RESUMEN
BACKGROUND: Tiotropium, a long-acting inhaled anticholinergic drug, has been widely used in the treatment of chronic obstructive pulmonary disease (COPD). However, the issue of whether perioperative tiotropium improves postoperative outcomes for gastric cancer patients with COPD remains unclear. Thus, the aim of this study was to determine the efficacy of perioperative tiotropium intervention for gastric cancer patients with COPD. PATIENTS AND METHODS: Eighty-four gastric cancer patients with mild-to-moderate COPD were randomly assigned to receive perioperative pulmonary rehabilitation alone (control group) or pulmonary rehabilitation with 18 µg of tiotropium once daily (tiotropium group). The patients in the tiotropium group received tiotropium for more than 1 week before surgery and for 2 weeks after surgery. Spirometry was performed prior to group assignment and at 2 weeks after surgery. Postoperative complications, forced expiratory volume in 1 second, forced vital capacity, and the ratio of forced expiratory volume in second to forced vital capacity (%) were compared between the two groups. RESULTS: There were no significant differences between the two groups in terms of age, body mass index, smoking, gastrectomy incision, operation time, and bleeding volume (all P>0.05). Postoperative complications and pulmonary functions did not differ significantly between the control and tiotropium groups. A subgroup analysis of gastric cancer patients with moderate COPD showed that perioperative tiotropium intervention significantly decreased the rate of postoperative complications compared with the control group (P=0.046). However, even after gastrectomy, many patients with mild COPD in both the control and tiotropium groups showed improved pulmonary function. CONCLUSION: Although perioperative tiotropium intervention had no significant effects in gastric cancer patients with mild COPD, it may be beneficial in those with moderate COPD. Therefore, the next prospective study should further evaluate perioperative tiotropium intervention for gastric cancer patients with moderate-to-severe COPD.
Asunto(s)
Gastrectomía , Complicaciones Posoperatorias/prevención & control , Enfermedad Pulmonar Obstructiva Crónica , Neoplasias Gástricas/cirugía , Bromuro de Tiotropio/administración & dosificación , Anciano , Broncodilatadores/administración & dosificación , Monitoreo de Drogas/métodos , Femenino , Gastrectomía/efectos adversos , Gastrectomía/métodos , Gastrectomía/rehabilitación , Humanos , Masculino , Atención Perioperativa/métodos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Pruebas de Función Respiratoria/métodos , Índice de Severidad de la Enfermedad , Neoplasias Gástricas/complicaciones , Resultado del TratamientoRESUMEN
We report on treatment with capecitabine plus oxaliplatin (CapeOX) as adjuvant therapy for patients with colorectal cancer. Twenty patients were treated. The mean age was 69 years; 15 patients were male and 5 were female. Thirteen patients with colon cancer and 7 patients with rectal cancer were enrolled after curative surgery. In total, 55% of patients completed the planned number of treatment cycles. Dose modifications were required for oxaliplatin in 60% of patients and for capecitabine in 67% of patients. The median relative dose intensities of oxaliplatin and capecitabine were 86% and 88%, respectively. Treatment-related Grade 3/4 neutropenia and Grade 3/4 thrombocytopenia were documented in 2 and 3 patients, respectively. Grade 3/4 hand-foot syndrome occurred in 1 patient. Treatment with CapeOX as adjuvant therapy for patients with colorectal cancer seems to be safe.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Colon/tratamiento farmacológico , Neoplasias del Recto/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Capecitabina , Quimioterapia Adyuvante , Neoplasias del Colon/patología , Neoplasias del Colon/cirugía , Desoxicitidina/administración & dosificación , Desoxicitidina/efectos adversos , Desoxicitidina/análogos & derivados , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Fluorouracilo/análogos & derivados , Síndrome Mano-Pie , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Compuestos Organoplatinos/administración & dosificación , Compuestos Organoplatinos/efectos adversos , Oxaliplatino , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Estudios RetrospectivosRESUMEN
We report having treated patients with metastatic colorectal cancer with panitumumab in our department. Ten patients were treated. The mean age was 65. 7 years-old with 7 males and 3 females. Seven patients were treated with only panitumumab, and three patients were treated with panitumumab and another drug. The median number of infusions was 8 times. In the 9 cases that could be evaluated, the disease control rate was 66. 6%. Skin toxicity was observed in all patients. A low serum magnesium value of grade 3 was observed in one patient. We consider that treatment with panitumumab for patients with metastatic colorectal cancer was a safe option.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antineoplásicos/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Anciano , Neoplasias Colorrectales/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , PanitumumabRESUMEN
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.
Asunto(s)
Ascitis/terapia , Drenaje/métodos , Endoscopía del Sistema Digestivo , Enfermedades Pancreáticas/terapia , Stents , Ascitis/diagnóstico , Diagnóstico por Imagen , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Pancreáticas/diagnóstico , Conductos Pancreáticos , Resultado del TratamientoRESUMEN
A 72-year-old man was admitted to our hospital for investigation of jaundice. We made a preoperative diagnosis of macrocystic serous cystadenoma (SCA) of the pancreas, but did not perform palliative choledochojejunostomy because aspiration of the pancreatic cystic fluid caused the cysts to shrink and relieved the compressive stenosis of the common bile duct (CBD) during the operation. Frozen sections of the cyst wall taken by incision biopsy showed no signs of malignancy. Therefore, we performed fenestration of the cystic wall after fixing the inner epithelium of the cyst with 100% ethanol and aspirating the cystic fluid. Cholangiography after the cystic fenestration showed resolution of the CBD stenosis and abdominal computed tomography (CT) confirmed the disappearance of the pancreatic cysts. No recurrence of cystic swelling or obstructive jaundice has been detected by abdominal CT or laboratory data for more than 2 years since the cystic fenestration. Thus, cystic fenestration may be a better palliative option for treating benign compressive tumors such as macrocystic SCA of the pancreas causing obstructive jaundice.
Asunto(s)
Cistadenoma Seroso/cirugía , Ictericia Obstructiva/etiología , Quiste Pancreático/cirugía , Anciano , Cistadenoma Seroso/complicaciones , Humanos , Masculino , Quiste Pancreático/complicacionesRESUMEN
Despite radical extension of surgical procedures, the cure rate of pancreatic head carcinoma patients still remains low. A cause of this concerns unsuccessful locoregional control, which may originate from a positive surgical margin near the superior mesenteric artery (SMA). However, no studies have examined invasion of pancreatic carcinoma around the SMA. En bloc resection of the head of the pancreas and the superior mesenteric vessels was performed on 6 patients who had pancreatic head carcinoma invading the superior mesenteric vein. The specimens were cut perpendicular to the SMA and consecutive serial sections were made. The slices were stained with hematoxylin and eosin or immunohistochemistry for cytokeratin 19 to easily detect carcinoma tissue under a microscope. Nodal metastasis around the SMAs was found in all of the cases. There were no characteristics of the arrangement of the metastatic nodes along the SMA. Lymphatic emboli were often observed close to the metastatic nodes. Neural invasions were detected around the tumors in every case and were continuously connected with the extrapancreatic nerve plexus. The nerve plexus covering the SMA were involved in 4 cases. Involvement was observed mainly behind the SMA, reaching as far as the left side of the SMA in 3 cases. The invasion extended further upwards along the right side of SMA for the celiac nerve plexus. The lymphatics and the nerve plexus in the area around the SMA were frequently involved by pancreatic head carcinoma. This involvement would have been left behind unless the SMA was resected.