudomembranous colitis. A 72-year-old woman was admitted with severe dehydration and shock. Computed tomography showed evidence of diffuse thickening of the colonic wall, colonic dilatation and ascites. She underwent transverse colostomy and received postoperative vancomycin, both orally and by administration from the stoma. Her clinical situation improved dramatically following surgery. When a patient is unable to tolerate subtotal colectomy and ileostomy because of a severe overall condition, temporary colostomy followed by administration of vancomycin through the stoma is recommended.
Asunto(s)
Antibacterianos/uso terapéutico , Colostomía , Enterocolitis Seudomembranosa/complicaciones , Megacolon Tóxico/terapia , Vancomicina/uso terapéutico , Anciano , Femenino , Humanos , Megacolon Tóxico/etiologíaRESUMEN
A 56-year-old man was admitted to our hospital with a diagnosis of hilar bile duct cancer. Abdominal ultrasonography, computed tomography and endoscopic retrograde cholangiopancreatography showed no other concomitant disease. Biochemical data showed 0.6 mg/dL of total bilirubin, 104 IU/L of alanine aminotransferase and 469 mg/dL of alkaline phosphatase. Carbohydrate antigen 19-9 was elevated as 112.1 U/mL. Operative findings included a resectable left hilar bile duct cancer and grayish-white nodules 0.3-0.5cm in diameter on the surface of segments 6 and 4 of the liver. Although intrahepatic metastasis of the bile duct cancer was highly suspected under intraoperative US, frozen section was reported to show the small nodules containing multiple biliary hamartomas, so-called von Meyenburg complex. Therefore, a left hepatic lobectomy together with resection of the extrahepatic bile duct followed by a Roux-en-Y hepaticojejunostomy was the procedure of choice. His postoperative course was uneventful. The intraoperative findings could have been misdiagnosed due to their similarity to intrahepatic metastasis and intraoperative histology is indispensable to differentiate von Meyenburg complex in this case. The possibility of a preoperative imaging diagnosis for von Meyenburg complex seems to depend on the size of the bile duct structure in each hamartoma. To the best of our knowledge, this is the fourteenth case of bile duct cancer associated with von Meyenburg complex reported in the literature. The following case is being reported because of the rarity of the disease and to stress the importance of intraoperative histology to avoid misdiagnosis as the disseminated disease, particularly when malignant neoplasia is surgically treated.
Asunto(s)
Enfermedades de los Conductos Biliares/cirugía , Neoplasias de los Conductos Biliares/cirugía , Conductos Biliares Intrahepáticos/cirugía , Colangiocarcinoma/cirugía , Hamartoma/cirugía , Enfermedades de los Conductos Biliares/complicaciones , Enfermedades de los Conductos Biliares/diagnóstico , Enfermedades de los Conductos Biliares/patología , Neoplasias de los Conductos Biliares/complicaciones , Neoplasias de los Conductos Biliares/diagnóstico , Neoplasias de los Conductos Biliares/patología , Conductos Biliares Extrahepáticos/patología , Conductos Biliares Extrahepáticos/cirugía , Conductos Biliares Intrahepáticos/patología , Biopsia , Transformación Celular Neoplásica/patología , Colangiocarcinoma/complicaciones , Colangiocarcinoma/diagnóstico , Colangiocarcinoma/patología , Diagnóstico Diferencial , Diagnóstico por Imagen , Hamartoma/complicaciones , Hamartoma/diagnóstico , Hamartoma/patología , Hepatectomía , Humanos , Yeyunostomía , Hígado/patología , Pruebas de Función Hepática , Masculino , Persona de Mediana EdadAsunto(s)
Anastomosis Quirúrgica/instrumentación , Cobalto , Fístula Cutánea/cirugía , Drenaje/instrumentación , Magnetismo/instrumentación , Fístula Pancreática/cirugía , Seudoquiste Pancreático/cirugía , Pancreatitis Aguda Necrotizante/cirugía , Samario , Anciano , Colangiopancreatografia Retrógrada Endoscópica , Fístula Cutánea/diagnóstico por imagen , Femenino , Humanos , Fístula Pancreática/diagnóstico por imagen , Seudoquiste Pancreático/diagnóstico por imagen , Pancreatitis Aguda Necrotizante/diagnóstico por imagen , Stents , Técnicas de SuturaRESUMEN
We attempt to quantify the amount of peritoneal irrigation required to significantly decrease the intraperitoneal bacteria in children with perforated appendicitis, as no ideal volume of peritoneal lavage has yet been determined. A series of 11 children who were operated on for peritonitis caused by perforated appendicitis were reviewed retrospectively. All children were treated with our treatment protocol that included intraoperative peritoneal lavage using a large volume of saline. Peritoneal fluid samples were taken before and after peritoneal lavage and then were cultured to determine the colony counts. Twenty of 24 bacteria were available for evaluation of the changes in the flora counts. We found 85% of species to be resistant to peritoneal lavage when 3-5 l of saline per square meter of body surface area (l/m2) were used. In contrast, 5.8+/-1.54 l/m2 of peritoneal lavage fluid was necessary to completely eradicate the intraperitoneal bacterial flora. The residual bacteria showed a greater decrease when lavage fluid in excess of 6 l/m2 was used. Although this is only a preliminary report, these findings could be used to justify a true prospective randomized trial in the future.