ショウチョウカンマク シボウ ニクシュ ノ 1レイ

We report a case of small intestinal mesenteric liposarcoma. An ８４-year-old woman was admitted to our hospital with a chief complaint of abdominal distension and pointing out a tumor in her abdomen. On physical examination an adult’s head-sized tumor was palpated from the left upper portion of the pelvis. Abdominal computed tomography（CT）revealed the mass２４×１８×１３cm in size which had clear borderline and smooth surface. Multi-detector-CT scan revealed a heterogeneously enhanced mass fed by the Superior mesenteric artery. With a clinical diagnosis of liposarcoma arisen from the small intestinal mesentery, the patient was operated on. The tumor was present in the mesentery of the small intestine and a removal of the tumor with associated resection of the small intestine was perfomed. The histological diagnosis was well-differentiated liposarcoma. The patient has been followed for nine months after the operation without evidence of local recurrence

Poorly differentiated neuroendocrine cell carcinoma of the rectum : report of a case and literal review

A 56-year-old man was admitted to our hospital because of anal bleeding. Colonoscopy and barium enema revealed type 4 tumor in the rectum. Biopsy revealed poorly differentiated adenocarcinoma. Low anterior resection with total mesorectal excision and lymph node dissection was performed. In immunohistochemical staining, chromogranin A and synaptophysin were positive at major lesion, and CEA were focal positive. The resected tumor was diagnosed pathologically as neuroendocrine cell carcinoma. The Ki-67 labeling index (LI) was 87.8%, so proliferative activity and potential malignancy was very high. Multiple metastatic tumors appeared in pelvis and lung eight months after operation. Treatment for neuroendocrine cell carcinoma of the rectum was controversial. Surgical resection and adjuvant chemotherapy might be one of the methods for gastrointestinal neruroendocrine cell carcinoma

Chemotherapy on QOL and night sleep of CC patients

Background : The aim of this study was to investigate quality of life (QOL) and night-time sleep disturbance in colon cancer patients with middle risk chemotherapy for proper antiemetic therapy. Methods : The study enrolled 139 patients with colorectal cancer. All patients received oxaliplatin or irinotecan-based chemotherapy. Patients completed a questionnaire about chemotherapy-induced nausea and vomiting and sleep disturbance. Sleep disturbance was checked, and the relationship between sleep disturbance and nausea was analyzed. Results : The prevalence of nausea was 48.9% (68 / 139). The degree of the nausea was slight / moderate / severe in 51 / 11 / 6 patients, and 12 patients had vomiting. Appetite showed no change / slightly decreased / half / one-fourth / none in 51 / 34 / 33 / 6 / 7 patients. There were significant differences in the mental component summary (MCS) score and the role-social component score (RCS). (MCS : nausea(+) vs nausea(-) 46.4 ± 1.1 vs 54.1 ± 1.1 p < 0.01 RCS : nausea(+) vs nausea(-) 33.1 ± 2.1 vs 41.6 ± 2.1 p < 0.01). Using the MCS with a cut-off score of 50, patients were divided into two groups, and nausea was significantly correlated with a low MCS score. Furthermore, patients were divided into two groups using a Pittsburgh Sleep Quality Index cut-off score of 6, and sleep disturbance was correlated with old age and second-line chemotherapy. Conclusions : Nausea affects QOL and night-time sleep of colon cancer patients with middle risk chemotherapy

カブ チョクチョウ ガン ノ ジュツゼン ホウシャセン カガク リョウホウ ニヨル アタラシイ チリョウ センリャク

Purpose : To report cases of advanced rectal cancer that showed significant responses after administration of preoperative chemoradiation therapy. Methods : 5-Fluorouracil（5-FU, 300mg//day）was administered by 24-hour continuous intravenous infusion after cancers had been decreased in size by radiation（2Gy）administered for 20 days preoperatively. All patients then underwent low anterior resection with lymph node dissection（two cases had super-low anterior resection）. Results : Clinical stages of all patients were down-staged preoperatively. All of operations resulted in a curative resection of the cancer cells macroscopically. In one, histological examination revealed no residual cancer cells in the resected specimen（CR）. Conclusion : Preoperative chemoradiation therapy was demonstrated as a promising regimen for patients with advanced lower rectal cancer, and should be considered to extend indications for even laparoscopic operations for advanced rectal cancer; a therapy tailor made for advanced rectal cancer

Balloon occluded retrograde transvenous obliteration and percutaneous transhepatic obliteration for ruptured duodenal varices after operation for rectal cancer with multiple liver metastasis : report of a case

We report a patient with duodenal varices oozing blood who had undergone low anterior resection of the rectum and resection of the liver tumor because of multiple liver metastasis from rectal cancer 80 months previously. Although endoscopic variceal ligation (EVL) was carried out for the ruptured duodenal varices, their bleeding persisted and hepatic encephalopathy also appeared. Finally, balloon occluded retrograde transvenous obliteration (BRTO)with percutaneous transhepatic obliteration (PTO)was carried out for the duodenal varices. Percutaneous transhepatic portography revealed detailed hemodynamics. Following PTO, the duodenal varices were stagnated by BRTO, and no complications were recognized. No re-bleeding episode has been observed since the treatment. In addition, the hepatic encephalopathy was also improved

ジョウチョウカンマク ジョウミャク ケッセンショウ ノ イチレイ

We report a case of superior mesenteric vein thrombosis successfully saved by resection of enteral necrosis. A ６７ years-old man who admitted for abdominal pain was diagnosed with acute enterocolitis and treated. After two days, abdominal pain increased and abdominal CT revealed superior mesenteric vein thrombosis. He was referred to the department of surgery. We conducted emergency operation. During surgery, bloody ascites and the enteral necrosis about５０cm in length was confirmed. The necrotic ileum was resected and an end-to-end anastomosis was performed. Immediately after surgery, we started anticoagulation therapy. The patient recoverd well and was discharged on POD３２． In a slow pattern like this case, we should suspect superior mesenteric vein thrombosis and diagnose by abdominal CT

ダイチョウ ガン ニ タイスル 5 FU アイソボリン リョウホウ デ コウカ ガ ミトメラレタ 2レイ

We report 2 cases of rectal cancer responding to postoperative chemotherapy with 5-fluorouracil and isovorin. Case 1 : A 60 years-old woman underwent low-anterior resection for rectal cancer in 1994 and partial right lung resection for metastatic lung cancer in 1998. She underwent chemotherapy with 5-fluorouracil and isovorin for mediastinal lymph node metastasis and high score of serum CEA in 2000. After the chemotherapy, the lymph node shrank and serum CEA normalized. Case 2 : A 75 years-old woman underwent low-anterior resection and hysterectomy for rectal cancer with multiple lung metastasis in 2000. She underwent postoperative chemotherapy with 5-fluorouracil and isovorin for metastatic lung cancer. The lung tumor shrank and serum CEA decreased. Chemotherapy with 5-fluorouracil and isovorin seemed to be effective for advanced colon cancer. We should reconfirm the effectiveness and improve the directions for use

Newly Diagnosed Atrial Fibrillation in Acute Myocardial Infarction

[Background] It remains controversial whether long‐term clinical impact of newly diagnosed atrial fibrillation (AF) in the acute phase of acute myocardial infarction (AMI) is different from that of prior AF diagnosed before the onset of AMI. [Methods and Results] The current study population from the CREDO‐Kyoto AMI (Coronary Revascularization Demonstrating Outcome Study in Kyoto Acute Myocardial Infarction) Registry Wave‐2 consisted of 6228 patients with AMI who underwent percutaneous coronary intervention. The baseline characteristics and long‐term clinical outcomes were compared according to AF status (newly diagnosed AF: N=489 [7.9%], prior AF: N=589 [9.5%], and no AF: N=5150 [82.7%]). Median follow‐up duration was 5.5 years. Patients with newly diagnosed AF and prior AF had similar baseline characteristics with higher risk profile than those with no AF including older age and more comorbidities. The cumulative 5‐year incidence of all‐cause death was higher in newly diagnosed AF and prior AF than no AF (38.8%, 40.7%, and 18.7%, P<0.001). The adjusted hazard ratios (HRs) for mortality of newly diagnosed AF and prior AF relative to no AF remained significant with similar magnitude (HR, 1.31; 95% CI, 1.12–1.54; P<0.001, and HR, 1.32; 95% CI, 1.14–1.52; P<0.001, respectively). The cumulative 5‐year incidence of stroke decreased in the order of newly diagnosed AF, prior AF and no AF (15.5%, 12.9%, and 6.3%, respectively, P<0.001). The higher adjusted HRs of both newly diagnosed AF and prior AF relative to no AF were significant for stroke, with a greater risk of newly diagnosed AF than that of prior AF (HR, 2.05; 95% CI, 1.56–2.69; P<0.001, and HR, 1.33; 95% CI, 1.00–1.78; P=0.048, respectively). The higher stroke risk of newly diagnosed AF compared with prior AF was largely driven by the greater risk within 30 days. The higher adjusted HRs of newly diagnosed AF and prior AF relative to no AF were significant for heart failure hospitalization (HR, 1.73; 95% CI, 1.35–2.22; P<0.001, and HR, 2.23; 95% CI, 1.82–2.74; P<0.001, respectively) and major bleeding (HR, 1.46; 95% CI, 1.23–1.73; P<0.001, and HR, 1.36; 95% CI, 1.15–1.60; P<0.001, respectively). [Conclusions] Newly diagnosed AF in AMI had risks for mortality, heart failure hospitalization, and major bleeding higher than no AF, and comparable to prior AF. The risk of newly diagnosed AF for stroke might be higher than that of prior AF