Hyperammonemia is a rare but serious adverse event of fluorouracil (5-FU). Although there are some cases of hyperammonemia in patients with colorectal cancer, it has rarely been reported in patients ...with esophageal cancer. We report two cases of hyperammonemia with disturbance of consciousness during FP therapy for esophageal cancer. Case 1 : A 58-year-old man was diagnosed with Stage IV esophageal cancer in the esophagogastric junction zone and had been treated with chemoradiation. During the fourth course of FP therapy, he suddenly presented with disturbance of consciousness on treatment day 5. Through laboratory data and radiographic examination, hyperammonemia (493μg/dl) was found. Case 2 : A 71-year-old man who underwent subtotal esophagectomy for thoracic esophageal cancer started postoperative FP therapy. He presented with the sudden onset of consciousness disturbance on treatment day 6. Blood tests showed hyperammonemia (361μg/dl). In both cases, patients were treated with rehydration and branched-chain amino acid solutions, resulting in gradual improvement of the symptoms. We should be aware that 5-FU may cause hyperammonemia and resultant disturbance of consciousness during FP therapy.
Introduction: Distal gastrectomy (DG) is a standard procedure for early gastric cancer located in lower and middle third of the stomach. Although pylorus preserving gastrectomy (PPG), one of the ...function preserving gastrectomies which has recently been applied for early gastric cancer, evaluation of this procedure has not yet been finalized. Patients and method: In this study, 71patients who underwent PPG were evaluated by prognosis, postoperative complications, abdominal symptoms examined by questionnaire survey and endoscopic findings of the residual stomach. Patients who underwent DG were examined by same items and the results were compared with those of the PPG group. Results: There was no significant difference in the survival rates of the two groups. The incidence of gastric stasis in the early postoperative period was higher in the PPG group (14.1%) compared with the DG group (3.4%). From the results of the questionnaire, the incidence of symptoms of regurgitation was lower in the PPG group (13.4%) than the DG group (38.0%). Early dumping syndrome such as abdominal sound, abdominal pain and diarrhea occured less frequently in the PPG group (36.2%) than the DG group (60.5%). Sixty-nine percent of PPG group patient had food residue in the remnant stomach as assessed endoscopically, which was higher than the DG group (32.5%). Gastritis and bile reflux in the gastric remnant were observed in 33.3% and 5.1% of the PPG group, and 68.3% and 22.0% of the DG group, respectively. Conclusion: PPG has advantages of lower incidences of the dumping syndrome, bile reflux and gastritis in the remnant stomach compared with DG. On the other hand, PPG has disadvantage in gastric empting over DG, but according to the results of the questionnaire, there was no difference in symptoms concerning residual food. PPG thus, seems to be the better procedure than DG from the point of view of the patient's QOL.
The prognosis in liver metastasis from AFP-producing gastric carcinoma is generally considered dismal. We report a case of successful chemotherapy for liver metastasis from AFP-producing gastric ...carcinoma. A 71-year-old woman referred diagnosed with gastric cancer was found in a preoperative biochemical blood examination to have elevated AFP. Under a diagnosis of suspicious AFP-producing gastric carcinoma, distal gastrectomy was conducted on May 11, 1998. Elevated blood AFP decreased to the normal range postoperatively and AFP production in the tumor was confirmed histologically. Five months after surgery, liver metastasis with tumor thrombi in the main portal vein was detected via elevated AFP. Because of tumor thrombi in the main portal vein, neither major hepatic resection nor TAE was indicated. We therefore undertook hepatic arterial injection chemotherapy using FAM (5-FU, ADM, MMC) with additional oral use of UFT. Liver metastasis by 91% during the first 4 months and tumor thrombi in the portal vein had completely disappeared 28 months after the beginning of treatment. All chemotherapy was discontinued 4 years ago, and the woman remains well 6 years after surgery. Liver metastasis remains 1% of the original size, suggesting almost complete remission of AFP-producing cancer.
We compared the results of immunohistochemical assessment of HER2 expression in 107 samples of advanced gastric cancer on using 3 currently used antibodies. Expression was scored as 0 to 3+, and ...equivocal or discordant cases were subjected to fluorescence in situ hybridization(FISH)analysis. HER2 scores of 2+or 3+were noted in 16.8% of cases(18/ 107)using SV2-61g, in 29.9% of cases(32/107)using Dako HercepTest, and in 34.6% of cases(37/107)using 4B5. The results of the HER2 test differed according to the antibodies used for immunohistochemistry preceding FISH analysis, and the HER2 positive rates after the FISH analysis were 14.0%(15/107)using SV2-61g, 19.6% (21/107)using Dako HercepTest, and 22.4% (24/107)using 4B5. Thus, therapeutic decisions might be considerably influenced by the antibody used for the HER2 test.
We previously reported that the new standardized clinical pathways for distal gastrectomy (DG-path : restarting semi-solid food on postoperative day 3 and discharging on postoperative day 8-14) and ...for total gastrectomy (TG-path : restarting semi-solid food on postoperative day 4 and discharging on postoperative day 9-16) could be used safely. If DG-path can apply to TG safely, it will promote an early hospital discharge to TG patients and will make perioperative treatments for both DG and TG simpler and more convenient. We have conducted a multicentric study to clarify whether DG-path can be used safely for TG. The DG-path was followed in 167 TG patients. Then their clinical outcomes and clinical pathway variance were compared with those of 161 TG patients who followed the TG-path in the previous study. The median postoperative hospital stay was shorter in the DG-path (13 days) than in the TG-path (14 days). The incidence of severe complications was lower in the DG-path (4.2%) than in the TG-path (6.8%). Our outcomes suggest that DG-path can be used safely following TG without increasing postoperative complications. In conclusion, DG-path can be used for both DG and TG safely.
PDF
